Henry E. Handerson

“ 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. ”

“ 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. ”

“ 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. ”

“ 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. ”

“ 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. ”

“ 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. ”

“ 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. ”

“ 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." ”

“ 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. ”

“ 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. ”

“ 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. ”

“ 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." ”

“ 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. ”

“ 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. ”

“ 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. ”

“ 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. ”

“ 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. ”

“ 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. ”

“ 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. ”

“ 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) . ”

“ 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. ”

“ 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 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. ”

“ 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. ”

“ 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. ”

“ 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. ”

“ 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. ”

“ 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. ”

“ 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. ”