SOME SIXTEENTH CENTURY 
SURGERY 
AS SEEN IN THE WORKS OF 
FELIX WURTZ AND PIERRE FRANCO. 
AN EDITORIAL ARTICLE REPRINTED FROM 
THE ANNALS OF SURGERY. 
By JAMES E. PILCHER, M.D., Ph.D., 
COLUMBUS BARRACKS, OHIO, 
CAPTAIN IN THE MEDICAL DEPARTMENT 
OF THE UNITED STATES ARMY. 
PHILADELPHIA : 
UNIVERSITY OF PENNSYLVANIA PRESS. 
1896. FELIX WURTZ AND PIERRE FRANCO,—A GLIMPSE OF 
SIXTEENTH CENTURY SURGERY. 
The renaissance of learning, which followed hard upon the long 
night of the Dark Ages, made itself felt in all departments of knowl- 
edge. Petrarch and Bocaccio infused new life into literary Italy, 
Chaucer awoke the spirit of English poesy, and Raphael and Michael 
Angelo set up new standards of art for the world. The rude bit of 
machinery erected in the dim court-yard of Mayence by Gutenberg 
and Faust rendered possible the spread of knowledge by giving birth 
to the possibility of rapid and infinite multiplication of books. The 
bold voyages of Christopher Columbus and his followers gave to 
geographical and ethnological study such an impetus that it could 
never return to its wonted groove of superstition and imagination, 
but must thenceforward advance indefinitely in the light of truth and 
precision. The philosophical mind of Copernicus evolved that 
system upon which all future study of the heavens was to be founded. 
And the great religious movement initiated by the Wittenberg 
theologian, Martin Luther, the Genevese polemic, John Calvin, and 
the Dutch scholar of the Reformation, Desiderius Erasmus, quickened 
the reasoning and thinking powers of the age and awakened a spirit 
of inquiry which readily extended from religion to science. 
In the sixteenth century, nuclei of intellectual activity appeared 
almost simultaneously in all parts of the known world. In Italy, 
Tasso commemorated the Liberated Jerusalem in an undying epic, 
and Ariosto made the name of Orlando Furioso a landmark of litera- 
ture ; in France, Marot made his prison walls ring with songs of 
religious faith, while Rabelais humorously commingled medicine, 
science, and romance in the hospitals of Lyons and Paris; in Spain, 
Sepulveda earned for himself the sobriquet of the “Livy” of his 
country, and Cervantes created the immortal knight of la Mancha; EDITORIAL ARTICLE. 
in England, Sir Thomas More dreamed of Utopia and administered 
justice from the woolsack, while the verse of Skelton and Wyat 
opened up the golden age of English literature, rendered illustrious 
by the names of Shakspere and Spenser, Sir Francis Bacon and Sir 
Philip Sydney. 
Medical science also was attracting to its service many of the 
most illustrious of its ancient teachers. Andreas Vesalius, the young 
Belgian, who, at the age of twenty-two, became at the University 
of Padua the incumbent of the first purely anatomical chair ever 
established, published his magnificent work on human anatomy, 
which was to its predecessors as a Brobdignagian to a native of 
Liliput. Bartolomeus Eustachius, dragging out an existence in 
Rome handicapped by the greatest penury, was making the dissec- 
tions which rendered his name immortal, and preparing the plates 
which, published 150 years after his death, have come down to the 
present day as among the most perfect expressions of anatomical 
portraiture ever executed. Realdus Columbus, the friend and suc- 
cessor of Vesalius, was working out the pulmonary circulation and 
preparing his work on anatomy, which was surpassed in originality 
and force only by that of his master. Michael Servetus, the hot- 
headed and versatile physician and controversialist, the pupil of 
Guentherius, and the fellow-student of Vesalius, was hair-splitting 
with the theologians, dissecting with the anatomists, and producing 
the heretical book, the entire edition of which, at the bidding of the 
stern old enthusiast, John Calvin, was formed into a funeral pyre for 
the living frame of its author. Gabriel Fallopius was delving deeply 
into the mysteries of nature at Padua, at one time studying plant-life 
so accurately as to attach his name imperishably to an important 
genus, at another devoting his attention assiduously to the form of 
the human body, and further immortalizing himself by discovering 
the canal in the temporal bone and describing the tube in the female 
pelvis, both of which still bear witness to his labors. Andreas 
Csesalpinus, the Tuscan savant to whom modern Italy with patriotic 
amaurosis has awarded the credit of the discovery of the circulation SIXTEENTH CENTURY SURGERY. 
3 
of the blood, in preference to the great anatomical lecturer of St. 
Bartholomew’s, was attending physician at the Vatican, and working 
industriously upon the great physiological problem which he so 
nearly solved. The young Englishman who, early in the following 
century, completed the discovery of the circulation of the blood, 
was working untiringly upon the investigations which won for him 
undying fame and the pseudonym of “the Divine Harvey.” John 
Caius was presiding over the College of Physicians of England, 
rendering medical attendance to three successive British sovereigns, 
and founding the college at Cambridge, which not only perpetuates 
his name but forms a permanent home for medicine there. 
The names memorable in medicine at this day were numerous 
indeed. Thomas Gale, “the Pare of England;” Ulysses Aldro- 
vandus and Jerome Mercurialis, of Italy; Joachim Camerarius, of 
Germany; Juan Valverde, of Spain; and Jacques Guillemeau, of 
France, labored effectively for the advancement of science; while 
Switzerland stood well to the front with Johannes Bauhinus at Basel 
and Guillaume Hildan at Berne. 
The scope of medical practice, however, and the status of the 
medical and particularly of the surgical practitioner was still un- 
settled. The notion of ecclesiastical supremacy, which had been so 
strongly accentuated in the Dark Ages, had impressed itself forcibly 
upon the practice of the healing art. The Church largely associated 
the cure of the body with the care of the soul, and by far the greatest 
proportion of the physicians of that period were clerics. Every 
monastery had a monk or two who devoted special attention to 
medical studies, and occasionally one was found who gave instruction 
upon the subject. Some of these treated their patients only at a dis- 
tance, never personally visiting nor receiving the sick, but making a 
diagnosis by examination of the urine and interrogation of the 
messenger. This practice was the prototype of the conduct of the 
nineteenth century quack, who makes his diagnosis from a lock of 
the patient’s hair. There were, however, other physicians who 
habitually attended the sick in person, and these increased in number EDITORIAL ARTICLE. 
4 
with the spread of knowledge, while the non-visitants disappeared in 
the same proportion. 
In the strictly classified society of the time the physician came 
to rank, as a member of a learned profession, with the lawyers, and 
only one grade below the clergy. Engagement in anything savoring 
of manual labor was regarded as degrading, and the great anatomical 
lecturers of mediaeval times made their demonstrations at second 
hand by means of a servant who did the actual dissection. Surgical 
work, involving mechanical manipulations, was regarded in the same 
light, and but few physicians dared to engage in it, for those who 
made the effort were promptly ostracized. Surgery was a handicraft, 
and surgeons were craftsmen ; medicine was a liberal art, and the 
physician a professional man. To the physician alone belonged the 
right to teach not only medicine but surgery and pharmacy as well, 
and to him belonged the sole right to authorize and direct the use 
not only of medicines but of surgical operations. Surgery was but 
an instrument in the armamentarium of the physician, and the sur- 
geon but a machine for the application of the instrument. Under 
these circumstances the surgeon had no need to understand Latin 
nor literature; a little anatomy and some manual dexterity gained 
by practice with the knife were all that he required. He was denied 
the right to practise medicine, and in serious operations he was 
required to call in a physician to authorize his work. An illustration 
of the physician, the apothecary, and the surgeon, found in a 
fifteenth century manuscript of the Grand Chirurgie of Guy de 
Chauliac, is an excellent representation of the relative position of 
the three. The physician in the centre, robed in stately garb, has at 
his command in lowly alcoves on either side the apothecary and the 
surgeon, and of the two servitors the surgeon is represented in the 
more inferior position. 
Occasionally a surgeon of surpassing genius would command 
respect in spite of his degrading practices, and ultimately the Frater- 
nity of St. Come, of Paris, obtained the right to practise to a certain 
extent independently of the physicians. Pitart, Lanfranc, Monde- SIXTEENTH CENTURY SURGERY. 
5 
ville, and Chauliac were surgeons whose power could not be subordi- 
nated, but they won respect and position for their practices only by 
their own exceptional genius, and the respect accorded them died 
with them. Mondeville, in his lectures at the School of Medicine in 
Paris, made a strong argument in favor of the superiority of surgery 
to medicine, crystallizing his argument into several propositions 
showing that it was more certain, more to be preferred, nobler,—for 
it removes what medicine cannot cure,—more perfect, more neces- 
sary, and more lucrative. The efforts of Mondeville were ineffectual, 
for centuries later saw surgery still in the subordinate position, and 
centuries more slipped by before it was elevated to an equality with 
medicine. In the sixteenth century surgery was still largely the 
prerogative of the barber. It must not be thought, however, that 
all barbers were alike. There were specialists among barbers in 
those days just as there are specialists among surgeons in this. One 
barber devoted himself to shaving and hair-cutting with only occa- 
sional incursions into the field of phlebotomy ; another devoted him- 
self to ordinary surgery, treating wounds, fractures, and the like, and 
shaving only to keep the pot boiling; another devoted himself more 
particularly to the genito-urinary system and the treatment of deform- 
ities; and still others gave their attention toother phases of the com- 
bined chirurgico-tonsorial art. 
In the sixteenth century Switzerland possessed two men, repre- 
senting the second and third classes respectively, who did so much to 
lift up their class that they became authorities for surgical work, not 
only at their homes and during their lives, but throughout Europe 
and during several hundred years. One, representing the Teutonic 
phase of the curious dual-tongued Helvetian life, wrote in German, 
and the other, representing the Gallic side, wrote in French. Felix 
Wiirtz, of Zurich, and Pierre Franco, of Lausanne, while they never 
attained to the celebrity of their great contemporary, Ambroise Pare, 
the barber-surgeon of the king of France, were, nevertheless, factors 
of the greatest importance in elevating, purifying, and developing 
the art of Surgery. 6 
EDITORIAL ARTICLE. 
In the early half of the century we are considering, Zurich was 
the home of Conrad Gesner, known in his day as the “ Pliny of Ger- 
many he was not only a naturalist of unquestioned erudition, but a 
physician of marked originality, a teacher of wide-spread influence, 
and surprisingly prolific as an author; of the more than forty works 
which he produced upon medical subjects, many were published at 
Basel. Whether Gesner knew his fellow-townsmen, Felix WCrtz, 
before he came to Basel to superintend the publication of his works, 
is unknown—indeed, it is not known that Wiirtz was in Basel at all— 
but whether in Basel or in Zurich he found in him a congenial spirit, 
and it was through his influence that Wiirtz was prompted to condense 
his surgical experience into a “small Enchiridium and pocket-book, 
easily to be carried about one, as well in time of war as in time of 
peace, for a present Instruction to Novices in Surgery. ’ ’ 
At this time there were no biographical encyclopaedias with full 
and flattering details written by the subjects,themselves, and all that 
we know of the life of Wiirtz must be gleaned from the few modest 
words let fall here and there in his book. He was born at Zurich 
early in the sixteenth century. He tells us he had been thirty-seven 
years in practice when he wrote his book in 1563, and he had been 
apprenticed to a barber at a very early age. It is fair to suppose 
that the thirty-seven years included his apprenticeship and that he 
was about fourteen when he entered the barber’s shop, which would 
place the year of his birth in 1512. At the close of his apprentice- 
ship, not satisfied with the career of a simple barber, he extended 
his studies beyond his native city to Nuremberg, Rome, and Padua, 
in the latter city possibly enjoying the prelections of Vesalius him- 
self. He was a great admirer of that prince of quacks, Paracelsus, 
and was himself held in high esteem by Van Helmont, Ettmiiller, 
and Boerhaave. The one incident in his career which is fully 
brought down to us is the operation of arteriotomy done upon him 
by the advice of the famous Gesner. 
“ I found it by experience,” says he, “ how hurtful hot glimbles 
of shines are to eyes ; for one time being troubled with an headach, SIXTEENTH CENTURY SURGERY 
7 
opening my eyes towards the place where the windowes stood open, 
looking then on a new whitned Wall, thinking the windowes were 
shut (but stood open unknown to me) there strook a white glass or 
shine so strongly into my brains that I thought I nere felt so great 
a pain in my life. Let every honest body be perswaded to beleeve 
that the like will be caused in young children, and not suffer any 
white or hot shinings fall on their bad eyes. I have been troubled 
with many infirmities in my body, but never felt greater pain than 
that head ach, caused by looking on that new white Wall, hath 
brought upon me; and was enforced by these extraordinary pains to 
have the pulse or temple vein on the left side to be cut, which all 
Surgeons, Barbars, and good friends diswaded me from; my Wife, 
also by perswasion, suffered no knife or other cutting instrument be 
brought near me and kept all such things from me, and all such that 
came to see me, were entreated not to let me have any manner of 
instrument to cut or stab withal. All were afraid I would lay violent 
hands upon myself, by reason of the great pains I was in. Thus 
making pittiful mourn to Surgeons and all my friends, on whom I 
called for help, entreating them to cut the pulse vein on my left 
temple, which crying and calling I continued for ten dayes, those that 
heard my outcries supposed I did out of impatience, for the which 
none would hearken unto my cries; but I continued still with my 
lamentation, hoping one or other would take pitty on me : At last 
my friends considered of my cries, and promised in case any one 
would undertake the cutting of the pulse vein, they would then con- 
sent unto my demand ; I thanked God that my cries were heard and 
my pulse vein to be cut: then came that famous and conscionable 
Dr. Cennad Gesner, comforted me and my familie, and advised that 
my pulse vein should be opened, then returned I thanks to God, 
again, who put this councill into his heart: then was I asked what 
means should be used for the stenching of that blood, and incision ; 
I gave directions to the Surgeons then present, that my friend and 
brother-in-law, John Waser, should make the incision, he took it in 
hand, and by my leave, and all the Master Surgeons then present, 8 
EDITORIAL ARTICLE. 
placed me on the beds side, and made the incision at twice cutting, the 
wound bleeded vehemently, before he laid down the incision knife ; 
I found myself better, for the which the Lord be praised for ever: 
thereby was I delivered from all my pains, and being drest accord- 
ing to the direction I gave, I lost nere another drop of blood ; 
after that I felt myself better in my head, than ever I was in my life, 
so long as I could remember. To the Lord be Praise, Honour and 
Glory, forevermore: Amen.” 
Wiirtz was enough of a leader in his profession then to cause 
the neighboring surgeons and barbers to congregate about his sick 
bed. He was evidently the head of an honest burgher family, on 
good terms with his relatives by marriage for he selected his brother- 
inclaw to operate upon him. He was happily married, for the affec- 
tionate solicitude which, for fear that he would injure himself, 
withheld the knife from him in spite of his cries, and entreated his 
visitors to do likewise, bears ample witness to the loving watchfulness 
of a faithful wife. He was the father of a family, for his “eldest 
Son” was a cripple, and, says the afflicted father, “all those that 
know him do pitty him ; for he is quite disabled to do any work, and 
must continue so as long as he liveth.” 
Where Wiirtz worked is a debatable question. The older 
authorities, while admitting Zurich as his birthplace, considered Basel 
as the scene of his later labors ; in the English version of his book, 
he is spoken of as “ that most famous and renowned Surgeon, Felix 
Wurtz, Citie Surgeon at Basell,” and the French version assigns him 
to the same city, but Brunner’s more recent studies assign him to 
Zurich—a view which is sustained by his own statement in the eigh- 
teenth chapter of the second part of his book where he says, “About 
the year 1540, the whole Company of Surgeons at Zurich hath been 
baffled and put to a non-plus by Sprains and small cracked bones, 
some whereof . . . were under cure a whole tvelvve moneths . . . 
before they came to my hands. . . . Some of the patients may be a 
witness this present year 1563.” The date of his death is also in- 
volved in doubt, but 1575 has been taken as the approximate time, SIXTEENTH CENTURY SURGERY. 
9 
since the edition of his book, which appeared in 1576, was put forth 
under the care of his brother, Rudolf Wiirtz. 
In 1563, Wiirtz produced his book, Practica der Wundartzney, 
was fur schadliche Missbrauch bey der Wundartzney in gemeinem 
schwanck und warumb die abzuschaffen seind. The practical char- 
acter of the book struck the popular taste and numerous editions 
were demanded during the century ensuing. In Dr. Johnson’s 
Epistle to the Reader of the English translation, published in 1656, 
he stated that at that time twenty-eight editions had been printed in 
German and two in Dutch. Probably as many more were issued 
afterwards. The edition published at Basel, in 1576, appeared under 
the editorship of a brother of the author, Rudolf Wiirtz, who was 
practising surgery at Strasburg, and the text of this edition was fol- 
lowed in all succeeding impressions. Basel produced editions also 
in 1596, 1612, 1616, 1638, 1667, 1670, and in 1675, an edition 
with a treatise on obstetrics adorned with figures by H. Schaeu. 
Editions also appeared in Breslau in 1651, in Wolfenbuttel in 1624, 
and in Stettin in 1649 and 1659. It was translated into French by 
the sieur Sauvin, and published in Paris in 1672 and 1689. 
A surgeon with an English name, who was practising his profes- 
sion in the Low Countries and who had previously translated it into 
low Dutch, prepared an English edition in 1632, under the name of 
An Experimental Treatise of Surgerie In Four Parts. 1. The first 
Part shewing the dangerous Abuses committed among the Modern Sur- 
geons. 2. Of Cures of all Sorts of Wounds in Mans Body from the 
Head to the Ioe, and of other Infirmities belonging to Surgerie ; how 
the same ought to be observed according to the Fundamentals of Art, to 
be handled and cured, j. Of the Symptomes of Wounds, how they are to 
be discerned and known before they appear, what they foretell, how to 
prevent them, and how to cure them when apparent, &*c. 4. Treatise 
of all kinds of Balmes, Salves, Plaisters, Ointments, Oyles, Bloud- 
stenchers, Potions, Tents, Corrosives, Crc., which are used for Wounds 
and have been mentioned hitherto in the former Parts of the Book; 
how they are to be Artificially prepared and used well. All which are 10 
EDITORIAL ARTICLE. 
very plain and easie to be understood and managed by an ordinary capa- 
city. By that most famous and renowned Surgeon, Felix Wurtz, 
Citie Surgeon at Basell. The praise of whose worth you may read in 
the following Epistles, the worth itself in this Book. Exactly perused 
after the Author's own Manuscrip, by Rodolph Wurtz, Surgeon at 
Strasburg. Faithfully the second time Translated into Neather Dutch, 
out of the twenty-eighth Copy printed in the German Tongue, and now 
also Englished and much corrected by Abraham Lenertzon Fox, Sur- 
geon at Zaerdam. London. Printed by Gartrude Dawson, over agamst 
the Black Horse in Alders gate Street, 1656. 
This elongated title might have been shortened and at the same 
time more correctly translated as the Treatment of Wounds, their 
Abuses, Symptoms, and Cure, for the book is in no sense a treatise 
upon surgery in general. The scope of the work, however, is so well 
shown in the sub-title that another list of the contents is hardly nec- 
essary. Twelve pages and four chapters in the Second Part are intro- 
ductory, forty-two pages and ten chapters are devoted to wounds in 
general, two chapters and nine pages to gunshot wounds, and five 
chapters and seventy-five pages to fractures. He does not discuss 
any of the special operations, nor does he touch upon any of the sub- 
jects considered by Franco. 
Like the genuine reformer that he is, he opens his book with a 
discussion of the abuses that had crept into the surgery of his day and 
the methods of correcting them. “Many profess themselves sur- 
geons,” he remarks, “and are ignorant Asses.” And these persons 
greatly increase the dangers of wounds by probing and handling 
them. “To what end is it,” says he, “ to groap and grable so 
much in Wounds? Ah ! how little do they consider, that with the 
poaking and searching they break and destroy that natural Gluten or 
Balsom (which settleth for the healing and is the healing itself) and 
spoil it altogether.” Indeed he is very emphatic in his condemna- 
tion of meddlesome Surgery, affirming even that “ a Surgeon ought to 
be careful that he breath not into the Wound, . . . for such breath- 
ing may cause that a Water may stick to the Wound, and incline it SIXTEENTH CENTURY SURGERY. 
11 
to rottenness,” and again that “ the air be kept out as much as pos- 
sible it may, for air doth hurt to the Wound.” He might almost be 
mistaken for a disciple of the present school of aseptic surgery when 
he remarks, “ yea, I say this, that if a Wound were onely kept clean 
and duly dressed, it would sooner heal, than if all the Art of Medi- 
cine had been used, and all the poultesses applied to it.” 
The consideration of abuses occupies the entire first part, amount- 
ing to one-sixth of the book. It will be convenient to refer to some 
of these later in connection with his own views, but he closes his 
account with an example, “ shewing all kind of abuses,” as exhibited 
toward a single patient, which is so delicious and picturesque as to 
be worthy of quotation in full. “ At Padua, in Italy, some fourteen 
years ago, a Noble German, in a Duel with a Polander, received on 
his left hand a Wound near his little finger, cross over the joynt; 
thereunto were called the chiefest Physitians and Surgeons, which 
came riding on their Asses, and took the wounded into their cure and 
drest him the first time, but how and what they had done then is 
unknown to me, because I was absent; the next day I went thither 
also to see their dressing, at which I saw excellent rarities and mys- 
teries, which I should not speak of, yet for the publick goods sake I 
cannot hold my tongue. And when they undrest him, they took off 
from the Wound the Poultess they applied, and with the little Seeker 
they searched round about in the Wound, which fell tedious to me 
by reason of the Patient, and the Wound being thus long sounded, 
then the Physitians stept aside to consult together, where an Anato- 
mist made an eloquent discourse, which of the veines, and which of 
the sinews in that Wound were cut and hurt: after the consultation 
they shewed and did an extraordinary Master Piece ; for they took 
two flat wicks or tents of linnen, and dipt it in their joynt-wound- 
oyle, and thrust them into the Wound, whereof the Wound gaped 
very much, then they laid a plaister over it, and upon that a cloth 
full of medicinal Poultesses, which I cannot name all. In this man- 
ner they drest him; and there was no end of their seeking in the 
Wound, of their stuffing and cleansing at their several dressings. 12 
EDITORIAL ARTICLE. 
“ Now hear what happened, and what their Medicines did work: 
few days after the Wound began to water and to run, which we call 
the joynt-water. Then they fell a purging of him, used all manner 
of things they could think upon to cure the wound, but all to no pur- 
pose, for they could not stop the joynt-water : then more things 
they tried and what ? they tied and bound his arme very hard and 
close by the elbow, hoping thereby to stop the course of the joynt- 
water, and other simptoms and rheumes coming from the head. But 
as they misunderstood the thing, so it went contrary to their expec- 
tation. For as much as they mist in the stopping of the course of 
the joynt-water, so much the more was there caused an inflammation 
and swelling, whereby the wound grew most horribly slimie and dan- 
gerous, at last it swelled up to the arm; then grew on a putrefaction 
in the veines and sinews, and holes fell in the arm of a finger’s 
length, thus the arm rotted, For to such simptoms truly belonged bet- 
ter skill than they brought forth and used. They supposing a heat 
had caused all this mischief, which indeed was not heat, but a meer 
suffocation, the which they knew not, which they went to quench with 
Vinegar and Well water put together, washing the wound therewith, 
dipping clothes in it and applied them. But all this was not yet 
enough, for these remedies availing nothing, and the Patient’s weak- 
ness growing on more and more, then they fell on other things, met 
and consulted, and disputed the cause very much, at last they re- 
solved to expell all these simptoms out at the Patients Arse, because 
it could be no otherwise. Here Glisters and Purges must walk, 
Sirrups, Electuaries, Decoctions of Honey and Sugar, all must help 
the poor Gentleman to some ease, for he was forced to swallow up a 
whole Apothecaries shop; when all came to all, the poor patient 
died in great misery. This was their good practice they used on that 
brave Gentleman: I have not told the fourth part of the abuses they 
committed upon him for it is too rude, and too grosse, and pitty to 
have it told. An old Woman might have cured this wound with a 
small and mean hearb, without any danger and pain.” 
He considers it “ exquisite that a Surgeon be well seen in SIXTEENTH CENTURY SURGERY. 
13 
Anatomy, of which among us there is great defect, so that scarce one 
amongst many understandeth the internal constitution of man, nay 
hardly have ever seen any man anatomized.” Yet he continues that 
it is unnecessary for a surgeon to be an anatomist, though he should 
have a “superficial knowledge of it, especially of mans bones” and 
“joynts.” To the nineteenth century surgeon the amount of 
anatomy thought necessary by Wiirtz to be “ well seen” is superficial 
indeed. The character of his own acquaintance with the subject 
may be observed in his statement that “ there goeth a strong sinew 
down from the Shoulder, divideth itself about the Elbow, from thence 
it scattereth into the Hand.” In another place he explains, “in 
case the party be run quite thorough [the breast] . . . though none 
of the inward parts be hurt, yet it may be that that thrust hath hit 
some of the white veins or sinews on his back, which is dangerous 
by reason of the affinity they have with the Heart. It happeneth 
many times that when a party is wounded in the Back that he fals 
lame, either in his hand, arme, or elsewhere, where no defect at all 
was, which is caused only by those white veins that are hurt.” 
He was evidently ignorant of catheterism, for he advises in case 
of urinary suppression the application of a hot decoction of Anise to 
the “ privy parts ;” that failing, he strengthens the decoction by the 
addition of parsley seed, maiden-hair, berberries, and vinegar; and 
if this also is unsuccessful he adds to it the internal administration of 
Maiden-hair and Winter cherries in the patient’s drink, combined 
with a diet of “ Oculi Cancrorum.” 
He does not lay much stress upon the condition of the bowels, 
and slight costiveness gives him no uneasiness, but, says he, “if he 
hath no stool in three or four dayes, then it is time to look to his 
back dore. Some think to remedy this with purging, but . . . it is 
better to make Suppositories of Honey and Mice turds mingled with 
salt.” This seems very like a sixteenth century anticipation of the 
doctrine of similars. However, our author did not confine himself 
to these very simple agents, but if purgation was thought to be neces- 
sary, he resorted to a “ Potion of Sene leaves and Rhubarb.” 14 
EDITORIAL ARTICLE. 
He considered suppuration an invariable consequence of a 
wound, “ for no wound can be drest so soon but the flesh and veins 
will change and separate; however, I did read, and heard it also, 
that some Wounds were healed, which never had any matter in them : 
I confess I never saw it and will not gain say it but leave them to 
their opinion ; yet I have cured a stab without bearing any matter 
and that stab was but narrow.” “Slight wounds,” he says in 
another place, “ may easily be cured, with pure Cloath or lint, Wine, 
Water, Salt, etc., for the natural balsam in Man doth much.” He 
devotes an entire chapter to pus or “ Corruption,” which he charac- 
terizes as the “excrement of Wounds,” the result of their effort to 
heal themselves, and he describes divers kinds of “ matter,” varying 
according to the source. “Flesh and blood have their singular 
matter; the white veins have their proper matter: and another 
matter affects the bones: the same must be understood also of the 
internal members. Bones at there healing yeild a white slime and 
somewhat thick : but if they are not in a right tune, they give a clear 
water, without any smell, and looks greasie.” “White veins afford 
a clear water, somewhat tuff and slimie.” “ Flesh affords its matter 
somewhat thick, white gray or of a carnation color.” 
He advocated conservative surgery: “If you have in hand a. 
flap-wound, then do not cut off the flap as many do, for Nature may 
strangely recover that and close it in a short time. ’ ’ 
He strongly disapproves of the routine use of sutures, urging 
that stitching, by closing the superficies, tends to the formation of 
fistula, the precluding of cleanliness, delay in healing, and the pre- 
vention of examination of the appearance of the wound. Wounds 
of the extremities should not be stitched - unless there hang down a 
great flap, “and chiefly have a care you stitch none of them that 
went into the great Muscle or joynt, as in the Shoulder, Elbow, 
Hands, Knees, Knockles or Ankles, for if you stitch them with 
needle and threed (as the fashion is) you will cause onely great pains. 
Rather stitch them with a twisted stitch or twisted Silk, for these 
must be stitched strongly, more strongly than other Wounds, or else SIXTEENTH CENTURY SURGERY. 
they break out again. For if you would stitch a Wound on the 
Shoulder like one on the Belly, that stitch would not hold a day and 
a night.” Face wounds should not be stitched unless a flap hangs 
down, and his readers should not be discouraged if “a Nose or an 
Ear is altogether grown cold at the stitching . . . but stitch it on.” 
Wounds of the chest should be stitched because the “wound being 
healed, loosen and thrust off the stitches, and leave a passage, 
whereby the matter can pass,” and he adds in justification of the 
stitching here, that “ these wounds have room enough to yeeld their 
matter, which other Wounds in outward joynts and members have 
not.” In case of intestinal wounds he recommends suture and 
cleansing “with Milk in which Anise seed is boyled;” however, he 
adds, “these Wounds are counted mortal, and it is a hard matter if 
ever they recover.” 
He devoted two chapters to gunshot wounds, remarking in the 
beginning that perforating wounds are “held mortal because the 
internal parts are spoiled and hurt by that heat” and by the resulting 
inflammation. In .common with all old surgeons he considered it 
essential to extract the missile, but he thought the various extractors 
of very little value, and that the bullet would gravitate to or near the 
external wound if the patient be laid with it downward; “if none 
of these be, Experience must shew you another way.” To quench 
the burning or fire in the wound, “ prepare an Ointment of Honey, 
and not of oyl or other greasie things, spout it into the Wound 
three or four times, or any other way you can best get it in, and 
moisten all places within, even the bullet also if it be in it. Then 
take a tent of Gum Tragacanth, annoint it with the said Wound- 
ointment and thrust it into the Wound ; at last apply a good stiptick 
Plaister upon. Then minister to the Patient of prepared saltpeter, 
3ss in fresh Well water or, according unto occasion, sirrup of Violets 
or of Sloe thorn floures.” “Let the Patient drink Water, let him 
not be opprest with thirst; the raw Water is better than if boyled.” 
“The greatest pain being gone, then another Cooler may be used, 
made of Oyls or fat things.” 16 
EDITORIAL ARTICLE. 
It was his custom to cover all wounds with a “ Wound Plaister,” 
which was intended not only to protect the injury, but to act cura- 
tively also. The chief of these Plaisters was the Opodeldoch Plaister, 
which “ separateth all impurities from wounds, taketh away the proud 
and superfluous flesh, causeth the growth of good flesh, preserveth 
from bad symptoms and bringeth on healing in a short time.” As 
an example of the wonderful and fearful compounds in vogue during 
the Middle Ages, the formula of this Plaister is worth quoting in full: 
Virgin’s Wax, lb 2 
Darkish Turpentine, lb 1 
Sallade Oyl, 5 3 
Mix these together and put to it the 
Juice of Celondine, 
Juice of Oak leaves, 
Juice of Starwort, 
and Speedwell, ana § 1 fs. 
Boil these and let all the moisture thereof be consumed: then put these Gums 
to it: 
Ammoniack, 
Galbanum, 
Opopanax, 
clarified with Vinegar, ana % 
Colophone, § 1 fs 
< Amber, 5 fs 
Mastick, 
Myrrh, 
» Frankincense, 
Sarcocolla, ana g 3 
When these are a little cool, then stirr among it: 
Magnet (prepared and pulverized), § 1 fs 
Crocus Martis, g 2 
Crocus Veneris, § 1 
All this must be stirred into the Plaister and when it is almost cold, then stirr 
amonst it 
Red sweet earrh of Vitriol (as before you 
put in also of prepared Tutia § 3> 
and of prepared Calamy § 10) as 
much as will make the Emplastrum 
brown red. SIXTEENTH CENTURY SURGERY. 
This mixture was made into rolls, which softened under moderate 
heat, and kept for use. Formulae are also given for the preparation of 
the Magnet, Calamy, Tutia, Crocus Martis, Crocus Veneris, and earth 
of Vitriol, used in constructing this Plaister. He also gives the- for- 
mula of his Brown Ointment which attained great celebrity in the 
treatment of wounds, but the receipt for the plaister may suffice as 
an example of the grape-shot style of his prescriptions. 
The ligature of bleeding arteries, the application of which upon 
the battle-field, made his contemporary, Ambroise Pare, famous, he 
does not refer to at all, but advises the use of “ quilts, lints, or mul- 
lipuss, cotton Wool, or the like,” and strongly disapproves of the 
use of “ nealed irons and other burning things.” He holds “all 
Blood-stenching good (except Cauteries and Corrosives) if used with- 
out danger and predjudice to the party, be they made of what they 
will,—viz., of Rye meal, of Mill dust, Pulmonaria, &c.” The 
author’s “ first and chiefest bloud stencher” is a “ Plaister” made of 
Amber, white Rosin, dark Turpentine, Mastick, and Crocus Martis. 
To apply the plaister, “ make the place dry with a sponge round about 
the wound and apply the afore written plaister to it, spread on a 
bladder, pritty broad and great.” Several other “ bloud-stenchers” 
are described and he refers to the then very prevalent practice of 
phlebotomy for the relief of haemorrhage with disapproval. 
In common with the surgical practice of his time, Wiirtz laid 
great stress upon the value of Vulnerary Potions to dispose the 
patient to healing through the digestive system. He described in 
great detail the construction of nine mixtures for this purpose. One 
of them is “ a rare Master Piece for a Wound or Stab, where you sus- 
pect there is a bone, proud flesh, broken veins or other impurities;” 
another is for “ spoyled Wounds, which yieldeth a tuff and slimie 
matter, environed with a swelling, and are deep and hollow under- 
neath, are like to turn to a Cancer.” Another potion, which he 
used extensively was the “ Anodynum Labdanum,” which was nothing 
more or less than a crude tincture of opium. 
He devoted five of his longest chapters to fractures, and in one 18 
EDITORIAL ARTICLE. 
of these he emulated the immortal Silas Wegg by “ dropping into 
poetry,” having for his theme the soul-stirring story of the appli- 
cation of bandages in the case of fractures. The following are his 
“Rimes:” 
“ The whole sum be spoken briefly, 
And this warning is given really: 
Bind the Patient not too strong, 
Else he’s choak’d and his bloud gone; 
Thereby is caused the cold Fire, 
It shames the Surgeon, to the sick it draws 
Smarting swellings, and hearts misery : 
Give way for the pulse and do not tarry. 
This advice I give you in good troth, 
In following my counsel be not sloth: 
In the binding be very cautious, 
Not too hard, nor yet too loose; 
The Band must hold the Fracture stiffely, 
Yet the pulse must have its way throughly. 
Signs bring to the Surgeons head 
That there is no pain where swelling is laid.” 
If a fracture were compound, he advised conservative treatment. 
“ Myself marvelled many times,” says he, “ how it was possible, that 
one or the other in such simptoms could have their food, and how 
life could remain in the Leg; however God gave his blessing there- 
unto, that many such Patients recovered to their going and jumping, 
and could perform all manner of work. I give you further warning, 
not to bereave any Member, though there be never so little hopes for 
their recovery, for Gods blessing may be upon it, beyond all mens 
expectation.” In illustration he quoted a case of a compound 
fracture, in which “ the Leg was off, hanging onely on a little piece, 
and I wondered much, how any life could be left in it.” He trimmed 
up the wound, placed the limb in a comfortable position and dressed 
it with a great deal of ointment; after fifteen days, he found it in so 
good a condition that he set the fracture, and leaves us to understand 
that he obtained a good result. 
He believed fully in the influence of the moon upon the healing SIXTEENTH CENTURY SURGERY. 
19 
of wounds. “ When a patient groweth still weaker,” says he, “at 
the decrease of the moon, then you may expect at the new moon a 
heavy and dangerous paroxisme : if the patient continueth in a strong 
heat at the increase of the Moon, it signifieth that a wound simptom 
is come, or any other bad accident.” 
The entire book is characterized by an intense devotion to prac- 
tical experience. He poetically affirms that,— 
“ Nature in herself doth remain, 
Which Experience makes known amain. 
No new thing on earth e’re comes on, 
Things past do return again.” 
“What is that to me,” continues he, “ what opinion Gallen, 
Avicen, Guido, &c., hatch’d in their breasts, were not the things 
they brought forth in their age new things.” And although his 
entire book was simply a presentation of his personal practice and 
observations, he remarked very modestly in one place, “ I am but a 
common Barber-Surgeon, not learned and much experienced,” and 
again, “ I do not intend to gain-say that, which others have found 
good in their trials; for experimental knowledge is endless, and 
every day new things are brought to light, and they may be such 
which I do not know of.” 
While Felix Wiirtz was thus gaining in Zurich or Basel the ex- 
perience upon which to found the opinions expressed in his Practica 
der Wundartzney, another city of Switzerland was honored by the 
presence of another surgeon whose methods of thought and points of 
view were so similar to his that it would seem as if there must have 
been some acquaintance between the two. Pierre Franco was born 
in Provence at Turriers, which is at the present day the principal 
town of the Canton of Sisteron in the department of the Lower 
Alps. Nothing is known of his personal chronology except that he 
published a small surgical treatise in 1556 and a larger one in 1561. 
In the former work he stated that he had been in practice for thirty 
years, and, supposing that he began at the age of twenty, which is 20 
EDITORIAL ARTICLE. 
quite justifiable as he passed through no long period of preliminary 
study, his birth would have taken place in 1506. The date of his 
death is equally problematical, but it is suggested by Nicaise that as 
his second work shows in its final arrangements a lack of finish, 
which is absent in the first, the supposition seems plausible that the 
hand of the author was not engaged in its completion, and that he 
had either died very recently or was entirely disabled by sickness at 
the time of its publication in 1561. It was in a similar way that 
Fisher determined the exact date of the death of Realdus Columbus, 
who is shown to have died in 1559, the same year as his patron, 
Paul IV, by the existence of identical copies of his De re anatomica 
of that date, in one of which the dedication to Paul is signed by the 
author and in the other a dedication is signed by the author’s sons 
to Pius IV, who succeeded Paul in that very year. 
Franco was eminently a self-made man. His family name, 
modified by himself, was Francou, Francoul, or Francone, and these 
names are not uncommon in Provence at the present day. He passed 
a brief apprenticeship with a barber-surgeon, and his only allusion to 
any special training is a reference to a hernia-surgeon as having been 
one of his masters. What education he may have acquired is uncer- 
tain, but it was probably slight. Latin was an especially easy study 
for a Provencal, and the first edition of his surgery contains a number 
of Latin formulae, while in the second there are frequent Latin cita- 
tions, all the formulae also being in that tongue; furthermore, he 
describes the operation of Marianus Sanctus whose Libellus aureus 
had not then been translated, and he refers extensively to the work 
of the older Masters. But this does not necessarily indicate that 
Franco was a Latin scholar, for while the classical works on surgery 
had been written in Latin, French translations of many of them 
were available in his time. Hippocrates, Galen, Salicetus, John de 
Vigo, Paulus Higineta, Stephanus, Vidus Vidius, and Guyde Chauliac 
had all been printed in French, and even in case of the lack of trans- 
lations, the collaboration of scholars to assist in the composition of 
books was a common feature of the literary work of that day. It SIXTEENTH CENTURY SURGERY. 
has been stated on the authority of Eloy that Franco taught anatomy 
at Freiburg and at Lausanne, but there appears to be nothing to con- 
firm this statement. He would appear, on the contrary, to be rather 
deficient in this respect, unless a familiarity with osteology may be 
excepted. In his chapter on la maniere de conjoindre le*s os he states 
that he prepared three or four skeletons while he was at Berne and at 
Lausanne and he appears to be very proud of his accomplishment, 
but his anatomical knowledge does not appear to extend much 
beyond the bones, all of which would seem to militate against the 
probability of his having occupied a university chair of anatomy. 
Franco was a profoundly religious man and this element of his 
character was doubtless responsible for his emigration from Provence. 
At that time the persecution of the Waldenses, to which sect he 
probably belonged, was in full swing, for it was in 1545 that the in- 
famous massacres occurred, resulting from the edict of extirpation 
promulgated by Francis I. He was a Calvinist, as appears from the 
<( Exhortation,” with which he opens his second edition and which 
is, as Warmont says, a veritable profession of religious faith. It was 
natural then that he should resort to Switzerland, the home of John 
Calvin himself, who had become all-powerful at Geneva in 1541. 
The State of Berne had adopted the Calvinistic tenets, and Lausanne, 
which had been included within that state since 1536, became the 
home of our Provencal emigrS. Here he entered into the service of 
the state as an official salaried surgeon, an evidence not only of the 
great confidence with which he was regarded by the public, but also 
of the character of his religious belief, for none but Calvinists were 
permitted to hold office in Berne. How long he remained in Switzer- 
land we do not know, but in 1561, when he prepared his second edi- 
tion, he had returned to Provence and was living at Orange, now in 
the department of Vaucluse. There was just at that time a period of 
comparative quiescence in religious persecution; although persecu- 
tion of the Protestants had not entirely ceased, the religious wars did 
not break out until the following year. It is a reasonable conjecture, 
then, to suppose that Franco, feeling the end of his days drawing 22 
EDITORIAL ARTICLE. 
near, took advantage of this period of comparative calm to revisit the 
scenes of his childhood and close both his work and his life there. 
Franco travelled much from place to place in the pursuit of his 
calling, although Nicaise does not believe him to have been a pro- 
fessional peripatetic operator. Nevertheless he made frequent jour- 
neys to see patients or perform operations in the various towns of 
Switzerland, Bourgogne, and Provence. To one of these, a trip 
to “ Sauagny” near “ Neufchastel,” “for hernias, hair-lips, and 
stones,” he refers in his Petit traite. 
After many years of practice, as we learn from the preface of his 
first edition, seeing that the branches of surgery, to which his life had 
been devoted, had been neglected by reputable authors, he conceived 
it to be his duty to lay before his fellow-practitioners the results of 
his experience; to disseminate a proper knowledge of the art of sur- 
gery for the benefit of “those who practice their profession with 
fidelity and fail only from ignorance,” and to “ repress the arrogance 
of the sharpers who deserve to be punished by the magistrates as 
robbers—the more as under the pretense of giving aid, they torture 
their poor patients and make them to die in misery.” As the outcome 
of this sentiment he prepared his Petit traitS contenant une des parties 
principalles de chirurgie, laquelles les chirurgiens hernieres exercent, 
which was published at Lyons as a thin duodecimo of 144 pages by 
Antoine Vincent in 1556. This edition is one of the rarest of incu- 
nabula, and originals can only be secured with the greatest difficulty, 
and when obtained at all, at extravagant prices. The work has, 
however, been made available to students of the present day by two 
reprints, one appearing under the editorship of Professor Albert, of 
Innsbruck,1 and accompanied by a biographical sketch, a critical 
1 Petit Traitt concernant une des parties principalles de la chirurgie, laquelle 
les chirurgiens hernaires exercent ainse qu'il m out re en la page suivante. Fait par 
Pierre Franco, chirurgien de Lausanne. Lyon 1556. Neu herausgegeben und 
begleitet von einer Biographie und Wiirdigung Petr. Franco’s nebst einer Vergleichung 
der zweiten Auflage von 1561, von Dr. Albert, Professor der Chirurgie in Inns- 
bruck. Deutsches Archiv fur Geschichte der Medicin und medicinische Geographie, 
Band iv, 1881, und Band v, 1882. SIXTEENTH CENTURY SURGERY. 
23 
study of the book and a comparison with the second edition ; the 
other,1 prepared by Dr. Warmont at the suggestion of Professor Ver- 
neuil, of Paris, was issued in 1884 in connection with the Revue de 
Chirurgie, of which Professor Verneuil was the editor-in-chief, and 
was preceded by a brief, but interesting preface prepared by him. 
The second edition, which was practically a new work, founded 
upon the first, was published also at Lyons, but by Thibauld Payan, 
a different publisher, as a i6mo of 554 pages, under the title of TraitS 
des hernies eontenant une ample declaration de toutes leurs especes, et 
autres excellentesparties de la chirurgie, assavoir de la Pierre, des Catar- 
actes des yeux, et autres maladies, desquelles comme la cure estperilleusc, 
aussi est-elle de peu d’hommes bien exercie : Avec leurs causes, signes, 
accidens, anatomie des parties appectes et leur etitiere guarison: par 
Pierre Franco de Turriers en Provence, demeurant <%present a Orenge. 
This edition, also, is very rare, although not so nearly inaccessible as 
the first, and, at the suggestion of Professor Verneuil, a magnificent 
reprint2 has been prepared by Professor Nicaise, of Paris, to whom we 
are indebted for his superb reprints of the works of Henri de Monde- 
ville and Guy de Chauliac, and for invaluable researches into the 
early history of French surgery. 
In the first edition Franco had no notion of preparing a text- 
book of surgery at large, but confined himself closely to the subjects 
indicated in his title. He gave us what he himself conceived and 
executed, uninfluenced by authority, and every line bears the stamp 
of originality. Guy de Chauliac is mentioned two or three times and 
Albucasis and Avicenna each once, but he gives no other indication 
of familiarity with surgical authors. The book is a simple recital of 
1 Petit Traite eontenant une des parties principalles de chirurgie. Fait par 
Pierre Franco. Reimpression identique au texte primitif, avec les figures. Publie 
par la Revue de Chirurgie, avec tirage a part, 8vo, pp. 92. Paris: F. Alcan, 1884. 
2 Chirurgie de Pierre Franco de Turners en Provence, composee en 1561, 
nouvelle Edition avec une Introduction historique, une biographie et /’Histoire du 
College de Chirurgie, par le Dr. E. Nicaise, Membre de l’Acad6mie de MSdecine, 
Professeur agr6g£ et Chirurgien de 1’hQpital Laennec, 1 vol., grand in-8° de 382— 
CLXIV pages, 42 figures. Paris, Felix Alcan editeur, 1895. 24 
EDITORIAL ARTICLE. 
the methods and practices of the author, and is characterized by a 
simplicity and sincerity of diction that marks the work of a man 
accustomed rather to wield the scalpel than to handle the pen. 
The second edition is far more pretentious than the first. It 
would seem as if Franco had been so spoiled by the success of the 
first, that his head had been puffed up with the notion of creating a 
great surgical monument like the Grande Chirurgie of Guy de Chau- 
liac. But neither his tastes nor his training adapted him to such 
work. In the effort he lost his freshness of style and acquired stiff- 
ness and artificiality with a tendency to rely upon authority rather 
than upon experience. Instead of merely referring to three authori- 
ties and only in five places, he refers to fifty-three and in three hun- 
dred and fifty-six places. The most of the new material is obtained 
from other authors and the selections from Galen, Guy de Chauliac, 
Stephanus, Thierry de Hery, Ambroise Pare, and others can readily 
be distinguished in the text, for the joints are crude and the assimi- 
lation defective. There is a lack of logical sequence in the arrange- 
ment of the matter, the chapters on wounds and hare-lip, for exam- 
ple, being interpolated among those on tumors. 
Franco’s fame rests chiefly upon the fact that he performed the 
first recorded operation for the extraction of vesical calculus through 
the suprapubic abdominal wall. The operation was performed by 
him, however, as a forlorn hope, he fearing in common with his con- 
temporaries that an incision of the body of the bladder would almost 
necessarily be fatal to the patient. Indeed, he warned surgeons 
against following his example, leaving it for Franciscus Roussetus, 
twenty years later in his “ "Yareporoixoroxiaq," to show, by its analogy 
to incision of the uterus in the Caesarean operation, that division of 
the wall of the bladder was not fatal nor even dangerous. Roussetus 
may then be said to be the real father of the operation to which 
Franco’s name has been attached. Franco’s account of his case, 
which is practically the same in both editions, is as follows: 
“ It once came to pass that I wished to remove a stone from a 
child of ten years or thereabouts, but in spite of all my efforts, I SIXTEENTH CENTURY SURGERY. 
25 
could not bring it down to the neck of the bladder. Seeing that the 
patient was very much exhausted by his sufferings, that the parents 
desired rather that he should die than live on in such agony, and 
that moreover I did not want it to be said that I gave up the case as 
impossible, although it was foolhardy, I determined to cut into the 
bladder from the pubis, a little to the left. This I did, cutting upon 
the stone which I had raised up with my fingers inserted into the 
fundament and held under control with the hand of an assistant, 
who compressed the belly down upon it, and so I took it out through 
the opening I cut. The stone was as large as an egg. And so the 
patient was cured without any drawback, and the wound was healed. 
However, I should not advise any person to operate thus, but rather 
to use the method devised by us, of which we have spoken.” 
The method “of which he had spoken” was a perineal section 
into the neck of the bladder with immediate removal of the stone 
if it were small and presented itself at the incision ; but if it were 
large and there was danger of wounding the vesical wall,—which he 
considered dangerous, if not fatal,—or if it did not present itself at 
the opening, the patient was allowed to rest and recuperate for a 
day or two. The stone was then at a second sitting extracted with 
the forceps if small, or if large, broken into fragments with cutting 
forceps and removed piecemeal. This was lithotomy in two sittings, 
which, reinvented by Colot at the end of the seventeenth century, 
had great vogue. He rendered clear and precise the operation of 
lateral lithotomy on the guide, using a channelled sound, a double- 
edged knife, a gorgeret, and a double-crossed forceps of his own 
invention. He also invented cutting forceps for breaking stone in 
the bladder, when too large to be removed entire through the vesical 
neck. In the second edition he describes the median operation of 
Marianus Sanctus with great detail, giving five chapters to it,—a chap- 
ter to each step of the operation. He treated urethral calculus and 
had the advantage of Wiirtz in being familiar with the use of the 
catheter, in connection with which he was the first to describe cathe- 
terism by the tour de maitre. 26 
EDITORIAL ARTICLE. 
The works of Franco have been spoken of for three centuries as 
works on hernia, although, as is clearly stated in the title of the first 
edition, they are rather treatises “ on those branches of surgery com- 
monly practised by hernia surgeons,” and include in the first edition 
the widely diverse topics of hernia, stone, cataract, hare-lip, amputa- 
tions, pterygium, and tumors. In the second edition, in addition 
to extensively padding the subjects considered in the first, he added 
a section on anatomy, a book on venereal disease, a discussion of 
numerous other affections of the eye in addition to cataract and 
pterygium, a treatise upon obstetrics and gynaecology, and a copious 
antidotary. 
Nevertheless, about one-half of the first edition was occupied 
with the subject of hernia, under which he included all scrotal and 
inguinal tumors,—hydrocele, sarcocele, varicocele, and humoral and 
gaseous tumors,—in addition to rupture proper, intestinal, omen- 
tal, and bubonocele. His operations for the relief of hernia proper 
were radical indeed. Using the word “didymis,” for the “two 
tunics, which envelop the spermatic vessels, and their contents,” he 
defined intestinal hernia as the descent of the intestines into the 
scrotum. To cure this, the ordinary operation was, after the patient 
had been “well purged under the direction of a physician,” to 
make an incision at the most dependent part of the scrotum to en- 
sure drainage. The intestines having been reduced and kept in place 
by an assistant pressing in the pubic region, the testicle was seized 
at the incision and removed together with as much of the didymis as 
possible. The stump was then firmly grasped by special clamps, 
while a ligature was passed through the middle of the didymis just 
above them, then, including half of the didymis, it was passed back 
and out upon the other side, and the two ends tied. The clamps 
were then loosened and the stump cauterized and allowed to drop 
back into the canal, the ends of the ligature hanging from the wound. 
The parts were then bandaged with a compress over the pubis, and 
the patient allowed to recover. In case of severe inflammation and 
the formation of “bad humors,” free openings were made for drain- SIXTEENTH CENTURY SURGERY. 
27 
age, and antidotes administered internally, lest “ the poison mount 
to the heart and suffocate it.” 
A second method, which had the “great advantage of not re- 
quiring the removal of the testicle,” consisted simply in drawing the 
didymis through an incision at the superior part of the scrotum, 
dividing it into four equal parts and ligating the middle ones. A 
third method was similar to the second except that the ligature was 
of gold wire and permitted to become encysted since it was a 
“friend of nature, like lead.” This use of the metal suture is 
another little evidence of the coming of the aseptic era which was so 
long delayed, but which even in the sixteenth century and earlier cast 
its shadow before. Franco was the first to speak of crural hernia, 
and we owe to him the operation for irreducible hernia with or with- 
out opening the sac. 
He devoted much space to a description of his method of couch- 
ing for cataract, “ with which he principally concerned himself,” 
and to a discussion of the difference between hard and soft cataract. 
His procedure was simply to force the lens backward and downward 
into the vitreous with a needle, and to hold it down “ during the 
time of saying the Lord’s prayer two or three times or more as 
would seem expedient.” He referred to the great amount of manual 
practice necessary to enable one to perform the operation deftly, and 
advised constant rehearsal upon the cadaver and on the eyes of ani- 
mals, and acquiring facility with both hands. 
Franco has by some been considered an independent inventor 
of podalic version, but the passage in his second edition referring to 
this procedure is clearly borrowed from Pare. He describes a new 
form of Csesarean section, and gives the details of a procedure which 
may be considered as the first attempt at assisting delivery by means 
of forceps. The instrument was not applied upon the child, however, 
but was simply a form of cervical dilator. 
He did not display the originality in the treatment of amputa- 
tions that he showed in other parts of his book. Although Pare had 
popularized the ligature of vessels several years before, Franco still 28 
EDITORIAL ARTICLE. 
clung to the actual cautery or boiling oil for checking haemorrhage, 
although he controlled bleeding during the operation by a tight band 
encircling the limb an inch or two above the proposed line of inci- 
sion. He performed a circular amputation, binding the patient 
firmly to the table and retracting the soft parts twice, once before 
applying the constricting band about the limb and once after section 
of the soft parts and before division of the bone, in order to increase 
the amount of flap. 
While Franco was a man eminent for piety, his faith was not 
equal to the strain of admitting the assertion of many of his con- 
temporaries that congenital deformities were visitations of Providence, 
and consequently an attempt to correct them a sinful interference 
with the purposes of the Almighty. “ The opinion,” says he, “that 
what God has given from birth cannot be cured, as Guido says, is 
not only wrong, but heretical. I have cured many by the help of 
God; wherefore I will shew how it is necessary to proceed.” He 
treated hare-lip by freshening the edges of the fissure and drawing 
them together with two triangular pieces of adhesive plaster, which, 
adherent to each side, were so drawn as to bring the two edges in 
apposition and stitched together. Another plan was to pass needles 
through the flaps in the manner of hare-lip pins. He refers to double 
hare-lip under the name of hare-teeth. In this chapter he also details 
an interesting case of facial autoplasty for the repair of extensive 
sloughing involving both lips and both cheeks. He slashed the skin 
without carefully in such direction as would enable him to draw the 
margins of the opening together and, after refreshing the edges, to 
form them into a very respectable mouth. 
Both of the works of Franco are adorned by rude cuts illustrating 
the various surgical instruments employed by the author. There are 
sixteen of these in the first edition and thirty-nine in the second. 
The latter also contains three comically crude representations of 
skeletons occupying various oratorical attitudes. 
The personality and influence of both Wiirtz and Franco were 
largely overshadowed by that of Ambroise Pare, who, living contem- SIXTEENTH CENTURY SURGERY. 
29 
poraneously with them, wielded the sceptre of surgical pre-eminence 
at Paris. Beginning his professional career as a barber-surgeon, he 
soon became a master-surgeon of the fraternity of St. Come in Paris, 
and ultimately provost of the order; he became an army surgeon, 
remaining in the military service for a quarter of a century, and 
was finally taken into the personal service of the kings of France, 
being transmitted from monarch to monarch during four successive 
reigns as a “ legacy of the crown.” He was an observer and learned 
much by patient devotion to his patients; he strove to elevate the 
profession not only by influencing favorable legislation, but by making 
professional knowledge more accessible, producing numerous works 
in which he not only abstracted the work of other authors but com- 
mented upon it and illustrated it by observations of his own; he 
modified the treatment of wounds and suppressed the old methods 
of controlling haemorrhage in favor of the ligature ; he brought 
podalic version into general use ; he was the first to extract loose 
cartilage from the knee-joint and the first to reduce dislocation of the 
shoulder by the heel in the axilla. His great faith in himself, justi- 
fied, indeed, by his magnificent success, was illustrated by the motto 
of his great book, “ Labor improbus omnia vincit 
Wiirtz was the personal antipodes of Pare, and in this respect 
more like Franco, but the professional opposite of both. Unag- 
gressive and retiring, working in a small and obscure arena, without 
powerful assistance of any kind, he was only persuaded to give his 
own experience to the world by the solicitations of a distinguished 
friend who had happened to become acquainted with his modest 
worth. Wiirtz was not a brilliant inventive genius, but a patient, 
plodding worker, of untiring industry, observing his patients con- 
scientiously and devoting himself rather to the improvement of daily 
routine than to original invention. He was a great clinician and his 
special field was emergency surgery. 
Franco was of a different type from either Parfe or Wiirtz. 
While personally modest and retiring, he was professionally belligerent 
and progressive. A worker of remarkable originality, with no royal 30 
EDITORIAL ARTICLE. 
patronage, with no university professorship, with none of the ad- 
vantages to be derived from wealth or high social station, he 
achieved his position by force of sheer independence and sterling 
worth. His life was an embodiment of his own motto, “ II faut 
endurer, pour durer." He was ready to endure all things for the 
good of his fellow-men and the advancement of his art. He sepa- 
rated himself even farther from tradition than Wiirtz and much be- 
yond Pare. He discarded unguents and plasters in which his prede- 
cessors and even his contemporaries reposed all faith. He created 
operations; he invented instruments; he opened up a new field for 
legitimate surgical practice. 
There was much that was alike and much that was dissimilar in the 
lives of Wiirtz and Franco. Both were men distinguished for piety, 
the latter was a religious refugee. Each passed his life in a limited 
field of labor, known only to his townsmen and neighbors, and both, 
by the publication of their work at its latter end, attained great 
renown. Both were without the assistance of royal, papal, or uni- 
versity patronage to which their great predecessors and contempora- 
ries owed much of their success. Both conducted a crusade against 
the “abuseurs” and “ coureurs,” who, by their ignorance and hardi- 
hood, were casting so much discredit upon surgery. Wiirtz was a 
German, Franco a Frenchman, and each manifested the character- 
istics of his racial type. Wiirtz was plodding and industrious, 
Franco brilliant and original. Each was obscure in life, only to 
become illustrious in memory. Both were crude in pathology, insuffi- 
cient in practice and unsatisfactory in result as compared with the 
elaborate surgery of the present day, but as compared with the past, 
the methods of each were like a step from the starlight into the dawn, 
and, standing in the penumbra of surgical progress, each contributed 
materially to the light of surgical knowledge which was to increase 
in volume and brilliancy throughout the illimitable future. 
James E. Pilcher.