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+The Project Gutenberg eBook, Gilbertus Anglicus, by Henry Ebenezer
+Handerson
+
+
+This eBook is for the use of anyone anywhere at no cost and with
+almost no restrictions whatsoever.  You may copy it, give it away or
+re-use it under the terms of the Project Gutenberg License included
+with this eBook or online at www.gutenberg.org
+
+
+
+
+
+Title: Gilbertus Anglicus
+       Medicine of the Thirteenth Century
+
+
+Author: Henry Ebenezer Handerson
+
+
+
+Release Date: June 30, 2005  [eBook #16155]
+
+Language: English
+
+Character set encoding: ISO-8859-1
+
+
+***START OF THE PROJECT GUTENBERG EBOOK GILBERTUS ANGLICUS***
+
+
+E-text prepared by Suzanne Lybarger, William Flis, and the Project
+Gutenberg Online Distributed Proofreading Team (https://www.pgdp.net/) from
+page images generously made available by Internet Archive and Canadian
+Libraries (http://www.archive.org/details/toronto)
+
+
+
+Note: Images of the original pages are available through the Internet
+      Archive and Canadian Libraries. See
+      http://www.archive.org/details/gilbertusanglicu00handuoft
+
+
+
+
+
+GILBERTUS ANGLICUS
+
+Medicine of the Thirteenth Century
+
+by
+
+HENRY E. HANDERSON, A.M., M.D.
+
+With a Biography of the Author
+
+Published Posthumously for Private Distribution by
+the Cleveland Medical Library Association
+Cleveland, Ohio
+
+1918
+
+
+
+
+
+
+
+CONTENTS
+
+
+                                                       Page
+  Frontispiece                                            5
+
+  Explanatory Foreword                                    7
+
+  Biography                                            9-14
+
+  Resolutions of the Cleveland Medical Library Ass'n     15
+
+  Gilbertus Anglicus--A Study of Medicine in the
+      Thirteenth Century                              17-78
+
+
+
+
+[Illustration: HENRY E. HANDERSON]
+
+
+
+
+EXPLANATORY FOREWORD
+
+
+In the summer of 1916 the librarian of the Cleveland Medical Library
+received a manuscript from Dr. Henry E. Handerson with the request
+that it be filed for reference in the archives of the library. The
+librarian at once recognized the value of the paper and referred it
+to the editorial board of the Cleveland Medical Journal, who sought
+the privilege of publishing it. Dr. Handerson's consent was secured
+and the article was set in type. However, when the time came for its
+publication the author was reluctant to have it appear since he was
+unable then to read the proof, and because he felt that the material
+present might not be suitable for publication in a clinical journal.
+To those who knew him, this painstaking attention to detail and desire
+for accuracy presents itself as a familiar characteristic. Though
+actual publication was postponed, the type forms were held, and when
+the Cleveland Medical Journal suspended publication, its editorial
+board informed the Council of the Cleveland Medical Library
+Association of the valuable material which it had been unable to
+give to the medical world. In the meantime Dr. Handerson's death
+had occurred, but the Council obtained the generous consent of the
+author's family to make this posthumous publication. It is hoped that
+those who read will bear this fact in mind and will be lenient in
+the consideration of typographical errors, of which the author was so
+fearful.
+
+The Cleveland Medical Library Association feels that it is fortunate
+in being enabled to present to its members and to others of the
+profession this work of Dr. Handerson's and to create from his own
+labors a memorial to him who was once its president.
+
+    SAMUEL W. KELLEY.
+    CLYDE L. CUMMER.
+    Committee on Publication.
+
+
+
+
+BIOGRAPHY
+
+HENRY EBENEZER HANDERSON
+
+
+Owing to Dr. Handerson's modesty, even we who were for years
+associated with him in medical college, in organization, and
+professional work, knew but little of him. He would much rather
+discuss some fact or theory of medical science or some ancient worthy
+of the profession than his own life. Seeing this tall venerable
+gentleman, sedate in manner and philosophical in mind, presiding over
+the Cuyahoga County Medical Society or the Cleveland Medical Library
+Association, few of the members ever pictured him as a fiery, youthful
+Confederate officer, leading a charge at a run up-hill over fallen
+logs and brush, sounding the "Rebel yell," leaping a hedge and
+alighting in a ten-foot ditch among Federal troopers who surrendered
+to him and his comrades. Yet this is history. We could perhaps more
+easily have recognized him even though in a military prison-pen, on
+finding him dispelling the tedium by teaching his fellow prisoners
+Latin and Greek, or perusing a precious volume of Herodotus.
+
+Henry Ebenezer Handerson was born on March 21, 1837, here in Cuyahoga
+county, in the township of Orange, near the point now known as
+"Handerson's Cross-Roads," on the Chagrin river. His mother's maiden
+name was Catharine Potts. His father was Thomas Handerson, son of Ira
+Handerson. The family immigrated to Ohio from Columbia county, New
+York, in 1834. Thos. Handerson died as the result of an accident in
+1839, leaving the widow with five children, the eldest thirteen years
+of age, to support. Henry and a sister were adopted by an uncle, Lewis
+Handerson, a druggist, of Cleveland. In spite of a sickly childhood
+the boy went to school a part of the time and at the age of fourteen
+was sent to a boarding school, Sanger Hall, at New-Hartford, Oneida
+county, New York. Henry's poor health compelled him to withdraw from
+school. No one at that time would have predicted that the delicate
+youth would live to be the sage of four score years and one. With his
+foster father and family he moved to Beersheba Springs, Grundy county,
+Tennessee.
+
+In 1854, in good health, the boy returned to Cleveland, prepared
+for college, and entered Hobart College, Geneva, New York, where he
+graduated as A.B. in 1858. Returning to Tennessee, he occupied himself
+for about a year with surveying land and in other work and then
+became private tutor in the family of Mr. Washington Compton on a
+cotton plantation near Alexandria, Louisiana. There he remained a
+year or more, then in the autumn of 1860 matriculated in the Medical
+Department of the University of Louisiana (now Tulane University),
+where he studied through the winter, and also heard much of the
+political oratory of that exciting period.
+
+The bombardment of Fort Sumter, April 12, 1861, followed by the call
+of President Lincoln for 75,000 troops to suppress the rebellion,
+found young Handerson again employed as tutor, this time in the family
+of General G. Mason Graham, a veteran of the Mexican war.
+
+With his friends and acquaintances, Handerson joined a company of
+"homeguards" consisting mostly of planters and their sons, formed
+for the purpose of maintaining "order among the negroes and other
+suspicious characters of the vicinity."
+
+Many years afterward Dr. Handerson wrote, in a narrative for his
+family, concerning this period of his life: "Without any disposition
+to violent partisanship, I had favored the party of which the
+standard-bearers were Bell and Everett and the battle cry 'The
+Constitution and the Union,' and I had grieved sincerely over the
+defeat by the Radicals of the North, aided by the 'fire-eaters' of
+the South."
+
+And again: "Born and educated in the North, I did not share in
+any degree the fears of the Southerners over the election to the
+Presidency of Mr. Lincoln. I could not but think the action of the
+seceding States unwise and dangerous to their future prosperity. On
+the other hand, this action had already been taken, and without any
+prospect of its revocation. Indeed, in the present frame of mind of
+the North, any steps toward recession seemed likely to precipitate
+the very evils which the secession of the states had been designed
+to anticipate. I believed slavery a disadvantage to the South, but
+no sin, and, in any event, an institution for which the Southerners
+of the present day were not responsible. An inheritance from their
+fore-fathers, properly administered, it was by no means an unmitigated
+evil, and it was one, moreover, in which the North but a few years
+before had shared. All my interests, present and future, apparently
+lay in the South and with Southerners, and if the seceding States, in
+one of which I resided, chose deliberately to try the experiment of
+self-government, I felt quite willing to give them such aid as lay
+in my feeble power. When I add to this that I was 24 years of age,
+and naturally affected largely by the ideas, the enthusiasm and
+the excitement of my surroundings, it is easy to understand to what
+conclusions I was led."
+
+So on June 17, 1861, he volunteered in the Stafford Guards under Capt.
+(afterward Brigadier General) L.A. Stafford. The Guards became company
+B of the 9th Regiment of Louisiana Volunteers, Confederate States of
+America, Colonel (later Brigadier General) "Dick" Taylor (son of
+"Old Zach," the President of the U.S.), in command. During the year
+that followed until the close of the war, Handerson experienced the
+adventures and trials of a soldier's life. He knew picket, scouting,
+and skirmishing duty, the bivouac, the attack and defense in battle
+formation, the charge, the retreat, hunger and thirst, the wearisome
+march in heat and dust, in cold, in rain, through swamps and stony
+wildernesses. He was shot through the hat and clothing and once
+through the muscles of the shoulder and neck within half inch of the
+carotid artery, lay in a hospital, and had secondary hemorrhage. At
+another time he survived weeks of typhoid fever.
+
+He was successively private soldier and accountant for his company,
+quarter-master, 2nd Lieutenant of the line, Captain of the line, and
+finally Adjutant General of the 2nd Louisiana Brigade, A. N. Va.,
+under Lee and Jackson, with rank of Major. On May 4, 1864, Adjutant
+General Handerson was taken prisoner, and from May 17th until August
+20th he was imprisoned at Fort Delaware in the Delaware river. He
+was then confined in a stockade enclosure on the beach between Forts
+Wagner and Gregg on Morris Island, until about the end of October,
+when he was transferred to Fort Pulaski at the mouth of the Savannah
+river, and in March, 1865, back to Fort Delaware. In April, after
+Lee's surrender, many of the prisoners were liberated on taking the
+oath of allegiance to the Federal Government. But Handerson did not
+consider his allegiance to the Southern Confederacy ended until
+after the capture of President Davis, and it was not until June 17,
+1865, that he signed the oath of allegiance and was liberated in
+Philadelphia.
+
+Since that time, with that spirit of tolerance and openness to truth
+which characterized the man, he has said, "in the triumph of the
+Union, the war ended as it should have ended."
+
+Mr. Handerson then resumed his medical studies, this time in the
+College of Physicians and Surgeons of New York, Medical Department of
+Columbia University, taking the degree of M.D. in 1867. Hobart College
+conferred the A.M. in 1868. On October 16, 1872, he married Juliet
+Alice Root, who died leaving him a daughter.
+
+February 25, 1878, Dr. Handerson read before the Medical Society of
+the County of New York an article entitled, "The School of Salernum,
+an Historical Sketch of Mediæval Medicine." This essay attracted wide
+attention to his scholarly attainments and love of laborious research.
+For example, Professor Edward Schaer of the chair of Pharmacology
+and Pharmaceutical Chemistry, of Neumünster-Zürich, pronounces
+this pamphlet "a valuable gift ... a remarkable addition to other
+historical materials ... in connection with the history of pharmacy
+and of pharmaceutical drugs"; that he found in it "a great deal of
+information which will be sought for in vain in many even renowned
+literary works."
+
+Dr. Handerson practiced medicine in New York City, from 1867 to 1885,
+removing to Cleveland in 1885.
+
+On June 12, 1888, he married Clara Corlett of Cleveland.
+
+Then in 1889 appeared the American edition of the "History of Medicine
+and the Medical Profession, by Joh. Hermann Baas, M.D.," which was
+translated, revised and enlarged by Dr. Handerson, to whom, in the
+words of Dr. Baas, "we are indebted for considerable amplification,
+particularly in the section on English and American medicine, with
+which he was, of course, better acquainted than the author, and
+for numerous corrections." ... As a matter of fact, the learning
+and judgment, and the conscientious industry of the translator and
+American editor of this work are evident throughout the book.
+
+Concerning Dr. Handerson's writings, Dr. Fielding H. Garrison
+writes (Medical Pickwick, March, 1915, P. 118): "The earliest of Dr.
+Handerson's papers recorded in the Index Medicus is 'An unusual case
+of intussusception' (1880). Most of his other medical papers, few in
+number, have dealt with the sanitation, vital statistics, diseases
+and medical history of Cleveland, and have the accuracy which
+characterizes slow and careful work. This is especially true of his
+historical essays of which that on 'The School of Salernum' (1883) is
+a solid piece of original investigation, worthy to be placed beside
+such things as Holmes on homoeopathy, Weir Mitchell on instrumental
+precision, or Kelly on American gynecology.
+
+"To the cognoscenti, Dr. Handerson's translation of 'Baas' History of
+Medicine' (1889) is known as 'Handerson's Book.' He modestly describes
+himself as its 'editor,' but he is more than that. As the witty and
+effective translator of a witty and effective work, he has added
+sections in brackets on English and American history which are
+based on original investigation and of permanent value to all future
+historians. Handerson's Baas is thus more complete and valuable than
+the Rhinelander's original text."
+
+As listed in the Index Medicus, the publications and writings of Dr.
+Handerson appear as follows:
+
+    An unusual case of intussusception. Medical Record, 1880,
+    xviii, 698.
+
+    The School of Salernum. An historical sketch of mediæval
+    medicine. 1883.
+
+    Outlines of the history of medicine (Baas). Translated, and in
+    conjunction with the author, revised and enlarged, 1887.
+
+    Clinical history of a case of abdominal cancer. Cleveland
+    Medical Gazette, 1891-2, vii, 315-321.
+
+    The Sanitary topography of Cleveland. Cleveland Medical
+    Gazette, 1895-6, xi, 651-659.
+
+    Cleveland in the Census Reports. Cleveland Medical Gazette,
+    1896-7, xii, 257-264.
+
+    The earliest contribution to medical literature in the United
+    States. Janus, 1899, p. 540.
+
+    A review of the Vital Statistics of Cleveland during the last
+    decennium. Cleveland Medical Journal, 1902, i, 71-76.
+
+    Epidemics of typhoid fever in Cleveland. Cleveland Medical
+    Journal, 1904, iii, 208-210.
+
+    The mortality statistics of the twelfth census. Cleveland
+    Medical Journal, 1905, iv, 425-431.
+
+    Co-operative sanitation. Ohio Medical Journal, 1905, i,
+    278-281.
+
+    The medical code of Hammurabi, King of Babylon. Cleveland
+    Medical Journal, 1908, vii, 72-75.
+
+    Carcinoma in high life. Cleveland Medical Journal, 1908, vii,
+    472-476.
+
+    Medical Cleveland in the nineteenth (19th) Century. Cleveland
+    Medical Journal, 1909, viii, 59, 146, 208.
+
+    Gilbert of England and his "Compendium Medicine." Medical
+    Pickwick, 1915, i, 118-120.
+
+Dr. Handerson was Professor of Hygiene and Sanitary Science in the
+Medical Department of the University of Wooster, 1894-96, and the
+same in the Cleveland College of Physicians and Surgeons (Medical
+Department of Ohio Wesleyan University), 1896 to 1907, and filled that
+chair with eminent ability. Thus it came about that the ex-Confederate
+officer taught sanitary science in a college standing upon ground
+donated by the survivors of an organization of abolitionists.
+
+Dr. Handerson was a member of the Cuyahoga County Medical Society,
+and its President in 1895; also a member of the Cleveland Academy
+of Medicine, of the Ohio State Medical Society, and of the American
+Medical Association. He was one of the founders and an active worker
+in the Cleveland Medical Library Association and its President from
+1896 to 1902.
+
+He was all his life devoted to the Episcopal Church, was Warden of
+Grace Episcopal Church, Cleveland, for many years, and Treasurer of
+the Diocese of Ohio during fourteen years.
+
+During his later years Dr. Handerson withdrew entirely from active
+practice and spent a great deal of time in his library. His papers
+abound in carefully prepared manuscripts, some of them running into
+hundreds of pages.
+
+Two years before his death Dr. Handerson became totally blind.
+This grievous affliction was borne with unvarying patience and
+cheerfulness. He still loved to recite from memory the classic
+authors, to relate and discuss episodes of world history and events
+of the present, to solve difficult mathematical problems, and to have
+his data on all subjects verified. He retained his faculties perfectly
+until April 23, 1918, when he died from cerebral hemorrhage.
+
+He is survived by a daughter, two sons by the second marriage, and his
+devoted wife.
+
+Among numerous letters received from prominent physicians and authors
+appreciative of Dr. Handerson's medico-historical labors, one from Dr.
+Oliver Wendell Holmes expresses high praise and requests to have sent
+to him everything which Dr. Handerson might in future write.
+
+It seems eminently appropriate that the essay on "Gilbertus Anglicus."
+the last from the pen of Dr. Handerson, should be put in book form,
+together with a sketch, however brief, of its author's earnest life,
+his sterling character, his geniality and imperturbable equanimity,
+and thus preserved in testimony of the high esteem in which he was
+held by his contemporaries.
+
+    SAMUEL WALTER KELLEY.
+
+
+       *       *       *       *       *
+
+
+
+
+RESOLUTIONS
+
+
+At a meeting of the Council of the Cleveland Medical Library
+Association, held on May 14, the following resolutions were adopted:
+
+_Resolved_, That in the death of Dr. Henry E. Handerson the Cleveland
+Medical Library Association has sustained the loss of one of its most
+honored and devoted members. His scholarly acquirements were notable,
+and his eminence as a medical historian generally recognized. His deep
+interest in the welfare of the Library and his thorough attention to
+every detail of his official duties were always evident, while his
+lovable personal qualities endeared him to all.
+
+The Association desires to express its high appreciation of his long
+and valued services, and extends to his bereaved family its heartfelt
+and sincere sympathy.
+
+    C.A. HAMANN,
+    WM. EVANS BRUNER,
+    J.B. McGEE.
+
+
+       *       *       *       *       *
+
+
+
+
+GILBERTUS ANGLICUS (GILBERT OF ENGLAND)
+
+A STUDY OF ENGLISH MEDICINE IN THE THIRTEENTH CENTURY.
+
+BY H.E. HANDERSON, A.M., M.D.
+
+CLEVELAND
+
+       *       *       *       *       *
+
+    "Nothing in the past is dead to the man who would learn how
+    the present came to be what it is."--Stubbs--_Constitutional
+    Hist. of England_.
+
+       *       *       *       *       *
+
+
+Among the literary monuments of early English medicine the "Compendium
+Medicinae" of Gilbertus Anglicus merits a prominent position as the
+earliest complete treatise on general medicine by an English author
+which has been preserved to our day, and equally because it forms in
+itself a very complete mirror of the medical science of its age and
+its country.
+
+Gilbert was undoubtedly one of the most famous physicians of his time.
+His reputation is recognized in those well-known lines of Chaucer
+which catalogue the "authorities" of his Doctor of Phisik:
+
+  "Wel knew he the olde Esculapius
+  And Deyscorides and eek Rufus,
+  Olde Ypocras, Haly and Galyen,
+  Serapion, Razis and Avycen,
+  Averrois, Damascien and Constantyn,
+  Bernard and Gatesden and Gilbertyn."
+
+He is also quoted with frequency and respect by the medical writers
+of many succeeding ages, and the Compendium, first printed in 1510,
+enjoyed the honor of a second edition as late as the seventeenth
+century (1608). The surname "Anglicus" in itself testifies to the
+European reputation of our author, for as Dr. Payne sensibly
+remarks, no one in England would speak of an English writer as "the
+Englishman."
+
+Yet, in spite of his reputation, we know almost no details of the life
+of Gilbert, and are forced to content ourselves with the few facts
+to be gleaned from the scanty biographies of early writers and the
+inferences drawn from the pages of the Compendium itself. The date
+and place of his birth and death, and even the field of his medical
+activities are equally unknown. Bale, Pits and Leland, the earliest
+English biographers, tell us that Gilbert, after the completion of
+his studies in England, proceeded to the Continent to enlarge his
+education, and finally became physician to the great Justiciar, Hubert
+Walter, archbishop of Canterbury, who died in the year 1205. This
+would place him under the reign of King John, in the early part of the
+thirteenth century.
+
+Dr. John Freind, however, the famous English physician and medical
+historian (1725), observing that Gilbert quotes the Arabian
+philosopher Averroës (who died in 1198), and believing that he also
+quotes a work of Roger Bacon and the surgical writings of Theodorius
+(Borgognoni) of Cervia (1266), was inclined to fix his period in the
+latter half of the thirteenth century, probably under the reign of
+Edward I. Most of the later historians of medicine have followed the
+views of Freind. Thus Eloy adopts the date 1272, Sprengel gives 1290,
+Haeser the same date, Hirsch says Gilbert lived towards the close of
+the thirteenth century, Baas adopts the figures 1290, etc.
+
+The most recent biographers of Gilbert, however, Mr. C.L.
+Kingsford[1], and the late Dr. Joseph Frank Payne[2], after an
+apparently careful and independent investigation of his life, have
+reached conclusions which vary materially from each other and from
+those of the historians mentioned. Mr. Kingsford fixes the date of
+Gilbert at about 1250, while Dr. Payne reverts to the views of Bale
+and Pits and suggests as approximate figures for the birth and death
+of Gilbert the years 1170-80 to 1230. This discrepancy of twenty-five
+or thirty years between the views of two competent and unprejudiced
+investigators, as a mere question of erudition and interpretation,
+is perhaps scarcely worthy of prolonged discussion. But as both
+biographers argue from substantially the same data, the arguments
+reveal so many interesting and pertinent facts, and the numerous
+difficulties attending the interpretation of these facts, that
+some comparison of the different views of the biographers and some
+criticism of their varying conclusions may not be unwelcome.
+
+[Footnote 1: In Leslie Stephen's "Dictionary of Biography."]
+
+[Footnote 2: _British Medical Journal_, Nov. 12, 1904, p. 1282.]
+
+In the first place then we must say that, as Gilbert is frequently
+quoted in the "Thesaurus Pauperum," a work ascribed to Petrus
+Hispanus, who (under the title Pope John XXI) died in 1277, this date
+determines definitely the _latest_ period to which the Compendium can
+be referred. If, as held by some historians, the "Thesaurus" is the
+work of Julian, the father of Petrus, the Compendium can be referred
+to an earlier date only.
+
+Now Gilbert in his Compendium (f. 259a) refers to the writings of
+Averroës (Ibn Roschd) regarding the color of the iris of the eye.
+Averroës died in the year 1198. There is no pretense that Gilbert was
+familiar with the Arabic tongue, and the earliest translations into
+Latin of the writings of Averroës are ascribed by Bacon to the famous
+Michael Scot, though Bacon says they were chiefly the work of a
+certain Jew named Andrew, who made the translations for Scot. Bacon
+also says that these translations were made "_nostris temporibus_,"
+in our time, a loose expression, which may, perhaps, be fairly
+interpreted to include the period 1230-1250. But if, as Dr. Payne
+believes, Gilbert died about 1230, it seems improbable that he could
+have been familiar with the translations of Michael Scot. Accordingly
+Dr. Payne suggests that, after the death of his patron in 1205,
+Gilbert returned to the Continent, and, perhaps in Paris or at
+Montpellier, met with earlier Latin versions of the writings of the
+Arabian physician and philosopher. This is, of course, possible, but
+there is no historical warrant for the hypothesis, which must, for
+the present at least, be regarded as merely a happy conjecture of
+Dr. Payne. The presence of Gilbert upon the Continent, probably as a
+teacher of reputation, seems, however, quite probable. Littre has even
+unearthed the fact that during the 14th century a street in Paris near
+the medical schools, bore the name of the Rue Gilbert l'Anglois. A
+MS. in the Bibliotheque Nationale entitled "_Experimenta Magistri
+Gilliberti, Cancellarii Montepessulani_" has suggested also the idea
+that Gilbert may have been at one time chancellor of the University
+of Montpellier. Dr. P. Pansier, of Avignon, however, who has carefully
+examined and published this manuscript[3], reports that while it
+contains some formulae found also in the Compendium of Gilbert, it
+contains many others from apparently other sources, and he was unable
+to convince himself that the compilation was in fact the work of
+Gilbertus Anglicus. Dr. Pansier also furnishes us with a list of
+the chancellors of Montpellier, which contains the name of a certain
+"Gillibertus," chancellor of the university in 1250. He could find,
+however, no evidence that this Gillibertus was Gilbertus Anglicus,
+author of the Compendium Medicinae. On the whole then the visit of
+Gilbert to France early in the 13th century, and his access in
+this way to early translations of Averroës, while a convenient and
+plausible conjecture on the part of Dr. Payne, does not seem supported
+by any trustworthy historical evidence.
+
+[Footnote 3: Janus, 1903, p. 20.]
+
+The "_Liber de speculis_" mentioned by Gilbert (f. 126 c), and since
+the time of Freind generally accepted as the work of Bacon, is almost
+certainly not from the pen of that eminent philosopher. In addition
+to the fact that Bacon himself says he had (for obvious reasons)
+written nothing except a few tracts (_capitula quaedam_) prior to the
+composition of his Opus Magnum in 1267, the real author of the Liber
+de speculis is probably mentioned by Bacon in the following passage
+from the Opus Tertium:
+
+"_Nam in hoc ostenditur specialiter bonitas naturae, ut dicit auctor
+libri de speculis comburentibus._"[4]
+
+[Footnote 4: Cap. XXXVI, p. 116, edition of Brewer.]
+
+We must therefore agree with Dr. Payne that the _Liber de speculis_ of
+Gilbert was at least not the work of Roger Bacon.
+
+Dr. Freind regards the chapters of Gilbert on the subject of leprosy
+as borrowed substantially from the "Chirurgia" of Theodorius of
+Cervia, who wrote about the year 1266. This view has also been
+generally accepted by later writers. But Dr. Payne boldly challenges
+the view of Freind, declares that Theodorius copied _his_ chapters
+from Gilbert, and asserts that Theodorius was a notorious plagiarist.
+Now, while the bold assertion of Dr. Payne cannot, of course, be
+accepted as _proof_ of Gilbert's precedence in chronological order,
+if that precedence is otherwise established, it will explain the
+similarity of the chapters of the two writers very satisfactorily. For
+the present, however, this similarity can be adduced as evidence on
+neither side.
+
+Again, Gilbert, with the enthusiasm of a loyal pupil, speaks (f. 47 b)
+of a certain Magister Ricardus, "_omnium doctorum doctissimus_," whose
+views on uroscopy certainly indicate a mind superior to his age. Now
+there were about this period at least two eminent physicians who bore
+the name of Ricardus. Of these the senior, a Frenchman, known also
+as Ricardus Salednitanus, is highly praised by Aegidius of Corbeil
+(Gilles de Corbeil, Aegidius Corboliensis), physician to King Philip
+Augustus of France (1180-1223). This Ricardus was a famous teacher at
+Salernum when Aegidius was in attendance at that famous university,
+therefore probably about the close of the 12th century. The second
+Ricardus, called Parisiensis, has been recently identified by Toply
+with Richard of Wendover, an English canon of St. Paul's, and at one
+time physician to Pope Gregory IX, who died in 1241. Toply believes
+him to have been also the author of the "_Anatomia Ricardi_," recently
+published. This Ricardus died in 1252.
+
+Now to which of these Ricardi does the eulogistic language of Gilbert
+refer? Dr. Payne believes it to be the senior, Ricardus Salernitanus.
+Mr. Kingsford, on the other hand, thinks it to be Ricardus
+Parisiensis, who died in 1252. A _Liber de urinis_ has been ascribed
+to each of them, but, it seems to me, with greater probability to
+Ricardus Salernitanus. If too the author of the "_Anatomia Ricardi_"
+was a contemporary of Gilbert, we might reasonably expect to find
+in the Compendium some evidences of Gilbert's acquaintance with that
+work. But Gilbert's discussion of anatomical questions is totally
+unlike that of the author of the "_Anatomia_," and betrays not the
+slightest evidence of knowledge of such a treatise. On the whole
+then I am inclined to agree in this question with Dr. Payne, and to
+consider the Ricardus of Gilbert identical with Ricardus Salernitanus,
+the famous professor of the School of Salernum. This conclusion
+is further justified by the fact, generally accepted by all modern
+writers, that Gilbert was himself a pupil of Salernum.
+
+Singularly enough, both Dr. Payne and Mr. Kingsford profess to find
+in the Compendium some evidence that Gilbert sojourned in Syria for
+a certain period, though the circumstances of this sojourn are
+viewed differently by the two biographers. Dr. Payne thinks that the
+physician, after completing his education in England, proceeded to the
+Continent and extended his travels as far as Syrian Tripoli, where he
+met Archbishop Walter and became attached to his staff. As the prelate
+returned to England in 1192, this sojourn of Gilbert in Syria must
+have been about 1190-91, when, according to Dr. Payne's chronology,
+Gilbert could have been not more than about twenty years of age.
+Dr. Payne bases his story upon a certain passage in the Compendium,
+in which Gilbert says that he met in Syrian Tripoli "a _canonicus_
+suffering from rheumatic symptoms." I have been entirely unable to
+find the passage referred to in this story, in spite of a careful
+search of the text of the edition of 1510. But, admitting the
+existence of the passage in question, it proves nothing as to the
+_date_ of this alleged Syrian sojourn. Tripoli was captured by
+the Crusaders in 1109, and continued under their control until its
+recapture by the Saracens in 1289, a period of nearly two hundred
+years. Gilbert's travels in Syria may then have occurred at almost
+any time during this long period, and his fortuitous meeting with
+Archbishop Walter has very much the appearance of a story evolved
+entirely from the consciousness of the biographer.
+
+On the other hand, Mr. Kingsford bases his theory of Gilbert's sojourn
+in Syria upon a story adopted, I think, from Littré and found in the
+Histoire litéraire de la France. The Compendium of Gilbert contains
+(f. 137a) a chapter giving the composition of a complex collyrium
+with which he professes to have cured the almost total blindness of
+Bertram, son of Hugo de Jubilet, after the disease had baffled the
+skill of the Saracen and Christian-Syrian physicians of his day.
+Now Littré avers that a certain Hugo de Jubilet was involved in an
+ambuscade in Syria in the year 1227, and that he had a son named
+Bertram. It is very natural, of course, to conclude that this Bertram
+was the patient recorded in the book of Gilbert. Kingsford says that
+Gilbert "met" Bertram in Syria, but the text of the Compendium says
+nothing of the locality of their meeting, which might have taken place
+almost anywhere in Europe, perhaps even at Salernum, a favorite resort
+of the invalided Crusaders in these times. Finally, Dr. Payne disposes
+effectually of the authenticity of the entire story by calling
+attention to the fact that the chapter referred to in the Compendium
+is marked plainly "_Additio_," without indicating whether this
+addition is from the pen of Gilbert or some later glossator.
+
+Finally, I may suggest another line of argument, which, so far as I
+know, has not yet been advanced for the determination of the period of
+Gilbert.
+
+The Compendium Medicinae of Gilbert is, of course, a compendium of
+internal medicine. But the book is also something more. Not less
+than fifty chapters are devoted to a comparatively full discussion of
+wounds, fractures and dislocations, lithotomy, herniotomy, fistulae
+and the various diseases on the border line between medicine and
+surgery. Not a single surgical writer, however, is quoted by name.
+Nevertheless the major part of these surgical chapters are either
+literal copies, or very close paraphrases, of the similar chapters
+of the "_Chirurgia_" of Roger of Parma, a distinguished professor
+in Salernum and the pioneer of modern surgery. The precise period
+of Roger is not definitely settled by the unanimous agreement of
+modern historians, but in the "_Epilogus_" of the "_Glosulae Quatuor
+Magistrorum_" it is said that Roger's "_Chirurgia_" was "_in lucem et
+ordinem redactum_" by Guido Arietinus, in the year of our Lord 1230.
+This date, while perhaps not unquestionable, is also adopted by De
+Renzi, the Italian historian of Medicine. The original MS. of Roger's
+work is said to be still in existence in the Magliabechian Library
+in Florence, but it has never been published in its original form.[5]
+Roland of Parma, however, a pupil of Roger, published in 1264 what
+purports to be a copy of Roger's "_Chirurgia_" with some notes and
+additions of his own, and it is from this MS. of Roland that all our
+copies of Roger's work have been printed. Roger's "_Chirurgia_" was
+popularly known as the "_Rogerina_;" the edition of Roland as the
+"_Rolandina_." They are frequently confounded, but are not identical,
+though the additions of Roland are usually regarded as of little
+importance. In the absence of Roger's manuscript, however, they lead
+often to considerable confusion, as it is not always easy to determine
+in the printed copies of the "_Rolandina_" just what belongs to Roger
+and what to his pupil and editor. Now a careful comparison of the
+surgical chapters of Gilbert of England with the published text of the
+"_Rolandina_" leads me to the conviction that Gilbert had before him
+the text of Roger, rather than that of Roland, his pupil. If such is
+the fact, Gilbert's Compendium must have been written between 1230 and
+1264, the dates respectively of the "_Rogerina_" and "_Rolandina_."
+
+[Footnote 5: Haeser says that this MS. of Roger's "Chirurgia," made by
+Guido Arenitensium, was discovered by Puccinoti in the Magliabechian
+library, and that an old Italian translation of the same work is also
+found there. The latter was the work of a certain Bartollomeo.
+
+The text used to represent Roger in the present paper is that
+published by De Renzi (Collectio Salernitana, tom. II, pp. 426-493)
+and entitled "Rogerii, Medici Celeberrimi Chirurgia." It is really
+the text published originally in the "Collectio Chirurgica Veneta" of
+1546, of which the preface says:
+
+"_His acceserunt Rogerii ac Guil. Saliceti chirurgiae, quarum prior
+quibusdam decorata adnotationibus nunc primum in lucem exit, etc._,"
+and adds further on:
+
+"_Addidimus etiam quasdam in Rogerium veluti explanationes, in
+antiquissimo codice inventas, et ab ipso fortasse Rolando factas._"
+While I may recognize gratefully the surgical enthusiasm which led the
+editor to the publication of these "_veluti explanationes_," for my
+present purpose he would have earned more grateful recognition if he
+had left them unprinted. As the text now stands it is merely a garbled
+edition of the Rolandina. However, it is the best representative of
+the "Chirurgia" of Roger at present available. See De Renzi, op. cit.,
+p. 425.]
+
+From a careful review of the data thus presented we may epitomize,
+somewhat conjecturally, the life of Gilbert substantially as follows:
+He was probably born about 1180 and received his early education in
+England. On the completion of this education, about the close of the
+12th century, he proceeded to the Continent to complete his studies,
+and spent some time in the school of Salernum, where it is probable
+that he enjoyed the instruction of Roger of Parma, Ricardus
+Salernitanus, and may have had among his fellow-students Aegidius of
+Corbeil. Probably after his return to England he served for a brief
+period on the staff of Archbishop Hubert Walter, after whose death
+in 1205, but at an unknown period, Gilbert returned once more to the
+Continent, where it seems probable he spent the remainder of his life.
+This comports best with his extensive European reputation, his surname
+"Anglicus" and the comparative dearth in England of any facts relating
+to his life. The date of the Compendium I am inclined to place about
+1240, prior to the literary activity of Ricardus Parisiensis or
+Richard of Wendover, Roland of Parma, Roger Bacon and Theodorius of
+Cervia. We may place his death, conjecturally, at about 1250.
+
+The first edition of the Compendium is a small quarto of 362 folios
+(724 modern pages), five by seven inches in size, printed in double
+narrow columns, in black letter, perfectly legible and clear. The
+pagination shows some errors, but the text itself is remarkably
+accurate, though the presence of a multiplicity of contractions
+and ligatures renders the reading somewhat difficult to the modern
+student. On the last page we find the following colophon:
+
+_Explicit compendium medicine Gilberti Anglici correctum et bene
+emendatum per dominum Michaelem de Capella artium et medicine
+doctorem: ac Lugduni Impressum per Jacobum Saccon: expensis
+Vincentii de Portonariis. Anno Domini M.D.x. die vero vigesima mensis
+Novembris._
+
+_Deo Gratias._
+
+The second edition (which I have not seen) is said to bear the title:
+"Laurea anglicana, sive compendium totius medicinae, etc," Geneva,
+1608.
+
+It should be noticed that the title "Laurea anglicana" is not
+mentioned in the original edition of 1510, but is apparently due to
+the exuberance of enthusiasm of the editor of the later edition, whose
+taste seems to have been more flamboyant.
+
+Various manuscript works of greater or less authenticity are ascribed
+to Gilbert by different authorities. Of these Mr. Kingsford furnishes
+the following list:
+
+  1. "Commentarii in Versus Aegidii de Urinis," quoted by John
+          Gaddesden and probably authentic.
+
+  2. "Practica Medicinae," mentioned by Pits, but of doubtful
+          authenticity.
+
+  3. "Experimenta Magistri Gilliberti, Cancellarii Montepessulani,"
+          noticed on page 2, but authenticity doubtful.
+
+  4. "Compendium super Librum Aphorismorum Hippocratis."
+  MS. in Bodleian.
+
+  5. "Eorundem Expositio." MS. in Bodleian.
+
+  6. "Antidotarium." MS. in Caius College.
+
+To these he adds, on the authority of Bale and Pits:
+
+  7. "De Viribus Aquarum et Specierum."
+
+  8. "De Proportione Fistularum."
+
+  9. "De Judicio Patientis."
+
+  10. "De Re Herbaria."
+
+  11. "De Tuenda Valentudine."
+
+  12. "De Particularibus Morbis."
+
+  13. "Thesaurus Pauperum."
+
+All of these latter may be regarded as doubtful.
+
+The authorities named by Gilbert are Pythagoras, Hippocrates, Plato,
+Aristotle, Galen, Rufus, Maerobius, Boetius, Alexander of Tralles,
+Theodorus Priscianus, Theophilus Philaretes, Stephanon (of Athens?),
+the Arabians Haly Abbas, Rhazes, Isaac Judaeus, Joannitius, Janus
+Damascenus, Jacobus Alucindi, Avicenna and Averroës; the Salernian
+writers, quoted generally as Salernitani and specifically Constantino
+Africanus, Nicholas Praepositus, Romoaldus Ricardus and Maurus, and
+two otherwise unknown authors, Torror and Funcius, classed by Gilbert
+as "_antiqui_." The latter author is also said to have written a
+"_Liber de lapidibus_." Certainly this list suggests a pretty good
+medical library for a practitioner of the 13th century.
+
+Dr. Payne calls attention to the fact that all these writers antedate
+the 13th century, and thus limit the period of Gilbert in antiquity.
+This is undoubtedly true with reference to authorities actually named,
+but does not exclude from consideration other writers quoted, but not
+named, whom we shall have occasion to refer to hereafter.
+
+The Compendium opens with a very brief and modest foreword, couched in
+the following terms:
+
+"_Incipit liber morborum tam universalium quam particularium a
+magistro Gilberto anglico editus ab omnibus autoribus et practicis
+magistrorum extractus et exceptus, qui compendium medicine
+intitulatur._"
+
+It will be observed that no claim whatever for originality is
+presented by the author. He calls his book a compendium extracted from
+all authors and the practice of the professors, and edited only by
+himself. The same idea is more fully emphasized later (f. 55c), where
+he says:
+
+"_Sed consuetudo nostra est ex dictis meliorum meliora aggregare, et
+ubi dubitatio est, opiniones diversas interserere; ut quisque sibi
+eligat quam velit retinere._"
+
+The self-abnegation implied in these extracts must not, however, be
+interpreted too literally, for the editorial "_dico_" on numerous
+pages, and even an occasional chapter marked "_Propria opinio_,"
+testify to the fact that Gilbert had opinions of his own, and was
+ready on occasion to furnish them to the profession. On the whole,
+however, the "Compendium" is properly classified by the author as a
+compilation, rather than an original work.
+
+The Compendium is divided into seven books, and the general
+classification of diseases is from head to foot--the usual method
+of that day. The modern reader will probably be surprised at the
+comprehensiveness of the work, which, besides general diseases,
+includes considerable portions of physiology, physiognomy,
+ophthalmology, laryngology, otology, gynecology, neurology,
+dermatology, embryology, obstetrics, dietetics, urinary and venereal
+diseases, therapeutics, toxicology, operative surgery, cosmetics and
+even the hygiene of travel and the prevention of sea-sickness. Some of
+these subjects too are discussed with an acuteness and a common sense
+quite unexpected. Of course, scholastic speculations, superstition,
+charms, polypharmacy and the use of popular and disgusting remedies
+are not wanting. Even the mind of a philosopher like Roger Bacon was
+unable to rise entirely above the superstition of his age. But the
+charms and popular specifics of Gilbert are often introduced with a
+sort of apology, implying his slight belief in their efficacy. Thus in
+his chapter on the general treatment of wounds (f. 87a) he introduces
+a popular charm with the following words:
+
+"_Alio modo, solo divino carmine confisi, quidam experti posse curari
+omnes plagas hoc._
+
+"_Carmine._
+
+"_Tres boni fratres per viam unam ibant, et obviavit eis noster dominus
+jesus christus et dixit eis, tres boni fratres quo itis_, etc."
+
+And again, in his discussion of the treatment of gout and rheumatism
+(f. 327b), Gilbert adds, under the title
+
+_Emperica_
+
+"_Quamvis ego declino ad has res parum, tamen est bonum scribere in
+libro nostro, ut non remaneat tractatus sine eis quas dixrunt antiqui.
+Dico igitur quod dixit torror: Si scinderis pedem rane viridis et
+ligaveris supra pendem podagrici per tres dies, curatur; ita quod
+dextrum pedum rane ponas supra dextrum pedem patientis, et e converso.
+Et dixit Funcius, qui composuit librum de lapidibus, quod magnes,
+si ligatus fuerit in pedem podagrici, curatur. Et alius philosophus
+dixit. Si accipiatur calcancus asine et ponatur ligatus supra pedem
+egri, curatur, ita quod dexter supra dextrum, et e converso. Et
+juravit quod sit verum. Et dixit torror quod si ponatur pes testudinis
+dexter supra dextrum pedem podagrici, et e converso, curatur._"
+
+We may believe, indeed, that Gilbert would have preferred to follow
+in the therapeutic footsteps of Hippocrates, had he not disliked to be
+regarded by his colleagues as eccentric and opinionated. For he says
+in his treatment of thoracic diseases (f. 193c):
+
+"_Etenim eleganter dedit Ipo. (Hippocrates) modum curationis, sed ne
+a medicis nostri temporis videamur dissidere, secundum eos curam
+assignemus._"
+
+Gilbert was a scholastic-humoralistic physician _par excellence_,
+delighting in superfine distinctions and hair-splitting definitions,
+and deriving even pediculi from a superfluity of the humors (f. 81d).
+Of course he was also a polypharmacist, and the complexity, ingenuity,
+and comprehensiveness of his prescriptions would put to shame even
+the "accomplished therapeutist" of these modern days. In dietetics
+too Gilbert was careful and intelligent, and upon this branch of
+therapeutics he justly laid great emphasis.
+
+The first book of the Compendium, comprising no less than 75 folios,
+is devoted entirely to the discussion of fevers. Beginning with the
+definition of Joannicius (Honain ebn Ishak):
+
+"Fever is a heat unnatural and surpassing the course of nature,
+proceeding from the heart into the arteries and injuring the patient
+by its effects."
+
+Gilbert launches out with genuine scholastic finesse and verbosity
+into a discussion of the questions whether this definition is based
+upon the essentia or the differentia of fever; whether the heat of
+fever is natural or unnatural, and other similar subtle speculations,
+and finally arrives at a classification of fevers so elaborate and
+complex as to be practically almost unintelligible to the modern
+reader.
+
+The more important of these fevers or febrile conditions are:
+
+  Ephemeral
+  Hemitertian
+  Double quartan
+  Interpolated
+  Synocha
+  Causon synochides
+  Epilala
+  Quotidian
+  Double tertian
+  Quintan
+  Continued
+  Causon
+  Putrid
+  Lipparia
+  Tertian
+  Quartan
+  Sextan
+  Synochus
+  Synochus causonides
+  Ethica
+  Erratica
+
+Some of these names are still preserved in our nosologies of the
+present day; others will be recalled by the memories of our older
+physicians, and a few have totally disappeared from our modern medical
+nomenclature.
+
+Interpolated fevers are characterized by intermissions and remissions,
+and thus include our intermittent and remittent fevers; synochus
+depended theoretically upon putrefaction of the blood in the vessels,
+and was a continued fever. Synocha, on the other hand, was occasioned
+by a mere superabundance of hot blood, hence the verse:
+
+"_Synocha de multo, sed synochus de putrefacto._"
+
+Causon was due to putrefaction of bile in the smaller vessels of
+the heart, diaphragm, stomach or liver, and was an acute fever
+characterized by furred tongue, intolerable frontal headache, tinnitus
+aurium, constant thirst, delirium, an olive-colored face, redness and
+twitching of the eyes and a full, frequent and rapid pulse. Epiala
+and lipparia were febrile conditions concerning which there seems to
+have been much difference of opinion, even in the days of Gilbert.
+Apparently they were distinguished by variations of external and
+internal temperature, or by chills combined with fever. Febris ethica
+is our modern hectic fever. In the discussion of this last variety we
+are introduced to the "_ros_" and "_cambium_" of Avicenna, apparently
+varieties of hypothetical humors.
+
+All these fevers are regarded from the standpoint of Humoralism,
+and depend upon variations in the quantity, quality, mixture or
+location of the four humors, blood, phlegm, bile and black-bile
+(_melancholia_).
+
+In the general treatment of febrile diseases, so-called preparatives
+and digestives are first employed to ripen the humors, after which
+evacuatives (emetics, cathartics, sudorifics, and occasionally even
+venesection) are utilized for the discharge of these peccant humors.
+Much emphasis is laid upon the dietetics of fevers, and this branch of
+treatment is highly elaborated. Complications are met by more or less
+appropriate treatment, and the condition of the urine is studied with
+great diligence. Venesection is recommended rather sparingly, and is
+never to be employed during the _dies caniculares_ (dog-days) or _dies
+Aegyptiaci_, nor during conjunctions of the moon and planets, nor upon
+the 5th, 15th, 17th, 25th, 26th, or 27th days thereafter, etc.
+
+Among the complications of fevers discussed by Gilbert, two seem
+sufficiently important to justify special attention. On folio 74b we
+find a section entitled "_De fluxu materie per parotidas venas_,"
+in which he remarks that "Sometimes matter flows through the parotid
+veins behind the ears down to the neck and nares, and obstructs the
+passages for air, food and drink, so as to threaten suffocation." He
+cautions us against the use of repressives, "lest the matter may run
+to the heart," and recommends mollitives and dissolvents, such
+as butter, dyaltea, hyssop and especially newly shorn wool (_lana
+succida_), which, he says, is a strong solvent. Is this a reference
+to the septic parotitis not unfrequently seen in low fevers?
+
+The following section, "_De inflatione vesice et dolore ejus_,"
+discusses the retention of urine in fevers, and its treatment. Gilbert
+says: "Inflation of, and pain in the bladder are sometimes symptoms
+of acute fevers, since the humors descend into and fill the bladder."
+If this occurs in an interpolated (remittent) fever, he directs the
+patient to be placed in a bath of a decoction of pellitory up to the
+umbilicus, "_et effundet urinam_." If the complication occurs in one
+suffering from a continued fever, the bath should be made of wormwood
+and a poultice should be placed over the bladder and genitals, "_et
+statim minget_." The same effect may be produced by poultice mixed
+with levisticum (lovage) or leaves of parsley. Singularly enough the
+catheter is not mentioned, though this instrument, under the medieval
+name of _argalia_ (cf. French algalie), is noticed frequently in the
+section devoted to vesical calculus.
+
+With the second book of the Compendium the system of the discussion of
+diseases _a capite ad pedes_ is commenced, and produces some curious
+associates. To the modern physician the sudden transition from
+diseases of the scalp to fractures of the cranium seems at least
+abrupt, if not illogical. It seems, therefore, wiser, in a hasty
+review like the present, to take up the various pathological
+conditions described by Gilbert in their modern order and relations,
+and to thus facilitate the orientation of the reader.
+
+The second book then opens with a consideration of the hair and scalp,
+and their respective disorders.
+
+The hair is a dry fume (_fumus siccus_), escaping from the body
+through the pores of the scalp and condensed by contact with the air
+into long, round cylinders. It increases rather by accretion than by
+internal growth, and its color depends upon the humors. Thus red hair
+arises from unconsumed blood or bile; white hair, from an excess of
+phlegm; black hair, from the abundance of black-bile (_melancholia_),
+etc. The use of the hair is for ornament, for protection and for the
+distinction of the sexes. Numerous prescriptions for dyeing the hair,
+for depilatories (_psilothra_), for the removal of misplaced hair and
+for the destruction of vermin in the hair are carefully recorded.
+
+Three varieties of soaps for medicinal use are described, and the
+process of their manufacture indicated. The base of each is a
+lixivium made from two parts of the ashes of burned bean-stalks and
+one of unslaked lime, mixed with water and strained. Of this base
+(_capitellum_), two parts mixed with one part of olive oil form the
+_sapo saracenicus_. In the _sapo gallicus_ the base is made with the
+ashes of chaff and bean-stalks with lime, and to it is added goat's
+fat, in place of the oil. The _sapo spatareuticus_ is made in a
+similar manner, except that oil replaces the goat's fat and the soap
+is made only during the dog days, since the necessary heat is to be
+supplied by the sun alone.
+
+Among the diseases of the scalp attention is given to alopecia,
+dandruff (_furfur_), tinea caries and various pustular affections,
+fanus (favus), rima, spidecia, achora, etc. Caries was a pustular
+disease, in which bristle-like hairs formed a prominent feature. Rima
+was a name applied by the physicians of Salernum to a superfluity
+of hair. In addition to these diseases of the scalp, we find also
+descriptions of gutta rosacea, morphoea and scabies, a fairly
+extensive dermatology for this early day. In favus, Gilbert tells us
+that, after the removal of the pustules, there remain foramina, from
+which exudes a poisonous substance, resembling honey. Of course his
+system of treatment is rich in variety and comprehensiveness.
+
+We may notice here too a few chapters on Toilet or Decorative
+Medicine, a branch of art to which modern physicians have devoted
+perhaps too little attention, with the natural result that it has
+fallen largely into the hands of charlatans of both sexes. Gilbert's
+chapter "_De ornatu capillorum_" offers the following sensible
+introduction: "The adornment of the hair affords to women the
+important advantages of beauty and convenience; and as women desire to
+please their husbands, they devote themselves to adornment and protect
+themselves from the charge of carelessness. In order, therefore,
+that our ministry may not be depreciated, and that we may not render
+ourselves liable to the accusation of ignorance, let us add a few
+words on the subject of the dressing of the hair and the general care
+of the person".
+
+Accordingly Gilbert advises ladies who desire to retain or renew the
+charms of youth to soften the skin and open its pores by the use of
+steam baths and careful washing in warm water, followed by drying the
+surface with the finest cloths (_panno mundissimo_). If necessary,
+superfluous hair is to be removed by suitable depilatories, color to
+be restored to the pale cheeks by a lotion of chips of Brazil-wood[6]
+soaked in rose-water and applied with pads of cotton; or, if the face
+is too red, it may be blanched by the root of the cyclamen (_panis
+porcinus_, sowbread) dried in an oven and powdered. A wealth of
+remedies for freckles, moles, warts, wrinkles, discolorations and
+other facial blemishes, with foul breath and fetidity of the armpits,
+is carefully recorded, and would suffice to establish the fortune of
+any of our modern specialists in female beauty. Finally a long chapter
+entitled "_De sophisticatione vulvae_" introduces us to a phase of
+decoration and sophistication which I would fain believe little known
+or studied in the development of modern civilization, in which we are
+prone at least to follow the advice of Hamlet, to
+
+  "Assume a virtue, if you have it not."
+
+At all events, we may congratulate ourselves that the details of these
+disgusting cess-pools of medical art have disappeared entirely
+from the pages of our modern text-books. Even Gilbert considers it
+advisable to preface this gruesome chapter with a sort of "_Caveat
+emptor_" apology to the reader:
+
+"_Ut tamen secundum ordinem procedamus, in primis cognosactur
+cognoscere desiderantibus, ne dolus dolo patrocinetur, vel simplex
+dolose muscipula claudatur._"
+
+[Footnote 6: This apparent anachronism carries us back to the history
+of the mythical Island of Brazil, which appeared upon our charts as
+late as the middle of the 19th century.]
+
+In the department of neurology Gilbert, after a philosophical
+discussion of the nature and variety of pain, devotes considerable
+chapters to the causes, symptoms, diagnosis and treatment of headache,
+hemicrania, epilepsy, catalepsy, analepsy, cerebral congestion,
+apoplexy and paralysis, phrenitis, mania and melancholia, incubus
+or nightmare, lethargy and stupor, lippothomia or syncope, sciatica,
+spasm, tremor, tetanus, vertigo, wakefulness, and jectigation
+(jactitation, formication, twitching).
+
+The third book of the Compendium opens with several chapters on
+the anatomy and physiology of the eye and the phenomena of vision.
+According to Gilbert, the eye consists of three humors, the
+albugineous (aqueous), the crystalline lens and the vitreous humor,
+and seven tunics, apparently
+
+  1. The conjunctiva
+  2. The albuginea or sclerotic
+  3. The cornea
+  4. The secundina (choroid)
+  5. The rethilea (retina)
+  6. The aranea (iris)
+  7. The uvea perforata (posterior layer of iris),
+
+though the definitions are not in all cases quite clear and definite.
+The tela aranea is said to take its origin from the retina, the retina
+from the optic nerve, and the latter from the rethi (rete, network)
+involving the substance of the brain. The cornea arises from the
+sclerotic tunic, the uvea and secundina take their origin from the
+pia mater, and the conjunctiva from a thin pellicle or membrane which
+covers the exterior of the cranium and is nourished by a transudation
+of the blood through the coronal suture. This pellicle is also said
+to have a connection with the heart, which arrangement furnishes a
+decidedly curious explanation of the mechanism of sympathetic and
+maudlin lachrymation. For, as Gilbert tells us, when the heart is
+compressed this pellicle is also compressed, and if any moisture is
+found beneath the pellicle it is expressed into the substance of the
+lachrymal gland by the constriction of the heart, and men in sorrow
+therefore shed tears. And again, if the heart is much dilated or
+elevated (by joy), this pellicle is also dilated or elevated, and
+if any moisture is found beneath it, it is expressed in the form of
+tears. Accordingly, men who are too joyful shed tears. Still further,
+drunken men, who are notoriously "moist," and have a superfluity of
+fluid between the pellicle and the skin of the cranium, are prone to
+weeping on slight provocation, and their tears are nothing more than
+an expression of this moisture, which makes its exit, not through the
+substance of the eye, but through the "lachrymal angle." Q.E.D.
+
+This odd demonstration is followed by a succession of optical
+questions, which are discussed and answered in true scholastic style,
+with no little acuteness of observation. Thus: "_Utrum visus fiat
+intus suscipiendo?_" Is vision accomplished by something received into
+the eye? "_Utrum color fit de nocte?_" Does color exist at night? To
+the latter question Gilbert replies that in the darkness color exists
+in posse, but not in esse. Again: "Why do some animals see at night,
+some in the day only and some only in the twilight?" This phenomenon
+he ascribes to "the clearness and subtilty of the visual spirits, or
+to the strength, weakness, grossness or turbidity of the organs of
+vision." Some animals, he says, have (visual) spirits, subtle and
+clear as fire, and these animals see perfectly at night because the
+visual spirits (_spiritus visibilis_) are sufficient to illuminate the
+external air. "Why do objects in water seem nearer than those in air?"
+Gilbert explains this as follows: "Nothing appears distant, except as
+perceived through an extensive intervening medium. But our judgment
+is largely guided by the transparency of this medium, since the
+medium itself is not perceived with much accuracy, except when it
+is transparent. Accordingly, as the lucidity of air is greater than
+that of water, an object looks more distant through air than through
+water."
+
+"Why does not a single object appear double, inasmuch as we have two
+eyes?" To this he replies: "From the anterior part of the brain two
+optic nerves pass to the two eyes. But these two nerves unite at a
+certain point into one. Now, since the two nerves are of equal length,
+two images proceeding from a single object do not make the object
+seem double, but single, since the two images are united into one, and
+accordingly one object is seen as one image."
+
+Other physiological speculations are introduced by the questions: "May
+one see an object not actually present?" "Why do some animals see best
+objects at a distance, others those near at hand?" "Why are objects
+seen in their proper position?" All these questions are answered in
+accordance with the scholastic formulae, and, not infrequently, with
+considerable acuteness.
+
+A chapter entitled "_De signis oculorum_" also introduces us to a
+curious discussion of ocular physiognomy. Thus:
+
+"When we see a man with large eyes, we argue that he is indolent."
+
+"If his eyes are deeply situated in his head, we say that he is crafty
+and a deceiver."
+
+"If his eyes are prominent, we say that he is immodest, loquacious and
+stupid."
+
+"He whose eyes are mobile and sharp is a deceiver, crafty and a
+thief."
+
+"He whose eyes are large and tremulous is lazy and a braggart
+(_spaciosus?_), and fond of women."
+
+and so forth for an entire page of the Compendium.
+
+Actual diseases of the eye are discussed in chapters on pain in the
+eyes, ophthalmia, pannus (including ungula, egilops and cataract),
+tumors of the conjunctiva, itching of the eyes, lachrymation, cancer,
+diseases of the cornea and uvea, diseases of the eyelids, lachrymal
+fistula and entropion. The treatment consists generally in ointments
+and collyria in abundance, but in fistula lachrymalis incision and
+tents of alder-pith, mandragora (_malum terrae_), briony, gentian,
+etc., are recommended, and entropion is referred directly to the
+surgeon.
+
+    The Latin term cataracta (also catarracta and catarractes) is
+    applied to a disease of the eyes by Gregory of Tours (Hist.
+    Franc., v. 6) as early as A.D. 650, and again by Constantine
+    Africanus, of the school of Salernum, in 1075 (De Chirurg.,
+    cap. XXX). Singularly the word is not found in the "Chirurgia"
+    of Roger of Parma, from whom Gilbert seems to have borrowed
+    most of his surgical knowledge. Nor is it employed by
+    Roland, Roger's pupil and editor. It recurs, however, in the
+    _Glossulae Quatuor Magistrorum_ (about 1270). But in all these
+    writers cataracta seems to be included under the general term
+    pannus, meaning opacities of every kind. Indeed Gilbert says,
+    "Ungula, egilops, cataracta and macula are species of pannus,
+    all arising from the same causes and cured by the same
+    treatment." A few lines later, however, in distinguishing
+    these various species, he adds: "Cataract arises from a
+    humor collected between the tunics of the eye": and again
+    it is said to be blood filling the veins of the eyes, and
+    especially those of the conjunctiva, and derives its name _a
+    caracteribus_ (?). The truth is none of these writers seem to
+    have any very definite knowledge of the distinction between
+    the various opacities of the media of the eye, all of which
+    were included under the general term pannus. But, what is more
+    remarkable, Roger, Roland and The Four Masters make no mention
+    of the possibility of surgical interference in these cases,
+    but content themselves with elaborate collyria and ointments,
+    or simply with internal treatment. Gilbert, on the other hand,
+    while recommending these collyria and ointments, and even the
+    internal remedies, adds the following:
+
+    "_Interior autem macula, quae tela vocatur, subcornea situata,
+    si vl'e (?) purgatione precendente et colliriis et pulveribus
+    non removetur, acu torta immissa per caprinum angulum
+    extrahatur aut inferius replicetur_" (f. 137a).
+
+    And again (f. 141d):
+
+    "_In uvea sunt largitas et constrictio et aqua sive
+    cataracta.... Aqua quandoque per medium pupille descendit,
+    inferius stans, subuvea apparens, quae perfecte curatur
+    secundum quosdam immisso acus aculeo per pupillam, ut extra
+    fluat aqua._"
+
+Chapters on the physiology of hearing, smelling and the sensation of
+touch are followed by a discussion of the symptoms and treatment of
+earache, abscess of the ear, discharges (bloody and sanious) from
+the ear, worms and other foreign bodies in the ear, tinnitus aurium,
+deafness, coryza, epistaxis, nasal polypi, ozaena, cancer of the nose,
+fissures and ulcers of the lips, foul breath, diseases of the tongue,
+toothache, etc.
+
+Physiognomy, a favorite theme with our author, appears again in a
+considerable chapter on the physiognomy of the nose, mouth, face and
+the teeth.
+
+"He who laughs frequently is kind and genial in all things and is not
+worried over trifles."
+
+"He who laughs rarely is contrary and critical."
+
+"He who has large ears is stolid and long-lived."
+
+"He who has a large mouth is gluttonous and daring."
+
+"He whose teeth are defective and small is weak in his whole body."
+
+"He whose canine teeth are long and straight is a glutton and a
+rascal."
+
+The department of genito-urinary diseases is introduced by a long
+chapter entitled "_De approximeron_," a formidable Latin word defined
+by Gilbert as sexual impotence. An elaborate discussion of the
+physiology of generation and the phenomena of impotence is followed by
+a collection of remedies for the condition, of which the best that can
+be said is that they are probably no less effective than most of the
+modern drugs recommended for the same purpose. Concerning a function
+over which so many fond superstitions still linger in the public mind
+we may, perhaps, charitably forgive Gilbert for the introduction
+of an empirical remedy for sterility, which, he assures us, he has
+often tried and with invariable success, and which enjoys the double
+advantage of applicability to either sex.
+
+"Let a man, twenty years of age or more, before the third hour of
+the vigil of St. John the Baptist, pull up by the roots a specimen of
+consolida major (comfrey) and another of consolida minor (healall),
+repeating thrice the Lord's prayer (_oratio dominica_). Let him speak
+to no one while either going or returning, say nothing whatever, but
+in deep silence let him extract the juice from the herbs and with this
+juice write on as many cards as may be required the following charm:
+
+"_Dixit dominus crescite._ [symbol: dagger]. _Uthihoth._ [symbol:
+dagger]. _multiplicamini._ [symbol: dagger]. _thahechay._ [symbol:
+dagger]. _et replete terram._ [symbol: dagger]. _amath._
+
+"If a man wears about his neck a card inscribed with these identical
+words written in this juice, he will beget a male. Conversely, if a
+woman, she will conceive a female" (f. 287b).
+
+Gilbert, however, cautions the bearer of this potent charm of the
+possible dangers of satyriasis incurred thereby, and offers suitable
+remedies for so alarming a condition.
+
+Chapters on satyriasis, gomorrhea (gonorrhea in its etymological
+sense, seminal emissions), with a third entitled "_De pustulis et_
+*_apostematibus virgae_" complete this department of medical art. The
+last chapter recognizes the venereal origin of the pustules and ulcers
+discussed, but furnishes no direct evidence of Gilbert's belief in the
+existence of a specific venereal poison.
+
+While Gilbert is very scrupulous in his examination of the gross
+appearances of the urine in most diseases, his discussion of the
+diseases of the kidneys and bladder includes only pain in the kidneys,
+abscess of the kidneys, renal and vesical calculus, hematuria,
+incontinence of urine, dysuria and strangury.
+
+The chapter on hematuria presents a very curious specimen of medieval
+pathology. Gilbert says: "The escape of blood in the urine is due
+sometimes to the liver, sometimes to the bile,[7] sometimes to the
+kidneys and loins, sometimes to the bladder. If the blood is pure
+and clear, in large quantity, mixed perfectly with the urine and
+accompanied by pain in the right hypochondrium, it comes from the
+liver. Such urine presents scarcely any sediment. If the blood comes
+from the lrili vein, it is also rather pure, but less pure than in the
+former case, nor is the quantity so great, while pain is felt over the
+region of the seventh vertebra, counting from below. If it comes from
+the kidneys, it is scanty and pure as it leaves the bladder, but soon
+coagulates and forms a dark deposit in the vessel, while pain is
+felt in the pubes and peritoneum.... If pus, blood and epithelium
+(_squamae_) are passed, and the odor is strong, it signifies
+ulceration of the bladder" (f. 275b).
+
+[Footnote 7: In his chapter on embryology (f. 304c) Gilbert describes
+the lrili vein as follows: "The embryo is nourished by means of the
+lrili or lrineli vein, which does not exist in man. This vein has
+its origin in the liver and divides into two branches. Of these the
+superior branch bifurcates, and one of its branches goes to the right
+breast, the other to the left, conveying blood from the liver. This
+blood in the breast is bleached white (_dealbatur_) like milk, and
+forms the nourishment of the infant. The inferior branch of the lrili
+vein also bifurcates, sending one of its branches to the right cornu
+of the uterus, the other to the left. These vessels carry blood into
+the cotyledons, whence it is transmitted to the fetus and digested by
+its digestive faculty."]
+
+Diabetes is defined as "An immoderate passage or attraction of urine
+from the liver to the kidneys and its passage through the kidneys, as
+the result of a warm or dry distemperature of these organs." The idea
+of some association of the liver and kidneys in the production of
+diabetes is at least as old as the eleventh century, and Gilbert's
+definition of the disease is undoubtedly borrowed from the "Practica"
+of John Platearius (A.D. 1075), of the school of Salernum. The
+symptoms, continual thirst, dryness of the mouth, emaciation, in
+spite of an inordinate appetite, frequent and profuse urination, are
+correctly given, but no knowledge of the presence of sugar in the
+urine is indicated.
+
+Dyampnes (involuntary micturition) claims a page or more of
+explanation and treatment, and its frequent occurrence in old men and
+children is noticed.
+
+In the department of the diseases of women chapters are devoted to
+amenorrhea, menorrhagia, hysteria (_suffocatio matricis_), prolapse,
+ulceration, abscess, cancer, dropsy and "ventosity" of the uterus
+(physometra).
+
+In the allied department of obstetrics we find chapters on the signs
+of conception, on the urine in pregnant women, on difficult labor,
+prolapsus uteri, retention of the placenta, post partum hemorrhage,
+afterpains, and the oedema of pregnancy. The causes of difficult
+labor, according to Gilbert, are malposition, dropsy, immoderate size
+and death of the fetus, debility of the uterus and obstruction of the
+maternal passages. Malpositions are to be corrected by the hand of
+the midwife (_obstetrix_). Adjuvant measures are hot baths, poultices,
+inunctions, fumigations and sternutatories, and the use of certain
+herbs.
+
+In the departments of general medicine not as yet entirely
+appropriated by specialists it will suffice to mention scrofula,
+pleurisy and pneumonia, hemoptysis, empyema, phthisis, cardiac
+affections, diseases of the stomach, liver and spleen, diarrhoea and
+dysentery, intestinal worms, dropsy, jaundice, cancer, rheumatism and
+gout, small-pox, measles, leprosy and hydrophobia, all of which claim
+more or less attention.
+
+Peripneumonia and pleurisy are both inflammations of the chest, the
+former affecting the lungs, the latter the diaphragm and the pellicle
+which lines the ribs. The prominent symptoms of both diseases are
+pain in the chest or side, cough and fever and dyspnoea. Accidents or
+sequelae are hemoptysis, empyema and phthisis.
+
+Empima (empyema) is the hawking-up of sanies, with infection of the
+lung and a sanious habit. Hence persons laboring under pneumonia
+or pleurisy are not necessarily empyemics, but when these diseases
+progress to such a point that blood and sanies are expectorated and
+the lung is infected, that is when the ulceration of the lungs fails
+to heal and corruption and infection occur, the disease becomes
+empima, and is with difficulty, or never cured.
+
+Ptisis is a substantial consumption of the humidity of the body, due
+to ulceration of the lungs. For when a solution of continuity occurs
+in the lungs, the inspiratory and expiratory forces fail. Hence the
+lungs do not inspire sufficient air to mitigate the innate heat of the
+heart, and the heart fails to purify itself of the fumosity or fumous
+vapors generated in itself. Accordingly, deprived of the means of
+mitigating its heat or ventilating its fumosities, the spirits within
+it become unduly heated, and a consuming fire is generated in the
+entire body.
+
+The symptoms of ptisis are a continued fever, greater or less,
+detected in the palms of the hands and the soles of the feet, thirst,
+a roughness of the tongue, slenderness of the neck, wasting of the
+entire body, constipation, wasting and shrinking of the finger-nails
+and fingers, hollowness of the eyes, pain in the left scapula
+extending to the shoulder, pharyngeal catarrh with abundant and
+mucilaginous sputum and a tendency to lachrymation. If the sputum
+thrown upon the coals emits a fetid odor, it is a sign of confirmed
+ptisis, which is incurable. The disease when it occurs in youths and
+young persons rarely lasts longer than a year, often terminates in
+less time, and may sometimes, by the aid of medicine, be prolonged for
+a greater period. If the sputum received during the night in a vessel
+is flushed in the morning with warm water, while some impurities
+remain upon the surface, the putrid matter will sink to the bottom
+(_sputum fundum petens_), and the indications are fatal. Likewise
+sharpness of the nose, hollow eyes, slender nails, falling hair,
+flattened temples and diarrhoea are of evil omen. These patients
+converse while dying, and die conversing (_moriendo loquentur, sed
+loquendo moriuntur_). Gilbert, of course, supplies a formidable array
+of remedies for the disease, but tells us that the "very latest" is
+cauterization over the clavicles (_Novissimum autem consilium est
+cauterium in furcula pectoris_).
+
+The varieties of difficulty of breathing are classified under the
+titles of asma, dispnea, orthomia, hanelitus and sansugium. The
+last title is given to a condition in which, as Gilbert says, "A
+superfluous humor is abundant in the superficies of the lung, which
+compresses that organ and renders it unable to dilate in inspiration.
+Hence it labors in inspiration like a leech, from which the dyspnea
+derives its name."
+
+Under the single title of "_cardiaca passio_" are included all
+possible diseases of the heart. The symptoms of this disease are
+said to be "palpitation, twitching of the limbs (_saltus membrorum_),
+perspiration, weakness of the nerves, facial pallor, weakness of the
+body as in hectic fever or phthisis, excessive pain and faintness over
+the precordia, a disposition to sleep and often constipation." The
+treatment is, of course, entirely symptomatic.
+
+Diseases of the digestive apparatus are discussed under the headings
+of difficulties of deglutition, canine appetite, bolismus (boulimia),
+disturbances of thirst, eructations, hiccup, nausea and anorexia,
+vomiting, anathimiasis (gastric debility), anatropha and catatropha
+(varieties of obstinate vomiting), pain in the stomach, abscess of the
+stomach, salivation, colic, dysentery and diarrhoea, intestinal worms,
+hemorrhoids, rectal tenesmus, prolapsus ani, fistula in ano, diseases
+of the liver, dropsy, jaundice and diseases of the spleen.
+
+Abscess of the stomach sometimes manifests a circumscribed tumor,
+and accordingly, probably includes cancer of that organ. Approved
+remedies are the Al'mirabile, the stomatichon frigidum, calidum or
+laxativumvum, etc., stereotyped formulae, of which the composition is
+carefully recorded.
+
+Dysentery is a flux of the bowels with a sanguinolent discharge and
+excoriation of the intestines. A variety called hepatic dysentery,
+however, lacks the intestinal excoriation. Diarrhoea is a simple
+flux of the bowels, without either the sanguinolent discharges or
+the intestinal excoriation. Lientery is a flux of the bowels with the
+discharge of undigested food, occasioned by irritability (_levitas_)
+of the stomach or intestines. Colical passion and iliac passion
+derive their names from the supposed origin of the pain in the colon
+or ileum, a remark which furnishes occasion for the statement that
+Gilbert divides the bowels into six sections, viz., the duodenum
+jejunum and ileum, and the orobus, colon and longaon (rectum).
+
+Intestinal worms are not generated in the stomach, as Gilbert says,
+because of the great heat produced by the process of digestion. In the
+intestines they originate chiefly from the varieties of phlegm, e.g.,
+saline, sweet, acid, natural, etc. The species mentioned specifically
+are lumbrici and ascarides or cucubitini, though the terms long,
+round, short and broad are also employed, and probably include the
+tape worm or taenia lata. The treatment of these parasites consists
+generally in the use of aromatic, bitter or acid mixtures, among which
+gentian, serpentaria, tithymal and cucumis agrestis are especially
+commended for lumbrici, and enemata of wormwood, lupinus, scammony,
+salt, aloes, etc., for ascarides.
+
+The diseases of the liver, though not numerous, are allotted
+considerable space most of which is occupied by scholastic
+speculations and the usual rich supply of therapeutical suggestions.
+
+Discrasia of the liver has several varieties, warm, cold, moist and
+dry, and seems nearly equivalent to our somewhat overworked term of
+"biliousness." Gilbert's favorite compounds for the relief of this
+condition are the Trifera sarracenica, the Electuarium psilliticum and
+above all the Dyantos Besonis.
+
+Obstruction (_oppilatio_) of the liver or enfraxis is defined as a
+disease of the canals (_pori_), of which four are enumerated, to-wit,
+the meseraic, that of the convexity of the organ (_gibbus--ubi sunt
+exitus capillarium venarum_), the duct leading to the gall-bladder
+and that leading to the spleen. With an abundance of symptoms, it is
+singular that this comprehensive disease does not seem characterized
+by any constant or severe pain, as we might reasonably expect.
+
+Abscess of the liver depends upon some vice of the blood, the bile,
+the phlegm or the black-bile. The general treatment is poultices and
+other maturatives, but, as the author adds rather sadly at the close,
+_ultima cura est per incisionem_.
+
+Dropsy is discussed as an independent disease through the exhaustive
+speculations of thirty-two pages. Gilbert tells us it depends upon
+some fault of the digestive faculty of the liver, and he divides
+it into four species, to-wit, leucoflantia, yposarcha, alchitis and
+tympanitis, each of which has its special and appropriate treatment.
+In the dreary waste of speculative discussion it is cheering, however,
+to observe Gilbert's positive recognition of the sphere of percussion
+indicated in the passage:
+
+"_Et venter percussus sonat ad modum utris semipleni aqua et venta._"
+(f. 250b.)
+
+Ycteritia or jaundice receives equally thorough discussion through
+eight weary pages, including the usual polypharmacal treatment.
+
+The spleen, Gilbert says, is sometimes the name of an organ, sometimes
+of a disease. As an organ it is spongy and loose in texture, and
+attracts and retains the superfluities of the black-bile, expelled
+from the liver for its own cleansing. Hence it is a servile and
+insensitive organ, and accordingly suffers different diseases, such
+as obstruction, tumors, hardening, softening, abscess, and sometimes
+flatulence or repletion. The symptoms and treatment of each of these
+morbid conditions, arising from either heat or cold, are discussed
+with exasperating thoroughness, and the chapter concludes with
+the composition and use of various specific remedies of compound
+character, bearing the impressive titles of Dyasene, Dyacapparis,
+Dyaceraseos (a mixture of cherry juice, honey, cinnamon, mastic and
+scammony) and Agrippa.
+
+Scrofulous swellings are carefully considered in a chapter entitled
+"_De scrophulis et glandulis._" "Scrophulae and glandulae are hard
+swellings developing in the soft parts, as in the emunctory localities
+of the veins and arteries, particularly in the neck, armpits
+and groins, and sometimes in other places. They spring from the
+superfluities of the principal organs, which nature expels, as it
+were, to the emunctories and localities designed to receive this
+flux." ... "Hence they are often found the cause of scabies, tinea,
+malum mortuum, cancer, fistula, etc., and are called glandes.
+Sometimes, however, a dryer matter is finely divided and falls into
+several minute portions, from which arise many hard and globular
+swellings, called scrofulae from the multiplicity of their progeny,
+like that of the sow (_scrofa_). The disease is also called _morbus
+regius_, because it is cured by kings."
+
+Gilbert advises that these swellings should not be "driven in"
+(_repercutienda_), but brought to suppuration generally by emollients
+and poultices. When softened they may be opened with a lancet and the
+pus allowed to escape gradually, but as this process is tedious, he
+prefers the entire removal of the glands with the knife, premissing,
+however, that no gland should be cut into which cannot be well grasped
+by the hand and pulled from its seat. This surgical manipulation is
+fully described, and is undoubtedly taken from the similar chapter
+of Roger. It is worthy of notice also that just at the close of this
+chapter, Gilbert mentions a swelling called "testudo," a gland-like,
+gaseous (_ventosa_) tumor, usually solitary and found in "nervous"
+localities, like the joints of the wrist and hand. He says it often
+occurs from fracture (_cassatura_?) of the nerves, is cured by
+pressure, friction or incision, but is not entirely free from danger.
+Possibly this may refer to ganglion. Now, Roger makes no mention
+whatever of "testudo," while Roland says:
+
+"_Nota quod quamvis Rogerius non designat inter glandulum et
+testudinem, scias igitur quod testudo fit ex majori parte flegmatica,
+minori melancholie, glandula vero a contrario_," a statement which
+might readily suggest the suspicion that Gilbert had before his
+eyes the text of Roland, or that, at least, he had not acquired his
+knowledge of testudo from Roger, his usual surgical authority.
+
+Gilbert's sections on goitre (_bocium gulae_)[8] are interesting in
+themselves, and characteristic of the method adopted by him in his
+discussion of surgical or semi-surgical subjects. An introduction
+relative to the pathology of the disease and which seems to be
+original, is followed by a treatment, medical and surgical, adopted
+almost literally from the Chirurgia of Roger. Thus he says: "Goiter
+occurs most commonly among the inhabitants of mountainous regions,
+and is due to an amplification and dilatation of the veins, arteries
+and nerves, together with the soft tissues, occasioned by the north
+wind (_ventum boreale_), or some other confined wind, which during
+childhood has accumulated in (_coadunabatur_) and enlarged the part
+to the size of the goiter." After suggesting an analogy between the
+disease and the redness and turgidity of the neck produced by passion
+or in singing, he adds that some cases are due to an accumulation
+of spongy tissue between the veins and arteries, or to the use of
+flatulent food, and he even tells us that some old women know how to
+produce and remove goitrous swellings by means of certain suitable
+herbs known to them.
+
+[Footnote 8: Cf. the French _bosse de la gorge_.]
+
+Under medical treatment we find the following: "Dig out of the ground
+while chanting a pater noster, a nut which has never borne fruit. The
+roots and other parts pound well with two hundred grains of pepper,
+and boil down in the best wine until reduced in volume to one-half.
+Let the patient take this freely on an empty stomach until cured."
+
+Another more elaborate prescription consists of a long list of
+ingredients, including burnt sponge, saponaria, the milk of a sow
+raising her first litter, with numerous simple herbs, and the sole
+object for which this nonsensical farrago is introduced here is to add
+that both these prescriptions are copied from the surgery of Roger. It
+is important too to remark here that we owe to Roger the introduction
+of iodine, under the form of burnt sponge, into the treatment of
+goiter.
+
+In the failure of medical treatment, Gilbert directs the employment
+of surgical means, e.g., the use of setons, or, in suitable cases,
+extirpation of the goiter with the knife. If, however, the tumor is
+very vascular, he prefers to leave the case to nature rather than
+expose the patient to the dangers of a bloody operation. The whole
+discussion of goiter is manifestly a paraphrase of the similar chapter
+of Roger, who also introduced into surgical practice the use of the
+seton.
+
+In Gilbert's chapter entitled "_De arthretica passione et ejus
+speciebus_," we are introduced to the earliest discussion by an
+English physician of that preeminently English disease--gout. We may
+infer, too, from the length of the discussion (thirty or more pages)
+that this was a disease with which Gilbert was not only familiar, but
+upon the knowledge of which he prided himself greatly. Indeed, it is
+one of the few diseases of the Compendium in which the author assumes
+the position of a clinician and introduces examples of the disease
+and its treatment taken from his own clientele. We shall, therefore,
+follow our author here rather more carefully and literally than usual,
+that we may learn the views of an English physician of the thirteenth
+century on, perhaps, the most characteristic disease of his
+countrymen.
+
+Gilbert says: "Arthetica is a disease of the joints arising from a
+flux of humors descending into their continuity (_concathenationem_).
+The name is derived from the Latin _artus_, a joint, and the disease
+comprehends three species, viz., _sciatica_, disease of the scia,
+or the ligaments uniting the spine with the hip; _cyragra_, disease
+of the joints of the hands; and _podagra_, disease of the bones
+and joints of the foot, due to the descent of humors into their
+continuity. Sometimes, too, the disease affects other organs,
+occasioning pain in sensitive members, as, e.g., the head, and then
+derives its name from the part affected, as _cephalea_, _emigranea_ or
+_monopagia_. Occasionally likewise some humor runs down (_reumatizat_)
+into the chest, spreading over the nerves of the breast or those of
+the spine between the vertebrae, and sometimes to other places.
+Hence the disease derives the general name gout (_gutta_), from its
+resemblance to a drop (_gutta_) trickling or falling downward and
+flowing over the weaker organs, which receive the humor. For gout
+arises particularly from rheumatic causes. Now, as the humors are
+rather uncontrollable (_male terminabiles_) fluids, they flow towards
+the exterior and softer parts, like the flesh and skin, which receive
+their moisture and being soft, dilatable and extensible, there results
+some swelling. But if the humors are hard and dry, they are confined
+within the interior of the organs, such as bones, nerves and
+membranes: and these, being hard in themselves, do not receive the
+moisture, nor suffer extension or dilatation, and thus no swelling
+results. Since, therefore, the material of this variety of arthetica,
+in which no swelling is present, is formed of grosser and harder
+substance and is found in the vicinity of hard and cold localities, it
+is dissolved slowly and the disease is not cured until this solution
+takes place. That form of the disease, however, in which there is
+swelling from a subtile and liquid material deposited in the soft
+parts is the more quickly cured. Hence swelling is the best sign
+of curability. This is most evidently true in podagra, unless the
+_materies morbi_, by reason of its scarcity, produces no enlargement
+of the affected part."
+
+Quoting the words of Rhazes, Gilbert tells us that the _materies
+morbi_ of gout is, for the most part, crude and bloody phlegm. Rarely
+is it bilious, and still more rarely, melancholic. If, however, it is
+compounded, it consists chiefly of bile mixed with a subtile phlegm,
+and more rarely, of phlegm mixed with black bile (_melancholia_),
+occasionally of black bile mixed with blood. The mixture of black bile
+and blood or bile is very rare, and still rarer a mixture of all the
+humors according to their proportion in the body.
+
+If the color of the affected part is red, it indicates that the
+_materies morbi_ is sanguineous; if greenish-yellow (_citrinus_), that
+it is bilious; if whiter than the general color of the body, that the
+materies is a subtile phlegm. If the color shades away into black, it
+does not signify necessarily that the materies is simply black bile,
+for such a color occurs at the close of acute abscesses, or from
+strangulation of the blood. But if, together with the black color, we
+find the tissues cold and no increase of heat in the affected part,
+this indicates that the _materies_ is black bile.
+
+By touching the diseased part we determine its heat or coldness,
+hardness or softness, roughness or smoothness, fullness, distention or
+evacuation, all of which signs possess special significance.
+
+The antecedent causes of gout, Gilbert tells us, are a heat too
+solvent, cold too constringent (f. 311 c), sometimes a strong bath
+or a severe journey in a plethoric person (_in plectorico_), again
+excessive coitus after a full meal (_satietatem_), or even habitual
+excess, by which the joints are weakened and deprived of their natural
+heat and subtile moisture. Hence boys and eunuchs are not commonly
+affected by gout--at least boys under the age of puberty. Women, too,
+do not usually suffer from this disease, because in coitus they are
+passive, unless their menstrual discharge is suspended. Again gout
+sometimes arises from infection of the primary semen; for a chronic
+disease may be inherited by the offspring and affect the material
+causes, i.e., the humors. Flatulence (_ventositas_) is likewise a
+cause of gout, as we have already hinted.
+
+In gout of the sanguineous type the favorite remedy of Gilbert was
+venesection, pushed to extremes which suggest the bloody theories of
+his later confrere Bouillaud. This bloodletting, however, was always
+to be practiced on the side opposite to that affected by the disease,
+as he tells us, for two reasons: First to solicit the peccant material
+to the opposite side; and, second, to retard its course toward the
+seat of the swelling. If, therefore, the disease is in the right foot,
+he bleeds from the basilic vein, or some of its branches, in the right
+hand. No other vein should be taken, but if neither the basilic vein
+nor one of its branches can be found, the bleeding may be performed
+upon the median vein, for certain branches of the basilic and cephalic
+veins unite to form the median. If the disease is in the hand, the
+material may be diverted in two ways, either to the other hand or to
+the opposite foot. Indeed, blood may be taken from both these parts
+in succession. The quantity of blood withdrawn should be in accordance
+with the strength of the patient, the character of the swelling, the
+pulsation, distention, heat and redness of the affected part. But it
+should be repeated frequently, and this bloodletting then frequently
+suffices, in itself, to cure the disease.
+
+Gilbert continues: "I will tell you also what I myself saw in a woman
+suffering and screaming with pain in her right wrist (_assuere_?),
+which was greatly swollen, hot, red and much distended. She was fat,
+full-blooded, and before the attack had lived freely on milk and
+flesh. Accordingly she was robust, and I bled her from the basilic
+vein of the left hand and the saphena of the right foot, both within
+an hour. Each hour I withdrew a half-pound of blood, then I fed her
+and for three hours I drew half a pound of blood from the saphena. In
+the last hour the pain and throbbing (_percussio_) ceased entirely,
+and the woman begged me to bleed her again from the hand, for she had
+experienced great relief. I wished, however, to divert the material
+to the lower extremities for two reasons, one of which I ought not to
+mention in this place, while the other is useful, and indeed necessary
+in such cases. You should know that this woman was suffering pain in
+her left hand also, though this pain was of a less severe character
+than in the right. For this reason I desired to divert the peccant
+matter downward, a point which the physician should consider and
+observe. Once, while treating a man suffering from sanguineous gout,
+the pain of which involved the joints between the assuerus and the
+racheta (?) of the right hand, I asked him whether any pain was felt
+in the other hand or in the feet. He replied that similar pain was
+felt in the left hand or its joints, and that hitherto it had been
+more severe, but that no pain had ever been experienced in the feet.
+Hence I was unwilling to bleed him at all from the left hand, but I
+bled him from the right foot. A physician who had treated him before,
+and had bled him from the right hand for acute swelling of the joints
+of the left, quieted, indeed, the pain in the left hand, but diverted
+the disease to the right, where a swelling developed larger than in
+the left. And when I asked him about this, he understood that I knew
+more about medicine than the other doctor did. And this is one of
+the reasons why one ought to divert the material to another part,
+especially when the pain is so located that it may be increased at
+the beginning. For under such conditions we ought to refrain from
+bleeding, frictions and other treatment which may attract the
+_materies morbi_ to the part. Indeed we ought to require derivation of
+the materies to another part whenever the affected locality contains
+one of the nobler organs, towards which the material is directing, or
+may direct its course. For instance: A person is suffering pain in
+the joints of the right hand, but has also an acute swelling in the
+bladder, the kidneys or the womb. Now, I say that in such a case we
+ought not to bleed from the hand, because if we do we shall injure the
+organ affected by the swelling. Perhaps, however, we may bleed from
+the right foot, provided we understand that there is on the right side
+a sanguineous tumor, the danger of which is greater than that of the
+swelling on the right hand. Again, suppose in the liver or in the
+right kidney an acute tumor, and in the joints of the right hand there
+is present a moderate pain. I say that we ought first to medicate the
+more dangerous lesion, and, possibly, two results may be obtained by
+the attraction of the peccant material. Or suppose a woman has gout in
+her hand, and with this a suppression of the menstrual flow. I say she
+ought to be bled from the foot and not from the hand for two objects,
+to solicit the material from the diseased hand, and to provoke a
+return of the menstrual discharge.
+
+"But to return to our original patient. I may say that after the third
+venesection, with an interval of two hours, I withdrew a half-pound
+of blood from the saphena vein, and that night she slept, although
+she had not slept for many nights. And I did nothing more, except to
+prescribe a light and cool diet. The third day after the bleeding she
+was entirely free from any trouble in her hand. Hence I say that we
+ought in such cases to begin our treatment by venesection."
+
+After this sanguinary introduction, Gilbert soothes the diseased part
+with cooling and astringent ointments, unless these occasion pain,
+in which event he omits them entirely and trusts the case to nature,
+"_quoniam natura per se curabit_."
+
+The vigorous plan of treatment thus outlined Gilbert seems to regard
+as original and peculiar to himself, for the next chapter bears the
+title, "The treatment of gout according to the authorities (_secundum
+magistros_)." Here he says he quotes the opinions of the modern
+teachers and writers, who lay down definite rules for the guidance of
+the physicians.
+
+Among these he mentions, as primary and of general application, the
+rule that, before all things, the body must be purified, either
+by venesection in cases where the material is sanguineous, or by
+purgation in other varieties of the disease. If the cause is rheumatic
+in its nature, fomentations should never be employed, for fear of
+increasing the flux. That the peccant material is to be eliminated
+gradually by mild remedies, just as it accumulated by degrees. In all
+cases of gout, and in all chronic diseases generally, much attention
+must be devoted to the stomach, since if this organ rejects the
+medicine, the latter must be at once abandoned, lest the stomach
+becomes weakened and even other organs, and thus the humors flow more
+readily (_magis reumatizarent_) to the joints, etc.
+
+These general medical rules are succeeded by some twenty pages devoted
+largely to special formulae for the different forms of gout, with
+remarks as to their applicability to the different varieties of the
+disease. Most of the formulae bear special titles, apparently to lend
+the weight of a famous name to the virtues of the prescription itself,
+something as in these modern days we speak of "Coxe's Hive Syrup,"
+"Dover's Powder," "Tully's Powder," etc. Thus we read of the "_Pilulae
+artheticae Salernitorum_," the "_Cathapcie Alexandrine_," the "_Oxymel
+Juliani_" the "_Pilulae Arabice_," the "_Pulvis Petrocelli_,"
+the "_Oleum benedictum_," the "_Pilulae Johannicii_," etc. It is
+important, too, to remark that the active ingredient of very many
+of these formulae is the root called hermodactyl, believed by the
+majority of our botanists to be the _colchicum autumnale_.
+
+Gilbert's discussion of gout closes with a short and characteristic
+chapter entitled "_Emperica_," in which he remarks: "Although I
+perhaps demean myself somewhat in making any reference to empirical
+remedies, yet it is well to write them in a new book, that the work
+may not be lacking in what the ancients (_antiqui_) have said on the
+subject. Accordingly I quote the words of Torror. If you cut off the
+foot of a green frog and bind it upon the foot of a gouty patient for
+three days, he will be cured, provided you place the right foot of
+the frog upon the right foot of the patient, and vice versa. Funcius,
+also, who wrote a book on stones, said that if a magnet was bound upon
+the foot of a gouty patient, he is cured. Another philosopher also
+declared that if you take the heel-bone of an ass and bind it upon
+the foot of the patient, he is cured, provided that you take the right
+bone for the right foot, and conversely, and he swore this was true.
+Torror also said that if the right foot of a turtle is placed upon the
+right foot of a patient suffering from the gout, and conversely, he
+will be cured."
+
+Gilbert's discussion of leprosy (_De lepra_, f. 336 d) covers twenty
+pages and, according to Sprengel, is "almost the first correct
+description of this disease in the Christian West." Freind says this
+chapter is copied chiefly _from_ Theodorius of Cervia. See page 3
+ante. If, however, I am correct in my conjecture that the Compendium
+was written about the year 1240, the copying must have been done _by_
+Theodorius, whose "Chirurgia" did not appear until 1266.
+
+Leprosy is defined as a malignant disease due to the dispersion of
+black bile throughout the whole body, corrupting both the constitution
+(_complexionem_) and the form of its members. Sometimes, too, it
+occasions a solution of continuity and the loss of members.
+
+The disease is sometimes congenital, arising from conception during
+the menstrual period. For the corrupt blood within the maternal
+body, which forms the nourishment of the fetus, leads likewise to the
+corruption of the latter. Sometimes the disease is the result of a
+corrupt diet, or of foul air, or of the breath or aspect of another
+leper. Avicenna tells us that eating fish and milk at the same meal
+will occasion the same result. Infected pork and similar articles of
+diet may likewise produce the disease. Cohabitation with a woman who
+has previously had commerce with a leper may also produce infection.
+
+Among the general symptoms of leprosy Gilbert enumerates a permanent
+loss of sensation proceeding from within (_insensibilitas mansive ad
+intrinseco veniens_) and affecting particularly the fingers and toes,
+more especially the first and the little finger, and extending to
+the forearm, the arm or the knees; coldness and formication in the
+affected parts; transparency (_luciditas_) of the skin, with the
+loss of its natural folds (_crispitudines_), and a look as if tightly
+stretched or polished; distortion of the joints of the hands and feet,
+the mouth or the nose, and a kind of tickling sensation as if some
+living thing were fluttering within the body, the thorax, the arms
+or the lips. There is felt also a sensation of motion, which is even
+visible also by inspection. Fetor of the breath, the perspiration and
+the skin are likewise noticeable. The localities affected lose their
+natural hair and are re-covered with very fine hairs, invisible except
+when held between the eye and the sun. The hair of the eyebrows
+and the eyelashes are lost--one of the worst of symptoms. There are
+present also hoarseness and an obstruction of the nostrils, without
+any visible cause. When the patient takes a bath the water runs off
+the affected localities as if they had been greased--another sign of
+evil omen. The angles of the eyes are rounded and shining. The skin,
+even when unaffected by cold, or other similar cause, is raised into
+very minute pimples, like the skin of a plucked goose. The blood in
+venesection has an oily appearance, and displays small particles like
+sand. Small tumors accompany the depilation of the eyebrows. Lepers
+are unusually and unduly devoted to sexual pleasures, and suffer
+unusual depression after sexual indulgence. The skin is tormented
+with a constant itching, and is alternately unduly hot or cold. Small
+grains are found under the tongue, as in leprous hogs.
+
+Gilbert divides leprosy into four varieties, _elephantia_, _leonina_,
+_tyria_ and _allopicia_, the pathology, symptoms and treatment of each
+of which are presented with wearisome minuteness and completeness.
+A long chapter, entitled "_De infectione post coitum leprosi_,"
+discusses the transmission of the disease by means of sexual
+intercourse, and suggests the possible confusion of lepra and
+syphilis.
+
+The usual catalogue of specific remedies terminates the discussion.
+
+An interesting chapter on small-pox[9] and measles, "_De variolis et
+morbillis_," gives us the prevailing ideas relative to these diseases
+in England during the thirteenth century. Premising his remarks with a
+classification of diseases as follows:
+
+Diseases universal and infectious--like _morphoea_, _serpigo_,
+_lepra_, _variolae et morbilli_.
+
+Diseases universal but not infectious.
+
+Diseases infectious but not universal--like _noli me tangere_.
+
+Diseases neither infectious nor universal.
+
+Gilbert classifies _variolae et morbilli_ among the universal and
+infectious diseases, and in the species _apostemata_. To this latter
+species belong also _ignis Persicus_, _carbunculus_ and _antrax_.
+
+[Footnote 9: It is at least interesting to know that small-pox is said
+to have made its first appearance in England in 1241.]
+
+_Variolae et morbilli_ arise from moist matter confined in the body
+and turbid, like turbid blood. Hence the disease occurs most commonly
+in boys and in those who are careless about cleanliness and neglect
+venesection. It is the result of a disposition of the blood resembling
+putrescence, in which there occurs an external ebullition in the
+efforts of nature to purify the interior of the body and to expel
+to the surface the virulent material within. Accordingly the common
+people declare that persons who have suffered from _variolae et
+morbilli_ never acquire leprosy. Occasionally, too, the disease arises
+from excessive corruption of matter in repletion of blood, and hence
+it is more frequent in sanguineous diseases, like synocha, and during
+the prevalence of south winds or the shifting of winds to the south,
+and in infancy--the age characterized particularly by heat and
+moisture.
+
+The eruptions vary in color in accordance with the mixture of the
+different humors with the corrupt blood. Hence some are light colored,
+some the color of saffron, some red, some green, some livid, some
+black, and the virulence of the disease is the greater, the nearer
+the color approaches to black. There are, too, four varieties of the
+eruption, distinguished by special names. When the eruption is light
+colored and tends to suppuration, it is called _scora_. When it
+is very fine and red, it is called _morbilli_ or _veterana_. The
+distinction between _variolae_ and _morbilli_ is in the form and
+matter of the disease, for in _variolae_ the pustules are large and
+the matter bilious (_colerica_), while in morbilli the eruption is
+smaller and does not penetrate the skin (_non-pertransit cutem_).
+_Variolae_, on the contrary, forms a prominent pustule (_facit
+eminentiam_). A third form of the disease displays only four or five
+large, black pustules on the whole body, and this form is the most
+dangerous, since it is due to an unnatural black bile, or to acute
+fevers, in which the humors are consumed. This variety bears the name
+of _pustula_. A fourth form is called _lenticula_. This latter form
+occurs sometimes with fever, like synocha, sometimes without fever,
+and it arises from pestilential air or corrupt food, or from sitting
+near a patient suffering from the disease, the exhalations of which
+are infectious.
+
+The premonitory symptoms of _variolae_ are a high fever, redness of
+the eyes, pain in the throat and chest, cough, itching of the nose,
+sneezing and pricking sensations over the surface of the body.
+
+_Morbilli_ is a mild disease, but requires protection from cold, which
+confines and coagulates the peccant matter.
+
+Attention is directed to the not infrequent ulcers of the eyes, which
+occur in _variolae_ and may destroy the sight; also to ulcerations
+of the nose, throat, oesophagus, lungs and intestines, the latter of
+which often produce a dangerous diarrhoea.
+
+When _variolae_ occurs in boys, it is recommended to tie the hands of
+the patient to prevent scratching.
+
+Whey is said to be an excellent drink for developing the eruption of
+_variolae_, and the time-honored saffron (_crocus_) appears in several
+of Gilbert's prescriptions for this disease. Here, too, we find
+the earliest mention of the use of red colors in the treatment of
+_variolae_ (f. 348 c):
+
+"_Vetule provinciales dant purpuram combustam in potu, habet enim
+occultam naturam curandi variolas. Similiter pannus tinctus de
+grano._"
+
+Acid and saline articles of food should be avoided, sweets used
+freely, and the patients should be carefully guarded from cold.
+
+Not the least interesting pages of the Compendium are those (there are
+about twenty of them) devoted to the discussion of poisons, poisoned
+wounds and hydrophobia.
+
+An introductory chapter on the general subject of the character of
+poisonous matters, illustrated by some gruesome and Munchausen-like
+tales, borrowed mainly from Avicenna and Ruffus, on the wonders
+of acquired immunity to poisons, the horrors of the basilisk, the
+_armaria_ (_?_), the deaf adder (_aspis surda_) and the red-hot
+_regulus_ of Nubia, leads naturally to the consideration of some
+special poisons derived from the three kingdoms of nature. Very
+characteristically Gilbert displays his caution in the discussion of a
+dangerous subject by the following preface:
+
+_Abstineamus a venesis occultis quae non sunt manifesta, ne virus in
+angues adjiciamus, aut doctrinam perniciosam tradere videamur_ (f. 351
+a).
+
+Beginning then with metallic mercury (_argentum vivum_), he considers
+the poisonous effects of various salts of lead and copper, the
+vegetable poisons hellebore, anacardium (_anacardis?_), castoreum,
+opium and cassilago (_semina hyoscyami_), and then proceeds to
+the bites or rabid men and animals, hydrophobia, and the bites of
+scorpions, serpents and the _animalia annulosa_, that is, worms,
+wasps, bees, ants and spiders.
+
+Space does not permit a careful review of this interesting subject,
+but a novel form of poisoning by the use of quicksilver is startling
+enough to claim our attention. Gilbert tells us that pouring metallic
+mercury into the ear produces the most distressing symptoms, severe
+pain, delirium, convulsions, epilepsy, apoplexy and, if the metal
+penetrates to the brain, ultimate death. In the treatment of this
+condition certain physicians had recommended the insertion into the
+ear of a thin lamina of lead, upon which it was believed that the
+mercury would fasten itself and might thus be drawn out. Avicenna
+objected to this that the mercury was liable to speedily pass into the
+ear so deeply as to be beyond the reach of the lead. Gilbert suggests
+as an improvement of the treatment that a thin lamina of gold be
+substituted for the lead, "because mercury thirsts after gold as
+animals do after water, as it is held in the books on alchemy" (_in
+libris allzinimicis_). This fact, too, he tells us can be easily
+demonstrated externally by placing upon a plate a portion of gold,
+and near, but not in contact with it, a little quicksilver, when the
+silver, he says, will at once "leap" upon the gold. Avicenna suggests
+that the patient stand upon the foot of the side affected, lean his
+head over to the same side, steady it in that position with the hands,
+and then leap suddenly over upon the other foot--demonstrating thereby
+his knowledge of both gravity and inertia. Manifestly our "laboratory
+physicians" of the present day can assume no airs of priority!
+
+The Compendium closes with two very sensible chapters on the hygiene
+of travel, entitled "_De regimine iter agentium_" and "_De regimine
+transfretantium_."
+
+In the hygiene of travel by land Gilbert commends a preliminary
+catharsis, frequent bathing, the avoidance of repletion of all kinds,
+an abundance of sleep and careful protection from the extremes of
+both heat and cold. The strange waters may be corrected by a dash of
+vinegar. Some travelers, he tells us, carry with them a package of
+their native soil, a few grains of which are added to the foreign
+waters, as a matter of precaution, before drinking. The breakfast of
+the traveler should be light, and a short period of rest after a day's
+travel should precede the hearty evening meal. Leavened bread two or
+three days old should be preferred. Of meats, the flesh of goats or
+swine, particularly the feet and neighboring parts, which, Gilbert
+tells us, the French call _gambones_, the flesh of domestic fowls and
+of the game fowls whose habitat is in dry places, is to be preferred
+to that of ducks and geese. Of fish, only those provided with scales
+should be eaten, and all forms of milk should be avoided, except whey,
+"which purifies the body of superfluities." Fruits are to be eschewed,
+except acid pomegranates, whose juice cools the stomach and relieves
+thirst. Boiled meats, seasoned with herbs like sage, parsley, mint,
+saffron, etc., are better than roasted meats, and onion and garlic are
+to be avoided.
+
+The primitive conditions of land travel in the days of Gilbert are
+emphasized by his minute directions for the care of the feet, which he
+directs to be rubbed briskly with salt and vinegar and then anointed
+with an ointment of nettle-juice (_urtica_) and mutton-fat, or with
+a mixture of garlic, soap and oil. If badly swollen, they should be
+bathed, before inunction, with a decoction of elder-bark and other
+emollients.
+
+In travel by sea, Gilbert tells us the four chief indications are to
+prevent nausea, to allay vomiting, to palliate the foul odor of the
+ship and to quiet thirst.
+
+For the prevention of nausea he recommends the juice of acid
+pomegranates, lemons, etc., or a decoction of parsley or sweet cicely
+(_cerfolium_). The traveler should endeavor to sit with his head
+erect, should avoid looking around, but maintain his head as immovable
+as possible, and support himself by a firm grasp upon some beam of the
+ship. Some sweets may be sucked, or he may chew a few aromatic seeds.
+If vomiting ensues, acid or sweet pomegranates, figs or barley-sugar
+(_penides_) may be taken sparingly, but no food should be ingested
+until the stomach is thoroughly quieted. Then the patient may take a
+little _stomatichon_ or _dyantos_, and a small portion of digestible
+food. As the diet must necessarily consist largely of salty food and
+vegetables, these should be cooked in three or four different waters,
+and then soaked in fresh water. A little aromatic wine will also
+benefit the patient, and a few aromatic seeds chewed in the morning
+are also of service.
+
+The effect of the foul odors of the ship may be combatted by the use
+of aromatic electuaries, "which comfort the heart, the brain and the
+stomach." The patient should be removed to some quiet portion of the
+ship, as distant as possible from the channels for the discharge of
+the bilge-water, and short walks upon the upper deck will contribute
+to convalescence. Frequent changes of clothing will palliate the
+annoyance of fleas and pediculi. Drinking water may be purified by
+aëration, or by straining, boiling and subsequent sedimentation and
+removal of the sediment by filtration through fresh and clean sand.
+For the wealthy, the water may be distilled in an alembic, if such an
+apparatus is obtainable. Avicenna says that bad water may be corrected
+by the addition of vinegar. Exposure to the midday sun and to the
+nocturnal cold, constipation and diarrhoea should be avoided, and
+prompt attention should be given to all disorders of the health.
+
+To these wise counsels Gilbert courteously adds a medieval _bon
+voyage_ in these words:
+
+"_Dominus autem omnia dirigat in tranquilitate. Amen._"
+
+It has been already remarked upon a preceding page that Gilbert of
+England was not a surgeon. Nevertheless it is only fair to say that
+the surgical chapters of the Compendium present a more scientific and
+complete view of surgical art, as then known, than any contemporaneous
+writings of the Christian West, outside of Italy.
+
+It is well known that during the Middle Ages the practice of surgery
+in western Europe was generally regarded as disreputable, and
+operative surgery was for the most part relegated to butchers,
+barbers, bath-keepers, executioners, itinerant herniotomists and
+oculists, _et id omne genus_, whose pernicious activity continued to
+make life precarious far down into the modern period.
+
+In Italy alone did surgery vindicate for itself an equality with
+medicine, and the pioneer of this advance was Roger of Parma, who, as
+we have seen, flourished early in the thirteenth century. Roger and
+his pupil Roland, with the somewhat mythical "Four Masters" (_Quatuor
+Magistri_), were the surgical representatives of the School of
+Salernum, while Hugo (Borgognoni) di Lucca and his more famous son
+Theodorius represented the rival school of Bologna. Equally famous
+Italian surgeons of this century were Bruno of Logoburgo (in Calabria)
+and Gulielmus of Saliceto (1275), the master of Lanfranchi (1296).
+Gilbert of England, as a pupil of Salernum, naturally followed the
+surgical teachings of that school, and we have already noticed that
+his chapters on surgery are taken chiefly from the writings of Roger
+of Parma, though the name of neither Roger, nor indeed of any other
+distinctly surgical writer, is mentioned in the Compendium. How
+closely in some cases Gilbert followed his masters may best be seen
+by a comparison of their respective chapters upon the same subject.
+I accordingly introduce here for such comparison Roger's chapter on
+wounds of the neck, and the corresponding chapter of Gilbert. Roger
+says:
+
+"_De vulnere quod fit in cervice._
+
+"_Si vero cum ense vel alio simili in cervice vulnus fiat, ita quod
+vena organica incidatur, sic est subveniendum. Vena tota sumatur
+(suatur) cum acu, ita quod vena non perforetur, et ex alia parte
+acus cum filo ei inhaerente ducatur, et cum ipso filo nectatur atque
+stringatur, quod sanguinem non emittat: et ita facias ex superiori
+parte et inferiori. In vulnere autem pannus infusus mittatur, non
+tamen de ipso vulnus multum impleatur. Embrocha, si fuerit in myeme,
+superponatur quosque (quousque) vulnus faciat saniem. Si vero fuerit
+in aestate vitellus avi semper superponatur. Quum autem saniem
+fecerit, cum panno sicco, unguento fusco et caeteris bonam carnem
+generantibus, adhibeatur cura, ut in caeteris vulneribus. Quum vero
+extremitatem venae superioris partis putruisse cognoveris, fila
+praedicta dissolvas, et a loco illo removeas: et deinde procedas ut
+dictum est superius. A. Si vero nervus incidatur in longum aut ex
+obliquo, sed non ex toto, hac cura potest consolidari. Terrestres
+enim vermes, idest qui sub terra nascuntur, qui in longitudine
+et rotunditate lumbricis assimilantur, et apud quondam terrestres
+lumbrici dicuntur, accipiantur et aliquantulum conterantur et in oleo
+infusi ad ignem calefiant: et nullo alio mediante, ter vel quater, vel
+etiam pluries, si opportunum videbis, plagae impone. Si vero incidatur
+ex obliquo totus, minime consolidatur: praedicto tamen remedio non
+coadjuvante saepe conglutinatur. Potest etiam cuticula, quae supra
+nervum est, sui, pulvisque rubens, qui jam dictus est, superaspergi,
+quae cura non est inutilis, aliquos enim non solum conglutinatas,
+sed etiam consolidatas, nostra cura prospeximus. Si vero locus tumet,
+embrocham illam, quam in prima particula ad tumorem removendum, qui
+ex percussura contigit, praediximus, ponatur, quousque talis tumor
+recesserit._"
+
+Gilbert, after premising two short chapters entitled "_De vulneribus
+colli_" and "_De perforatione colli ex utraque parte_," continues as
+follows:
+
+"_De vena organica incisa._
+
+"_Si vena organica in cervice incidatur: tota vena suatur cum acu, ita
+quod vena non perforetur, et ux alia parte acus cum filo ei adherente
+ita nectatur atque stringatur quod (non) emittat sanguinem, et ita
+fiat ex superiori parte et inferiore vene. In vulnere autem pannus
+infusus in albumine ovi mittatur, nec tamen de ipso panno vulnus
+multum impleatur. Embroca vero superius dicta, si in hyeme fuerit,
+superponatur, donec vulnus saniem emittat. Si vere in estate, vitellum
+ovi tum super ponatur, et cum saniem fecerit, panno sicco, et unguento
+fusco et ceteris regenerantibus carnem, curetur. Cum vero extremitatem
+vene superioris et inferioris putruisse cognoveris, fila dissolvantur
+et a loco removeantur, et deinde ut dictum est procedatur._
+
+"_De incisione nervi secundum longum aut secundum obliquum._
+
+"_Si vero secundum longum aut obliquum vervi incidantur, et non ex
+toto, ita consolidamus. Terrestres vermes, qui sub terra nascuntur,
+similes in longitudine et rotunditate lumbricis, qui etaim lumbrici
+terre appellantur: hi aliquantulum conterantur et in oleo infusi ad
+ignem calefiant, et nullo aliomediante, ter vel quater vel pluries,
+si opportunum fuerit, plagelle impone. Si vero ex oblique nervus
+incidatur, eodem remedio curatur, et natura cooperante saepe
+conglutinatur. Potest quoque cuticula quae supra nervum est sui, et
+pulvis ruber superaspergatur. Nervos enim conglutinari et consolidari
+hoc modo sepius videmus. Si vero locus tumeat, embroca, praedicta in
+vulnere capitis quae prima est ad tumorem removendum, superponatur,
+quousque tumor recesserit. Si vena organica non inciditur,
+pannus albumine ovi infusus in vulnere ponatur. Embroca vero post
+desuperponatur_" (f. 179 c).
+
+The selection and collection of words and phrases in these two
+passages leaves little doubt that one was copied from the other.
+Indeed, so close is their resemblance that it is quite possible from
+the one text to secure the emendation of the other. Numerous similar
+passages, with others in which the text of Gilbert is rather a
+paraphrase than a copy of the text of Roger, serve to confirm the
+conclusion that the surgical writings of the English physician are
+borrowed mainly from the "Chirurgia" of the Italian surgeon. Some few
+surgical chapters of the Compendium appear to be either original or
+borrowed from some other authority, but their number is not sufficient
+to disturb the conclusion at which we have already arrived. Now, as
+Roger's "Chirurgia" was probably committed to writing in the year
+1230, when the surgeon was an old man, these facts lead us to the
+conclusion that Gilbert must have written his Compendium at least
+after the date mentioned.
+
+Another criticism of these chapters suggests certain interesting
+chronological data. It will be observed that Roger, in the passage
+quoted above, recommends a dressing of egg-albumen for wounds of the
+neck, and expresses considerable doubt whether nerves, when totally
+divided, can be regenerated (_consolidari_), though they may
+undoubtedly be reunited (_conglutinari_).
+
+Now Roland, in his edition of Roger's "Chirurgia," criticises both of
+these statements of his master, as follows:
+
+_Nota quod quamvis Rogerius dicat quod apponatur albumen ovi, non
+approbo, quia frigidum est naturaliter, et vena et nervus et arteria
+frigida sunt naturaliter, et propter frigiditatem utrorumque non
+potest perfecte fieri consolidatio._
+
+And again:
+
+_Nota quod secundum Rogerium nervus omnino incisus non potest
+consolidari, vel conjungi nec sui. Nos autem dicimus quod potest
+consolidari et iterum ad motum reddi habillis, cum hac cautela:
+Cauterizetur utrumque caput nervi incisi peroptime cum ferro candenti,
+sed cave vulneris lobia cum ferro calido tangantur. Deinde apponantur
+vermes contusi et pulveres consolidativi, etc._
+
+It will be observed that Gilbert, in spite of the rejection by Roland
+of the egg-albumen dressing of Roger, still recommends its use in
+wounds of the neck, and although he professes to have seen many nerves
+regenerated (_consolidari_) under the simple angle-worm treatment
+of his master, he still makes no mention of the painful treatment of
+divided nerves by the actual cautery, so highly praised by Roland. It
+would seem, therefore, that Gilbert was not familiar with the writings
+of Roland when his Compendium was written, or he would, doubtless,
+not have omitted so peculiar a plan of treatment in an injury of such
+gravity. As Roland's edition of Roger's "Chirurgia" is said to have
+been written in 1264, the comparison of these passages would seem to
+indicate that Gilbert must have written the Compendium after 1230 and
+prior to the year 1264.
+
+Gilbert's surgical chapters discuss the general treatment of wounds
+and their complications, and more specifically that of wounds of the
+head, neck, throat, wounds of nerves, of the oesophagus, scapula,
+clavicle, of the arm, the stomach, intestines and the spleen;
+fractures of the clavicle, arm, forearm and ribs; compound fractures;
+dislocations of the atlas, jaw, shoulder and elbows; fistulae in
+various localities, and the operations on the tonsils and uvula, on
+goitre, hernia and stone in the bladder, etc.--certainly a surgical
+compendium of no despicable comprehensiveness for a physician of his
+age and country.
+
+In the general treatment of wounds (f. 86 c) Gilbert tells us
+the surgeon must consider the time, the age of the patient, his
+temperament (_complexio_) and the locality, and be prepared to
+temper the hot with the cold and the dry with the moist. Measures
+for healing, cleansing and consolidation are required in all wounds,
+and these objects may, not infrequently, be accomplished by a single
+agent. The general dressing of most wounds is a piece of linen
+moistened with the white of egg (_pecia panni in albumine ovi
+infusa_), and, as a rule, the primary dressing should not be changed
+for two days in summer, and for three days in the winter. In moist
+wounds _vitreolum_ reduces the flesh; in dry wounds it repairs and
+consolidates. _Flos aeris_, in dry wounds, reduces but does not
+consolidate, but rather corrodes the tissues. Excessive suppuration
+is sometimes the result of too stimulating applications, sometimes
+of those which are too weak. In the former case the wound enlarges,
+assumes a concave form, is red, hot, hard and painful, and the pus is
+thin and watery (_subtilis_). If the application is too weak, the pus
+is thick and viscous, and the other signs mentioned are wanting. In
+either case the dressings are to be reversed. If any dyscrasia, such
+as excessive heat, coldness, dryness or moisture appears in the wound
+and delays its healing, it is to be met by its contrary. If fistula or
+cancer develops, this complication is to be first cured and then the
+primary wound. The signs of a hot dyscrasia are heat, burning and pain
+in the wound; of a cold dyscrasia, lividity of the wound; the moist
+dyscrasia occasions flabbiness (_mollicies_) and profuse suppuration,
+and the dry produces dryness and induration.
+
+Wounds of the head (f. 84 c) occur with or without fracture of the
+cranium, but always require careful examination and exact diagnosis.
+The wound is to be carefully explored with the finger, and, if
+necessary, should be enlarged for this purpose. Large, but simple,
+wounds of the scalp should be stitched with silk in three or four
+places, leaving the most dependent angle open for escape of the
+discharges, and in this opening should be inserted a tent (_tuellus_),
+to facilitate drainage. The wound is then sprinkled with the _pulvis
+rubeus_ and covered with a plantain or other leaf. On the ninth to the
+eleventh day, if the wound seems practically healed, the stitches are
+to be removed and the cure completed with simple dressings.
+
+The signs and symptoms of fracture of the cranium are: Loss
+of appetite and failure of digestion, insomnia, difficulty in
+micturition, constipation, a febrile dyscrasia, difficulty in cracking
+nuts or crusts of bread with the jaws, or severe pain when a string is
+attached to the teeth and pulled sharply. If the meninges are injured
+we have further: headache, a slow and irregular but increasing fever,
+alternating with chills, distortion of the angles of the eyes, redness
+of the cheeks, mental disturbances, dimness of vision, a weak voice
+and bleeding from the ears or the nose. In the presence of such
+symptoms the death of the patient may be expected within at most a
+hundred days.
+
+If the fracture of the cranium is accompanied by a large scalp wound,
+any fragments of bone or other foreign body are to be extracted at
+once, unless haemorrhage or the weakness of the patient are feared,
+and then a piece of linen is to be cautiously worked in with a feather
+between the cranium and the dura mater. In the fracture itself a piece
+of linen, or better of silk, is inserted, the apparent purpose of this
+double dressing being to protect the dura mater from the discharges
+and to solicit their flow to the exterior. A piece of sponge,
+carefully washed, dried and placed in the wound, Gilbert tells us,
+absorbs the discharges satisfactorily and prevents their penetration
+internally. Over the wound is placed a bit of linen moistened with
+egg-albumen, then a dressing of lint, and the whole is maintained in
+place by a suitable bandage. Finally the patient is to be laid in bed
+and maintained in such a position that the wound will be dependent, so
+as to favor the ready escape of the discharges. This dressing is to be
+renewed three times a day in summer, and twice in winter. Proud flesh
+upon the dura mater is to be repressed by the application of a sponge,
+well-washed and dried, and if it appears upon the surface of the wound
+after the healing of the fracture, it is to be destroyed by the use of
+the hermodactyl. When the external wound is healed, the cicatrix is
+to be dressed with the _apostolicon cyrurgicum_, an ointment very
+valuable for the consolidation of bones, the leveling (_adaequatio?_)
+of wounds, etc.
+
+When the wound of the scalp is small, so as to render difficult the
+determination of the extent of the fracture by exploration with the
+finger, it should be enlarged by crucial incisions, the flaps loosened
+from the cranium by a suitable scraper (_rugine_) and folded back
+out of the way, and any fragments of bone removed by the forceps
+(_pinceolis_). If, however, haemorrhage prevents the immediate removal
+of the fragments, this interference may be deferred for a day or
+two, until the bleeding has stopped or has been checked by suitable
+remedies. Then, after their removal, the piece of linen described
+above is to be inserted between the cranium and dura mater. Upon the
+cranium and over the flaps of the scalp, as well as in their angles,
+the ordinary dressing of albumen is to be applied, covered by a
+pledget of lint and a suitable bandage. No ointment, nor anything
+greasy, should be applied until after the healing of the wound, lest
+some of it may accidentally run down into the fracture and irritate
+the dura matter. Some surgeons, Gilbert tells us, insert in the place
+of the fragments of the cranium removed a piece of a cup (_ciphi_) or
+bowl (_mazer_), or a plate of gold, but this plan, he says, has been
+generally abandoned (_dimittitur_.)
+
+Sometimes the cranium is simply cracked without any depression of the
+bone, and such fractures are not easily detected. Gilbert tells us,
+however, that if the patient will close firmly his mouth and nose and
+blow hard, the escape of air through the fissured bone will reveal the
+presence of the fracture (f. 88a). In the treatment of such fissures
+he directs that the scalp wound be enlarged, the cranium perforated
+very cautiously with a trepan (_trepano_) at each extremity of the
+fissure and the two openings then connected by a chisel (_spata_?),
+in order to enable the surgeon to remove the discharges by a delicate
+bit of silk or linen introduced with a feather. If a portion of the
+cranium is depressed so that it cannot be easily raised into position,
+suitable openings are to be made through the depressed bone in order
+to facilitate the free escape of the discharges.
+
+Gunshot wounds were, of course, unknown in Gilbert's day. In a chapter
+entitled "_De craneo perforato_" he gives us, however, the treatment
+of wounds of the head produced by the transfixion of that member by an
+arrow. If the arrow passes entirely through the head, and the results
+are not immediately fatal, he directs the surgeon to enlarge the wound
+of exit with a trephine, remove the arrowhead through this opening,
+and withdraw the shaft of the arrow through the wound of entrance. The
+wounds of the cranium are then to be treated like ordinary fractures
+of that organ (f. 88c).
+
+In wounds of the neck involving the jugular vein (_vena organica_),
+Gilbert directs ligation of both extremities of the wounded vessel,
+after which the wound is to be dressed (but not packed) with the
+ordinary dressing of egg-albumen.
+
+Wounds of nerves are treated with a novel dressing of earthworms
+lightly beaten in a mortar and mixed with warm oil, and he professes
+to have seen nerves not only healed (_conglutinari_), but even the
+divided nerve fibres regenerated (_consolidari_) under this treatment.
+In puncture of a nerve Gilbert surprises us (f. 179d) by the advice
+to divide completely the wounded nerve, in order to relieve pain and
+prevent tetanus (_spasmus_).
+
+Goitre, not too vascular in character, is removed by a longitudinal
+incision over the tumor, after which the gland is to be dragged out,
+with its entire capsule, by means of a blunt hook. A large goitre in
+a feeble patient, however, is better left alone, as it is difficult
+to remove all the intricate roots of the tumor, and if any portion is
+left it is prone to return. In such cases Gilbert says we shrink
+from the application of the actual cautery, for fear of injury to
+the surrounding vessels and nerves. Whatever method of operation is
+selected, the patient is to be tied to a table and firmly held in
+position.
+
+Wounds of the trachea and oesophagus, according to Gilbert, are
+invariably mortal.
+
+In wounds of the thorax the ordinary dressing of albumen is to be
+applied, but if blood or pus enters the cavity of the thorax, the
+patient is directed to bend his body over a dish, twisting himself
+from one side to another (_supra discum[10] flectat se modo hac modo
+ilac vergendo_) until he expels the sanies through the wound, and to
+always lie with the wound dependent until it is completely healed (f.
+182d).
+
+[Footnote 10: It is interesting to observe how the Latin discus
+developed dichotomously into the English "dish" and the German
+"Tisch." The former is doubtless the meaning of the word in this
+place.]
+
+In case an arrow is lodged within the cavity of the thorax, the
+surgeon is directed to trepan the sternum (_os pectoris_), remove the
+head of the arrow gently from the shaft, and withdraw the shaft itself
+through the original wound of entrance. If the head is lodged beneath
+or between the ribs, an opening is to be made into the nearest
+intercostal space, the ribs forced apart by a suitable wedge and
+the head thus extracted. The wound through the soft parts is to be
+kept open by a tent greased with lard and provided with a suitable
+prolongation (_cauda aliqua_) to facilitate its extraction and prevent
+its falling into the cavity of the chest.
+
+Wounds of the heart, lungs, liver, stomach and diaphragm are regarded
+as hopelessly mortal (f. 233d), and the physician is advised to have
+nothing to do with them. Wounds of the heart are recognized by the
+profuse haemorrhage and the black color of the blood; those of the
+lung by the foamy character of the blood and the dyspnoea; wounds of
+the diaphragm occasion similar dyspnoea and are speedily fatal; those
+of the liver are known by the disturbance of the hepatic functions,
+and wounds of the stomach by the escape of its contents. Wounds of
+the intestine are either incurable, or at least are cured only with
+the utmost difficulty. Longitudinal wounds of the spine which do not
+penetrate the cord may be repaired, but transverse wounds involving
+the cord, so that the latter escapes from the wound, are rarely, if
+ever, cured by surgery. Wounds of the kidneys are also beyond the art
+of the surgeon. Wounds of the penis are curable, and if the wound is
+transverse and divides the nerve, they are likewise painless.
+
+_Si vene titillares in coxis abscidantur homo moritur ridendo._ A
+passage which I can refer only to the erudition and risibility of our
+modern surgeons and anatomists. The ticklish _vene titillares_ are to
+me entirely unknown.
+
+Modern abdominal surgeons will probably be interested in reading
+Gilbert's chapter on the treatment of wounds of the intestines in the
+thirteenth century. He says (f. 234c):
+
+If some portion of the intestine has escaped from a wound of the
+abdomen and is cut either longitudinally or transversely, while the
+major portion remains uninjured; if the wound has existed for some
+time and the exposed intestine is cold, some living animal, like a
+puppy (_catulus_), is to be killed, split longitudinally and placed
+over the intestine, until the latter is warmed, vivified by the
+natural heat and softened. Then a small tube of alder is prepared, an
+inch longer than the wound of the intestine, carefully thinned down
+(_subtilietur_) and introduced into the gut through the wound and
+stitched in position with a very fine square-pointed needle, threaded
+with silk. This tube or canula should be so placed as to readily
+transmit the contents of the intestine, and yet form no impediment to
+the stitches of the wound. When this has been done, a sponge moistened
+in warm water and well washed should be employed to gently cleanse the
+intestines from all foreign matters, and the gut, thus cleansed, is to
+be returned to the abdominal cavity through the wound of the abdominal
+wall. The patient is then to be laid upon a table and gently shaken,
+in order that the intestines may resume their normal position in the
+abdomen. If necessary the primary wound should be enlarged for this
+purpose. When the intestines have been thus replaced, the wound in
+the abdominal wall is to be kept open until the wound of the intestine
+seems healed. Over the intestinal suture a little _pulvis ruber_
+should be sprinkled every day, and when the wound of the intestine is
+entirely healed (_consolidatur_), the wound of the abdominal wall is
+to be sewed up and treated in the manner of ordinary flesh wounds.
+
+If, however, the wound is large, a pledget (_pecia_) of lint, long
+enough to extend from one end to the other and project a little, is
+placed in the wound, and over this the exterior portion of the wound
+is to be carefully sewed, and sprinkled daily with the _pulvis ruber_.
+Every day the pledget which remains in the wound is to be drawn
+towards the most dependent part, so that the dressing in the wound may
+be daily renewed. When the intestinal wound is found to be healed, the
+entire pledget is to be removed and the unhealed openings dressed as
+in other simple wounds. The diet of the patient should be also of the
+most digestible sort.
+
+Thus far Gilbert has followed Roger almost literally. But he now adds,
+apparently upon his own responsibility, the following paragraph:
+
+_Quod si placuerit, extrahe canellum: factis punctis in sutura
+ubi debent fieri antequan stringantur, inter duo puncta canellus
+extrahatur, et post puncta stringantur. Hoc dico si vulnus intestini
+sic (sit) ex transverso._
+
+Apparently Gilbert feels some compunctions of conscience relative to
+the ultimate disposition of the canula of alder-wood, and permits,
+if he does not advise, its removal from the intestine before the
+tightening of the last stitches.
+
+Roland adds nothing to the text of Roger. But The Four Masters
+(_Quatuor Magistri_, about A.D. 1270) suggest that the canula be made
+of the trachea of some animal, and add:
+
+_Canellus autem per processum temporis putrefit et emittur per
+egestionem, et iterum per concavitatem canelli transibit egestio._
+
+In his further discussion of wounds of the intestine and their
+treatment Gilbert also volunteers the information that:
+
+"Mummy (shade of Lord Lister!) is very valuable in the healing of
+wounds of the intestine, if applied with some astringent powder upon
+the suture."
+
+In amends for the mummy, however, we are also introduced to the
+practice of mediaeval anaesthesia by means of what Gilbert calls the
+_Confectio soporifera_ (f. 234d), composed as follows:
+
+_R._
+
+  _Opii,
+  Succi Jusquiami (hyoscyami),
+  Succi papaveris nigri, vel ejus seminis,
+  Sacci mandragorae, vel ejus corticis, vel pomorunt ipsius si succo
+          carueris,
+  Foliorum hederae arborae (ivy),
+  Succi mororum rubi maturorum,
+  Seminis lactucae,
+  Succi cuseutae (dodder)_,    aa. ounce I.
+
+Mix together in a brazen vessel and place this in the sun during the
+dog-days. Put in a sponge to absorb the mixture, and then place the
+sponge in the sun until all the moisture has evaporated. When an
+operation is necessary, let the patient hold the sponge over his nose
+and mouth until he goes to sleep, when the operation may be begun.
+To awaken the patient after the operation, fill another sponge with
+vinegar and rub the teeth and nostrils with the sponge, and put some
+vinegar in the nostrils. An anaesthetic drink may also be prepared as
+follows:
+
+_R._
+
+  _Seminis papaveris albi et nigri,
+  Seminis lactucae,      aa. ounce I.
+  Opii,
+  Misconis (         , poppy juice?)_,     aa. scruples I-II, as
+          required.
+
+The patient is to be aroused as before.
+
+On folio 180d we find a chapter entitled "_De cathena gulae incisa
+vel fracta_," and copied almost literally from the chapter "_De catena
+gulae_" of Roger. In neither writer do I find any precise definition
+of what the _cathena gulae_ is, though Roger says, _Si es gulae,
+quod est catena, fractum fuerit_, etc., nor do I find the terms used
+explained in any dictionary at present available. The description of
+the treatment of this fracture seems, however, to indicate that the
+_catena gulae_ of Roger and Gilbert is what we call the clavicle,
+though the more common Latin names of this bone are _claviculus_,
+_furcula_, _juglum_ or _os juguli_. Gilbert says: "But if the bone
+which is the _cathena gulae_ is broken or in any way displaced
+(_recesserit_), let the physician with one hand raise the forearm
+(_brachium_) or arm (_humerum_) of the patient, and with the other
+hand press down upon the projecting portion of the bone. Then apply a
+pledget moistened with albumen, a pad and a splint in form of a cross,
+and over all a long bandage embracing both the arm and the neck and
+suspending the arm. A pad (_cervical_) should also be placed in the
+axilla to prevent the dropping of the arm, and should not be removed
+until the fracture is repaired. If the fracture is compound, the wound
+of the soft parts is to be left open and uncovered by the bandage, so
+that a tent (_stuellus_) may be inserted, and the wound is then to be
+dressed in the ordinary manner."
+
+Simple fracture of the humerus, Gilbert tells us, is to be reduced
+(_ad proprium locum reducator_) at once by grasping the arm above and
+below the seat of fracture and exercising gentle and gradual extension
+and compression. Then four pieces of lint wet in egg-albumen are
+to be placed around the arm on all sides, a bandage, four fingers
+wide, also moistened in albumen is to be snugly applied, another dry
+bandage placed above this, and finally splints fastened in position
+by cords. This dressing is to remain undisturbed for three days, and
+then renewed every third day for nine days. After the ninth day a
+_strictura_ (cast, apparatus immobile?) is to be prepared and firmly
+applied with splints and a bandage, and the patient is to be cautioned
+not to bear any weight upon the injured arm (_ne infirmus se super
+illud appodiet_?). The fracture is then left until it is believed that
+consolidation has occurred. If, however, it is found that swelling
+is occasioned by the cast (_ex strictorio_?), the latter should be
+removed, and the arm well bathed in warm water containing mallowae and
+other emollients and thoroughly cleansed. If the bone seems to be well
+consolidated, it should be rubbed with an ointment of _dialthea_ or
+the _unguentum marciation_, after which the splints and bandage are
+to be reapplied. If, however, it is found that the bone is not well
+consolidated, the cast should be replaced in the original manner,
+until consolidation is accomplished. If erysipelas results from
+the dressings, it is to be treated in the ordinary manner. During
+the entire treatment potions of nasturtium seeds, _pes columbini_
+(crowfoot) and other "consolidatives" are to be administered
+diligently. If the fracture is compound, any loose fragments of
+bone are to be removed, the fracture reduced as before, and similar
+dressings applied, perforated, however, over the wound in the soft
+parts.
+
+In fracture of the ribs (_flexura costi_) Gilbert recommends a
+somewhat novel plan for the replacement of the displaced bone. Having
+put the patient in a bath, the physician rubs his hands well with
+honey, turpentine, pitch or bird-lime (_visco_), applies his sticky
+palms over the displaced ribs, and gradually raises them to their
+normal position. He also says (f. 183a), the application of a dry cup
+(_cuffa vero cum igne_?) over the displaced rib is a convenient method
+for raising it into position.
+
+Of fractures of the forearm Gilbert simply says that they are to be
+recognized by the touch and a comparison of the injured with the sound
+arm. They should be diligently fomented, extension made if necessary,
+and then treated like other fractures.
+
+Dislocation of the atlo-axoid articulation (_os juguli_) he tells us
+threatens speedy death. The mouth of the patient is to be kept open
+by a wooden gag, a bandage passed beneath the jaw and held by the
+physician, who places his feet upon the shoulders of the patient and
+pressing down upon them while he elevates the head by the bandage,
+endeavors to restore the displaced bone to its normal position.
+Inunctions of various mollitives are then useful.
+
+Dislocations of the lower jaw are recognized by the failure of the
+teeth to fit their fellows of the upper jaw, and by the detection of
+the condyles of the jaw beneath the ears. The bone is to be grasped
+by the rami and dragged down until the teeth resume and retain
+their natural position, and the jaw is then to be kept in place by a
+suitable bandage.
+
+In dislocation of the humerus the patient is to be bound in the supine
+position, a wedge-shaped stone wrapped with yarn placed in the axilla,
+and the surgeon, pressing against the padded stone with his foot and
+raising the humerus with his hands, reduces the head of the bone to
+its natural position. If this method fails, a long crutch-like stick
+is prepared to receive at one end the axillary pad, the patient is
+placed standing upon a box or bench, the pad and crutch adjusted in
+the axilla, and while the surgeon stands ready to guide the dislocated
+bone to its place, his assistants remove the bench, leaving the
+patient suspended by his shoulder upon the rude crutch. In boys,
+Gilbert tells us, no special apparatus is required. The surgeon merely
+places his doubled fist in the axilla, with the other hand grasps the
+humerus and lifts the boy off the ground, and the head of the bone
+slips readily back into place. After we are assured that the reduction
+is complete, a strictorium is prepared, consisting of the _pulvis
+ruber_, egg-albumen and a little wheat flour, with which the shoulder
+is to be rubbed. Finally, when all seems to be going on well, warm
+_spata drapum_ (sparadrap) is to be applied upon a bandage, and if
+necessary the apostolicon ointment.
+
+Dislocation of the elbow is reduced by passing a bandage around the
+bend of the arm, forming in this a loop (_scapham_) into which the
+foot of the surgeon is to be placed for counter-extension, while with
+the hands extension is to be made upon the forearm until the bones are
+drawn into their normal position. Flexion and extension of the joint
+are then to be practised three or four times (to assure complete
+reduction?), and the forearm flexed and supported by a bandage from
+the neck. After a few days, Gilbert tells us, the patient will himself
+often try to flex and extend the arm, and the bandage should be so
+applied as not to interfere with these movements.
+
+Dislocation of the wrist is reduced by gentle extension from the hand
+and counter-extension from the forearm, and dislocation of the fingers
+by a similar manipulation.
+
+After so full a consideration of the surgical injuries of the head,
+trunk and upper extremities, we are somewhat surprised to find
+Gilbert's discussion of the similar injuries of the lower extremities
+condensed into a single very moderate chapter entitled "De vulneribus
+cruris et tybie" (f. 358a b).
+
+In this, Gilbert, emphasizing the importance of wounds of the patella
+and knee-joint and the necessity for their careful treatment, also
+declares that wounds of both the leg and thigh within three inches of
+the joints, or in the fleshy portion of the thigh _ubi organum est_
+(?), involve considerable danger. He then speaks of a blackish, hard
+and very painful tumor of the thigh, which, when it ascends the
+thigh (_ad superiora ascendit_) is mortal, but if it descends is
+less dangerous. Separation of the sacrum (_vertebrum_) from the ilium
+(_scia_), either by accident or from the corrosion of humors, leaves
+the patient permanently lame, though suitable fomentations and
+inunctions may produce some improvement. Sprains of the ankle are to
+be treated by placing the joint immediately in very cold water _ad
+repercussionem spiritus et sanguinis_, and the joint is to be kept
+thus refrigerated until it even becomes numb (_stupefactionem_); after
+which stupes of salt water and urine are to be applied, followed by a
+plaster of galbanum, opoponax, the apostolicon, etc.
+
+Fractures of the femur are to be treated like those of the humerus,
+except that the ends of the fractured bone are to be separated by
+the space of an inch, and a bandage six fingers in width carefully
+applied. Such fractures within three inches of the hip or knee-joint
+are regarded as specially dangerous.
+
+Dislocations of the ankle, after reduction of proper manipulation,
+should be bound with suitable splints. If of a less severe character,
+the dislocation may be dressed with stupes of canabina (Indian hemp),
+urine and salt water, which greatly mitigate the pain and swelling.
+Afterwards the joint should be strapped for four or five inches above
+the ankle with plaster, _ut prohibeatur fluxus_.
+
+It should be said that the brevity of this chapter of Gilbert is
+modeled after the manner of Roger of Parma, who refers the treatment
+of injuries of the lower extremities very largely to that of similar
+injuries of the upper, merely adding thereto such explanations as may
+be demanded by the differences of location and function of the members
+involved. Thus in his discussion of dislocation of the femur Roger
+says:
+
+_Si crus a coxa sit disjunctum, eadem sit cura quam et in disjuncturam
+brachii et cubiti diximus, etc._
+
+The general subject of fistulae is treated at considerable length on
+folio 205b, and fistula lachrymalis and fistulae of the jaw receive
+special attention in their appropriate places. As a rule, the fistula
+is dilated by a tent of alder-pith, mandragora, briony or gentian,
+the lining membrane destroyed by an ointment of quick-lime or even the
+actual cautery, and the wound then dressed with egg-albumen followed
+by the _unguentum viride_. Necrosed bone is to be removed, if
+necessary, by deep incisions, and decayed teeth are to be extracted.
+
+The elongated uvula is to be snipped off, and abscesses of the tonsils
+opened _tout comme chez nous_.
+
+An elaborate discussion of the subject of hernia is given under the
+title "_De relaxatione siphac et ruptura_" (f. 280c)--siphac being
+the Arabian name for the peritoneum. Gilbert tells us the siphac is
+sometimes relaxed, sometimes ruptured (_crepatur_?) and sometimes
+inflated. He had seen a large rupture (_crepatura_) in which it was
+impossible to restore the intestines to the cavity of the abdomen
+in consequence of the presence in them of large hard masses of fecal
+matter, which no treatment proved adequate to remove, and which
+finally occasioned the death of the patient. Rupture of the siphac is
+most frequently the result of accident, jumping, straining in lifting
+or carrying heavy weights, or in efforts at defecation, or of shouting
+in boys or persons of advanced age, or even in excessive weeping,
+etc. It is distinguished from hernia by the fact that in hernia pain
+is felt in the testicle, radiating to the kidneys, while in rupture
+of the siphac a swelling on one side of the pubes extends into the
+scrotum, where it produces a tumor not involving the testicle. Rupture
+of the siphac, he says, is a lesion of the organs of nutrition, hernia
+a disease of the organs of generation. Accordingly, in the pathology
+of Gilbert, the term hernia is applied to hydrocele, orchitis and
+other diseases of the testicle, and not, as with us to protrusions of
+the viscera through the walls of their cavities.
+
+In young persons, he tells us, recent ruptures of the siphac may be
+cured by appropriate treatment. The patient is to be laid upon his
+back, the hips raised, the intestines restored to the abdominal cavity
+and the opening of exit dressed with a plaster of exsiccative and
+consolidating remedies, of which he furnishes a long and diversified
+catalogue. He is also to avoid religiously all exercise or motion, all
+anger, clamor, coughing, sneezing, equitation, cohabitation, etc.,
+and to lie with his feet elevated for forty days, until the rupture
+(_crepatura_) is consolidated. The bowels are to be kept soluble by
+enemata or appropriate medicines, and the diet should be selected so
+as to avoid constipation and flatulence. A bandage or truss (_bracale
+vel colligar_) made of silk and well fitted to the patient is also
+highly recommended. If the patient is a boy, cakes (_crispelle_?) of
+_consolida major_ mixed with the yolk of eggs should be administered,
+one each day for nine days before the wane of the moon. If, however,
+the rupture is large in either a boy or an adult, and of long
+standing, whether the intestine descends into the scrotum or not,
+operation, either by incision or by the cautery offers the only hope
+of relief. Singularly enough too, while Roger devotes to the operation
+for the cure of hernia nearly half a page of his text, Gilbert
+dismisses the whole subject in a single sentence, as follows:
+
+_Scindatur igitur totus exitus super hac cute exteriori cum carne
+fissa, et uatur y fac cum file serice et acu quadrata. Deinde
+persequere ut in exitu intestini per vulnus superius demonstratum est_
+(f. 281d).
+
+Turning now to the title "_De hernia_" (f. 289b), Gilbert tells us
+"Swelling (_inflatio_) of the testicles is due sometimes to humors
+trickling down upon them (_rheumatizantibus_), sometimes to abscess,
+or to gaseous collections (_ventositate_), and sometimes to escape
+of the intestines through rupture of the siphac." He adds also: "Some
+doubt the propriety of using the term hernia for an inflation. On
+this point magister Rn says: There is a certain chronic and inveterate
+tumor of the testicles, which is never cured except by means of
+surgery, as e.g., hernia. For hernia is an affection common to the
+scrotum and the testicles."
+
+The apparent confusion between these two passages is easily relieved
+by the explanation that inguinal or other herniae not extending into
+the scrotum are called by Gilbert ruptures of the siphac, but scrotal
+hernia is classed with other troubles located in the scrotum as
+hernia. Accordingly hernia, with Gilbert, includes not only scrotal
+hernia, but also hydrocele, orchitis, tumors of the testicles, etc.
+This is apparent, too, in his treatment of hernia, which consists
+usually in the employment of various poultices and ointments, bleeding
+from the saphena, cups over the kidneys, etc., though hydrocele is
+tapped and a seton inserted. If the testicle itself is "putrid,"
+it should be removed; otherwise it is left. It may be remarked _en
+passant_ that the surgeons of medieval times, in their desire for
+thoroughness, often displayed very little respect to what Baas calls
+"the root of humanity."
+
+We will terminate our hasty review of diseases discussed in the
+Compendium by an abstract of Gilbert's views on vesical calculus and
+its treatment, which cover more than fifteen pages of his work.
+
+Stone and gravel arise from various viscous superfluities in the
+kidneys and bladder, which occasion difficulty in micturition. Stone
+is produced by the action of heat upon viscous moisture, sublimating
+the volatile elements and condensing the denser portions.
+Putrefication of stone in the bladder is the result of three causes,
+viz., consuming heat, viscous matter and stricture of the meatus.
+For consuming heat acting on viscous material retained by reason
+of stricture of the meatus, by long action dries up, coagulates and
+hardens the moisture. This is particularly manifest in boys who have a
+constricted meatus.
+
+Stones are thus generated not only in the kidneys and bladder,
+but also even in the stomach and the intestines, whence they are
+ejected by vomiting or in the stools. Indeed they may also be found
+occasionally in the lungs, the joints and other places. They are
+comparatively rare in women, in consequence of the shortness of the
+urethra and the size of their meatus.
+
+Sometimes calculi occur in the bladder, sometimes in one kidney and
+occasionally in both kidneys. The symptoms produced by their presence
+vary in accordance with the situation of the concretion. If the stone
+is in the kidney, the foot of the side affected is numb (_stupidus_),
+the spine on the affected side is sore and there is difficulty of
+micturition and considerable gravelly sediment in the urine. If the
+stone is increasing in size, the quantity of sediment also increases,
+but if the stone is fully formed and confirmed, the amount of sediment
+decreases daily, and the urine becomes milky both in the kidneys and
+the bladder. A stone in the bladder occasions very similar symptoms,
+together with pain in the peritoneum and pubes, dysuria and strangury,
+and sometimes the appearance of blood and flocculi (_trumbos_?)
+in the urine. Patients suffering from vesical calculus are always
+constipated, and the dysuria may increase to the degree called furia,
+a condition not without some danger.
+
+Three things are necessary in the cure of stone, viz., a spare and
+simple diet, the use of diuretics and a moderate amount of exercise.
+It should, however, be remarked that confirmed stone is rarely or
+never cured, except by a surgical operation.... If a boy has a clear
+and watery urine after it has been sandy, if he frequently scratches
+his foot, has involuntary erections and finally obstruction in
+micturition, I say that he has a stone in the neck of his bladder.
+If now he be laid upon his back with his feet well elevated, and his
+whole body be well shaken, if there is a stone present it is possible
+that it may fall to the fundus of the bladder. Afterwards direct
+the boy to bear down (_ut exprimat se_) and try to make water. If
+this treatment turns out in accordance with your theory, the urine
+necessarily escapes and your idea and treatment are confirmed. If,
+however, the urine not escape, let the boy be shaken vigorously
+a second time. If this too fails and strangury ensues, it will be
+necessary to resort to the use of a sound or catheter (_argaliam_),
+so that when the stone is pushed away from the neck of the bladder the
+passage may be opened and the urine may flow out. It may be possible
+too that no stone exists, but the urethra is obstructed or closed
+by pure coagulated blood. Perhaps there may have been a wound of the
+bladder, although no external haemorrhage has appeared, but the blood
+coagulating gradually in the bladder has occasioned an obstruction or
+narrowing of the urinary passage. Or possibly the blood from a renal
+haemorrhage has descended into the bladder and obstructs the urethra.
+Hence I say that the sound is useful in these cases where the urethra
+is obstructed by blood or gross humors. Examination should also be
+made as to whether a fleshy body exists in the bladder, as the result
+of some wound. This condition is manifest if, on the introduction of
+the sound, the urine flows out promptly. I once saw a man suffering
+from this condition, who complained of severe pain in the urinary
+passage as I was introducing the sound, and I recognized that there
+were wounds in the same part, for as soon as these were touched by
+the sound the urine began to flow, followed soon after by a little
+blood and fleshy particles.... So far as the operation of physicians
+is concerned, it is necessary only to be certain of the fact that
+obstruction to the passage of urine depends upon no other cause than
+stone or the presence of coagulated blood (f. 271).
+
+Gilbert's medical treatment of vesical calculus consists generally
+in the administration of diuretics and lithontriptics and the local
+application of poultices, plasters and inunctions of various kinds.
+Of the lithontriptics, certain combinations, characterized by famous
+names or notable historical origin, are evident favorites. Among
+this class we read of the _Philoantropos major_ and _minor_, the
+_Justinum_, the _Usina_ "approved by many wise men of Babylon and
+Constantinople," the _Lithontripon_ and the "_Pulvis Eugenii pape_,"
+with numerous others.
+
+Rather curiously and suggestively no mention is made in this immediate
+connection of the technique of lithotomy. On a later page, however (f.
+309a), we find a chapter entitled "_De cura lapidis per cyrurgiam_,"
+in which Gilbert writes:
+
+"Mark here a chapter on the cure of stone in the bladder by means
+of surgery, which we have omitted above. Accordingly, to determine
+whether a stone exists in the bladder, let the patient take a warm
+bath. Then let him be placed with his buttocks elevated, and, having
+inserted into the anus two fingers of the right hand, press the fist
+of the left hand deeply above the pubes and lift and draw the entire
+bladder upward. If you find anything hard and heavy, it is manifest
+that there is a stone in the bladder. If the body feels soft and
+fleshy, it is a fleshy excrescence (_carnositas_), which impedes the
+flow of urine. Now, if the stone is located in the neck of the bladder
+and you wish to force it to the fundus: after the use of fomentations
+and inunctions, inject through a syringe (_siringa_) some petroleum,
+and after a short interval pass the syringe again up to the neck of
+the bladder and cautiously and gently push the stone away from the
+neck to the fundus. Or, which is safer and better, having used the
+preceding fomentations and inunctions, and having assured yourself
+that there is a stone in the bladder, introduce your fingers into the
+anus and compress the neck of the bladder with the fist of the left
+hand above the pubes, and cautiously remove the stone and guide it
+to the fundus. But if you wish to extract the stone, let a spare diet
+precede the operation, and let the patient lie abed for a couple of
+days with very little food. On the third day introduce the fingers
+into the anus as before, and draw down the stone into the neck of
+the bladder. Then make your incision lengthwise in the fontanel, the
+width of two fingers above the anus, and extract the stone. For nine
+days after the operation let the patient use, morning and evening,
+fomentations of _branca_ (_acanthus mollis_), _paritaria_ (pellitery)
+and _malva_ (mallows). A bit of tow (_stupa_) moistened with the yolk
+of egg in winter, and with both the yolk and white of egg in summer,
+is to be placed over the wound. Proud flesh, which often springs up
+near a wound in the neck of the bladder, should be removed by the
+knife (_rasorio_), and two or three sutures inserted. The wound is
+then to be treated like other wounds. It should be remarked, however,
+that if the stone is very large, it should be simply pushed up to the
+fundus of the bladder and left there, and no effort should be made to
+extract it."
+
+This description of the diagnosis of stone and of the operation of
+lithotomy is copied almost literally from Roger of Parma.
+
+Sufficient (perhaps more than enough) has been written to give the
+reader a fair idea of the general character of Gilbert's "Compendium
+Medicine."
+
+A few words may be added with reference to the proper place of the
+work in our medical literature.
+
+It is not difficult, of course, to select from the Compendium a charm
+or two, a few impossible etymologies and a few silly statements, to
+display these with a witty emphasis and to draw therefrom the easy
+conclusion that the book is a mass of crass superstition and absurd
+nonsense. This, however, is not criticism. It is mere caricature.
+
+To compare the work with the teachings of modern medicine is not only
+to expect of the writer a miraculous prescience, but to minimize the
+advances of medical science within the last seven hundred years.
+
+Even Freind and Sprengel, admirable historians, though more thoughtful
+and judicious in their criticisms, seem for the moment to have
+forgotten or overlooked the true character of the Compendium.
+
+Freind says:
+
+"I believe we may even say with justice that he (Gilbert) has written
+as well as any of his contemporaries of other nations, and has merely
+followed their example in borrowing very largely from the Arabians,"
+and Sprengel writes: "Here and there, though only very rarely, the
+author offers some remarks of his own, which merit special attention."
+
+Now, what precisely is Gilbert's Compendium designed to be? In the
+words of its author it is
+
+"A book of general and special diseases, selected and extracted
+from the writings of all authors and the practice of the professors
+(_magistrorum_), edited by Gilbert of England and entitled a
+Compendium of Medicine."
+
+and a few pages later he adds:
+
+"It is our habit to select the best sayings of the best authorities,
+and where any doubt exists, to insert the different opinions, so that
+each reader may choose for himself what he prefers to maintain."
+
+The author does not claim for his work any considerable originality,
+but presents it as a compendium proper of the teachings of other
+writers. Naturally his own part in the book is not obtruded upon our
+notice.
+
+Now the desiderata of such a compendium are:
+
+1. That it shall be based upon the best attainable authorities.
+
+2. That these authorities shall be accurately represented.
+
+3. That the compendium shall be reasonably comprehensive.
+
+In neither of these respects is the compendium of Gilbert liable, I
+think, to adverse criticism.
+
+The book is, undoubtedly, the work of a famous and strictly orthodox
+physician, possessed of exceptional education in the science of his
+day, a man of wide reading, broadened by extensive travel and endowed
+with the knowledge acquired by a long experience, honest, truthful and
+simple minded, yet not uncritical in regard to novelties, firm in his
+own opinions but not arrogant, sympathetic, possessed of a high sense
+of professional honor, a firm believer in authority and therefore
+credulous, superstitious after the manner of his age, yet harboring,
+too, a germ of that healthy skepticism which Roger Bacon, his great
+contemporary, developed and illustrated.
+
+I believe, therefore, that we may justly award to the medical pages of
+the Compendium not only the rather negative praise of being written
+as well as the work of any of Gilbert's contemporaries, but the more
+positive credit of being thoroughly abreast of the medical science of
+its age and country, an "Abstract and brief chronicle of the time."
+
+The surgical chapters of the work are unique in a compendium of
+medicine, and merit even more favorable criticism.
+
+The discouragement of the practice of medicine and surgery on the
+part of ecclesiastics by the popes and church councils of the twelfth
+century, culminating in the decree of Pope Innocent III in 1215,
+which forbade the participation of the higher clergy in any operation
+involving the shedding of blood (_Ecclesia abhorret a sanguine_); the
+relatively scanty supply of educated lay physicians and surgeons, and
+finally the pride and inertia of the lay physicians themselves; all
+these combined to relegate surgery in the thirteenth century to the
+hands of a class of ignorant and unconscionable empirics, whose rash
+activity shed a baleful light upon the art of surgery itself. As a
+natural result the practice of this art drifted into an _impasse_,
+from which the organization of the barber-surgeons seemed the only
+logical means of escape.
+
+The earliest evidence of the public surgical activity of the barbers,
+as a class, is found, I believe, in Joinville's Chronicle of the
+Crusade of St. Louis (Louis IX) in the year 1250. According to
+Malgaigne, no trustworthy evidence of any organization of the
+barbers of Paris is available before 1301, and the fraternity was not
+chartered until 1427, under Charles VII. The barbers of London are
+noticed in 1308, and they received their charter from Edward IV in
+1462. The parallel lines upon which the confraternities of the two
+cities developed is very noticeable--making due allowance for Gallic
+enthusiasm and bitterness.
+
+Lanfranchi, the great surgeon of Paris, about the year 1300 is moved
+to write as follows:
+
+"Why, in God's name, in our days is there such a great difference
+between the physician and the surgeon? The physicians have abandoned
+operative procedures to the laity, either, as some say, because they
+disdain to operate with their hands, or rather, as I think, because
+they do not know how to perform operations. Indeed, this abuse is
+so inveterate that the common people look upon it as impossible for
+the same person to understand both surgery and medicine. It ought,
+however, to be understood that no one can be a good physician who
+has no idea of surgical operations, and that a surgeon is nothing
+if ignorant of medicine. In a word, one must be familiar with both
+departments of medicine."
+
+Now Gilbert by the incorporation of many chapters on surgery in his
+Compendium inculcates practically the same idea more than fifty years
+before Lanfranchi, and may claim to be the earliest representative
+of surgical teaching in England. Malgaigne, indeed, does not include
+his name in the admirable sketch of medieval surgery with which he
+introduces his edition of the works of Ambroise Pare, and says Gilbert
+was no more a surgeon than Bernard Gordon. This is in a certain sense
+true. Gilbert was certainly not an operative surgeon. But it needs
+only a very superficial comparison of the Compendium of Gilbert with
+the Lilium Medicinae of Gordon to establish the fact that the books
+are entirely unlike. Indeed, it may be truthfully said that Gordon's
+work does not contain a single chapter on surgery proper. His cases
+involving surgical assistance are turned over at once, and with
+little or no discussion, to those whom he calls "restauratores" or
+"chirurgi," and his own responsibility thereupon ends.
+
+We have no historical facts which demonstrate that Gilbert's
+Compendium exercised any considerable influence upon the development
+of surgery in England, but when we consider the depressed condition
+of both medicine and surgery in his day, we should certainly emphasize
+the clearness of vision which led our author to indicate the natural
+association of these two departments of the healing art, and the
+assistance which each lends to the other.
+
+
+
+***END OF THE PROJECT GUTENBERG EBOOK GILBERTUS ANGLICUS***
+
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diff --git a/16155-8.zip b/16155-8.zip
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+<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN"
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+<html>
+<head>
+<meta http-equiv="Content-Type" content="text/html; charset=ISO-8859-1" />
+<title>The Project Gutenberg eBook of Gilbertus Anglicus, by Henry Ebenezer Handerson</title>
+  <style type="text/css">
+  <!--
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+<body>
+<h1>The Project Gutenberg eBook, Gilbertus Anglicus, by Henry Ebenezer
+Handerson</h1>
+<pre>
+This eBook is for the use of anyone anywhere at no cost and with
+almost no restrictions whatsoever.  You may copy it, give it away or
+re-use it under the terms of the Project Gutenberg License included
+with this eBook or online at <a href = "https://www.gutenberg.org">www.gutenberg.org</a></pre>
+<p>Title: Gilbertus Anglicus</p>
+<p>       Medicine of the Thirteenth Century</p>
+<p>Author: Henry Ebenezer Handerson</p>
+<p>Release Date: June 30, 2005  [eBook #16155]</p>
+<p>Language: English</p>
+<p>Character set encoding: ISO-8859-1</p>
+<p>***START OF THE PROJECT GUTENBERG EBOOK GILBERTUS ANGLICUS***</p>
+<p>&nbsp;</p>
+<h4>E-text prepared by Suzanne Lybarger, William Flis,<br />
+    and the Project Gutenberg Online Distributed Proofreading Team<br />
+    (<a href="https://www.pgdp.net/">https://www.pgdp.net/</a>)<br />
+    from page images generously made available by<br />
+    Internet Archive and Canadian Libraries<br />
+    (<a href="http://www.archive.org/details/toronto">http://www.archive.org/details/toronto</a>)</h4>
+<p>&nbsp;</p>
+<table border="0" cellpadding="10" style="background-color: #ccccff;">
+  <tr>
+    <td valign="top">
+      Note:
+    </td>
+    <td>
+         Images of the original pages are available through the Internet
+		 Archive and Canadian Libraries. See
+         <a href="http://www.archive.org/details/gilbertusanglicu00handuoft">
+         http://www.archive.org/details/gilbertusanglicu00handuoft</a>
+    </td>
+  </tr>
+</table>
+<p>&nbsp;</p>
+<hr class="full" />
+<p>&nbsp;</p>
+<p>&nbsp;</p>
+<h1>GILBERTUS ANGLICUS</h1>
+
+<h2>Medicine of the Thirteenth Century</h2>
+
+<h4>by</h4>
+
+<h3>HENRY E. HANDERSON, A.M., M.D.</h3>
+
+<h3>With a Biography of the Author</h3>
+
+
+<h4>Published Posthumously</h4>
+
+<h4>FOR PRIVATE DISTRIBUTION</h4>
+
+<h4>by</h4>
+
+<h3>The Cleveland Medical Library Association</h3>
+
+<h4>CLEVELAND, OHIO</h4>
+
+<h3>1918</h3>
+
+<p>&nbsp;</p>
+<hr />
+<span class="pagenum"><a name="page2" id="page2"></a>[pg 2]</span>
+<p>&nbsp;</p>
+<span class="pagenum"><a name="page3" id="page3"></a>[pg 3]</span>
+<p>&nbsp;</p>
+
+<h2>Contents</h2>
+
+
+<div class="poem">  <div class="stanza">
+<p class="i10">                                           Page</p>
+<p>Frontispiece      <a href="#page5">5</a></p>
+  </div><div class="stanza">
+<p>Explanatory Foreword      <a href="#page7">7</a></p>
+  </div><div class="stanza">
+<p>Biography      <a href="#page9">9</a>-14</p>
+  </div><div class="stanza">
+<p>Resolutions of the Cleveland Medical Library Ass'n      <a href="#page15">15</a></p>
+  </div><div class="stanza">
+<p>Gilbertus Anglicus&mdash;A Study of Medicine in the Thirteenth Century      <a href="#page17">17</a>-78</p>
+  </div>  </div>
+<span class="pagenum"><a name="page5" id="page5"></a>[pg 5]</span>
+<div class="figcenter" style="width:80%;"><a href="images/frontispiece.jpg"><img width="70%" src="images/frontispiece.jpg" alt="HENRY E. HANDERSON" /></a><h3>HENRY E. HANDERSON</h3></div>
+<span class="pagenum"><a name="page7" id="page7"></a>[pg 7]</span>
+
+
+
+
+<h2>Explanatory Foreword</h2>
+
+
+<p>In the summer of 1916 the librarian of the Cleveland Medical
+Library received a manuscript from Dr. Henry E. Handerson with
+the request that it be filed for reference in the archives of the
+library. The librarian at once recognized the value of the paper
+and referred it to the editorial board of the Cleveland Medical
+Journal, who sought the privilege of publishing it. Dr. Handerson's
+consent was secured and the article was set in type. However,
+when the time came for its publication the author was reluctant to
+have it appear since he was unable then to read the proof, and because
+he felt that the material present might not be suitable for
+publication in a clinical journal. To those who knew him, this
+painstaking attention to detail and desire for accuracy presents itself
+as a familiar characteristic. Though actual publication was postponed,
+the type forms were held, and when the Cleveland Medical Journal
+suspended publication, its editorial board informed the Council
+of the Cleveland Medical Library Association of the valuable
+material which it had been unable to give to the medical world. In
+the meantime Dr. Handerson's death had occurred, but the Council
+obtained the generous consent of the author's family to make this
+posthumous publication. It is hoped that those who read will bear
+this fact in mind and will be lenient in the consideration of typographical
+errors, of which the author was so fearful.</p>
+
+<p>The Cleveland Medical Library Association feels that it is
+fortunate in being enabled to present to its members and to others
+of the profession this work of Dr. Handerson's and to create from
+his own labors a memorial to him who was once its president.</p>
+
+<p class="author">SAMUEL W. KELLEY.<br />
+CLYDE L. CUMMER.<br />
+Committee on Publication.</p>
+<span class="pagenum"><a name="page9" id="page9"></a>[pg 9]</span>
+
+
+
+
+<h2>Biography</h2>
+
+<h3>HENRY EBENEZER HANDERSON</h3>
+
+
+<p>Owing to Dr. Handerson's modesty, even we who were for
+years associated with him in medical college, in organization, and
+professional work, knew but little of him. He would much
+rather discuss some fact or theory of medical science or some ancient
+worthy of the profession than his own life. Seeing this tall
+venerable gentleman, sedate in manner and philosophical in mind,
+presiding over the Cuyahoga County Medical Society or the Cleveland
+Medical Library Association, few of the members ever pictured
+him as a fiery, youthful Confederate officer, leading a charge at a
+run up-hill over fallen logs and brush, sounding the "Rebel yell,"
+leaping a hedge and alighting in a ten-foot ditch among Federal
+troopers who surrendered to him and his comrades. Yet this is
+history. We could perhaps more easily have recognized him even
+though in a military prison-pen, on finding him dispelling the tedium
+by teaching his fellow prisoners Latin and Greek, or perusing a
+precious volume of Herodotus.</p>
+
+<p>Henry Ebenezer Handerson was born on March 21, 1837, here
+in Cuyahoga county, in the township of Orange, near the point
+now known as "Handerson's Cross-Roads," on the Chagrin river.
+His mother's maiden name was Catharine Potts. His father was
+Thomas Handerson, son of Ira Handerson. The family immigrated
+to Ohio from Columbia county, New York, in 1834. Thos. Handerson
+died as the result of an accident in 1839, leaving the widow with
+five children, the eldest thirteen years of age, to support. Henry
+and a sister were adopted by an uncle, Lewis Handerson, a druggist,
+of Cleveland. In spite of a sickly childhood the boy went to school
+a part of the time and at the age of fourteen was sent to a boarding
+school, Sanger Hall, at New-Hartford, Oneida county, New York.
+Henry's poor health compelled him to withdraw from school. No
+one at that time would have predicted that the delicate youth would
+live to be the sage of four score years and one. With his foster
+father and family he moved to Beersheba Springs, Grundy county, Tennessee.</p>
+
+<p>In 1854, in good health, the boy returned to Cleveland, prepared
+for college, and entered Hobart College, Geneva, New York,
+<span class="pagenum"><a name="page10" id="page10"></a>[pg 10]</span>
+where he graduated as A.B. in 1858. Returning to Tennessee, he
+occupied himself for about a year with surveying land and in other
+work and then became private tutor in the family of Mr. Washington
+Compton on a cotton plantation near Alexandria, Louisiana.
+There he remained a year or more, then in the autumn of 1860
+matriculated in the Medical Department of the University of Louisiana
+(now Tulane University), where he studied through the winter,
+and also heard much of the political oratory of that exciting period.</p>
+
+<p>The bombardment of Fort Sumter, April 12, 1861, followed
+by the call of President Lincoln for 75,000 troops to suppress the
+rebellion, found young Handerson again employed as tutor, this
+time in the family of General G. Mason Graham, a veteran of the Mexican war.</p>
+
+<p>With his friends and acquaintances, Handerson joined a company
+of "homeguards" consisting mostly of planters and their sons,
+formed for the purpose of maintaining "order among the negroes
+and other suspicious characters of the vicinity."</p>
+
+<p>Many years afterward Dr. Handerson wrote, in a narrative for
+his family, concerning this period of his life: "Without any disposition
+to violent partisanship, I had favored the party of which
+the standard-bearers were Bell and Everett and the battle cry 'The
+Constitution and the Union,' and I had grieved sincerely over the
+defeat by the Radicals of the North, aided by the 'fire-eaters' of the South."</p>
+
+<p>And again: "Born and educated in the North, I did not share
+in any degree the fears of the Southerners over the election to the
+Presidency of Mr. Lincoln. I could not but think the action of the
+seceding States unwise and dangerous to their future prosperity.
+On the other hand, this action had already been taken, and without
+any prospect of its revocation. Indeed, in the present frame of
+mind of the North, any steps toward recession seemed likely to precipitate
+the very evils which the secession of the states had been
+designed to anticipate. I believed slavery a disadvantage to the
+South, but no sin, and, in any event, an institution for which the
+Southerners of the present day were not responsible. An inheritance
+from their fore-fathers, properly administered, it was by no means
+an unmitigated evil, and it was one, moreover, in which the North
+but a few years before had shared. All my interests, present and
+future, apparently lay in the South and with Southerners, and if
+the seceding States, in one of which I resided, chose deliberately to
+try the experiment of self-government, I felt quite willing to give
+<span class="pagenum"><a name="page11" id="page11"></a>[pg 11]</span>
+them such aid as lay in my feeble power. When I add to this that
+I was 24 years of age, and naturally affected largely by the ideas,
+the enthusiasm and the excitement of my surroundings, it is easy
+to understand to what conclusions I was led."</p>
+
+<p>So on June 17, 1861, he volunteered in the Stafford Guards
+under Capt. (afterward Brigadier General) L.A. Stafford. The
+Guards became company B of the 9th Regiment of Louisiana Volunteers,
+Confederate States of America, Colonel (later Brigadier
+General) "Dick" Taylor (son of "Old Zach," the President of the
+U.S.), in command. During the year that followed until the close
+of the war, Handerson experienced the adventures and trials of a
+soldier's life. He knew picket, scouting, and skirmishing duty, the
+bivouac, the attack and defense in battle formation, the charge, the
+retreat, hunger and thirst, the wearisome march in heat and dust,
+in cold, in rain, through swamps and stony wildernesses. He was
+shot through the hat and clothing and once through the muscles of
+the shoulder and neck within half inch of the carotid artery, lay in
+a hospital, and had secondary hemorrhage. At another time he
+survived weeks of typhoid fever.</p>
+
+<p>He was successively private soldier and accountant for his
+company, quarter-master, 2nd Lieutenant of the line, Captain of the
+line, and finally Adjutant General of the 2nd Louisiana Brigade,
+A. N. Va., under Lee and Jackson, with rank of Major. On May
+4, 1864, Adjutant General Handerson was taken prisoner, and from
+May 17th until August 20th he was imprisoned at Fort Delaware
+in the Delaware river. He was then confined in a stockade enclosure
+on the beach between Forts Wagner and Gregg on Morris Island,
+until about the end of October, when he was transferred to Fort
+Pulaski at the mouth of the Savannah river, and in March, 1865,
+back to Fort Delaware. In April, after Lee's surrender, many of
+the prisoners were liberated on taking the oath of allegiance to the
+Federal Government. But Handerson did not consider his allegiance
+to the Southern Confederacy ended until after the capture of
+President Davis, and it was not until June 17, 1865, that he signed
+the oath of allegiance and was liberated in Philadelphia.</p>
+
+<p>Since that time, with that spirit of tolerance and openness to
+truth which characterized the man, he has said, "in the triumph of
+the Union, the war ended as it should have ended."</p>
+
+<p>Mr. Handerson then resumed his medical studies, this time in
+the College of Physicians and Surgeons of New York, Medical
+<span class="pagenum"><a name="page12" id="page12"></a>[pg 12]</span>
+Department of Columbia University, taking the degree of M.D. in
+1867. Hobart College conferred the A.M. in 1868. On October
+16, 1872, he married Juliet Alice Root, who died leaving him a daughter.</p>
+
+<p>February 25, 1878, Dr. Handerson read before the Medical
+Society of the County of New York an article entitled, "The School
+of Salernum, an Historical Sketch of Mediæval Medicine." This
+essay attracted wide attention to his scholarly attainments and love
+of laborious research. For example, Professor Edward Schaer of
+the chair of Pharmacology and Pharmaceutical Chemistry, of Neum&#252;nster-Z&#252;rich,
+pronounces this pamphlet "a valuable gift ... a
+remarkable addition to other historical materials ... in connection
+with the history of pharmacy and of pharmaceutical drugs"; that he
+found in it "a great deal of information which will be sought for in
+vain in many even renowned literary works."</p>
+
+<p>Dr. Handerson practiced medicine in New York City, from
+1867 to 1885, removing to Cleveland in 1885.</p>
+
+<p>On June 12, 1888, he married Clara Corlett of Cleveland.</p>
+
+<p>Then in 1889 appeared the American edition of the "History
+of Medicine and the Medical Profession, by Joh. Hermann Baas,
+M.D.," which was translated, revised and enlarged by Dr. Handerson,
+to whom, in the words of Dr. Baas, "we are indebted for considerable
+amplification, particularly in the section on English and
+American medicine, with which he was, of course, better acquainted
+than the author, and for numerous corrections." ... As a matter
+of fact, the learning and judgment, and the conscientious industry
+of the translator and American editor of this work are evident
+throughout the book.</p>
+
+<p>Concerning Dr. Handerson's writings, Dr. Fielding H. Garrison
+writes (Medical Pickwick, March, 1915, P. 118): "The earliest of
+Dr. Handerson's papers recorded in the Index Medicus is 'An unusual
+case of intussusception' (1880). Most of his other medical
+papers, few in number, have dealt with the sanitation, vital statistics,
+diseases and medical history of Cleveland, and have the accuracy
+which characterizes slow and careful work. This is especially
+true of his historical essays of which that on 'The School of Salernum'
+(1883) is a solid piece of original investigation, worthy to be
+placed beside such things as Holmes on homoeopathy, Weir Mitchell
+on instrumental precision, or Kelly on American gynecology.</p>
+
+<p>"To the cognoscenti, Dr. Handerson's translation of 'Baas' History
+of Medicine' (1889) is known as 'Handerson's Book.' He
+<span class="pagenum"><a name="page13" id="page13"></a>[pg 13]</span>
+modestly describes himself as its 'editor,' but he is more than that.
+As the witty and effective translator of a witty and effective work,
+he has added sections in brackets on English and American history
+which are based on original investigation and of permanent value to
+all future historians. Handerson's Baas is thus more complete and
+valuable than the Rhinelander's original text."</p>
+
+<p>As listed in the Index Medicus, the publications and writings of
+Dr. Handerson appear as follows:</p>
+
+<blockquote><p>
+An unusual case of intussusception. Medical Record, 1880, xviii, 698.</p>
+
+<p>The School of Salernum. An historical sketch of mediæval medicine.
+1883.</p>
+
+<p>Outlines of the history of medicine (Baas). Translated, and in conjunction
+with the author, revised and enlarged, 1887.</p>
+
+<p>Clinical history of a case of abdominal cancer. Cleveland Medical
+Gazette, 1891-2, vii, 315-321.</p>
+
+<p>The Sanitary topography of Cleveland. Cleveland Medical Gazette,
+1895-6, xi, 651-659.</p>
+
+<p>Cleveland in the Census Reports. Cleveland Medical Gazette, 1896-7,
+xii, 257-264.</p>
+
+<p>The earliest contribution to medical literature in the United States.
+Janus, 1899, p. 540.</p>
+
+<p>A review of the Vital Statistics of Cleveland during the last decennium.
+Cleveland Medical Journal, 1902, i, 71-76.</p>
+
+<p>Epidemics of typhoid fever in Cleveland. Cleveland Medical Journal,
+1904, iii, 208-210.</p>
+
+<p>The mortality statistics of the twelfth census. Cleveland Medical
+Journal, 1905, iv, 425-431.</p>
+
+<p>Co-operative sanitation. Ohio Medical Journal, 1905, i, 278-281.</p>
+
+<p>The medical code of Hammurabi, King of Babylon. Cleveland Medical
+Journal, 1908, vii, 72-75.</p>
+
+<p>Carcinoma in high life. Cleveland Medical Journal, 1908, vii, 472-476.</p>
+
+<p>Medical Cleveland in the nineteenth (19th) Century. Cleveland Medical
+Journal, 1909, viii, 59, 146, 208.</p>
+
+<p>Gilbert of England and his "Compendium Medicine." Medical Pickwick,
+1915, i, 118-120.
+</p></blockquote>
+
+<p>Dr. Handerson was Professor of Hygiene and Sanitary Science
+in the Medical Department of the University of Wooster, 1894-96,
+and the same in the Cleveland College of Physicians and Surgeons
+(Medical Department of Ohio Wesleyan University), 1896 to 1907,
+and filled that chair with eminent ability. Thus it came about that
+the ex-Confederate officer taught sanitary science in a college standing
+upon ground donated by the survivors of an organization of abolitionists.</p>
+
+<p>Dr. Handerson was a member of the Cuyahoga County Medical
+Society, and its President in 1895; also a member of the Cleveland
+Academy of Medicine, of the Ohio State Medical Society, and of
+<span class="pagenum"><a name="page14" id="page14"></a>[pg 14]</span>
+the American Medical Association. He was one of the founders
+and an active worker in the Cleveland Medical Library Association
+and its President from 1896 to 1902.</p>
+
+<p>He was all his life devoted to the Episcopal Church, was
+Warden of Grace Episcopal Church, Cleveland, for many years, and
+Treasurer of the Diocese of Ohio during fourteen years.</p>
+
+<p>During his later years Dr. Handerson withdrew entirely from
+active practice and spent a great deal of time in his library. His
+papers abound in carefully prepared manuscripts, some of them
+running into hundreds of pages.</p>
+
+<p>Two years before his death Dr. Handerson became totally blind.
+This grievous affliction was borne with unvarying patience and
+cheerfulness. He still loved to recite from memory the classic
+authors, to relate and discuss episodes of world history and events
+of the present, to solve difficult mathematical problems, and to have
+his data on all subjects verified. He retained his faculties perfectly
+until April 23, 1918, when he died from cerebral hemorrhage.</p>
+
+<p>He is survived by a daughter, two sons by the second marriage,
+and his devoted wife.</p>
+
+<p>Among numerous letters received from prominent physicians
+and authors appreciative of Dr. Handerson's medico-historical labors,
+one from Dr. Oliver Wendell Holmes expresses high praise
+and requests to have sent to him everything which Dr. Handerson
+might in future write.</p>
+
+<p>It seems eminently appropriate that the essay on "Gilbertus
+Anglicus." the last from the pen of Dr. Handerson, should be put
+in book form, together with a sketch, however brief, of its author's
+earnest life, his sterling character, his geniality and imperturbable
+equanimity, and thus preserved in testimony of the high esteem in
+which he was held by his contemporaries.</p>
+
+<p class="author">SAMUEL WALTER KELLEY.</p>
+<span class="pagenum"><a name="page15" id="page15"></a>[pg 15]</span>
+
+
+<hr class="memorial" />
+
+
+
+
+<h2>Resolutions</h2>
+
+
+<p>At a meeting of the Council of the Cleveland Medical Library
+Association, held on May 14, the following resolutions were adopted:</p>
+
+<p><i>Resolved</i>, That in the death of Dr. Henry E. Handerson the
+Cleveland Medical Library Association has sustained the loss of
+one of its most honored and devoted members. His scholarly
+acquirements were notable, and his eminence as a medical historian
+generally recognized. His deep interest in the welfare of the
+Library and his thorough attention to every detail of his official
+duties were always evident, while his lovable personal qualities
+endeared him to all.</p>
+
+<p>The Association desires to express its high appreciation of his
+long and valued services, and extends to his bereaved family its
+heartfelt and sincere sympathy.</p>
+
+<p class="author">C.A. HAMANN,<br />
+WM. EVANS BRUNER,<br />
+J.B. McGEE.</p>
+
+
+<hr class="memorial" />
+<span class="pagenum"><a name="page17" id="page17"></a>[pg 17]</span>
+
+
+
+
+<h2>Gilbertus Anglicus (Gilbert of England)</h2>
+
+<h3>A Study of English Medicine in the Thirteenth Century.</h3>
+
+<h3 class="sc">By H.E. Handerson, A.M., M.D.</h3>
+
+<h4>CLEVELAND</h4>
+
+<hr class="short" />
+
+<blockquote><p>
+"Nothing in the past is dead to the man who would learn how the present
+came to be what it is."&mdash;Stubbs&mdash;<i>Constitutional Hist. of England</i>.
+</p></blockquote>
+
+<hr class="short" />
+
+
+<p>Among the literary monuments of early English medicine the
+"Compendium Medicinae" of Gilbertus Anglicus merits a prominent
+position as the earliest complete treatise on general medicine by an
+English author which has been preserved to our day, and equally
+because it forms in itself a very complete mirror of the medical
+science of its age and its country.</p>
+
+<p>Gilbert was undoubtedly one of the most famous physicians of
+his time. His reputation is recognized in those well-known lines of
+Chaucer which catalogue the "authorities" of his Doctor of Phisik:</p>
+
+<div class="poem">  <div class="stanza">
+<p>"Wel knew he the olde Esculapius</p>
+<p>And Deyscorides and eek Rufus,</p>
+<p>Olde Ypocras, Haly and Galyen,</p>
+<p>Serapion, Razis and Avycen,</p>
+<p>Averrois, Damascien and Constantyn,</p>
+<p>Bernard and Gatesden and Gilbertyn."</p>
+  </div>  </div>
+
+<p>He is also quoted with frequency and respect by the medical
+writers of many succeeding ages, and the Compendium, first printed
+in 1510, enjoyed the honor of a second edition as late as the seventeenth
+century (1608). The surname "Anglicus" in itself testifies
+to the European reputation of our author, for as Dr. Payne sensibly
+remarks, no one in England would speak of an English writer as "the Englishman."</p>
+
+<p>Yet, in spite of his reputation, we know almost no details of the
+life of Gilbert, and are forced to content ourselves with the few
+<span class="pagenum"><a name="page18" id="page18"></a>[pg 18]</span>
+facts to be gleaned from the scanty biographies of early writers
+and the inferences drawn from the pages of the Compendium itself.
+The date and place of his birth and death, and even the field of his
+medical activities are equally unknown. Bale, Pits and Leland, the
+earliest English biographers, tell us that Gilbert, after the completion
+of his studies in England, proceeded to the Continent to enlarge his
+education, and finally became physician to the great Justiciar, Hubert
+Walter, archbishop of Canterbury, who died in the year 1205. This
+would place him under the reign of King John, in the early part of
+the thirteenth century.</p>
+
+<p>Dr. John Freind, however, the famous English physician and
+medical historian (1725), observing that Gilbert quotes the Arabian
+philosopher Averro&#235;s (who died in 1198), and believing that he
+also quotes a work of Roger Bacon and the surgical writings of
+Theodorius (Borgognoni) of Cervia (1266), was inclined to fix his
+period in the latter half of the thirteenth century, probably under
+the reign of Edward I. Most of the later historians of medicine
+have followed the views of Freind. Thus Eloy adopts the date
+1272, Sprengel gives 1290, Haeser the same date, Hirsch says Gilbert
+lived towards the close of the thirteenth century, Baas adopts
+the figures 1290, etc.</p>
+
+<p>The most recent biographers of Gilbert, however, Mr. C.L.
+Kingsford<a id="footnotetag1" name="footnotetag1"></a><a href="#footnote1"><sup>1</sup></a>, and the late Dr. Joseph Frank Payne<a id="footnotetag2" name="footnotetag2"></a><a href="#footnote2"><sup>2</sup></a>, after an apparently
+careful and independent investigation of his life, have reached
+conclusions which vary materially from each other and from those
+of the historians mentioned. Mr. Kingsford fixes the date of Gilbert
+at about 1250, while Dr. Payne reverts to the views of Bale
+and Pits and suggests as approximate figures for the birth and
+death of Gilbert the years 1170-80 to 1230. This discrepancy of
+twenty-five or thirty years between the views of two competent and
+unprejudiced investigators, as a mere question of erudition and interpretation,
+is perhaps scarcely worthy of prolonged discussion.
+But as both biographers argue from substantially the same data,
+the arguments reveal so many interesting and pertinent facts, and
+the numerous difficulties attending the interpretation of these facts,
+that some comparison of the different views of the biographers and
+some criticism of their varying conclusions may not be unwelcome.</p>
+<span class="pagenum"><a name="page19" id="page19"></a>[pg 19]</span>
+
+<p>In the first place then we must say that, as Gilbert is frequently
+quoted in the "Thesaurus Pauperum," a work ascribed to Petrus
+Hispanus, who (under the title Pope John XXI) died in 1277, this
+date determines definitely the <i>latest</i> period to which the Compendium
+can be referred. If, as held by some historians, the
+"Thesaurus" is the work of Julian, the father of Petrus, the Compendium
+can be referred to an earlier date only.</p>
+
+<p>Now Gilbert in his Compendium (f. 259a) refers to the writings
+of Averro&#235;s (Ibn Roschd) regarding the color of the iris of
+the eye. Averro&#235;s died in the year 1198. There is no pretense that
+Gilbert was familiar with the Arabic tongue, and the earliest translations
+into Latin of the writings of Averro&#235;s are ascribed by
+Bacon to the famous Michael Scot, though Bacon says they were
+chiefly the work of a certain Jew named Andrew, who made the
+translations for Scot. Bacon also says that these translations were
+made "<i>nostris temporibus</i>," in our time, a loose expression, which
+may, perhaps, be fairly interpreted to include the period 1230-1250.
+But if, as Dr. Payne believes, Gilbert died about 1230, it seems improbable
+that he could have been familiar with the translations of
+Michael Scot. Accordingly Dr. Payne suggests that, after the death
+of his patron in 1205, Gilbert returned to the Continent, and, perhaps
+in Paris or at Montpellier, met with earlier Latin versions of
+the writings of the Arabian physician and philosopher. This is, of
+course, possible, but there is no historical warrant for the hypothesis,
+which must, for the present at least, be regarded as merely a
+happy conjecture of Dr. Payne. The presence of Gilbert upon the
+Continent, probably as a teacher of reputation, seems, however,
+quite probable. Littre has even unearthed the fact that during the
+14th century a street in Paris near the medical schools, bore the
+name of the Rue Gilbert l'Anglois. A MS. in the Bibliotheque
+Nationale entitled "<i>Experimenta Magistri Gilliberti, Cancellarii
+Montepessulani</i>" has suggested also the idea that Gilbert may have
+been at one time chancellor of the University of Montpellier. Dr.
+P. Pansier, of Avignon, however, who has carefully examined and
+published this manuscript<a id="footnotetag3" name="footnotetag3"></a><a href="#footnote3"><sup>3</sup></a>, reports that while it contains some
+formulae found also in the Compendium of Gilbert, it contains
+many others from apparently other sources, and he was unable to
+convince himself that the compilation was in fact the work of Gilbertus
+Anglicus. Dr. Pansier also furnishes us with a list of the
+<span class="pagenum"><a name="page20" id="page20"></a>[pg 20]</span>
+chancellors of Montpellier, which contains the name of a certain
+"Gillibertus," chancellor of the university in 1250. He could find,
+however, no evidence that this Gillibertus was Gilbertus Anglicus,
+author of the Compendium Medicinae. On the whole then the visit
+of Gilbert to France early in the 13th century, and his access in
+this way to early translations of Averro&#235;s, while a convenient and
+plausible conjecture on the part of Dr. Payne, does not seem supported
+by any trustworthy historical evidence.</p>
+
+<p>The "<i>Liber de speculis</i>" mentioned by Gilbert (f. 126 c), and
+since the time of Freind generally accepted as the work of Bacon,
+is almost certainly not from the pen of that eminent philosopher.
+In addition to the fact that Bacon himself says he had (for obvious
+reasons) written nothing except a few tracts (<i>capitula quaedam</i>)
+prior to the composition of his Opus Magnum in 1267, the real
+author of the Liber de speculis is probably mentioned by Bacon in
+the following passage from the Opus Tertium:</p>
+
+<p>"<i>Nam in hoc ostenditur specialiter bonitas naturae, ut dicit
+auctor libri de speculis comburentibus.</i>"<a id="footnotetag4" name="footnotetag4"></a><a href="#footnote4"><sup>4</sup></a></p>
+
+<p>We must therefore agree with Dr. Payne that the <i>Liber de
+speculis</i> of Gilbert was at least not the work of Roger Bacon.</p>
+
+<p>Dr. Freind regards the chapters of Gilbert on the subject of
+leprosy as borrowed substantially from the "Chirurgia" of Theodorius
+of Cervia, who wrote about the year 1266. This view has
+also been generally accepted by later writers. But Dr. Payne boldly
+challenges the view of Freind, declares that Theodorius copied <i>his</i>
+chapters from Gilbert, and asserts that Theodorius was a notorious
+plagiarist. Now, while the bold assertion of Dr. Payne cannot, of
+course, be accepted as <i>proof</i> of Gilbert's precedence in chronological
+order, if that precedence is otherwise established, it will explain the
+similarity of the chapters of the two writers very satisfactorily.
+For the present, however, this similarity can be adduced as evidence
+on neither side.</p>
+
+<p>Again, Gilbert, with the enthusiasm of a loyal pupil, speaks
+(f. 47 b) of a certain Magister Ricardus, "<i>omnium doctorum doctissimus</i>,"
+whose views on uroscopy certainly indicate a mind superior
+to his age. Now there were about this period at least two
+eminent physicians who bore the name of Ricardus. Of these the
+senior, a Frenchman, known also as Ricardus Salednitanus, is highly
+<span class="pagenum"><a name="page21" id="page21"></a>[pg 21]</span>
+praised by Aegidius of Corbeil (Gilles de Corbeil, Aegidius Corboliensis),
+physician to King Philip Augustus of France (1180-1223).
+This Ricardus was a famous teacher at Salernum when
+Aegidius was in attendance at that famous university, therefore
+probably about the close of the 12th century. The second Ricardus,
+called Parisiensis, has been recently identified by Toply with Richard
+of Wendover, an English canon of St. Paul's, and at one time
+physician to Pope Gregory IX, who died in 1241. Toply believes
+him to have been also the author of the "<i>Anatomia Ricardi</i>," recently
+published. This Ricardus died in 1252.</p>
+
+<p>Now to which of these Ricardi does the eulogistic language of
+Gilbert refer? Dr. Payne believes it to be the senior, Ricardus
+Salernitanus. Mr. Kingsford, on the other hand, thinks it to be
+Ricardus Parisiensis, who died in 1252. A <i>Liber de urinis</i> has been
+ascribed to each of them, but, it seems to me, with greater probability
+to Ricardus Salernitanus. If too the author of the "<i>Anatomia
+Ricardi</i>" was a contemporary of Gilbert, we might reasonably expect
+to find in the Compendium some evidences of Gilbert's acquaintance
+with that work. But Gilbert's discussion of anatomical
+questions is totally unlike that of the author of the "<i>Anatomia</i>,"
+and betrays not the slightest evidence of knowledge of such a treatise.
+On the whole then I am inclined to agree in this question
+with Dr. Payne, and to consider the Ricardus of Gilbert identical
+with Ricardus Salernitanus, the famous professor of the School of
+Salernum. This conclusion is further justified by the fact, generally
+accepted by all modern writers, that Gilbert was himself a pupil of Salernum.</p>
+
+<p>Singularly enough, both Dr. Payne and Mr. Kingsford profess
+to find in the Compendium some evidence that Gilbert sojourned in
+Syria for a certain period, though the circumstances of this sojourn
+are viewed differently by the two biographers. Dr. Payne thinks
+that the physician, after completing his education in England, proceeded
+to the Continent and extended his travels as far as Syrian
+Tripoli, where he met Archbishop Walter and became attached to
+his staff. As the prelate returned to England in 1192, this sojourn
+of Gilbert in Syria must have been about 1190-91, when, according
+to Dr. Payne's chronology, Gilbert could have been not more than
+about twenty years of age. Dr. Payne bases his story upon a certain
+passage in the Compendium, in which Gilbert says that he met
+in Syrian Tripoli "a <i>canonicus</i> suffering from rheumatic symptoms."
+<span class="pagenum"><a name="page22" id="page22"></a>[pg 22]</span>
+I have been entirely unable to find the passage referred to in this
+story, in spite of a careful search of the text of the edition of 1510.
+But, admitting the existence of the passage in question, it proves
+nothing as to the <i>date</i> of this alleged Syrian sojourn. Tripoli was
+captured by the Crusaders in 1109, and continued under their control
+until its recapture by the Saracens in 1289, a period of nearly
+two hundred years. Gilbert's travels in Syria may then have occurred
+at almost any time during this long period, and his fortuitous
+meeting with Archbishop Walter has very much the appearance of
+a story evolved entirely from the consciousness of the biographer.</p>
+
+<p>On the other hand, Mr. Kingsford bases his theory of Gilbert's
+sojourn in Syria upon a story adopted, I think, from Littr&#233; and
+found in the Histoire lit&#233;raire de la France. The Compendium
+of Gilbert contains (f. 137a) a chapter giving the composition of a
+complex collyrium with which he professes to have cured the almost
+total blindness of Bertram, son of Hugo de Jubilet, after the disease
+had baffled the skill of the Saracen and Christian-Syrian physicians
+of his day. Now Littr&#233; avers that a certain Hugo de Jubilet was
+involved in an ambuscade in Syria in the year 1227, and that he
+had a son named Bertram. It is very natural, of course, to conclude
+that this Bertram was the patient recorded in the book of
+Gilbert. Kingsford says that Gilbert "met" Bertram in Syria, but
+the text of the Compendium says nothing of the locality of their
+meeting, which might have taken place almost anywhere in Europe,
+perhaps even at Salernum, a favorite resort of the invalided Crusaders
+in these times. Finally, Dr. Payne disposes effectually of the
+authenticity of the entire story by calling attention to the fact that
+the chapter referred to in the Compendium is marked plainly
+"<i>Additio</i>," without indicating whether this addition is from the pen
+of Gilbert or some later glossator.</p>
+
+<p>Finally, I may suggest another line of argument, which, so far
+as I know, has not yet been advanced for the determination of the
+period of Gilbert.</p>
+
+<p>The Compendium Medicinae of Gilbert is, of course, a compendium
+of internal medicine. But the book is also something more.
+Not less than fifty chapters are devoted to a comparatively full discussion
+of wounds, fractures and dislocations, lithotomy, herniotomy,
+fistulae and the various diseases on the border line between
+medicine and surgery. Not a single surgical writer, however, is
+quoted by name. Nevertheless the major part of these surgical
+<span class="pagenum"><a name="page23" id="page23"></a>[pg 23]</span>
+chapters are either literal copies, or very close paraphrases, of the
+similar chapters of the "<i>Chirurgia</i>" of Roger of Parma, a distinguished
+professor in Salernum and the pioneer of modern surgery.
+The precise period of Roger is not definitely settled by the unanimous
+agreement of modern historians, but in the "<i>Epilogus</i>" of
+the "<i>Glosulae Quatuor Magistrorum</i>" it is said that Roger's "<i>Chirurgia</i>"
+was "<i>in lucem et ordinem redactum</i>" by Guido Arietinus,
+in the year of our Lord 1230. This date, while perhaps not unquestionable,
+is also adopted by De Renzi, the Italian historian of
+Medicine. The original MS. of Roger's work is said to be still in
+existence in the Magliabechian Library in Florence, but it has never
+been published in its original form.<a id="footnotetag5" name="footnotetag5"></a><a href="#footnote5"><sup>5</sup></a> Roland of Parma, however,
+a pupil of Roger, published in 1264 what purports to be a copy of
+Roger's "<i>Chirurgia</i>" with some notes and additions of his own, and
+it is from this MS. of Roland that all our copies of Roger's work
+have been printed. Roger's "<i>Chirurgia</i>" was popularly known as
+the "<i>Rogerina</i>;" the edition of Roland as the "<i>Rolandina</i>." They
+are frequently confounded, but are not identical, though the additions
+of Roland are usually regarded as of little importance. In the
+absence of Roger's manuscript, however, they lead often to considerable
+confusion, as it is not always easy to determine in the printed
+copies of the "<i>Rolandina</i>" just what belongs to Roger and what to
+his pupil and editor. Now a careful comparison of the surgical
+chapters of Gilbert of England with the published text of the
+"<i>Rolandina</i>" leads me to the conviction that Gilbert had before him
+<span class="pagenum"><a name="page24" id="page24"></a>[pg 24]</span>
+the text of Roger, rather than that of Roland, his pupil. If such
+is the fact, Gilbert's Compendium must have been written between
+1230 and 1264, the dates respectively of the "<i>Rogerina</i>" and
+"<i>Rolandina</i>."</p>
+
+<p>From a careful review of the data thus presented we may epitomize,
+somewhat conjecturally, the life of Gilbert substantially as
+follows: He was probably born about 1180 and received his early
+education in England. On the completion of this education, about
+the close of the 12th century, he proceeded to the Continent to complete
+his studies, and spent some time in the school of Salernum,
+where it is probable that he enjoyed the instruction of Roger of
+Parma, Ricardus Salernitanus, and may have had among his fellow-students
+Aegidius of Corbeil. Probably after his return to England
+he served for a brief period on the staff of Archbishop Hubert
+Walter, after whose death in 1205, but at an unknown period, Gilbert
+returned once more to the Continent, where it seems probable
+he spent the remainder of his life. This comports best with his
+extensive European reputation, his surname "Anglicus" and the
+comparative dearth in England of any facts relating to his life.
+The date of the Compendium I am inclined to place about 1240,
+prior to the literary activity of Ricardus Parisiensis or Richard of
+Wendover, Roland of Parma, Roger Bacon and Theodorius of
+Cervia. We may place his death, conjecturally, at about 1250.</p>
+
+<p>The first edition of the Compendium is a small quarto of 362
+folios (724 modern pages), five by seven inches in size, printed in
+double narrow columns, in black letter, perfectly legible and clear.
+The pagination shows some errors, but the text itself is remarkably
+accurate, though the presence of a multiplicity of contractions and
+ligatures renders the reading somewhat difficult to the modern student.
+On the last page we find the following colophon:</p>
+
+<p><i>Explicit compendium medicine Gilberti Anglici correctum et
+bene emendatum per dominum Michaelem de Capella artium et
+medicine doctorem: ac Lugduni Impressum per Jacobum Saccon:
+expensis Vincentii de Portonariis. Anno Domini M.D.x. die vero
+vigesima mensis Novembris.</i></p>
+
+<center><i>Deo Gratias.</i></center>
+
+<p>The second edition (which I have not seen) is said to bear the
+title: "Laurea anglicana, sive compendium totius medicinae, etc," Geneva, 1608.</p>
+<span class="pagenum"><a name="page25" id="page25"></a>[pg 25]</span>
+
+<p>It should be noticed that the title "Laurea anglicana" is not
+mentioned in the original edition of 1510, but is apparently due to
+the exuberance of enthusiasm of the editor of the later edition,
+whose taste seems to have been more flamboyant.</p>
+
+<p>Various manuscript works of greater or less authenticity are
+ascribed to Gilbert by different authorities. Of these Mr. Kingsford
+furnishes the following list:</p>
+
+<div class="poem">  <div class="stanza">
+<p>1. "Commentarii in Versus Aegidii de Urinis," quoted by John Gaddesden and probably authentic.</p>
+  </div><div class="stanza">
+<p>2. "Practica Medicinae," mentioned by Pits, but of doubtful authenticity.</p>
+  </div><div class="stanza">
+<p>3. "Experimenta Magistri Gilliberti, Cancellarii Montepessulani," noticed on page 2, but authenticity doubtful.</p>
+  </div><div class="stanza">
+<p>4. "Compendium super Librum Aphorismorum Hippocratis."</p>
+<p>MS. in Bodleian.</p>
+  </div><div class="stanza">
+<p>5. "Eorundem Expositio." MS. in Bodleian.</p>
+  </div><div class="stanza">
+<p>6. "Antidotarium." MS. in Caius College.</p>
+  </div>  </div>
+
+<p>To these he adds, on the authority of Bale and Pits:</p>
+
+<div class="poem">  <div class="stanza">
+<p>7. "De Viribus Aquarum et Specierum."</p>
+  </div><div class="stanza">
+<p>8. "De Proportione Fistularum."</p>
+  </div><div class="stanza">
+<p>9. "De Judicio Patientis."</p>
+  </div><div class="stanza">
+<p>10. "De Re Herbaria."</p>
+  </div><div class="stanza">
+<p>11. "De Tuenda Valentudine."</p>
+  </div><div class="stanza">
+<p>12. "De Particularibus Morbis."</p>
+  </div><div class="stanza">
+<p>13. "Thesaurus Pauperum."</p>
+  </div>  </div>
+
+<p>All of these latter may be regarded as doubtful.</p>
+
+<p>The authorities named by Gilbert are Pythagoras, Hippocrates,
+Plato, Aristotle, Galen, Rufus, Maerobius, Boetius, Alexander of
+Tralles, Theodorus Priscianus, Theophilus Philaretes, Stephanon
+(of Athens?), the Arabians Haly Abbas, Rhazes, Isaac Judaeus,
+Joannitius, Janus Damascenus, Jacobus Alucindi, Avicenna and
+Averro&#235;s; the Salernian writers, quoted generally as Salernitani
+and specifically Constantino Africanus, Nicholas Praepositus,
+Romoaldus Ricardus and Maurus, and two otherwise unknown
+authors, Torror and Funcius, classed by Gilbert as "<i>antiqui</i>." The
+latter author is also said to have written a "<i>Liber de lapidibus</i>."
+Certainly this list suggests a pretty good medical library for a practitioner
+of the 13th century.</p>
+<span class="pagenum"><a name="page26" id="page26"></a>[pg 26]</span>
+
+<p>Dr. Payne calls attention to the fact that all these writers antedate
+the 13th century, and thus limit the period of Gilbert in antiquity.
+This is undoubtedly true with reference to authorities
+actually named, but does not exclude from consideration other
+writers quoted, but not named, whom we shall have occasion to refer
+to hereafter.</p>
+
+<p>The Compendium opens with a very brief and modest foreword,
+couched in the following terms:</p>
+
+<p>"<i>Incipit liber morborum tam universalium quam particularium
+a magistro Gilberto anglico editus ab omnibus autoribus et practicis
+magistrorum extractus et exceptus, qui compendium medicine intitulatur.</i>"</p>
+
+<p>It will be observed that no claim whatever for originality is
+presented by the author. He calls his book a compendium extracted
+from all authors and the practice of the professors, and edited only
+by himself. The same idea is more fully emphasized later (f. 55c),
+where he says:</p>
+
+<p>"<i>Sed consuetudo nostra est ex dictis meliorum meliora aggregare,
+et ubi dubitatio est, opiniones diversas interserere; ut quisque
+sibi eligat quam velit retinere.</i>"</p>
+
+<p>The self-abnegation implied in these extracts must not, however,
+be interpreted too literally, for the editorial "<i>dico</i>" on numerous
+pages, and even an occasional chapter marked "<i>Propria opinio</i>,"
+testify to the fact that Gilbert had opinions of his own, and was
+ready on occasion to furnish them to the profession. On the
+whole, however, the "Compendium" is properly classified by the
+author as a compilation, rather than an original work.</p>
+
+<p>The Compendium is divided into seven books, and the general
+classification of diseases is from head to foot&mdash;the usual method of
+that day. The modern reader will probably be surprised at the
+comprehensiveness of the work, which, besides general diseases,
+includes considerable portions of physiology, physiognomy, ophthalmology,
+laryngology, otology, gynecology, neurology, dermatology,
+embryology, obstetrics, dietetics, urinary and venereal diseases,
+therapeutics, toxicology, operative surgery, cosmetics and even the
+hygiene of travel and the prevention of sea-sickness. Some of these
+subjects too are discussed with an acuteness and a common sense
+quite unexpected. Of course, scholastic speculations, superstition,
+charms, polypharmacy and the use of popular and disgusting remedies
+<span class="pagenum"><a name="page27" id="page27"></a>[pg 27]</span>
+are not wanting. Even the mind of a philosopher like Roger
+Bacon was unable to rise entirely above the superstition of his age.
+But the charms and popular specifics of Gilbert are often introduced
+with a sort of apology, implying his slight belief in their efficacy.
+Thus in his chapter on the general treatment of wounds (f. 87a)
+he introduces a popular charm with the following words:</p>
+
+<p>"<i>Alio modo, solo divino carmine confisi, quidam experti posse
+curari omnes plagas hoc.</i></p>
+
+<center>"<i>Carmine.</i></center>
+
+<p>"<i>Tres boni fratres per viam unam ibant, et obviavit eis noster
+dominus jesus christus et dixit eis, tres boni fratres quo itis</i>, etc."</p>
+
+<p>And again, in his discussion of the treatment of gout and
+rheumatism (f. 327b), Gilbert adds, under the title</p>
+
+<center><i>Emperica</i></center>
+
+<p>"<i>Quamvis ego declino ad has res parum, tamen est bonum
+scribere in libro nostro, ut non remaneat tractatus sine eis quas
+dixrunt antiqui. Dico igitur quod dixit torror: Si scinderis pedem
+rane viridis et ligaveris supra pendem podagrici per tres dies, curatur;
+ita quod dextrum pedum rane ponas supra dextrum pedem patientis,
+et e converso. Et dixit Funcius, qui composuit librum de lapidibus,
+quod magnes, si ligatus fuerit in pedem podagrici, curatur. Et
+alius philosophus dixit. Si accipiatur calcancus asine et ponatur
+ligatus supra pedem egri, curatur, ita quod dexter supra dextrum,
+et e converso. Et juravit quod sit verum. Et dixit torror quod si
+ponatur pes testudinis dexter supra dextrum pedem podagrici, et e
+converso, curatur.</i>"</p>
+
+<p>We may believe, indeed, that Gilbert would have preferred to
+follow in the therapeutic footsteps of Hippocrates, had he not disliked
+to be regarded by his colleagues as eccentric and opinionated.
+For he says in his treatment of thoracic diseases (f. 193c):</p>
+
+<p>"<i>Etenim eleganter dedit Ipo. (Hippocrates) modum curationis,
+sed ne a medicis nostri temporis videamur dissidere, secundum eos
+curam assignemus.</i>"</p>
+
+<p>Gilbert was a scholastic-humoralistic physician <i>par excellence</i>,
+delighting in superfine distinctions and hair-splitting definitions, and
+deriving even pediculi from a superfluity of the humors (f. 81d).
+Of course he was also a polypharmacist, and the complexity, ingenuity,
+and comprehensiveness of his prescriptions would put to
+shame even the "accomplished therapeutist" of these modern days.
+<span class="pagenum"><a name="page28" id="page28"></a>[pg 28]</span>
+In dietetics too Gilbert was careful and intelligent, and upon this
+branch of therapeutics he justly laid great emphasis.</p>
+
+<p>The first book of the Compendium, comprising no less than 75
+folios, is devoted entirely to the discussion of fevers. Beginning
+with the definition of Joannicius (Honain ebn Ishak):</p>
+
+<p>"Fever is a heat unnatural and surpassing the course of nature,
+proceeding from the heart into the arteries and injuring the patient
+by its effects."</p>
+
+<p>Gilbert launches out with genuine scholastic finesse and verbosity
+into a discussion of the questions whether this definition is
+based upon the essentia or the differentia of fever; whether the
+heat of fever is natural or unnatural, and other similar subtle speculations,
+and finally arrives at a classification of fevers so elaborate
+and complex as to be practically almost unintelligible to the modern reader.</p>
+
+<p>The more important of these fevers or febrile conditions are:</p>
+
+<div class="poem">  <div class="stanza">
+<p>Ephemeral</p>
+<p>Hemitertian</p>
+<p>Double quartan</p>
+<p>Interpolated</p>
+<p>Synocha</p>
+<p>Causon synochides</p>
+<p>Epilala</p>
+<p>Quotidian</p>
+<p>Double tertian</p>
+<p>Quintan</p>
+<p>Continued</p>
+<p>Causon</p>
+<p>Putrid</p>
+<p>Lipparia</p>
+<p>Tertian</p>
+<p>Quartan</p>
+<p>Sextan</p>
+<p>Synochus</p>
+<p>Synochus causonides</p>
+<p>Ethica</p>
+<p>Erratica</p>
+  </div>  </div>
+
+<p>Some of these names are still preserved in our nosologies of
+the present day; others will be recalled by the memories of our
+older physicians, and a few have totally disappeared from our
+modern medical nomenclature.</p>
+
+<p>Interpolated fevers are characterized by intermissions and remissions,
+and thus include our intermittent and remittent fevers;
+synochus depended theoretically upon putrefaction of the blood in
+the vessels, and was a continued fever. Synocha, on the other hand,
+was occasioned by a mere superabundance of hot blood, hence the verse:</p>
+
+<center>"<i>Synocha de multo, sed synochus de putrefacto.</i>"</center>
+
+<p>Causon was due to putrefaction of bile in the smaller vessels
+of the heart, diaphragm, stomach or liver, and was an acute fever
+characterized by furred tongue, intolerable frontal headache, tinnitus
+aurium, constant thirst, delirium, an olive-colored face, redness and
+<span class="pagenum"><a name="page29" id="page29"></a>[pg 29]</span>
+twitching of the eyes and a full, frequent and rapid pulse. Epiala
+and lipparia were febrile conditions concerning which there seems
+to have been much difference of opinion, even in the days of Gilbert.
+Apparently they were distinguished by variations of external and
+internal temperature, or by chills combined with fever. Febris
+ethica is our modern hectic fever. In the discussion of this last
+variety we are introduced to the "<i>ros</i>" and "<i>cambium</i>" of Avicenna,
+apparently varieties of hypothetical humors.</p>
+
+<p>All these fevers are regarded from the standpoint of Humoralism,
+and depend upon variations in the quantity, quality, mixture or
+location of the four humors, blood, phlegm, bile and black-bile
+(<i>melancholia</i>).</p>
+
+<p>In the general treatment of febrile diseases, so-called preparatives
+and digestives are first employed to ripen the humors, after
+which evacuatives (emetics, cathartics, sudorifics, and occasionally
+even venesection) are utilized for the discharge of these peccant
+humors. Much emphasis is laid upon the dietetics of fevers, and
+this branch of treatment is highly elaborated. Complications are
+met by more or less appropriate treatment, and the condition of the
+urine is studied with great diligence. Venesection is recommended
+rather sparingly, and is never to be employed during the <i>dies caniculares</i>
+(dog-days) or <i>dies Aegyptiaci</i>, nor during conjunctions of the
+moon and planets, nor upon the 5th, 15th, 17th, 25th, 26th, or 27th
+days thereafter, etc.</p>
+
+<p>Among the complications of fevers discussed by Gilbert, two
+seem sufficiently important to justify special attention. On folio
+74b we find a section entitled "<i>De fluxu materie per parotidas
+venas</i>," in which he remarks that "Sometimes matter flows through
+the parotid veins behind the ears down to the neck and nares, and
+obstructs the passages for air, food and drink, so as to threaten
+suffocation." He cautions us against the use of repressives, "lest
+the matter may run to the heart," and recommends mollitives and
+dissolvents, such as butter, dyaltea, hyssop and especially newly
+shorn wool (<i>lana succida</i>), which, he says, is a strong solvent. Is
+this a reference to the septic parotitis not unfrequently seen in low fevers?</p>
+
+<p>The following section, "<i>De inflatione vesice et dolore ejus</i>,"
+discusses the retention of urine in fevers, and its treatment. Gilbert
+says: "Inflation of, and pain in the bladder are sometimes symptoms
+of acute fevers, since the humors descend into and fill the
+<span class="pagenum"><a name="page30" id="page30"></a>[pg 30]</span>
+bladder." If this occurs in an interpolated (remittent) fever, he
+directs the patient to be placed in a bath of a decoction of pellitory
+up to the umbilicus, "<i>et effundet urinam</i>." If the complication occurs
+in one suffering from a continued fever, the bath should be
+made of wormwood and a poultice should be placed over the bladder
+and genitals, "<i>et statim minget</i>." The same effect may be produced
+by poultice mixed with levisticum (lovage) or leaves of
+parsley. Singularly enough the catheter is not mentioned, though
+this instrument, under the medieval name of <i>argalia</i> (cf. French
+algalie), is noticed frequently in the section devoted to vesical calculus.</p>
+
+<p>With the second book of the Compendium the system of the
+discussion of diseases <i>a capite ad pedes</i> is commenced, and produces
+some curious associates. To the modern physician the sudden transition
+from diseases of the scalp to fractures of the cranium seems
+at least abrupt, if not illogical. It seems, therefore, wiser, in a hasty
+review like the present, to take up the various pathological conditions
+described by Gilbert in their modern order and relations, and
+to thus facilitate the orientation of the reader.</p>
+
+<p>The second book then opens with a consideration of the hair
+and scalp, and their respective disorders.</p>
+
+<p>The hair is a dry fume (<i>fumus siccus</i>), escaping from the body
+through the pores of the scalp and condensed by contact with the
+air into long, round cylinders. It increases rather by accretion than
+by internal growth, and its color depends upon the humors. Thus
+red hair arises from unconsumed blood or bile; white hair, from an
+excess of phlegm; black hair, from the abundance of black-bile
+(<i>melancholia</i>), etc. The use of the hair is for ornament, for protection
+and for the distinction of the sexes. Numerous prescriptions
+for dyeing the hair, for depilatories (<i>psilothra</i>), for the removal
+of misplaced hair and for the destruction of vermin in the
+hair are carefully recorded.</p>
+
+<p>Three varieties of soaps for medicinal use are described, and
+the process of their manufacture indicated. The base of each is a
+lixivium made from two parts of the ashes of burned bean-stalks
+and one of unslaked lime, mixed with water and strained. Of this
+base (<i>capitellum</i>), two parts mixed with one part of olive oil form
+the <i>sapo saracenicus</i>. In the <i>sapo gallicus</i> the base is made with
+the ashes of chaff and bean-stalks with lime, and to it is added
+goat's fat, in place of the oil. The <i>sapo spatareuticus</i> is made in
+<span class="pagenum"><a name="page31" id="page31"></a>[pg 31]</span>
+a similar manner, except that oil replaces the goat's fat and the
+soap is made only during the dog days, since the necessary heat is
+to be supplied by the sun alone.</p>
+
+<p>Among the diseases of the scalp attention is given to alopecia,
+dandruff (<i>furfur</i>), tinea caries and various pustular affections,
+fanus (favus), rima, spidecia, achora, etc. Caries was a pustular
+disease, in which bristle-like hairs formed a prominent feature.
+Rima was a name applied by the physicians of Salernum to a superfluity
+of hair. In addition to these diseases of the scalp, we find
+also descriptions of gutta rosacea, morphoea and scabies, a fairly
+extensive dermatology for this early day. In favus, Gilbert tells us
+that, after the removal of the pustules, there remain foramina, from
+which exudes a poisonous substance, resembling honey. Of course
+his system of treatment is rich in variety and comprehensiveness.</p>
+
+<p>We may notice here too a few chapters on Toilet or Decorative
+Medicine, a branch of art to which modern physicians have devoted
+perhaps too little attention, with the natural result that it has
+fallen largely into the hands of charlatans of both sexes. Gilbert's
+chapter "<i>De ornatu capillorum</i>" offers the following sensible introduction:
+"The adornment of the hair affords to women the important
+advantages of beauty and convenience; and as women desire
+to please their husbands, they devote themselves to adornment
+and protect themselves from the charge of carelessness. In order,
+therefore, that our ministry may not be depreciated, and that we
+may not render ourselves liable to the accusation of ignorance, let
+us add a few words on the subject of the dressing of the hair and
+the general care of the person".</p>
+
+<p>Accordingly Gilbert advises ladies who desire to retain or renew
+the charms of youth to soften the skin and open its pores by the
+use of steam baths and careful washing in warm water, followed
+by drying the surface with the finest cloths (<i>panno mundissimo</i>).
+If necessary, superfluous hair is to be removed by suitable depilatories,
+color to be restored to the pale cheeks by a lotion of chips
+of Brazil-wood<a id="footnotetag6" name="footnotetag6"></a><a href="#footnote6"><sup>6</sup></a> soaked in rose-water and applied with pads of
+cotton; or, if the face is too red, it may be blanched by the root
+of the cyclamen (<i>panis porcinus</i>, sowbread) dried in an oven and
+powdered. A wealth of remedies for freckles, moles, warts, wrinkles,
+<span class="pagenum"><a name="page32" id="page32"></a>[pg 32]</span>
+discolorations and other facial blemishes, with foul breath
+and fetidity of the armpits, is carefully recorded, and would suffice
+to establish the fortune of any of our modern specialists in female
+beauty. Finally a long chapter entitled "<i>De sophisticatione vulvae</i>"
+introduces us to a phase of decoration and sophistication which I
+would fain believe little known or studied in the development of
+modern civilization, in which we are prone at least to follow the
+advice of Hamlet, to</p>
+
+<div class="poem">  <div class="stanza">
+<p>"Assume a virtue, if you have it not."</p>
+  </div>  </div>
+
+<p>At all events, we may congratulate ourselves that the details of these
+disgusting cess-pools of medical art have disappeared entirely from
+the pages of our modern text-books. Even Gilbert considers it advisable
+to preface this gruesome chapter with a sort of "<i>Caveat
+emptor</i>" apology to the reader:</p>
+
+<p>"<i>Ut tamen secundum ordinem procedamus, in primis cognosactur
+cognoscere desiderantibus, ne dolus dolo patrocinetur, vel
+simplex dolose muscipula claudatur.</i>"</p>
+
+<p>In the department of neurology Gilbert, after a philosophical
+discussion of the nature and variety of pain, devotes considerable
+chapters to the causes, symptoms, diagnosis and treatment of headache,
+hemicrania, epilepsy, catalepsy, analepsy, cerebral congestion,
+apoplexy and paralysis, phrenitis, mania and melancholia, incubus
+or nightmare, lethargy and stupor, lippothomia or syncope, sciatica,
+spasm, tremor, tetanus, vertigo, wakefulness, and jectigation (jactitation,
+formication, twitching).</p>
+
+<p>The third book of the Compendium opens with several chapters
+on the anatomy and physiology of the eye and the phenomena
+of vision. According to Gilbert, the eye consists of three humors,
+the albugineous (aqueous), the crystalline lens and the vitreous
+humor, and seven tunics, apparently</p>
+
+<div class="poem">  <div class="stanza">
+<p>1. The conjunctiva</p>
+<p>2. The albuginea or sclerotic</p>
+<p>3. The cornea</p>
+<p>4. The secundina (choroid)</p>
+<p>5. The rethilea (retina)</p>
+<p>6. The aranea (iris)</p>
+<p>7. The uvea perforata (posterior layer of iris),</p>
+  </div>  </div>
+
+<p>though the definitions are not in all cases quite clear and definite.
+The tela aranea is said to take its origin from the retina, the retina
+<span class="pagenum"><a name="page33" id="page33"></a>[pg 33]</span>
+from the optic nerve, and the latter from the rethi (rete, network)
+involving the substance of the brain. The cornea arises from the
+sclerotic tunic, the uvea and secundina take their origin from the pia
+mater, and the conjunctiva from a thin pellicle or membrane which
+covers the exterior of the cranium and is nourished by a transudation
+of the blood through the coronal suture. This pellicle is also
+said to have a connection with the heart, which arrangement furnishes
+a decidedly curious explanation of the mechanism of sympathetic
+and maudlin lachrymation. For, as Gilbert tells us, when the
+heart is compressed this pellicle is also compressed, and if any moisture
+is found beneath the pellicle it is expressed into the substance
+of the lachrymal gland by the constriction of the heart, and men in
+sorrow therefore shed tears. And again, if the heart is much dilated
+or elevated (by joy), this pellicle is also dilated or elevated, and if
+any moisture is found beneath it, it is expressed in the form of
+tears. Accordingly, men who are too joyful shed tears. Still
+further, drunken men, who are notoriously "moist," and
+have a superfluity of fluid between the pellicle and the skin of
+the cranium, are prone to weeping on slight provocation, and their
+tears are nothing more than an expression of this moisture, which
+makes its exit, not through the substance of the eye, but through the
+"lachrymal angle." Q.E.D.</p>
+
+<p>This odd demonstration is followed by a succession of optical
+questions, which are discussed and answered in true scholastic style,
+with no little acuteness of observation. Thus: "<i>Utrum visus fiat
+intus suscipiendo?</i>" Is vision accomplished by something received
+into the eye? "<i>Utrum color fit de nocte?</i>" Does color exist at
+night? To the latter question Gilbert replies that in the darkness
+color exists in posse, but not in esse. Again: "Why do some animals
+see at night, some in the day only and some only in the twilight?"
+This phenomenon he ascribes to "the clearness and subtilty
+of the visual spirits, or to the strength, weakness, grossness or
+turbidity of the organs of vision." Some animals, he says, have
+(visual) spirits, subtle and clear as fire, and these animals see perfectly
+at night because the visual spirits (<i>spiritus visibilis</i>) are sufficient
+to illuminate the external air. "Why do objects in water
+seem nearer than those in air?" Gilbert explains this as follows:
+"Nothing appears distant, except as perceived through an extensive
+intervening medium. But our judgment is largely guided by the
+transparency of this medium, since the medium itself is not perceived
+<span class="pagenum"><a name="page34" id="page34"></a>[pg 34]</span>
+with much accuracy, except when it is transparent. Accordingly,
+as the lucidity of air is greater than that of water, an object
+looks more distant through air than through water."</p>
+
+<p>"Why does not a single object appear double, inasmuch as we
+have two eyes?" To this he replies: "From the anterior part of
+the brain two optic nerves pass to the two eyes. But these two
+nerves unite at a certain point into one. Now, since the two nerves
+are of equal length, two images proceeding from a single object do
+not make the object seem double, but single, since the two images
+are united into one, and accordingly one object is seen as one image."</p>
+
+<p>Other physiological speculations are introduced by the questions:
+"May one see an object not actually present?" "Why do
+some animals see best objects at a distance, others those near at
+hand?" "Why are objects seen in their proper position?" All
+these questions are answered in accordance with the scholastic
+formulae, and, not infrequently, with considerable acuteness.</p>
+
+<p>A chapter entitled "<i>De signis oculorum</i>" also introduces us to a
+curious discussion of ocular physiognomy. Thus:</p>
+
+<p>"When we see a man with large eyes, we argue that he is indolent."</p>
+
+<p>"If his eyes are deeply situated in his head, we say that he is
+crafty and a deceiver."</p>
+
+<p>"If his eyes are prominent, we say that he is immodest, loquacious and stupid."</p>
+
+<p>"He whose eyes are mobile and sharp is a deceiver, crafty and a thief."</p>
+
+<p>"He whose eyes are large and tremulous is lazy and a braggart
+(<i>spaciosus?</i>), and fond of women."</p>
+
+<p>and so forth for an entire page of the Compendium.</p>
+
+<p>Actual diseases of the eye are discussed in chapters on pain in
+the eyes, ophthalmia, pannus (including ungula, egilops and cataract),
+tumors of the conjunctiva, itching of the eyes, lachrymation,
+cancer, diseases of the cornea and uvea, diseases of the eyelids,
+lachrymal fistula and entropion. The treatment consists generally
+in ointments and collyria in abundance, but in fistula lachrymalis
+incision and tents of alder-pith, mandragora (<i>malum terrae</i>), briony,
+gentian, etc., are recommended, and entropion is referred directly
+to the surgeon.</p>
+<span class="pagenum"><a name="page35" id="page35"></a>[pg 35]</span>
+
+<blockquote><p>
+The Latin term cataracta (also catarracta and catarractes) is applied to
+a disease of the eyes by Gregory of Tours (Hist. Franc., v. 6) as early as
+A.D. 650, and again by Constantine Africanus, of the school of Salernum,
+in 1075 (De Chirurg., cap. XXX). Singularly the word is not found in the
+"Chirurgia" of Roger of Parma, from whom Gilbert seems to have borrowed
+most of his surgical knowledge. Nor is it employed by Roland, Roger's
+pupil and editor. It recurs, however, in the <i>Glossulae Quatuor Magistrorum</i>
+(about 1270). But in all these writers cataracta seems to be included under
+the general term pannus, meaning opacities of every kind. Indeed Gilbert
+says, "Ungula, egilops, cataracta and macula are species of pannus, all arising
+from the same causes and cured by the same treatment." A few lines later,
+however, in distinguishing these various species, he adds: "Cataract arises
+from a humor collected between the tunics of the eye": and again it is said
+to be blood filling the veins of the eyes, and especially those of the conjunctiva,
+and derives its name <i>a caracteribus</i> (?). The truth is none of these
+writers seem to have any very definite knowledge of the distinction between
+the various opacities of the media of the eye, all of which were included
+under the general term pannus. But, what is more remarkable, Roger, Roland
+and The Four Masters make no mention of the possibility of surgical interference
+in these cases, but content themselves with elaborate collyria and
+ointments, or simply with internal treatment. Gilbert, on the other hand,
+while recommending these collyria and ointments, and even the internal
+remedies, adds the following:</p>
+
+<p>"<i>Interior autem macula, quae tela vocatur, subcornea situata, si vl'e (?)
+purgatione precendente et colliriis et pulveribus non removetur, acu torta
+immissa per caprinum angulum extrahatur aut inferius replicetur</i>" (f. 137a).</p>
+
+<p>And again (f. 141d):</p>
+
+<p>"<i>In uvea sunt largitas et constrictio et aqua sive cataracta.... Aqua
+quandoque per medium pupille descendit, inferius stans, subuvea apparens,
+quae perfecte curatur secundum quosdam immisso acus aculeo per pupillam,
+ut extra fluat aqua.</i>"
+</p></blockquote>
+
+<p>Chapters on the physiology of hearing, smelling and the sensation
+of touch are followed by a discussion of the symptoms and
+treatment of earache, abscess of the ear, discharges (bloody and
+sanious) from the ear, worms and other foreign bodies in the ear,
+tinnitus aurium, deafness, coryza, epistaxis, nasal polypi, ozaena,
+cancer of the nose, fissures and ulcers of the lips, foul breath, diseases
+of the tongue, toothache, etc.</p>
+
+<p>Physiognomy, a favorite theme with our author, appears again
+in a considerable chapter on the physiognomy of the nose, mouth,
+face and the teeth.</p>
+
+<p>"He who laughs frequently is kind and genial in all things and
+is not worried over trifles."</p>
+
+<p>"He who laughs rarely is contrary and critical."</p>
+
+<p>"He who has large ears is stolid and long-lived."</p>
+
+<p>"He who has a large mouth is gluttonous and daring."</p>
+
+<p>"He whose teeth are defective and small is weak in his whole body."</p>
+<span class="pagenum"><a name="page36" id="page36"></a>[pg 36]</span>
+
+<p>"He whose canine teeth are long and straight is a glutton and a rascal."</p>
+
+<p>The department of genito-urinary diseases is introduced by a
+long chapter entitled "<i>De approximeron</i>," a formidable Latin word
+defined by Gilbert as sexual impotence. An elaborate discussion of
+the physiology of generation and the phenomena of impotence is
+followed by a collection of remedies for the condition, of which the
+best that can be said is that they are probably no less effective than
+most of the modern drugs recommended for the same purpose.
+Concerning a function over which so many fond superstitions still
+linger in the public mind we may, perhaps, charitably forgive Gilbert
+for the introduction of an empirical remedy for sterility, which,
+he assures us, he has often tried and with invariable success, and
+which enjoys the double advantage of applicability to either sex.</p>
+
+<p>"Let a man, twenty years of age or more, before the third hour
+of the vigil of St. John the Baptist, pull up by the roots a specimen
+of consolida major (comfrey) and another of consolida minor
+(healall), repeating thrice the Lord's prayer (<i>oratio dominica</i>).
+Let him speak to no one while either going or returning, say
+nothing whatever, but in deep silence let him extract the juice from
+the herbs and with this juice write on as many cards as may be
+required the following charm:</p>
+
+<p>"<i>Dixit dominus crescite.</i> &dagger;. <i>Uthihoth.</i> &dagger;. <i>multiplicamini.</i> &dagger;.
+<i>thahechay.</i> &dagger;. <i>et replete terram.</i> &dagger;. <i>amath.</i></p>
+
+<p>"If a man wears about his neck a card inscribed with these
+identical words written in this juice, he will beget a male. Conversely,
+if a woman, she will conceive a female" (f. 287b).</p>
+
+<p>Gilbert, however, cautions the bearer of this potent charm of
+the possible dangers of satyriasis incurred thereby, and offers suitable
+remedies for so alarming a condition.</p>
+
+<p>Chapters on satyriasis, gomorrhea (gonorrhea in its etymological
+sense, seminal emissions), with a third entitled "<i>De pustulis et</i>
+<span class="pagenum"><a name="page37" id="page37"></a>[pg 37]</span>
+*<i>apostematibus virgae</i>" complete this department of medical art. The
+last chapter recognizes the venereal origin of the pustules and ulcers
+discussed, but furnishes no direct evidence of Gilbert's belief in the
+existence of a specific venereal poison.</p>
+
+<p>While Gilbert is very scrupulous in his examination of the gross
+appearances of the urine in most diseases, his discussion of the diseases
+of the kidneys and bladder includes only pain in the kidneys,
+abscess of the kidneys, renal and vesical calculus, hematuria, incontinence
+of urine, dysuria and strangury.</p>
+
+<p>The chapter on hematuria presents a very curious specimen of
+medieval pathology. Gilbert says: "The escape of blood in the
+urine is due sometimes to the liver, sometimes to the bile,<a id="footnotetag7" name="footnotetag7"></a><a href="#footnote7"><sup>7</sup></a> sometimes
+to the kidneys and loins, sometimes to the bladder. If the blood is
+pure and clear, in large quantity, mixed perfectly with the urine and
+accompanied by pain in the right hypochondrium, it comes from
+the liver. Such urine presents scarcely any sediment. If the blood
+comes from the lrili vein, it is also rather pure, but less pure than
+in the former case, nor is the quantity so great, while pain is felt
+over the region of the seventh vertebra, counting from below. If it
+comes from the kidneys, it is scanty and pure as it leaves the bladder,
+but soon coagulates and forms a dark deposit in the vessel, while
+pain is felt in the pubes and peritoneum.... If pus, blood
+and epithelium (<i>squamae</i>) are passed, and the odor is strong, it
+signifies ulceration of the bladder" (f. 275b).</p>
+
+<p>Diabetes is defined as "An immoderate passage or attraction of
+urine from the liver to the kidneys and its passage through the kidneys,
+as the result of a warm or dry distemperature of these organs."
+The idea of some association of the liver and kidneys in
+the production of diabetes is at least as old as the eleventh century,
+and Gilbert's definition of the disease is undoubtedly borrowed from
+the "Practica" of John Platearius (A.D. 1075), of the school of
+Salernum. The symptoms, continual thirst, dryness of the mouth,
+emaciation, in spite of an inordinate appetite, frequent and profuse
+urination, are correctly given, but no knowledge of the presence of
+sugar in the urine is indicated.</p>
+
+<p>Dyampnes (involuntary micturition) claims a page or more of
+explanation and treatment, and its frequent occurrence in old men
+and children is noticed.</p>
+
+<p>In the department of the diseases of women chapters are devoted
+<span class="pagenum"><a name="page38" id="page38"></a>[pg 38]</span>
+to amenorrhea, menorrhagia, hysteria (<i>suffocatio matricis</i>),
+prolapse, ulceration, abscess, cancer, dropsy and "ventosity" of the
+uterus (physometra).</p>
+
+<p>In the allied department of obstetrics we find chapters on the
+signs of conception, on the urine in pregnant women, on difficult
+labor, prolapsus uteri, retention of the placenta, post partum hemorrhage,
+afterpains, and the oedema of pregnancy. The causes of
+difficult labor, according to Gilbert, are malposition, dropsy, immoderate
+size and death of the fetus, debility of the uterus and
+obstruction of the maternal passages. Malpositions are to be corrected
+by the hand of the midwife (<i>obstetrix</i>). Adjuvant measures
+are hot baths, poultices, inunctions, fumigations and sternutatories,
+and the use of certain herbs.</p>
+
+<p>In the departments of general medicine not as yet entirely appropriated
+by specialists it will suffice to mention scrofula, pleurisy
+and pneumonia, hemoptysis, empyema, phthisis, cardiac affections,
+diseases of the stomach, liver and spleen, diarrhoea and dysentery,
+intestinal worms, dropsy, jaundice, cancer, rheumatism and gout,
+small-pox, measles, leprosy and hydrophobia, all of which claim
+more or less attention.</p>
+
+<p>Peripneumonia and pleurisy are both inflammations of the chest,
+the former affecting the lungs, the latter the diaphragm and the pellicle
+which lines the ribs. The prominent symptoms of both diseases
+are pain in the chest or side, cough and fever and dyspnoea. Accidents
+or sequelae are hemoptysis, empyema and phthisis.</p>
+
+<p>Empima (empyema) is the hawking-up of sanies, with infection
+of the lung and a sanious habit. Hence persons laboring under
+pneumonia or pleurisy are not necessarily empyemics, but when
+these diseases progress to such a point that blood and sanies are
+expectorated and the lung is infected, that is when the ulceration of
+the lungs fails to heal and corruption and infection occur, the disease
+becomes empima, and is with difficulty, or never cured.</p>
+
+<p>Ptisis is a substantial consumption of the humidity of the body,
+due to ulceration of the lungs. For when a solution of continuity
+occurs in the lungs, the inspiratory and expiratory forces fail.
+Hence the lungs do not inspire sufficient air to mitigate the innate
+heat of the heart, and the heart fails to purify itself of the fumosity
+or fumous vapors generated in itself. Accordingly, deprived of the
+means of mitigating its heat or ventilating its fumosities, the spirits
+within it become unduly heated, and a consuming fire is generated
+in the entire body.</p>
+<span class="pagenum"><a name="page39" id="page39"></a>[pg 39]</span>
+
+<p>The symptoms of ptisis are a continued fever, greater or less,
+detected in the palms of the hands and the soles of the feet, thirst,
+a roughness of the tongue, slenderness of the neck, wasting of the
+entire body, constipation, wasting and shrinking of the finger-nails
+and fingers, hollowness of the eyes, pain in the left scapula extending
+to the shoulder, pharyngeal catarrh with abundant and mucilaginous
+sputum and a tendency to lachrymation. If the sputum
+thrown upon the coals emits a fetid odor, it is a sign of confirmed
+ptisis, which is incurable. The disease when it occurs in youths
+and young persons rarely lasts longer than a year, often terminates
+in less time, and may sometimes, by the aid of medicine, be prolonged
+for a greater period. If the sputum received during the
+night in a vessel is flushed in the morning with warm water, while
+some impurities remain upon the surface, the putrid matter will
+sink to the bottom (<i>sputum fundum petens</i>), and the indications
+are fatal. Likewise sharpness of the nose, hollow eyes, slender
+nails, falling hair, flattened temples and diarrhoea are of evil omen.
+These patients converse while dying, and die conversing (<i>moriendo
+loquentur, sed loquendo moriuntur</i>). Gilbert, of course, supplies a
+formidable array of remedies for the disease, but tells us that the
+"very latest" is cauterization over the clavicles (<i>Novissimum autem
+consilium est cauterium in furcula pectoris</i>).</p>
+
+<p>The varieties of difficulty of breathing are classified under the
+titles of asma, dispnea, orthomia, hanelitus and sansugium. The
+last title is given to a condition in which, as Gilbert says, "A superfluous
+humor is abundant in the superficies of the lung, which compresses
+that organ and renders it unable to dilate in inspiration.
+Hence it labors in inspiration like a leech, from which the dyspnea
+derives its name."</p>
+
+<p>Under the single title of "<i>cardiaca passio</i>" are included all possible
+diseases of the heart. The symptoms of this disease are said
+to be "palpitation, twitching of the limbs (<i>saltus membrorum</i>), perspiration,
+weakness of the nerves, facial pallor, weakness of the
+body as in hectic fever or phthisis, excessive pain and faintness
+over the precordia, a disposition to sleep and often constipation."
+The treatment is, of course, entirely symptomatic.</p>
+
+<p>Diseases of the digestive apparatus are discussed under the
+headings of difficulties of deglutition, canine appetite, bolismus
+(boulimia), disturbances of thirst, eructations, hiccup, nausea and
+anorexia, vomiting, anathimiasis (gastric debility), anatropha and
+<span class="pagenum"><a name="page40" id="page40"></a>[pg 40]</span>
+catatropha (varieties of obstinate vomiting), pain in the stomach,
+abscess of the stomach, salivation, colic, dysentery and diarrhoea,
+intestinal worms, hemorrhoids, rectal tenesmus, prolapsus ani, fistula
+in ano, diseases of the liver, dropsy, jaundice and diseases of the spleen.</p>
+
+<p>Abscess of the stomach sometimes manifests a circumscribed
+tumor, and accordingly, probably includes cancer of that organ.
+Approved remedies are the Al'mirabile, the stomatichon frigidum,
+calidum or laxativumvum, etc., stereotyped formulae, of which the
+composition is carefully recorded.</p>
+
+<p>Dysentery is a flux of the bowels with a sanguinolent discharge
+and excoriation of the intestines. A variety called hepatic dysentery,
+however, lacks the intestinal excoriation. Diarrhoea is a simple
+flux of the bowels, without either the sanguinolent discharges
+or the intestinal excoriation. Lientery is a flux of the bowels with
+the discharge of undigested food, occasioned by irritability (<i>levitas</i>)
+of the stomach or intestines. Colical passion and iliac passion derive
+their names from the supposed origin of the pain in the colon
+or ileum, a remark which furnishes occasion for the statement that
+Gilbert divides the bowels into six sections, viz., the duodenum
+jejunum and ileum, and the orobus, colon and longaon (rectum).</p>
+
+<p>Intestinal worms are not generated in the stomach, as Gilbert
+says, because of the great heat produced by the process of digestion.
+In the intestines they originate chiefly from the varieties of phlegm,
+e.g., saline, sweet, acid, natural, etc. The species mentioned specifically
+are lumbrici and ascarides or cucubitini, though the terms
+long, round, short and broad are also employed, and probably include
+the tape worm or taenia lata. The treatment of these parasites
+consists generally in the use of aromatic, bitter or acid mixtures,
+among which gentian, serpentaria, tithymal and cucumis agrestis
+are especially commended for lumbrici, and enemata of wormwood,
+lupinus, scammony, salt, aloes, etc., for ascarides.</p>
+
+<p>The diseases of the liver, though not numerous, are allotted
+considerable space most of which is occupied by scholastic speculations
+and the usual rich supply of therapeutical suggestions.</p>
+
+<p>Discrasia of the liver has several varieties, warm, cold, moist
+and dry, and seems nearly equivalent to our somewhat overworked
+term of "biliousness." Gilbert's favorite compounds for the relief
+of this condition are the Trifera sarracenica, the Electuarium psilliticum
+and above all the Dyantos Besonis.</p>
+<span class="pagenum"><a name="page41" id="page41"></a>[pg 41]</span>
+
+<p>Obstruction (<i>oppilatio</i>) of the liver or enfraxis is defined as a
+disease of the canals (<i>pori</i>), of which four are enumerated, to-wit,
+the meseraic, that of the convexity of the organ (<i>gibbus&mdash;ubi sunt
+exitus capillarium venarum</i>), the duct leading to the gall-bladder
+and that leading to the spleen. With an abundance of symptoms,
+it is singular that this comprehensive disease does not seem characterized
+by any constant or severe pain, as we might reasonably expect.</p>
+
+<p>Abscess of the liver depends upon some vice of the blood, the
+bile, the phlegm or the black-bile. The general treatment is poultices
+and other maturatives, but, as the author adds rather sadly at
+the close, <i>ultima cura est per incisionem</i>.</p>
+
+<p>Dropsy is discussed as an independent disease through the exhaustive
+speculations of thirty-two pages. Gilbert tells us it depends
+upon some fault of the digestive faculty of the liver, and he
+divides it into four species, to-wit, leucoflantia, yposarcha, alchitis
+and tympanitis, each of which has its special and appropriate treatment.
+In the dreary waste of speculative discussion it is cheering,
+however, to observe Gilbert's positive recognition of the sphere of
+percussion indicated in the passage:</p>
+
+<p>"<i>Et venter percussus sonat ad modum utris semipleni aqua et
+venta.</i>" (f. 250b.)</p>
+
+<p>Ycteritia or jaundice receives equally thorough discussion
+through eight weary pages, including the usual polypharmacal treatment.</p>
+
+<p>The spleen, Gilbert says, is sometimes the name of an organ,
+sometimes of a disease. As an organ it is spongy and loose in texture,
+and attracts and retains the superfluities of the black-bile,
+expelled from the liver for its own cleansing. Hence it is a servile
+and insensitive organ, and accordingly suffers different diseases,
+such as obstruction, tumors, hardening, softening, abscess, and sometimes
+flatulence or repletion. The symptoms and treatment of each
+of these morbid conditions, arising from either heat or cold, are
+discussed with exasperating thoroughness, and the chapter concludes
+with the composition and use of various specific remedies of
+compound character, bearing the impressive titles of Dyasene, Dyacapparis,
+Dyaceraseos (a mixture of cherry juice, honey, cinnamon,
+mastic and scammony) and Agrippa.</p>
+
+<p>Scrofulous swellings are carefully considered in a chapter entitled
+"<i>De scrophulis et glandulis.</i>" "Scrophulae and glandulae are
+<span class="pagenum"><a name="page42" id="page42"></a>[pg 42]</span>
+hard swellings developing in the soft parts, as in the emunctory localities
+of the veins and arteries, particularly in the neck, armpits
+and groins, and sometimes in other places. They spring from the
+superfluities of the principal organs, which nature expels, as it
+were, to the emunctories and localities designed to receive this
+flux." ... "Hence they are often found the cause of scabies,
+tinea, malum mortuum, cancer, fistula, etc., and are called glandes.
+Sometimes, however, a dryer matter is finely divided and falls into
+several minute portions, from which arise many hard and globular
+swellings, called scrofulae from the multiplicity of their progeny,
+like that of the sow (<i>scrofa</i>). The disease is also called <i>morbus
+regius</i>, because it is cured by kings."</p>
+
+<p>Gilbert advises that these swellings should not be "driven in"
+(<i>repercutienda</i>), but brought to suppuration generally by emollients
+and poultices. When softened they may be opened with a lancet
+and the pus allowed to escape gradually, but as this process is tedious,
+he prefers the entire removal of the glands with the knife, premissing,
+however, that no gland should be cut into which cannot be
+well grasped by the hand and pulled from its seat. This surgical
+manipulation is fully described, and is undoubtedly taken from the
+similar chapter of Roger. It is worthy of notice also that just at
+the close of this chapter, Gilbert mentions a swelling called "testudo,"
+a gland-like, gaseous (<i>ventosa</i>) tumor, usually solitary and found
+in "nervous" localities, like the joints of the wrist and hand. He
+says it often occurs from fracture (<i>cassatura</i>?) of the nerves, is
+cured by pressure, friction or incision, but is not entirely free from
+danger. Possibly this may refer to ganglion. Now, Roger makes
+no mention whatever of "testudo," while Roland says:</p>
+
+<p>"<i>Nota quod quamvis Rogerius non designat inter glandulum et
+testudinem, scias igitur quod testudo fit ex majori parte flegmatica,
+minori melancholie, glandula vero a contrario</i>," a statement which
+might readily suggest the suspicion that Gilbert had before his eyes
+the text of Roland, or that, at least, he had not acquired his knowledge
+of testudo from Roger, his usual surgical authority.</p>
+
+<p>Gilbert's sections on goitre (<i>bocium gulae</i>)<a id="footnotetag8" name="footnotetag8"></a><a href="#footnote8"><sup>8</sup></a> are interesting in
+themselves, and characteristic of the method adopted by him in his
+discussion of surgical or semi-surgical subjects. An introduction
+relative to the pathology of the disease and which seems to be
+<span class="pagenum"><a name="page43" id="page43"></a>[pg 43]</span>
+original, is followed by a treatment, medical and surgical, adopted
+almost literally from the Chirurgia of Roger. Thus he says:
+"Goiter occurs most commonly among the inhabitants of mountainous
+regions, and is due to an amplification and dilatation of the
+veins, arteries and nerves, together with the soft tissues, occasioned
+by the north wind (<i>ventum boreale</i>), or some other confined wind,
+which during childhood has accumulated in (<i>coadunabatur</i>) and
+enlarged the part to the size of the goiter." After suggesting an
+analogy between the disease and the redness and turgidity of the
+neck produced by passion or in singing, he adds that some cases are
+due to an accumulation of spongy tissue between the veins and
+arteries, or to the use of flatulent food, and he even tells us that
+some old women know how to produce and remove goitrous swellings
+by means of certain suitable herbs known to them.</p>
+
+<p>Under medical treatment we find the following: "Dig out of
+the ground while chanting a pater noster, a nut which has never
+borne fruit. The roots and other parts pound well with two hundred
+grains of pepper, and boil down in the best wine until reduced in
+volume to one-half. Let the patient take this freely on an empty
+stomach until cured."</p>
+
+<p>Another more elaborate prescription consists of a long list of
+ingredients, including burnt sponge, saponaria, the milk of a sow
+raising her first litter, with numerous simple herbs, and the sole
+object for which this nonsensical farrago is introduced here is to
+add that both these prescriptions are copied from the surgery of
+Roger. It is important too to remark here that we owe to Roger
+the introduction of iodine, under the form of burnt sponge, into the
+treatment of goiter.</p>
+
+<p>In the failure of medical treatment, Gilbert directs the employment
+of surgical means, e.g., the use of setons, or, in suitable
+cases, extirpation of the goiter with the knife. If, however, the
+tumor is very vascular, he prefers to leave the case to nature rather
+than expose the patient to the dangers of a bloody operation. The
+whole discussion of goiter is manifestly a paraphrase of the similar
+chapter of Roger, who also introduced into surgical practice the use
+of the seton.</p>
+
+<p>In Gilbert's chapter entitled "<i>De arthretica passione et ejus
+speciebus</i>," we are introduced to the earliest discussion by an
+English physician of that preeminently English disease&mdash;gout. We
+may infer, too, from the length of the discussion (thirty or more
+<span class="pagenum"><a name="page44" id="page44"></a>[pg 44]</span>
+pages) that this was a disease with which Gilbert was not only
+familiar, but upon the knowledge of which he prided himself greatly.
+Indeed, it is one of the few diseases of the Compendium in which
+the author assumes the position of a clinician and introduces examples
+of the disease and its treatment taken from his own clientele.
+We shall, therefore, follow our author here rather more carefully
+and literally than usual, that we may learn the views of an English
+physician of the thirteenth century on, perhaps, the most characteristic
+disease of his countrymen.</p>
+
+<p>Gilbert says: "Arthetica is a disease of the joints arising from
+a flux of humors descending into their continuity (<i>concathenationem</i>).
+The name is derived from the Latin <i>artus</i>, a joint, and
+the disease comprehends three species, viz., <i>sciatica</i>, disease of the
+scia, or the ligaments uniting the spine with the hip; <i>cyragra</i>, disease
+of the joints of the hands; and <i>podagra</i>, disease of the bones
+and joints of the foot, due to the descent of humors into their continuity.
+Sometimes, too, the disease affects other organs, occasioning
+pain in sensitive members, as, e.g., the head, and then derives
+its name from the part affected, as <i>cephalea</i>, <i>emigranea</i> or <i>monopagia</i>.
+Occasionally likewise some humor runs down (<i>reumatizat</i>)
+into the chest, spreading over the nerves of the breast or those of
+the spine between the vertebrae, and sometimes to other places.
+Hence the disease derives the general name gout (<i>gutta</i>), from its
+resemblance to a drop (<i>gutta</i>) trickling or falling downward and
+flowing over the weaker organs, which receive the humor. For
+gout arises particularly from rheumatic causes. Now, as the
+humors are rather uncontrollable (<i>male terminabiles</i>) fluids, they
+flow towards the exterior and softer parts, like the flesh and skin,
+which receive their moisture and being soft, dilatable and extensible,
+there results some swelling. But if the humors are hard and dry,
+they are confined within the interior of the organs, such as bones,
+nerves and membranes: and these, being hard in themselves, do not
+receive the moisture, nor suffer extension or dilatation, and thus
+no swelling results. Since, therefore, the material of this variety of
+arthetica, in which no swelling is present, is formed of grosser and
+harder substance and is found in the vicinity of hard and cold
+localities, it is dissolved slowly and the disease is not cured until this
+solution takes place. That form of the disease, however, in which
+there is swelling from a subtile and liquid material deposited in the
+soft parts is the more quickly cured. Hence swelling is the best sign
+<span class="pagenum"><a name="page45" id="page45"></a>[pg 45]</span>
+of curability. This is most evidently true in podagra, unless the
+<i>materies morbi</i>, by reason of its scarcity, produces no enlargement
+of the affected part."</p>
+
+<p>Quoting the words of Rhazes, Gilbert tells us that the <i>materies
+morbi</i> of gout is, for the most part, crude and bloody phlegm.
+Rarely is it bilious, and still more rarely, melancholic. If, however,
+it is compounded, it consists chiefly of bile mixed with a subtile
+phlegm, and more rarely, of phlegm mixed with black bile (<i>melancholia</i>),
+occasionally of black bile mixed with blood. The mixture
+of black bile and blood or bile is very rare, and still rarer a mixture
+of all the humors according to their proportion in the body.</p>
+
+<p>If the color of the affected part is red, it indicates that the
+<i>materies morbi</i> is sanguineous; if greenish-yellow (<i>citrinus</i>), that
+it is bilious; if whiter than the general color of the body, that the
+materies is a subtile phlegm. If the color shades away into black,
+it does not signify necessarily that the materies is simply black bile,
+for such a color occurs at the close of acute abscesses, or from
+strangulation of the blood. But if, together with the black color,
+we find the tissues cold and no increase of heat in the affected part,
+this indicates that the <i>materies</i> is black bile.</p>
+
+<p>By touching the diseased part we determine its heat or coldness,
+hardness or softness, roughness or smoothness, fullness, distention
+or evacuation, all of which signs possess special significance.</p>
+
+<p>The antecedent causes of gout, Gilbert tells us, are a heat too
+solvent, cold too constringent (f. 311 c), sometimes a strong bath
+or a severe journey in a plethoric person (<i>in plectorico</i>), again excessive
+coitus after a full meal (<i>satietatem</i>), or even habitual excess,
+by which the joints are weakened and deprived of their natural heat
+and subtile moisture. Hence boys and eunuchs are not commonly
+affected by gout&mdash;at least boys under the age of puberty. Women,
+too, do not usually suffer from this disease, because in coitus they
+are passive, unless their menstrual discharge is suspended. Again
+gout sometimes arises from infection of the primary semen; for a
+chronic disease may be inherited by the offspring and affect the
+material causes, i.e., the humors. Flatulence (<i>ventositas</i>) is likewise
+a cause of gout, as we have already hinted.</p>
+
+<p>In gout of the sanguineous type the favorite remedy of Gilbert
+was venesection, pushed to extremes which suggest the bloody theories
+of his later confrere Bouillaud. This bloodletting, however, was
+always to be practiced on the side opposite to that affected by the
+<span class="pagenum"><a name="page46" id="page46"></a>[pg 46]</span>
+disease, as he tells us, for two reasons: First to solicit the peccant
+material to the opposite side; and, second, to retard its course
+toward the seat of the swelling. If, therefore, the disease is in the
+right foot, he bleeds from the basilic vein, or some of its branches,
+in the right hand. No other vein should be taken, but if neither the
+basilic vein nor one of its branches can be found, the bleeding may
+be performed upon the median vein, for certain branches of the
+basilic and cephalic veins unite to form the median. If the disease
+is in the hand, the material may be diverted in two ways, either to
+the other hand or to the opposite foot. Indeed, blood may be taken
+from both these parts in succession. The quantity of blood withdrawn
+should be in accordance with the strength of the patient, the
+character of the swelling, the pulsation, distention, heat and redness
+of the affected part. But it should be repeated frequently, and this
+bloodletting then frequently suffices, in itself, to cure the disease.</p>
+
+<p>Gilbert continues: "I will tell you also what I myself saw in a
+woman suffering and screaming with pain in her right wrist
+(<i>assuere</i>?), which was greatly swollen, hot, red and much distended.
+She was fat, full-blooded, and before the attack had lived
+freely on milk and flesh. Accordingly she was robust, and I bled
+her from the basilic vein of the left hand and the saphena of the
+right foot, both within an hour. Each hour I withdrew a half-pound
+of blood, then I fed her and for three hours I drew half a
+pound of blood from the saphena. In the last hour the pain and
+throbbing (<i>percussio</i>) ceased entirely, and the woman begged me
+to bleed her again from the hand, for she had experienced great
+relief. I wished, however, to divert the material to the lower extremities
+for two reasons, one of which I ought not to mention in
+this place, while the other is useful, and indeed necessary in such
+cases. You should know that this woman was suffering pain in her
+left hand also, though this pain was of a less severe character than in
+the right. For this reason I desired to divert the peccant matter
+downward, a point which the physician should consider and observe.
+Once, while treating a man suffering from sanguineous gout, the
+pain of which involved the joints between the assuerus and the
+racheta (?) of the right hand, I asked him whether any pain was
+felt in the other hand or in the feet. He replied that similar pain
+was felt in the left hand or its joints, and that hitherto it had been
+more severe, but that no pain had ever been experienced in the feet.
+Hence I was unwilling to bleed him at all from the left hand, but
+<span class="pagenum"><a name="page47" id="page47"></a>[pg 47]</span>
+I bled him from the right foot. A physician who had treated him
+before, and had bled him from the right hand for acute swelling
+of the joints of the left, quieted, indeed, the pain in the left hand,
+but diverted the disease to the right, where a swelling developed
+larger than in the left. And when I asked him about this, he understood
+that I knew more about medicine than the other doctor did.
+And this is one of the reasons why one ought to divert the material
+to another part, especially when the pain is so located that it may
+be increased at the beginning. For under such conditions we
+ought to refrain from bleeding, frictions and other treatment which
+may attract the <i>materies morbi</i> to the part. Indeed we ought to
+require derivation of the materies to another part whenever the
+affected locality contains one of the nobler organs, towards which
+the material is directing, or may direct its course. For instance:
+A person is suffering pain in the joints of the right hand, but has
+also an acute swelling in the bladder, the kidneys or the womb. Now,
+I say that in such a case we ought not to bleed from the hand, because
+if we do we shall injure the organ affected by the swelling.
+Perhaps, however, we may bleed from the right foot, provided we
+understand that there is on the right side a sanguineous tumor, the
+danger of which is greater than that of the swelling on the right
+hand. Again, suppose in the liver or in the right kidney an acute
+tumor, and in the joints of the right hand there is present a moderate
+pain. I say that we ought first to medicate the more dangerous
+lesion, and, possibly, two results may be obtained by the attraction of
+the peccant material. Or suppose a woman has gout in her hand,
+and with this a suppression of the menstrual flow. I say she ought
+to be bled from the foot and not from the hand for two objects, to
+solicit the material from the diseased hand, and to provoke a return
+of the menstrual discharge.</p>
+
+<p>"But to return to our original patient. I may say that after the
+third venesection, with an interval of two hours, I withdrew a half-pound
+of blood from the saphena vein, and that night she slept, although
+she had not slept for many nights. And I did nothing more,
+except to prescribe a light and cool diet. The third day after the
+bleeding she was entirely free from any trouble in her hand. Hence
+I say that we ought in such cases to begin our treatment by venesection."</p>
+
+<p>After this sanguinary introduction, Gilbert soothes the diseased
+part with cooling and astringent ointments, unless these occasion
+<span class="pagenum"><a name="page48" id="page48"></a>[pg 48]</span>
+pain, in which event he omits them entirely and trusts the case
+to nature, "<i>quoniam natura per se curabit</i>."</p>
+
+<p>The vigorous plan of treatment thus outlined Gilbert seems to
+regard as original and peculiar to himself, for the next chapter
+bears the title, "The treatment of gout according to the authorities
+(<i>secundum magistros</i>)." Here he says he quotes the opinions of the
+modern teachers and writers, who lay down definite rules for the
+guidance of the physicians.</p>
+
+<p>Among these he mentions, as primary and of general application,
+the rule that, before all things, the body must be purified, either
+by venesection in cases where the material is sanguineous, or by
+purgation in other varieties of the disease. If the cause is rheumatic
+in its nature, fomentations should never be employed, for
+fear of increasing the flux. That the peccant material is to be
+eliminated gradually by mild remedies, just as it accumulated by
+degrees. In all cases of gout, and in all chronic diseases generally,
+much attention must be devoted to the stomach, since if this organ
+rejects the medicine, the latter must be at once abandoned, lest the
+stomach becomes weakened and even other organs, and thus the
+humors flow more readily (<i>magis reumatizarent</i>) to the joints, etc.</p>
+
+<p>These general medical rules are succeeded by some twenty pages
+devoted largely to special formulae for the different forms of gout,
+with remarks as to their applicability to the different varieties of
+the disease. Most of the formulae bear special titles, apparently to
+lend the weight of a famous name to the virtues of the prescription
+itself, something as in these modern days we speak of "Coxe's Hive
+Syrup," "Dover's Powder," "Tully's Powder," etc. Thus we read
+of the "<i>Pilulae artheticae Salernitorum</i>," the "<i>Cathapcie Alexandrine</i>,"
+the "<i>Oxymel Juliani</i>" the "<i>Pilulae Arabice</i>," the "<i>Pulvis
+Petrocelli</i>," the "<i>Oleum benedictum</i>," the "<i>Pilulae Johannicii</i>," etc.
+It is important, too, to remark that the active ingredient of very
+many of these formulae is the root called hermodactyl, believed by
+the majority of our botanists to be the <i>colchicum autumnale</i>.</p>
+
+<p>Gilbert's discussion of gout closes with a short and characteristic
+chapter entitled "<i>Emperica</i>," in which he remarks: "Although I
+perhaps demean myself somewhat in making any reference to empirical
+remedies, yet it is well to write them in a new book, that the
+work may not be lacking in what the ancients (<i>antiqui</i>) have said
+on the subject. Accordingly I quote the words of Torror. If you
+cut off the foot of a green frog and bind it upon the foot of a gouty
+<span class="pagenum"><a name="page49" id="page49"></a>[pg 49]</span>
+patient for three days, he will be cured, provided you place the right
+foot of the frog upon the right foot of the patient, and vice versa.
+Funcius, also, who wrote a book on stones, said that if a magnet
+was bound upon the foot of a gouty patient, he is cured. Another
+philosopher also declared that if you take the heel-bone of an ass
+and bind it upon the foot of the patient, he is cured, provided that
+you take the right bone for the right foot, and conversely, and he
+swore this was true. Torror also said that if the right foot of a
+turtle is placed upon the right foot of a patient suffering from the
+gout, and conversely, he will be cured."</p>
+
+<p>Gilbert's discussion of leprosy (<i>De lepra</i>, f. 336 d) covers
+twenty pages and, according to Sprengel, is "almost the first correct
+description of this disease in the Christian West." Freind says this
+chapter is copied chiefly <i>from</i> Theodorius of Cervia. See page 3
+ante. If, however, I am correct in my conjecture that the Compendium
+was written about the year 1240, the copying must have been
+done <i>by</i> Theodorius, whose "Chirurgia" did not appear until 1266.</p>
+
+<p>Leprosy is defined as a malignant disease due to the dispersion
+of black bile throughout the whole body, corrupting both the constitution
+(<i>complexionem</i>) and the form of its members. Sometimes,
+too, it occasions a solution of continuity and the loss of members.</p>
+
+<p>The disease is sometimes congenital, arising from conception
+during the menstrual period. For the corrupt blood within the maternal
+body, which forms the nourishment of the fetus, leads likewise
+to the corruption of the latter. Sometimes the disease is the
+result of a corrupt diet, or of foul air, or of the breath or aspect
+of another leper. Avicenna tells us that eating fish and milk at the
+same meal will occasion the same result. Infected pork and similar
+articles of diet may likewise produce the disease. Cohabitation with
+a woman who has previously had commerce with a leper may also produce infection.</p>
+
+<p>Among the general symptoms of leprosy Gilbert enumerates a
+permanent loss of sensation proceeding from within (<i>insensibilitas
+mansive ad intrinseco veniens</i>) and affecting particularly the fingers
+and toes, more especially the first and the little finger, and extending
+to the forearm, the arm or the knees; coldness and formication in
+the affected parts; transparency (<i>luciditas</i>) of the skin, with the
+loss of its natural folds (<i>crispitudines</i>), and a look as if tightly
+stretched or polished; distortion of the joints of the hands and feet,
+the mouth or the nose, and a kind of tickling sensation as if some
+<span class="pagenum"><a name="page50" id="page50"></a>[pg 50]</span>
+living thing were fluttering within the body, the thorax, the arms
+or the lips. There is felt also a sensation of motion, which is even
+visible also by inspection. Fetor of the breath, the perspiration and
+the skin are likewise noticeable. The localities affected lose their
+natural hair and are re-covered with very fine hairs, invisible except
+when held between the eye and the sun. The hair of the eyebrows
+and the eyelashes are lost&mdash;one of the worst of symptoms. There
+are present also hoarseness and an obstruction of the nostrils, without
+any visible cause. When the patient takes a bath the water runs
+off the affected localities as if they had been greased&mdash;another sign
+of evil omen. The angles of the eyes are rounded and shining.
+The skin, even when unaffected by cold, or other similar cause, is
+raised into very minute pimples, like the skin of a plucked goose.
+The blood in venesection has an oily appearance, and displays small
+particles like sand. Small tumors accompany the depilation of the
+eyebrows. Lepers are unusually and unduly devoted to sexual
+pleasures, and suffer unusual depression after sexual indulgence.
+The skin is tormented with a constant itching, and is alternately
+unduly hot or cold. Small grains are found under the tongue, as in leprous hogs.</p>
+
+<p>Gilbert divides leprosy into four varieties, <i>elephantia</i>, <i>leonina</i>,
+<i>tyria</i> and <i>allopicia</i>, the pathology, symptoms and treatment of each
+of which are presented with wearisome minuteness and completeness.
+A long chapter, entitled "<i>De infectione post coitum leprosi</i>,"
+discusses the transmission of the disease by means of sexual intercourse,
+and suggests the possible confusion of lepra and syphilis.</p>
+
+<p>The usual catalogue of specific remedies terminates the discussion.</p>
+
+<p>An interesting chapter on small-pox<a id="footnotetag9" name="footnotetag9"></a><a href="#footnote9"><sup>9</sup></a> and measles, "<i>De variolis
+et morbillis</i>," gives us the prevailing ideas relative to these diseases
+in England during the thirteenth century. Premising his remarks
+with a classification of diseases as follows:</p>
+
+<p>Diseases universal and infectious&mdash;like <i>morphoea</i>, <i>serpigo</i>,
+<i>lepra</i>, <i>variolae et morbilli</i>.</p>
+
+<p>Diseases universal but not infectious.</p>
+
+<p>Diseases infectious but not universal&mdash;like <i>noli me tangere</i>.</p>
+
+<p>Diseases neither infectious nor universal.</p>
+<span class="pagenum"><a name="page51" id="page51"></a>[pg 51]</span>
+
+<p>Gilbert classifies <i>variolae et morbilli</i> among the universal and
+infectious diseases, and in the species <i>apostemata</i>. To this latter
+species belong also <i>ignis Persicus</i>, <i>carbunculus</i> and <i>antrax</i>.</p>
+
+<p><i>Variolae et morbilli</i> arise from moist matter confined in the
+body and turbid, like turbid blood. Hence the disease occurs most
+commonly in boys and in those who are careless about cleanliness
+and neglect venesection. It is the result of a disposition of the blood
+resembling putrescence, in which there occurs an external ebullition
+in the efforts of nature to purify the interior of the body and to
+expel to the surface the virulent material within. Accordingly the
+common people declare that persons who have suffered from
+<i>variolae et morbilli</i> never acquire leprosy. Occasionally, too, the
+disease arises from excessive corruption of matter in repletion of
+blood, and hence it is more frequent in sanguineous diseases, like
+synocha, and during the prevalence of south winds or the shifting
+of winds to the south, and in infancy&mdash;the age characterized particularly
+by heat and moisture.</p>
+
+<p>The eruptions vary in color in accordance with the mixture of
+the different humors with the corrupt blood. Hence some are light
+colored, some the color of saffron, some red, some green, some livid,
+some black, and the virulence of the disease is the greater, the nearer
+the color approaches to black. There are, too, four varieties of the
+eruption, distinguished by special names. When the eruption is light
+colored and tends to suppuration, it is called <i>scora</i>. When it is very
+fine and red, it is called <i>morbilli</i> or <i>veterana</i>. The distinction between
+<i>variolae</i> and <i>morbilli</i> is in the form and matter of the disease,
+for in <i>variolae</i> the pustules are large and the matter bilious
+(<i>colerica</i>), while in morbilli the eruption is smaller and does not
+penetrate the skin (<i>non-pertransit cutem</i>). <i>Variolae</i>, on the contrary,
+forms a prominent pustule (<i>facit eminentiam</i>). A third
+form of the disease displays only four or five large, black pustules
+on the whole body, and this form is the most dangerous, since it is
+due to an unnatural black bile, or to acute fevers, in which the
+humors are consumed. This variety bears the name of <i>pustula</i>. A
+fourth form is called <i>lenticula</i>. This latter form occurs sometimes
+with fever, like synocha, sometimes without fever, and it arises from
+pestilential air or corrupt food, or from sitting near a patient suffering
+from the disease, the exhalations of which are infectious.</p>
+
+<p>The premonitory symptoms of <i>variolae</i> are a high fever, redness
+<span class="pagenum"><a name="page52" id="page52"></a>[pg 52]</span>
+of the eyes, pain in the throat and chest, cough, itching of the
+nose, sneezing and pricking sensations over the surface of the body.</p>
+
+<p><i>Morbilli</i> is a mild disease, but requires protection from cold,
+which confines and coagulates the peccant matter.</p>
+
+<p>Attention is directed to the not infrequent ulcers of the eyes,
+which occur in <i>variolae</i> and may destroy the sight; also to ulcerations
+of the nose, throat, oesophagus, lungs and intestines, the latter
+of which often produce a dangerous diarrhoea.</p>
+
+<p>When <i>variolae</i> occurs in boys, it is recommended to tie the
+hands of the patient to prevent scratching.</p>
+
+<p>Whey is said to be an excellent drink for developing the eruption
+of <i>variolae</i>, and the time-honored saffron (<i>crocus</i>) appears in
+several of Gilbert's prescriptions for this disease. Here, too, we find
+the earliest mention of the use of red colors in the treatment of
+<i>variolae</i> (f. 348 c):</p>
+
+<p>"<i>Vetule provinciales dant purpuram combustam in potu, habet
+enim occultam naturam curandi variolas. Similiter pannus tinctus de grano.</i>"</p>
+
+<p>Acid and saline articles of food should be avoided, sweets used
+freely, and the patients should be carefully guarded from cold.</p>
+
+<p>Not the least interesting pages of the Compendium are those
+(there are about twenty of them) devoted to the discussion of
+poisons, poisoned wounds and hydrophobia.</p>
+
+<p>An introductory chapter on the general subject of the character
+of poisonous matters, illustrated by some gruesome and Munchausen-like
+tales, borrowed mainly from Avicenna and Ruffus, on the wonders
+of acquired immunity to poisons, the horrors of the basilisk, the
+<i>armaria</i> (<i>?</i>), the deaf adder (<i>aspis surda</i>) and the red-hot <i>regulus</i>
+of Nubia, leads naturally to the consideration of some special
+poisons derived from the three kingdoms of nature. Very characteristically
+Gilbert displays his caution in the discussion of a dangerous
+subject by the following preface:</p>
+
+<p><i>Abstineamus a venesis occultis quae non sunt manifesta, ne
+virus in angues adjiciamus, aut doctrinam perniciosam tradere
+videamur</i> (f. 351 a).</p>
+
+<p>Beginning then with metallic mercury (<i>argentum vivum</i>), he
+considers the poisonous effects of various salts of lead and copper,
+the vegetable poisons hellebore, anacardium (<i>anacardis?</i>), castoreum,
+opium and cassilago (<i>semina hyoscyami</i>), and then proceeds
+<span class="pagenum"><a name="page53" id="page53"></a>[pg 53]</span>
+to the bites or rabid men and animals, hydrophobia, and the bites of
+scorpions, serpents and the <i>animalia annulosa</i>, that is, worms, wasps,
+bees, ants and spiders.</p>
+
+<p>Space does not permit a careful review of this interesting subject,
+but a novel form of poisoning by the use of quicksilver is
+startling enough to claim our attention. Gilbert tells us that pouring
+metallic mercury into the ear produces the most distressing symptoms,
+severe pain, delirium, convulsions, epilepsy, apoplexy and, if
+the metal penetrates to the brain, ultimate death. In the treatment
+of this condition certain physicians had recommended the insertion
+into the ear of a thin lamina of lead, upon which it was believed
+that the mercury would fasten itself and might thus be drawn out.
+Avicenna objected to this that the mercury was liable to speedily
+pass into the ear so deeply as to be beyond the reach of the lead.
+Gilbert suggests as an improvement of the treatment that a thin
+lamina of gold be substituted for the lead, "because mercury thirsts
+after gold as animals do after water, as it is held in the books on
+alchemy" (<i>in libris allzinimicis</i>). This fact, too, he tells us can be
+easily demonstrated externally by placing upon a plate a portion of
+gold, and near, but not in contact with it, a little quicksilver, when
+the silver, he says, will at once "leap" upon the gold. Avicenna
+suggests that the patient stand upon the foot of the side affected,
+lean his head over to the same side, steady it in that position with
+the hands, and then leap suddenly over upon the other foot&mdash;demonstrating
+thereby his knowledge of both gravity and inertia. Manifestly
+our "laboratory physicians" of the present day can assume no airs of priority!</p>
+
+<p>The Compendium closes with two very sensible chapters on the
+hygiene of travel, entitled "<i>De regimine iter agentium</i>" and "<i>De
+regimine transfretantium</i>."</p>
+
+<p>In the hygiene of travel by land Gilbert commends a preliminary
+catharsis, frequent bathing, the avoidance of repletion of all kinds,
+an abundance of sleep and careful protection from the extremes of
+both heat and cold. The strange waters may be corrected by a dash
+of vinegar. Some travelers, he tells us, carry with them a package
+of their native soil, a few grains of which are added to the foreign
+waters, as a matter of precaution, before drinking. The breakfast
+of the traveler should be light, and a short period of rest after a
+day's travel should precede the hearty evening meal. Leavened
+bread two or three days old should be preferred. Of meats, the
+<span class="pagenum"><a name="page54" id="page54"></a>[pg 54]</span>
+flesh of goats or swine, particularly the feet and neighboring parts,
+which, Gilbert tells us, the French call <i>gambones</i>, the flesh of domestic
+fowls and of the game fowls whose habitat is in dry places, is to
+be preferred to that of ducks and geese. Of fish, only those provided
+with scales should be eaten, and all forms of milk should be
+avoided, except whey, "which purifies the body of superfluities."
+Fruits are to be eschewed, except acid pomegranates, whose juice
+cools the stomach and relieves thirst. Boiled meats, seasoned with
+herbs like sage, parsley, mint, saffron, etc., are better than roasted
+meats, and onion and garlic are to be avoided.</p>
+
+<p>The primitive conditions of land travel in the days of Gilbert
+are emphasized by his minute directions for the care of the feet,
+which he directs to be rubbed briskly with salt and vinegar and then
+anointed with an ointment of nettle-juice (<i>urtica</i>) and mutton-fat,
+or with a mixture of garlic, soap and oil. If badly swollen, they
+should be bathed, before inunction, with a decoction of elder-bark
+and other emollients.</p>
+
+<p>In travel by sea, Gilbert tells us the four chief indications are
+to prevent nausea, to allay vomiting, to palliate the foul odor of the
+ship and to quiet thirst.</p>
+
+<p>For the prevention of nausea he recommends the juice of acid
+pomegranates, lemons, etc., or a decoction of parsley or sweet cicely
+(<i>cerfolium</i>). The traveler should endeavor to sit with his head
+erect, should avoid looking around, but maintain his head as immovable
+as possible, and support himself by a firm grasp upon some
+beam of the ship. Some sweets may be sucked, or he may chew a
+few aromatic seeds. If vomiting ensues, acid or sweet pomegranates,
+figs or barley-sugar (<i>penides</i>) may be taken sparingly, but no
+food should be ingested until the stomach is thoroughly quieted.
+Then the patient may take a little <i>stomatichon</i> or <i>dyantos</i>, and a
+small portion of digestible food. As the diet must necessarily consist
+largely of salty food and vegetables, these should be cooked in
+three or four different waters, and then soaked in fresh water. A
+little aromatic wine will also benefit the patient, and a few aromatic
+seeds chewed in the morning are also of service.</p>
+
+<p>The effect of the foul odors of the ship may be combatted by
+the use of aromatic electuaries, "which comfort the heart, the brain
+and the stomach." The patient should be removed to some quiet
+portion of the ship, as distant as possible from the channels for
+the discharge of the bilge-water, and short walks upon the upper
+<span class="pagenum"><a name="page55" id="page55"></a>[pg 55]</span>
+deck will contribute to convalescence. Frequent changes of clothing
+will palliate the annoyance of fleas and pediculi. Drinking water
+may be purified by a&#235;ration, or by straining, boiling and subsequent
+sedimentation and removal of the sediment by filtration through
+fresh and clean sand. For the wealthy, the water may be distilled
+in an alembic, if such an apparatus is obtainable. Avicenna says
+that bad water may be corrected by the addition of vinegar. Exposure
+to the midday sun and to the nocturnal cold, constipation
+and diarrhoea should be avoided, and prompt attention should be
+given to all disorders of the health.</p>
+
+<p>To these wise counsels Gilbert courteously adds a medieval <i>bon
+voyage</i> in these words:</p>
+
+<p>"<i>Dominus autem omnia dirigat in tranquilitate. Amen.</i>"</p>
+
+<p>It has been already remarked upon a preceding page that Gilbert
+of England was not a surgeon. Nevertheless it is only fair to
+say that the surgical chapters of the Compendium present a more
+scientific and complete view of surgical art, as then known, than
+any contemporaneous writings of the Christian West, outside of Italy.</p>
+
+<p>It is well known that during the Middle Ages the practice of
+surgery in western Europe was generally regarded as disreputable,
+and operative surgery was for the most part relegated to butchers,
+barbers, bath-keepers, executioners, itinerant herniotomists and
+oculists, <i>et id omne genus</i>, whose pernicious activity continued to
+make life precarious far down into the modern period.</p>
+
+<p>In Italy alone did surgery vindicate for itself an equality with
+medicine, and the pioneer of this advance was Roger of Parma,
+who, as we have seen, flourished early in the thirteenth century.
+Roger and his pupil Roland, with the somewhat mythical "Four
+Masters" (<i>Quatuor Magistri</i>), were the surgical representatives of
+the School of Salernum, while Hugo (Borgognoni) di Lucca and
+his more famous son Theodorius represented the rival school of
+Bologna. Equally famous Italian surgeons of this century were
+Bruno of Logoburgo (in Calabria) and Gulielmus of Saliceto
+(1275), the master of Lanfranchi (1296). Gilbert of England, as
+a pupil of Salernum, naturally followed the surgical teachings of
+that school, and we have already noticed that his chapters on
+surgery are taken chiefly from the writings of Roger of
+Parma, though the name of neither Roger, nor indeed of
+<span class="pagenum"><a name="page56" id="page56"></a>[pg 56]</span>
+any other distinctly surgical writer, is mentioned in the Compendium.
+How closely in some cases Gilbert followed his masters
+may best be seen by a comparison of their respective chapters upon
+the same subject. I accordingly introduce here for such comparison
+Roger's chapter on wounds of the neck, and the corresponding
+chapter of Gilbert. Roger says:</p>
+
+<center>"<i>De vulnere quod fit in cervice.</i></center>
+
+<p>"<i>Si vero cum ense vel alio simili in cervice vulnus fiat, ita quod
+vena organica incidatur, sic est subveniendum. Vena tota sumatur
+(suatur) cum acu, ita quod vena non perforetur, et ex alia
+parte acus cum filo ei inhaerente ducatur, et cum ipso filo nectatur
+atque stringatur, quod sanguinem non emittat: et ita facias ex
+superiori parte et inferiori. In vulnere autem pannus infusus
+mittatur, non tamen de ipso vulnus multum impleatur. Embrocha,
+si fuerit in myeme, superponatur quosque (quousque) vulnus
+faciat saniem. Si vero fuerit in aestate vitellus avi semper superponatur.
+Quum autem saniem fecerit, cum panno sicco,
+unguento fusco et caeteris bonam carnem generantibus, adhibeatur
+cura, ut in caeteris vulneribus. Quum vero extremitatem venae
+superioris partis putruisse cognoveris, fila praedicta dissolvas, et a
+loco illo removeas: et deinde procedas ut dictum est superius. A. Si
+vero nervus incidatur in longum aut ex obliquo, sed non ex toto,
+hac cura potest consolidari. Terrestres enim vermes, idest qui sub
+terra nascuntur, qui in longitudine et rotunditate lumbricis assimilantur,
+et apud quondam terrestres lumbrici dicuntur, accipiantur
+et aliquantulum conterantur et in oleo infusi ad ignem calefiant: et
+nullo alio mediante, ter vel quater, vel etiam pluries, si opportunum
+videbis, plagae impone. Si vero incidatur ex obliquo totus, minime
+consolidatur: praedicto tamen remedio non coadjuvante saepe conglutinatur.
+Potest etiam cuticula, quae supra nervum est, sui,
+pulvisque rubens, qui jam dictus est, superaspergi, quae cura non
+est inutilis, aliquos enim non solum conglutinatas, sed etiam consolidatas,
+nostra cura prospeximus. Si vero locus tumet, embrocham
+illam, quam in prima particula ad tumorem removendum,
+qui ex percussura contigit, praediximus, ponatur, quousque talis
+tumor recesserit.</i>"</p>
+
+<p>Gilbert, after premising two short chapters entitled "<i>De vulneribus
+colli</i>" and "<i>De perforatione colli ex utraque parte</i>," continues
+as follows:</p>
+<span class="pagenum"><a name="page57" id="page57"></a>[pg 57]</span>
+
+<center>"<i>De vena organica incisa.</i></center>
+
+<p>"<i>Si vena organica in cervice incidatur: tota vena suatur cum acu,
+ita quod vena non perforetur, et ux alia parte acus cum filo ei adherente
+ita nectatur atque stringatur quod (non) emittat sanguinem, et
+ita fiat ex superiori parte et inferiore vene. In vulnere autem pannus
+infusus in albumine ovi mittatur, nec tamen de ipso panno vulnus
+multum impleatur. Embroca vero superius dicta, si in hyeme fuerit,
+superponatur, donec vulnus saniem emittat. Si vere in estate,
+vitellum ovi tum super ponatur, et cum saniem fecerit, panno sicco,
+et unguento fusco et ceteris regenerantibus carnem, curetur. Cum
+vero extremitatem vene superioris et inferioris putruisse cognoveris,
+fila dissolvantur et a loco removeantur, et deinde ut dictum est procedatur.</i></p>
+
+<p>"<i>De incisione nervi secundum longum aut secundum obliquum.</i></p>
+
+<p>"<i>Si vero secundum longum aut obliquum vervi incidantur, et non
+ex toto, ita consolidamus. Terrestres vermes, qui sub terra nascuntur,
+similes in longitudine et rotunditate lumbricis, qui etaim
+lumbrici terre appellantur: hi aliquantulum conterantur et in oleo
+infusi ad ignem calefiant, et nullo aliomediante, ter vel quater vel
+pluries, si opportunum fuerit, plagelle impone. Si vero ex oblique
+nervus incidatur, eodem remedio curatur, et natura cooperante saepe
+conglutinatur. Potest quoque cuticula quae supra nervum est sui,
+et pulvis ruber superaspergatur. Nervos enim conglutinari et consolidari
+hoc modo sepius videmus. Si vero locus tumeat, embroca,
+praedicta in vulnere capitis quae prima est ad tumorem removendum,
+superponatur, quousque tumor recesserit. Si vena organica non
+inciditur, pannus albumine ovi infusus in vulnere ponatur. Embroca
+vero post desuperponatur</i>" (f. 179 c).</p>
+
+<p>The selection and collection of words and phrases in these two
+passages leaves little doubt that one was copied from the other.
+Indeed, so close is their resemblance that it is quite possible from
+the one text to secure the emendation of the other. Numerous
+similar passages, with others in which the text of Gilbert is rather a
+paraphrase than a copy of the text of Roger, serve to confirm the
+conclusion that the surgical writings of the English physician are
+borrowed mainly from the "Chirurgia" of the Italian surgeon.
+Some few surgical chapters of the Compendium appear to be
+either original or borrowed from some other authority, but their
+number is not sufficient to disturb the conclusion at which we have
+<span class="pagenum"><a name="page58" id="page58"></a>[pg 58]</span>
+already arrived. Now, as Roger's "Chirurgia" was probably committed
+to writing in the year 1230, when the surgeon was an old
+man, these facts lead us to the conclusion that Gilbert must have
+written his Compendium at least after the date mentioned.</p>
+
+<p>Another criticism of these chapters suggests certain interesting
+chronological data. It will be observed that Roger, in the passage
+quoted above, recommends a dressing of egg-albumen for wounds
+of the neck, and expresses considerable doubt whether nerves, when
+totally divided, can be regenerated (<i>consolidari</i>), though they may
+undoubtedly be reunited (<i>conglutinari</i>).</p>
+
+<p>Now Roland, in his edition of Roger's "Chirurgia," criticises
+both of these statements of his master, as follows:</p>
+
+<p><i>Nota quod quamvis Rogerius dicat quod apponatur albumen
+ovi, non approbo, quia frigidum est naturaliter, et vena et nervus et
+arteria frigida sunt naturaliter, et propter frigiditatem utrorumque
+non potest perfecte fieri consolidatio.</i></p>
+
+<p>And again:</p>
+
+<p><i>Nota quod secundum Rogerium nervus omnino incisus non
+potest consolidari, vel conjungi nec sui. Nos autem dicimus quod
+potest consolidari et iterum ad motum reddi habillis, cum hac
+cautela: Cauterizetur utrumque caput nervi incisi peroptime cum
+ferro candenti, sed cave vulneris lobia cum ferro calido tangantur.
+Deinde apponantur vermes contusi et pulveres consolidativi, etc.</i></p>
+
+<p>It will be observed that Gilbert, in spite of the rejection by
+Roland of the egg-albumen dressing of Roger, still recommends its
+use in wounds of the neck, and although he professes to have seen
+many nerves regenerated (<i>consolidari</i>) under the simple angle-worm
+treatment of his master, he still makes no mention of the
+painful treatment of divided nerves by the actual cautery, so highly
+praised by Roland. It would seem, therefore, that Gilbert was not
+familiar with the writings of Roland when his Compendium was
+written, or he would, doubtless, not have omitted so peculiar a plan
+of treatment in an injury of such gravity. As Roland's edition of
+Roger's "Chirurgia" is said to have been written in 1264, the comparison
+of these passages would seem to indicate that Gilbert must
+have written the Compendium after 1230 and prior to the year 1264.</p>
+
+<p>Gilbert's surgical chapters discuss the general treatment of
+wounds and their complications, and more specifically that of
+wounds of the head, neck, throat, wounds of nerves, of the
+<span class="pagenum"><a name="page59" id="page59"></a>[pg 59]</span>
+oesophagus, scapula, clavicle, of the arm, the stomach, intestines
+and the spleen; fractures of the clavicle, arm, forearm and ribs;
+compound fractures; dislocations of the atlas, jaw, shoulder and
+elbows; fistulae in various localities, and the operations on the
+tonsils and uvula, on goitre, hernia and stone in the bladder, etc.&mdash;certainly
+a surgical compendium of no despicable comprehensiveness
+for a physician of his age and country.</p>
+
+<p>In the general treatment of wounds (f. 86 c) Gilbert tells us
+the surgeon must consider the time, the age of the patient, his temperament
+(<i>complexio</i>) and the locality, and be prepared to temper
+the hot with the cold and the dry with the moist. Measures for
+healing, cleansing and consolidation are required in all wounds, and
+these objects may, not infrequently, be accomplished by a single
+agent. The general dressing of most wounds is a piece of linen
+moistened with the white of egg (<i>pecia panni in albumine ovi
+infusa</i>), and, as a rule, the primary dressing should not be changed
+for two days in summer, and for three days in the winter. In moist
+wounds <i>vitreolum</i> reduces the flesh; in dry wounds it repairs and
+consolidates. <i>Flos aeris</i>, in dry wounds, reduces but does not consolidate,
+but rather corrodes the tissues. Excessive suppuration is
+sometimes the result of too stimulating applications, sometimes of
+those which are too weak. In the former case the wound enlarges,
+assumes a concave form, is red, hot, hard and painful, and the pus
+is thin and watery (<i>subtilis</i>). If the application is too weak, the
+pus is thick and viscous, and the other signs mentioned are wanting.
+In either case the dressings are to be reversed. If any dyscrasia,
+such as excessive heat, coldness, dryness or moisture appears in
+the wound and delays its healing, it is to be met by its contrary.
+If fistula or cancer develops, this complication is to be first cured
+and then the primary wound. The signs of a hot dyscrasia are heat,
+burning and pain in the wound; of a cold dyscrasia, lividity of the
+wound; the moist dyscrasia occasions flabbiness (<i>mollicies</i>) and
+profuse suppuration, and the dry produces dryness and induration.</p>
+
+<p>Wounds of the head (f. 84 c) occur with or without fracture
+of the cranium, but always require careful examination and exact
+diagnosis. The wound is to be carefully explored with the finger,
+and, if necessary, should be enlarged for this purpose. Large, but
+simple, wounds of the scalp should be stitched with silk in three or
+four places, leaving the most dependent angle open for escape of
+the discharges, and in this opening should be inserted a tent (<i>tuellus</i>),
+<span class="pagenum"><a name="page60" id="page60"></a>[pg 60]</span>
+to facilitate drainage. The wound is then sprinkled with the <i>pulvis
+rubeus</i> and covered with a plantain or other leaf. On the ninth to
+the eleventh day, if the wound seems practically healed, the stitches
+are to be removed and the cure completed with simple dressings.</p>
+
+<p>The signs and symptoms of fracture of the cranium are: Loss
+of appetite and failure of digestion, insomnia, difficulty in micturition,
+constipation, a febrile dyscrasia, difficulty in cracking nuts or
+crusts of bread with the jaws, or severe pain when a string is attached
+to the teeth and pulled sharply. If the meninges are injured
+we have further: headache, a slow and irregular but increasing
+fever, alternating with chills, distortion of the angles of the eyes,
+redness of the cheeks, mental disturbances, dimness of vision, a
+weak voice and bleeding from the ears or the nose. In the presence
+of such symptoms the death of the patient may be expected within
+at most a hundred days.</p>
+
+<p>If the fracture of the cranium is accompanied by a large scalp
+wound, any fragments of bone or other foreign body are to be extracted
+at once, unless haemorrhage or the weakness of the patient
+are feared, and then a piece of linen is to be cautiously worked in
+with a feather between the cranium and the dura mater. In the
+fracture itself a piece of linen, or better of silk, is inserted, the
+apparent purpose of this double dressing being to protect the dura
+mater from the discharges and to solicit their flow to the exterior.
+A piece of sponge, carefully washed, dried and placed in the wound,
+Gilbert tells us, absorbs the discharges satisfactorily and prevents
+their penetration internally. Over the wound is placed a bit of linen
+moistened with egg-albumen, then a dressing of lint, and the whole
+is maintained in place by a suitable bandage. Finally the patient is
+to be laid in bed and maintained in such a position that the wound
+will be dependent, so as to favor the ready escape of the discharges.
+This dressing is to be renewed three times a day in summer, and
+twice in winter. Proud flesh upon the dura mater is to be repressed
+by the application of a sponge, well-washed and dried, and
+if it appears upon the surface of the wound after the healing of the
+fracture, it is to be destroyed by the use of the hermodactyl. When
+the external wound is healed, the cicatrix is to be dressed with the
+<i>apostolicon cyrurgicum</i>, an ointment very valuable for the consolidation
+of bones, the leveling (<i>adaequatio?</i>) of wounds, etc.</p>
+
+<p>When the wound of the scalp is small, so as to render difficult
+the determination of the extent of the fracture by exploration with
+<span class="pagenum"><a name="page61" id="page61"></a>[pg 61]</span>
+the finger, it should be enlarged by crucial incisions, the flaps loosened
+from the cranium by a suitable scraper (<i>rugine</i>) and folded
+back out of the way, and any fragments of bone removed by the
+forceps (<i>pinceolis</i>). If, however, haemorrhage prevents the immediate
+removal of the fragments, this interference may be deferred
+for a day or two, until the bleeding has stopped or has been checked
+by suitable remedies. Then, after their removal, the piece of linen
+described above is to be inserted between the cranium and dura
+mater. Upon the cranium and over the flaps of the scalp, as well
+as in their angles, the ordinary dressing of albumen is to be applied,
+covered by a pledget of lint and a suitable bandage. No ointment,
+nor anything greasy, should be applied until after the healing of the
+wound, lest some of it may accidentally run down into the fracture
+and irritate the dura matter. Some surgeons, Gilbert tells us, insert
+in the place of the fragments of the cranium removed a piece of a
+cup (<i>ciphi</i>) or bowl (<i>mazer</i>), or a plate of gold, but this plan, he
+says, has been generally abandoned (<i>dimittitur</i>.)</p>
+
+<p>Sometimes the cranium is simply cracked without any depression
+of the bone, and such fractures are not easily detected. Gilbert
+tells us, however, that if the patient will close firmly his mouth and
+nose and blow hard, the escape of air through the fissured bone will
+reveal the presence of the fracture (f. 88a). In the treatment of
+such fissures he directs that the scalp wound be enlarged, the cranium
+perforated very cautiously with a trepan (<i>trepano</i>) at each extremity
+of the fissure and the two openings then connected by a chisel
+(<i>spata</i>?), in order to enable the surgeon to remove the discharges
+by a delicate bit of silk or linen introduced with a feather. If a portion
+of the cranium is depressed so that it cannot be easily raised
+into position, suitable openings are to be made through the depressed
+bone in order to facilitate the free escape of the discharges.</p>
+
+<p>Gunshot wounds were, of course, unknown in Gilbert's day.
+In a chapter entitled "<i>De craneo perforato</i>" he gives us, however,
+the treatment of wounds of the head produced by the transfixion of
+that member by an arrow. If the arrow passes entirely through the
+head, and the results are not immediately fatal, he directs the surgeon
+to enlarge the wound of exit with a trephine, remove the arrowhead
+through this opening, and withdraw the shaft of the arrow
+through the wound of entrance. The wounds of the cranium are
+then to be treated like ordinary fractures of that organ (f. 88c).</p>
+
+<p>In wounds of the neck involving the jugular vein (<i>vena organica</i>),
+<span class="pagenum"><a name="page62" id="page62"></a>[pg 62]</span>
+Gilbert directs ligation of both extremities of the wounded
+vessel, after which the wound is to be dressed (but not packed)
+with the ordinary dressing of egg-albumen.</p>
+
+<p>Wounds of nerves are treated with a novel dressing of earthworms
+lightly beaten in a mortar and mixed with warm oil, and he
+professes to have seen nerves not only healed (<i>conglutinari</i>), but
+even the divided nerve fibres regenerated (<i>consolidari</i>) under this
+treatment. In puncture of a nerve Gilbert surprises us (f. 179d)
+by the advice to divide completely the wounded nerve, in order to
+relieve pain and prevent tetanus (<i>spasmus</i>).</p>
+
+<p>Goitre, not too vascular in character, is removed by a longitudinal
+incision over the tumor, after which the gland is to be
+dragged out, with its entire capsule, by means of a blunt hook. A
+large goitre in a feeble patient, however, is better left alone, as it is
+difficult to remove all the intricate roots of the tumor, and if any
+portion is left it is prone to return. In such cases Gilbert says we
+shrink from the application of the actual cautery, for fear of injury
+to the surrounding vessels and nerves. Whatever method of operation
+is selected, the patient is to be tied to a table and firmly held in position.</p>
+
+<p>Wounds of the trachea and oesophagus, according to Gilbert,
+are invariably mortal.</p>
+
+<p>In wounds of the thorax the ordinary dressing of albumen is to
+be applied, but if blood or pus enters the cavity of the thorax, the
+patient is directed to bend his body over a dish, twisting himself
+from one side to another (<i>supra discum<a id="footnotetag10" name="footnotetag10"></a><a href="#footnote10"><sup>10</sup></a> flectat se modo hac modo
+ilac vergendo</i>) until he expels the sanies through the wound, and to
+always lie with the wound dependent until it is completely healed (f. 182d).</p>
+
+<p>In case an arrow is lodged within the cavity of the thorax, the
+surgeon is directed to trepan the sternum (<i>os pectoris</i>), remove the
+head of the arrow gently from the shaft, and withdraw the shaft
+itself through the original wound of entrance. If the head is lodged
+beneath or between the ribs, an opening is to be made into the nearest
+intercostal space, the ribs forced apart by a suitable wedge and
+the head thus extracted. The wound through the soft parts is to
+<span class="pagenum"><a name="page63" id="page63"></a>[pg 63]</span>
+be kept open by a tent greased with lard and provided with a suitable
+prolongation (<i>cauda aliqua</i>) to facilitate its extraction and prevent
+its falling into the cavity of the chest.</p>
+
+<p>Wounds of the heart, lungs, liver, stomach and diaphragm are
+regarded as hopelessly mortal (f. 233d), and the physician is advised
+to have nothing to do with them. Wounds of the heart are recognized
+by the profuse haemorrhage and the black color of the blood;
+those of the lung by the foamy character of the blood and the
+dyspnoea; wounds of the diaphragm occasion similar dyspnoea and
+are speedily fatal; those of the liver are known by the disturbance
+of the hepatic functions, and wounds of the stomach by the escape
+of its contents. Wounds of the intestine are either incurable, or
+at least are cured only with the utmost difficulty. Longitudinal
+wounds of the spine which do not penetrate the cord may be repaired,
+but transverse wounds involving the cord, so that the latter escapes
+from the wound, are rarely, if ever, cured by surgery. Wounds of
+the kidneys are also beyond the art of the surgeon. Wounds of the
+penis are curable, and if the wound is transverse and divides the
+nerve, they are likewise painless.</p>
+
+<p><i>Si vene titillares in coxis abscidantur homo moritur ridendo.</i>
+A passage which I can refer only to the erudition and risibility of
+our modern surgeons and anatomists. The ticklish <i>vene titillares</i>
+are to me entirely unknown.</p>
+
+<p>Modern abdominal surgeons will probably be interested in reading
+Gilbert's chapter on the treatment of wounds of the intestines in
+the thirteenth century. He says (f. 234c):</p>
+
+<p>If some portion of the intestine has escaped from a wound of the
+abdomen and is cut either longitudinally or transversely, while the
+major portion remains uninjured; if the wound has existed for
+some time and the exposed intestine is cold, some living animal, like
+a puppy (<i>catulus</i>), is to be killed, split longitudinally and placed over
+the intestine, until the latter is warmed, vivified by the natural heat
+and softened. Then a small tube of alder is prepared, an inch longer
+than the wound of the intestine, carefully thinned down (<i>subtilietur</i>)
+and introduced into the gut through the wound and stitched in position
+with a very fine square-pointed needle, threaded with silk.
+This tube or canula should be so placed as to readily transmit the
+contents of the intestine, and yet form no impediment to the stitches
+of the wound. When this has been done, a sponge moistened in
+warm water and well washed should be employed to gently cleanse
+<span class="pagenum"><a name="page64" id="page64"></a>[pg 64]</span>
+the intestines from all foreign matters, and the gut, thus cleansed,
+is to be returned to the abdominal cavity through the wound of the
+abdominal wall. The patient is then to be laid upon a table and
+gently shaken, in order that the intestines may resume their normal
+position in the abdomen. If necessary the primary wound should
+be enlarged for this purpose. When the intestines have been thus
+replaced, the wound in the abdominal wall is to be kept open until
+the wound of the intestine seems healed. Over the intestinal suture
+a little <i>pulvis ruber</i> should be sprinkled every day, and when the
+wound of the intestine is entirely healed (<i>consolidatur</i>), the wound
+of the abdominal wall is to be sewed up and treated in the manner
+of ordinary flesh wounds.</p>
+
+<p>If, however, the wound is large, a pledget (<i>pecia</i>) of lint, long
+enough to extend from one end to the other and project a little, is
+placed in the wound, and over this the exterior portion of the
+wound is to be carefully sewed, and sprinkled daily with the <i>pulvis
+ruber</i>. Every day the pledget which remains in the wound is to be
+drawn towards the most dependent part, so that the dressing in the
+wound may be daily renewed. When the intestinal wound is found
+to be healed, the entire pledget is to be removed and the unhealed
+openings dressed as in other simple wounds. The diet of the patient
+should be also of the most digestible sort.</p>
+
+<p>Thus far Gilbert has followed Roger almost literally. But he
+now adds, apparently upon his own responsibility, the following paragraph:</p>
+
+<p><i>Quod si placuerit, extrahe canellum: factis punctis in sutura
+ubi debent fieri antequan stringantur, inter duo puncta canellus
+extrahatur, et post puncta stringantur. Hoc dico si vulnus intestini
+sic (sit) ex transverso.</i></p>
+
+<p>Apparently Gilbert feels some compunctions of conscience relative
+to the ultimate disposition of the canula of alder-wood, and
+permits, if he does not advise, its removal from the intestine before
+the tightening of the last stitches.</p>
+
+<p>Roland adds nothing to the text of Roger. But The Four
+Masters (<i>Quatuor Magistri</i>, about A.D. 1270) suggest that the
+canula be made of the trachea of some animal, and add:</p>
+
+<p><i>Canellus autem per processum temporis putrefit et emittur per
+egestionem, et iterum per concavitatem canelli transibit egestio.</i></p>
+<span class="pagenum"><a name="page65" id="page65"></a>[pg 65]</span>
+
+<p>In his further discussion of wounds of the intestine and their
+treatment Gilbert also volunteers the information that:</p>
+
+<p>"Mummy (shade of Lord Lister!) is very valuable in the
+healing of wounds of the intestine, if applied with some astringent
+powder upon the suture."</p>
+
+<p>In amends for the mummy, however, we are also introduced to
+the practice of mediaeval anaesthesia by means of what Gilbert calls
+the <i>Confectio soporifera</i> (f. 234d), composed as follows:</p>
+
+<p><i>R.</i></p>
+
+<div class="poem">  <div class="stanza">
+<p><i>Opii,</i></p>
+<p><i>Succi Jusquiami (hyoscyami),</i></p>
+<p><i>Succi papaveris nigri, vel ejus seminis,</i></p>
+<p><i>Sacci mandragorae, vel ejus corticis, vel pomorunt ipsius si succo carueris,</i></p>
+<p><i>Foliorum hederae arborae (ivy),</i></p>
+<p><i>Succi mororum rubi maturorum,</i></p>
+<p><i>Seminis lactucae,</i></p>
+<p><i>Succi cuseutae (dodder)</i>,&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;aa. ounce I.</p>
+  </div>  </div>
+
+<p>Mix together in a brazen vessel and place this in the sun during
+the dog-days. Put in a sponge to absorb the mixture, and then
+place the sponge in the sun until all the moisture has evaporated.
+When an operation is necessary, let the patient hold the sponge over
+his nose and mouth until he goes to sleep, when the operation may be
+begun. To awaken the patient after the operation, fill another
+sponge with vinegar and rub the teeth and nostrils with the sponge,
+and put some vinegar in the nostrils. An anaesthetic drink may also
+be prepared as follows:</p>
+
+<p><i>R.</i></p>
+
+<div class="poem">  <div class="stanza">
+<p><i>Seminis papaveris albi et nigri,</i></p>
+<p><i>Seminis lactucae,&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;aa. ounce I.</i></p>
+<p><i>Opii,</i></p>
+<p><i>Misconis (&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;, poppy juice?)</i>,&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;aa. scruples I-II, as required.</p>
+  </div>  </div>
+
+<p>The patient is to be aroused as before.</p>
+
+<p>On folio 180d we find a chapter entitled "<i>De cathena gulae
+incisa vel fracta</i>," and copied almost literally from the chapter "<i>De
+catena gulae</i>" of Roger. In neither writer do I find any precise
+definition of what the <i>cathena gulae</i> is, though Roger says,
+<span class="pagenum"><a name="page66" id="page66"></a>[pg 66]</span>
+<i>Si es gulae, quod est catena, fractum fuerit</i>, etc., nor do I find the terms
+used explained in any dictionary at present available. The description
+of the treatment of this fracture seems, however, to indicate
+that the <i>catena gulae</i> of Roger and Gilbert is what we call the
+clavicle, though the more common Latin names of this bone are
+<i>claviculus</i>, <i>furcula</i>, <i>juglum</i> or <i>os juguli</i>. Gilbert says: "But if the
+bone which is the <i>cathena gulae</i> is broken or in any way displaced
+(<i>recesserit</i>), let the physician with one hand raise the forearm
+(<i>brachium</i>) or arm (<i>humerum</i>) of the patient, and with the other
+hand press down upon the projecting portion of the bone. Then
+apply a pledget moistened with albumen, a pad and a splint in form
+of a cross, and over all a long bandage embracing both the arm and
+the neck and suspending the arm. A pad (<i>cervical</i>) should also be
+placed in the axilla to prevent the dropping of the arm, and should
+not be removed until the fracture is repaired. If the fracture is
+compound, the wound of the soft parts is to be left open and uncovered
+by the bandage, so that a tent (<i>stuellus</i>) may be inserted,
+and the wound is then to be dressed in the ordinary manner."</p>
+
+<p>Simple fracture of the humerus, Gilbert tells us, is to be reduced
+(<i>ad proprium locum reducator</i>) at once by grasping the arm
+above and below the seat of fracture and exercising gentle and
+gradual extension and compression. Then four pieces of lint wet in
+egg-albumen are to be placed around the arm on all sides, a bandage,
+four fingers wide, also moistened in albumen is to be snugly
+applied, another dry bandage placed above this, and finally splints
+fastened in position by cords. This dressing is to remain undisturbed
+for three days, and then renewed every third day for nine
+days. After the ninth day a <i>strictura</i> (cast, apparatus immobile?)
+is to be prepared and firmly applied with splints and a bandage, and
+the patient is to be cautioned not to bear any weight upon the injured
+arm (<i>ne infirmus se super illud appodiet</i>?). The fracture is
+then left until it is believed that consolidation has occurred. If,
+however, it is found that swelling is occasioned by the cast (<i>ex
+strictorio</i>?), the latter should be removed, and the arm well bathed
+in warm water containing mallowae and other emollients and thoroughly
+cleansed. If the bone seems to be well consolidated, it
+should be rubbed with an ointment of <i>dialthea</i> or the <i>unguentum
+marciation</i>, after which the splints and bandage are to be reapplied.
+If, however, it is found that the bone is not well consolidated, the
+cast should be replaced in the original manner, until consolidation
+<span class="pagenum"><a name="page67" id="page67"></a>[pg 67]</span>
+is accomplished. If erysipelas results from the dressings, it is to
+be treated in the ordinary manner. During the entire treatment
+potions of nasturtium seeds, <i>pes columbini</i> (crowfoot) and other
+"consolidatives" are to be administered diligently. If the fracture
+is compound, any loose fragments of bone are to be removed, the
+fracture reduced as before, and similar dressings applied, perforated,
+however, over the wound in the soft parts.</p>
+
+<p>In fracture of the ribs (<i>flexura costi</i>) Gilbert recommends a
+somewhat novel plan for the replacement of the displaced bone.
+Having put the patient in a bath, the physician rubs his hands well
+with honey, turpentine, pitch or bird-lime (<i>visco</i>), applies his sticky
+palms over the displaced ribs, and gradually raises them to their
+normal position. He also says (f. 183a), the application of a dry
+cup (<i>cuffa vero cum igne</i>?) over the displaced rib is a convenient
+method for raising it into position.</p>
+
+<p>Of fractures of the forearm Gilbert simply says that they are
+to be recognized by the touch and a comparison of the injured with
+the sound arm. They should be diligently fomented, extension made
+if necessary, and then treated like other fractures.</p>
+
+<p>Dislocation of the atlo-axoid articulation (<i>os juguli</i>) he tells us
+threatens speedy death. The mouth of the patient is to be kept
+open by a wooden gag, a bandage passed beneath the jaw and held
+by the physician, who places his feet upon the shoulders of the
+patient and pressing down upon them while he elevates the head by
+the bandage, endeavors to restore the displaced bone to its normal
+position. Inunctions of various mollitives are then useful.</p>
+
+<p>Dislocations of the lower jaw are recognized by the failure of
+the teeth to fit their fellows of the upper jaw, and by the detection
+of the condyles of the jaw beneath the ears. The bone is to be
+grasped by the rami and dragged down until the teeth resume and
+retain their natural position, and the jaw is then to be kept in place
+by a suitable bandage.</p>
+
+<p>In dislocation of the humerus the patient is to be bound in the
+supine position, a wedge-shaped stone wrapped with yarn placed in
+the axilla, and the surgeon, pressing against the padded stone with
+his foot and raising the humerus with his hands, reduces the head
+of the bone to its natural position. If this method fails, a long
+crutch-like stick is prepared to receive at one end the axillary pad,
+the patient is placed standing upon a box or bench, the pad and
+<span class="pagenum"><a name="page68" id="page68"></a>[pg 68]</span>
+crutch adjusted in the axilla, and while the surgeon stands ready to
+guide the dislocated bone to its place, his assistants remove the
+bench, leaving the patient suspended by his shoulder upon the rude
+crutch. In boys, Gilbert tells us, no special apparatus is required.
+The surgeon merely places his doubled fist in the axilla, with the
+other hand grasps the humerus and lifts the boy off the ground, and
+the head of the bone slips readily back into place. After we are
+assured that the reduction is complete, a strictorium is prepared,
+consisting of the <i>pulvis ruber</i>, egg-albumen and a little wheat flour,
+with which the shoulder is to be rubbed. Finally, when all seems
+to be going on well, warm <i>spata drapum</i> (sparadrap) is to be applied
+upon a bandage, and if necessary the apostolicon ointment.</p>
+
+<p>Dislocation of the elbow is reduced by passing a bandage
+around the bend of the arm, forming in this a loop (<i>scapham</i>) into
+which the foot of the surgeon is to be placed for counter-extension,
+while with the hands extension is to be made upon the forearm until
+the bones are drawn into their normal position. Flexion and
+extension of the joint are then to be practised three or four times
+(to assure complete reduction?), and the forearm flexed and supported
+by a bandage from the neck. After a few days, Gilbert tells
+us, the patient will himself often try to flex and extend the arm,
+and the bandage should be so applied as not to interfere with these movements.</p>
+
+<p>Dislocation of the wrist is reduced by gentle extension from the
+hand and counter-extension from the forearm, and dislocation of
+the fingers by a similar manipulation.</p>
+
+<p>After so full a consideration of the surgical injuries of the
+head, trunk and upper extremities, we are somewhat surprised to
+find Gilbert's discussion of the similar injuries of the lower extremities
+condensed into a single very moderate chapter entitled "De
+vulneribus cruris et tybie" (f. 358a b).</p>
+
+<p>In this, Gilbert, emphasizing the importance of wounds of the
+patella and knee-joint and the necessity for their careful treatment,
+also declares that wounds of both the leg and thigh within three
+inches of the joints, or in the fleshy portion of the thigh <i>ubi organum
+est</i> (?), involve considerable danger. He then speaks of a blackish,
+hard and very painful tumor of the thigh, which, when it ascends
+the thigh (<i>ad superiora ascendit</i>) is mortal, but if it descends is less
+dangerous. Separation of the sacrum (<i>vertebrum</i>) from the ilium
+(<i>scia</i>), either by accident or from the corrosion of humors, leaves
+<span class="pagenum"><a name="page69" id="page69"></a>[pg 69]</span>
+the patient permanently lame, though suitable fomentations and
+inunctions may produce some improvement. Sprains of the ankle
+are to be treated by placing the joint immediately in very cold water
+<i>ad repercussionem spiritus et sanguinis</i>, and the joint is to be kept
+thus refrigerated until it even becomes numb (<i>stupefactionem</i>);
+after which stupes of salt water and urine are to be applied, followed
+by a plaster of galbanum, opoponax, the apostolicon, etc.</p>
+
+<p>Fractures of the femur are to be treated like those of the
+humerus, except that the ends of the fractured bone are to be separated
+by the space of an inch, and a bandage six fingers in width
+carefully applied. Such fractures within three inches of the hip or
+knee-joint are regarded as specially dangerous.</p>
+
+<p>Dislocations of the ankle, after reduction of proper manipulation,
+should be bound with suitable splints. If of a less severe
+character, the dislocation may be dressed with stupes of canabina
+(Indian hemp), urine and salt water, which greatly mitigate the
+pain and swelling. Afterwards the joint should be strapped for
+four or five inches above the ankle with plaster, <i>ut prohibeatur fluxus</i>.</p>
+
+<p>It should be said that the brevity of this chapter of Gilbert is
+modeled after the manner of Roger of Parma, who refers the treatment
+of injuries of the lower extremities very largely to that of
+similar injuries of the upper, merely adding thereto such explanations
+as may be demanded by the differences of location and function
+of the members involved. Thus in his discussion of dislocation
+of the femur Roger says:</p>
+
+<p><i>Si crus a coxa sit disjunctum, eadem sit cura quam et in disjuncturam
+brachii et cubiti diximus, etc.</i></p>
+
+<p>The general subject of fistulae is treated at considerable length
+on folio 205b, and fistula lachrymalis and fistulae of the jaw receive
+special attention in their appropriate places. As a rule, the fistula
+is dilated by a tent of alder-pith, mandragora, briony or gentian,
+the lining membrane destroyed by an ointment of quick-lime or even
+the actual cautery, and the wound then dressed with egg-albumen
+followed by the <i>unguentum viride</i>. Necrosed bone is to be removed,
+if necessary, by deep incisions, and decayed teeth are to be extracted.</p>
+
+<p>The elongated uvula is to be snipped off, and abscesses of the
+tonsils opened <i>tout comme chez nous</i>.</p>
+<span class="pagenum"><a name="page70" id="page70"></a>[pg 70]</span>
+
+<p>An elaborate discussion of the subject of hernia is given under
+the title "<i>De relaxatione siphac et ruptura</i>" (f. 280c)&mdash;siphac being
+the Arabian name for the peritoneum. Gilbert tells us the siphac is
+sometimes relaxed, sometimes ruptured (<i>crepatur</i>?) and sometimes
+inflated. He had seen a large rupture (<i>crepatura</i>) in which it was
+impossible to restore the intestines to the cavity of the abdomen in
+consequence of the presence in them of large hard masses of fecal
+matter, which no treatment proved adequate to remove, and which
+finally occasioned the death of the patient. Rupture of the siphac
+is most frequently the result of accident, jumping, straining in lifting
+or carrying heavy weights, or in efforts at defecation, or of
+shouting in boys or persons of advanced age, or even in excessive
+weeping, etc. It is distinguished from hernia by the fact that in
+hernia pain is felt in the testicle, radiating to the kidneys, while in
+rupture of the siphac a swelling on one side of the pubes extends
+into the scrotum, where it produces a tumor not involving the
+testicle. Rupture of the siphac, he says, is a lesion of the organs
+of nutrition, hernia a disease of the organs of generation. Accordingly,
+in the pathology of Gilbert, the term hernia is applied to
+hydrocele, orchitis and other diseases of the testicle, and not, as with
+us to protrusions of the viscera through the walls of their cavities.</p>
+
+<p>In young persons, he tells us, recent ruptures of the siphac may
+be cured by appropriate treatment. The patient is to be laid upon
+his back, the hips raised, the intestines restored to the abdominal
+cavity and the opening of exit dressed with a plaster of exsiccative
+and consolidating remedies, of which he furnishes a long and diversified
+catalogue. He is also to avoid religiously all exercise or motion,
+all anger, clamor, coughing, sneezing, equitation, cohabitation,
+etc., and to lie with his feet elevated for forty days, until the rupture
+(<i>crepatura</i>) is consolidated. The bowels are to be kept soluble
+by enemata or appropriate medicines, and the diet should be selected
+so as to avoid constipation and flatulence. A bandage or truss
+(<i>bracale vel colligar</i>) made of silk and well fitted to the patient is
+also highly recommended. If the patient is a boy, cakes (<i>crispelle</i>?)
+of <i>consolida major</i> mixed with the yolk of eggs should be administered,
+one each day for nine days before the wane of the moon.
+If, however, the rupture is large in either a boy or an adult, and of
+long standing, whether the intestine descends into the scrotum or
+not, operation, either by incision or by the cautery offers the only
+hope of relief. Singularly enough too, while Roger devotes to the
+<span class="pagenum"><a name="page71" id="page71"></a>[pg 71]</span>
+operation for the cure of hernia nearly half a page of his text, Gilbert
+dismisses the whole subject in a single sentence, as follows:</p>
+
+<p><i>Scindatur igitur totus exitus super hac cute exteriori cum carne
+fissa, et uatur y fac cum file serice et acu quadrata. Deinde persequere
+ut in exitu intestini per vulnus superius demonstratum est</i> (f. 281d).</p>
+
+<p>Turning now to the title "<i>De hernia</i>" (f. 289b), Gilbert tells us
+"Swelling (<i>inflatio</i>) of the testicles is due sometimes to humors
+trickling down upon them (<i>rheumatizantibus</i>), sometimes to abscess,
+or to gaseous collections (<i>ventositate</i>), and sometimes to
+escape of the intestines through rupture of the siphac." He adds
+also: "Some doubt the propriety of using the term hernia for an
+inflation. On this point magister Rn says: There is a certain
+chronic and inveterate tumor of the testicles, which is never cured
+except by means of surgery, as e.g., hernia. For hernia is an affection
+common to the scrotum and the testicles."</p>
+
+<p>The apparent confusion between these two passages is easily
+relieved by the explanation that inguinal or other herniae not extending
+into the scrotum are called by Gilbert ruptures of the siphac,
+but scrotal hernia is classed with other troubles located in the
+scrotum as hernia. Accordingly hernia, with Gilbert, includes not
+only scrotal hernia, but also hydrocele, orchitis, tumors of the testicles,
+etc. This is apparent, too, in his treatment of hernia, which
+consists usually in the employment of various poultices and ointments,
+bleeding from the saphena, cups over the kidneys, etc.,
+though hydrocele is tapped and a seton inserted. If the testicle
+itself is "putrid," it should be removed; otherwise it is left. It may
+be remarked <i>en passant</i> that the surgeons of medieval times, in their
+desire for thoroughness, often displayed very little respect to what
+Baas calls "the root of humanity."</p>
+
+<p>We will terminate our hasty review of diseases discussed in the
+Compendium by an abstract of Gilbert's views on vesical calculus
+and its treatment, which cover more than fifteen pages of his work.</p>
+
+<p>Stone and gravel arise from various viscous superfluities in the
+kidneys and bladder, which occasion difficulty in micturition. Stone
+is produced by the action of heat upon viscous moisture, sublimating
+the volatile elements and condensing the denser portions. Putrefication
+of stone in the bladder is the result of three causes, viz., consuming
+heat, viscous matter and stricture of the meatus. For consuming
+<span class="pagenum"><a name="page72" id="page72"></a>[pg 72]</span>
+heat acting on viscous material retained by reason of stricture
+of the meatus, by long action dries up, coagulates and hardens
+the moisture. This is particularly manifest in boys who have a constricted
+meatus.</p>
+
+<p>Stones are thus generated not only in the kidneys and bladder,
+but also even in the stomach and the intestines, whence they are
+ejected by vomiting or in the stools. Indeed they may also be found
+occasionally in the lungs, the joints and other places. They are
+comparatively rare in women, in consequence of the shortness of
+the urethra and the size of their meatus.</p>
+
+<p>Sometimes calculi occur in the bladder, sometimes in one kidney
+and occasionally in both kidneys. The symptoms produced by their
+presence vary in accordance with the situation of the concretion. If
+the stone is in the kidney, the foot of the side affected is numb
+(<i>stupidus</i>), the spine on the affected side is sore and there is difficulty
+of micturition and considerable gravelly sediment in the urine.
+If the stone is increasing in size, the quantity of sediment also increases,
+but if the stone is fully formed and confirmed, the amount
+of sediment decreases daily, and the urine becomes milky both in
+the kidneys and the bladder. A stone in the bladder occasions very
+similar symptoms, together with pain in the peritoneum and pubes,
+dysuria and strangury, and sometimes the appearance of blood and
+flocculi (<i>trumbos</i>?) in the urine. Patients suffering from vesical
+calculus are always constipated, and the dysuria may increase to the
+degree called furia, a condition not without some danger.</p>
+
+<p>Three things are necessary in the cure of stone, viz., a spare and
+simple diet, the use of diuretics and a moderate amount of exercise.
+It should, however, be remarked that confirmed stone is rarely or
+never cured, except by a surgical operation.... If a boy
+has a clear and watery urine after it has been sandy, if he frequently
+scratches his foot, has involuntary erections and finally obstruction
+in micturition, I say that he has a stone in the neck of his bladder.
+If now he be laid upon his back with his feet well elevated, and his
+whole body be well shaken, if there is a stone present it is possible
+that it may fall to the fundus of the bladder. Afterwards direct
+the boy to bear down (<i>ut exprimat se</i>) and try to make water. If
+this treatment turns out in accordance with your theory, the urine
+necessarily escapes and your idea and treatment are confirmed. If,
+however, the urine not escape, let the boy be shaken vigorously
+a second time. If this too fails and strangury ensues, it will be
+<span class="pagenum"><a name="page73" id="page73"></a>[pg 73]</span>
+necessary to resort to the use of a sound or catheter (<i>argaliam</i>),
+so that when the stone is pushed away from the neck of the bladder
+the passage may be opened and the urine may flow out. It may be
+possible too that no stone exists, but the urethra is obstructed or
+closed by pure coagulated blood. Perhaps there may have been a
+wound of the bladder, although no external haemorrhage has appeared,
+but the blood coagulating gradually in the bladder has occasioned
+an obstruction or narrowing of the urinary passage. Or
+possibly the blood from a renal haemorrhage has descended into the
+bladder and obstructs the urethra. Hence I say that the sound is
+useful in these cases where the urethra is obstructed by blood or
+gross humors. Examination should also be made as to whether a
+fleshy body exists in the bladder, as the result of some wound. This
+condition is manifest if, on the introduction of the sound, the urine
+flows out promptly. I once saw a man suffering from this condition,
+who complained of severe pain in the urinary passage as I
+was introducing the sound, and I recognized that there were wounds
+in the same part, for as soon as these were touched by the sound
+the urine began to flow, followed soon after by a little blood and
+fleshy particles.... So far as the operation of physicians is
+concerned, it is necessary only to be certain of the fact that obstruction
+to the passage of urine depends upon no other cause than
+stone or the presence of coagulated blood (f. 271).</p>
+
+<p>Gilbert's medical treatment of vesical calculus consists generally
+in the administration of diuretics and lithontriptics and the local
+application of poultices, plasters and inunctions of various kinds.
+Of the lithontriptics, certain combinations, characterized by famous
+names or notable historical origin, are evident favorites. Among
+this class we read of the <i>Philoantropos major</i> and <i>minor</i>, the <i>Justinum</i>,
+the <i>Usina</i> "approved by many wise men of Babylon and Constantinople,"
+the <i>Lithontripon</i> and the "<i>Pulvis Eugenii pape</i>," with
+numerous others.</p>
+
+<p>Rather curiously and suggestively no mention is made in this
+immediate connection of the technique of lithotomy. On a later
+page, however (f. 309a), we find a chapter entitled "<i>De cura lapidis
+per cyrurgiam</i>," in which Gilbert writes:</p>
+
+<p>"Mark here a chapter on the cure of stone in the bladder by
+means of surgery, which we have omitted above. Accordingly, to
+determine whether a stone exists in the bladder, let the patient take
+a warm bath. Then let him be placed with his buttocks elevated,
+<span class="pagenum"><a name="page74" id="page74"></a>[pg 74]</span>
+and, having inserted into the anus two fingers of the right hand,
+press the fist of the left hand deeply above the pubes and lift and
+draw the entire bladder upward. If you find anything hard and
+heavy, it is manifest that there is a stone in the bladder. If the
+body feels soft and fleshy, it is a fleshy excrescence (<i>carnositas</i>),
+which impedes the flow of urine. Now, if the stone is located in
+the neck of the bladder and you wish to force it to the fundus:
+after the use of fomentations and inunctions, inject through a
+syringe (<i>siringa</i>) some petroleum, and after a short interval pass
+the syringe again up to the neck of the bladder and cautiously and
+gently push the stone away from the neck to the fundus. Or, which
+is safer and better, having used the preceding fomentations and inunctions,
+and having assured yourself that there is a stone in the
+bladder, introduce your fingers into the anus and compress the
+neck of the bladder with the fist of the left hand above the pubes,
+and cautiously remove the stone and guide it to the fundus. But if
+you wish to extract the stone, let a spare diet precede the operation,
+and let the patient lie abed for a couple of days with very little food.
+On the third day introduce the fingers into the anus as before, and
+draw down the stone into the neck of the bladder. Then make your
+incision lengthwise in the fontanel, the width of two fingers above
+the anus, and extract the stone. For nine days after the operation
+let the patient use, morning and evening, fomentations of <i>branca</i>
+(<i>acanthus mollis</i>), <i>paritaria</i> (pellitery) and <i>malva</i> (mallows). A
+bit of tow (<i>stupa</i>) moistened with the yolk of egg in winter, and
+with both the yolk and white of egg in summer, is to be placed over
+the wound. Proud flesh, which often springs up near a wound in
+the neck of the bladder, should be removed by the knife (<i>rasorio</i>),
+and two or three sutures inserted. The wound is then to be treated
+like other wounds. It should be remarked, however, that if the
+stone is very large, it should be simply pushed up to the fundus of
+the bladder and left there, and no effort should be made to extract it."</p>
+
+<p>This description of the diagnosis of stone and of the operation
+of lithotomy is copied almost literally from Roger of Parma.</p>
+
+<p>Sufficient (perhaps more than enough) has been written to
+give the reader a fair idea of the general character of Gilbert's
+"Compendium Medicine."</p>
+
+<p>A few words may be added with reference to the proper place
+of the work in our medical literature.</p>
+<span class="pagenum"><a name="page75" id="page75"></a>[pg 75]</span>
+
+<p>It is not difficult, of course, to select from the Compendium a
+charm or two, a few impossible etymologies and a few silly statements,
+to display these with a witty emphasis and to draw therefrom
+the easy conclusion that the book is a mass of crass superstition
+and absurd nonsense. This, however, is not criticism. It is mere caricature.</p>
+
+<p>To compare the work with the teachings of modern medicine is
+not only to expect of the writer a miraculous prescience, but to
+minimize the advances of medical science within the last seven hundred years.</p>
+
+<p>Even Freind and Sprengel, admirable historians, though more
+thoughtful and judicious in their criticisms, seem for the moment to
+have forgotten or overlooked the true character of the Compendium.</p>
+
+<p>Freind says:</p>
+
+<p>"I believe we may even say with justice that he (Gilbert) has
+written as well as any of his contemporaries of other nations, and
+has merely followed their example in borrowing very largely from
+the Arabians," and Sprengel writes: "Here and there, though only
+very rarely, the author offers some remarks of his own, which merit
+special attention."</p>
+
+<p>Now, what precisely is Gilbert's Compendium designed to be?
+In the words of its author it is</p>
+
+<p>"A book of general and special diseases, selected and extracted
+from the writings of all authors and the practice of the professors
+(<i>magistrorum</i>), edited by Gilbert of England and entitled a Compendium
+of Medicine."</p>
+
+<p>and a few pages later he adds:</p>
+
+<p>"It is our habit to select the best sayings of the best authorities,
+and where any doubt exists, to insert the different opinions, so that
+each reader may choose for himself what he prefers to maintain."</p>
+
+<p>The author does not claim for his work any considerable originality,
+but presents it as a compendium proper of the teachings of
+other writers. Naturally his own part in the book is not obtruded
+upon our notice.</p>
+
+<p>Now the desiderata of such a compendium are:</p>
+
+<p>1. That it shall be based upon the best attainable authorities.</p>
+
+<p>2. That these authorities shall be accurately represented.</p>
+
+<p>3. That the compendium shall be reasonably comprehensive.</p>
+<span class="pagenum"><a name="page76" id="page76"></a>[pg 76]</span>
+
+<p>In neither of these respects is the compendium of Gilbert liable,
+I think, to adverse criticism.</p>
+
+<p>The book is, undoubtedly, the work of a famous and strictly
+orthodox physician, possessed of exceptional education in the science
+of his day, a man of wide reading, broadened by extensive travel
+and endowed with the knowledge acquired by a long experience,
+honest, truthful and simple minded, yet not uncritical in regard to
+novelties, firm in his own opinions but not arrogant, sympathetic,
+possessed of a high sense of professional honor, a firm believer in
+authority and therefore credulous, superstitious after the manner of
+his age, yet harboring, too, a germ of that healthy skepticism which
+Roger Bacon, his great contemporary, developed and illustrated.</p>
+
+<p>I believe, therefore, that we may justly award to the medical
+pages of the Compendium not only the rather negative praise of
+being written as well as the work of any of Gilbert's contemporaries,
+but the more positive credit of being thoroughly abreast of the
+medical science of its age and country, an "Abstract and brief
+chronicle of the time."</p>
+
+<p>The surgical chapters of the work are unique in a compendium
+of medicine, and merit even more favorable criticism.</p>
+
+<p>The discouragement of the practice of medicine and surgery on
+the part of ecclesiastics by the popes and church councils of the
+twelfth century, culminating in the decree of Pope Innocent III in
+1215, which forbade the participation of the higher clergy in any
+operation involving the shedding of blood (<i>Ecclesia abhorret a
+sanguine</i>); the relatively scanty supply of educated lay physicians
+and surgeons, and finally the pride and inertia of the lay physicians
+themselves; all these combined to relegate surgery in the thirteenth
+century to the hands of a class of ignorant and unconscionable empirics,
+whose rash activity shed a baleful light upon the art of surgery
+itself. As a natural result the practice of this art drifted into
+an <i>impasse</i>, from which the organization of the barber-surgeons
+seemed the only logical means of escape.</p>
+
+<p>The earliest evidence of the public surgical activity of the barbers,
+as a class, is found, I believe, in Joinville's Chronicle of the
+Crusade of St. Louis (Louis IX) in the year 1250. According to
+Malgaigne, no trustworthy evidence of any organization of the barbers
+of Paris is available before 1301, and the fraternity was not
+chartered until 1427, under Charles VII. The barbers of London
+are noticed in 1308, and they received their charter from Edward
+<span class="pagenum"><a name="page77" id="page77"></a>[pg 77]</span>
+IV in 1462. The parallel lines upon which the confraternities of the
+two cities developed is very noticeable&mdash;making due allowance for
+Gallic enthusiasm and bitterness.</p>
+
+<p>Lanfranchi, the great surgeon of Paris, about the year 1300 is
+moved to write as follows:</p>
+
+<p>"Why, in God's name, in our days is there such a great difference
+between the physician and the surgeon? The physicians have
+abandoned operative procedures to the laity, either, as some say,
+because they disdain to operate with their hands, or rather, as I
+think, because they do not know how to perform operations. Indeed,
+this abuse is so inveterate that the common people look upon it
+as impossible for the same person to understand both surgery and
+medicine. It ought, however, to be understood that no one can be
+a good physician who has no idea of surgical operations, and that a
+surgeon is nothing if ignorant of medicine. In a word, one must
+be familiar with both departments of medicine."</p>
+
+<p>Now Gilbert by the incorporation of many chapters on surgery
+in his Compendium inculcates practically the same idea more than
+fifty years before Lanfranchi, and may claim to be the earliest representative
+of surgical teaching in England. Malgaigne, indeed,
+does not include his name in the admirable sketch of medieval surgery
+with which he introduces his edition of the works of Ambroise
+Pare, and says Gilbert was no more a surgeon than Bernard Gordon.
+This is in a certain sense true. Gilbert was certainly not an
+operative surgeon. But it needs only a very superficial comparison
+of the Compendium of Gilbert with the Lilium Medicinae of Gordon
+to establish the fact that the books are entirely unlike. Indeed,
+it may be truthfully said that Gordon's work does not contain a
+single chapter on surgery proper. His cases involving surgical
+assistance are turned over at once, and with little or no discussion,
+to those whom he calls "restauratores" or "chirurgi," and his own
+responsibility thereupon ends.</p>
+
+<p>We have no historical facts which demonstrate that Gilbert's
+Compendium exercised any considerable influence upon the development
+of surgery in England, but when we consider the depressed
+condition of both medicine and surgery in his day, we should certainly
+emphasize the clearness of vision which led our author to
+indicate the natural association of these two departments of the
+healing art, and the assistance which each lends to the other.</p>
+
+<blockquote class="footnote"><a id="footnote1" name="footnote1"></a><b>Footnote 1: </b><a href="#footnotetag1">(return) </a><p>In Leslie Stephen's "Dictionary of Biography."</p></blockquote>
+
+<blockquote class="footnote"><a id="footnote2" name="footnote2"></a><b>Footnote 2: </b><a href="#footnotetag2">(return) </a><p><i>British Medical Journal</i>, Nov. 12, 1904, p. 1282.</p></blockquote>
+
+<blockquote class="footnote"><a id="footnote3" name="footnote3"></a><b>Footnote 3: </b><a href="#footnotetag3">(return) </a><p>Janus, 1903, p. 20.</p></blockquote>
+
+<blockquote class="footnote"><a id="footnote4" name="footnote4"></a><b>Footnote 4: </b><a href="#footnotetag4">(return) </a><p>Cap. XXXVI, p. 116, edition of Brewer.</p></blockquote>
+
+<blockquote class="footnote"><a id="footnote5" name="footnote5"></a><b>Footnote 5: </b><a href="#footnotetag5">(return) </a><p>Haeser says that this MS. of Roger's "Chirurgia," made by Guido
+Arenitensium, was discovered by Puccinoti in the Magliabechian library, and
+that an old Italian translation of the same work is also found there. The
+latter was the work of a certain Bartollomeo.</p>
+
+<p>The text used to represent Roger in the present paper is that published
+by De Renzi (Collectio Salernitana, tom. II, pp. 426-493) and entitled
+"Rogerii, Medici Celeberrimi Chirurgia." It is really the text published
+originally in the "Collectio Chirurgica Veneta" of 1546, of which the preface
+says:</p>
+
+<p>"<i>His acceserunt Rogerii ac Guil. Saliceti chirurgiae, quarum prior quibusdam
+decorata adnotationibus nunc primum in lucem exit, etc.</i>," and adds
+further on:</p>
+
+<p>"<i>Addidimus etiam quasdam in Rogerium veluti explanationes, in antiquissimo
+codice inventas, et ab ipso fortasse Rolando factas.</i>" While I may
+recognize gratefully the surgical enthusiasm which led the editor to the publication
+of these "<i>veluti explanationes</i>," for my present purpose he would
+have earned more grateful recognition if he had left them unprinted. As the
+text now stands it is merely a garbled edition of the Rolandina. However,
+it is the best representative of the "Chirurgia" of Roger at present available.
+See De Renzi, op. cit., p. 425.</p></blockquote>
+
+<blockquote class="footnote"><a id="footnote6" name="footnote6"></a><b>Footnote 6: </b><a href="#footnotetag6">(return) </a><p>This apparent anachronism carries us back to the history of the mythical Island of Brazil, which appeared upon our charts as late as the middle of the 19th century.</p></blockquote>
+
+<blockquote class="footnote"><a id="footnote7" name="footnote7"></a><b>Footnote 7: </b><a href="#footnotetag7">(return) </a><p>In his chapter on embryology (f. 304c) Gilbert describes the lrili
+vein as follows: "The embryo is nourished by means of the lrili or lrineli
+vein, which does not exist in man. This vein has its origin in the liver and
+divides into two branches. Of these the superior branch bifurcates, and one
+of its branches goes to the right breast, the other to the left, conveying blood
+from the liver. This blood in the breast is bleached white (<i>dealbatur</i>) like
+milk, and forms the nourishment of the infant. The inferior branch of the
+lrili vein also bifurcates, sending one of its branches to the right cornu of
+the uterus, the other to the left. These vessels carry blood into the cotyledons,
+whence it is transmitted to the fetus and digested by its digestive
+faculty."</p></blockquote>
+
+<blockquote class="footnote"><a id="footnote8" name="footnote8"></a><b>Footnote 8: </b><a href="#footnotetag8">(return) </a><p>Cf. the French <i>bosse de la gorge</i>.</p></blockquote>
+
+<blockquote class="footnote"><a id="footnote9" name="footnote9"></a><b>Footnote 9: </b><a href="#footnotetag9">(return) </a><p>It is at least interesting to know that small-pox is said to have made its first appearance in England in 1241.</p></blockquote>
+
+<blockquote class="footnote"><a id="footnote10" name="footnote10"></a><b>Footnote 10: </b><a href="#footnotetag10">(return) </a><p>It is interesting to observe how the Latin discus developed dichotomously into the English "dish" and the German "Tisch." The former is doubtless the meaning of the word in this place.</p></blockquote>
+
+<p>&nbsp;</p>
+<p>&nbsp;</p>
+<hr class="full" />
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+The Project Gutenberg eBook, Gilbertus Anglicus, by Henry Ebenezer
+Handerson
+
+
+This eBook is for the use of anyone anywhere at no cost and with
+almost no restrictions whatsoever.  You may copy it, give it away or
+re-use it under the terms of the Project Gutenberg License included
+with this eBook or online at www.gutenberg.org
+
+
+
+
+
+Title: Gilbertus Anglicus
+       Medicine of the Thirteenth Century
+
+
+Author: Henry Ebenezer Handerson
+
+
+
+Release Date: June 30, 2005  [eBook #16155]
+
+Language: English
+
+Character set encoding: ISO-646-US (US-ASCII)
+
+
+***START OF THE PROJECT GUTENBERG EBOOK GILBERTUS ANGLICUS***
+
+
+E-text prepared by Suzanne Lybarger, William Flis, and the Project
+Gutenberg Online Distributed Proofreading Team (https://www.pgdp.net/) from
+page images generously made available by Internet Archive and Canadian
+Libraries (http://www.archive.org/details/toronto)
+
+
+
+Note: Images of the original pages are available through the Internet
+      Archive and Canadian Libraries. See
+      http://www.archive.org/details/gilbertusanglicu00handuoft
+
+
+
+
+
+GILBERTUS ANGLICUS
+
+Medicine of the Thirteenth Century
+
+by
+
+HENRY E. HANDERSON, A.M., M.D.
+
+With a Biography of the Author
+
+Published Posthumously for Private Distribution by
+the Cleveland Medical Library Association
+Cleveland, Ohio
+
+1918
+
+
+
+
+
+
+
+CONTENTS
+
+
+                                                       Page
+  Frontispiece                                            5
+
+  Explanatory Foreword                                    7
+
+  Biography                                            9-14
+
+  Resolutions of the Cleveland Medical Library Ass'n     15
+
+  Gilbertus Anglicus--A Study of Medicine in the
+      Thirteenth Century                              17-78
+
+
+
+
+[Illustration: HENRY E. HANDERSON]
+
+
+
+
+EXPLANATORY FOREWORD
+
+
+In the summer of 1916 the librarian of the Cleveland Medical Library
+received a manuscript from Dr. Henry E. Handerson with the request
+that it be filed for reference in the archives of the library. The
+librarian at once recognized the value of the paper and referred it
+to the editorial board of the Cleveland Medical Journal, who sought
+the privilege of publishing it. Dr. Handerson's consent was secured
+and the article was set in type. However, when the time came for its
+publication the author was reluctant to have it appear since he was
+unable then to read the proof, and because he felt that the material
+present might not be suitable for publication in a clinical journal.
+To those who knew him, this painstaking attention to detail and desire
+for accuracy presents itself as a familiar characteristic. Though
+actual publication was postponed, the type forms were held, and when
+the Cleveland Medical Journal suspended publication, its editorial
+board informed the Council of the Cleveland Medical Library
+Association of the valuable material which it had been unable to
+give to the medical world. In the meantime Dr. Handerson's death
+had occurred, but the Council obtained the generous consent of the
+author's family to make this posthumous publication. It is hoped that
+those who read will bear this fact in mind and will be lenient in
+the consideration of typographical errors, of which the author was so
+fearful.
+
+The Cleveland Medical Library Association feels that it is fortunate
+in being enabled to present to its members and to others of the
+profession this work of Dr. Handerson's and to create from his own
+labors a memorial to him who was once its president.
+
+    SAMUEL W. KELLEY.
+    CLYDE L. CUMMER.
+    Committee on Publication.
+
+
+
+
+BIOGRAPHY
+
+HENRY EBENEZER HANDERSON
+
+
+Owing to Dr. Handerson's modesty, even we who were for years
+associated with him in medical college, in organization, and
+professional work, knew but little of him. He would much rather
+discuss some fact or theory of medical science or some ancient worthy
+of the profession than his own life. Seeing this tall venerable
+gentleman, sedate in manner and philosophical in mind, presiding over
+the Cuyahoga County Medical Society or the Cleveland Medical Library
+Association, few of the members ever pictured him as a fiery, youthful
+Confederate officer, leading a charge at a run up-hill over fallen
+logs and brush, sounding the "Rebel yell," leaping a hedge and
+alighting in a ten-foot ditch among Federal troopers who surrendered
+to him and his comrades. Yet this is history. We could perhaps more
+easily have recognized him even though in a military prison-pen, on
+finding him dispelling the tedium by teaching his fellow prisoners
+Latin and Greek, or perusing a precious volume of Herodotus.
+
+Henry Ebenezer Handerson was born on March 21, 1837, here in Cuyahoga
+county, in the township of Orange, near the point now known as
+"Handerson's Cross-Roads," on the Chagrin river. His mother's maiden
+name was Catharine Potts. His father was Thomas Handerson, son of Ira
+Handerson. The family immigrated to Ohio from Columbia county, New
+York, in 1834. Thos. Handerson died as the result of an accident in
+1839, leaving the widow with five children, the eldest thirteen years
+of age, to support. Henry and a sister were adopted by an uncle, Lewis
+Handerson, a druggist, of Cleveland. In spite of a sickly childhood
+the boy went to school a part of the time and at the age of fourteen
+was sent to a boarding school, Sanger Hall, at New-Hartford, Oneida
+county, New York. Henry's poor health compelled him to withdraw from
+school. No one at that time would have predicted that the delicate
+youth would live to be the sage of four score years and one. With his
+foster father and family he moved to Beersheba Springs, Grundy county,
+Tennessee.
+
+In 1854, in good health, the boy returned to Cleveland, prepared
+for college, and entered Hobart College, Geneva, New York, where he
+graduated as A.B. in 1858. Returning to Tennessee, he occupied himself
+for about a year with surveying land and in other work and then
+became private tutor in the family of Mr. Washington Compton on a
+cotton plantation near Alexandria, Louisiana. There he remained a
+year or more, then in the autumn of 1860 matriculated in the Medical
+Department of the University of Louisiana (now Tulane University),
+where he studied through the winter, and also heard much of the
+political oratory of that exciting period.
+
+The bombardment of Fort Sumter, April 12, 1861, followed by the call
+of President Lincoln for 75,000 troops to suppress the rebellion,
+found young Handerson again employed as tutor, this time in the family
+of General G. Mason Graham, a veteran of the Mexican war.
+
+With his friends and acquaintances, Handerson joined a company of
+"homeguards" consisting mostly of planters and their sons, formed
+for the purpose of maintaining "order among the negroes and other
+suspicious characters of the vicinity."
+
+Many years afterward Dr. Handerson wrote, in a narrative for his
+family, concerning this period of his life: "Without any disposition
+to violent partisanship, I had favored the party of which the
+standard-bearers were Bell and Everett and the battle cry 'The
+Constitution and the Union,' and I had grieved sincerely over the
+defeat by the Radicals of the North, aided by the 'fire-eaters' of
+the South."
+
+And again: "Born and educated in the North, I did not share in
+any degree the fears of the Southerners over the election to the
+Presidency of Mr. Lincoln. I could not but think the action of the
+seceding States unwise and dangerous to their future prosperity. On
+the other hand, this action had already been taken, and without any
+prospect of its revocation. Indeed, in the present frame of mind of
+the North, any steps toward recession seemed likely to precipitate
+the very evils which the secession of the states had been designed
+to anticipate. I believed slavery a disadvantage to the South, but
+no sin, and, in any event, an institution for which the Southerners
+of the present day were not responsible. An inheritance from their
+fore-fathers, properly administered, it was by no means an unmitigated
+evil, and it was one, moreover, in which the North but a few years
+before had shared. All my interests, present and future, apparently
+lay in the South and with Southerners, and if the seceding States, in
+one of which I resided, chose deliberately to try the experiment of
+self-government, I felt quite willing to give them such aid as lay
+in my feeble power. When I add to this that I was 24 years of age,
+and naturally affected largely by the ideas, the enthusiasm and
+the excitement of my surroundings, it is easy to understand to what
+conclusions I was led."
+
+So on June 17, 1861, he volunteered in the Stafford Guards under Capt.
+(afterward Brigadier General) L.A. Stafford. The Guards became company
+B of the 9th Regiment of Louisiana Volunteers, Confederate States of
+America, Colonel (later Brigadier General) "Dick" Taylor (son of
+"Old Zach," the President of the U.S.), in command. During the year
+that followed until the close of the war, Handerson experienced the
+adventures and trials of a soldier's life. He knew picket, scouting,
+and skirmishing duty, the bivouac, the attack and defense in battle
+formation, the charge, the retreat, hunger and thirst, the wearisome
+march in heat and dust, in cold, in rain, through swamps and stony
+wildernesses. He was shot through the hat and clothing and once
+through the muscles of the shoulder and neck within half inch of the
+carotid artery, lay in a hospital, and had secondary hemorrhage. At
+another time he survived weeks of typhoid fever.
+
+He was successively private soldier and accountant for his company,
+quarter-master, 2nd Lieutenant of the line, Captain of the line, and
+finally Adjutant General of the 2nd Louisiana Brigade, A. N. Va.,
+under Lee and Jackson, with rank of Major. On May 4, 1864, Adjutant
+General Handerson was taken prisoner, and from May 17th until August
+20th he was imprisoned at Fort Delaware in the Delaware river. He
+was then confined in a stockade enclosure on the beach between Forts
+Wagner and Gregg on Morris Island, until about the end of October,
+when he was transferred to Fort Pulaski at the mouth of the Savannah
+river, and in March, 1865, back to Fort Delaware. In April, after
+Lee's surrender, many of the prisoners were liberated on taking the
+oath of allegiance to the Federal Government. But Handerson did not
+consider his allegiance to the Southern Confederacy ended until
+after the capture of President Davis, and it was not until June 17,
+1865, that he signed the oath of allegiance and was liberated in
+Philadelphia.
+
+Since that time, with that spirit of tolerance and openness to truth
+which characterized the man, he has said, "in the triumph of the
+Union, the war ended as it should have ended."
+
+Mr. Handerson then resumed his medical studies, this time in the
+College of Physicians and Surgeons of New York, Medical Department of
+Columbia University, taking the degree of M.D. in 1867. Hobart College
+conferred the A.M. in 1868. On October 16, 1872, he married Juliet
+Alice Root, who died leaving him a daughter.
+
+February 25, 1878, Dr. Handerson read before the Medical Society of
+the County of New York an article entitled, "The School of Salernum,
+an Historical Sketch of Mediaeval Medicine." This essay attracted wide
+attention to his scholarly attainments and love of laborious research.
+For example, Professor Edward Schaer of the chair of Pharmacology
+and Pharmaceutical Chemistry, of Neumuenster-Zuerich, pronounces
+this pamphlet "a valuable gift ... a remarkable addition to other
+historical materials ... in connection with the history of pharmacy
+and of pharmaceutical drugs"; that he found in it "a great deal of
+information which will be sought for in vain in many even renowned
+literary works."
+
+Dr. Handerson practiced medicine in New York City, from 1867 to 1885,
+removing to Cleveland in 1885.
+
+On June 12, 1888, he married Clara Corlett of Cleveland.
+
+Then in 1889 appeared the American edition of the "History of Medicine
+and the Medical Profession, by Joh. Hermann Baas, M.D.," which was
+translated, revised and enlarged by Dr. Handerson, to whom, in the
+words of Dr. Baas, "we are indebted for considerable amplification,
+particularly in the section on English and American medicine, with
+which he was, of course, better acquainted than the author, and
+for numerous corrections." ... As a matter of fact, the learning
+and judgment, and the conscientious industry of the translator and
+American editor of this work are evident throughout the book.
+
+Concerning Dr. Handerson's writings, Dr. Fielding H. Garrison
+writes (Medical Pickwick, March, 1915, P. 118): "The earliest of Dr.
+Handerson's papers recorded in the Index Medicus is 'An unusual case
+of intussusception' (1880). Most of his other medical papers, few in
+number, have dealt with the sanitation, vital statistics, diseases
+and medical history of Cleveland, and have the accuracy which
+characterizes slow and careful work. This is especially true of his
+historical essays of which that on 'The School of Salernum' (1883) is
+a solid piece of original investigation, worthy to be placed beside
+such things as Holmes on homoeopathy, Weir Mitchell on instrumental
+precision, or Kelly on American gynecology.
+
+"To the cognoscenti, Dr. Handerson's translation of 'Baas' History of
+Medicine' (1889) is known as 'Handerson's Book.' He modestly describes
+himself as its 'editor,' but he is more than that. As the witty and
+effective translator of a witty and effective work, he has added
+sections in brackets on English and American history which are
+based on original investigation and of permanent value to all future
+historians. Handerson's Baas is thus more complete and valuable than
+the Rhinelander's original text."
+
+As listed in the Index Medicus, the publications and writings of Dr.
+Handerson appear as follows:
+
+    An unusual case of intussusception. Medical Record, 1880,
+    xviii, 698.
+
+    The School of Salernum. An historical sketch of mediaeval
+    medicine. 1883.
+
+    Outlines of the history of medicine (Baas). Translated, and in
+    conjunction with the author, revised and enlarged, 1887.
+
+    Clinical history of a case of abdominal cancer. Cleveland
+    Medical Gazette, 1891-2, vii, 315-321.
+
+    The Sanitary topography of Cleveland. Cleveland Medical
+    Gazette, 1895-6, xi, 651-659.
+
+    Cleveland in the Census Reports. Cleveland Medical Gazette,
+    1896-7, xii, 257-264.
+
+    The earliest contribution to medical literature in the United
+    States. Janus, 1899, p. 540.
+
+    A review of the Vital Statistics of Cleveland during the last
+    decennium. Cleveland Medical Journal, 1902, i, 71-76.
+
+    Epidemics of typhoid fever in Cleveland. Cleveland Medical
+    Journal, 1904, iii, 208-210.
+
+    The mortality statistics of the twelfth census. Cleveland
+    Medical Journal, 1905, iv, 425-431.
+
+    Co-operative sanitation. Ohio Medical Journal, 1905, i,
+    278-281.
+
+    The medical code of Hammurabi, King of Babylon. Cleveland
+    Medical Journal, 1908, vii, 72-75.
+
+    Carcinoma in high life. Cleveland Medical Journal, 1908, vii,
+    472-476.
+
+    Medical Cleveland in the nineteenth (19th) Century. Cleveland
+    Medical Journal, 1909, viii, 59, 146, 208.
+
+    Gilbert of England and his "Compendium Medicine." Medical
+    Pickwick, 1915, i, 118-120.
+
+Dr. Handerson was Professor of Hygiene and Sanitary Science in the
+Medical Department of the University of Wooster, 1894-96, and the
+same in the Cleveland College of Physicians and Surgeons (Medical
+Department of Ohio Wesleyan University), 1896 to 1907, and filled that
+chair with eminent ability. Thus it came about that the ex-Confederate
+officer taught sanitary science in a college standing upon ground
+donated by the survivors of an organization of abolitionists.
+
+Dr. Handerson was a member of the Cuyahoga County Medical Society,
+and its President in 1895; also a member of the Cleveland Academy
+of Medicine, of the Ohio State Medical Society, and of the American
+Medical Association. He was one of the founders and an active worker
+in the Cleveland Medical Library Association and its President from
+1896 to 1902.
+
+He was all his life devoted to the Episcopal Church, was Warden of
+Grace Episcopal Church, Cleveland, for many years, and Treasurer of
+the Diocese of Ohio during fourteen years.
+
+During his later years Dr. Handerson withdrew entirely from active
+practice and spent a great deal of time in his library. His papers
+abound in carefully prepared manuscripts, some of them running into
+hundreds of pages.
+
+Two years before his death Dr. Handerson became totally blind.
+This grievous affliction was borne with unvarying patience and
+cheerfulness. He still loved to recite from memory the classic
+authors, to relate and discuss episodes of world history and events
+of the present, to solve difficult mathematical problems, and to have
+his data on all subjects verified. He retained his faculties perfectly
+until April 23, 1918, when he died from cerebral hemorrhage.
+
+He is survived by a daughter, two sons by the second marriage, and his
+devoted wife.
+
+Among numerous letters received from prominent physicians and authors
+appreciative of Dr. Handerson's medico-historical labors, one from Dr.
+Oliver Wendell Holmes expresses high praise and requests to have sent
+to him everything which Dr. Handerson might in future write.
+
+It seems eminently appropriate that the essay on "Gilbertus Anglicus."
+the last from the pen of Dr. Handerson, should be put in book form,
+together with a sketch, however brief, of its author's earnest life,
+his sterling character, his geniality and imperturbable equanimity,
+and thus preserved in testimony of the high esteem in which he was
+held by his contemporaries.
+
+    SAMUEL WALTER KELLEY.
+
+
+       *       *       *       *       *
+
+
+
+
+RESOLUTIONS
+
+
+At a meeting of the Council of the Cleveland Medical Library
+Association, held on May 14, the following resolutions were adopted:
+
+_Resolved_, That in the death of Dr. Henry E. Handerson the Cleveland
+Medical Library Association has sustained the loss of one of its most
+honored and devoted members. His scholarly acquirements were notable,
+and his eminence as a medical historian generally recognized. His deep
+interest in the welfare of the Library and his thorough attention to
+every detail of his official duties were always evident, while his
+lovable personal qualities endeared him to all.
+
+The Association desires to express its high appreciation of his long
+and valued services, and extends to his bereaved family its heartfelt
+and sincere sympathy.
+
+    C.A. HAMANN,
+    WM. EVANS BRUNER,
+    J.B. McGEE.
+
+
+       *       *       *       *       *
+
+
+
+
+GILBERTUS ANGLICUS (GILBERT OF ENGLAND)
+
+A STUDY OF ENGLISH MEDICINE IN THE THIRTEENTH CENTURY.
+
+BY H.E. HANDERSON, A.M., M.D.
+
+CLEVELAND
+
+       *       *       *       *       *
+
+    "Nothing in the past is dead to the man who would learn how
+    the present came to be what it is."--Stubbs--_Constitutional
+    Hist. of England_.
+
+       *       *       *       *       *
+
+
+Among the literary monuments of early English medicine the "Compendium
+Medicinae" of Gilbertus Anglicus merits a prominent position as the
+earliest complete treatise on general medicine by an English author
+which has been preserved to our day, and equally because it forms in
+itself a very complete mirror of the medical science of its age and
+its country.
+
+Gilbert was undoubtedly one of the most famous physicians of his time.
+His reputation is recognized in those well-known lines of Chaucer
+which catalogue the "authorities" of his Doctor of Phisik:
+
+  "Wel knew he the olde Esculapius
+  And Deyscorides and eek Rufus,
+  Olde Ypocras, Haly and Galyen,
+  Serapion, Razis and Avycen,
+  Averrois, Damascien and Constantyn,
+  Bernard and Gatesden and Gilbertyn."
+
+He is also quoted with frequency and respect by the medical writers
+of many succeeding ages, and the Compendium, first printed in 1510,
+enjoyed the honor of a second edition as late as the seventeenth
+century (1608). The surname "Anglicus" in itself testifies to the
+European reputation of our author, for as Dr. Payne sensibly
+remarks, no one in England would speak of an English writer as "the
+Englishman."
+
+Yet, in spite of his reputation, we know almost no details of the life
+of Gilbert, and are forced to content ourselves with the few facts
+to be gleaned from the scanty biographies of early writers and the
+inferences drawn from the pages of the Compendium itself. The date
+and place of his birth and death, and even the field of his medical
+activities are equally unknown. Bale, Pits and Leland, the earliest
+English biographers, tell us that Gilbert, after the completion of
+his studies in England, proceeded to the Continent to enlarge his
+education, and finally became physician to the great Justiciar, Hubert
+Walter, archbishop of Canterbury, who died in the year 1205. This
+would place him under the reign of King John, in the early part of the
+thirteenth century.
+
+Dr. John Freind, however, the famous English physician and medical
+historian (1725), observing that Gilbert quotes the Arabian
+philosopher Averroes (who died in 1198), and believing that he also
+quotes a work of Roger Bacon and the surgical writings of Theodorius
+(Borgognoni) of Cervia (1266), was inclined to fix his period in the
+latter half of the thirteenth century, probably under the reign of
+Edward I. Most of the later historians of medicine have followed the
+views of Freind. Thus Eloy adopts the date 1272, Sprengel gives 1290,
+Haeser the same date, Hirsch says Gilbert lived towards the close of
+the thirteenth century, Baas adopts the figures 1290, etc.
+
+The most recent biographers of Gilbert, however, Mr. C.L.
+Kingsford[1], and the late Dr. Joseph Frank Payne[2], after an
+apparently careful and independent investigation of his life, have
+reached conclusions which vary materially from each other and from
+those of the historians mentioned. Mr. Kingsford fixes the date of
+Gilbert at about 1250, while Dr. Payne reverts to the views of Bale
+and Pits and suggests as approximate figures for the birth and death
+of Gilbert the years 1170-80 to 1230. This discrepancy of twenty-five
+or thirty years between the views of two competent and unprejudiced
+investigators, as a mere question of erudition and interpretation,
+is perhaps scarcely worthy of prolonged discussion. But as both
+biographers argue from substantially the same data, the arguments
+reveal so many interesting and pertinent facts, and the numerous
+difficulties attending the interpretation of these facts, that
+some comparison of the different views of the biographers and some
+criticism of their varying conclusions may not be unwelcome.
+
+[Footnote 1: In Leslie Stephen's "Dictionary of Biography."]
+
+[Footnote 2: _British Medical Journal_, Nov. 12, 1904, p. 1282.]
+
+In the first place then we must say that, as Gilbert is frequently
+quoted in the "Thesaurus Pauperum," a work ascribed to Petrus
+Hispanus, who (under the title Pope John XXI) died in 1277, this date
+determines definitely the _latest_ period to which the Compendium can
+be referred. If, as held by some historians, the "Thesaurus" is the
+work of Julian, the father of Petrus, the Compendium can be referred
+to an earlier date only.
+
+Now Gilbert in his Compendium (f. 259a) refers to the writings of
+Averroes (Ibn Roschd) regarding the color of the iris of the eye.
+Averroes died in the year 1198. There is no pretense that Gilbert was
+familiar with the Arabic tongue, and the earliest translations into
+Latin of the writings of Averroes are ascribed by Bacon to the famous
+Michael Scot, though Bacon says they were chiefly the work of a
+certain Jew named Andrew, who made the translations for Scot. Bacon
+also says that these translations were made "_nostris temporibus_,"
+in our time, a loose expression, which may, perhaps, be fairly
+interpreted to include the period 1230-1250. But if, as Dr. Payne
+believes, Gilbert died about 1230, it seems improbable that he could
+have been familiar with the translations of Michael Scot. Accordingly
+Dr. Payne suggests that, after the death of his patron in 1205,
+Gilbert returned to the Continent, and, perhaps in Paris or at
+Montpellier, met with earlier Latin versions of the writings of the
+Arabian physician and philosopher. This is, of course, possible, but
+there is no historical warrant for the hypothesis, which must, for
+the present at least, be regarded as merely a happy conjecture of
+Dr. Payne. The presence of Gilbert upon the Continent, probably as a
+teacher of reputation, seems, however, quite probable. Littre has even
+unearthed the fact that during the 14th century a street in Paris near
+the medical schools, bore the name of the Rue Gilbert l'Anglois. A
+MS. in the Bibliotheque Nationale entitled "_Experimenta Magistri
+Gilliberti, Cancellarii Montepessulani_" has suggested also the idea
+that Gilbert may have been at one time chancellor of the University
+of Montpellier. Dr. P. Pansier, of Avignon, however, who has carefully
+examined and published this manuscript[3], reports that while it
+contains some formulae found also in the Compendium of Gilbert, it
+contains many others from apparently other sources, and he was unable
+to convince himself that the compilation was in fact the work of
+Gilbertus Anglicus. Dr. Pansier also furnishes us with a list of
+the chancellors of Montpellier, which contains the name of a certain
+"Gillibertus," chancellor of the university in 1250. He could find,
+however, no evidence that this Gillibertus was Gilbertus Anglicus,
+author of the Compendium Medicinae. On the whole then the visit of
+Gilbert to France early in the 13th century, and his access in
+this way to early translations of Averroes, while a convenient and
+plausible conjecture on the part of Dr. Payne, does not seem supported
+by any trustworthy historical evidence.
+
+[Footnote 3: Janus, 1903, p. 20.]
+
+The "_Liber de speculis_" mentioned by Gilbert (f. 126 c), and since
+the time of Freind generally accepted as the work of Bacon, is almost
+certainly not from the pen of that eminent philosopher. In addition
+to the fact that Bacon himself says he had (for obvious reasons)
+written nothing except a few tracts (_capitula quaedam_) prior to the
+composition of his Opus Magnum in 1267, the real author of the Liber
+de speculis is probably mentioned by Bacon in the following passage
+from the Opus Tertium:
+
+"_Nam in hoc ostenditur specialiter bonitas naturae, ut dicit auctor
+libri de speculis comburentibus._"[4]
+
+[Footnote 4: Cap. XXXVI, p. 116, edition of Brewer.]
+
+We must therefore agree with Dr. Payne that the _Liber de speculis_ of
+Gilbert was at least not the work of Roger Bacon.
+
+Dr. Freind regards the chapters of Gilbert on the subject of leprosy
+as borrowed substantially from the "Chirurgia" of Theodorius of
+Cervia, who wrote about the year 1266. This view has also been
+generally accepted by later writers. But Dr. Payne boldly challenges
+the view of Freind, declares that Theodorius copied _his_ chapters
+from Gilbert, and asserts that Theodorius was a notorious plagiarist.
+Now, while the bold assertion of Dr. Payne cannot, of course, be
+accepted as _proof_ of Gilbert's precedence in chronological order,
+if that precedence is otherwise established, it will explain the
+similarity of the chapters of the two writers very satisfactorily. For
+the present, however, this similarity can be adduced as evidence on
+neither side.
+
+Again, Gilbert, with the enthusiasm of a loyal pupil, speaks (f. 47 b)
+of a certain Magister Ricardus, "_omnium doctorum doctissimus_," whose
+views on uroscopy certainly indicate a mind superior to his age. Now
+there were about this period at least two eminent physicians who bore
+the name of Ricardus. Of these the senior, a Frenchman, known also
+as Ricardus Salednitanus, is highly praised by Aegidius of Corbeil
+(Gilles de Corbeil, Aegidius Corboliensis), physician to King Philip
+Augustus of France (1180-1223). This Ricardus was a famous teacher at
+Salernum when Aegidius was in attendance at that famous university,
+therefore probably about the close of the 12th century. The second
+Ricardus, called Parisiensis, has been recently identified by Toply
+with Richard of Wendover, an English canon of St. Paul's, and at one
+time physician to Pope Gregory IX, who died in 1241. Toply believes
+him to have been also the author of the "_Anatomia Ricardi_," recently
+published. This Ricardus died in 1252.
+
+Now to which of these Ricardi does the eulogistic language of Gilbert
+refer? Dr. Payne believes it to be the senior, Ricardus Salernitanus.
+Mr. Kingsford, on the other hand, thinks it to be Ricardus
+Parisiensis, who died in 1252. A _Liber de urinis_ has been ascribed
+to each of them, but, it seems to me, with greater probability to
+Ricardus Salernitanus. If too the author of the "_Anatomia Ricardi_"
+was a contemporary of Gilbert, we might reasonably expect to find
+in the Compendium some evidences of Gilbert's acquaintance with that
+work. But Gilbert's discussion of anatomical questions is totally
+unlike that of the author of the "_Anatomia_," and betrays not the
+slightest evidence of knowledge of such a treatise. On the whole
+then I am inclined to agree in this question with Dr. Payne, and to
+consider the Ricardus of Gilbert identical with Ricardus Salernitanus,
+the famous professor of the School of Salernum. This conclusion
+is further justified by the fact, generally accepted by all modern
+writers, that Gilbert was himself a pupil of Salernum.
+
+Singularly enough, both Dr. Payne and Mr. Kingsford profess to find
+in the Compendium some evidence that Gilbert sojourned in Syria for
+a certain period, though the circumstances of this sojourn are
+viewed differently by the two biographers. Dr. Payne thinks that the
+physician, after completing his education in England, proceeded to the
+Continent and extended his travels as far as Syrian Tripoli, where he
+met Archbishop Walter and became attached to his staff. As the prelate
+returned to England in 1192, this sojourn of Gilbert in Syria must
+have been about 1190-91, when, according to Dr. Payne's chronology,
+Gilbert could have been not more than about twenty years of age.
+Dr. Payne bases his story upon a certain passage in the Compendium,
+in which Gilbert says that he met in Syrian Tripoli "a _canonicus_
+suffering from rheumatic symptoms." I have been entirely unable to
+find the passage referred to in this story, in spite of a careful
+search of the text of the edition of 1510. But, admitting the
+existence of the passage in question, it proves nothing as to the
+_date_ of this alleged Syrian sojourn. Tripoli was captured by
+the Crusaders in 1109, and continued under their control until its
+recapture by the Saracens in 1289, a period of nearly two hundred
+years. Gilbert's travels in Syria may then have occurred at almost
+any time during this long period, and his fortuitous meeting with
+Archbishop Walter has very much the appearance of a story evolved
+entirely from the consciousness of the biographer.
+
+On the other hand, Mr. Kingsford bases his theory of Gilbert's sojourn
+in Syria upon a story adopted, I think, from Littre and found in the
+Histoire literaire de la France. The Compendium of Gilbert contains
+(f. 137a) a chapter giving the composition of a complex collyrium
+with which he professes to have cured the almost total blindness of
+Bertram, son of Hugo de Jubilet, after the disease had baffled the
+skill of the Saracen and Christian-Syrian physicians of his day.
+Now Littre avers that a certain Hugo de Jubilet was involved in an
+ambuscade in Syria in the year 1227, and that he had a son named
+Bertram. It is very natural, of course, to conclude that this Bertram
+was the patient recorded in the book of Gilbert. Kingsford says that
+Gilbert "met" Bertram in Syria, but the text of the Compendium says
+nothing of the locality of their meeting, which might have taken place
+almost anywhere in Europe, perhaps even at Salernum, a favorite resort
+of the invalided Crusaders in these times. Finally, Dr. Payne disposes
+effectually of the authenticity of the entire story by calling
+attention to the fact that the chapter referred to in the Compendium
+is marked plainly "_Additio_," without indicating whether this
+addition is from the pen of Gilbert or some later glossator.
+
+Finally, I may suggest another line of argument, which, so far as I
+know, has not yet been advanced for the determination of the period of
+Gilbert.
+
+The Compendium Medicinae of Gilbert is, of course, a compendium of
+internal medicine. But the book is also something more. Not less
+than fifty chapters are devoted to a comparatively full discussion of
+wounds, fractures and dislocations, lithotomy, herniotomy, fistulae
+and the various diseases on the border line between medicine and
+surgery. Not a single surgical writer, however, is quoted by name.
+Nevertheless the major part of these surgical chapters are either
+literal copies, or very close paraphrases, of the similar chapters
+of the "_Chirurgia_" of Roger of Parma, a distinguished professor
+in Salernum and the pioneer of modern surgery. The precise period
+of Roger is not definitely settled by the unanimous agreement of
+modern historians, but in the "_Epilogus_" of the "_Glosulae Quatuor
+Magistrorum_" it is said that Roger's "_Chirurgia_" was "_in lucem et
+ordinem redactum_" by Guido Arietinus, in the year of our Lord 1230.
+This date, while perhaps not unquestionable, is also adopted by De
+Renzi, the Italian historian of Medicine. The original MS. of Roger's
+work is said to be still in existence in the Magliabechian Library
+in Florence, but it has never been published in its original form.[5]
+Roland of Parma, however, a pupil of Roger, published in 1264 what
+purports to be a copy of Roger's "_Chirurgia_" with some notes and
+additions of his own, and it is from this MS. of Roland that all our
+copies of Roger's work have been printed. Roger's "_Chirurgia_" was
+popularly known as the "_Rogerina_;" the edition of Roland as the
+"_Rolandina_." They are frequently confounded, but are not identical,
+though the additions of Roland are usually regarded as of little
+importance. In the absence of Roger's manuscript, however, they lead
+often to considerable confusion, as it is not always easy to determine
+in the printed copies of the "_Rolandina_" just what belongs to Roger
+and what to his pupil and editor. Now a careful comparison of the
+surgical chapters of Gilbert of England with the published text of the
+"_Rolandina_" leads me to the conviction that Gilbert had before him
+the text of Roger, rather than that of Roland, his pupil. If such is
+the fact, Gilbert's Compendium must have been written between 1230 and
+1264, the dates respectively of the "_Rogerina_" and "_Rolandina_."
+
+[Footnote 5: Haeser says that this MS. of Roger's "Chirurgia," made by
+Guido Arenitensium, was discovered by Puccinoti in the Magliabechian
+library, and that an old Italian translation of the same work is also
+found there. The latter was the work of a certain Bartollomeo.
+
+The text used to represent Roger in the present paper is that
+published by De Renzi (Collectio Salernitana, tom. II, pp. 426-493)
+and entitled "Rogerii, Medici Celeberrimi Chirurgia." It is really
+the text published originally in the "Collectio Chirurgica Veneta" of
+1546, of which the preface says:
+
+"_His acceserunt Rogerii ac Guil. Saliceti chirurgiae, quarum prior
+quibusdam decorata adnotationibus nunc primum in lucem exit, etc._,"
+and adds further on:
+
+"_Addidimus etiam quasdam in Rogerium veluti explanationes, in
+antiquissimo codice inventas, et ab ipso fortasse Rolando factas._"
+While I may recognize gratefully the surgical enthusiasm which led the
+editor to the publication of these "_veluti explanationes_," for my
+present purpose he would have earned more grateful recognition if he
+had left them unprinted. As the text now stands it is merely a garbled
+edition of the Rolandina. However, it is the best representative of
+the "Chirurgia" of Roger at present available. See De Renzi, op. cit.,
+p. 425.]
+
+From a careful review of the data thus presented we may epitomize,
+somewhat conjecturally, the life of Gilbert substantially as follows:
+He was probably born about 1180 and received his early education in
+England. On the completion of this education, about the close of the
+12th century, he proceeded to the Continent to complete his studies,
+and spent some time in the school of Salernum, where it is probable
+that he enjoyed the instruction of Roger of Parma, Ricardus
+Salernitanus, and may have had among his fellow-students Aegidius of
+Corbeil. Probably after his return to England he served for a brief
+period on the staff of Archbishop Hubert Walter, after whose death
+in 1205, but at an unknown period, Gilbert returned once more to the
+Continent, where it seems probable he spent the remainder of his life.
+This comports best with his extensive European reputation, his surname
+"Anglicus" and the comparative dearth in England of any facts relating
+to his life. The date of the Compendium I am inclined to place about
+1240, prior to the literary activity of Ricardus Parisiensis or
+Richard of Wendover, Roland of Parma, Roger Bacon and Theodorius of
+Cervia. We may place his death, conjecturally, at about 1250.
+
+The first edition of the Compendium is a small quarto of 362 folios
+(724 modern pages), five by seven inches in size, printed in double
+narrow columns, in black letter, perfectly legible and clear. The
+pagination shows some errors, but the text itself is remarkably
+accurate, though the presence of a multiplicity of contractions
+and ligatures renders the reading somewhat difficult to the modern
+student. On the last page we find the following colophon:
+
+_Explicit compendium medicine Gilberti Anglici correctum et bene
+emendatum per dominum Michaelem de Capella artium et medicine
+doctorem: ac Lugduni Impressum per Jacobum Saccon: expensis
+Vincentii de Portonariis. Anno Domini M.D.x. die vero vigesima mensis
+Novembris._
+
+_Deo Gratias._
+
+The second edition (which I have not seen) is said to bear the title:
+"Laurea anglicana, sive compendium totius medicinae, etc," Geneva,
+1608.
+
+It should be noticed that the title "Laurea anglicana" is not
+mentioned in the original edition of 1510, but is apparently due to
+the exuberance of enthusiasm of the editor of the later edition, whose
+taste seems to have been more flamboyant.
+
+Various manuscript works of greater or less authenticity are ascribed
+to Gilbert by different authorities. Of these Mr. Kingsford furnishes
+the following list:
+
+  1. "Commentarii in Versus Aegidii de Urinis," quoted by John
+          Gaddesden and probably authentic.
+
+  2. "Practica Medicinae," mentioned by Pits, but of doubtful
+          authenticity.
+
+  3. "Experimenta Magistri Gilliberti, Cancellarii Montepessulani,"
+          noticed on page 2, but authenticity doubtful.
+
+  4. "Compendium super Librum Aphorismorum Hippocratis."
+  MS. in Bodleian.
+
+  5. "Eorundem Expositio." MS. in Bodleian.
+
+  6. "Antidotarium." MS. in Caius College.
+
+To these he adds, on the authority of Bale and Pits:
+
+  7. "De Viribus Aquarum et Specierum."
+
+  8. "De Proportione Fistularum."
+
+  9. "De Judicio Patientis."
+
+  10. "De Re Herbaria."
+
+  11. "De Tuenda Valentudine."
+
+  12. "De Particularibus Morbis."
+
+  13. "Thesaurus Pauperum."
+
+All of these latter may be regarded as doubtful.
+
+The authorities named by Gilbert are Pythagoras, Hippocrates, Plato,
+Aristotle, Galen, Rufus, Maerobius, Boetius, Alexander of Tralles,
+Theodorus Priscianus, Theophilus Philaretes, Stephanon (of Athens?),
+the Arabians Haly Abbas, Rhazes, Isaac Judaeus, Joannitius, Janus
+Damascenus, Jacobus Alucindi, Avicenna and Averroes; the Salernian
+writers, quoted generally as Salernitani and specifically Constantino
+Africanus, Nicholas Praepositus, Romoaldus Ricardus and Maurus, and
+two otherwise unknown authors, Torror and Funcius, classed by Gilbert
+as "_antiqui_." The latter author is also said to have written a
+"_Liber de lapidibus_." Certainly this list suggests a pretty good
+medical library for a practitioner of the 13th century.
+
+Dr. Payne calls attention to the fact that all these writers antedate
+the 13th century, and thus limit the period of Gilbert in antiquity.
+This is undoubtedly true with reference to authorities actually named,
+but does not exclude from consideration other writers quoted, but not
+named, whom we shall have occasion to refer to hereafter.
+
+The Compendium opens with a very brief and modest foreword, couched in
+the following terms:
+
+"_Incipit liber morborum tam universalium quam particularium a
+magistro Gilberto anglico editus ab omnibus autoribus et practicis
+magistrorum extractus et exceptus, qui compendium medicine
+intitulatur._"
+
+It will be observed that no claim whatever for originality is
+presented by the author. He calls his book a compendium extracted from
+all authors and the practice of the professors, and edited only by
+himself. The same idea is more fully emphasized later (f. 55c), where
+he says:
+
+"_Sed consuetudo nostra est ex dictis meliorum meliora aggregare, et
+ubi dubitatio est, opiniones diversas interserere; ut quisque sibi
+eligat quam velit retinere._"
+
+The self-abnegation implied in these extracts must not, however, be
+interpreted too literally, for the editorial "_dico_" on numerous
+pages, and even an occasional chapter marked "_Propria opinio_,"
+testify to the fact that Gilbert had opinions of his own, and was
+ready on occasion to furnish them to the profession. On the whole,
+however, the "Compendium" is properly classified by the author as a
+compilation, rather than an original work.
+
+The Compendium is divided into seven books, and the general
+classification of diseases is from head to foot--the usual method
+of that day. The modern reader will probably be surprised at the
+comprehensiveness of the work, which, besides general diseases,
+includes considerable portions of physiology, physiognomy,
+ophthalmology, laryngology, otology, gynecology, neurology,
+dermatology, embryology, obstetrics, dietetics, urinary and venereal
+diseases, therapeutics, toxicology, operative surgery, cosmetics and
+even the hygiene of travel and the prevention of sea-sickness. Some of
+these subjects too are discussed with an acuteness and a common sense
+quite unexpected. Of course, scholastic speculations, superstition,
+charms, polypharmacy and the use of popular and disgusting remedies
+are not wanting. Even the mind of a philosopher like Roger Bacon was
+unable to rise entirely above the superstition of his age. But the
+charms and popular specifics of Gilbert are often introduced with a
+sort of apology, implying his slight belief in their efficacy. Thus in
+his chapter on the general treatment of wounds (f. 87a) he introduces
+a popular charm with the following words:
+
+"_Alio modo, solo divino carmine confisi, quidam experti posse curari
+omnes plagas hoc._
+
+"_Carmine._
+
+"_Tres boni fratres per viam unam ibant, et obviavit eis noster dominus
+jesus christus et dixit eis, tres boni fratres quo itis_, etc."
+
+And again, in his discussion of the treatment of gout and rheumatism
+(f. 327b), Gilbert adds, under the title
+
+_Emperica_
+
+"_Quamvis ego declino ad has res parum, tamen est bonum scribere in
+libro nostro, ut non remaneat tractatus sine eis quas dixrunt antiqui.
+Dico igitur quod dixit torror: Si scinderis pedem rane viridis et
+ligaveris supra pendem podagrici per tres dies, curatur; ita quod
+dextrum pedum rane ponas supra dextrum pedem patientis, et e converso.
+Et dixit Funcius, qui composuit librum de lapidibus, quod magnes,
+si ligatus fuerit in pedem podagrici, curatur. Et alius philosophus
+dixit. Si accipiatur calcancus asine et ponatur ligatus supra pedem
+egri, curatur, ita quod dexter supra dextrum, et e converso. Et
+juravit quod sit verum. Et dixit torror quod si ponatur pes testudinis
+dexter supra dextrum pedem podagrici, et e converso, curatur._"
+
+We may believe, indeed, that Gilbert would have preferred to follow
+in the therapeutic footsteps of Hippocrates, had he not disliked to be
+regarded by his colleagues as eccentric and opinionated. For he says
+in his treatment of thoracic diseases (f. 193c):
+
+"_Etenim eleganter dedit Ipo. (Hippocrates) modum curationis, sed ne
+a medicis nostri temporis videamur dissidere, secundum eos curam
+assignemus._"
+
+Gilbert was a scholastic-humoralistic physician _par excellence_,
+delighting in superfine distinctions and hair-splitting definitions,
+and deriving even pediculi from a superfluity of the humors (f. 81d).
+Of course he was also a polypharmacist, and the complexity, ingenuity,
+and comprehensiveness of his prescriptions would put to shame even
+the "accomplished therapeutist" of these modern days. In dietetics
+too Gilbert was careful and intelligent, and upon this branch of
+therapeutics he justly laid great emphasis.
+
+The first book of the Compendium, comprising no less than 75 folios,
+is devoted entirely to the discussion of fevers. Beginning with the
+definition of Joannicius (Honain ebn Ishak):
+
+"Fever is a heat unnatural and surpassing the course of nature,
+proceeding from the heart into the arteries and injuring the patient
+by its effects."
+
+Gilbert launches out with genuine scholastic finesse and verbosity
+into a discussion of the questions whether this definition is based
+upon the essentia or the differentia of fever; whether the heat of
+fever is natural or unnatural, and other similar subtle speculations,
+and finally arrives at a classification of fevers so elaborate and
+complex as to be practically almost unintelligible to the modern
+reader.
+
+The more important of these fevers or febrile conditions are:
+
+  Ephemeral
+  Hemitertian
+  Double quartan
+  Interpolated
+  Synocha
+  Causon synochides
+  Epilala
+  Quotidian
+  Double tertian
+  Quintan
+  Continued
+  Causon
+  Putrid
+  Lipparia
+  Tertian
+  Quartan
+  Sextan
+  Synochus
+  Synochus causonides
+  Ethica
+  Erratica
+
+Some of these names are still preserved in our nosologies of the
+present day; others will be recalled by the memories of our older
+physicians, and a few have totally disappeared from our modern medical
+nomenclature.
+
+Interpolated fevers are characterized by intermissions and remissions,
+and thus include our intermittent and remittent fevers; synochus
+depended theoretically upon putrefaction of the blood in the vessels,
+and was a continued fever. Synocha, on the other hand, was occasioned
+by a mere superabundance of hot blood, hence the verse:
+
+"_Synocha de multo, sed synochus de putrefacto._"
+
+Causon was due to putrefaction of bile in the smaller vessels of
+the heart, diaphragm, stomach or liver, and was an acute fever
+characterized by furred tongue, intolerable frontal headache, tinnitus
+aurium, constant thirst, delirium, an olive-colored face, redness and
+twitching of the eyes and a full, frequent and rapid pulse. Epiala
+and lipparia were febrile conditions concerning which there seems to
+have been much difference of opinion, even in the days of Gilbert.
+Apparently they were distinguished by variations of external and
+internal temperature, or by chills combined with fever. Febris ethica
+is our modern hectic fever. In the discussion of this last variety we
+are introduced to the "_ros_" and "_cambium_" of Avicenna, apparently
+varieties of hypothetical humors.
+
+All these fevers are regarded from the standpoint of Humoralism,
+and depend upon variations in the quantity, quality, mixture or
+location of the four humors, blood, phlegm, bile and black-bile
+(_melancholia_).
+
+In the general treatment of febrile diseases, so-called preparatives
+and digestives are first employed to ripen the humors, after which
+evacuatives (emetics, cathartics, sudorifics, and occasionally even
+venesection) are utilized for the discharge of these peccant humors.
+Much emphasis is laid upon the dietetics of fevers, and this branch of
+treatment is highly elaborated. Complications are met by more or less
+appropriate treatment, and the condition of the urine is studied with
+great diligence. Venesection is recommended rather sparingly, and is
+never to be employed during the _dies caniculares_ (dog-days) or _dies
+Aegyptiaci_, nor during conjunctions of the moon and planets, nor upon
+the 5th, 15th, 17th, 25th, 26th, or 27th days thereafter, etc.
+
+Among the complications of fevers discussed by Gilbert, two seem
+sufficiently important to justify special attention. On folio 74b we
+find a section entitled "_De fluxu materie per parotidas venas_,"
+in which he remarks that "Sometimes matter flows through the parotid
+veins behind the ears down to the neck and nares, and obstructs the
+passages for air, food and drink, so as to threaten suffocation." He
+cautions us against the use of repressives, "lest the matter may run
+to the heart," and recommends mollitives and dissolvents, such
+as butter, dyaltea, hyssop and especially newly shorn wool (_lana
+succida_), which, he says, is a strong solvent. Is this a reference
+to the septic parotitis not unfrequently seen in low fevers?
+
+The following section, "_De inflatione vesice et dolore ejus_,"
+discusses the retention of urine in fevers, and its treatment. Gilbert
+says: "Inflation of, and pain in the bladder are sometimes symptoms
+of acute fevers, since the humors descend into and fill the bladder."
+If this occurs in an interpolated (remittent) fever, he directs the
+patient to be placed in a bath of a decoction of pellitory up to the
+umbilicus, "_et effundet urinam_." If the complication occurs in one
+suffering from a continued fever, the bath should be made of wormwood
+and a poultice should be placed over the bladder and genitals, "_et
+statim minget_." The same effect may be produced by poultice mixed
+with levisticum (lovage) or leaves of parsley. Singularly enough the
+catheter is not mentioned, though this instrument, under the medieval
+name of _argalia_ (cf. French algalie), is noticed frequently in the
+section devoted to vesical calculus.
+
+With the second book of the Compendium the system of the discussion of
+diseases _a capite ad pedes_ is commenced, and produces some curious
+associates. To the modern physician the sudden transition from
+diseases of the scalp to fractures of the cranium seems at least
+abrupt, if not illogical. It seems, therefore, wiser, in a hasty
+review like the present, to take up the various pathological
+conditions described by Gilbert in their modern order and relations,
+and to thus facilitate the orientation of the reader.
+
+The second book then opens with a consideration of the hair and scalp,
+and their respective disorders.
+
+The hair is a dry fume (_fumus siccus_), escaping from the body
+through the pores of the scalp and condensed by contact with the air
+into long, round cylinders. It increases rather by accretion than by
+internal growth, and its color depends upon the humors. Thus red hair
+arises from unconsumed blood or bile; white hair, from an excess of
+phlegm; black hair, from the abundance of black-bile (_melancholia_),
+etc. The use of the hair is for ornament, for protection and for the
+distinction of the sexes. Numerous prescriptions for dyeing the hair,
+for depilatories (_psilothra_), for the removal of misplaced hair and
+for the destruction of vermin in the hair are carefully recorded.
+
+Three varieties of soaps for medicinal use are described, and the
+process of their manufacture indicated. The base of each is a
+lixivium made from two parts of the ashes of burned bean-stalks and
+one of unslaked lime, mixed with water and strained. Of this base
+(_capitellum_), two parts mixed with one part of olive oil form the
+_sapo saracenicus_. In the _sapo gallicus_ the base is made with the
+ashes of chaff and bean-stalks with lime, and to it is added goat's
+fat, in place of the oil. The _sapo spatareuticus_ is made in a
+similar manner, except that oil replaces the goat's fat and the soap
+is made only during the dog days, since the necessary heat is to be
+supplied by the sun alone.
+
+Among the diseases of the scalp attention is given to alopecia,
+dandruff (_furfur_), tinea caries and various pustular affections,
+fanus (favus), rima, spidecia, achora, etc. Caries was a pustular
+disease, in which bristle-like hairs formed a prominent feature. Rima
+was a name applied by the physicians of Salernum to a superfluity
+of hair. In addition to these diseases of the scalp, we find also
+descriptions of gutta rosacea, morphoea and scabies, a fairly
+extensive dermatology for this early day. In favus, Gilbert tells us
+that, after the removal of the pustules, there remain foramina, from
+which exudes a poisonous substance, resembling honey. Of course his
+system of treatment is rich in variety and comprehensiveness.
+
+We may notice here too a few chapters on Toilet or Decorative
+Medicine, a branch of art to which modern physicians have devoted
+perhaps too little attention, with the natural result that it has
+fallen largely into the hands of charlatans of both sexes. Gilbert's
+chapter "_De ornatu capillorum_" offers the following sensible
+introduction: "The adornment of the hair affords to women the
+important advantages of beauty and convenience; and as women desire to
+please their husbands, they devote themselves to adornment and protect
+themselves from the charge of carelessness. In order, therefore,
+that our ministry may not be depreciated, and that we may not render
+ourselves liable to the accusation of ignorance, let us add a few
+words on the subject of the dressing of the hair and the general care
+of the person".
+
+Accordingly Gilbert advises ladies who desire to retain or renew the
+charms of youth to soften the skin and open its pores by the use of
+steam baths and careful washing in warm water, followed by drying the
+surface with the finest cloths (_panno mundissimo_). If necessary,
+superfluous hair is to be removed by suitable depilatories, color to
+be restored to the pale cheeks by a lotion of chips of Brazil-wood[6]
+soaked in rose-water and applied with pads of cotton; or, if the face
+is too red, it may be blanched by the root of the cyclamen (_panis
+porcinus_, sowbread) dried in an oven and powdered. A wealth of
+remedies for freckles, moles, warts, wrinkles, discolorations and
+other facial blemishes, with foul breath and fetidity of the armpits,
+is carefully recorded, and would suffice to establish the fortune of
+any of our modern specialists in female beauty. Finally a long chapter
+entitled "_De sophisticatione vulvae_" introduces us to a phase of
+decoration and sophistication which I would fain believe little known
+or studied in the development of modern civilization, in which we are
+prone at least to follow the advice of Hamlet, to
+
+  "Assume a virtue, if you have it not."
+
+At all events, we may congratulate ourselves that the details of these
+disgusting cess-pools of medical art have disappeared entirely
+from the pages of our modern text-books. Even Gilbert considers it
+advisable to preface this gruesome chapter with a sort of "_Caveat
+emptor_" apology to the reader:
+
+"_Ut tamen secundum ordinem procedamus, in primis cognosactur
+cognoscere desiderantibus, ne dolus dolo patrocinetur, vel simplex
+dolose muscipula claudatur._"
+
+[Footnote 6: This apparent anachronism carries us back to the history
+of the mythical Island of Brazil, which appeared upon our charts as
+late as the middle of the 19th century.]
+
+In the department of neurology Gilbert, after a philosophical
+discussion of the nature and variety of pain, devotes considerable
+chapters to the causes, symptoms, diagnosis and treatment of headache,
+hemicrania, epilepsy, catalepsy, analepsy, cerebral congestion,
+apoplexy and paralysis, phrenitis, mania and melancholia, incubus
+or nightmare, lethargy and stupor, lippothomia or syncope, sciatica,
+spasm, tremor, tetanus, vertigo, wakefulness, and jectigation
+(jactitation, formication, twitching).
+
+The third book of the Compendium opens with several chapters on
+the anatomy and physiology of the eye and the phenomena of vision.
+According to Gilbert, the eye consists of three humors, the
+albugineous (aqueous), the crystalline lens and the vitreous humor,
+and seven tunics, apparently
+
+  1. The conjunctiva
+  2. The albuginea or sclerotic
+  3. The cornea
+  4. The secundina (choroid)
+  5. The rethilea (retina)
+  6. The aranea (iris)
+  7. The uvea perforata (posterior layer of iris),
+
+though the definitions are not in all cases quite clear and definite.
+The tela aranea is said to take its origin from the retina, the retina
+from the optic nerve, and the latter from the rethi (rete, network)
+involving the substance of the brain. The cornea arises from the
+sclerotic tunic, the uvea and secundina take their origin from the
+pia mater, and the conjunctiva from a thin pellicle or membrane which
+covers the exterior of the cranium and is nourished by a transudation
+of the blood through the coronal suture. This pellicle is also said
+to have a connection with the heart, which arrangement furnishes a
+decidedly curious explanation of the mechanism of sympathetic and
+maudlin lachrymation. For, as Gilbert tells us, when the heart is
+compressed this pellicle is also compressed, and if any moisture is
+found beneath the pellicle it is expressed into the substance of the
+lachrymal gland by the constriction of the heart, and men in sorrow
+therefore shed tears. And again, if the heart is much dilated or
+elevated (by joy), this pellicle is also dilated or elevated, and
+if any moisture is found beneath it, it is expressed in the form of
+tears. Accordingly, men who are too joyful shed tears. Still further,
+drunken men, who are notoriously "moist," and have a superfluity of
+fluid between the pellicle and the skin of the cranium, are prone to
+weeping on slight provocation, and their tears are nothing more than
+an expression of this moisture, which makes its exit, not through the
+substance of the eye, but through the "lachrymal angle." Q.E.D.
+
+This odd demonstration is followed by a succession of optical
+questions, which are discussed and answered in true scholastic style,
+with no little acuteness of observation. Thus: "_Utrum visus fiat
+intus suscipiendo?_" Is vision accomplished by something received into
+the eye? "_Utrum color fit de nocte?_" Does color exist at night? To
+the latter question Gilbert replies that in the darkness color exists
+in posse, but not in esse. Again: "Why do some animals see at night,
+some in the day only and some only in the twilight?" This phenomenon
+he ascribes to "the clearness and subtilty of the visual spirits, or
+to the strength, weakness, grossness or turbidity of the organs of
+vision." Some animals, he says, have (visual) spirits, subtle and
+clear as fire, and these animals see perfectly at night because the
+visual spirits (_spiritus visibilis_) are sufficient to illuminate the
+external air. "Why do objects in water seem nearer than those in air?"
+Gilbert explains this as follows: "Nothing appears distant, except as
+perceived through an extensive intervening medium. But our judgment
+is largely guided by the transparency of this medium, since the
+medium itself is not perceived with much accuracy, except when it
+is transparent. Accordingly, as the lucidity of air is greater than
+that of water, an object looks more distant through air than through
+water."
+
+"Why does not a single object appear double, inasmuch as we have two
+eyes?" To this he replies: "From the anterior part of the brain two
+optic nerves pass to the two eyes. But these two nerves unite at a
+certain point into one. Now, since the two nerves are of equal length,
+two images proceeding from a single object do not make the object
+seem double, but single, since the two images are united into one, and
+accordingly one object is seen as one image."
+
+Other physiological speculations are introduced by the questions: "May
+one see an object not actually present?" "Why do some animals see best
+objects at a distance, others those near at hand?" "Why are objects
+seen in their proper position?" All these questions are answered in
+accordance with the scholastic formulae, and, not infrequently, with
+considerable acuteness.
+
+A chapter entitled "_De signis oculorum_" also introduces us to a
+curious discussion of ocular physiognomy. Thus:
+
+"When we see a man with large eyes, we argue that he is indolent."
+
+"If his eyes are deeply situated in his head, we say that he is crafty
+and a deceiver."
+
+"If his eyes are prominent, we say that he is immodest, loquacious and
+stupid."
+
+"He whose eyes are mobile and sharp is a deceiver, crafty and a
+thief."
+
+"He whose eyes are large and tremulous is lazy and a braggart
+(_spaciosus?_), and fond of women."
+
+and so forth for an entire page of the Compendium.
+
+Actual diseases of the eye are discussed in chapters on pain in the
+eyes, ophthalmia, pannus (including ungula, egilops and cataract),
+tumors of the conjunctiva, itching of the eyes, lachrymation, cancer,
+diseases of the cornea and uvea, diseases of the eyelids, lachrymal
+fistula and entropion. The treatment consists generally in ointments
+and collyria in abundance, but in fistula lachrymalis incision and
+tents of alder-pith, mandragora (_malum terrae_), briony, gentian,
+etc., are recommended, and entropion is referred directly to the
+surgeon.
+
+    The Latin term cataracta (also catarracta and catarractes) is
+    applied to a disease of the eyes by Gregory of Tours (Hist.
+    Franc., v. 6) as early as A.D. 650, and again by Constantine
+    Africanus, of the school of Salernum, in 1075 (De Chirurg.,
+    cap. XXX). Singularly the word is not found in the "Chirurgia"
+    of Roger of Parma, from whom Gilbert seems to have borrowed
+    most of his surgical knowledge. Nor is it employed by
+    Roland, Roger's pupil and editor. It recurs, however, in the
+    _Glossulae Quatuor Magistrorum_ (about 1270). But in all these
+    writers cataracta seems to be included under the general term
+    pannus, meaning opacities of every kind. Indeed Gilbert says,
+    "Ungula, egilops, cataracta and macula are species of pannus,
+    all arising from the same causes and cured by the same
+    treatment." A few lines later, however, in distinguishing
+    these various species, he adds: "Cataract arises from a
+    humor collected between the tunics of the eye": and again
+    it is said to be blood filling the veins of the eyes, and
+    especially those of the conjunctiva, and derives its name _a
+    caracteribus_ (?). The truth is none of these writers seem to
+    have any very definite knowledge of the distinction between
+    the various opacities of the media of the eye, all of which
+    were included under the general term pannus. But, what is more
+    remarkable, Roger, Roland and The Four Masters make no mention
+    of the possibility of surgical interference in these cases,
+    but content themselves with elaborate collyria and ointments,
+    or simply with internal treatment. Gilbert, on the other hand,
+    while recommending these collyria and ointments, and even the
+    internal remedies, adds the following:
+
+    "_Interior autem macula, quae tela vocatur, subcornea situata,
+    si vl'e (?) purgatione precendente et colliriis et pulveribus
+    non removetur, acu torta immissa per caprinum angulum
+    extrahatur aut inferius replicetur_" (f. 137a).
+
+    And again (f. 141d):
+
+    "_In uvea sunt largitas et constrictio et aqua sive
+    cataracta.... Aqua quandoque per medium pupille descendit,
+    inferius stans, subuvea apparens, quae perfecte curatur
+    secundum quosdam immisso acus aculeo per pupillam, ut extra
+    fluat aqua._"
+
+Chapters on the physiology of hearing, smelling and the sensation of
+touch are followed by a discussion of the symptoms and treatment of
+earache, abscess of the ear, discharges (bloody and sanious) from
+the ear, worms and other foreign bodies in the ear, tinnitus aurium,
+deafness, coryza, epistaxis, nasal polypi, ozaena, cancer of the nose,
+fissures and ulcers of the lips, foul breath, diseases of the tongue,
+toothache, etc.
+
+Physiognomy, a favorite theme with our author, appears again in a
+considerable chapter on the physiognomy of the nose, mouth, face and
+the teeth.
+
+"He who laughs frequently is kind and genial in all things and is not
+worried over trifles."
+
+"He who laughs rarely is contrary and critical."
+
+"He who has large ears is stolid and long-lived."
+
+"He who has a large mouth is gluttonous and daring."
+
+"He whose teeth are defective and small is weak in his whole body."
+
+"He whose canine teeth are long and straight is a glutton and a
+rascal."
+
+The department of genito-urinary diseases is introduced by a long
+chapter entitled "_De approximeron_," a formidable Latin word defined
+by Gilbert as sexual impotence. An elaborate discussion of the
+physiology of generation and the phenomena of impotence is followed by
+a collection of remedies for the condition, of which the best that can
+be said is that they are probably no less effective than most of the
+modern drugs recommended for the same purpose. Concerning a function
+over which so many fond superstitions still linger in the public mind
+we may, perhaps, charitably forgive Gilbert for the introduction
+of an empirical remedy for sterility, which, he assures us, he has
+often tried and with invariable success, and which enjoys the double
+advantage of applicability to either sex.
+
+"Let a man, twenty years of age or more, before the third hour of
+the vigil of St. John the Baptist, pull up by the roots a specimen of
+consolida major (comfrey) and another of consolida minor (healall),
+repeating thrice the Lord's prayer (_oratio dominica_). Let him speak
+to no one while either going or returning, say nothing whatever, but
+in deep silence let him extract the juice from the herbs and with this
+juice write on as many cards as may be required the following charm:
+
+"_Dixit dominus crescite._ [symbol: dagger]. _Uthihoth._ [symbol:
+dagger]. _multiplicamini._ [symbol: dagger]. _thahechay._ [symbol:
+dagger]. _et replete terram._ [symbol: dagger]. _amath._
+
+"If a man wears about his neck a card inscribed with these identical
+words written in this juice, he will beget a male. Conversely, if a
+woman, she will conceive a female" (f. 287b).
+
+Gilbert, however, cautions the bearer of this potent charm of the
+possible dangers of satyriasis incurred thereby, and offers suitable
+remedies for so alarming a condition.
+
+Chapters on satyriasis, gomorrhea (gonorrhea in its etymological
+sense, seminal emissions), with a third entitled "_De pustulis et_
+*_apostematibus virgae_" complete this department of medical art. The
+last chapter recognizes the venereal origin of the pustules and ulcers
+discussed, but furnishes no direct evidence of Gilbert's belief in the
+existence of a specific venereal poison.
+
+While Gilbert is very scrupulous in his examination of the gross
+appearances of the urine in most diseases, his discussion of the
+diseases of the kidneys and bladder includes only pain in the kidneys,
+abscess of the kidneys, renal and vesical calculus, hematuria,
+incontinence of urine, dysuria and strangury.
+
+The chapter on hematuria presents a very curious specimen of medieval
+pathology. Gilbert says: "The escape of blood in the urine is due
+sometimes to the liver, sometimes to the bile,[7] sometimes to the
+kidneys and loins, sometimes to the bladder. If the blood is pure
+and clear, in large quantity, mixed perfectly with the urine and
+accompanied by pain in the right hypochondrium, it comes from the
+liver. Such urine presents scarcely any sediment. If the blood comes
+from the lrili vein, it is also rather pure, but less pure than in the
+former case, nor is the quantity so great, while pain is felt over the
+region of the seventh vertebra, counting from below. If it comes from
+the kidneys, it is scanty and pure as it leaves the bladder, but soon
+coagulates and forms a dark deposit in the vessel, while pain is
+felt in the pubes and peritoneum.... If pus, blood and epithelium
+(_squamae_) are passed, and the odor is strong, it signifies
+ulceration of the bladder" (f. 275b).
+
+[Footnote 7: In his chapter on embryology (f. 304c) Gilbert describes
+the lrili vein as follows: "The embryo is nourished by means of the
+lrili or lrineli vein, which does not exist in man. This vein has
+its origin in the liver and divides into two branches. Of these the
+superior branch bifurcates, and one of its branches goes to the right
+breast, the other to the left, conveying blood from the liver. This
+blood in the breast is bleached white (_dealbatur_) like milk, and
+forms the nourishment of the infant. The inferior branch of the lrili
+vein also bifurcates, sending one of its branches to the right cornu
+of the uterus, the other to the left. These vessels carry blood into
+the cotyledons, whence it is transmitted to the fetus and digested by
+its digestive faculty."]
+
+Diabetes is defined as "An immoderate passage or attraction of urine
+from the liver to the kidneys and its passage through the kidneys, as
+the result of a warm or dry distemperature of these organs." The idea
+of some association of the liver and kidneys in the production of
+diabetes is at least as old as the eleventh century, and Gilbert's
+definition of the disease is undoubtedly borrowed from the "Practica"
+of John Platearius (A.D. 1075), of the school of Salernum. The
+symptoms, continual thirst, dryness of the mouth, emaciation, in
+spite of an inordinate appetite, frequent and profuse urination, are
+correctly given, but no knowledge of the presence of sugar in the
+urine is indicated.
+
+Dyampnes (involuntary micturition) claims a page or more of
+explanation and treatment, and its frequent occurrence in old men and
+children is noticed.
+
+In the department of the diseases of women chapters are devoted to
+amenorrhea, menorrhagia, hysteria (_suffocatio matricis_), prolapse,
+ulceration, abscess, cancer, dropsy and "ventosity" of the uterus
+(physometra).
+
+In the allied department of obstetrics we find chapters on the signs
+of conception, on the urine in pregnant women, on difficult labor,
+prolapsus uteri, retention of the placenta, post partum hemorrhage,
+afterpains, and the oedema of pregnancy. The causes of difficult
+labor, according to Gilbert, are malposition, dropsy, immoderate size
+and death of the fetus, debility of the uterus and obstruction of the
+maternal passages. Malpositions are to be corrected by the hand of
+the midwife (_obstetrix_). Adjuvant measures are hot baths, poultices,
+inunctions, fumigations and sternutatories, and the use of certain
+herbs.
+
+In the departments of general medicine not as yet entirely
+appropriated by specialists it will suffice to mention scrofula,
+pleurisy and pneumonia, hemoptysis, empyema, phthisis, cardiac
+affections, diseases of the stomach, liver and spleen, diarrhoea and
+dysentery, intestinal worms, dropsy, jaundice, cancer, rheumatism and
+gout, small-pox, measles, leprosy and hydrophobia, all of which claim
+more or less attention.
+
+Peripneumonia and pleurisy are both inflammations of the chest, the
+former affecting the lungs, the latter the diaphragm and the pellicle
+which lines the ribs. The prominent symptoms of both diseases are
+pain in the chest or side, cough and fever and dyspnoea. Accidents or
+sequelae are hemoptysis, empyema and phthisis.
+
+Empima (empyema) is the hawking-up of sanies, with infection of the
+lung and a sanious habit. Hence persons laboring under pneumonia
+or pleurisy are not necessarily empyemics, but when these diseases
+progress to such a point that blood and sanies are expectorated and
+the lung is infected, that is when the ulceration of the lungs fails
+to heal and corruption and infection occur, the disease becomes
+empima, and is with difficulty, or never cured.
+
+Ptisis is a substantial consumption of the humidity of the body, due
+to ulceration of the lungs. For when a solution of continuity occurs
+in the lungs, the inspiratory and expiratory forces fail. Hence the
+lungs do not inspire sufficient air to mitigate the innate heat of the
+heart, and the heart fails to purify itself of the fumosity or fumous
+vapors generated in itself. Accordingly, deprived of the means of
+mitigating its heat or ventilating its fumosities, the spirits within
+it become unduly heated, and a consuming fire is generated in the
+entire body.
+
+The symptoms of ptisis are a continued fever, greater or less,
+detected in the palms of the hands and the soles of the feet, thirst,
+a roughness of the tongue, slenderness of the neck, wasting of the
+entire body, constipation, wasting and shrinking of the finger-nails
+and fingers, hollowness of the eyes, pain in the left scapula
+extending to the shoulder, pharyngeal catarrh with abundant and
+mucilaginous sputum and a tendency to lachrymation. If the sputum
+thrown upon the coals emits a fetid odor, it is a sign of confirmed
+ptisis, which is incurable. The disease when it occurs in youths and
+young persons rarely lasts longer than a year, often terminates in
+less time, and may sometimes, by the aid of medicine, be prolonged for
+a greater period. If the sputum received during the night in a vessel
+is flushed in the morning with warm water, while some impurities
+remain upon the surface, the putrid matter will sink to the bottom
+(_sputum fundum petens_), and the indications are fatal. Likewise
+sharpness of the nose, hollow eyes, slender nails, falling hair,
+flattened temples and diarrhoea are of evil omen. These patients
+converse while dying, and die conversing (_moriendo loquentur, sed
+loquendo moriuntur_). Gilbert, of course, supplies a formidable array
+of remedies for the disease, but tells us that the "very latest" is
+cauterization over the clavicles (_Novissimum autem consilium est
+cauterium in furcula pectoris_).
+
+The varieties of difficulty of breathing are classified under the
+titles of asma, dispnea, orthomia, hanelitus and sansugium. The
+last title is given to a condition in which, as Gilbert says, "A
+superfluous humor is abundant in the superficies of the lung, which
+compresses that organ and renders it unable to dilate in inspiration.
+Hence it labors in inspiration like a leech, from which the dyspnea
+derives its name."
+
+Under the single title of "_cardiaca passio_" are included all
+possible diseases of the heart. The symptoms of this disease are
+said to be "palpitation, twitching of the limbs (_saltus membrorum_),
+perspiration, weakness of the nerves, facial pallor, weakness of the
+body as in hectic fever or phthisis, excessive pain and faintness over
+the precordia, a disposition to sleep and often constipation." The
+treatment is, of course, entirely symptomatic.
+
+Diseases of the digestive apparatus are discussed under the headings
+of difficulties of deglutition, canine appetite, bolismus (boulimia),
+disturbances of thirst, eructations, hiccup, nausea and anorexia,
+vomiting, anathimiasis (gastric debility), anatropha and catatropha
+(varieties of obstinate vomiting), pain in the stomach, abscess of the
+stomach, salivation, colic, dysentery and diarrhoea, intestinal worms,
+hemorrhoids, rectal tenesmus, prolapsus ani, fistula in ano, diseases
+of the liver, dropsy, jaundice and diseases of the spleen.
+
+Abscess of the stomach sometimes manifests a circumscribed tumor,
+and accordingly, probably includes cancer of that organ. Approved
+remedies are the Al'mirabile, the stomatichon frigidum, calidum or
+laxativumvum, etc., stereotyped formulae, of which the composition is
+carefully recorded.
+
+Dysentery is a flux of the bowels with a sanguinolent discharge and
+excoriation of the intestines. A variety called hepatic dysentery,
+however, lacks the intestinal excoriation. Diarrhoea is a simple
+flux of the bowels, without either the sanguinolent discharges or
+the intestinal excoriation. Lientery is a flux of the bowels with the
+discharge of undigested food, occasioned by irritability (_levitas_)
+of the stomach or intestines. Colical passion and iliac passion
+derive their names from the supposed origin of the pain in the colon
+or ileum, a remark which furnishes occasion for the statement that
+Gilbert divides the bowels into six sections, viz., the duodenum
+jejunum and ileum, and the orobus, colon and longaon (rectum).
+
+Intestinal worms are not generated in the stomach, as Gilbert says,
+because of the great heat produced by the process of digestion. In the
+intestines they originate chiefly from the varieties of phlegm, e.g.,
+saline, sweet, acid, natural, etc. The species mentioned specifically
+are lumbrici and ascarides or cucubitini, though the terms long,
+round, short and broad are also employed, and probably include the
+tape worm or taenia lata. The treatment of these parasites consists
+generally in the use of aromatic, bitter or acid mixtures, among which
+gentian, serpentaria, tithymal and cucumis agrestis are especially
+commended for lumbrici, and enemata of wormwood, lupinus, scammony,
+salt, aloes, etc., for ascarides.
+
+The diseases of the liver, though not numerous, are allotted
+considerable space most of which is occupied by scholastic
+speculations and the usual rich supply of therapeutical suggestions.
+
+Discrasia of the liver has several varieties, warm, cold, moist and
+dry, and seems nearly equivalent to our somewhat overworked term of
+"biliousness." Gilbert's favorite compounds for the relief of this
+condition are the Trifera sarracenica, the Electuarium psilliticum and
+above all the Dyantos Besonis.
+
+Obstruction (_oppilatio_) of the liver or enfraxis is defined as a
+disease of the canals (_pori_), of which four are enumerated, to-wit,
+the meseraic, that of the convexity of the organ (_gibbus--ubi sunt
+exitus capillarium venarum_), the duct leading to the gall-bladder
+and that leading to the spleen. With an abundance of symptoms, it is
+singular that this comprehensive disease does not seem characterized
+by any constant or severe pain, as we might reasonably expect.
+
+Abscess of the liver depends upon some vice of the blood, the bile,
+the phlegm or the black-bile. The general treatment is poultices and
+other maturatives, but, as the author adds rather sadly at the close,
+_ultima cura est per incisionem_.
+
+Dropsy is discussed as an independent disease through the exhaustive
+speculations of thirty-two pages. Gilbert tells us it depends upon
+some fault of the digestive faculty of the liver, and he divides
+it into four species, to-wit, leucoflantia, yposarcha, alchitis and
+tympanitis, each of which has its special and appropriate treatment.
+In the dreary waste of speculative discussion it is cheering, however,
+to observe Gilbert's positive recognition of the sphere of percussion
+indicated in the passage:
+
+"_Et venter percussus sonat ad modum utris semipleni aqua et venta._"
+(f. 250b.)
+
+Ycteritia or jaundice receives equally thorough discussion through
+eight weary pages, including the usual polypharmacal treatment.
+
+The spleen, Gilbert says, is sometimes the name of an organ, sometimes
+of a disease. As an organ it is spongy and loose in texture, and
+attracts and retains the superfluities of the black-bile, expelled
+from the liver for its own cleansing. Hence it is a servile and
+insensitive organ, and accordingly suffers different diseases, such
+as obstruction, tumors, hardening, softening, abscess, and sometimes
+flatulence or repletion. The symptoms and treatment of each of these
+morbid conditions, arising from either heat or cold, are discussed
+with exasperating thoroughness, and the chapter concludes with
+the composition and use of various specific remedies of compound
+character, bearing the impressive titles of Dyasene, Dyacapparis,
+Dyaceraseos (a mixture of cherry juice, honey, cinnamon, mastic and
+scammony) and Agrippa.
+
+Scrofulous swellings are carefully considered in a chapter entitled
+"_De scrophulis et glandulis._" "Scrophulae and glandulae are hard
+swellings developing in the soft parts, as in the emunctory localities
+of the veins and arteries, particularly in the neck, armpits
+and groins, and sometimes in other places. They spring from the
+superfluities of the principal organs, which nature expels, as it
+were, to the emunctories and localities designed to receive this
+flux." ... "Hence they are often found the cause of scabies, tinea,
+malum mortuum, cancer, fistula, etc., and are called glandes.
+Sometimes, however, a dryer matter is finely divided and falls into
+several minute portions, from which arise many hard and globular
+swellings, called scrofulae from the multiplicity of their progeny,
+like that of the sow (_scrofa_). The disease is also called _morbus
+regius_, because it is cured by kings."
+
+Gilbert advises that these swellings should not be "driven in"
+(_repercutienda_), but brought to suppuration generally by emollients
+and poultices. When softened they may be opened with a lancet and the
+pus allowed to escape gradually, but as this process is tedious, he
+prefers the entire removal of the glands with the knife, premissing,
+however, that no gland should be cut into which cannot be well grasped
+by the hand and pulled from its seat. This surgical manipulation is
+fully described, and is undoubtedly taken from the similar chapter
+of Roger. It is worthy of notice also that just at the close of this
+chapter, Gilbert mentions a swelling called "testudo," a gland-like,
+gaseous (_ventosa_) tumor, usually solitary and found in "nervous"
+localities, like the joints of the wrist and hand. He says it often
+occurs from fracture (_cassatura_?) of the nerves, is cured by
+pressure, friction or incision, but is not entirely free from danger.
+Possibly this may refer to ganglion. Now, Roger makes no mention
+whatever of "testudo," while Roland says:
+
+"_Nota quod quamvis Rogerius non designat inter glandulum et
+testudinem, scias igitur quod testudo fit ex majori parte flegmatica,
+minori melancholie, glandula vero a contrario_," a statement which
+might readily suggest the suspicion that Gilbert had before his
+eyes the text of Roland, or that, at least, he had not acquired his
+knowledge of testudo from Roger, his usual surgical authority.
+
+Gilbert's sections on goitre (_bocium gulae_)[8] are interesting in
+themselves, and characteristic of the method adopted by him in his
+discussion of surgical or semi-surgical subjects. An introduction
+relative to the pathology of the disease and which seems to be
+original, is followed by a treatment, medical and surgical, adopted
+almost literally from the Chirurgia of Roger. Thus he says: "Goiter
+occurs most commonly among the inhabitants of mountainous regions,
+and is due to an amplification and dilatation of the veins, arteries
+and nerves, together with the soft tissues, occasioned by the north
+wind (_ventum boreale_), or some other confined wind, which during
+childhood has accumulated in (_coadunabatur_) and enlarged the part
+to the size of the goiter." After suggesting an analogy between the
+disease and the redness and turgidity of the neck produced by passion
+or in singing, he adds that some cases are due to an accumulation
+of spongy tissue between the veins and arteries, or to the use of
+flatulent food, and he even tells us that some old women know how to
+produce and remove goitrous swellings by means of certain suitable
+herbs known to them.
+
+[Footnote 8: Cf. the French _bosse de la gorge_.]
+
+Under medical treatment we find the following: "Dig out of the ground
+while chanting a pater noster, a nut which has never borne fruit. The
+roots and other parts pound well with two hundred grains of pepper,
+and boil down in the best wine until reduced in volume to one-half.
+Let the patient take this freely on an empty stomach until cured."
+
+Another more elaborate prescription consists of a long list of
+ingredients, including burnt sponge, saponaria, the milk of a sow
+raising her first litter, with numerous simple herbs, and the sole
+object for which this nonsensical farrago is introduced here is to add
+that both these prescriptions are copied from the surgery of Roger. It
+is important too to remark here that we owe to Roger the introduction
+of iodine, under the form of burnt sponge, into the treatment of
+goiter.
+
+In the failure of medical treatment, Gilbert directs the employment
+of surgical means, e.g., the use of setons, or, in suitable cases,
+extirpation of the goiter with the knife. If, however, the tumor is
+very vascular, he prefers to leave the case to nature rather than
+expose the patient to the dangers of a bloody operation. The whole
+discussion of goiter is manifestly a paraphrase of the similar chapter
+of Roger, who also introduced into surgical practice the use of the
+seton.
+
+In Gilbert's chapter entitled "_De arthretica passione et ejus
+speciebus_," we are introduced to the earliest discussion by an
+English physician of that preeminently English disease--gout. We may
+infer, too, from the length of the discussion (thirty or more pages)
+that this was a disease with which Gilbert was not only familiar, but
+upon the knowledge of which he prided himself greatly. Indeed, it is
+one of the few diseases of the Compendium in which the author assumes
+the position of a clinician and introduces examples of the disease
+and its treatment taken from his own clientele. We shall, therefore,
+follow our author here rather more carefully and literally than usual,
+that we may learn the views of an English physician of the thirteenth
+century on, perhaps, the most characteristic disease of his
+countrymen.
+
+Gilbert says: "Arthetica is a disease of the joints arising from a
+flux of humors descending into their continuity (_concathenationem_).
+The name is derived from the Latin _artus_, a joint, and the disease
+comprehends three species, viz., _sciatica_, disease of the scia,
+or the ligaments uniting the spine with the hip; _cyragra_, disease
+of the joints of the hands; and _podagra_, disease of the bones
+and joints of the foot, due to the descent of humors into their
+continuity. Sometimes, too, the disease affects other organs,
+occasioning pain in sensitive members, as, e.g., the head, and then
+derives its name from the part affected, as _cephalea_, _emigranea_ or
+_monopagia_. Occasionally likewise some humor runs down (_reumatizat_)
+into the chest, spreading over the nerves of the breast or those of
+the spine between the vertebrae, and sometimes to other places.
+Hence the disease derives the general name gout (_gutta_), from its
+resemblance to a drop (_gutta_) trickling or falling downward and
+flowing over the weaker organs, which receive the humor. For gout
+arises particularly from rheumatic causes. Now, as the humors are
+rather uncontrollable (_male terminabiles_) fluids, they flow towards
+the exterior and softer parts, like the flesh and skin, which receive
+their moisture and being soft, dilatable and extensible, there results
+some swelling. But if the humors are hard and dry, they are confined
+within the interior of the organs, such as bones, nerves and
+membranes: and these, being hard in themselves, do not receive the
+moisture, nor suffer extension or dilatation, and thus no swelling
+results. Since, therefore, the material of this variety of arthetica,
+in which no swelling is present, is formed of grosser and harder
+substance and is found in the vicinity of hard and cold localities, it
+is dissolved slowly and the disease is not cured until this solution
+takes place. That form of the disease, however, in which there is
+swelling from a subtile and liquid material deposited in the soft
+parts is the more quickly cured. Hence swelling is the best sign
+of curability. This is most evidently true in podagra, unless the
+_materies morbi_, by reason of its scarcity, produces no enlargement
+of the affected part."
+
+Quoting the words of Rhazes, Gilbert tells us that the _materies
+morbi_ of gout is, for the most part, crude and bloody phlegm. Rarely
+is it bilious, and still more rarely, melancholic. If, however, it is
+compounded, it consists chiefly of bile mixed with a subtile phlegm,
+and more rarely, of phlegm mixed with black bile (_melancholia_),
+occasionally of black bile mixed with blood. The mixture of black bile
+and blood or bile is very rare, and still rarer a mixture of all the
+humors according to their proportion in the body.
+
+If the color of the affected part is red, it indicates that the
+_materies morbi_ is sanguineous; if greenish-yellow (_citrinus_), that
+it is bilious; if whiter than the general color of the body, that the
+materies is a subtile phlegm. If the color shades away into black, it
+does not signify necessarily that the materies is simply black bile,
+for such a color occurs at the close of acute abscesses, or from
+strangulation of the blood. But if, together with the black color, we
+find the tissues cold and no increase of heat in the affected part,
+this indicates that the _materies_ is black bile.
+
+By touching the diseased part we determine its heat or coldness,
+hardness or softness, roughness or smoothness, fullness, distention or
+evacuation, all of which signs possess special significance.
+
+The antecedent causes of gout, Gilbert tells us, are a heat too
+solvent, cold too constringent (f. 311 c), sometimes a strong bath
+or a severe journey in a plethoric person (_in plectorico_), again
+excessive coitus after a full meal (_satietatem_), or even habitual
+excess, by which the joints are weakened and deprived of their natural
+heat and subtile moisture. Hence boys and eunuchs are not commonly
+affected by gout--at least boys under the age of puberty. Women, too,
+do not usually suffer from this disease, because in coitus they are
+passive, unless their menstrual discharge is suspended. Again gout
+sometimes arises from infection of the primary semen; for a chronic
+disease may be inherited by the offspring and affect the material
+causes, i.e., the humors. Flatulence (_ventositas_) is likewise a
+cause of gout, as we have already hinted.
+
+In gout of the sanguineous type the favorite remedy of Gilbert was
+venesection, pushed to extremes which suggest the bloody theories of
+his later confrere Bouillaud. This bloodletting, however, was always
+to be practiced on the side opposite to that affected by the disease,
+as he tells us, for two reasons: First to solicit the peccant material
+to the opposite side; and, second, to retard its course toward the
+seat of the swelling. If, therefore, the disease is in the right foot,
+he bleeds from the basilic vein, or some of its branches, in the right
+hand. No other vein should be taken, but if neither the basilic vein
+nor one of its branches can be found, the bleeding may be performed
+upon the median vein, for certain branches of the basilic and cephalic
+veins unite to form the median. If the disease is in the hand, the
+material may be diverted in two ways, either to the other hand or to
+the opposite foot. Indeed, blood may be taken from both these parts
+in succession. The quantity of blood withdrawn should be in accordance
+with the strength of the patient, the character of the swelling, the
+pulsation, distention, heat and redness of the affected part. But it
+should be repeated frequently, and this bloodletting then frequently
+suffices, in itself, to cure the disease.
+
+Gilbert continues: "I will tell you also what I myself saw in a woman
+suffering and screaming with pain in her right wrist (_assuere_?),
+which was greatly swollen, hot, red and much distended. She was fat,
+full-blooded, and before the attack had lived freely on milk and
+flesh. Accordingly she was robust, and I bled her from the basilic
+vein of the left hand and the saphena of the right foot, both within
+an hour. Each hour I withdrew a half-pound of blood, then I fed her
+and for three hours I drew half a pound of blood from the saphena. In
+the last hour the pain and throbbing (_percussio_) ceased entirely,
+and the woman begged me to bleed her again from the hand, for she had
+experienced great relief. I wished, however, to divert the material
+to the lower extremities for two reasons, one of which I ought not to
+mention in this place, while the other is useful, and indeed necessary
+in such cases. You should know that this woman was suffering pain in
+her left hand also, though this pain was of a less severe character
+than in the right. For this reason I desired to divert the peccant
+matter downward, a point which the physician should consider and
+observe. Once, while treating a man suffering from sanguineous gout,
+the pain of which involved the joints between the assuerus and the
+racheta (?) of the right hand, I asked him whether any pain was felt
+in the other hand or in the feet. He replied that similar pain was
+felt in the left hand or its joints, and that hitherto it had been
+more severe, but that no pain had ever been experienced in the feet.
+Hence I was unwilling to bleed him at all from the left hand, but I
+bled him from the right foot. A physician who had treated him before,
+and had bled him from the right hand for acute swelling of the joints
+of the left, quieted, indeed, the pain in the left hand, but diverted
+the disease to the right, where a swelling developed larger than in
+the left. And when I asked him about this, he understood that I knew
+more about medicine than the other doctor did. And this is one of
+the reasons why one ought to divert the material to another part,
+especially when the pain is so located that it may be increased at
+the beginning. For under such conditions we ought to refrain from
+bleeding, frictions and other treatment which may attract the
+_materies morbi_ to the part. Indeed we ought to require derivation of
+the materies to another part whenever the affected locality contains
+one of the nobler organs, towards which the material is directing, or
+may direct its course. For instance: A person is suffering pain in
+the joints of the right hand, but has also an acute swelling in the
+bladder, the kidneys or the womb. Now, I say that in such a case we
+ought not to bleed from the hand, because if we do we shall injure the
+organ affected by the swelling. Perhaps, however, we may bleed from
+the right foot, provided we understand that there is on the right side
+a sanguineous tumor, the danger of which is greater than that of the
+swelling on the right hand. Again, suppose in the liver or in the
+right kidney an acute tumor, and in the joints of the right hand there
+is present a moderate pain. I say that we ought first to medicate the
+more dangerous lesion, and, possibly, two results may be obtained by
+the attraction of the peccant material. Or suppose a woman has gout in
+her hand, and with this a suppression of the menstrual flow. I say she
+ought to be bled from the foot and not from the hand for two objects,
+to solicit the material from the diseased hand, and to provoke a
+return of the menstrual discharge.
+
+"But to return to our original patient. I may say that after the third
+venesection, with an interval of two hours, I withdrew a half-pound
+of blood from the saphena vein, and that night she slept, although
+she had not slept for many nights. And I did nothing more, except to
+prescribe a light and cool diet. The third day after the bleeding she
+was entirely free from any trouble in her hand. Hence I say that we
+ought in such cases to begin our treatment by venesection."
+
+After this sanguinary introduction, Gilbert soothes the diseased part
+with cooling and astringent ointments, unless these occasion pain,
+in which event he omits them entirely and trusts the case to nature,
+"_quoniam natura per se curabit_."
+
+The vigorous plan of treatment thus outlined Gilbert seems to regard
+as original and peculiar to himself, for the next chapter bears the
+title, "The treatment of gout according to the authorities (_secundum
+magistros_)." Here he says he quotes the opinions of the modern
+teachers and writers, who lay down definite rules for the guidance of
+the physicians.
+
+Among these he mentions, as primary and of general application, the
+rule that, before all things, the body must be purified, either
+by venesection in cases where the material is sanguineous, or by
+purgation in other varieties of the disease. If the cause is rheumatic
+in its nature, fomentations should never be employed, for fear of
+increasing the flux. That the peccant material is to be eliminated
+gradually by mild remedies, just as it accumulated by degrees. In all
+cases of gout, and in all chronic diseases generally, much attention
+must be devoted to the stomach, since if this organ rejects the
+medicine, the latter must be at once abandoned, lest the stomach
+becomes weakened and even other organs, and thus the humors flow more
+readily (_magis reumatizarent_) to the joints, etc.
+
+These general medical rules are succeeded by some twenty pages devoted
+largely to special formulae for the different forms of gout, with
+remarks as to their applicability to the different varieties of the
+disease. Most of the formulae bear special titles, apparently to lend
+the weight of a famous name to the virtues of the prescription itself,
+something as in these modern days we speak of "Coxe's Hive Syrup,"
+"Dover's Powder," "Tully's Powder," etc. Thus we read of the "_Pilulae
+artheticae Salernitorum_," the "_Cathapcie Alexandrine_," the "_Oxymel
+Juliani_" the "_Pilulae Arabice_," the "_Pulvis Petrocelli_,"
+the "_Oleum benedictum_," the "_Pilulae Johannicii_," etc. It is
+important, too, to remark that the active ingredient of very many
+of these formulae is the root called hermodactyl, believed by the
+majority of our botanists to be the _colchicum autumnale_.
+
+Gilbert's discussion of gout closes with a short and characteristic
+chapter entitled "_Emperica_," in which he remarks: "Although I
+perhaps demean myself somewhat in making any reference to empirical
+remedies, yet it is well to write them in a new book, that the work
+may not be lacking in what the ancients (_antiqui_) have said on the
+subject. Accordingly I quote the words of Torror. If you cut off the
+foot of a green frog and bind it upon the foot of a gouty patient for
+three days, he will be cured, provided you place the right foot of
+the frog upon the right foot of the patient, and vice versa. Funcius,
+also, who wrote a book on stones, said that if a magnet was bound upon
+the foot of a gouty patient, he is cured. Another philosopher also
+declared that if you take the heel-bone of an ass and bind it upon
+the foot of the patient, he is cured, provided that you take the right
+bone for the right foot, and conversely, and he swore this was true.
+Torror also said that if the right foot of a turtle is placed upon the
+right foot of a patient suffering from the gout, and conversely, he
+will be cured."
+
+Gilbert's discussion of leprosy (_De lepra_, f. 336 d) covers twenty
+pages and, according to Sprengel, is "almost the first correct
+description of this disease in the Christian West." Freind says this
+chapter is copied chiefly _from_ Theodorius of Cervia. See page 3
+ante. If, however, I am correct in my conjecture that the Compendium
+was written about the year 1240, the copying must have been done _by_
+Theodorius, whose "Chirurgia" did not appear until 1266.
+
+Leprosy is defined as a malignant disease due to the dispersion of
+black bile throughout the whole body, corrupting both the constitution
+(_complexionem_) and the form of its members. Sometimes, too, it
+occasions a solution of continuity and the loss of members.
+
+The disease is sometimes congenital, arising from conception during
+the menstrual period. For the corrupt blood within the maternal
+body, which forms the nourishment of the fetus, leads likewise to the
+corruption of the latter. Sometimes the disease is the result of a
+corrupt diet, or of foul air, or of the breath or aspect of another
+leper. Avicenna tells us that eating fish and milk at the same meal
+will occasion the same result. Infected pork and similar articles of
+diet may likewise produce the disease. Cohabitation with a woman who
+has previously had commerce with a leper may also produce infection.
+
+Among the general symptoms of leprosy Gilbert enumerates a permanent
+loss of sensation proceeding from within (_insensibilitas mansive ad
+intrinseco veniens_) and affecting particularly the fingers and toes,
+more especially the first and the little finger, and extending to
+the forearm, the arm or the knees; coldness and formication in the
+affected parts; transparency (_luciditas_) of the skin, with the
+loss of its natural folds (_crispitudines_), and a look as if tightly
+stretched or polished; distortion of the joints of the hands and feet,
+the mouth or the nose, and a kind of tickling sensation as if some
+living thing were fluttering within the body, the thorax, the arms
+or the lips. There is felt also a sensation of motion, which is even
+visible also by inspection. Fetor of the breath, the perspiration and
+the skin are likewise noticeable. The localities affected lose their
+natural hair and are re-covered with very fine hairs, invisible except
+when held between the eye and the sun. The hair of the eyebrows
+and the eyelashes are lost--one of the worst of symptoms. There are
+present also hoarseness and an obstruction of the nostrils, without
+any visible cause. When the patient takes a bath the water runs off
+the affected localities as if they had been greased--another sign of
+evil omen. The angles of the eyes are rounded and shining. The skin,
+even when unaffected by cold, or other similar cause, is raised into
+very minute pimples, like the skin of a plucked goose. The blood in
+venesection has an oily appearance, and displays small particles like
+sand. Small tumors accompany the depilation of the eyebrows. Lepers
+are unusually and unduly devoted to sexual pleasures, and suffer
+unusual depression after sexual indulgence. The skin is tormented
+with a constant itching, and is alternately unduly hot or cold. Small
+grains are found under the tongue, as in leprous hogs.
+
+Gilbert divides leprosy into four varieties, _elephantia_, _leonina_,
+_tyria_ and _allopicia_, the pathology, symptoms and treatment of each
+of which are presented with wearisome minuteness and completeness.
+A long chapter, entitled "_De infectione post coitum leprosi_,"
+discusses the transmission of the disease by means of sexual
+intercourse, and suggests the possible confusion of lepra and
+syphilis.
+
+The usual catalogue of specific remedies terminates the discussion.
+
+An interesting chapter on small-pox[9] and measles, "_De variolis et
+morbillis_," gives us the prevailing ideas relative to these diseases
+in England during the thirteenth century. Premising his remarks with a
+classification of diseases as follows:
+
+Diseases universal and infectious--like _morphoea_, _serpigo_,
+_lepra_, _variolae et morbilli_.
+
+Diseases universal but not infectious.
+
+Diseases infectious but not universal--like _noli me tangere_.
+
+Diseases neither infectious nor universal.
+
+Gilbert classifies _variolae et morbilli_ among the universal and
+infectious diseases, and in the species _apostemata_. To this latter
+species belong also _ignis Persicus_, _carbunculus_ and _antrax_.
+
+[Footnote 9: It is at least interesting to know that small-pox is said
+to have made its first appearance in England in 1241.]
+
+_Variolae et morbilli_ arise from moist matter confined in the body
+and turbid, like turbid blood. Hence the disease occurs most commonly
+in boys and in those who are careless about cleanliness and neglect
+venesection. It is the result of a disposition of the blood resembling
+putrescence, in which there occurs an external ebullition in the
+efforts of nature to purify the interior of the body and to expel
+to the surface the virulent material within. Accordingly the common
+people declare that persons who have suffered from _variolae et
+morbilli_ never acquire leprosy. Occasionally, too, the disease arises
+from excessive corruption of matter in repletion of blood, and hence
+it is more frequent in sanguineous diseases, like synocha, and during
+the prevalence of south winds or the shifting of winds to the south,
+and in infancy--the age characterized particularly by heat and
+moisture.
+
+The eruptions vary in color in accordance with the mixture of the
+different humors with the corrupt blood. Hence some are light colored,
+some the color of saffron, some red, some green, some livid, some
+black, and the virulence of the disease is the greater, the nearer
+the color approaches to black. There are, too, four varieties of the
+eruption, distinguished by special names. When the eruption is light
+colored and tends to suppuration, it is called _scora_. When it
+is very fine and red, it is called _morbilli_ or _veterana_. The
+distinction between _variolae_ and _morbilli_ is in the form and
+matter of the disease, for in _variolae_ the pustules are large and
+the matter bilious (_colerica_), while in morbilli the eruption is
+smaller and does not penetrate the skin (_non-pertransit cutem_).
+_Variolae_, on the contrary, forms a prominent pustule (_facit
+eminentiam_). A third form of the disease displays only four or five
+large, black pustules on the whole body, and this form is the most
+dangerous, since it is due to an unnatural black bile, or to acute
+fevers, in which the humors are consumed. This variety bears the name
+of _pustula_. A fourth form is called _lenticula_. This latter form
+occurs sometimes with fever, like synocha, sometimes without fever,
+and it arises from pestilential air or corrupt food, or from sitting
+near a patient suffering from the disease, the exhalations of which
+are infectious.
+
+The premonitory symptoms of _variolae_ are a high fever, redness of
+the eyes, pain in the throat and chest, cough, itching of the nose,
+sneezing and pricking sensations over the surface of the body.
+
+_Morbilli_ is a mild disease, but requires protection from cold, which
+confines and coagulates the peccant matter.
+
+Attention is directed to the not infrequent ulcers of the eyes, which
+occur in _variolae_ and may destroy the sight; also to ulcerations
+of the nose, throat, oesophagus, lungs and intestines, the latter of
+which often produce a dangerous diarrhoea.
+
+When _variolae_ occurs in boys, it is recommended to tie the hands of
+the patient to prevent scratching.
+
+Whey is said to be an excellent drink for developing the eruption of
+_variolae_, and the time-honored saffron (_crocus_) appears in several
+of Gilbert's prescriptions for this disease. Here, too, we find
+the earliest mention of the use of red colors in the treatment of
+_variolae_ (f. 348 c):
+
+"_Vetule provinciales dant purpuram combustam in potu, habet enim
+occultam naturam curandi variolas. Similiter pannus tinctus de
+grano._"
+
+Acid and saline articles of food should be avoided, sweets used
+freely, and the patients should be carefully guarded from cold.
+
+Not the least interesting pages of the Compendium are those (there are
+about twenty of them) devoted to the discussion of poisons, poisoned
+wounds and hydrophobia.
+
+An introductory chapter on the general subject of the character of
+poisonous matters, illustrated by some gruesome and Munchausen-like
+tales, borrowed mainly from Avicenna and Ruffus, on the wonders
+of acquired immunity to poisons, the horrors of the basilisk, the
+_armaria_ (_?_), the deaf adder (_aspis surda_) and the red-hot
+_regulus_ of Nubia, leads naturally to the consideration of some
+special poisons derived from the three kingdoms of nature. Very
+characteristically Gilbert displays his caution in the discussion of a
+dangerous subject by the following preface:
+
+_Abstineamus a venesis occultis quae non sunt manifesta, ne virus in
+angues adjiciamus, aut doctrinam perniciosam tradere videamur_ (f. 351
+a).
+
+Beginning then with metallic mercury (_argentum vivum_), he considers
+the poisonous effects of various salts of lead and copper, the
+vegetable poisons hellebore, anacardium (_anacardis?_), castoreum,
+opium and cassilago (_semina hyoscyami_), and then proceeds to
+the bites or rabid men and animals, hydrophobia, and the bites of
+scorpions, serpents and the _animalia annulosa_, that is, worms,
+wasps, bees, ants and spiders.
+
+Space does not permit a careful review of this interesting subject,
+but a novel form of poisoning by the use of quicksilver is startling
+enough to claim our attention. Gilbert tells us that pouring metallic
+mercury into the ear produces the most distressing symptoms, severe
+pain, delirium, convulsions, epilepsy, apoplexy and, if the metal
+penetrates to the brain, ultimate death. In the treatment of this
+condition certain physicians had recommended the insertion into the
+ear of a thin lamina of lead, upon which it was believed that the
+mercury would fasten itself and might thus be drawn out. Avicenna
+objected to this that the mercury was liable to speedily pass into the
+ear so deeply as to be beyond the reach of the lead. Gilbert suggests
+as an improvement of the treatment that a thin lamina of gold be
+substituted for the lead, "because mercury thirsts after gold as
+animals do after water, as it is held in the books on alchemy" (_in
+libris allzinimicis_). This fact, too, he tells us can be easily
+demonstrated externally by placing upon a plate a portion of gold,
+and near, but not in contact with it, a little quicksilver, when the
+silver, he says, will at once "leap" upon the gold. Avicenna suggests
+that the patient stand upon the foot of the side affected, lean his
+head over to the same side, steady it in that position with the hands,
+and then leap suddenly over upon the other foot--demonstrating thereby
+his knowledge of both gravity and inertia. Manifestly our "laboratory
+physicians" of the present day can assume no airs of priority!
+
+The Compendium closes with two very sensible chapters on the hygiene
+of travel, entitled "_De regimine iter agentium_" and "_De regimine
+transfretantium_."
+
+In the hygiene of travel by land Gilbert commends a preliminary
+catharsis, frequent bathing, the avoidance of repletion of all kinds,
+an abundance of sleep and careful protection from the extremes of
+both heat and cold. The strange waters may be corrected by a dash of
+vinegar. Some travelers, he tells us, carry with them a package of
+their native soil, a few grains of which are added to the foreign
+waters, as a matter of precaution, before drinking. The breakfast of
+the traveler should be light, and a short period of rest after a day's
+travel should precede the hearty evening meal. Leavened bread two or
+three days old should be preferred. Of meats, the flesh of goats or
+swine, particularly the feet and neighboring parts, which, Gilbert
+tells us, the French call _gambones_, the flesh of domestic fowls and
+of the game fowls whose habitat is in dry places, is to be preferred
+to that of ducks and geese. Of fish, only those provided with scales
+should be eaten, and all forms of milk should be avoided, except whey,
+"which purifies the body of superfluities." Fruits are to be eschewed,
+except acid pomegranates, whose juice cools the stomach and relieves
+thirst. Boiled meats, seasoned with herbs like sage, parsley, mint,
+saffron, etc., are better than roasted meats, and onion and garlic are
+to be avoided.
+
+The primitive conditions of land travel in the days of Gilbert are
+emphasized by his minute directions for the care of the feet, which he
+directs to be rubbed briskly with salt and vinegar and then anointed
+with an ointment of nettle-juice (_urtica_) and mutton-fat, or with
+a mixture of garlic, soap and oil. If badly swollen, they should be
+bathed, before inunction, with a decoction of elder-bark and other
+emollients.
+
+In travel by sea, Gilbert tells us the four chief indications are to
+prevent nausea, to allay vomiting, to palliate the foul odor of the
+ship and to quiet thirst.
+
+For the prevention of nausea he recommends the juice of acid
+pomegranates, lemons, etc., or a decoction of parsley or sweet cicely
+(_cerfolium_). The traveler should endeavor to sit with his head
+erect, should avoid looking around, but maintain his head as immovable
+as possible, and support himself by a firm grasp upon some beam of the
+ship. Some sweets may be sucked, or he may chew a few aromatic seeds.
+If vomiting ensues, acid or sweet pomegranates, figs or barley-sugar
+(_penides_) may be taken sparingly, but no food should be ingested
+until the stomach is thoroughly quieted. Then the patient may take a
+little _stomatichon_ or _dyantos_, and a small portion of digestible
+food. As the diet must necessarily consist largely of salty food and
+vegetables, these should be cooked in three or four different waters,
+and then soaked in fresh water. A little aromatic wine will also
+benefit the patient, and a few aromatic seeds chewed in the morning
+are also of service.
+
+The effect of the foul odors of the ship may be combatted by the use
+of aromatic electuaries, "which comfort the heart, the brain and the
+stomach." The patient should be removed to some quiet portion of the
+ship, as distant as possible from the channels for the discharge of
+the bilge-water, and short walks upon the upper deck will contribute
+to convalescence. Frequent changes of clothing will palliate the
+annoyance of fleas and pediculi. Drinking water may be purified by
+aeration, or by straining, boiling and subsequent sedimentation and
+removal of the sediment by filtration through fresh and clean sand.
+For the wealthy, the water may be distilled in an alembic, if such an
+apparatus is obtainable. Avicenna says that bad water may be corrected
+by the addition of vinegar. Exposure to the midday sun and to the
+nocturnal cold, constipation and diarrhoea should be avoided, and
+prompt attention should be given to all disorders of the health.
+
+To these wise counsels Gilbert courteously adds a medieval _bon
+voyage_ in these words:
+
+"_Dominus autem omnia dirigat in tranquilitate. Amen._"
+
+It has been already remarked upon a preceding page that Gilbert of
+England was not a surgeon. Nevertheless it is only fair to say that
+the surgical chapters of the Compendium present a more scientific and
+complete view of surgical art, as then known, than any contemporaneous
+writings of the Christian West, outside of Italy.
+
+It is well known that during the Middle Ages the practice of surgery
+in western Europe was generally regarded as disreputable, and
+operative surgery was for the most part relegated to butchers,
+barbers, bath-keepers, executioners, itinerant herniotomists and
+oculists, _et id omne genus_, whose pernicious activity continued to
+make life precarious far down into the modern period.
+
+In Italy alone did surgery vindicate for itself an equality with
+medicine, and the pioneer of this advance was Roger of Parma, who, as
+we have seen, flourished early in the thirteenth century. Roger and
+his pupil Roland, with the somewhat mythical "Four Masters" (_Quatuor
+Magistri_), were the surgical representatives of the School of
+Salernum, while Hugo (Borgognoni) di Lucca and his more famous son
+Theodorius represented the rival school of Bologna. Equally famous
+Italian surgeons of this century were Bruno of Logoburgo (in Calabria)
+and Gulielmus of Saliceto (1275), the master of Lanfranchi (1296).
+Gilbert of England, as a pupil of Salernum, naturally followed the
+surgical teachings of that school, and we have already noticed that
+his chapters on surgery are taken chiefly from the writings of Roger
+of Parma, though the name of neither Roger, nor indeed of any other
+distinctly surgical writer, is mentioned in the Compendium. How
+closely in some cases Gilbert followed his masters may best be seen
+by a comparison of their respective chapters upon the same subject.
+I accordingly introduce here for such comparison Roger's chapter on
+wounds of the neck, and the corresponding chapter of Gilbert. Roger
+says:
+
+"_De vulnere quod fit in cervice._
+
+"_Si vero cum ense vel alio simili in cervice vulnus fiat, ita quod
+vena organica incidatur, sic est subveniendum. Vena tota sumatur
+(suatur) cum acu, ita quod vena non perforetur, et ex alia parte
+acus cum filo ei inhaerente ducatur, et cum ipso filo nectatur atque
+stringatur, quod sanguinem non emittat: et ita facias ex superiori
+parte et inferiori. In vulnere autem pannus infusus mittatur, non
+tamen de ipso vulnus multum impleatur. Embrocha, si fuerit in myeme,
+superponatur quosque (quousque) vulnus faciat saniem. Si vero fuerit
+in aestate vitellus avi semper superponatur. Quum autem saniem
+fecerit, cum panno sicco, unguento fusco et caeteris bonam carnem
+generantibus, adhibeatur cura, ut in caeteris vulneribus. Quum vero
+extremitatem venae superioris partis putruisse cognoveris, fila
+praedicta dissolvas, et a loco illo removeas: et deinde procedas ut
+dictum est superius. A. Si vero nervus incidatur in longum aut ex
+obliquo, sed non ex toto, hac cura potest consolidari. Terrestres
+enim vermes, idest qui sub terra nascuntur, qui in longitudine
+et rotunditate lumbricis assimilantur, et apud quondam terrestres
+lumbrici dicuntur, accipiantur et aliquantulum conterantur et in oleo
+infusi ad ignem calefiant: et nullo alio mediante, ter vel quater, vel
+etiam pluries, si opportunum videbis, plagae impone. Si vero incidatur
+ex obliquo totus, minime consolidatur: praedicto tamen remedio non
+coadjuvante saepe conglutinatur. Potest etiam cuticula, quae supra
+nervum est, sui, pulvisque rubens, qui jam dictus est, superaspergi,
+quae cura non est inutilis, aliquos enim non solum conglutinatas,
+sed etiam consolidatas, nostra cura prospeximus. Si vero locus tumet,
+embrocham illam, quam in prima particula ad tumorem removendum, qui
+ex percussura contigit, praediximus, ponatur, quousque talis tumor
+recesserit._"
+
+Gilbert, after premising two short chapters entitled "_De vulneribus
+colli_" and "_De perforatione colli ex utraque parte_," continues as
+follows:
+
+"_De vena organica incisa._
+
+"_Si vena organica in cervice incidatur: tota vena suatur cum acu, ita
+quod vena non perforetur, et ux alia parte acus cum filo ei adherente
+ita nectatur atque stringatur quod (non) emittat sanguinem, et ita
+fiat ex superiori parte et inferiore vene. In vulnere autem pannus
+infusus in albumine ovi mittatur, nec tamen de ipso panno vulnus
+multum impleatur. Embroca vero superius dicta, si in hyeme fuerit,
+superponatur, donec vulnus saniem emittat. Si vere in estate, vitellum
+ovi tum super ponatur, et cum saniem fecerit, panno sicco, et unguento
+fusco et ceteris regenerantibus carnem, curetur. Cum vero extremitatem
+vene superioris et inferioris putruisse cognoveris, fila dissolvantur
+et a loco removeantur, et deinde ut dictum est procedatur._
+
+"_De incisione nervi secundum longum aut secundum obliquum._
+
+"_Si vero secundum longum aut obliquum vervi incidantur, et non ex
+toto, ita consolidamus. Terrestres vermes, qui sub terra nascuntur,
+similes in longitudine et rotunditate lumbricis, qui etaim lumbrici
+terre appellantur: hi aliquantulum conterantur et in oleo infusi ad
+ignem calefiant, et nullo aliomediante, ter vel quater vel pluries,
+si opportunum fuerit, plagelle impone. Si vero ex oblique nervus
+incidatur, eodem remedio curatur, et natura cooperante saepe
+conglutinatur. Potest quoque cuticula quae supra nervum est sui, et
+pulvis ruber superaspergatur. Nervos enim conglutinari et consolidari
+hoc modo sepius videmus. Si vero locus tumeat, embroca, praedicta in
+vulnere capitis quae prima est ad tumorem removendum, superponatur,
+quousque tumor recesserit. Si vena organica non inciditur,
+pannus albumine ovi infusus in vulnere ponatur. Embroca vero post
+desuperponatur_" (f. 179 c).
+
+The selection and collection of words and phrases in these two
+passages leaves little doubt that one was copied from the other.
+Indeed, so close is their resemblance that it is quite possible from
+the one text to secure the emendation of the other. Numerous similar
+passages, with others in which the text of Gilbert is rather a
+paraphrase than a copy of the text of Roger, serve to confirm the
+conclusion that the surgical writings of the English physician are
+borrowed mainly from the "Chirurgia" of the Italian surgeon. Some few
+surgical chapters of the Compendium appear to be either original or
+borrowed from some other authority, but their number is not sufficient
+to disturb the conclusion at which we have already arrived. Now, as
+Roger's "Chirurgia" was probably committed to writing in the year
+1230, when the surgeon was an old man, these facts lead us to the
+conclusion that Gilbert must have written his Compendium at least
+after the date mentioned.
+
+Another criticism of these chapters suggests certain interesting
+chronological data. It will be observed that Roger, in the passage
+quoted above, recommends a dressing of egg-albumen for wounds of the
+neck, and expresses considerable doubt whether nerves, when totally
+divided, can be regenerated (_consolidari_), though they may
+undoubtedly be reunited (_conglutinari_).
+
+Now Roland, in his edition of Roger's "Chirurgia," criticises both of
+these statements of his master, as follows:
+
+_Nota quod quamvis Rogerius dicat quod apponatur albumen ovi, non
+approbo, quia frigidum est naturaliter, et vena et nervus et arteria
+frigida sunt naturaliter, et propter frigiditatem utrorumque non
+potest perfecte fieri consolidatio._
+
+And again:
+
+_Nota quod secundum Rogerium nervus omnino incisus non potest
+consolidari, vel conjungi nec sui. Nos autem dicimus quod potest
+consolidari et iterum ad motum reddi habillis, cum hac cautela:
+Cauterizetur utrumque caput nervi incisi peroptime cum ferro candenti,
+sed cave vulneris lobia cum ferro calido tangantur. Deinde apponantur
+vermes contusi et pulveres consolidativi, etc._
+
+It will be observed that Gilbert, in spite of the rejection by Roland
+of the egg-albumen dressing of Roger, still recommends its use in
+wounds of the neck, and although he professes to have seen many nerves
+regenerated (_consolidari_) under the simple angle-worm treatment
+of his master, he still makes no mention of the painful treatment of
+divided nerves by the actual cautery, so highly praised by Roland. It
+would seem, therefore, that Gilbert was not familiar with the writings
+of Roland when his Compendium was written, or he would, doubtless,
+not have omitted so peculiar a plan of treatment in an injury of such
+gravity. As Roland's edition of Roger's "Chirurgia" is said to have
+been written in 1264, the comparison of these passages would seem to
+indicate that Gilbert must have written the Compendium after 1230 and
+prior to the year 1264.
+
+Gilbert's surgical chapters discuss the general treatment of wounds
+and their complications, and more specifically that of wounds of the
+head, neck, throat, wounds of nerves, of the oesophagus, scapula,
+clavicle, of the arm, the stomach, intestines and the spleen;
+fractures of the clavicle, arm, forearm and ribs; compound fractures;
+dislocations of the atlas, jaw, shoulder and elbows; fistulae in
+various localities, and the operations on the tonsils and uvula, on
+goitre, hernia and stone in the bladder, etc.--certainly a surgical
+compendium of no despicable comprehensiveness for a physician of his
+age and country.
+
+In the general treatment of wounds (f. 86 c) Gilbert tells us
+the surgeon must consider the time, the age of the patient, his
+temperament (_complexio_) and the locality, and be prepared to
+temper the hot with the cold and the dry with the moist. Measures
+for healing, cleansing and consolidation are required in all wounds,
+and these objects may, not infrequently, be accomplished by a single
+agent. The general dressing of most wounds is a piece of linen
+moistened with the white of egg (_pecia panni in albumine ovi
+infusa_), and, as a rule, the primary dressing should not be changed
+for two days in summer, and for three days in the winter. In moist
+wounds _vitreolum_ reduces the flesh; in dry wounds it repairs and
+consolidates. _Flos aeris_, in dry wounds, reduces but does not
+consolidate, but rather corrodes the tissues. Excessive suppuration
+is sometimes the result of too stimulating applications, sometimes
+of those which are too weak. In the former case the wound enlarges,
+assumes a concave form, is red, hot, hard and painful, and the pus is
+thin and watery (_subtilis_). If the application is too weak, the pus
+is thick and viscous, and the other signs mentioned are wanting. In
+either case the dressings are to be reversed. If any dyscrasia, such
+as excessive heat, coldness, dryness or moisture appears in the wound
+and delays its healing, it is to be met by its contrary. If fistula or
+cancer develops, this complication is to be first cured and then the
+primary wound. The signs of a hot dyscrasia are heat, burning and pain
+in the wound; of a cold dyscrasia, lividity of the wound; the moist
+dyscrasia occasions flabbiness (_mollicies_) and profuse suppuration,
+and the dry produces dryness and induration.
+
+Wounds of the head (f. 84 c) occur with or without fracture of the
+cranium, but always require careful examination and exact diagnosis.
+The wound is to be carefully explored with the finger, and, if
+necessary, should be enlarged for this purpose. Large, but simple,
+wounds of the scalp should be stitched with silk in three or four
+places, leaving the most dependent angle open for escape of the
+discharges, and in this opening should be inserted a tent (_tuellus_),
+to facilitate drainage. The wound is then sprinkled with the _pulvis
+rubeus_ and covered with a plantain or other leaf. On the ninth to the
+eleventh day, if the wound seems practically healed, the stitches are
+to be removed and the cure completed with simple dressings.
+
+The signs and symptoms of fracture of the cranium are: Loss
+of appetite and failure of digestion, insomnia, difficulty in
+micturition, constipation, a febrile dyscrasia, difficulty in cracking
+nuts or crusts of bread with the jaws, or severe pain when a string is
+attached to the teeth and pulled sharply. If the meninges are injured
+we have further: headache, a slow and irregular but increasing fever,
+alternating with chills, distortion of the angles of the eyes, redness
+of the cheeks, mental disturbances, dimness of vision, a weak voice
+and bleeding from the ears or the nose. In the presence of such
+symptoms the death of the patient may be expected within at most a
+hundred days.
+
+If the fracture of the cranium is accompanied by a large scalp wound,
+any fragments of bone or other foreign body are to be extracted at
+once, unless haemorrhage or the weakness of the patient are feared,
+and then a piece of linen is to be cautiously worked in with a feather
+between the cranium and the dura mater. In the fracture itself a piece
+of linen, or better of silk, is inserted, the apparent purpose of this
+double dressing being to protect the dura mater from the discharges
+and to solicit their flow to the exterior. A piece of sponge,
+carefully washed, dried and placed in the wound, Gilbert tells us,
+absorbs the discharges satisfactorily and prevents their penetration
+internally. Over the wound is placed a bit of linen moistened with
+egg-albumen, then a dressing of lint, and the whole is maintained in
+place by a suitable bandage. Finally the patient is to be laid in bed
+and maintained in such a position that the wound will be dependent, so
+as to favor the ready escape of the discharges. This dressing is to be
+renewed three times a day in summer, and twice in winter. Proud flesh
+upon the dura mater is to be repressed by the application of a sponge,
+well-washed and dried, and if it appears upon the surface of the wound
+after the healing of the fracture, it is to be destroyed by the use of
+the hermodactyl. When the external wound is healed, the cicatrix is
+to be dressed with the _apostolicon cyrurgicum_, an ointment very
+valuable for the consolidation of bones, the leveling (_adaequatio?_)
+of wounds, etc.
+
+When the wound of the scalp is small, so as to render difficult the
+determination of the extent of the fracture by exploration with the
+finger, it should be enlarged by crucial incisions, the flaps loosened
+from the cranium by a suitable scraper (_rugine_) and folded back
+out of the way, and any fragments of bone removed by the forceps
+(_pinceolis_). If, however, haemorrhage prevents the immediate removal
+of the fragments, this interference may be deferred for a day or
+two, until the bleeding has stopped or has been checked by suitable
+remedies. Then, after their removal, the piece of linen described
+above is to be inserted between the cranium and dura mater. Upon the
+cranium and over the flaps of the scalp, as well as in their angles,
+the ordinary dressing of albumen is to be applied, covered by a
+pledget of lint and a suitable bandage. No ointment, nor anything
+greasy, should be applied until after the healing of the wound, lest
+some of it may accidentally run down into the fracture and irritate
+the dura matter. Some surgeons, Gilbert tells us, insert in the place
+of the fragments of the cranium removed a piece of a cup (_ciphi_) or
+bowl (_mazer_), or a plate of gold, but this plan, he says, has been
+generally abandoned (_dimittitur_.)
+
+Sometimes the cranium is simply cracked without any depression of the
+bone, and such fractures are not easily detected. Gilbert tells us,
+however, that if the patient will close firmly his mouth and nose and
+blow hard, the escape of air through the fissured bone will reveal the
+presence of the fracture (f. 88a). In the treatment of such fissures
+he directs that the scalp wound be enlarged, the cranium perforated
+very cautiously with a trepan (_trepano_) at each extremity of the
+fissure and the two openings then connected by a chisel (_spata_?),
+in order to enable the surgeon to remove the discharges by a delicate
+bit of silk or linen introduced with a feather. If a portion of the
+cranium is depressed so that it cannot be easily raised into position,
+suitable openings are to be made through the depressed bone in order
+to facilitate the free escape of the discharges.
+
+Gunshot wounds were, of course, unknown in Gilbert's day. In a chapter
+entitled "_De craneo perforato_" he gives us, however, the treatment
+of wounds of the head produced by the transfixion of that member by an
+arrow. If the arrow passes entirely through the head, and the results
+are not immediately fatal, he directs the surgeon to enlarge the wound
+of exit with a trephine, remove the arrowhead through this opening,
+and withdraw the shaft of the arrow through the wound of entrance. The
+wounds of the cranium are then to be treated like ordinary fractures
+of that organ (f. 88c).
+
+In wounds of the neck involving the jugular vein (_vena organica_),
+Gilbert directs ligation of both extremities of the wounded vessel,
+after which the wound is to be dressed (but not packed) with the
+ordinary dressing of egg-albumen.
+
+Wounds of nerves are treated with a novel dressing of earthworms
+lightly beaten in a mortar and mixed with warm oil, and he professes
+to have seen nerves not only healed (_conglutinari_), but even the
+divided nerve fibres regenerated (_consolidari_) under this treatment.
+In puncture of a nerve Gilbert surprises us (f. 179d) by the advice
+to divide completely the wounded nerve, in order to relieve pain and
+prevent tetanus (_spasmus_).
+
+Goitre, not too vascular in character, is removed by a longitudinal
+incision over the tumor, after which the gland is to be dragged out,
+with its entire capsule, by means of a blunt hook. A large goitre in
+a feeble patient, however, is better left alone, as it is difficult
+to remove all the intricate roots of the tumor, and if any portion is
+left it is prone to return. In such cases Gilbert says we shrink
+from the application of the actual cautery, for fear of injury to
+the surrounding vessels and nerves. Whatever method of operation is
+selected, the patient is to be tied to a table and firmly held in
+position.
+
+Wounds of the trachea and oesophagus, according to Gilbert, are
+invariably mortal.
+
+In wounds of the thorax the ordinary dressing of albumen is to be
+applied, but if blood or pus enters the cavity of the thorax, the
+patient is directed to bend his body over a dish, twisting himself
+from one side to another (_supra discum[10] flectat se modo hac modo
+ilac vergendo_) until he expels the sanies through the wound, and to
+always lie with the wound dependent until it is completely healed (f.
+182d).
+
+[Footnote 10: It is interesting to observe how the Latin discus
+developed dichotomously into the English "dish" and the German
+"Tisch." The former is doubtless the meaning of the word in this
+place.]
+
+In case an arrow is lodged within the cavity of the thorax, the
+surgeon is directed to trepan the sternum (_os pectoris_), remove the
+head of the arrow gently from the shaft, and withdraw the shaft itself
+through the original wound of entrance. If the head is lodged beneath
+or between the ribs, an opening is to be made into the nearest
+intercostal space, the ribs forced apart by a suitable wedge and
+the head thus extracted. The wound through the soft parts is to be
+kept open by a tent greased with lard and provided with a suitable
+prolongation (_cauda aliqua_) to facilitate its extraction and prevent
+its falling into the cavity of the chest.
+
+Wounds of the heart, lungs, liver, stomach and diaphragm are regarded
+as hopelessly mortal (f. 233d), and the physician is advised to have
+nothing to do with them. Wounds of the heart are recognized by the
+profuse haemorrhage and the black color of the blood; those of the
+lung by the foamy character of the blood and the dyspnoea; wounds of
+the diaphragm occasion similar dyspnoea and are speedily fatal; those
+of the liver are known by the disturbance of the hepatic functions,
+and wounds of the stomach by the escape of its contents. Wounds of
+the intestine are either incurable, or at least are cured only with
+the utmost difficulty. Longitudinal wounds of the spine which do not
+penetrate the cord may be repaired, but transverse wounds involving
+the cord, so that the latter escapes from the wound, are rarely, if
+ever, cured by surgery. Wounds of the kidneys are also beyond the art
+of the surgeon. Wounds of the penis are curable, and if the wound is
+transverse and divides the nerve, they are likewise painless.
+
+_Si vene titillares in coxis abscidantur homo moritur ridendo._ A
+passage which I can refer only to the erudition and risibility of our
+modern surgeons and anatomists. The ticklish _vene titillares_ are to
+me entirely unknown.
+
+Modern abdominal surgeons will probably be interested in reading
+Gilbert's chapter on the treatment of wounds of the intestines in the
+thirteenth century. He says (f. 234c):
+
+If some portion of the intestine has escaped from a wound of the
+abdomen and is cut either longitudinally or transversely, while the
+major portion remains uninjured; if the wound has existed for some
+time and the exposed intestine is cold, some living animal, like a
+puppy (_catulus_), is to be killed, split longitudinally and placed
+over the intestine, until the latter is warmed, vivified by the
+natural heat and softened. Then a small tube of alder is prepared, an
+inch longer than the wound of the intestine, carefully thinned down
+(_subtilietur_) and introduced into the gut through the wound and
+stitched in position with a very fine square-pointed needle, threaded
+with silk. This tube or canula should be so placed as to readily
+transmit the contents of the intestine, and yet form no impediment to
+the stitches of the wound. When this has been done, a sponge moistened
+in warm water and well washed should be employed to gently cleanse the
+intestines from all foreign matters, and the gut, thus cleansed, is to
+be returned to the abdominal cavity through the wound of the abdominal
+wall. The patient is then to be laid upon a table and gently shaken,
+in order that the intestines may resume their normal position in the
+abdomen. If necessary the primary wound should be enlarged for this
+purpose. When the intestines have been thus replaced, the wound in
+the abdominal wall is to be kept open until the wound of the intestine
+seems healed. Over the intestinal suture a little _pulvis ruber_
+should be sprinkled every day, and when the wound of the intestine is
+entirely healed (_consolidatur_), the wound of the abdominal wall is
+to be sewed up and treated in the manner of ordinary flesh wounds.
+
+If, however, the wound is large, a pledget (_pecia_) of lint, long
+enough to extend from one end to the other and project a little, is
+placed in the wound, and over this the exterior portion of the wound
+is to be carefully sewed, and sprinkled daily with the _pulvis ruber_.
+Every day the pledget which remains in the wound is to be drawn
+towards the most dependent part, so that the dressing in the wound may
+be daily renewed. When the intestinal wound is found to be healed, the
+entire pledget is to be removed and the unhealed openings dressed as
+in other simple wounds. The diet of the patient should be also of the
+most digestible sort.
+
+Thus far Gilbert has followed Roger almost literally. But he now adds,
+apparently upon his own responsibility, the following paragraph:
+
+_Quod si placuerit, extrahe canellum: factis punctis in sutura
+ubi debent fieri antequan stringantur, inter duo puncta canellus
+extrahatur, et post puncta stringantur. Hoc dico si vulnus intestini
+sic (sit) ex transverso._
+
+Apparently Gilbert feels some compunctions of conscience relative to
+the ultimate disposition of the canula of alder-wood, and permits,
+if he does not advise, its removal from the intestine before the
+tightening of the last stitches.
+
+Roland adds nothing to the text of Roger. But The Four Masters
+(_Quatuor Magistri_, about A.D. 1270) suggest that the canula be made
+of the trachea of some animal, and add:
+
+_Canellus autem per processum temporis putrefit et emittur per
+egestionem, et iterum per concavitatem canelli transibit egestio._
+
+In his further discussion of wounds of the intestine and their
+treatment Gilbert also volunteers the information that:
+
+"Mummy (shade of Lord Lister!) is very valuable in the healing of
+wounds of the intestine, if applied with some astringent powder upon
+the suture."
+
+In amends for the mummy, however, we are also introduced to the
+practice of mediaeval anaesthesia by means of what Gilbert calls the
+_Confectio soporifera_ (f. 234d), composed as follows:
+
+_R._
+
+  _Opii,
+  Succi Jusquiami (hyoscyami),
+  Succi papaveris nigri, vel ejus seminis,
+  Sacci mandragorae, vel ejus corticis, vel pomorunt ipsius si succo
+          carueris,
+  Foliorum hederae arborae (ivy),
+  Succi mororum rubi maturorum,
+  Seminis lactucae,
+  Succi cuseutae (dodder)_,    aa. ounce I.
+
+Mix together in a brazen vessel and place this in the sun during the
+dog-days. Put in a sponge to absorb the mixture, and then place the
+sponge in the sun until all the moisture has evaporated. When an
+operation is necessary, let the patient hold the sponge over his nose
+and mouth until he goes to sleep, when the operation may be begun.
+To awaken the patient after the operation, fill another sponge with
+vinegar and rub the teeth and nostrils with the sponge, and put some
+vinegar in the nostrils. An anaesthetic drink may also be prepared as
+follows:
+
+_R._
+
+  _Seminis papaveris albi et nigri,
+  Seminis lactucae,      aa. ounce I.
+  Opii,
+  Misconis (         , poppy juice?)_,     aa. scruples I-II, as
+          required.
+
+The patient is to be aroused as before.
+
+On folio 180d we find a chapter entitled "_De cathena gulae incisa
+vel fracta_," and copied almost literally from the chapter "_De catena
+gulae_" of Roger. In neither writer do I find any precise definition
+of what the _cathena gulae_ is, though Roger says, _Si es gulae,
+quod est catena, fractum fuerit_, etc., nor do I find the terms used
+explained in any dictionary at present available. The description of
+the treatment of this fracture seems, however, to indicate that the
+_catena gulae_ of Roger and Gilbert is what we call the clavicle,
+though the more common Latin names of this bone are _claviculus_,
+_furcula_, _juglum_ or _os juguli_. Gilbert says: "But if the bone
+which is the _cathena gulae_ is broken or in any way displaced
+(_recesserit_), let the physician with one hand raise the forearm
+(_brachium_) or arm (_humerum_) of the patient, and with the other
+hand press down upon the projecting portion of the bone. Then apply a
+pledget moistened with albumen, a pad and a splint in form of a cross,
+and over all a long bandage embracing both the arm and the neck and
+suspending the arm. A pad (_cervical_) should also be placed in the
+axilla to prevent the dropping of the arm, and should not be removed
+until the fracture is repaired. If the fracture is compound, the wound
+of the soft parts is to be left open and uncovered by the bandage, so
+that a tent (_stuellus_) may be inserted, and the wound is then to be
+dressed in the ordinary manner."
+
+Simple fracture of the humerus, Gilbert tells us, is to be reduced
+(_ad proprium locum reducator_) at once by grasping the arm above and
+below the seat of fracture and exercising gentle and gradual extension
+and compression. Then four pieces of lint wet in egg-albumen are
+to be placed around the arm on all sides, a bandage, four fingers
+wide, also moistened in albumen is to be snugly applied, another dry
+bandage placed above this, and finally splints fastened in position
+by cords. This dressing is to remain undisturbed for three days, and
+then renewed every third day for nine days. After the ninth day a
+_strictura_ (cast, apparatus immobile?) is to be prepared and firmly
+applied with splints and a bandage, and the patient is to be cautioned
+not to bear any weight upon the injured arm (_ne infirmus se super
+illud appodiet_?). The fracture is then left until it is believed that
+consolidation has occurred. If, however, it is found that swelling
+is occasioned by the cast (_ex strictorio_?), the latter should be
+removed, and the arm well bathed in warm water containing mallowae and
+other emollients and thoroughly cleansed. If the bone seems to be well
+consolidated, it should be rubbed with an ointment of _dialthea_ or
+the _unguentum marciation_, after which the splints and bandage are
+to be reapplied. If, however, it is found that the bone is not well
+consolidated, the cast should be replaced in the original manner,
+until consolidation is accomplished. If erysipelas results from
+the dressings, it is to be treated in the ordinary manner. During
+the entire treatment potions of nasturtium seeds, _pes columbini_
+(crowfoot) and other "consolidatives" are to be administered
+diligently. If the fracture is compound, any loose fragments of
+bone are to be removed, the fracture reduced as before, and similar
+dressings applied, perforated, however, over the wound in the soft
+parts.
+
+In fracture of the ribs (_flexura costi_) Gilbert recommends a
+somewhat novel plan for the replacement of the displaced bone. Having
+put the patient in a bath, the physician rubs his hands well with
+honey, turpentine, pitch or bird-lime (_visco_), applies his sticky
+palms over the displaced ribs, and gradually raises them to their
+normal position. He also says (f. 183a), the application of a dry cup
+(_cuffa vero cum igne_?) over the displaced rib is a convenient method
+for raising it into position.
+
+Of fractures of the forearm Gilbert simply says that they are to be
+recognized by the touch and a comparison of the injured with the sound
+arm. They should be diligently fomented, extension made if necessary,
+and then treated like other fractures.
+
+Dislocation of the atlo-axoid articulation (_os juguli_) he tells us
+threatens speedy death. The mouth of the patient is to be kept open
+by a wooden gag, a bandage passed beneath the jaw and held by the
+physician, who places his feet upon the shoulders of the patient and
+pressing down upon them while he elevates the head by the bandage,
+endeavors to restore the displaced bone to its normal position.
+Inunctions of various mollitives are then useful.
+
+Dislocations of the lower jaw are recognized by the failure of the
+teeth to fit their fellows of the upper jaw, and by the detection of
+the condyles of the jaw beneath the ears. The bone is to be grasped
+by the rami and dragged down until the teeth resume and retain
+their natural position, and the jaw is then to be kept in place by a
+suitable bandage.
+
+In dislocation of the humerus the patient is to be bound in the supine
+position, a wedge-shaped stone wrapped with yarn placed in the axilla,
+and the surgeon, pressing against the padded stone with his foot and
+raising the humerus with his hands, reduces the head of the bone to
+its natural position. If this method fails, a long crutch-like stick
+is prepared to receive at one end the axillary pad, the patient is
+placed standing upon a box or bench, the pad and crutch adjusted in
+the axilla, and while the surgeon stands ready to guide the dislocated
+bone to its place, his assistants remove the bench, leaving the
+patient suspended by his shoulder upon the rude crutch. In boys,
+Gilbert tells us, no special apparatus is required. The surgeon merely
+places his doubled fist in the axilla, with the other hand grasps the
+humerus and lifts the boy off the ground, and the head of the bone
+slips readily back into place. After we are assured that the reduction
+is complete, a strictorium is prepared, consisting of the _pulvis
+ruber_, egg-albumen and a little wheat flour, with which the shoulder
+is to be rubbed. Finally, when all seems to be going on well, warm
+_spata drapum_ (sparadrap) is to be applied upon a bandage, and if
+necessary the apostolicon ointment.
+
+Dislocation of the elbow is reduced by passing a bandage around the
+bend of the arm, forming in this a loop (_scapham_) into which the
+foot of the surgeon is to be placed for counter-extension, while with
+the hands extension is to be made upon the forearm until the bones are
+drawn into their normal position. Flexion and extension of the joint
+are then to be practised three or four times (to assure complete
+reduction?), and the forearm flexed and supported by a bandage from
+the neck. After a few days, Gilbert tells us, the patient will himself
+often try to flex and extend the arm, and the bandage should be so
+applied as not to interfere with these movements.
+
+Dislocation of the wrist is reduced by gentle extension from the hand
+and counter-extension from the forearm, and dislocation of the fingers
+by a similar manipulation.
+
+After so full a consideration of the surgical injuries of the head,
+trunk and upper extremities, we are somewhat surprised to find
+Gilbert's discussion of the similar injuries of the lower extremities
+condensed into a single very moderate chapter entitled "De vulneribus
+cruris et tybie" (f. 358a b).
+
+In this, Gilbert, emphasizing the importance of wounds of the patella
+and knee-joint and the necessity for their careful treatment, also
+declares that wounds of both the leg and thigh within three inches of
+the joints, or in the fleshy portion of the thigh _ubi organum est_
+(?), involve considerable danger. He then speaks of a blackish, hard
+and very painful tumor of the thigh, which, when it ascends the
+thigh (_ad superiora ascendit_) is mortal, but if it descends is
+less dangerous. Separation of the sacrum (_vertebrum_) from the ilium
+(_scia_), either by accident or from the corrosion of humors, leaves
+the patient permanently lame, though suitable fomentations and
+inunctions may produce some improvement. Sprains of the ankle are to
+be treated by placing the joint immediately in very cold water _ad
+repercussionem spiritus et sanguinis_, and the joint is to be kept
+thus refrigerated until it even becomes numb (_stupefactionem_); after
+which stupes of salt water and urine are to be applied, followed by a
+plaster of galbanum, opoponax, the apostolicon, etc.
+
+Fractures of the femur are to be treated like those of the humerus,
+except that the ends of the fractured bone are to be separated by
+the space of an inch, and a bandage six fingers in width carefully
+applied. Such fractures within three inches of the hip or knee-joint
+are regarded as specially dangerous.
+
+Dislocations of the ankle, after reduction of proper manipulation,
+should be bound with suitable splints. If of a less severe character,
+the dislocation may be dressed with stupes of canabina (Indian hemp),
+urine and salt water, which greatly mitigate the pain and swelling.
+Afterwards the joint should be strapped for four or five inches above
+the ankle with plaster, _ut prohibeatur fluxus_.
+
+It should be said that the brevity of this chapter of Gilbert is
+modeled after the manner of Roger of Parma, who refers the treatment
+of injuries of the lower extremities very largely to that of similar
+injuries of the upper, merely adding thereto such explanations as may
+be demanded by the differences of location and function of the members
+involved. Thus in his discussion of dislocation of the femur Roger
+says:
+
+_Si crus a coxa sit disjunctum, eadem sit cura quam et in disjuncturam
+brachii et cubiti diximus, etc._
+
+The general subject of fistulae is treated at considerable length on
+folio 205b, and fistula lachrymalis and fistulae of the jaw receive
+special attention in their appropriate places. As a rule, the fistula
+is dilated by a tent of alder-pith, mandragora, briony or gentian,
+the lining membrane destroyed by an ointment of quick-lime or even the
+actual cautery, and the wound then dressed with egg-albumen followed
+by the _unguentum viride_. Necrosed bone is to be removed, if
+necessary, by deep incisions, and decayed teeth are to be extracted.
+
+The elongated uvula is to be snipped off, and abscesses of the tonsils
+opened _tout comme chez nous_.
+
+An elaborate discussion of the subject of hernia is given under the
+title "_De relaxatione siphac et ruptura_" (f. 280c)--siphac being
+the Arabian name for the peritoneum. Gilbert tells us the siphac is
+sometimes relaxed, sometimes ruptured (_crepatur_?) and sometimes
+inflated. He had seen a large rupture (_crepatura_) in which it was
+impossible to restore the intestines to the cavity of the abdomen
+in consequence of the presence in them of large hard masses of fecal
+matter, which no treatment proved adequate to remove, and which
+finally occasioned the death of the patient. Rupture of the siphac is
+most frequently the result of accident, jumping, straining in lifting
+or carrying heavy weights, or in efforts at defecation, or of shouting
+in boys or persons of advanced age, or even in excessive weeping,
+etc. It is distinguished from hernia by the fact that in hernia pain
+is felt in the testicle, radiating to the kidneys, while in rupture
+of the siphac a swelling on one side of the pubes extends into the
+scrotum, where it produces a tumor not involving the testicle. Rupture
+of the siphac, he says, is a lesion of the organs of nutrition, hernia
+a disease of the organs of generation. Accordingly, in the pathology
+of Gilbert, the term hernia is applied to hydrocele, orchitis and
+other diseases of the testicle, and not, as with us to protrusions of
+the viscera through the walls of their cavities.
+
+In young persons, he tells us, recent ruptures of the siphac may be
+cured by appropriate treatment. The patient is to be laid upon his
+back, the hips raised, the intestines restored to the abdominal cavity
+and the opening of exit dressed with a plaster of exsiccative and
+consolidating remedies, of which he furnishes a long and diversified
+catalogue. He is also to avoid religiously all exercise or motion, all
+anger, clamor, coughing, sneezing, equitation, cohabitation, etc.,
+and to lie with his feet elevated for forty days, until the rupture
+(_crepatura_) is consolidated. The bowels are to be kept soluble by
+enemata or appropriate medicines, and the diet should be selected so
+as to avoid constipation and flatulence. A bandage or truss (_bracale
+vel colligar_) made of silk and well fitted to the patient is also
+highly recommended. If the patient is a boy, cakes (_crispelle_?) of
+_consolida major_ mixed with the yolk of eggs should be administered,
+one each day for nine days before the wane of the moon. If, however,
+the rupture is large in either a boy or an adult, and of long
+standing, whether the intestine descends into the scrotum or not,
+operation, either by incision or by the cautery offers the only hope
+of relief. Singularly enough too, while Roger devotes to the operation
+for the cure of hernia nearly half a page of his text, Gilbert
+dismisses the whole subject in a single sentence, as follows:
+
+_Scindatur igitur totus exitus super hac cute exteriori cum carne
+fissa, et uatur y fac cum file serice et acu quadrata. Deinde
+persequere ut in exitu intestini per vulnus superius demonstratum est_
+(f. 281d).
+
+Turning now to the title "_De hernia_" (f. 289b), Gilbert tells us
+"Swelling (_inflatio_) of the testicles is due sometimes to humors
+trickling down upon them (_rheumatizantibus_), sometimes to abscess,
+or to gaseous collections (_ventositate_), and sometimes to escape
+of the intestines through rupture of the siphac." He adds also: "Some
+doubt the propriety of using the term hernia for an inflation. On
+this point magister Rn says: There is a certain chronic and inveterate
+tumor of the testicles, which is never cured except by means of
+surgery, as e.g., hernia. For hernia is an affection common to the
+scrotum and the testicles."
+
+The apparent confusion between these two passages is easily relieved
+by the explanation that inguinal or other herniae not extending into
+the scrotum are called by Gilbert ruptures of the siphac, but scrotal
+hernia is classed with other troubles located in the scrotum as
+hernia. Accordingly hernia, with Gilbert, includes not only scrotal
+hernia, but also hydrocele, orchitis, tumors of the testicles, etc.
+This is apparent, too, in his treatment of hernia, which consists
+usually in the employment of various poultices and ointments, bleeding
+from the saphena, cups over the kidneys, etc., though hydrocele is
+tapped and a seton inserted. If the testicle itself is "putrid,"
+it should be removed; otherwise it is left. It may be remarked _en
+passant_ that the surgeons of medieval times, in their desire for
+thoroughness, often displayed very little respect to what Baas calls
+"the root of humanity."
+
+We will terminate our hasty review of diseases discussed in the
+Compendium by an abstract of Gilbert's views on vesical calculus and
+its treatment, which cover more than fifteen pages of his work.
+
+Stone and gravel arise from various viscous superfluities in the
+kidneys and bladder, which occasion difficulty in micturition. Stone
+is produced by the action of heat upon viscous moisture, sublimating
+the volatile elements and condensing the denser portions.
+Putrefication of stone in the bladder is the result of three causes,
+viz., consuming heat, viscous matter and stricture of the meatus.
+For consuming heat acting on viscous material retained by reason
+of stricture of the meatus, by long action dries up, coagulates and
+hardens the moisture. This is particularly manifest in boys who have a
+constricted meatus.
+
+Stones are thus generated not only in the kidneys and bladder,
+but also even in the stomach and the intestines, whence they are
+ejected by vomiting or in the stools. Indeed they may also be found
+occasionally in the lungs, the joints and other places. They are
+comparatively rare in women, in consequence of the shortness of the
+urethra and the size of their meatus.
+
+Sometimes calculi occur in the bladder, sometimes in one kidney and
+occasionally in both kidneys. The symptoms produced by their presence
+vary in accordance with the situation of the concretion. If the stone
+is in the kidney, the foot of the side affected is numb (_stupidus_),
+the spine on the affected side is sore and there is difficulty of
+micturition and considerable gravelly sediment in the urine. If the
+stone is increasing in size, the quantity of sediment also increases,
+but if the stone is fully formed and confirmed, the amount of sediment
+decreases daily, and the urine becomes milky both in the kidneys and
+the bladder. A stone in the bladder occasions very similar symptoms,
+together with pain in the peritoneum and pubes, dysuria and strangury,
+and sometimes the appearance of blood and flocculi (_trumbos_?)
+in the urine. Patients suffering from vesical calculus are always
+constipated, and the dysuria may increase to the degree called furia,
+a condition not without some danger.
+
+Three things are necessary in the cure of stone, viz., a spare and
+simple diet, the use of diuretics and a moderate amount of exercise.
+It should, however, be remarked that confirmed stone is rarely or
+never cured, except by a surgical operation.... If a boy has a clear
+and watery urine after it has been sandy, if he frequently scratches
+his foot, has involuntary erections and finally obstruction in
+micturition, I say that he has a stone in the neck of his bladder.
+If now he be laid upon his back with his feet well elevated, and his
+whole body be well shaken, if there is a stone present it is possible
+that it may fall to the fundus of the bladder. Afterwards direct
+the boy to bear down (_ut exprimat se_) and try to make water. If
+this treatment turns out in accordance with your theory, the urine
+necessarily escapes and your idea and treatment are confirmed. If,
+however, the urine not escape, let the boy be shaken vigorously
+a second time. If this too fails and strangury ensues, it will be
+necessary to resort to the use of a sound or catheter (_argaliam_),
+so that when the stone is pushed away from the neck of the bladder the
+passage may be opened and the urine may flow out. It may be possible
+too that no stone exists, but the urethra is obstructed or closed
+by pure coagulated blood. Perhaps there may have been a wound of the
+bladder, although no external haemorrhage has appeared, but the blood
+coagulating gradually in the bladder has occasioned an obstruction or
+narrowing of the urinary passage. Or possibly the blood from a renal
+haemorrhage has descended into the bladder and obstructs the urethra.
+Hence I say that the sound is useful in these cases where the urethra
+is obstructed by blood or gross humors. Examination should also be
+made as to whether a fleshy body exists in the bladder, as the result
+of some wound. This condition is manifest if, on the introduction of
+the sound, the urine flows out promptly. I once saw a man suffering
+from this condition, who complained of severe pain in the urinary
+passage as I was introducing the sound, and I recognized that there
+were wounds in the same part, for as soon as these were touched by
+the sound the urine began to flow, followed soon after by a little
+blood and fleshy particles.... So far as the operation of physicians
+is concerned, it is necessary only to be certain of the fact that
+obstruction to the passage of urine depends upon no other cause than
+stone or the presence of coagulated blood (f. 271).
+
+Gilbert's medical treatment of vesical calculus consists generally
+in the administration of diuretics and lithontriptics and the local
+application of poultices, plasters and inunctions of various kinds.
+Of the lithontriptics, certain combinations, characterized by famous
+names or notable historical origin, are evident favorites. Among
+this class we read of the _Philoantropos major_ and _minor_, the
+_Justinum_, the _Usina_ "approved by many wise men of Babylon and
+Constantinople," the _Lithontripon_ and the "_Pulvis Eugenii pape_,"
+with numerous others.
+
+Rather curiously and suggestively no mention is made in this immediate
+connection of the technique of lithotomy. On a later page, however (f.
+309a), we find a chapter entitled "_De cura lapidis per cyrurgiam_,"
+in which Gilbert writes:
+
+"Mark here a chapter on the cure of stone in the bladder by means
+of surgery, which we have omitted above. Accordingly, to determine
+whether a stone exists in the bladder, let the patient take a warm
+bath. Then let him be placed with his buttocks elevated, and, having
+inserted into the anus two fingers of the right hand, press the fist
+of the left hand deeply above the pubes and lift and draw the entire
+bladder upward. If you find anything hard and heavy, it is manifest
+that there is a stone in the bladder. If the body feels soft and
+fleshy, it is a fleshy excrescence (_carnositas_), which impedes the
+flow of urine. Now, if the stone is located in the neck of the bladder
+and you wish to force it to the fundus: after the use of fomentations
+and inunctions, inject through a syringe (_siringa_) some petroleum,
+and after a short interval pass the syringe again up to the neck of
+the bladder and cautiously and gently push the stone away from the
+neck to the fundus. Or, which is safer and better, having used the
+preceding fomentations and inunctions, and having assured yourself
+that there is a stone in the bladder, introduce your fingers into the
+anus and compress the neck of the bladder with the fist of the left
+hand above the pubes, and cautiously remove the stone and guide it
+to the fundus. But if you wish to extract the stone, let a spare diet
+precede the operation, and let the patient lie abed for a couple of
+days with very little food. On the third day introduce the fingers
+into the anus as before, and draw down the stone into the neck of
+the bladder. Then make your incision lengthwise in the fontanel, the
+width of two fingers above the anus, and extract the stone. For nine
+days after the operation let the patient use, morning and evening,
+fomentations of _branca_ (_acanthus mollis_), _paritaria_ (pellitery)
+and _malva_ (mallows). A bit of tow (_stupa_) moistened with the yolk
+of egg in winter, and with both the yolk and white of egg in summer,
+is to be placed over the wound. Proud flesh, which often springs up
+near a wound in the neck of the bladder, should be removed by the
+knife (_rasorio_), and two or three sutures inserted. The wound is
+then to be treated like other wounds. It should be remarked, however,
+that if the stone is very large, it should be simply pushed up to the
+fundus of the bladder and left there, and no effort should be made to
+extract it."
+
+This description of the diagnosis of stone and of the operation of
+lithotomy is copied almost literally from Roger of Parma.
+
+Sufficient (perhaps more than enough) has been written to give the
+reader a fair idea of the general character of Gilbert's "Compendium
+Medicine."
+
+A few words may be added with reference to the proper place of the
+work in our medical literature.
+
+It is not difficult, of course, to select from the Compendium a charm
+or two, a few impossible etymologies and a few silly statements, to
+display these with a witty emphasis and to draw therefrom the easy
+conclusion that the book is a mass of crass superstition and absurd
+nonsense. This, however, is not criticism. It is mere caricature.
+
+To compare the work with the teachings of modern medicine is not only
+to expect of the writer a miraculous prescience, but to minimize the
+advances of medical science within the last seven hundred years.
+
+Even Freind and Sprengel, admirable historians, though more thoughtful
+and judicious in their criticisms, seem for the moment to have
+forgotten or overlooked the true character of the Compendium.
+
+Freind says:
+
+"I believe we may even say with justice that he (Gilbert) has written
+as well as any of his contemporaries of other nations, and has merely
+followed their example in borrowing very largely from the Arabians,"
+and Sprengel writes: "Here and there, though only very rarely, the
+author offers some remarks of his own, which merit special attention."
+
+Now, what precisely is Gilbert's Compendium designed to be? In the
+words of its author it is
+
+"A book of general and special diseases, selected and extracted
+from the writings of all authors and the practice of the professors
+(_magistrorum_), edited by Gilbert of England and entitled a
+Compendium of Medicine."
+
+and a few pages later he adds:
+
+"It is our habit to select the best sayings of the best authorities,
+and where any doubt exists, to insert the different opinions, so that
+each reader may choose for himself what he prefers to maintain."
+
+The author does not claim for his work any considerable originality,
+but presents it as a compendium proper of the teachings of other
+writers. Naturally his own part in the book is not obtruded upon our
+notice.
+
+Now the desiderata of such a compendium are:
+
+1. That it shall be based upon the best attainable authorities.
+
+2. That these authorities shall be accurately represented.
+
+3. That the compendium shall be reasonably comprehensive.
+
+In neither of these respects is the compendium of Gilbert liable, I
+think, to adverse criticism.
+
+The book is, undoubtedly, the work of a famous and strictly orthodox
+physician, possessed of exceptional education in the science of his
+day, a man of wide reading, broadened by extensive travel and endowed
+with the knowledge acquired by a long experience, honest, truthful and
+simple minded, yet not uncritical in regard to novelties, firm in his
+own opinions but not arrogant, sympathetic, possessed of a high sense
+of professional honor, a firm believer in authority and therefore
+credulous, superstitious after the manner of his age, yet harboring,
+too, a germ of that healthy skepticism which Roger Bacon, his great
+contemporary, developed and illustrated.
+
+I believe, therefore, that we may justly award to the medical pages of
+the Compendium not only the rather negative praise of being written
+as well as the work of any of Gilbert's contemporaries, but the more
+positive credit of being thoroughly abreast of the medical science of
+its age and country, an "Abstract and brief chronicle of the time."
+
+The surgical chapters of the work are unique in a compendium of
+medicine, and merit even more favorable criticism.
+
+The discouragement of the practice of medicine and surgery on the
+part of ecclesiastics by the popes and church councils of the twelfth
+century, culminating in the decree of Pope Innocent III in 1215,
+which forbade the participation of the higher clergy in any operation
+involving the shedding of blood (_Ecclesia abhorret a sanguine_); the
+relatively scanty supply of educated lay physicians and surgeons, and
+finally the pride and inertia of the lay physicians themselves; all
+these combined to relegate surgery in the thirteenth century to the
+hands of a class of ignorant and unconscionable empirics, whose rash
+activity shed a baleful light upon the art of surgery itself. As a
+natural result the practice of this art drifted into an _impasse_,
+from which the organization of the barber-surgeons seemed the only
+logical means of escape.
+
+The earliest evidence of the public surgical activity of the barbers,
+as a class, is found, I believe, in Joinville's Chronicle of the
+Crusade of St. Louis (Louis IX) in the year 1250. According to
+Malgaigne, no trustworthy evidence of any organization of the
+barbers of Paris is available before 1301, and the fraternity was not
+chartered until 1427, under Charles VII. The barbers of London are
+noticed in 1308, and they received their charter from Edward IV in
+1462. The parallel lines upon which the confraternities of the two
+cities developed is very noticeable--making due allowance for Gallic
+enthusiasm and bitterness.
+
+Lanfranchi, the great surgeon of Paris, about the year 1300 is moved
+to write as follows:
+
+"Why, in God's name, in our days is there such a great difference
+between the physician and the surgeon? The physicians have abandoned
+operative procedures to the laity, either, as some say, because they
+disdain to operate with their hands, or rather, as I think, because
+they do not know how to perform operations. Indeed, this abuse is
+so inveterate that the common people look upon it as impossible for
+the same person to understand both surgery and medicine. It ought,
+however, to be understood that no one can be a good physician who
+has no idea of surgical operations, and that a surgeon is nothing
+if ignorant of medicine. In a word, one must be familiar with both
+departments of medicine."
+
+Now Gilbert by the incorporation of many chapters on surgery in his
+Compendium inculcates practically the same idea more than fifty years
+before Lanfranchi, and may claim to be the earliest representative
+of surgical teaching in England. Malgaigne, indeed, does not include
+his name in the admirable sketch of medieval surgery with which he
+introduces his edition of the works of Ambroise Pare, and says Gilbert
+was no more a surgeon than Bernard Gordon. This is in a certain sense
+true. Gilbert was certainly not an operative surgeon. But it needs
+only a very superficial comparison of the Compendium of Gilbert with
+the Lilium Medicinae of Gordon to establish the fact that the books
+are entirely unlike. Indeed, it may be truthfully said that Gordon's
+work does not contain a single chapter on surgery proper. His cases
+involving surgical assistance are turned over at once, and with
+little or no discussion, to those whom he calls "restauratores" or
+"chirurgi," and his own responsibility thereupon ends.
+
+We have no historical facts which demonstrate that Gilbert's
+Compendium exercised any considerable influence upon the development
+of surgery in England, but when we consider the depressed condition
+of both medicine and surgery in his day, we should certainly emphasize
+the clearness of vision which led our author to indicate the natural
+association of these two departments of the healing art, and the
+assistance which each lends to the other.
+
+
+
+***END OF THE PROJECT GUTENBERG EBOOK GILBERTUS ANGLICUS***
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