Some of his details of technique are very interesting as showing how carefully he thought out even minor problems connected with the practice of surgery. For instance, he says as to wounds of the face, that as "the beauty of the countenance is what above every other thing makes men beautiful, the surgeon must take the greatest care that no ill-looking or ugly union should take place in it, and just as far as possible the parts should be brought together and kept in apposition, with as delicate means as possible, until healing has taken place."
On the other hand he does not hesitate to discuss even fractures of the breast-bone, and says that if the patient expectorates blood it is a bad sign, for almost surely some of the arteries lying under the bone have been ruptured. He suggests position to help in the correction of deformity and displacement of the bone, and mentions that some of the older surgeons sought to raise it up by means of large dry cups. In fractures of the ribs similar recommendations were made, but Brunschwig was of the opinion that they did more harm than good. He recommended bandages, thickened with albumen, or leather moulded to the part, and he covered the thorax with a large binder.
There is no doubt at all that he knew very well the books of his predecessors and that he had thoughtfully adapted them in the way that had been taught him by his forty years of experience. He begins his book with a dedication to the praise of God and His Mother, not forgetting the honorable magistrates of the city of Strassburg. He says in the preface that he is tempted to write his book because there are many young, inexpert masters of surgery in the care of wounds who do not understand it and consequently inflict much harm on mankind. He hopes to be able to instruct them and also others who, living in the smaller towns and villages, have not had the opportunity to see the practice of surgery and yet must be able to help the ailing and injured. The picture of the position of the surgeon of the time is rather interesting.
The next of the German surgeons of this period was Hans von Gerssdorff, who practised in Strassburg. His well-known work is the "Field Book of Surgery," in which he gives some of the experiences of long years as a military and municipal physician. The book was issued with a series of woodcuts, some of them anatomical but most of them surgical in interest, which are very well executed. His illustration of an amputation is the first one of this subject ever made, and there are many pictures of his instruments. We have only room to note some of his discussions of subjects usually not supposed to be thought of in his time. He discusses wounds of the liver, especially such as occur from large wounds of the abdomen, and says that if the liver substance itself has been wounded the issue will surely be fatal. If the liver is not wounded, yet appears in the wound, it should be replaced and the external wounds sewed. His discussions of wounds of the deep organs are all in about this same conservative strain.
Gerssdorff has much to say with regard to contractures and anchyloses. When these deformities are to be corrected, the tissues around the joints should be softened by means of embrocations and the rubbing in of old oil, and the contractures gradually overcome by manipulation or by instrumental means. He invented a number of apparatus for stretching such contractures, and four of the large pictures reproduce them. They are partly in the shape of armor or [{425}] splints so arranged that they can be bent or made straight by means of a screw. There is also a screw arrangement for bringing about extension in various directions. He did not believe very much in going too slowly about the correction, for he declares that most of the contractures and anchyloses can be overcome in a few hours.
In discussing amputations he mentions the use of anaesthetics by the older surgeons, and quotes from Guy de Chauliac the method of anaesthesia employed by him, but he thinks that better results are obtained without the use of such material. He had never employed anaesthetics himself, though he had performed over 100 amputations. Perhaps his Teutonic people were able to stand pain better than the patients of the Latin countries. The refusal to use anaesthetics is very interesting at this time, for the practice gradually disappeared and was forgotten. Gerssdorff warns particularly against the use of opium alone as a means of preventing pain, and Chauliac had done the same thing earlier.
The spirit that the surgeons of the time were expected to have is very well illustrated by a passage from John Hall, written shortly after the close of Columbus' Century in his "Historian Expostulation," which is referred to more at length in the chapter on Medicine. He said, "I would therefore that all Chirurgiens should be learned, so would I have no man think himself learned otherwise than chiefly by experience, for learning in Chirurgery consisteth not in speculation only, nor in practice only, but in speculation well practised by experience."
Dr. Hall made a series of rhyming verses which were meant to be helpful to the young surgeon to enable him to recall his duties readily. He urged him above all never to treat a case unless he understood it, when in doubt to call in a consultant and advises him after consultation to console the patient, but to talk seriously to some of the patient's friends. Above all not to disturb the patient's feelings. Among other excellent bits of good advice he insists very much on the knowledge of anatomy, and two of his rhyming stanzas regarding it seem worth while quoting to show the spirit in which he wrote: