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diff --git a/16155.txt b/16155.txt new file mode 100644 index 0000000..7400637 --- /dev/null +++ b/16155.txt @@ -0,0 +1,3518 @@ +The Project Gutenberg eBook, Gilbertus Anglicus, by Henry Ebenezer +Handerson + + +This eBook is for the use of anyone anywhere at no cost and with +almost no restrictions whatsoever. You may copy it, give it away or +re-use it under the terms of the Project Gutenberg License included +with this eBook or online at www.gutenberg.org + + + + + +Title: Gilbertus Anglicus + Medicine of the Thirteenth Century + + +Author: Henry Ebenezer Handerson + + + +Release Date: June 30, 2005 [eBook #16155] + +Language: English + +Character set encoding: ISO-646-US (US-ASCII) + + +***START OF THE PROJECT GUTENBERG EBOOK GILBERTUS ANGLICUS*** + + +E-text prepared by Suzanne Lybarger, William Flis, and the Project +Gutenberg Online Distributed Proofreading Team (https://www.pgdp.net/) from +page images generously made available by Internet Archive and Canadian +Libraries (http://www.archive.org/details/toronto) + + + +Note: Images of the original pages are available through the Internet + Archive and Canadian Libraries. See + http://www.archive.org/details/gilbertusanglicu00handuoft + + + + + +GILBERTUS ANGLICUS + +Medicine of the Thirteenth Century + +by + +HENRY E. HANDERSON, A.M., M.D. + +With a Biography of the Author + +Published Posthumously for Private Distribution by +the Cleveland Medical Library Association +Cleveland, Ohio + +1918 + + + + + + + +CONTENTS + + + Page + Frontispiece 5 + + Explanatory Foreword 7 + + Biography 9-14 + + Resolutions of the Cleveland Medical Library Ass'n 15 + + Gilbertus Anglicus--A Study of Medicine in the + Thirteenth Century 17-78 + + + + +[Illustration: HENRY E. HANDERSON] + + + + +EXPLANATORY FOREWORD + + +In the summer of 1916 the librarian of the Cleveland Medical Library +received a manuscript from Dr. Henry E. Handerson with the request +that it be filed for reference in the archives of the library. The +librarian at once recognized the value of the paper and referred it +to the editorial board of the Cleveland Medical Journal, who sought +the privilege of publishing it. Dr. Handerson's consent was secured +and the article was set in type. However, when the time came for its +publication the author was reluctant to have it appear since he was +unable then to read the proof, and because he felt that the material +present might not be suitable for publication in a clinical journal. +To those who knew him, this painstaking attention to detail and desire +for accuracy presents itself as a familiar characteristic. Though +actual publication was postponed, the type forms were held, and when +the Cleveland Medical Journal suspended publication, its editorial +board informed the Council of the Cleveland Medical Library +Association of the valuable material which it had been unable to +give to the medical world. In the meantime Dr. Handerson's death +had occurred, but the Council obtained the generous consent of the +author's family to make this posthumous publication. It is hoped that +those who read will bear this fact in mind and will be lenient in +the consideration of typographical errors, of which the author was so +fearful. + +The Cleveland Medical Library Association feels that it is fortunate +in being enabled to present to its members and to others of the +profession this work of Dr. Handerson's and to create from his own +labors a memorial to him who was once its president. + + SAMUEL W. KELLEY. + CLYDE L. CUMMER. + Committee on Publication. + + + + +BIOGRAPHY + +HENRY EBENEZER HANDERSON + + +Owing to Dr. Handerson's modesty, even we who were for years +associated with him in medical college, in organization, and +professional work, knew but little of him. He would much rather +discuss some fact or theory of medical science or some ancient worthy +of the profession than his own life. Seeing this tall venerable +gentleman, sedate in manner and philosophical in mind, presiding over +the Cuyahoga County Medical Society or the Cleveland Medical Library +Association, few of the members ever pictured him as a fiery, youthful +Confederate officer, leading a charge at a run up-hill over fallen +logs and brush, sounding the "Rebel yell," leaping a hedge and +alighting in a ten-foot ditch among Federal troopers who surrendered +to him and his comrades. Yet this is history. We could perhaps more +easily have recognized him even though in a military prison-pen, on +finding him dispelling the tedium by teaching his fellow prisoners +Latin and Greek, or perusing a precious volume of Herodotus. + +Henry Ebenezer Handerson was born on March 21, 1837, here in Cuyahoga +county, in the township of Orange, near the point now known as +"Handerson's Cross-Roads," on the Chagrin river. His mother's maiden +name was Catharine Potts. His father was Thomas Handerson, son of Ira +Handerson. The family immigrated to Ohio from Columbia county, New +York, in 1834. Thos. Handerson died as the result of an accident in +1839, leaving the widow with five children, the eldest thirteen years +of age, to support. Henry and a sister were adopted by an uncle, Lewis +Handerson, a druggist, of Cleveland. In spite of a sickly childhood +the boy went to school a part of the time and at the age of fourteen +was sent to a boarding school, Sanger Hall, at New-Hartford, Oneida +county, New York. Henry's poor health compelled him to withdraw from +school. No one at that time would have predicted that the delicate +youth would live to be the sage of four score years and one. With his +foster father and family he moved to Beersheba Springs, Grundy county, +Tennessee. + +In 1854, in good health, the boy returned to Cleveland, prepared +for college, and entered Hobart College, Geneva, New York, where he +graduated as A.B. in 1858. Returning to Tennessee, he occupied himself +for about a year with surveying land and in other work and then +became private tutor in the family of Mr. Washington Compton on a +cotton plantation near Alexandria, Louisiana. There he remained a +year or more, then in the autumn of 1860 matriculated in the Medical +Department of the University of Louisiana (now Tulane University), +where he studied through the winter, and also heard much of the +political oratory of that exciting period. + +The bombardment of Fort Sumter, April 12, 1861, followed by the call +of President Lincoln for 75,000 troops to suppress the rebellion, +found young Handerson again employed as tutor, this time in the family +of General G. Mason Graham, a veteran of the Mexican war. + +With his friends and acquaintances, Handerson joined a company of +"homeguards" consisting mostly of planters and their sons, formed +for the purpose of maintaining "order among the negroes and other +suspicious characters of the vicinity." + +Many years afterward Dr. Handerson wrote, in a narrative for his +family, concerning this period of his life: "Without any disposition +to violent partisanship, I had favored the party of which the +standard-bearers were Bell and Everett and the battle cry 'The +Constitution and the Union,' and I had grieved sincerely over the +defeat by the Radicals of the North, aided by the 'fire-eaters' of +the South." + +And again: "Born and educated in the North, I did not share in +any degree the fears of the Southerners over the election to the +Presidency of Mr. Lincoln. I could not but think the action of the +seceding States unwise and dangerous to their future prosperity. On +the other hand, this action had already been taken, and without any +prospect of its revocation. Indeed, in the present frame of mind of +the North, any steps toward recession seemed likely to precipitate +the very evils which the secession of the states had been designed +to anticipate. I believed slavery a disadvantage to the South, but +no sin, and, in any event, an institution for which the Southerners +of the present day were not responsible. An inheritance from their +fore-fathers, properly administered, it was by no means an unmitigated +evil, and it was one, moreover, in which the North but a few years +before had shared. All my interests, present and future, apparently +lay in the South and with Southerners, and if the seceding States, in +one of which I resided, chose deliberately to try the experiment of +self-government, I felt quite willing to give them such aid as lay +in my feeble power. When I add to this that I was 24 years of age, +and naturally affected largely by the ideas, the enthusiasm and +the excitement of my surroundings, it is easy to understand to what +conclusions I was led." + +So on June 17, 1861, he volunteered in the Stafford Guards under Capt. +(afterward Brigadier General) L.A. Stafford. The Guards became company +B of the 9th Regiment of Louisiana Volunteers, Confederate States of +America, Colonel (later Brigadier General) "Dick" Taylor (son of +"Old Zach," the President of the U.S.), in command. During the year +that followed until the close of the war, Handerson experienced the +adventures and trials of a soldier's life. He knew picket, scouting, +and skirmishing duty, the bivouac, the attack and defense in battle +formation, the charge, the retreat, hunger and thirst, the wearisome +march in heat and dust, in cold, in rain, through swamps and stony +wildernesses. He was shot through the hat and clothing and once +through the muscles of the shoulder and neck within half inch of the +carotid artery, lay in a hospital, and had secondary hemorrhage. At +another time he survived weeks of typhoid fever. + +He was successively private soldier and accountant for his company, +quarter-master, 2nd Lieutenant of the line, Captain of the line, and +finally Adjutant General of the 2nd Louisiana Brigade, A. N. Va., +under Lee and Jackson, with rank of Major. On May 4, 1864, Adjutant +General Handerson was taken prisoner, and from May 17th until August +20th he was imprisoned at Fort Delaware in the Delaware river. He +was then confined in a stockade enclosure on the beach between Forts +Wagner and Gregg on Morris Island, until about the end of October, +when he was transferred to Fort Pulaski at the mouth of the Savannah +river, and in March, 1865, back to Fort Delaware. In April, after +Lee's surrender, many of the prisoners were liberated on taking the +oath of allegiance to the Federal Government. But Handerson did not +consider his allegiance to the Southern Confederacy ended until +after the capture of President Davis, and it was not until June 17, +1865, that he signed the oath of allegiance and was liberated in +Philadelphia. + +Since that time, with that spirit of tolerance and openness to truth +which characterized the man, he has said, "in the triumph of the +Union, the war ended as it should have ended." + +Mr. Handerson then resumed his medical studies, this time in the +College of Physicians and Surgeons of New York, Medical Department of +Columbia University, taking the degree of M.D. in 1867. Hobart College +conferred the A.M. in 1868. On October 16, 1872, he married Juliet +Alice Root, who died leaving him a daughter. + +February 25, 1878, Dr. Handerson read before the Medical Society of +the County of New York an article entitled, "The School of Salernum, +an Historical Sketch of Mediaeval Medicine." This essay attracted wide +attention to his scholarly attainments and love of laborious research. +For example, Professor Edward Schaer of the chair of Pharmacology +and Pharmaceutical Chemistry, of Neumuenster-Zuerich, pronounces +this pamphlet "a valuable gift ... a remarkable addition to other +historical materials ... in connection with the history of pharmacy +and of pharmaceutical drugs"; that he found in it "a great deal of +information which will be sought for in vain in many even renowned +literary works." + +Dr. Handerson practiced medicine in New York City, from 1867 to 1885, +removing to Cleveland in 1885. + +On June 12, 1888, he married Clara Corlett of Cleveland. + +Then in 1889 appeared the American edition of the "History of Medicine +and the Medical Profession, by Joh. Hermann Baas, M.D.," which was +translated, revised and enlarged by Dr. Handerson, to whom, in the +words of Dr. Baas, "we are indebted for considerable amplification, +particularly in the section on English and American medicine, with +which he was, of course, better acquainted than the author, and +for numerous corrections." ... As a matter of fact, the learning +and judgment, and the conscientious industry of the translator and +American editor of this work are evident throughout the book. + +Concerning Dr. Handerson's writings, Dr. Fielding H. Garrison +writes (Medical Pickwick, March, 1915, P. 118): "The earliest of Dr. +Handerson's papers recorded in the Index Medicus is 'An unusual case +of intussusception' (1880). Most of his other medical papers, few in +number, have dealt with the sanitation, vital statistics, diseases +and medical history of Cleveland, and have the accuracy which +characterizes slow and careful work. This is especially true of his +historical essays of which that on 'The School of Salernum' (1883) is +a solid piece of original investigation, worthy to be placed beside +such things as Holmes on homoeopathy, Weir Mitchell on instrumental +precision, or Kelly on American gynecology. + +"To the cognoscenti, Dr. Handerson's translation of 'Baas' History of +Medicine' (1889) is known as 'Handerson's Book.' He modestly describes +himself as its 'editor,' but he is more than that. As the witty and +effective translator of a witty and effective work, he has added +sections in brackets on English and American history which are +based on original investigation and of permanent value to all future +historians. Handerson's Baas is thus more complete and valuable than +the Rhinelander's original text." + +As listed in the Index Medicus, the publications and writings of Dr. +Handerson appear as follows: + + An unusual case of intussusception. Medical Record, 1880, + xviii, 698. + + The School of Salernum. An historical sketch of mediaeval + medicine. 1883. + + Outlines of the history of medicine (Baas). Translated, and in + conjunction with the author, revised and enlarged, 1887. + + Clinical history of a case of abdominal cancer. Cleveland + Medical Gazette, 1891-2, vii, 315-321. + + The Sanitary topography of Cleveland. Cleveland Medical + Gazette, 1895-6, xi, 651-659. + + Cleveland in the Census Reports. Cleveland Medical Gazette, + 1896-7, xii, 257-264. + + The earliest contribution to medical literature in the United + States. Janus, 1899, p. 540. + + A review of the Vital Statistics of Cleveland during the last + decennium. Cleveland Medical Journal, 1902, i, 71-76. + + Epidemics of typhoid fever in Cleveland. Cleveland Medical + Journal, 1904, iii, 208-210. + + The mortality statistics of the twelfth census. Cleveland + Medical Journal, 1905, iv, 425-431. + + Co-operative sanitation. Ohio Medical Journal, 1905, i, + 278-281. + + The medical code of Hammurabi, King of Babylon. Cleveland + Medical Journal, 1908, vii, 72-75. + + Carcinoma in high life. Cleveland Medical Journal, 1908, vii, + 472-476. + + Medical Cleveland in the nineteenth (19th) Century. Cleveland + Medical Journal, 1909, viii, 59, 146, 208. + + Gilbert of England and his "Compendium Medicine." Medical + Pickwick, 1915, i, 118-120. + +Dr. Handerson was Professor of Hygiene and Sanitary Science in the +Medical Department of the University of Wooster, 1894-96, and the +same in the Cleveland College of Physicians and Surgeons (Medical +Department of Ohio Wesleyan University), 1896 to 1907, and filled that +chair with eminent ability. Thus it came about that the ex-Confederate +officer taught sanitary science in a college standing upon ground +donated by the survivors of an organization of abolitionists. + +Dr. Handerson was a member of the Cuyahoga County Medical Society, +and its President in 1895; also a member of the Cleveland Academy +of Medicine, of the Ohio State Medical Society, and of the American +Medical Association. He was one of the founders and an active worker +in the Cleveland Medical Library Association and its President from +1896 to 1902. + +He was all his life devoted to the Episcopal Church, was Warden of +Grace Episcopal Church, Cleveland, for many years, and Treasurer of +the Diocese of Ohio during fourteen years. + +During his later years Dr. Handerson withdrew entirely from active +practice and spent a great deal of time in his library. His papers +abound in carefully prepared manuscripts, some of them running into +hundreds of pages. + +Two years before his death Dr. Handerson became totally blind. +This grievous affliction was borne with unvarying patience and +cheerfulness. He still loved to recite from memory the classic +authors, to relate and discuss episodes of world history and events +of the present, to solve difficult mathematical problems, and to have +his data on all subjects verified. He retained his faculties perfectly +until April 23, 1918, when he died from cerebral hemorrhage. + +He is survived by a daughter, two sons by the second marriage, and his +devoted wife. + +Among numerous letters received from prominent physicians and authors +appreciative of Dr. Handerson's medico-historical labors, one from Dr. +Oliver Wendell Holmes expresses high praise and requests to have sent +to him everything which Dr. Handerson might in future write. + +It seems eminently appropriate that the essay on "Gilbertus Anglicus." +the last from the pen of Dr. Handerson, should be put in book form, +together with a sketch, however brief, of its author's earnest life, +his sterling character, his geniality and imperturbable equanimity, +and thus preserved in testimony of the high esteem in which he was +held by his contemporaries. + + SAMUEL WALTER KELLEY. + + + * * * * * + + + + +RESOLUTIONS + + +At a meeting of the Council of the Cleveland Medical Library +Association, held on May 14, the following resolutions were adopted: + +_Resolved_, That in the death of Dr. Henry E. Handerson the Cleveland +Medical Library Association has sustained the loss of one of its most +honored and devoted members. His scholarly acquirements were notable, +and his eminence as a medical historian generally recognized. His deep +interest in the welfare of the Library and his thorough attention to +every detail of his official duties were always evident, while his +lovable personal qualities endeared him to all. + +The Association desires to express its high appreciation of his long +and valued services, and extends to his bereaved family its heartfelt +and sincere sympathy. + + C.A. HAMANN, + WM. EVANS BRUNER, + J.B. McGEE. + + + * * * * * + + + + +GILBERTUS ANGLICUS (GILBERT OF ENGLAND) + +A STUDY OF ENGLISH MEDICINE IN THE THIRTEENTH CENTURY. + +BY H.E. HANDERSON, A.M., M.D. + +CLEVELAND + + * * * * * + + "Nothing in the past is dead to the man who would learn how + the present came to be what it is."--Stubbs--_Constitutional + Hist. of England_. + + * * * * * + + +Among the literary monuments of early English medicine the "Compendium +Medicinae" of Gilbertus Anglicus merits a prominent position as the +earliest complete treatise on general medicine by an English author +which has been preserved to our day, and equally because it forms in +itself a very complete mirror of the medical science of its age and +its country. + +Gilbert was undoubtedly one of the most famous physicians of his time. +His reputation is recognized in those well-known lines of Chaucer +which catalogue the "authorities" of his Doctor of Phisik: + + "Wel knew he the olde Esculapius + And Deyscorides and eek Rufus, + Olde Ypocras, Haly and Galyen, + Serapion, Razis and Avycen, + Averrois, Damascien and Constantyn, + Bernard and Gatesden and Gilbertyn." + +He is also quoted with frequency and respect by the medical writers +of many succeeding ages, and the Compendium, first printed in 1510, +enjoyed the honor of a second edition as late as the seventeenth +century (1608). The surname "Anglicus" in itself testifies to the +European reputation of our author, for as Dr. Payne sensibly +remarks, no one in England would speak of an English writer as "the +Englishman." + +Yet, in spite of his reputation, we know almost no details of the life +of Gilbert, and are forced to content ourselves with the few facts +to be gleaned from the scanty biographies of early writers and the +inferences drawn from the pages of the Compendium itself. The date +and place of his birth and death, and even the field of his medical +activities are equally unknown. Bale, Pits and Leland, the earliest +English biographers, tell us that Gilbert, after the completion of +his studies in England, proceeded to the Continent to enlarge his +education, and finally became physician to the great Justiciar, Hubert +Walter, archbishop of Canterbury, who died in the year 1205. This +would place him under the reign of King John, in the early part of the +thirteenth century. + +Dr. John Freind, however, the famous English physician and medical +historian (1725), observing that Gilbert quotes the Arabian +philosopher Averroes (who died in 1198), and believing that he also +quotes a work of Roger Bacon and the surgical writings of Theodorius +(Borgognoni) of Cervia (1266), was inclined to fix his period in the +latter half of the thirteenth century, probably under the reign of +Edward I. Most of the later historians of medicine have followed the +views of Freind. Thus Eloy adopts the date 1272, Sprengel gives 1290, +Haeser the same date, Hirsch says Gilbert lived towards the close of +the thirteenth century, Baas adopts the figures 1290, etc. + +The most recent biographers of Gilbert, however, Mr. C.L. +Kingsford[1], and the late Dr. Joseph Frank Payne[2], after an +apparently careful and independent investigation of his life, have +reached conclusions which vary materially from each other and from +those of the historians mentioned. Mr. Kingsford fixes the date of +Gilbert at about 1250, while Dr. Payne reverts to the views of Bale +and Pits and suggests as approximate figures for the birth and death +of Gilbert the years 1170-80 to 1230. This discrepancy of twenty-five +or thirty years between the views of two competent and unprejudiced +investigators, as a mere question of erudition and interpretation, +is perhaps scarcely worthy of prolonged discussion. But as both +biographers argue from substantially the same data, the arguments +reveal so many interesting and pertinent facts, and the numerous +difficulties attending the interpretation of these facts, that +some comparison of the different views of the biographers and some +criticism of their varying conclusions may not be unwelcome. + +[Footnote 1: In Leslie Stephen's "Dictionary of Biography."] + +[Footnote 2: _British Medical Journal_, Nov. 12, 1904, p. 1282.] + +In the first place then we must say that, as Gilbert is frequently +quoted in the "Thesaurus Pauperum," a work ascribed to Petrus +Hispanus, who (under the title Pope John XXI) died in 1277, this date +determines definitely the _latest_ period to which the Compendium can +be referred. If, as held by some historians, the "Thesaurus" is the +work of Julian, the father of Petrus, the Compendium can be referred +to an earlier date only. + +Now Gilbert in his Compendium (f. 259a) refers to the writings of +Averroes (Ibn Roschd) regarding the color of the iris of the eye. +Averroes died in the year 1198. There is no pretense that Gilbert was +familiar with the Arabic tongue, and the earliest translations into +Latin of the writings of Averroes are ascribed by Bacon to the famous +Michael Scot, though Bacon says they were chiefly the work of a +certain Jew named Andrew, who made the translations for Scot. Bacon +also says that these translations were made "_nostris temporibus_," +in our time, a loose expression, which may, perhaps, be fairly +interpreted to include the period 1230-1250. But if, as Dr. Payne +believes, Gilbert died about 1230, it seems improbable that he could +have been familiar with the translations of Michael Scot. Accordingly +Dr. Payne suggests that, after the death of his patron in 1205, +Gilbert returned to the Continent, and, perhaps in Paris or at +Montpellier, met with earlier Latin versions of the writings of the +Arabian physician and philosopher. This is, of course, possible, but +there is no historical warrant for the hypothesis, which must, for +the present at least, be regarded as merely a happy conjecture of +Dr. Payne. The presence of Gilbert upon the Continent, probably as a +teacher of reputation, seems, however, quite probable. Littre has even +unearthed the fact that during the 14th century a street in Paris near +the medical schools, bore the name of the Rue Gilbert l'Anglois. A +MS. in the Bibliotheque Nationale entitled "_Experimenta Magistri +Gilliberti, Cancellarii Montepessulani_" has suggested also the idea +that Gilbert may have been at one time chancellor of the University +of Montpellier. Dr. P. Pansier, of Avignon, however, who has carefully +examined and published this manuscript[3], reports that while it +contains some formulae found also in the Compendium of Gilbert, it +contains many others from apparently other sources, and he was unable +to convince himself that the compilation was in fact the work of +Gilbertus Anglicus. Dr. Pansier also furnishes us with a list of +the chancellors of Montpellier, which contains the name of a certain +"Gillibertus," chancellor of the university in 1250. He could find, +however, no evidence that this Gillibertus was Gilbertus Anglicus, +author of the Compendium Medicinae. On the whole then the visit of +Gilbert to France early in the 13th century, and his access in +this way to early translations of Averroes, while a convenient and +plausible conjecture on the part of Dr. Payne, does not seem supported +by any trustworthy historical evidence. + +[Footnote 3: Janus, 1903, p. 20.] + +The "_Liber de speculis_" mentioned by Gilbert (f. 126 c), and since +the time of Freind generally accepted as the work of Bacon, is almost +certainly not from the pen of that eminent philosopher. In addition +to the fact that Bacon himself says he had (for obvious reasons) +written nothing except a few tracts (_capitula quaedam_) prior to the +composition of his Opus Magnum in 1267, the real author of the Liber +de speculis is probably mentioned by Bacon in the following passage +from the Opus Tertium: + +"_Nam in hoc ostenditur specialiter bonitas naturae, ut dicit auctor +libri de speculis comburentibus._"[4] + +[Footnote 4: Cap. XXXVI, p. 116, edition of Brewer.] + +We must therefore agree with Dr. Payne that the _Liber de speculis_ of +Gilbert was at least not the work of Roger Bacon. + +Dr. Freind regards the chapters of Gilbert on the subject of leprosy +as borrowed substantially from the "Chirurgia" of Theodorius of +Cervia, who wrote about the year 1266. This view has also been +generally accepted by later writers. But Dr. Payne boldly challenges +the view of Freind, declares that Theodorius copied _his_ chapters +from Gilbert, and asserts that Theodorius was a notorious plagiarist. +Now, while the bold assertion of Dr. Payne cannot, of course, be +accepted as _proof_ of Gilbert's precedence in chronological order, +if that precedence is otherwise established, it will explain the +similarity of the chapters of the two writers very satisfactorily. For +the present, however, this similarity can be adduced as evidence on +neither side. + +Again, Gilbert, with the enthusiasm of a loyal pupil, speaks (f. 47 b) +of a certain Magister Ricardus, "_omnium doctorum doctissimus_," whose +views on uroscopy certainly indicate a mind superior to his age. Now +there were about this period at least two eminent physicians who bore +the name of Ricardus. Of these the senior, a Frenchman, known also +as Ricardus Salednitanus, is highly praised by Aegidius of Corbeil +(Gilles de Corbeil, Aegidius Corboliensis), physician to King Philip +Augustus of France (1180-1223). This Ricardus was a famous teacher at +Salernum when Aegidius was in attendance at that famous university, +therefore probably about the close of the 12th century. The second +Ricardus, called Parisiensis, has been recently identified by Toply +with Richard of Wendover, an English canon of St. Paul's, and at one +time physician to Pope Gregory IX, who died in 1241. Toply believes +him to have been also the author of the "_Anatomia Ricardi_," recently +published. This Ricardus died in 1252. + +Now to which of these Ricardi does the eulogistic language of Gilbert +refer? Dr. Payne believes it to be the senior, Ricardus Salernitanus. +Mr. Kingsford, on the other hand, thinks it to be Ricardus +Parisiensis, who died in 1252. A _Liber de urinis_ has been ascribed +to each of them, but, it seems to me, with greater probability to +Ricardus Salernitanus. If too the author of the "_Anatomia Ricardi_" +was a contemporary of Gilbert, we might reasonably expect to find +in the Compendium some evidences of Gilbert's acquaintance with that +work. But Gilbert's discussion of anatomical questions is totally +unlike that of the author of the "_Anatomia_," and betrays not the +slightest evidence of knowledge of such a treatise. On the whole +then I am inclined to agree in this question with Dr. Payne, and to +consider the Ricardus of Gilbert identical with Ricardus Salernitanus, +the famous professor of the School of Salernum. This conclusion +is further justified by the fact, generally accepted by all modern +writers, that Gilbert was himself a pupil of Salernum. + +Singularly enough, both Dr. Payne and Mr. Kingsford profess to find +in the Compendium some evidence that Gilbert sojourned in Syria for +a certain period, though the circumstances of this sojourn are +viewed differently by the two biographers. Dr. Payne thinks that the +physician, after completing his education in England, proceeded to the +Continent and extended his travels as far as Syrian Tripoli, where he +met Archbishop Walter and became attached to his staff. As the prelate +returned to England in 1192, this sojourn of Gilbert in Syria must +have been about 1190-91, when, according to Dr. Payne's chronology, +Gilbert could have been not more than about twenty years of age. +Dr. Payne bases his story upon a certain passage in the Compendium, +in which Gilbert says that he met in Syrian Tripoli "a _canonicus_ +suffering from rheumatic symptoms." I have been entirely unable to +find the passage referred to in this story, in spite of a careful +search of the text of the edition of 1510. But, admitting the +existence of the passage in question, it proves nothing as to the +_date_ of this alleged Syrian sojourn. Tripoli was captured by +the Crusaders in 1109, and continued under their control until its +recapture by the Saracens in 1289, a period of nearly two hundred +years. Gilbert's travels in Syria may then have occurred at almost +any time during this long period, and his fortuitous meeting with +Archbishop Walter has very much the appearance of a story evolved +entirely from the consciousness of the biographer. + +On the other hand, Mr. Kingsford bases his theory of Gilbert's sojourn +in Syria upon a story adopted, I think, from Littre and found in the +Histoire literaire de la France. The Compendium of Gilbert contains +(f. 137a) a chapter giving the composition of a complex collyrium +with which he professes to have cured the almost total blindness of +Bertram, son of Hugo de Jubilet, after the disease had baffled the +skill of the Saracen and Christian-Syrian physicians of his day. +Now Littre avers that a certain Hugo de Jubilet was involved in an +ambuscade in Syria in the year 1227, and that he had a son named +Bertram. It is very natural, of course, to conclude that this Bertram +was the patient recorded in the book of Gilbert. Kingsford says that +Gilbert "met" Bertram in Syria, but the text of the Compendium says +nothing of the locality of their meeting, which might have taken place +almost anywhere in Europe, perhaps even at Salernum, a favorite resort +of the invalided Crusaders in these times. Finally, Dr. Payne disposes +effectually of the authenticity of the entire story by calling +attention to the fact that the chapter referred to in the Compendium +is marked plainly "_Additio_," without indicating whether this +addition is from the pen of Gilbert or some later glossator. + +Finally, I may suggest another line of argument, which, so far as I +know, has not yet been advanced for the determination of the period of +Gilbert. + +The Compendium Medicinae of Gilbert is, of course, a compendium of +internal medicine. But the book is also something more. Not less +than fifty chapters are devoted to a comparatively full discussion of +wounds, fractures and dislocations, lithotomy, herniotomy, fistulae +and the various diseases on the border line between medicine and +surgery. Not a single surgical writer, however, is quoted by name. +Nevertheless the major part of these surgical chapters are either +literal copies, or very close paraphrases, of the similar chapters +of the "_Chirurgia_" of Roger of Parma, a distinguished professor +in Salernum and the pioneer of modern surgery. The precise period +of Roger is not definitely settled by the unanimous agreement of +modern historians, but in the "_Epilogus_" of the "_Glosulae Quatuor +Magistrorum_" it is said that Roger's "_Chirurgia_" was "_in lucem et +ordinem redactum_" by Guido Arietinus, in the year of our Lord 1230. +This date, while perhaps not unquestionable, is also adopted by De +Renzi, the Italian historian of Medicine. The original MS. of Roger's +work is said to be still in existence in the Magliabechian Library +in Florence, but it has never been published in its original form.[5] +Roland of Parma, however, a pupil of Roger, published in 1264 what +purports to be a copy of Roger's "_Chirurgia_" with some notes and +additions of his own, and it is from this MS. of Roland that all our +copies of Roger's work have been printed. Roger's "_Chirurgia_" was +popularly known as the "_Rogerina_;" the edition of Roland as the +"_Rolandina_." They are frequently confounded, but are not identical, +though the additions of Roland are usually regarded as of little +importance. In the absence of Roger's manuscript, however, they lead +often to considerable confusion, as it is not always easy to determine +in the printed copies of the "_Rolandina_" just what belongs to Roger +and what to his pupil and editor. Now a careful comparison of the +surgical chapters of Gilbert of England with the published text of the +"_Rolandina_" leads me to the conviction that Gilbert had before him +the text of Roger, rather than that of Roland, his pupil. If such is +the fact, Gilbert's Compendium must have been written between 1230 and +1264, the dates respectively of the "_Rogerina_" and "_Rolandina_." + +[Footnote 5: Haeser says that this MS. of Roger's "Chirurgia," made by +Guido Arenitensium, was discovered by Puccinoti in the Magliabechian +library, and that an old Italian translation of the same work is also +found there. The latter was the work of a certain Bartollomeo. + +The text used to represent Roger in the present paper is that +published by De Renzi (Collectio Salernitana, tom. II, pp. 426-493) +and entitled "Rogerii, Medici Celeberrimi Chirurgia." It is really +the text published originally in the "Collectio Chirurgica Veneta" of +1546, of which the preface says: + +"_His acceserunt Rogerii ac Guil. Saliceti chirurgiae, quarum prior +quibusdam decorata adnotationibus nunc primum in lucem exit, etc._," +and adds further on: + +"_Addidimus etiam quasdam in Rogerium veluti explanationes, in +antiquissimo codice inventas, et ab ipso fortasse Rolando factas._" +While I may recognize gratefully the surgical enthusiasm which led the +editor to the publication of these "_veluti explanationes_," for my +present purpose he would have earned more grateful recognition if he +had left them unprinted. As the text now stands it is merely a garbled +edition of the Rolandina. However, it is the best representative of +the "Chirurgia" of Roger at present available. See De Renzi, op. cit., +p. 425.] + +From a careful review of the data thus presented we may epitomize, +somewhat conjecturally, the life of Gilbert substantially as follows: +He was probably born about 1180 and received his early education in +England. On the completion of this education, about the close of the +12th century, he proceeded to the Continent to complete his studies, +and spent some time in the school of Salernum, where it is probable +that he enjoyed the instruction of Roger of Parma, Ricardus +Salernitanus, and may have had among his fellow-students Aegidius of +Corbeil. Probably after his return to England he served for a brief +period on the staff of Archbishop Hubert Walter, after whose death +in 1205, but at an unknown period, Gilbert returned once more to the +Continent, where it seems probable he spent the remainder of his life. +This comports best with his extensive European reputation, his surname +"Anglicus" and the comparative dearth in England of any facts relating +to his life. The date of the Compendium I am inclined to place about +1240, prior to the literary activity of Ricardus Parisiensis or +Richard of Wendover, Roland of Parma, Roger Bacon and Theodorius of +Cervia. We may place his death, conjecturally, at about 1250. + +The first edition of the Compendium is a small quarto of 362 folios +(724 modern pages), five by seven inches in size, printed in double +narrow columns, in black letter, perfectly legible and clear. The +pagination shows some errors, but the text itself is remarkably +accurate, though the presence of a multiplicity of contractions +and ligatures renders the reading somewhat difficult to the modern +student. On the last page we find the following colophon: + +_Explicit compendium medicine Gilberti Anglici correctum et bene +emendatum per dominum Michaelem de Capella artium et medicine +doctorem: ac Lugduni Impressum per Jacobum Saccon: expensis +Vincentii de Portonariis. Anno Domini M.D.x. die vero vigesima mensis +Novembris._ + +_Deo Gratias._ + +The second edition (which I have not seen) is said to bear the title: +"Laurea anglicana, sive compendium totius medicinae, etc," Geneva, +1608. + +It should be noticed that the title "Laurea anglicana" is not +mentioned in the original edition of 1510, but is apparently due to +the exuberance of enthusiasm of the editor of the later edition, whose +taste seems to have been more flamboyant. + +Various manuscript works of greater or less authenticity are ascribed +to Gilbert by different authorities. Of these Mr. Kingsford furnishes +the following list: + + 1. "Commentarii in Versus Aegidii de Urinis," quoted by John + Gaddesden and probably authentic. + + 2. "Practica Medicinae," mentioned by Pits, but of doubtful + authenticity. + + 3. "Experimenta Magistri Gilliberti, Cancellarii Montepessulani," + noticed on page 2, but authenticity doubtful. + + 4. "Compendium super Librum Aphorismorum Hippocratis." + MS. in Bodleian. + + 5. "Eorundem Expositio." MS. in Bodleian. + + 6. "Antidotarium." MS. in Caius College. + +To these he adds, on the authority of Bale and Pits: + + 7. "De Viribus Aquarum et Specierum." + + 8. "De Proportione Fistularum." + + 9. "De Judicio Patientis." + + 10. "De Re Herbaria." + + 11. "De Tuenda Valentudine." + + 12. "De Particularibus Morbis." + + 13. "Thesaurus Pauperum." + +All of these latter may be regarded as doubtful. + +The authorities named by Gilbert are Pythagoras, Hippocrates, Plato, +Aristotle, Galen, Rufus, Maerobius, Boetius, Alexander of Tralles, +Theodorus Priscianus, Theophilus Philaretes, Stephanon (of Athens?), +the Arabians Haly Abbas, Rhazes, Isaac Judaeus, Joannitius, Janus +Damascenus, Jacobus Alucindi, Avicenna and Averroes; the Salernian +writers, quoted generally as Salernitani and specifically Constantino +Africanus, Nicholas Praepositus, Romoaldus Ricardus and Maurus, and +two otherwise unknown authors, Torror and Funcius, classed by Gilbert +as "_antiqui_." The latter author is also said to have written a +"_Liber de lapidibus_." Certainly this list suggests a pretty good +medical library for a practitioner of the 13th century. + +Dr. Payne calls attention to the fact that all these writers antedate +the 13th century, and thus limit the period of Gilbert in antiquity. +This is undoubtedly true with reference to authorities actually named, +but does not exclude from consideration other writers quoted, but not +named, whom we shall have occasion to refer to hereafter. + +The Compendium opens with a very brief and modest foreword, couched in +the following terms: + +"_Incipit liber morborum tam universalium quam particularium a +magistro Gilberto anglico editus ab omnibus autoribus et practicis +magistrorum extractus et exceptus, qui compendium medicine +intitulatur._" + +It will be observed that no claim whatever for originality is +presented by the author. He calls his book a compendium extracted from +all authors and the practice of the professors, and edited only by +himself. The same idea is more fully emphasized later (f. 55c), where +he says: + +"_Sed consuetudo nostra est ex dictis meliorum meliora aggregare, et +ubi dubitatio est, opiniones diversas interserere; ut quisque sibi +eligat quam velit retinere._" + +The self-abnegation implied in these extracts must not, however, be +interpreted too literally, for the editorial "_dico_" on numerous +pages, and even an occasional chapter marked "_Propria opinio_," +testify to the fact that Gilbert had opinions of his own, and was +ready on occasion to furnish them to the profession. On the whole, +however, the "Compendium" is properly classified by the author as a +compilation, rather than an original work. + +The Compendium is divided into seven books, and the general +classification of diseases is from head to foot--the usual method +of that day. The modern reader will probably be surprised at the +comprehensiveness of the work, which, besides general diseases, +includes considerable portions of physiology, physiognomy, +ophthalmology, laryngology, otology, gynecology, neurology, +dermatology, embryology, obstetrics, dietetics, urinary and venereal +diseases, therapeutics, toxicology, operative surgery, cosmetics and +even the hygiene of travel and the prevention of sea-sickness. Some of +these subjects too are discussed with an acuteness and a common sense +quite unexpected. Of course, scholastic speculations, superstition, +charms, polypharmacy and the use of popular and disgusting remedies +are not wanting. Even the mind of a philosopher like Roger Bacon was +unable to rise entirely above the superstition of his age. But the +charms and popular specifics of Gilbert are often introduced with a +sort of apology, implying his slight belief in their efficacy. Thus in +his chapter on the general treatment of wounds (f. 87a) he introduces +a popular charm with the following words: + +"_Alio modo, solo divino carmine confisi, quidam experti posse curari +omnes plagas hoc._ + +"_Carmine._ + +"_Tres boni fratres per viam unam ibant, et obviavit eis noster dominus +jesus christus et dixit eis, tres boni fratres quo itis_, etc." + +And again, in his discussion of the treatment of gout and rheumatism +(f. 327b), Gilbert adds, under the title + +_Emperica_ + +"_Quamvis ego declino ad has res parum, tamen est bonum scribere in +libro nostro, ut non remaneat tractatus sine eis quas dixrunt antiqui. +Dico igitur quod dixit torror: Si scinderis pedem rane viridis et +ligaveris supra pendem podagrici per tres dies, curatur; ita quod +dextrum pedum rane ponas supra dextrum pedem patientis, et e converso. +Et dixit Funcius, qui composuit librum de lapidibus, quod magnes, +si ligatus fuerit in pedem podagrici, curatur. Et alius philosophus +dixit. Si accipiatur calcancus asine et ponatur ligatus supra pedem +egri, curatur, ita quod dexter supra dextrum, et e converso. Et +juravit quod sit verum. Et dixit torror quod si ponatur pes testudinis +dexter supra dextrum pedem podagrici, et e converso, curatur._" + +We may believe, indeed, that Gilbert would have preferred to follow +in the therapeutic footsteps of Hippocrates, had he not disliked to be +regarded by his colleagues as eccentric and opinionated. For he says +in his treatment of thoracic diseases (f. 193c): + +"_Etenim eleganter dedit Ipo. (Hippocrates) modum curationis, sed ne +a medicis nostri temporis videamur dissidere, secundum eos curam +assignemus._" + +Gilbert was a scholastic-humoralistic physician _par excellence_, +delighting in superfine distinctions and hair-splitting definitions, +and deriving even pediculi from a superfluity of the humors (f. 81d). +Of course he was also a polypharmacist, and the complexity, ingenuity, +and comprehensiveness of his prescriptions would put to shame even +the "accomplished therapeutist" of these modern days. In dietetics +too Gilbert was careful and intelligent, and upon this branch of +therapeutics he justly laid great emphasis. + +The first book of the Compendium, comprising no less than 75 folios, +is devoted entirely to the discussion of fevers. Beginning with the +definition of Joannicius (Honain ebn Ishak): + +"Fever is a heat unnatural and surpassing the course of nature, +proceeding from the heart into the arteries and injuring the patient +by its effects." + +Gilbert launches out with genuine scholastic finesse and verbosity +into a discussion of the questions whether this definition is based +upon the essentia or the differentia of fever; whether the heat of +fever is natural or unnatural, and other similar subtle speculations, +and finally arrives at a classification of fevers so elaborate and +complex as to be practically almost unintelligible to the modern +reader. + +The more important of these fevers or febrile conditions are: + + Ephemeral + Hemitertian + Double quartan + Interpolated + Synocha + Causon synochides + Epilala + Quotidian + Double tertian + Quintan + Continued + Causon + Putrid + Lipparia + Tertian + Quartan + Sextan + Synochus + Synochus causonides + Ethica + Erratica + +Some of these names are still preserved in our nosologies of the +present day; others will be recalled by the memories of our older +physicians, and a few have totally disappeared from our modern medical +nomenclature. + +Interpolated fevers are characterized by intermissions and remissions, +and thus include our intermittent and remittent fevers; synochus +depended theoretically upon putrefaction of the blood in the vessels, +and was a continued fever. Synocha, on the other hand, was occasioned +by a mere superabundance of hot blood, hence the verse: + +"_Synocha de multo, sed synochus de putrefacto._" + +Causon was due to putrefaction of bile in the smaller vessels of +the heart, diaphragm, stomach or liver, and was an acute fever +characterized by furred tongue, intolerable frontal headache, tinnitus +aurium, constant thirst, delirium, an olive-colored face, redness and +twitching of the eyes and a full, frequent and rapid pulse. Epiala +and lipparia were febrile conditions concerning which there seems to +have been much difference of opinion, even in the days of Gilbert. +Apparently they were distinguished by variations of external and +internal temperature, or by chills combined with fever. Febris ethica +is our modern hectic fever. In the discussion of this last variety we +are introduced to the "_ros_" and "_cambium_" of Avicenna, apparently +varieties of hypothetical humors. + +All these fevers are regarded from the standpoint of Humoralism, +and depend upon variations in the quantity, quality, mixture or +location of the four humors, blood, phlegm, bile and black-bile +(_melancholia_). + +In the general treatment of febrile diseases, so-called preparatives +and digestives are first employed to ripen the humors, after which +evacuatives (emetics, cathartics, sudorifics, and occasionally even +venesection) are utilized for the discharge of these peccant humors. +Much emphasis is laid upon the dietetics of fevers, and this branch of +treatment is highly elaborated. Complications are met by more or less +appropriate treatment, and the condition of the urine is studied with +great diligence. Venesection is recommended rather sparingly, and is +never to be employed during the _dies caniculares_ (dog-days) or _dies +Aegyptiaci_, nor during conjunctions of the moon and planets, nor upon +the 5th, 15th, 17th, 25th, 26th, or 27th days thereafter, etc. + +Among the complications of fevers discussed by Gilbert, two seem +sufficiently important to justify special attention. On folio 74b we +find a section entitled "_De fluxu materie per parotidas venas_," +in which he remarks that "Sometimes matter flows through the parotid +veins behind the ears down to the neck and nares, and obstructs the +passages for air, food and drink, so as to threaten suffocation." He +cautions us against the use of repressives, "lest the matter may run +to the heart," and recommends mollitives and dissolvents, such +as butter, dyaltea, hyssop and especially newly shorn wool (_lana +succida_), which, he says, is a strong solvent. Is this a reference +to the septic parotitis not unfrequently seen in low fevers? + +The following section, "_De inflatione vesice et dolore ejus_," +discusses the retention of urine in fevers, and its treatment. Gilbert +says: "Inflation of, and pain in the bladder are sometimes symptoms +of acute fevers, since the humors descend into and fill the bladder." +If this occurs in an interpolated (remittent) fever, he directs the +patient to be placed in a bath of a decoction of pellitory up to the +umbilicus, "_et effundet urinam_." If the complication occurs in one +suffering from a continued fever, the bath should be made of wormwood +and a poultice should be placed over the bladder and genitals, "_et +statim minget_." The same effect may be produced by poultice mixed +with levisticum (lovage) or leaves of parsley. Singularly enough the +catheter is not mentioned, though this instrument, under the medieval +name of _argalia_ (cf. French algalie), is noticed frequently in the +section devoted to vesical calculus. + +With the second book of the Compendium the system of the discussion of +diseases _a capite ad pedes_ is commenced, and produces some curious +associates. To the modern physician the sudden transition from +diseases of the scalp to fractures of the cranium seems at least +abrupt, if not illogical. It seems, therefore, wiser, in a hasty +review like the present, to take up the various pathological +conditions described by Gilbert in their modern order and relations, +and to thus facilitate the orientation of the reader. + +The second book then opens with a consideration of the hair and scalp, +and their respective disorders. + +The hair is a dry fume (_fumus siccus_), escaping from the body +through the pores of the scalp and condensed by contact with the air +into long, round cylinders. It increases rather by accretion than by +internal growth, and its color depends upon the humors. Thus red hair +arises from unconsumed blood or bile; white hair, from an excess of +phlegm; black hair, from the abundance of black-bile (_melancholia_), +etc. The use of the hair is for ornament, for protection and for the +distinction of the sexes. Numerous prescriptions for dyeing the hair, +for depilatories (_psilothra_), for the removal of misplaced hair and +for the destruction of vermin in the hair are carefully recorded. + +Three varieties of soaps for medicinal use are described, and the +process of their manufacture indicated. The base of each is a +lixivium made from two parts of the ashes of burned bean-stalks and +one of unslaked lime, mixed with water and strained. Of this base +(_capitellum_), two parts mixed with one part of olive oil form the +_sapo saracenicus_. In the _sapo gallicus_ the base is made with the +ashes of chaff and bean-stalks with lime, and to it is added goat's +fat, in place of the oil. The _sapo spatareuticus_ is made in a +similar manner, except that oil replaces the goat's fat and the soap +is made only during the dog days, since the necessary heat is to be +supplied by the sun alone. + +Among the diseases of the scalp attention is given to alopecia, +dandruff (_furfur_), tinea caries and various pustular affections, +fanus (favus), rima, spidecia, achora, etc. Caries was a pustular +disease, in which bristle-like hairs formed a prominent feature. Rima +was a name applied by the physicians of Salernum to a superfluity +of hair. In addition to these diseases of the scalp, we find also +descriptions of gutta rosacea, morphoea and scabies, a fairly +extensive dermatology for this early day. In favus, Gilbert tells us +that, after the removal of the pustules, there remain foramina, from +which exudes a poisonous substance, resembling honey. Of course his +system of treatment is rich in variety and comprehensiveness. + +We may notice here too a few chapters on Toilet or Decorative +Medicine, a branch of art to which modern physicians have devoted +perhaps too little attention, with the natural result that it has +fallen largely into the hands of charlatans of both sexes. Gilbert's +chapter "_De ornatu capillorum_" offers the following sensible +introduction: "The adornment of the hair affords to women the +important advantages of beauty and convenience; and as women desire to +please their husbands, they devote themselves to adornment and protect +themselves from the charge of carelessness. In order, therefore, +that our ministry may not be depreciated, and that we may not render +ourselves liable to the accusation of ignorance, let us add a few +words on the subject of the dressing of the hair and the general care +of the person". + +Accordingly Gilbert advises ladies who desire to retain or renew the +charms of youth to soften the skin and open its pores by the use of +steam baths and careful washing in warm water, followed by drying the +surface with the finest cloths (_panno mundissimo_). If necessary, +superfluous hair is to be removed by suitable depilatories, color to +be restored to the pale cheeks by a lotion of chips of Brazil-wood[6] +soaked in rose-water and applied with pads of cotton; or, if the face +is too red, it may be blanched by the root of the cyclamen (_panis +porcinus_, sowbread) dried in an oven and powdered. A wealth of +remedies for freckles, moles, warts, wrinkles, discolorations and +other facial blemishes, with foul breath and fetidity of the armpits, +is carefully recorded, and would suffice to establish the fortune of +any of our modern specialists in female beauty. Finally a long chapter +entitled "_De sophisticatione vulvae_" introduces us to a phase of +decoration and sophistication which I would fain believe little known +or studied in the development of modern civilization, in which we are +prone at least to follow the advice of Hamlet, to + + "Assume a virtue, if you have it not." + +At all events, we may congratulate ourselves that the details of these +disgusting cess-pools of medical art have disappeared entirely +from the pages of our modern text-books. Even Gilbert considers it +advisable to preface this gruesome chapter with a sort of "_Caveat +emptor_" apology to the reader: + +"_Ut tamen secundum ordinem procedamus, in primis cognosactur +cognoscere desiderantibus, ne dolus dolo patrocinetur, vel simplex +dolose muscipula claudatur._" + +[Footnote 6: This apparent anachronism carries us back to the history +of the mythical Island of Brazil, which appeared upon our charts as +late as the middle of the 19th century.] + +In the department of neurology Gilbert, after a philosophical +discussion of the nature and variety of pain, devotes considerable +chapters to the causes, symptoms, diagnosis and treatment of headache, +hemicrania, epilepsy, catalepsy, analepsy, cerebral congestion, +apoplexy and paralysis, phrenitis, mania and melancholia, incubus +or nightmare, lethargy and stupor, lippothomia or syncope, sciatica, +spasm, tremor, tetanus, vertigo, wakefulness, and jectigation +(jactitation, formication, twitching). + +The third book of the Compendium opens with several chapters on +the anatomy and physiology of the eye and the phenomena of vision. +According to Gilbert, the eye consists of three humors, the +albugineous (aqueous), the crystalline lens and the vitreous humor, +and seven tunics, apparently + + 1. The conjunctiva + 2. The albuginea or sclerotic + 3. The cornea + 4. The secundina (choroid) + 5. The rethilea (retina) + 6. The aranea (iris) + 7. The uvea perforata (posterior layer of iris), + +though the definitions are not in all cases quite clear and definite. +The tela aranea is said to take its origin from the retina, the retina +from the optic nerve, and the latter from the rethi (rete, network) +involving the substance of the brain. The cornea arises from the +sclerotic tunic, the uvea and secundina take their origin from the +pia mater, and the conjunctiva from a thin pellicle or membrane which +covers the exterior of the cranium and is nourished by a transudation +of the blood through the coronal suture. This pellicle is also said +to have a connection with the heart, which arrangement furnishes a +decidedly curious explanation of the mechanism of sympathetic and +maudlin lachrymation. For, as Gilbert tells us, when the heart is +compressed this pellicle is also compressed, and if any moisture is +found beneath the pellicle it is expressed into the substance of the +lachrymal gland by the constriction of the heart, and men in sorrow +therefore shed tears. And again, if the heart is much dilated or +elevated (by joy), this pellicle is also dilated or elevated, and +if any moisture is found beneath it, it is expressed in the form of +tears. Accordingly, men who are too joyful shed tears. Still further, +drunken men, who are notoriously "moist," and have a superfluity of +fluid between the pellicle and the skin of the cranium, are prone to +weeping on slight provocation, and their tears are nothing more than +an expression of this moisture, which makes its exit, not through the +substance of the eye, but through the "lachrymal angle." Q.E.D. + +This odd demonstration is followed by a succession of optical +questions, which are discussed and answered in true scholastic style, +with no little acuteness of observation. Thus: "_Utrum visus fiat +intus suscipiendo?_" Is vision accomplished by something received into +the eye? "_Utrum color fit de nocte?_" Does color exist at night? To +the latter question Gilbert replies that in the darkness color exists +in posse, but not in esse. Again: "Why do some animals see at night, +some in the day only and some only in the twilight?" This phenomenon +he ascribes to "the clearness and subtilty of the visual spirits, or +to the strength, weakness, grossness or turbidity of the organs of +vision." Some animals, he says, have (visual) spirits, subtle and +clear as fire, and these animals see perfectly at night because the +visual spirits (_spiritus visibilis_) are sufficient to illuminate the +external air. "Why do objects in water seem nearer than those in air?" +Gilbert explains this as follows: "Nothing appears distant, except as +perceived through an extensive intervening medium. But our judgment +is largely guided by the transparency of this medium, since the +medium itself is not perceived with much accuracy, except when it +is transparent. Accordingly, as the lucidity of air is greater than +that of water, an object looks more distant through air than through +water." + +"Why does not a single object appear double, inasmuch as we have two +eyes?" To this he replies: "From the anterior part of the brain two +optic nerves pass to the two eyes. But these two nerves unite at a +certain point into one. Now, since the two nerves are of equal length, +two images proceeding from a single object do not make the object +seem double, but single, since the two images are united into one, and +accordingly one object is seen as one image." + +Other physiological speculations are introduced by the questions: "May +one see an object not actually present?" "Why do some animals see best +objects at a distance, others those near at hand?" "Why are objects +seen in their proper position?" All these questions are answered in +accordance with the scholastic formulae, and, not infrequently, with +considerable acuteness. + +A chapter entitled "_De signis oculorum_" also introduces us to a +curious discussion of ocular physiognomy. Thus: + +"When we see a man with large eyes, we argue that he is indolent." + +"If his eyes are deeply situated in his head, we say that he is crafty +and a deceiver." + +"If his eyes are prominent, we say that he is immodest, loquacious and +stupid." + +"He whose eyes are mobile and sharp is a deceiver, crafty and a +thief." + +"He whose eyes are large and tremulous is lazy and a braggart +(_spaciosus?_), and fond of women." + +and so forth for an entire page of the Compendium. + +Actual diseases of the eye are discussed in chapters on pain in the +eyes, ophthalmia, pannus (including ungula, egilops and cataract), +tumors of the conjunctiva, itching of the eyes, lachrymation, cancer, +diseases of the cornea and uvea, diseases of the eyelids, lachrymal +fistula and entropion. The treatment consists generally in ointments +and collyria in abundance, but in fistula lachrymalis incision and +tents of alder-pith, mandragora (_malum terrae_), briony, gentian, +etc., are recommended, and entropion is referred directly to the +surgeon. + + The Latin term cataracta (also catarracta and catarractes) is + applied to a disease of the eyes by Gregory of Tours (Hist. + Franc., v. 6) as early as A.D. 650, and again by Constantine + Africanus, of the school of Salernum, in 1075 (De Chirurg., + cap. XXX). Singularly the word is not found in the "Chirurgia" + of Roger of Parma, from whom Gilbert seems to have borrowed + most of his surgical knowledge. Nor is it employed by + Roland, Roger's pupil and editor. It recurs, however, in the + _Glossulae Quatuor Magistrorum_ (about 1270). But in all these + writers cataracta seems to be included under the general term + pannus, meaning opacities of every kind. Indeed Gilbert says, + "Ungula, egilops, cataracta and macula are species of pannus, + all arising from the same causes and cured by the same + treatment." A few lines later, however, in distinguishing + these various species, he adds: "Cataract arises from a + humor collected between the tunics of the eye": and again + it is said to be blood filling the veins of the eyes, and + especially those of the conjunctiva, and derives its name _a + caracteribus_ (?). The truth is none of these writers seem to + have any very definite knowledge of the distinction between + the various opacities of the media of the eye, all of which + were included under the general term pannus. But, what is more + remarkable, Roger, Roland and The Four Masters make no mention + of the possibility of surgical interference in these cases, + but content themselves with elaborate collyria and ointments, + or simply with internal treatment. Gilbert, on the other hand, + while recommending these collyria and ointments, and even the + internal remedies, adds the following: + + "_Interior autem macula, quae tela vocatur, subcornea situata, + si vl'e (?) purgatione precendente et colliriis et pulveribus + non removetur, acu torta immissa per caprinum angulum + extrahatur aut inferius replicetur_" (f. 137a). + + And again (f. 141d): + + "_In uvea sunt largitas et constrictio et aqua sive + cataracta.... Aqua quandoque per medium pupille descendit, + inferius stans, subuvea apparens, quae perfecte curatur + secundum quosdam immisso acus aculeo per pupillam, ut extra + fluat aqua._" + +Chapters on the physiology of hearing, smelling and the sensation of +touch are followed by a discussion of the symptoms and treatment of +earache, abscess of the ear, discharges (bloody and sanious) from +the ear, worms and other foreign bodies in the ear, tinnitus aurium, +deafness, coryza, epistaxis, nasal polypi, ozaena, cancer of the nose, +fissures and ulcers of the lips, foul breath, diseases of the tongue, +toothache, etc. + +Physiognomy, a favorite theme with our author, appears again in a +considerable chapter on the physiognomy of the nose, mouth, face and +the teeth. + +"He who laughs frequently is kind and genial in all things and is not +worried over trifles." + +"He who laughs rarely is contrary and critical." + +"He who has large ears is stolid and long-lived." + +"He who has a large mouth is gluttonous and daring." + +"He whose teeth are defective and small is weak in his whole body." + +"He whose canine teeth are long and straight is a glutton and a +rascal." + +The department of genito-urinary diseases is introduced by a long +chapter entitled "_De approximeron_," a formidable Latin word defined +by Gilbert as sexual impotence. An elaborate discussion of the +physiology of generation and the phenomena of impotence is followed by +a collection of remedies for the condition, of which the best that can +be said is that they are probably no less effective than most of the +modern drugs recommended for the same purpose. Concerning a function +over which so many fond superstitions still linger in the public mind +we may, perhaps, charitably forgive Gilbert for the introduction +of an empirical remedy for sterility, which, he assures us, he has +often tried and with invariable success, and which enjoys the double +advantage of applicability to either sex. + +"Let a man, twenty years of age or more, before the third hour of +the vigil of St. John the Baptist, pull up by the roots a specimen of +consolida major (comfrey) and another of consolida minor (healall), +repeating thrice the Lord's prayer (_oratio dominica_). Let him speak +to no one while either going or returning, say nothing whatever, but +in deep silence let him extract the juice from the herbs and with this +juice write on as many cards as may be required the following charm: + +"_Dixit dominus crescite._ [symbol: dagger]. _Uthihoth._ [symbol: +dagger]. _multiplicamini._ [symbol: dagger]. _thahechay._ [symbol: +dagger]. _et replete terram._ [symbol: dagger]. _amath._ + +"If a man wears about his neck a card inscribed with these identical +words written in this juice, he will beget a male. Conversely, if a +woman, she will conceive a female" (f. 287b). + +Gilbert, however, cautions the bearer of this potent charm of the +possible dangers of satyriasis incurred thereby, and offers suitable +remedies for so alarming a condition. + +Chapters on satyriasis, gomorrhea (gonorrhea in its etymological +sense, seminal emissions), with a third entitled "_De pustulis et_ +*_apostematibus virgae_" complete this department of medical art. The +last chapter recognizes the venereal origin of the pustules and ulcers +discussed, but furnishes no direct evidence of Gilbert's belief in the +existence of a specific venereal poison. + +While Gilbert is very scrupulous in his examination of the gross +appearances of the urine in most diseases, his discussion of the +diseases of the kidneys and bladder includes only pain in the kidneys, +abscess of the kidneys, renal and vesical calculus, hematuria, +incontinence of urine, dysuria and strangury. + +The chapter on hematuria presents a very curious specimen of medieval +pathology. Gilbert says: "The escape of blood in the urine is due +sometimes to the liver, sometimes to the bile,[7] sometimes to the +kidneys and loins, sometimes to the bladder. If the blood is pure +and clear, in large quantity, mixed perfectly with the urine and +accompanied by pain in the right hypochondrium, it comes from the +liver. Such urine presents scarcely any sediment. If the blood comes +from the lrili vein, it is also rather pure, but less pure than in the +former case, nor is the quantity so great, while pain is felt over the +region of the seventh vertebra, counting from below. If it comes from +the kidneys, it is scanty and pure as it leaves the bladder, but soon +coagulates and forms a dark deposit in the vessel, while pain is +felt in the pubes and peritoneum.... If pus, blood and epithelium +(_squamae_) are passed, and the odor is strong, it signifies +ulceration of the bladder" (f. 275b). + +[Footnote 7: In his chapter on embryology (f. 304c) Gilbert describes +the lrili vein as follows: "The embryo is nourished by means of the +lrili or lrineli vein, which does not exist in man. This vein has +its origin in the liver and divides into two branches. Of these the +superior branch bifurcates, and one of its branches goes to the right +breast, the other to the left, conveying blood from the liver. This +blood in the breast is bleached white (_dealbatur_) like milk, and +forms the nourishment of the infant. The inferior branch of the lrili +vein also bifurcates, sending one of its branches to the right cornu +of the uterus, the other to the left. These vessels carry blood into +the cotyledons, whence it is transmitted to the fetus and digested by +its digestive faculty."] + +Diabetes is defined as "An immoderate passage or attraction of urine +from the liver to the kidneys and its passage through the kidneys, as +the result of a warm or dry distemperature of these organs." The idea +of some association of the liver and kidneys in the production of +diabetes is at least as old as the eleventh century, and Gilbert's +definition of the disease is undoubtedly borrowed from the "Practica" +of John Platearius (A.D. 1075), of the school of Salernum. The +symptoms, continual thirst, dryness of the mouth, emaciation, in +spite of an inordinate appetite, frequent and profuse urination, are +correctly given, but no knowledge of the presence of sugar in the +urine is indicated. + +Dyampnes (involuntary micturition) claims a page or more of +explanation and treatment, and its frequent occurrence in old men and +children is noticed. + +In the department of the diseases of women chapters are devoted to +amenorrhea, menorrhagia, hysteria (_suffocatio matricis_), prolapse, +ulceration, abscess, cancer, dropsy and "ventosity" of the uterus +(physometra). + +In the allied department of obstetrics we find chapters on the signs +of conception, on the urine in pregnant women, on difficult labor, +prolapsus uteri, retention of the placenta, post partum hemorrhage, +afterpains, and the oedema of pregnancy. The causes of difficult +labor, according to Gilbert, are malposition, dropsy, immoderate size +and death of the fetus, debility of the uterus and obstruction of the +maternal passages. Malpositions are to be corrected by the hand of +the midwife (_obstetrix_). Adjuvant measures are hot baths, poultices, +inunctions, fumigations and sternutatories, and the use of certain +herbs. + +In the departments of general medicine not as yet entirely +appropriated by specialists it will suffice to mention scrofula, +pleurisy and pneumonia, hemoptysis, empyema, phthisis, cardiac +affections, diseases of the stomach, liver and spleen, diarrhoea and +dysentery, intestinal worms, dropsy, jaundice, cancer, rheumatism and +gout, small-pox, measles, leprosy and hydrophobia, all of which claim +more or less attention. + +Peripneumonia and pleurisy are both inflammations of the chest, the +former affecting the lungs, the latter the diaphragm and the pellicle +which lines the ribs. The prominent symptoms of both diseases are +pain in the chest or side, cough and fever and dyspnoea. Accidents or +sequelae are hemoptysis, empyema and phthisis. + +Empima (empyema) is the hawking-up of sanies, with infection of the +lung and a sanious habit. Hence persons laboring under pneumonia +or pleurisy are not necessarily empyemics, but when these diseases +progress to such a point that blood and sanies are expectorated and +the lung is infected, that is when the ulceration of the lungs fails +to heal and corruption and infection occur, the disease becomes +empima, and is with difficulty, or never cured. + +Ptisis is a substantial consumption of the humidity of the body, due +to ulceration of the lungs. For when a solution of continuity occurs +in the lungs, the inspiratory and expiratory forces fail. Hence the +lungs do not inspire sufficient air to mitigate the innate heat of the +heart, and the heart fails to purify itself of the fumosity or fumous +vapors generated in itself. Accordingly, deprived of the means of +mitigating its heat or ventilating its fumosities, the spirits within +it become unduly heated, and a consuming fire is generated in the +entire body. + +The symptoms of ptisis are a continued fever, greater or less, +detected in the palms of the hands and the soles of the feet, thirst, +a roughness of the tongue, slenderness of the neck, wasting of the +entire body, constipation, wasting and shrinking of the finger-nails +and fingers, hollowness of the eyes, pain in the left scapula +extending to the shoulder, pharyngeal catarrh with abundant and +mucilaginous sputum and a tendency to lachrymation. If the sputum +thrown upon the coals emits a fetid odor, it is a sign of confirmed +ptisis, which is incurable. The disease when it occurs in youths and +young persons rarely lasts longer than a year, often terminates in +less time, and may sometimes, by the aid of medicine, be prolonged for +a greater period. If the sputum received during the night in a vessel +is flushed in the morning with warm water, while some impurities +remain upon the surface, the putrid matter will sink to the bottom +(_sputum fundum petens_), and the indications are fatal. Likewise +sharpness of the nose, hollow eyes, slender nails, falling hair, +flattened temples and diarrhoea are of evil omen. These patients +converse while dying, and die conversing (_moriendo loquentur, sed +loquendo moriuntur_). Gilbert, of course, supplies a formidable array +of remedies for the disease, but tells us that the "very latest" is +cauterization over the clavicles (_Novissimum autem consilium est +cauterium in furcula pectoris_). + +The varieties of difficulty of breathing are classified under the +titles of asma, dispnea, orthomia, hanelitus and sansugium. The +last title is given to a condition in which, as Gilbert says, "A +superfluous humor is abundant in the superficies of the lung, which +compresses that organ and renders it unable to dilate in inspiration. +Hence it labors in inspiration like a leech, from which the dyspnea +derives its name." + +Under the single title of "_cardiaca passio_" are included all +possible diseases of the heart. The symptoms of this disease are +said to be "palpitation, twitching of the limbs (_saltus membrorum_), +perspiration, weakness of the nerves, facial pallor, weakness of the +body as in hectic fever or phthisis, excessive pain and faintness over +the precordia, a disposition to sleep and often constipation." The +treatment is, of course, entirely symptomatic. + +Diseases of the digestive apparatus are discussed under the headings +of difficulties of deglutition, canine appetite, bolismus (boulimia), +disturbances of thirst, eructations, hiccup, nausea and anorexia, +vomiting, anathimiasis (gastric debility), anatropha and catatropha +(varieties of obstinate vomiting), pain in the stomach, abscess of the +stomach, salivation, colic, dysentery and diarrhoea, intestinal worms, +hemorrhoids, rectal tenesmus, prolapsus ani, fistula in ano, diseases +of the liver, dropsy, jaundice and diseases of the spleen. + +Abscess of the stomach sometimes manifests a circumscribed tumor, +and accordingly, probably includes cancer of that organ. Approved +remedies are the Al'mirabile, the stomatichon frigidum, calidum or +laxativumvum, etc., stereotyped formulae, of which the composition is +carefully recorded. + +Dysentery is a flux of the bowels with a sanguinolent discharge and +excoriation of the intestines. A variety called hepatic dysentery, +however, lacks the intestinal excoriation. Diarrhoea is a simple +flux of the bowels, without either the sanguinolent discharges or +the intestinal excoriation. Lientery is a flux of the bowels with the +discharge of undigested food, occasioned by irritability (_levitas_) +of the stomach or intestines. Colical passion and iliac passion +derive their names from the supposed origin of the pain in the colon +or ileum, a remark which furnishes occasion for the statement that +Gilbert divides the bowels into six sections, viz., the duodenum +jejunum and ileum, and the orobus, colon and longaon (rectum). + +Intestinal worms are not generated in the stomach, as Gilbert says, +because of the great heat produced by the process of digestion. In the +intestines they originate chiefly from the varieties of phlegm, e.g., +saline, sweet, acid, natural, etc. The species mentioned specifically +are lumbrici and ascarides or cucubitini, though the terms long, +round, short and broad are also employed, and probably include the +tape worm or taenia lata. The treatment of these parasites consists +generally in the use of aromatic, bitter or acid mixtures, among which +gentian, serpentaria, tithymal and cucumis agrestis are especially +commended for lumbrici, and enemata of wormwood, lupinus, scammony, +salt, aloes, etc., for ascarides. + +The diseases of the liver, though not numerous, are allotted +considerable space most of which is occupied by scholastic +speculations and the usual rich supply of therapeutical suggestions. + +Discrasia of the liver has several varieties, warm, cold, moist and +dry, and seems nearly equivalent to our somewhat overworked term of +"biliousness." Gilbert's favorite compounds for the relief of this +condition are the Trifera sarracenica, the Electuarium psilliticum and +above all the Dyantos Besonis. + +Obstruction (_oppilatio_) of the liver or enfraxis is defined as a +disease of the canals (_pori_), of which four are enumerated, to-wit, +the meseraic, that of the convexity of the organ (_gibbus--ubi sunt +exitus capillarium venarum_), the duct leading to the gall-bladder +and that leading to the spleen. With an abundance of symptoms, it is +singular that this comprehensive disease does not seem characterized +by any constant or severe pain, as we might reasonably expect. + +Abscess of the liver depends upon some vice of the blood, the bile, +the phlegm or the black-bile. The general treatment is poultices and +other maturatives, but, as the author adds rather sadly at the close, +_ultima cura est per incisionem_. + +Dropsy is discussed as an independent disease through the exhaustive +speculations of thirty-two pages. Gilbert tells us it depends upon +some fault of the digestive faculty of the liver, and he divides +it into four species, to-wit, leucoflantia, yposarcha, alchitis and +tympanitis, each of which has its special and appropriate treatment. +In the dreary waste of speculative discussion it is cheering, however, +to observe Gilbert's positive recognition of the sphere of percussion +indicated in the passage: + +"_Et venter percussus sonat ad modum utris semipleni aqua et venta._" +(f. 250b.) + +Ycteritia or jaundice receives equally thorough discussion through +eight weary pages, including the usual polypharmacal treatment. + +The spleen, Gilbert says, is sometimes the name of an organ, sometimes +of a disease. As an organ it is spongy and loose in texture, and +attracts and retains the superfluities of the black-bile, expelled +from the liver for its own cleansing. Hence it is a servile and +insensitive organ, and accordingly suffers different diseases, such +as obstruction, tumors, hardening, softening, abscess, and sometimes +flatulence or repletion. The symptoms and treatment of each of these +morbid conditions, arising from either heat or cold, are discussed +with exasperating thoroughness, and the chapter concludes with +the composition and use of various specific remedies of compound +character, bearing the impressive titles of Dyasene, Dyacapparis, +Dyaceraseos (a mixture of cherry juice, honey, cinnamon, mastic and +scammony) and Agrippa. + +Scrofulous swellings are carefully considered in a chapter entitled +"_De scrophulis et glandulis._" "Scrophulae and glandulae are hard +swellings developing in the soft parts, as in the emunctory localities +of the veins and arteries, particularly in the neck, armpits +and groins, and sometimes in other places. They spring from the +superfluities of the principal organs, which nature expels, as it +were, to the emunctories and localities designed to receive this +flux." ... "Hence they are often found the cause of scabies, tinea, +malum mortuum, cancer, fistula, etc., and are called glandes. +Sometimes, however, a dryer matter is finely divided and falls into +several minute portions, from which arise many hard and globular +swellings, called scrofulae from the multiplicity of their progeny, +like that of the sow (_scrofa_). The disease is also called _morbus +regius_, because it is cured by kings." + +Gilbert advises that these swellings should not be "driven in" +(_repercutienda_), but brought to suppuration generally by emollients +and poultices. When softened they may be opened with a lancet and the +pus allowed to escape gradually, but as this process is tedious, he +prefers the entire removal of the glands with the knife, premissing, +however, that no gland should be cut into which cannot be well grasped +by the hand and pulled from its seat. This surgical manipulation is +fully described, and is undoubtedly taken from the similar chapter +of Roger. It is worthy of notice also that just at the close of this +chapter, Gilbert mentions a swelling called "testudo," a gland-like, +gaseous (_ventosa_) tumor, usually solitary and found in "nervous" +localities, like the joints of the wrist and hand. He says it often +occurs from fracture (_cassatura_?) of the nerves, is cured by +pressure, friction or incision, but is not entirely free from danger. +Possibly this may refer to ganglion. Now, Roger makes no mention +whatever of "testudo," while Roland says: + +"_Nota quod quamvis Rogerius non designat inter glandulum et +testudinem, scias igitur quod testudo fit ex majori parte flegmatica, +minori melancholie, glandula vero a contrario_," a statement which +might readily suggest the suspicion that Gilbert had before his +eyes the text of Roland, or that, at least, he had not acquired his +knowledge of testudo from Roger, his usual surgical authority. + +Gilbert's sections on goitre (_bocium gulae_)[8] are interesting in +themselves, and characteristic of the method adopted by him in his +discussion of surgical or semi-surgical subjects. An introduction +relative to the pathology of the disease and which seems to be +original, is followed by a treatment, medical and surgical, adopted +almost literally from the Chirurgia of Roger. Thus he says: "Goiter +occurs most commonly among the inhabitants of mountainous regions, +and is due to an amplification and dilatation of the veins, arteries +and nerves, together with the soft tissues, occasioned by the north +wind (_ventum boreale_), or some other confined wind, which during +childhood has accumulated in (_coadunabatur_) and enlarged the part +to the size of the goiter." After suggesting an analogy between the +disease and the redness and turgidity of the neck produced by passion +or in singing, he adds that some cases are due to an accumulation +of spongy tissue between the veins and arteries, or to the use of +flatulent food, and he even tells us that some old women know how to +produce and remove goitrous swellings by means of certain suitable +herbs known to them. + +[Footnote 8: Cf. the French _bosse de la gorge_.] + +Under medical treatment we find the following: "Dig out of the ground +while chanting a pater noster, a nut which has never borne fruit. The +roots and other parts pound well with two hundred grains of pepper, +and boil down in the best wine until reduced in volume to one-half. +Let the patient take this freely on an empty stomach until cured." + +Another more elaborate prescription consists of a long list of +ingredients, including burnt sponge, saponaria, the milk of a sow +raising her first litter, with numerous simple herbs, and the sole +object for which this nonsensical farrago is introduced here is to add +that both these prescriptions are copied from the surgery of Roger. It +is important too to remark here that we owe to Roger the introduction +of iodine, under the form of burnt sponge, into the treatment of +goiter. + +In the failure of medical treatment, Gilbert directs the employment +of surgical means, e.g., the use of setons, or, in suitable cases, +extirpation of the goiter with the knife. If, however, the tumor is +very vascular, he prefers to leave the case to nature rather than +expose the patient to the dangers of a bloody operation. The whole +discussion of goiter is manifestly a paraphrase of the similar chapter +of Roger, who also introduced into surgical practice the use of the +seton. + +In Gilbert's chapter entitled "_De arthretica passione et ejus +speciebus_," we are introduced to the earliest discussion by an +English physician of that preeminently English disease--gout. We may +infer, too, from the length of the discussion (thirty or more pages) +that this was a disease with which Gilbert was not only familiar, but +upon the knowledge of which he prided himself greatly. Indeed, it is +one of the few diseases of the Compendium in which the author assumes +the position of a clinician and introduces examples of the disease +and its treatment taken from his own clientele. We shall, therefore, +follow our author here rather more carefully and literally than usual, +that we may learn the views of an English physician of the thirteenth +century on, perhaps, the most characteristic disease of his +countrymen. + +Gilbert says: "Arthetica is a disease of the joints arising from a +flux of humors descending into their continuity (_concathenationem_). +The name is derived from the Latin _artus_, a joint, and the disease +comprehends three species, viz., _sciatica_, disease of the scia, +or the ligaments uniting the spine with the hip; _cyragra_, disease +of the joints of the hands; and _podagra_, disease of the bones +and joints of the foot, due to the descent of humors into their +continuity. Sometimes, too, the disease affects other organs, +occasioning pain in sensitive members, as, e.g., the head, and then +derives its name from the part affected, as _cephalea_, _emigranea_ or +_monopagia_. Occasionally likewise some humor runs down (_reumatizat_) +into the chest, spreading over the nerves of the breast or those of +the spine between the vertebrae, and sometimes to other places. +Hence the disease derives the general name gout (_gutta_), from its +resemblance to a drop (_gutta_) trickling or falling downward and +flowing over the weaker organs, which receive the humor. For gout +arises particularly from rheumatic causes. Now, as the humors are +rather uncontrollable (_male terminabiles_) fluids, they flow towards +the exterior and softer parts, like the flesh and skin, which receive +their moisture and being soft, dilatable and extensible, there results +some swelling. But if the humors are hard and dry, they are confined +within the interior of the organs, such as bones, nerves and +membranes: and these, being hard in themselves, do not receive the +moisture, nor suffer extension or dilatation, and thus no swelling +results. Since, therefore, the material of this variety of arthetica, +in which no swelling is present, is formed of grosser and harder +substance and is found in the vicinity of hard and cold localities, it +is dissolved slowly and the disease is not cured until this solution +takes place. That form of the disease, however, in which there is +swelling from a subtile and liquid material deposited in the soft +parts is the more quickly cured. Hence swelling is the best sign +of curability. This is most evidently true in podagra, unless the +_materies morbi_, by reason of its scarcity, produces no enlargement +of the affected part." + +Quoting the words of Rhazes, Gilbert tells us that the _materies +morbi_ of gout is, for the most part, crude and bloody phlegm. Rarely +is it bilious, and still more rarely, melancholic. If, however, it is +compounded, it consists chiefly of bile mixed with a subtile phlegm, +and more rarely, of phlegm mixed with black bile (_melancholia_), +occasionally of black bile mixed with blood. The mixture of black bile +and blood or bile is very rare, and still rarer a mixture of all the +humors according to their proportion in the body. + +If the color of the affected part is red, it indicates that the +_materies morbi_ is sanguineous; if greenish-yellow (_citrinus_), that +it is bilious; if whiter than the general color of the body, that the +materies is a subtile phlegm. If the color shades away into black, it +does not signify necessarily that the materies is simply black bile, +for such a color occurs at the close of acute abscesses, or from +strangulation of the blood. But if, together with the black color, we +find the tissues cold and no increase of heat in the affected part, +this indicates that the _materies_ is black bile. + +By touching the diseased part we determine its heat or coldness, +hardness or softness, roughness or smoothness, fullness, distention or +evacuation, all of which signs possess special significance. + +The antecedent causes of gout, Gilbert tells us, are a heat too +solvent, cold too constringent (f. 311 c), sometimes a strong bath +or a severe journey in a plethoric person (_in plectorico_), again +excessive coitus after a full meal (_satietatem_), or even habitual +excess, by which the joints are weakened and deprived of their natural +heat and subtile moisture. Hence boys and eunuchs are not commonly +affected by gout--at least boys under the age of puberty. Women, too, +do not usually suffer from this disease, because in coitus they are +passive, unless their menstrual discharge is suspended. Again gout +sometimes arises from infection of the primary semen; for a chronic +disease may be inherited by the offspring and affect the material +causes, i.e., the humors. Flatulence (_ventositas_) is likewise a +cause of gout, as we have already hinted. + +In gout of the sanguineous type the favorite remedy of Gilbert was +venesection, pushed to extremes which suggest the bloody theories of +his later confrere Bouillaud. This bloodletting, however, was always +to be practiced on the side opposite to that affected by the disease, +as he tells us, for two reasons: First to solicit the peccant material +to the opposite side; and, second, to retard its course toward the +seat of the swelling. If, therefore, the disease is in the right foot, +he bleeds from the basilic vein, or some of its branches, in the right +hand. No other vein should be taken, but if neither the basilic vein +nor one of its branches can be found, the bleeding may be performed +upon the median vein, for certain branches of the basilic and cephalic +veins unite to form the median. If the disease is in the hand, the +material may be diverted in two ways, either to the other hand or to +the opposite foot. Indeed, blood may be taken from both these parts +in succession. The quantity of blood withdrawn should be in accordance +with the strength of the patient, the character of the swelling, the +pulsation, distention, heat and redness of the affected part. But it +should be repeated frequently, and this bloodletting then frequently +suffices, in itself, to cure the disease. + +Gilbert continues: "I will tell you also what I myself saw in a woman +suffering and screaming with pain in her right wrist (_assuere_?), +which was greatly swollen, hot, red and much distended. She was fat, +full-blooded, and before the attack had lived freely on milk and +flesh. Accordingly she was robust, and I bled her from the basilic +vein of the left hand and the saphena of the right foot, both within +an hour. Each hour I withdrew a half-pound of blood, then I fed her +and for three hours I drew half a pound of blood from the saphena. In +the last hour the pain and throbbing (_percussio_) ceased entirely, +and the woman begged me to bleed her again from the hand, for she had +experienced great relief. I wished, however, to divert the material +to the lower extremities for two reasons, one of which I ought not to +mention in this place, while the other is useful, and indeed necessary +in such cases. You should know that this woman was suffering pain in +her left hand also, though this pain was of a less severe character +than in the right. For this reason I desired to divert the peccant +matter downward, a point which the physician should consider and +observe. Once, while treating a man suffering from sanguineous gout, +the pain of which involved the joints between the assuerus and the +racheta (?) of the right hand, I asked him whether any pain was felt +in the other hand or in the feet. He replied that similar pain was +felt in the left hand or its joints, and that hitherto it had been +more severe, but that no pain had ever been experienced in the feet. +Hence I was unwilling to bleed him at all from the left hand, but I +bled him from the right foot. A physician who had treated him before, +and had bled him from the right hand for acute swelling of the joints +of the left, quieted, indeed, the pain in the left hand, but diverted +the disease to the right, where a swelling developed larger than in +the left. And when I asked him about this, he understood that I knew +more about medicine than the other doctor did. And this is one of +the reasons why one ought to divert the material to another part, +especially when the pain is so located that it may be increased at +the beginning. For under such conditions we ought to refrain from +bleeding, frictions and other treatment which may attract the +_materies morbi_ to the part. Indeed we ought to require derivation of +the materies to another part whenever the affected locality contains +one of the nobler organs, towards which the material is directing, or +may direct its course. For instance: A person is suffering pain in +the joints of the right hand, but has also an acute swelling in the +bladder, the kidneys or the womb. Now, I say that in such a case we +ought not to bleed from the hand, because if we do we shall injure the +organ affected by the swelling. Perhaps, however, we may bleed from +the right foot, provided we understand that there is on the right side +a sanguineous tumor, the danger of which is greater than that of the +swelling on the right hand. Again, suppose in the liver or in the +right kidney an acute tumor, and in the joints of the right hand there +is present a moderate pain. I say that we ought first to medicate the +more dangerous lesion, and, possibly, two results may be obtained by +the attraction of the peccant material. Or suppose a woman has gout in +her hand, and with this a suppression of the menstrual flow. I say she +ought to be bled from the foot and not from the hand for two objects, +to solicit the material from the diseased hand, and to provoke a +return of the menstrual discharge. + +"But to return to our original patient. I may say that after the third +venesection, with an interval of two hours, I withdrew a half-pound +of blood from the saphena vein, and that night she slept, although +she had not slept for many nights. And I did nothing more, except to +prescribe a light and cool diet. The third day after the bleeding she +was entirely free from any trouble in her hand. Hence I say that we +ought in such cases to begin our treatment by venesection." + +After this sanguinary introduction, Gilbert soothes the diseased part +with cooling and astringent ointments, unless these occasion pain, +in which event he omits them entirely and trusts the case to nature, +"_quoniam natura per se curabit_." + +The vigorous plan of treatment thus outlined Gilbert seems to regard +as original and peculiar to himself, for the next chapter bears the +title, "The treatment of gout according to the authorities (_secundum +magistros_)." Here he says he quotes the opinions of the modern +teachers and writers, who lay down definite rules for the guidance of +the physicians. + +Among these he mentions, as primary and of general application, the +rule that, before all things, the body must be purified, either +by venesection in cases where the material is sanguineous, or by +purgation in other varieties of the disease. If the cause is rheumatic +in its nature, fomentations should never be employed, for fear of +increasing the flux. That the peccant material is to be eliminated +gradually by mild remedies, just as it accumulated by degrees. In all +cases of gout, and in all chronic diseases generally, much attention +must be devoted to the stomach, since if this organ rejects the +medicine, the latter must be at once abandoned, lest the stomach +becomes weakened and even other organs, and thus the humors flow more +readily (_magis reumatizarent_) to the joints, etc. + +These general medical rules are succeeded by some twenty pages devoted +largely to special formulae for the different forms of gout, with +remarks as to their applicability to the different varieties of the +disease. Most of the formulae bear special titles, apparently to lend +the weight of a famous name to the virtues of the prescription itself, +something as in these modern days we speak of "Coxe's Hive Syrup," +"Dover's Powder," "Tully's Powder," etc. Thus we read of the "_Pilulae +artheticae Salernitorum_," the "_Cathapcie Alexandrine_," the "_Oxymel +Juliani_" the "_Pilulae Arabice_," the "_Pulvis Petrocelli_," +the "_Oleum benedictum_," the "_Pilulae Johannicii_," etc. It is +important, too, to remark that the active ingredient of very many +of these formulae is the root called hermodactyl, believed by the +majority of our botanists to be the _colchicum autumnale_. + +Gilbert's discussion of gout closes with a short and characteristic +chapter entitled "_Emperica_," in which he remarks: "Although I +perhaps demean myself somewhat in making any reference to empirical +remedies, yet it is well to write them in a new book, that the work +may not be lacking in what the ancients (_antiqui_) have said on the +subject. Accordingly I quote the words of Torror. If you cut off the +foot of a green frog and bind it upon the foot of a gouty patient for +three days, he will be cured, provided you place the right foot of +the frog upon the right foot of the patient, and vice versa. Funcius, +also, who wrote a book on stones, said that if a magnet was bound upon +the foot of a gouty patient, he is cured. Another philosopher also +declared that if you take the heel-bone of an ass and bind it upon +the foot of the patient, he is cured, provided that you take the right +bone for the right foot, and conversely, and he swore this was true. +Torror also said that if the right foot of a turtle is placed upon the +right foot of a patient suffering from the gout, and conversely, he +will be cured." + +Gilbert's discussion of leprosy (_De lepra_, f. 336 d) covers twenty +pages and, according to Sprengel, is "almost the first correct +description of this disease in the Christian West." Freind says this +chapter is copied chiefly _from_ Theodorius of Cervia. See page 3 +ante. If, however, I am correct in my conjecture that the Compendium +was written about the year 1240, the copying must have been done _by_ +Theodorius, whose "Chirurgia" did not appear until 1266. + +Leprosy is defined as a malignant disease due to the dispersion of +black bile throughout the whole body, corrupting both the constitution +(_complexionem_) and the form of its members. Sometimes, too, it +occasions a solution of continuity and the loss of members. + +The disease is sometimes congenital, arising from conception during +the menstrual period. For the corrupt blood within the maternal +body, which forms the nourishment of the fetus, leads likewise to the +corruption of the latter. Sometimes the disease is the result of a +corrupt diet, or of foul air, or of the breath or aspect of another +leper. Avicenna tells us that eating fish and milk at the same meal +will occasion the same result. Infected pork and similar articles of +diet may likewise produce the disease. Cohabitation with a woman who +has previously had commerce with a leper may also produce infection. + +Among the general symptoms of leprosy Gilbert enumerates a permanent +loss of sensation proceeding from within (_insensibilitas mansive ad +intrinseco veniens_) and affecting particularly the fingers and toes, +more especially the first and the little finger, and extending to +the forearm, the arm or the knees; coldness and formication in the +affected parts; transparency (_luciditas_) of the skin, with the +loss of its natural folds (_crispitudines_), and a look as if tightly +stretched or polished; distortion of the joints of the hands and feet, +the mouth or the nose, and a kind of tickling sensation as if some +living thing were fluttering within the body, the thorax, the arms +or the lips. There is felt also a sensation of motion, which is even +visible also by inspection. Fetor of the breath, the perspiration and +the skin are likewise noticeable. The localities affected lose their +natural hair and are re-covered with very fine hairs, invisible except +when held between the eye and the sun. The hair of the eyebrows +and the eyelashes are lost--one of the worst of symptoms. There are +present also hoarseness and an obstruction of the nostrils, without +any visible cause. When the patient takes a bath the water runs off +the affected localities as if they had been greased--another sign of +evil omen. The angles of the eyes are rounded and shining. The skin, +even when unaffected by cold, or other similar cause, is raised into +very minute pimples, like the skin of a plucked goose. The blood in +venesection has an oily appearance, and displays small particles like +sand. Small tumors accompany the depilation of the eyebrows. Lepers +are unusually and unduly devoted to sexual pleasures, and suffer +unusual depression after sexual indulgence. The skin is tormented +with a constant itching, and is alternately unduly hot or cold. Small +grains are found under the tongue, as in leprous hogs. + +Gilbert divides leprosy into four varieties, _elephantia_, _leonina_, +_tyria_ and _allopicia_, the pathology, symptoms and treatment of each +of which are presented with wearisome minuteness and completeness. +A long chapter, entitled "_De infectione post coitum leprosi_," +discusses the transmission of the disease by means of sexual +intercourse, and suggests the possible confusion of lepra and +syphilis. + +The usual catalogue of specific remedies terminates the discussion. + +An interesting chapter on small-pox[9] and measles, "_De variolis et +morbillis_," gives us the prevailing ideas relative to these diseases +in England during the thirteenth century. Premising his remarks with a +classification of diseases as follows: + +Diseases universal and infectious--like _morphoea_, _serpigo_, +_lepra_, _variolae et morbilli_. + +Diseases universal but not infectious. + +Diseases infectious but not universal--like _noli me tangere_. + +Diseases neither infectious nor universal. + +Gilbert classifies _variolae et morbilli_ among the universal and +infectious diseases, and in the species _apostemata_. To this latter +species belong also _ignis Persicus_, _carbunculus_ and _antrax_. + +[Footnote 9: It is at least interesting to know that small-pox is said +to have made its first appearance in England in 1241.] + +_Variolae et morbilli_ arise from moist matter confined in the body +and turbid, like turbid blood. Hence the disease occurs most commonly +in boys and in those who are careless about cleanliness and neglect +venesection. It is the result of a disposition of the blood resembling +putrescence, in which there occurs an external ebullition in the +efforts of nature to purify the interior of the body and to expel +to the surface the virulent material within. Accordingly the common +people declare that persons who have suffered from _variolae et +morbilli_ never acquire leprosy. Occasionally, too, the disease arises +from excessive corruption of matter in repletion of blood, and hence +it is more frequent in sanguineous diseases, like synocha, and during +the prevalence of south winds or the shifting of winds to the south, +and in infancy--the age characterized particularly by heat and +moisture. + +The eruptions vary in color in accordance with the mixture of the +different humors with the corrupt blood. Hence some are light colored, +some the color of saffron, some red, some green, some livid, some +black, and the virulence of the disease is the greater, the nearer +the color approaches to black. There are, too, four varieties of the +eruption, distinguished by special names. When the eruption is light +colored and tends to suppuration, it is called _scora_. When it +is very fine and red, it is called _morbilli_ or _veterana_. The +distinction between _variolae_ and _morbilli_ is in the form and +matter of the disease, for in _variolae_ the pustules are large and +the matter bilious (_colerica_), while in morbilli the eruption is +smaller and does not penetrate the skin (_non-pertransit cutem_). +_Variolae_, on the contrary, forms a prominent pustule (_facit +eminentiam_). A third form of the disease displays only four or five +large, black pustules on the whole body, and this form is the most +dangerous, since it is due to an unnatural black bile, or to acute +fevers, in which the humors are consumed. This variety bears the name +of _pustula_. A fourth form is called _lenticula_. This latter form +occurs sometimes with fever, like synocha, sometimes without fever, +and it arises from pestilential air or corrupt food, or from sitting +near a patient suffering from the disease, the exhalations of which +are infectious. + +The premonitory symptoms of _variolae_ are a high fever, redness of +the eyes, pain in the throat and chest, cough, itching of the nose, +sneezing and pricking sensations over the surface of the body. + +_Morbilli_ is a mild disease, but requires protection from cold, which +confines and coagulates the peccant matter. + +Attention is directed to the not infrequent ulcers of the eyes, which +occur in _variolae_ and may destroy the sight; also to ulcerations +of the nose, throat, oesophagus, lungs and intestines, the latter of +which often produce a dangerous diarrhoea. + +When _variolae_ occurs in boys, it is recommended to tie the hands of +the patient to prevent scratching. + +Whey is said to be an excellent drink for developing the eruption of +_variolae_, and the time-honored saffron (_crocus_) appears in several +of Gilbert's prescriptions for this disease. Here, too, we find +the earliest mention of the use of red colors in the treatment of +_variolae_ (f. 348 c): + +"_Vetule provinciales dant purpuram combustam in potu, habet enim +occultam naturam curandi variolas. Similiter pannus tinctus de +grano._" + +Acid and saline articles of food should be avoided, sweets used +freely, and the patients should be carefully guarded from cold. + +Not the least interesting pages of the Compendium are those (there are +about twenty of them) devoted to the discussion of poisons, poisoned +wounds and hydrophobia. + +An introductory chapter on the general subject of the character of +poisonous matters, illustrated by some gruesome and Munchausen-like +tales, borrowed mainly from Avicenna and Ruffus, on the wonders +of acquired immunity to poisons, the horrors of the basilisk, the +_armaria_ (_?_), the deaf adder (_aspis surda_) and the red-hot +_regulus_ of Nubia, leads naturally to the consideration of some +special poisons derived from the three kingdoms of nature. Very +characteristically Gilbert displays his caution in the discussion of a +dangerous subject by the following preface: + +_Abstineamus a venesis occultis quae non sunt manifesta, ne virus in +angues adjiciamus, aut doctrinam perniciosam tradere videamur_ (f. 351 +a). + +Beginning then with metallic mercury (_argentum vivum_), he considers +the poisonous effects of various salts of lead and copper, the +vegetable poisons hellebore, anacardium (_anacardis?_), castoreum, +opium and cassilago (_semina hyoscyami_), and then proceeds to +the bites or rabid men and animals, hydrophobia, and the bites of +scorpions, serpents and the _animalia annulosa_, that is, worms, +wasps, bees, ants and spiders. + +Space does not permit a careful review of this interesting subject, +but a novel form of poisoning by the use of quicksilver is startling +enough to claim our attention. Gilbert tells us that pouring metallic +mercury into the ear produces the most distressing symptoms, severe +pain, delirium, convulsions, epilepsy, apoplexy and, if the metal +penetrates to the brain, ultimate death. In the treatment of this +condition certain physicians had recommended the insertion into the +ear of a thin lamina of lead, upon which it was believed that the +mercury would fasten itself and might thus be drawn out. Avicenna +objected to this that the mercury was liable to speedily pass into the +ear so deeply as to be beyond the reach of the lead. Gilbert suggests +as an improvement of the treatment that a thin lamina of gold be +substituted for the lead, "because mercury thirsts after gold as +animals do after water, as it is held in the books on alchemy" (_in +libris allzinimicis_). This fact, too, he tells us can be easily +demonstrated externally by placing upon a plate a portion of gold, +and near, but not in contact with it, a little quicksilver, when the +silver, he says, will at once "leap" upon the gold. Avicenna suggests +that the patient stand upon the foot of the side affected, lean his +head over to the same side, steady it in that position with the hands, +and then leap suddenly over upon the other foot--demonstrating thereby +his knowledge of both gravity and inertia. Manifestly our "laboratory +physicians" of the present day can assume no airs of priority! + +The Compendium closes with two very sensible chapters on the hygiene +of travel, entitled "_De regimine iter agentium_" and "_De regimine +transfretantium_." + +In the hygiene of travel by land Gilbert commends a preliminary +catharsis, frequent bathing, the avoidance of repletion of all kinds, +an abundance of sleep and careful protection from the extremes of +both heat and cold. The strange waters may be corrected by a dash of +vinegar. Some travelers, he tells us, carry with them a package of +their native soil, a few grains of which are added to the foreign +waters, as a matter of precaution, before drinking. The breakfast of +the traveler should be light, and a short period of rest after a day's +travel should precede the hearty evening meal. Leavened bread two or +three days old should be preferred. Of meats, the flesh of goats or +swine, particularly the feet and neighboring parts, which, Gilbert +tells us, the French call _gambones_, the flesh of domestic fowls and +of the game fowls whose habitat is in dry places, is to be preferred +to that of ducks and geese. Of fish, only those provided with scales +should be eaten, and all forms of milk should be avoided, except whey, +"which purifies the body of superfluities." Fruits are to be eschewed, +except acid pomegranates, whose juice cools the stomach and relieves +thirst. Boiled meats, seasoned with herbs like sage, parsley, mint, +saffron, etc., are better than roasted meats, and onion and garlic are +to be avoided. + +The primitive conditions of land travel in the days of Gilbert are +emphasized by his minute directions for the care of the feet, which he +directs to be rubbed briskly with salt and vinegar and then anointed +with an ointment of nettle-juice (_urtica_) and mutton-fat, or with +a mixture of garlic, soap and oil. If badly swollen, they should be +bathed, before inunction, with a decoction of elder-bark and other +emollients. + +In travel by sea, Gilbert tells us the four chief indications are to +prevent nausea, to allay vomiting, to palliate the foul odor of the +ship and to quiet thirst. + +For the prevention of nausea he recommends the juice of acid +pomegranates, lemons, etc., or a decoction of parsley or sweet cicely +(_cerfolium_). The traveler should endeavor to sit with his head +erect, should avoid looking around, but maintain his head as immovable +as possible, and support himself by a firm grasp upon some beam of the +ship. Some sweets may be sucked, or he may chew a few aromatic seeds. +If vomiting ensues, acid or sweet pomegranates, figs or barley-sugar +(_penides_) may be taken sparingly, but no food should be ingested +until the stomach is thoroughly quieted. Then the patient may take a +little _stomatichon_ or _dyantos_, and a small portion of digestible +food. As the diet must necessarily consist largely of salty food and +vegetables, these should be cooked in three or four different waters, +and then soaked in fresh water. A little aromatic wine will also +benefit the patient, and a few aromatic seeds chewed in the morning +are also of service. + +The effect of the foul odors of the ship may be combatted by the use +of aromatic electuaries, "which comfort the heart, the brain and the +stomach." The patient should be removed to some quiet portion of the +ship, as distant as possible from the channels for the discharge of +the bilge-water, and short walks upon the upper deck will contribute +to convalescence. Frequent changes of clothing will palliate the +annoyance of fleas and pediculi. Drinking water may be purified by +aeration, or by straining, boiling and subsequent sedimentation and +removal of the sediment by filtration through fresh and clean sand. +For the wealthy, the water may be distilled in an alembic, if such an +apparatus is obtainable. Avicenna says that bad water may be corrected +by the addition of vinegar. Exposure to the midday sun and to the +nocturnal cold, constipation and diarrhoea should be avoided, and +prompt attention should be given to all disorders of the health. + +To these wise counsels Gilbert courteously adds a medieval _bon +voyage_ in these words: + +"_Dominus autem omnia dirigat in tranquilitate. Amen._" + +It has been already remarked upon a preceding page that Gilbert of +England was not a surgeon. Nevertheless it is only fair to say that +the surgical chapters of the Compendium present a more scientific and +complete view of surgical art, as then known, than any contemporaneous +writings of the Christian West, outside of Italy. + +It is well known that during the Middle Ages the practice of surgery +in western Europe was generally regarded as disreputable, and +operative surgery was for the most part relegated to butchers, +barbers, bath-keepers, executioners, itinerant herniotomists and +oculists, _et id omne genus_, whose pernicious activity continued to +make life precarious far down into the modern period. + +In Italy alone did surgery vindicate for itself an equality with +medicine, and the pioneer of this advance was Roger of Parma, who, as +we have seen, flourished early in the thirteenth century. Roger and +his pupil Roland, with the somewhat mythical "Four Masters" (_Quatuor +Magistri_), were the surgical representatives of the School of +Salernum, while Hugo (Borgognoni) di Lucca and his more famous son +Theodorius represented the rival school of Bologna. Equally famous +Italian surgeons of this century were Bruno of Logoburgo (in Calabria) +and Gulielmus of Saliceto (1275), the master of Lanfranchi (1296). +Gilbert of England, as a pupil of Salernum, naturally followed the +surgical teachings of that school, and we have already noticed that +his chapters on surgery are taken chiefly from the writings of Roger +of Parma, though the name of neither Roger, nor indeed of any other +distinctly surgical writer, is mentioned in the Compendium. How +closely in some cases Gilbert followed his masters may best be seen +by a comparison of their respective chapters upon the same subject. +I accordingly introduce here for such comparison Roger's chapter on +wounds of the neck, and the corresponding chapter of Gilbert. Roger +says: + +"_De vulnere quod fit in cervice._ + +"_Si vero cum ense vel alio simili in cervice vulnus fiat, ita quod +vena organica incidatur, sic est subveniendum. Vena tota sumatur +(suatur) cum acu, ita quod vena non perforetur, et ex alia parte +acus cum filo ei inhaerente ducatur, et cum ipso filo nectatur atque +stringatur, quod sanguinem non emittat: et ita facias ex superiori +parte et inferiori. In vulnere autem pannus infusus mittatur, non +tamen de ipso vulnus multum impleatur. Embrocha, si fuerit in myeme, +superponatur quosque (quousque) vulnus faciat saniem. Si vero fuerit +in aestate vitellus avi semper superponatur. Quum autem saniem +fecerit, cum panno sicco, unguento fusco et caeteris bonam carnem +generantibus, adhibeatur cura, ut in caeteris vulneribus. Quum vero +extremitatem venae superioris partis putruisse cognoveris, fila +praedicta dissolvas, et a loco illo removeas: et deinde procedas ut +dictum est superius. A. Si vero nervus incidatur in longum aut ex +obliquo, sed non ex toto, hac cura potest consolidari. Terrestres +enim vermes, idest qui sub terra nascuntur, qui in longitudine +et rotunditate lumbricis assimilantur, et apud quondam terrestres +lumbrici dicuntur, accipiantur et aliquantulum conterantur et in oleo +infusi ad ignem calefiant: et nullo alio mediante, ter vel quater, vel +etiam pluries, si opportunum videbis, plagae impone. Si vero incidatur +ex obliquo totus, minime consolidatur: praedicto tamen remedio non +coadjuvante saepe conglutinatur. Potest etiam cuticula, quae supra +nervum est, sui, pulvisque rubens, qui jam dictus est, superaspergi, +quae cura non est inutilis, aliquos enim non solum conglutinatas, +sed etiam consolidatas, nostra cura prospeximus. Si vero locus tumet, +embrocham illam, quam in prima particula ad tumorem removendum, qui +ex percussura contigit, praediximus, ponatur, quousque talis tumor +recesserit._" + +Gilbert, after premising two short chapters entitled "_De vulneribus +colli_" and "_De perforatione colli ex utraque parte_," continues as +follows: + +"_De vena organica incisa._ + +"_Si vena organica in cervice incidatur: tota vena suatur cum acu, ita +quod vena non perforetur, et ux alia parte acus cum filo ei adherente +ita nectatur atque stringatur quod (non) emittat sanguinem, et ita +fiat ex superiori parte et inferiore vene. In vulnere autem pannus +infusus in albumine ovi mittatur, nec tamen de ipso panno vulnus +multum impleatur. Embroca vero superius dicta, si in hyeme fuerit, +superponatur, donec vulnus saniem emittat. Si vere in estate, vitellum +ovi tum super ponatur, et cum saniem fecerit, panno sicco, et unguento +fusco et ceteris regenerantibus carnem, curetur. Cum vero extremitatem +vene superioris et inferioris putruisse cognoveris, fila dissolvantur +et a loco removeantur, et deinde ut dictum est procedatur._ + +"_De incisione nervi secundum longum aut secundum obliquum._ + +"_Si vero secundum longum aut obliquum vervi incidantur, et non ex +toto, ita consolidamus. Terrestres vermes, qui sub terra nascuntur, +similes in longitudine et rotunditate lumbricis, qui etaim lumbrici +terre appellantur: hi aliquantulum conterantur et in oleo infusi ad +ignem calefiant, et nullo aliomediante, ter vel quater vel pluries, +si opportunum fuerit, plagelle impone. Si vero ex oblique nervus +incidatur, eodem remedio curatur, et natura cooperante saepe +conglutinatur. Potest quoque cuticula quae supra nervum est sui, et +pulvis ruber superaspergatur. Nervos enim conglutinari et consolidari +hoc modo sepius videmus. Si vero locus tumeat, embroca, praedicta in +vulnere capitis quae prima est ad tumorem removendum, superponatur, +quousque tumor recesserit. Si vena organica non inciditur, +pannus albumine ovi infusus in vulnere ponatur. Embroca vero post +desuperponatur_" (f. 179 c). + +The selection and collection of words and phrases in these two +passages leaves little doubt that one was copied from the other. +Indeed, so close is their resemblance that it is quite possible from +the one text to secure the emendation of the other. Numerous similar +passages, with others in which the text of Gilbert is rather a +paraphrase than a copy of the text of Roger, serve to confirm the +conclusion that the surgical writings of the English physician are +borrowed mainly from the "Chirurgia" of the Italian surgeon. Some few +surgical chapters of the Compendium appear to be either original or +borrowed from some other authority, but their number is not sufficient +to disturb the conclusion at which we have already arrived. Now, as +Roger's "Chirurgia" was probably committed to writing in the year +1230, when the surgeon was an old man, these facts lead us to the +conclusion that Gilbert must have written his Compendium at least +after the date mentioned. + +Another criticism of these chapters suggests certain interesting +chronological data. It will be observed that Roger, in the passage +quoted above, recommends a dressing of egg-albumen for wounds of the +neck, and expresses considerable doubt whether nerves, when totally +divided, can be regenerated (_consolidari_), though they may +undoubtedly be reunited (_conglutinari_). + +Now Roland, in his edition of Roger's "Chirurgia," criticises both of +these statements of his master, as follows: + +_Nota quod quamvis Rogerius dicat quod apponatur albumen ovi, non +approbo, quia frigidum est naturaliter, et vena et nervus et arteria +frigida sunt naturaliter, et propter frigiditatem utrorumque non +potest perfecte fieri consolidatio._ + +And again: + +_Nota quod secundum Rogerium nervus omnino incisus non potest +consolidari, vel conjungi nec sui. Nos autem dicimus quod potest +consolidari et iterum ad motum reddi habillis, cum hac cautela: +Cauterizetur utrumque caput nervi incisi peroptime cum ferro candenti, +sed cave vulneris lobia cum ferro calido tangantur. Deinde apponantur +vermes contusi et pulveres consolidativi, etc._ + +It will be observed that Gilbert, in spite of the rejection by Roland +of the egg-albumen dressing of Roger, still recommends its use in +wounds of the neck, and although he professes to have seen many nerves +regenerated (_consolidari_) under the simple angle-worm treatment +of his master, he still makes no mention of the painful treatment of +divided nerves by the actual cautery, so highly praised by Roland. It +would seem, therefore, that Gilbert was not familiar with the writings +of Roland when his Compendium was written, or he would, doubtless, +not have omitted so peculiar a plan of treatment in an injury of such +gravity. As Roland's edition of Roger's "Chirurgia" is said to have +been written in 1264, the comparison of these passages would seem to +indicate that Gilbert must have written the Compendium after 1230 and +prior to the year 1264. + +Gilbert's surgical chapters discuss the general treatment of wounds +and their complications, and more specifically that of wounds of the +head, neck, throat, wounds of nerves, of the oesophagus, scapula, +clavicle, of the arm, the stomach, intestines and the spleen; +fractures of the clavicle, arm, forearm and ribs; compound fractures; +dislocations of the atlas, jaw, shoulder and elbows; fistulae in +various localities, and the operations on the tonsils and uvula, on +goitre, hernia and stone in the bladder, etc.--certainly a surgical +compendium of no despicable comprehensiveness for a physician of his +age and country. + +In the general treatment of wounds (f. 86 c) Gilbert tells us +the surgeon must consider the time, the age of the patient, his +temperament (_complexio_) and the locality, and be prepared to +temper the hot with the cold and the dry with the moist. Measures +for healing, cleansing and consolidation are required in all wounds, +and these objects may, not infrequently, be accomplished by a single +agent. The general dressing of most wounds is a piece of linen +moistened with the white of egg (_pecia panni in albumine ovi +infusa_), and, as a rule, the primary dressing should not be changed +for two days in summer, and for three days in the winter. In moist +wounds _vitreolum_ reduces the flesh; in dry wounds it repairs and +consolidates. _Flos aeris_, in dry wounds, reduces but does not +consolidate, but rather corrodes the tissues. Excessive suppuration +is sometimes the result of too stimulating applications, sometimes +of those which are too weak. In the former case the wound enlarges, +assumes a concave form, is red, hot, hard and painful, and the pus is +thin and watery (_subtilis_). If the application is too weak, the pus +is thick and viscous, and the other signs mentioned are wanting. In +either case the dressings are to be reversed. If any dyscrasia, such +as excessive heat, coldness, dryness or moisture appears in the wound +and delays its healing, it is to be met by its contrary. If fistula or +cancer develops, this complication is to be first cured and then the +primary wound. The signs of a hot dyscrasia are heat, burning and pain +in the wound; of a cold dyscrasia, lividity of the wound; the moist +dyscrasia occasions flabbiness (_mollicies_) and profuse suppuration, +and the dry produces dryness and induration. + +Wounds of the head (f. 84 c) occur with or without fracture of the +cranium, but always require careful examination and exact diagnosis. +The wound is to be carefully explored with the finger, and, if +necessary, should be enlarged for this purpose. Large, but simple, +wounds of the scalp should be stitched with silk in three or four +places, leaving the most dependent angle open for escape of the +discharges, and in this opening should be inserted a tent (_tuellus_), +to facilitate drainage. The wound is then sprinkled with the _pulvis +rubeus_ and covered with a plantain or other leaf. On the ninth to the +eleventh day, if the wound seems practically healed, the stitches are +to be removed and the cure completed with simple dressings. + +The signs and symptoms of fracture of the cranium are: Loss +of appetite and failure of digestion, insomnia, difficulty in +micturition, constipation, a febrile dyscrasia, difficulty in cracking +nuts or crusts of bread with the jaws, or severe pain when a string is +attached to the teeth and pulled sharply. If the meninges are injured +we have further: headache, a slow and irregular but increasing fever, +alternating with chills, distortion of the angles of the eyes, redness +of the cheeks, mental disturbances, dimness of vision, a weak voice +and bleeding from the ears or the nose. In the presence of such +symptoms the death of the patient may be expected within at most a +hundred days. + +If the fracture of the cranium is accompanied by a large scalp wound, +any fragments of bone or other foreign body are to be extracted at +once, unless haemorrhage or the weakness of the patient are feared, +and then a piece of linen is to be cautiously worked in with a feather +between the cranium and the dura mater. In the fracture itself a piece +of linen, or better of silk, is inserted, the apparent purpose of this +double dressing being to protect the dura mater from the discharges +and to solicit their flow to the exterior. A piece of sponge, +carefully washed, dried and placed in the wound, Gilbert tells us, +absorbs the discharges satisfactorily and prevents their penetration +internally. Over the wound is placed a bit of linen moistened with +egg-albumen, then a dressing of lint, and the whole is maintained in +place by a suitable bandage. Finally the patient is to be laid in bed +and maintained in such a position that the wound will be dependent, so +as to favor the ready escape of the discharges. This dressing is to be +renewed three times a day in summer, and twice in winter. Proud flesh +upon the dura mater is to be repressed by the application of a sponge, +well-washed and dried, and if it appears upon the surface of the wound +after the healing of the fracture, it is to be destroyed by the use of +the hermodactyl. When the external wound is healed, the cicatrix is +to be dressed with the _apostolicon cyrurgicum_, an ointment very +valuable for the consolidation of bones, the leveling (_adaequatio?_) +of wounds, etc. + +When the wound of the scalp is small, so as to render difficult the +determination of the extent of the fracture by exploration with the +finger, it should be enlarged by crucial incisions, the flaps loosened +from the cranium by a suitable scraper (_rugine_) and folded back +out of the way, and any fragments of bone removed by the forceps +(_pinceolis_). If, however, haemorrhage prevents the immediate removal +of the fragments, this interference may be deferred for a day or +two, until the bleeding has stopped or has been checked by suitable +remedies. Then, after their removal, the piece of linen described +above is to be inserted between the cranium and dura mater. Upon the +cranium and over the flaps of the scalp, as well as in their angles, +the ordinary dressing of albumen is to be applied, covered by a +pledget of lint and a suitable bandage. No ointment, nor anything +greasy, should be applied until after the healing of the wound, lest +some of it may accidentally run down into the fracture and irritate +the dura matter. Some surgeons, Gilbert tells us, insert in the place +of the fragments of the cranium removed a piece of a cup (_ciphi_) or +bowl (_mazer_), or a plate of gold, but this plan, he says, has been +generally abandoned (_dimittitur_.) + +Sometimes the cranium is simply cracked without any depression of the +bone, and such fractures are not easily detected. Gilbert tells us, +however, that if the patient will close firmly his mouth and nose and +blow hard, the escape of air through the fissured bone will reveal the +presence of the fracture (f. 88a). In the treatment of such fissures +he directs that the scalp wound be enlarged, the cranium perforated +very cautiously with a trepan (_trepano_) at each extremity of the +fissure and the two openings then connected by a chisel (_spata_?), +in order to enable the surgeon to remove the discharges by a delicate +bit of silk or linen introduced with a feather. If a portion of the +cranium is depressed so that it cannot be easily raised into position, +suitable openings are to be made through the depressed bone in order +to facilitate the free escape of the discharges. + +Gunshot wounds were, of course, unknown in Gilbert's day. In a chapter +entitled "_De craneo perforato_" he gives us, however, the treatment +of wounds of the head produced by the transfixion of that member by an +arrow. If the arrow passes entirely through the head, and the results +are not immediately fatal, he directs the surgeon to enlarge the wound +of exit with a trephine, remove the arrowhead through this opening, +and withdraw the shaft of the arrow through the wound of entrance. The +wounds of the cranium are then to be treated like ordinary fractures +of that organ (f. 88c). + +In wounds of the neck involving the jugular vein (_vena organica_), +Gilbert directs ligation of both extremities of the wounded vessel, +after which the wound is to be dressed (but not packed) with the +ordinary dressing of egg-albumen. + +Wounds of nerves are treated with a novel dressing of earthworms +lightly beaten in a mortar and mixed with warm oil, and he professes +to have seen nerves not only healed (_conglutinari_), but even the +divided nerve fibres regenerated (_consolidari_) under this treatment. +In puncture of a nerve Gilbert surprises us (f. 179d) by the advice +to divide completely the wounded nerve, in order to relieve pain and +prevent tetanus (_spasmus_). + +Goitre, not too vascular in character, is removed by a longitudinal +incision over the tumor, after which the gland is to be dragged out, +with its entire capsule, by means of a blunt hook. A large goitre in +a feeble patient, however, is better left alone, as it is difficult +to remove all the intricate roots of the tumor, and if any portion is +left it is prone to return. In such cases Gilbert says we shrink +from the application of the actual cautery, for fear of injury to +the surrounding vessels and nerves. Whatever method of operation is +selected, the patient is to be tied to a table and firmly held in +position. + +Wounds of the trachea and oesophagus, according to Gilbert, are +invariably mortal. + +In wounds of the thorax the ordinary dressing of albumen is to be +applied, but if blood or pus enters the cavity of the thorax, the +patient is directed to bend his body over a dish, twisting himself +from one side to another (_supra discum[10] flectat se modo hac modo +ilac vergendo_) until he expels the sanies through the wound, and to +always lie with the wound dependent until it is completely healed (f. +182d). + +[Footnote 10: It is interesting to observe how the Latin discus +developed dichotomously into the English "dish" and the German +"Tisch." The former is doubtless the meaning of the word in this +place.] + +In case an arrow is lodged within the cavity of the thorax, the +surgeon is directed to trepan the sternum (_os pectoris_), remove the +head of the arrow gently from the shaft, and withdraw the shaft itself +through the original wound of entrance. If the head is lodged beneath +or between the ribs, an opening is to be made into the nearest +intercostal space, the ribs forced apart by a suitable wedge and +the head thus extracted. The wound through the soft parts is to be +kept open by a tent greased with lard and provided with a suitable +prolongation (_cauda aliqua_) to facilitate its extraction and prevent +its falling into the cavity of the chest. + +Wounds of the heart, lungs, liver, stomach and diaphragm are regarded +as hopelessly mortal (f. 233d), and the physician is advised to have +nothing to do with them. Wounds of the heart are recognized by the +profuse haemorrhage and the black color of the blood; those of the +lung by the foamy character of the blood and the dyspnoea; wounds of +the diaphragm occasion similar dyspnoea and are speedily fatal; those +of the liver are known by the disturbance of the hepatic functions, +and wounds of the stomach by the escape of its contents. Wounds of +the intestine are either incurable, or at least are cured only with +the utmost difficulty. Longitudinal wounds of the spine which do not +penetrate the cord may be repaired, but transverse wounds involving +the cord, so that the latter escapes from the wound, are rarely, if +ever, cured by surgery. Wounds of the kidneys are also beyond the art +of the surgeon. Wounds of the penis are curable, and if the wound is +transverse and divides the nerve, they are likewise painless. + +_Si vene titillares in coxis abscidantur homo moritur ridendo._ A +passage which I can refer only to the erudition and risibility of our +modern surgeons and anatomists. The ticklish _vene titillares_ are to +me entirely unknown. + +Modern abdominal surgeons will probably be interested in reading +Gilbert's chapter on the treatment of wounds of the intestines in the +thirteenth century. He says (f. 234c): + +If some portion of the intestine has escaped from a wound of the +abdomen and is cut either longitudinally or transversely, while the +major portion remains uninjured; if the wound has existed for some +time and the exposed intestine is cold, some living animal, like a +puppy (_catulus_), is to be killed, split longitudinally and placed +over the intestine, until the latter is warmed, vivified by the +natural heat and softened. Then a small tube of alder is prepared, an +inch longer than the wound of the intestine, carefully thinned down +(_subtilietur_) and introduced into the gut through the wound and +stitched in position with a very fine square-pointed needle, threaded +with silk. This tube or canula should be so placed as to readily +transmit the contents of the intestine, and yet form no impediment to +the stitches of the wound. When this has been done, a sponge moistened +in warm water and well washed should be employed to gently cleanse the +intestines from all foreign matters, and the gut, thus cleansed, is to +be returned to the abdominal cavity through the wound of the abdominal +wall. The patient is then to be laid upon a table and gently shaken, +in order that the intestines may resume their normal position in the +abdomen. If necessary the primary wound should be enlarged for this +purpose. When the intestines have been thus replaced, the wound in +the abdominal wall is to be kept open until the wound of the intestine +seems healed. Over the intestinal suture a little _pulvis ruber_ +should be sprinkled every day, and when the wound of the intestine is +entirely healed (_consolidatur_), the wound of the abdominal wall is +to be sewed up and treated in the manner of ordinary flesh wounds. + +If, however, the wound is large, a pledget (_pecia_) of lint, long +enough to extend from one end to the other and project a little, is +placed in the wound, and over this the exterior portion of the wound +is to be carefully sewed, and sprinkled daily with the _pulvis ruber_. +Every day the pledget which remains in the wound is to be drawn +towards the most dependent part, so that the dressing in the wound may +be daily renewed. When the intestinal wound is found to be healed, the +entire pledget is to be removed and the unhealed openings dressed as +in other simple wounds. The diet of the patient should be also of the +most digestible sort. + +Thus far Gilbert has followed Roger almost literally. But he now adds, +apparently upon his own responsibility, the following paragraph: + +_Quod si placuerit, extrahe canellum: factis punctis in sutura +ubi debent fieri antequan stringantur, inter duo puncta canellus +extrahatur, et post puncta stringantur. Hoc dico si vulnus intestini +sic (sit) ex transverso._ + +Apparently Gilbert feels some compunctions of conscience relative to +the ultimate disposition of the canula of alder-wood, and permits, +if he does not advise, its removal from the intestine before the +tightening of the last stitches. + +Roland adds nothing to the text of Roger. But The Four Masters +(_Quatuor Magistri_, about A.D. 1270) suggest that the canula be made +of the trachea of some animal, and add: + +_Canellus autem per processum temporis putrefit et emittur per +egestionem, et iterum per concavitatem canelli transibit egestio._ + +In his further discussion of wounds of the intestine and their +treatment Gilbert also volunteers the information that: + +"Mummy (shade of Lord Lister!) is very valuable in the healing of +wounds of the intestine, if applied with some astringent powder upon +the suture." + +In amends for the mummy, however, we are also introduced to the +practice of mediaeval anaesthesia by means of what Gilbert calls the +_Confectio soporifera_ (f. 234d), composed as follows: + +_R._ + + _Opii, + Succi Jusquiami (hyoscyami), + Succi papaveris nigri, vel ejus seminis, + Sacci mandragorae, vel ejus corticis, vel pomorunt ipsius si succo + carueris, + Foliorum hederae arborae (ivy), + Succi mororum rubi maturorum, + Seminis lactucae, + Succi cuseutae (dodder)_, aa. ounce I. + +Mix together in a brazen vessel and place this in the sun during the +dog-days. Put in a sponge to absorb the mixture, and then place the +sponge in the sun until all the moisture has evaporated. When an +operation is necessary, let the patient hold the sponge over his nose +and mouth until he goes to sleep, when the operation may be begun. +To awaken the patient after the operation, fill another sponge with +vinegar and rub the teeth and nostrils with the sponge, and put some +vinegar in the nostrils. An anaesthetic drink may also be prepared as +follows: + +_R._ + + _Seminis papaveris albi et nigri, + Seminis lactucae, aa. ounce I. + Opii, + Misconis ( , poppy juice?)_, aa. scruples I-II, as + required. + +The patient is to be aroused as before. + +On folio 180d we find a chapter entitled "_De cathena gulae incisa +vel fracta_," and copied almost literally from the chapter "_De catena +gulae_" of Roger. In neither writer do I find any precise definition +of what the _cathena gulae_ is, though Roger says, _Si es gulae, +quod est catena, fractum fuerit_, etc., nor do I find the terms used +explained in any dictionary at present available. The description of +the treatment of this fracture seems, however, to indicate that the +_catena gulae_ of Roger and Gilbert is what we call the clavicle, +though the more common Latin names of this bone are _claviculus_, +_furcula_, _juglum_ or _os juguli_. Gilbert says: "But if the bone +which is the _cathena gulae_ is broken or in any way displaced +(_recesserit_), let the physician with one hand raise the forearm +(_brachium_) or arm (_humerum_) of the patient, and with the other +hand press down upon the projecting portion of the bone. Then apply a +pledget moistened with albumen, a pad and a splint in form of a cross, +and over all a long bandage embracing both the arm and the neck and +suspending the arm. A pad (_cervical_) should also be placed in the +axilla to prevent the dropping of the arm, and should not be removed +until the fracture is repaired. If the fracture is compound, the wound +of the soft parts is to be left open and uncovered by the bandage, so +that a tent (_stuellus_) may be inserted, and the wound is then to be +dressed in the ordinary manner." + +Simple fracture of the humerus, Gilbert tells us, is to be reduced +(_ad proprium locum reducator_) at once by grasping the arm above and +below the seat of fracture and exercising gentle and gradual extension +and compression. Then four pieces of lint wet in egg-albumen are +to be placed around the arm on all sides, a bandage, four fingers +wide, also moistened in albumen is to be snugly applied, another dry +bandage placed above this, and finally splints fastened in position +by cords. This dressing is to remain undisturbed for three days, and +then renewed every third day for nine days. After the ninth day a +_strictura_ (cast, apparatus immobile?) is to be prepared and firmly +applied with splints and a bandage, and the patient is to be cautioned +not to bear any weight upon the injured arm (_ne infirmus se super +illud appodiet_?). The fracture is then left until it is believed that +consolidation has occurred. If, however, it is found that swelling +is occasioned by the cast (_ex strictorio_?), the latter should be +removed, and the arm well bathed in warm water containing mallowae and +other emollients and thoroughly cleansed. If the bone seems to be well +consolidated, it should be rubbed with an ointment of _dialthea_ or +the _unguentum marciation_, after which the splints and bandage are +to be reapplied. If, however, it is found that the bone is not well +consolidated, the cast should be replaced in the original manner, +until consolidation is accomplished. If erysipelas results from +the dressings, it is to be treated in the ordinary manner. During +the entire treatment potions of nasturtium seeds, _pes columbini_ +(crowfoot) and other "consolidatives" are to be administered +diligently. If the fracture is compound, any loose fragments of +bone are to be removed, the fracture reduced as before, and similar +dressings applied, perforated, however, over the wound in the soft +parts. + +In fracture of the ribs (_flexura costi_) Gilbert recommends a +somewhat novel plan for the replacement of the displaced bone. Having +put the patient in a bath, the physician rubs his hands well with +honey, turpentine, pitch or bird-lime (_visco_), applies his sticky +palms over the displaced ribs, and gradually raises them to their +normal position. He also says (f. 183a), the application of a dry cup +(_cuffa vero cum igne_?) over the displaced rib is a convenient method +for raising it into position. + +Of fractures of the forearm Gilbert simply says that they are to be +recognized by the touch and a comparison of the injured with the sound +arm. They should be diligently fomented, extension made if necessary, +and then treated like other fractures. + +Dislocation of the atlo-axoid articulation (_os juguli_) he tells us +threatens speedy death. The mouth of the patient is to be kept open +by a wooden gag, a bandage passed beneath the jaw and held by the +physician, who places his feet upon the shoulders of the patient and +pressing down upon them while he elevates the head by the bandage, +endeavors to restore the displaced bone to its normal position. +Inunctions of various mollitives are then useful. + +Dislocations of the lower jaw are recognized by the failure of the +teeth to fit their fellows of the upper jaw, and by the detection of +the condyles of the jaw beneath the ears. The bone is to be grasped +by the rami and dragged down until the teeth resume and retain +their natural position, and the jaw is then to be kept in place by a +suitable bandage. + +In dislocation of the humerus the patient is to be bound in the supine +position, a wedge-shaped stone wrapped with yarn placed in the axilla, +and the surgeon, pressing against the padded stone with his foot and +raising the humerus with his hands, reduces the head of the bone to +its natural position. If this method fails, a long crutch-like stick +is prepared to receive at one end the axillary pad, the patient is +placed standing upon a box or bench, the pad and crutch adjusted in +the axilla, and while the surgeon stands ready to guide the dislocated +bone to its place, his assistants remove the bench, leaving the +patient suspended by his shoulder upon the rude crutch. In boys, +Gilbert tells us, no special apparatus is required. The surgeon merely +places his doubled fist in the axilla, with the other hand grasps the +humerus and lifts the boy off the ground, and the head of the bone +slips readily back into place. After we are assured that the reduction +is complete, a strictorium is prepared, consisting of the _pulvis +ruber_, egg-albumen and a little wheat flour, with which the shoulder +is to be rubbed. Finally, when all seems to be going on well, warm +_spata drapum_ (sparadrap) is to be applied upon a bandage, and if +necessary the apostolicon ointment. + +Dislocation of the elbow is reduced by passing a bandage around the +bend of the arm, forming in this a loop (_scapham_) into which the +foot of the surgeon is to be placed for counter-extension, while with +the hands extension is to be made upon the forearm until the bones are +drawn into their normal position. Flexion and extension of the joint +are then to be practised three or four times (to assure complete +reduction?), and the forearm flexed and supported by a bandage from +the neck. After a few days, Gilbert tells us, the patient will himself +often try to flex and extend the arm, and the bandage should be so +applied as not to interfere with these movements. + +Dislocation of the wrist is reduced by gentle extension from the hand +and counter-extension from the forearm, and dislocation of the fingers +by a similar manipulation. + +After so full a consideration of the surgical injuries of the head, +trunk and upper extremities, we are somewhat surprised to find +Gilbert's discussion of the similar injuries of the lower extremities +condensed into a single very moderate chapter entitled "De vulneribus +cruris et tybie" (f. 358a b). + +In this, Gilbert, emphasizing the importance of wounds of the patella +and knee-joint and the necessity for their careful treatment, also +declares that wounds of both the leg and thigh within three inches of +the joints, or in the fleshy portion of the thigh _ubi organum est_ +(?), involve considerable danger. He then speaks of a blackish, hard +and very painful tumor of the thigh, which, when it ascends the +thigh (_ad superiora ascendit_) is mortal, but if it descends is +less dangerous. Separation of the sacrum (_vertebrum_) from the ilium +(_scia_), either by accident or from the corrosion of humors, leaves +the patient permanently lame, though suitable fomentations and +inunctions may produce some improvement. Sprains of the ankle are to +be treated by placing the joint immediately in very cold water _ad +repercussionem spiritus et sanguinis_, and the joint is to be kept +thus refrigerated until it even becomes numb (_stupefactionem_); after +which stupes of salt water and urine are to be applied, followed by a +plaster of galbanum, opoponax, the apostolicon, etc. + +Fractures of the femur are to be treated like those of the humerus, +except that the ends of the fractured bone are to be separated by +the space of an inch, and a bandage six fingers in width carefully +applied. Such fractures within three inches of the hip or knee-joint +are regarded as specially dangerous. + +Dislocations of the ankle, after reduction of proper manipulation, +should be bound with suitable splints. If of a less severe character, +the dislocation may be dressed with stupes of canabina (Indian hemp), +urine and salt water, which greatly mitigate the pain and swelling. +Afterwards the joint should be strapped for four or five inches above +the ankle with plaster, _ut prohibeatur fluxus_. + +It should be said that the brevity of this chapter of Gilbert is +modeled after the manner of Roger of Parma, who refers the treatment +of injuries of the lower extremities very largely to that of similar +injuries of the upper, merely adding thereto such explanations as may +be demanded by the differences of location and function of the members +involved. Thus in his discussion of dislocation of the femur Roger +says: + +_Si crus a coxa sit disjunctum, eadem sit cura quam et in disjuncturam +brachii et cubiti diximus, etc._ + +The general subject of fistulae is treated at considerable length on +folio 205b, and fistula lachrymalis and fistulae of the jaw receive +special attention in their appropriate places. As a rule, the fistula +is dilated by a tent of alder-pith, mandragora, briony or gentian, +the lining membrane destroyed by an ointment of quick-lime or even the +actual cautery, and the wound then dressed with egg-albumen followed +by the _unguentum viride_. Necrosed bone is to be removed, if +necessary, by deep incisions, and decayed teeth are to be extracted. + +The elongated uvula is to be snipped off, and abscesses of the tonsils +opened _tout comme chez nous_. + +An elaborate discussion of the subject of hernia is given under the +title "_De relaxatione siphac et ruptura_" (f. 280c)--siphac being +the Arabian name for the peritoneum. Gilbert tells us the siphac is +sometimes relaxed, sometimes ruptured (_crepatur_?) and sometimes +inflated. He had seen a large rupture (_crepatura_) in which it was +impossible to restore the intestines to the cavity of the abdomen +in consequence of the presence in them of large hard masses of fecal +matter, which no treatment proved adequate to remove, and which +finally occasioned the death of the patient. Rupture of the siphac is +most frequently the result of accident, jumping, straining in lifting +or carrying heavy weights, or in efforts at defecation, or of shouting +in boys or persons of advanced age, or even in excessive weeping, +etc. It is distinguished from hernia by the fact that in hernia pain +is felt in the testicle, radiating to the kidneys, while in rupture +of the siphac a swelling on one side of the pubes extends into the +scrotum, where it produces a tumor not involving the testicle. Rupture +of the siphac, he says, is a lesion of the organs of nutrition, hernia +a disease of the organs of generation. Accordingly, in the pathology +of Gilbert, the term hernia is applied to hydrocele, orchitis and +other diseases of the testicle, and not, as with us to protrusions of +the viscera through the walls of their cavities. + +In young persons, he tells us, recent ruptures of the siphac may be +cured by appropriate treatment. The patient is to be laid upon his +back, the hips raised, the intestines restored to the abdominal cavity +and the opening of exit dressed with a plaster of exsiccative and +consolidating remedies, of which he furnishes a long and diversified +catalogue. He is also to avoid religiously all exercise or motion, all +anger, clamor, coughing, sneezing, equitation, cohabitation, etc., +and to lie with his feet elevated for forty days, until the rupture +(_crepatura_) is consolidated. The bowels are to be kept soluble by +enemata or appropriate medicines, and the diet should be selected so +as to avoid constipation and flatulence. A bandage or truss (_bracale +vel colligar_) made of silk and well fitted to the patient is also +highly recommended. If the patient is a boy, cakes (_crispelle_?) of +_consolida major_ mixed with the yolk of eggs should be administered, +one each day for nine days before the wane of the moon. If, however, +the rupture is large in either a boy or an adult, and of long +standing, whether the intestine descends into the scrotum or not, +operation, either by incision or by the cautery offers the only hope +of relief. Singularly enough too, while Roger devotes to the operation +for the cure of hernia nearly half a page of his text, Gilbert +dismisses the whole subject in a single sentence, as follows: + +_Scindatur igitur totus exitus super hac cute exteriori cum carne +fissa, et uatur y fac cum file serice et acu quadrata. Deinde +persequere ut in exitu intestini per vulnus superius demonstratum est_ +(f. 281d). + +Turning now to the title "_De hernia_" (f. 289b), Gilbert tells us +"Swelling (_inflatio_) of the testicles is due sometimes to humors +trickling down upon them (_rheumatizantibus_), sometimes to abscess, +or to gaseous collections (_ventositate_), and sometimes to escape +of the intestines through rupture of the siphac." He adds also: "Some +doubt the propriety of using the term hernia for an inflation. On +this point magister Rn says: There is a certain chronic and inveterate +tumor of the testicles, which is never cured except by means of +surgery, as e.g., hernia. For hernia is an affection common to the +scrotum and the testicles." + +The apparent confusion between these two passages is easily relieved +by the explanation that inguinal or other herniae not extending into +the scrotum are called by Gilbert ruptures of the siphac, but scrotal +hernia is classed with other troubles located in the scrotum as +hernia. Accordingly hernia, with Gilbert, includes not only scrotal +hernia, but also hydrocele, orchitis, tumors of the testicles, etc. +This is apparent, too, in his treatment of hernia, which consists +usually in the employment of various poultices and ointments, bleeding +from the saphena, cups over the kidneys, etc., though hydrocele is +tapped and a seton inserted. If the testicle itself is "putrid," +it should be removed; otherwise it is left. It may be remarked _en +passant_ that the surgeons of medieval times, in their desire for +thoroughness, often displayed very little respect to what Baas calls +"the root of humanity." + +We will terminate our hasty review of diseases discussed in the +Compendium by an abstract of Gilbert's views on vesical calculus and +its treatment, which cover more than fifteen pages of his work. + +Stone and gravel arise from various viscous superfluities in the +kidneys and bladder, which occasion difficulty in micturition. Stone +is produced by the action of heat upon viscous moisture, sublimating +the volatile elements and condensing the denser portions. +Putrefication of stone in the bladder is the result of three causes, +viz., consuming heat, viscous matter and stricture of the meatus. +For consuming heat acting on viscous material retained by reason +of stricture of the meatus, by long action dries up, coagulates and +hardens the moisture. This is particularly manifest in boys who have a +constricted meatus. + +Stones are thus generated not only in the kidneys and bladder, +but also even in the stomach and the intestines, whence they are +ejected by vomiting or in the stools. Indeed they may also be found +occasionally in the lungs, the joints and other places. They are +comparatively rare in women, in consequence of the shortness of the +urethra and the size of their meatus. + +Sometimes calculi occur in the bladder, sometimes in one kidney and +occasionally in both kidneys. The symptoms produced by their presence +vary in accordance with the situation of the concretion. If the stone +is in the kidney, the foot of the side affected is numb (_stupidus_), +the spine on the affected side is sore and there is difficulty of +micturition and considerable gravelly sediment in the urine. If the +stone is increasing in size, the quantity of sediment also increases, +but if the stone is fully formed and confirmed, the amount of sediment +decreases daily, and the urine becomes milky both in the kidneys and +the bladder. A stone in the bladder occasions very similar symptoms, +together with pain in the peritoneum and pubes, dysuria and strangury, +and sometimes the appearance of blood and flocculi (_trumbos_?) +in the urine. Patients suffering from vesical calculus are always +constipated, and the dysuria may increase to the degree called furia, +a condition not without some danger. + +Three things are necessary in the cure of stone, viz., a spare and +simple diet, the use of diuretics and a moderate amount of exercise. +It should, however, be remarked that confirmed stone is rarely or +never cured, except by a surgical operation.... If a boy has a clear +and watery urine after it has been sandy, if he frequently scratches +his foot, has involuntary erections and finally obstruction in +micturition, I say that he has a stone in the neck of his bladder. +If now he be laid upon his back with his feet well elevated, and his +whole body be well shaken, if there is a stone present it is possible +that it may fall to the fundus of the bladder. Afterwards direct +the boy to bear down (_ut exprimat se_) and try to make water. If +this treatment turns out in accordance with your theory, the urine +necessarily escapes and your idea and treatment are confirmed. If, +however, the urine not escape, let the boy be shaken vigorously +a second time. If this too fails and strangury ensues, it will be +necessary to resort to the use of a sound or catheter (_argaliam_), +so that when the stone is pushed away from the neck of the bladder the +passage may be opened and the urine may flow out. It may be possible +too that no stone exists, but the urethra is obstructed or closed +by pure coagulated blood. Perhaps there may have been a wound of the +bladder, although no external haemorrhage has appeared, but the blood +coagulating gradually in the bladder has occasioned an obstruction or +narrowing of the urinary passage. Or possibly the blood from a renal +haemorrhage has descended into the bladder and obstructs the urethra. +Hence I say that the sound is useful in these cases where the urethra +is obstructed by blood or gross humors. Examination should also be +made as to whether a fleshy body exists in the bladder, as the result +of some wound. This condition is manifest if, on the introduction of +the sound, the urine flows out promptly. I once saw a man suffering +from this condition, who complained of severe pain in the urinary +passage as I was introducing the sound, and I recognized that there +were wounds in the same part, for as soon as these were touched by +the sound the urine began to flow, followed soon after by a little +blood and fleshy particles.... So far as the operation of physicians +is concerned, it is necessary only to be certain of the fact that +obstruction to the passage of urine depends upon no other cause than +stone or the presence of coagulated blood (f. 271). + +Gilbert's medical treatment of vesical calculus consists generally +in the administration of diuretics and lithontriptics and the local +application of poultices, plasters and inunctions of various kinds. +Of the lithontriptics, certain combinations, characterized by famous +names or notable historical origin, are evident favorites. Among +this class we read of the _Philoantropos major_ and _minor_, the +_Justinum_, the _Usina_ "approved by many wise men of Babylon and +Constantinople," the _Lithontripon_ and the "_Pulvis Eugenii pape_," +with numerous others. + +Rather curiously and suggestively no mention is made in this immediate +connection of the technique of lithotomy. On a later page, however (f. +309a), we find a chapter entitled "_De cura lapidis per cyrurgiam_," +in which Gilbert writes: + +"Mark here a chapter on the cure of stone in the bladder by means +of surgery, which we have omitted above. Accordingly, to determine +whether a stone exists in the bladder, let the patient take a warm +bath. Then let him be placed with his buttocks elevated, and, having +inserted into the anus two fingers of the right hand, press the fist +of the left hand deeply above the pubes and lift and draw the entire +bladder upward. If you find anything hard and heavy, it is manifest +that there is a stone in the bladder. If the body feels soft and +fleshy, it is a fleshy excrescence (_carnositas_), which impedes the +flow of urine. Now, if the stone is located in the neck of the bladder +and you wish to force it to the fundus: after the use of fomentations +and inunctions, inject through a syringe (_siringa_) some petroleum, +and after a short interval pass the syringe again up to the neck of +the bladder and cautiously and gently push the stone away from the +neck to the fundus. Or, which is safer and better, having used the +preceding fomentations and inunctions, and having assured yourself +that there is a stone in the bladder, introduce your fingers into the +anus and compress the neck of the bladder with the fist of the left +hand above the pubes, and cautiously remove the stone and guide it +to the fundus. But if you wish to extract the stone, let a spare diet +precede the operation, and let the patient lie abed for a couple of +days with very little food. On the third day introduce the fingers +into the anus as before, and draw down the stone into the neck of +the bladder. Then make your incision lengthwise in the fontanel, the +width of two fingers above the anus, and extract the stone. For nine +days after the operation let the patient use, morning and evening, +fomentations of _branca_ (_acanthus mollis_), _paritaria_ (pellitery) +and _malva_ (mallows). A bit of tow (_stupa_) moistened with the yolk +of egg in winter, and with both the yolk and white of egg in summer, +is to be placed over the wound. Proud flesh, which often springs up +near a wound in the neck of the bladder, should be removed by the +knife (_rasorio_), and two or three sutures inserted. The wound is +then to be treated like other wounds. It should be remarked, however, +that if the stone is very large, it should be simply pushed up to the +fundus of the bladder and left there, and no effort should be made to +extract it." + +This description of the diagnosis of stone and of the operation of +lithotomy is copied almost literally from Roger of Parma. + +Sufficient (perhaps more than enough) has been written to give the +reader a fair idea of the general character of Gilbert's "Compendium +Medicine." + +A few words may be added with reference to the proper place of the +work in our medical literature. + +It is not difficult, of course, to select from the Compendium a charm +or two, a few impossible etymologies and a few silly statements, to +display these with a witty emphasis and to draw therefrom the easy +conclusion that the book is a mass of crass superstition and absurd +nonsense. This, however, is not criticism. It is mere caricature. + +To compare the work with the teachings of modern medicine is not only +to expect of the writer a miraculous prescience, but to minimize the +advances of medical science within the last seven hundred years. + +Even Freind and Sprengel, admirable historians, though more thoughtful +and judicious in their criticisms, seem for the moment to have +forgotten or overlooked the true character of the Compendium. + +Freind says: + +"I believe we may even say with justice that he (Gilbert) has written +as well as any of his contemporaries of other nations, and has merely +followed their example in borrowing very largely from the Arabians," +and Sprengel writes: "Here and there, though only very rarely, the +author offers some remarks of his own, which merit special attention." + +Now, what precisely is Gilbert's Compendium designed to be? In the +words of its author it is + +"A book of general and special diseases, selected and extracted +from the writings of all authors and the practice of the professors +(_magistrorum_), edited by Gilbert of England and entitled a +Compendium of Medicine." + +and a few pages later he adds: + +"It is our habit to select the best sayings of the best authorities, +and where any doubt exists, to insert the different opinions, so that +each reader may choose for himself what he prefers to maintain." + +The author does not claim for his work any considerable originality, +but presents it as a compendium proper of the teachings of other +writers. Naturally his own part in the book is not obtruded upon our +notice. + +Now the desiderata of such a compendium are: + +1. That it shall be based upon the best attainable authorities. + +2. That these authorities shall be accurately represented. + +3. That the compendium shall be reasonably comprehensive. + +In neither of these respects is the compendium of Gilbert liable, I +think, to adverse criticism. + +The book is, undoubtedly, the work of a famous and strictly orthodox +physician, possessed of exceptional education in the science of his +day, a man of wide reading, broadened by extensive travel and endowed +with the knowledge acquired by a long experience, honest, truthful and +simple minded, yet not uncritical in regard to novelties, firm in his +own opinions but not arrogant, sympathetic, possessed of a high sense +of professional honor, a firm believer in authority and therefore +credulous, superstitious after the manner of his age, yet harboring, +too, a germ of that healthy skepticism which Roger Bacon, his great +contemporary, developed and illustrated. + +I believe, therefore, that we may justly award to the medical pages of +the Compendium not only the rather negative praise of being written +as well as the work of any of Gilbert's contemporaries, but the more +positive credit of being thoroughly abreast of the medical science of +its age and country, an "Abstract and brief chronicle of the time." + +The surgical chapters of the work are unique in a compendium of +medicine, and merit even more favorable criticism. + +The discouragement of the practice of medicine and surgery on the +part of ecclesiastics by the popes and church councils of the twelfth +century, culminating in the decree of Pope Innocent III in 1215, +which forbade the participation of the higher clergy in any operation +involving the shedding of blood (_Ecclesia abhorret a sanguine_); the +relatively scanty supply of educated lay physicians and surgeons, and +finally the pride and inertia of the lay physicians themselves; all +these combined to relegate surgery in the thirteenth century to the +hands of a class of ignorant and unconscionable empirics, whose rash +activity shed a baleful light upon the art of surgery itself. As a +natural result the practice of this art drifted into an _impasse_, +from which the organization of the barber-surgeons seemed the only +logical means of escape. + +The earliest evidence of the public surgical activity of the barbers, +as a class, is found, I believe, in Joinville's Chronicle of the +Crusade of St. Louis (Louis IX) in the year 1250. According to +Malgaigne, no trustworthy evidence of any organization of the +barbers of Paris is available before 1301, and the fraternity was not +chartered until 1427, under Charles VII. The barbers of London are +noticed in 1308, and they received their charter from Edward IV in +1462. The parallel lines upon which the confraternities of the two +cities developed is very noticeable--making due allowance for Gallic +enthusiasm and bitterness. + +Lanfranchi, the great surgeon of Paris, about the year 1300 is moved +to write as follows: + +"Why, in God's name, in our days is there such a great difference +between the physician and the surgeon? The physicians have abandoned +operative procedures to the laity, either, as some say, because they +disdain to operate with their hands, or rather, as I think, because +they do not know how to perform operations. Indeed, this abuse is +so inveterate that the common people look upon it as impossible for +the same person to understand both surgery and medicine. It ought, +however, to be understood that no one can be a good physician who +has no idea of surgical operations, and that a surgeon is nothing +if ignorant of medicine. In a word, one must be familiar with both +departments of medicine." + +Now Gilbert by the incorporation of many chapters on surgery in his +Compendium inculcates practically the same idea more than fifty years +before Lanfranchi, and may claim to be the earliest representative +of surgical teaching in England. Malgaigne, indeed, does not include +his name in the admirable sketch of medieval surgery with which he +introduces his edition of the works of Ambroise Pare, and says Gilbert +was no more a surgeon than Bernard Gordon. This is in a certain sense +true. Gilbert was certainly not an operative surgeon. But it needs +only a very superficial comparison of the Compendium of Gilbert with +the Lilium Medicinae of Gordon to establish the fact that the books +are entirely unlike. Indeed, it may be truthfully said that Gordon's +work does not contain a single chapter on surgery proper. His cases +involving surgical assistance are turned over at once, and with +little or no discussion, to those whom he calls "restauratores" or +"chirurgi," and his own responsibility thereupon ends. + +We have no historical facts which demonstrate that Gilbert's +Compendium exercised any considerable influence upon the development +of surgery in England, but when we consider the depressed condition +of both medicine and surgery in his day, we should certainly emphasize +the clearness of vision which led our author to indicate the natural +association of these two departments of the healing art, and the +assistance which each lends to the other. + + + +***END OF THE PROJECT GUTENBERG EBOOK GILBERTUS ANGLICUS*** + + +******* This file should be named 16155.txt or 16155.zip ******* + + +This and all associated files of various formats will be found in: +https://www.gutenberg.org/dirs/1/6/1/5/16155 + + + +Updated editions will replace the previous one--the old editions +will be renamed. + +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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