In Century VII. there is given an account of a man of the wealthy class who had been exposed to an excessive degree of cold for so long a time that he was literally almost half frozen. “As he was being carried into the village he gave orders that an ox should be slaughtered and that he himself should be snugly stowed away inside the carcass of the animal as soon as its interior furnishings had been removed. Thus he escaped freezing to death.”
In the same century Amatus speaks of having seen a rather interesting case of Filaria Medinensis (called by the Arabs “vena medena”) in a negro boy, eighteen years old, who had come to Thessalonica from Memphis, Egypt. “The worm had caused the production of an ulcer close to the boy’s heel, and in this the creature’s head, which looked very much like a vein, was recognizable. After the Turks had correctly diagnosed the nature of the trouble an Arabian physician, who had managed to secure a purchase on the worm, began rolling it up on a small stick. Gradually, after the lapse of several days, he succeeded in uncoiling the animal in its entire length (three cubits), as shown by the construction of the end of the tail, and thus permanently freed the boy from his trouble. The ancient authors express doubts as to the true nature of the object found in these ulcers, but I, Amatus, having examined the slender white creature and having witnessed its curved outlines as it projected itself outside the opening, do vouch for the fact that it possesses all the characteristics of a true worm.”
CHAPTER XXXIX
THE DEVELOPMENT OF SURGERY IN FRANCE DURING THE RENAISSANCE.—PIERRE FRANCO
Von Gurlt speaks of Pierre Franco as “one of the most skilful surgeons and at the same time one of the most original medical writers of the sixteenth century.” He and his contemporary, Ambroise Paré, were of French birth, and to France therefore belongs the conspicuous distinction of having contributed to medical science during the Renaissance two of its most illuminating and efficient laborers. These men, who were the leading operative surgeons in France during the first half of the sixteenth century, did not owe their education as physicians to the official training provided by the Medical Faculty, but partly to the men who were classed as barbers and surgeons, or barber-surgeons (Collège de St. Côme), and still more to their own efforts. They gathered practical knowledge wherever they might—largely from their official connection with armies during the progress of different wars. Further details with regard to their personal characters and the principal events of their professional careers will be furnished in the following brief sketches.
Pierre Franco.—Pierre Franco was born in the village of Turriers, in Provence (now the Department of Basses-Alpes), about the year 1500. He received his instruction in surgery from itinerant lithotomists, operators for cataract, hernia-healers and men of that class; and it is quite likely that, in the early days of his professional career in Provence, he was himself a practitioner of this humble type. At a somewhat later date he left the southern part of France and took up his residence in Switzerland, first at Berne and then at Lausanne. He probably left Provence because, in the early part of the sixteenth century, the Protestants of that region were being subjected to every form of persecution; and it is almost certain that Franco belonged then to the Reformed Church, for he accepted the salaried office of City Surgeon at Berne, the authorities of which city were bitterly opposed to everybody and everything connected with the Roman Catholic Church. Franco held the office named during a period of ten years, the first part of the time at Berne, and afterward at Lausanne, which latter city was then under the control of the Bernese Government. He was a very close observer, a most enthusiastic student of his art, and a man of intensely religious nature. Malgaigne, the distinguished editor of the modern edition of Paré’s writings, speaks thus of Franco: “I have no intention of writing here the history of this man who was endowed with such a fine surgical genius; I may say, however, that his was a life devoted entirely to the advancement of surgery as a science.”
As an operative surgeon, says Edouard Nicaise, Franco ranked higher than any of his contemporaries. Strange as it may appear, Ambroise Paré frequently refused to take charge of cases in which an operation for stone in the bladder, for hernia, or for cataract was required, whereas Franco owed much of his reputation to the success which he had in operating upon these three classes of cases. The latter, furthermore, did most of his work on patients who belonged to the middle class, and consequently his operations were characterized by very little of the éclat which marked a large part of the work done by Paré, who from the very beginning was befriended by Royalty and the Court circle. At the same time, says Nicaise, Franco did more than any other man of that period to enrich surgery with new discoveries.
Franco has written only two treatises. The first one, which was published in Lyons, France, in 1556, bears the title: “A Small Treatise on the Operative Treatment of Hernia”—one of the most important departments of surgery (a book of 144 pages, 8vo). The second work, which was issued in 1561, also at Lyons but by a different publisher, bears the title: “Traité des hernies contenant une ample déclaration de toutes leurs espèces, etc.” (a book of 554 pages, 8vo). This work goes very thoroughly into the subject of hernia in all its bearings, and also deals with several other important surgical topics, such as genito-urinary diseases (in both the male and the female), affections of the eyes, hare-lip, tumors, wounds in general, dislocations, fractures, amputations, etc.; in short, it is a fairly complete and decidedly original treatise on general surgery. When Franco wrote the smaller work (that of 1556), he was settled at Lausanne; but in 1561 he was living in Orange, which at that time was the capital of a Principality that belonged to the House of Nassau.[89] A few brief citations from the larger of the two treatises will suffice to give our readers some idea of the manner in which Franco deals with the subject-matter of the book.
Franco, says von Gurlt, was one of the first surgeons—perhaps the very first—to perform the operation required for the relief of strangulated hernia and at the same time to furnish a description of the manner in which it should be performed. After mentioning the fact that the strangulation of a portion of the intestine is attended with considerable danger to the patient’s life, Franco proceeds to consider the subject in greater detail:—
Owing to the large amount of the fecal matter and gas contained within the portion of the intestine that is imprisoned in the scrotum, and also owing to the inflamed condition of the parts, it is frequently not possible to push the bowel back through the narrow aperture in the peritoneum; and this condition of things is apt to be aggravated by the constipation or by the efforts at vomiting that frequently accompany such strangulation. The vomiting, it is true, may in certain cases facilitate the desired reduction, but in others it does harm, especially by forcing more fecal matter into the scrotum. If the conditions described are permitted to continue unrelieved, death may certainly be expected to result. In a few cases the timely administration of medicine internally may overcome the difficulty, but, if this measure fail to produce the desired result, recourse must be had to surgery—not, however, if already the scrotum and neighboring genital parts have changed their color to a black, livid, bluish or some other unnatural hue, or if the hernial tumor manifest a round rather than an elongated shape, for all these signs are harbingers of death; and, as further unfavorable signs, should be reckoned a livid or black mucous membrane of the patient’s mouth, contracted nostrils, and an appreciably sunken condition of the eyes. But if, on the other hand, the scrotum possess a natural color and if it have not a spherical form but rather an oval shape, then it is proper, after a failure to secure the desired reduction by the internal use of medicine, to resort to a surgical operation.
For the proper performance of this operation the surgeon should be provided with a nicely rounded metal staff, flat on one side, and a little larger than a goose’s quill. [Paré’s grooved sound or director, says von Gurlt, had not yet at that time been invented, and this staff was intended to serve, in a crude fashion, the same purpose.] The first step is to make an incision in the upper part of the scrotum, the direction in which it is to be carried being toward the symphysis pubis. When the hernial sac is reached the staff is introduced into the slit and pushed upward between the wall of the sac and the fleshy part of the penis, the flat side of the instrument being kept uppermost, as it is upon this surface that the cutting with the scalpel or the razor is to be done. After the end of the staff has been pushed well upward the flesh of the scrotum is to be divided upon the flat surface of this instrument; all danger of injuring the intestine being thus avoided. Then the attempt should cautiously be made to reduce or replace the intestinal folds. But if these efforts fail,—owing to the excessive distension of the bowel or because the constricting band has not yet been sufficiently relaxed,—then the following steps should be taken:—Grasp the spermatic cord (“didymis”), lift up its enveloping membranes one by one with hooks, and divide each one of them completely upon one’s finger nail, up to the point where the intestine is encountered. Then, having established, between the intestinal wall and the membranous coverings of the cord, an aperture large enough to admit the end of the metal staff, push the instrument onward and upward while at the same time it is held as it were balanced in the air, so that early warning may be communicated to the holding fingers in case the instrument, as it travels onward, should become caught in the folds of the intestine—an accident, however, which the slippery nature of the outer surface of the intestine renders improbable, but which nevertheless may occur if at any point there happen to be a break in the continuity of the tissues. As the next step in the operation the cord should be completely divided high up (the incision being made upon the staff) close to the opening in the peritoneum through which the folds of the intestine forced their way, in the first instance, into the scrotum; but the surgeon must, without fear of doing harm, and remembering that he is dealing with conditions of a desperate nature, see to it that the opening made in the peritoneum is amply large. Finally, with the aid of a soft piece of linen he should return the folds of the intestine to the peritoneal cavity, etc. [The remaining portions of the description are of minor importance and may well be omitted here.]