Teachings of the Old Surgeons
Boston Medical and Surgical Journal
On the Continent and in England many men read the old masters, aud in our own country their writings are well known to not a few. Quite recently a new impulse has been given to such studies by the publication iu Paris of Nicaine's editions of the works of Guy de Chauliac and Henri de Mondeville. The latter, born in the thirteenth century, compoaed his 8urgery about 1310. He was surgeon to Philip the Fair and Louis X. He was expoaed to the obliquy so commonly poured out on reformers in those
... ormers in those days. His great heresy consisted in his adherence to the familiar teaching vis medicatrix naturae. His work for 600 years was disregarded. De Chauliac died an old man in 1365. His work, composed in his later years, remained for two centuries the great text-book of surgery. Perhaps, to us now, the most interesting thing about these two teachers, is that, more than a hundred years before Paré, they spoke familiarly of the ligature of arteries. The thought of the rational studies of those two men, working on lines centuries in advance of their contemporaries, furnished me with a text for this article. One seldom goes to a large general medical meeting, attends a medical dinner or listens to a formal professional speech, without being told, by the orator, of the wonderful recent advances in surgical science, of the ignorance of our fathers, of the brilliancy of ourselves ; so that one would almost think, as many do think, that surgery is a modern science. Mr. W. Watson Cheyne, in his chapter on " The History of Antiseptic Surgery," says that all the old surgeons were governed by one thoughtthe desire to make the wound heal, as they said ; and that the feeliug was universal that wounda left to themaelves went to the bad. That is not true, as I read the old writers. It is the very error which the best of them were constantly preaching against. To be sure, their voices may have been lifted in the wilderness, and doubtless the practice of the times was often bad among the rank and tile; but this is true of all ages. " Give nature a chance," " Leave more to nature "was frequently aaid. Paul d'Egineta, even in the 8eventh century, taught it, and Rogerius in the thirteenth. So did Bouve about the same time, aud later De Vigo and Paracelsus. That most entertaining writer, Le Dran, in the second quarter of the last century, taught his Parisian students to assist nature and not to thwart her ; and Napoleon's great surgeon, Baron Larrey, taught to cloae a simple wound and leave it to nature for a first intention, as even the savages knew that. We do better now, to be sure, than that. We guard nature without interfering with her, at least, that is our effort ; but one is 8ometimes inclined to think that our aaepai8 accompliahed, we care for little elae. Surgical rest, comfort and support are almost equally important ; discomfort and pain are still serious complications. They used to be danger signals. They must be thought so still. Not only did Larrey teach local but general support, the sustaining of the general strength, a stimulating and nourishing diet. We are apt to think that those surgeons confined themselves to bleeding and purging. So far was Larrey from this that he was fertile in devices for forced feeding. The stomachtube was in common use ; and when that would not serve, he adviaed a soft-rubber catheter passed through the nose and well down into the esophagus. He remarks that this method is especially valuable with hysterical patients and those whose fauces are paralyzed. Hia contemporary, Benjamin Bell, in 1804, said that with patienta exhausted by suppuration a full diet, aupplemented by an abundance of alcohol, was absolutely needful. The danger of superficiality was keenly appreciated by such men ; aud Bell Bays : " Accordingly, in different hospitals we daily meet with good operators, but we do not often find surgeons possessed of that knowledge in the prognosis of chirurgical diseases which might be expected, that attention being seldom bestowed which is necessary to attain it." Indeed, Bell thought that his success was more largely due to his prescribing wine, food and Peruvian bark than to hia operative skill. Thia use of wine and spirits with alcoholic subjects was especially urged by Sir Astley Cooper, who may almost be considered a modern. He said : " When a drunkard is injured, don't cut off his rum too soon ; it keeps up his strength and acts as an antidote to the infective poison of the wouud." Iudeed, Sir Astley, in making his prognosis as regards sepsis, laid more stress on the patient's general condition than do we ordinarily. He most emphatically recognized that, whatever the immediate cause might be, a patient in wretched general condition offered a better field for a rapid septic infection, whether from traumatism or any other cause, than did a person in robust health. It is interesting that his exception to this general rule is in the case of an "acute peritonitis, so severe and commonly fatal in vigorous young men." This parallels our own experience with rapidly fatal appendicitis. The grand principle in the cure of disease, says he, is that all the secretions must be restored. " If the bowels, the kidneys and the sweat-glands are working, the poison will be eliminated and the patieut recover." Though we seek our object by other methods aud for better understood cause, this maxim is the same with us to-day. Emotional causes of disease were greatly considered one hundred years ago. Keen's recent suggestive article on the " Operation, per se " recalls many of the experiences of Sir Astley, who had no doubt that general conditions aud mental impressions entered moré largely into surgical therapeutica than was or is believed. Even for those in health he preached a carefully regulated life, and says that in his own case he always employed temperance, early rising and cold morning baths, for the cold bath is especially valuable in an increased irritability of the nervous system ; and Benjamin Bell says that in persons afflicted with chilblains or tuberculous tumors " the only good is from cold bathing and tonic8." " There are few satisfactions greater than being satisfied with one's personal appearance," says Sir Astley, and tells of " a drawing-master with bow shins ; a deformity which he considered so grievous.