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: