Theodoric

This son, after having completed his medical studies at the age of about

twenty-three, entered the Dominican Order, then only recently

established, but continued his practice of medicine undisturbed. His

ecclesiastical preferment was rapid. He attracted the attention of the

Bishop of Valencia, and became his chaplain in Rome. At the age of about

fifty he was made a bishop in South Italy and later transferred to the

Bis opric of Cervia, not far from Ravenna. Most of his life seems to

have been passed in Bologna however, and he continued to practise

medicine, devoting his fees, however, entirely to charity. His text-book

of surgery was written about 1266 and is signed with his full name and

title as Bishop of Cervia. Even at this time however, he still retained

the custom of designating himself as a member of the Dominican Order.



The most interesting thing in the first book of his surgery is

undoubtedly his declaration that all wounds should be treated only with

wine and bandaging. Wine he insists on as the best possible dressing for

wounds. It was the most readily available antiseptic that they had at

that time, and undoubtedly both his father's recommendation of it and

his own favorable experience with it were due to this quality. It must

have acted as an excellent inhibitive agent of many of the simple forms

of pus formation. At the conclusion of this first book he emphasizes

that it is extremely important for the healing of wounds that the

patient should have good blood, and this can only be obtained from

suitable nutrition. It is essential therefore for the physician to be

familiar with the foods which produce good blood in order that his

wounded patients may be fed appropriately. He suggests, then, a number

of articles of diet which are particularly useful in producing such a

favorable state of the tissues as will bring about the rebirth of flesh

and the adhesion of wound surfaces. Shortly before he emphasizes the

necessity for not injuring nerves, though if nerves have been cut they

should be brought together as carefully as possible, the wound edges

being then approximated.



Probably the most interesting feature for our generation of the great

text-books of the surgeons of the medieval universities is the

occurrence in them of definite directions for securing union in surgical

wounds, at least by first intention and their insistence on keeping

wounds clear. The expression union by first intention comes to us from

the olden time. They even boasted that the scars left after their

incisions were often so small as to be scarcely noticeable. Such

expressions of course could only have come from men who had succeeded in

solving some of the problems of antisepsis that were solved once more in

the generation preceding our own. With regard to their treatment of

wounds, Professor Clifford Allbutt says:[19]



They washed the wound with wine, scrupulously removing every

foreign particle; then they brought the edges together, not

allowing wine nor anything else to remain within--dry adhesive

surfaces were their desire. Nature, they said, produces the

means of union in a viscous exudation, or natural balm, as it

was afterwards called by Paracelsus, Pare, and Wurtz. In older

wounds they did their best to obtain union by cleansing,

desiccation, and refreshing of the edges. Upon the outer

surface they laid only lint steeped in wine. Powders they

regarded as too desiccating, for powder shuts in decomposing

matters wine after washing, purifying, and drying the raw

surfaces evaporates.



Theodoric comes nearest to us of all these old surgeons. The surgeon

who in 1266 wrote: For it is not necessary, as Roger and Roland have

written, as many of their disciples teach, and as all modern surgeons

profess, that pus should be generated in wounds. No error can be greater

than this. Such a practice is indeed to hinder nature, to prolong the

disease, and to prevent the conglutination and consolidation of the

wound was more than half a millennium ahead of his time. The italics in

the word modern are mine, but might well have been used by some early

advocate of antisepsis or even by Lord Lister himself. Just six

centuries almost to the year would separate the two declarations, yet

they would be just as true at one time as at another. When we learn that

Theodoric was proud of the beautiful cicatrices which he obtained

without the use of any ointment, pulcherrimas cicatrices sine unguento

aliquo inducebat, then further that he impugned the use of poultices

and of oils on wounds, while powders were too drying and besides had a

tendency to prevent drainage, the literal meaning of the Latin words

saniem incarcerare is to incarcerate sanious material, it is easy to

understand that the claim that antiseptic surgery was anticipated six

centuries ago is no exaggeration and no far-fetched explanation with

modern ideas in mind of certain clever modes of dressing hit upon

accidentally by medieval surgeons.



Theodoric's treatment of many practical problems is interesting for the

modern time. For instance, in his discussion of cancer he says that

there are two forms of the affection. One of them is due to a

melancholy humor, a constitutional tendency as it were, and occurs

especially in the breasts of women or latent in the womb. This is

difficult of treatment and usually fatal. The other class consists of a

deep ulcer with undermined edges, occurring particularly on the legs,

difficult to cure and ready of relapse, but for which the outlook is not

so bad. His description of noli me tangere and of lupus is rather

practical. Lupus is eating herpes, occurs mainly on the nose, or

around the mouth, slowly increases, and either follows a preceding

erysipelas or comes from some internal cause. Noli me tangere is a

corroding ulcer, so called perhaps because irritation of it causes it to

spread more rapidly. He thinks that deep cauterization of it is the best

treatment. Since these are in the department of skin diseases this seems

the place to mention that Theodoric describes salivation as occurring

after the use of mercury for certain skin diseases. He has already shown

that he knows of certain genital ulcers and sores on the genital regions

and of distinctions between them.