Guido Lanfranchi

1250-1306

Italian French Surgeon

Guido Lanfranchi is regarded as the founder of surgery in France. He was born in 1250 in Milan, Italy, and was educated by the famous physician William of Saliceto (1210-1277), who contributed to the renaissance in medical teaching at Salerno.

Lanfranchi (also known as Lanfranc of Milan, Lanfranc, or Lanfranco) had to leave Milan in a hurry in 1290 because he was on the wrong side of a dispute between the powerful Guelf and Ghibelline families. He escaped to Lyons, France, a city that was accepting of diverse ideas. Five years later he moved to Paris to become a professor, but this was cut short when it was discovered that he was married; professors were supposed to remain unmarried. However, Lanfranchi was not too unhappy about losing this job when he learned that teachers at the medical college were housed in the artist's center with straw covered floors, where the rats outnumbered the students. The independent college of Saint Come subsequently hired Lanfranchi and gave him a choice of more respectable quarters. Later, he did lecture at the university in Paris.

The study and practice of surgery as a learned art was just emerging, spreading to Bologna and, with the formation of the Confraternity of Saint Cosmos and Damian, moving into Paris during the thirteenth century. However, most of the surgery that was practiced at that time was still barbaric and done by untrained barber-surgeons.

Lanfranchi was convinced that medicine and surgery were inseparable; he firmly asserted that a good internist must know surgery and, likewise, a good surgeon must know medicine. He promoted the Hippocratic oath (the physician's pledge to do no harm) and attempted to make surgery as free from pain as possible.

Lanfranchi felt the need to document his experiences in a book. At first he penned the popular Chirugia Parva, ("Little book of surgery"). He later expanded it into his great work, the Chirugia Magna, ("Grand surgery"). Both books enjoyed widespread circulation and were much used. His beliefs were conservative, but also constructive and creative. For example, he was the first to use a silver tube in the wind-pipe to free objects that might cause suffocation. Both works were translated into French, Italian, Spanish, German, English, Dutch, and Hebrew.

His Chirugia Magna is divided into sections on general principles, anatomy, embryology, ulcers, fistulas, fractures, and luxations, baldness and skin diseases, phlebotomy and scarification, cautery, and diseases of various organs.

Among Lanfranchi's most important contributions was a chapter on brain injuries, in which he described symptoms and signs of concussion. He developed a system of percussion to determine skull injury. Tying a waxed string to a patient's tooth and holding it taut, he would pluck the string like a musical instrument and the tones produced would indicate skull injury.

He also referred to trephination, a procedure practiced by twelfth-century Arab surgeons, which involved boring a hole in the skull to treat various ailments. Lanfranchi alluded to this procedure in his writings and showed the instrument used to bore through the skull. He referred to "a trepane wich the brayn scalle schal be trepaned with."

Lanfranchi was one of the first to promote learned medicine in medieval Europe. During a time when surgery began to separate from the barbers as a profession, he was one of the first to write about the role and practice of the surgeon. He realized that surgeons must have specialized skills and suggested that exceptional mental and physical attributes were also essential for the task. He asserted that the surgeon must have a restrained and modest disposition, and wrote that "a surgian must have handes wel shaped, long smale fyngres and his body not quakying." Contemporary English translations of his writings emphasized the physical and mental qualities of the surgeon. Lanfranchi, a great humanist and person of high morals, also added that the surgeon must be versed in philosophy and logic and be able to read scriptures critically.

Still, Lanfranchi encountered well-established cultural hierarchies in medieval society that relegated the surgeon to the role of a menial subordinate who shared the duties of the pharmacist, dentist, and barber. This subordinate status is well illustrated in a famous woodcut by Johannes de Ketham in the Fasciculus Medicinae (1491). The picture shows a distinguished professor lecturing from his elevated "Chair of Medicine," while his surgical assistant, armed with an enormous butcher knife, performs the dissection on the operating floor down below.

Lanfranchi was not fond of his colleagues in Paris, whom he considered unqualified, illiterate, and clumsy mechanics. However, he was valued by his distinguished successors, Henri de Mondeville (1260-1320) and Guy de Chauliac (1300-1368). Lanfranchi later ended his brilliant career by becoming the personal physician of Philip the Fair.

EVELYN B. KELLY