THEODORIC
This son, after having completed his medical studies at the age of about twenty-three, entered the Dominican Order, then only recently established, but continued his practice of medicine undisturbed. His ecclesiastical preferment was rapid. He attracted the attention of the Bishop of Valencia, and became his chaplain in Rome. At the age of about fifty he was made a bishop in South Italy and later transferred to the Bishopric of Cervia, not far from Ravenna. Most of his life seems to have been passed in Bologna however, and he continued to practise medicine, devoting his fees, however, entirely to charity. His text-book of surgery was written about 1266 and is signed with his full name and title as Bishop of Cervia. Even at this time however, he still retained the custom of designating himself as a member of the Dominican Order.
The most interesting thing in the first book of his surgery is undoubtedly his declaration that all wounds should be treated only with wine and bandaging. Wine he insists on as the best possible dressing for wounds. It was the most readily available antiseptic that they had at that time, and undoubtedly both his father's recommendation of it and his own favorable experience with it were due to this quality. It must have acted as an excellent inhibitive agent of many of the simple forms of pus formation. At the conclusion of this first book he emphasizes that it is extremely important for the healing of wounds that the patient should have good blood, and this can only be obtained from suitable nutrition. It is essential therefore for the physician to be familiar with the foods which produce good blood in order that his wounded patients may be fed appropriately. He suggests, then, a number of articles of diet which are particularly useful in producing such a favorable state of the tissues as will bring about the rebirth of flesh and the adhesion of wound surfaces. Shortly before he emphasizes the necessity for not injuring nerves, though if nerves have been cut they should be brought together as carefully as possible, the wound edges being then approximated.
Probably the most interesting feature for our generation of the great text-books of the surgeons of the medieval universities is the occurrence in them of definite directions for securing union in surgical wounds, at least by first intention and their insistence on keeping wounds clear. The expression union by first intention comes to us from the olden time. They even boasted that the scars left after their incisions were often so small as to be scarcely noticeable. Such expressions of course could only have come from men who had succeeded in solving some of the problems of antisepsis that were solved once more in the generation preceding our own. With regard to their treatment of wounds, Professor Clifford Allbutt says:[19]
"They washed the wound with wine, scrupulously removing every foreign particle; then they brought the edges together, not allowing wine nor anything else to remain within—dry adhesive surfaces were their desire. Nature, they said, produces the means of union in a viscous exudation, or natural balm, as it was afterwards called by Paracelsus, Paré, and Wurtz. In older wounds they did their best to obtain union by cleansing, desiccation, and refreshing of the edges. Upon the outer surface they laid only lint steeped in wine. Powders they regarded as too desiccating, for powder shuts in decomposing matters wine after washing, purifying, and drying the raw surfaces evaporates."
Theodoric comes nearest to us of all these old surgeons. The surgeon who in 1266 wrote: "For it is not necessary, as Roger and Roland have written, as many of their disciples teach, and as all modern surgeons profess, that pus should be generated in wounds. No error can be greater than this. Such a practice is indeed to hinder nature, to prolong the disease, and to prevent the conglutination and consolidation of the wound" was more than half a millennium ahead of his time. The italics in the word modern are mine, but might well have been used by some early advocate of antisepsis or even by Lord Lister himself. Just six centuries almost to the year would separate the two declarations, yet they would be just as true at one time as at another. When we learn that Theodoric was proud of the beautiful cicatrices which he obtained without the use of any ointment, pulcherrimas cicatrices sine unguento aliquo inducebat, then further that he impugned the use of poultices and of oils on wounds, while powders were too drying and besides had a tendency to prevent drainage, the literal meaning of the Latin words saniem incarcerare is to "incarcerate sanious material," it is easy to understand that the claim that antiseptic surgery was anticipated six centuries ago is no exaggeration and no far-fetched explanation with modern ideas in mind of certain clever modes of dressing hit upon accidentally by medieval surgeons.
Theodoric's treatment of many practical problems is interesting for the modern time. For instance, in his discussion of cancer he says that there are two forms of the affection. One of them is due to a melancholy humor, a constitutional tendency as it were, and occurs especially in the breasts of women or latent in the womb. This is difficult of treatment and usually fatal. The other class consists of a deep ulcer with undermined edges, occurring particularly on the legs, difficult to cure and ready of relapse, but for which the outlook is not so bad. His description of noli me tangere and of lupus is rather practical. Lupus is "eating herpes," occurs mainly on the nose, or around the mouth, slowly increases, and either follows a preceding erysipelas or comes from some internal cause. Noli me tangere is a corroding ulcer, so called perhaps because irritation of it causes it to spread more rapidly. He thinks that deep cauterization of it is the best treatment. Since these are in the department of skin diseases this seems the place to mention that Theodoric describes salivation as occurring after the use of mercury for certain skin diseases. He has already shown that he knows of certain genital ulcers and sores on the genital regions and of distinctions between them.