The Century of Columbus Part 28

It is this trusting to observation rather than books that is, of course, the key-note of clinical medicine and of medical progress. The men of this time are often blamed for not having trusted to their observation more and to their books too much. There is no doubt that some of them erred rather seriously in this matter. Yet at all times in the history of medicine the great majority of physicians have not observed for themselves, but have taken their observation at second hand from others. Hall has insisted over and over again that as regards surgery the necessity for observation was extremely important.

In the chapter on Surgery a quotation from his Expostulation on this matter will be found.

Even in the department of mental diseases there were distinct contributions to the problems of this intricate specialty of great value. This is not so surprising, for above all the men of the Renaissance could see things for themselves and describe what they saw. Shakespeare represents the Renaissance in England and no one has ever succeeded so well as he in describing forms of the milder mental diseases as they occur in characters like Ophelia or King Lear.

Paracelsus even attempted what has not been achieved yet, a definition of the insane person. "The person is sick in mind in whom the reasonable and unreasonable spirit are not present in proper {402} proportion and strength." He distinguished fools "who are animals without any sense" from the imbeciles and idiots "who are deranged beasts." His contemporary, Monta.n.u.s, who was professor at Padua, and has been called the second Galen, treated of melancholy in his medical consultations and ascribed its etiology to _intemperies cerebri._ He recommended treatment by water, by venesection and by h.e.l.lebore. Jean Fernel divided melancholy into what we now know as melancholy in the proper sense of the word and mania. He considered that both affections were due to disturbances of the fluids of the brain. Jodocus Lommius differentiated between delirium, phrenitis, melancholia and mania and described a particular variety of this last form as hydrophobia.

William Rondelet, Professor at Montpellier, frankly abandoned all metaphysics in this subject and considered that melancholia was due either to a defect of the brain or to some disturbance of the body which brought about a sympathetic derangement of the brain, the stomach particularly being likely to do this. He gave a rather striking picture of the fixed ideas that take possession of those suffering from melancholia. He differentiated mania from melancholia by saying that the melancholia was due to a frigid humor, while mania was due to the malignity of the thin and bilious humors of the body.

His contemporary, Francis Varreliora, described cases in which insanity had occurred as a consequence of love troubles and in which the cure of melancholy came about through the successful treatment of an affection such as haemorrhoids that had been disturbing the patient for a good while. It was a good many generations before medicine advanced very far beyond the ideas that were put forward by these physicians of the Renaissance in discussing their mental cases.

The extent to which balneotherapy was appreciated in this century may be realized very well from the fact that just after the close of it Winternach mentions some seventy-five places in Europe where there were bathing establishments. About the same time Dr. Ruland of Regensburg, published a monograph of twenty-eight pages containing an alphabetically arranged list of diseases with the indication of the particular watering place that would do them good. Indeed just after {403} the close of Columbus' Century there is abundant evidence of the very great revival of interest in the old hydrotherapeutic methods which had taken place during the Renaissance.

One of the most interesting things about the medicine of this century, that is often not appreciated, is that it did not go to that excess in the employment of certain means of treatment to which some of the succeeding centuries unfortunately did. Columbus' medical contemporaries corrected the Arabian abuse of polypharmacy, which had a tendency to manifest itself over and over again during the later Middle Ages in spite of the well directed efforts of thoughtful physicians to suppress it. The diffusion of a knowledge of the cla.s.sic authors in medicine did more than anything else to secure its eradication at this time. Physicians used bleeding, but not in every case, as came to be the custom later, and not to the excess in which it was employed at the end of the eighteenth and the beginning of the nineteenth century. Poor Mirabeau, the orator of the French Revolution, under the best French skilled care a century ago, was bled some eighty ounces in the course of forty-eight hours. Under the impetus given by Basil Valentine's "Triumphant Chariot of Antimony"

they used antimony frequently, but not at all to the extent that it was employed in the eighteenth century. Purgatives were much more abused in the later seventeenth and eighteenth centuries than during Columbus' Century. Under the immediate influence of the Greeks the physicians of this time were thoroughly conservative, and there is as little of regrettable therapeutics to be chronicled as at any time in the world's history.

Jerome Cardan of this time is one of the geniuses of the history of science whose career is extremely difficult to understand. His mixture of credulity with a genuine scientific temper of mind that tests everything by experiment, combined with his wonderful ability in mathematics, adds to the difficulty of understanding him. He was a great believer in dreams but then that was because he was sure that so many of his own dreams had come true. He was a serious student of all the borderland subjects between spirit and matter and const.i.tuted a Psychic Research Society in himself, but with the tendency to accept the marvellous on general principles. He {404} heard that instruments which had been magnetized could be used for surgical operations without producing pain and having tried some experiments in the matter he announced this as a great discovery. He was sure that he had the power to magnetize others in such a way as to prevent pain, but, after all, it must not be forgotten that in these he only imitated what has attracted much attention at many times in the history of medicine and electricity. As the publisher of the formula for cubic equations he has a distinguished place in mathematics, and he was looked upon as one of the great thinkers of his time. His contributions to medicine, and the estimation he secured for the profession by his popularity among the great ones of Europe at this time, have made his life most interesting to our generation.

Cardan's almost infantile absurdities have sometimes been cited as indicating a lack of the critical scientific spirit at this time.

Anyone who recalls, however, the att.i.tude of mind of some of the most prominent scientists of our time towards certain questions, as, for instance, vaccination, spiritism, and even phrenology and other psychic subjects, will not be likely to accept any criterion of lack of the critical faculty that might be set up arbitrarily, because a scientist exhibited a tendency to accept some things without as absolute proof as other men demand. Nearly all the great scientists had certain peculiarities in this regard and Cardan is only an exaggeration of this tendency. His absurdities have sometimes been quoted as if they represented common opinions of the learned men of this time and exhibited their lack of critical judgment, but no one has scored Cardan's absurd opinions more severely, nor called attention more emphatically to the fact that this great scientific genius accepted some childish trivialities, than his contemporary, Scaliger, who so often entered into controversies with him.

An instructive contrast to some of Cardan's absurdities is a little book that has been a cla.s.sic ever since in popular medicine, Louis Cornaro's "Means of Obtaining a Long and Healthy Life," which was published at this time (Padua, 1558). Editions of it have been issued in nearly every generation since. Cornaro, to give a sentence or two from Addison's essay {405} on the volume "was of an infirm const.i.tution till about forty, when by obstinately persisting in the Rules recommended in this Book, he recovered a perfect state of health, insomuch, that at four-score he published this Treatise. He lived to give a fourth edition of it, and after having pa.s.sed his hundredth year, died without pain or agony, like one who falls asleep.

This Book is highly extolled by many eminent authors, and is written with such a spirit of cheerfulness and good sense, as are the natural concomitants of temperance and virtue."

The little book insists very much on temperance in eating and drinking and is quite as sensible in its way as any popular book on medicine ever written. It is a living proof that in spite of the popular medical delusions of many kinds so frequent in this period, though not more frequent than they are in our own, men of sense could view the question of right living from the proper standpoint and give good advice with regard to it. In the preface to the latest American edition (New York, 1912) the publisher said: "The methods followed by Cornaro and the recommendations and suggestions submitted by him can be compared to advantage with the teachings of authorities of the present day, such as Metchnikoff. The book is now presented to the American public, not only as a literary and scientific curiosity, but as a manual of practical instruction." [Footnote 40]

[Footnote 40: The first American edition, annotated by Mason L.

Weems (Philadelphia, 1809), had with what might be thought characteristic American enterprise Benjamin Franklin's "Way to Wealth" as an Appendix.]

It is interesting to bring together some of the sanitary regulations of this period because it is often presumed that it is only in our time that public care of the health has come to be recognized as a duty of the civil authorities. Wickersheimer in his "Medicine and Physicians in France, at the Time of the Renaissance," [Footnote 41]

has gathered a number of the details. It was forbidden butchers in Paris to keep meat for sale more than two days in winter or thirty-six hours in summer. Hotel keepers were not allowed to kill their own meat because, as {406} they could cook it before selling it, it was easy for them to "dissimulate bad meats." Restaurateurs were forbidden to serve meat which had been warmed over or warmed-over soup or vegetables. Fish was guarded particularly by detailed regulations and heavy fines were inflicted for its sale, except under conditions that must have a.s.sured its absolute freshness. b.u.t.ter and fish could not be sold in the same shop. It was forbidden to put coloring matter in b.u.t.ter, no matter what the form of color material used, and also to mix old b.u.t.ter with new. The sellers of spices were required by Louis XII to watch over the absolute cleanness of their mustard mills and to employ as workmen only those who were clean and in good health.

Similar regulations existed for the bakers. In a word, they antic.i.p.ated in many ways the pure food laws of our time. Unfortunately these regulations were allowed to fall into abeyance during the neglect of social order that characterized the notable degeneration of the eighteenth and earlier nineteenth centuries.

[Footnote 41: _"La Medicine et Les Medecins en France a l'epoque de la Renaissance,"_ Paris: Thesis 1905.]

Some of the popular hygiene of the time is very interesting and distinctly foreshadows practices of our own time. Erasmus gave directions to students for cleanliness. The hands were to be washed after each meal; a practice rendered necessary by the absence of forks and the nails were to be cut and cleaned every week. Gums and teeth were to be rubbed with a rough towel every day according to Montaigne, and various tooth powders were commonly employed. The feet and the hair ought to be washed at least once a week. Among foods, sea-fish were preferred to river fish and the livelier the fish the better it was liked. Sh.e.l.lfish were recommended by some and deprecated by others. Lobsters were usually counted difficult of digestion, and oysters and other sh.e.l.lfish shared in this prejudice. Popular traditions as to food were quite like our own. Peas were very much praised as an article of diet, spinach was considered to be good for torpid liver, water cress was said to have a favorable action on the bowels and lettuce as well as most of the material for green salads was declared to be sedative in action. Cuc.u.mbers were indigestible unless cooked, melons must be ripe and soft and without any spots in them or they were dangerous, and cabbage and onions were {407} praised or blamed as articles of food according to the particular part of the country from which one came.

Even in the matter of drinks opinions were not so different from those which are held at the present time, though there was just as much disagreement as regards their effects as we are accustomed to. In Normandy, where apples were common and cider a familiar drink, cider was considered to be much better for men than wine. In the middle and South of France, however, wine was considered of the greatest value for health, and white wine was considered to be diuretic while red wine was recommended for diarrheic conditions. Wine was declared to be much more wholesome as a drink than water and there is no doubt at all that in this our colleagues of that time were eminently justified by their observations. Any water in the neighborhood of cities or considerable centres of population was almost sure to be contaminated by sewage of some description and to be distinctly dangerous. Wine was ever so much less likely to be followed by disease than water. There were many who recognized how much of evil was done by the abuse of wine however, and Renou declared that in that century wine had killed many more people than the sword. He declared that the abuse of wine led to degenerations of the brain and the liver, disturbances of the nerves, brought on tremors, convulsions, even paralysis, and was active in the production of dyspnoea and other serious conditions.

Dr. Cramer calls attention [Footnote 42] to the fact that in 1481 the republic of Lucca in Italy elected three citizens to serve as a board of health. They were given plenary powers to act in case of epidemics.

Their main purpose was to prevent the spread of infectious diseases.

For this purpose they kept in touch with other countries, so as to be forewarned of places where epidemics were raging, and they had the right to forbid entrance into Lucca of persons, animals or goods until after a sufficient delay to insure the absence of infection or thorough disinfection. The word quarantine of course is very old, though often the idea is supposed to be new, and there seems no doubt that in most of the Italian cities health boards and health regulations antic.i.p.ating many supposedly modern developments were in existence. There is even question of {408} the contagiousness of tuberculosis having been recognized at this time, and measures taken to prevent its spread. We know that scarcely more than a century after Columbus' period every princ.i.p.ality in Italy has laws declaring tuberculosis contagious and regulating it.

[Footnote 42: _Revue Medicale de la Suisse Romaine._ 1914, XXIX, No. I.]

Sir Thomas More in his "Utopia" has a very curiously interesting paragraph with regard to the status of physicians in his ideal Republic, which shows what his own idea of the place of medicine in the world is. His long friendship with Linacre might very well have been expected to give him such a high estimation of the physician. It is all the more interesting because he expresses depreciation of his own profession of the law in "Utopia." What is striking in this pa.s.sage is his recognition of the lofty place that medicine deserves to hold in the intellectual world as a department of philosophy and science. He emphasizes the fact that the less people need physicians the more they appreciate them, thus antic.i.p.ating the modern idea that prevention rather than cure is the great basis for prestige in medical science. His fine tribute to the honor that medicine should have in the estimation of men will make his words a fitting close to this chapter on medicine in Columbus' Century.

"One of my companions, Thricius Apinatus, happened to carry with him some of Hippocrates' works and Galen's 'Microtechne,' which they hold in great estimation, for though there is no nation in the world that need physic so little as they do, yet there is not any that honors it so much; they reckon the knowledge of it one of the most pleasantest and profitable parts of philosophy, by which as they search into the secrets of nature, so they not only find this study highly agreeable, but think that such inquiries are very acceptable to the Author of nature; and imagine, that as He, like the inventors of curious engines amongst mankind, has exposed this great machine of the universe to the view of the only creatures capable of contemplating it, so an exact and curious observer, who admires His workmanship, is much more acceptable to Him than one of the herd, who, like a beast incapable of reason, looks on this glorious scene with the eyes of a dull and unconcerned spectator."

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CHAPTER XIII

SURGERY

Ordinarily it is a.s.sumed that surgery has received almost its only and its greatest development in our time. Probably no development of knowledge that has come to us in the recent revival of interest in the history of medicine has been more surprising than the finding that surgery had several periods of great progress before our time. One of these and the most important came during the thirteenth and fourteenth centuries. Another great phase of surgical advance, after a period of decline such as seems inevitable in all human affairs, occurred during the Renaissance. It had its origin in or at least was greatly influenced by the publication of the chapters on surgery in the Latin and Greek cla.s.sics, though strange as that may sound to modern ears even more was probably accomplished for surgical development by the printing of the text-books of the later mediaeval surgeons. The new impetus thus given affected nearly every phase of surgery and accomplished ever so much more than we would be likely to think possible, only that the republication of old surgical text-books in recent years has proved such a revelation to us.

As I have said in preceding chapters, one of the greatest debts of the modern time to the Renaissance is due for the printing of old books in the early days of printing. Scholars were willing to give liberally of their time and to devote patient labor to secure a good text for the printers, and somehow or other great printers succeeded in bringing out usually in magnificent editions, though of small size as regards the number of copies, not only the ancient but what we have now come to recognize as the mediaeval cla.s.sics of medicine and surgery. The chapters on surgery in such writers as Aetius, Alexander of Tralles and the Arab writers like Abulca.s.sis are among the most important contributions to the medicine of {410} their time. The text-books on surgery of such men as Theodoric, Hugo of Lucca, the Four Masters, William of Salicet and Guy de Chauliac are landmarks in the history of a great surgical era. All of these were reprinted usually in magnificent editions during Columbus' Century. Without such reprinting at a cost of time and money that we can scarcely understand, many of these precious treasures of the history of medicine and surgery would almost surely have been lost. Certainly very few of them would have remained in the ma.n.u.script forms in which they then existed and at most, only in seriously mutilated conditions. There have been several centuries since when they would have been utterly neglected, for almost no hint of their value survived and there was an impression prevalent that no one knew anything either about medicine or surgery during the Middle Ages at all worthy of preservation. This publication of the old text-books gave an impetus to the surgeons of the time that brought about a great new era in surgery, though there were other important factors at work in producing this. Above all the development of anatomy made for a corresponding development in surgery and by increasing men's knowledge of the tissues through which operations had to be made, added to their confidence and decreased the mortality of surgical intervention. The magnificent hospitals of the time are of themselves the best possible evidence of proper care for patients, not alone in a medical, but also surgical way. It cannot be too often repeated that whenever hospitals are well built, properly cared for and suitably maintained, there is sure to be good medical practice and a fine development of surgery; whenever hospitals are neglected, medical and surgical practice both sink to a very low standard.

Hospital construction reached a very high plane during the Renaissance period, only to sink afterwards, as did every other constructive effort for humanitarian purposes, to what Jacobsohn, the German historian of hospitals and care for the ailing, calls an indescribable level of degradation. Literally, the worst hospitals in the world's history were erected at the end of the eighteenth and the beginning of the nineteenth century. Hospital organization and maintenance inevitably sank in the same way. A corresponding decadence in medical and surgical practice could {411} not help but occur,--fortunately to be followed by the progress of our own time. There are many, however, who seem to think that because the twentieth century is so far ahead of the early nineteenth it must be correspondingly in advance of preceding centuries. This a.s.sumption const.i.tutes the most important reason for the very common failure in our time to understand properly the history of medicine and surgery as well, indeed, as that of every phase of science.

This was the period when gunpowder began to be used extensively in the operations of war and it is not surprising that a great deal of attention was given to gunshot surgery. We have four books, treatises in their way on gunshot wounds, that were written at this time by men of large experience. They made mistakes of course, there is no period in the world's history, even our own, when men have not made mistakes, but the surgeons of Columbus' Century acc.u.mulated an immense number of observations and gradually worked out a rather valuable set of suggestions with regard to the treatment of various kinds of wounds.

At the beginning of the century they made the mistake of thinking that bullets caused both poisoned and burned wounds, and they were over-anxious to treat these imaginary consequences rather than the mechanical effects produced in their pa.s.sage. They gradually worked out their problems however, even using experiment in order to show the effects of wounds. Braunschweig, Felix Wurtz, De Vigo and Ferri are the cla.s.sics of the time on gunshot wounds and their books have probably been more read in our generation than in any other since the end of the sixteenth century. Nothing is indeed more surprising than the recognition of the value of the observations made by these old-time surgeons which has come in the last twenty years.

The greatest of the surgeons of Columbus' Century is the Frenchman, Ambroise Pare, who has come to be spoken of as the Father of Modern Surgery. He well deserves the t.i.tle if we restrict it definitely to the modern time and do not conclude, as so many do, that there had been no surgery since the cla.s.sical period, for, of course, there was a very great era of surgery during the thirteenth and fourteenth centuries, but as is the way with humanity a period of decadence occurred, {412} followed by another upward phase in the curve of history of which in his time Pare is the apex.

It is to him that we owe the treatment of gunshot wounds by simple water dressings, or at most by aromatics. When he began his work they were treating gunshot wounds as if they were poisoned and burned wounds by pouring boiling oil along the track of the bullet. Pare ran out of oil on an historical occasion but found that the wounded left untreated recovered with less pain and complications than those subjected to the heroic remedy. He recognized the mistake and had the genius to correct it properly. He reinvented the ligature, though, of course, it had been in use a number of times before and had gone out because of the tendency to produce sepsis involved in it, and because so often secondary hemorrhage occurred from the coming away of the ligature in the suppuration which ensued. He deserves, as do several others, the credit of real invention in its use. Pare himself speaks of this discovery, which he made just at the close of Columbus'

Century, as an inspiration which came to him through Divine Grace.

In nearly every department of surgery Pare left his mark. He was a thoroughly practical surgeon. He suggested, as did also Maggi, the Italian surgeon at this time, exarticulation as an important mode of amputation. This consisted of the removal of an injured limb or a gangrenous member at the joint just above, because in this way there was less danger of complications and a better stump could be obtained for subsequent use. In order to demonstrate that gunshots did not make a burned wound he demonstrated that when b.a.l.l.s are fired even into a bag of gunpowder it does not explode. Maggi [Footnote 43]

independently made this same observation but went further and showed also that shot do not melt when they strike a hard surface and that b.a.l.l.s of wax that are fired do not spread out {413} as if the wax were melted. This series of experiments made to demonstrate certain valuable points in gunshot surgery is quite worthy of the most modern time and indicates well the thoroughly scientific spirit that was abroad at this period. Pare also suggested that cut tendons should be sewed, the ends being carefully brought together and that no portion of the tongue should be removed after injury, but the parts should be brought together, for there was great power of healing in this organ.

He advised the cutting of the uvula with a ligature gradually made tighter and he, as well as Franco, devised an apparatus to fill up the cleft in the bone of a defective palate and other similar mechanical appliances.

[Footnote 43: Anyone who doubts the ability of the men of this time to discuss a practical scientific question from a thoroughly scientific standpoint with experimental demonstrations and close reasoning, should read Gurlt's account of Maggi's experiments with gunshot, and the German surgeon's comparison of the conclusions of this colleague of the early sixteenth century with the facts brought out by the discussion of the same subject after the Franco-German War of 1871 and the experiments which were made just afterwards along the same line.]

[Ill.u.s.tration: HOLBEIN, DR. WILLIAM b.u.t.tS ]

Indeed from the mechanical side of surgery Pare is the most interesting. Orthopedics, that is the treatment mechanical and surgical of deformed children, in order to bring about their cure or at least the lessening of their deformity, is generally supposed to be new, but there are many suggestions for it in the Renaissance period.

Helferich in his _"Geschichte der Chirurgie"_ in Puschmann's _"Handbuch"_ says, for instance, that Pare's orthopedic armamentarium was rather extensive. He used various apparatus and specially designed shoes with bandages in order to bring on the over-correction of club foot. He treated flat foot in various ways and particularly by the use of special shoes. He invented a corset with holes in it for ventilation to be worn for various torsions of the spine and other spinal deformities. He and Fallopius taught the value of resections for joint troubles of various kinds and even for deformities. Pare declared that _genu valgum,_ that is knock-knees, were due to similar causes as those which produced club foot, or at least that the affections were related.

A very interesting incident in his experience is related by Pare in his memoirs with regard to one of these surprising cases of deep injury to the brain which seem inevitably fatal, yet the patient survives. It is, as suggested by Dr. Mumford, a replica of the well-known Harvard crowbar case, the most famous in American surgery, in which a quarry man recovered from his injury in spite of the fact that a tamping iron had pa.s.sed completely through his head from beneath the chin upwards, coming out through the top of the skull.

{414} The specimens from the case, secured long afterwards at the time of the man's death, may still be seen in the Harvard Museum. Pare's case was very similar but concerns a very important individual.

Francis of Lorraine, Duke of Guise, was wounded before Boulogne, "with a thrust of a lance, which entered above the right eye, towards the nose, and pa.s.sed out on the other side between the ear and the back of the neck, with so great a violence that the head of the lance, with a piece of wood, was broken and remained fast; so that it could not be drawn out save with extreme force with smith's pincers. Yet, notwithstanding the violence of the blow, which was not without fracture of bones, nerves, veins and arteries, and other parts torn and broken, my lord, by the grace of G.o.d, was healed." Without the corroboration of the possibility of this by our modern case, it is probable that there would be serious doubts as to it.

The bone surgery of the Renaissance period is particularly interesting. Fallopius declared for the preservation of the periosteum of the bone just as far as was possible whenever there was bone disease or injury. We know now that the periosteum in healthy condition will bring about regeneration of bone, and it was evidently because of clinical observation of the satisfactory improvement that occurred in cases when the periosteum was interfered with just as little as possible that brought Fallopius to this conclusion. Their treatment of fractures was excellent and they secured good results. It was during this time that the older methods of using force in the reduction of dislocations yielded to the maxim that joints should be restored along the same path through which the dislocation took place.

A series of surgeons at this time, notably Ma.s.sa, Ingra.s.sias and Vigo, wrote about spinal disease, describing "penetrating corruption" of the spine, persistent suppuration and the subsequent deformity, using the term _"ventositas spinae,"_ and others that would indicate their interest in what we know as Pott's Disease. Vigo described fractures of the inner table of the skull when the outer table is unbroken, and Argelata described depression without fracture as occurring in young folks.

Considerable valuable advance was made in the treatment of fractures of the skull and injuries of the brain. Vigo {415} brought back the use of the crown trephine and did much to make the instrument popular.

A great many surgeons invented a variety of instruments for lifting up depressed bone, or for removing fragments, and each one was sure that his particular type of instrument was the best to use. It is interesting to read Helferich's "History of Surgery" in Puschmann's _"Handbuch"_ on these and other points, because they are arranged in the order in which the discoveries and rediscoveries and inventions and reinventions were made. The Renaissance is particularly full of interesting surgical history. The late effects of brain injury, dementia, deafness and various forms of paralyses were carefully studied by such men as Fallopius, Pare and Della Croce.

Various phases of surgery were taken up and discussed that are often supposed to be much more modern. The whole question of the transfusion of blood, for instance, attracted wide attention at this time. Magnus Pegelius of Rostock suggested that the artery of one patient should be fastened directly to the artery of another patient in order to bring about transfusion. The use of this method of treatment, after large losses of blood or in case of anaemia, is mentioned by a number of men. At least as much was hoped for from it as in our time from opotherapy. Jerome Cardan went farther than any in what he looked for from the transfusion of blood. He always saw the possibility of mystical results and his suggestion was that the transfusion of blood might bring about a change in the morals of individuals. It was even said that the use of animal's blood in the same way might bring about an endowment of the human individual with certain animal qualities of disposition. This is quite as absurd yet quite as reasonable as many of our surgical attempts at the reform of criminals by operation on their brains. In 1539 Benedictus noted the occurrence of hemophilia or bleeders' disease. This had been noticed before in the Middle Ages, but had been lost sight of.

With regard to varicose veins the Renaissance abandoned the older methods of operation and suggested the use of bandages. Savonarola, the grandfather of Savonarola the Dominican, who was burnt to death in Florence, described various forms of bandages and suggested rest in the p.r.o.ne position {416} with the feet higher than the head for the relief of discomfort. Savonarola was much interested in the correction of deformities and cla.s.sifies rather carefully the different forms of gibbosity of the spine, forward, backward and to the side, and suggests their treatment with bandages that may be put on when soft and pliable, but which harden after their application. Pare at the end of the century used a corset made of very thin perforated iron plates which he insisted should be well padded. This should be changed every three months and its shape often altered so as to suit the growth of the body and the changes brought about by itself.

Some of the developments of surgical technique at this time are extremely interesting because they ill.u.s.trate that accurate attention to detail and inventive ability in surgery that is usually supposed to be reserved for a much later time. Pare, for instance, invented a whole series of special apparatus for nearly every phase of corrective surgery, many of which have been mentioned. Fallopius insisted on bringing the muscles of the neck together and retaining them in position by sutures whenever they were severed, because results were nearly always excellent and function was restored. Every important surgeon of the time emphasized the sewing of severed tendons. Vidus Vidius invented a gold or silver tube to be used after tracheotomy in order to permit breathing through it, and suggested the use of this instrument also after injuries of the larynx. Monteux devised a magnet to aid in the extraction of swallowed iron objects that were caught in the throat.

All the specialties developed wonderfully at this time. The story of the Caesarean operation attests the evolution of obstetrics. In 1500 Jacob Nufer, a veterinarian, performed this operation successfully on his own wife, and a number of others followed the example until within twenty-five years after the close of our period, Rousset counts up his cases of the operation as 15. Gynaecology and obstetrics always develop together, and Weyer, the Dutch physician and surgeon, who did so much to rid the world of the witchcraft delusion and point out its connection with what we know as hysterical manifestations, wrote a text-book on gynaecology, and Caspar {417} Wolff laid the deep foundations of the science of gynaecology at this time. Wurtz, who comes after our period, but was deeply influenced by it, and who must indeed be considered as a follower of Paracelsus, insisted very much on the simple treatment of wounds and emphatically opposed the common custom of "thrusting clouts and rags, balsam, oil and salve into them." Such teaching would have much to do with making advances in gynaecology and obstetrics possible.

Cabrol advised the removal of the breast for cancer and insisted on its complete removal and also of a part of the pectoral muscle, if that seemed to the operator to be necessary, because of actual or apparent involvement. Cabrol also declared that wounds of the heart were not necessarily fatal and gives the details of one which he himself had treated and had afterwards seen at autopsy, death having taken place from another condition. He mentions the fact that stags'

hearts had been found in which there were definite indications of healed wounds so that the long-time tradition as to the fatality of heart wounds is not absolute. Della Croce taught that blood or pus or other fluid should be emptied out of the thorax by aspiration. He suggested the use of a cupping gla.s.s or a syringe, or in case of necessity even of the mouth for this purpose. He advised the placing of a metal tube in the thorax for drainage purposes. Arcula.n.u.s advised the opening of empyemata by a perforation of the thorax that would permit drainage. If one had opened spontaneously and become chronic, a lower opening for better drainage should be made.