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with cira shght defect of memory, and this disappeared after a time. He lays down notimit cations for the opening of the therax, that roli me tangere of surgeons at all times inn our own, and points out the relations of the ribs and the via phragm, so as to show just where the opening should be made in order to remore fluid of any kind,
In abdominal conditions, however, Chaniae 's an. ticipation of modern views is most surprising lo recognized that wounds of the intestines are surely fata) unless leakage could be prevented, ont ingly he suggested the opening of the abdomen and the sewing up of such intestinal wounds as could be located. He describes a method of sature for these cases and seems, like many another abdominal sur. geon, even to have invented a special needleholder.
To most people it would seem absolutely out of the question that such surgical procedures could be prac tised in the fourteenth century. We have the definito record of them, however, in a text-book that was the most read volume on the subject for several con turies. Most of the surprise with regard to these operations will vanish when it is recalled that in Italy during the thirteenth century, as we have al. ready seen, methods of anæsthesia by means of opium and mandragora were in common uso, having been invented in the twelfth century and perfected by Ugo da Lucca, and Chauline must not only have known but must have frequently employed various methods of anæsthesia.
In discussing amputations he has described in general certain methods of anasthesia in tine in his time, and especially the method by means of inhala. tion. It would not seem to us in the modern time that this method would be very successful, but there is an enthusiastic accord of authorities attesting that operations were done at this time with the help of this inhalant without the infliction of pain. Chauliac says:
“ Some prescribe medicaments which send the patient to sleep, so that the incision may not be felt, such as opium, the juice of the morel, hyoscyamus, mandrake, ivy, hemlock, lettuce. A new sponge is soaked by them in these juices and left to dry in the sun; and when they have need of it they put this sponge into warm water and then hold it under the nostrils of the patient until he goes to sleep. Then they perform the operation."
Many people might be prone to think that the hospitals of Chauliac's time would not be suitable for such surgical work as he describes. It is, however, only another amusing assumption of this selfcomplacent age of ours to think that we were the first who ever made hospitals worthy of the name and of the great humanitarian purpose they subserve. As a matter of fact, the old-time hospitals were even better than ours or, as a rule, better than any we had until the present generation. In “ The Popes and Science,” in the chapter on “ The Foundation of City Hospitals," I call attention to the fact that architects of the present day go back to the hospitals of the Middle Ages in order to find the models for hospitals for the modern times. Mr. Arthur Dillon, a well-known New York architect, writing of a hospital built at Tonnerre in France, toward the end of the thirteenth century (1292), says: “ It was an admirable hospital in every way, and it is doubtful if we to-day surpass it. It was isolated; the ward was separated from the other buildings; it had the advantage we so often lose of being but one story high, and more space was given to each patient than we can now afford.
“ The ventilation by the great windows and ventilators in the ceiling was excellent; it was cheerfully lighted; and the arrangement of the gallery shielded the patients from dazzling light and from draughts from the windows and afforded an easy means of supervision, while the division by the roofless low partitions isolated the sick and obviated the depression that comes from sight of others in pain.
“ It was, moreover, in great contrast to the cheerless white wards of to-day. The vaulted ceiling was very beautiful; the woodwork was richly carved, and the great windows over the altars were filled with colored glass. Altogether it was one of the best examples of the best period of Gothic Architecture.” 1
The fine hospital thus described was but one of many. Virchow, in his article on hospitals quoted in the same chapter, called attention to the fact that in the thirteenth and fourteenth centuries every town of five thousand or more inhabitants had its hospital, founded on the model of the great Santo Spirito Hospital in Rome, and all of them did good work. The surgeons of Guy de Chauliac's time would indeed find hospitals wherever they might be called in consultation, even in small towns. They were more numerous in proportion to population than our own
1 See picture of the hospital ward at Tonnerre, in “The Thirteenth Greatest of Centuries,” 3rd edit., New York, 1911.
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