The Dark Ages
As the Roman Empire was slowly being replaced by less organised societies. Britain and Europe descended into what we know today as The Dark Ages. The Italian Scholar, Francesco Petrarch, was the first to coin this phrase.
The Dark Ages were being fuelled by religious extremism and the Catholic Church wanted to control what the civilised and uncivilised world should and should not do. Penalties for breaking their religious laws of the time were extreme.
If you healed somebody, using methods that were not approved by the Roman Catholic Church and the treatment was successful, their suspicion of the cure would lead them to accuse you of sorcery, as it would be their opinion that the substances being used were magic potions. The tying of blood vessels was seen as sacrilegious, the use of hot irons and boiling oil was imposed. You could be tried as a witch or a warlock. Before the trial, the accused would have to endure torture that most men and women would find difficult if not impossible to tolerate.
The torturers were good at their trade and they, during these periods handed down their techniques to their apprentices who improved on them, the idea being to keep the person alive as long as possible, so they would eventually give in to the horrendous torture and confess what the questioner wanted them to confess, guilty or not.
Eventually, they would confess to any crime they were accused of just to stop the barbaric torturous ordeal. Most of the victims were then burnt at the stake, although some were garrotted as a reward for confessing to the allegations prior to the fire being lit.
To say that this was what the Christ wanted them to do, is the greatest insult to his life and death on the cross at Calvary. Yes, the Catholic Church has a lot to answer and apologise for. The picture is of the armchair of spikes which the defendant is strapped into and the mechanism is turned to allow the spikes to enter the body slowly until the defendant confesses or dies. It in most cases ended with the death of the defendant, either due to the injuries received from the tortures, or by confessing after torture, you were killed anyway.1
It was the catholic church that supported this form of torture as it scared most into becoming an active catholic and that meant more tithes to the church to help build its cathedrals and increase the fineries at Avignon and the Vatican. The progression in medical advancement was stagnated by the threats of this period within the Christian occupied world. The inscription at the entrance to Hell:"Abandon all hope, you who enter!”2 , perhaps should have been hung over the Papal seat.
It was during the height of this Inquisition that Columbus discovered America (or at least the Dominican Republic/Haiti) It did not take too long for European diseases to infect the Native American peoples. Europe had exported its greatest killers in the form of viruses and bacteria. As the Native Americans existed like that of the early Europeans, they relied upon their ritual healing by witch doctors and sorcerers and these were ineffective against these unseen enemies.
The people of today blame all Christians for the horrors of the inquisition and also the mass slaughter of Muslims and Jews by the authority of the Roman Catholic Church.
Jesus Christ never once said Kill your enemies or if you do not accept me you should be killed, no he says Love your enemies, do good to those who hate you for my sake. Blame the power hungry people who dress as clerics or Kings and only have their own self-interests at heart. Anyone who preaches hate is of the Devil. The reformation of the Christian Church was a consequence of the failure of Rome to practise what Christ preached.
Monastic HospitalsDuring these times, because of the extreme penalties imposed by the church, science in any form was stifled, so medicine continued to be based upon Galen’s reports and theories. Superstition returned, Monks wrote about medicine, in essence medicine and surgical techniques did not advance at all.
Christian and pagan belief taught that disease was due punishment from God, this divine chastising should not be interfered with. This unfortunately is where the term Dark Ages lived up to its label.
The monasteries became the hospitals of the dark ages as it was there where all the writings about medical conditions were kept. These contained the cures using herbs and other substances which could only be obtained at that time by the monks. The typical design for this was a hospice at the World War Two battle of Monte Casino; this was opened by Benedict who later became Saint Benedict.
In contrast, the religion of Islam during this early period was in its infancy but growing rapidly, it was also responsible for advancing medical research. Medical Colleges were built in the Middle East and in the Muslim strongholds of North Africa. This was fortunate for medical science as very little was being done in the Christian controlled states.
"Also say to them, that they suffer him this day to win his spurs, for if god be pleased, I will this journey be his and the honour thereof."3
The Monastery at Monte Casino became a death sentence for thousands of soldiers during WW2 and was totally destroyed.
Abu Bakr Muhammad Ibn Zakariya al-Razl (865–925)Abu Bakr Mohammed Ibn Zakariya al-Razi, known as Al-Raze, or At-Razi, or IbnZakaria (Zakariya) or (in Latin) as Rhazes and Rasis (8641-930 AD).
He was an Iranian polymath who contributed much to the fields of medicine and chemistry. He was born in Ray (Rages) (actually, in Persian language Razi means from the city of Ray).4
Muslim physicians like Rhazes were researching into medical cures. Rhazes was one of the first to use animal gut as a material for an absorbent suture. He did perform surgery but was primarily a physician. The Islamic physicians were also known to use a soporific sponge (soaked in hashish or opium). It would be moistened and held over the face inducing a State of sleep.
At this time the Jews of the world, who had been scattered by the Romans after the destruction of Jerusalem in 70AD, were full of the knowledge of Christian and Muslim medicine. Most Jewish physicians were fluent in Arabic.
The Roman Catholic Church then forbade them to practice medicine, especially on Christians, this became punishable by death.
Rhazes major achievement was he was the first to identify the difference between measles and smallpox. “The eruption of the smallpox is preceded by a continued fever, pain in the back, itching in the nose, and terrors in the sleep. These are the more peculiar symptoms to approach, especially a pain in the back with fever; then also a pricking which the patient feels all over his body; a fullness of the face, which at times comes and goes; an infectious colour, and vehement redness in both cheeks; a redness of both eyes, heaviness of the whole body; great uneasiness, the symptoms of which are stretching and yawning; pain in the throat and chest, with slight difficulty in breathing and cough; a dryness of breath, thick spittle and hoarseness of the voice; pain and heaviness of the in quietude, nausea and anxiety; (with this difference that the in quietude, nausea, and anxiety are more frequent in the measles than in the smallpox; while on the other hand, the pain in the back is more peculiar to the smallpox than to the measles) heat of the whole body; and an inflamed colon, and shining redness, especially an intense redness of the gums.”5
"Except by the lawful judgement of his peers or by the law of the land. To no man will we sell, or deny, or delay, right or justice." 6
The doctor's aim is to do good, even to our enemies, so much more to our friends, and my profession forbids us to do harm to our kindred, as it is instituted for the benefit and welfare of the human race, and God imposed on physicians the oath not to compose deadly remedies.
MauritiusIn the 7th century, Emperor of Rome, Mauritius (born Maurice) stands out as one of the last emperors whose empire still bore a strong resemblance to the Roman Empire of previous centuries. It was upon the assassination of him and his sons that led Rome into a civil war that they never recovered from, as after his death the spectre of the Muslim giant was expanding across the Middle East, his death was the start of the major infighting amongst the Roman occupied lands.
Mauritius had surgeons and field hospitals albeit a crude form. They also had horsemen who formed a class of ambulance. These men were known as the Desputati or "drink givers”.7 Pope Leo VI mentions them also in his “Tactics” The Desputati, who had two straps on the left side of the stirrup would pick up the wounded, give them water and then convey them to an area where they could obtain some sort of medical treatment for their wounds. They were also responsible for refreshing the active soldiers with water.
This led the Byzantine army to the eventual formation of the Ambulance Corps. During the tenth century the Ambulance corps of the Byzantine armies incorporated a surgeon with between six and eight stretcher-bearers to a ratio of 250 men, this was by far the best that the times could offer.
In the majority of other armies, men who were sick or wounded were often left to die or left to the mercy of the enemy who commonly slit the throats of the wounded and robbed them of what little possessions they had.
During this time the emergence of the quack surgeon and doctor became common throughout Europe, offering cures or treatments that were ineffective and most times damaging.
“In the middle ages, people took potions for their ailments. In the 19th century they took snake oil. Citizens of today's shiny, technological age are too modern for that. They take antioxidants and extract of cactus instead.”8
The Byzantine Empire was one of the first empires to have recognised medical Hospitals.
It was in the Confessor period of English History that the earliest anaesthetic using ice is mentioned AD. 1050, The relevant passage translates as follows: “Again, for eruptive rash. Let him sit in cold water until it be deadened; then, draw him up, cut four scarification’s around the pocks and let it drip as long as he will.”9
It is believed that Hippocrates was aware that cold, especially ice would alleviate the pain associated with surgery.
William 1 (The Conqueror)This Norman King of England was born in 1028, at Falaise Castle, the illegitimate son of Robert the Devil or the Magnificent. At the time of the Norman conquest of Britain, he had within his force’s “Leeches", usually clerics, who treated the wounded following a battle.
His conquest of England was the last time this land was occupied by a foreign invader. He maintained his hold on England by the use of savage force and replacing all the Saxon Lords with his own Norman nobility. He maintained Law and order by enforcing his rulings rigidly and met any attempt to defy his decrees and challenge his ultimate power with brutal force. It was the brutality of conflicts that led the clergy into the field to provide both religious and medical help, the intention to first save the soul and then offer what assistance they can to the mutilated body.
Roger, King of SicilyRoger King of Sicily was the son of Robert Guiscard's brother who was also Roger, known as Roger the Great Count of Sicily and Adelaide of Savona. Robert Guiscard was reputed to be the greatest of the Norman rulers of Sicily.
Roger was born when his father was 64, and his father died shortly afterwards in 1101, leaving his widow and two small sons to rule his small but turbulent kingdom. Countess Adelaide managed to retain power on the island but in 1105 her elder son, Simon died, leaving the young Roger as sole heir.
By 1112 when Roger was knighted, he and his mother had made Palermo their capital. Roger a member of the first generation of the Hauteville family to been born in their southern Italian domains.
The society of Sicily at that time was a mix of Arabic, Norman, Italian and Greek cultures, this cosmopolitan upbringing was to sculpture his character and give him the determination and diverse wisdom needed to rule that kingdom.
Adelaide his mother died in 1118 and Roger who was then aged 23, became King.
Roger united all of Sicily and Norman southern Italy under his rule, and was crowned King Roger II of Sicily in 1130. King Roger presided over a diverse court, whose administrators included men of many nationalities and faith, both Christian and Muslim.10
Roger enforced a law prohibiting the practice of medicine to anyone who had not graduated. This was done, in order that his subjects should not suffer harm. Many of his citizens had suffered, due to of the incompetence of untrained Physicians. This was in essence, a medieval day Hammurabi code.11
During the 12th century in 1139 Pope Innocent II had threatened with severe penalties, monks who carried out medicine and surgery “at the neglect of their sacred duties.”
The relevant section reads: "There are also those who, neglecting the care of souls, completely ignore their state in life, promise health in return for hateful money and make themselves healers of human bodies. And since an immodest eye manifests an immodest heart, religion ought to have nothing to do with those things of which virtue is ashamed to speak. Therefore, we forbid by apostolic authority this practice to continue, so that the monastic order and the order of canons may be preserved without stain in a state of life pleasing to God, in accord with their holy purpose. Furthermore, Bishops, Abbots and Priors who consent to and fail to correct such an outrageous practice are to be deprived of their own honours and kept from the thresholds of the church."12
With the outbreak of the Second Crusade, Roger II was able to turn some old enemies into allies and launched his naval forces against Byzantine.
"An age is called Dark not because the light fails to shine, but because people refuse to see it"13
Edward Long Shanks King of EnglandWhilst Edward (then a Prince) was on one of the crusades, one of the members of the Baibars tried to kill him with a poisoned knife. The prince quickly killed his assailant but was wounded in the arm.
Soon after the limb swelled, and the foul-smelling gangrenes flesh grew black. His personal physicians were at a loss on what to do, and they lost all hope of saving this young Princes life.
However, there was a surgeon who name to this day remains unknown, approached the wound in very much the same way as a surgeon would today and cut away the blackened tissue cleaned up the wound and dressed it. He repeated the dressing every day. As a result of his actions, the surgeon restored him to health within two weeks.
The surgeon used the debridement technique to clean and eventually repair the wound that is not too different to the present-day technique.
It must be said that a similar wound with the aid of some feckless surgery brought the end to the reign of Richard Coer de Lion (Richard I) some decades before.
Maybe it was because of the surgeon’s skill, which led Edward when he became King Edward I (Long shanks) of England to set up the first Military Medical Service in Britain. It is a shame that people only seem to remember the Long shanks of Brave heart when in reality he was King of England and a very strong King for the English.
The medical profession was given more licence to practise, and several more surgeons were recruited into the armies that future Kings would take on their campaigns abroad. History shows that the most successful rulers were the tyrannical or strong rulers.
“Perhaps in time the so-called Dark Ages will be thought of as including our own. “14
Edward 1st was a strong King and has been misrepresented by modern historians and motion pictures, his son however was a bad King and below is Edward's rebuke to his son.
"In the morning, I depart for France to press our rights there, and I leave you here to quell this little rebellion, understood? Is it? One day you will be a king. At least try to act like one"10
When [Edward] perceived he could not recover, he called to his eldest son, who was later to become king, and made him swear, in presence of all his barons, by the Saints, "That as soon as he should be dead, he would have his body boiled in a large cauldron until the flesh should be separated from the bones; that he would have the flesh buried and the bones preserved; that every time the Scots should rebel against him, he would summon his people, and carry with him the bones of his father".
That wish was not carried out.
CrusadesIn Jerusalem in 1023, the Amalfi opened a hospital for Christian pilgrims. This hospital became the basis for the formation of the Knights of St John or as they are famously known, the Hospitallers. These were fearsome knights. These Knights came about when Gerard who was the first master of the order, was running a pilgrim’s hospice. This was the time when during the first crusade that Jerusalem was captured.
Pope Urban II was the leader who incited the first crusade.
The First Crusaders reached the walls of Jerusalem in June 1099 and were unable to conduct a proper siege of Jerusalem due to their depleted numbers, shortage of food and shortage of water.
Instead of waiting for the surrender of the residents of Jerusalem, the Crusaders were forced to attack the city after a 5-week siege on the 15 July 1099. They attacked from St. Stephen's Gate and Jaffa Gate and were easily successful.15
The victorious "Christian" army slaughtered men women and children of the Muslim and Jewish faith.
It was said that blood ran through the gates. Several thousand Muslims as well as Egyptian, Jews and even Christians were slaughtered although it is generally thought the figures have been inflated for its propaganda value. The reasons are not fully known however, perhaps it was to assert the power of the Roman Catholic Church to the Near East. Pope Urban II died July 29th, 1099, before word of the Christian triumph and the slaughter of the innocents had reached his ears.
Ibn al-Qalanisi has written "The Franks stormed the town and gained possession of it. A number of the townsfolk fled to the sanctuary and a great host were killed. The Jews assembled in the synagogue, and the Franks burned it over their heads. The sanctuary was surrendered to them on guarantee of safety on 22 Sha'ban [July 14 of this year], and they destroyed the shrines and the tomb of Abraham."16
Al-Azimi of Aleppo's Description:“Then they turned to Jerusalem and conquered it from the hands of the Egyptians. Godfrey took it. They burned the Church of the Jews (Kanisat al-Yahud)." 17 This "church" was presumably the principal Jewish synagogue.
In 1113 he was given Papal backing and thus assumed the title of a Religious order The Knights of St John (named after St John the Alms giver). Eventually, the Hospital of St John of Jerusalem.
They soon had a military wing to provide protection to ambulance trains, and eventually as the Hospitallers. They were made up of religious fanatics and Monks and were ferocious in battle, fighting mostly to the death.
During the 12th and 13th centuries, many large hospitals were constructed including several great London hospitals. Rahere founded St Bartholomew’s hospital in 1123.
Rahere made a vow after becoming sick on a pilgrimage to Rome, he is said to have seen St Bartholomew in a vision and this moved Rahere to set up a priory and a hospital for the sick at Smithfield’s in London. It must also be noted that after a battle it was common for the nobility to care for the wounded.18
“The Crusades - the most signal and most durable monument of human folly that has yet appeared in any age or nation.”
David Hume, The History of England 1What was done at the siege of Jerusalem was what can only be described as a massacre. It must also be pointed out that there were Jews amongst the dead, and there were many of them. The Muslim Army later led the Christian army to its doom and slaughtered the soldiers in their thousands. Jerusalem has been fought over for centuries, one day however a new Jerusalem will appear and there will be no more war.
Roger of Salerno 1140-1195Roger of Salerno was also known as Roger of Palermo, Roger of Parma, Rogerius Salernitanus, Ruggiero Frugardi. He was the first writer on Surgery in Italy. Roger taught and practised at Parma.
By the nineteenth century, many European towns were demanding that physicians have several years of study or training before they could practice. Surgery had a lower status than pure medicine, beginning as a craft tradition until Rogerius composed his treatise, which laid the foundation for the species of the occidental surgical manuals, influencing them up to modern times.19
His work, Practica Chirurgiae, (A Practise of Surgery) was, according to some authorities, complied by Guido Aretino, one of his pupils. Aretino took notes at his lectures.
It was an incredible work for the time in 1170. The Practica Chirurgiae was considered a classic for at least three centuries and many of the surgical texts later associated with Salerno were probably based on Roger's own manuscripts and taken from the notes of pupils at his lectures.
He believed that nerves could not regenerate but could be tethered back together.
His method of examination for leaks of CSF in a patient with a skull fracture: was to have the patient hold his breath (Valsalva manoeuvre), the surgeon watched for CSF leak or air bubbles.
He also wrote about the re-anastomosis of nerves and the treatment of Haemorrhoids.
For wounds of the scalp, sutures of silk were recommended because this resists putrefaction and holds the wound edges together. Interrupted sutures about a finger-breadth apart are recommended.“The lower part of the wound should be left open so that the cure may proceed properly."
Red powder was strewed over the wound and the leaf of a plant set above it.
In the lower angle of the wound a pledge of lint for drainage purposes was inlaid. Haemorrhage was prevented by pressure, by the binding on of burnt wool firmly, and by the ligature of veins and by the cautery. Rogers work maintained the strong tradition of Salerno’s medical school, in existence since the ninth century, which pioneered the study of anatomy and surgery.
Roger is also known in numismatic history for the unique series of coins, minted during his reign. Despite ruling for less than seven years, he had two different types of coin, minted in his name at Antioch. The first type bore the image of the Mother of God Oran’s, standing full-height. The second type bore the image of the Miracle of Saint George and the Dragon. It is quite possible that it was minted after Roger's great victory at the Battle of Tell Danith. Prince Roger was in fact the first ruler in the Christian world to depict the Miracle of Saint George and the Dragon on his coinage.
Raymundus LulliusHe was born in Majorca in 1232, possibly in 1233. His parents, Ramon Amat Llull and Isabel d’Erill, were members of a bourgeois middle-class family in Barcelona. In 1229 they encouraged and financed, alongside other Catalan merchants, the efforts of King James I of Aragon to conquer the island of Majorca, at that time under Muslim dominion, in exchange for land and privileges. Following the triumph over the Moors, they received lands and moved to the island. Ramon, their only son, was born there only a few years later.
In 1257 he married Blanca Picany, who belonged to another Catalan family settled in Majorca, with whom he had two children, Domènec and Magdalena.21
Raymundus Lullius was a tertiary Franciscan monk and Poet from Spain and wrote treatises on alchemy. He is said to have discovered “Sweet Vitriol” (Ether) in 1275.
Raymundus Lullius became the tutor to James II of Aragon. He also published major works on Christian theology, mostly on ways to convert Muslims to Christianity.20
He travelled to Sicily during the summer of 1313. Shortly afterwards, he travelled to Tunisia, with the approval of Frederick III and the support of James II of Aragon, who translated some of Llull’s work from Catalan to Latin. After this last trip to African lands, Llull went back to Majorca. He passed away in this island, at the age of 84, after March 1316. 21
He was beatified in 1847 by Pope Pius IX. "Who loves not lives not; he who lives by the Life cannot die."22
William of Saliceto.1210-1280William of Saliceto was the best and ablest Italian surgeon of the 13th century. He was a Professor at the University of Bologna. He was instrumental in setting up a school of surgery. His book "Chirurgia” was highly original and not based on any previous writings.
Book IV of Chirurgia is particularly important because it contains the first section dealing with regional or surgical anatomy.
A major advance promoted at the time by William was replacing the Arabic method of burning with cautery with the use of the surgical knife.23
He probably dissected human remains himself to further his knowledge. He recommended the use of the knife as well as cautery in surgery.
He also stressed that pus formation was a bad thing and not something which should be encouraged. Pus formation was accepted as part and parcel of wound healing at the time. Most surgeons at the time followed Aetius of Amida (d. 444 AD) practice and encouraged the formation of pus by using poultices.
William of Saliceto also sutured severed nerves and blood vessels back together in surgery and tried to bring the disciplines of medicine and surgery closer together.24 However, his works on fractures and spinal lesions mostly failed, as these lesions are rarely treatable.
Hundreds of years before Lister, this man said that pus was bad for you. He said, “We owe to the Middle Ages the two worst inventions of humanity - romantic love and gunpowder.”25
The Knights of St JohnDuring the 12th and 13th centuries, orders of the knighthood came about to care for the sick.
The Knights of St John was formed during the crusades, to escort pilgrims to the holy city of Jerusalem and Bethlehem. They established there first hospital in Jerusalem and later founded one in Rhodes in 1311.
The hospitals of the middle ages were grand affairs that were specifically built to be hospitals as opposed to a place of worship where the sick and injured were treated. The 14th century ushered in some amazing advances in surgery, due unfortunately to the use of guns in warfare; these were becoming more common in battle. Some amputations were closed with a skin flap instead of just being cauterised and sealed. Plastic surgery came into being as a result of these closure changes.
During the wars between the English and the French, the English devised an evacuation chain from France to England. On arrival in England, the wounded were discharged. It was a long way from today’s system where soldiers are treated and returned to duty, in those times it was seen as uneconomical to do so.
These monastic Knights were pursued to near extinction by King Phillip of France and eventually disbanded and today the nearest to them would be the Freemasons.
The image on the right depicts Hospitallers Grand Master, Guillaume de Villiers or Guillaume de Clermont defending the walls of Acre, Galilee, 1291. by Dominique-Louis Papéty (1815–1849) at Versailles.
John of ArdeneThe first book by an English surgeon was written during this period; entitled De Arte Medicinal.
It was by John of Ardene who it is said, was the only English surgeon at the battle of Crecy. 26 He has also been described as the first real English surgeon, 27 and one of the great fathers of surgery.
John of Ardene also allegedly advocated the use of mandrake to relieve the pain associated with surgery, he apparently rubbed it on the soles of the feet. It is however not confirmed that mandrake was any use at all.
His view on fees was that rich men should be charged as much as possible, but poor men should be remedied free of charge.
It was during this time that cannon was first used by the English, in 1347 at Calais.
King Edward III’s crushing English victory over the French; where the Black Prince won his spurs and acquired the emblem of the Three White Feathers.28
Although he is known to history as a great soldier, the Black Prince's victories were due more to superior numbers than to great skill on his part. His greater contribution was his attempt to deal with the political situation in England
Theodoric (1205-1298) Bishop of CerviaIt was during the 14th century that the first antiseptic technique was used, not the “clean” aseptic method used today, but rather one based on the avoidance of Pus bonum ET laudable “laudable pus”.
This was when Theodoric of Cervia (1205-1298) an Italian, soaked his dressings in Arnica, (a plant of the composite family) before applying it to the wound.
Both Theodoric advocated the use of wine to clean a wound and also pointed out that the substances that were being commonly used at the time made matters worse.
These physicians are well worth their place in surgical history, because they stressed the importance of a clean wound.
It has also been documented that Theodoric used substances to ease the suffering of the patient.
Theodoric gives the following directions for making "a soporific sponge", taught to him, as he says, by his master Hugh of Lucca:" Take of opium, of the juice of the unripe mulberry, of henbane, of the juice of hemlock, of the juice of the leaves of mandragora, of the juice of wood ivy, of the juice of the forest mulberry, of the seeds of lettuce, of the seeds of the dock which has round apples, and of the water hemlock, of each an ounce. Mix them all in a brazen vessel and then place a new sponge in it. Boil them all together for so long as the sun lasts in the dog days and until the sponge absorbs all the liquid. Put it aside to dry and when it is required for use put the sponge in hot water for an hour and afterwards apply it to the face of the patient until he falls asleep. When the operation is finished soak another sponge in vinegar and let the patient breathe through it or drop the juice of fenugrek into his nostrils; he will quickly awaken."29
This man was believed to have lived to 91, an incredible age for the time.
“He who is born in imagination discovers the latent forces of Nature. Besides the stars that are established, there is yet another Imagination that begets a new star and a new heaven.”30
Henri de Mondeville. (d1307)One of Theodoric’s students was Henri de Mondeville.
Henri de Mondeville, who taught at Montpellier, was an important figure in the history of French medicine and surgery.
He offered some new wound treatments, opting for cleanliness and avoiding like his mentor Theodoric, “laudable pus” in the surgical treatment of wounds.
He argued for removal of foreign bodies and the use of wine dressings in wound care the wine acting as an antiseptic and providing better healing.
Henri began writing his treatise on surgery in 1306 but was unable to finish it because of poor health (tuberculosis). He was also a designer of surgical instruments and, in particular, is remembered for the creation of a special needle holder and also an instrument for extraction of arrowheads.
The inclusion of illustrations in his Chirurgie, especially anatomical depictions, was of great importance to Henri. His work is considered the first to actually make use of illustrations for teaching purposes, a concept unheard of in the 14th century, but widely accepted since the Renaissance.
His methods became the forerunner of modern day technique; it had to wait over 500 years however for acceptance.
Henri de Mondeville also documented the use of narcotics such as opium,mandragora and othersbeing soaked in sponges. These were held over the patient’s noses to induce a “Deep Sleep” during surgery. Henry de Mondeville went on to be surgeon to Philip le Bel, (the fair) King of France who as a King was made infamous by his eradication of the Knights Templar.31
"The philosophers of the Middle Ages demonstrated both that the Earth did not exist and also that it was flat. Today they are still arguing about whether the world exists, but they no longer dispute about whether it is flat.” 32
Henri de Mondeville was quoted to have said often "The confidence of the patient in his physician does more for the cure of his disease than the physician with all his remedies".
Guy de Chauliac. (1300–1368)One of the most famous surgeons during the 14th century was Guy de Chauliac. (1300–1368)
As the surname indicates he was born in Chauliac around about the end of the 13th century. He was educated at Toulouse and completed his medical education under Raymond de Molière’s at Montpellier.
Eventually he became a Master of Medicine and took holy orders, as it is recorded he was Canon of the cathedral of Saint Just.
He practised Surgery at Lyons and was also very active during the outbreak of the great plague which devastated most of Europe, he himself catching the disease and surviving it. His famous comment about the Plague was: "it is so contagious...that even by looking at one another people are likely to catch it'.33
It was said that he had trepanned Pope Clement VI and remained Physician to several Popes.
His book “The Chirurgia Magna Grande Chirurgie” was written in 1363, it was this book that contributed to the advancement of medicine.
Guy de Chauliac posited four conditions that must be satisfied for a practitioner to be a good surgeon:
1. The surgeon should be correctly educated in surgery and anatomy
2. The Surgeon should be good at surgery, expeditious and knowledgeable.
3. The Surgeon must be ingenious; and inventive.
4. The Surgeon should be able to adapt himself to the different situations.
He also described the surgeons that were abundant at the time, these were;
1. One who applied cataplasms to every wound and ulcer.
2. One who used wine only.
3. One who applied emollient plasters and ointments.
Military surgeons who employed oils, wool, potions and charms.34
Guy de Chauliac went on to become surgeon to the Popes of Rome.
It was during this period in history that the art of trepanning the skull was more carefully studied and used with better precision.
Herbalism was on the increase and cleanliness in general was improving.
He said once about how is the best way to deal with uncontrolled haemorrhage “All bleeding eventually ceases”.
GunpowderAs was mentioned in previous pages, the English first introduced gunpowder to war in 1347 at Calais. Henry V invaded France during the 15th century. He used his cannon at the siege of Harfleur. It was at Harfleur that disease decimated the army of Henry V with an outbreak of dysentery; it eventually killed 2000 and incapacitated many more.
It was his courage and leadership that enabled the final victory. The wounds that were created as a result of gunpowder were automatically considered septic.
The Arabs introduced the standard treatment for a gunshot wound, which was to pour boiling Elder oils into the wound and using a hot iron arrest the bleeding. It is also widely believed initially during the early years of gunpowder, that priests ignorant of the nature of the substance felt it better to exorcise the wound.
Because of the lack of any suitable substance to relieve pain, death due to agonizing pain was common.
The surgeon had to work expeditiously, surgery was severely restricted. The common procedures were splinting of fractures, lleurancing of boils, and limb amputation. Death from the simplest surgical procedure was common.
The most common cause of death following a surgical operation was from sepsis, although as has been mentioned, surgeons believed that sepsis was part and parcel of wound healing. The discharge that seeped from the wound was known at the time, as ‘laudable pus’.
To explain this term more, I quote an article from Jefferey Frieberg: "The presence of pus is one of the most easily recognizable signs of an infection. However, for several centuries suppuration, known as ‘laudable pus,’ was believed to be a sign of a healthy, healing wound. This historical misconception can be explained by the difference in the presentation of a necrotizing soft tissue infection versus other more common skin and soft tissue infections. Chronic wound infections, due to pyogenic bacteria, typically produce large amounts of thick, whitish-yellow pus. On the other hand, necrotizing soft tissue infections, despite their severe mortality and morbidity, are devoid of pus in the traditional sense. What the ancient medical observers recognized was the fact that pus is not characteristic of this subset of incredibly severe infections. This is an important distinction to remember when evaluating an infection, even today."35
An important change in the type of wounds managed by surgeons occurred midway through the 13th century with the introduction of gunpowder into Europe by the Franciscan Friar Roger Bacon.
Of Harfleur Shakespeare says:"Once more into the breach, dear friends, once more; Or close the wall up with our English dead! In peace, there's nothing so becomes a man As modest stillness and humility: But when the blast of war blows in our ears, then imitate the action of the tiger; Stiffen the sinews, summon up the blood, Disguise fair nature with hard-favour'd rage; Then lend the eye a terrible aspect."36
Agincourt 1415During this campaign, history records one of the greatest victories for England under the leadership of Henry V, the battle of Agincourt (1415). This battle was to inspire many generations of English and Welsh soldiers in battle from then.
The army of Henry marched toward Calais after defeating the French forces at Harfleur, with the intent of returning to England, the French however had gathered an enormous army to block his way.
A Welsh man-at-arms, David Gambe, on being questioned by King Henry as to the size of the French army, said:“There are enough to kill, enough to capture and enough to run away.”
Henry V was made famous by winning this battle. The view that God was on the side of the English King is strongly held because of the impossible odds on that Crispin’s day. The rain made the terrain unsuitable for masses of knights on horseback, the narrowing of the battlefield was a plus for Henry. It was the English and Welsh archers however that ensured victory. The arrogance of the French Nobility is also legendary.
David Gambe was knighted by the King, for his courage, as he lay dying on the field of battle.
The French were over confident because of the overwhelming odds in their favour. Henry’s army were mainly made up of English and Welsh Longbow men, the army had been decimated by a dysentery outbreak at Harfleur. The French were also aware of this, which was to the English armies advantage, the arrogance the French Aristocracy displayed gave them supreme confidence of a certain victory over Henry's "rag tag force".
The result of this battle is touted as the most famous of all battles fought by the English.
During this battle, there were over twenty barber surgeons on the battlefield. The principle surgeon was Thomas Morestede he was the Kings Surgeon and was surgeon to his father and Henry VI. There was also a physician by the name of Nicolas Colnet who also attended closely to the King.37
Because surgeons were held in as much esteem as a tailor at the time, they had very little equipment and hardly any means of transporting their meagre supplies.
They were however deemed important enough for the King to pay their salary a quarter in advance.37
Colnet also wrote several books one being "Leech Book", that contains the sort of medical recipes he used at Agincourt. He was given the Prebendal Manor in 1417, probably in return for his services.38
It also seems that he could have been partly responsible for the death of Henry V as he died of some say, dysentery, but others of surgical complications. It is probable that he was then in attendance on him at Vincennes, A.D. 1422. 39
"He that shall live this day, and see old age, will yearly on the vigil feast his neighbours, and say, 'Tomorrow is Saint Crispin:' Then will he strip his sleeve and show his scars, And say, 'These wounds I had on Crispin's day."40
Queen Isabella (1451-1504)Isabella surnamed la Catolica, the Catholic, Queen of Castile, was the second child and only daughter of John II of Castile by his second wife Isabella, granddaughter of John I of Portugal.41 Isabella married Ferdinand of Aragon, known also as Ferdinand V, the Catholic. In 1474 Isabella and Ferdinand jointly succeeded to the throne of Castile and Leon. Isabella's succession was contested, however, by Alfonso V of Portugal, who supported the claim of Henry's daughter Juana la Beltraneja. Alfonso attacked Castile and Leon but was defeated by the Castilian army in 1476.
Three years later Ferdinand succeeded to the throne of Aragon. This union of the two main Spanish kingdoms laid the foundation of Spain's future greatness.
They had five children, including Catherine of Aragon, the first wife of Henry VIII of England. Isabella and her husband known together as:The Catholic Kings"
To explain this term, you must understand the situation.
In Spain the united crowns of Castile and Aragon, along with Valencia, had formed a powerful new federal power which was on the verge of driving the Moors from the Iberian Peninsula.
The success of this venture would increase the resources available to the monarchs of this land. As Castile was the greater of the two kingdoms, Isabella was in many ways the senior partner of the relationship with her husband Ferdinand.
Queen Isabella of Spain was the first monarch to organise help for the wounded in Europe in 1484.42
She is even being reputed to have worn armour as a female knight and accompanied her troops to battle.
It was probably whilst accompanying her Army that she noticed the suffering of the wounded that were left to die on the field of battle.
She arranged for the first movable Hospital to accompany the troops during active operations. She arranged for bedded wagons to carry the casualties to large hospital tents at the end of the battle.
This all seems quite strange coming from the monarch responsible for the 1478 Spanish Inquisition that brutally tortured and killed thousands of innocent people throughout Christendom. She also along with her husband expelled the Jews and defeated the remaining moors.
She is more famous however for her support of Christopher Columbus, in financing his expedition to the Americas.
Isabella fell ill in September of 1504 and died in November, aged 53 years old.
In Britain the Caxton printing press was beginning to produce amongst others, medical textbooks. Hospitals were also on the increase, cities competed with each other for who had the best hospitals with the best doctors.
Andreas Vesalius textbook on anatomy, was one of first to be printed by the Caxton Press.
"I will assume the undertaking for my own crown of Castile, and am ready to pawn my jewels to defray the expenses of it, if the funds in the treasury should be found inadequate”43
Ambroise Paré (1510-1590)Ambroise Paré was a French Barber Surgeon and was born of poor parents, at Laval, France.
Paré received his early education from a parish priest, and then went on to be an apprentice to a Barber Surgeon for 13 years. His first real position was “Resident Dresser” at the Paris Hotel Dieu, which at the time rivalled any teaching hospital in Europe for its reputation in surgery.
If the question is: "What did Ambroise Paré do for Renaissance surgery? The answer is easy, he raised it from a despised, horrid even ghastly craft to one of professional standing.
His example at the sharp end (no pun intended) and his superb manuscripts, taught many of his colleagues and pupils toward a more scientific and humane approach to surgery. He alone can be said of to have elevated the art of surgery to a respectable level.
In 1536 he joined the French Army, and some months after joining he took part in his first campaign, at Turin.
During the bloody battle of Turin, Paré was greatly disturbed by the suffering of the wounded. After entering the city, he went into a stable to rest, feed and water his horse. What he saw when entering the stable were several lifeless soldiers on the floor.
There were also three wounded propped against the wall. Their faces were completely disfigured. They could not see, hear or speak and their clothes were still smouldering from the gunpowder that had scorched them.
While Paré was trying to comfort the wretched wounded, a soldier walked in and asked Paré if it was at all possible for him to cure them, to that a sad Paré replied “no”. The soldier then walked over to the three wounded men, and calmly slit their throats.
Paré rebuked the man calling him a "cowardly villain". The soldier answered him by saying:"I pray to God that if ever I was in such a state as those poor fellows, that someone would do the same to me so that I would not suffer as they did.”
During Paré's career with the French army, he observed that when he treated patients with gunshot wounds by using the conventional treatment at the time, which was to pour boiling oil into the wound, the patients endured unbelievable agony, some died in agony.
Paré was very distraught to see these brave helpless souls being put through such torture, and the echo of their agonising screams used to haunt him and give him nightmares.
In 1567, Ambroise Paré described an experiment to test the properties of bezoar stones. At the time, the stones were commonly believed to be able to cure the effects of any poison, but Paré believed this to be impossible. It happened that a cook at Paré's court was caught stealing fine silver cutlery and was condemned to be hanged. The cook agreed to be poisoned, on the conditions that he would be given a bezoar straight after the poison and go free in case he survived. The stone did not cure him, and he died in agony seven hours after being poisoned. Thus, Paré had proved that bezoars could not cure all poison.
One day whilst treating casualties after the battle of Susa Pass, Paré ran out of Elder oil. He decided to just to dress the wounds, but he first applied an ointment made up of turpentine, egg yolk and rose oil. Arising the next morning, he expected the patients that he dressed in the ointment either suffering from great pain, or dead.
He was astonished to find that these patients had a quiet night, in stark comparison to those who had their wounds treated in the conventional way with boiling elder oil; they had their usual agonising night. Pare was heard to remark, “Je le pansay; Dieu le guarit”, which when translated into English means, I dressed, and God healed. After that particular experience Paré vowed never again to use boiling oil, saying:“I will abandon this miserable way of burning and roasting and boiling.”
Paré was also one of the first to ligate the main vessels avoiding the use of the hot iron, which was the accepted method at the time.
Although the ancient Indians, Celsus and Galen ligated vessels, it was not a common accepted practice.
He contributed to pain relief by describing the effectiveness of nerve compression that relieved agonising pain during amputation.
Parés contribution to pain relief was to describe and document the effectiveness of nerve compression to relieve agonising pain at amputation.
In 1542, during the siege of Perpignan, Paré, accompanying the French army, employed a novel technique to aid in bullet extraction.
During the battle, Maréchal de Brissac was wounded, having been shot in the shoulder. When finding the bullet seemed impossible, Paré had the idea to ask the victim to put himself in the exact position he was in when shot. The bullet was then found and removed by Henry's personal surgeon.
During his lifetime Paré was responsible for the development of many surgical instruments and artificial limbs. Paré can certainly rank in the eyes of most as the greatest barber surgeon that ever was.
He was the one responsible for separating surgery from the quacks and raising the standard of the profession to one of noble calling.
The finest of compliments ever paid to him was by the soldiers in the besieged town of Metz in 1552. Paré was smuggled in at the request of the commander.
His presence had a remarkable effect on morale. It was said that the men on realising that Paré was within the town whispered: "If we are wounded we cannot die; because Paré is amongst us.”
Paré stated there were five reasons to perform surgery: "To eliminate that which is the superfluous, restore that which has been dislocated, for separate the doubt which has been united, joined doubt which has been divided and repair the defects of nature."
He published his methods in a book, "The Collected Works of Surgery>", in 1575.
The Paris College of Physicians were typical at the time in their discrimination of barber surgeons, they tried to stop the publication of his texts and never accepted Paré because he was only a barber-surgeon. He did however have the support of the King, to whom he became the personal physician. Royal approval enabled Paré to overcome the medical community's antagonism to his ideas.44
Ambroise Paré is known as the father of modern day surgery (especially if you are French) I as an Englishman, also agree with this statement.
“I put my hand on the dark skin and felt the chill of centuries long gone. It was as if I had touched the Stone Age.”45
Ambroise Paré to me was the Winston Churchill of all Barber Surgeons.
Peter AngheriusIn 1516 the Italian, Peter Angherius (Pieter Martyr d’Anghera) described curare in his book De Orbe Novo (The New World).
This writer was born in 1457 and moved to Spain during the time of the Great Inquisition, his Italian heritage gave him some protection, but he still took a chance as did other Italians at that time like Columbus. The Curare is the substance South American Indians used as an arrow poison.
Pieter Martyr was an Italian who rose to a high position in the church and was then attached to the Court of King Ferdinand and Queen Isabella of Spain.
There he met and entertained travellers who had returned from the New World, subsequently incorporating their tales in a series of letters to his friend in Rome.
In one of his letters he described how some Spaniards had been attacked by the natives with poisoned arrows and then continued with a description of the preparation of the arrow poison. He wrote: "The arrows are dipped in juice obtained from certain trees. There are old women skilled in its preparation who, furnished with the necessary materials, are shut in for two days to distil the ointment. When the house is opened, if the women are well and not found lying on the ground, half dead from the fumes of the poison, they are severely punished, and the ointment is thrown away as valueless. Oh, to be a native female of these tribes."46
Pedro de Cieza de Leon 1520- 1554Pedro de Cieza de Leon was likely born in 1520 in Llerena, a town in south-eastern Extremadura. Little is known of his early life; given the fact that he left home at age thirteen, his parents were Jews who were forced to accept the Roman Catholic faith or suffer the consequences of not doing so. It is doubtful that Cieza de Leon received more than a rudimentary education at a local parish school. His father, Lope de Leon, was a shopkeeper in the town, and his mother was a native of Llerena, and there is scant documentary evidence of the young Cieza de Leon’s childhood.
Victor Von Hagen suggested that the poor soil of “This bald and eroded land” was one of the reasons that Extremadura seemed to be the birthplace of so many New World conquistadores. You see Extremadura was the source of many of the initial Spanish conquerors (conquistadores) and settlers in America. Hernan Cortes, Francisco Pizarro, Gonzalo Pizarro, Juan Pizarro, Hernando Pizarro, Hernando de Soto, Pedro de Alvarado, Pedro de Valdivia, Alvar Nunez Cabeza de Vaca, Ines Suarez, Alonso de Sotomayor, Francisco de Orellana, Pedro Gomez Duran Chaves, and Vasco Nunez de Balboa were all born in Extremadura.47
The conquistadors were a violent band of murderers who ravaged the South Americas in search of gold and silver, destroying all those who opposed them. Still, the lure of the reputed vast wealth of the newly discovered lands would have likely served as a magnet to impoverished young men irrespective of the relative fertility of the Extremadura soil. In 1550, he wrote about the cocoa plant.48 The first mention from an English source was in 1577 in Frampton’s joyful News out of the new-found world. In 1595 de Costa mentioned the effect of ice on the limbs and its use as an anaesthetic.49 In 1553, the first part of the chronicles of Peru (Primera Parte). He died the following year, leaving the rest of his work unpublished.
Valreius CordusIn 1540 Valreius Cordus prepared a substance calling it Sweet Oil of Vitriol, which would later be renamed "Ether". It has been suggested, that he may have learned the method from Portuguese Explorers, who brought the knowledge from the Middle East.
His lecture notes (Annotations on Dioscorides) were published posthumously in 1546. This brilliant young chemist was to have his life cut short, but in his 29 years he made discoveries that had a great impact on the future of chemistry especially when it came to anaesthesia.
The son of an ardent Lutheran convert Euricius Cordus (Heinrich Ritze, 1486-1535) Valreius Cordus was born either in Hesse or Erfurt.
He began his higher education in 1527, at the young age of 12, studying botany and pharmacy under the tutelage of his father.
After spending his childhood and youth at Kassel, then at Erfurt and Brunswick, Cordus went to Marburg; he completed his bachelor's degree in 1531. From then until 1539, he furthered his studies by working at an apothecary shop owned by his uncle (either Johannes or Joachim) in Leipzig and enrolling in the University of Leipzig.50
After his death, Conrad Gessner published a considerable amount of his remaining unpublished work, including "De Extractione" (which featured Cordus' ether synthesis method) and "Historia Stirpium et Sylva" in 1561.50
It is surprising that this substance Ether, able to deaden pain and suffering was produced 400 years before it was used successfully as an anaesthetic substance.
Theophrastus Philippus Aureolus Bombastus von Hohenheim (or simply Paracelsus 1493-1541)Paracelsus was born in Einsiedeln Switzerland, and was an alchemist, physician, astrologer, and general occultist. Born Theophrastus Philippus Aureolus Bombastus von Hohenheim, he took the name Paracelsus later in life, meaning "Beside or similar to Celsus", an early Roman physician.51
Little is known of Theophrastus Bombastus von Hohenheim, who took the name Paracelsus for himself. He was the son to a physician, and at the age of sixteen entered Basel University where he studied alchemy.
He later worked in the mines at Tirol, where he gained first-hand knowledge of the properties of metals.
He was a physician who had a reputation for being quite arrogant (well his middle name was Bombastus) and whom it seems could have been in working with Cordus.
Some say Paracelsus prepared Sweet oil of Vitriol for himself, but instead, sweetened his chicken feed instead, he commented on how the chickens slept and awakened without harm.
Paracelsus believed that the physician’s main weapon against disease was tender loving care; he is responsible for a preparation of a tincture of opium.
This is still known under the name he gave it, "Laudanum".51
By his early thirties he had become famous as a physician in Basel, where he gave lectures on medicine. His disputes with the authorities in 1528 were symptomatic of his abrasive and arrogant disputing style, and led to his expulsion from Basel. In the last year of his life he settled in Salzburg.
He argued that human life could be created through alchemy and believed in the long-sought-after elixir vitae as a means of infinitely prolonging life free from disease.
His lasting contribution to science is the rejection of Galen's humoral theory of illness.52
He once said “Poison is in everything, and no thing is without poison. The dosage makes it either a poison or a remedy.”
Percy Bysshe Shelley listed Paracelsus (along with Agrippa) among his favourite writers in a discussion with Godwin in 1812. Incidentally, it was nearly two hundred years later, in 1730 when W.G Frobenius, a German, renamed Sweet oil of Vitriol, Ether. “What the eyes perceive in herbs or stones or trees is not yet a remedy; the eyes see only the dross"53
William Clowes 1540-1604During the end of the 16th century, the surgeon still had not reached professional status. He was still regarded as a skilled artisan; this was reflected in his pay, getting paid the same as a drummer or sergeant at the time.
Because of their degrading association with the barbers, recognition was slow. It did not help their cause, as many of the surgeons at the time were ignorant charlatans.
In the 16th century, the Catholic regime in Spain was at war with England and her allies in the Low Countries.
William Clowes was born in 1540, of Kingsbury, Warwickshire gentry (His family had their own coat of arms) and after apprenticeship to George Keble, became a London surgeon, at the age of 12 and apprenticed for six years and then became a member of the Barber-Surgeons’ Company.54
After spending some time as a young man at war, applying his trade (He was on the unsuccessful venture to Normandy with the Earl of Warwick) and then in the Navy, he left for London and worked at the famous St Bartholomew's Hospital.
He was a surgeon at St. Bartholomew’s Hospital from 1575 to 1585, and afterwards served with the army abroad, and was in the field when Sir Philip Sidney was wounded.
The story says that during the battle of Zutphen, Sidney was shot in the thigh and died twenty-six days later, at the age of 31.
According to the story, while lying wounded Sidney gave his water-bottle to another wounded soldier, saying, "Thy necessity is yet greater than mine". This became possibly the most famous story about Sir Phillip, intended to illustrate his noble character.
Before settling in practice, he had been some years in the navy, and in 1588 he again went to sea in the fleet which defeated the Armada.
He worked at St Bartholomew’ and was surgeon General to Queen Elizabeth 1 of England.
He is noted for pointing out surgeons of poor quality. Clowes is quoted as saying: “There is no coin so counterfeit, which make it suspicious; and none so much as there is in these days, that take upon them the honest names of travelling surgeons. They have been and are entertained as principle surgeons of ships of war, in charge of a number of men. Truly many brave soldiers and mariners have died as a result.”55
Clowes also published one of the first reports in English on how to reduce a fractured femur.
As a man, Clowes was typical of his age. Energetic, ambitious and self-confident, he was quickly angered but easily reconciled. His one constant foe was the quack, "...by whom so many perish"; his one constant aim was the improvement of his profession for the "...good of the country and common wealth wherein he was bred." A devoted servant of the Queen, his patriotism was as genuine as his religious feeling.56
William Clowes died aged just 64.
Peter Lowe 1550-1612Another book published at the time was by a Scot, Peter Lowe, "A Discourse of the Whole Art of Chirurgery" (1596) this is one of the best works of the period on the subject. In his book he advocated amputation by the axe, and then to cauterise the wound by the application of a hot iron. He founded the Faculty of Physicians and Surgeons of Glasgow in 1599. This being a unique organisation as it did not separate the two specialities. Much of Lowe's life remains something of a mystery and the subject of some conjecture. He was born probably somewhere in the west of Scotland. He called himself a 'Scottish man'.
In about 1566, Lowe travelled to France and there he spent some 30 or so years, serving as a surgeon in both the French and Spanish armies, the latter during campaigns in Flanders. He certainly acquired considerable experience of military surgery. 57
During the Civil War the surgeon had reached commissioned status, although this only applied to the senior surgeon. The assistant surgeon had to wait another hundred years or so. 1655 saw the end to the Barber surgeons reign in England; a Surgeons mate replaced his position. (All initially did not approve this, as it was argued who will shave the men, if the surgeon will not do it). Lowe, then, is still an enigmatic figure. His greatest medical achievement was surely his obtaining in 1599 the Royal Charter that led to the foundation of what became the Faculty – now the Royal College – of Physicians and Surgeons of Glasgow.
It is sad that the loss of the records of the venerable surgical College de St Come in Paris, the earliest professional body of surgeons, means that it is not now possible to verify Quesnay’s claims about the existence of what one might call a joint training in medicine and surgery in the later sixteenth century. If such a course of training existed and if Lowe was one of those Parisian Master of Arts who transferred to surgery via a course in medicine, this influenced him in founding a Scottish society which, at its foundation, regulated both surgery and medicine and later developed into a society in which the relations between surgeons and physicians were as associates rather than as rivals. 58
"A surgeon should be young a physician old"59
Richard Wiseman 1621-1676During the English civil war, the most prominent royalist surgeon was Richard Wiseman.
Historically war has elevated the profile of military leaders, if you win a battle you are glorified in the history books, if you lose you get mentioned. The same was with surgeons except that the winning and losing did not matter as much. The surgeon was recognised not only because of his efforts in treating the wounded, but also in the way he progressed the art of surgery with new ideas and techniques.
Richard Wiseman was no exception, having completed his training, entering the ranks of the Barber Surgeons just before the civil war between the Crown and Parliament broke out in 1642.
This conflict was to continue on and off for another 15 years. Wiseman took the side of the crown and was at many of the famous civil war battles.
Wiseman was taken prisoner in the Battle of Worcester 1651. In 1652 after being released, he qualified as a member of the Barber-Surgeons' Company and worked at St. Thomas' Hospital. He was it seems imprisoned again in the Tower of London accused of aiding the escape of a Royalist prisoner.60
His observations and writings were his legacy. An extensive writer, he noted many conditions and outlined his treatment for them. He escaped the Parliamentary forces and accompanied the future Charles II to France.
He was also supposed to have joined the Spanish navy for 3 years and eventually returned to England in 1657 when the anti-royalist sentiments waned. Charles II returned as King on the death of Cromwell, and Wiseman was made Sergeant Surgeon to the King in 1672.
His book "Several Surgical Treatises" is now seen as a landmark in English Surgery, this book outlines over 600 surgical procedures. His observations on gunshot wounds are extensive and his detailed remarks on the treatment of these wounds are superb.
One of the entries in the book reads:"A gentleman of about sixty years of age, labouring of a hydrocele, was referred to me by Dr Morrison. The swelling was within the tunicles of the right testicle, the scrotum was thick. I let out the water by puncture with a cannula; it was drained a quart: then I dressed it., and on the third day applied a restrictive emplaster over it with a truss. He was cured in a few days and discharged. “61
He was rewarded eventually by becoming King Charles II personal surgeon and is also responsible for raising the Profession to a class equal to the Clergy. With this class elevation came harder entry standards for would be apprentices.
Wiseman deserves notice as the first of the really great surgeons who lifted the surgical profession from its state of subordination to the physicians.
His work was continued by Samuel Sharp (1700? –1778) [q. v.], by Percival Pott [q. v.], and by John Hunter (1728–1793) [q. v.], until the social position of a surgeon was sufficiently high to enable the sovereign to confer hereditary rank upon him as in the case of Sir Astley Paston Cooper and Sir Benjamin Brodie.
Wiseman was professionally the descendant of the great surgeons of the reign of Elizabeth, Clowes, Gale, and perhaps Read and Halle.
Like them, he was essentially a clinical observer; unlike them, it is possible to find in his writings some trace of a scientific spirit. His cases are clearly described, and their treatment is carried out to a successful issue upon a rational plan.
A fervent royalist, he believed in the royal touch for the cure of scrofula, even when it was applied through so degenerate a hand as that of his master. He believed too in the miracles wrought by the blood of Charles I, yet he married the granddaughter of a regicide
Richard Wiseman died in 1676 and was buried in Covent Garden in London. Wiseman advocated early amputation on the field of battle and wrote extensively about his observations.
He said: “Surgery is always second best. If you can do something else, it's better.”62
2 Dante Inferno
3 Edward III 312 - 1377 Referring to the Black Prince at Crecy. William Shakespeare
5 Razi. A Treatise on the Smallpox and Measles. Translated by Greenhill WA.London: the Sydenham Society; 1847.
6 Magna Carta - 1215 signed at Runnymede
7 Gore The Story of our Services under the Crown Balliere Tindall & Cox (1879). p17
8 Charles Kruathamm http://thinkexist.com/quotes/charles_krauthammer
9 Lacnunga (1050) Anglo Saxon Remedies
10 King Edward Longshanks From Braveheart
11 International Handbook of Research in Medical Education
13 James A. MichenerU.S. novelist and short-story writer, 1907?- 1997 http://thinkexist.com/quotes/james_a._michener
14 http://www.mcwilliams.com/books/quotes/qt_d.htm G. C. LICHTENBERG
17 The Crusades Islamic Perspectives. Carole Hillenbrande (P68)
24 History of Spinal Surgery of the Ancient and Medieval World James Tait Goodrich, M.D., Ph.D.
25 Andre Maurois http://thinkexist.com/quotes/andre_maurois
26 Gore. The Story of our Services under the Crown p27 Balliere Tindall & Cox (1879).
29 Br Med J 2 : 1135 doi: 10.1136/bmj.2.1868.1135 (Published 17 October 1896)
30 Attributed to Paracelsus c1540
32 Vilhjalmur Stefansson
34 Guy de Chaulac (AD 1363) On wounds and Fractures (Translated by Brennan WA) 1923
36 Henry V Act 3, scene 1, lines 1-9, Siege of Harfleur
37 Gore. The Story of our Services under the Crown p32 Balliere Tindall & Cox (1879).
39 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2293392/pdf/brmedj0518 3-0010.pdf
40 William Shakespeare's Henry V
42 http://www.mainlesson.com/display.php?author=howard&book=isabella &story
44 Malgaigne, JF Surgery and Ambroise Pare,. New York 1968.
45 Nikolai Vereshchagin
46&nsbp;Sir Keith Sykes, The Griffith Legacy
49 General Anaesthesia Vol 1 T. Cecil Gray J.F. Nunn 1971
55 William Clowes
56 https://en.wikipedia.org/wiki/William_Clowes_(surgeon) 352
61 Severall Chirurgical Treatises By Wiseman, Richard, 1622-1676 London : Printed For Benj. Tooke, And Luke Meredith, Fleet-Street, MDCXCVI.