Part 7 (1/2)
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 st.i.tches.
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._
_Opii, Succi Jusquiami (hyoscyami), Succi papaveris nigri, vel ejus seminis, Sacci mandragorae, vel ejus corticis, vel pomorunt ipsius si succo carueris, Foliorum hederae arborae (ivy), Succi mororum rubi maturorum, Seminis lactucae, Succi cuseutae (dodder)_, aa. ounce I.
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._
_Seminis papaveris albi et nigri, Seminis lactucae, aa. ounce I.
Opii, Misconis ( , poppy juice?)_, aa. scruples I-II, as required.
The patient is to be aroused as before.
On folio 180d we find a chapter ent.i.tled ”_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, _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 alb.u.men, 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 loc.u.m 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-alb.u.men are to be placed around the arm on all sides, a bandage, four fingers wide, also moistened in alb.u.men 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 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 c.u.m 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 pa.s.sed 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 crutch adjusted in the axilla, and while the surgeon stands ready to guide the dislocated bone to its place, his a.s.sistants 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 a.s.sured that the reduction is complete, a strictorium is prepared, consisting of the _pulvis ruber_, egg-alb.u.men 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 pa.s.sing 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 a.s.sure 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 ent.i.tled ”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 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 s.p.a.ce 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.