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Quinancia was to be treated by gargles, applications, venesection from the sublingual vein, and these methods were to be used at first also in the other forms of the affection.
In the same chapter Roger treats of goiter and suggests various applications, but considers also in the severe forms the necessity for extirpation. He warns against any attempt to remove large goiters, but suggests that a temporary ligature of the goiter might be made and then a subsequent radical removal. Evidently a favorite palliative mode of treatment of his was cauterization with the hot iron and sometimes even penetration of the goiter in
While Roger is the first of the western surgeons who wrote a treatise on this subject, he was very soon followed by Roland, a pupil whose work contains very little of importance that was not covered by his master, but who adds some personal comments which serve to show that men were thinking seriously about a great many surgical problems and solving them very well.
These two were followed in a few years by the "Textbook of the Four Masters,” since famous in the history of medicine and surgery. Manifestly within the first century, probably indeed within the first fifty years of western surgical writing, it was recognized that a group of men could make a more complete textbook than a single man. It is usually thought that the “Four Masters” were Archimatteo, Petroncello, Plateario, and Ferrario. Of these only Plateario, or Platearius, is known apart from this book, for he was the son or the grandson of Platearius and Trotula, Platearius having been the Professor of Medicine and Trotula the Professor of Women's Diseases and the head of that department in the medical school of the University of Salerno, and for several generations their sons and grandsons continued to be prom
inent in the teaching staff of that school.
The next important writer on surgery in Italy, after Roland and Roger and the “Four Masters,” was Bruno of Longoburgo, who was born down in Calabria—the heel of the Italian boot, as the name of his birthplace attached to his Christian name indicates—and who was probably a student at Salerno. In the Latin literature of the time, for of course all wrote in Latin, his name was Brunus and it is usually under this name that he is quoted. Though he studied in the south of Italy he practiced and taught in Verona and Padua. His book “Chirurgia Magna” was finished at Padua, as he himself declares toward the end of it, in January, 1252. His volume is noteworthy, mainly for the reason that he was the first of these mediæval surgeons of the West to quote not only the Greeks, but the Arabs. Arabian influence was an afterthought and a subsidiary factor, and not the origin of this mediæval surgery, as it is often declared to be by those who theorize without weighing the facts of chronology.
Bruno, to use his Italian name, has much to say of the treatment of various intranasal pathological conditions which disturb breathing. He describes several varieties of nasal polyps and differentiates one of them as a “malignant tumor.” This was of darker color, of slight sensibility and was very hard. He advised against operation upon it and suggested that it should not be touched, as surgical intervention merely hastened its growth and made the patient
With regard to the removal of polyps he quotes Abulcasim, or Albucasis, the Moorish physician, special medical attendant of the Khalif el-Hakim III (961-976). Albulcasim, who flourished in the second half of the tenth century, wrote a very comprehensive medical and surgical work under the title “Altasrif” or “Tesrif," in some thirty books. This Moorish physician, who
is quoted by Bruno, suggests the removal knew that this was the ideal way for healof polyps by drawing them down with a ing to occur. His great contemporary, hook, severing the connecting portion with Theodoric, whose textbook appeared some a knife, and then shaving off any projection ten years later, declared quite explicitly: that may remain. The cautery was used to prevent recurrence and to assure the
“It is not necessary, as Roger and freedom of the nose for breathing. Bruno
Roland have taught and as many of suggests that the root of the polyp should their disciples are still teaching and be cauterized with a hot iron or with some as all modern * surgeons profess, that cauterizing material. He adds that some- pus should be generated in wounds. times the use of a cauterizing substance is No error can be greater than this. Such quite sufficient to destroy a polyp and pre
a practice is indeed to hinder nature, vent its recurrence.
to prolong the disease, and to prevent Bruno next discusses obstructions of the the conglutination and consolidation nasal passages which may occur from over
of the wound.” growths in the back part of the nose, in the nose and throat space. For the treatment
Theodoric himself copies Bruno with of these he quotes Paul of Ægina, the most
regard to operations within the nose, and famous medical writer of the late Greek
has something special to say with regard time, of whose career we know so little,
to nasal repair after injuries. Every possible however, that differing authorities place portion should be saved and if a part of him anywhere from the fourth to the sev
the nose hang down this should be reenth century A.D. Paul suggested that a
placed and very carefully sewed on again. ligature with knots at intervals should be
A pledget of silk soaked in warm wine passed through a tube into the nose and of proper thickness and length should be then brought out through the mouth and
inserted into the nostrils in order to mainby to-and-fro motion employed to cut off
tain the parts in their proper places just projecting growths at the back of the as far as possible. If the patient's breathing, nose. After this, cauterizing materials were
disturbed by this procedure, threatens in to be used to prevent recurrence. Bruno
any way to interfere with the success of seems to have been quite satisfied that he
the operation, then the pledget of silk should could make the nose patulous in this way
have a goose quill run through it in order and greatly relieve the patient and prevent
to facilitate breathing. The older medical the development of complications.
and surgical authorities, especially Paul of It may seem surprising that a surgeon in
Ægina and Hippocrates, had suggested a the middle of the thirteenth century should
tube made of lead, but Theodoric found a have so much surgical sense, but when it is
quill much more cleanly and less bothersome. recalled that Bruno was the originator of
Theodoric has a good deal to say about the expression “union by first intention,'
the possibilities of repair of disfiguring it will be easier to comprehend. That ex
wounds of the face and is a distinct pioneer pression, so familiar in the modern times,
in plastic surgery. His use of strong wine as has of course no significance in any modern
the only dressing, his insistence on the ablanguage except what is lent to it by the sence of manipulation and his advice not old mediæval Latin, unio per primam in
to remove the dry dressing, as it was calledtentionem. Bruno knew exactly what he
because after a time the strong wine evapwas talking about when he used it, for he
• How curious this use of the word "modern” had seen wounds heal without pus and he seems just after the middle of the thirteenth century.
orated, leaving the dressings perfectly dry- benefit of humanity in his own and subgave him abundant opportunity for secur- sequent generations. Among other things, ing such healing as would provide the best he gave us, particularly, as we have said, results. He did not hesitate to say, when a the method of producing narcosis, evisurgeon made an incision in a hitherto dently carefully worked out so as to make unbroken part, that if pus developed in it it possible that extensive surgical work that complication was due to the surgeon's might be done on a patient without his feelerror-his manipulations were at fault. For ing it, or but to a slight degree, and yet this reason he advised against sewing up without
serious risk of his not awaking wounds of the scalp, though he gives a at the end of the operation. number of details of the procedure that Theodoric's description of the mode of should be employed to bring the parts care- obtaining anesthesia practiced by his father fully together and, by proper bandaging is as follows: and pressure, to keep them together. Strange as it may seem, Theodoric was
“Having made a mixture of the a bishop as well as a surgeon and had been wine extracts of opium, hemlock, mana member of the Dominican Order. His dragora, unripe mulberries and wild textbook of surgery published in the Vene- lettuce, a sponge should be boiled in tian Collection of surgical works in 1498
this fluid until all is boiled away, and makes that fact very clear. He is the first then whenever anesthesia is wanted surgical writer who definitely mentions the this sponge should be placed in warm use of an anæsthetic during operations. water for an hour and applied to the He says that its introduction was due to nostrils until the patient sleeps, when his father Ugo, or Hugh, of Lucca, as he is the surgical operation should be percalled, who is known to have been a great
formed. At its end another sponge surgeon, but who wrote nothing, and whose dipped in vinegar should be frequently fame is preserved only through his son's applied to the nostrils, or some of the writings. Ugo of Lucca, or Hugh Bor- juice of the root of hay should be ingognoni, to use the. family name that he jected into the nostrils, when the paand his three physician sons employed, had tient will soon awaken.' been a surgeon to the crusaders about 1218 and was present at the siege of Damietta. A mode of anesthesia resembling this in After his return he was made the City many respects is described by Guy de Physician of Bologna, to whom not only Chauliac after the middle of the fourteenth matters of health but also of medico-legal century, so that there seems to be no doubt significance were referred. His appointment that for several centuries operations in and the statutes granting him powers are Europe were done under the influence the first documents in the history of legal of an anesthetic and that the practice was medicine in modern times.
reasonably successful. It is easy to underTheodoric wrote of his father's experi- stand that it was neither so safe nor so sure ences and those of his brothers as well as as our practice in the matter. The surprise is his own. Many of these details of surgical that it should have existed, and for so long, technique had been carefully treasured as and then have been entirely forgotten, so secrets up to this time and transmitted as that the very idea of an anesthetic came family heritages, as among the Asclepiadean as a surprise to the mid-nineteenth century. families in the olden time. Theodoric broke As a matter of fact the English poet Middlethis tradition and published them for the ton mentions “the pities of old surgeons” and how they put them to sleep before to find among them developments of the cutting them, and there are other literary specialty of the nose and throat which passages to the same purport; but readers would otherwise have seemed almost inused to think that these represented poetic credible. How curious it is, however, to licenses or were due to the writers' imagina- find that these two great cycles of develoption, the poets' enthusiasm spurring them ment of surgery, including the specialties, on to tell things that would have been ideal should be separated in their initial stages had they existed, though in reality they at least by seven centuries. The student of never did.
history who can explain the reason for the We know otherwise now, and knowing interval between these two cycles of adthe generations that practiced both anes- vance knows something about human histhesia and antisepsis we are not surprised tory and its philosophy.
THE CHASSEURS D'ALPIN
(The "shock troops" of the French army)
See the Chasseurs marching through
To the front. To the front.
Bear the brunt!
'Tis their wont.
Pause while they are passing by,
Last resource in direst need
On they go. Forward go.
O’er the foe.
'Twas ever so.
Here a cross and there a mound,
Thus they sleep. Silent sleep.
And glory reap.
They are called the troops of shock.
Sturdy men. Heroic men.
One for ten!
Traveler, plait a laurel wreath
Of a girth, majestic girth.
With Mother Earth.
To their worth.
CARLETON B. McCULLOCH, M.D.
MODERN COMMENTARIES ON HIPPOCRATES
By JONATHAN WRIGHT, M.D.
PLEASANTVILLE, N. Y.
ERHAPS it is not the only way, but disturb us if Plato is thought by the young
one of the ways of judging of the lady at the library to have written someexcellence of a work of science or thing on astronomy or if the man who
literature is to take note of the preaches in our church thinks Aristotle discussion the author has elicited in les was a monk. We ourselves may be unable talented readers and the stimulation of to get up any enthusiasm for either. But the faculties thereby evidenced. In the when we learn that all these men have by conceit and braggadocio of Falstaff, aside their words tapped the ocean of thought in from his being the butt of jokes, we every era of civilization since they lived perceive he is conscious of the quality of and at their magic touch abundant streams his mind when he says he is not only witty of mental activity have gone forth to enrich himself, but is the cause of wit in others. the world, when we once realize what an
There is no standard of truth whereby ever living power they still exercise over the the accuracy of theory and practice of one best minds which humanity produces, then age can be judged by another, though there what Dotty says about Ibsen or what Bill are underlying general principles which per- Broker thinks of Kipling, that the Reverend sist as much perhaps by their vagueness Mr. Stiggins is mistaken about Aristotle, and lack of limitation and inclusiveness as or that we ourselves fall asleep or our by their validity, but, for the most part, minds wander when we read the “Phaetime withers most specific facts as they drus" of Plato or the “Poetics" of Ariswere apprehended two thousand or more totle, is of no consequence. It is a subjecyears ago. When, however, a discourse, an tivity which has nothing in the least to do oration, a poem, a philosophical treatise, or with the quality of the writer's works; a narrative continues for generation after that we must judge of from what we come generation, century after century, for ages, to know of the phenomena which the to excite the comment of readers, as do, history of thought furnishes us. for instance, those of Homer, Herodotus, The acknowledgment of this as a reality Hippocrates, Horace, Virgil, we are safe in is common enough, so common as to have recognizing in that objective evidence the become perfunctory and of course occaproof of an inherent excellence which
sionally a little ostentatious, but it is seldom haps our own faculties do not reveal to us. the subject of analysis. Why is it, then, Subjective testimony is of little interest that these master artists continue to be to us. We care not if the intellectual crea- the wellsprings of thought and the or igin, ture at our side adores Ibsen—we might usually unrecognized, of inspiration? Cerhate him; or if the man in the street reads tainly not because of the facts they display. Kipling to-day-to-morrow he may likely These are denied or discredited in a short never give him a thought. It need not time; but through every vicissitude of
1 The translations of Francis Adams' Hippocrates, "Genuine Works,” y. I. New York: William Wood & Co., and E. Littré's Hippocrates, “Euvres complètes.” Paris: J.-B. Bailliere, 1839-1845. These volumes have been chiefly used and compared with Littré's Greek text.