The growth of medicine from the earliest times to about 1800

by Albert H. Buck

State of Surgery in England During the Seventeenth Century.—Before I pass on to the consideration of the state of surgery in England during the seventeenth century it seems desirable that I should say a few words with regard to the relative standing of the two branches of the medical profession—the physicians and the surgeons—in the esteem of their fellow Englishmen at this period of history. In France, it will be remembered, a surgeon was looked upon, even as recently as during the first half of the sixteenth century, as a man of inferior social standing, perhaps a shade better than an apothecary, but certainly far below his more highly educated associate—the physician. The favors extended by French Royalty to Ambroise Paré and the very high esteem in which he was held by French society in general effected a great change in the relative status of the two classes of practitioners in France; and, as a result of this change in public opinion, medical practitioners, subsequent to 1560 or 1570, were led to realize that a surgeon, if sufficiently educated, if earnestly devoted to his professional work, and if intent upon helping his fellow men rather than upon accumulating a fortune, might confidently aspire to a position of equality with the best physicians of the community in which he lived. In England a similar change of opinion in regard to the honorableness of the career of surgeon took place about this time, probably in consequence of the great reputation gained by Gale, Clowes and Woodall. In both countries the change occurred slowly, and in France what was gained during Paré’s lifetime seemed afterward to be lost for a period of several years. But eventually the prevailing opinion again became favorable to the surgeons, and from that time to the present they have enjoyed an ever-increasing esteem in public opinion. But there was a brief period, early in the seventeenth century, when it must have been very galling to the pride of an honorable and experienced surgeon to be placed as it were under the tutelage of the physicians who were his official associates in certain hospitals—as, for example, in St. Bartholomew’s, London. The following extracts[95] from the “Orders” or “Articles” of that institution (1633) explain more precisely what is meant by the use of the word “tutelage”:—

9. That no surgeon or his man do trepan the head, pierce the body, dismember or do any great operation on the body of any but with the approbation and by the direction of the Doctor (when conveniently it may be had) and the surgeons shall think it needful to require.

13. That every surgeon shall follow the directions of the Doctor in outward operations for inward causes, for recovery of every patient under their several cures, and to this end shall once in the week attend the Doctor, at the set hour he sitteth to give directions for the poor.

(From St. Bartholomew’s Hospital Reports, Vol. XXII., 1886.)

Among the English surgeons of the seventeenth century there appears to have been only one who attained some degree of eminence, viz., Richard Wiseman, who is often spoken of as the Ambroise Paré of England. Haeser mentions 1625 as the date of his birth, and at the same time states that he was in the service of the Stuart Kings from Charles the First to James the Second. It seems to me highly probable that this statement regarding the date of Wiseman’s birth is erroneous; for if it be accepted as correct, then he (Wiseman) must have been only fifteen years of age when he first started out with the prince (in 1640) on the latter’s wanderings through France and the Low Countries. On the other hand, if Wiseman was really born in 1625, then we shall be justified in assuming that he traveled with the prince at first simply as his companion and not in a professional capacity; and we shall be further justified in assuming that he acquired his medical and surgical training during his residence on the continent.

In 1650 Wiseman returned with the prince to Scotland. At the battle of Worcester he was taken prisoner by the Parliamentary army under Cromwell and did not regain his liberty until 1652, at which time he settled permanently in London. After the Restoration in 1660, his practice increased very greatly and, so far as one may judge from the large number of cases which he reports in his work on surgery that was first published in 1676, it must have been very extensive and of a most varied character. I have read many of these reports of cases that occurred in Wiseman’s practice, and have been much impressed with the thoroughly practical character of the treatment which he adopted in the majority of instances, and also with the very clear and concise manner in which he narrates the attendant circumstances—the nature of the malady or of the injuries received, the treatment which he adopted, and the final results attained. In the belief that they may furnish corroborative evidence of the statements which I have just made, I now take the liberty of reproducing here two of these reports of cases:—

(1) Whilst I was a prisoner at Chester (1651), after the battel of Worcester, I was carried by Colonel Duckinfield’s order to a man that out of much zeal to the Cause, pursuing our scattered forces, was shot through the joint of the elbow; the bullet entering in at the external part of the os humeri, and passing out between the ulna and radius. He had been afflicted with great pain the space of six weeks. I found the wound undigested,[96] and full of a loose, soft, white flesh, the bones fractured, and not likely to unite, many shivers lying included within the joints, and incapable of being drawn out. The lower part of the arm was oedematous to the fingers’ ends as full as the skin could well contain, and the upper part was inflamed; also about the os humeri and axilla a perfect phlegmon was formed. The patient thus tired with pain, desired to be cured or have his arm cut off. To which purpose he had procured the Governor’s leave for my staying with him. But, while that phlegmon was upon the upper parts, there was no hope of a prosperous amputation, nor of cure while those shivers of bone lay pricking the nervous parts within the joint. The phlegmon was too forward for repercussion,[97] and yet not likely to suppurate in less than a week’s time. Wherefore I endeavored by emollients and some discutients to succour the grieved shoulder and parts thereabout by hindering the increase of the phlegmon, and to give some perspiration to the part. Then with good fomentations I corroborated the weak and oedematous member below; in which end I also raised his hand nearer to his breast. Also by detergents and bandage I disposed the wounds and fractured part to a better condition, made way for discharge of matter, and endeavored to extract the shivers of bones; then applied medicaments to remove the caries. After some days the abscess suppurated in the upper part of the shoulder and in the armpit; and while the matter discharged from thence, the tumour discussed, and that upper orifice cured soon after. But the continual pain in the fractured joint kept that opening in the axilla from healing. The patient growing weaker, and without hopes of cure, I was necessitated to proceed to amputation. To which purpose I sent to Chester to Mr. Murry, a knowing chirurgeon (since Mayor of that city), to come with instruments and other necessaries, whereby I might the better do the work. He accordingly came, and we prepared dressings ready; which were stupes or pledgits of fine short tow well worked, some like splenia [bandages], others were round, and bigger or less. We wetted them all in oxycrate [water and vinegar], and dried them; et cetera....

The apparatus thus made, and the patient some while before refreshed with a good draught of caudle [98] After which, with as few motions of my saw [as possible], I separated the bone, the patient not so much as whimpering the while. After this Mr. Murry thrusting his hands downwards with the museulous flesh and skin which he had drawn upwards, I passed a strong needle and thread through the middle of the flesh and skin on both sides, within half an inch of the edges, and brought the lips close within a narrow compass; and having tied that ligature fast, and cut off the string, I passed the needle again through the two contrary sides, which I tied as close; then loosened the ligature above, and applied the little round stupes of tow spread with a quantity of Galen’s powder mixed with egg albumen. The long pledgits were applied from the middle of the stump each way upwards along the arm, over which I put on a bladder and a cross cloth, then rowled up the stump, and made the bandage [pass] under his other arm and over his neck.... He being thus dressed up, we put him into his bed. The third day we took off his dressings, and found the stump well digested, and at least two spoonfuls of matter discharged.... During which the bone exfoliated, and the stump soon after cicatrized. Then having procured a pass to come to London, I hastened away.

(2) A lady coming to town with a swelling in her left breast, consulted some of our Profession, and at last me. She said she had some years since kernels in her breast, which were judged the “King’s Evil”; upon consideration of which she was presented to His Majesty, and touched. In progress of time they swelled, and her breast being extremely painful, she desired my judgment of it. The swelling was large and round, and greatly inflamed, under which it was soft and seemed to have matter in it. The parts more distant were hard, and several tubercles lying under the skin made it unequal; yet the breast was not fixed. She urged me instantly to deliver my thoughts of it; which to decline I turned from her, and told her friend it was a cancer, and that I saw no hopes to save her life but by cutting it off. He wished me to consider how I delivered such judgment of it, two chirurgeons having lately assured her the contrary, they taking it for a phlegmon. But I, not being used to guide my judgment by what others delivered, confirmed to him what I had before said by a sad prediction, which befel her in few weeks after. And indeed there was no way then to deal with it but by cutting off her breast.

One is not a little startled, after reading a number of case-histories like the two which I have just reproduced, to discover other portions of text (Vol. I., pp. 384 and 385) which show clearly that Wiseman, although a surgeon of the most practical character and a man equipped with excellent reasoning powers when he was placed in the presence of most of the problems which are constantly being submitted to physicians for solution, was nevertheless the victim of a belief that supernatural powers may reside in certain human beings. Speaking of the cure of the “King’s Evil”—also called by him “struma” and “scrofula”—Wiseman, in the chapter which he devotes to this subject, makes the following statement:—