Gilbertus Anglicus: Medicine of the Thirteenth Century

by Henry E. Handerson

Misconis ( , poppy juice?), aa. scruples I-II, as required.

The patient is to be aroused as before.

On folio 180d we find a chapter entitled "De cathena gulae incisa vel fracta," and copied almost literally from the chapter "De catena gulae" of Roger. In neither writer do I find any precise definition of what the cathena gulae is, though Roger says, Si es gulae, quod est catena, fractum fuerit, etc., nor do I find the terms used explained in any dictionary at present available. The description of the treatment of this fracture seems, however, to indicate that the catena gulae of Roger and Gilbert is what we call the clavicle, though the more common Latin names of this bone are claviculus, furcula, juglum or os juguli. Gilbert says: "But if the bone which is the cathena gulae is broken or in any way displaced (recesserit), let the physician with one hand raise the forearm (brachium) or arm (humerum) of the patient, and with the other hand press down upon the projecting portion of the bone. Then apply a pledget moistened with albumen, a pad and a splint in form of a cross, and over all a long bandage embracing both the arm and the neck and suspending the arm. A pad (cervical) should also be placed in the axilla to prevent the dropping of the arm, and should not be removed until the fracture is repaired. If the fracture is compound, the wound of the soft parts is to be left open and uncovered by the bandage, so that a tent (stuellus) may be inserted, and the wound is then to be dressed in the ordinary manner."

Simple fracture of the humerus, Gilbert tells us, is to be reduced (ad proprium locum reducator) at once by grasping the arm above and below the seat of fracture and exercising gentle and gradual extension and compression. Then four pieces of lint wet in egg-albumen are to be placed around the arm on all sides, a bandage, four fingers wide, also moistened in albumen is to be snugly applied, another dry bandage placed above this, and finally splints fastened in position by cords. This dressing is to remain undisturbed for three days, and then renewed every third day for nine days. After the ninth day a strictura (cast, apparatus immobile?) is to be prepared and firmly applied with splints and a bandage, and the patient is to be cautioned not to bear any weight upon the injured arm (ne infirmus se super illud appodiet?). The fracture is then left until it is believed that consolidation has occurred. If, however, it is found that swelling is occasioned by the cast (ex strictorio?), the latter should be removed, and the arm well bathed in warm water containing mallowae and other emollients and thoroughly cleansed. If the bone seems to be well consolidated, it should be rubbed with an ointment of dialthea or the unguentum marciation, after which the splints and bandage are to be reapplied. If, however, it is found that the bone is not well consolidated, the cast should be replaced in the original manner, until consolidation is accomplished. If erysipelas results from the dressings, it is to be treated in the ordinary manner. During the entire treatment potions of nasturtium seeds, pes columbini (crowfoot) and other "consolidatives" are to be administered diligently. If the fracture is compound, any loose fragments of bone are to be removed, the fracture reduced as before, and similar dressings applied, perforated, however, over the wound in the soft parts.

In fracture of the ribs (flexura costi) Gilbert recommends a somewhat novel plan for the replacement of the displaced bone. Having put the patient in a bath, the physician rubs his hands well with honey, turpentine, pitch or bird-lime (visco), applies his sticky palms over the displaced ribs, and gradually raises them to their normal position. He also says (f. 183a), the application of a dry cup (cuffa vero cum igne?) over the displaced rib is a convenient method for raising it into position.

Of fractures of the forearm Gilbert simply says that they are to be recognized by the touch and a comparison of the injured with the sound arm. They should be diligently fomented, extension made if necessary, and then treated like other fractures.

Dislocation of the atlo-axoid articulation (os juguli) he tells us threatens speedy death. The mouth of the patient is to be kept open by a wooden gag, a bandage passed beneath the jaw and held by the physician, who places his feet upon the shoulders of the patient and pressing down upon them while he elevates the head by the bandage, endeavors to restore the displaced bone to its normal position. Inunctions of various mollitives are then useful.

Dislocations of the lower jaw are recognized by the failure of the teeth to fit their fellows of the upper jaw, and by the detection of the condyles of the jaw beneath the ears. The bone is to be grasped by the rami and dragged down until the teeth resume and retain their natural position, and the jaw is then to be kept in place by a suitable bandage.

In dislocation of the humerus the patient is to be bound in the supine position, a wedge-shaped stone wrapped with yarn placed in the axilla, and the surgeon, pressing against the padded stone with his foot and raising the humerus with his hands, reduces the head of the bone to its natural position. If this method fails, a long crutch-like stick is prepared to receive at one end the axillary pad, the patient is placed standing upon a box or bench, the pad and crutch adjusted in the axilla, and while the surgeon stands ready to guide the dislocated bone to its place, his assistants remove the bench, leaving the patient suspended by his shoulder upon the rude crutch. In boys, Gilbert tells us, no special apparatus is required. The surgeon merely places his doubled fist in the axilla, with the other hand grasps the humerus and lifts the boy off the ground, and the head of the bone slips readily back into place. After we are assured that the reduction is complete, a strictorium is prepared, consisting of the pulvis ruber, egg-albumen and a little wheat flour, with which the shoulder is to be rubbed. Finally, when all seems to be going on well, warm spata drapum (sparadrap) is to be applied upon a bandage, and if necessary the apostolicon ointment.

Dislocation of the elbow is reduced by passing a bandage around the bend of the arm, forming in this a loop (scapham) into which the foot of the surgeon is to be placed for counter-extension, while with the hands extension is to be made upon the forearm until the bones are drawn into their normal position. Flexion and extension of the joint are then to be practised three or four times (to assure complete reduction?), and the forearm flexed and supported by a bandage from the neck. After a few days, Gilbert tells us, the patient will himself often try to flex and extend the arm, and the bandage should be so applied as not to interfere with these movements.