Part 10

The premonitory symptoms of variolae are a high fever, redness of the eyes, pain in the throat and chest, cough, itching of the nose, sneezing and pricking sensations over the surface of the body.

Morbilli is a mild disease, but requires protection from cold, which confines and coagulates the peccant matter.

Attention is directed to the not infrequent ulcers of the eyes, which occur in variolae and may destroy the sight; also to ulcerations of the nose, throat, oesophagus, lungs and intestines, the latter of which often produce a dangerous diarrhoea.

When variolae occurs in boys, it is recommended to tie the hands of the patient to prevent scratching.

Whey is said to be an excellent drink for developing the eruption of variolae, and the time-honored saffron (crocus) appears in several of Gilbert's prescriptions for this disease. Here, too, we find the earliest mention of the use of red colors in the treatment of variolae (f. 348 c):

"Vetule provinciales dant purpuram combustam in potu, habet enim occultam naturam curandi variolas. Similiter pannus tinctus de grano."

Acid and saline articles of food should be avoided, sweets used freely, and the patients should be carefully guarded from cold.

Not the least interesting pages of the Compendium are those (there are about twenty of them) devoted to the discussion of poisons, poisoned wounds and hydrophobia.

An introductory chapter on the general subject of the character of poisonous matters, illustrated by some gruesome and Munchausen-like tales, borrowed mainly from Avicenna and Ruffus, on the wonders of acquired immunity to poisons, the horrors of the basilisk, the armaria (?), the deaf adder (aspis surda) and the red-hot regulus of Nubia, leads naturally to the consideration of some special poisons derived from the three kingdoms of nature. Very characteristically Gilbert displays his caution in the discussion of a dangerous subject by the following preface:

Abstineamus a venesis occultis quae non sunt manifesta, ne virus in angues adjiciamus, aut doctrinam perniciosam tradere videamur (f. 351 a).

Beginning then with metallic mercury (argentum vivum), he considers the poisonous effects of various salts of lead and copper, the vegetable poisons hellebore, anacardium (anacardis?), castoreum, opium and cassilago (semina hyoscyami), and then proceeds to the bites or rabid men and animals, hydrophobia, and the bites of scorpions, serpents and the animalia annulosa, that is, worms, wasps, bees, ants and spiders.

Space does not permit a careful review of this interesting subject, but a novel form of poisoning by the use of quicksilver is startling enough to claim our attention. Gilbert tells us that pouring metallic mercury into the ear produces the most distressing symptoms, severe pain, delirium, convulsions, epilepsy, apoplexy and, if the metal penetrates to the brain, ultimate death. In the treatment of this condition certain physicians had recommended the insertion into the ear of a thin lamina of lead, upon which it was believed that the mercury would fasten itself and might thus be drawn out. Avicenna objected to this that the mercury was liable to speedily pass into the ear so deeply as to be beyond the reach of the lead. Gilbert suggests as an improvement of the treatment that a thin lamina of gold be substituted for the lead, "because mercury thirsts after gold as animals do after water, as it is held in the books on alchemy" (in libris allzinimicis). This fact, too, he tells us can be easily demonstrated externally by placing upon a plate a portion of gold, and near, but not in contact with it, a little quicksilver, when the silver, he says, will at once "leap" upon the gold. Avicenna suggests that the patient stand upon the foot of the side affected, lean his head over to the same side, steady it in that position with the hands, and then leap suddenly over upon the other foot--demonstrating thereby his knowledge of both gravity and inertia. Manifestly our "laboratory physicians" of the present day can assume no airs of priority!

The Compendium closes with two very sensible chapters on the hygiene of travel, entitled "De regimine iter agentium" and "De regimine transfretantium."

In the hygiene of travel by land Gilbert commends a preliminary catharsis, frequent bathing, the avoidance of repletion of all kinds, an abundance of sleep and careful protection from the extremes of both heat and cold. The strange waters may be corrected by a dash of vinegar. Some travelers, he tells us, carry with them a package of their native soil, a few grains of which are added to the foreign waters, as a matter of precaution, before drinking. The breakfast of the traveler should be light, and a short period of rest after a day's travel should precede the hearty evening meal. Leavened bread two or three days old should be preferred. Of meats, the flesh of goats or swine, particularly the feet and neighboring parts, which, Gilbert tells us, the French call gambones, the flesh of domestic fowls and of the game fowls whose habitat is in dry places, is to be preferred to that of ducks and geese. Of fish, only those provided with scales should be eaten, and all forms of milk should be avoided, except whey, "which purifies the body of superfluities." Fruits are to be eschewed, except acid pomegranates, whose juice cools the stomach and relieves thirst. Boiled meats, seasoned with herbs like sage, parsley, mint, saffron, etc., are better than roasted meats, and onion and garlic are to be avoided.

The primitive conditions of land travel in the days of Gilbert are emphasized by his minute directions for the care of the feet, which he directs to be rubbed briskly with salt and vinegar and then anointed with an ointment of nettle-juice (urtica) and mutton-fat, or with a mixture of garlic, soap and oil. If badly swollen, they should be bathed, before inunction, with a decoction of elder-bark and other emollients.

In travel by sea, Gilbert tells us the four chief indications are to prevent nausea, to allay vomiting, to palliate the foul odor of the ship and to quiet thirst.

For the prevention of nausea he recommends the juice of acid pomegranates, lemons, etc., or a decoction of parsley or sweet cicely (cerfolium). The traveler should endeavor to sit with his head erect, should avoid looking around, but maintain his head as immovable as possible, and support himself by a firm grasp upon some beam of the ship. Some sweets may be sucked, or he may chew a few aromatic seeds. If vomiting ensues, acid or sweet pomegranates, figs or barley-sugar (penides) may be taken sparingly, but no food should be ingested until the stomach is thoroughly quieted. Then the patient may take a little stomatichon or dyantos, and a small portion of digestible food. As the diet must necessarily consist largely of salty food and vegetables, these should be cooked in three or four different waters, and then soaked in fresh water. A little aromatic wine will also benefit the patient, and a few aromatic seeds chewed in the morning are also of service.

The effect of the foul odors of the ship may be combatted by the use of aromatic electuaries, "which comfort the heart, the brain and the stomach." The patient should be removed to some quiet portion of the ship, as distant as possible from the channels for the discharge of the bilge-water, and short walks upon the upper deck will contribute to convalescence. Frequent changes of clothing will palliate the annoyance of fleas and pediculi. Drinking water may be purified by aëration, or by straining, boiling and subsequent sedimentation and removal of the sediment by filtration through fresh and clean sand. For the wealthy, the water may be distilled in an alembic, if such an apparatus is obtainable. Avicenna says that bad water may be corrected by the addition of vinegar. Exposure to the midday sun and to the nocturnal cold, constipation and diarrhoea should be avoided, and prompt attention should be given to all disorders of the health.

To these wise counsels Gilbert courteously adds a medieval bon voyage in these words:

"Dominus autem omnia dirigat in tranquilitate. Amen."

It has been already remarked upon a preceding page that Gilbert of England was not a surgeon. Nevertheless it is only fair to say that the surgical chapters of the Compendium present a more scientific and complete view of surgical art, as then known, than any contemporaneous writings of the Christian West, outside of Italy.

It is well known that during the Middle Ages the practice of surgery in western Europe was generally regarded as disreputable, and operative surgery was for the most part relegated to butchers, barbers, bath-keepers, executioners, itinerant herniotomists and oculists, et id omne genus, whose pernicious activity continued to make life precarious far down into the modern period.

In Italy alone did surgery vindicate for itself an equality with medicine, and the pioneer of this advance was Roger of Parma, who, as we have seen, flourished early in the thirteenth century. Roger and his pupil Roland, with the somewhat mythical "Four Masters" (Quatuor Magistri), were the surgical representatives of the School of Salernum, while Hugo (Borgognoni) di Lucca and his more famous son Theodorius represented the rival school of Bologna. Equally famous Italian surgeons of this century were Bruno of Logoburgo (in Calabria) and Gulielmus of Saliceto (1275), the master of Lanfranchi (1296). Gilbert of England, as a pupil of Salernum, naturally followed the surgical teachings of that school, and we have already noticed that his chapters on surgery are taken chiefly from the writings of Roger of Parma, though the name of neither Roger, nor indeed of any other distinctly surgical writer, is mentioned in the Compendium. How closely in some cases Gilbert followed his masters may best be seen by a comparison of their respective chapters upon the same subject. I accordingly introduce here for such comparison Roger's chapter on wounds of the neck, and the corresponding chapter of Gilbert. Roger says:

"De vulnere quod fit in cervice.

"Si vero cum ense vel alio simili in cervice vulnus fiat, ita quod vena organica incidatur, sic est subveniendum. Vena tota sumatur (suatur) cum acu, ita quod vena non perforetur, et ex alia parte acus cum filo ei inhaerente ducatur, et cum ipso filo nectatur atque stringatur, quod sanguinem non emittat: et ita facias ex superiori parte et inferiori. In vulnere autem pannus infusus mittatur, non tamen de ipso vulnus multum impleatur. Embrocha, si fuerit in myeme, superponatur quosque (quousque) vulnus faciat saniem. Si vero fuerit in aestate vitellus avi semper superponatur. Quum autem saniem fecerit, cum panno sicco, unguento fusco et caeteris bonam carnem generantibus, adhibeatur cura, ut in caeteris vulneribus. Quum vero extremitatem venae superioris partis putruisse cognoveris, fila praedicta dissolvas, et a loco illo removeas: et deinde procedas ut dictum est superius. A. Si vero nervus incidatur in longum aut ex obliquo, sed non ex toto, hac cura potest consolidari. Terrestres enim vermes, idest qui sub terra nascuntur, qui in longitudine et rotunditate lumbricis assimilantur, et apud quondam terrestres lumbrici dicuntur, accipiantur et aliquantulum conterantur et in oleo infusi ad ignem calefiant: et nullo alio mediante, ter vel quater, vel etiam pluries, si opportunum videbis, plagae impone. Si vero incidatur ex obliquo totus, minime consolidatur: praedicto tamen remedio non coadjuvante saepe conglutinatur. Potest etiam cuticula, quae supra nervum est, sui, pulvisque rubens, qui jam dictus est, superaspergi, quae cura non est inutilis, aliquos enim non solum conglutinatas, sed etiam consolidatas, nostra cura prospeximus. Si vero locus tumet, embrocham illam, quam in prima particula ad tumorem removendum, qui ex percussura contigit, praediximus, ponatur, quousque talis tumor recesserit."

Gilbert, after premising two short chapters entitled "De vulneribus colli" and "De perforatione colli ex utraque parte," continues as follows:

"De vena organica incisa.

"Si vena organica in cervice incidatur: tota vena suatur cum acu, ita quod vena non perforetur, et ux alia parte acus cum filo ei adherente ita nectatur atque stringatur quod (non) emittat sanguinem, et ita fiat ex superiori parte et inferiore vene. In vulnere autem pannus infusus in albumine ovi mittatur, nec tamen de ipso panno vulnus multum impleatur. Embroca vero superius dicta, si in hyeme fuerit, superponatur, donec vulnus saniem emittat. Si vere in estate, vitellum ovi tum super ponatur, et cum saniem fecerit, panno sicco, et unguento fusco et ceteris regenerantibus carnem, curetur. Cum vero extremitatem vene superioris et inferioris putruisse cognoveris, fila dissolvantur et a loco removeantur, et deinde ut dictum est procedatur.