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built shortly before the town determined upon the very sensible procedure of securing good surgery beyond all doubt by having a townsman specially educated for that purpose.
Yperman's work was practically unknown to us until Broeck, the Belgian historian, discovered manuscript copies of his book on surgery and gathered some details of his life. After his return from Paris, Yperman obtained great renown, which maintained itself in the custom extant in that part of the country even yet of calling an expert surgeon an Yperman. He is the author of two works in Flemish. One of these is a smaller compendium of internal medicine, which is very interesting, however, because it shows the many subjects that were occupying physicians' minds at that time. He treats of dropsy, rheumatism, under which occur the terms coryza and catarrh (the flowing diseases), icterus, phthisis (he calls the tuberculosis, tysiken), apoplexy, epilepsy, frenzy, lethargy, fallen palate, cough, shortness of breath, lung abscess, hemorrhage, blood-spitting, liver abscess, hardening of the spleen, affections of the kidney, bloody urine, diabetes, incontinence of urine, dysuria, strangury, gonorrhea, and involuntary seminal emissions—all these terms are quoted directly from Pagel's account of his work; the original is not available in this country.
In English-speaking countries of course we are interested in what was done by Englishmen at this time. Fortunately we have the record of one great English surgeon of the period worthy to be placed beside even the writers already mentioned. This is John Ardern, whose name is probably a modification of the more familiar Arden, whose career well deserves attention. I have given a sketch of his work in " The Popes and Science." 1 He was educated at Montpellier, and practised surgery for a time in France. About the middle of the century however, according to Pagel, he went back to his native land and settled for some twenty years at Newark, in Nottinghamshire, and then for nearly thirty years longer, until about the end of the century, was in London. He is the chief representative of English surgery during the Middle Ages. His " Practica," as yet unprinted, contains, according to Pagel, a short sketch of internal medicine, but is mainly devoted to surgery. Contrary to the usual impression with regard to works in medicine and surgery at this time, the book abounds in references to case histories which Ardern had gathered, partly from his own and partly from others' experience. The therapeutic measures that he suggests are usually very simple, in the majority of cases quite rational, though, of course, there are many superstitions among them; but Ardern always furnished a number of suggestions from which to choose. He must have been an expert operator, and had excellent success in the treatment of diseases of the rectum. He seems to have been the first operator who made careful statistics of his cases, and was quite as proud as any modern surgeon of the large numbers that he had operated on, which he gives very exactly. He was the inventor of a new clyster apparatus. Fortunately we possess here in America, in the Surgeon General's Library at Washington, a very interesting manuscript containing Ardern's surgical writings, though it has not yet been published. Even a little study of this and of the notes on it prepared by an English bibliophile before its purchase by the Surgeon General's Library, serves to show how valuable the work is in the history of surgery. There are illustrations scarcely less interesting than the text. Some of these illustrations were inserted by the original writer or copyist, and some of them later. In general, however, they show a rather high development of the mechanics of surgery at that time. Some of the pages have spaces for illustrations left unfilled, so that evidently the copyist did not complete his work. The titles of certain of the chapters are interesting, as illustrating the fact that our medical and surgical problems were stated clearly in the olden time, and thinking physicians, even six centuries ago, met them quite rationally. There is, for instance, a chapter headed " Against Colic and the Iliac Passion," immediately followed by the subheading, "Method of Administering Clysters." The iliac passion, passio iliaca of the old Latin, is usually taken to signify some obstruction of the intestines causing severe pain, vomiting, and eventually fecal vomiting. A good many different forms of severe painful conditions, especially all those complicated by peritonitis, were included under the term, and the modern student of surgery is likely to won der whether these old observers had not noted that the right iliac region was particularly psone to be the source of fatal conditions. There is a chapter entitled " Against Pain in the Loins and the Kidneys," followed by the chapter subheading, "Against Stone in the Kidneys." There is a chapter with the title, '' Against Ulceration of the Bladder or the Kidneys." Another one, with the title "Against Burning of the Urine and Excoriation of the Lower Part of the Yard.'' Gonorrhea is frankly treated under the name Shawdepisse, evidently an English alliteration of the corresponding French word. As to the instrumentation of such conditions and for probing in general, Ardern suggests the use of a lead probe, because it may readily be made to bend any way and not injure the tissues.
Even this brief account of the surgeons who taught and studied at the medieval universities demonstrates what fine work they did. It is surely not too much to say that the chapter on university education mainly concerned with them is one of the most interesting in the whole history of the universities. Their story alone is quite enough to refute most of the prevalent impressions and patronizing expressions with regard to medieval education. Their careers serve to show how interested were the men of many nations in the development of an extremely important application of science for the benefit of suffering humanity. Their work utterly contradicts the idea so frequently emphasized that the great students of the Middle Ages were lacking in practicalness. Besides, they make very clear that we have been prone to judge the Middle Ages too much from its speculative philosophies. It has been the custom to say that speculation ruled men's minds and prevented them from making observations, developing science, or applying scientific principles. There was much speculation during the Middle Ages, but probably not any more in proportion than exists at the present day. We were either not acquainted with, or failed to appreciate properly, until comparatively recent years, the other side of medieval accomplishment. Our ignorance led us into misunderstanding of what these generations really did. It was our own fault, because during the Renaissance practically all of these books were edited and printed under the direction of the great scholars of the time in fine editions, but during the eighteenth century nearly all interest was lost in them, and we are only now beginning to get back a certain amount of the precious knowledge that they had in the Renaissance period of this other side of medieval life. We have learned so much about surgery because distinguished scholars devoted themselves to this phase of the history of science. Doubtless there are many other phases of the history of science which suffered the same fate of neglect and with regard to which the future will bring us equally startling revelations. For this reason this marvellous chapter in the history of surgery is a warning as well as a startling record of a marvellous epoch of human progress.