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 ' ■•] CAT. NO ?3 233 PRINTED IN U.S.A.
 
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 or/
 
 THE HISTORICAL RELATIONS 
 
 OF 
 
 MEDICINE AND SURGERY
 
 " Or, comme il est impossible de connaitre parfaitement lapartie, 
 si Von ne connaU au moins grosso modo le tout, il est ivipossihle 
 d'Hre hon chirurgien si Von ne connaU pas les principles et les 
 generalites les plus importantes de la medecine. D'autre part, 
 comme il est impossible de connaltre parfaitement le tout, si Von 
 ne connaU dans une certaine mesure chacune de ses parties, il est 
 impossible que celui-ld soil bon medecin qui ignore absolument Vart 
 de la chirurgie." 
 
 Henri de Mondeville.
 
 THE 
 
 HISTOEICAL EELATIONS 
 
 OF 
 
 MEDICINE AND SUEGERY 
 
 TO THE END OF THE SIXTEENTH CENTURY 
 
 AN ADDRESS 
 
 DELIVERED AT THE ST. LOUIS CONGRESS 
 
 IN 1904 
 
 BY 
 T. CLIFFORD ALLBUTT, M.A, M.D. 
 
 HON. M.D. (duel.), HON. LL.D. (GLASGOW) 
 HON. D.SC. (OXF. AND VICT.), F.K.C.P., F.R.S., F.L.S., F.S.A. 
 
 UEGIUS PROFESSOR OF PHYSIC IN THE UNIVERSITY OF CAMBRIDGE 
 
 FELLOW OF GONVILLE AND CAIUS COLLEGE, HON. FELLOW 
 
 ROYAL COLLEGE OF PHYSICIANS OF IRELAND, AND 
 
 OF THE NEW Y'ORK ACADEMY OF MEDICINE 
 
 3Lontron 
 MACMILLAN AND CO., Limited 
 
 NEW YORK: THE MACMILLAN COMPANY 
 1905 
 
 A II rights reserved
 
 
 TO MY 
 
 MANY GENEEOUS AMERICAN FRIENDS 
 
 FRIENDS AS GENEROUS IN THEIR HOSPITALITY 
 
 TO THE STRANGER 
 
 AND THEIR APPRECIATION OF HIS DIFFIDENT SERVICE 
 
 AS IN THEIR LOVE OF LEARNING 
 
 THIS TRACT IS DEDICATED 
 
 S. Francisco, 1898. 
 St. Louis, 1904.
 
 PEEFACE 
 
 In Inner medicine, as in all the other departments 
 of the Congress at St. Louis, two addresses were 
 proposed — the first to deal with the outward rela- 
 tions of the subject, the second with its internal 
 problems. My colleague, Dr. Thayer, was so good 
 as to commit to me the outward relations, as in 
 this respect I had some materials already in hand. 
 In recent times the relations of medicine and surgery 
 have become so complex, and in certain directions 
 are still so perverse, that I have preferred to deal 
 with them at their sources, and in their earlier and 
 simpler connexions and contrasts ; that is, in ancient 
 and medieval times. In the times of Greece and 
 Alexandria medicine and surgery were one ; to the 
 clear eye of the Greek they could not be sundered : 
 in medieval times on the other hand new and 
 vaster social constructions, new and more conflicting 
 conditions, compelled our fathers to build in their 
 eagerness on a narrow and temporary framework. 
 
 The analytic historian lays bare the Middle Ages 
 of Europe ; he goes to the sources, he works up his
 
 viii MEDICINE AND SUEGEEY 
 
 descriptions, and we think we are learning some- 
 thing of that wonderful time until we drop pikes 
 justificatives for the Canterhiry Tales, and the drone 
 of the lecture-room for the clarion of St. Bernard, 
 or perchance wander into one of its minsters 
 during the Benedicite or the Be profundis, and 
 start almost with fear to discover that their 
 deeper and richer possession seems farther from 
 us than ever. While we were repainting their 
 pageants, deploring their furies, refuting their 
 dialectics, it is suddenly revealed to us that to 
 refute the conceptions of medieval thinkers is 
 not to explain the origin of their ideas, and that 
 beside their vision and their passion our hearts 
 have grown cold and slow. To the Middle Ages 
 we may adapt the fine thought of Burke that 
 " dark confused uncertain images have a greater 
 power to form the grander passions than those 
 have which are more clear and determinate." And 
 as to our modern civilities, have not these new 
 islanders of the Pacific put them all on before 
 our eyes, in a few months as it were ; and dressed 
 them even better than we have done ! Still 
 in our way we must on, anatomising the Middle 
 Ages and searching for the lost key of their lyrical 
 secret, that peradventure by dismembering the body 
 we may reach its soul. Or is it rather by chemistry 
 that we may extract this essence ? Is it by weigh- 
 ing the spirit of Ionia, the spirit of Eome, the spirit
 
 PKEFACE ix 
 
 of Byzantium, the spirit of Cordova, that we shall 
 capture the essence of Chartres, of Fulda, of Paris, 
 of Bologna, of Florence ? One spirit, indeed, glows 
 through all their magic, a fire never utterly extinct, 
 the spirit of ancient Greece — of Ionia, Athens, and 
 Greek Italy, and so of all Italy, penetrating the 
 alien hearts of Jew and Syrian, of Gaul and Spaniard, 
 of Frank and Teuton, and revealing to all the wonder 
 and beauty in common things. 
 
 As we cannot know any part of an age or people 
 without an idea of the whole, nor take to ourselves 
 a lesson from other times and other folk without 
 some conception of their nature and fashion, so 
 we cannot know modern Medicine unless we study 
 it as a whole, in the past as well as in the present. 
 From Greece and medieval Italy we have to bring 
 home the lesson that our division of Medicine ^ into 
 medicine and surgery had its root not in nature, nor 
 even in natural artifice, but in clerical feudal and 
 humanistic conceits. " Quae enim in natura fundata 
 sunt crescent et augeantur ; quae autem in opinione 
 variantur non augentur." 
 
 If we inquire more closely how Medicine fared 
 in the fiery youth of modern Europe, we may offer 
 at any rate two parts of the answer : first, the 
 iron rule of prince and prelate, wicked as individual 
 
 ^ In this essay I have written " Medicine " (with capital initial) 
 to signify our profession as a whole ; and "medicine" (with small 
 initial) to signify "Inner medicine," as divided from surgery and 
 obstetrics.
 
 X MEDICINE AND SUEGEKY 
 
 rulers have been, was possible because the peoples 
 felt instinctively the radical and universal need of 
 the age to be that the elements of the new Europe 
 should be welded into a stable and coherent whole. 
 This passionate idea of unity, called now the Church, 
 now the Empire ; here visible as the feudal tramp 
 of the crusades, there as the tyrannous vociferations 
 of the schools, would brook no schism, ecclesiastical 
 social or personal. As of every other sphere, so 
 this spirit of domination took possession of Medicine, 
 and therein set up the idolatry of Galen as inexorably 
 as that of Aristotle in the sphere of philosophy. 
 Whatever at one period were the constructive effects 
 of this despotism, when it had outlasted its time it 
 became as oppressive to Medicine, and to all know- 
 ledge, as formerly it had been socially integrative. 
 
 Secondly — or indeed it is another aspect of these 
 reflections — the soul of the Middle Ages was a 
 collective soul ; its great works were the offspring 
 not of individuals but of peoples. Who built the 
 minsters, who painted the windows and the Books 
 of Hours, who wrote the liturgies and chansons, 
 we know not. As the churches, the liturgies, the 
 manuscripts, the poetry and drama were achieve- 
 ments not so much of persons as of congregations, 
 so also medieval learning was for the most part 
 the learning of inspired crowds at the heels of a 
 rhetorician. 
 
 Thus all this medieval achievement, fervid and
 
 PKEFACE xi 
 
 beautiful as it was, could uot do much for science ; 
 nor even for the intellectual harmonies of the fine 
 arts. As the medieval spirit was multiform and 
 catholic, the Greek spirit on the contrary was choice 
 and personal, and owed its being to individuals — 
 to Ictinus and Mnesicles, Phidias and Polygnotus, 
 Homer and Aeschylus, Plato and Aristotle, Man- 
 tegna and Donatello. The Greek was an in- 
 dividualising and an emancipating spirit, the 
 medieval collective and enthralling — a genius 
 of assemblies and associations of men. It was 
 by strife of individuals for personal development 
 that through much suffering Greek thought and 
 the personal life was reawakened ; and until this 
 emancipation scientific research and intellectual art 
 were impossible or ineffectual. In art the finer 
 harmonies of form and the conscious appreciations 
 of the personal artist were not medieval but 
 Greek ; likewise in science the spirit of individual 
 research and the freedom of individual opinion 
 were impossible under the oppressions and the 
 checks of collective despotisms. In this cause 
 of the individual against society, if Luther and 
 Knox were triumphant Dolet and Bruno were 
 burned, Galileo and Palissy were spared re- 
 luctantly. It is interesting to reflect however that 
 as in Italy a sense of unity never died away, even 
 in medieval times, so in this land the need of a 
 compulsive uniformity was less passionately felt ;
 
 xii MEDICINE AND SUEGEEY 
 
 and, until the ascent of the malignant star of Spain, 
 a larger life was open to the sciences and to 
 Medicine, especially in the free cities of Florence 
 and Venice. But in France a new nation had to 
 be forged out of conflicting and reluctant elements ; 
 and therefore till consolidation was achieved the 
 framework of custom had to be as rigid as steel. 
 Thus in Paris Medicine, like other energies, was 
 far more rigidly fixed by sacerdotal scholastic and 
 military convention than in Italy ; in Paris the 
 inflexible rule of privilege strangled all quickening 
 in science and stiffened its professors into obsequious 
 automatons. 
 
 To the student of Greek Medicine the separa- 
 tion in later times of surgery from medicine, which 
 cut most deeply in Paris, seems as false in notion 
 as in practice it has been pernicious. If the 
 modern surgeon is vexed to hear that surgery is, as 
 Galen declared, but a method of treatment, he is 
 vexed by a truth which in the best interests of 
 our profession he ought to welcome. That in later 
 ages in Europe the field of surgery has been 
 avoided by the "physician," and the field of 
 medicine forbidden to the surgeon, and that by 
 this unnatural schism Medicine has suffered much 
 bane, is illustrated in history, as it is day by day 
 in the fragmentation of our work. For example, 
 a few weeks ago an able surgeon wrote — and so 
 far as I read him — in no ironical mood : " Let
 
 PEEFACE xiii 
 
 us realise that the Cci3cum in these cases is the 
 physician's, and the appendix the surgeon's. . . . 
 This would make an honourable draw of the tug- 
 of-war." In the next paragraph he wrote : " Those 
 cases which apparently do not get well after an 
 affected appendix has been removed have only them- 
 selves and the physician to blame . . . when the 
 surgeon has done his share." What a mockery 
 for the physician no doubt the shrewd surgeon 
 knew well enough. Another surgeon demurely 
 writes : " Here I am afraid to go on lest I should 
 trench upon the subject of medicine." Professor 
 Penzoldt more frankly laments the evil of the 
 factitious division of practice into medicine and sur- 
 gery, and sees no compensation for its disadvantages. 
 How ungracious a part all this is for the surgeon, 
 how hollow a part for the physician, how incon- 
 venient, mischievous and adverse to the organisation 
 of our science and art it is my purpose to enforce. 
 How many years have we lost in such maladies as 
 infantile palsy, diseases of the stomach, diseases of 
 the pelvis, and so forth, because surgeons pretend 
 to be " afraid to trench upon " a large and essential 
 part of their own pursuit, and because physicians 
 have been brought up in unhandy ways. 
 
 It will not be supposed that I ignore the limits 
 and diversities of human faculty, for to one may be 
 given manual dexterity, to another sagacity of ob- 
 servation and inference ; nor forget the field of
 
 xiv MEDICINE AND SUEGEEY 
 
 Medicine is so vast that for the narrowness of man's 
 capacity it must be divided : what I urge is that 
 the limits should be by personal choice on natural 
 lines, not by the survival of medieval rules, even 
 in their own day vicious, whereby we have made 
 an idol of this divergence, telling each physician, 
 each surgeon, that he shall not follow the bent and 
 growth of his own faculties and the intimate tracks 
 of nature, but that, whatever his capacities and 
 occasions, thus far he shall go and no farther ; in 
 the use of his natural gifts he shall be fettered by 
 an artificial rule. Every wise man learns, but too 
 soon, his own defects, his own limits, his own bents, 
 and the natural economy which they impose upon 
 him ; but to maintain separate Colleges to intensify 
 schism, to separate the man who treats a disease 
 with one remedy from the man who treats the same 
 disease with another remedy, to distribute half of a 
 malady to one practitioner, to another the remnant, 
 to encourage in the surgeon a show of ignorance 
 of one portion of a disease which he has to treat, 
 and the pretence of taking this at second hand 
 from another, to prescribe to the physician that he 
 may carry a merely inferential knowledge of a 
 disease to the utmost, but shall not occupy himself 
 with the directest way of ascertaining its intimate 
 nature, and perhaps the only way of curing it, is 
 contrary to nature, art and common-sense. Surely 
 the hour has come to amalgamate medical institu-
 
 PEEFACE XV 
 
 tions and customs, to establish an Academy of 
 Medicine every member of which shall be free 
 to develop his faculties in whatsoever honourable 
 paths they may lead him, and formally to recognise 
 an integration which, in spite of custom, in ophthal- 
 mology, dermatology, gynaecology, has established 
 itself before our eyes. In diseases of the abdomen 
 shall we continue to hamper and confine the 
 disciples of Hippocrates, Linacre, and Harvey in the 
 study of the anatomy of the living disease which 
 is the privilege of their brethren who own allegi- 
 ance to Hippocrates, Pare, and Hunter ? In 
 cerebral surgery for instance is it not absurd for 
 one institution to deny, let us say, to Sir William 
 Gowers and Professor Terrier a liberty which by 
 another institution is granted, let us say, to Professors 
 M'Ewen and Horsley ? 
 
 It is unnecessary to carry on this argument 
 into the diseases of the stomach, of the peritoneum, 
 of the gall-bladder, of the pancreas, and so forth, 
 where the surgeon, besides his peculiar advantages, 
 has all that liberty of inferential methods with 
 which alone the physician has perforce to content 
 himself. Does not the physician see how treacherous 
 is the bottom of this alliance ; how rapidly the 
 surgeon is not only attaining " medical " sagacity 
 but, every day correcting sagacity in the laboratory 
 of living processes, is even in security and precision 
 of diagnosis coming to surpass the mere physician ?
 
 xvi MEDICINE AND SUEGEEY 
 
 Moreover — to pass to higher considerations — the 
 habit of dwelhng rather in appearance than in 
 realities is, as Acton said, the habit of regarding 
 the report rather than the bnllet and the echo rather 
 than the report. Let us take for our new Academy 
 the Wriothesley motto : " Uiig par tout et tout par 
 ung!' 
 
 In writing of ancient authors I have preferred 
 familiar use to scientific orthography. Nothing 
 does more to make history unreal than to give men 
 pedantic names, or names which to us seem uncouth. 
 As Horace, Avicenna, Tintoret are of " our business 
 and bosoms," so are Galen, Salicet, Guy ; on the 
 other hand to write John Kaye for " Caius " would 
 be as pedantic as to substitute Albert the Great for 
 Albertus Magnus, or von Hohenheim for Paracelsus. 
 In doubtful instances however it is best to prefer 
 the less exotic forms. 
 
 In conclusion I would thank my colleague 
 Professor Howard Marsh for his charity in perusing 
 my proofs ; but I scarcely know how to do this as 
 I ought without seeming to lay upon him some 
 portion of a responsibility which I must bear 
 alone. 
 
 T. C. A.
 
 THE HISTORICAL RELATIONS 
 
 OF 
 
 MEDICINE AND SURGERY 
 
 It was I think in the year 1864, when I was a 
 novice in the Honorary Staff of the Leeds General 
 Infirmary, that the unsurgical division of us was 
 summoned in great solemnity to discuss a method 
 of administration of drugs by means of a needle. 
 This method having obtained some vogue, it behoved 
 those wlio practised " pure " medicine to decide 
 whether the operation were consistent with the 
 traditions of purity. For my part I answered that 
 the method had come up early, if not originally, in 
 St. George's Hospital, and in the hands of a House 
 Physician — Dr. C. Hunter ; that I had accustomed 
 myself already to the practice, and proposed to con- 
 tinue it ; moreover that I had recently come from 
 the classes of Professor Trousseau who, when his 
 cases demanded such treatment, did not hesitate 
 himself to perform paracentesis of the pleura, or 
 even incision of this sac, or of the pericardium. As, 
 for lack not of will but of skill and nerve, I did not 
 
 B
 
 2 THE HISTOEICAL KELATIONS 
 
 intend myself to perform even minor operations, my 
 heresy, as one in thought only, was indulgently 
 ignored, and we were set free to manipulate the 
 drug needle, if we felt disposed to this humble 
 service. About this time, when indeed few Fellows 
 of the London College of Physicians would con- 
 descend even to a digital examination of rectum 
 or uterus, certain of them, concerned with the 
 diseases of women, began to make little operations 
 about the uterus ; and, meeting after all with but 
 slight rebuke, they rode on the tide of science and 
 circumstance, encroaching farther and farther, until 
 they were discovered in the act of laparotomy ; 
 and, rather in defiance than by conversion of the 
 prevailing sentiment of that Corporation, they went 
 on doing it. 
 
 Meanwhile the surgeons, emboldened by great 
 events in their mystery, wrought much evil to the 
 " pure " physicians ; accusing them with some 
 asperity of dawdling with cases of ileus and the 
 like until the opportunity of efficient treatment had 
 passed away : nay, audacious murmurs arose that 
 such " abdominal cases " should be admitted into 
 the surgical wards from the first. . Then by 
 dexterous cures growing bolder and bolder the 
 surgeons went so far as to make a like demand for 
 cases of tuberculous peritonitis, of empyema, and 
 even of cerebral tumour. As thus the surgeons 
 laid hands on organ after organ which hitherto had 
 been sacred to " pure " medicine, and indeed as the 
 achievements of surgery became more and more 
 glorious, not only the man in the street but the
 
 OF MEDICINE AND SURGERY 3 
 
 man of the Hospital Committee also began to 
 tattle about the progress of surgery and the diminu- 
 tion of medicine, until it was only by the natural 
 sweetness of our tempers that the surgeon and the 
 inner mediciner kept friends. At a dinner given on 
 the 30th of June last to Mr. Chamberlain, in recog- 
 nition of his great services to tropical medicine, 
 this eminent statesman said, " I have often heard 
 that while surgery has made gigantic progress 
 during the last generation, medical science has 
 not advanced in equal proportion " ; then, while 
 modestly disclaiming the knowledge to " distinguish 
 between the respective claims of these two great 
 professions," he generously testified that " medical 
 research assisted by surgical science has thrown a 
 flood of light on the origin of disease, and that this 
 at any rate is the first step to the cure of disease." 
 Now Mr. Chamberlain is the first of English states- 
 men to ally himself actively with our profession, 
 the first with imagination enough to apprehend the 
 great part which medical science is playing in the 
 world already, and to realise that only by medicine 
 can vast surfaces of the earth be made habitable by 
 white men, and those " great assets of civilisation," 
 the officers of our colonies, be saved alive. It seems 
 to me then that the present is a critical moment in 
 the relations of medicine and surgery, especially in 
 England where the two branches of the art have 
 been so radically separated as to be regarded as 
 " two professions " ; a moment when it is our duty 
 to contemplate the unity of Medicine, to forecast its 
 development as a connected whole, and to conceive
 
 4 THE HISTOEICAL EELATIONS 
 
 a rational ideal of its means and ends. But this 
 large and prophetic vision of Medicine we cannot 
 attain without a thoughtful study of its past. 
 
 If thus, as from a height, we contemplate the 
 story of the world, not its pageants, for in their 
 splendour our eyes are dimmed, but the gathering, 
 propagation and ordination of its forces, whence 
 they sprang, and how they blend this way and that 
 to build the institutions of men, we wonder at 
 their creative energy, or weep over the errors and 
 the failm-es, the spoliation and the decay, which 
 have marred or thwarted them ; and if we contem- 
 plate not the whole but some part of men's sowing 
 and men's harvest, such as Medicine, the intenser is 
 our sorrow and disappointment, or our joy and hope, 
 as we admire the great ends we have gained, or 
 dwell upon the loss and suft'ering which have 
 darkened the way. In the development of Medicine, 
 said Helmholtz, " there lies a great lesson on the 
 true principles of scientific progress." ^ 
 
 Pray do not fear however lest, to fulfil the mean- 
 ing of the title of this address, I should describe 
 to you the history of medicine, and the history of 
 surgery, and on this double line compare and com- 
 bine my researches ; in the time allotted to me no 
 such survey is possible. I can but select certain 
 eminent features of the histories of these depart- 
 ments of knowledge, and compare them with a view 
 to edification ; your fear may be rather lest I should 
 
 1 ("Es liegt eine grosse Lehre liber die wahren Priuzipien 
 wissenschaftlicher Forschung in dem Eiitwickelungsgange der 
 Medizin.")
 
 OF MEDICINE AND SUEGEEY 5 
 
 dress an arbitrary story with the unrighteousness 
 of a man with a moral. 
 
 In his address on iMorgagni, at Eome in 1894, 
 Yirchow said tliat Medicine is remarkable in its 
 unbroken development for twenty-five centuries ; as 
 we may say without irreverence, from Hippocrates 
 to Virchow himself However the great patholo- 
 gist's opinion seems to need severe qualification ; if 
 so it be, the stream has more than once flowed long 
 underground. The discontinuity of Medicine from 
 Egypt to Crotona and Ionia is even greater than 
 from Galen to Avicenna, a period during which, in 
 spite of a few eminent physicians in the Byzantine 
 Empire, it sank into a sterile and superstitious 
 routine. 
 
 Classical medicine, the medicine of the fifth 
 century B.C., is represented for us by the great 
 monument of the scriptures collected under the 
 name of the foremost teacher of his age, Hippo- 
 crates; in genius perhaps the greatest physician of 
 all past time. The treatises of the Canon may be 
 divided into medicine, surgery, and obstetrics. The 
 medical treatises, when read in an historical spirit, 
 command our reverent admiration. Written at a 
 time when an inductive physiology was out of 
 reach, we are impressed nevertheless by their 
 broad, rational, and almost scientific spirit. Medi- 
 cine, even when not dominated by contemporary 
 philosophy, has always taken its colour from it ; 
 and the working physiology of Hippocrates was 
 that humoral doctrine, originally derived from
 
 6 THE HISTORICAL EELATIONS 
 
 Egypt and the East, which, as enlarged by Galen, 
 ruled over medicine till recent times. That in 
 later ages it became the engine of a fantastic and 
 tyrannous dogmatism we know but too well ; how 
 was it then that Hippocrates and his school were 
 so little perverted by it ? To pretend that it had 
 no such effect, or that the speculative schools of 
 Greece swept over medicine without perverting it, 
 would be idle. Hippocrates, w^hile distinguishing 
 between the methods of outward and inward 
 maladies ((pavepa kol aBrjXa pocr^fiara), taught that 
 even for the inner many facts are accessible to 
 methodical investigation, by careful sight and touch, 
 laborious inspection of excretions and so forth ; yet 
 as in these diseases the field of inference is much 
 larger than in the outward, the data even of direct 
 observation fell the more readily into the scheme 
 of the four humours, and by this doctrine were so 
 coloured that, although noted and pondered with 
 rare clinical insight, they were read into the scheme 
 of a fictitious pathology. 
 
 How was it then, I repeat, that the specula- 
 tive side of the medicine of the period bewildered 
 Hippocrates so little ? Because in the first in- 
 stance the clinical method of the school was broadly 
 and soundly based upon the outward maladies. No 
 sooner did an internal affection — empyema for 
 example — work outwards than the mastery of 
 Hippocrates became manifest. What we moderns 
 separate as surgery, surgery which from Galen 
 to Pare, by Clerks, Faculties and Humanists, was 
 despised as vile, and from Pare to Hunter as
 
 OF MEDICINE AND SUEGERY 7 
 
 illiberal, was in the age of Hippocrates, as in all 
 epochs of medicine since that age, its saviour. By 
 his surgery it was that Hippocrates was led to 
 announce clearly and categorically the first principles 
 of inductive research and practice ; namely, pheno- 
 mena first, then judgment, then general propositions, 
 then practical knowledge and craft. One principle 
 only, but that a great one, was wanting to him, 
 namely, experimental verification ; a principle not 
 definitely apprehended by Aristotle, nor by any 
 ancient physician except Galen. 
 
 If our admiration of the inner medicine of 
 Hippocrates, great as it is, is a relative admiration, 
 an admiration of the historical sense, of his outer 
 medicine our admiration is immediate and un- 
 qualified. Little as the fifth century knew of 
 inward anatomy, as compared with Alexandria 
 about two centuries later, yet the marvellous eye 
 and touch of the Greek phjTsician had made an 
 anatomy of palpable parts — a clinical anatomy — 
 sufficient to establish a Medicine of such parts of 
 the body of which our own generation would not 
 be ashamed. That this acuteness of the " cerebral " 
 as well as of the " retinal eye," was a note of the 
 time, is illustrated by the observation, by Professor 
 Waldstein, in sculpture of this period, of a certain 
 muscle of the groin, especially developed no doubt 
 by Greek athletics, which in its now diminished 
 form had escaped the eyes of modern anatomists. 
 
 In respect of fractures and luxations -of the 
 forearm M. Petrequin pronounces Hippocrates more 
 complete than Boyer ; in respect of congenital
 
 8 THE HISTOEICAL EELATIONS 
 
 luxations richer than Dupuytren. Malgaigne again 
 admires his comparison of the effects of nnreduced 
 luxations on the bones, muscles, and functions of 
 the limb, in adults, in young children, and before 
 birth, as a wonderful piece of clinics. In Littre's 
 judgment the work of Hippocrates on the joints is 
 a work for all time. In gibbous spine he dis- 
 tinguishes the traumatic kind from that of internal 
 origin ; and points out that in this case tubercles 
 are often found in the lungs and mediastinum, and 
 may indeed by extension be the direct cause of the 
 spinal affection ; a doctrine accepted by Galen, and 
 then forgotten till it was recalled by Zachary Platner 
 early in the eighteentli century, and re-established 
 by Delpech in the second half of the nineteenth. 
 Hippocrates chides those blunderers who take a 
 spinal apophysis for the body of the vertebra, or 
 the internal tubercle of the humerus for a part of 
 the forearm. On wounds, which in warlike and 
 unruly ages have constituted a principal branch 
 of surgery, Littre pronounces that the Hippocratic 
 books must be studied witli deep attention ; for 
 they are founded on a w*ide experience, minute and 
 profound observation, and an enlightened and in- 
 finitely cautious judgment. In the handling of 
 wounds the surgeons of the Hippocratic school 
 were indeed, as we shall see presently, far better 
 instructed than the surgeons of the medieval and 
 renaissance periods. If poultices were used they 
 were applied near but not upon the wound ; 
 tlie water for washing the wounds, unless very 
 pure, was filtered and boiled ; their linen dress-
 
 OF MEDICINE AND SUEGEEY 9 
 
 ings were of new material, and the hands and 
 nails of the operator were cleansed. Of the 
 access of air to the wound the Greeks were very- 
 jealous, a jealousy which in later times led to 
 abuse of the suture. Their local medications 
 were wine and oil, with some excess in oil ; greasy 
 applications, or salves, became the curse of later 
 surgery. In fresh wounds healing by first inten- 
 tion was expected, though in less recent and in 
 contused wounds suppuration was anticipated. To 
 foul wounds certain balsams were applied. Wound- 
 fever was known to the school, and the different 
 significance of fever in the first week and in later 
 weeks was pointed out. Puerperal fever was inter- 
 preted as a wound-fever, and its occasional origin 
 in retention of putrid uterine contents was recog- 
 nised. In wounds of the head Hippocrates warns 
 against careless interference with the temporal 
 regions, lest convulsions and palsy occur on the 
 opposite side of the body ; for the trepan was then 
 in vogue, as it had been from the darkest backward 
 of time. In spinal injury he notes that incontin- 
 ence of urine and faeces is of fatal augury. From 
 amputation of the larger limbs he flinched, as did 
 most if not all responsible surgeons down to Pare ; 
 for inner anatomy was ill-known, and ligature of 
 arteries, even in wounds, made slow way : indeed 
 before Celsus this method seems to have been un- 
 known. Caries was not definitely distinguished 
 from necrosis ; but a case of disease of the palate 
 with fallen nose irresistibly suggests syphilis. On 
 eye diseases we find much of interest, though the
 
 10 THE HISTOEICAL EELATIONS 
 
 media were imperfectly distinguished, and the seat 
 of cataract was undetected. Nyctalopia however 
 was recognised ; and relief was given by operation 
 for such diseases as ectropion, hypopyon, and the 
 like. Of obstetrical practice, I must ])e content to 
 say that it had reached a high standard ; when 
 surgery flourishes obstetrics flourish. By the very 
 wealth of knowledge in these treatises indeed we 
 realise that the Father of Medicine stood in the 
 line of a noble ancestry; and that by his genius 
 and leadership what I may call a great Paradosis 
 received a permanent form. 
 
 It is by comparison of one part of the Hippo- 
 cratic Canon with another that we learn how a 
 strong grasp of inner medicine was attained by way 
 of severe discipline on its positive or surgical side. 
 And this not by mere empiricism ; it may well have 
 been from Hippocrates himself that Aristotle learned 
 how by empiricism (i/xiretpia) we perceive a certain 
 remedy to be good for this person or for that — for 
 Socrates, let us say, or for Callias — when he has 
 a certain fever ; but by reason we discover the 
 characteristic common to these particular persons 
 whereby they react alike. In his Book of Precepts 
 Hippocrates tells us that rpi^r) jxera \6jov is the 
 basis of all medical knowledge. Now rpi^/] is 
 primarily a grinding or rubbing ; so the student 
 must rub and grind at nature, using his reason at 
 the same time : but his reason must be a perceptive 
 and interpretative, not a productive faculty ; for he 
 who lends himself to plausible ratiocination (Xoyia/xS 
 'TTidavo) 7rpocre'^o)v) will find himself ere long in a
 
 OF MEDICINE AND SUEGERY 11 
 
 blind alley ; and those who have pursued this course 
 have done no credit to Medicine. How soundly, for 
 the time, this lesson was learned we see in the 
 theoretical appreciation of these several faculties in 
 the first chapter of the Metaphysics, and in the 
 Sixth Book of the Ethics, where the senses, it is 
 urged, cannot really be separated from the mind ; 
 for, as St. Thomas forcibly reiterated, the senses 
 and the mind contribute each an element to every 
 knowledge.^ I would venture to suggest that this 
 method of observation, experience, and judgment 
 was established in Medicine first, because Medicine 
 of all arts is the most practical and imperative ; 
 and, as Aristotle says, is concerned with the indi- 
 vidual patient : thus to our art may belong the 
 honour of the first application of positive methods 
 to all subjects of natural knowledge. 
 
 The chief lesson of the Hippocratic period for 
 us is that, in practice as in honour, medicine and 
 surgery were then one. The Greek physician had 
 no more scruple in using his hands in the service 
 of his brains than had Pheidias or Archimedes ; 
 and it was by this co-operation that in the fifth 
 century an advance was achieved which in our 
 eyes is marvellous. As we pursue the history of 
 medicine in later times we shall see the error, the 
 blindness, and even the degradation of the physicians 
 who neglected and despised a great handicraft. To 
 the clear eyes of the ancient Greeks an art was 
 not liberal or illiberal by its manipulations but by 
 its ends. As because of its ends the cleansing and 
 
 ' Compare also the last chapter of the Fosterior Analytics.
 
 12 THE HISTOEICAL EELATIONS 
 
 solace of the lepers by St. Basil, St. Francis and 
 Fatlier Damien was a service of angels, so Hippo- 
 crates saw no baseness even in manipulations which 
 obtained for his followers the name of coprophagi : 
 where there is no overcoming there is no victory. 
 
 Between Hippocrates and Galen, an interval of 
 some five centuries, flourished the great anatomical and 
 medical schools of Alexandria. Our only important 
 source however for the medicine of the Alexandrian 
 period is Celsus, who lived in the reign of Augustus. 
 From Celsus we infer indeed that the brilliant 
 anatomy of Alexandria made for good practice in 
 surgery, and for surgical diagnosis ; yet the influ- 
 ence seems not to have been so direct and effective 
 as might be supposed. Haeser argues indeed that 
 too intense a devotion to healing as a craft pre- 
 vented the healer from thinking anatomically. As 
 regards the Empirical School this may be true ; for 
 by it not only was systematic thinking discouraged, 
 but ancillary science was regarded also as vain, if 
 not mischievous. Its spokesman Serapion protested, 
 against the great anatomists, that in Medicine 
 observation and record are all-sufficient. This was 
 to look at nature indeed, but with the many faceted 
 eye of the insect. No doubt with the exception of 
 anatomy the ancillary sciences were in a vaporous 
 condition, and to the hardihood of the empirics, 
 narrow as it was, medicine owed much. Still, as 
 facts will return in ever new combinations they 
 must provisionally he interpreted by analogy ; that 
 is, by the application of universals from one sphere
 
 OF MEDICINE AND SURGERY 13 
 
 to another. Thus in Airs, Waters, and Places 
 analogy was safer for Hippocrates than a rudi- 
 mentary geography and meteorology, and, as is not- 
 able in his school, it did good service in prognosis ; 
 yet analogy is so facile an instrument that even 
 in the school of Hippocrates the temptation to 
 use it became too strong and too general. Inductive 
 in spirit analogy may be, as even Serapion (in his 
 " 1] Tou ojjLOLov /jLeTdl3aaL<; ") admitted ; but it lends 
 itself very freely to airy and even to metaphysical 
 hypotheses, wares which can be turned out in satis- 
 factory profusion without that Treipa Tpi/3iKi] — that 
 grinding and rubbing in nature — on which Hippo- 
 crates insisted. For the solid work of surgery and 
 midwifery, however, such fabrics are too flimsy ; 
 they find their market in inner medicine, a domain 
 in which, as surgeons in all times have been wont 
 to complain, our failures are covered up and buried. 
 Nevertheless in the Vllth and Vlllth Books 
 of Celsus we see that surgery and midwifery had 
 made substantial progress since Hippocrates, and 
 probably since the Alexandrine School of Erasis- 
 tratus and Herophilus. Celsus, probably not him- 
 self a practitioner,^ is rather vague in detail : still, 
 
 ^ 111 deference to the opinion of the last editors of Celsus, 
 Angiolo and Lsidoro Del Lungo, who opine that Celsus was himself 
 formally a practitioner of Medicine, 1 changed the " probably not " 
 of my manuscript into " perhaps not." But on further considera- 
 tion of the arguments of the Del Lunges I have returned to "prob- 
 ably not." What Scaliger and Casaubon thought may on this 
 point have little weight with us ; that Jlorgagiii regarded Celsus 
 as a practising physician has no doubt far more. Still Dareniberg 
 [the standard Latin text is that of Dareniberg (Leipzig, 1859)1, 
 Pidoux, Broca, Veorenes, have decided otherwise ; and although I 
 cannot set my superficial impressions of this author beside the ripe 
 studies of Angiolo Del Lungo, yet I cannot help coming also to
 
 14 THE HISTOKICAL EELATIONS 
 
 besides the Hippocratic surgery, we recognise means 
 of treatment in piles, fistula, rodent ulcer, eczema, 
 fractures, and luxations ; missiles were removed 
 from their wounds ; tumours — of which surgeons 
 before and after were afraid — were excised ; the 
 nasal passages were cauterised for ozeena ; dropsies 
 were systematically tapped ; hernias were submitted 
 to radical cure ; genito-urinary diseases were attacked 
 in both sexes ; his operation for stone, as we shall 
 see, held the field till Malgaigne and Cheselden ; 
 plastic operations were undertaken ; arteries were 
 tied, and, for the first time, the larger limbs were 
 deliberately amputated — though only in extreme 
 need, and often with fatal results by secondary 
 haemorrhage and otherwise. His wound surgery was 
 Hippocratic (p. 8), and he warns the surgeon, in his 
 anxiety to exclude the air, not to use the suture 
 until the depth of the wound has been so cleansed 
 that no clot remains, for this turns into pus, excites 
 inflammation and prevents union. These chapters 
 signify a large accumulation of experience on a 
 positive method, which can hardly be predicated of 
 the inner medicine of the period.^ 
 
 the opinion that in some places Celsus speaks as a physician would 
 hardly have spoken, and in other and not a few places omits, to 
 one's vexation, those intimate details which a practical man would 
 surely have made a point of. And how strange it is that no one 
 of the physicians of the later Empire — Greek physicians, it is true, 
 but again that neither Pliny nor Quintilian — alludes to Celsus as a 
 jtractitioner ; strangely inconsistent as this calling would have been 
 with the prejudices of his class in Rome. Furthermore, we know that 
 Celsus wrote " non sine cultu et nitore" (Quintilian) like treatises on 
 agriculture, rhetoric, law, philosophy, and the art of war. Celsus, 
 it would seem, preceded Robert PuUen and Brunetto Latini as an 
 encyclopedist. After all the matter is not worth much ink. 
 
 1 Recent excavations have yielded a rich collection of surgical
 
 OF MEDICINE AND SUKGEEY 15 
 
 How active surgery was from Celsus to Galen, 
 and how honourable and progressive a part of 
 Medicine, we know from the scanty records handed 
 down to us in the compilations of Oribasius and 
 other authors. From the remnants of the writings 
 of Heliodorus we gather many things ; among 
 others that amputation was resorted to in com- 
 minuted fracture — e.g. of the leg below the knee — 
 before gangrene actually set in ; moreover that 
 the operation was very carefully performed, in- 
 cluding the preparation of some sort of flaps. 
 Archigenes of Apamea also practised in Kome, 
 in the reign of Trajan. Galen calls him an acute 
 but too subtle a physician ; such of his subtilties 
 as are known to us however — his distinction 
 between primary and consequential symptoms for 
 instance — are to his credit. He applied the liga- 
 ture in amputations ; and that remarkable man 
 Antyllus, who unfortunately is known to us only 
 in Oribasius and his copyist Paul/ applied the 
 method to the cure' of aneurysm, which however 
 Rufus seems to have done before him. Galen 
 tells us where he got his " Celtic linen thread " 
 for the purpose, namely " at a shop in the Via 
 Sacra between the Temple of Rome and the 
 Forum " : a shop near his own house, which was 
 
 instruments which are a vivid illustration of the ingenious and 
 methodical surgery of the Roman Empire. In his edition of Celsus 
 M. Vedrenes publishes plates of these, and uses them aptly in the 
 interpretation of the author. 
 
 ^ That Paul in the seventh century may have had direct access 
 to extant works of Antyllus is possible ; but the manner of his 
 citation is that of a copyist, and in matter coincides with the 
 selections of Oribasius. I ought to say that Haeser gives Paul 
 more credit for originality than I am yet able to do.
 
 16 THE HISTOEICAL RELATIONS 
 
 also in the Via Sacra, by the Temple of Peace, 
 We learn also, from Oribasius, that Antyllus prac- 
 tised extensive resections of bone in tlie limbs, 
 and even in the upper and lower jaw. Much ex- 
 cellent surgery, of which I cannot now speak in 
 detail, disappeared in the chaos of the Dark Ages. 
 
 Galen came to Eome under Marcus Aurelius. 
 In the biological sciences this great physician 
 stands to Harvey as in physics Archimedes stood 
 to another great physician, William Gilbert ; Galen 
 was the first, as for many centuries he was tlie last, 
 to apply the experimental method to physiology. 
 He embraced the ancillary sciences ; he opened 
 out new routes and he improved the old. Un- 
 happily his soaring genius took delight also in 
 the spheres of speculation ; and it was not the 
 breadth of his science nor the depth of his 
 methodical experiment, but the height of his 
 visionary conceits which imposed upon the Middle 
 Ages. Galen did not himself forget the precept 
 of Hippocrates — To look, to touch, to hear (" koX 
 ISelv, KoX Oc^elv, koI ciKovaai ") ; but he did not 
 wholly subdue himself to the irelpa rpt^LKr] — 
 this toilsome conversation with troublesome facts. 
 For example ; in a pseudo-galenist treatise, but 
 one which fairly represents what we know of 
 Galen's doctrines,^ we read ..." Trporjyecrat Se ttj^ 
 7rpd^€(o<i 7) Oewpia . . . dpxv 7^P '^V^ ^'^^'' '^^^ 
 €pyo)v Tpi/3i]<; rj Sia Tov \oyov BiBaaKakta. Nay, 
 possessed by platonist visions, enamoured of an 
 
 ^ Definitiones viedicae, Ed. Kiihn, xix. 351. Palissy said his 
 proofs were '^la veue, I'ouye et l' attouchement."
 
 OF MEDICINE AND SURGERY 17 
 
 elaborate teleology of his own, aud iu violent re- 
 action against the Empirics, he formulated an 
 eclectic doctrine contrary to the experimental reason 
 {Tpi/3r] fiera \6yov) ; and taught categorically that 
 speculation shall guide experience. So it was that 
 he imposed philosophical lectures upon students as 
 preliminary to medical study, carried speculation 
 into his physiological experiments and even into 
 anatomy itself, gave a subjective cast to his finest 
 work, and foisted metaphysics in another guise on 
 medicine. Galen did not make any great mark on 
 surgery. He followed Hippocrates in the distinction 
 between healing by first and second intention, and, 
 to promote healing by first intention, in desiring a 
 clean and dry wound, with good apposition for ex- 
 clusion of air. His tracts on the eye are lost; but, 
 so far as we know, his surgery was adopted in the 
 main from the Alexandrians, and from Soranus. 
 However, Galen successfully resected the sternum 
 for caries, exposing the heart ; and he excised a 
 splintered shoulder blade : moreover, with all his 
 bent to speculative reason, we have no hint that he 
 fell into the medieval abyss of regarding surgery as 
 unfit for a scholar and a gentleman. 
 
 As a positive discipline the diseases of women 
 may be counted with surgery; but within our limits 
 that subject cannot be discussed separately. How- 
 ever it would never do to omit the name of no less 
 a physician of the time — Soranus of Ephesus — 
 who, by the accident of surviving records, is 
 chiefly associated with these diseases. Soranus 
 practised at Rome under Trajan and Hadrian, and 
 
 C
 
 18 THE HISTOEICAL EELATIONS 
 
 was therefore a contemporary of Archigenes, and 
 little older than Galen. If in breadth of thought 
 and swiftness of invention Soranus pales before 
 Galen, yet in sober moments we may be tempted 
 to regard him as the greater physician. In 
 any case he must rank with Galen as one of the 
 greatest physicians of antiquity. If the Methodists, 
 of whom Soranus was the chief, fashioned for 
 themselves the yoke of " strictum and laxum " as 
 the poles of a new physiology, yet it is not easy 
 to say that by this doctrine they were more 
 entangled than were the dogmatists by the 
 humoral doctrine, than was Hoffmann by " tone 
 and atony," or the other systematists of the 
 eighteenth century by their respective notions ; 
 physicians, many of them at any rate, masters 
 in medicine nevertheless. The treatise of Soranus 
 on Diseases of Women may be ranked with the 
 surgical treatises of Hippocrates as a classic which 
 no lapse of time can efface ; and if on the degree 
 of his influence as a general surgeon, and on those 
 remnants of his surgical writings which have 
 floated down to us on such rafts as Aetius and 
 Paul of Egina, we have to assign to Soranus a 
 place much lower than Hippocrates, yet his place 
 was considerable enough to testify that in the 
 Empire, as in Ionia and Alexandria, Medicine was 
 saved by the honour and vitality of its surgery 
 from the fictions and the petrifactions of philo- 
 sophical systems. If in many directions, as for 
 instance in the treatment of empyema, Soranus 
 evidently fell behind Hippocrates, on the detail of
 
 OF MEDICINE AND SURGERY 19 
 
 operations for hernia, and even for stone, he was 
 clearer than Celsus. 
 
 After Galen and Soranus Medicine came to 
 the evening of its second day, to the long night 
 before the rise of the Arabian, Italian, and French 
 surgeons of the thirteenth and fourteenth centuries. 
 By the divulsion of the Empire, by the degradation 
 of morals to which even Pliny and Galen had begun 
 to bear witness, and by the inroads of barbarians, 
 arts and sciences were trampled under foot in the 
 West until by the iron scaffold of the Faith a new 
 society should be erected. In the East was more 
 tranquillity ; and the night was illumined by 
 moons, such as Oribasius, Alexander of Tralles, 
 and Paul of Egina, by whose reflected light men 
 groped their way. To these physicians our debt 
 is rather one of preservation of good tradition than 
 of discovery. Alexander was no great surgeon ; but 
 he tells us of the diagnosis of ascites by percussion, 
 of anasarca by pitting, of large spleen by palpation ; 
 and he makes some shrewd remarks on urinary sedi- 
 ments : still all these were parts no doubt of the 
 current knowledge of his time. Such swallows 
 made no summer ; and their work lies out of my 
 argument that surgery, though scorned by the high 
 stomachs of the Middle Ages, has never been the 
 child or the humble companion of medicine but 
 the stone of the corner and the key to its true 
 method. 
 
 Not only did Greek Medicine reach the medieval 
 physicians in a fragmentary, mutilated and per-
 
 20 THE HISTORICAL RELATIONS 
 
 verted form, but in this form Medicine came to them ' 
 untempered. A mutilated and special tradition 
 was separated from the organism of Greek accom- 
 plishment ; it was deprived of the Greek breadth of 
 thought, of the Greek spirit of intellectual freedom. 
 Remnants of Greek lore, thus distorted never 
 coherent, lay heavily upon minds unprepared to 
 assimilate or use them. The mystical tendency of 
 thought in the Middle Ages, the disposition to 
 ontological absoluteness, the reliance upon pre- 
 cision of argument as the means of attaining truth, 
 the transfusion of doctrine with Eastern fantasies, 
 made of the Greek Medicine a widely different and 
 far less scientific conception. By its ontological 
 form medieval thought led to the idea of a wound 
 as an entity having a substantial existence apart 
 from or imposed upon the body ; and, as such, 
 possessed of its own modes and phases of life, 
 modes and phases susceptible of independent fashion 
 and direction under the hand of the physician. 
 Moreover the scholastic tendency to dialectical sub- 
 tilties led to an elaboration of factitious schedules 
 and nomenclatures of these modes and phases, which 
 enthralled the faculty of observation ; while the mys- 
 ticism manifested itself in magic, in egregious medi- 
 cines and in barbarous perplexities of ingredients. 
 
 Thus it came about that in spite of the docile 
 industry of certain physicians of the Byzantine period, 
 medicine gradually sank not into sterility only but 
 into deep degradation : for the wholesome discipline 
 of practical surgery had fallen off. Eastern folk, who 
 bear heaven-sent sores with fatal stoicism, repel
 
 OF MEDICINE AND SURGEEY 21 
 
 the profane hand of man ; ^ and the tradition of 
 Galen made for a plague of drugs which were least 
 mischievous when merely superfluous. Nor was an 
 overloaded and a tilthy pharmacy the only sorrow 
 of the sick ; as art grew empty, sorcery, demonology 
 and astrology entered more and more into the void. 
 The Saracens, keen and intelligent as they were, 
 and rich as were their gifts to the West, did little 
 to remove and something perhaps to favour the 
 aversion from surgery, and the social contempt of it, 
 which culminated in the ban of the Council of Tours. 
 Under the sanctions of Islam anatomy was impos- 
 sible. By the door of the East, Rhazes, Albucasis, 
 Avicenna — the Arabian Galen, had entered into 
 a great scientific inheritance ; and though they 
 did not do much, it is true, to ennoble surgery, 
 yet with them it was a grave and an honourable 
 calling ; with them Medicine had not yet lopped off 
 her right arm. The Danaan gifts of the Western 
 Church to Medicine issued in a far worse treachery. 
 The Greek of Ireland, and of England in the time 
 of Bede, was banished by Augustine and the Bene- 
 dictine missionaries ; and the medicine of Monte 
 Cassino, itself indeed but a farrago of receipts, fell 
 lower and lower in the monkish hostels of the 
 West.^ We have reason however to believe that 
 
 ^ In modem Islam I understand Medicine is now almost wholly 
 in the hands of tlie barbers ; the actual cautery is in much 
 request ; and cutting for stone, and operation for cataract are in 
 the lian'ls of specialists as tliey were from time immemorial in the 
 West. Some of tliese customs are evident, even to the passing 
 traveller, in Algeria, Tunisia, or Egypt. 
 
 '^ Before printing medical precepts were often put into verse, an 
 aid to memory which it is not for us to scoff at ; though when in
 
 22 THE HISTOEICAL RELATIONS 
 
 some fair surgery persisted, even in the cloister, 
 until it was formally abandoned to the " secular 
 arm" in a.d. 1163;^ and books on surgery and 
 midwifery began to disappear from conventual 
 libraries. About the same time the University 
 of Paris excluded all those who worked with their 
 hands ; ^ so that students of medicine had to abjure 
 manual occupation, and to content themselves with 
 syllogisms and inspections of urine, often without 
 any inspection of the patient himself From the 
 University the Faculty of Medicine took its tone, 
 and the surgical corporation of St. Come aped the 
 Faculty (p. 59). But by the expulsion of surgery 
 from the liberal arts Medicine herself was eviscer- 
 ated; the pernicious bisection of Medicine was made 
 
 the third century one Serenas Samonicus wrote De meilicina 
 praccepta saluberriina, in 1115 clumsy hexameters, we can 
 scarcely wonder that Caracalla had him destroyed. Early in the 
 twelfth century Odo de Meudon, or de Meiine, wrote in poetry on 
 65 herbs and 12 medicines (Haeser) ; and the medical poetry of 
 Gilles de Corbeuil, body physician of Philip Augustus, " De 
 urinis" and " De jiulsibus," and the versifications of Salerno are 
 well known. (Cf. Kiihn, Ahh. c. Gesch. d. Med. Heft viii. 1904). 
 Unfortunntely even Fracastoro chose this fanciful shape for his 
 work on Syphilis, and was hymned in English by Nahum Tate. 
 
 1 The Rheims (a.d. 1125) and Lateran (a.d. 1139) Councils 
 restricted the surgery of the clerical or, in other words, of the 
 educated class, and no doubt feudal ideas did no less to abase its 
 services ; it was at Tours however that the sinister and perfidious 
 " ecclesia abhorret a sanguine" was first pronounced. 
 
 ^ The denunciations of the Faculty of Medicine in Paris were 
 almost as appalling as those of Ernulphus : e.g. " Famosum 
 libellum mendacibus conviciis, impudentibus calumnis refertum," 
 etc. etc. " Ipsum Torquetum indignuni judicat, qui nequam 
 medicinam faciat, propter temeritatem, impudeutiam et verae 
 medicinae ignorantiam . . . ijisum Torquetum similiaque 
 hominum et opinionum portenta a se suisque finibus arceant," 
 etc. etc. This specimen is of the late fifteenth century but is no 
 unfair instance of the spirit of the University of Paris in the Middle 
 Ages.
 
 OF MEDICINP: and SUEGEEY 23 
 
 which has not yet spent its evil : the very founda- 
 tion of the art was gone, and the clergy and the 
 faculties, in France and England at any rate, 
 devoted all their energies to shoring up the 
 superstructure. Surgery had its revenge, its hitter 
 -revenge ; but in the desecration of its own temple. 
 
 In the thirteenth and fourteenth centuries 
 however surgery, hated and avoided by Medical 
 Faculties, scorned in clerical and feudal circles, 
 began in the hands of lowly and unlettered men 
 to grow from the root ; while inward medicine, 
 withdrawing itself more and more from the sources 
 and the laboratory of nature, hardened into the 
 shell which till the seventeenth century bore but a 
 false counterfeit of life. The surgeons of the 
 thirteenth, fourteenth and fifteenth centuries, 
 reared in base apprenticeships, not only illiterate 
 but forbidden even the means of learning, lay 
 under heavy disadvantages ; yet by practical ex- 
 perience and technical resource they were making 
 the future of our art. Towards the end of the 
 fifteenth century indeed even this progress had 
 slackened ; it was soon reinforced however by 
 new and urgent problems, not of the schools 
 but of direct rougli and tumble with nature : of 
 these new problems, of which l^are became the 
 chief interpreter, the wounds of firearms were 
 perhaps the most urgent. 
 
 It is remarkable that around the papal chair 
 the velvet of the hand of the Church was 
 thicker than the iron. In the air of Eome or of 
 Avignon the grim rigour of Paris was marvellously
 
 24 THE HISTOKICAL EELATIONS 
 
 softened. In Bologna, Padua and Montpellier 
 Medicine could develop, if not freely, yet in 
 tranquillity, and undivided. The peace of Con- 
 stance (a.D. 1183) had enfranchised the great 
 Italian cities, and a truce with the Empire gave 
 to lay and clerical potentates time and occasion for 
 the foundation of universities. In Italy the unity 
 of Medicine, as in Greek and Latin ages, was still 
 preserved : in Bologna there w^ere indeed physicians 
 and surgeons and barbers, but divisions had not 
 yet gone deep ; the titles melted into one another. 
 In the twelfth century Gerard of Cremona, the 
 translator of the Arabian versions of Greek 
 Medicine, who by the frank and discreet selection 
 of his authors did more for North Italy than 
 Constantine had done in the eleventh for Monte 
 Cassino and South Italy, rendered the surgical 
 treatise of Albucasis (p. 44) into latin ; and he left 
 his books to the convent of St. Lucia, where he 
 was buried : now in those days to a school books 
 were a fortune.^ With the rise of Bologna, and 
 the richer endowments of its chairs, the school 
 of Salerno, the oldest medical school of modern 
 Europe, but the poorest in the books of the best 
 Arab physicians, began to diminish ; and Bologna, 
 quickly surpassing the other Italian schools, 
 now rivalled Montpellier and Paris. In Medicine 
 indeed Italy ^ then led the world ; in the great 
 schools of Salerno, Naples, Bologna, Padua, there 
 
 ^ In the thirteenth centnry a k-arneJ Spanish Jew, Ferragutli, 
 made tlie most im]iortaiit contributions from tlie Arabian schools. 
 
 ^ Italy had at this period a far wider and keener sense of unity 
 than in later centuries.
 
 OF MEDICINE AND SUEGERY 25 
 
 was contained a strong lay and imperial tradition, 
 which arrested hieratic ascendancy. Moreover 
 latin medical prose, which was not established in 
 France, England, or Germany till the middle of 
 the thirteenth century,^ was forming in Italy, even 
 in the eleventh, upon the latin renderings of Arab 
 versions of the Greek physicians ; a condition of 
 progress as vital for the time as the rise of the 
 vernaculars in the fourteenth (p. 81). 
 
 Before the rise of Padua, Bologna was indeed 
 a large and plenteous mother to Medicine in her 
 full orb ; yet even in Salerno far-seeing men had 
 begun to dread the divorce of surgery from 
 medicine. In the middle of the thirteenth century 
 Bruno, a Calabrian probably educated at Salerno, 
 in his " Chirurgia Magna" a work which, although 
 a motley blend of Hippocrates, Galen, Paul of 
 Egina and the Arabs, was that of a learned and 
 experienced man, bitterly resents the separation 
 of medicine from surgery by celibate clerks who 
 in false squeamishness shirked operations.^ Even 
 
 ^ This great service was of course first undertaken by Celsus, 
 and performed consummately; though where latin fell short he had 
 to insert " quod Graeci voeant " and the like. But, as the eminent 
 physicians of the Empire after his time were Greeks, Celsus, to 
 the grievous misfortune of Europe, was practically forgotten till 
 Thomas of Sarzannc's (afterwards Nicholas V.) discovery of the 
 Ambrosian manuscript (p. 55) in 1443. Nevertheless from some 
 hints of Cassiodorus, which are possibly allusions to Celsus, and 
 again of Gerbert (Sylvester II.) it would seem that even in the 
 tenth century Celsus was read in some monastic libraries. On the 
 other hand his treatise was printed as early as 1478 and sixty 
 latin editions lollowed between that date and the time of Fabriciiis 
 who declared : — "Admirabilis Celsus in omnibus, quem nocturna 
 versare manu, versare diurno consulo." How Morgagni studied 
 Celsus, and enriched his work with commentaries, is still better 
 known. Aretseus was little known in the Middle Ages. 
 
 - Yet even in early Salernitan times there was a class of inferior
 
 26 THE HISTOEICAL EELATIONS 
 
 in Italy the clergy carried much weight in uni- 
 versity graduation, and the students in all faculties 
 bore the tonsure. And if Papal Bulls conferred 
 privileges, they usually implied or imposed restric- 
 tions. When in some places a lower examination 
 was provided for unclerkly, that is in other words, 
 illiterate, persons desiring to practise as surgeons 
 only, the wedge was driven in deeper. The 
 important Salernitan treatise — The Glosses of the 
 Four Masters on the Surgery of Roger and Roland, 
 edited by Daremberg and de Eenzi, begins with 
 regretting the decadence of surgery, which these 
 masters attribute to two causes ; namely, the 
 division of surgery from medicine, and the neglect 
 of anatomy. By the wisdom of Bologna and 
 Naples, where were founded chairs of surgery, this 
 ill-starred divorce was postponed ; in his University 
 of Naples indeed Frederick the Second made it 
 a condition that surgery should be an essential 
 part of Medicine, should occupy as long a course 
 of study, and should be founded on anatomy 
 " without which no operator can be successful." 
 
 The School of Salerno was the first renascence 
 of clinical experience ; and Eoger, the Salernitan, 
 and Eoland of Parma, upon whose surgery was 
 founded the commentary of The Four Masters,^ 
 
 barbers or surgeons ; for Bruno himself, while claiming the right 
 of performing "all operations," yet in respect of minor practice 
 excuses himself thus : "praeterqnam de scariticatione et ilebotomia, 
 que licet cyrurgie species habeantur . . . noluerunt medici propter 
 indecentiam exercere sed illas barberiorum in manibus reliqiierunt." 
 (Quoted by .lulius Pagel in Puschmann's Handbuch.) 
 
 1 In Cambridge we have two MSS. of the Four Masters ; that 
 iu the Peterhouse Library being the finer example. It is a folio
 
 OF MEDICINE AND SUKGEEY 27 
 
 stand like Twin Brethren in the dawn of modern 
 Medicine, bearing the very names of romance. 
 Eoger's " Practica Chiritrgiae" was written in 1180, 
 and was re-edited by Eoland nearly a hundred years 
 later. It was no mere recooking of Albucasis : 
 although of course it rests upon the traditional 
 surgery of his day, there are not a few points of 
 interest in the book, such as certain descriptions 
 suggestive of syphilis. Under the title of the 
 paragraph — for it is no more — De cancro in 
 virga virili, carcinoma is included, but probably 
 syphilis also. In some of these cases they tell us 
 phagedena ensued. Before Theodoric, Roger refrac- 
 tured badly united bones. For luiemorrhage he 
 used styptics, the suture, or the ligature ; the 
 ligature he learned no doubt from Paul : but 
 Roger, like most or all qualified practitioners 
 of the period, was a " wound -surgeon " ; that is 
 he did not undertake the larger operations. He 
 warns against operating in cancer, especially if of 
 
 on vellum, written in a good fourteenth century liand, and evidently 
 not a scholar's but a professor's copy. It is neatly illuminated 
 and rubricated. Tiie title is Cirurgia iiii magistroriim cum 
 additionibus Rolandi. The volume contains in the first jdace 
 the " Breviarius Constantini qui dicitur viaticus, cum glossulis 
 Gerardi." This work extends to 143 ff., that of the Four Masters 
 to about 30. One may see that Roger's tract on surgery owes much 
 to Constantine's Viaticum. Who the four masters were who 
 developed Roger's tract into a still more interesting work is mere 
 speculation. Roland's additions were composed in 126-t. The 
 Peterhouse scribe entitles the work as of Mag. Rogerus and three 
 others, and gives 1230 a.d. as the date of its appearance. This 
 may have been the date of the early (original ?) copy now in 
 Florence (Lihr. Magliabecchi). This I have not seen, but I under- 
 stand that this copy Mag. Guido aretinus (Arensium) "correxit et 
 manifestavit," and it is to the care of this editor that the Peter- 
 house text is attributed.
 
 28 THE HISTOEICAL EELATIONS 
 
 uterus or rectum. He was in favour, as a rule, of 
 immediate extraction of weapons from their wounds; 
 in these wounds, even after extrusion of the foreign 
 body, "he promoted coction or suppuration, and 
 dressed them with galenical salves on lint. His 
 bandaging seems to have been very efficient. To 
 these points especially — to the withdrawal of the 
 weapon, to the promotion of pus, and to unctuous 
 dressings — I would call your attention ; for now 
 we are approaching more nearly the controversy 
 which, pale reflexion as it may be of the great 
 surgical regeneration of the nineteenth century, is, 
 historically speaking, of singular interest. Less 
 blessed than we, our fathers determined this con- 
 troversy the wrong way, and thereby brought upon 
 themselves, and upon their children for many 
 generations, malpractices and tortures which — or 
 so it seems to us — a contrary decision would have 
 averted. 
 
 Let us now return to Bologna. Hugh of 
 Lucca, says Malgaigne, is the first of the surgeons 
 of modern Europe whom we can cite with honour. 
 This tribute is a little strained ; we may say, 
 however, that of these honourable ancestors Hugh 
 seems to have been the greatest. I say " seems to 
 have been " ; for Hugh is even a dimmer giant 
 than Eoger or Eoland. We know that he served 
 as surgeon in campaigns, and was present at the 
 siege of Damietta ; but of writing he left not a 
 line. Such vision as we have of him we owe to 
 his loyal disciple, perhaps his son, the Dominican 
 Theodoric (Teodorico Borgognoni : a.d. 1205-1296),
 
 OF MEDICINE AND SURGERY 29 
 
 Bishop of Cervia uear Ravenna, confessor of 
 Innocent IV./ and the master of Henry of Monde- 
 ville. From Lucca Theodoric extended his practice 
 far and wide, and, as Haeser remarks, made the 
 noblest use of his earnings. He completed his 
 treatise in 126G." Salernitan practice needed the 
 reforms of Theodoric " qui pulcherrimas cicatrices 
 sine unguento aliquo inducebat." After some refer- 
 ence to Theodoric's work and a close study of Henry 
 of Mondeville and Guy of Chauliac, I am of Haeser's 
 opinion that Guy dealt with Theodoric unfairly; and, 
 I would add, not only unfairly but even disastrously. 
 What the later history of surgery might have been 
 had that illustrious surgeon been more illustrious still, 
 and carried forward the reform of Hugh, Theodoric, 
 and Henry, is one of those historical specuhitions 
 which may be left to tlie curious ; the history of 
 what has not happened cannot occupy much of 
 the attention of serious students. It is sufficient 
 to say that the judicious Guy held to galenism and 
 to coction or suppuration, and rivetted upon surgery 
 the grievous orthodoxy of which it had not purged 
 itself even in the days of the studentship of many 
 of us now living.^ 
 
 What was Theodoric's message ? He -wrote: — 
 
 ^ I give the current story, Lut there is some evidence of two 
 Theodorics — the Bishoj), and a surgeon, by birth a Catalan. 
 
 '•^ Dr. Piiyne (FitzPatrick Lectures for 1904) says that Theodoric 
 took his description of leprosy from Gilbertiis Anglicus, a descrip- 
 tion evidently at hrst hand, and in many respects vei-y accurate. 
 
 * Dr. Ernst Becker in his interesting tract on Medicine in 
 medieval Hildesheiiu (Berlin, 1899) in estimating the value of 
 medical fees in the fifteenth centnry says we must remember the 
 long duration ol' attendances " bei der wohl regelmjissig eintre- 
 tenden Eiternng aller Wunden."
 
 30 THE HISTORICAL RELATIONS 
 
 " for it is not necessary, as Roger and Roland have 
 written, as many of their disciples teach, and as 
 all modern surgeons profess, that pus should be 
 generated in wounds. No error can be greater 
 than this. Such a practice is indeed to hinder 
 nature, to prolong the disease, and to prevent the 
 conglutination and consolidation of the wound." 
 (Book II. c. 27.) In principle what more did 
 Lister say than this ? Henry of Mondeville made 
 a hard fight for the new principle, but the 
 advocates of suppuration won all along the line ; 
 and for centuries to come poultices and grease were 
 still to be applied to fresh wounds ; and tents, 
 plastered with irritants to promote suppuration, 
 were still to be thrust into the recesses of them, 
 even when there was no foreign matter to be 
 discharged. If after all this erysipelas set in — 
 well, says Henry, we will lay it at the door of 
 St. Eligius ! 
 
 It is not easy to trace the growth of opinion on 
 the process of healing by suppuration. The Hippo- 
 cratic schools are responsible for the original form 
 of the doctrine of the four humovirs and for the 
 conception of crudity and coction ; but in this 
 school, and probably in Alexandria, if we may 
 judge by Celsus, the practice of wound surgery 
 was, as I have said (p. 8), sound on the whole. 
 Speculation was not allowed to vitiate positive and 
 direct experience. It must not be forgotten that 
 suppuration was a rude method of expelling the 
 foulness of wounds ; but we must attribute the 
 enormous vogue of treating wounds by salves and
 
 OF MEDICINE AND SURGERY 31 
 
 sophistry, to the medieval travesty of Galen, and to 
 that galenical machine which, in the manufacture 
 of opinion, was as exacting and as inveterate as 
 the aristotelian (p. 20). Wine was an old remedy 
 in wounds ; hefore Hippocrates it was exhibited 
 by the Good Samaritan. Rhazes used alcohol as 
 an antiseptic wound -wash ; but he complicated 
 his practice with a mystical polypharmacy. Hugh 
 and Theodoric denounced the suppurative remedies 
 and promoteet healing by first intention. For the 
 fresh wound they rejected oils and salves as too 
 slippery for union, and poultices as too moist 
 ("oleum et caetera unctuosa labefaciunt et maculant 
 vulnus ") : they washed the wound with wine 
 only, scrupulously removing every foreign particle ; 
 then they brought the edges together, forbidding 
 any of the wine or other dressing to remain within. 
 As with the genuine Hippocratic school, a dry and 
 adhesive edge was their desire. Nature, they said, 
 produces the means of union in a viscous exudation, 
 or balm— as Paracelsus called it, a word which Pare 
 and Wiirtz adopted. In stale wounds they did 
 their best to obtain union by cleansing, desiccation, 
 and refreshing of the edges. Upon the outer 
 surface they laid lint steeped in wine. Powders 
 however they regarded as too desiccating, for 
 powders thus shut in decomposing matters (" saniem 
 incarcerant ") ; wine, after washing, purifying, and 
 drying the raw surfaces, evaporates. The quick, 
 shrewd, and rational observation and the original 
 genius of Theodoric I would gladly illustrate 
 did time permit ; in passing I may say that he
 
 32 THE HISTORICAL RELATIONS 
 
 was the first to notice salivation as the result of 
 administration of mercury in " skin diseases." ^ 
 
 Of the adherents of Hugh and Theodoric was 
 the well-known Arnold of Villanova, the prototype 
 of Basil Valentine and Paracelsus, and the champion 
 of spirits of wine ; a visionary indeed but a man 
 of mark. He tells us naively that, like all the 
 wound surgeons of his time, he flinched from 
 large operations because of the " venae pulsatiles " 
 which are so dangerous, defying even the cautery. 
 Amputations of the larger limbs, I repeat, were 
 rarely undertaken by any kind of surgeon ; and 
 the radical cure of hernia, cutting for stone, and 
 eye operations were performed, often brutally enough, 
 by travelling surgeons of the short robe, who were 
 usually out of reach of the avenger before the result 
 became manifest. Franco, as we shall presently see, 
 was the first modern surgeon to raise these operations 
 again to the standard of Celsus. 
 
 Both for his own "reat merits, as an original 
 and independent observer, and as the master of 
 Lanfranc, William Salicet (Guglielmo Salicetti of 
 Piacenza, in latin use G. Placentinus or de Saliceto 
 — now Cadeo) was eminent among the great Italian 
 physicians of the latter half of the thirteenth cen- 
 tury. Now these great Italians were as distin- 
 guished in surgery as in medicine, and AVilliam was 
 
 ^ Theodoric's treatise is to be found in most of the early printed 
 collections of surgical treatises which were published in Venice : 
 e.g. that of 1519. I ought perhaps to say this Address was written 
 — nnd indeed delivered at St. Louis, before I had lighted on the 
 article Gesch. d. Medizin im Mittelaltcr in the new volume of Pusch- 
 maun's Handbuch by that admirable historian Dr. Pagel.
 
 OF MEDICINE AND SUIiGERY 33 
 
 one of the protestants of the period against the 
 division of surgery from inner medicine ; a division 
 which he regarded as a separation of Medicine 
 from intimate touch with nature. Like Lanfranc and 
 the other great surgeons of the Italian tradition, 
 and unlike Franco and Pare, he had the advantage 
 of the liberal university education of Italy ; but, 
 like Pare and Wlirtz, he had large practical ex- 
 perience in hospital and in the battlefield. He 
 practised first at Bologna, afterwards in Verona. 
 William fully recognised that surgery cannot be 
 learned from books only. His Surgery contains 
 many case histories, for he rightly opined that 
 good notes of cases are the soundest founda- 
 tion of good practice ; and in this opinion and 
 method Lanfranc followed him. William dis- 
 covered that dropsy may be due to a " durities 
 renum " ; he substituted the knife for the arabist 
 abuse of the cautery ; he investigated the causes of 
 the failure of healing by first intention; he described 
 the danger of wounds of the neck; he sutured divided 
 nerves ; he forwarded the diagnosis of suppurative 
 disease of the hip ; and he referred chancre and 
 phagedsena to " coitus cum meretrice." 
 
 Lanfranc (Lanfranchi), like William Salicet a 
 clerkly physician, was driven from Milan by the 
 violence of the Yisconti ; he tied to Lyons, and in 
 1295 to Paris, where he became a founder of French 
 surgery, and gave a temporary renown to the surgical 
 College of St. Come, which had then received formal 
 institution from St. Louis. He established clinical 
 classes, and honourably and explicitly taught in 
 
 D
 
 34 THE HISTOEICAL EELATIONS 
 
 them all he knew. We learn from Mondeville, 
 and many another source, that one cause of the 
 poverty and defect of medieval medicine lay in the 
 jealous secretiveness of its practitioners, a reticence 
 which they carried even into their private con- 
 sultations.^ Seeing that even the greatest of them 
 lifted matter literally and in bulk from others 
 without the smallest sign of acknowledgment, 
 this reticence is scarcely surprising. Theodoric 
 himself had deferred to put his experience into 
 writing till his old age, and much book -making 
 was stopped by this jealousy ; a result which the 
 hearer will regard, as his mood may be, with thank- 
 fulness or with regret. 
 
 Lanfranc's " Chirurgia Magna " was a great 
 work, written by a reverent but independent 
 follower of Salicet. He distinguished between 
 venous and arterial haemorrhage, and used styptics 
 (rabbit's fur, aloes, and white of egg was a popular 
 styptic in elder surgery), digital compression for 
 an hour, or in severe cases ligature. His chapter 
 on injuries of the head is one of the classics of 
 medieval surgery. Clerk as he was, Lanfranc never- 
 theless saw but the more clearly the danger of 
 
 ^ Even in tlie sixteenth century no less a man than Galileo 
 declined to make public his secret method of grinding lenses till 
 near his death. A veterinary surgeon, who flourished greatly in 
 Yorkshire some liundred years ago as a marvellously successful 
 operator, astutely evaded all prying and questioning into his secret, 
 even when in imminent peril on a bed of sickness. He survived 
 to carry all before him for many years longer. At length, bowed 
 down by old age and decrepitude, he was again implored by his 
 son to tell what he did in the secret half hour before operating. 
 Life was ebbing at last, and the worn out old man whispered 
 with liis passing breatli " I biles my tools."
 
 OF MEDICINE AND SURGEEY 35 
 
 separating surgery from medicine. " Good God ! " 
 he exclaims, " why this abandoning of operations 
 by physicians to lay persons, disdaining surgery, as 
 I perceive, because they do not know how to 
 operate ... an abuse which has reached such a 
 point that the vulgar begin to think the same man 
 cannot know medicine and surgery. ... I say 
 however that no man can be a good physician 
 who has no knowledge of operative surgery ; a 
 knowledge of both branches is essential." (Chir. 
 Magna.) Is it not strange that this ancient was 
 wiser than most of us are even yet ! 
 
 In the Medicine of the Netherlands one of the 
 pupils of Lanfranc, a Flemish physician named 
 Yperman, appears to have been the greatest name 
 before Vesalius. In the recent edition of M. Broeckx, 
 no doubt an excellent text, there is no translation of 
 the Dutch ; not even an analysis of the contents. 
 Now it is not given to many of us to read Dutch ; 
 in the midst of other tasks one can but decipher this 
 passage or that, in a literal way, without however 
 gaining a sense of the general tone or qualities of the 
 author. The father of Flemish surgery was born, 
 probably at Ypres, at the close of the thirteenth 
 century. He completed his studies in Paris, as a 
 pupil of Lanfranc, with whom he kept up some 
 friendship after his return to Ypres, where he 
 settled in practice. He became entitled to be 
 called "Master" in the year 1303-4. He was 
 not in holy orders, but was a clerk, in the sense 
 of academic culture and degree ; his writings indeed
 
 36 THE HISTORICAL RELATIONS 
 
 reveal a learned as well as a sagacious and skilful 
 surgeon. In one passage he describes what a good 
 surgeon ought to be, and among his requirements 
 are grammar, rhetoric and ethics ; moreover, says 
 M. Broeckx, a lofty tone animates all his work. 
 He displays — the same critic tells us — a genius 
 for surgery, and sturdily held his own, even with 
 Lanfranc himself. Yperman describes the ligature, 
 and, a few lines lower down, torsion of arteries. 
 In two of the manuscripts, one of which I have 
 examined in the library of St. John's College in 
 Cambridge, are not a few drawings of instruments. 
 The date of his death is unknown. This great 
 surgeon, whose name won almost a proverbial 
 renown, worked for good in the midst of a degraded 
 surgery of salves and superstitions ; but his writings, 
 strangely enough, were lost in oblivion for six 
 centuries ! Copies of them in Flemish were dis- 
 covered in the year 1818. It seems certain that 
 he wrote the first manuscript in latin, for the use of 
 his son ; and that later copies were written in 
 Flemish, but we have no copy in his own hand- 
 writing. That in St. John's College is evidently a 
 school copy, and may be compared with the much 
 finer MS. of Lanfranc, a professor's copy, in' the 
 same library. Yperman wrote also a treatise, now 
 very incomplete, on inner medicine, which also 
 indicates, says Dr. Pagel,^ considerable originality 
 and self-reliance. In comparing these treatises, I 
 am struck, in the Medicine, by the little reliance 
 he placed on the physicians ; he does not quote 
 
 ^ Piischmann's Handhuch, vol. i. p. 737.
 
 OF MEDICINE AND SUEGERY 37 
 
 more than a dozen of them ; in the Surgery on the 
 other hand he quotes from surgical authors many 
 times on a page. May we not thus infer the 
 opinion of an observer so independent and pene- 
 trating as Yperman on the comparative poverty of 
 the medicine of the period ? 
 
 The early history of French surgery, to which 
 after a brief digression I return, has been diminished 
 by the light of Pare, which eclipsed the illustrious 
 men wdio went before him and beside him ; of these 
 indigenous French surgeons Henry of Mondeville and 
 Guy of Chauliac were the chief. The Cliirurgia 
 Magna of Guy may be regarded indeed as the 
 foundation of modern surgical doctrine in Western 
 Europe. In Henry of Mondeville, of Montpellier 
 and Paris, we still find the clerkly physician who 
 notwithstanding vindicated for surgery its true 
 place in Medicine. More clear-headed in this 
 respect than Guy, who claimed for surgery only a 
 place beside medicine and coequal with it, Henry 
 rightly declared, with Galen, that surgery is but a 
 method of treatment, and belongs to all Medicine. 
 Haeser seems to me to do less than justice to this 
 hardy and original reformer, the last champion in 
 his day of two causes — the solidarity of Medicine, 
 and union by first intention ; the second of these 
 causes was lost for 600 years, the first is not 
 fully won even yet. Of his student life little is 
 known. It seems probable that he was educated at 
 Montpellier, and certainly he was a pupil of Theo- 
 doric in Italy. Henry's writings, rich in mother
 
 38 THE HISTOKICAL RELATIONS 
 
 wit, and only too racy of worldly wisdom, are as 
 entertaining as they are instructive. For their 
 audacity of opinion and biting satire they were 
 displeasing to the Church, and consequently remained 
 long unprinted ; thus their fame was obscured, and 
 Guy of Chauliac got a quiet opportunity of appro- 
 priating no little of them. The Church, to extend 
 a rigid frame for society as widely as possible, took 
 under its protection the Civil as well as the Canon 
 Law ; and in Medicine its clerks found, in the 
 galenist code, a congruous system of dogma. But 
 with mordant raillery Henry declared that God did 
 not exhaust His creative power in making Galen ; 
 he twitted the clerks who were supposed to know 
 surgery by the grace of God, and asked how a man 
 is to make even so small a thing as a nail by listen- 
 ing to lectures on the art, or indeed by merely 
 watching others do it for ever so long. As himself 
 a clerk, he reminds us of the well-known chapter in 
 the Ethics where we are told to learn virtue by the 
 practice of it ; as builders learn by building, and 
 harpers by playing the harp. With Lanfranc he 
 insisted on anatomy as the foundation of Medicine ; 
 at Montpellier, where he had some relations with 
 Gordon the learned author of the Lilium Medieinae, 
 he taught anatomy by bones and pictures, as he had 
 learnt it at Bologna ; and he prefixed an anatomical 
 introduction to his Surgery, as Guy, Pare and others 
 did after him. "While declaring that too much faith in 
 books chokes natural talent, he resented almost with 
 violence the gibe that surgery is merely a handicraft ; 
 if the mind must inform the hand in its operation,
 
 OF MEDICINE AND SURGERY 39 
 
 the hand in its turn instructs the mind to interpret 
 the general proposition by the particular instance. 
 By experience without reason, he says, we make 
 some progress, but by reason without experience we 
 cannot get along at all. He lashes the physicians 
 and counsels the students of his time with the 
 merciless wit of Petrarch, Rabelais or Moliere, and 
 with the worldly wisdom of Polonius. The poor 
 man's case every doctor tries to shuftle out of; tlie 
 high-born and rich, with their impatient changes of 
 doctors and their deficiency of ideas, are sketched 
 as vividly as if he had lived to-day : some of them 
 he says also " malentes in corporibus pati, quam in 
 bursa." Yet after all his device to out-cunning the 
 cunning, and to out-cozen the cozeners, he says 
 well — " if you have operated conscientiously on 
 the rich for a proper fee, and on the poor for 
 charity, you need not play the monk, nor make 
 pilgrimages for your soul." 
 
 Into Paris then, in academical form such as we 
 have described it, Henry of Mondeville entered as, 
 for the most part, a loyal disciple of Lanfranc ; and 
 aided, as it would seem, by John Pitard,^ Surgeon 
 to Philip the Fair, attempted for wounds to banish 
 Galen's salve surgery, and to introduce the new 
 methods of Hugh and Theodoric : for his pains he 
 
 ^ Jean Pitard or Pitart (Giovanni Pitardi), like Lanfranc, was 
 probably one of the Italian academic surgical physicians who to 
 the benefit of France were driven from Italy by wars and civil 
 commotion. He was indeed one of those great physicians, like 
 Hugh of Lucca, whose radiance has persisted to our own day, 
 although no line of his writings, if ever he wrote any, survives. 
 By the College of St. Come he was raised to an almost mythical 
 renown, as a reputed founder.
 
 40 THE HISTOEICAL EELATIONS 
 
 exposed himself to bad language, threats and perils ; 
 and, " had it not been for Truth and Charles of 
 Valois," to far worse things. So he warns the 
 young and poor surgeon not to plough the sand ; 
 but to prefer complaisance to truth, and ease to new 
 ideas. I will summarise briefly the teaching of 
 Monde villa on the cardinal features of the new 
 method : — Wash the wound scrupulously from all 
 foreign matter ; use no probes, no tents — except 
 under special circumstances ; apply no oily or irri- 
 tant matters ; avoid the formation of pus, which is 
 not a. stage of healing hut a complication. " Wounds 
 dry much better before suppuration than after it." 
 " Sequitur ergo minor probata quod in omni vulnere 
 in quantum possumus evitare causas geuerationis 
 saniei. Sequitur ulterius conclusio principalis quod 
 possibile est omue vulnus in quantum hujusmodi sic 
 procuratum curari absque eo quod fiat in eo notabilis 
 generatio saniei." Theodoric had said before him 
 " Sanies vulnus corrodet et auget." Henry then 
 proceeds to combat those galenist doctrines which 
 were contrary to his own experience, and proceeds 
 thus : — Distinguish always between oozing haemor- 
 rhage, haemorrhage by jets, and that which pumps 
 out of an inward wound ; using styptics for oozing, 
 and for jets the cautery or, where practicable, digital 
 compression for not less than a full hour (vide p. 34). 
 In another place he points out the fault of the cautery 
 — that when the eschar falls the hemorrhage may 
 recur, and the wound must be disturbed for a 
 second application. So for large vessels he advises 
 acupressure, in these words : — " Infigatur acus cum
 
 OF MEDICINE AND SUKGEKY 41 
 
 filo su];) utraque extremitate venae aut arteriae, et 
 nectatiir illud tilum et fortiter stringatur." " But 
 let the vessel be isolated from all surrounding parts 
 with the knife, and torsion may be practised with 
 ligature." His words are (Oportet) " scindere carnem 
 exteriorem quae est supra extremitates venae aut 
 arteriae e qua fluit sanguis, deinde dictas extremi- 
 tates extrahere, torquere, et ligare." Lanfranc had 
 given the warning not to let a nerve get caught in 
 a ligature.^ Henry proceeds — do not, as Galen 
 teaches, allow the wound to bleed, with the notion of 
 preventing inflammation ; for you will only weaken 
 the patient's vitality (virtus), give him two diseases 
 instead of one, and favour secondary hsemorrhage. 
 When your dressings have been carefully made, do 
 not interfere with them for some days ; keep the 
 air out, for a wound left in contact with the air 
 suppurates ; however, should pain and heat arise, 
 open and wash out again, or even a poultice may 
 be necessary ; but do not pull your dressings about, 
 nature works better alone : if first intention fail 
 she may succeed in the second, as a jeweller if he 
 can solder gold to gold does so, if not, he has to 
 take to borax ; these resources however we learn 
 well not by arguing but by operating.^ By the 
 
 ^ I liave read a story somewhere in medieval surgical literature 
 of a patient whose musculo -spiral nerve wns thus caught and 
 crushed by a surgeon while tying an artery of tlie arm. Thence- 
 fortli the wretched operator hardly dare show himself in the streets, 
 for the ])atient would furiously pursue liim, shaking the palsied 
 arm and hurling execrations. 
 
 ^ The reader must understand tlie conviction was rooted in 
 the medieval mind that the way to discover truth was by 
 disputation.
 
 42 THE HISTORICAL RELATIONS 
 
 new method you will have no stinks, shorter con- 
 valescence, and clean thin scars. In wounds of the 
 neck he says that alterations of the voice suggest 
 some implication of the larynx. When using the 
 word " Nature " he freely admits that the word is 
 an equivocal one ; but he would speak of her alle- 
 gorically, as " a lute-player to whose melodies the 
 physician has to dance." Here he detaches himself 
 from medieval ontology (pp. 20 and 50) and returns 
 to that ministry of nature which was the key to the 
 Medicine of Hippocrates, and was renewed again in 
 Park's admirable " Je I'ai pansay, Dieu le guarit." 
 
 To illustrate the care of this surgeon I will 
 quote also the following instructions : — " Always put 
 your needles and thread in order before you begin 
 to operate, and the thread not in a tangle, or you 
 will have to wait and rethread it ; now blood will 
 not wait." He then describes an ingenious turn 
 — not a knot — of the thread, so that by one twitch 
 it will come straight away. Needles are to be of 
 various sizes, triangular and sharp, and clean, or 
 they luill infect the wound ; there must be grooves 
 by the sides of the eye into which the thread may 
 fall so as not to hurt as the flesh is pierced. The 
 processes of suture, a prolific source of controversy 
 and various practice in medieval surgery — as the 
 fear of access of air (p. 9), or of retention of 
 putrid matters had the ascendancy — are enjoined 
 with no less precision and foresight. If the 
 edges of a wound be altered by exposure they 
 must be refreshed. " If treated on Theodoric's 
 and my instructions, every simple ivouncl will heal
 
 OF MEDICINE AND SUKGERY 43 
 
 without any notciMe quantity of pus." Every cause of 
 formation of pus is to be avoided, not only irritating 
 applications (" medicinae quae faciunt nasci pus," 
 says Theodoric), but exposure, high diet, oedema, or 
 local plethora. " Many more surgeons know how 
 to cause suppuration than how to heal a wound." ^ 
 
 His caustic and reckless wit is manifest in his 
 remarks on the effects of the mind on the body. 
 If your patient is losing heart tell him he has been 
 nominated to a canonry : never mind whether your 
 story be true or untrue. 
 
 For the misfortune of Europe social progress is 
 discontinuous ; the civil faction fights of Italy in 
 the fourteenth century, the schism of the Papacy, 
 and a wave of mysticism, drew much of the life 
 from the universities of this gifted people, then 
 and in the fifteenth century so apt to engraft the 
 fruits of art upon the conceptions of learning. 
 Petrarch lamented the flagging of Salerno, Bologna, 
 and Padua. Boccaccio found the library of Monte 
 Cassino doorless, the grass growing on the window- 
 sills, and the books covered with filth. Bologna was 
 drooping in spite of Mundino, the father of modern 
 anatomy ; but as it drooped so Montpellier waxed. 
 In the thirteenth and fourteenth centuries, as I 
 
 1 The copy of Henry of Mondeville I have chiefly used is in 
 old French, published by the Society of Old French Texts, edited 
 by Dr. A. Bos from the unique J\1S. of the Bibliorheque Nationale, 
 Paris, in 1897. But Henry being a cleik, wrote, what was prob- 
 ably the original copy of his Surgery, in latin. This first text 
 (from which I have quoted) was edited by Dr. Pagel in 1892. The 
 edition of Nicaise (Paris, 1893) is of course indispensable.
 
 44 THE HISTOKICAL KELATIONS 
 
 have said (p. 24), books were to a university what 
 the millionaire is, or ought to be, in the twentieth. 
 Montpellier, with Italy on the East and Cordova 
 on the West, became as rich in books as Paris 
 was poor. Even in the later fourteenth century 
 there appear to have been only nine medical 
 works in the University of Paris ; nor in the 
 fifteenth was it much richer until in 1498 Charles 
 VIII. carried off the library of St. Mark in 
 Florence, which contained some 800 MSS., and 
 Louis XII. that of Pavia ; a transfer of books 
 which probably led to Brissot's venesection revolt in 
 1514 (p. 107). But Montpellier had obtained all 
 Constantine's and Gerard's translations ; Charles 
 of Anjou secured a copy of the Continent of Ehazes 
 — till then unknown in Europe ; and one of her 
 elder sons — Arnold of Villanova (p. 32) — added to 
 Gerard's translations of Avicenna. The Surgery 
 of Albucasis, chiefly derived from the Sixth Book 
 of Paul of Egina, and this in its turn from 
 Celsus and Galen, was of great assistance in the 
 early Middle Ages (p. 24), and handed on a 
 body of surgery to Lanfranc, Salicet, Henry of 
 Mondeville, and Guy of Chauliac. Much of Galen 
 was at Montpellier ; and, in the fourteenth century, 
 the Sixth, or Surgical Book of Paul of Egina itself, 
 afterwards to be lost again till the fifteenth. On 
 the other hand Alexander of Tralles was no surgeon ; 
 and the surgery of Hippocrates was only appre- 
 hended in the allusions of Galen. The transcripts 
 of Aetius were as yet undiscovered, and the original 
 work of Celsus had been lost again.
 
 OF MEDICTXE AND SUEGEEY 45 
 
 Still Guy of Chauliac, who flourished in the 
 second half of the fourteenth century, was enabled 
 to feed his virile and inquisitive spirit on rich 
 sources of learning. While he succeeded to the 
 stores of Arnold and Gordon, with his just and 
 cautious reason, and wealth of experience he cast 
 out of them much of the sorcery, jugglery, astrology, 
 and mysticism which were their reproach. Chauliac 
 is a village in the Auvergne, and Guy was but a 
 farmer's lad : it was by the aid of powerful friends 
 that he studied at Toulouse and Montpellier, took 
 orders, and the degree of Master of Medicine ; in 
 his time there was no degree of Doctor of Medicine 
 in France. Then he studied anatomy at Bologna 
 under Bertruccio, the successor of Mundino — a 
 study which, with Henry, he regarded as the founda- 
 tion of surgery. The surgeon ignorant of anatomy, 
 he says, " carves the human body as a blind man 
 carves wood." Thence he paid a brief visit to 
 Paris where for a moment, by the renown of Lan- 
 franc, Jean Pitard, and Henry of Mondeville, 
 surgery was in the ascendant. For the moment 
 the Church and the Faculty had not succeeded 
 in paralysing the scientific arm of Medicine. 
 Guy began practice in Lyons, whence he was 
 called to Avignon by Clement VI. as " vene- 
 rabilis et circumspectus vir, dominus Guijo de 
 Cauliaco, canonicus et praepositus ecclesiae Sancti 
 Justi Lugduni, medicusque domiui Nostri Pape." 
 In Avignon he stayed, while other physicians fled, 
 to minister to the victims of the plague (a.d. 1348), 
 and he may have attended Laura, in spite of
 
 4G THE HISTOKICAL EELATIONS 
 
 Petrarch's tirades against all physicians, and even 
 against Guy himself. His description of this 
 epidemic is terrible in its naked simplicity. He did 
 not indeed himself escape ; he had an attack with 
 bubo, and was ill for six weeks. He gave succour 
 also in a later epidemic in Avignon, in 1360. His 
 Chirurgia Magna, or Inventarium sen Collectorium 
 Artis chirurgicalis medicinae — so called in distinc- 
 tion to the meagre little handbooks or Chirurgiae 
 Parvae compiled from the larger treatises — was 
 in preparation in 1363. This great work I have 
 studied carefully,^ and not without prejudice ; yet 
 I cannot wonder that Fallopius compared the 
 author to Hippocrates, or that John Freind calls 
 him the Prince of Surgeons. It is rich, aphoristic, 
 orderly and precise. As a clerk, he wrote in 
 latin, in the awkward hybrid tongue that medical 
 latin then was, containing many Arabian, Provenqal 
 and French words, but very little greek ^ (p. 25). 
 
 The sects of surgery in his time Guy made to 
 be five: — (1) Those who (like Galen and himself) 
 promoted coction and suppuration; (2) those who, 
 after Theodoric, taught the dry management of 
 wounds with washings of wine ; (3) those who, 
 after Lanfranc and Salicet, trimmed, and used mild 
 unguents and plasters ; (4) those who used charms, 
 with oil, wool, and cabbage leaves, and supposed 
 God to have deposited His grace " in verbis, herbis 
 
 1 Chiefly in the edition of Nicaise, Paris, 1890 ; incidentally in 
 various editions in the Library of Cambridge University. 
 
 - The curious reader may be referred to the three editions of 
 Guidon en francoys by Jehan Falcon, Dean and Professor of Mont- 
 pellier, published 1520, 1534, and 1537.
 
 OF MEDICINE AND SURGERY 47 
 
 et lapidibus " ; (5) women and silly folk, who sat 
 and folded their hands under the will of God, Amen 
 — which may remind us of one of the happy sayings 
 of Henry that " the vulgar divide diseases into those 
 which have causes and those which have none." 
 
 That Guy should have emancipated himself from 
 the thraldom of authority is not to be expected ; 
 no man of his day could look upon Aristotle with 
 an equal eye. Yet the critical spirit of the great 
 southern surgeons was awake in him. He scorned 
 the physicians of his day " who followed each other 
 like cranes, whether for love or fear he would not 
 say." In courtesy and honour he showed a far 
 gentler and loftier temper than Henry ; though 
 indeed it is hard to say when Henry is serious, 
 when ironical, and when medieval. In respect of 
 its unity of reason and practice, Malgaigne con- 
 siders Guy's Surgery a masterpiece of learned and 
 luminous writing. Guy was a more adventurous 
 siu'geon than Lanfranc ; as was indeed Franco, a 
 later Provenqal, than Pare. Guy still kept clear 
 of cutting for stone, as Pare did after him ; but 
 Pare had the eminent example of Franco before his 
 eyes. Guy did, however, operate for radical cure 
 of hernia, and for cataract ; operations till his time 
 left wholly to the wayfaring specialists. 
 
 Nevertheless in respect of surgical principles, as 
 I have foreshadowed, Guy was not infallible. Too 
 sedulous a disciple of galenism, he was as a deaf 
 adder to the new message of Hugh of Lucca, Theo- 
 doric and Henry ; and not only was he deaf him- 
 self but, as the authoritative writer of the early
 
 48 THE HISTOEICAL EELATIONS 
 
 renaissance, he closed the ears of his brethren, even to 
 the day of Lister. This is the more remarkable as 
 in Guy we find an historical sense, the first criticism 
 of medicine and medical authors on broad lines of 
 judgment, since Celsus. If his judgments were not 
 always true they were always weighty. Even 
 Haller never penned a more discriminating judgment 
 than this of Guy on Galen : " fuit enim maximus 
 in scientia demonstrativa " ; this on Albucasis also 
 is notable : — " omnes praedecessorum suorum 
 majorum doctrinas congregavit, quas tamen non 
 elegit." I regret to say his opinion of Gaddesden's 
 Rosa Anglicana — " una rosa fatua et sine odore 
 suavitatis " — -is not to our credit.^ In respect of 
 the thesis I am supporting to-day, he says, " et 
 usque ad eum (Avicenna) omnes inveniuntur fuisse 
 physici et chirurgici. Sed post, vel propter lassi- 
 viam vel occupationem curarum, nimium separata 
 fuit chirurgia et demissa in nianus mechanicorum." 
 Guy was a man rather of sound judgment than 
 of penetrating insight. Eich and comprehensive 
 as were his talents, he was not a man of genius 
 as we speak of genius in Lanfranc or William 
 Salicet ; nor had he the ardour or the audacity of 
 Henry. At the close of his century he appears 
 rather as an equable, sensible and critical than an 
 inventive spirit. As in the medieval schools, he 
 was disposed to balance his authorities — Avicenna, 
 Haly, Albucasis, Lanfranc, Theodoric, Salicet, Henry, 
 and so forth — by enumeration rather than by 
 
 ^ Dr. Payne says that Giiy had in view John of Gaddesden, not 
 Gilbert (v. et Freind (2nd ed.) ii. 274).
 
 OF MEDICINE AND SUEGERY 49 
 
 appreciation. Shrewd, and full of learning and ex- 
 perience, he lacked the fine temerity of the greatest 
 surgeons ; with all his sagacity he was prone to be too 
 judicious, too eclectic. For instance, Yperman the 
 great fourteenth century surgeon of the Netherlands 
 (p. 35), divided scrofulous patients into those who 
 are touched by the king for the evil and those who 
 are not ; slily adding that some get well without 
 the touch, others are touched and do not get 
 well ; Guy on the other hand says sedately : — 
 " Concedo tamen quod virtute divina Serenissimus 
 Rex Franciae tangendo liberet multos." Moreover 
 his influence, so long dominant, was, as I have said, 
 exercised against the true principles of the treat- 
 ment of wounds. 
 
 Unfortunately also, we find reflections upon 
 surgeons of his own period which are harsh, un- 
 just, and either ill informed or disingenuous. On 
 the sense of literary honesty and magnanimity in 
 those times we can only hold our peace. These 
 virtues were unbegotten. Guy was a sinner; but 
 even Pare sinned with him. 
 
 Of his substantial advances in surgery no suffi- 
 cient account is possible ; but some chief points, 
 with the aid of Haeser, Malgaigne and Nicaise, I 
 may briefly sum up thus :— He pointed out the 
 dangers of surgery of the neck, among them that of 
 injuring the voice by section of the recurrent 
 laryngeal nerve, a precaution he probably learned 
 from Paul. He urges a low diet for the wounded, 
 as did Mondeville and many others. He uses sutures 
 well and discreetly (p. 9), but with far too many 
 
 E
 
 50 THE HTSTOEICAL EELATIONS 
 
 salves. On fractures of the skull he is at his best ; 
 he notes the escape of cerebro-spinal fluid, and the 
 effect of pressure on the respiration. It is some- 
 what strange that, in days of war, the study of chest 
 wounds had been rather neglected by Galen, Haly, 
 and Aviceuna ; their practice however was to leave 
 them open, lest pus should gather about the heart. 
 Theodoric and Henry ordered chest wounds to be 
 closed " lest the vital spirits escape." Guy also 
 closed these wounds, unless there were any effusion 
 to be removed. In empyema he objects to caustics, 
 and prefers the knife. For haemorrhages he used 
 sutures — a little too closely perhaps, styptics, 
 cautery, or ligature. Sinuses he dilated with tents 
 of gentian root, or he incised them upon a director. 
 On ulcers his large experience is fully manifest ; he 
 describes the carcinomatous kind as hopeless, unless 
 the mass can be excised at a very early stage and 
 the incision followed by caustics. If in fractures and 
 dislocations he tells us nothing new, these sections 
 testify to a remarkable fulness of knowledge at a 
 period when the Hippocratic treatises were unknown. 
 Haeser says that in respect of position in fraciared 
 femur he was the best physician of the Middle 
 Ages. On the other hand my own reading tells 
 me that Guy restored and reanimated the vicious 
 doctrine that the healing of a wound is the work 
 of the surgeon ; that not by natural process and 
 bodily function is it brought about — as Theo- 
 doric and Henry had taught — but by the educative 
 means of the surgeon operating upon a modifiable 
 entity (p. 20). In it, it is the surgeon who models,
 
 OF MEDICINE AND SUEGEEY 51 
 
 who incarnates, who builds ; who commands the 
 elaborate methods and the recondite means — tents, 
 tampons, salves and plasters — by which these pro- 
 cesses are initiated and governed ; who assembles the 
 functions, engenders and regulates the new flesh, 
 and knits up the scar. 
 
 "With Guy of Ghauliac, the ablest surgeon of 
 his time, medieval medicine may be said to end. 
 The vigorous push of surgery in the thirteenth and 
 fourteenth centuries was checked in the West by 
 the feudal pride and academic bigotry which, cul- 
 minating in the reactionary ferocity of the Church, 
 thrust surgery down into the ranks of illiterate 
 barbers, reckless specialists, and adventurous charla- 
 tans. In Italy, however, the genius and bent of 
 the people, for art as well as for philosophy, and 
 the ascendancy of the secular element in the 
 Universities, still kept sm'gery more nearly to its 
 place as the positive and fruitful side of Medicine, 
 and as " the scientific arm of the physician." ^ 
 Provence, strengthened for a time by the Arabs on 
 the south-west, by the Italians on the south-east, 
 and by the Papal Court at Avignon, had produced 
 Mondeville and Guy of Chauliac ; and was to pro- 
 duce Franco. But the slackness of the Italian 
 schools of medicine was temporary, as the advantages 
 of Montpellier were temporary. In the fifteenth 
 century Bologna rose again quickly to surpass all 
 other schools, to surpass in vitality if not in 
 ^ An excellent phrase which I owe to Sir John Burdon Sanderson.
 
 52 THE HISTOEICAL EELATIONS 
 
 numbers Montpellier and even Paris. We have 
 seen that before the rich endowments of its chairs 
 Salerno, the oldest medical school of modern Europe, 
 had diminished. Moreover, as Paris waxed, Mont- 
 pelUer and Toulouse, Oxford and Cambridge, 
 stiffened under its harsh and sapless domination. 
 In spite of the Italians and Mondeville, Guy's 
 influence turned the tide back towards arabist and 
 galenical polypharmacy and salve surgery ; and 
 turned it, not in France only but even in Italy 
 itself, where he influenced Argelata, and in Germany, 
 where he influenced Brunschwig (p. 91). During 
 the fifteenth and sixteenth centuries, fifty - two 
 editions of Guy's Surgery were printed ; and it held 
 the field until tradition was broken again in Italy 
 by Fabricius, who founded surgery anew upon 
 anatomy and upon the original texts of Hippocrates, 
 Galen, Celsus and Paul, and fortified the new edifice 
 with the work of his own talents and experience 
 and those of his contemporaries, such as Fallopius 
 and Eustachius. Still in Italy of the fifteenth 
 century surgery never withered as it did in the 
 West ; if it slumbered for a spell, it soon aw^oke 
 again, to be refreshed in the new hellenism. 
 
 Peter of Argelata (d. 1423), Doctor of Arts and 
 Medicine, and a professor of Bologna, wrote an 
 excellent Surgery full of personal observation ; and, 
 perhaps for the first time, was frank about his own 
 mistakes. In some bolder adventure in operative 
 work, as distinguished from mere wound-surgery, 
 Peter followed the lead of Henry and Guy ; and was 
 himself a learned and skilful practitioner. He was
 
 OF MEDICINE AND SUEGEEY 53 
 
 for a dry wound ; but to this end used powders 
 which, as we have seen, Hugh and Theodoric refused, 
 as retentive of putrescent matters. He helped him- 
 self freely of course to Guy's writings, but was bold 
 in preferring experience to authority. He used 
 sutures for the larger wounds, with drainage tubes of 
 perforated metal. He trepanned the long bones as 
 well as the skull, and even operated in the lines of 
 the specialists on hernia and stone. He cured 
 fistula by incision, and in extraction of the dead 
 foetus followed Guy's method of operating through 
 a large spectrum. 
 
 Of one of Peter's pupils, Marcello Cumano, a 
 surgeon known to few of us even by name, I must 
 speak in passing ; for, if De Eenzi be correct, he 
 was the first to write upon the wounds of firearms. 
 Cumano was an army surgeon who died in the 
 Morea, and the manuscript of his Vade Mecum 
 lay unknown in Florence till 1650. It was printed 
 n-ot " eighteen " years later, but seventeen. I can- 
 not discover the grounds of Haeser's commendation 
 of this surgeon. The edition ^ which T had before 
 me as I wrote this paragraph is but a " Chirurgia 
 parva," a meagre collection of galenical receipts, 
 many of them, it is important to note, for venereal 
 eruptions ; I discover not a gleam in it of surgical 
 or medical sagacity. His writing on shot wounds 
 is exiguous, even as a beginning. This paragraph 
 is entitled Dolor vulneris scloiJeto illati vel ballista. 
 The pain is to be soothed by the warm application 
 
 ^ A collection of medical tracts published at Ulm. Ed. 
 Velschius, 1667.
 
 54 THE HISTOKICAL EELATIONS 
 
 of oil of roses, of galbaiium and of assafoitida. 
 This receipt does not suggest that the opinion was 
 then current that these wounds were poisoned ; but 
 the author does not discuss the matter, as Haeser 
 seems to imply. The discovery of firearms shook 
 not the nations only, but also the dominion of 
 authority in Medicine, by raising, as we shall 
 presently see, another and a new controversy on 
 the treatment of wounds. 
 
 Leonardo Bertapaglia, another great Paduan 
 Professor, flourished a little after Peter of Argelata, 
 but was a man of ftir less originality. He held 
 more closely to the Arabs, especially to Avicenna 
 and salve surgery ; he knew but little anatomy, 
 and not only, like other wound surgeons, avoided 
 major operations, but left even minor operations to 
 the barbers, wherein he betrayed the weakness 
 which had crept even into the surgery of the 
 Universities of harassed Italy. Moreover we note 
 in his Surgery the advancing influence of Arabian 
 astrology in this century. Still, Bertapaglia did 
 good service in investigatiiig the conditions and 
 improving the method of the ligature. His method 
 was to draw the vessel forwards with a steel hook, 
 to isolate it, to tie it with a flaxen thread, then, to 
 prevent slipping, to pierce it with the needle and 
 thread and, twisting the thread round, to make 
 fast by knots. It was a clumsy method, but in 
 isolation of the vessel was better than Pare's ligature 
 en masse. He resected ribs in empyema, as Guy 
 had done ; he sutured wounds of the intestine, 
 with the glover's (" furrier's ") stitch, and used
 
 OF MEDICINE AND SURGEEY 55 
 
 softened catgut in preference to thread for the 
 purpose. 
 
 At Padua, in the fifteenth century, by the 
 hand of Montagnana the elder, were instituted the 
 Consilia, or published collections of notes and reflec- 
 tions on cases, which played so efficient a part in the 
 advance of clinical Medicine in the two following 
 centuries. For Montagnana we cannot claim more 
 than a commencement, yet he also was among the 
 first of those who returned to the fountains of Greek. 
 He quotes directly from Paul, whose writings had dis- 
 appeared for a while after Guy used them ; and from 
 Celsus, whose great work had been recovered again, in 
 1443, in the church of St. Ambrose at Milan (p. 25 n.). 
 
 In the midst of these mainly arabist professors 
 of Medicine of the fifteenth century arose Antonio 
 Benivieni, to be revered as the forerunner of Mor- 
 gagni, and as one of the greatest physicians of the 
 late Middle Ages. This distinguished man, a Doctor 
 of Medicine and a man of culture, was born in 1448 
 and died in 1502. He was not a professor but an 
 eminent practitioner in Florence, at a period when, 
 in spite of its platonism (p. 63), Florence on the whole 
 was doing the most for science; for as Bologna turned 
 to law Padua turned to humanism and pliilosophy. 
 He was one of those fresh and independent observers 
 who, like Mondeville, was oppressed by the authority 
 neither of Arab nor Greek. Malgaigne claims for 
 him the first performance of lithotrity ; but even 
 if this statement were correct,^ Benivieni's case 
 
 ^ Lithotrity, or lithothripsy, is an old story. Attempts at it 
 were made by Byzantines and Arabs, more or less as secrets of the
 
 56 THE HISTOEICAL EELATIONS 
 
 was in a woman, in whom the stone was hooked 
 forward, and then knocked to bits with a punch.^ 
 Carefully as the bits were washed out, this opera- 
 tion in woman, even if it had not been anticipated, 
 was no great matter in lithotrity. Nor do his claims 
 to our admiration rest upon his puncture of the 
 hymen for retained menses ; nor upon his division 
 and slow extension of the cicatricial contractions 
 of a burned arm, ingenious as these devices were. 
 Nor again shall we admire Benivieni chiefly 
 because he was the first to communicate his own 
 matter tersely and practically, without fabricating 
 a complete treatise to contain it, and without 
 tricking it out with dogmatisings, ratiocination, or 
 the chimeras of oriental lore. This is true enough, 
 no doubt ; but Malgaigne does not state that 
 
 adept. A remarkable passage from the Corpus script, hist. 
 Byzant. (vol. ii. p. xxxiv. ) is quoted by Hae.ser (Bk. i. p. 509) 
 (I paraphrase the Greek, but keep closely to the meaning) : — 
 In one afflicted tvith a very chronic di/suria instruments were passed 
 by the natural passage {rod (pvaiKov inrovbfiov) into the Madder, 
 tvhich breaking up [the stories] {5i.a6pinrTovTa) pi'omoted their 
 discharge and thus gave free issue to the urine. Haller points 
 out that a later surgeon, Sanctorius [Comm. Aviccnnae, 1626), 
 pictured a trifid catheter with a spear in it, wherewith to pierce 
 the stone, but regards it as a mere suggestion. In a MS. at 
 Vercelli how-ever Haeser says a long pair of nippers is figured 
 with such a boring stem, the instrument to h& passed per 
 urethram. Ciucci of Arezzo and Rome (about 1650) invented such 
 an instrument — very like that of Civiale ; and says by its means his 
 own bladder was relieved of a stone in three .sittings. He adds 
 that the bladder may be caught in the nippers and torn, when (the 
 operator) "misero patienti et lapidem et animam educit ! " In his 
 own case he laid upon the operator " ut mihi religiosissime obtem- 
 perasset," and that if he felt the least catch on the bladder the 
 operator should stop instantly. 
 
 ^ Celsus tells us that the Alexandrine stirgeon Ammonius 
 (d XidoToiiios) used the same means, in both sexes, to break up stones 
 too large to pass by the perineal incision. (Lib. vii. ch. 26, § 3. 
 Vedrene's Ed. p. 540.)
 
 OF MEDICINE AND SUEGERY 57 
 
 the little book De abditis causis morlorum (brief 
 title) was not published in any form by Antony 
 Benivieni himself, but posthumously by his brother 
 Jerome, who found these precious notes in Antony's 
 desk after his death, and with the cordial consent 
 of a friend,^ competent in the subject, published 
 them in 1506," in the form which no doubt justly 
 merits our admiration. Benivieni's chief fame for 
 us is far more than all this ; it is that he was the 
 founder of pathological anatomy. So far as I know 
 he w^as the first to make the custom and to declare 
 the need of necropsy to reveal what he called not 
 exactly " the secret causes " but the hidden causes 
 of diseases. Before Vesalius, before Eustachius, he 
 opened the bodies of the dead as deliberately and 
 clear-sightedly as any pathologist in the spacious 
 times of Baillie, Bright, and Addison. Virchow, in 
 his address at Eome, said Morgagni was the first 
 pathologist who, instead of asking What is disease ? 
 asked Where is it ? But Benivieni asked this 
 question plainly before Morgagni : not only, says 
 he, must we observe the disease but also with more 
 diligence searcli out the seat of it. The precept is 
 so important I will quote the original words : — 
 "Oportet igitur medic'ivmnon solum morhumcognoscere, 
 sed et locum in quo Jit, diligentius p)^'>'scrutari." 
 Among his pathological reports are morbus coxae 
 (two cases) ; biliary calculus (two cases) ; abscess of 
 
 1 Rosaliiis, who says tliat the loss of such notes "magnum 
 detrimeutum, magna injuria fieret cum presentis tum futuri saeculi 
 hominibus." 
 
 ■■^ The R.C.P.L. copy — a pretty one, containing Scribonius Largus 
 also, was printed by Cratander of Basil in 1529.
 
 58 THE HISTORICAL RELATIONS 
 
 the mesentery ; thrombosis of the mesenteric vessels ; 
 stenosis of the intestine ; some remarkable cardiac 
 cases, several of " polypus " (clot, which was a will- 
 of-the-\visp to the elder pathologists) ; scirrhus of 
 the pylorus, and probably another case in the colon ; 
 ruptured bowel (two cases) ; caries of ribs with ex- 
 posure of the heart (vide G-alen's case, p. 17). He 
 gives a good description of senile gangrene which 
 even Pare did not discriminate. He seems to have 
 had remarkable success in obtaining necropsies : con- 
 cerning one fatal case he says plaintively " Sed nescio 
 qua superstitione versi negantibus cognatis," etc. 
 Of another he says " cadavere publicae utilitatis 
 gratia inciso " (the case of cancer of the stomach).^ 
 With this admirable and original leader Italian 
 Medicine of the fifteenth century closes gloriously, 
 to slumber for some fifty years, till the dayspring of 
 the new learning. Of his work Malgaigne says, and 
 apparently with truth, that "up to now it is the only 
 work on pathology wdiich owes nothing to any one."^ 
 
 Some of my readers may wonder how it is that 
 
 ^ It is interesting to note that Benivieni held the opinion of the 
 march of the "French Pox," that it was from Spain to Italy, and 
 from Italy to France. The pestilence seems to have received this 
 name on the invasion of Naples by the French in 1495. The note 
 on Benivieni as a pathologist in Signor Chiari's "History of 
 Pathological Anatomy " in the second volume of Puschmann's 
 Handbuch, seems to me very inadequate to the proper appreciation 
 of his merits. 
 
 ^ Dodoens published an edition of Benivieni at Leyden in 1585, 
 with notes of his own, which has not fallen in my way. Nor have 
 I seen the fifty additional records discovered in the last century, 
 and published by Puccinotti (see Haeser in loc). Haeser tells us 
 that we have to lament the loss of a work of Benivieni on Surgery. 
 He says that for haemorrhage he used the cautery 'Hncisam 
 arter'iam candente ferro inicro."
 
 OF MEDICINE AND SUEGERY 59 
 
 in discoursing of medieval surgery I have not dwelt 
 upon the surgical College of St. Come of Paris. 
 Well, St. Come did no great things for surgery. 
 The truth is tliat, infected with the exclusiveness 
 and dialectical conceits of all the schools of Paris, 
 St. Come was almost ready to sacrifice surgery itself 
 if thereby it might choke off its parasites the 
 barbers. Lest they should be suspected of mixing 
 their philosophy with facts, its members went about 
 with their hands ostentatiously tied behind them. 
 If perhaps Malgaigne speaks too contemptuously 
 of St. Come, it must be admitted that the College 
 was in a false position throughout. In aping the 
 Faculty of Medicine, it lost touch of mother 
 earth without gaining any harbourage in the deep 
 waters of the proud. Nay, such is the Nemesis of 
 pride, the barbers came to command the position. 
 It did not suit the Faculty to see the barbers 
 weakened ; for in their weakness lay the strength 
 of the surgeons of St. Come, who sought incessantly 
 to appear as lettered clerks, to attach their College 
 to the University, and even to claim a place beside 
 the Faculty itself. To bring St. Come to its knees, 
 and to check the presumptuous claims of this 
 Corporation on the privileges of the Faculty of 
 Medicine, on a liberal education in arts and 
 medicine, on a place in the university, on the 
 suppression of unqualified surgical practice, and, 
 less honourably, on relief from handicraft and 
 urgent calls,^ the Faculty had but to coquette with 
 
 1 To be subject to urgent calls was in the opinion of the time 
 the status of a slave. I trust that none of my readers can see any 
 excuse for such a sentiment.
 
 60 THE HISTOKICAL EELATIONS 
 
 the barbers. Medicine, proclaimed the Faculty 
 when it suited its purpose, contains the theoretical 
 and the practical sides of surgery ; a surgeon is 
 therefore but the servant of the physician. If 
 St. Come sought to provide lectures in surgery, 
 the Faculty, which kept possession of teaching 
 licenses and desired in the surgeon a docile 
 assistant, took the teaching from the college, 
 and invited the barbers to lectures of its own. In 
 their duplicity and conceit of caste physicians of 
 the Faculty condescended even to publish books on 
 surgery, books as arid and as insincere as their 
 lectures. On the other hand, in the person of the 
 King's Barber, the barbers had a secret and potent 
 influence at Court.^ The Faculty persisted in 
 denying to St. Come all " esoteric " teaching, all 
 diagnosis, and all use of medical therapeutics. 
 Aristotle was pronounced to be unfavourable to 
 the " vulgarising of science." Joubert was attacked 
 for editing Guy, but replied with dignity (in the 
 notes to his edition). While the Faculty thus tried 
 to prevent the access to letters of a presumptuous 
 body of artisans, St. Come in mimic arrogance 
 disdained the barbers, sought to deny tliem the 
 name of surgeon, and was jealous of the diffusion 
 of technical knowledge among them in the ver- 
 nacular tongue.^ Thus, as it was only during the 
 
 ^ In 13/2 the Barbers obtained the right "de curir et de guerir 
 toiites manieres de clous, bosses, apostumes, et plaies ouvertes en 
 cas de peril, ct autrenient si les plaies n'etaient niortelles, sans 
 pouvoir en estre empeehes par les mires, on chirurgiens jur^s." At 
 Hildesheim at any rate the Barbers dedicated their guild (1487) to 
 St. Come and Damian (Becker, loc. cit. p. 29, n. 3). 
 
 2 Tolet in his translation of Paul of Egina into latin (Lyons,
 
 OF MEDICINE AND SUEGEEY 61 
 
 brief ascendancy of the great southern surgeons, 
 such as Lanfranc, Pitard, and Henry of Mondeville, 
 who were both surgeons and scholars, that St. 
 Come exercised any real and beneficial influence, I 
 have not occupied myself with this College at any 
 greater length. 
 
 In discussing French sm-gery of the fifteenth 
 century we must distinguish then between the 
 surgery of Paris, of the provinces, and of the rural 
 districts. And it would be unjust to forget that 
 in the latter half of the fifteenth century Paris 
 suffered some reforms, although the public w^as 
 then as convinced that orders were essential in a 
 physician as now in a schoolmaster ; celibacy was 
 abolished for physicians, and with it diminished 
 the allurements of prebends and rectories, and the 
 pernicious practice of the " medecins reclus " 
 (Bucharzte) who did not visit patients, nor even see 
 them, but received their ambassadors, who brought 
 gifts and vessels of urine, and carried back answers 
 far more presumptuous than the wise response of 
 Falstaff's physician.^ Nevertheless reform in Paris 
 was not only very grudging, but was capriciously 
 favoured or thwarted by the Court. Fortunately 
 however the surgeons were carried out of Paris 
 into war, a far better school than the barren 
 Faculty of Medicine. 
 
 1540) says he was not disposed to let the surgeons learn latin, as 
 this would be to rival the physicians in knowledge "ce que les 
 medecins ne doivent vouloir." 
 
 ' In the many handbooks of the water casters to be found 'in 
 our libraries are schedules of the colours and other superficial 
 appearances of the urine with the proper medicines in a parallel 
 column.
 
 62 THE HISTOEICAL EELATIONS 
 
 Montpellier towards the end of the fifteenth 
 and in the sixteenth century fell upon evil days. 
 Deserted by the Popes who had maintained the 
 liberal traditions of Italy, ravaged by war, and 
 her libraries rifled, it was a sign as well as a 
 cause of farther decay that, to herself untrue, she 
 fell under the influence of Paris, and committed 
 the fatal error of separating surgery farther from 
 medicine, whereby she cut Medicine away from its 
 living root, forbad her graduates even to meddle 
 with the craft, and abolislied surgical teaching. 
 
 Meanwhile, however, the return of the Popes 
 to Rome, and the displacement of Albucasis and 
 Avicenna by the greek texts, renewed the shrivel- 
 ling body of Medicine, and with the help of anatomy 
 Italian Medicine awoke again ; though until the 
 days of Vesalius and Harvey the renascence came 
 rather of men of letters than of medicine. The 
 Arabs and Paris said ; — Why dissect if you trust 
 Galen ? But the Italian physicians insisted on 
 verification ; and therefore back to Italy again the 
 earnest and clear-sighted students flocked from 
 all regions. Vesalius was a young man when he 
 professed in Padua, yet, young or venerable, where 
 but in Italy would he have won, I will not say 
 renown but even sufferance ! If normal anatomy 
 was not directly a reformer of Medicine, by way of 
 anatomy came morbid anatomy, as conceived by the 
 genius of Benivieni, of Morgagui, and of Valsalva ; 
 the galenical or humoral doctrine of pathology 
 was sapped, and soaring in excelsis for the essence 
 of disease gave place to grubbing for its roots.
 
 OF MEDICINE AND SURGEEY 63 
 
 We caunot make however brief an adventure on 
 the history of Medicine in the sixteenth century, 
 that dramatic century as vast and swift in the com- 
 pass of its art and thought as bigoted and fierce in 
 its reactions, without a livelier sense of that intimate 
 dependence of Medicine upon the spirit of its age 
 which we have recognised already. Tormented by 
 pestilence and war, seeking a false succour in the 
 black arts of the East, in astrology, magic, and 
 priestcraft, our fathers of the sixteenth century 
 fought a dark and troublous way to light, truth, 
 and beauty. Amid materialism, indifference, and 
 bold unbelief in Church and State, when even priests 
 were making a mock of religion, it was the men of 
 science, in the armour of natural knowledge, who 
 awakened religion anew, and brought refreshment to 
 stunted souls and withered hearts.^ The platonism 
 of this century, soon as it settled down on its lees, 
 was for a while the powerful adversary of aristotelian 
 orthodoxy, in cloister, in academy, and even in the 
 Papal Chair. Da Vinci, Michael Angelo, Eaphael, 
 were Platonists ; though, like Telesio who turned 
 from the Church to natural philosophy, they re- 
 jected much of its flummery. Before them Petrarch 
 had denounced inordinately, but he had given no 
 lead. Vives, the Spanish Professor of Oxford and 
 friend of Erasmus, was the first of a great procession 
 of builders — De la Eamee, Palissy, Bacon, Charrou, 
 Gassendi, Descartes — who doomed the fabric of 
 the dogmatic schools, and in letters and natural 
 philosophy laid the stronger foundation of inductive 
 
 ^ For this true and profound reflection I am indebted to Haeser.
 
 64 THE HISTOEICAL EELATIONS 
 
 research. Vives urged the study of anatomy, and 
 with De La Eamee (both of ithem laymen) declared 
 the futility of lectures on Medicine without clinical 
 instruction. Such instruction was established in 
 Padua — by Montanus, and probably in Montpellier. 
 Paracelsus, as ardent a system-maker as Galen, in- 
 toxicated by platonism and blinded by an impatient 
 temper, did much service nevertheless in blowing 
 his horn over against the ancient and toppling 
 walls of convention ; and, although he ignored 
 anatomy, he sketched in some chemical background 
 for Medicine. .The great princes of Florence, Milan, 
 Perrara, and Mantua endowed liberal learning. 
 More than a century before Battista Porta in 
 Naples, and two centuries before Boyle and Wren 
 in Oxford, Bessarion in Konie, Pomponius Laetus 
 in Naples, Nicholas of Cusa in Germany had pro- 
 moted associations of learned men which, directly and 
 indirectly, were the strength of science in successive 
 generations. In the sixteenth century Palissy 
 founded the science of geology, a foundation scarcely 
 built upon till the nineteenth. Bacon contrasted 
 the " anticipatio," or speculative conception of nature 
 — which he calls a rash and precocious method — 
 with the interpretation of nature ; the logic of 
 thought being perfect enough he proclaimed that 
 the stuff and premises of it must be verified, 
 and that experiment must not be desultory, but 
 systematic and consistent ("seriatim et continenter"). 
 Strangely lacking in the qualities of an investigator, 
 and too violent in reaction against hypothesis, yet 
 as a philosopher he inscribed on a monumental
 
 OF MEDICINE AND SUEGERY 65 
 
 page principles which Copernicus, Kepler, Galileo, 
 Harvey, were putting into practice. Vesalius re- 
 generated anatomy, by proving that Galen's anatomy 
 was largely based upon dissection of apes and dogs, 
 and in any case was faulty and defective.^ In 
 physiology Colombo and Cesalpini were pre- 
 paring for Harvey. But ratiocination founded 
 on scholastic dogmas is not upset in a year, 
 nor in a century of years. A ruthless war 
 against enlightenment lasted all the second moiety 
 of the sixteenth century, and well on into the 
 seventeenth ; for, as Hippocrates warned us, ex- 
 perience is difficult, verification fallible, observation 
 long and costly, occasion fleeting. Many changes 
 however conspired to disturb the serenity of medical 
 self-satisfaction, and to undermine the long domina- 
 tion of traditional medical doctrine which, even 
 if genuine, would as a formal and transcendent 
 authority have become sterile enough, and, as a 
 bogus doctrine of partial and distorted texts, 
 was infinitely mischievous. Now however " uralte 
 Wasser steigen verjiingst." On the discovery of 
 the original greek texts, the false texts, glosses and 
 commentaries were put to shame ; while the in- 
 vention of hempen or rag papers in place of silk 
 paper or parchment, the discovery of printing, 
 and the vindication of the vernacular tongues 
 sapped the privileges of the clerks. 
 
 I have said elsewhere,^ that the aid of the 
 
 ' The De corporis humani fabrica Libri scptem appeared in the 
 same year (1543) as the De revolutionibus orbium celestium. 
 ' Harveian Oration 1900. 
 
 F
 
 66 THE HISTOEICAL EELATIONS 
 
 humanists in the development of Medicine was no 
 unmixed advantage ; for if in art and letters they 
 were reformers they were for the most part as 
 scornful of handiwork, and as alien from natural 
 knowledge, as the clerks and the nobles. It is true 
 nevertheless that such men as Vidus Vidius — 
 Francis the First's Eegius Professor at the College 
 of France — if themselves no very original observers, 
 by leading their pupils back to the ancient 
 texts, indirectly loosened the rusty chains of the 
 galeno-arabist bondage, and of all such bondage ; 
 and in this work Vidius had successors greater 
 than himself — such scientific humanists as Beroaldo 
 of Bologna, Leoniceno of Ferrara, Linacre, Caius, 
 and the two editors of the Hippocratic Canon, 
 Cornarus and Foesius. From Petrarch to Moliere 
 great laymen had demanded why, if medicine were 
 not a going concern, but a static doctrinal scheme 
 derived, like the Athanasian Confession, from the 
 fathers, and immutable, it needed any augurs, adepts, 
 or illuminati for its comprehension and use. To 
 this question there was no good answer ; and 
 thoughtful physicians influenced, perhaps insensibly, 
 by the searching spirit of the greek texts of Hip- 
 pocrates, began to stir in their sleep, and uneasily to 
 suspect there were many maladies on which even 
 this great ancient threw but a glimmering light 
 or none, — such, for example, as syphilis and the 
 great pestilences of the West, upon which new 
 problems books began to appear, such as those of 
 Fracastoro, Caius, and Baillou. Dialectical and 
 scholastic as it was, Baillou's treatise made its mark
 
 OF MEDICINE AND SUEGEEY 67 
 
 as the first comprehensive treatise on Epidemics 
 since Hippocrates ; in spite of himself he was com- 
 pelled to teach what Galen did not know, to begin 
 to discriminate certain fevers hitherto confounded 
 under one name, and thus to develop symptoma- 
 tology, and slowly and insensibly to bring into view 
 authorities concurrent with the ancients themselves. 
 Other direct causes of the break-up of the frost 
 were the use of firearms,^ which made wounds 
 that even Galen had failed to foresee or to pro- 
 vide against ; a like defect of galenical doctrine in 
 respect of syphilis and other' epidemics ; not defect 
 only but grievous error in anatomy ; the reform of 
 this science ; the germination of pathological 
 anatomy ; the prodigious discovery of a vast con- 
 tinent of which the omniscient ancients had no sus- 
 picion ; a strange schism on venesection — whether, 
 that is, it were orthodox to bleed on the side of the 
 disease or on the opposite side (p. 107); and the 
 revelation in the light of the genuine Hippocratic 
 treatises of the incompetence of the Arabs in 
 fractures and luxations.^ 
 
 In the opening of the century Italian Medicine 
 was still in the van until the birth of the u;reat 
 French surgeons, Franco and Pare ; and of Gersdorff 
 
 ^ Althougli for siege work pieces of ordnance were used in the 
 middle of the fourteenth century, field pieces and the small firearms 
 did not come into use till a hundred years later. The first picture 
 of a cannon is in an illuminated MS. of the fourteenth century in 
 the Christchurch Library. 
 
 2 The chief Greek texts were not directly accessible till towards 
 the middle and end of the sixteenth century ; but Aetius was 
 discovered, and Celsus and Paul, more than once lost, were found 
 again (pp. 25, note, and 55).
 
 68 THE HISTOEICAL EELATIONS 
 
 and Wiirtz in Germany. Among the great Italians 
 of this time, first perhaps in interest was the un- 
 lucky Berengario da Carpi, a pioneer in anatomy — 
 he tells us he had " dissected " a hundred bodies ^ 
 ■ — and a Doctor of Medicine of Bologna, whose name 
 has been made familiar to us by Cellini. Cellini 
 maliciously twits Berengario on the enormous profits 
 of his practice in the French pox ; this he treated 
 by mercurial inunctions. Cardinal Colonna, well 
 known to us by his portrait by Eaphael in the Uffizi, 
 was one of his most lucrative patients. Berengar 
 practised in Kome in the first part of the sixteenth 
 century. Twice he extirpated the uterus for pro- 
 lapsus ; he wrote an able treatise on gunshot 
 wounds ; and in the course of his anatomical inves- 
 tigations he added a few facts to pathology. A 
 still more celebrated physician was John of Vigo 
 (1460-1520) who, as attached to that fighting 
 l*ope Julius II., saw much of field surgery. His 
 Surgery, printed at Eome 1514, had enormous 
 vogue, a vogue perhaps unique. If of Guy's 
 Surgery, at the end of the fifteenth century and 
 the beginning of the sixteenth, there were, as we 
 have seen, 52 editions, the run of editions and 
 translations of Vigo seems to have been endless. 
 
 ^ It is not easy to know what in those days ' ' dissection of a 
 body " meant. Tlie corpses soon became putrid, and on many 
 occasions probably a public demonstration of the chief viscera 
 sufficed. Moreover some of the bodies were probably of monkeys, 
 or only of the domestic pig, so useful to medieval anatomists. That 
 Berengar was an ardent anatomist however, even of the human 
 subject, may be confirmed from the persecutions he suffered at 
 the hands of the priests. Nevertheless all the anatomists before 
 Vesalius professed to work only in the illustration and elaboration 
 of Galen.
 
 OF MEDICINE AND SUEGEIJV 69 
 
 For since the work of Guy uo standard surgical 
 treatise had appeared. A French translation of 
 Vigo's treatise on the wounds of firearms fell into 
 the hands of Pare, and probably, as a modern 
 and independent work, had, with Guy's Surgery, 
 then the standard authority, an inspiring influ- 
 ence upon the barber's boy while he was shaving, 
 trimming wigs, or brushing out the shop at cock- 
 crow. Nevertheless the value of Vigo's w^ork is 
 far less ; he may be called the last of the elder or 
 didactic surgeons, he had little of the initiative of 
 Fabricius, and drew freely on Guy. Yet he was a 
 shrewd and skilful as well as a learned physician, 
 who had read his Celsus to some profit. In his 
 Pradica, published at Eome in 1514, he observed 
 that gangrene is apt to arise from bad bandaging 
 in fractures, and from access of frost ; also he 
 compared wound gangrene with the dry senile 
 form which, as I have said, had been described by 
 Benivieni (p. 58) ; he noted fracture of the inner 
 table of the skull without that of the outer ; and 
 he undertook certain of the graver operations, 
 though not such as fell within the custom of 
 the professional cutters— not, that is to say, hernia, 
 stone, plastic work, or cataract : these he discreetly 
 left to the " vagabonds qui courent de pais en pais." 
 He treated syphilis with mercurial inunctions. 
 In amputation, like Benivieni, he relied upon the 
 cautery, and mentions ligature only in the case of 
 tying an uncut vessel before dividing it, as for 
 example Antyllus did in aneurysm. The current 
 fame of Viso is that he first wrote of the wounds
 
 VO THE HISTORICAL KELATIONS 
 
 of firearms, though a bare priority is said to belong 
 to Cumano (p. 53). In respect of a controversy of 
 which I shall have to speak more fully, John of Vigo 
 held that the wounds of firearms were scorched and 
 poisoned wounds, and therefore to be purified by 
 the cautery and injections of boiling oil. 
 
 Although even in Italy pus kept in favour 
 with physicians and surgeons alike, till Lister swept 
 it away,^ yet in the sixteenth century, as in all 
 periods of the history of Medicine, surgery, being 
 conversant directly with nature and fact, was before 
 inner medicine to receive the inspiration of the new 
 methods of personal experience and free inquiry. 
 Indeed the unscholarly training of its practi- 
 tioners saved them from the tyranny of the letter ; 
 while the enlightenmeiit of truth slowly compelled 
 the regard of their haughtier fellows. In all 
 countries, Italy excepted where from Salernitan 
 times onwards scientific surgery had always been 
 held in honour, the barbers, the bone-setters and 
 the cutters, the most intimate of the servants of 
 nature, gained upon the superior surgical persons 
 of the colleges, and demanded admission to their 
 ranks. All honour to them ; for these humble and 
 faithful ministers of such medicine as they knew, 
 tended the lepers and the syphilitic, and in times 
 of pestilence stuck bravely to their posts when their 
 
 ^ Professor Howard Marsh makes the following note on this 
 sentence: — "I do not think surgeons down to Lister (say 
 Lawrence, Jjrodie, Paget or Syme) favoured, or, consciously, took 
 steps to ))rocure pus. But, not seeing how to avoid it, they 
 desired 'healthy pus,' 'pus laudabile ' instead of sanious or 
 ichorous pus. They were always glad (even if surprised) when 
 none formed."
 
 OF MEDICINE AND SUEGERY 71 
 
 betters stood timorously aloof, or even took to 
 flight. 
 
 When we turn from these general considerations 
 to consider the life of Franco, the surgeon who 
 shares with Par^ the glories of French Medicine of 
 the sixteenth century, we shall see how it was from 
 the depths not from the heights that Medicine was 
 fed ; from the springs not from the sky, which was 
 as brass. There is a well-known passage in the 
 Oath of Hippocrates, a passage well known not only 
 as a part of that great injunction, but also as a some- 
 what unintelligible part : that, namely, in whicli 
 the aspirant is to promise that he will not cut for 
 stone, but will leave this operation to a peculiar 
 class of practitioners. That this warning signifies 
 surgery to be a calling inferior to medicine is, as 
 Littre well says, an opinion devoid of the smallest 
 probability, one which is belied by the whole of the 
 Canon wliereiu the Greek physicians appear con- 
 stantly as practitioners of medicine and surgery 
 alike. And in so high a discourse it is difficult to 
 accept the explanation of Franco that the counsel 
 was one of vulgar prudence ; that Hippocrates, and 
 after him Galen, not despising either the work or 
 the workmen, yet shirked undertakings which were 
 full of risk and exposed the surgeon to calumnious 
 tongues. Franco murmurs indeed that if a patient 
 die under medicine the faults of the physician are 
 laid to the score of the imperfection of nature ; but 
 that if he die under operation the surgeon is an 
 executioner or a murderer, and not rarely has to 
 take to his heels. Such are the words of the
 
 72 THE HISTOEICAL RELATIONS 
 
 boldest of the responsible surgeons of the sixteenth 
 century. Franco, like Pare, was no clerk ; he came 
 of a class lower even than that of Pare and the 
 barbers, that class, mostly wanderers, of bonesetters, 
 oculists, plastic operators, and cutters for stone and 
 hernia, of whom I have often spoken. Seeing 
 that until the time of Gersdorff and Pare the 
 regular surgeons, if . they ventured at all upon the 
 larger amputations, postponed them till, to the cer- 
 tain witness of the bystanders, the patient was 
 moribund, we cannot wonder that, even from the 
 time of Hippocrates — to say nothing of the 
 Egyptians — the dangerous ventral operations, and 
 those on the eye which but too often were swiftly 
 disastrous, fell into the hands of peripatetic crafts- 
 men, runagates Gale calls them, men usually of 
 low origin, ignorant, reckless, and rapacious. These 
 travelling surgeons of the short robe operated but 
 too often with great brutality, — and usually got out 
 of reach before the issue. If the issue were fatal, 
 or indeed without substantial relief to the patient, 
 they stood a good chance of paying with their skins. 
 In Dr. Henri -Maxime Ferrari's interesting book 
 line Chair e de Medecine au XVmc sUclc are some 
 anecdotes of these operators, and of their mode of 
 life. One of them, who by an operation on the eye 
 had failed to relieve the pain of a certain lady 
 (who would seem to have had a glaucoma ?), was 
 pursued in tlie night by her infuriated husband 
 with a naked sword in his hand. 
 
 As the truss was a very clumsy instrument, at 
 any rate till the end of the seventeenth century,
 
 or MEDICINE AND SURGEEY 73 
 
 the radical cure of hernia was in great demand.^ 
 In the district of Crotona twenty-seven families of 
 these special operators flourished for a long period. 
 In later times they got more culture, did sub- 
 stantial work for Medicine, and were called to 
 great nobles even down to the eighteenth century." 
 One of them was surgeon to Sixtus IV. in Eome, 
 and to Francesco Sforza in Milan. But from the 
 time of Franco no important book came again from 
 such operators till that of Durante Scacclii of 
 Urbino in 1596. That Calabria was a chief 
 nursery of these cutters may possibly signify that 
 the craft had survived from the days of the Greek "^ 
 " Periodeutes " who pretty surely travelled to the 
 Doric Hellenes of Magna Graecia.^ Now it is 
 the chief merit of Franco that he brought these 
 operations within the lines of responsible surgery, 
 raised them again to the standard of Celsus, and 
 thrust them into the ken of Pare and Fabricius. 
 
 The illustrious Proven(;al surgeon — " ce beau 
 genie chirurgical," as Malgaigne, in declining the 
 task of entering upon so full a life, calls Franco, — 
 was born about 1503. It is a note of his fearless 
 and penetrating spirit that he was a Huguenot, and 
 
 ^ So far as I remember Franco never even mentions the 
 truss. Fabricius of Hilden (p. 97) was perhaps the firet surgeon 
 to bring the instrument into a practicable form. 
 
 '■' Cf Fabbri's History of the Lithoto mists and Oculists of Xorciu. 
 Bologna, 1870. 
 
 ^ Of operation for hernia we have no record in the Hippocratic 
 canon; if Praxagoras of Cos performed it (cf. Caclius Aurelianus, 
 Acut. morb. iii. 17) unfortunately the texts are not convincing. 
 
 ■* It is difficult here to avoid a ])assing allusion to the survival 
 of some precious rivulets of Greek art and Greek language which 
 had not dried up in Calabria in the time of the Fisani.
 
 74 THE HISTOEICAL KELATIONS 
 
 for his religious opinions was driven to Switzer- 
 land.^ We may wish we had his concise opinion 
 of the mock St. Come, founded at Toulouse in 
 1517, whose "mires" (myrrhes) or " medecins 
 chirurgiens," determined not to be behind the 
 Paris body, declared " qu'il n'y avait rien de plus 
 vil que la chirurgie," a " rifiuto " which the 
 students joyfully acclaimed. 
 
 Franco began as an apprentice to an operating 
 barber, and to a hernia specialist. He had no 
 more " education " than Pare or Wiirtz, and he was 
 spared the misfortune of a speculative intellect. 
 Dr. Alezais ^ describes him as a " membre de St. 
 Come a Paris," but this is certainly incorrect. He 
 picked up some anatomy, educated himself by 
 observation, experience and manipulation, and as 
 a simple operator or " Master " won considerable 
 renown. As upright and modest as Pare, though 
 he never attained Pare's social position, he sub- 
 mitted to work under the physicians, taking his 
 quiet revenge in the remark that they did not 
 know enough to distinguish good surgery from bad. 
 Nicaise ^ says roundly " No surgeon made such 
 discoveries as Franco ; for hernia, stone and 
 cataract he did much more than Pare." In com- 
 parison with Pare Haeser treats Franco somewhat 
 slightingly, for not only did Franco bring the 
 operations for hernia (whether for strangulation or 
 for radical cure), lithotomy, diseases of the eye, 
 
 ^ The Waldensian massacres took place in 1545, 
 " Lcs ancicns CJiirurgicns et Barbicrs de Marseilles, 1901. 
 ^ No longer do I write Mons. Nicaise, as unhappily this able 
 historian at the height of his attainments has been taken from lis.
 
 OF MEDICINE AND SUEGERY 75 
 
 and plastic operations into the field of legitimate 
 Medicine, but by the great advances he made in 
 the technique of these several departments he did 
 so with great effect. In asserting that no surgeon 
 made more advances than Franco, and few so many, 
 Nicaise is probably right. His compatriot of 
 Chauliac had much influence upon him, but 
 Guy had not made much adventure into these 
 specialist fields of surgery ; he had not in- 
 vaded the monopolies of the " vagabonds," nor 
 contended against their ignorance and audacity. 
 Whether from sheer ignorance, or the brutality of 
 habit, it had been the custom during the Middle 
 Ages, and down even till the middle of the seven- 
 teenth century, in operating for hernia — and in 
 spite of Celsus' clear distinction (vii. 21), hydrocele 
 and sarcocele were not too carefully discriminated 
 from hernia — to sacrifice one or even both testicles ; 
 an abuse against which Franco took successful pre- 
 cautions, and proved that the canal could be closed 
 and the ring sutured without castration. In irre- 
 ducible inguinal hernia he distinguished between 
 opening and not opening the sac, and described 
 adhesions of sac and intestine. From him indeed 
 dates the rational operation for strangulated hernia,^ 
 and in strangulated scrotal hernia he founded the 
 method. Pare, and after him Petit, condemned the 
 
 ^ The earlier practice of the specialists was to puncture the skin 
 and bowel, and alter recession to apply the cautery to the skin. 
 Guy saw 30 cases so treated. Fabricius inverted the jiatient 
 and shook him by the legs. AVe must judge gently of such primi- 
 tive methods as these ; even Pare spoke favourably of reducing 
 hernia by strewing iron filings on the tumour, and administering 
 lodestone internallv.
 
 76 THE HISTOEICAL EELATIONS 
 
 ablation of the testicle/ a procedure however which 
 many surgeons thought quite good enough for priests; 
 and for these advances he gives credit to Franco, 
 though Fabricius does not even mention them. But 
 Pare did not himself attempt such operations ; he 
 did the best he could with long recumbency, and the 
 local use of bandages, plasters, strong astringents 
 (such as dragons' blood), or cauterising and cicatrising 
 agents. In children it seems that, with the help of 
 nature, such methods were not altogether fruitless ; 
 but in spite of the improvement in trusses by both 
 the surgeons distinguished under the name of Fabri- 
 cius '' and by later surgeons, the Council of Zurich 
 even so late as 1693 had to forbid excision of the 
 testicle,and indeed all herniotomy save in urgent cases. 
 Stone must have been a very common disease in 
 the Middle Ages ; and cutting for stone, though sur- 
 rendered to specialists, was in rather better hands 
 than herniotomy ; for in large part, as I have said, 
 it became the profession of responsible families of 
 which the Collots, whose dexterity Pare commended, 
 were the chief. These men were not all charlatans 
 by any means,^ and in their hands no doubt the 
 
 ^ As Franco's book on hernia was published under the approval 
 of the Chirurgiens-jures of Paris and in two editions, Pare must 
 have known it well. 
 
 - Fabrizio carried Pare's improvement of trusses so far forward 
 that he reduced the operations of one Italian family of hernia 
 cutters from 200 to 20 in the year. Very early in the 
 sixteenth century Benedetti, a Professor of Perugia, adopted a 
 Spanish method of saving the testicle. (See Fabbri's history of 
 these specialists. Bologna, 1870.) 
 
 ^ Franco speaks of the " JMaitres de bon aloi qu'il faut distinguer 
 des periodeutes charlatans." The more resjtectable of these peri- 
 ])atetics seem to have confined themselves to one country or district 
 \vidc note, jx 73). 
 
 ^»
 
 OF MEDICINE AND SUKGERY 77 
 
 operation gained both in method and in skill ; 
 though as such a family depended for its reputation 
 on the possession of secrets real or supposed, our 
 records of their methods are few and insufficient. 
 At this time no surgeon graduate, not even Pare, 
 as I have said, dared to meddle with the operation. 
 The method of Celsus was with the finger in the 
 rectum to cut the perina3um transversely on the 
 stone without a director, and to hook the stone 
 forwards ; for this purpose John of Gaddesden used 
 forceps. But such a blind method could not 
 answer well, except perhaps in children. The next 
 step, to pass a catheter or sound into the bladder, is 
 attributed to an unknown surgeon of Genoa ; and 
 sounds and catheters of wax, tin, or silver were no 
 new things at the beginning of the sixteenth century. 
 Stricture of the urethra however in these centuries 
 was even commoner than stone. Franco, who did 
 more for the operation than any surgeon of the 
 sixteenth century, work indeed of permanent value, 
 took the lead in the lateral, and also in the high 
 operation — that is in opening the bladder for large 
 stones directly above the pubes, a method which 
 until his day was misliked. He pictured soft 
 sounds of lead, and many catheters, some with 
 stylets. Sanctus, a Neapolitan surgeon and pupil 
 of Vigo, fully described the median operation on 
 a channelled director, thitherto a secret. This 
 director, or " itinerarium," Collot got hold of, and 
 showed to Pare. Franco, who seems to have known 
 some Latin, probably got it directly from Sanctus' 
 Libellus aureus de lapide a vesica.,^m^--xacisionem 
 
 SCHOOL OF 
 4fj^ MEDICINF u
 
 78 THE HISTOEICAL EELATIONS 
 
 extrahendo, 1524; and as Franco's books were well 
 known in Paris (p. 76, note) Pare probably had this 
 higher authority in its favour. Malgaigne confesses 
 that Pare was far from doing justice to his great 
 contemporary, who even in hare -lip was more 
 precise than Pare. However literary property was 
 scarcely recognised in those days, and Franco in like 
 manner lifted much of his knowledge of syphilis 
 from the Des hubons vin6riens of de Hery, to whom 
 neither Franco nor Pare seems to have been very 
 generous. Pare defends plagiarism by the meta- 
 phor that every candle must be lighted from another 
 candle. Fallopius was perhaps the first to recognise 
 literary honesty, at any rate in Medicine. 
 
 Unhappily in lithotomy the director fell into 
 disuse, and tearing and errant divisions of the parts 
 resumed their vogue. Even the Collots were prob- 
 ably rough, bruising operators ; and such was griev- 
 ously the case with the celebrated Frere Jacques, 
 who practised the lateral operation with prodigious 
 renown. To him I am tempted to turn for a moment 
 in passing, although by his later date he lies out 
 of my proper limits. Jacques Beaulieu, or Frere 
 Jacques, was born of poor parentage in Franche 
 Comte, in 1 6 5 1 . He was a great friend to the poor ; 
 but he was uncouth in manipulation, and his instru- 
 ments were clumsy. On his European celebrity he 
 received a friendly invitation to Paris from the 
 all-powerful Felix, and exhibited the lateral opera- 
 tion there; but things went ill with him, for out of 
 65 operations he had 25 deaths, and only 19 cures. 
 At that time at any rate he knew no anatomy ; he
 
 OF MEDICINE AND SUEGEKY 79 
 
 used to cut into the body of the hhidder beyond 
 the prostate, so that urine was extravasated into 
 the cellular tissue of the pelvis ; and he often 
 wounded neighbouring organs and blood-vessels. 
 At a later date, having learnt some anatomy, 
 improved his instruments, and introduced the staff, 
 he returned to Paris, when he is said to have 
 operated on 38 patients without a death. By 
 care and skill Kau of Amsterdam, Cheselden, and 
 Hawkins reduced the mortality of Frere Jacques' 
 operation — in the hands of Cheselden to 7" 5 per 
 cent. Eau, according to John Bell, behaved in this 
 matter with duplicity towards Cheselden. 
 
 When Franco steps beyond his surgery he 
 becomes, as Guy in like manner, as blindly galenical 
 as the pure physicians. He does not even suspect 
 that Galen had not to deal with lues. In the 
 Middle Ages ophthalmic surgery also, in the hands 
 of barbers and wayfarers, had fallen into sad decay 
 and abuse.^ For eye surgery however the ancients 
 and the Arabs had done a good deal, and even 
 John XXI. something ; in Bern and Lausanne an 
 illiterate practitioner like Franco would get access 
 to Celsus, and to Paul or Albucasis. Franco prac- 
 tised his eye operations on animals, and on dead 
 bodies of men ; and in the treatment of cataract is 
 full in his instructions and precautions. 
 
 I cannot make more than a passing reference to 
 the large and interesting subject of plastic opera- 
 
 ^ The best insight into the state of this department of surgery 
 in those days is to be had by jjerusing the treatise of Bartisch 
 Court barber, cutter for stone and oculist, in Dresden (1535-1606). 
 It contains good ligures both of diseases and instruments.
 
 80 THE HISTORICAL RELATIONS 
 
 tions which, after the times of Celsus and Paul, 
 became the industry of specialists. The Brancas of 
 Catania, who were celebrated nose restorers in the 
 fifteenth century, seem to have got their knowledge 
 from some stray MS. of Celsus. In the fifteenth 
 century these operations had been many and im- 
 portant, probably Ijecause of judicial mutilations, 
 free fighting, and syphilis. The material for re- 
 generation was generally taken from one arm, which 
 was bandaged to the face for some weeks. These 
 operations fell into disuse till Tagliacozzi of Bologna 
 rediscovered them two liundred years later. Pare 
 and Pallopius rather ignorantly denounced them, 
 and the clergy looked askance at such restorations, 
 as a blasphemous invasion of the prerogatives of the 
 Creator. After Tagliacozzi's burial, in the Convent 
 of St. John the Baptist in Bologna, his cries in 
 everlasting torment so disturbed the holy peace 
 of the nuns that there was nothing for it but to 
 howk his body out of its tomb and to restore it 
 to unconsecrated earth. Even in 1742 that 
 sublime body the Paris Faculty forbade such 
 creative adventures altogether. 
 
 The very eminence of Ambroise Pare encourages, 
 if it does not command me, to be content with few 
 words of commemoration. If in some respects 
 perhaps Pare may not be lifted far above his great 
 Italian contemporaries, such as Carpi, Maggi, or 
 Botallo, yet in a comprehensive judgment he surely 
 stands alone in the surgery of the renaissance as 
 an independent, original and inventive genius, and 
 as a gentle, masterly and true man. Himself of
 
 OF MEDICINE AND SUIiGEEY 81 
 
 humble origin he won for surgery in France a 
 social place and respect it had never attained 
 before. Born in 1517, he became a barber's 
 apprentice in the Hotel Dieu, whence he was called 
 to join the campaign of Francis I. against Charles V. 
 As he could not write a Latin thesis, his ad- 
 mission to St. Come was of course opposed by the 
 Faculty ; but Pare stoutly and sagaciously declared 
 that the vernacular^ tongue was essential to the pro- 
 gress of Medicine ; sagaciously, because the rise of 
 the vernaculars from the fourteenth century onwards 
 was as vital a factor in science as the formation of 
 a latin medical prose had been.- Eiolan the elder, 
 who had taken part in the opposition to Pare, wrote 
 a tract in 1577 with the following insolent title: 
 Ad irrvpudentiam quoriindam CMrurgorum, qui 
 medicis sequari et chirurgiam 'public^ jjrojitere volnnt 
 jyo'o dignitate veteri medicinae ajiologia philosophica. 
 To such inflated vanity the medieval " pure " physi- 
 cian lifted up not his mind only but his very soul. 
 At this time, be it remembered, Pare was sixty 
 years of age, and Surgeon to the King. 
 
 The first subject which comes into our thoughts 
 with the name of Pare is that of the ligature of 
 arteries ; and you will scarcely desire me to pass 
 
 ^ Gale also wrote in tlie vernacular. The favour shown in the 
 fifteenth century by tlie modish liouse of Este to the Itnlian 
 vernacular (to Boiardo for example) gave a new impulse to its use 
 in literature. The humanist, tlien as now, was fastidiously averse 
 to vulgar progress. When, at Lorenzo's advice, Bernardo Rucellai 
 invited Erasmus to answer his letters in Italian, Erasmus declined 
 — lest he should spoil his style ! 
 
 ■^ One is tempted here to remark that Pare was testifying foi 
 his mother tongue seven centuries after Alfred, the pontiff" of the 
 vernaculars. On the formation of medical latin vide p. 25. 
 
 G
 
 82 THE HISTOKICAL IIELATIONS 
 
 on without some discussion of it. I am often 
 surprised to see, even to-day, the invention of the 
 ligature attributed to Par^, whose surprise, if our 
 journals have an astral shape, must be greater 
 still, seeing that he himself, to justify an apparent 
 innovation, refers the ligature to Galen. He says 
 the ligature must have been taught him by the 
 special favour of the sacred Deity, for he learned 
 it not of his masters, nor of any other, neither had 
 he found it to be used at any time by any. Only 
 he had read in Galen there was no speedier remedy 
 for stanchino; blood than to bind the vessels through 
 which it flows. (Johnson's Edition, 1634.) The 
 attribution is of course a legend. Malgaigne dis- 
 creetly claims no more for Pare than the application 
 of the ligature from wound-surgery to amputations; 
 but I have implied already that even this claim 
 goes beyond the truth of history. I must remind 
 you once more that in all ages until the time of 
 Pare the surgeons, for very intelligible reasons, 
 shirked the larger amputations. Gersdorff indeed, 
 a great surgeon of Strassburg of the previous 
 generation, had rejected boiling oil and the cautery 
 and, using only a styptic of hare's fur and white 
 of egg, had performed two hundred of such amputa- 
 tions. He enclosed the stump in a bladder. The 
 first picture of an amputation — it represents that 
 of the leg just below the knee — is in Gersdorff 's 
 book (a.d. 1528). Yet it would be no great 
 exaggeration to say that even to the time of Petit, 
 who in the middle of the eighteenth century 
 substituted the screw tourniquet for bandages
 
 OF MEDICINE AND SUKGEKY 83 
 
 tightened with sticks and stones, amputation of 
 the larger limbs, save in gangrene, was avoided 
 as long as possible, and only too often longer than 
 that. Celsus speaks of the ligature as an ordinary 
 method in wounds/ From Oribasius we learn that 
 Archigenes of Apamea tied vessels even in amputa- 
 tion, after fixing a tight band at the root of the 
 limb.^ In the Middle Ages Yperman (p. 35) and 
 others— even Eoger and Koland — knew the use 
 of the ligature, and Yperman indicates the method 
 as proper for arteries. It seems probable that, 
 imless performed with modern nicety, secondary 
 haemorrhage must have been frequent under ligature, 
 especially on the battlefield ;^ indeed so late as 1773 
 Petit discarded the ligature, as Franco and Fabricius 
 had done. Although Guy had endeavoured to 
 improve amputation, by drawing up the skin and 
 muscles, he never mentions ligature ; he used the 
 red-hot knife and styptics. Pare however tells us 
 plainly enough that he undertook his experiments 
 with the ligature, and his improvement of this 
 means, because of the general experience of sur- 
 geons that the cautery, scalding oil, and styptics 
 such as rabbit's fur, aloes, and white of egg so 
 fouled the wound, and destroyed the flesh, as to set 
 up fever and to spoil the flaps which were then 
 
 ' "Quod si ilia (medicaiiienta) quoque profluvio vincuntiir, venae 
 quae saiiguinem fundunt apprelieudae, circaque id quod ictuni est, 
 duobus locis deligandae, intcrcidendaeque sunt, ut et in se ipsae 
 coeant, et nihilominus era proclusa habeant. " — Lib. v. c. 26, § 21. 
 - Paul on removal of tumours says "rd jxh ayyela SLaa-(pi^onev." 
 ^ The best description of the ligature to be found in the seven- 
 teenth century is by Fallopius in the second volume of the Frank- 
 fort Edition of 1660, p. 210.
 
 84 THE HISTOIUCAL RELATIONS 
 
 being designed and brought into practice. In con- 
 taminated wounds the cautery often acted no doubt 
 as a purifier, as suppuration did (p. 30); but the 
 means were indirect, precarious, and fraught with 
 incidental mischief. It is a more intelligent service 
 to a great man to point out how this detail and 
 that of his invention were no mere incidents, but 
 steps in a large reform of method ; a reform which 
 developed itself in Park's hands on the introduction 
 of firearms, whose ravages could not be covered up 
 with galenisms. 
 
 If John of Vigo was not the first to mention, 
 it seems he was the first to discuss the wounds of 
 these new instruments of war. In a translation of 
 Vigo's Surgery of 1514 is a chapter entitled 
 " Plaies faites de hacquehute, de hombardes ct d'in- 
 struments semUahles " in which we read that Vigo 
 shared the belief of the surgeons who first wrote of 
 gunshot wounds, such as Brunswick and Gersdorff, 
 that these wounds were envenomed burns ; so that 
 the chief aim of the surgeon should be to destroy 
 the dead fiesh and to neutralise the venom. To 
 this end Vigo used the actual cautery, where pos- 
 sible ; ]jut for penetrating wounds the injection of 
 boiling oil was more effective and convenient.^ 
 Berengar, Paracelsus, and Wlirtz did not accept 
 the element of poison, but that of scorching only, 
 and were content therefore with cooling methods ; 
 of their opinions, however. Pare had no knowledge. 
 
 ^ I ought perhaps to say here that long before sliot wounds were 
 known boiling oil had been poured into any poisoned wound, as 
 of venomous bites and the like, as the reader mil readily discover, 
 for instance, in Guy's chapters on wounds.
 
 OF MEDICINE AND SUEGEIJY 85 
 
 After a long verbal strife, the next step was made 
 by Maggi, who iu a series of novel and interesting 
 experiments, publislied in 1551, discomfited Vigo 
 by tiring balls at bags of gunpowder which did not 
 explode ; and arrows tipped with wax or sulphur, 
 which, however swiftly shot forth, respectively 
 neither melted nor ignited. Thus he disproved 
 the combustion hypothesis also. But to return 
 to Pare : the story goes that on the evening of an 
 engagement Pare administered the " first aid " of 
 boiling oil, as an antidote to the venom, to all 
 those injured by gunshot save one, for whom the 
 supply fell short. After tossing on his couch with 
 regret and apprehension, Pare rose betimes to see 
 this patient, in the hope no doubt of being enabled 
 to provide boiling oil for him also : but to his 
 amazement the unscalded limb was the best of the 
 bunch ; the patient had passed a fair night, his 
 wound was not angry, swollen or throbbing, as the 
 others were ; nor was he feverish. From this time 
 the receptive mind of Pare perceived that venom 
 and burn were figments both, and that a gunshot 
 wound was just a contusion or a comminution like 
 another. So severe however were the injuries of 
 gunshot, so frequently did these contusions become 
 septic, even in the greatest seigneurs, and so rife 
 the wound fever which, at the siege of Rouen, 
 Pare attributed in part only to a " malignant 
 atmosphere" and in part to putridity of the wounds, 
 that he determined to devote himself to the per- 
 fection of a more timely method of amputation. 
 It was as a part then of a great reform of method
 
 86 THE HISTOEICAL EELATIONS 
 
 that Pare was led to improve tlie ligature; his most 
 orthodox patients proved not unwilling to forego 
 boiling oil and the red-hot knife, and a successful 
 early amputation of a smashed leg, at the siege of 
 Damvilliers in 1552, placed his new method in 
 safety. 
 
 Upon the many other contributions of Pare to 
 surgery I cannot dwell ; such, for example, as his 
 ingenious method of detecting the course of bullets 
 by placing the injured man in position as he was 
 when he was struck — a plan first adopted by him 
 in a consultation on the case of M. de Brissac. 
 By this device Sylvius was so much pleased that he 
 urged Pare to write liis treatise Des playes d'hacque- 
 butes (1546).^ Sylvius (Jacques Delboe, or Sylvius 
 the first) was the most erudite anatomist of the 
 medical schools ; yet Pare in his illiteracy had 
 over him, as Palissy, whose demonstrations in his 
 museum were attended by Pare, had over his 
 learned audience, the ineffable advantage that when 
 Hippocrates, Pliny and other great ancients came by 
 translation within his reach, he read them in the 
 unrefracted light of one practised in immediate con- 
 tact with nature herself ; and thus, without servility 
 
 1 Vesalius, born three years before Pare, was also a pupil of 
 Sylvius, who by the way was afterwards terrified to see what sort 
 of a wildfowl he had hatched ; but there was a great gulf between 
 a lettered graduate and a barber's boy. Malgaigne reminds us 
 that Vesalius' first anatomy anil Fare's first tract on gunshot 
 wounds were likewise published at the age of twenty-eight. How 
 Pai'e })Ounced upon Vesalius' anatomy, how he used it "to verify 
 his own experience," and how he prefixed to his Surgery a com- 
 pendium of it, which during the next hundred years did more 
 than the large and academic work of Vesalius himself to vulgarise 
 the new anatomy, is too well known to be told again at large.
 
 OF MEDICINE AND SURGEKY 87 
 
 or prepossession, assimilated what he saw was mas- 
 terly in them, as for example in the " Fractures and 
 Luxations " of the Canon, upon which Pare drew 
 largely. But it was probably before he read Hippo- 
 crates that Pare described for the first time fracture 
 of the neck of the femur. He did not hesitate how- 
 ever to criticise Hippocrates, nor to differ frankly 
 from him, or from Celsus, Paul, or Albucasis, if occa- 
 sion required. He writes " II ne faut pas s'endormir 
 sur le labeur des anciens comme s'ils avaient tout su 
 ou tout dit." As Guy was the last and greatest sur- 
 geon of the arabists, so Pare was the first and greatest 
 of the renaissance ; Guy was the champion against 
 medieval tyrants, Pare against the humanists and 
 the Greek tradition. Nor was Pare great on the 
 positive side of progress only; he was no less resolute 
 in confutation of fabulous lore. If he believed in his 
 puppy dog fat — and how could he resign a secret 
 remedy which had cost him so many prayers ! — he 
 denounced, with an audacity which in our tepid and 
 sceptical times we can scarcely appreciate, the bogus 
 virtues of mummy and unicorn. As great person- 
 ages would marvel that he had not administered 
 mummy in their lacerations,^ Pare was aroused to 
 indite his opinion of the stuff; and the King must 
 have been annoyed to read farther that the horn 
 of the unicorn at St. Denis, for which he had 
 refused 100,000 crowns, was but an old woman's 
 charm. 
 
 We parted from Henry of Mondeville carrying 
 
 ^ " Mummy," says Francis Bacon, " hath great force in starmch- 
 ing of blood, which may be ascribed to the mixture of balsams 
 that are glutinous,"
 
 88 THE HISTOKICAL EELATIONS 
 
 with us a pious and dignified sentiment ; let us 
 take leave of Pare with these words of his in our 
 ears : — " You will have to render account not to 
 the ancients hut to God for your humanity and 
 your skill." Was Pare the first modern surgeon 
 to put humanity even before skill ? To us 
 the barbarous practices of medieval surgery seem 
 ferocious, yet we may reflect that in those violent 
 days men's nerves were mercifully blunted, even, 
 let us hope, the nerves of the patients. 
 
 In Germany, for all its meddlesomeness in Italy, 
 Medicine, save in the debatable lands of Alsatia and 
 Switzerland which drew some enlightenment from 
 France, was in a barbarous condition. The manu- 
 scripts in Germany were few, and its universities, 
 potent as they were to be in the emancipation of 
 thouo'ht, were of later foundation than those of 
 Italy. Germany had not even a St. Come ; and 
 it would seem that, in the fourteenth century at 
 any rate, there was no regular apprenticeship. 
 Thus German surgery was grossly artisan, and 
 therefore barbers and bathmen ^ flourished ex- 
 
 ^ The virtues of mineral Avaters and baths never lost the high 
 repute attributed to them during the Roman Empire. I have 
 before me a handsome thick folio in double columns De Balneis, 
 published by Giunta in 1553, which is but one of those collections 
 of treatises in the department of Medicine of which so many Avere 
 ])ublished in Venice at and before this date. Some of my readers 
 may remember Albert Buret's plate of a man's bath in a German 
 town early in the sixteenth century. Becker {loc. cit.) includes 
 bathmen among the practitionei-s, regular and irregular, of Hildes- 
 heim [" Aerzte und Wundiiizte, Bader und Barbiere, Quacksalber, 
 die Alexianerbriider (a kind of sick club) Aerztinnen und Hebam- 
 men, und sogar — der Schinder ! " ]. Aachen was the fashionable 
 spa in that district.
 
 OF MEDICINE AND SUKGERY 89 
 
 ceediugly. Nevertheless eveu in the fifteenth 
 century, whither we may turn back for a moment, 
 some great surgeons had arisen in Germany ; the 
 earliest of them who deserves remembrance was 
 Heinrieh von I'folspeundt — Pfalzpaint, in Bavaria, 
 south of Nuremberg — the manuscript of whose 
 Bunth-Ertzney had the fate of Yperman's treatise ; 
 written in the middle of the fifteenth century, it fell 
 into oblivion until the nineteenth, when it was dis- 
 covered in Breslau, and was published in 1868 by 
 Haeser and Middeldorpf. Heinrieh, like Pare and 
 many of the greater surgeons, was an army doctor 
 and saw much service ; he was of noble family and 
 seems not only to have served but also to have 
 studied in Italy ; yet he was unlettered, un- 
 instructed, and, as it would seem, knew only his 
 mother tongue. As a wound surgeon (" Schaden 
 und Wunden ") he left minor surgery to the 
 barbers, and the larger operative work to the 
 cutters (" Schneid-Aerzte ") ; on the other hand 
 he had learned " from a foreigner " the guild secret 
 of making new noses (p. 80). His aversion from 
 the vulgar herniotomy was a rational aversion : 
 Pfolspeundt appears indeed to have been the first con- 
 siderable surgeon to protest against the barbarities 
 of such specialists {vide p. 75). In an appendix he 
 deals with some inward maladies. Heinrieh was no 
 anatomist, and in fractures and luxations a mere 
 empiric ; moreover, in common with most or all 
 of his contemporaries, he was helpless in com- 
 pound comminuted fracture. Still he was a 
 shrewd, resourceful and not uninteresting person.
 
 90 THE HISTOKICAL EELATIONS 
 
 who divided wounds into fresh and foul ; and 
 although, even in fresh wounds, he was a " suppu- 
 rator," and used turpentine and the like to promote 
 pus, yet he discarded tents, except for sinuses. For 
 haemorrhage he does not mention the ligature ; he 
 employed cold applications, and styptics on tampons. 
 In arrow wounds he had a large experience ; he 
 was opposed to too much haste in extracting the 
 weapon, and to too early a use of the suture. 
 Of gunshot wounds he makes no mention. As 
 did the surgeons of all previous ages, he placed 
 much trust in " wound drinks," such as ptisan of 
 Artemisia and so forth. He devotes a section of 
 his book to the anaesthetic inhalation of Theodoric, 
 and recommends its use.^ 
 
 In the history of the part of Germany in 
 European surgery we are apt, in the light of his 
 physical and chemical excursions and of his many- 
 sided character, to forget that Paracelsus (Lorn 
 1491) was a surgeon, and no inconsiderable one. 
 Had this extraordinary man been endowed with a 
 little patience he would have been a leader in 
 wound surgery, though, like Wlirtz, and unlike 
 Gersdorff, he was not an operator. Paracelsus 
 pointed out not only the abuse of the suture by 
 the surgeons of the day,^ but also that suppura- 
 tion is bad healincj. If left to herself, he declared, 
 nature heals wounds by a " natural balm," a phrase 
 
 ^ Gu}"^ of Chauliac tells us that sponges were impreguated with a 
 mixture of opium, henbane, hemlock, lettuce and other drugs and 
 dried in the sun. Before use a sponge was dipjied in hot water, 
 and the patient then respired the vapours from it till he fell asleep. 
 
 - John of Vigo used the suture extensively, but always left an 
 exit for the pus {vide p. 9).
 
 OF MEDICINE AND SUEGERY 91 
 
 which Pare adopted (p. 31). In his Grosse Wuncl- 
 arznei he says he began at the surgical because 
 it is the most certain })art of Medicine ; and time 
 after time he rebukes those who withdrew medi- 
 cine from surgery. The unlearned, he says, speak 
 of " surgical diseases," which is unreasonable, for 
 Medicine (Artznei) is one (einerley). Called to 
 the Chair of Medicine and Surgery in Basel,^ he 
 burnt Galen and Avicenna in the marketplace, 
 lectured boldly in the vernacular, and declared 
 reason based on experience of nature to be better 
 than authority. Nature, he says, has her plan, and 
 the physician's duty is to see fair play, and to keep 
 the ring for her (pp. 42 and 97). Conrad Gesner 
 (b. 1516), the naturalist and physician of Zurich, 
 the friend of Caius,^ in his wise way saved what was 
 good in this revolt, and wrought at the ancillary 
 sciences. To the dawn of natural science, however, 
 the apostle of mystics was blind or waywardly 
 averse. Eightly but too exclusively Paracelsus laid 
 stress on function ; as to every several function 
 he gave its " Archaeus " so for him every disease 
 was an entity, and every cure was to consist in an 
 arcanum against the Archaeus. He had genius, but 
 his experience was crude and precipitate. 
 
 Brunschwig (born 1497), the first of the great 
 Alsatian surgeons, was, until the discovery of Hein- 
 rich of Pfolspeundt's manuscript (written thirty- 
 
 1 It is interesting to remember that in the sixteenth century. 
 Franco also was practising at Berne and Lausanne, and Wiirtz at 
 Basel. Wittenberg was not founded till 1502. 
 
 - Whose History of English Doggcs was composed for Gesner's 
 History of Animals. Wiirtz may have met Caius (p. 94).
 
 92 THE HISTOEICAL EELATIONS 
 
 seven years before his own work), regarded as the 
 father of German surgery. He was a barber, but 
 had received a good education in Bologna, Padua, 
 and Paris. Like Wlirtz he was a wound surgeon and 
 bone-setter, and undertook no large operations save 
 those amputations which, in the case of the severest 
 injuries, became inevitable. For Brunschwig, how- 
 ever, as later for Pare, gunshot wounds compelled 
 operative procedure more into prominence. He 
 was indeed the first surgeon to enter upon the 
 surgery of gunshot wounds with any fulness or pre- 
 cision. He too held that a gunshot wound was a 
 poisoned wound ; and, to eliminate the poison by 
 free suppuration, used the medicated tents, or, in 
 case of through penetration, the setons, which were 
 to arouse the angry antagonism of Wlirtz. If the 
 ball were out of reach in the body, he promoted 
 suppuration by poultices, turpentine and other 
 balsams ; and seems to have hunted for the missile 
 with a kind of duck-billed speculum. No wonder 
 erysipelas and phagedsena were rampant. When 
 he was driven to amputate a large limb he bound 
 it above and below, drew up the skin before in- 
 cision, and applied boiling oil or the cautery to the 
 stump. With Heinrich he objected to anipsthesia 
 l)y opivim, and used the narcotic inhalation of 
 Theodoric, which had some vogue all through the 
 Middle Ages (p. 90, note). Like all the German 
 surgeons he wrote in the vernacular. 
 
 I would remind you again how large and various 
 was the experience of the battlefield, and how fertile 
 the blood of warriors in rearing good surgeons.
 
 OF MEDICINE AND SURGERY 93 
 
 As Ypernian and Pare, Gale and Wiseman, Maggi 
 and Botallo, so Brunschwig, Gersdorff and Wiirtz 
 won their spurs in Papal and Royal wars, as the 
 crusading surgeons had done from the Council of 
 Clermont to the fall of Acre. Brunschwig, how- 
 ever, leaned heavily on Rhazes and Guy, and even 
 with gunshot surgery did not get very far ; a greater 
 reformer in this new military surgery in Germany was 
 Gersdorff, also an Alsatian, a man of great experience 
 and originality, and evidently a good mechanic. As 
 did Pare and Wiseman, in amputation Gersdorff made 
 great use of the constricting band, to blunt the pain 
 as well as to check hsemorrhage. He did not sear, 
 but used a styptic of his own, and covered the stump 
 with a bull's bladder. In a more and more complete 
 retraction of the tissues l)efore incision he made a 
 great improvement upon the old " sausage cut." If 
 he probed gunshot wounds too eagerly, he did not 
 pour in boiling oil. The works of both Brunschwig 
 and Gersdorff are illustrated, and not by drawings of 
 apparatus only; in both volumes are large and spirited 
 pictures. In one of the illustrations of Brunschwig's 
 Surgery (Strassburg, 1497), for example, a man is 
 laid upon a couch with many and grievous wounds 
 upon him ; one of them being an ugly compound 
 fracture of the right leg. A woman and two men 
 are deliberating on his case. In Gersdorff"s Field- 
 hook of Wound Surgery (the Strassburg edition of 
 1528) is a lively scene of an amputation of the leg, 
 in which however it must be admitted that the cut 
 is shown very much after that of the " sausage." In 
 another excellent woodcut two surgeons with some
 
 94 THE HISTORICAL RELATIONS 
 
 mighty probe are digging for an arrowhead into the 
 breast of a man seated on a three-legged stool. In 
 the near distance an animated fight is in progress, 
 and cannons and arquebuses, as well as spears, pikes 
 and crossbows, are in full activity. 
 
 In Germany even of the sixteenth century 
 there were no medical schools, not even of anatomy 
 (p. 88). Thus Felix Wiirtz, if like Franco and 
 Pare he had good fortune in escaping a scholastic 
 education, was lucky also in the enjoyment of 
 the more liberal education of Gesner's friendship. 
 Gifted with an independent and penetrating mind, 
 and aroused by the fiery disputes of Paracelsus, he is 
 as fresli and racy as Henry of Mondeville had genius 
 enough to be in spite of the schools. Like all his 
 compatriots he wrote " i7i sermone harbaro " ; and 
 for its originality and conciseness Wlirtz's Practica, 
 published in 1563, stands in a very small company. 
 Had he known as much anatomy as Pare, his defect 
 in which he bewails, he might have advanced in 
 operative surgery and become as great a man ; for 
 his clinical advances were both new and important. 
 It is in the freshness and originality of his mind 
 and in Ins freedom from scholastic convention, that 
 he reminds us of Pare. Wiirtz protests against the 
 kind of examinations for practice held in some 
 cities, where candidates patter off cut and dried 
 phrases like parrots, and apprentices " play upon 
 the old fiddle the old tune continually." Surgery, 
 he says, is a painful calling, and is not to be learned 
 by sitting on a cushion at home. Who would order 
 a picture of one who prates much of colours, but
 
 or MEDICINE AND SUEGEEY 95 
 
 scarce knows how to hold a pencil ? Wiirtz, being, 
 as I have said, a wound surgeon, does not venture 
 so far as Gersdorff in amputation, and the ligature 
 he never mentions ; but he abhors barbarous blood 
 staunchers, though in case of amputation of the 
 thigh ^ hot irons must be at hand. He has seen 
 no reason to believe that bleeding is of use for 
 " revulsion," nor that it " draws away liumours from 
 the head " ; it is a remedy to be used opportunely 
 and discreetly. Wiirtz is urgent on cleanliness ; 
 clean hands, no hanging sleeves. He protests 
 against probing " and tenting, and dislikes poultice 
 messes ; but as to suppirration, well, in spite of 
 Paracelsus, it must be : he has never seen a severe 
 wound heal without it. As in any wound the virtue 
 of coction is diminished, is not suppuration therefore 
 necessary as a cleansing process? (pp. 30 and 84). 
 Still practice is better than conjecture, and if neither 
 he nor Pare attacked suppuration in principle as 
 Theodoric and Henry of Mondeville had done, Wiirtz, 
 by setting his face against cataplasms and grease, 
 made for progress. Discreet as Pare and Wiirtz may 
 themselves have been, yet the fidgety manceuvres, 
 the probes and the plasters, the tents the salves 
 and the setons, the handlings and the gropings, the 
 meddlesome dressings, two or three a day, as the in- 
 dications were incarnative, mundificative, maturative, 
 cicatrisative, or consolidative, held on their fantastic 
 and mischievous way. 
 
 ^ Pei'haps the first definite mention of this grave operation ? 
 
 - " If there is more than one surgeon each of tlieni must thrust 
 his iron up and down in it, disturlDing the healing bahn, which 
 should lie like a crystal on a clean wound."
 
 96 THE HISTOEICAL EELATIONS 
 
 Wiirtz's chief title to fame, a fame far less ripe 
 of course than that of Sydenham but, as it seems to 
 me, not unworthy to be remembered beside it, lies 
 in his clinical acumen ; and especially in his develop- 
 ment of the Hippocratic doctrine on wound in- 
 fections and their results ; a doctrine which in 
 arabist tradition was embedded in a partial and 
 fragmentary way. He publishes, as Pare did, and 
 as Salicet and Lanfranc had done, a large and 
 various collection of cases. Watch, he says, and 
 learn to read any sign, be it never so mean ; for 
 every day one may discover new secrets of nature. 
 Wlirtz divides wound fevers into three classes : — 
 First, those which set in with rigor, heat and sweat- 
 ing ; secondly, with pain in the wound followed by 
 repeated chilliness ; thirdly, with restlessness and 
 twitchings, the chills being less distinct. He 
 says definitely that these disasters are due to 
 absorption of poisons from the wound.^ His descrip- 
 tion of diphtheria in throat or wound, — sometimes 
 first appearing in the one, sometimes in the other ,^ — 
 when " prunella," as it is called in the only copy I 
 had at hand,^ may be stripped off like a rag, is very 
 remarkable. Yet on the curious German myth of 
 " joint- water " he is even more didactic and inex- 
 plicable than others of his compatriots of the period ; 
 a myth which that " ever angry " man Johann Lange 
 of LimJjerg demolished at last. No surgeon of his day, 
 or before it, had given the attention which Wlirtz 
 
 ^ For a full account of these observations I refei* the reader to 
 Billroth's Historische Notizen iiber die Beurtheilung uml Behand- 
 lung Sclmsswunden, 1889. 
 
 ^ An English translation by A. L. Fox, London, 1656.
 
 OF MEDICINE AND SUEGEEY 97 
 
 gave to conservative surgery. " Never, if you can 
 help it, bereave a man of any part ; for God's grace 
 may be great upon it beyond the expectation of 
 men." If this rule be more pious than definite, I 
 may refer to his fuller details of splinting and 
 bandaging joints, fingers, and other movable parts, 
 in such positions that, if they must become stiff, 
 they may give the least inconvenience. 
 
 Of the French Pox Wiirtz notes its peculiar in- 
 fluence on concurrent diseases and wounds ; and 
 that surgeons use mercury for it as indiscriminately 
 as if mercury " were a saddle for any horse." He 
 tells us not to thwart but to follow nature, " for 
 she is as a strong river." He claimed truly that 
 he had written no big book copied from those of his 
 forerunners — for " naught will still be naught 
 though practised for a thousand years " ; that he 
 had trimmed himself with no strange feathers, that 
 he wrote only what he had made trial of, and that 
 he had concealed nothing of what was known to him.^ 
 
 In this period of German surgery it is con- 
 venient to mention that learned and skilful 
 physician Wilhelm Fabry (or Schmidt) of Hilden 
 near Cologne (1560 - 1634), usually known as 
 Fabricius Hildanus ; though he belongs in large 
 part to the seventeenth century. He practised 
 in Switzerland, was " Stadtarzt " of Bern, was 
 associated with the Platters in Basel, and raised 
 surgery in Germany to such honour and social con- 
 
 ^ I regret that Wiirtz's appendix nii tlie inanageineiit and cure 
 of little children falls wholly outside my suhject. It is full of wit, 
 shrewd practice and coninion-sense. 
 
 H
 
 98 THE HISTOEICAL EELATIONS 
 
 sideration as to deserve the name of the German 
 Pare. The several parts of his Ohservationum et 
 curationum cJiirurgicarum centuriae were published 
 at Basel from 1606 to 1646. With him we find 
 not only that cases are published, as they were by 
 his ablest predecessors (p. 33), but that his book 
 consists of them ; and we note, as in the Penta- 
 teuch of that other and greater Fabricius, " de 
 Aquapendente," that we have entered upon a new 
 kind of surgical literature. Fabry was far more 
 than a " wound surgeon " ; he operated boldly, and 
 in the whole field of surgery. Like Vesalius he 
 used the hot knife, which Pare had discarded ; and 
 in Gersdortf's fashion put the stump in a bull's 
 bladder. Flaps were not adequately designed till a 
 later date, but with a leather collar or compressor 
 he carefully drew up the soft parts before dividing 
 the bone, whereby also he prevented haemorrhage. 
 Thus he successfully amputated above the knee, but 
 perhaps not — as his latest biographer alleges — for 
 the first time (p. 95)? For hsemorrhage he some- 
 times cauterised, but sometimes he drew out the 
 vessel with forceps and tied it with ligatures of flaxen 
 thread. Another hundred years were to pass before 
 the ligature became the general and predominant 
 method. His examples of syphilis were a notable 
 contribution to the history of this grievous and in 
 those days terrible pestilence. He believed it to 
 be transmissible on clothing and the like. For 
 wounds Fabry favoured a simpler surgery, but he 
 was no little of a galenist and refused to follow 
 "Wllrtz in the repudiation of pus. He cannot be
 
 OF MEDICINE AND SUEGERY 99 
 
 ranked ^Yith the far-seeing men who once more 
 advocated healing by first intention. And in the 
 third quarter of the nineteenth century, in my 
 callow days as a physician, the apothecary of a large 
 hospital showed me a row of amputations, with 
 stumps pouring out pus in cataracts upon the 
 cushions, and exclaimed — " That, sir, is what I 
 like to see ; nothing so wholesome in a wound as 
 a good discharge of laudable pus." As a university 
 graduate, — for as universities were then we knew 
 nothing of surgery, — I assented in superior ignorance. 
 
 England, if by England in the Middle Ages we 
 mean no more than the Isles of Britain, made no 
 progress in medieval or early renaissance Medicine. 
 The Wars of the Roses may have been too savage 
 for surgery. It was the misfortune of England, by 
 whose surgeons in the nineteenth century Medicine 
 was to be regenerated, that until the seventeenth 
 century her master surgeons were few and insig- 
 nificant ; before Wiseman indeed, it were hard to 
 find one worthy to rival even the slender merits of 
 Arderne and Gale.^ Oxford and Cambridge, as they 
 took their origin, took their fashions from Paris ; 
 Linacre and Caius were strongly humanist in bent;^ 
 
 ^ If Italy wliile mistress of the formative arts produced great 
 surgeons, does the poverty of England in these arts illustrate its 
 defects in surgery, until both arrived with Hogarth and Reynolds, 
 Cheselden and Hunter. 
 
 2 It is fair to add that Caius was more than a humanist. He 
 wrote an important treatise on the Sweating Sickness, and was a 
 professed teacher of anatomy. Dr. Venn says that Harvey pretty 
 surely attended the dissections of Dr. Grimstone in Caius College.
 
 100 THE HISTOEICAL EELATIONS 
 
 and thus in England the division of the house of 
 Medicine into surgery and physic became as deep and 
 more abiding than in France ; so deep and abiding 
 that the evil of it is still at work among us.^ 
 
 Arderne was probably a better surgeon than 
 Gilbert, or John of Gaddesdeu ; but he is little 
 more than a name. Nor after Mondeville, Guy, 
 Pare, Wiirtz, or Maggi, is it very interesting to 
 peruse Thomas Gale (1507-1586 ?). From Gale's 
 pages however we learn how deplorable was the 
 state of military surgery even in the constructive 
 time of Henry VIII. Tinkers, cobblers, sowgelders, 
 are not the worst of the words he applies to the 
 army doctors. So terrible were the deaths and 
 tortures under their hands, that better men were 
 demanded ; and of these was Gale, who on arrival 
 at Montreuil found the wounds dressed with filth 
 fit only for horses' heels. Like Wiirtz and Pare, 
 Gale wrote in the vernacular, and like them again 
 seems to have been a high-minded and gentle person. 
 His Certaine Works of Chirurgerie was published in 
 London in 1563, a stout duodecimo in Black Letter 
 with a few rude woodcuts.^ To each of the four 
 
 ^ In the (la3's of my graduation in my own University, since 
 eminent in Surgery, we were not examined in Surgery. We were 
 only called upon to produce a certificate of having attended a course 
 of lectures on Surgery and Obstetric Medicine, certificates which I 
 suppose I produced, though I have no remembrance of the lectures. 
 In examination indeed Surgery was expressly excluded, for the 
 requirement was "The medical treatment of surgical and obstetrical 
 disease." During the time of ray studentship at St. George's I 
 believe I never entered a surgical ward. Happily when I settled at 
 Leeds I was instructed in these matters under the second Wm. Hey 
 and the two Teales 
 
 - Copies are in the liljraries of Cambridge University and Caius 
 College.
 
 OF MEDICINE AND SURGEKY 101 
 
 parts of which it consists there was a separate 
 title. The " Wounds made by Gonneshot " is tlie 
 third part, and here lies Gale's chief merit, that he 
 withstood " the gross error of Jerome Brunswicke 
 and John of Vigo, that they make the wound 
 venomous." ^ For this independent opinion I 
 think he deserved mention by Haeser. Gale is 
 wise also in advising that if a ball has so entered 
 the body that there is much difficulty in reaching 
 it, it be left there rather than "cause mortal 
 accidents " by the surgeon's ferreting after it. 
 Eleven soldiers shot in the body, and thus let 
 alone by him on service in 1544, did well. 
 
 For the rest Gale is sadly galenical,^ and his 
 pages are stuffed with unguents and other receipts. 
 Like many of the elder surgeons he had a styptic 
 of his own, which he honestly publishes. I regret 
 to say he was no " first intention " man, but would 
 put his salves even into green wounds, a surgery 
 Sir Thomas Browne was unwilling for his charity's 
 
 ^ The title runs thus :■ — An excellent treatise of wounds made 
 with gonneshot, in which is confuted both the grose errour of 
 Jerome Breunswicke, John Wiga, Allonse Ferrius, and others : in 
 that they make the wounde venomous, which conimeth through 
 the common powder and shotte : and also there is set out a perfect 
 and trewe method of curying these woundes, newly compiled and 
 ])ublished by Thomas Gale, Maister in Chirurgerie. Printed at 
 London by Rowland Hall for Thomas Gale 1563. 
 
 ^ Galen, like Aristotle, was dressed as a counterfeit in distort( d 
 and conventional forms. In a dialogue prefixed to the volume, 
 a dialogue which in scene and temper and even in expression 
 is curiously like Isaak Walton, John Yates says he has read 
 " Theodoricus, l^runus, Laufrancus, Rolandus, Rogerus, Bartilimlia, 
 Wilhehiius, Guido, Brunswicke and Vigo " — an excellent list. Gale 
 replies "What iiart of Hippocrates, Galene, Avicenne, Paulus, 
 Rhasis, Albucasis, and Haliabbas have you rede ? thees be of greter 
 authoritie."
 
 102 THE HISTOEICAL KELATIONS 
 
 sake to disparage in the good Samaritan ; though 
 in this case the wine may have converted it into a 
 less improper medicine. There is no resisting the 
 truth that hitherto the land of Harvey, Sydenham 
 and Wiseman had not done much for any part of 
 Medicine.^ The great Elizabethan glory shed little 
 of its light upon our profession. Even in the seven- 
 teenth century Harvey was a maker of physiology 
 rather than of Medicine, and in surgery Wiseman 
 was a bridge of one plank between the Stuarts and 
 the great eighteenth century school of Cheselden, 
 Pott and Hunter. 
 
 Amid the English barbers of the fourteenth 
 century some members took the name of Barber 
 Surffeons,^ and it was in their ranks rather than in 
 the universities or the College of Physicians ^ that, 
 as we have seen, surgery was likely to be advanced ; 
 in technical education indeed the London barbers 
 were rather active. Moreover in England, as else- 
 where, the post of King's Barber was one of much 
 influence and profit. If we may judge by Holbein's 
 picture, many of the leading barber surgeons were 
 men of dignity and intelligence. Not a few of 
 them, as in 1595 the College of Physicians com- 
 
 1 To a little quarto by John Halle, published in 1565, with a 
 portrait of the author, I may allude, but it seems to be no more 
 than a translation of Lanlranc's Chirurgia Parva, with an appendix 
 on the current anatomy, and an expostulation against the beastly 
 abusers of chirurgery and physick. 
 
 ' They were denoted as " Barbers exercising the faculty of 
 surgery." There was an unincorporated and, in numbers at any 
 rate, an insignificant body or guild of surgeons, not well disposed 
 of course to the Barbers ; and thus by divisions the cause of surgery 
 was weakened. 
 
 ^ In the sixteenth century the London College of Physicians 
 deliberately avoided its privileges in surgery.
 
 OF MEDICINE AND SURGERY 103 
 
 plained, tried " the lenity and sufferance " of this 
 body by practising some pliysic. The Barber 
 Surgeons were incorporated by Charter in 1462, 
 and thereby obtained in London power of examina- 
 tion, of suspension of practitioners whether home 
 or foreign, and of inspection of drugs. Moreover 
 towards the end of the fifteenth century, by a 
 policy too enlightened to last long, a sort of con- 
 joint board, with a more or less shadowy guild of 
 surgeons, was established for these ends. Yet in 
 the sixteenth century this promise and privilege 
 faded ; and " all the king's subjects having know- 
 ledge or experience of the nature of herbs whether 
 obtained by regular study or by divine favour, 
 recovered the right of ministration to any outward 
 sore or wound according to their cunning." Indeed 
 in 1540 the unincorporated company of surgeons 
 was merged in the Barber Surgeons Guild, to which 
 the power of licensing surgeons was restored ; and 
 the bodies of four malefactors a year were assigned 
 to the Guild. In that year also my own Chair of 
 Physic was founded, but unhappily without this 
 valuable endowment. 
 
 Of Spanish surgery in the sixteenth century I 
 know nothing of my own reading : Haeser speaks of 
 it as progressive, both in the simplification of wound 
 treatment, and of apparatus. Three Spanish surgeons 
 of this century are said to have claims of priority 
 for the method of healing by first intention ; namely, 
 by cleansing, exclusion of the air, and the use of
 
 104 THE HISTOEICAL EELATIONS 
 
 drying and " conglutinating " dressings. When such 
 claims were made again in the seventeenth century 
 the claimants were referred to these Spaniards. Into 
 the justice of this cause I have made no inquiry, for 
 I need not repeat to you that any such claims must 
 be put very much farther back. 
 
 Time will not permit me to dwell upon renais- 
 sance surgery by any narration of the large advances 
 of surgery in Italy during the latter half of the six- 
 teenth century. I can dwell no more on Vesalius 
 than to remind you that he was surgeon as well as 
 anatomist ; and, in common with his great contem- 
 poraries Fallopius, Ingrassias, and Fabricius, did 
 much to reduce the use of the cautery and to im- 
 prove the method in amputations. Biondo of Venice 
 in the same period protested against the mistrust 
 of water on wounds, and used free irrigation ; as 
 Humphry was doing in my student days, before 
 Lister's discoveries. The names of Maggi and 
 Botallo I have mentioned already. Maggi's work 
 on gunshot wounds was published, on his death 
 in 1552, at Bologna; thus really coinciding with 
 if not anticipating Fare's opinions ; moreover, 
 as I have said, they were attained by the ex- 
 perimental method (p. 85). Tlie edition I used for 
 this essay forms a part of a collection of excellent 
 surgical treatises in a handsome folio published 
 at Zurich in 1555.^ The introductory research 
 into the nature of gunshot wounds (p. 85) is admir- 
 able ; and if the rest of the work be less original 
 and too much occupied by the " concoquentia et 
 
 1 lu the Library of the Royal College of Physicians, Lnndou.
 
 OF MEDICINE AND SUEGEKY 105 
 
 pus moventia," it is well and forcil)ly written and 
 scholarly in form and completeness. A still greater 
 surgeon who had to thank the Popes, those stiff- 
 necked enemies of peace, for a familiarity with the 
 lacerations of war, was Botallo, whose treatise on 
 gunshot wounds, an excellent and exhaustive work 
 on wounds of the head, breast, abdomen, and limbs, 
 was published in 1560. This essay may be regarded 
 as some compensation for his bloodthirsty and mis- 
 chievous tract on Venesection in the same volume. 
 
 Now during the periods I have surveyed what 
 were the clerks of inner medicine about ? Here you 
 will be on your guard against the sinister ways of 
 the man with a moral ; for it is my moral that physic 
 was sterile in proportion to its divorce from surgery : 
 yet, in the time allotted to me, if I may illustrate 
 this theorem I cannot prove it. Happily we have 
 Sydenham's summary of the matter, to Blackmore 
 who asked what book on medicine he should read ? 
 " Don Quixote" was the answer : as if to say, — 
 " contemplate medicine, that ponderous fantasy, in a 
 gentle, pathetic, and ironical spirit ; be tender with 
 it as human endeavour, yet recognise it for the 
 baseless and insubstantial fabric that it is." That 
 the life of surgery from the thirteenth to the six- 
 teenth century was comparatively vigorous we have 
 just seen ; but it were an ungracious task to ramble 
 through physic only to illustrate its chimeras. A 
 perusal of the first 200 pages of the excellent 
 John Freind's History would suffice. I think no
 
 106 THE HISTOEICAL RELATIONS 
 
 historian will deny that in those ages medicine, 
 in the narrower sense of this word, was a painted 
 effigy — hollow, turgid and reactionary. Until 
 we reach the first treatises on Epidemics, as for 
 example Fracastoro ^ on syphilis and typhus, and 
 the Spanish physicians on diphtheria (garotillo),^ it 
 is hard to discover in " pure medicine " any vitality, 
 clinical or scientific, unless it lurked in the Aristo- 
 phanic scepticism of Guy Patin, in the chemical 
 therapeutics of the elusive Basil Valentine and 
 of Paracelsus, or in the foggy platonism of Cardan. 
 Even the staple of it was intimately entangled in 
 astrology, alchemy, fantastical humoralism, urino- 
 scopies and sphygmoscopies, and other dialectical 
 puerilities. Pharmacy was, it is true, purged of 
 some of its grossest, loathsomest, and foolishest 
 ingredients ; and the champions of mercury and 
 antimony climbed over the dialectical fence under 
 a deadly fire from Paris : hut it was by surgery, 
 then the laboratory of Medicine, especially by the 
 large and manifold surgery of war, that medicine 
 was regenerated ; and by such handicraft as that 
 with which Harvey laid bare the secret of the cir- 
 culation, and dealt the last blow to the crumbling 
 carcase of galenism.^ 
 
 ^ Fracastoro may be regarded as the founder of the doctrine of 
 Infection. A collection of many treatises on syphilis was published 
 at Venice in 1567, fol. It contains Maggi's treatise of 1550. 
 Galen is quoted three or four times in each of these tracts as an 
 authority on the French pox. 
 
 '•^ Thus Dr. Payne says that the strong points of Gilbertus 
 Anglicus were his account (evidently at first hand) of the plague ; 
 and also of variola and morbilli. 
 
 ^ We know tiiat Harvey was but too familiar with the battle- 
 field ; and, if we do not know that he operated upon the wounded,
 
 OF MEDICINE AND SUEGERY 107 
 
 One episode of inner medicine, however, I will 
 select to serve as an example of the state of this 
 side of our craft, namely, the schism on the place 
 of venesection ; a schism which had a far-reaching 
 effect in the discomfiture of conventional galenism. 
 The heresy was as follows : — the Arabs, on purely 
 conjectural grounds, had always taught that 
 bleeding should be derivative, practised, that is, 
 on the side away from the lesion, or even in some 
 limb far away from it. In the common case of 
 pleuro - pneumonia, for example, bleeding was 
 practised on the arm opposite to the side of the 
 pain. Now Brissot, a learned Professor of Paris, and 
 one conversant with the Hippocratic treatises, pro- 
 claimed in 1514 that bleeding should be practised 
 on the same side as the disease ; in order, as he 
 said, to remove directly thence the fouled blood, 
 and to attract the good, A strife ensued, of pro- 
 portions which to us seem incredible. Parlia- 
 ment stretched out its arm to suppress Brissot, and 
 at length banished him ; but the war still raged, a 
 war against the arabists which surged even to the 
 foot of the throne of Charles V., who proclaimed 
 Brissot to be as infamous as Luther. Clement 
 VII. himself joined in the fight ; and one far 
 
 we know that in times of peace he operated both as surgeon and 
 obstetrician. Dr. Robert Willis in his Life of Harvey (S3'd. 
 Soc. 1847) makes the amazing statement that surgery in the 
 seventeenth century "had not shown any good title to an inde- 
 pendent existence. The surgeon oF those days was but the hand 
 or instrument of the physician . . . though Harvey it seems did 
 not feel himself degraded — (as Dr. Willis nught have sujiposed ?) — 
 by taking uji the knife or practising midwifery " (pp. xxvi.-xxvii.). 
 As Dr. Willis was librarian to the College of Surgeons all this may 
 be "writ sarcastic."
 
 108 THE HISTOEICAL EELATIONS 
 
 greater than Clement, namely Vesalius. It so 
 happened, however, that in the midst of the fray 
 a kinsman of the Emperor died of pleuro-pneumonia; 
 and the rumour grew that he had heen bled in 
 Arab orthodoxy. Thus all was thrown into con- 
 fusion ; the judgments of Bologna and Clement 
 died on delivery, and, while many of Brissot's 
 followers proceeded to drop bleeding altogether, 
 Botallo and his school turned vampire. Servetus 
 was against the arabists, whose hair-splitting pulse 
 and urine lore was falling at last into discredit ; 
 and even pus itself got into some disgrace. At 
 length, towards the end of the century, after all 
 this clamour, it became generally admitted that 
 Hippocrates himself bled on the side of the disease. 
 Thus the orthodox who had disdained an intimate 
 occupation with nature as common and unclean, 
 and who augustly, confidently, and superciliously 
 had been entertaining heresy for centuries with- 
 out knowing it, were put to confusion. When 
 the sticks are dry, when men's minds are pre- 
 pared for a revulsion of opinions, a small crisis 
 may have great issues ; and so it was with this 
 bitter venesection controversy. We might suppose 
 indeed that when reigning creeds have to submit 
 to such rebuff they cannot last long ; yet, as it 
 is far easier to preach than to think, men clung 
 desperately then, as they cling still, even to the 
 very skirts of them. 
 
 No better example, though of a little later date, 
 of the stupifying effects of obsequious scholarship 
 can be offered than that of Caesar Magati. Magati,
 
 OF MEDICINE AND SUEGEEY 109 
 
 a Professor of Ferrara, was liy no means a pedant or 
 a dry-as-dust. He was a man of considerable parts, 
 who might have appealed more directly to a large 
 personal experience ; and had he relied upon him- 
 self would have been a far more interesting man 
 than he now appears. Out of his own observation 
 and intelligence he contributed no little to the 
 simpler and cleaner treatment of wounds, a subject 
 on which he published — in Venice (16 16) — a 
 handsome book ; too handsome indeed, for not 
 content with his own counsels and proofs, for which 
 his elegant Latin is almost too fine a garment, 
 he must needs display his learning, or cajole his 
 readers, by incessant quotations from the ancients. 
 Page after page, and many times upon a page, he 
 hides himself under authority, or adorns himself with 
 antique frippery. Two or three chapters are occu- 
 pied in an attempt by glosses to warp Hippocrates 
 and Galen towards his own opinions. Thus even 
 in the seventeenth century this scholastic sequacity 
 still tormented the books, those especially which 
 issued from tlie universities. How well Magati 
 could have spared this otiose labour may be per- 
 ceived from such a passage as this, in protest against 
 the incessant interference of the galenists : — " The 
 more frequently a wound is opened up, the more 
 frequently it is disturbed (interturbatur), and nature 
 is distracted from her proper office." He protests 
 also against the prevalent notion that wounds may 
 be healed too soon, as even nowadays some of us 
 suppose of an eczema. And not rarely he says 
 such wise things as this : — " Scientia est quae opus
 
 110 THE HISTOEICAL EELATIONS 
 
 facile reddit, ignorantia vero difficile " — would that 
 an introduction of this maxim into the heads of 
 statesmen of our own time could be added to the 
 " triumphs " of modern surgery ! 
 
 The physicians of the later sixteenth century 
 who, as practitioners of internal medicine, can be 
 readily named as profiting by the advances of the 
 ancillary sciences are very few. Of them were Jean 
 Fernel (1485-1558), Professor of Medicine in Paris, 
 and the eminent follower of Vesalius, the Basel 
 anatomist Felix Platter (1536-1614). Fernel was 
 one of the early explorers of the seats of disease. He 
 distinguished the causes from the processes, placing 
 the diseases in the solid parts, and their causes in 
 the blood ; symptoms he regarded as functional 
 perversions. He endeavoured, as Broussais did 
 some three centuries after him, to trace the specific 
 fevers to definite local origins. Platter on the same 
 lines achieved even more. These two physicians 
 did much to establish or rather to restore " solid 
 pathology," as opposed to the humoral. Vigorous 
 antagonists of galenism on the same lines, though 
 smaller men, were Giovanni Argenterio (1513- 
 1572), and Laurent Joubert, the renowned and high- 
 minded Chancellor of Montpellier, physician to 
 Catherine of Medici. Joubert (1529-1583) laid 
 much emphasis on natural causes, on physical laws, 
 and on obedience to nature. But in this department 
 of Medicine such men laboured in vain, except as 
 champions of a new order. Their followers, such 
 as Jerome Cardan, the dogmatist of " contraria 
 contrariis," of whom Haller said " sapienter nemo
 
 OF MEDICINE AND SUEGERY 111 
 
 quum sapit, dementior nullus ubi errat," bitten by 
 neoplatonism, abandoned themselves to the building 
 of card liouses (" speculative Prunkgebiiude " as 
 some one has put it), and were lost to Medicine 
 and to science. 
 
 With the sixteenth century my survey must end : 
 from this time Medicine entered upon a new life ; 
 upon a new surgery founded on a new anatomy, and 
 on a new physiology of the circulation of the blood 
 and lymph. These sciences, thus initiated, not only 
 served surgery directly, but indirectly also, by the 
 pervading influence of the new accuracy of observa- 
 tion and the enlargement of the field of induction, 
 modified the traditional medicine of physicians 
 unversed in methods of research, as we perceive 
 in the objective clinical medicine of Sydenham, 
 who was no ardent friend of the ancillary sciences, 
 and of Boerhaave. Physiologists tell us that de- 
 struction is easy, construction difficult ; but in the 
 history of medical dogma this truth finds little illus- 
 tration. So impatient is the speculative intellect 
 of the yoke of inductive research, so tenacious is 
 it of its liberty of prophesying, that no sooner did 
 Harvey, by revealing the mechanics of the circula- 
 tion, sap the doctrines of the schools, than some 
 physicians instantly set to w^ork to run up a 
 scheme of iatro-physics ; others to build a system 
 of iatro-chemics, but upon Von Helmont rather than 
 upon Willis and Mayow, while Hoftmann and his 
 school resuscitated the strictum and laxum syllogisms 
 of the Greek Methodists. 
 
 Fortunately for the seventeenth century those
 
 112 THE HISTOEIGAL EELATIONS 
 
 busy schoolmasters, the fingers, were making their 
 way into medicine by other than surgical routes ; 
 and by the physics of G-alileo, by the anatomy of 
 Vesalius, by the experimental physiology of Harvey, 
 by the pathological scalpel of Morgagni, and by the 
 chemistry of Mayow, had built into its structure 
 some solider stutf. Yet even in the seventeenth, 
 eighteenth and early nineteenth centuries English 
 physicians worked still aloof from such men as 
 Cheselden (the friend of Mead), Pott, Hunter, the 
 Bells, Hey, Astley Cooper, and Brodie ; an alienation 
 made absolute by the establishment of the College of 
 Surgeons, separate from the College of Physicians, 
 in 1798, whereby the integration of Medicine in 
 unity was once more defeated, and is still prevented, 
 in spite of Lister, and of the masterly disciples of 
 Lister, who in the obscure diseases of the abdomen 
 and pelvis are doing no less intimate a service for 
 inward medicine than Avenbrugger and Laennec 
 had done in those of the chest. 
 
 In this sketch of the past, a sketch necessarily 
 indiscriminate but not, I trust, indiscreet, we have 
 seen that up to the time of Avicenna, medicine 
 was one and undivided ; that surgery was regarded 
 truly, not as a department of disease, but as an 
 alternative treatment of any disease which the 
 physician could reach with his hands ; that the 
 cleavage of Medicine, not by some natural and 
 essential divisions, but in arbitrary paltering to 
 false pride and conceit, let the blood run out of
 
 OF MEDICINE AND SUEGERY 113 
 
 both its moieties ; that cert.ain diseases thus cut 
 adrift, being nourished only on the wind, dried 
 into mummy or wasted in an atrophy, and that 
 such was medicine ; while the diseases which were 
 on the side of the roots, if they lost their upper sap, 
 were fed from below, and that such was surgery. 
 
 Thus the physicians, who were cut off from the 
 life-giving earth, being filled with husks and dust, 
 became themselves stark and fantastic. Broadly 
 speaking, pathology until the seventeenth century 
 was a factitious schedule, and medicine a farrago 
 of receipts, most of them nauseous, many of them 
 filthy ; most of them directly mischievous, all of 
 them indirectly mischievous as tokens of a false 
 conception of therapy. A few domestic simples, 
 such as the laxatives, w^ere indispensable ; for the 
 rest we are tempted to reflect that mankind might 
 have been happier and better if Dioscorides had 
 been strangled in his cradle. 
 
 This is the truth I have tried to get home to 
 you : — That in the truncation of medicine the 
 physician lost not only nor chiefly a potent means 
 of treatment, he lost thereby the inductive 
 method ; he lost the only laboratory at his service ; 
 he lost touch with facts ; he deprived his brains 
 of the co-operation of the subtlest machine in the 
 world — the human hand, a machine which does far 
 more than manufacture, which returns its benefits 
 on the maker with usury, blessing both him that 
 takes and him that gives. 
 
 Pure thought, for its own sake, especially in 
 early life when the temptation to it is strong and 
 
 I
 
 114 THE HISTOEIOAL EELATIONS 
 
 experience small, seems so disinterested, so aloof 
 from crude utility and temptation of gain, that in 
 the history of ideas the construction of speculative 
 systems has played but too great a part, and occu- 
 pied but too many minds of eminent capacity. We 
 are bound to assume that these speculations have 
 served — and for auglit we know may still serve — 
 some good end. It seems " unhistorical " to suppose 
 that age after age men have busied themselves to 
 build up these vast systems in idle exercise. That 
 nature is wasteful we know but too well ; yet she is 
 wasteful by the way, not in the main direction of 
 her work. If some of her seed falls on stony ground, 
 if her rain falls on the just and on the unjust, yet 
 in the main the sowing and the rain are fruitful and 
 joyful. Peradventure, in our modern conviction of 
 the efficiency of the experimental method, we may 
 be too ready to denounce methods alien to us but 
 which, hard as it is for us to conceive, may yet 
 play some lasting part in evolution. In our own 
 day and fashion may we not become even too 
 analytical ; on our good side may we not be too ex- 
 clusive ? In the pale hue of inductive analysis, 
 sick with too much deliberation, may we not lose 
 resolution, overlook the concrete, and forget that if 
 by any mode of generalisation we lose the indi- 
 vidual in the type, and the concrete in the negations 
 and eliminations of abstraction, we ourselves may 
 fall by another route into the very error of the 
 school-authors ? If their search for entities was 
 false, may there not be a sort of imposition in 
 " laws " ? Wlien in the last analysis we attain to
 
 OF MEDICINE AND SURGERY 115 
 
 unresolved axioms may we not err in calling our- 
 selves " synthetic philosophers," in giving even to a 
 true residuum too solid a significance ? An abstrac- 
 tion is an abstraction, whether it be a summation 
 of phenomena or a speculative vision ; and abstrac- 
 tions may carry us a long way from life, from nature, 
 and from action. 
 
 In the minds of academical teachers the notion 
 still survives that the theoretical or university form 
 and the practical or technical form of a profession 
 or other calling may not only be regarded separately, 
 and taught in some distinction — which may be true, 
 but in independence of each other ; nay, that the 
 intrusion of the technical quality by materialising 
 tends to degrade the purity or liberality of the 
 theoretical ; that indeed, if he have not to get his 
 daily bread, the high-minded student may do well 
 to let the shop severely alone. Thus the university 
 is prone to make of education thought without 
 hands ; the technical school, hands without thought ; 
 each fighting shy of the other. But if in a liberal 
 training the sciences must be taught whereby the 
 crafts are interpreted, economised, and developed, 
 no less do the crafts, by finding ever new problems 
 and tests for the sciences, inseminate and inform 
 the sciences, as in our day physics have been 
 informed and fertilised by the fine craft of such 
 men as Helmholtz, Cornu, and Stokes ; or biology 
 by that of Darwin, Virchow, .Pasteur, and Lister. 
 At the commemoration of Stokes in Westminster 
 Abbey, Lord Kelvin honoured in him the " com- 
 bination of technical skill with intuition "; and
 
 116 THE HISTOEICAL EELATIONS 
 
 Lord Eayleigh admired in him " the reciprocity 
 of accurate workmanship and instinctive genius " ; 
 appreciations no less true of the distinguished 
 speakers themselves. If it be true, as I have been 
 told, that the University of Birmingham has a coal 
 mine upon the premises, I anticipate that the craft 
 of coal getting, by carrying practice into thought, 
 will fortify the web of theory. 
 
 There exists no doubt the opposite danger of 
 reducing education to the narrow ideas and station- 
 ary habits of the mere artisan. By stereotyped 
 methods the shopmaster who does not see beyond 
 his nose may cramp the prentice ; and the prentice 
 becomes shopmaster in his turn. If in the feudal 
 times, and times like them in this respect, manual 
 craft was despised, and the whole reason of man 
 was driven into the attenuated spray of abstract 
 ingenuity, in other times or parts of society a 
 heavy plod of manual habit has so thickened " the 
 nimble spirits in the arteries " that man was little 
 better than a beaver : on the one side matter, 
 gross and blockish ; on the other, speculation 
 vacuous of all touch of nature. We need sorely 
 the elevation, the breadth, the disinterestedness, the 
 imagination which universities create and maintain ; 
 but in universities we need also bridges in every 
 parish between the provinces of craft and thought. 
 Our purpose must be to obtain the blend of craft 
 and thought which on the one hand delivers us from 
 a creeping empiricism, on the other from exorbitant 
 ratiocinations. That for the progress and advan- 
 tage of knowledge the polar activities of sense and
 
 OF MEDICINE AND SUKGERY 117 
 
 thought should tind a fair balance and an integra- 
 tion of function, is set forth judicially enough in 
 modern philosophy, and is eminent in great examples 
 of mankind. Moreover, it is apprehended in the 
 reciprocal tensions of faith and works, of hypothesis 
 and experience, of science and craft, and so forth. 
 In our controversies on theory and practice, on 
 universities and technical schools, on grammar and 
 apprenticeship, we see their opposite stresses. The 
 unison is far from being, as too often we suppose, 
 one merely of wind and helm, it is one rather of 
 wind and wing ; it consists not in a mere obedience 
 of hand to mind, but in some mutual implication, 
 or generative conjugation of them. 
 
 " Nor soul helps flesli more now than tlesh helps soul."' 
 
 How these two functions should live in each other 
 we see in tlie Fine Arts — in the swift confederacy 
 of hand and mind in Diirer, Michael Angelo, 
 Kembrandt, Velasquez, Watteau, Eeynolds, Watts. 
 Genoa, Florence, Venice, Japan never disdained the 
 crafts. The infinite delicacy of educated senses is 
 almost more incredible than the compass of imagina- 
 tion. When they unite in creation no shadow is 
 too fleeting, no line too exquisite for their common 
 engagement and mutual reinforcement. The craft 
 of Verrocchio becomes the magic of Leonardo 
 da Vinci. Leonardo and Michael Angelo, in genius 
 perhaps the greatest craftsmen the world has seen, 
 were as skilful to invent a water engine, to anato- 
 mise a plant, or to make a stone-cutter's saw, 
 as to paint the lineaments of the soul, and to
 
 118 THE HISTOEICAL RELATIONS 
 
 build the dome of St. Peter above the clouds of 
 Christendom. 
 
 Solve the problem as hereafter we may, now 
 we can take heed at least that energy shall not 
 accumulate about one pole or the other. Our 
 little children have a message to us if we would 
 but hearken to them. Every moment they are 
 translating action into thought and thought into 
 action. Eye, ear, and hand are incessantly on 
 the watch and in pursuit, gathering incessantly for 
 the mind the forms of thought which as rapidly 
 issue again in new activities. As we mature we 
 gain indeed in power of restraint, but it is not that 
 we shall cease to act, that the mind shall depose 
 the hand ; but that these variables shall issue in 
 richer and richer functions. If we forget the liands, 
 the cunning loom which wove our minds, if thrust- 
 ing them into our pockets we turn our eyes in- 
 wards, will our minds still grow true ? That by 
 virtue of the apposable thumb, monkey became 
 man is no metaphor ; in its measure it is sobey 
 truth. The bane of our profession for the last 
 millennium has been too much thinking ; we have 
 actually made it a point of honour to ignore the 
 hands out of which we have grown, and in this 
 false honour to forget that the end of life is action, 
 and that only by action is action bred. While we 
 profess to admire Bernard Palissy (whose lectures 
 Pare attended) or Jean Goujon, the medieval masons 
 or the medieval goldsmiths, we act nevertheless as 
 if fine arts only are honoiu'able, and mechanical arts 
 servile ^ whereby we blind ourselves to the common
 
 OF MEDICINE AND SUEGEEY 119 
 
 laws of growth, which, knowing no such distinctions, 
 deal out barrenness to those who make them. We 
 begin even with our children to wean them from 
 the life of imaginative eyes and of thoughtful 
 fingers ; and, instead of teaching them to rise from 
 simple crafts to practical crafts, to scientific crafts, 
 or to lovely crafts, and thus to pursue the mean of 
 nature herself, we teach them the insolence that, 
 except in sports, the mind should drop the acquaint- 
 ance of the hands. 
 
 Shall we wonder then that in this generation 
 bold men call English people stupid ; all stupid 
 save those few men of genius or rich talent who, 
 like Gilbert, Harvey, or Darwin, were great enough 
 to be true to eye and hand, and to breed great 
 conceptions by their intimate coition with the 
 mind ? Shall we wonder then that Medicine fell 
 into sterility when by most unnatural bonds surgery, 
 her scientific arm, was tied behind her, when she was 
 too squeamish for raw trutli, when she turned her 
 sight inwards from lusty natiu'e to formulas ? Shall 
 we wonder that even in the eighteenth century, 
 when Medicine had begun tardily to occupy herself in 
 the crafts of pathology and chemistry, one visionary 
 after another, striding in long procession athwart 
 the barren wilderness of physic, still wasted his 
 generation in fastidious evasion of the things that 
 happen, and in vain pursuit of vacuous unities ! 
 Happily, if to the high stomachs of our medieval 
 forefathers surgical dabblings were common and 
 unclean, still there remained some eyes curious 
 enough and some fingers dexterous enough to carry
 
 120 MEDICINE AND SUEGEEY 
 
 the art back to the skill of Hippocrates and forward 
 to the skill of Lister ; and by the mouths of barbers 
 and cutters, rather than of the pharisees of the 
 colleges, Medicine breathed her lowly message to 
 her children.
 
 We are requested by the Congress of Arts and Science 
 of St. Louis, 1904, to append brief lists of the more 
 important works on our respective subjects. The 
 chief part of my Address was founded upon a study 
 — virtually in all cases — of the original works of the 
 ancient writers themselves, and upon a number of 
 short monographs and other articles — many of them 
 in periodicals — the titles and references of which it 
 would be difficult now to collect ; and the list would 
 be a long one. I append a list of the more compre- 
 hensive works to which I am indebted : — 
 
 Haeser. — Gcscli. da- Medicin. 1875-81. 
 
 PusCHMANN. — Handbuch d. Gesch. d. Medizin, 2 vols. Jena, 1902-3. 
 
 Darembeug. — Hist, des sciences medicales. Paris, 1870. 
 
 Abhl. zur Gesch. d. Medicin,^ Ed. Magnus. Breslau, 1902 et seq. 
 
 HtPPOCRATis.— O^)., Ed. Littre, 10 vols. Paris, 1839-61. 
 
 P:^TREQiTiN. — Chirurgie d' Hiijpocrate, 2 vols. Paris, 1877. 
 
 Celse. — TraiU de Medicin, Ed. Vedrenes. Paris, 1876. 
 
 Galen, Ed. Daremberg (two vols, only published). Paris, 1854-56. 
 
 Oribase, Oeuvres d', Ed. Bussemaker et Daremberg, 5 vols. Paris, 
 
 1851-76. 
 Paulus Aegineta, Ed. Adams, 3 vols. Syd. Soc, 1845-47. 
 Salicet, Guill. de. — Chirurgie, Ed. Pifteau. Toulouse, 1898. 
 MoNDEViLLE, Maitre Henri de. — La Chirurgie (Soc. anc. 
 
 textesFr.), 2vols. 1897-98. iJwi, Ed. Nicaise. Paris, 1893. 
 
 ^ The tract on the history of Antiseptic Surgery in this series was 
 issued after my Address was delivered, and I have not yet had time 
 to read it. 
 
 121
 
 122 MEDICINE AND SUKGEEY 
 
 Guy de Chauliac. — La Grande Chirurgic, Ed. Nicaise. Paris, 
 
 1890. 
 YiJeriiian, Chirurgic de Maitrc, Ed. Broeckz. Anvers, 1868. 
 Billroth. — Historische Nolizen iiher die Beurtlieihmg und Behaml- 
 
 limg Schussxvunden. 1889. 
 Ferrari. — Une Chaire de Medicine au XV. siecle. Pari.s, 1899. 
 Franco, Pierre. — Chirurgic, Ed. Nicaise. Paris, 1895. 
 Par:^, Ambroise. — (Euvres, par Malgaigne, 3 vols. Paris, 1840-41. 
 
 Ibid., par L. Pauliuier. Paris, 1887. 
 Annals of the Barber- Surgeons of LondAin. 1890. 
 Alezais. — Chirurgiens et Barbiers de Marseille. 1901.
 
 INDEX 
 
 Absti-act r. Concrete, 115-116 
 
 Aetius, 18 
 
 Albucarfs, 21, 24, 27, 44, 62 
 
 Alexander of Tralles, 19, 44 
 
 Alexandrian school, 12, 30 
 
 Ammonius, 56 
 
 Amputation, before Celsus, 14 
 
 before Heliodorus, 15 
 
 in 13tli-16tli centnries, 32, 69, 
 82, 83, 95 
 Ana>sthe.sia, 90, 92 
 Analogy in medicine, 13 
 Anatomy, Greek, 21 
 
 medieval, 21, 62, 64-65, 68 n., 
 94 
 Antylliis, 15 
 Arab translations, 24 
 Arcliigenes, 15, 18, 83 
 Arderne, 99, 100 
 Argelata. Peter of, 52-53 
 Arnold of Villanova, 32, 44 
 Aviceuna, 5, 21, 62 
 
 Bacon, Francis, 65 
 Bail Ion, 66 
 Balm, the natural, 31 
 Balneotherapy, 88 
 Barl)ers, 24, 60, 162 
 Becker, Dr. E., 29, 88 
 Beuivieni, Antonio, 55-58 
 Bereugario da Carpi, 68, 80, 84 
 Bertipaglia, L., 54 
 Billroth, 96 n. 
 Biondo, 104 
 
 Bolonga, 24, 28, 38, 43, 51, 55 
 Books, value of, in schools, 24, 
 43, 44, 88 
 
 Botallo, 80, 104, 105 
 Brancas, the, 80 
 Brissot's protest, 107 
 Bruno's Chirurgia, 25 
 Brunschwig, 84, 91-93, 101 
 
 Caius, 91, 99 
 
 Calalirian surgeons, 73 
 
 Case histories, 33 
 
 Cellini, 68 
 
 Celsus, surgery of, 13, 30, 44, 
 
 56 
 discovery of works, 25 n., 55, 
 
 67 
 Chauliac, Guy of, 29, 37, 38, 45- 
 
 51, 52, 87, 90 n. 
 Cheselden, 79, 99 n., 112 
 Ciucci of Arezzo, 56 
 Collot family, 77, 78 
 Come, College of St., 22, 33, 39 w., 
 
 59-61 
 Consilia, 55 
 Constance, Peace of, 24 
 Council, Lateran, 22 n. 
 of Rheims, 22 n. 
 of Tours, 22 n. 
 Crotona, the herniotomists of, 73 
 Cumano, Marcello, 53 
 Cutters for stone, 70 
 
 Diphtheria, 96, 106 
 Division of medicine and surgery, 
 3, 22, 35, 48, 113 
 Mr. Chamberlain on, 3 
 Dry or moist dressings, 31 
 
 Empiricism, 10, 12 
 
 123
 
 124 
 
 MEDICINE AND SUEGEEY 
 
 English medieval surgery, 99 
 Epidemics, 66 
 Eye diseases, 9-10 
 Eye, surgery of the, 79 
 
 Fabriuius de Acquapendente, 52, 
 
 69, 76 n., 83 
 Fallopius, 46 
 Fernel, 110 
 Ferrari, Dr. H. -M., 72 
 Fine and mechanical crafts, 99 ti., 
 
 117 
 Firearms, wounds of, 54, 67, 84- 
 
 86, 92, 104 
 Florence, 55, 64 
 Four Masters' Commentary, 26 
 Fracastoro, 106 
 
 Franco, 32, 33, 71-79, 83, 91 n. 
 French surgery of 15th uenturj-, 
 
 61 
 
 Gaddesden, Jolui of, 48, 77 
 Gale, 99-101 
 
 Gerard of Cremona, 24, 44 
 German surgery, 88-99 
 Gersdorflf, 82, 84, 90, 93 
 Gesner, Conrad, 91, 94 
 Gilbert, William, 16 
 Gilbertus Auglicus, 29 
 Gilles de Corbeuil, 22 n. 
 Gordon, 38 
 
 Greek medicine and medieval 
 Europe, 20-21 
 
 Hajmostatics, 27, 41, 83 
 
 Halle, John, 102 
 
 Handicraft, 11, 115 
 
 Harvey, 16, 65, 99, 102, 106, 
 112 
 
 Healing by first intention, 30, 40 
 
 Helmholtz on history of Medi- 
 cine, 4 
 
 Herniotomists, 70, 73, 75-76 
 
 Hildanus, Fabricius, 73, 97-98 
 
 Hippocratean Canon, 5 
 
 Hoffmann, 18 
 
 Hugh of Lucca, 28, 32, 39, 47 
 
 Humphry, Sir G., 104 
 
 Hypodermic injection, 1 
 
 Inner medicine, medieval, 1 05-1 06 
 
 17th century. 111 
 Irrigation, 104 
 Italian physicians, 32, 58 
 
 Jacques, Frere, 78-79 
 Joint-water, 96 
 
 King's evil, 49 
 
 Lanfranc, 32, 33-35, 38, 46, 47, 
 
 48, 60 
 Lange, Johanu, 96 
 Ligature, history of, 15, 41, 54, 
 
 81-84, 98, etc. 
 Lithotomy, 76-79 
 Lithotrity, 55 n. 
 
 Magati, 108-109 
 Maggi, 80, 85, 104 
 Malgaigne, 8, 14, 28, 73 
 Medecius reclus, 61 
 Meudon, Odo de, 22 ?). 
 Mondeville, Henry of, 29, 34, 37- 
 
 43, 45, 47, 60, 94 
 Montaguana, 55 
 Montpellier, 24, 43, 51, 62, 64 
 Morgagni on Celsus, 25 n. 
 Mummy, 87 
 Mundino, 43, 45 
 
 Naples, 24 
 
 Nicholas Cusanus, 64 
 
 Observation, methods of, 16 
 Oribasius, 15, 19 
 
 Padua, 24, 43, 55, 64 
 
 Pagel, Dr., 32 «., 36 
 
 Palissy, 63, 64 
 
 Papacy and Medicine, 23, 26, 45, 
 
 51, 62 
 Paracelsus, 31, 84, 90-91, 94 
 Paracentesis, by physicians, 1 
 Pare, Ambroise, 31, 33, 37, 38, 
 
 47, 80-88, 94, 98 
 Paris, University of, 22, 44, 52 
 Faculty of Medicine, 22, 59- 
 
 60
 
 INDEX 
 
 125 
 
 Paul of Egiua, 15, 18, 44 
 Payne, Dr. J. F., 29, 106 n. 
 Peripatetic surgeons, 71, 72 
 Petit, 82, 83 
 Pt'trequin on Hippoci-ates' sair- 
 
 gery, 7 
 Pfolspeundt, Heinrich von, 89-90 
 Pitard, John, 39, 45, 60 
 Plastic operations, 79-80 
 Platner, Zacliary, 8 
 Platonisni, 63 
 Platter, Felix, 110 
 Puerperal fever, Greeks on, 9 
 
 Ramus, 63, 64 
 
 Rhazes, 21, 31, 44 
 
 Riolanus, 81 
 
 Roger and Roland, 26 
 
 Salerno, school of, 24, 43, 52 
 
 Salicet, William, 32, 46, 48 
 
 Samonicus, 22 n. 
 
 Sanctorius Santoro, 56 n. 
 
 Sanctus (Santo), 77 
 
 Scacchi, Durante, 73 
 
 Scrofula, 49 
 
 Soraniis, 17 
 
 Spanish surgery, 16th century, 
 
 103 
 Speculative medicine, 113-114,119 
 Suppuration, 28, 30, 40, 70, 84, 99 
 Surgeons, their advance into 
 
 medicine, 2 
 Surgery, 6, 8, 10, 30 
 
 and medicine, one, 11 
 
 Hippocrates on, 18 and passim 
 
 Littre on, 8 
 
 Surgery in 13th and 14th 
 Centuries, 23 
 in 15th and 16th centuries, 52 
 Suture of wounds, 54 
 Sydenham, 96, 102, 105, 111 
 Sylvius, 86 
 Syphilis, 27, 33, 58, 66, 69, 97, 98 
 
 Tagliacozzi, 80 
 
 Technical and theoretical educa- 
 tion, 115-119 
 
 Theodoric of Lucca, 28-29. 31, 32, 
 34, 37, 39, 40, 46, 47 
 
 Torsion of arteries, 41, 54 
 
 Truss, the, 72-73, 76 
 
 Unicorn, 87 
 
 Universities, foundation of, 24 
 clerical and lay elements in, 26 
 
 Valentine, Basil, 32, 106 
 Venesection (Brissot on), 107 
 Vernaculars, the rise of, 25, 81, 92 
 Vesalius, 62, 86 n., 98, 104, 112 
 Vidus Vidius. 66 
 Vigo, John of, 68-69, 84, 90 )i., 
 
 101 
 Virchow on history of Medicine, 5 
 Vives, 63, 64 
 
 War, surgery of, 61, 92-93, 100 
 Wiseman, 93, 99, 102 
 Wound surgeons, 27, 32, 92 
 Wiirtz, 31, 33, 84, 90, 91 «., 
 94-97 
 
 Yperman, 35, 49, 83 
 
 THE END 
 
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