Among the affections of the upper air passages mentioned by Arculanus are
various forms of sore throat, which he calls Synanche or Cynanche, or
angina. A milder form of the affection was called Parasynanche. The
medieval teaching with regard to an angina that was causing severe
difficulty of breathing was to perform tracheotomy. Arculanus goes into
some detail with regard to affections of the uvula, which was made much
more responsible for throat affections than at the present time. The
popular tradition in our time of the uvula and its fall is evidently a
remnant of the medieval teaching with regard to it. Arculanus's
description of the removal of the uvula, or at least of the tip of it,
gives a very good idea of how thorough the teaching of surgical technique
was in his time. His directions are: "Seat the patient upon a stool in a
bright light, while an assistant holds the head; after the tongue has been
firmly depressed by means of a speculum, let the assistant hold this
speculum in place. With the left hand then insert an instrument, a stilus,
by which the uvula is pulled forward; and then remove the end of it by
means of a heated knife or some other process of cauterization. The mouth
should afterwards be washed out with fresh milk."
The application of a cauterizing solution by means of a cotton swab
wrapped round the end of a sound may be of service in patients who refuse
the actual cautery. To be successful, he insists that the application must
be firmly made and must be frequently repeated.
With regard to ophthalmology the older history has always been thoroughly
appreciated. Even as early as the time of Hammurabi (2200 B.C.) some
rather extensive and interesting surgery of the eye was practised, for the
fees for these operations are mentioned in the code. All of the early
medieval writers on medicine and surgery--Aëtius, Alexander of Tralles,
and Paul of Ægina--have paragraphs at least, and sometimes more, with
regard to eye operations and the care of the eyes.
Public-domain text, read in full here on John Shaqi.
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