Gilbertus Anglicus Part 8

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 b.u.t.tocks elevated, and, having inserted into the a.n.u.s two fingers of the right hand, press the fist of the left hand deeply above the p.u.b.es 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 pa.s.s 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 a.s.sured yourself that there is a stone in the bladder, introduce your fingers into the a.n.u.s and compress the neck of the bladder with the fist of the left hand above the p.u.b.es, 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 a.n.u.s 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 a.n.u.s, 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 ma.s.s of cra.s.s superst.i.tion 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 ent.i.tled 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, superst.i.tious after the manner of his age, yet harboring, too, a germ of that healthy skepticism which Roger Bacon, his great contemporary, developed and ill.u.s.trated.

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 partic.i.p.ation 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 cla.s.s 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 _impa.s.se_, 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 cla.s.s, 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 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 G.o.d'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 a.s.sistance 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 a.s.sociation of these two departments of the healing art, and the a.s.sistance which each lends to the other.