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MEDICINE IN THE SIXTEENTH AND SEVENTEENTH CENTURIES
Of the half-dozen surgeons who were prominent in the sixteenth
century, Ambroise Pare (1517-1590), called the father of French
surgery, is perhaps the most widely known. He rose from the
position of a common barber to that of surgeon to three French
monarchs, Henry II., Francis II., and Charles IX. Some of his
mottoes are still first principles of the medical man. Among
others are: "He who becomes a surgeon for the sake of money, and
not for the sake of knowledge, will accomplish nothing"; and "A
tried remedy is better than a newly invented." On his statue is
his modest estimate of his work in c 16416k109q aring for the wounded, "Je le
pansay, Dieu le guarit"--I dressed him, God cured him.
It was in this dressing of wounds on the battlefield that he
accidentally discovered how useless and harmful was the terribly
painful treatment of applying boiling oil to gunshot wounds as
advocated by John of Vigo. It happened that after a certain
battle, where there was an unusually large number of casualties,
Pare found, to his horror, that no more boiling oil was available
for the surgeons, and that he should be obliged to dress the
wounded by other simpler methods. To his amazement the results
proved entirely satisfactory, and from that day he discarded the
hot-oil treatment.
As Pare did not understand Latin he wrote his treatises in
French, thus inaugurating a custom in France that was begun by
Paracelsus in Germany half a century before. He reintroduced the
use of the ligature in controlling hemorrhage, introduced the
"figure of eight" suture in the operation for hare-lip, improved
many of the medico-legal doctrines, and advanced the practice of
surgery generally. He is credited with having successfully
performed the operation for strangulated hernia, but he probably
borrowed it from Peter Franco (1505-1570), who published an
account of this operation in 1556. As this operation is
considered by some the most important operation in surgery, its
discoverer is entitled to more than passing notice, although he
was despised and ignored by the surgeons of his time.
Franco was an illiterate travelling lithotomist--a class of
itinerant physicians who were very generally frowned down by the
regular practitioners of medicine. But Franco possessed such
skill as an operator, and appears to have been so earnest in the
pursuit of what he considered a legitimate calling, that he
finally overcame the popular prejudice and became one of the
salaried surgeons of the republic of Bern. He was the first
surgeon to perform the suprapubic lithotomy operation--the
removal of stone through the abdomen instead of through the
perineum. His works, while written in an illiterate style, give
the clearest descriptions of any of the early modern writers.
As the fame of Franco rests upon his operation for prolonging
human life, so the fame of his Italian contemporary, Gaspar
Tagliacozzi (1545-1599), rests upon his operation for increasing
human comfort and happiness by restoring amputated noses. At the
time in which he lived amputation of the nose was very common,
partly from disease, but also because a certain pope had fixed
the amputation of that member as the penalty for larceny.
Tagliacozzi probably borrowed his operation from the East; but he
was the first Western surgeon to perform it and describe it. So
great was the fame of his operations that patients flocked to him
from all over Europe, and each "went away with as many noses as
he liked." Naturally, the man who directed his efforts to
restoring structures that bad been removed by order of the Church
was regarded in the light of a heretic by many theologians; and
though he succeeded in cheating the stake or dungeon, and died a
natural death, his body was finally cast out of the church in
which it had been buried.
In the sixteenth century Germany produced a surgeon, Fabricius
Hildanes (1560-1639), whose work compares favorably with that of
Pare, and whose name would undoubtedly have been much better
known had not the circumstances of the time in which he lived
tended to obscure his merits. The blind followers of Paracelsus
could see nothing outside the pale of their master's teachings,
and the disastrous Thirty Years' War tended to obscure and retard
all scientific advances in Germany. Unlike many of his
fellow-surgeons, Hildanes was well versed in Latin and Greek;
and, contrary to the teachings of Paracelsus, he laid particular
stress upon the necessity of the surgeon having a thorough
knowledge of anatomy. He had a helpmate in his wife, who was also
something of a surgeon, and she is credited with having first
made use of the magnet in removing particles of metal from the
eye. Hildanes tells of a certain man who had been injured by a
small piece of steel in the cornea, which resisted all his
efforts to remove it. After observing Hildanes' fruitless efforts
for a time, it suddenly occurred to his wife to attempt to make
the extraction with a piece of loadstone. While the physician
held open the two lids, his wife attempted to withdraw the steel
with the magnet held close to the cornea, and after several
efforts she was successful--which Hildanes enumerates as one of
the advantages of being a married man.
Hildanes was particularly happy in his inventions of surgical
instruments, many of which were designed for locating and
removing the various missiles recently introduced in warfare.
The seventeenth century, which was such a flourishing one for
anatomy and physiology, was not as productive of great surgeons
or advances in surgery as the sixteenth had been or the
eighteenth was to be. There was a gradual improvement all along
the line, however, and much of the work begun by such surgeons as
Pare and Hildanes was perfected or improved. Perhaps the most
progressive surgeon of the century was an Englishman, Richard
Wiseman (1625-1686), who, like Harvey, enjoyed royal favor, being
in the service of all the Stuart kings. He was the first surgeon
to advocate primary amputation, in gunshot wounds, of the limbs,
and also to introduce the treatment of aneurisms by compression;
but he is generally rated as a conservative operator, who favored
medication rather than radical operations, where possible.
In Italy, Marcus Aurelius Severinus (1580-1656) and Peter
Marchettis (1589-1675) were the leading surgeons of their nation.
Like many of his predecessors in Europe, Severinus ran amuck with
the Holy Inquisition and fled from Naples. But the waning of the
powerful arm of the Church is shown by the fact that he was
brought back by the unanimous voice of the grateful citizens, and
lived in safety despite the frowns of the theologians.
The sixteenth century cannot be said to have added much of
importance in the field of practical medicine, and, as in the
preceding and succeeding centuries, was at best only struggling
along in the wake of anatomy, physiology, and surgery. In the
seventeenth century, however, at least one discovery in
therapeutics was made that has been an inestimable boon to
humanity ever since. This was the introduction of cinchona bark
(from which quinine is obtained) in 1640. But this century was
productive of many medical SYSTEMS, and could boast of many great
names among the medical profession, and, on the whole, made
considerably more progress than the preceding century.
Of the founders of medical systems, one of the most widely known
is Jan Baptista van Helmont (1578-1644), an eccentric genius who
constructed a system of medicine of his own and for a time
exerted considerable influence. But in the end his system was
destined to pass out of existence, not very long after the death
of its author. Van Helmont was not only a physician, but was
master of all the other branches of learning of the time, taking
up the study of medicine and chemistry as an after-thought, but
devoting himself to them with the greatest enthusiasm once he had
begun his investigations. His attitude towards existing doctrines
was as revolutionary as that of Paracelsus, and he rejected the
teachings of Galen and all the ancient writers, although
retaining some of the views of Paracelsus. He modified the
archaeus of Paracelsus, and added many complications to it. He
believed the whole body to be controlled by an archaeus influus,
the soul by the archaei insiti, and these in turn controlled by
the central archeus. His system is too elaborate and complicated
for full explanation, but its chief service to medicine was in
introducing new chemical methods in the preparation of drugs. In
this way he was indirectly connected with the establishment of
the Iatrochemical school. It was he who first used the word
"gas"--a word coined by him, along with many others that soon
fell into disuse.
The principles of the Iatrochemical school were the use of
chemical medicines, and a theory of pathology different from the
prevailing "humoral" pathology. The founder of this school was
Sylvius (Franz de le Boe, 1614-1672), professor of medicine at
Leyden. He attempted to establish a permanent system of medicine
based on the newly discovered theory of the circulation and the
new chemistry, but his name is remembered by medical men because
of the fissure in the brain (fissure of Sylvius) that bears it.
He laid great stress on the cause of fevers and other diseases as
originating in the disturbances of the process of fermentation in
the stomach. The doctrines of Sylvius spread widely over the
continent,
but were not generally accepted in
modified by Thomas Willis (1622-1675), whose name, like that of
Sylvius, is perpetuated by a structure in the brain named after
him, the circle of Willis. Willis's descriptions of certain
nervous diseases, and an account of diabetes, are the first
recorded, and added materially to scientific medicine. These
schools of medicine lasted until the end of the seventeenth
century, when they were finally overthrown by Sydenham.
The Iatrophysical school (also called iatromathematical,
iatromechanical, or physiatric) was founded on theories of
physiology, probably by Borelli, of Naples (1608-1679), although
Sanctorius; Sanctorius, a professor at Padua, was a precursor, if
not directly interested in establishing it. Sanctorius discovered
the fact that an "insensible perspiration" is being given off by
the body continually, and was amazed to find that loss of weight
in this way far exceeded the loss of weight by all other
excretions of the body combined. He made this discovery by means
of a peculiar weighing-machine to which a chair was attached, and
in which he spent most of his time. Very naturally he
overestimated the importance of this discovery, but it was,
nevertheless, of great value in pointing out the hygienic
importance of the care of the skin. He also introduced a
thermometer which he advocated as valuable in cases of fever, but
the instrument was probably not his own invention, but borrowed
from his friend Galileo.
Harvey's discovery of the circulation of the blood laid the
foundation of the Iatrophysical school by showing that this vital
process was comparable to a hydraulic system. In his On the
Motive of Animals, Borelli first attempted to account for the
phenomena of life and diseases on these principles. The
iatromechanics held that the great cause of disease is due to
different states of elasticity of the solids of the body
interfering with the movements of the fluids, which are
themselves subject to changes in density, one or both of these
conditions continuing to cause stagnation or congestion. The
school thus founded by Borelli was the outcome of the unbounded
enthusiasm, with its accompanying exaggeration of certain
phenomena with the corresponding belittling of others that
naturally follows such a revolutionary discovery as that of
Harvey. Having such a founder as the brilliant Italian Borelli,
it was given a sufficient impetus by his writings to carry it
some distance before it finally collapsed. Some of the
exaggerated mathematical calculations of Borelli himself are
worth noting. Each heart-beat, as he calculated it, overcomes a
resistance equal to one hundred and eighty thousand pounds;--the
modern physiologist estimates its force at from five to nine
ounces!
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