VI. THE RISE OF SURGERY

Despite the advances of anatomy, the science and art of medicine were still in leading strings to Greek and Arabic authorities. The evidence of the senses hardly availed against the word of Galen or Avicenna; even Vesalius, when his dissections disproved Galen, said, “I could hardly believe my eyes.” Editions or translations of Galen or Hippocrates, while spreading old knowledge, discouraged new experiments—very much as the efforts of Petrarch and Ronsard to write Virgilian epics diverted and injured their natural genius. When Linacre founded what was later named the Royal College of Physicians (1518), its principal texts were his translations of Galen.

Therapy benefited from new drugs brought to Europe—cinchona, ipecacuanha, and rhubarb from America, ginger and benzoin from Sumatra, cloves from the Moluccas, aloes from Cochin China, camphor and cinnabar from China; and the development widened the use of native plants. Valerius Cordus compiled the first German pharmacopoeia (1546). The treatment of syphilis with infusions of guaiac wood from the West Indies was so popular that the Fuggers made another fortune by securing from their debtor, Jharles V, a monopoly on its sale in his realms.

The poverty and uncleanliness of the masses kept diseases always ahead of cures. Open heaps of refuse or dung poisoned the air, and sometimes littered the streets. Paris had a system of sewers, which Henry II proposed to empty into the Seine; the municipal authorities dissuaded him by explaining that the river was the sole drinking water that half the people had.67 Sewer commissions were set up in England in 1532, but as late as 1844 there were only two English towns where refuse was removed at public expense from the slums.

Epidemics were less virulent than in the Middle Ages, but they sufficed—along with high puerperal and infantile mortality, to keep the population almost stationary. Plagues swept through Germany and France repeatedly between 1500 and 1568. Typhus fever spread in England in 1422, 1577, and 1586, through the migrations of lice. The “sweating sickness”—probably a form of influenza—ravaged England in 1528, 1529, 1551, 1578; Germany in 1543-45; France in 1550-51; Hamburg and Aachen, we are told, each lost a thousand souls to it within a few days.68 Influenza was ascribed to celestial influences—hence its name. The bubonic plague reappeared in Germany in 1562, taking 9,000 of the 40,000 inhabitants of Nuremberg69—though we may suspect all plague statistics as exaggerations. Brighter sides of the picture are the fading out of leprosy and such mental disorders as St. Vitus’s Dance.

Medical practice progressed more slowly than medical knowledge. Quacks still abounded; despite some restrictive laws it was easy to practice medicine without a degree. Most babies were eased into the world by midwives. Specialism had hardly begun. Dentistry was not separated from medicine or surgery; barber surgeons extracted teeth, and replaced them with ivory substitutes. Nearly all physicians—Vesalius was one of the exceptions—left surgery to barber surgeons, who, however, must not be thought of as barbers; many of them were men of training and skill.

Ambroise Paré began as a barber’s apprentice, and rose to be surgeon to kings. Born (1517) at Bourg-Hersent in Maine, he made his way to Paris, and set up his barber’s stall in the Place St.-Michel. During the war of 1536 he served as a regimental surgeon. In treating soldiers he accepted the prevailing theory that gunshot wounds were poisonous, and (like Vesalius) he followed the current practice of cauterizing them with boiling elder oil, which turned pain into agony. One night the oil ran out, and for lack of it Paré dressed the wounds with a salve of egg yolk, attar of roses, and turpentine. On the morrow he wrote:

Last night I could hardly sleep for continually thinking about the wounded men whose hurts I had not been able to cauterize. I expected to find them all dead the next morning. With this in view I rose early to visit them. Greatly to my surprise, I found that those whom I had treated with the salve had very little pain in their wounds, no inflammation .... and had passed a comfortable night. The others, whose wounds had been treated with boiling elder oil, were in high fever, while their wounds were inflamed .... and acutely painful. I determined, therefore, that I would no longer cauterize the unfortunate in so cruel a manner.70

Paré had little education, and it was not till 1545 that he published his little manual, now a medical classic, on the treatment of wounds (Méthode de traicter les plaies). In the war of 1552 he proved that ligature of the artery was preferable to cauterization to check bleeding in amputations. Captured by the enemy, he earned his release by successful operations. On returning to Paris he was appointed head surgeon at the Collège St.-Côme, to the horror of the Sorbonne, where a professor innocent of Latin seemed a biological monstrosity. Nevertheless he became surgeon to Henry II, then to Francis II, then to Charles IX; and though a professed Huguenot, he was spared by royal order in the Massacre of St. Bartholomew. His Deux livres de chirurgie (1573) added little to the theory, much to the practice, of surgery. He invented new instruments, introduced artificial limbs, popularized the use of the truss in hernia, improved podalic version in childbirth, made the first exarticulation of the elbow joint, described monoxide poisoning, and indicated flies as carriers of disease. Famous in the annals of medicine is his demurrer to congratulations on his success in a difficult case: Je le pansay, Dieu le guarit—“! treated him, God cured him.” He died in 1590, age seventy-three. He had considerably improved the status and competence of surgeons, and had given France, in surgery, that lead which it was to retain for several centuries.

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