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