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diff --git a/16155-h/16155-h.htm b/16155-h/16155-h.htm new file mode 100644 index 0000000..dea3ff3 --- /dev/null +++ b/16155-h/16155-h.htm @@ -0,0 +1,3692 @@ +<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" + "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd"> +<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"> + <!-- + body {margin-left: 10%; margin-right: 10%;} + p {text-align: justify;} + blockquote {text-align: justify;} + h1,h2,h3,h4 {text-align: center;} + pre {font-size: 0.7em;} + .sc {font-variant: small-caps;} + + hr {text-align: center; width: 50%;} + html>body hr {margin-right: 25%; margin-left: 25%; width: 50%;} + hr.full {width: 100%;} + html>body hr.full {margin-right: 0%; margin-left: 0%; width: 100%;} + hr.short {text-align: center; width: 20%;} + html>body hr.short {margin-right: 40%; margin-left: 40%; width: 20%;} + hr.memorial {width: 20%; height: 8px; color: black;} + html>body hr.memorial {margin-right: 40%; margin-left: 40%; width: 20%;} + + .note + {margin-left: 10%; margin-right: 10%; font-size: 0.9em;} + + span.pagenum + {position: absolute; left: 1%; right: 91%; font-size: 8pt; text-indent: 0;} + + .poem + {margin-left:10%; margin-right:10%; margin-bottom: 1em; text-align: left;} + .poem .stanza {margin: 1em 0em 1em 0em;} + .poem p {margin: 0; padding-left: 3em; text-indent: -3em;} + .poem p.i2 {margin-left: 1em;} + .poem p.i4 {margin-left: 2em;} + .poem p.i6 {margin-left: 3em;} + .poem p.i8 {margin-left: 4em;} + .poem p.i10 {margin-left: 5em;} + + .figure, .figcenter, .figright, .figleft + {padding: 1em; margin: 0; text-align: center; font-size: 0.8em;} + .figure img, .figcenter img, .figright img, .figleft img + {border: none;} + .figure p, .figcenter p, .figright p, .figleft p + {margin: 0; text-indent: 1em;} + .figcenter {margin: auto;} + .figright {float: right;} + .figleft {float: left;} + + .footnote {font-size: 0.9em; margin-right: 10%; margin-left: 10%;} + + p.author {text-align: right; margin-right:10%;} + --> + </style> +</head> +<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> </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> </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> </p> +<hr class="full" /> +<p> </p> +<p> </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> </p> +<hr /> +<span class="pagenum"><a name="page2" id="page2"></a>[pg 2]</span> +<p> </p> +<span class="pagenum"><a name="page3" id="page3"></a>[pg 3]</span> +<p> </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—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 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."</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."—Stubbs—<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 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.</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 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 "<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 Averroës, 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 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 +"<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 +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 "<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—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> †. <i>Uthihoth.</i> †. <i>multiplicamini.</i> †. +<i>thahechay.</i> †. <i>et replete terram.</i> †. <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—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—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—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—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.</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—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—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—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—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 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.</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.—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>, 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, aa. ounce I.</i></p> +<p><i>Opii,</i></p> +<p><i>Misconis ( , poppy juice?)</i>, 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)—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—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> </p> +<p> </p> +<hr class="full" /> +<p>***END OF THE PROJECT GUTENBERG EBOOK GILBERTUS ANGLICUS***</p> +<p>******* This file should be named 16155-h.txt or 16155-h.zip *******</p> +<p>This and all associated files of various formats will be found in:<br /> +<a href="https://www.gutenberg.org/dirs/1/6/1/5/16155">https://www.gutenberg.org/1/6/1/5/16155</a></p> +<p>Updated editions will replace the previous one--the old editions +will be renamed.</p> + +<p>Creating the works from public domain print editions means that no +one owns a United States copyright in these works, so the Foundation +(and you!) can copy and distribute it in the United States without +permission and without paying copyright royalties. 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