PART I. HISTORY OF SURGERY

Part 5. 16th and 17th Centuries. Wiseman.

Surgery in the 16th century recovered much of the dexterity and resource that had distinguished it in the best periods of antiquity, while it underwent the developments opened up to it by new forms of wounds inflicted by new weapons of warfare. The use of the staff and other instruments of the "apparatus major" was the chief improvement in lithotomy. A "radical cure" of hernia by sutures superseded the old application of the actual cautery. The earlier modes of treating stricture of the urethra were tried ; plastic operations were once more done with something like the skill of Brahmanical and classical times; and ophthalmic surgery was to some extent rescued from the hands of ignorant pretenders. It is noteworthy that even in the legitimate profession dexterous special operations were kept secret; thus the use of the "apparatus major" in lithotomy was handed down as a secret in the family of Laurence Colot, a contemporary of Paré's.

The 17th century was distinguished rather for the rapid progress of anatomy and physiology, for the Baconian and Seven-Cartesian philosophies, and the keen interest taken in com- teentu plete systems of medicine, than for a high standard of surgical practice. The teaching of Pare that gunshot wounds were merely contused and not i>oisoned, and that simple treatment was the best for them, was enforced anew by Magati (1579-1647), Wiseman, and others. Trephining was freely resorted to, even for inveterate migraine; Philip William, prince of Orange, is said to have been trephined seventeen times. Flap-amputations, which had been prac-tised in the best period of Bpman surgery by Leonides and Heliodorus, were reintroduced by Lowdliam, an Oxford surgeon, in 1679, and jirobably used by Wiseman, "who was the first to practise the primary major amputations. Fabriz von Hilclen (1560-1634) introduced a form of tourniquet, made by placing a piece of wood under the bandage en-circling the limb; out of that there grew the block-tourniquet of Morel, first used at the siege of Besangon in 1674; and this, again, was superseded by Jean Louis Petit's screw-tourniquet in 1718. Strangulated hernia, which was for long avoided as a noli me tangere, became a subject of operation. Lithotomy by the lateral method came to great perfection in the hands of Jacques Beaulieu. To this century also belong the first indications (not to mention the Alexandrian practice of Ammonius) of crushing the stone in the bladder. The theory and practice of trans-fusion of blood occupied much attention, especially among the busy spirits of the Royal Society, such as Boyle, Lower, and others. The seat of cataract in the substance of the lens was first made out by two French surgeons, Quarre and Lasnier. Perhaps the most important figure in the surgical history of the century is Richard Wiseman, the Wise-father of English surgery. Wiseman took the Royalist side man-in the wars of the Commonwealth, and was surgeon to James I. and Charles I., and accompanied Charles II. in his exile in France and the Low Countries. After serving for a time in the Spanish fleet, lie joined the Royalist cause in England and was taken prisoner at the battle of Worce-ster. At the Restoration he became serjeant-surgeon to Charles II., and held the same office under James II. His Seven Chirurgical Treatises were first published in 1676, and went through several editions ; they relate to tumours, ulcers, diseases of the anus, king's evil (scrofula), wounds, fractures, luxations, and lues venerea. Wiseman was the first to advocate primary amputation (or operation before the onset of fever) in cases of gunshot wounds and other injuries of the limbs. He introduced also the practice of treating aneurisms by compression, gave an accurate account of fungus articnlorum, and improved the operative procedure for hernia.






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