The most important contributions to medical science made by the Medical School of Salerno at the height of its development were in surgery. The text-books written by men trained in her halls or inspired by her teachers were to influence many succeeding generations of surgeons for centuries. Salerno's greatest legacy to Bologna was the group of distinguished surgical teachers whose text-books we have reviewed in the chapter, "Great Surgeons of the Medieval Universities." Bologna herself was to win a place in medical history, however, mainly in connection with anatomy, and it was in this department that she was to provide incentive especially for her sister universities of north Italy, though also for Western Europe generally. The first manual of dissection, that is, the first handy volume giving explicit directions for the dissection of human cadavers, was written at Bologna. This was scattered in thousands of copies in manuscript all over the medical world of the fourteenth and early fifteenth centuries. Even after the invention of printing, many editions of it were printed. Down to the sixteenth century it continued to be the most used text-book of anatomy, as well as manual of dissection, which students of every university had in hand when they made their dissection, or wished to prepare for making it, or desired to review it after the body had been taken away, for with lack of proper preservative preparation, bodies had to be removed in a comparatively short time. Probably no man more influenced the medical teaching of the fourteenth and fifteen centuries than Mundinus, or, as he was called in the Italian fashion, Mondino, who wrote this manual of dissection.

Mundinus quem omnis studentium universitas colit ut deum (Mundinus, whom all the world of students cultivated as a god), is the expression by which the German scholar who edited, about 1500, the Leipzig edition of Mundinus' well-known manual, the Anathomia, introduces it to his readers. The expression is well worth noting, because it shows what was still the reputation of Mundinus in the medical educational world nearly two centuries after his death.[12]

Until the time of Vesalius, whose influence was exerted about the middle of the sixteenth century, Mondino was looked up to by all teachers as the most important contributor to the science of anatomy in European medicine since the Greeks. He owed his reputation to two things: his book, of which we have already spoken, and then, the fact that he reintroduced dissection demonstrations as a regular practice in the medical schools. His book is really a manual of making anatomical preparations for demonstration purposes. These demonstrations had to be hurried, owing to the rapid decomposition of material consequent upon the lack of preservatives. The various chapters were prepared with the idea of supplying explicit directions and practical help during the anatomical demonstrations, so that these might be made as speedily as possible. The book does not comprise much that was new at that time, but it is a good compendium of previous knowledge, and contains some original observations. It was entirely owing to its form as a handy manual of anatomical knowledge and, besides, because it was an incentive to the practice of human dissection, that it attained and maintained its popularity.

Mondino followed Galen, of course, and so did every other teacher in medicine and its allied sciences, until Vesalius' time. Even Vesalius permitted himself to be influenced overmuch by Galen at points where we wonder that he did not make his observations for himself, since, apparently, they were so obvious. The more we know of Galen, however, the less surprised are we at his hold over the minds of men. Only those who are ignorant of Galen's immense knowledge, his practical common sense, and the frequent marvellous anticipations of what we think most modern, affect to despise him. His works have never been translated into any modern language except piecemeal, there is no complete translation, and one must be ready to delve into some large Latin, if not Greek, volumes to know what a marvel of medical knowledge he was, and how wise were the men who followed him closely, though, being human, there are times when necessarily he failed them.

For those who know even a little at first hand of Galen, it is only what might be expected, then, that Mondino, trying to break away from the anatomy of the pig, which had been before this the basis of all anatomical teaching in the medical schools (Copho's book, used at Salerno and Bologna before Mondino's was founded on dissections of the pig), should have clung somewhat too closely to this old Greek teacher and Greek master. The incentive furnished by Mondino's book helped to break the tradition of Galen's unquestioned authority. Besides this, the group of men around Mondino, his master, Taddeo Alderotti, with his disciples and assistants, form the initial chapter in the history of the medical school of Bologna, which gradually assumed the place of Salerno at this time. There is no better way of getting a definite idea of what was being done in medicine, and how it was being done, than by knowing some of the details of the life of this group of medical workers.

Mondino di Liucci, or Luzzi, is usually said to have been born about 1275. His first name is a diminutive for Raimondo. It used to be said of him that, like many of the great men of history, many cities claimed to be his birthplace. Five were particularly mentioned—Florence, Milan, Bologna, Forli, and Friuli. There is, however, another Mondino, a distinguished physician, who was born and lived at Friuli, and it is because of confusion with him that the claim for Friuli has been set up. Florence and Milan are considered out of the question. Mondino was probably born in or near Bologna. The fact that there should have been this multiple set of claims shows how much was thought of him. Indeed, his was the best known name in the medical schools of Europe for nearly two centuries and a half. He seems to have been a particularly brilliant student, for tradition records that he had obtained his degree of doctor of medicine when he was scarcely more than twenty. This seems quite out of the question for us at the present time, but we have taken to pushing back the time of graduation, and it is not sure whether this is, beyond peradventure, so beneficial as is usually thought.

That his early graduation did not hamper his intellectual development, the fact that, in 1306, when he was about thirty-one years of age, he was offered the professorial chair in anatomy, which he continued to occupy with such distinction for the next twenty years, would seem to prove. His public dissections of human bodies, probably the first thus regularly made, attracted widespread attention, and students came to him not only from all over Italy, but also from Europe generally. In this, after all, Mondino was only continuing the tradition of world teaching that Bologna had acquired under her great surgeons in the preceding century. (See "Great Surgeons of the Medieval Universities.")

Mondino came from a family that had already distinguished itself in medicine at Bologna. His uncle was a professor of physic at the university. His father, Albizzo di Luzzi, seems to have come from Florence not long after the middle of the thirteenth century, for the records show that, about 1270, he formed a partnership with one Bartolommeo Raineri for the establishment of a pharmacy at Bologna. Later this passed entirely under the control of the Mondino family, and came to be known as the Spezieria del Mondino. In it were sold, besides Eastern perfumes, spices, condiments, probably all sorts of toilet articles, and even rugs and silks and feminine ornaments. The stricter pharmacy of the earlier times developed into a sort of department store, something like our own. The Mondini, however, insisted always on the pharmacy feature as a specialty, and the fact was made patent to the general public by a sign with the picture of a doctor on it. This drug shop of the Mondini continued to be maintained as such, according to Dr. Pilcher, until the beginning of the nineteenth century.[13]

One of the fellow students of Mondino at the University of Bologna had been Mondeville. He came from distant France to take a course in surgery with Theodoric, whose high reputation in the olden time, vague with us half a century ago, is now amply justified by what we know of him from such ardent students and admirers as Pagel and Nicaise. Not long after Mondino's death, Guy de Chauliac came from France to reap similar opportunities to these, which had proved so fruitful for Mondeville. The more that we learn about this time the more do we find to make it clear how deeply interested the generation was in education in every form, artistic, philosophic, but, also, though this is often not realized, scientific.

The long distances, so much longer in that time than in ours, to which men were willing, and even anxious, to go, in order to obtain opportunities for research, and to get in touch with a special master, the associations with stimulating fellow pupils of other lands, the scientific correspondences, almost necessarily initiated by such circumstances, all indicate an enthusiasm for knowledge such as we have not been accustomed to attribute to this period. On the contrary, we have been rather inclined to think them neglectful of all education, and have, above all, listened acquiescently while men deprecated the lack of interest in things scientific displayed by these generations. Indeed, many writers have gone out of their way to find a reason for the supposed lack of interest in science at this time, and have proclaimed the Church's opposition to scientific education and study as the cause.

At this time Italy was the home of the graduate teaching for all Europe. The Italian Peninsula continued to be the foster-mother of the higher education in letters and art, but also, though this is less generally known, in science, for the next five centuries. Germany has come to be the place of pilgrimage for those who want higher opportunities in science than can be afforded in their own country only during the latter half of the nineteenth century. France occupied it during the first half of the nineteenth century. Except for short intervals, when political troubles disturbed Italy, as about the middle of the fourteenth century, when the removal of the Popes to Avignon brought their influence for education over to France and a short period at the beginning of the eighteenth century, when the Netherlands for a time came into educational prominence, Italy has always been the European Mecca for advanced students. Practically all our great discoverers in medicine, until the last century, were either Italians, or else had studied in Italy. Mondino, Bertruccio, Salicet, Lanfranc, Baverius, Berengarius, John De Vigo, who first wrote on gun-shot wounds; John of Arcoli, first to mention gold filling and other anticipations of modern dentistry; Varolius, Eustachius, CÆsalpinus, Columbus, Malpighi, Lancisi, Morgagni, Spallanzani, Galvani, Volta, were all Italians. Mondeville, Guy de Chauliac, Linacre, Vesalius, Harvey, Steno, and many others who might be named, all studied in Italy, and secured their best opportunities to do their great work there.

It would be amusing, if it were not amazing, to have serious writers of history in the light of this plain story of graduate teaching of science in Italy for over five centuries, write about the opposition of the Church to science during the Medieval and Renaissance periods. It is particularly surprising to have them talk of Church opposition to the medical sciences. The universities of the world all had their charters from the Popes at this time, and were all ruled by ecclesiastics, and most of the students and practically all of the professors down to the end of the sixteenth century belonged to the clerical order. The universities of Italy were all more directly under the control of ecclesiastical authority than anywhere else, and nearly all of them were dominated by papal influence. Bologna, while doing much of the best graduate work in science, especially in medicine, was, in the Papal States, absolutely under the rule of the Popes. The university was, practically, a department of the Papal government. The medical school at the University of Rome itself was for several centuries, at the end of the Middle Ages, the teaching-place where were assembled the pick of the great medical investigators, who, having reached distinction by their discoveries elsewhere, were summoned to Rome in order to add prestige to the Papal University. All of them became special friends of the Popes, dedicated their books to them, and evidently looked to them as beneficent patrons and hearty encouragers of original scientific research.

While this is so strikingly true of medical science as to make contrary declarations in the matter utterly ridiculous, and to suggest at once that there must be some motive for seeing things so different to the reality, the same story can be told of graduate science in other departments. It was to Italy that men came for special higher studies in mathematics and astronomy, in botany, in mineralogy, and in applied chemistry, so far as it related to the arts of painting, illuminating, stained-glass making, and the like. No student of science felt that he had quite exhausted the opportunities for study that were possible for him until he had been down in Italy for some time. To meet the great professors in Italy was looked on as sure to be a source of special incentive in any department of science. This is coming to be generally recognized just in proportion as our own interest in the arts and crafts, and in the history of science, leads us to go carefully into the details of these subjects at first hand. The editors of the "Cambridge Modern History," in their preface, declared ten years ago that we can no longer accept with confidence the declaration of any secondary writer on history. This is particularly true of the medieval period. We must go back to the writers of those times.

If it seems surprising that the University of Bologna should have come into such great prominence as an institute for higher education at this time, it would be well to recall some of the great work that is being done in this part of Italy in other departments at this time. Cimabue laid the foundation of modern art towards the end of the thirteenth century, and during Mondino's life Giotto, his pupil, raised an artistic structure that is the admiration of all generations of artists since. Dante's years are almost exactly contemporary with those of Giotto and of Mondino. If men were doing such wondrous work in literature and in art, why should not the same generation produce a man who will accomplish for the practical science of medicine what his friends and contemporaries had done in other great intellectual departments.

In recent years we have come to think much more of environment as an influence in human development and accomplishment than was the custom sometime ago. The broader general environment in Italy, with genius at work in other departments, was certainly enough to arouse in younger minds all their powers of original work. The narrower environment at Bologna itself was quite as stimulating, for a great clinical teacher, Taddeo Alderotti, had come, in 1260, from Florence to Bologna, to take up there the practice and teaching of medicine. It was under him that Mondino was to be trained for his life work.

To understand the place of Mondino, and of the medical school of Bologna, in his time, and the reputation that came to them as world teachers of medicine, we must know, first, this great teacher of Mondino and the atmosphere of progressive medicine that enveloped the university in the latter half of the thirteenth century. In the chapter on "Great Surgeons of the Medieval Universities" we call particular attention to the series of distinguished men, the first four of whom were educated at Salerno, and who came to Bologna to teach surgery. They were doing the best surgery in the world, much better than was done in many centuries after their time; indeed, probably better than at any period down to our own day. Besides, they seem to have been magnetic teachers who attracted and inspired pupils. We have the surgical contributions of a series of men, written at Bologna, that serve to show what fine work was accomplished. At this time, however, the field of medicine was not neglected, though we have but a single great historical name in it that has lived. This was Taddeo Alderotti, a man who lifted the medical profession as high in the estimation of his fellow citizens at Florence as the great painters and literary men of his time did their departments, and who then moved to Bologna, because of the opportunity to teach afforded him by the university.

It is sometimes a little difficult for casual students of the time to understand the marvellous reputation acquired by this medieval physician. It should not be, however, when we recall the enthusiastic reception and procession of welcome accorded to Cimabue's Madonna, and the almost universal acclaim of the greatness of Dante's work, even in his own time. In something of that same spirit Bologna came to appreciate Taddeo, as he is familiarly known, looked upon him as a benefactor of the community, and voted to relieve him of the burden of paying taxes. He came to be considered as a public institution, whose presence was a blessing to his fellow citizens, and whose goodness to them should be recognized in this public way. One is not surprised to hear Villani, the well-known contemporary historian, speak of him as the greatest physician in Christendom.

The feelings of the citizens of Bologna, it may well be confessed, were not entirely unselfish, or due solely to the desire to encourage a great scientific genius. Few men of his generation had done more for the city in a material way quite apart from whatever benefits he conferred upon the health of its citizens than Dr. Taddeo. It was he who organized medical teaching in the city on such a plane that it attracted students from all over the world. Bologna had had a great law school before this, founded by Irnerius, to which students had come from all over the world. With the advent of Taddeo from Florence, and his success as a medical practitioner, there began to flock to his lectures many students who spread his fame far and wide. The city council could scarcely do less than grant the same privileges to the medical students and teachers of Taddeo's school as they had previously accorded to the faculty of law and its students. The city council recognized quite as clearly as any board of aldermen in the modern time how much, even of material benefit, a great university was to the building up of a city, though their motives were probably much higher than that, and their enlightened policy had its reward in the rapid growth of Bologna until, very probably at the end of the thirteenth century, it had more students than any university of the modern time. The number was not less than fifteen thousand, and may have been twenty thousand.

To this great university success Taddeo and his medical school contributed not a little. The especially attractive feature of his teaching seems to have been its eminent practicalness. He himself had made an immense success of the practice of medicine, and accumulated a great fortune, so much so that Dante, in his "Paradiso," when he wishes to find a figure that would represent exactly the opposite to what St. Dominic, the founder of the Dominicans, did for the love of wisdom and humanity, he takes that of Taddeo, who had accomplished so much for personal reputation and wealth.

This might easily lead to the impression that Taddeo's teaching was unscientific, or merely empiric, or that he himself was a narrow-minded maker of money, intent only on his immediate influence, and hampered by exclusive devotion to practical medicine. Nothing could be farther from the truth than any such impression. Taddeo was not only the head of a great medical school, a great teacher whom his students almost worshipped, a physician to whom patients flocked because of his marvellous success, a fine citizen of a great city, whom his fellow citizens honored, but he was a broad-minded scholar, a philosopher, and even an author in branches apart from medicine.

In that older time it was the custom to combine the study of philosophy and medicine. For centuries after that period in Italy it was the custom for men to take both degrees, the doctorate in philosophy and in medicine at the same time. Indeed, most of those whose work has made them famous, down to and including Galvani, did so. Taddeo wrote commentaries on the works of Hippocrates and Galen, but he also translated the ethics of Aristotle, and did much to make the learning of the Arabs easily available for his students. His was a broad, liberal scholarship. Dr. Lewis Pilcher, in his article on "The Mondino Myth,"[14] does not hesitate to say that "to the spirit which, from his professorial chair, Taddeo infused into the teaching and study of medicine undoubtedly is due the high position which for many generations thereafter the school of Bologna continued to maintain as a centre of medical teaching."

Of course, erudition had its revenge, and carried Taddeo too far. The difficult thing in human nature is to stay in the mean and avoid exaggeration. His methods of illustrating medical truths from many literary and philosophical sources often caused the kernel of observation to be hidden beneath a blanket of speculation or, at least, to be concealed to a great extent. Even the Germans, who have insisted most on this unfortunate tendency of Taddeo, have been compelled to confess that there is much that is valuable in what he accomplished, and that even his modes of expression were not without a certain vivacity which attracted attention and doubtless added materially to his success as a teacher. Pagel, in Puschmann's "Handbuch," says: "It cannot be denied [this is just after he has quoted a passage of Taddeo with regard to dreams] that Taddeo's expressions have a certain liveliness all their own that gives us some idea why he was looked upon as so good a teacher, a teacher who, as we know now, also gave instruction by the bedside of patients." Pagel adds, "Taddeo's greatest merit and his highest significance in medical education consist in the fact that a great many (zahlreiche) physicians followed directly in his footsteps and were counted as his pupils. They were all men, as we know them, who as writers and practitioners of medicine succeeded in going far beyond the level of mediocrity in what they accomplished."

This was the teacher who most influenced young Mondino when he came to the University of Bologna, for it seems not unlikely that as a medical student he was actually the pupil of Taddeo, then in a vigorous old age. If not, he was at least brought under the direct influence of the teaching tradition created during more than thirty years by that wonderful old man. Knowing what we do of Taddeo it is not surprising that his pupil should have accomplished work that was to influence succeeding generations more than any other of that wonderful thirteenth century. Dr. Pilcher in the article on "The Mondino Myth," so often placed under contribution in this sketch, says that "It needs no great stretch of the imagination to picture somewhat of the effect that contact with such a man as Taddeo di Alderotto[15] might have, in molding the character of his young neighbor and pupil, the chemist's son, who a few years later, by his devotion to the study of human anatomy, was to re-establish the practical pursuit of study on the human cadaver as the common privilege of the skilled physician, and was to engrave his own name deeply on the records of medicine."

Under this worthy compatriot and contemporary of the great Florentines, Mondino was inspired to be the teacher that did so much for Bologna. Until recent years it has usually been the custom to give too much significance to the work of the men whose names stand out most prominently in the early history of departments of the intellectual life. Mondino's reputation has shared in this exaggerative tendency to some extent, hence the necessity for realizing what was accomplished before his time and the fact that he only stands as the culmination of a progressive period. Carlyle spoke of Dante as the man in whom "ten silent centuries found a voice." The centuries, however, were only silent because the moderns did not know how to listen to their message. We know now that every country in Europe had a great contributor to literature in the century before Dante. The Cid, the Arthur Legends, the Nibelungen, the Troubadours, naturally led up to Dante. He was only the culmination of a great period of literature. We know now that men had worked in art before Cimabue and Giotto, and had done impressive work that made for the progress of art. These names, however, have come to represent in many minds the sort of solitary phenomena that Dante has seemed sometimes even to scholars.

Because Mondino did such good work in medical teaching it is sometimes declared, even in rather serious histories, that he was the first to accomplish anything in his department, and that before his time there is a blank. Some historians, for instance, have insisted that Mondino was the first to do human dissections, and that he did at most but two or three. Only those who are unacquainted with the magnificent development of surgery that took place during the preceding century, the evidence for which is so abundantly given in modern historians of medicine and especially in Gurlt's great work on the history of surgery, from which we have quoted enough to give a good idea of the extent to which the movement went, are likely to accept any such declaration. There could not have been all that successful surgery without much dissection not only of animals but also of human bodies. The teaching of dissection was not regularly organized until Mondino's time, but it seems very clear that even he must have dissected many more bodies than the number usually attributed to him. Professor Lewis Stephen Pilcher of Brooklyn, who made a special study of Mondino traditions in Bologna itself, and collected some of the early editions of his books, feels so acutely the absurdity of the ordinarily accepted tradition in this matter, that he has written a paper on the subject bearing the suggestive title, "The Mondino Myth." He says:[16]

"We are accustomed to think of the practice of dissection as having been re-created by Mondino, and at once fully developed, springing into acceptance. The year 1315 is the generally accepted date for the first public anatomical demonstration upon a human body made by Mondino, and yet it is true that among the laws promulgated by Frederick II, more than seventy-five years before (a.d. 1231), was included a decree that a human body should be dissected at Salernum at least once in five years in the presence of the assembled physicians and surgeons of the kingdom, and that in the regulations established for admission to the practice of medicine and surgery in the kingdom it was decreed that no surgeon should be admitted to practise unless he should bring testimonials from the masters teaching in the medical faculty, that he was 'learned in the anatomy of human bodies, and had become perfect in that part of medicine without which neither incisions could safely be made nor fractures cured.'

"Salernum was notable in its legalization of the dissection of human bodies before the first public work of Mondino, for, according to a document of the Maggiore Consiglio of Venice of 1308, it appears that there was a college of medicine at Venice which was even then authorized to dissect a body every year. Common experience tells us that the embodiment of such regulations into formal law would occur only after a considerable preceding period of discussion, and in this particular field of clandestine practice. It is too much to ask us to believe that in all this period, from the date of the promulgation of Frederick's decree of 1231 to the first public demonstration by Mondino, at Bologna in 1315, the decree had been a dead letter and no human body had been anatomized. It is true there is not, as far as I am aware, any record of any such work, and commentators and historians of a later date have, without exception, accepted the view that none was done, and thereby heightened the halo assigned to Mondino as the one who ushered in a new era. Such a view seems to me to be incredible. Be that as it may, it is undeniable that at the beginning of the 14th century the idea of dissecting the human body was not a novel one; the importance of a knowledge of the intimate structure of the body had already been appreciated by divers ruling bodies, and specific regulations prescribing its practice had been enacted. It is more reasonable to believe that in the era immediately preceding that of Mondino human bodies were being opened and after a fashion anatomized. All that we know of the work of Mondino suggests that it was not a new enterprise in which he was a pioneer, but rather that he brought to an old practice a new enthusiasm and better methods, which, caught on the rising wave of interest in medical teaching at Bologna, and preserved by his own energy as a writer in the first original systematic treatise written since the time of Galen, created for him in subsequent uncritical times the reputation of being the Restorer of the practice of anatomizing the human body, the first one to demonstrate and teach such knowledge since the time of the Ptolemaic anatomists, Erasistratus and Herophilus.

"The changes have been rung by medical historians upon a casual reference in Mondino's chapter on the uterus to the bodies of two women and one sow which he had dissected, as if these were the first and the only cadavers dissected by him. The context involves no such construction. He is enforcing a statement that the size of the uterus may vary, and to illustrate it remarks that 'a woman whom I anatomized in the month of January last year, viz., 1315 Anno Christi, had a larger uterus than one whom I anatomized in the month of March of the same year.' And further, he says that 'the uterus of a sow which I dissected in 1316 (the year in which he was writing) was a hundred times greater than any I have seen in the human female, for she was pregnant and contained thirteen pigs.' These happen to be the only reference to specific bodies that he makes in his treatise. But it is a far cry to wring out of these references the conclusion that these are the only dissections he made. It is quite true that if we incline to enshroud his work in a cloud of mystery and to figure it as an unprecedented awe-inspiring feature to break down the prejudices of the ages, it is easy to think of him as having timidly profaned the human body by his anatomizing zeal in but one or two instances. His own language, however, throughout his book is that of a man who was familiar with the differing conditions of the organs found in many different bodies; a man who was habitually dissecting."

(Quotations from the work of Mundinus showing his familiarity with dissections. The leaf and line references are to the Dryander edition, Marburg, 1541.)

"I do not consider separately the anatomy of component parts, because their anatomy does not appear clearly in the fresh subject, but rather in those macerated in water." (Leaf 2, lines 8-13.)

"... these differences are more noticeable in the cooked or perfectly dried body, and so you need not be concerned about them, and perhaps I will make an anatomy upon such a one at another time and will write what I shall observe with my own senses, as I have proposed from the beginning." (Leaf 60, lines 14-17.)

"What the members are to which these nerves come cannot well be seen in such a dissection as this, but it should be liquefied with rain water, and this is not contemplated in the present body." (Leaf 60, lines 31-33.)

"After the veins you will note many muscles and many large and strong cords, the complete anatomy of which you will not endeavor to find in such a body but in a body dried in the sun for three years, as I have demonstrated at another time; I also declared completely their number, and wrote the anatomy of the muscles of the arms, hands, and feet in a lecture which I gave over the first, second, third, and fourth subjects." (Leaf 61, lines 1-7.)