Another important surgeon of the West of Europe whose book has come down to us was John Yperman, who owes his name to the fact that he was a native of the town of Ypres (in Flemish Ypern) in Flanders. Yperman was sent by his fellow-townsmen to Paris in order to study surgery, apparently at the expense of the municipality, because they wanted to have a good surgeon in their town, and Paris seemed the best school at that time. Ypres, so familiar now as the scene of bloody battles, had become even before the war one of the less important cities even of Belgium, with less than 20,000 people. It was in the thirteenth century one of the greatest commercial cities of Europe, and probably had several hundred thousand inhabitants. The great hall of the Cloth Guild, one of the architectural triumphs of the time, and such an attraction for visitors to the town ever since (destroyed in the war) was built at this time, and is another tribute to the community feeling of the citizens, who determined upon the very sensible procedure of assuring the best possible surgery for themselves and fellow-citizens by having one of their townsmen specially educated for that purpose. Yperman’s book on surgery was well known in his own time, but remained unprinted until about half a century ago (1854), when Carolus of Ghent issued an edition. Subsequent editions were issued by Broeckx, the Belgian historian (Antwerp, 1863), and by van Leersum (1913), who gathered some details of the great Flemish surgeon’s life. After his return from Paris, Yperman obtained great renown, which maintains in the custom extant in that part of the country even yet of calling an expert surgeon “an Yperman.” He is the author of two works in Flemish. One of these is a smaller compendium of internal medicine, which is very interesting, however, because it shows the many subjects that were occupying physicians’ minds at that time. He treats of dropsy, rheumatism, under which occur the terms coryza and catarrh (the flowing diseases), icterus, phthisis (he calls the tuberculous, tysiken), apoplexy, epilepsy, frenzy, lethargy, fallen palate, cough, shortness of breath, lung abscess, hæmorrhage, blood-spitting, liver abscess, hardening of the spleen, affections of the kidney, bloody urine, diabetes, incontinence of urine, dysuria, strangury, gonorrhœa, and involuntary seminal emissions—all these terms are quoted directly from Pagel’s account of his work.

There is not much to be said of the surgery of Germany during the Middle Ages, though toward the end of this period a series of important documents for the history of surgery were written which serve to show how much was being accomplished, though the subsequent religious and political disturbances in Germany doubtless led to the destruction of many other documents that would have supplied valuable information. Heinrich von Pfolspeundt’s book, which is a work on bandaging—“Bundth-Ertzney”—was published in 1460, and the experience for it was therefore all obtained in the Middle Ages. While its main purpose is bandaging, it contains many hints of the surgical knowledge of the time. There are chapters devoted to injuries and wounds, though it is distinctly stated that the book is for “wound physicians” (Wund Aertzte) and not for cutting physicians (Schneide Aertzte)—that is, for those who do operations apart from wounds. There are two operations described, however, that have particular interest. One of them involves the plastic surgery of the nose, and the other the repair of a hare-lip.

Pfolspeundt suggested that stitches should be placed on the mucous surface as well as on the skin surface, after the edges of the cleft in hare-lip had been freshened in order to be brought closely together for healing with as little deformity as possible. Perhaps his most interesting surgical hint for us is a description of a silver tube with flanges to be inserted in the intestines whenever there were large wounds, or when the intestines had been divided. The ends of the gut were brought together carefully over the tube and stitched together, the tube being allowed to remain in situ. Pfolspeundt says that he had often seen these tubes used and the patient live for many years afterwards. While this resembles some of the mechanical aids to surgery of the intestines that have been suggested in our time, this was not the first mechanical device of this kind that had been thought of. One of the later medieval surgeons in Italy, one of the Brancas, had employed the trachea of an animal as the tube over which the wounded intestines were brought together. This had the advantage of not having to be passed, for after a time it became disintegrated in the secretions, but it remained intact until after thorough agglutination of the intestines had occurred.

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BRUNSCHWIG’S SURGICAL ARMAMENTARIUM

From Gurlt’s “Geschichte der Chirurgie”

Hans von Gerssdorff and Hieronymus Brunschwig, who flourished in the latter half of the fifteenth century in Germany, have both left early printed treatises on Surgery which give excellent woodcuts showing pictures of instruments, operations, and costumes, at the end of the medieval period.