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.