makes new observations and wakes the world up. He is surprised that men should not have used their powers of observation for themselves, but should have been following old-time masters. His comtemporaries often refuse to listen to him at first. His observations, however, eventually make their way. We blame the Middle Ages for following authority, but what have we been always doing but following authority, except for the geniuses who come and lift us out of the rut and illuminate a new portion of the realm of medicine. After they have come, however, and done their work, their disciples proceed to see with their eyes and to think that they are making observations for themselves when they are merely following authority. When the next master in medicine comes along his discovery is neglected because men have not found it in the old books, and usually he has to suffer for daring to have opinions of his own. The fact of the matter is that at any time there is only a very limited number of men who think for themselves. The rest think other people's thoughts and think they are thinking and doing things. As for observation, John Ruskin once said, "Nothing is harder than to see something and tell it simply as you saw it." This is as true in science as in art, and only genius succeeds in doing it well.

Chauliac's book is confessedly a compilation. He has taken the good wherever he found it, though he adds, modestly enough, that "his work also contains. whatever his own measure of intelligence enabled him to find useful (quæ juxta modicitatem mei ingenii utilia reputavi). Indeed it is the critical judg

ment displayed by Chauliac in selecting from his predecessors that best illustrates at once the practical character of his intellect and his discerning spirit. What the men of his time are said to have lacked is the critical faculty. They were encyclopedic in intellect and gathered all kinds of information without discrimination, is a very common criticism of medieval writers. No one can say this of Chauliac, however, and, above all, he was no respecter of authority, merely for the sake of authority. His criticism of John of Gaddesden's book shows that the blind following of those who had gone before was his special bête noir. His bitterest reproach for many of his predecessors was that they follow one another like cranes, whether for love or fear, I cannot say."

66

Chauliac's right to the title of father of surgery will perhaps be best appreciated from the brief account of his recommendations as to the value of surgical intervention for conditions in the three most important cavities of the body, the skull, the thorax, and the abdomen. These cavities have usually been the dread of surgeons. Chauliac not only used the trephine, but laid down very exact indications for its application. Expectant treatment was to be the rule in wounds of the head, yet when necessary, interference was counselled as of great value. His prognosis of brain injuries was much better than that of his predecessors. He says that he had seen injuries of the brain followed by some loss of brain substance, yet with complete recovery of the patient. In one case that he notes a considerable amount of brain substance was lost, yet the patient recovered

with only a slight defect of memory, and even this disappeared after a time. He lays down exact indi cations for the opening of the thorax, that molt me tangere of surgeons at all times, even our own, and points out the relations of the ribs and the dia phragm, so as to show just where the opening should be made in order to remove fluid of any kind,

In abdominal conditions, however, Chauliac's an ticipation of modern views is most surprising. Ho recognized that wounds of the intestines were surely fatal unless leakage could be prevented. Accord ingly be suggested the opening of the abdomen and the sewing up of such intestinal wounds as could be located. He describes a method of suture 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 definite record of them, however, in a text-book that was the most read volume on the subject for several conturies. Most of the surprise with regard to those operations will vanish when it is recalled that in Italy during the thirteenth century, as we have already seen, methods of anesthesia by means of opium and mandragora were in common use, 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 anesthesia.

In discussing amputations he has described in general certain methods of anesthesia in use 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.