hæmorrhage. This also was no invention of his, for, like most sound practice, it has its roots in Greek surgery, and reaches back at least as far as Antyllus and Galen. Moreover, we have seen that in Paré's own time Ferri was accustomed to underpin vessels, as had been done by Brunschwig before him. Paré's improvement in the method, however, which probably dates from 1552, consisted in tying the vessel by means of a ligature in the open wound, the bleeding point having been secured by catch-forceps similar to those still used by surgeons (Fig. 4 (3)). He tells us how (Ib. p. 241) the operators,

...

so soon as the limb was removed, would use many cauteries, both actual and potential, to stop the flow of blood, a thing very horrible and cruel in the mere telling. . . . Of six thus cruelly treated scarce two ever escaped, and even these were long ill, and the wounds thus burned were slow to heal; in most of them, moreover, when the scar fell off, there came fresh bleeding, which must again be staunched with the cauteries. . . . The bones remained long after bare and exposed, so that, for many, healing was impossible; and they had an ulcer there to the end of their lives, which prevented them from having an artificial limb. Therefore I counsel the young surgeon to leave such cruelty and inhumanity, and follow my method of practice, which it pleased God to teach me, without I had ever seen it done in any case, no, nor read of it.'

He tried his new method tentatively at first,

'so that in my budding practice thereof I always had my cauteries and hot irons in readiness, that, if anything happened otherwise than I expected in this new work, I might fetch succour from the ancient practice; until, at length, confirmed by the happy experience of almost an infinite number of particulars, I bid eternally adieu to all hot irons and cauteries which were commonly used in this work. And I think it fit that chirurgeons do the like; . . . for antiquity and custom in such things as are performed by art ought not to have any sway, authority or place contrary to reason, as they ofttimes have in civil affairs; wherefore let no man say unto us that "the Ancients have always done thus.”

With Paré begins a new age of surgery, into which the limits that we set to this article will hardly allow us to enter. We will but briefly review the work of a few

contemporaries whose writings helped or hindered the immediate spread of his teaching.

Paré's doctrine that gunshot wounds were not poisonous was espoused by the Bolognese Bartolomeo Maggi (1477?—1552), a military surgeon in the papal service, who had been present at the sieges of Parma and Mirandola. Later he became professor at Bologna; and his work, 'De vulnerum sclopetorum et bombardarum curatione tractatus,' appeared in 1552, the year of his death. He was a 'learned' surgeon, but also a practical one; and he held that the essential element of gunshot wounds was not their poisonous but their contused character. He advised that the ball should always be withdrawn as soon as possible, and contrived a number of instruments for the purpose. The principle of one of these, a pair of forceps with detachable blades, has remained in modern surgery. Somewhat similar to Maggi's work is that of Giovanni Francesco Rota, De Tormentariorum Vulnerum Natura and Curatione,' Bologna, 1555. Rota still believed that gunshot wounds are poisoned, but he advised against the use of cautery and was in favour of evacuating the venom by the free letting of blood.

A supporter of Paré's doctrine that gunshot wounds were not poisonous was the Piedmontese anatomist, Leonardo Botallo of Asti (fl. circa 1550), much of whose life was passed in France as body-physician to Charles IX and Henri III. His work, 'De curandis vulneribus sclopetorum,' was published in Lyons in 1560. He is against the constant probing and searching of wounds for foreign bodies, especially by those ignorant of anatomy; and he rightly regards amputation as the lesser evil. He follows also a more scientific line in his simplification of wound salves. Those he adopts are neither numerous nor complex. The most noteworthy part of his work, however, is his treatment of head wounds; and the instruments he used and the lines that he laid down for the treatment of these injuries were hardly improved until quite modern times. If any internal injury to the head is suspected, the skull must be laid bare over the spot, so that any depressed fragments and splinters may be removed. If the ball has entered into the cranial cavity, the case is hopeless; but, if trephining is decided on, the operation

should be undertaken at the first possible moment. The indications for this operation are internal hæmorrhage or suppuration or pressure from depression of the skull. In spite, however, of his surgical skill, he was an ardent supporter of blood-letting. His technique of trephining was further elaborated in Giovanni Battista Cacano Leone's 'De vulneribus sclopetorum,' Milan, 1584. A follower of Botallo in the free use of bleeding in gunshot wounds was Hippolyto Boscho, professor at Ferrara, whose bloodthirsty work, De vulneribus bellico fulmine illatis tractatus,' appeared at Ferrara in 1596. Like the other Italian writers, Maggi, Rota, and Botallo, Boscho abandons the cautery.

The man who in his own day was the most influential supporter of the doctrines of Ambroise Paré was his countryman Laurent Joubert (1529-1583), who was perhaps the most distinguished French physician of the age. He was a pupil of the naturalist Rondelet, whom he succeeded in the chair of anatomy at Montpellier in 1566; subsequently he became physician to Henri III. Although a Protestant, Joubert followed the wars with the king's army, and from the experience thus earned he wrote his book, which appeared at Paris in 1570 as Traicte des arcbusades, contenant la vraye essence du mal, et sa propre curation.' He was a scientific as well as a learned man, and master of a trenchant style which Haller describes as 'dictio boccacciana et jocularis.' He finally convinced the scientific world that gunshot wounds were not of necessity poisoned or burnt, but were best treated as simple solutions of continuity. Although he had as wide a knowledge of drugs as any of his day and stood unrivalled as a medical botanist, his treatment became simpler and simpler, until at last the learned physician came to rely on that 'vis medicatrix naturae,' to which the father of medicine had taught him to look. Towards the end of his life he came to regard pure springwater as the best dressing for wounds, a doctrine that he describes in his charming little dialogue 'Deux belles questions, sur la curation des harquebuses and autres playes,' dedicated to Henry of Navarre.* This was

* Printed at Bergerac, 1577; reprinted by the surgeon Alexandre Dionyse at Paris in 1581, and again by Claude Lancelot at Lyon in 1588.

probably as good a dressing as any that was applied to gunshot wounds until the days of Lister and Pasteur.

A character somewhat similar to Paré, but far inferior, was that of the Swiss, Felix Wirtz (1514-1574) of Basel, whose 'Practica der Wundartzney' first appeared in 1563 and went through numerous editions, some of which were edited by his son. Wirtz was a friend of his great and scholarly countryman, Conrad Gesner, who collected into a volume some of the most interesting of the 16thcentury treatises on gunshot wounds. Wirtz himself had travelled much in Italy, France, and the Low Countries, but we have no information as to what were the campaigns in which he gained his experience. He was an ignorant man and proud of his ignorance, but as a surgeon he was skilful and efficient. Wounds involving the great cavities of the body he regards as always fatal, and he therefore dismisses them as beyond his province. Gunshot wounds he considers to be poisonous only when severely burnt. He advises that they should be washed out and afterwards dressed with a salve compounded of gum tragacanth and the old German folk-medicine Ehrenpreis' (speedwell). In those days the soldiers themselves had many rough remedies for their own wounds; and one of these, which savours of sympathetic magic, was a draught of gunpowder and water. This is probably the origin of a potion recommended by Wirtz, consisting of a solution of saltpetre. In other cases he gave aqua vitæ -a mixture of myrrh and spirit of hartshorn (which in those days was really made from the horn of the hart), or one of those ever reappearing marvels of medieval therapeutic ingenuity, the Mithridate or the Theriac. On the whole, Wirtz does not seem to us worthy of the praise that has been lavished on him by Billroth and other German writers; but he appears at his best, to modern eyes, in his opposition to all undue interference with wounds, such as probing, tamponage or the use of tents, to which resort was so frequent in his time.

In England the general level of surgery during the 16th century was, it must be admitted, below the best Continental standards. There was no Elizabethan surgeon who made any addition to knowledge; and the work of the only two who may be mentioned here