different diseases; and as a further result of this promotion in rank
his private practice grew rapidly, monarchs and princes coming from
every country in Europe to consult him about their maladies. Boerhaave
was also most popular among his fellow townsmen. It is related of
him, for example, that on one occasion, after he had been confined to
the house for about six months by an illness of a gouty nature, the
citizens of Leyden manifested their joy at his recovery by inaugurating
a general illumination of the town during the evening of the day on
which he made his first appearance on the street. He had two relapses
of the gouty affection, one in 1727 and another in 1729, and he finally
died from disease of the heart on September 23, 1738. The monument
raised in his honor by the city of Leyden bears the inscription:
“_Salutifero Boerhaavii genio sacrum_” (Sacred to the memory of
the health-giving genius of Boerhaave).

Some idea of the lucrative character of Boerhaave’s private practice
may be gained from the fact that he left to his only child, a daughter,
the sum of about four million francs. And yet he was noted for the
generous gifts which he made during his lifetime to all sorts of
scientific and benevolent objects.

Boerhaave, says Dezeimeris, exercised during his career, and also for a
long time after his death, an immense influence upon medical thought.
He is justly ranked, he adds, among the iatromathematicians, and it
is correct to say that he was largely instrumental in overthrowing
the chemical system which de le Boë (Sylvius) had developed. His own
treatise on this branch of knowledge (“Elementa Chemiae”), which was
published toward the end of his life, soon became the standard work
on this subject, and it retained its popularity for many years. “It
is to be regretted that, possessing as Boerhaave unquestionably did,
remarkable powers of observation, he should have allowed himself, in
opposition to the very principles which he advocated so strongly,
to indulge in the making of systems and hypotheses. He commenced by
advocating with enthusiasm the method of Hippocrates, and ended by
following the brilliant but not very trustworthy example of Galen.”
(Dezeimeris.)

The number of treatises which Boerhaave published is quite large,
the most important among them being the following: “_Oratio de
commendando studio Hippocratico_,” 1701; “_Institutiones medicae
in usus annuae exercitationis domesticos_,” 1708; “_Aphorismi
de cognoscendis et curandis morbis in usum doctrinae medicae_,”
1709 (English version printed in London in 1742); and “_Elementa
chemiae_,” 1732 (English translation by Peter Shaw, London, 1741).

Of the “Aphorisms,” one of the most widely known of Boerhaave’s
published treatises, I shall take the liberty of saying a few words.
This work is in reality a very concise statement of the author’s views
regarding pathology, pathological anatomy and therapeutics, and I
believe that the following paragraphs, although few in number, will
suffice to give our readers a fair idea of the general character of the
book. At the same time I must confess that I have not found it an easy
matter to understand and satisfactorily digest many of the individual
aphorisms, the text of which has been compressed into such a small
space. It therefore does seem surprising to learn from one critic that,
if one wishes to ascertain what Boerhaave’s views are with regard to
the science of medicine, one should read by preference the Commentaries
of Van Swieten, who was Boerhaave’s favorite pupil and assistant.

The following four or five aphorisms are typical specimens belonging to
the earlier sections of the book:--[84]

   (7.) A disease when present in a body, must needs be the bodily
   effect of a particular cause directed to that body.

   (8.) Which effect being entirely removed, health is recovered.

   (9.) It may be removed by correcting the illness itself in
   particular, _viz._, by the applications of medicines
   to the particular diseased part, or by some remedies which
   operate equally upon the whole: the first we’ll call a
   _particular_, the latter a _general_ cure.

   (10.) The way to both is discovered either _by
   observation_, or _by comparing_ one case with another,
   or _by a true reasoning_ from them both.

   (13.) He who doth, with the greatest exactness imaginable, weigh
   every individual thing that shall happen or hath happened to
   his patient and may be known from the observations of his own
   or of others, and who afterward compareth all these with one
   another, and puts them in an opposite view to such things as
   happen in an healthy state; and lastly, from all this, with the
   nicest and severest bridle upon his reasoning faculty, riseth
   to the knowledge of the very first cause of the disease, and of
   the remedies fit to remove them; _he_, and _only he_,
   deserveth the name of _a true physician_.

Then Boerhaave proceeds to make a classification of diseases, and among
the very first groups which one finds in this classified list are the
following: “Distempers of a lax and weak fibre”; “Distempers of the
stiff and elastic fibre”; “Distempers of the less and larger vessels”;
“Distempers of weak and lax entrails”; “Distempers of the too strong
and stiff entrails”; etc.--from which it is apparent that the old
doctrine of the _strictum_ and the _laxum_, which was taught
by the Methodists in the early centuries of our era, has here been
adopted by Boerhaave in all its essential characters; and also that the
treatment which he recommends for some of these classes of maladies
does not materially differ from that advocated by this ancient school
of medicine. The following extracts, I believe, will suffice to give
the reader a fairly clear understanding of what Boerhaave means by the
expressions “distempers of the solid simple fibre,” “distempers of a
lax and weak fibre,” and “distempers of the stiff and elastic fibre,”
and will at the same time show what methods he employed for overcoming
these distempers. At the time when Boerhaave made use of the term
“fibre” (_fibra_) in the very uncertain sense in which he here
employs it, Leeuwenhoek and Malpighi were demonstrating, by aid of the
newly perfected microscope, that the so-called simple tissues were in
reality quite complex structures; and one’s first impulse, therefore,
is to express surprise that a physician of such high standing as our
author should have used the term. But we moderns must not forget that,
in those early days, it took decades for knowledge of this nature
to spread even a very short distance, as from Delft to Leyden, and
then to exert its legitimate influence upon medical thought--that
is, to be digested and afterward permanently appropriated. There can
be scarcely any doubt that, at the time (1709) when Boerhaave wrote
these aphorisms, he had already heard about the existence and the
capabilities of the recently perfected microscope, but it is not at all
likely that he had as yet digested the gains in anatomical knowledge
which had been acquired through the assistance of this instrument. The
extracts referred to above are the following:--

                 DISTEMPERS OF THE SOLID SIMPLE FIBRE

   (21) Those parts (which, being separated from the fluid
   contained in the vessels, are applied and sticking to each other
   by the strength of the living body, and make the least fibre)
   are the least, the simplest, earthy, and hardly changeable from
   or by virtue of any cause, which are found in our living bodies.

                  DISTEMPERS OF A LAX AND WEAK FIBRE

   (24) The weakness of the fibre is that cohesion of the minutest
   parts described (21), which is so loosely linked that it may be
   pulled asunder even by that degree of motion which is requisite
   in healthy bodies, or not much exceeding it.

   (26) The weakness produceth easily a stretching and a breaking
   of the small vessels made up of those weak fibres (24), and
   consequently abates of their power over the fluids therein
   contained; from which distensions arise tumors, from the
   stagnating or extravasated liquids putrefactions, and, farther,
   all such innumerable ills as are the consequences of them both.

   (28) [In distempers of a lax and weak fibre] the cure must
   be obtained, 1. By aliments that abound in such matter as
   is described in section 21, and which [should] be almost so
   prepared beforehand as they are in a strong and healthy body;
   such are milk, eggs, flesh-broths, panadoes[85] rightly prepared
   of well-fermented bread; and rough wines. All which must be
   given in small quantities, but often. 2. By increasing and
   invigorating the motion of the solids and fluids by means of
   frictions with a flesh-brush, or with flannel; by riding on
   horseback, and in a coach, or by being carried in a boat; and
   lastly by walking, running and other bodily exercises. 3. By a
   gentle pressure or a bandage upon the vessels, and a moderate
   repelling of the liquids therein contained. 4. By medicines
   both acid and austere, or such as are spirituous and well
   fermented, but applied with great caution and gentleness. 5. By
   any means that will remove and remedy the too great pulling of
   them.

[That Boerhaave belonged to the iatrophysical or iatromechanical school
appears very clearly throughout these quotations.]

               DISTEMPERS OF THE STIFF AND ELASTIC FIBRE

   (35) [In distempers of this group] the cure is effected, 1.
   By such meat and drink as is thin and watery, without any
   roughness, chiefly by the continued use of milk-whey, of
   the softest herbs and salads, barley-water, thin gruel, and
   unfermented liquors. 2. By avoiding of exercise, and dwelling in
   a moist, coolish air, and taking long sleeps. 3. By the taking
   or outwardly applying watery, lukewarm, tasteless medicines, and
   such as contain the lightest and softest oils.

In the second half of the volume I find abundant evidence of
Boerhaave’s ability to treat efficiently some of the acute and chronic
maladies; and, after a perusal of the text which deals with these
affections, I have no difficulty in understanding how he came to be
looked upon as one of the leading medical practitioners of the period
during which he lived. I should be glad to reproduce here such portions
of the aphorisms as would corroborate the statement that I have just
made, but unfortunately the small amount of space that I can command
does not permit me to do this. At every step, as I advance, I am warned
against the danger of exceeding the limits permitted, and I shall,
therefore, in the present instance, have to rest satisfied with quoting
the larger part of a single paragraph in which is given an account of
the treatment employed in a case of acute pleurisy.

   (890) ... If the same pleurisy be recent before the end of the
   third day, yet violent from the many and strong symptoms, and
   dry, in a strong, exercised, dry body, without the hopes of
   the presence of (887 and 888) [a resolution or a concoction
   and excretion of the cause], then let the patient immediately
   be blooded largely, with a quick running stream out of a
   great vessel, and a large orifice, keeping his body quiet and
   leaning backwards, enforcing his breathing all the while with
   coughing or panting, fomenting the side at the same time, and
   gently rubbing it; which bleeding ought to be continued till the
   pain seems to abate pretty considerably, unless a fainting fit
   forces you to leave off sooner; at whose approach the vein must
   immediately be stopped. Bleeding ought to be repeated according
   as these symptoms do return upon whose account it was done the
   first time; and when that skin doth not any longer appear upon
   the surface of the blood, it is time to forbear more bleeding.

   From the beginning ought to be used fomentations, bathings, warm
   streams, liniments, plaisters, and the like; which may be of use
   as they loosen, resolve, mitigate, and avert....

As only extracts of considerable length would suffice to give our
readers a satisfactory idea of the attractive manner in which Boerhaave
deals with the subject of chemistry, I prefer to omit them altogether,
and to recommend to those who are specially interested in this
branch of science, that they consult Peter Shaw’s excellent English
translation of the “_Elementa Chemiae_.”

Albert von Haller, the celebrated Swiss physiologist and historian of
medical literature, speaks of Boerhaave as “my beloved preceptor, a man
of refined taste and a speaker or lecturer so logical and charming that
one more gifted can hardly be imagined.”

                             CHAPTER XXXV

    GENERAL REMARKS ON THE DEVELOPMENT OF SURGERY IN EUROPE DURING
                 THE FIFTEENTH AND SIXTEENTH CENTURIES

In the early period of the Renaissance surgery was apparently the
first of the practical branches of medicine to spring forward into
active life. Anatomy,--that is, human anatomy,--the foundation that is
absolutely necessary to the solid growth of surgery, scarcely existed
before the beginning of the sixteenth century; and it is therefore
not surprising that the records of the past reveal to us so very few
instances of men who attained any eminence as surgeons. When this
fact is taken into consideration I cannot help feeling that, in the
sketches which I drew, on earlier pages, of Theodoric of Cervia,
William of Saliceto, Lanfranchi of Milan (and later of France), Henri
de Mondeville and Guy de Chauliac, I gave to these men only a small
fraction of the credit to which they were justly entitled. Indeed,
the excellence of the work done by them and recorded in the treatises
which they published, is so great as to arouse the suspicion that they
had clandestinely acquired more knowledge of human anatomy than they
dared to admit. The life of a dissector of human bodies, it should be
remembered, was by no means safe in those days.

But the lack of a trustworthy knowledge of anatomy was not the only
hindrance to a healthy development of the art of surgery. There were
other obstacles which, up to a comparatively late period in the
sixteenth century, continued to block the advance of this art. Of
these, the principal one was perhaps the custom--not by any means
considered at that period professionally dishonorable--of keeping
secret the technique of certain operative procedures like that of
cutting for stone in the bladder or that of the radical cure of hernia.
Such knowledge was treated as private property, and was very carefully
handed down from father to son, or was sold for a large sum of money to
certain surgeons who engaged, under oath, not to reveal the details to
others. Thus we are assured by Haeser that two such eminent surgeons as
Ambroise Paré and Fabricius of Hilden were obliged to pay handsomely
for the information which they received from certain specialists
concerning their particular methods of procedure. It is from such
scraps of information which come to our knowledge casually that we
often learn the actual truth concerning the advance made at a given
period of time by a certain department of medical science. Although it
is not possible to fix the date when the custom to which I have just
referred was definitely abandoned, it may be stated as a fact that
after the seventeenth century very few instances of such ownership of
surgical secrets are discoverable in the records.

Inasmuch as at the very beginning of the Renaissance surgery was looked
upon, in the southern and central parts of Europe, as an occupation of
a somewhat menial character, the regularly organized medical schools
made very inadequate provision for the proper education and training of
those young men who were disposed to adopt a surgical career. During
the fourteenth and fifteenth centuries surgery was still tolerated at
Montpellier, but after the papal seat had been removed from Avignon
to Rome--that is, after 1479,--the pupils of that university were
forbidden to do any surgical work. In 1490, however, a course in
surgery was provided for the exclusive use of barbers. At first the
instruction was given in Latin, but, as these men did not understand
this language, the professor was soon compelled to employ a barbaric
Latin (half French and half Latin) in making his comments upon the
text of the lecture. This state of affairs lasted for more than a
century. In fact, it was not until after Paré, Franco and Wuertz had
demonstrated by their remarkable careers how honorable was this branch
of the science of medicine, that provision was made at Montpellier (in
1597) for regular instruction in surgery. But even then, for a period
of several years, it was found to be a very difficult matter to keep
the peace between the two groups of students--the medical and the
surgical; the governing authorities being finally obliged, in order
to prevent the encounters which frequently took place between the
rival bodies, to appoint four a.m. as the hour when the instruction in
surgery was to be given. Those students who were pursuing the course in
medicine looked upon the surgical pupils as intruders, as men unworthy
to associate with them, and they availed themselves of every possible
opportunity for making their connection with the university unpleasant.

In Paris, during the twelfth and thirteenth centuries the surgeons
formed themselves into corporations. Minor surgery was left entirely
in the hands of the barbers (a word which is derived from the Latin
“_barbarus_,” uncultivated) and barber-surgeons. They were
largely itinerant practitioners and army surgeons. As they traveled
from one city to another, the more enterprising ones announced their
approach by means of a sort of herald who proclaimed loudly the cures
which his chief was able to accomplish. In the course of time the
surgeons who lived in Paris formed themselves into the so-called
“College of Surgeons.” At a later date (1255) there was established
in that city by Jehan Pitard, the surgeon of Louis the Ninth (“Saint
Louis,” 1215–1270), a more perfect organization under the name of
the “College of Saint Cosmas,” which was placed under the protection
of Saints Cosmas and Damian. The members of this Brotherhood were
known as “Surgeons of the Long Robe,” to distinguish them from the
Barber-Surgeons or “Surgeons of the Short Robe”; and they were also
known as “_Maitres Chirurgiens Jurés_.” Through the influence of
Pitard this organization received from the King a set of governing
rules or constitution.

It may prove interesting to learn who Cosmas and Damian were, how they
came to be canonized, and for what reasons the organizers of the new
brotherhood preferred them to all others, as guardian saints. Cosmas
and Damian were the youngest of five brothers who belonged to a family
of some distinction in Arabia. They chose the career of peripatetic
physicians, and gave their services free to those who might have need
of them. They spent some time in the Province of Cilicia, Asia Minor,
and while in that country they met the death of martyrs, somewhere
about 287 A. D., during the persecutions of the Christians which
occurred in the reign of Diocletian. In the church pictures they are
represented as physicians, each one of whom holds in his hand either
a vessel containing a remedial preparation, or a staff around which
the emblematic serpent is twined, or (less frequently) a surgical
instrument of some kind. During the time of the Crusades there existed
an Order of Knights of Saint Cosmas and Saint Damian, who devoted
themselves specially to the care of sick pilgrims and to the freeing of
those who were held as prisoners.

In all the large cities of France there existed, during the fourteenth
and fifteenth centuries, corporations of surgeons, the great majority
of whom belonged to the class or grade of barbers. These men were not
permitted by their rules to use the knife, and, as a result, great
jealousy existed between them and the few who, having passed the
required examination, were authorized to perform cutting operations
and to assume the title of “Masters in Surgery.” In 1493, as the
result of an effort made by the barbers of Paris as a body, to gain
some knowledge of medical science, they obtained from the university
permission to purchase a corpse which had not yet been removed from the
gallows. They had, it appears, engaged a doctor of medicine to give
them instruction in anatomy, and it was upon a dissection of this body
that the teaching was to be based. In 1494 the Faculty made provision
for giving the barbers a regular course of lectures on surgery; and,
eleven years later (1505), additional privileges having in the meantime
been granted them by the university, they organized the “Corporation
of Barber Surgeons, or Surgeons of the Short Robe.” In the oath
which the members of this organization were obliged to take, it is
expressly stated, among other things, that “they will give due honor
and reverence to the Faculty, and will not administer any laxative or
alterative drug.”

From 1601 to 1731, when the _Académie de Chirurgie_ was founded,
there was an almost continuous series of squabbles between the surgeons
and the barbers, on the one hand, and the Medical Faculty of the
University, on the other. At a still earlier period, dating back even
to the fourteenth century, the quarrels were between the surgeons
(École de St. Côme) and the barbers, but, during the seventeenth
century and the early part of the eighteenth, the surgeons and the
barbers seem to have harmonized their interests and to have made common
cause against the Faculty. An edict was issued by Louis the Twelfth
in 1613 to the effect that the two corporations (the surgeons and
the barbers) should be fused into a single organization; and, even
before this, it had become customary to employ the words “surgeon” and
“barber” as synonymous terms. Finally, in the years 1644, 1645 and
1656, further agreements were entered into by the two bodies. After the
founding of the Academy of Surgery in 1731 nothing further is heard of
barber-surgeons.

In the account which I have thus far given of the agencies that were
available during the Renaissance for the perpetuation and increase of
medical knowledge, I make reference only to the established medical
schools and to the less pretentious but much more practical teaching
organizations furnished by the guilds or brotherhoods. In my remarks
I have said little or nothing about hospitals, which--potentially, at
least,--have a great deal to do with the advance of medical knowledge,
especially in the department of surgery. Unfortunately, my efforts to
procure information relating to this subject have not been rewarded
with much success and I shall therefore not be able to furnish more
than a few disconnected and very imperfect details.

At the beginning of the sixteenth century the city of Lyons possessed
(and it still possesses) the oldest hospital in France--viz., the
Hôtel-Dieu,--which was founded by Childebert the First in 542 A. D.
The city itself was at that period second in importance only to
Paris, and in some respects it was the equal of the metropolis in
celebrity. The art of printing was introduced there in 1472, and the
presses of that city were soon reckoned the best in Europe. Many
medical books were published at Lyons. François Rabelais (1483–1553),
the celebrated author of the humorous and satirical works “Gargantua”
and “Pantagruel,” was a regularly educated physician, and during his
residence at Lyons he edited various works of Hippocrates and Galen.
Michael Servetus, who displayed such marked ability by his researches
in regard to the circulation of the blood, was also a resident of Lyons
from 1530 to 1543. Some idea of the way in which a large hospital was
managed in those early days may be gained from the following statement
of facts: In 1619 as many as five patients were permitted to occupy
one bed in Hôtel-Dieu at Lyons. Although the hospital possessed
accommodations for a total of five hundred and forty-nine patients
(including pilgrims and poor people), there was only one medical man
whose duty it was to look after the surgical cases, and he resided
outside the building. At a somewhat later date there was provided a
“_chirurgien principal_,” whose duty it was to give the needed
surgical care to this class of patients, and who was obliged to
reside in the hospital. When this chief surgeon required assistance
in the dressing of wounds, etc., he was authorized to make use of
the “apothecary’s boy.” The stock of surgical instruments possessed
by the hospital in 1543 comprised the following items: One uterine
speculum; one trephine, which was composed of thirteen separate
parts; one mouth-plug, for use in keeping the jaws separated; one
ear speculum; and one elevatorium. All these facts, taken together,
furnish strongly corroborative evidence of the statement made by von
Gurlt in his _Geschichte der Chirurgie_, viz., that in France,
during the sixteenth century, the occupation of surgeon was considered
by the community but little better than that of a hair-cutter. It
is therefore not surprising that the great hospital of Lyons should
have been managed at that time in accordance with such a low sanitary
standard and with an almost total disregard of the purposes for which
a hospital exists. So far as I am able to learn, the conditions just
described were not peculiar to the city of Lyons. “During the reign of
Francis the First (1515–1547) there were in the main room (thirty-six
feet wide) of the Infirmary of Hôtel-Dieu at Paris,” says Boisseau,
“six rows of beds (three feet wide), each one of which accommodated
ordinarily three (at times even four) sick persons, who necessarily
were very uncomfortable. This is not all; for there were also in this
same infirmary seven or eight beds which were designed to accommodate
from twenty-five to thirty infants or young children, the great
majority of whom died from the poor quality of air which they had to
breathe in that institution.” I do not need to furnish additional
proofs in corroboration of the truth of the statement that during the
Renaissance the French civil hospitals contributed practically nothing
to the advance of medical science. It is possible that in Italy these
institutions may have been better managed, for, in the account which he
gives of his trip to Rome, Luther speaks of having visited a hospital
which particularly attracted his notice by reason of its orderliness
and the conspicuous cleanliness of every part of the building. As an
offset, however, to this favorable testimony I should state that in
some documents discovered in comparatively recent times there are
memoranda relating to the duties of the medical staff in the civil
hospital of Padua (1569)--a city in which was located the most famous
medical school to be found anywhere in Europe during the sixteenth
century. These memoranda read as follows: “There shall be a doctor of
physic upon whom rests the duty of visiting all the poor patients in
the building, females as well as males; a doctor of surgery whose duty
it is to apply ointments to all the poor people in the hospital who
have wounds of any kind; and a barber who is competent to do, for the
women as well as for the men, all the other things that a good surgeon
usually does.” (The word “surgeon” is evidently employed here in the
sense of barber-surgeon, and not in the modern sense of the word.) This
testimony and that furnished on a preceding page with regard to the
management at the two leading civil hospitals in France amply justify
the statement that during the sixteenth century medicine received no
aid whatever from these institutions in its efforts to advance.

For the sake of orderliness I shall, from this point onward, arrange
the information which I may find it desirable to furnish, under the
headings of the different countries of Europe; and in carrying out
this plan I shall begin with Germany, as it was there that the oldest
fifteenth-century treatises on practical surgery were first printed.

                             CHAPTER XXXVI

      SURGERY IN GERMANY AND SWITZERLAND DURING THE FIFTEENTH AND
                          SIXTEENTH CENTURIES

There were five men in Germany and German Switzerland who, during the
Renaissance, attained distinction as surgeons, and who at the same
time contributed, by their published writings as well as by the force
of example, to the advancement of medical science. The names of these
five surgeons are: Pfolspeundt, Brunschwig, von Gerssdorff, Fabricius
of Hilden and Felix Wuertz. The first three mentioned were born in the
early part of the fifteenth century, and all five of them derived their
practical knowledge of surgery in large measure from their experience
in warfare. Individual sketches of these men will be furnished farther
on, but I believe that these will be better understood if a brief
account of the state of medical education in general throughout
Germany, at the period which I am now considering, be first supplied.

_State of Medical Education in General Throughout Germany
(1400–1600)._--The University of Heidelberg was founded in 1386,
but it was not until about 1550 that the first beginnings of medical
teaching made their appearance in that institution. Equally feeble
attempts were made, twenty years later, to organize the teaching of
medicine at the University of Wuertzburg; but very little appears to
have been accomplished during the immediately following years, as may
be judged from the official announcement, in 1587, of what things
the Professor of Surgery would teach in the three-years’ course.
“_First year_: Lectures on the subject of tumors, in accordance
with the teachings of Galen; _Second year_: Lectures on the
subjects of wounds and ulcers, in accordance with the teachings of
Galen and Hippocrates and the Arabian medical writers; _Third
year_: Lectures on fractures and dislocations, in accordance with
the teachings of Galen and Hippocrates. Then, if sufficient time
is available during this last year of the course, a certain amount
of anatomy is to be taught (during the winter season) from Galen’s
writings on this subject. In the summer time the subject of simple
remedies may be taken up advantageously, and botanical demonstrations
may also be given.” Von Gurlt quotes Koelliker as his authority for
the statement that throughout the seventeenth century the medical and
surgical teaching at the University of Wuertzburg was very defective,
“almost nothing worthy of mention being accomplished during that long
period in the departments of anatomy and physiology.” In the University
of Basel, Switzerland, which was founded in 1460, medical teaching
was as barren as it was in all the German universities at that early
period. It was only in 1542 that the first public dissection of a
human body took place there. Vesalius was visiting the city at that
time for the purpose of superintending the printing of his great work
on anatomy, and the university authorities availed themselves of the
opportunity to secure from him not only this single demonstration, but
also in addition a course of lectures on anatomy. Fifteen years later,
Felix Platter, a native of Basel and a man of exceptional ability
(see sketch on pp. 332 _et seq._), made the first postmortem
examination known to have been made in that city. Two years later
still (1559), following in the footsteps of Vesalius, he made a public
dissection of a criminal’s corpse in the Church of St. Elizabeth.
From 1581 onward, with occasional omissions, a public dissection of
the corpse of a criminal was made by the professor of anatomy once
every year. In 1590 the question was discussed by the Faculty whether
it “might not also be practicable to secure from the hospital, for
dissection, an occasional corpse.” The first body obtained from this
source was dissected in 1604, but it was not until 1669 that a second
one was available. There was no museum of anatomy and the medical
school owned only two human skeletons--one male, that had been set
up by Vesalius, and one female which had been prepared by Platter.
During the first two hundred years of the existence of this university,
only twenty-three copies of the different writings of Hippocrates, of
Galen, of Dioscorides and of Paulus Aegineta were available for the
instruction of the medical students. “These books should be diligently
read aloud to the young men if their contents are to furnish the
maximum of useful information.” As for clinical instruction, each
student was expected to secure for himself, by private arrangement
with some active practitioner, the position of assistant, or to obtain
from the Archiater or City Physician an occasional opportunity of
seeing patients at the hospital. According to the rules established by
the Faculty the students were permitted to take private courses with
different physicians. Another and very valuable source of information
that was within the reach of these young men, was supplied by the
public disputations which were held quite frequently.

The preceding brief account, which I have compiled from von Gurlt’s
work, will serve, as I believe, to convey a fairly clear idea of the
primitive and very limited opportunities of acquiring a knowledge of
medicine and surgery which were afforded the student in Germany during
the fifteenth and sixteenth centuries. (It should be borne in mind that
Basel, although located in Switzerland, was in nearly all respects a
German city.) It was not until a much later period that the schools of
that country, in nearly every department of human knowledge, caught
up with and eventually surpassed--at least for a number of years--the
similar institutions in Italy and France.

  [Illustration: FIG. 18. CONSULTATION BY THREE PHYSICIANS UPON A CASE
  OF WOUND IN THE CHEST.

  (From a woodcut in the _Surgery of Hieronymus Brunschwig_,
  Strassburg, 1508.)

  This treatise, which was written by the author in 1497, passed
  through nine successive editions, the last one in 1539. Probably
  no woodcuts of a higher order of merit than those represented in
  this and the two following illustrations (Figs. XIX and XX) are
  to be found in medical literature.]

_Hieronymus Brunschwig._--Hieronymus Brunschwig was born at
Strassburg during the early part of the fifteenth century, the exact
date not being known. It is believed that he attained a great age, some
even claiming that he was one hundred and ten years old at the time of
his death. His treatise on surgery, bearing the simple title “_Das
buchler Wund Artzeny_,” was first published in 1497,
when he was already an old man, and it passed through nine editions
during the following forty-two years. It was also twice translated
into English. Up to the time of the discovery of Pfolspeundt’s work
it was believed to be the oldest German treatise on surgery known. It
was very freely illustrated with original woodcuts, not a few of which
possess considerable artistic merit. (See accompanying reproduction.)
The following headings of some of the more important chapters will
convey at least a fair idea of the character of the book: “Definition
of the Word ‘Surgeon’”; “Anatomy”; “Fatality of Wounds in Different
Parts of the Body”; “Different Kinds of Wounds”; “Different Kinds of
Surgical Instruments”; “Different Modes of Ligating Blood-Vessels”;
“Wounds of Blood-Vessels and Nerves”; “Methods of Arresting Bleeding”;
“Foreign Bodies in Wounds”; “Treatment of Wounds Inflicted by Poisoned
Arrows”; “Bruised or Crushed Wounds”; “Stab Wounds”; “Bites and
Stings”; “Wounds of the Head”; “Operations for Hare-Lip”; and several
other chapters on wounds and pathological conditions of other parts of
the body. Syphilis is not once mentioned in the book; and from this
circumstance von Gurlt infers that a knowledge of the existence of
this disease had not yet, at that early date (1497), reached Germany.
In Brunschwig’s _Liber pestilentialis, etc._, however, which was
printed three years later, syphilis is incidentally mentioned as the
“_malefrancose_” or “_malum mortuum_.” That Brunschwig was
well informed in the earlier surgical literature is shown by the fact
that he quotes from the writings of Theodoric, Guillaume de Saliceto,
Guy de Chauliac, Henri de Mondeville, and many others. A hasty and
necessarily very superficial perusal of the text of a few of the more
important chapters of this remarkable book satisfies me that Brunschwig
deserves to be classed among the really great surgeons of the fifteenth
and sixteenth centuries. A copy of this rare book may be seen in the
Surgeon-General’s Library at Washington, D. C.

_Heinrich von Pfolspeundt._--The earliest German treatise
relating to surgery is that which bears the title “_Buch der
Bündth-Ertznei_,” by Heinrich von Pfolspeundt, “_Bruder des
deutschen Ordens_.” It was written in 1460, and was first published
in printed form in 1868 by H. Haeser and A. Middeldorpf, Berlin.
The text of this very early German work on the practice of surgery
furnishes ample evidence to show that the author was worthy to be
ranked among the leading surgeons of the fifteenth century. At page
fifty-seven, says von Gurlt, may be read the remarkable statement that,
in the case of a wound of the intestinal canal, one may cut through
that organ at the point of injury and then introduce into the opposite
ends of the divided bowel a silver tube the margins of which have been
carefully bent so as not to offer at any point a cutting edge. The
tube may then be tied in place with thread of green silk. (Von Gurlt
speaks of this as the forerunner of Murphy’s button.) Speaking of
wounds caused by arrows, Pfolspeundt says that, to insure the patient’s
recovery, the planet under which he happens at that time to be, should
be in favorable conjunction. In one case which came under Pfolspeundt’s
care he was obliged to pay an astrologer the sum of fifty gulden in
order to ascertain whether the planet in question was or was not in a
favorable conjunction.

There is only one place in the entire book, says von Gurlt, where a
gunshot wound is mentioned, and then only incidentally; but this is
positively the first reference (about the middle of the fifteenth
century) to such wounds discoverable in medical literature.

Among the topics which are treated quite fully and in such a manner as
to show clearly that the author was well versed in at least this part
of operative surgery, those relating to rhinoplasty deserve to receive
special mention. From the viewpoint of history, this part of the book
is of very great importance. In no other treatise, says von Gurlt, do
we find an equally detailed and satisfactory account of the operative
method employed by the Two Brancas (father and son, from Catania,
Italy), who were contemporaries of Pfolspeundt. The latter learned this
method from an Italian surgeon, whose name he does not mention, and
he was particularly careful not to divulge the essential details to
anybody except two of his brethren in the Order to which he belonged.

For anaesthetic purposes in operative cases, Pfolspeundt was in the
habit of employing sponges saturated with the juices of opium, Atropa
mandragora, Conium maculatum, Hedera helix or arborosa, Lactuca and
Daphne mezereum; his technique resembling very closely that employed by
Guy de Chauliac, Theodoric and others. (See the appropriate chapters in
the earlier part of this volume.)

In his remarks upon the manner of bringing about the healing of an open
wound, Pfolspeundt says that “in all cases he tries to dispense with
stitches, but that, when he finds such support necessary, he first
spreads a thick layer of adhesive material over both margins of the
wound and afterward introduces the threaded needle through the mass
into the skin. Then, in order to bring the edges of the wound together,
he draws the thread taut and makes it fast by means of a very small
knot.... Whether the sharp fever which sometimes sets in afterward as
a complication, is due to simple inflammation or to erysipelas, is a
question which cannot always be decided; and it is still more difficult
to determine whether the thin watery secretion which sometimes develops
in a wound may not signify--as some writers maintain--the beginning of
suppuration in a joint.”

Were it not for the difficulty which one experiences in translating
correctly the ancient provincial German of Pfolspeundt’s text, I might
readily furnish further examples of his surgical pathology and methods
of treatment. The few, however, which I have already given will have to
suffice.

  [Illustration: FIG. 19. BARBER-SURGEON (_WUNDARZT_) EXTRACTING
  AN ARROW FROM A WOUNDED SOLDIER’S CHEST WHILE THE BATTLE IS STILL IN
  PROGRESS.

  (From the _Feldbuch der Wundarznei_ of Hans von Gerssdorff, first
  published in 1517; many later editions followed.)]

_Hans von Gerssdorff._--Hans von Gerssdorff, who was also called
“Schielhans” (squint-eyed Hans), was born in Strassburg about the
middle of the fifteenth century. He was a bold and skilful surgeon,
and acquired a wide experience and great self-confidence from his long
service in connection with the army. He was present, for example, at
the famous battles of Grandson (1476, in Switzerland) and Nancy (1477,
in France), in both of which the slaughter was very great, and in both
also Charles the Bold, Duke of Burgundy, was badly beaten. In 1517 von
Gerssdorff published at Strassburg a treatise on military surgery,
under the title: “_Feldbuch der Wundartzney_.” This book, which
is illustrated with exceptionally good woodcuts, two specimens of
which are here reproduced (Figs. 19 and 20), contains the earliest
discussion of gunshot wounds; and, in his remarks on the proper manner
of treating such wounds, von Gerssdorff leads one to infer that he
shared, although somewhat hesitatingly, the at that time prevailing
belief that these wounds are poisoned. He was a pronounced advocate of
the use of the red-hot cautery in cases of serious hemorrhage from a
wound. When it was found that the ball had penetrated the flesh to some
depth, he recommended that it be cut out; and if, after the removal
of the missile, the patient complained of much pain in the wound, hot
oil was to be poured into it freely. Before the employment of firearms
in warfare, amputation of a limb was rarely performed--that is, only
in cases where gangrene had developed in the corresponding hand or
foot. But von Gerssdorff assures us that, up to the time of writing
his “_Feldbuch_,” he had personally performed “nearly two hundred
amputations.” This great increase in the frequency of performing this
operation is clearly to be attributed to the increased use of the new
agent--gunpowder--in warfare. In this operation, according to his own
declaration, von Gerssdorff was not in the habit of suturing the flaps.
Instead, he brought the opposing edges together and then covered the
stump thus formed with the bladder of some animal. There are a number
of other interesting details relating to von Gerssdorff’s manner of
conducting this important operation, but it is not practicable to give
up the space that would be required for a satisfactory description of
them. There is one point, however, to which I may be permitted to refer
very briefly in this place, viz., the manner in which the surgeons of
this and even much earlier periods secured a fairly satisfactory degree
of local anaesthesia when they had occasion to perform an amputation.
They produced insensibility of the part by tying a band tightly around
the limb a short distance above the spot at which the amputation was
to be performed. At a somewhat later period, as in the middle of the
seventeenth century, artificial anaesthesia was also effected through
the application of snow or ice to the part.

The date of von Gerssdorff’s death is not known.

  [Illustration: FIG. 20. AMPUTATION OF THE LEG.

  (From Hans von Gerssdorff’s _Feldbuch der Wundarznei_.)

  Von Gurlt says that this is the earliest known pictorial
  illustration of the amputation of a limb.]

_Fabricius of Hilden._--Fabricius Hildanus--or Fabricius of
Hilden, near Düsseldorf--was born in 1560 and received his early
training in surgery from Cosmas Slotanus, a pupil of Vesalius and the
first barber-surgeon of Duke Wilhelm of Guelich-Cleve-Berg (eighteen
miles northeast of Aix-la-Chapelle). In 1585 he visited Geneva,
Switzerland, and continued his studies in that city under the guidance
of Jean Griffon, one of the most distinguished surgeons of that period.
After leaving Geneva he practiced medicine at Cologne, and during that
period (1591–1596) steadily increased his reputation as a skilful
surgeon, particularly well versed in anatomy. But he appears to have
acquired a strong liking for Switzerland and for the professional
friends whom he had gained in that country; and consequently it is not
surprising to learn that, during the later years of his life, he spent
long periods of time in Geneva, Lausanne and Berne, in the last of
which cities he filled the office of City Physician. He died in 1634,
at the age of seventy-four, full of honors and greatly beloved by all
who knew him.

Fabricius of Hilden laid great stress upon the importance, to the
surgeon, of a thorough grounding in anatomy. He had been profoundly
impressed by the fact that his instructor at Geneva, Jean Griffon,
never undertook an important operation until after he had refreshed
his memory by a dissection of the region involved. He was also much
interested in pathological anatomy, and always availed himself of every
possible opportunity for making a postmortem examination. As evidence
of the slowness with which news of important scientific discoveries,
particularly in the domain of medicine, traveled in those days I may
mention here the fact that, up to the time of his death in 1634,
Fabricius had not heard of Harvey’s great discovery of the circulation
of the blood (1628). Although he gained distinction in more than one
field of medicine his greatest reputation was unquestionably gained in
that of surgery; and his success in this field was to be ascribed to
his profound knowledge of anatomy, to his inventive genius, and to his
great technical skill. He insisted very strongly upon the importance,
for the surgeon, of possessing good instruments and well-constructed
apparatus.

If we compare Fabricius of Hilden with Ambroise Paré we are obliged
to admit that the latter, although decidedly inferior to his rival in
scientific training, was the greater surgeon of the two. It is perhaps
worth recording that Paracelsus and Wuertz were Fabricius’ bitter
opponents.

Of his published contributions to surgical literature, the most
important are to be found in the work entitled: “_Observationum et
curationum chirurgicarum centuriae VII._,” published at Lyons in
1641.

_Felix Wuertz._--Felix Wuertz was born at Zurich, Switzerland,
between the years 1500 and 1510 (the exact date is not known). As to
his early life and surroundings I am only able to say that his father
was a painter, that he himself took service under a barber, and that
at the end of two or three years, after he had learned the details of
this branch of work, he started out on his travels over Europe in the
character of a barber’s apprentice, as was, in those days, the regular
custom with apprentices of all trades or occupations. In this way he
visited such cities as Bamberg, Pforzheim, Nuernberg, Padua and Rome,
in each of which he spent a certain length of time as an aid to those
surgeons who were willing to employ him. It is not unlikely that it was
during this wandering period of his life that he gained some experience
in the treatment of gunshot wounds. In 1536, after an absence of
four or five years, he returned to his native city and was regularly
enrolled as a member of the barbers’ guild. During the following twenty
years he carried on the practice of medicine and surgery, but more
particularly the latter, with ever-increasing success. In 1559, for
reasons which are not mentioned by any of his biographers, he left
Zurich and established himself in Strassburg; and then, at the end of
another ten or twelve years, he again changed his residence, this time
giving the preference to Basel, a Swiss city located at the boundary
line between Germany and Switzerland. The exact date of Wuertz’s
death is not known, but--from various facts which he mentions in his
book--it may be inferred that it occurred in 1576, and that he was
residing at the time in the house of his son, who had the same name
as himself and was also a surgeon. The title of the treatise which he
wrote and which passed through a number of editions between the years
1563 and 1651,--not to mention translations into the French and Dutch
languages--was: “_Practica der Wundarznei_” (The Treatment of
Surgical Affections).

Malgaigne--says von Gurlt, in his History of Surgery--does not hesitate
to speak of Wuertz as one of the three greatest surgeons of the
sixteenth century (Franco and Ambroise Paré being the other two); and
von Gurlt adds that Wuertz’s “_Practica_” is rich in facts which
he had gathered from his own experience in everyday practice, and upon
which he makes comments that really represent his own views and not
those of various other authors. The leading principles which guided
Wuertz in his treatment of wounds of all kinds are thus formulated by
him:--

   Keep them as neat and clean as possible, and disturb them as
   little as you can; so far as may be practicable, exclude the
   air; favor healing under a scab; and do not give the patient a
   lowering diet, but feed him as you would a woman recovering from
   her confinement.

According to von Gurlt, Wuertz attached relatively small importance
to healing by first intention, and only in rare cases did he make
special efforts to secure this result. On the other hand, he availed
himself of every opportunity to enter his protest against some of
the bad tendencies which had somewhat suddenly made their appearance
in the practice of surgery in his day, and more especially “against
the almost universal employment of caustics and the red-hot iron for
arresting bleeding; against the uncalled-for and positively harmful
habit of repeatedly probing a wound; against the unreasonable practice
of inserting tents into wounds; against the uncontrolled application
of mushy poultices to wounds; and against the excessive employment of
bloodletting in the treatment of wounds.” He exhibited his conservatism
in still other ways. Thus, for example, he was very slow in reaching a
decision to amputate a limb or to remove splinters or larger portions
of loose bone from a wound, for he put greater trust in the reparative
powers of Nature than did most of the surgeons of that day. Wuertz was
also slower than were most of them in resorting to the operation of
trephining the skull. His ideas with regard to the nature of gunshot
wounds were not very clear, for he still believed that the projectile
caused some burning and a certain degree of poisoning of the wound;
but he condemned all unnecessary efforts at extraction, especially by
means of complicated instruments. It was better, he said, to wait until
the bullet or other missile manifested its presence at some easily
accessible spot in the body.

The statements made above bring out some of the good features
of Wuertz’s treatise. This work, however, says von Gurlt, also
contains not a few bad features, and among them he mentions the fact
that it abounds in repetitions and in evidences of the author’s
superstitiousness.

Some of Wuertz’s comments on the symptoms which occasionally develop in
cases of injury to the head, and the suggestions which he makes as to
the treatment that should be adopted, throw considerable light upon his
mode of procedure in the presence of certain surgical phenomena. The
following clinical lesson is based upon three hypothetical developments
in a case of cranial injuries:--

   (1) The patient’s wound in the head, let us suppose, has to
   all appearances healed, when it unexpectedly becomes swollen
   and painful and begins to discharge again. What measures are
   indicated under these circumstances? The wound should at once
   be freely reopened, for it may confidently be assumed that such
   a lighting up of the local symptoms is due either to a loose
   splinter of bone that is trying to escape or to the presence of
   a small area of bone caries. If, under these circumstances, you
   should not establish a free opening a large abscess will surely
   collect in that region and will soon make for itself a new
   outlet.

   (2) If the patient complains that he has constant pain in his
   head on the same side as that on which the injury was originally
   inflicted, that the pain is steadily increasing in severity,
   and that in addition he feels a sensation of pulsation in his
   head; and if, furthermore, you inspect closely the site of
   the original wound, and pass your finger cautiously over the
   spot, but fail to discover any appreciable external swelling,
   you may feel almost certain that a splinter or a spicule of
   bone projects from the inner table of the skull cap into the
   substance of the brain. Then, when the surgeon believes that
   the condition as just described truly represents the existing
   intracranial lesions, he should not hesitate to make an opening
   in the calvarium over the affected spot and remove the offending
   splinter.

   (3) If the patient, after the external wound has healed,
   complains of a throbbing and roaring in his head, not merely in
   the region of the actual injury but involving the entire head,
   and if the symptoms tend rather to increase than to diminish,
   and eventually become so severe that the patient is almost
   beside himself with the pain, then is the surgeon justified in
   believing that a clot of blood is imprisoned somewhere beneath
   the cranium and is gradually being converted into an abscess or
   a condition of ulceration. And if at the same time some swelling
   appears in the vicinity of the eyes, or if a bloody and purulent
   discharge begins to flow from the nose or the ears, he may not
   merely entertain a belief that his diagnosis is correct, but
   may assert with positiveness that the lesions just named really
   exist. And then the proper treatment for him to adopt is [in
   essentials] the following: The head having first been shaved
   over the site of the original wound, make a crucial incision
   through the scalp and pericranium, turn the flaps back, apply
   a strong, sharp-edged chisel to the surface of the bone, and
   remove enough of the cranium to afford a satisfactory view
   of the underlying parts. [Among the effects first observed]
   probably pus will well up into the opening, and the patient will
   then experience relief; and if a spicule of bone comes into
   view, remove it forthwith. The plan of treatment here suggested
   is the only one which can be trusted to effect a cure in a
   case like that which is now being considered.... If a boring
   instrument is employed for making an opening in the bone, be
   careful not to allow any of the chips made by the borer to enter
   or remain in the cranial cavity. Some surgeons teach that, if
   pus be not found at the first opening, a second one should be
   made at the distance of a finger’s breadth from the first, and
   that the intervening bone should be broken down with a strong
   and sharp knife so as to convert the two into a single opening.
   [Wuertz adds that he had never found it necessary to act in
   accordance with this advice.] After the pus or clot of blood
   has been removed, one may as a rule readily discover the true
   cause of the pain and other symptoms. As a final step, suitable
   dressings should be applied to the wound.

Another important department of practical surgery, in which Wuertz
appears to have gained special distinction, is that which relates to
wounds and certain diseases of the abdomen. Owing to lack of space it
will not be practicable to reproduce here any histories of the cases of
this nature which came under his observation, but I believe that the
following brief extracts from his remarks upon the best way of treating
them may in some measure answer the same purpose:--

   Penetrating wounds of the abdomen are universally admitted to
   be very dangerous, no matter what organs (stomach, intestines,
   liver, gall-bladder, spleen or kidneys) be involved in the
   injury. In the case of a wound of the liver or spleen it is not
   advisable to employ sutures; instead, one may use some kind of
   sticking plaster for bringing the edges of the wound together.
   Proper regulation of the diet plays an important part in the
   treatment of these conditions, and so also may venesection. When
   an intestine is the organ wounded I adopt the plan of treatment
   recommended by most authorities; that is, I stitch together the
   opposite edges of the wound and I cleanse the surface of the
   bowel carefully with milk that has been well saturated with the
   juice of anise seeds.

In his remarks about the treatment of suppurative processes involving
the thigh in the vicinity of the knee, Wuertz gives the following
advice:--

   Do not allow the knee to remain quiet, but stretch the
   surrounding parts and manipulate them as much as you can, in
   order that the joint may not become permanently rigid; for if
   you wait until the healing is completed before you resort to
   these measures you will often find that it is already too late.

Separate chapters are devoted to such topics as would to-day receive
the designations “pyaemia,” “hospital gangrene,” and “septicaemia”;
and in a separate short treatise which deals with the various ailments
of young children, Wuertz mentions the fact that he once suffered
greatly for ten days from an attack of migraine (hemicrania) and that
he experienced marked and permanent relief only after the operation
of arteriotomy had been performed upon his left temporal artery. In
another part of the volume he expresses himself in terms which justify
the belief that he must have performed amputation of the thigh on
one or more occasions. He does not, it is true, furnish any details
regarding the indications that point to the necessity of resorting
to this operation, nor does he state how it should be carried out;
he simply makes the remark, while speaking of the employment of the
red-hot cautery iron in arresting hemorrhage, that “it is useful in
amputation of a limb, particularly in the thicker part of the thigh,
and occasionally in other places, as in the removal of a tumor by the
use of the knife.” So far as I am aware, Celsus was the first among
ancient writers on surgery to say anything about amputations, and what
he does say on this subject consists simply of quotations from still
earlier writers--from Archigenes, Leonides and Heliodorus, surgeons
whose writings no longer exist except in the form of detached extracts
that appear in more modern treatises. The portions of text which Celsus
quotes show clearly that the surgeons whom I have just named were in
the habit of making flap operations in cases of amputation above the
elbow and above the knee; and Archigenes even taught the advisability
of first ligating the larger supply blood-vessels before one proceeds
to the amputation of a limb.

From the remarks which Wuertz makes in one or two places it is easy
to see that he was often not a little annoyed by the criticisms which
his professional brethren made with regard to some of his methods of
procedure. Thus, for example, he boldly declares that one’s experience
is of much greater value than any rule that may have been laid down by
the ancients.

   There can be no doubt, he says, that the ancients occasionally
   displayed great ignorance and great want of judgment, just as
   happens in our own time.... How much do you suppose I care
   whether Galen’s, or Avicenna’s, or Guy de Chauliac’s opinion
   does or does not agree with mine? Every such opinion--it should
   be remembered--was, at one time or another in their day, a new
   [and therefore unproved] opinion.... In practical surgery much
   more importance attaches to the manner in which one carries out
   one’s manipulations, and to the amount of experience which one
   may have acquired, than to the length of time which one devotes
   to windy consultations.

Fortune conferred very few favors upon Wuertz in the course of his
career; the aid granted by kings and princes played no part in the
moulding of his character; his greatness was entirely due to his
own unaided efforts. Paré, on the other hand, was certainly one of
Fortune’s favorites. He, too, like Franco and Wuertz, began his
professional life as a barber’s apprentice, but, as he was made of
a much finer clay, the ultimate product of his development was a
princely surgeon, perhaps no more efficient or skilful than his two
distinguished contemporaries, but unquestionably more many-sided,
more lovable than either of them. On the other hand, Wuertz rendered
a most valuable service to the science of surgery by his close and
patient study of certain symptoms which his confrères had overlooked
or incorrectly interpreted (such, for example, as pyaemia, hospital
gangrene and septicaemia); and he thus established the fact that these
were in reality independent diseases.

                            CHAPTER XXXVII

      THE DEVELOPMENT OF SURGERY IN ITALY DURING THE RENAISSANCE

During the latter part of the fifteenth, all of the sixteenth and the
early part of the seventeenth centuries quite a large number of Italian
surgeons attained honorable distinction by the contributions which they
made to the science of medicine; and even in the neighboring Latin
countries of Spain and Portugal,--countries in which the force of the
revival of all departments of learning had made itself felt to a much
feebler degree, and in which at the same time the opposition to such
revival was much more active,--several surgeons succeeded in winning
creditable places for themselves in the history of their art. The names
of the Italian surgeons are as follows: Giovanni da Vigo, Bartolommeo
Maggi, Marianus Sanctus, Fallopius, Carcano Leone, Fabricius ab
Acquapendente, Aranzi and Tagliacozzi. I will now add brief notices of
the careers of all these men, in order to convey at least some idea of
the grounds upon which their claim to honorable distinction rests.

Giovanni da Vigo--perhaps more frequently referred to in literature
by the French form of his name, “Jean de Vigo”--was born at Rapallo,
near Genoa, Italy, about the year 1460. He was the son of Bernardo di
Rapallo, who was also a surgeon; and he himself was the founder of a
school which sent out quite a number of practical surgeons. In 1485 he
began the practice of his profession at Saluzzo, a small town about
forty miles south of Turin; and ten years later he settled at Savona,
which is located on the Mediterranean, a short distance to the west
of Genoa. In 1503 he was chosen the personal physician of Cardinal
Giuliano della Rovere, who resided at Savona, and he continued to hold
this position after the cardinal was elected to the papal office under
the name of Julius the Second.

Da Vigo’s great treatise on surgery (“_Practica in arte chirurgica
copiosa continens novem libros_,” Rome, 1514) owed its celebrity,
during the early part of the sixteenth century, chiefly to the fact
that he was the first author to write somewhat thoroughly upon syphilis
and upon gunshot wounds--two surgical disorders of great importance
at that time. As to gunshot wounds, da Vigo was one of the first to
maintain that they were poisoned wounds; and for a long time afterward
this was the generally accepted opinion. Like all his contemporaries,
da Vigo was not willing to undertake such operations as those for the
cure of stone in the bladder, for the relief of cataract, and for the
cure of hernia. He left these, says Haeser, to the itinerant surgeons.
But he gained well-merited credit by his employment of ligatures for
the arrest of bleeding in a variety of conditions--not, however,
in amputations, as he appears to have avoided cutting operations.
According to the same authority, the circular pattern of trephine (the
kind which the surgeons of the present day prefer) was first introduced
by da Vigo. The following passage copied from his “_Practica_”
shows that he was familiar with the use of the ear speculum: “...
_si ad solem speculo instrumento aure ampliata_.” Da Vigo died
soon after 1517.

Bartolommeo Maggi, who was born at Bologna either in 1477 (Haeser)
or in 1516 (von Gurlt), held the Chair of Anatomy and Surgery in the
medical school of his native city, and then at a later date accepted
the position of private physician to Pope Julius the Third (1550–1555).
He held this position, however, only for a short time, as he found that
the climate of Rome did not agree with him. His posthumous fame rests
largely on the treatise which he wrote on gunshot wounds and which
was published by his brother a short time after the former’s death.
His treatise, says von Gurlt, is one of the best of those which were
published on this subject during the sixteenth century. Henry the
Second, King of France, expressed his gratitude to Maggi for the care
which he took of the wounded French soldiers who fell into the hands of
the papal troops at the sieges of Parma and Mirandola. Maggi maintained
firmly the belief that gunshot wounds are either poisoned or burned.
His death occurred in 1552. The title of his treatise on gunshot wounds
is: “_De vulnerum bombardarum etc._,” Bologna, 1552.

Marianus Sanctus of Barletta near Naples (born in 1489, died at some
unknown date after 1550) is credited with having been the first to
publish a description of the so-called “_apparatus magnus_”--the
name given in those early days to the method of extracting a calculus
from the urinary bladder through an incision in the perineum after a
grooved sound or director had first been passed into this organ by
way of the urethra. The title of the book in which this description
is given is the following: “_De lapide renum liber et de lapide ex
vesica per incisionem extrahendo_,” Venice, 1535. Marianus, however,
does not claim to have been the inventor of this method. Some writers
give the credit for this to Jean da Vigo’s father, Bernardo di Rapallo,
who communicated a knowledge of the method to Giovanni de Romanis,
who in turn instructed Marianus Sanctus. It is believed, furthermore,
by some writers that Giovanni de Romanis was the inventor of
lithontripsy[86]--the operation of crushing a stone in the bladder or
urethra. Laurent Colot, the famous French lithotomist of the eighteenth
century, obtained his knowledge from a certain Octavianus de Villa, a
friend of Marianus Sanctus, and then kept the matter secret for many
years.

Fallopius, the famous anatomist of the early part of the sixteenth
century, does not appear to have attained equal distinction in the
field of surgery. So far as one may judge from the portions of the
text selected from his writings by von Gurlt, Fallopius was a very
conservative if not a very timid surgeon, in this respect being not
unlike Fabricius ab Acquapendente. In the text to which reference has
just been made, I find a brief mention of a case which passed under
Fallopius’ observation and which, perhaps, is of sufficient interest
to be recorded here. The patient’s--a German student’s--finger had
been nearly severed by some cutting instrument, and the greater part
of the member remained attached to the hand only by a narrow strip of
flesh. “I stitched together the separated edges, and at the end of
three or four days I was astonished to find that firm union between the
separated parts had already taken place. This result seemed to me like
something miraculous.”

Carcano Leone was born at Milan in 1536, his parents being people of
good social standing. After receiving a thorough classical education,
he began his medical studies in his native city, under the guidance
of Pietro Martire, a pupil of Vesalius. He next continued his studies
at the University of Pavia, but eventually went to Padua, where he
enrolled himself among the pupils of Fallopius. After a residence of
two years in that city, he returned to Milan and opened a medical
school of his own. Upon the occasion of the death of the Cardinal and
Archbishop Carlo Borromeo, whose remains now rest in the cathedral of
Milan, it was Carcano Leone who was invited to make the postmortem
examination. He carried on the practice of his profession during a
period of about twenty-eight years, his death occurring--so far as may
now be learned--in 1606.

Carcano Leone’s reputation as a surgeon rests mainly on the treatise
which he wrote on the wounds of the head, and which was published at
Milan in 1583. From among the numerous cases of this character which
came under his observation, and of which a certain number are reported
by von Gurlt, I have selected the very brief histories of three that
seem to me well adapted to serve as examples of Leone’s knowledge of
surgery and also of his ability to cope with problems of so serious
a character. They reveal the fact that he was a surgeon of excellent
judgment, most persevering, and very resourceful. Briefly told, the
accounts of the three cases to which I have referred read as follows:--

   Case I.--A small boy was hit on the right temple by a stone
   that had been thrown by one of his companions. Unconsciousness
   resulted and lasted for six days. On the seventh day signs of
   returning consciousness manifested themselves, but inability to
   speak persisted. By the end of another week the boy had already
   made some efforts to speak, but his speech was incomprehensible.
   After the twentieth day it was possible to understand a little
   of what the boy was trying to say; and from this time onward
   steady improvement in this respect was recognizable from day
   to day; but the boy’s speech did not become quite normal until
   after the lapse of about a year.

   When Carcano Leone was called to see the patient he found that
   the entire temporal muscle had been crushed and that almost the
   entire right side of the head was occupied by a fluctuating
   swelling. By making a free incision in the swelling Leone gave
   exit to a large quantity of black coagulated blood. On the
   following day, when he made an examination with the probe, he
   found that the entire squamous portion of the temporal bone was
   in a fractured state, one part of it overriding the rest. By the
   aid of elevators he succeeded in lifting up the depressed part
   of the bone, but the accomplishment of this result left a large
   gap between the opposite edges of the fragments, and through
   this opening one could see the movements of the dura mater.
   Complete healing took place only after the lapse of twelve
   months.

   When Leone reported the case to his former teacher, Fallopius,
   the latter replied that he would not have had the courage to
   adopt the course which his former pupil had pursued.

   Case II.--In another case the patient, a full-grown man, was
   struck on the right temple by a highwayman with a heavy cane
   which broke in two in the middle under the great force which
   the assailant had employed. He was left lying on the roadside
   in a state of unconsciousness until some passers-by discovered
   him and carried him to his home. He remained unconscious for
   several days. Before the physician was summoned all sorts of
   measures had been resorted to for the purpose of dissipating the
   swelling in the temporal region, but without success. Leone, on
   arriving upon the scene, made a free incision which afforded
   escape to a large quantity of decomposing blood that appeared to
   be collected, not between the muscle and the skin, but between
   the muscle and the bone. The latter was found to be fractured
   transversely and depressed; and, in order to lift it back to
   its proper level, it became necessary first to incise the
   muscle transversely. At the end of three months the wound had
   completely healed and the patient had regained his health.

Speaking of the cases just narrated and of others of a similar nature,
Leone remarks that he has never had any experience that would justify
the fear expressed by Hippocrates that convulsions are likely to result
from dividing the temporal muscle.

With reference to the value of trephining the skull in cases of injury
to the head, Leone narrates the following experience:--

   Case III.--A man was struck by a heavy stone on the upper part
   of the forehead close to where the hair grows, and was thrown
   to the ground by the force of the blow. Here he lay as if dead.
   When Leone was called, a short time afterward, to see the
   patient he found the skin unbroken except at one small spot,
   and from this point he made an incision of such length that he
   was thereby enabled to explore the surface of the skull. In
   this way he discovered that there was a fracture which appeared
   to extend through the entire thickness of the skull. He then,
   without further delay, trephined the cranium over the line
   of the fracture. This was followed by such a copious flow of
   blood that Leone was obliged to adopt measures for arresting
   any further hemorrhage. During the following fourteen days (the
   summer season then being at its height) large quantities of
   decomposed and evil-smelling blood escaped from the wound; but
   the dura mater gradually assumed a more natural appearance, many
   splinters of bone were ejected, and finally--at the end of forty
   days--the wound healed. (As no further details are given in the
   text, it is fair to assume that there were no sequelae of an
   unfavorable nature.)

The whole subject of injuries to the skull is treated in a most
thorough manner by Leone, and the book is pronounced by Scarpa
(1752–1832), the famous anatomist, the best that, up to his time, had
been written on the subject. The three histories of cases which I have
here reproduced and which furnish such striking proof of what surgery
may accomplish when practiced by a man of good courage as well as of
good judgment, certainly justify the favorable opinion expressed by
Scarpa upon Leone’s work.

Fabricius ab Acquapendente, of whom I have already given some account
on a previous page, was distinguished not only as an anatomist and as a
physiologist, but also--which was true of his instructor, Fallopius--as
a surgeon. From his published writings, however, it appears very
clearly that, like Fallopius, he had a decided aversion to the use
of the knife; his activities as a surgeon being restricted largely
to the improvement of certain of the more bloodless operations (for
example, tracheotomy and thoracentesis and operations for the relief
of stricture of the urethra). He also invented several new surgical
instruments and devised a number of machines for use in orthopaedic
practice. He attached great value to the teachings of Celsus and Paulus
Aegineta, his writings containing frequent and copious references
to these authorities and relatively few data based upon his own
experience. In the section which he devotes to the subject of wounds of
the abdomen, Fabricius confirms the opinion very generally held by the
ancients, viz., that a wound of the small intestine is invariably fatal.

Gaspare Tagliacozzi was born at Bologna in 1546. He studied medicine
under Girolamo Cardano, Professor of Medicine, first at Pavia and
afterward at Bologna, and received his degree (“Doctor of Philosophy
and Medicine”) in 1570. Very soon afterward he began teaching surgery,
and a little later he also taught anatomy and the theoretical part of
medicine. In this work he was so successful that in 1576 he was made
a member of the Faculty. He died on November 7, 1599, at the age of
fifty-three.

The Italian method of performing plastic operations, says von Gurlt,
had already flourished for about one hundred and fifty years before
Tagliacozzi took up the subject in serious earnest and attained results
of decided scientific value. There are some doubts, however, as to the
precise degree of credit that should be awarded Tagliacozzi for his
share in the development of the operation which bears his name. The
facts which throw some light upon this question may be stated in the
following paragraphs:--

   (1.) Tagliacozzi’s Latin is not easy to understand, and he
   certainly does not furnish satisfactory information as to the
   manner in which he learned the details of the operation which we
   are here considering. Vesalius, Paré and other surgical authors
   of that period throw no light upon that question and furnish
   erroneous descriptions of the steps of the operation. Apparently
   they had never witnessed one of that character. (Von Gurlt.)

   (2.) The records seem to warrant the statement that, about
   the middle of the fifteenth century a surgeon by the name of
   Branca, who lived in the city of Catania on the southeast coast
   of Sicily, devoted himself largely to the reconstruction of
   damaged or defective noses. At first he transplanted a flap from
   the forehead or cheek; but afterward his son sought to improve
   the method by utilizing a flap of skin taken from the arm. By
   this plan the disfiguring of the patient’s face was avoided.
   The son employed the same method in repairing the lips and the
   ears. Pupils of the latter carried a knowledge of the method to
   the Bojano (Vianea or Vieneo) family in Tropea, Calabria, and
   from them it was transmitted, about the middle of the sixteenth
   century, to Tagliacozzi and eventually to the medical profession
   in every part of the world.

   (3.) In 1581 there was published at Cracow, Galicia (formerly
   Poland), a book which bore the title “Przymiot” and which gave
   a most complete account of the disease syphilis in all its
   manifestations and complications. This book, in its original
   form, is to-day one of the greatest bibliographical rarities;
   but a reprint of the work was published in 1881 by the Warsaw
   Surgical Society. In this volume Wojciech Oczko, the personal
   physician and secretary of the Polish kings Stephan Bathory and
   Sigismund the Third, discusses other surgical topics beside
   syphilis. He states, for example, that Aranzio (or Arantius),
   who was Professor of Surgery at Bologna at the time (1569) when
   he frequented that medical school, was successful in making a
   new nose by transplanting a flap of skin from the patient’s
   arm; and that he performed this operation without injuring the
   muscles of the arm, and also with perfect success as regards
   the creation of a straight and shapely nose. “This statement,”
   says von Gurlt, “coming as it does from an eye-witness who was
   at Bologna several years before Tagliacozzi’s time, furnishes
   satisfactory proof that rhinoplasty was successfully performed
   in that city several years before the date of publication
   (1586) of Tagliacozzi’s earliest comments on the subject,
   and that the credit for first bringing the operation to the
   knowledge of European surgeons is due to Aranzio rather than
   to Tagliacozzi.” The latter’s famous treatise on rhinoplasty
   (“_De chirurgia curtorum per insitionem_”) was published at
   Venice in 1597.

  [Illustration: FIG. 21. THE MANNER IN WHICH THE SO-CALLED
  TAGLIACOTIAN OPERATION FOR REPAIRING A DEFECTIVE NOSE SHOULD BE
  CARRIED OUT.

  (From the treatise published by Tagliacozzi, Venice, 1597.)]

   (4.) Fabricius of Hilden, the distinguished German surgeon
   of the sixteenth century, assures us that his teacher, Jean
   Griffon, at that time the leading surgeon of Lausanne (but, at
   an earlier period, of Geneva), performed the same operation in
   1592. The patient was a young Genevese woman whose nose had been
   cut off by some soldiers belonging to the army of the Duke of
   Savoy who were enraged at the resistance which she offered to
   their familiarities; and the operation proved most successful,
   “the new nose eliciting the admiration of all who saw it.”
   Fabricius adds that during the winter seasons, up to the year
   1613, the tip of this nose presented a somewhat purplish hue.
   The woman married in 1603.

   (5.) During the short lifetime of Tagliacozzi several tablets,
   on which laudatory inscriptions were engraved, were erected in
   the high school (_archiginasio_) of Bologna, and after his
   death a bust that represented him holding a nose in his hand was
   erected in the same building. Corradi, the medical historian
   (1833–1892), writes that in his time both bust and tablets had
   disappeared. Tagliacozzi’s remains were temporarily lodged in
   the cloisters of the church of San Giovanni Battista, and the
   report was circulated that, a few weeks after his death, a
   voice was heard saying that he was among the damned. Thereupon
   the remains were removed to the walls of the city, and the
   Tagliacotian method was soon forgotten, to be revived only after
   the lapse of many years.

All the data which I have reproduced in the preceding paragraphs
seem to point to the conclusion suggested by von Gurlt, viz., that
Tagliacozzi was willing to accept for himself a credit which belonged
in reality to another, and that there would be more justice in calling
the famous rhinoplastic method of procedure “the Arantian operation”
than the Tagliacotian; especially as our knowledge of the method
adopted by the younger Branca is entirely too vague to justify us in
bestowing this honor upon him.

Giulio Cesare Aranzio (or Arantius) was born at Bologna about the year
1530. He studied medicine first in his native city, under the guidance
of his uncle, Bartolommeo Maggi, and then afterward went to Padua,
where he may possibly have been one of Vesalius’ pupils. In 1548 he
made, at Padua, his first anatomical discovery--that of the _musculus
levator palpebrae superioris_. Before he was twenty-seven years
old he was chosen Professor of Medicine, Surgery and Anatomy in the
University of Bologna, and he filled the position with distinction up
to the time of his death on April 7, 1589--_i.e._, during a period
of thirty-three years.

The part taken by Aranzio in the advancement of surgery was apparently
of small importance. He succeeded, it is true (see remarks on page
479), in reviving the interest of contemporary surgeons in the
possibility of restoring damaged parts of the human face by means
of flaps taken from the patient’s arm. But I have not been able
to discover that he made any other material contributions to this
department of the science of medicine. It is possible, however, that
his plan of illuminating the interior of the nose and of operating upon
nasal polypi may possess some measure of originality; but I do not
feel competent to decide this question. As regards the procedure just
referred to, it may be stated briefly that Aranzio was in the habit,
when operating within the nasal cavity, of using by preference, for
illuminating purposes, the direct rays of the sun, which were allowed
to enter the room through a slit or hole in the wooden window blind;
and, when sunlight was not available, he used as a source of light
the rays emanating from a lighted wax candle. In the latter case he
increased the brilliancy of the illumination by interposing between the
flame of the candle and the illuminated field, a glass globe filled
with water,--an idea which probably originated with the goldsmiths or
the shoemakers. The employment of light reflected from a concave mirror
supplanted this method somewhere about the year 1866.

In Italy, during the sixteenth century, there were several
surgeons--uneducated empirics--who contributed not a little to our
knowledge of the radical cure of hernia; and of this number the
members of the Norsa family (from Norsa, a small town in the district
of Naples) were undoubtedly the best known and most experienced
operators. Horazio Norsa, for example, is reputed to have performed the
radical operation (in combination with castration) no less than two
hundred times. It was this same Horazio Norsa who, in the latter part
of his career, complained to Fabricius ab Acquapendente that, since the
wearing of trusses had become so common a custom as it then was, the
number of operations for the cure of hernia had greatly diminished.

                            CHAPTER XXXVIII

THE DEVELOPMENT OF SURGERY IN SPAIN AND PORTUGAL DURING THE RENAISSANCE

According to the authority of Morejon, who published (1842–1852) an
elaborate history of medicine in Spain and Portugal, these countries
almost rivaled Italy, during the sixteenth century, in the number and
excellence of their physicians. But, so far as I am able to judge
from the record, very few of these men appear to have taken a strong
interest in surgery, and of these few there are only three--Daza
Chacon, Francisco Arceo and Amatus Lusitanus--who left behind them
treatises which seem to call for a brief notice.

Dionisio Daza Chacon, who was born in 1503 at Valladolid, about one
hundred miles north of Madrid, received his early training partly in
his native city and partly at the University of Salamanca. After being
engaged for some time in private practice he joined the imperial army
(Charles the Fifth) in the capacity of a field surgeon in charge of a
corps of three thousand men. In addition to these troops there were
six thousand English archers, in the pay of the Emperor. At the two
sieges in which these men participated--the siege of Landrecy in 1543
and that of Saint Dizier in 1544--Daza Chacon acquired an extensive
experience in the treatment of both arrow and gunshot wounds, for the
number of those injured on those occasions was very great. In 1545,
after he had been chosen personal physician of Charles the Fifth, he
returned home by way of Madrid, and distinguished himself greatly in
1547 by his self-sacrificing attendance upon the victims of the Plague
in his native city. In 1557 he offered himself as a candidate for the
position of Surgeon-in-Chief of the hospital at Valladolid, and, after
passing with great credit the competitive examination, he was given the
appointment. During the following six years he served that institution
with conspicuous ability, and then accepted the position of private
physician to Prince Don Carlos, the son of Philip the Second, King of
Spain. Four years later he entered the service of Don Juan of Austria
(the natural brother of Philip the Second), and accompanied this prince
on his sea voyages to various parts of the Mediterranean; being with
him, for example, on the occasion of the bloody sea fight in the Gulf
of Lepanto in 1571. On reaching the age of seventy, Daza Chacon retired
from active practice and devoted himself to the writing of his great
work on surgery--“_Practica y teorica de cirujia, en Romance y en
Latin_,” Valladolid, 1600; and several later editions. The date
of Chacon’s death is not known, but it certainly occurred before the
publication of his book.

Von Gurlt says that Chacon’s treatise is distinguished by the
systematic and clear manner in which the author treats the subjects
with which he deals, and it shows him to be well versed in the
teachings of other writers on surgery, that he is ready at all times
to give them full credit for any contributions which they may have
made to this branch of medicine, and that he is remarkably free from
the superstitiousness which was so prevalent in his day. Of all the
treatises on surgery which have been written by Spaniards, either
during the sixteenth century or at a more recent date, this work, says
von Gurlt, is unquestionably the best.

The edition of the treatise published at Madrid in 1626 contains 922
pages--a large work. Among the reports of cases published in Part II.,
there are several which possess features of considerable interest, but
I shall be able to reproduce only one of them here:--

   The young prince, Don Carlos, aged seventeen, while residing
   temporarily at Alcalá de Henares, plunged head foremost, in
   the dark, down a steep staircase and struck his head against a
   closed door. When the lad was picked up it was found that, at
   the back of his head, there was an open wound about the size of
   a man’s thumbnail, that the surrounding scalp showed evidences
   of being bruised, and that the pericranium in this region
   had been laid bare. During the first three days following the
   accident the patient manifested only a moderate degree of fever,
   but on the fourth day the fever became more pronounced. The
   wound, which by this time was discharging actively, presented at
   first a healthy appearance, but it soon acquired an unhealthy
   aspect, and the patient began to complain of numbness in the
   right leg. Vesalius, the private physician of Charles the Fifth,
   the boy’s grandfather, was one of the many physicians who were
   called in to consult about the treatment of this case; he was
   sent for on the eleventh day following the accident. On the
   seventeenth day the wound was enlarged and the bone carefully
   examined, but no evidence of a fracture or a fissure was
   discovered. On the following day erysipelas manifested itself on
   the head and neck and extended downward until it had involved
   both arms. At the same time the fever increased very markedly,
   and for five days the patient was delirious. As by this time
   there was ample reason for suspecting that some intracranial
   injury had occurred, it was decided to trephine the skull. The
   operation was performed on the twenty-first day, but nothing of
   importance was discovered. The patient’s life was now evidently
   in great peril, and an unfavorable prognosis was pronounced.
   Four days later, however, complete consciousness returned.
   On the twenty-ninth day a quantity of pus was evacuated from
   the very much swollen eyelids; and, three days later still,
   the patient was found to be quite free from fever. On the
   forty-sixth day he left his bed for the first time, and at the
   end of ninety-three days the wound was found to have firmly
   cicatrized.

   [Some interesting details concerning the subsequent life of Don
   Carlos will be found in Motley’s “Rise of the Dutch Republic.”
   They suggest the possibility that his attacks of violent temper
   may have resulted from the lesions produced by the accident
   narrated above.]

Francisco Arceo was born, about the year 1493, at Fregenal in the
Province of Badajoz, Spain. It is not known at what university or other
educational institution he received his early training in the science
of medicine. It is a well-established fact, however, that at quite an
early stage of his professional career he acquired great celebrity for
his skill in treating both surgical and internal maladies, and that,
as a consequence, patients flocked in large numbers from all parts of
Spain to consult him. Rather late in life he wrote two treatises--one
on the treatment of wounds, as well as on ulcers and syphilis, and
another on the management of fevers. These two works were published at
Antwerp, in the year 1574, as a single volume, the author being at that
time, despite his advanced age (eighty), still in vigorous health and
able to practice with skill both branches of the science of medicine.
In 1658 a second edition of Arceo’s two treatises was published
at Amsterdam; and even at an earlier date there were published an
English translation (1588) and a German version (1614). A perusal of
the chapter which he devotes to the treatment of clubfoot gives the
impression that Arceo was an excellent surgeon--eminently practical
in his choice of means for securing certain results, and thoroughly
familiar with the extent to which he might depend upon the powers of
Nature to aid his efforts. The date of his death is not known.

Amatus Lusitanus is the name by which the Portuguese medical writer,
Juan Rodriguez de Castel Bianco, is commonly known. He was born in the
Province of Beira, Portugal, in 1511, of Jewish parents, and studied
medicine at the University of Salamanca. After doing duty as a surgeon
in two of the hospitals of that city, he took up his residence, for
short periods of time, first in Antwerp and then in Ragusa, Dalmatia,
on the eastern coast of the Adriatic. At this period of our history
the Inquisition was extremely active throughout the domains that were
under the rule of Charles the Fifth, and as a result Amatus soon
found himself obliged to abandon all his books, instruments, etc.,
and flee for his life to Northern Greece. As the Turks, who were in
possession of that country, were perfectly indifferent with regard to
the religious beliefs of the Jews, Amatus was allowed to settle down
quietly for the rest of his life at Thessalonica, in Macedonia.

During the later years of his career he published several books on
topics relating to the science of medicine--two of them on materia
medica and two on the cases of special interest which had come under
his personal observation during the course of his practice. The
latter work, which is entitled “_Curationum medicinalium centuriae
VII._,”[87] was printed in its entirety in Venice, in 1556 (2
vols.). Von Gurlt speaks of Amatus as a cultivated scholar and an
excellent observer. Of the seven hundred cases reported in this work
only a very few are of interest to the surgeon. Von Gurlt calls
attention to the fact that, during the earlier years of his practice,
Amatus devoted a fair share of his attention to surgery, but that
subsequently he performed no operations whatever; it being his rule to
intrust this work entirely to a regular surgeon or to a specialist.

In my search among the dozen or more histories of cases selected by
von Gurlt from the seven “Centuries” (700) of the complete treatise
as suitably illustrating Amatus’ manner of reporting the cases which
he had seen in practice, the various methods of treatment which he
adopted in his efforts to relieve the diseases or injuries that came
under his observation, and the demeanor of the man in the presence of
the ever-changing problems presented to the physician, I have succeeded
in finding only four that seem to furnish in even a slight degree the
information which I have just outlined. Unsatisfactory as these four
reports are in certain respects,--especially in their failure to reveal
to us the more strictly surgical capabilities of Amatus,--they at least
show that he was an able and conscientious practitioner, and to this
extent they possess value.

   The first case reported in Century I. is that of a peasant girl,
   aged thirteen, who, while walking barefooted in a field was
   bitten by a viper. Amatus did not see the patient until three
   hours later, but already at this early stage he observed many
   blue and red patches, scattered over the leg and thigh of the
   side on which the bite had been inflicted. Near the base of
   the foot there were two quite black spots corresponding to the
   bites of the reptile; and from the fact that there were only two
   such spots Amatus inferred that the snake must have been a male
   viper, which has only two poison fangs and is therefore less
   dangerous than the female which has four. The symptoms which
   the girl experienced were faintness, trembling and dizziness.
   As regards the treatment adopted, the skin in the immediate
   neighborhood of the bites was scarified and suction by the means
   of cupping glasses was employed; afterward a plaster, which was
   composed in part of theriaca, was applied to this region. The
   patient made a complete recovery.

   In Century V., Amatus gives an account of a fatal case of ear
   disease. The patient, a sickly-looking boy of eight who had
   been affected for a long time with a discharge from one ear,
   presented a non-sensitive lump on the side of the head. “As he
   began to show signs of feverishness it was decided to incise the
   lump; and when the incision had been made, it was found that a
   large part of the skull in this region had been destroyed by
   caries, as a result of which there was left a cavity in the side
   of the head, and this cavity was filled with a foul-smelling
   pus, débris, and granulation tissue that apparently rested on
   the dura mater. Three days later the surgeon[88] succeeded in
   removing from the cavity only a small quantity of the sanious
   material. On the fourth day, after an attack of convulsions, the
   patient died.”

   In Century VII. there is given an account of a man of the
   wealthy class who had been exposed to an excessive degree of
   cold for so long a time that he was literally almost half
   frozen. “As he was being carried into the village he gave orders
   that an ox should be slaughtered and that he himself should be
   snugly stowed away inside the carcass of the animal as soon
   as its interior furnishings had been removed. Thus he escaped
   freezing to death.”

   In the same century Amatus speaks of having seen a rather
   interesting case of _Filaria Medinensis_ (called by the
   Arabs “_vena medena_”) in a negro boy, eighteen years old,
   who had come to Thessalonica from Memphis, Egypt. “The worm
   had caused the production of an ulcer close to the boy’s heel,
   and in this the creature’s head, which looked very much like a
   vein, was recognizable. After the Turks had correctly diagnosed
   the nature of the trouble an Arabian physician, who had managed
   to secure a purchase on the worm, began rolling it up on a
   small stick. Gradually, after the lapse of several days, he
   succeeded in uncoiling the animal in its entire length (three
   cubits), as shown by the construction of the end of the tail,
   and thus permanently freed the boy from his trouble. The ancient
   authors express doubts as to the true nature of the object found
   in these ulcers, but I, Amatus, having examined the slender
   white creature and having witnessed its curved outlines as it
   projected itself outside the opening, do vouch for the fact that
   it possesses all the characteristics of a true worm.”

                             CHAPTER XXXIX

 THE DEVELOPMENT OF SURGERY IN FRANCE DURING THE RENAISSANCE.--PIERRE
                                FRANCO

Von Gurlt speaks of Pierre Franco as “one of the most skilful surgeons
and at the same time one of the most original medical writers of the
sixteenth century.” He and his contemporary, Ambroise Paré, were
of French birth, and to France therefore belongs the conspicuous
distinction of having contributed to medical science during the
Renaissance two of its most illuminating and efficient laborers. These
men, who were the leading operative surgeons in France during the
first half of the sixteenth century, did not owe their education as
physicians to the official training provided by the Medical Faculty,
but partly to the men who were classed as barbers and surgeons, or
barber-surgeons (_Collège de St. Côme_), and still more to
their own efforts. They gathered practical knowledge wherever they
might--largely from their official connection with armies during the
progress of different wars. Further details with regard to their
personal characters and the principal events of their professional
careers will be furnished in the following brief sketches.

_Pierre Franco._--Pierre Franco was born in the village of
Turriers, in Provence (now the Department of Basses-Alpes), about
the year 1500. He received his instruction in surgery from itinerant
lithotomists, operators for cataract, hernia-healers and men of
that class; and it is quite likely that, in the early days of his
professional career in Provence, he was himself a practitioner of this
humble type. At a somewhat later date he left the southern part of
France and took up his residence in Switzerland, first at Berne and
then at Lausanne. He probably left Provence because, in the early
part of the sixteenth century, the Protestants of that region were
being subjected to every form of persecution; and it is almost certain
that Franco belonged then to the Reformed Church, for he accepted the
salaried office of City Surgeon at Berne, the authorities of which city
were bitterly opposed to everybody and everything connected with the
Roman Catholic Church. Franco held the office named during a period
of ten years, the first part of the time at Berne, and afterward at
Lausanne, which latter city was then under the control of the Bernese
Government. He was a very close observer, a most enthusiastic student
of his art, and a man of intensely religious nature. Malgaigne, the
distinguished editor of the modern edition of Paré’s writings, speaks
thus of Franco: “I have no intention of writing here the history of
this man who was endowed with such a fine surgical genius; I may say,
however, that his was a life devoted entirely to the advancement of
surgery as a science.”

As an operative surgeon, says Edouard Nicaise, Franco ranked higher
than any of his contemporaries. Strange as it may appear, Ambroise Paré
frequently refused to take charge of cases in which an operation for
stone in the bladder, for hernia, or for cataract was required, whereas
Franco owed much of his reputation to the success which he had in
operating upon these three classes of cases. The latter, furthermore,
did most of his work on patients who belonged to the middle class, and
consequently his operations were characterized by very little of the
éclat which marked a large part of the work done by Paré, who from the
very beginning was befriended by Royalty and the Court circle. At the
same time, says Nicaise, Franco did more than any other man of that
period to enrich surgery with new discoveries.

Franco has written only two treatises. The first one, which was
published in Lyons, France, in 1556, bears the title: “A Small
Treatise on the Operative Treatment of Hernia”--one of the most
important departments of surgery (a book of 144 pages, 8vo). The second
work, which was issued in 1561, also at Lyons but by a different
publisher, bears the title: “_Traité des hernies contenant une
ample déclaration de toutes leurs espèces, etc._” (a book of 554
pages, 8vo). This work goes very thoroughly into the subject of hernia
in all its bearings, and also deals with several other important
surgical topics, such as genito-urinary diseases (in both the male
and the female), affections of the eyes, hare-lip, tumors, wounds in
general, dislocations, fractures, amputations, etc.; in short, it is
a fairly complete and decidedly original treatise on general surgery.
When Franco wrote the smaller work (that of 1556), he was settled at
Lausanne; but in 1561 he was living in Orange, which at that time was
the capital of a Principality that belonged to the House of Nassau.[89]
A few brief citations from the larger of the two treatises will suffice
to give our readers some idea of the manner in which Franco deals with
the subject-matter of the book.

Franco, says von Gurlt, was one of the first surgeons--perhaps the
very first--to perform the operation required for the relief of
strangulated hernia and at the same time to furnish a description of
the manner in which it should be performed. After mentioning the fact
that the strangulation of a portion of the intestine is attended with
considerable danger to the patient’s life, Franco proceeds to consider
the subject in greater detail:--

   Owing to the large amount of the fecal matter and gas contained
   within the portion of the intestine that is imprisoned in
   the scrotum, and also owing to the inflamed condition of
   the parts, it is frequently not possible to push the bowel
   back through the narrow aperture in the peritoneum; and this
   condition of things is apt to be aggravated by the constipation
   or by the efforts at vomiting that frequently accompany such
   strangulation. The vomiting, it is true, may in certain cases
   facilitate the desired reduction, but in others it does harm,
   especially by forcing more fecal matter into the scrotum. If
   the conditions described are permitted to continue unrelieved,
   death may certainly be expected to result. In a few cases the
   timely administration of medicine internally may overcome the
   difficulty, but, if this measure fail to produce the desired
   result, recourse must be had to surgery--not, however, if
   already the scrotum and neighboring genital parts have changed
   their color to a black, livid, bluish or some other unnatural
   hue, or if the hernial tumor manifest a round rather than an
   elongated shape, for all these signs are harbingers of death;
   and, as further unfavorable signs, should be reckoned a livid
   or black mucous membrane of the patient’s mouth, contracted
   nostrils, and an appreciably sunken condition of the eyes. But
   if, on the other hand, the scrotum possess a natural color and
   if it have not a spherical form but rather an oval shape, then
   it is proper, after a failure to secure the desired reduction by
   the internal use of medicine, to resort to a surgical operation.

   For the proper performance of this operation the surgeon
   should be provided with a nicely rounded metal staff, flat on
   one side, and a little larger than a goose’s quill. [Paré’s
   grooved sound or director, says von Gurlt, had not yet at that
   time been invented, and this staff was intended to serve, in
   a crude fashion, the same purpose.] The first step is to make
   an incision in the upper part of the scrotum, the direction in
   which it is to be carried being toward the symphysis pubis. When
   the hernial sac is reached the staff is introduced into the slit
   and pushed upward between the wall of the sac and the fleshy
   part of the penis, the flat side of the instrument being kept
   uppermost, as it is upon this surface that the cutting with the
   scalpel or the razor is to be done. After the end of the staff
   has been pushed well upward the flesh of the scrotum is to be
   divided upon the flat surface of this instrument; all danger
   of injuring the intestine being thus avoided. Then the attempt
   should cautiously be made to reduce or replace the intestinal
   folds. But if these efforts fail,--owing to the excessive
   distension of the bowel or because the constricting band has
   not yet been sufficiently relaxed,--then the following steps
   should be taken:--Grasp the spermatic cord (“_didymis_”),
   lift up its enveloping membranes one by one with hooks, and
   divide each one of them completely upon one’s finger nail, up
   to the point where the intestine is encountered. Then, having
   established, between the intestinal wall and the membranous
   coverings of the cord, an aperture large enough to admit the end
   of the metal staff, push the instrument onward and upward while
   at the same time it is held as it were balanced in the air, so
   that early warning may be communicated to the holding fingers in
   case the instrument, as it travels onward, should become caught
   in the folds of the intestine--an accident, however, which the
   slippery nature of the outer surface of the intestine renders
   improbable, but which nevertheless may occur if at any point
   there happen to be a break in the continuity of the tissues. As
   the next step in the operation the cord should be completely
   divided high up (the incision being made upon the staff) close
   to the opening in the peritoneum through which the folds of the
   intestine forced their way, in the first instance, into the
   scrotum; but the surgeon must, without fear of doing harm, and
   remembering that he is dealing with conditions of a desperate
   nature, see to it that the opening made in the peritoneum is
   amply large. Finally, with the aid of a soft piece of linen
   he should return the folds of the intestine to the peritoneal
   cavity, etc. [The remaining portions of the description are of
   minor importance and may well be omitted here.]

Franco, speaking of those cases in which a portion of the omentum is
found projecting into the hernial sac, lays great stress upon the
importance of “not doing what many a surgeon has done in the past
and what not a few are still doing in our time, viz., simply cutting
off the imprisoned distal portion of this membrane and returning
the remainder to the peritoneal cavity without first ligating the
divided blood-vessels and then cauterizing the cut surface; the
danger being that a failure to take these steps frequently leads to
a fatal hemorrhage into the peritoneal cavity--an occurrence which
actually happened to one of our most experienced surgeons in a case of
enterepiplocele.”

There were certain operative procedures in which Franco took a greater
interest than in others. Thus, for example, he was particularly fond of
operating for the relief of cataract, and the results which he obtained
were exceptionally favorable (180 cures out of a total of 200 cases
subjected to operation). Von Gurlt quotes him as saying:--

   If I had to choose between operations for the cure of cataract
   and abandoning all the rest of my surgical practice, I should
   prefer to adopt the latter course, so highly do I estimate the
   amount of good which I can do in this line of work, so very
   important does it appear to me, and so small is the amount of
   labor and worry which it entails.

Franco was also greatly interested in the cure of stone in the bladder,
and it was while treating cases of this character that he invented the
very important surgical procedure known in France as the “Franconian
operation for stone in the bladder” (hypogastric cystotomy, suprapubic
lithotomy). Here is the account which he gives of the circumstances
under which he was led to devise this method of removing a stone from
the bladder:--

   I will mention here an experience which I had on one occasion
   when I tried to remove a calculus from the bladder of a boy
   about ten years of age. The stone was about as large as a
   hen’s egg and resisted all my efforts to extract it by way of
   the incision made in the perinaeum. Being in a quandary as to
   how I should proceed next, and the parents and friends being
   greatly demoralized by the suffering to which I was unavoidably
   subjecting their child,--they maintained, I should add, that
   they would rather have him die than be subjected to such awful
   suffering;--and being influenced also by the thought that I
   could not afford to have it charged against me that I was not
   able to extract the calculus, I deliberately decided that I
   would make an opening above the pubic bone, and would remove
   the stone in this manner. Accordingly I incised the skin above
   the pubes, a little to one side of the base of the penis, and
   carried the knife through the soft tissues down to the calculus,
   which I had simultaneously pushed upward by pressing the fingers
   of my left hand against the perinaeum, while at the same time
   my assistant made counter-pressure against the stone by firmly
   compressing the abdominal wall above the object. This method of
   extraction proved successful.

   In due time the wounds healed firmly and the patient was
   relieved of his trouble, but only after a long and most serious
   illness.

Franco does not appear to have performed the suprapubic operation
for the extraction of a cystic calculus more than once (the case
just narrated), and he carefully refrains from recommending it to
other physicians. Most surgical authors, says Edouard Nicaise, blame
Franco very strongly for not having dared to recommend his suprapubic
operation. “But I do not agree with this judgment; Franco should rather
be praised for his prudence in not immediately announcing to the world
his invention of an important surgical operation.”[90]

The subsequent history of suprapubic lithotomy shows that Franco was
laboring under an exaggerated idea of the dangers attending this
operation. The comments of Pascal Baseilhac--a nephew of “Brother
Cosmas” (the famous French lithotomist of the early part of the
eighteenth century) and himself a skilled lithotomist--are worthy
of being repeated here. He says (p. 318 of his “_Traité sur la
lithotomie_,” Paris, 1804): “Franco based his unwillingness to
recommend the operation of suprapubic lithotomy on the belief which
was then widely prevalent, and which still persists even in our time
(middle of the eighteenth century), that the making of an incision into
the main body of the urinary bladder is sure to prove fatal, a belief
which experience and observation have now shown to be unwarranted.”

The Franconian operation, the great value of which was not sufficiently
appreciated by its inventor nor by contemporary surgeons, was revived
in 1719 by an Englishman, John Douglas, the distinguished surgeon of
Westminster Hospital, London, and the brother of James Douglas--the
anatomist who in 1730 described so minutely the relations of the
peritonaeum to the bladder (Douglas’ cul-de-sac).

In the case the history of which has just been narrated, the
circumstances attending the invention of the operation known to-day as
suprapubic cystotomy[91] or “suprapubic lithotomy,” were certainly of
such an unfavorable character as to call for the display of an unusual
degree of courage, wisdom, patience and manual skill on the part of
the surgeon in charge; and it was through a careful consideration of
these facts that Edouard Nicaise was led to award such high praise to
Franco for the work which he had done. Scarcely less remarkable is
the talent which the latter displayed in the invention of a forceps
(Fig. 22) strong enough to crush all but the hardest calculi and
yet so cleverly planned that it is practicable, while the crushing
end of the instrument is lying inside the bladder, to separate the
blades sufficiently far apart to render possible the grasping of the
stone between the jaws of the instrument without at the same moment
injuriously crushing the soft parts in the narrow channel of the wound
or opening.[92]

  [Illustration: FIG. 22. PIERRE FRANCO’S FORCEPS FOR CRUSHING CALCULI
  IN THE URINARY BLADDER.

  (From Edouard Nicaise’s _Pierre Franco_, Paris, 1895.)

  _a_, closed; _b_, open.]

In Franco’s day the belief was widely prevalent that there were
remedies which possessed the power of dissolving a cystic calculus.
His own opinion in regard to this matter is expressed in the following
words: “I am astonished that there should be many men who do not
hesitate to undertake the disintegration and pulverization of a stone
in the bladder by the employment of remedies which are either to be
administered by the mouth or to be injected _per urethram_ into
that organ.” He adds that a remedy strong enough to dissolve even the
softer stones would become so changed and weakened in passing through
the various organs which it must traverse on its journey from the
mouth to the bladder that it could not possibly produce the desired
effect; nor could a chemical solution strong enough to dissolve such
a calculus be injected into the bladder by way of the urethra without
either causing inflammation and ulceration of the walls of that organ
or promptly exciting muscular contraction that would effectively expel
the solution.

This seems to be an appropriate place in which to state that lithotrity
was practiced at an earlier date by Antonio Beniveni (1440–1502), a
Florentine physician whose writings reveal him to have been a man of
a very practical and unprejudiced type of mind, a very clear writer,
and a practitioner of wide experience. He also deserves credit for
having been the first surgeon to revive the operation of tracheotomy, a
procedure which was carried out by Antyllus fourteen centuries earlier,
but which appears to have been forgotten during this long interval. He
saved a patient’s life by means of the operation.

The date of Franco’s death is not known.

                              CHAPTER XL

   THE DEVELOPMENT OF SURGERY IN FRANCE (Continued).--AMBROISE PARÉ

Ambroise Paré was born, about the year 1517, at Laval, a small town in
the Department of Mayenne, France. His father was probably the valet
and barber of the Count of Laval. He went to Paris in early manhood
and spent three years, at this period, in fitting himself for the
career of a surgeon. He attended lectures on anatomy and surgery, did a
certain amount of dissecting, served for over two years as a surgeon’s
assistant in the great hospital of Hôtel-Dieu, made notes of some of
the cases which he saw, and was occasionally permitted to prescribe
for patients and even to perform some minor operations. From 1536
onward, nearly up to the time of his death, he was almost continuously
engaged, in the capacity of a surgeon, in accompanying different
French armies on their military expeditions. His professional title
at first was that of “barber,” but he doubtless very soon discovered
that, if he wished to advance, it would be absolutely necessary for
him to secure a higher title. Accordingly, in 1541, he and his friend
Thierry de Héry presented themselves for, and passed successfully,
the required examination and were accepted as “master-barbers.” It is
an interesting fact that, during his long professional career, Paré
was Chief Surgeon to four Kings of France in succession--first to
Henry the Second (1547–1559), next to Francis the Second (1559–1560),
then to Charles the Ninth (1560–1574), and finally to Henry the Third
(1574–1589). The last-named King bestowed upon him the additional
honor of “Councilor to his Majesty.” He also served, during a certain
period of his career, as an attending surgeon at Hôtel-Dieu. The three
large volumes of Paré’s writings (Malgaigne’s edition) are filled with
the rich experience which this great surgeon gained in the course
of a large private practice and in the field expeditions and sieges
conducted during the reigns of these Kings. Interspersed among the
reports of cases and descriptions of operations are to be found not a
few comments of a more general character and some biographic details
which add greatly to the charm of the work as a whole, and which at
the same time make it possible to form a general idea of Paré’s traits
of character. On almost every page one finds statements which reveal
the fact that he weighed almost all the duties of his daily life in a
profoundly religious manner. He showed himself warmly sympathetic for
all those whose ailments he was called upon to treat, and he was always
as ready to bestow his best services upon the Roman Catholics as upon
the Huguenots--to which latter denomination (if we may so call it) he
himself is commonly reported to have belonged. It seems to me more
probable, however, that he was a liberal-minded Roman Catholic rather
than a Protestant, for there is trustworthy evidence showing that all
his ten children were baptized in that faith and that he himself,
nineteen years before the night of Saint Bartholomew (August 24, 1572),
held the office of “_Pathe_” in the church of the parish in which
he lived. Another prominent trait of Paré’s character was the modest
estimate which he placed upon his own professional achievements. One of
his sayings, which occurs a number of times in his writings and which
has since become famous, is this:--

    _Je le pansay, et Dieu le guarist._
    [I dressed his wound and God caused it to heal.]

Some of the other sayings attributed to his pen and printed under
the heading “Surgical Canons and Rules,” at the end of Book XXVI.,
are characterized by a homely type of wisdom which seems to have
secured for them a permanent place in French literature. I give here
in the form of English translations six or seven of the more striking
specimens:--

   Mere knowledge without experience does not give the surgeon much
   self-confidence.

   Small will be the influence exerted by him who chooses surgery
   as a career simply for what he may make out of it.

   The frequent changing of physicians is not likely to bring
   comfort to the patient.

   The facts already discovered are few in comparison with those
   which are yet to be brought to light. We must not allow
   ourselves to lie down or fall asleep under the impression
   that the ancients knew all or have divulged all that is worth
   knowing. What they have accomplished should be utilized by us as
   a sort of scaffolding from which a more extensive view may be
   obtained.

In another place Paré expresses the same sentiment in a somewhat
different form, as follows:--

   My professional brethren must not expect to find any new and
   startling facts [Paré is speaking here of his treatise on
   surgery], but simply here and there some little addition to
   our previous stock of knowledge; for the good Guy de Chauliac
   has taught us that we are like the child who sits astride the
   giant’s neck; that is, we can see all that he sees and just a
   little more--or, in other words, we are able, through the aid
   afforded by the writings of our predecessors, to learn all that
   they have learned, and may at the same time acquire a little
   further knowledge through our own observations.

   A remedy that has been thoroughly tested is better than one
   recently invented.

   An injury which opens a large blood-vessel is likely to lead the
   victim of such a wound to the tomb.

   It is always wise to hold out hope to the patient, even if the
   symptoms point strongly to a fatal issue.

All through his professional career, but more especially during the
later years, Paré was repeatedly annoyed by the efforts which the
Medical Faculty made to bring him into disrepute. These men were
bitterly jealous of him on account of the great favor which he enjoyed
at Court, and so they adopted every possible means to injure his
reputation. When the complete collection of his writings was published
in 1575, they petitioned the authorities not to allow these “works of
a very impudent and ignorant man” to be sold until they should have
received the official sanction of the Faculty. One of Paré’s chief
offenses, as it appears, was that of not writing his treatises in
Latin, and among the twenty-nine specifications of his shortcomings was
that of plagiarism. (See remarks on this subject further on.)

In his efforts to extend his knowledge of the science of medicine, and
in particular to learn what the ancients had written on the subject,
Paré soon discovered that many obstacles stood in his way. He did not
allow himself, however, to be discouraged by this fact, but set to
work, without delay and in his usual resolute fashion, to remove them.
He found, in the first place, that all the available treatises of the
ancient medical authors were written in Latin, a language of which he
possessed scarcely any knowledge. So he was obliged to hire men to
translate for his own use large portions of these books. Then, at a
later date, after he had begun to accumulate notes for the treatises
in which he proposed to publish his own experiences and his own views
about the surgical topics in which he was interested, he saw clearly
that suitable pictorial illustrations would add materially to the
value of the written text, and he therefore did not hesitate to spend
a considerable sum of money--Malgaigne says three thousand livres--in
having the needed drawings made. Paré was also in no small degree
a public benefactor, for he purchased the formulae of some of the
more valuable of the remedies employed by the leading charlatans, in
order that he might print them and so place them within the reach of
everybody.

Paré gives the following picturesque account of his first experiences
as an army surgeon in actual warfare:--

   In 1536, he says, I accompanied the large army sent to Turin by
   Francis the First, King of France, to retake certain castles and
   fortifications which were held at that time by the troops of
   the Emperor Charles the Fifth. My official position was that of
   surgeon to the foot soldiers; and when our men took possession
   of Susa, after the enemy had been defeated, I was among the
   first to enter the city. Our horses rode rough-shod over the
   dead bodies lying on the roadway, and over the bodies of many
   who were simply wounded. It excited my compassion strongly
   to hear the cries of those who were thus subjected to great
   additional suffering, and I could not help wishing that I had
   never left Paris. Once actually in the city, I began to look
   around for a stable in which the horses of myself and my orderly
   might find shelter. The one I entered contained the corpses of
   four soldiers who had presumably died there, and three badly
   wounded men who were still alive, but whose faces were greatly
   disfigured by the wounds which they had received, and who--as we
   soon learned--were unable to see, hear or speak. An old soldier
   who entered the stable at that moment, and whose pity was
   excited by what he saw, asked me if it would be possible to save
   the lives of the men who were so badly injured. I replied “No.”
   He thereupon proceeded, without the least excitement and with
   due gentleness, to cut the throats of all three. At the sight of
   this act, of what seemed to me to be great cruelty, I exclaimed,
   “You are a wicked man!” His reply was: “I pray God that, if it
   should ever be my fate to be situated as these three men were
   when I entered the stable, there may be somebody at hand who
   will do to me what I have just done to these men, and will save
   me from a lingering and painful death.”

   When the fighting was entirely over, we surgeons had much work
   to do. I had not yet had any personal experience with the
   treatment of gunshot wounds, but I had read in Giovanni da
   Vigo’s work that such injuries should be considered poisoned
   wounds, by reason of their contact with gunpowder, and that the
   correct way of treating such wounds was to cauterize them with
   oil of sambucus (elder flowers) that was actually boiling and
   to which a little theriaca had been added. At first I hesitated
   somewhat about carrying out this practice, but after watching
   the other surgeons, in order to learn exactly how they applied
   the boiling oil, I plucked up my courage and did exactly what
   they did. My supply of oil, however, soon gave out, and I then
   decided to use as a substitute a healing preparation composed of
   yolk of egg, oil of roses, and turpentine. I slept badly that
   night, as I greatly feared that, when I came to examine the
   wounded on the following morning, I should find that those whose
   wounds I had failed to treat with boiling oil had died from
   poisoning. I arose at a very early hour, and was much surprised
   to discover that the wounds to which I had applied the egg and
   turpentine mixture were doing well; they were quite free from
   swelling and from all evidence of inflammatory action; and the
   patients themselves, who showed no signs of feverishness, said
   that they had experienced little or no pain and had slept quite
   well.

   On the other hand the men to whose wounds I had applied the
   boiling oil said that they had experienced during the night, and
   were still suffering from, much pain at the seat of the injury;