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Among numerous letters received from prominent physicians and authors appreciative of Dr. Handerson's medico-historical labors, one from Dr. Oliver Wendell Holmes expresses high praise and requests to have sent to him everything which Dr. Handerson might in future write.

It seems eminently appropriate that the essay on "Gilbertus Anglicus." the last from the pen of Dr. Handerson, should be put in book form, together with a sketch, however brief, of its author's earnest life, his sterling character, his geniality and imperturbable equanimity, and thus preserved in testimony of the high esteem in which he was held by his contemporaries.

SAMUEL WALTER KELLEY.

RESOLUTIONS

At a meeting of the Council of the Cleveland Medical Library Association, held on May 14, the following resolutions were adopted:

The Association desires to express its high appreciation of his long and valued services, and extends to his bereaved family its heartfelt and sincere sympathy.

C.A. HAMANN, WM. EVANS BRUNER, J.B. McGEE.

GILBERTUS ANGLICUS

A STUDY OF ENGLISH MEDICINE IN THE THIRTEENTH CENTURY.

BY H.E. HANDERSON, A.M., M.D.

CLEVELAND

Among the literary monuments of early English medicine the "Compendium Medicinae" of Gilbertus Anglicus merits a prominent position as the earliest complete treatise on general medicine by an English author which has been preserved to our day, and equally because it forms in itself a very complete mirror of the medical science of its age and its country.

Gilbert was undoubtedly one of the most famous physicians of his time. His reputation is recognized in those well-known lines of Chaucer which catalogue the "authorities" of his Doctor of Phisik:

"Wel knew he the olde Esculapius And Deyscorides and eek Rufus, Olde Ypocras, Haly and Galyen, Serapion, Razis and Avycen, Averrois, Damascien and Constantyn, Bernard and Gatesden and Gilbertyn."

He is also quoted with frequency and respect by the medical writers of many succeeding ages, and the Compendium, first printed in 1510, enjoyed the honor of a second edition as late as the seventeenth century . The surname "Anglicus" in itself testifies to the European reputation of our author, for as Dr. Payne sensibly remarks, no one in England would speak of an English writer as "the Englishman."

Yet, in spite of his reputation, we know almost no details of the life of Gilbert, and are forced to content ourselves with the few facts to be gleaned from the scanty biographies of early writers and the inferences drawn from the pages of the Compendium itself. The date and place of his birth and death, and even the field of his medical activities are equally unknown. Bale, Pits and Leland, the earliest English biographers, tell us that Gilbert, after the completion of his studies in England, proceeded to the Continent to enlarge his education, and finally became physician to the great Justiciar, Hubert Walter, archbishop of Canterbury, who died in the year 1205. This would place him under the reign of King John, in the early part of the thirteenth century.

The most recent biographers of Gilbert, however, Mr. C.L. Kingsford, and the late Dr. Joseph Frank Payne, after an apparently careful and independent investigation of his life, have reached conclusions which vary materially from each other and from those of the historians mentioned. Mr. Kingsford fixes the date of Gilbert at about 1250, while Dr. Payne reverts to the views of Bale and Pits and suggests as approximate figures for the birth and death of Gilbert the years 1170-80 to 1230. This discrepancy of twenty-five or thirty years between the views of two competent and unprejudiced investigators, as a mere question of erudition and interpretation, is perhaps scarcely worthy of prolonged discussion. But as both biographers argue from substantially the same data, the arguments reveal so many interesting and pertinent facts, and the numerous difficulties attending the interpretation of these facts, that some comparison of the different views of the biographers and some criticism of their varying conclusions may not be unwelcome.

Finally, I may suggest another line of argument, which, so far as I know, has not yet been advanced for the determination of the period of Gilbert.

From a careful review of the data thus presented we may epitomize, somewhat conjecturally, the life of Gilbert substantially as follows: He was probably born about 1180 and received his early education in England. On the completion of this education, about the close of the 12th century, he proceeded to the Continent to complete his studies, and spent some time in the school of Salernum, where it is probable that he enjoyed the instruction of Roger of Parma, Ricardus Salernitanus, and may have had among his fellow-students Aegidius of Corbeil. Probably after his return to England he served for a brief period on the staff of Archbishop Hubert Walter, after whose death in 1205, but at an unknown period, Gilbert returned once more to the Continent, where it seems probable he spent the remainder of his life. This comports best with his extensive European reputation, his surname "Anglicus" and the comparative dearth in England of any facts relating to his life. The date of the Compendium I am inclined to place about 1240, prior to the literary activity of Ricardus Parisiensis or Richard of Wendover, Roland of Parma, Roger Bacon and Theodorius of Cervia. We may place his death, conjecturally, at about 1250.

The first edition of the Compendium is a small quarto of 362 folios , five by seven inches in size, printed in double narrow columns, in black letter, perfectly legible and clear. The pagination shows some errors, but the text itself is remarkably accurate, though the presence of a multiplicity of contractions and ligatures renders the reading somewhat difficult to the modern student. On the last page we find the following colophon:

The second edition is said to bear the title: "Laurea anglicana, sive compendium totius medicinae, etc," Geneva, 1608.

It should be noticed that the title "Laurea anglicana" is not mentioned in the original edition of 1510, but is apparently due to the exuberance of enthusiasm of the editor of the later edition, whose taste seems to have been more flamboyant.

Various manuscript works of greater or less authenticity are ascribed to Gilbert by different authorities. Of these Mr. Kingsford furnishes the following list:

To these he adds, on the authority of Bale and Pits:

All of these latter may be regarded as doubtful.

Dr. Payne calls attention to the fact that all these writers antedate the 13th century, and thus limit the period of Gilbert in antiquity. This is undoubtedly true with reference to authorities actually named, but does not exclude from consideration other writers quoted, but not named, whom we shall have occasion to refer to hereafter.

The Compendium opens with a very brief and modest foreword, couched in the following terms:

It will be observed that no claim whatever for originality is presented by the author. He calls his book a compendium extracted from all authors and the practice of the professors, and edited only by himself. The same idea is more fully emphasized later , where he says:

The Compendium is divided into seven books, and the general classification of diseases is from head to foot--the usual method of that day. The modern reader will probably be surprised at the comprehensiveness of the work, which, besides general diseases, includes considerable portions of physiology, physiognomy, ophthalmology, laryngology, otology, gynecology, neurology, dermatology, embryology, obstetrics, dietetics, urinary and venereal diseases, therapeutics, toxicology, operative surgery, cosmetics and even the hygiene of travel and the prevention of sea-sickness. Some of these subjects too are discussed with an acuteness and a common sense quite unexpected. Of course, scholastic speculations, superstition, charms, polypharmacy and the use of popular and disgusting remedies are not wanting. Even the mind of a philosopher like Roger Bacon was unable to rise entirely above the superstition of his age. But the charms and popular specifics of Gilbert are often introduced with a sort of apology, implying his slight belief in their efficacy. Thus in his chapter on the general treatment of wounds he introduces a popular charm with the following words:

And again, in his discussion of the treatment of gout and rheumatism , Gilbert adds, under the title

We may believe, indeed, that Gilbert would have preferred to follow in the therapeutic footsteps of Hippocrates, had he not disliked to be regarded by his colleagues as eccentric and opinionated. For he says in his treatment of thoracic diseases :

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 :

"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."

Gilbert launches out with genuine scholastic finesse and verbosity into a discussion of the questions whether this definition is based upon the essentia or the differentia of fever; whether the heat of fever is natural or unnatural, and other similar subtle speculations, and finally arrives at a classification of fevers so elaborate and complex as to be practically almost unintelligible to the modern reader.

The more important of these fevers or febrile conditions are:

Ephemeral Hemitertian Double quartan Interpolated Synocha Causon synochides Epilala Quotidian Double tertian Quintan Continued Causon Putrid Lipparia Tertian Quartan Sextan Synochus Synochus causonides Ethica Erratica

Some of these names are still preserved in our nosologies of the present day; others will be recalled by the memories of our older physicians, and a few have totally disappeared from our modern medical nomenclature.

Interpolated fevers are characterized by intermissions and remissions, and thus include our intermittent and remittent fevers; synochus depended theoretically upon putrefaction of the blood in the vessels, and was a continued fever. Synocha, on the other hand, was occasioned by a mere superabundance of hot blood, hence the verse:

All these fevers are regarded from the standpoint of Humoralism, and depend upon variations in the quantity, quality, mixture or location of the four humors, blood, phlegm, bile and black-bile .

The second book then opens with a consideration of the hair and scalp, and their respective disorders.

The hair is a dry fume , 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 , etc. The use of the hair is for ornament, for protection and for the distinction of the sexes. Numerous prescriptions for dyeing the hair, for depilatories , for the removal of misplaced hair and for the destruction of vermin in the hair are carefully recorded.

Among the diseases of the scalp attention is given to alopecia, dandruff , tinea caries and various pustular affections, fanus , rima, spidecia, achora, etc. 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.

"Assume a virtue, if you have it not."

In the department of neurology Gilbert, after a philosophical discussion of the nature and variety of pain, devotes considerable chapters to the causes, symptoms, diagnosis and treatment of headache, hemicrania, epilepsy, catalepsy, analepsy, cerebral congestion, apoplexy and paralysis, phrenitis, mania and melancholia, incubus or nightmare, lethargy and stupor, lippothomia or syncope, sciatica, spasm, tremor, tetanus, vertigo, wakefulness, and jectigation .

The third book of the Compendium opens with several chapters on the anatomy and physiology of the eye and the phenomena of vision. According to Gilbert, the eye consists of three humors, the albugineous , the crystalline lens and the vitreous humor, and seven tunics, apparently

though the definitions are not in all cases quite clear and definite. The tela aranea is said to take its origin from the retina, the retina from the optic nerve, and the latter from the rethi involving the substance of the brain. The cornea arises from the sclerotic tunic, the uvea and secundina take their origin from the pia mater, and the conjunctiva from a thin pellicle or membrane which covers the exterior of the cranium and is nourished by a transudation of the blood through the coronal suture. This pellicle is also said to have a connection with the heart, which arrangement furnishes a decidedly curious explanation of the mechanism of sympathetic and maudlin lachrymation. 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 , 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. 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." Q.E.D.

"Why does not a single object appear double, inasmuch as we have two eyes?" To this he replies: "From the anterior part of the brain two optic nerves pass to the two eyes. But these two nerves unite at a certain point into one. Now, since the two nerves are of equal length, two images proceeding from a single object do not make the object seem double, but single, since the two images are united into one, and accordingly one object is seen as one image."

Other physiological speculations are introduced by the questions: "May one see an object not actually present?" "Why do some animals see best objects at a distance, others those near at hand?" "Why are objects seen in their proper position?" All these questions are answered in accordance with the scholastic formulae, and, not infrequently, with considerable acuteness.

"When we see a man with large eyes, we argue that he is indolent."

"If his eyes are deeply situated in his head, we say that he is crafty and a deceiver."

"If his eyes are prominent, we say that he is immodest, loquacious and stupid."

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