"_Interior autem macula, quae tela vocatur, subcornea situata, si vl'e (?) purgatione precendente et colliriis et pulveribus non removetur, acu torta immissa per caprinum angulum extrahatur aut inferius replicetur_" (f. 137a).

And again (f. 141d):

"_In uvea sunt largitas et constrictio et aqua sive cataracta.... Aqua quandoque per medium pupille descendit, inferius stans, subuvea apparens, quae perfecte curatur secundum quosdam immisso acus aculeo per pupillam, ut extra fluat aqua._"

Chapters on the physiology of hearing, smelling and the sensation of touch are followed by a discussion of the symptoms and treatment of earache, abscess of the ear, discharges (b.l.o.o.d.y and sanious) from the ear, worms and other foreign bodies in the ear, tinnitus aurium, deafness, coryza, epistaxis, nasal polypi, ozaena, cancer of the nose, fissures and ulcers of the lips, foul breath, diseases of the tongue, toothache, etc.

Physiognomy, a favorite theme with our author, appears again in a considerable chapter on the physiognomy of the nose, mouth, face and the teeth.

"He who laughs frequently is kind and genial in all things and is not worried over trifles."

"He who laughs rarely is contrary and critical."

"He who has large ears is stolid and long-lived."

"He who has a large mouth is gluttonous and daring."

"He whose teeth are defective and small is weak in his whole body."

"He whose canine teeth are long and straight is a glutton and a rascal."

The department of genito-urinary diseases is introduced by a long chapter ent.i.tled "_De approximeron_," a formidable Latin word defined by Gilbert as s.e.xual impotence. An elaborate discussion of the physiology of generation and the phenomena of impotence is followed by a collection of remedies for the condition, of which the best that can be said is that they are probably no less effective than most of the modern drugs recommended for the same purpose. Concerning a function over which so many fond superst.i.tions still linger in the public mind we may, perhaps, charitably forgive Gilbert for the introduction of an empirical remedy for sterility, which, he a.s.sures us, he has often tried and with invariable success, and which enjoys the double advantage of applicability to either s.e.x.

"Let a man, twenty years of age or more, before the third hour of the vigil of St. John the Baptist, pull up by the roots a specimen of consolida major (comfrey) and another of consolida minor (healall), repeating thrice the Lord's prayer (_oratio dominica_). Let him speak to no one while either going or returning, say nothing whatever, but in deep silence let him extract the juice from the herbs and with this juice write on as many cards as may be required the following charm:

"_Dixit dominus crescite._ [symbol: dagger]. _Uthihoth._ [symbol: dagger]. _multiplicamini._ [symbol: dagger]. _thahechay._ [symbol: dagger]. _et replete terram._ [symbol: dagger]. _amath._

"If a man wears about his neck a card inscribed with these identical words written in this juice, he will beget a male. Conversely, if a woman, she will conceive a female" (f. 287b).

Gilbert, however, cautions the bearer of this potent charm of the possible dangers of satyriasis incurred thereby, and offers suitable remedies for so alarming a condition.

Chapters on satyriasis, gomorrhea (gonorrhea in its etymological sense, seminal emissions), with a third ent.i.tled "_De pustulis et_ *_apostematibus virgae_" complete this department of medical art. The last chapter recognizes the venereal origin of the pustules and ulcers discussed, but furnishes no direct evidence of Gilbert's belief in the existence of a specific venereal poison.

While Gilbert is very scrupulous in his examination of the gross appearances of the urine in most diseases, his discussion of the diseases of the kidneys and bladder includes only pain in the kidneys, abscess of the kidneys, renal and vesical calculus, hematuria, incontinence of urine, dysuria and strangury.

The chapter on hematuria presents a very curious specimen of medieval pathology. 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 quant.i.ty, 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 quant.i.ty so great, while pain is felt over the region of the seventh vertebra, counting from below. If it comes from the kidneys, it is scanty and pure as it leaves the bladder, but soon coagulates and forms a dark deposit in the vessel, while pain is felt in the p.u.b.es and peritoneum.... If pus, blood and epithelium (_squamae_) are pa.s.sed, and the odor is strong, it signifies ulceration of the bladder" (f. 275b).

[Footnote 7: In his chapter on embryology (f. 304c) Gilbert describes the lrili vein as follows: "The embryo is nourished by means of the lrili or lrineli vein, which does not exist in man. This vein has its origin in the liver and divides into two branches. Of these the superior branch bifurcates, and one of its branches goes to the right breast, the other to the left, conveying blood from the liver. This blood in the breast is bleached white (_dealbatur_) like milk, and forms the nourishment of the infant. The inferior branch of the lrili vein also bifurcates, sending one of its branches to the right cornu of the uterus, the other to the left. These vessels carry blood into the cotyledons, whence it is transmitted to the fetus and digested by its digestive faculty."]

Diabetes is defined as "An immoderate pa.s.sage or attraction of urine from the liver to the kidneys and its pa.s.sage through the kidneys, as the result of a warm or dry distemperature of these organs." The idea of some a.s.sociation of the liver and kidneys in the production of diabetes is at least as old as the eleventh century, and Gilbert's definition of the disease is undoubtedly borrowed from the "Practica"

of John Platearius (A.D. 1075), of the school of Salernum. The symptoms, continual thirst, dryness of the mouth, emaciation, in spite of an inordinate appet.i.te, frequent and profuse urination, are correctly given, but no knowledge of the presence of sugar in the urine is indicated.

Dyampnes (involuntary micturition) claims a page or more of explanation and treatment, and its frequent occurrence in old men and children is noticed.

In the department of the diseases of women chapters are devoted to amenorrhea, menorrhagia, hysteria (_suffocatio matricis_), prolapse, ulceration, abscess, cancer, dropsy and "ventosity" of the uterus (physometra).

In the allied department of obstetrics we find chapters on the signs of conception, on the urine in pregnant women, on difficult labor, prolapsus uteri, retention of the placenta, post partum hemorrhage, afterpains, and the oedema of pregnancy. The causes of difficult labor, according to Gilbert, are malposition, dropsy, immoderate size and death of the fetus, debility of the uterus and obstruction of the maternal pa.s.sages. Malpositions are to be corrected by the hand of the midwife (_obstetrix_). Adjuvant measures are hot baths, poultices, inunctions, fumigations and sternutatories, and the use of certain herbs.

In the departments of general medicine not as yet entirely appropriated by specialists it will suffice to mention scrofula, pleurisy and pneumonia, hemoptysis, empyema, phthisis, cardiac affections, diseases of the stomach, liver and spleen, diarrhoea and dysentery, intestinal worms, dropsy, jaundice, cancer, rheumatism and gout, small-pox, measles, leprosy and hydrophobia, all of which claim more or less attention.

Peripneumonia and pleurisy are both inflammations of the chest, the former affecting the lungs, the latter the diaphragm and the pellicle which lines the ribs. The prominent symptoms of both diseases are pain in the chest or side, cough and fever and dyspnoea. Accidents or sequelae are hemoptysis, empyema and phthisis.

Empima (empyema) is the hawking-up of sanies, with infection of the lung and a sanious habit. 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. Hence the lungs do not inspire sufficient air to mitigate the innate heat of the heart, and the heart fails to purify itself of the fumosity or fumous vapors generated in itself. Accordingly, deprived of the means of mitigating its heat or ventilating its fumosities, the spirits within it become unduly heated, and a consuming fire is generated in the entire body.

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. 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. These patients converse while dying, and die conversing (_moriendo loquentur, sed loquendo moriuntur_). Gilbert, of course, supplies a formidable array of remedies for the disease, but tells us that the "very latest" is cauterization over the clavicles (_Novissimum autem consilium est cauterium in furcula pectoris_).

The varieties of difficulty of breathing are cla.s.sified under the t.i.tles of asma, dispnea, orthomia, hanelitus and sansugium. The last t.i.tle is given to a condition in which, as Gilbert says, "A superfluous humor is abundant in the superficies of the lung, which compresses that organ and renders it unable to dilate in inspiration.

Hence it labors in inspiration like a leech, from which the dyspnea derives its name."

Under the single t.i.tle of "_cardiaca pa.s.sio_" are included all possible diseases of the heart. The symptoms of this disease are said to be "palpitation, twitching of the limbs (_saltus membrorum_), perspiration, weakness of the nerves, facial pallor, weakness of the body as in hectic fever or phthisis, excessive pain and faintness over the precordia, a disposition to sleep and often constipation." The treatment is, of course, entirely symptomatic.

Diseases of the digestive apparatus are discussed under the headings of difficulties of deglut.i.tion, canine appet.i.te, bolismus (boulimia), disturbances of thirst, eructations, hiccup, nausea and anorexia, vomiting, anathimiasis (gastric debility), anatropha and catatropha (varieties of obstinate vomiting), pain in the stomach, abscess of the stomach, salivation, colic, dysentery and diarrhoea, intestinal worms, hemorrhoids, rectal tenesmus, prolapsus ani, fistula in ano, diseases of the liver, dropsy, jaundice and diseases of the spleen.

Abscess of the stomach sometimes manifests a circ.u.mscribed tumor, and accordingly, probably includes cancer of that organ. Approved remedies are the Al'mirabile, the stomatichon frigidum, calidum or laxativumvum, etc., stereotyped formulae, of which the composition is carefully recorded.

Dysentery is a flux of the bowels with a sanguinolent discharge and excoriation of the intestines. A variety called hepatic dysentery, however, lacks the intestinal excoriation. Diarrhoea is a simple flux of the bowels, without either the sanguinolent discharges or the intestinal excoriation. Lientery is a flux of the bowels with the discharge of undigested food, occasioned by irritability (_levitas_) of the stomach or intestines. Colical pa.s.sion and iliac pa.s.sion derive their names from the supposed origin of the pain in the colon or ileum, a remark which furnishes occasion for the statement that Gilbert divides the bowels into six sections, viz., the duodenum jejunum and ileum, and the orobus, colon and longaon (r.e.c.t.u.m).

Intestinal worms are not generated in the stomach, as Gilbert says, because of the great heat produced by the process of digestion. In the intestines they originate chiefly from the varieties of phlegm, e.g., saline, sweet, acid, natural, etc. The species mentioned specifically are lumbrici and ascarides or cucubitini, though the terms long, round, short and broad are also employed, and probably include the tape worm or taenia lata. The treatment of these parasites consists generally in the use of aromatic, bitter or acid mixtures, among which gentian, serpentaria, t.i.thymal and cuc.u.mis agrestis are especially commended for lumbrici, and enemata of wormwood, lupinus, scammony, salt, aloes, etc., for ascarides.

The diseases of the liver, though not numerous, are allotted considerable s.p.a.ce most of which is occupied by scholastic speculations and the usual rich supply of therapeutical suggestions.

Discrasia of the liver has several varieties, warm, cold, moist and dry, and seems nearly equivalent to our somewhat overworked term of "biliousness." Gilbert's favorite compounds for the relief of this condition are the Trifera sarracenica, the Electuarium psillitic.u.m and above all the Dyantos Besonis.

Obstruction (_oppilatio_) of the liver or enfraxis is defined as a disease of the ca.n.a.ls (_pori_), of which four are enumerated, to-wit, the meseraic, that of the convexity of the organ (_gibbus--ubi sunt exitus capillarium venarum_), the duct leading to the gall-bladder and that leading to the spleen. With an abundance of symptoms, it is singular that this comprehensive disease does not seem characterized by any constant or severe pain, as we might reasonably expect.

Abscess of the liver depends upon some vice of the blood, the bile, the phlegm or the black-bile. The general treatment is poultices and other maturatives, but, as the author adds rather sadly at the close, _ultima cura est per incisionem_.

Dropsy is discussed as an independent disease through the exhaustive speculations of thirty-two pages. Gilbert tells us it depends upon some fault of the digestive faculty of the liver, and he divides it into four species, to-wit, leucoflantia, yposarcha, alchitis and tympanitis, each of which has its special and appropriate treatment.

In the dreary waste of speculative discussion it is cheering, however, to observe Gilbert's positive recognition of the sphere of percussion indicated in the pa.s.sage:

"_Et venter percussus sonat ad modum utris semipleni aqua et venta._"

(f. 250b.)

Ycteritia or jaundice receives equally thorough discussion through eight weary pages, including the usual polypharmacal treatment.

The spleen, Gilbert says, is sometimes the name of an organ, sometimes of a disease. As an organ it is spongy and loose in texture, and attracts and retains the superfluities of the black-bile, expelled from the liver for its own cleansing. Hence it is a servile and insensitive organ, and accordingly suffers different diseases, such as obstruction, tumors, hardening, softening, abscess, and sometimes flatulence or repletion. The symptoms and treatment of each of these morbid conditions, arising from either heat or cold, are discussed with exasperating thoroughness, and the chapter concludes with the composition and use of various specific remedies of compound character, bearing the impressive t.i.tles of Dyasene, Dyacapparis, Dyaceraseos (a mixture of cherry juice, honey, cinnamon, mastic and scammony) and Agrippa.

Scrofulous swellings are carefully considered in a chapter ent.i.tled "_De scrophulis et glandulis._" "Scrophulae and glandulae are hard swellings developing in the soft parts, as in the emunctory localities of the veins and arteries, particularly in the neck, armpits and groins, and sometimes in other places. They spring from the superfluities of the princ.i.p.al organs, which nature expels, as it were, to the emunctories and localities designed to receive this flux." ... "Hence they are often found the cause of scabies, tinea, malum mortuum, cancer, fistula, etc., and are called glandes.

Sometimes, however, a dryer matter is finely divided and falls into several minute portions, from which arise many hard and globular swellings, called scrofulae from the multiplicity of their progeny, like that of the sow (_scrofa_). The disease is also called _morbus regius_, because it is cured by kings."

Gilbert advises that these swellings should not be "driven in"

(_repercutienda_), but brought to suppuration generally by emollients and poultices. When softened they may be opened with a lancet and the pus allowed to escape gradually, but as this process is tedious, he prefers the entire removal of the glands with the knife, premissing, however, that no gland should be cut into which cannot be well grasped by the hand and pulled from its seat. This surgical manipulation is fully described, and is undoubtedly taken from the similar chapter of Roger. It is worthy of notice also that just at the close of this chapter, Gilbert mentions a swelling called "testudo," a gland-like, gaseous (_ventosa_) tumor, usually solitary and found in "nervous"

localities, like the joints of the wrist and hand. He says it often occurs from fracture (_ca.s.satura_?) of the nerves, is cured by pressure, friction or incision, but is not entirely free from danger.

Possibly this may refer to ganglion. Now, Roger makes no mention whatever of "testudo," while Roland says:

"_Nota quod quamvis Rogerius non designat inter glandulum et testudinem, scias igitur quod testudo fit ex majori parte flegmatica, minori melancholie, glandula vero a contrario_," a statement which might readily suggest the suspicion that Gilbert had before his eyes the text of Roland, or that, at least, he had not acquired his knowledge of testudo from Roger, his usual surgical authority.