The century of Columbus

by James J. Walsh

Ordinarily it is assumed that surgery has received almost its only and its greatest development in our time. Probably no development of knowledge that has come to us in the recent revival of interest in the history of medicine has been more surprising than the finding that surgery had several periods of great progress before our time. One of these and the most important came during the thirteenth and fourteenth centuries. Another great phase of surgical advance, after a period of decline such as seems inevitable in all human affairs, occurred during the Renaissance. It had its origin in or at least was greatly influenced by the publication of the chapters on surgery in the Latin and Greek classics, though strange as that may sound to modern ears even more was probably accomplished for surgical development by the printing of the text-books of the later mediaeval surgeons. The new impetus thus given affected nearly every phase of surgery and accomplished ever so much more than we would be likely to think possible, only that the republication of old surgical text-books in recent years has proved such a revelation to us.

As I have said in preceding chapters, one of the greatest debts of the modern time to the Renaissance is due for the printing of old books in the early days of printing. Scholars were willing to give liberally of their time and to devote patient labor to secure a good text for the printers, and somehow or other great printers succeeded in bringing out usually in magnificent editions, though of small size as regards the number of copies, not only the ancient but what we have now come to recognize as the mediaeval classics of medicine and surgery. The chapters on surgery in such writers as Aëtius, Alexander of Tralles and the Arab writers like Abulcassis are among the most important contributions to the medicine of [{410}] their time. The text-books on surgery of such men as Theodoric, Hugo of Lucca, the Four Masters, William of Salicet and Guy de Chauliac are landmarks in the history of a great surgical era. All of these were reprinted usually in magnificent editions during Columbus' Century. Without such reprinting at a cost of time and money that we can scarcely understand, many of these precious treasures of the history of medicine and surgery would almost surely have been lost. Certainly very few of them would have remained in the manuscript forms in which they then existed and at most, only in seriously mutilated conditions. There have been several centuries since when they would have been utterly neglected, for almost no hint of their value survived and there was an impression prevalent that no one knew anything either about medicine or surgery during the Middle Ages at all worthy of preservation. This publication of the old text-books gave an impetus to the surgeons of the time that brought about a great new era in surgery, though there were other important factors at work in producing this. Above all the development of anatomy made for a corresponding development in surgery and by increasing men's knowledge of the tissues through which operations had to be made, added to their confidence and decreased the mortality of surgical intervention. The magnificent hospitals of the time are of themselves the best possible evidence of proper care for patients, not alone in a medical, but also surgical way. It cannot be too often repeated that whenever hospitals are well built, properly cared for and suitably maintained, there is sure to be good medical practice and a fine development of surgery; whenever hospitals are neglected, medical and surgical practice both sink to a very low standard. Hospital construction reached a very high plane during the Renaissance period, only to sink afterwards, as did every other constructive effort for humanitarian purposes, to what Jacobsohn, the German historian of hospitals and care for the ailing, calls an indescribable level of degradation. Literally, the worst hospitals in the world's history were erected at the end of the eighteenth and the beginning of the nineteenth century. Hospital organization and maintenance inevitably sank in the same way. A corresponding decadence in medical and surgical practice could [{411}] not help but occur,--fortunately to be followed by the progress of our own time. There are many, however, who seem to think that because the twentieth century is so far ahead of the early nineteenth it must be correspondingly in advance of preceding centuries. This assumption constitutes the most important reason for the very common failure in our time to understand properly the history of medicine and surgery as well, indeed, as that of every phase of science.

This was the period when gunpowder began to be used extensively in the operations of war and it is not surprising that a great deal of attention was given to gunshot surgery. We have four books, treatises in their way on gunshot wounds, that were written at this time by men of large experience. They made mistakes of course, there is no period in the world's history, even our own, when men have not made mistakes, but the surgeons of Columbus' Century accumulated an immense number of observations and gradually worked out a rather valuable set of suggestions with regard to the treatment of various kinds of wounds. At the beginning of the century they made the mistake of thinking that bullets caused both poisoned and burned wounds, and they were over-anxious to treat these imaginary consequences rather than the mechanical effects produced in their passage. They gradually worked out their problems however, even using experiment in order to show the effects of wounds. Braunschweig, Felix Würtz, De Vigo and Ferri are the classics of the time on gunshot wounds and their books have probably been more read in our generation than in any other since the end of the sixteenth century. Nothing is indeed more surprising than the recognition of the value of the observations made by these old-time surgeons which has come in the last twenty years.

The greatest of the surgeons of Columbus' Century is the Frenchman, Ambroise Paré, who has come to be spoken of as the Father of Modern Surgery. He well deserves the title if we restrict it definitely to the modern time and do not conclude, as so many do, that there had been no surgery since the classical period, for, of course, there was a very great era of surgery during the thirteenth and fourteenth centuries, but as is the way with humanity a period of decadence occurred, [{412}] followed by another upward phase in the curve of history of which in his time Paré is the apex.

It is to him that we owe the treatment of gunshot wounds by simple water dressings, or at most by aromatics. When he began his work they were treating gunshot wounds as if they were poisoned and burned wounds by pouring boiling oil along the track of the bullet. Paré ran out of oil on an historical occasion but found that the wounded left untreated recovered with less pain and complications than those subjected to the heroic remedy. He recognized the mistake and had the genius to correct it properly. He reinvented the ligature, though, of course, it had been in use a number of times before and had gone out because of the tendency to produce sepsis involved in it, and because so often secondary hemorrhage occurred from the coming away of the ligature in the suppuration which ensued. He deserves, as do several others, the credit of real invention in its use. Paré himself speaks of this discovery, which he made just at the close of Columbus' Century, as an inspiration which came to him through Divine Grace.

In nearly every department of surgery Paré left his mark. He was a thoroughly practical surgeon. He suggested, as did also Maggi, the Italian surgeon at this time, exarticulation as an important mode of amputation. This consisted of the removal of an injured limb or a gangrenous member at the joint just above, because in this way there was less danger of complications and a better stump could be obtained for subsequent use. In order to demonstrate that gunshots did not make a burned wound he demonstrated that when balls are fired even into a bag of gunpowder it does not explode. Maggi [Footnote 43] independently made this same observation but went further and showed also that shot do not melt when they strike a hard surface and that balls of wax that are fired do not spread out [{413}] as if the wax were melted. This series of experiments made to demonstrate certain valuable points in gunshot surgery is quite worthy of the most modern time and indicates well the thoroughly scientific spirit that was abroad at this period. Paré also suggested that cut tendons should be sewed, the ends being carefully brought together and that no portion of the tongue should be removed after injury, but the parts should be brought together, for there was great power of healing in this organ. He advised the cutting of the uvula with a ligature gradually made tighter and he, as well as Franco, devised an apparatus to fill up the cleft in the bone of a defective palate and other similar mechanical appliances.

[Footnote 43: Anyone who doubts the ability of the men of this time to discuss a practical scientific question from a thoroughly scientific standpoint with experimental demonstrations and close reasoning, should read Gurlt's account of Maggi's experiments with gunshot, and the German surgeon's comparison of the conclusions of this colleague of the early sixteenth century with the facts brought out by the discussion of the same subject after the Franco-German War of 1871 and the experiments which were made just afterwards along the same line.]

HOLBEIN, DR. WILLIAM BUTTS

Indeed from the mechanical side of surgery Paré is the most interesting. Orthopedics, that is the treatment mechanical and surgical of deformed children, in order to bring about their cure or at least the lessening of their deformity, is generally supposed to be new, but there are many suggestions for it in the Renaissance period. Helferich in his "Geschichte der Chirurgie" in Puschmann's "Handbuch" says, for instance, that Paré's orthopedic armamentarium was rather extensive. He used various apparatus and specially designed shoes with bandages in order to bring on the over-correction of club foot. He treated flat foot in various ways and particularly by the use of special shoes. He invented a corset with holes in it for ventilation to be worn for various torsions of the spine and other spinal deformities. He and Fallopius taught the value of resections for joint troubles of various kinds and even for deformities. Paré declared that genu valgum, that is knock-knees, were due to similar causes as those which produced club foot, or at least that the affections were related.