versities. The degradation of the surgeon comes later in the middle ages. The greatest surgical teacher of the early thirteenth century was Roger, who wrote about 1180. His work was annotated by his pupil Poland, and the work of both edited later by the Four Masters. Gurlt says of the latter:
This volume constitutes one of the most important sources for the history of surgery in the later Middle Ages, and makes it very clear that these writers drew their opinions from a very rich experience.
Their diagnosis of fractures of the skull is quite modern, subdural hemorrhage is described, and the technique is given for a decompression operation for depressed fractures, the old writers saying:
In elevating the cranium, be solicitous lest you infect the dura mater.
Suturing with silk, and drainage, are recommended for scalp wounds, and the prognosis of infected wounds is considered at length. The surgeon was told that he must keep his hands clean and that he must especially avoid not only menstruating women, but all women, if he would operate successfully.
Bruno da Longoburgo, Theodoric, Hugo of Lucca, and William of Salicet are a famous group of North Italian surgeons of this period. Mondino, the author of the first book on dissection, Lanfranc, who taught at Paris, and, in the words of Pagel, "gave that primacy to French surgery which it maintained all the centuries down to the nineteenth/' as well as de Mondeville and Guy de Chauliac, belong to the early fourteenth century.
Hugo of Lucca and his son Theodoric used opium and mandragora to produce anesthesia, and also used a mixture to be inhaled from a sponge, the composition of which is not definitely known. Fifteen great universities arose in Italy from the tenth to the fourteenth centuries, and in all of these surgery was taught. Bruno was the first of the Italian surgeons to quote Arabian as well as Greek authorities. He worked at the universities of Vicenza, Padua and Verona. His "Chirurgia Magna" was completed at Padua in 1252. He insisted that surgery was largely handwork, and must therefore be learned from practical experience and observation. He sums up three important offices of surgery as: "to bring together separated parts, to separate those abnormally united and to extirpate what is superfluous." He discusses wounds, healing by first and second intention, indications for suturing and for drainage. He advised against the use of water in wounds, especially the water in camps and battlefields. Wounds of the intestine he directed to be cleansed with warm wine and closed with fine silk sutures.
Hugh of Lucca was city physician to Bologna, and his writings were edited by his son Theodoric. Theodoric studied medicine, entered the Dominican order at the age of 23, but continued to practise surgery in Bologna, devoting his fees to charity. At 50 he was made a bishop. In his text-book, finished about 1226, he says:
