"Si vero secundum longum aut obliquum vervi incidantur, et non ex toto, ita consolidamus. Terrestres vermes, qui sub terra nascuntur, similes in longitudine et rotunditate lumbricis, qui etaim lumbrici terre appellantur: hi aliquantulum conterantur et in oleo infusi ad ignem calefiant, et nullo aliomediante, ter vel quater vel pluries, si opportunum fuerit, plagelle impone. Si vero ex oblique nervus incidatur, eodem remedio curatur, et natura cooperante saepe conglutinatur. Potest quoque cuticula quae supra nervum est sui, et pulvis ruber superaspergatur. Nervos enim conglutinari et consolidari hoc modo sepius videmus. Si vero locus tumeat, embroca, praedicta in vulnere capitis quae prima est ad tumorem removendum, superponatur, quousque tumor recesserit. Si vena organica non inciditur, pannus albumine ovi infusus in vulnere ponatur. Embroca vero post desuperponatur" (f. 179 c).
The selection and collection of words and phrases in these two passages leaves little doubt that one was copied from the other. Indeed, so close is their resemblance that it is quite possible from the one text to secure the emendation of the other. Numerous similar passages, with others in which the text of Gilbert is rather a paraphrase than a copy of the text of Roger, serve to confirm the conclusion that the surgical writings of the English physician are borrowed mainly from the "Chirurgia" of the Italian surgeon. Some few surgical chapters of the Compendium appear to be either original or borrowed from some other authority, but their number is not sufficient to disturb the conclusion at which we have already arrived. Now, as Roger's "Chirurgia" was probably committed to writing in the year 1230, when the surgeon was an old man, these facts lead us to the conclusion that Gilbert must have written his Compendium at least after the date mentioned.
Another criticism of these chapters suggests certain interesting chronological data. It will be observed that Roger, in the passage quoted above, recommends a dressing of egg-albumen for wounds of the neck, and expresses considerable doubt whether nerves, when totally divided, can be regenerated (consolidari), though they may undoubtedly be reunited (conglutinari).
Now Roland, in his edition of Roger's "Chirurgia," criticises both of these statements of his master, as follows:
Nota quod quamvis Rogerius dicat quod apponatur albumen ovi, non approbo, quia frigidum est naturaliter, et vena et nervus et arteria frigida sunt naturaliter, et propter frigiditatem utrorumque non potest perfecte fieri consolidatio.
And again:
Nota quod secundum Rogerium nervus omnino incisus non potest consolidari, vel conjungi nec sui. Nos autem dicimus quod potest consolidari et iterum ad motum reddi habillis, cum hac cautela: Cauterizetur utrumque caput nervi incisi peroptime cum ferro candenti, sed cave vulneris lobia cum ferro calido tangantur. Deinde apponantur vermes contusi et pulveres consolidativi, etc.
It will be observed that Gilbert, in spite of the rejection by Roland of the egg-albumen dressing of Roger, still recommends its use in wounds of the neck, and although he professes to have seen many nerves regenerated (consolidari) under the simple angle-worm treatment of his master, he still makes no mention of the painful treatment of divided nerves by the actual cautery, so highly praised by Roland. It would seem, therefore, that Gilbert was not familiar with the writings of Roland when his Compendium was written, or he would, doubtless, not have omitted so peculiar a plan of treatment in an injury of such gravity. As Roland's edition of Roger's "Chirurgia" is said to have been written in 1264, the comparison of these passages would seem to indicate that Gilbert must have written the Compendium after 1230 and prior to the year 1264.
Gilbert's surgical chapters discuss the general treatment of wounds and their complications, and more specifically that of wounds of the head, neck, throat, wounds of nerves, of the oesophagus, scapula, clavicle, of the arm, the stomach, intestines and the spleen; fractures of the clavicle, arm, forearm and ribs; compound fractures; dislocations of the atlas, jaw, shoulder and elbows; fistulae in various localities, and the operations on the tonsils and uvula, on goitre, hernia and stone in the bladder, etc.—certainly a surgical compendium of no despicable comprehensiveness for a physician of his age and country.
In the general treatment of wounds (f. 86 c) Gilbert tells us the surgeon must consider the time, the age of the patient, his temperament (complexio) and the locality, and be prepared to temper the hot with the cold and the dry with the moist. Measures for healing, cleansing and consolidation are required in all wounds, and these objects may, not infrequently, be accomplished by a single agent. The general dressing of most wounds is a piece of linen moistened with the white of egg (pecia panni in albumine ovi infusa), and, as a rule, the primary dressing should not be changed for two days in summer, and for three days in the winter. In moist wounds vitreolum reduces the flesh; in dry wounds it repairs and consolidates. Flos aeris, in dry wounds, reduces but does not consolidate, but rather corrodes the tissues. Excessive suppuration is sometimes the result of too stimulating applications, sometimes of those which are too weak. In the former case the wound enlarges, assumes a concave form, is red, hot, hard and painful, and the pus is thin and watery (subtilis). If the application is too weak, the pus is thick and viscous, and the other signs mentioned are wanting. In either case the dressings are to be reversed. If any dyscrasia, such as excessive heat, coldness, dryness or moisture appears in the wound and delays its healing, it is to be met by its contrary. If fistula or cancer develops, this complication is to be first cured and then the primary wound. The signs of a hot dyscrasia are heat, burning and pain in the wound; of a cold dyscrasia, lividity of the wound; the moist dyscrasia occasions flabbiness (mollicies) and profuse suppuration, and the dry produces dryness and induration.