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.

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.