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.