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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

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,
[pg 10]
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
[pg 11]
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
[pg 12]
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
[pg 13]
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
[pg 14]
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:

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
[pg 18]
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.
Kingsford¹, and the late Dr. Joseph Frank Payne², 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.

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 manuscript³, 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
[pg 20]
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.

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

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
[pg 21]
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.”
[pg 22]
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
[pg 23]
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
[pg 24]
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.”

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.

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:

To these he adds, on the authority of Bale and Pits:

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
[pg 27]
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.

“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

“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.
[pg 28]
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:

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:

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
[pg 29]
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
[pg 30]
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
[pg 31]
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-wood⁶ 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,
[pg 32]
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

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.“

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

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
[pg 33]
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
[pg 34]
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. †. Uthihoth. †. multiplicamini. †.
thahechay. †. et replete terram. †. 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
[pg 37]
*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).

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
[pg 38]
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
[pg 40]
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
[pg 42]
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
[pg 43]
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.

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
[pg 44]
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
[pg 45]
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
[pg 46]
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
[pg 47]
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
[pg 48]
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
[pg 49]
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
[pg 50]
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-pox⁹ 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.

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
[pg 52]
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
[pg 53]
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
[pg 54]
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
[pg 55]
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
[pg 56]
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:

“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:

“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
[pg 58]
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
[pg 59]
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),
[pg 60]
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
[pg 61]
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),
[pg 62]
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 discum¹⁰ 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).

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
[pg 63]
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
[pg 64]
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.

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.

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,
[pg 66]
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
[pg 67]
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
[pg 68]
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
[pg 69]
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
[pg 71]
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
[pg 72]
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
[pg 73]
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,
[pg 74]
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
[pg 77]
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.

Footnote 1: (return)

In Leslie Stephen’s “Dictionary of Biography.”

Footnote 2: (return)

British Medical Journal, Nov. 12, 1904, p. 1282.

Footnote 3: (return)

Janus, 1903, p. 20.

Footnote 4: (return)

Cap. XXXVI, p. 116, edition of Brewer.

Footnote 5: (return)

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.

Footnote 6: (return)

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.

Footnote 7: (return)

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.”

Footnote 8: (return)

Cf. the French bosse de la gorge.

Footnote 9: (return)

It is at least interesting to know that small-pox is said to have made its first appearance in England in 1241.

Footnote 10: (return)

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.