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.
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.