The Century of Columbus Part 29

Nor were they less ingenious in their suggestions as to surgical intervention in conditions within the abdomen. Riola.n.u.s explained ileus as thoroughly as anyone has ever done it and recognized exactly what the condition was and the only way by which it could be treated.

Pare advised the letting out of gas from over-distended intestines when these could not easily be returned to the abdomen. Fioravanti reported a case of splenectomy with the recovery of the patient. All sorts of bougies for strictures were invented, and many suggestions as to instrumental relief in difficult strictures made.

Savonarola suggested the extirpation of _ranula,_ evidently {418} after having had the experience that the mere emptying of this cyst of the gland beneath the tongue is practically always followed by the refilling of it. He gave the technique of puncture for ascites and has some interesting details of cases, including one in which a fall led to the traumatic evacuation of the fluid with subsequent cure. He recommended the puncture of the pleural cavity for pleural effusion, and above all for empyema whenever the case was in serious condition.

A little bit later, Berengar of Carpi, who is usually considered much more important in anatomy than in surgery, discussed the question of fracture of the skull by _contrecoup,_ evidently after considerable experience. He detailed some cases of _extirpatio uteri_ for procidentia and developed the technique of inunctions of mercury for lues. Whether he was the first to do this or not we are not sure.

There is no doubt that his practice attracted wide attention. He was visited by patients from all over the world and was summoned on consultations even to great distances in order to see members of the n.o.bility. There probably never has been a more important discovery in therapeutics than the use of mercury for specific disease, and the men of this time to whom must be attributed the development of this phase of therapeutics deserve the highest praise. It required the most careful, patient, prolonged observation, and this was successfully given.

While gunshot wounds were becoming so frequent as to claim much attention, wounds from swords and other sharp instruments causing ugly disfigurements were rather common. Cosmetic surgery attracted attention. It might be thought that owing to their ignorance of aseptic surgery there would be no possibility of any great development of plastic surgery at this time. As a matter of fact, however, not a little was done that was of great significance for the correction of disfigurements due to injury and unsightly congenital defects or scars after disease. A number of procedures for the correction of harelip and of cleft palate have already been noted. Just at the beginning of Columbus' Century the technique of the Brancas, father and son, for the restoration of noses that had been lost by injury or disease attracted wide attention. Their method was to make the new nose from the skin of the arm, {419} lifting a flap from the inner portion of the upper arm, fastening it to the forehead and bandaging the hand firmly on top of the head so as to keep the flap in place, fed by the circulation of the arm until it had obtained a firm hold, when the attachment to the arm was cut and the nose fashioned from the living tissue thus obtained. Vianeo and Aranzi both described methods of forming the nose, and it was suggested that a portion of the skin of the forehead might be used for that purpose. Defects of the lips and eyelids were cured by slipping tissues over and by freshening the edges and bringing them together.

An extremely interesting surgical writer of the beginning of the sixteenth century is Michele Angelo Biondo, sometimes known by his Latin name of Blondus. There are some pa.s.sages in his writings with regard to the use of warm water as the only proper dressing for wounds that are rather startling. He tells of some physicians of his time who, in place of liniments and all the various applications that are made by the "wax-dealers," simply wash off their wounds with warm water. He adds that these physicians insist that a great many surgical patients are not killed by their disease so much as by the custom of allowing them only small amounts of food and the unfortunate effect produced on them by the applications to their wounds. He adds further that these men are not wont to treat patients suffering from fevers by keeping them on a light diet, but on the contrary they give them wine and nourishing food instead of slops (ptisans). His comment is that this sensible method of supporting treatment unfortunately does not make much headway in the profession. Apparently it was too simple and natural to appeal to the physician of the time. He adds with fine irony, "It is said to be preferable to die methodically than to live empirically."

Gurlt in his _"Geschichte der Chirurgie"_ (Berlin, 1898), to whom I owe most of what is here said of the work of these old surgeons, gives some further details of Biondo's treatment of wounds. After the staunching of the bleeding, the wound was to be cleansed and then covered with _oleum abjetinum,_ very probably oil of turpentine, one part to two parts of oil of roses. With regard to the use of water in the treatment of {420} wounds, Biondo said: "The most experienced of the older physicians held water in such dread that they would scarcely use it in removing dirt from the neighborhood of wounds. I myself, however, having seen the wonderful effect of water in wounded parts, cannot help but be amazed at its super-celestial virtue." In spite of this strong declaration, Biondo in his book gives chapters on all the old methods of treating wounds and the various applications that were supposed to work wonders in bringing about healing. The consequence was that the water doctrine was pushed into the background and probably attracted very little attention. Here was the germ of a great discovery, the use of boiled water, evidently with some experience behind it, and yet it was to remain untried, its true value unappreciated until four centuries later.

Paracelsus, who brought about the revolution in medicine at this time, worked almost as great a change with regard to surgery. At least the principles that he laid down were as startlingly different from much of those accepted in his time and strikingly like those we have come to accept in our time. He insisted that to as great an extent as possible wounds should be left to nature, for there was a definite tendency to cure. He inveighed strongly against meddlesome surgery and declared that not a little of the subsequent complications in wounds were due to misdirected efforts at cure of them. He talked about _pestilence_ due to wounds, and declared that he had seen it spread epidemically from one patient to another in hospital wards. He discussed pyaemia as _Wundsucht,_ that is, an infectious disease produced from a wound. Paracelsus described gangrene and proclaimed its epidemic character. He is the first from whom we have a careful study of the effects of lightning and almost the first who believed that it was possible for a man to be struck by lightning and yet not be killed or even fatally injured.

In general, the ideas of this time were not nearly so distant from our own as some of the intermediate periods have been. Fallopius described union by first intention as resembling that which occurred between two waxed surfaces when they were brought together in parallel lines and adhered. {421} Wurtz described a wound fever, evidently erysipelas, and warned about the possibility of its becoming epidemic.

Arceo, known also by his Latin name of Francisco Arceus, a Spanish surgeon, born near the end of the fifteenth century, ill.u.s.trates the vitality of surgery in Spain at this time. He has a number of interesting surgical suggestions and has this to say with regard to club foot. The foot should be soaked thoroughly for thirty days in warm water in which some cereal has been cooked. Then the surgeon, taking the lame foot, should exert all his force to put it back into its due position and the form that he desires. This can usually be accomplished without difficulty or delay, partly because of the preceding softening of the tissues, but above all because of the tender age and soft tissues of the child. Then a bandage should be used to maintain the foot in this position until the correction becomes permanent. Ambroise Pare, as I have said, accomplished similar results, but he also used a number of forms of apparatus for the cure of club foot and for the prevention of contractures in the joints as a consequence of paralysis. He is the first surgeon whom we know to have interested himself in artificial hands, arms and legs for those deprived by amputation of members and the first to employ artificial eyes. Fabricius of Aquapendente, born in Columbus' period, but doing his work afterwards, recommends ma.s.sage and bandaging for _pes varus_ and an iron shoe with side pieces for _pes valgus._ He made the correction gradual. He said, "I talk from experience, as I have had much to do with crooked legs, feet and backs and have made them straight and proper."

That Germany was not without the distinctive spirit of the time by thoughtful work in surgery is made clear through the writings of Hugo von Pfolspeundt, which were found only a few years ago. In what relates to the mechanics of surgery he made many practical suggestions and inventions. For harelip he suggested that st.i.tches should be placed on the mucous surface as well as on the skin surface, after the edges of the cleft had been freshened in order to be brought closely together and held in coaptation. He also suggested the use of a permanent weight extension for fractures and for certain {422} injuries of the joints. Perhaps his most interesting surgical development for us is a description of a silver tube with f.l.a.n.g.es to be inserted in the intestines when there were large wounds, or when the intestines had been severed, the ends being brought together carefully over the tube which was allowed to remain in situ.

Pfolspeundt said that he had often seen these tubes used and the patient live for many years afterwards. This is an early form of what is known as the Murphy b.u.t.ton in our time, though it was not the first suggestion of a mechanical device to aid the repair of intestinal injuries. One of the latest mediaeval surgeons had employed the trachea of an animal as the tube over which the wounded intestines were brought together. This became disintegrated after a while in the secretions, but remained intact until after thorough agglutination of the intestines had occurred.

Pfolspeundt was not an educated man and did not even write his own German tongue with correctness, not to say elegance. He was just a practical devotee of surgery, probably not even a regularly practising physician, and yet his writings show how much there was that he knew of technical details, extremely important for surgical practice, that are usually supposed to be of much later origin. After all, some of our own distinguished surgeons have not been educated men in any sense of the word, and there has sometimes been the feeling that a surplus of information of what had been accomplished just before his time, sometimes deterred the physician, as well as the surgeon, from thinking independently about problems connected with practice and reaching valuable practical conclusions.

Besides Pfolspeundt there are at least two other German surgeons of this time whose writings have come down to us that deserve a place in a history of distinguished accomplishment in Columbus' Century. One of these is Jerome of Brunschwig, whose name is spelled in many different ways, and the other is Hans von Gerssdorff. Brunschwig, or Braunschweig, used to be considered the oldest writer on surgery in German until the comparatively recent discovery of Hugo von Pfolspeundt's ma.n.u.script. He published his surgery in 1497, and it went through nine editions in a few years. It {423} contains a number of woodcuts, and these probably helped to give it its popularity.

Brunschwig was very proud of his calling as a surgeon, and quotes what Galen, Rhazes, Abulca.s.sis, Lanfranc and Guy de Chauliac had declared should be the qualities possessed by a surgeon and insisted particularly that he "should have deep knowledge and trained observation of anatomy, so that whenever it may be necessary to cut or cauterize, he shall know exactly in what regions to do it, so as to do just as little damage as possible and that he shall be capable of diagnosing joint conditions and know what important organs may be injured by bullet or other wounds with weapons and be able to judge of the danger of cutting down for their removal." He recommends above all that the young surgeon should invariably call an older and more experienced colleague, or even two, in consultation, if the case is very difficult, and he has doubts about it.

Some of his details of technique are very interesting as showing how carefully he thought out even minor problems connected with the practice of surgery. For instance, he says as to wounds of the face, that as "the beauty of the countenance is what above every other thing makes men beautiful, the surgeon must take the greatest care that no ill-looking or ugly union should take place in it, and just as far as possible the parts should be brought together and kept in apposition, with as delicate means as possible, until healing has taken place."

On the other hand he does not hesitate to discuss even fractures of the breast-bone, and says that if the patient expectorates blood it is a bad sign, for almost surely some of the arteries lying under the bone have been ruptured. He suggests position to help in the correction of deformity and displacement of the bone, and mentions that some of the older surgeons sought to raise it up by means of large dry cups. In fractures of the ribs similar recommendations were made, but Brunschwig was of the opinion that they did more harm than good. He recommended bandages, thickened with alb.u.men, or leather moulded to the part, and he covered the thorax with a large binder.

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There is no doubt at all that he knew very well the books of his predecessors and that he had thoughtfully adapted them in the way that had been taught him by his forty years of experience. He begins his book with a dedication to the praise of G.o.d and His Mother, not forgetting the honorable magistrates of the city of Stra.s.sburg. He says in the preface that he is tempted to write his book because there are many young, inexpert masters of surgery in the care of wounds who do not understand it and consequently inflict much harm on mankind. He hopes to be able to instruct them and also others who, living in the smaller towns and villages, have not had the opportunity to see the practice of surgery and yet must be able to help the ailing and injured. The picture of the position of the surgeon of the time is rather interesting.

The next of the German surgeons of this period was Hans von Gerssdorff, who practised in Stra.s.sburg. His well-known work is the "Field Book of Surgery," in which he gives some of the experiences of long years as a military and munic.i.p.al physician. The book was issued with a series of woodcuts, some of them anatomical but most of them surgical in interest, which are very well executed. His ill.u.s.tration of an amputation is the first one of this subject ever made, and there are many pictures of his instruments. We have only room to note some of his discussions of subjects usually not supposed to be thought of in his time. He discusses wounds of the liver, especially such as occur from large wounds of the abdomen, and says that if the liver substance itself has been wounded the issue will surely be fatal. If the liver is not wounded, yet appears in the wound, it should be replaced and the external wounds sewed. His discussions of wounds of the deep organs are all in about this same conservative strain.

Gerssdorff has much to say with regard to contractures and anchyloses.

When these deformities are to be corrected, the tissues around the joints should be softened by means of embrocations and the rubbing in of old oil, and the contractures gradually overcome by manipulation or by instrumental means. He invented a number of apparatus for stretching such contractures, and four of the large pictures reproduce them. They are partly in the shape of armor or {425} splints so arranged that they can be bent or made straight by means of a screw.

There is also a screw arrangement for bringing about extension in various directions. He did not believe very much in going too slowly about the correction, for he declares that most of the contractures and anchyloses can be overcome in a few hours.

In discussing amputations he mentions the use of anaesthetics by the older surgeons, and quotes from Guy de Chauliac the method of anaesthesia employed by him, but he thinks that better results are obtained without the use of such material. He had never employed anaesthetics himself, though he had performed over 100 amputations.

Perhaps his Teutonic people were able to stand pain better than the patients of the Latin countries. The refusal to use anaesthetics is very interesting at this time, for the practice gradually disappeared and was forgotten. Gerssdorff warns particularly against the use of opium alone as a means of preventing pain, and Chauliac had done the same thing earlier.

The spirit that the surgeons of the time were expected to have is very well ill.u.s.trated by a pa.s.sage from John Hall, written shortly after the close of Columbus' Century in his "Historian Expostulation," which is referred to more at length in the chapter on Medicine. He said, "I would therefore that all Chirurgiens should be learned, so would I have no man think himself learned otherwise than chiefly by experience, for learning in Chirurgery consisteth not in speculation only, nor in practice only, but in speculation well practised by experience."

Dr. Hall made a series of rhyming verses which were meant to be helpful to the young surgeon to enable him to recall his duties readily. He urged him above all never to treat a case unless he understood it, when in doubt to call in a consultant and advises him after consultation to console the patient, but to talk seriously to some of the patient's friends. Above all not to disturb the patient's feelings. Among other excellent bits of good advice he insists very much on the knowledge of anatomy, and two of his rhyming stanzas regarding it seem worth while quoting to show the spirit in which he wrote:

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"He is no true chirurgien That cannot show by arte The nature of every member Each from other apart.

For in that n.o.ble handy work There doth nothing excell The knowledge of anatomy If it be learned well."

In a chapter of this kind, almost needless to say, it is impossible to give any formal account of the surgery of the time. All that I have been able to do is to point out that in every country in Europe surgeons were thinking for themselves and facing most of our modern surgical problems and finding not inept solutions. There is scarcely a phase of our modern surgery from antisepsis and anaesthesia to technical details of various kinds, through plastic surgery, the use of apparatus, manipulation and many forms of instruments, which cannot be found in the surgical text-books of this time. Gurlt in his great "History of Surgery" has taken some 400 pages of a large octavo volume, with the excerpts in rather small type, to tell the story of the surgery of Columbus' Century. Helferich occupies several hundred pages of Puschmann's "Handbook of the History of Medicine" with the details of what was done by the period's surgeons. The specialties developed, and in all of them important contributions were made. The great independent, seeking temper of the era is as noteworthy in surgery as it is in every other department of intellectual effort at this time.

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BOOK III

THE BOOK OF THE WORDS

CHAPTER I

LATIN LITERATURE

The Latin literature produced during Columbus' period, or at least the books written in Latin, are literally legion. There has seldom been an age of greater literary productivity, and in every department men wrote in Latin. It was the universal language of scholars. Every educated man understood it; whenever he wrote for educated men he employed it. When scholars of different languages met it was a ready resource. This custom did not begin to lose its hold until after the end of Columbus' Century, though it received a severe shock from Paracelsus' refusal to use anything but the vernacular and was given its death blow by the popularization of even theological subjects in the vernacular during the reformation movement. Latin continued for two centuries after Luther's time to be the medium of communication between scholars, but its use gradually went out in the depths of the degradation of scholarship in the eighteenth century.

There are many who apparently can see only unmixed good in the gradual supersession of Latin by the various vernacular languages, but a universal academic language had many advantages. As a rule, an educated man needed to know only one language besides his own at this time. Practical education for scientific purposes, and above all for law and medicine and philosophy and theology, was very much simplified. Now the student of science must know, as a rule, at least two languages besides his own. In recent years we have come to recognize the need of a universal language, and hence the {428} successive waves of interest in newly-invented languages. Latin, however, besides its practical usefulness as a common tongue, rewarded the student of it by opening up to him a precious literature which made it well worth his while to have devoted time and labor to its acquisition.

The most fertile period of modern Latin was undoubtedly the era of the Renaissance from 1450 to 1550, yet of all this Latin writing of Columbus' Century very little endures in the sense of being read for its own sake in our time. The old books have many of them gone up in value, but that is mainly because of their special significance in the history of their particular science or in the development of printing.

Books like Vesalius' _"Fabrica Humani Corporis"_ have become cla.s.sics that every scholarly student of medicine must have seen, though in practical value they have been superseded by later books. Some of the philosophical and theological works of the period and a number of the mystical and spiritual works are still read for their own sake, but with certain exceptions, like Thomas a Kempis' works and others that we shall mention, these are rather curiosities that appeal to the erudition of the special student than real living books to be consulted.

An immense amount of Latin verse was written at this time. Sannazaro, one of the ablest members of the Academy of Naples, wrote a poem comparable in size to Virgil's AEneid on "The Birth of Christ." This is only one instance. There were literally hundreds of scholars at this time who thought because they could write Latin verses in which the rules of grammar and prosody were not violated, and above all if they could use the words that had been employed by their favorite Latin authors and repeat felicitously the expressions of Virgil and Horace and the cla.s.sic poets generally, that they were making literature at least if not poetry. Men have always had such illusions, have always written what was only of interest for their own time and have had the pleasure and satisfaction derived from the occupation of mind and the antic.i.p.ations of reputation and glory. None of this Latin poetry has survived, and indeed it is only a very rare specialist in Latin literature, and usually one who has devoted himself to Renaissance Latin, who is likely to know anything about it.

Undoubtedly some {429} of it was eminently scholarly. There is no doubt either that not a little of it was of fair poetic quality. It was all, however, of distinctly academic character, and it has gone into the limbo of forgotten writing, which now contains such an immense amount of material.

There is probably nothing which shows so clearly that the writer, and above all the poet, is born and not made, that it is originality of thought and not mode of expression that makes for enduring literature, as the fate of so much of the product of these Renaissance writers. On the other hand, there is nothing that better ill.u.s.trates the value of originality of thought apart from style than the preservation as enduring influences upon mankind of a series of books in which style was probably the last thing that the author thought about, and the mode of expression had almost no place in his mind compared to his desire to set forth his thought effectively.

Three of the books that have lived from this time and will, so far as human judgment can foresee, always continue to live, are Thomas a Kempis' _"De Imitatione Christi"_ Sir Thomas More's "Utopia" and St.

Ignatius of Loyola's _"Exercitia Spiritualia"_ All three of them were written in Latin because that was the language in which they would appeal to most readers at the time. All three of the authors probably thought nothing at all about the language that they were using except for its convenience for others, inasmuch as it could be read by the men of all nations whom they most wished to reach. All of them are direct, simple, even forcible in their modes of expression, but there was surely little filing done and probably very little rewriting.

Thomas a Kempis' book, almost without a doubt, flowed from his pen just in the way that his words flowed out of his full heart in the spiritual conferences that he gave to his brethren. There was probably never a thought given to verbal nicety except to secure as simple an expression of his overflowing ideas as possible. The "Utopia" is written in correct, but not cla.s.sical Latin, and it is very likely that Erasmus would have found many faults of usage in it, while the Ciceronians of that time would surely have been horrified at the very thought of having to read such Latin and would scarcely be able to understand how anyone could write {430} such unCiceronian phrases. As was said of Michelangelo, St Ignatius wrote things rather than words, and the "Spiritual Exercises" are a mine of thought, but not a model of style in any sense.

There has been question as to whether the "Imitation of Christ" was really written by Thomas a Kempis, but that question has now, I think, been definitely settled. Everything points to the authorship by the brother of the Common Life, who was born in the little town of Kempen and lived some seventy years in the Monastery of St. Agnes, acting as spiritual adviser to his brethren, giving them consolation and advice in times of trial, directing their thoughts always to the higher life.

There are many Flemicisms, that is, Latin usages which were common in the Netherlands of this time, in most of the ma.n.u.scripts. It has been argued that since these do not exist in all the ma.n.u.scripts, the argument founded on them is not absolute. The preponderance of evidence, however, is for the Flemish copies as being nearer the original, and the absence of these special modes of expression in other ma.n.u.scripts only indicates that a great many copyists of the time, particularly in Italy and France, were quite aware of these imperfections of language and endeavored to correct them out of their better knowledge of Latin. This only serves to show how little the style of the book had to do with its popularity and that it was the thought that appealed to the world of the time and has continued ever since to give the work wide popularity.

a Kempis himself was born in the fourteenth century, but as he lived to be past ninety, dying in 1471, more than twenty years of his life, during which he was active and in possession of his faculties, were pa.s.sed in our period. The "Imitation of Christ" was probably written some twenty years before Columbus' Century began, but did not take the definitive form in which we know it until about the beginning of our period. It has a right to a place, therefore, among the great works of the time. I have sometimes suggested that three men, whose names begin with _k_ sounds, accomplished magnificent broadenings of human knowledge at this time. Columbus discovered a new continent, Copernicus revealed a new universe and a Kempis unveiled a wonderful new world in man's own soul. {431} He did as much for the microcosm man as Copernicus for the cosmos or Columbus for our earth. Hitherto unexplored regions were laid bare and the beginning of the mapping out of them was made. More than either of his great contemporaries, however, a Kempis finished his work. Very little has been added to what he was able to accomplish for man's self-revelation in his little book.

[Ill.u.s.tration: CIMA DA CONEGLIANO, CHRIST (DRESDEN)]

The work did not spring into popularity at once, though it gradually began to be known and used by chosen spirits in many places, and some of the greatest of the men of the time learned to appreciate it. It is a charming testimony to the fact that a Kempis himself first did and then taught that he cared so little for the reputation attached to his work, that his name was not directly a.s.sociated with it, and in the course of time there came to be some doubt about its authorship. "If thou wilt profitably know and learn," he had said, "desire to be unknown." It is one of the most difficult of tasks, but the humble brother of the Common Life who had written a sublimely beautiful book had learned it. He had written other books, indeed there are probably at least a dozen attributed to him on reasonably good evidence, yet had said, "In general we all need to be silent more than to speak, indeed there are few who are too slow to speak." None of his other books are quite equal to the "Imitation," yet many of them, as "The Little Garden of Roses" and "The Valley of Lilies," are well worth reading and exhibit many of the traits of charming simplicity, marvellous insight and psychological power that have given his greatest work its reputation.

All down the centuries since men have admired and praised the "Imitation." It has not been a cla.s.sic in the sense of a book that everyone praises and very few read, but on the contrary it has been the familiar reading of a great many of the chosen spirits among mankind ever since. To have been the favorite book of Sir Thomas More, Bossuet and Ma.s.sillon, of Loyola and Bellarmine, of John Wesley, Samuel Johnson, Lamartine, La Harpe, Michelet, Leibnitz and Villemain is indeed a distinction. Nor has it appealed only to Christians, for men like Renan and Comte almost in our own time have praised it very highly. Far from its reading being confined {432} to scholars by profession or those much occupied with the things of the spirit, we find that it was the favorite reading of General Chinese Gordon, General Wolseley, the late Emperor Frederick and Stanley the explorer.

George Eliot shows her deep appreciation of it in "The Mill on the Floss," where she says that "It works miracles to this day, turning bitter waters into sweetness." Sir James Stephen speaks of it as a work "which could not fail to attract notice and which commended itself to all souls driven to despair." The late Lord Russell of Killowen always carried a copy of it with him and used to read a chapter in it every day quite as Ignatius of Loyola had done three centuries and a half before. The frequent surprise is the contrast of the men devoted to it. Pobiedonostseff, the head of the Holy Russian Synod, the power behind the Czar for so long, used to read in it every day.