The danger of wounds of the neck is, of course, not a modern doctrine, and yet very few people would think for a moment that it could be traced back to the middle of the Thirteenth Century and to a practical teacher of surgery in a medieval Italian university. Here once more there is evidence of the work of a careful observer who has seen patients expire in a few minutes as the result of some serious incident during the course of operations upon the neck. He did not realize that the danger was due, in many cases, to the sucking in of air into the large veins, but even at the present time this question is not wholly settled and the problem as to the danger of the presence of air is still the subject of investigation.
As to the suture of divided nerves, it would ordinarily and as a matter of course be claimed by most modern historians of surgery and by practically all surgeons, as an affair entirely of the last half century. William of Salicet, however, neglected none of the ordinary surgical procedures that could be undertaken under the discouraging surgical circumstances in which he lived. The limitations of anesthesia, though there was much more of this aid than there has commonly been any idea of, and the frequent occurrence of suppuration must have been constant sources of disheartenment. His insistence on the use of the knife rather than on the cautery shows how much he appreciated the value of proper healing. It is from such a man that we might expect the advance by careful [{87}] investigation as to just what tissues had been injured, with the idea of bringing them together in such juxtaposition as would prevent loss of function and encourage rapid and perfect union.
SCREEN (HEREFORD)
DOORWAY OF SACRISTY (BOURGES)
Perhaps to the ordinary individual William's reference of certain known venereal affections to their proper cause, will be the most astonishing in this marvelous list of anticipations of what is supposed to be very modern. The whole subject of venereal disease in anything like a scientific treatment of it is supposed to date from the early part of the Sixteenth Century. There is even question in certain minds as to whether the venereal diseases did not come into existence, or at least were not introduced from America or from some other distant country that the Europeans had been exploring about this time. William's studies in this subject, however, serve to show that nothing escaped his watchful eye and that he was in the best sense of the word a careful observer and must have been an eminently suggestive and helpful teacher.
What has thus been learned about him will serve of itself and without more ado, to stamp all that has been said about the unpractical character of the medical teaching of the medieval universities as utterly unfounded. Because men have not taken the trouble to look up the teaching of these times, and because their works were until recent years buried in old folios, difficult to obtain and still more difficult to read when obtained, it has been easy to ignore their merit and even to impugn the value of their teaching completely. William of Salicet was destined, moreover, to be surpassed in some ways by his most distinguished pupil, Lanfranc, who taught at the University of Paris at the end of the Thirteenth Century. Of Lanfranc, in the address already quoted from, Professor Allbutt has one very striking paragraph that shows how progressive was the work of this great French surgeon, and how fruitful had been the suggestive teaching of his great master. He says:
"Lanfranc's 'Chirurgia Magna' was a great work, written by a reverent but independent follower of Salicet. He distinguished between venous and arterial hemorrhage, and used styptics (rabbit's fur, aloes, and white of egg was a popular styptic in elder surgery), digital compression for an hour, or in severe cases ligature. His chapter on injuries of the head [{88}] is one of the classics of medieval surgery. Clerk (cleric) as he was, Lanfranc nevertheless saw but the more clearly the danger of separating surgery from medicine."