and, as a rule, at least as well organized as ours were until the last few years.

It is no wonder that with such a good hospital organization excellent surgery was accomplished. Hernia was Chauliac's specialty, and in it his surgical judgment is admirable Mondeville before his time did not hesitate to say that many operations for hernia were done not for the benefit of the patient, but for the benefit of the surgeon,—a very striking anticipation of remarks that one sometimes hears even at the present time. Chauliac discussed operations for hernia very conservatively. His rule was that a truss should be worn, and no operation attempted unless the patient's life was endangered by the hernia. It is to him that we owe the invention of a well-developed method of taxis, or manipulation of a hernia, to bring about its reduction, which was in use until the end of the nineteenth century. He suggested that trusses could not be made according to rule, but must be adapted to each individual case. He invented several forms of truss himself, and in general it may be said that his manipulative skill and his power to apply his mechanical principles to his work are the most characteristic of his qualities. This is particularly noteworthy in his chapters on fractures and dislocations, in which he suggests various methods of reduction and realizes very practically the mechanical difficulties that were to be encountered in the correction of the deformities due to these pathological conditions. In a word, we have a picture of the skilled surgeon of the modern time in this treatise of a fourteenth-century teacher of surgery.

Chauliac discusses six different operations for the radical cure of hernia. As Gurlt points out, he criticises them from the same standpoint as that of recent surgeons. The object of radical operations for hernia is to produce a strong, firm tissue support over the ring through which the cord passes, so that the intestines cannot descend through it. It is rather interesting to find that the surgeons of this time tried to obliterate the canal by means of the cautery, or inflammation producing agents, arsenic and the like, a practice that recalls some methods still used more or less irregularly. They also used gold wire, which was to be left in the tissues and is supposed to protect and strengthen the closure of the ring. At this time all these operations for the radical cure of hernia involved the sacrifice of the testicle because the old surgeons wanted to obliterate the ring completely, and thought this the easiest way. Chauliac discusses the operation in this respect and says that he has seen many cases in which men possessed of but one testicle have procreated, and this is a case where the lesser of two evils is to be chosen.

Of course Guy de Chauliac would not have been able to operate so freely on hernia and suggest, following his own experience, methods of treatment of penetrating wounds of the abdomen only that he had learned the lessons of antiseptic surgery which had been gradually developed among the great surgeons of Italy during the preceding century. The use of the stronger wines as a dressing together with insistence on the most absolute cleanliness of the surgeon before the operation, and careful details of

cleanliness during the operation, made possible the performance of many methods of surgical intervention that would otherwise surely have been fatal. Probably nothing is harder to understand than that after these practical discoveries men should have lost sight of their significance, and after having carefully studied the viscous exudation which produces healthy natural union, should have come to the thought of the necessity for the formation of laudable pus before union might be expected. The mystery is really no greater than that of many another similar incident in human history, but it strikes us more forcibly because the discovery and gradual development of antiseptic surgery in our own time has meant so much for us. Already even in Chauliac's practice, however, some of the finer elements of the technique that made surgery antiseptic to a marked degree, if not positively aseptic in many cases, were not being emphasized as they were by his predecessors, and there was a beginning of surgical meddlesomeness reasserting itself.

It must not be thought, however, that it was only with the coarse applications of surgery that Chauliac concerned himself. He was very much interested in the surgical treatment of eye diseases and wrote a monograph on cataract, in which he gathers what was known before his time and discusses it in the light of his own experience. The writing of such a book is not so surprising at this time if we recall that in the preceding century the famous Pope John XXI, who had been a physician before he became Pope, and under the name of Peter of Spain was looked up to as one of the distinguished sci

entists of his time, had written a book on eye diseases that has recently been the subject of much attention.

Pope John had much to say of cataract, dividing it into traumatic and spontaneous, and suggesting the needling of cataract, a gold needle being used for the purpose. Chauliac's method of treating cataract was by depression. His care in the selection of patients may be appreciated from his treatment of John of Luxembourg, King of Bavaria, blind from cataract, who consulted Chauliac in 1336 while on a visit to Avignon with the King of France. Chauliac refused to operate, however, and put off the King with dietary regulations.

In the chapter on John of Arcoli and Medieval Dentistry we call attention to the fact that Chauliac discussed dental surgery briefly, yet with such practical detail as to show very clearly how much more was known about this specialty in his time than we have had any idea of until recent years. He recognized the dentists as specialists, calls them dentatores, but thinks that they should operate under the direction of a physician-hence the physician should know much about teeth and especially about their preservation. He enumerates instruments that dentists should have and shows very clearly that the specialty had reached a high state of development. A typical example of Chauliac's common sense and dependence on observation and not tradition is to be found in what he has to say with regard to methods of removing the teeth without the use of extracting instruments. It is characteristic of his method of dealing with traditional remedies, even

though of long standing, that he brushes them aside with some impatience if they have not proved themselves in his experience.

"The ancients mention many medicaments, which draw out the teeth without iron instruments or which make them more easy to draw out; such as the milky juice of the tithymal with pyrethrum, the roots of the mulberry and caper, citrine arsenic, aqua fortis, the fat of forest frogs. But these remedies promise much and accomplish but little-mais ils donnent beaucoup de promesses, et peu d'opérations."

It is no wonder that Chauliac has been enthusiastically praised. Nicaise has devoutly gathered many of these praises into a sheaf of eulogies at the end of his biography of the great French surgeon. He tells us that Fallopius compared him to Hippocrates. John Calvo of Valencia, who translated the "Great Surgery" into Spanish, looks upon him as the first law-giver of surgery. Freind, the great English physician, in 1725 called him the Prince of Surgeons. Ackermann said that Guy de Chauliac's text-book will take the place of all that has been written on the subject down to his time, so that even if all the other works had been lost his would replace them. Dezimeris, commenting on this, says that if one should take this appreciation literally, this surgeon of the fourteenth century would be the first and, up to the present time, the only author who ever merited such an eulogy." "At least," he adds, "we cannot refuse him the distinction of having made a work infinitely superior to all those which appeared up to this time and even for a long time afterwards. Posterity rendered him this justice, for