In one of his writings Gale states, after witnessing the surgical practice at the Royal hospitals of St. Bartholomew and St. Thomas in 1562, “that it was saide that Carpinters, women, weuvers, coblers and tinkers did cure more people than the chirurgians.” (South.)
William Clowes.—William Clowes was born, about the year 1540, at Kingsbury, in Warwickshire, and received his early training in surgery under George Keble of London. In 1563 he accepted the position of surgeon in the army which was under the command of Earl Ambrose of Warwick and was stationed at that time in France. Six years later he settled in London, and was made a member of the Barber-Surgeons’ Company. In 1575 he received an appointment on the Surgical Staff of St. Bartholomew’s Hospital and six years later still he was promoted to the rank of full surgeon, a position which he already held in Christ’s Hospital. In 1585 he resigned his appointment at St. Bartholomew’s and accepted an invitation to serve in the Earl of Leicester’s army, which was at that time in the Netherlands. During this war Clowes acquired a rich and varied experience in the treatment of wounds. Soon after his return to London in 1588 he joined the fleet which vanquished the Spanish Armada. Later, he was given the appointment of Surgeon to the Queen. His death took place at Plaistow, County of Essex, in August, 1604. Von Gurlt does not hesitate to qualify him as one of the most distinguished English surgeons of his day.
Of the four surgical treatises which were written by Clowes, and of which several editions were published between the years 1575 and 1637, there is only one to which I shall refer in this brief account, viz., that which, in the edition of 1637, bears the title: “A profitable and necessarie Book of Observations, for all those that are burned with the flame of Gun-Powder.” This book is full of brief histories of cases which came under the author’s personal observation, and it therefore furnishes an excellent and truthful picture of the kind of wounds which the highwaymen and soldiers of that day inflicted, and of the treatment which was employed by the best English surgeons. The following may serve as sufficient examples:—
(1) A clothier, who had been assailed by robbers, received a dangerous wound in the left thigh. It was about four inches long and of such a depth that “the rotula or round bone of the knee did hang downe very much.” Clowes first removed a clot of blood from the wound and then, “with a sharp and square-pointed needle, armed with a strong, even and smooth silke thred, well waxed, introduced five stitches, one good inch distant betweene every stitch, leaving a decent place for the wound to purge at.” He then applied a suitable bandage. The patient’s friends were not at all pleased that Clowes, having pronounced the wound dangerous, should not have been willing to state how much time would elapse before it would be healed. So they called in a charlatan, who on the following day removed the dressings and cut through all the stitches. Seven days later, Clowes was once more asked to see the case. He found the wound gaping widely and in a bad state. After adopting such measures as were most urgently required, he brought the edges of the wound together by the application of three strips of sticking-plaster. In due time healing took place, “but the motion perished: for the patient had the imperfection of a stiff knee, which constrained him to use a leather strap, fastened unto the toe of his shooe, and again made fast unto his body; and so he remaineth unto this day.”
(2) The history of the second case may be given here in the following brief outlines. The patient, a ship’s gunner, was wounded in the lower part of the abdomen by what was probably a partially spent ball. The wound made by the missile was of such a nature that it permitted a large portion of the “zirbus” (omentum), together with some of the intestinal canal, to protrude from the opening. After making a careful examination of the parts, Clowes was satisfied that the intestine was still uninjured.
Then with a strong double thread I did tie fast the zirbus as close unto the wound as possible wel I might, and within a finger bredth or thereabouts I did cut off that part of the zirb that hanged out of the wound, and so I cauterized it with a hot iron almost to the knot; all this being done, I put again into the body that part of the zirb which I had fast tied, and I left the peece of thred hanging out of the wound: which, within four or five days after, nature cast forth, the thred as I say being fast tied; then presently I did take a needle with a double strong silke thred waxed, wherewith I did thrust thorow both mirach [skin, adipose layer and muscular tissue] and ziphach [peritoneum] on the right side of the wound, but on the left side of the wound I did put the needle but thorow mirach only, and so tied these three fast together with a very strong knot, and presently I did cut of the thred.... All which is according to Weckers[94] and other learned men’s opinions and practices, who also say that the stitches of the one side must be higher than on the other side. [The usual dressings were afterward applied and were renewed three days later. At the end of twenty-one days the wound was found to be completely healed.]
In chapter 27 of the same work there is given a list of the medicaments and instruments with which a field-or ship’s-surgeon should be equipped before he engages in active service. From this list I select the following items as showing—at least in some measure—in what respect the tools employed by surgeons four hundred years ago differ from the modern ones of a similar character: “Small and long waxe candles to search the hollownesse or depth of a wound.” “Small buttons or cauterizing irons meete to stay the flux of an artery or veine.” “A trepan.” “Needles two or three, some eight inches, some ten or twelve inches in length, having a decent eye in it guttered like a Spanish needle, and point or end blunt or round, that it offend not in the going in of it, made fit to draw a Flammula, or a pece of fine lawne or linnen cloth through the body or member that is wounded.” “As for stitching quils and other instruments, that a Surgeon ought always to carry about him, I leave unspoken of.”
In praise of one of the plasters enumerated in the list, Clowes narrates the following incident which occurred near Arnheim in the Netherlands: “A horseman was wounded with a pike neere the middle of his right thigh; the weapon so passing upwards that by good fortune it rested upon the os pubis, otherwise he had been slaine.” As the first step in the treatment, the copious bleeding was arrested; after which warm oleum hyperici [oil of St. John’s wort] was injected into the wound, then a short tent was introduced, and the sticking plaster was applied on the outside. “Thus he was cured in fourteene days, and so was ready to serve in the field again.”
John Woodall.—John Woodall or Woodhall was born in England about 1569, and was sent as a military surgeon to France by Queen Elizabeth with the troops which Her Majesty placed at the disposal of the French King, Henry the Fourth. After his return to England, Woodall was made a surgeon of St. Bartholomew’s Hospital and also Surgeon-General of the East India Company. He was already at that time a member of the Company of Barber-Surgeons of London. Woodall must have had a very extensive experience in the practice of surgery, for he states that he had performed the operation of amputation of a limb more than one hundred times. The date of his death is not known.
Von Gurlt calls attention to the fact that the first notice printed in English of Ambroise Paré’s method of ligating blood-vessels after an amputation is to be found in the treatise written by John Woodall and published in London in 1639, under the title: “The Surgeon’s Mate, or Military and Domestic Surgery.” As the first edition of this book, which was published in 1617, says nothing about Paré’s method, it seems permissible to infer that the news of this improvement, one of the most important made in surgery (1552), reached England from France only after the lapse of eighty-seven years! There can be scarcely any doubt, however, that individual English surgeons had already learned about Paré’s improved method at a much earlier date.