"Of his substantial advances in surgery no sufficient account is possible; but some chief points, with the aid of Haeser, Malgaigne, and Nicaise, I may briefly sum up thus: He pointed out the dangers of surgery of the neck, among them that of injuring the voice by section of the recurrent laryngeal nerve, a precaution he probably learned from Paul. He urges a low diet for the wounded, as did Mondeville and many others. He uses sutures well and discreetly (p. 9), but with far too many salves. {183} On fractures of the skull he is at his best; he noted the escape of cerebro-spinal fluid, and the effect of pressure on the respiration. It is somewhat strange that in days of war the study of chest wounds had been rather neglected by Galen, Haly, and Avicenna; their practice, however, was to leave them open, lest pus should gather about the heart. Theodoric and Henry ordered chest wounds to be closed 'lest the vital spirits escape.' Guy also closed these wounds, unless there were any effusion to be removed. In empyema he objects to caustics and prefers the knife. For haemorrhages he used sutures--a little too closely perhaps--styptics, cautery or ligature. Sinuses he dilated with tents of gentian root, or he incised them upon a director. On ulcers his large experience is fully manifest. He describes the carcinomatous kind as hopeless, unless the mass can be excised at a very early stage and the incision followed by caustics. If in fractures and dislocations he tells us nothing new, these sections testify to a remarkable fulness of knowledge at a period when the Hippocratic treatises were unknown. Haeser says that in respect of position in fractured femur he was the best physician in the Middle Ages." [Illustration: Guy de Chauliac's Cauteries:--5, 6, 7, 8, cauteries called from their shapes: knife, sword, olive, date kernel; 9, cautery with protective nail to be inserted cold; 10, protective plate for cauteries.] [Illustration: Guy de Chauliac's Cauteries:--11, 12, long, smooth cautery and canula protector; 13, 14, ring cautery with five buttons and the protective plate with five openings.] This is the period, it must not be forgotten, when, according to President White, surgery was in such a state that _the application of various ordures relieved fractures; the touch of the hangman cured sprains; the breath of a donkey expelled poison; friction with a dead man's tooth cured a toothache._ [Footnote 23]