Trauma Surgery in Early Modern Europe For Beau Monde and Hearts through History, July 30, 2008

Scott Moore

Questions, complaints and corrections may be addressed to scott@phoom.com

Created: July 19, 2008. Updated: Aug 1, 2008

Workshop Description: Separating fact from fiction, this presentation will provide some basic

understanding of pre-anesthesia wound treatment 1500 – 1800 and recommendations for researching

your own questions in the history of medicine. Not for the faint of stomach, topics will include myth

busting about amputation and methods of treating cuts, stabs, arrow and gunshot removal, fractures

and dislocations, and head trauma.

“The course of illness was not often dramatically altered or shortened or terminated… surgery entailed

weeks of daily wound care rather than dramatic interventions that characterize modern operative

surgery”. - Mary E. Fissel, Bulletin of the History of Medicine, Spring 2008 V82no1, page 14.

“Why, just fifty years ago, they thought a disease like your daughter's was caused by demonic

possession or witchcraft. But nowadays we know that Isabelle is suffering from an imbalance of bodily

humors, perhaps caused by a toad or a small dwarf living in her stomach.” - Theodoric of York, Medieval

Barber

Introduction

Caveats

I do not have medical education or training. I am an amateur historian with an interest in 16thC German

military surgery. Do not take anything here as sound medical treatment, I try to stick with the point of

view of the people during their time period.

Because this is a large topic and time is limited, the focus will be on:

• Early Modern Period ~1500 – ~1830

• Surgery and not all medicine

• Trauma surgery and not operative surgery

• General wound care, wounds from arrows and gunshot, fractures and dislocations, head

trauma, and recovery from surgery

Will skip over couching cataracts, lithotomy (removing bladder stones), hernias, fistulas, bites, tumors,

STDs, child birth.

A brief history of the history of medicine (warnings about potential

research pitfalls).

The history of medicine and surgery has been, for centuries, conducted by medical practitioners. These

physicians and surgeons tended to use contemporary medical terms and often judged their forebears

through their own frame of reference. This contemporary viewpoint lead to using the history of

medicine as a way to demonstrate contemporary medicine as a benefit to society, promote nationality

by promoting innovation to a countryman or to reject medical claims of imposters as examples of the

errors of the past. Because these writers of history were not historians seeking understanding, but often

very biased, the context of a particular writing must be placed in a broader context. (see Burnham)

In the 20th Century, historians in nonmedical fields began to take an interest in the role of medicine in

society through history. A social history of medicine began and by the 1980’s the way medical history

was researched and presented had shifted, opening more windows on how medicine and society

influenced and directly affected each other. A variety of sources and view points are now available

when considering some aspect of medical history.

Patients and how they perceive their body and ailments were influenced by societal attitudes which

were influenced by medicine. Patients of the 16thC viewed disease as internal and personal, but also in

relation to impiety which opens the body to corruption, physically as well as spiritually.

Specific diseases can be viewed as having their own histories (developmentally or evolutionarily)and

how different incarnations of a disease interacted with their human hosts and impacted culture, events

or treatment.

Healers and their practices have been long the focus of the history of medicine, but now practices,

successful or not, can be viewed in a broader context of local culture, geography, politics, economy and

the ability to receive, develop and transmit healing knowledge.

Innovation did not occur uniformly or monolithically. The history of healers is full of stories where a

particular surgeons innovation or recommendation is not adopted for decades after. Andre Vesalius’

more accurate anatomies were fought over for 50 years as were William Harvey’s publications on the

circulation of blood. Ambroise Paré fought with his contemporaries against using cauterization and

advocated ligature of the blood vessels only to have his own students abandon the practice after his

death. Nitrous Oxide was discovered by Joeseph Preistly in 1772, but it was not until 1800 that

Humphrey Davy recommended its use in surgery. Even then, it was not adopted immediately and in

1845, Horace Wells’ demonstration at Harvard – failed. Too little used may have been the cause. Two

years later, ether took the stage and dominated anesthesia. Yet, today, ether is no longer used and

Nitrous Oxide is. The history of innovation, especially medical innovation is not linear!

Early Modern Europe provides an excellent example of the range of variation. Below is a table showing

the barest outline of variations of surgical training and knowledge between countries and centuries

underscoring the fact the European surgery (medicine) did not develop monolithically.

Table 1: Rough outline of Surgical training and skill in Europe

Area 16thC 17thC 18thC 19thC

England,

Scotland

Barber-

surgeon

guilds –

limited

knowledge

Harvey and circulation, but not

accepted

Political instability lead to isolation

1599 – James VI granted charter for

faculty of physicians and surgeons in

Glasgow

London physicians and surgeons become

unregulated

Education shift from guilds to private schools

and new hospitals in London

Small pox vaccination developed

Glasgow develops as significant center of

medical education

Better

communication

between nations

leads to

transnational

influences in

advances in

anesthesia, antisepsis

and cellular

pathology. These

advances radically

change surgical

possibilities.

(For example, Lister,

who developed

antisepsis was

influenced by the

French Pasteur and

then carried his ideas

to America.)

France Medical

schools and

hospital

(Hôtel Dieu)

in Paris,

Ambroise

Paré,

innovator

Paré’s innovation not widely accepted

Intense fighting between barbers and

surgeons stifles innovation

Surgeons gain political and professional

status with university training mandatory

before surgical apprenticeship until

revolution abolishes guilds and medical

societies.

Paris becomes center for surgical education

Italy Some

university

training for

surgeons in

Pavia, Padua,

Bologna

More medical schools open in Pisa

and Naples, but surgery is generally

unorganized.

Some experimentation with kidney

stone surgery

Surgical training remains unorganized.

Napoleonic conquest and division further

stifles advances.

German

speaking

lands

No unified

surgeon

guilds

30 Years War devastates country.

Prior to war, Fabry von Hilden taught

in Basel and after war Johannes

Scultetus published surgical works.

Formal education fails to take hold in Austria.

Prussia establishes military surgery school in

Berlin. Generally, suspicion, superstition,

poor training, and competition with other

trades stifles surgical advances.

Others Spain: no

significant

contributions

to European

surgery

Netherlands: Leyden and Amsterdam

rise as significant centers of medical

education

Netherlands: Clinical teaching of medicine

and advances in anatomy

USA: lack of established healers means fewer

divisions between surgeons, physicians and

apothecaries

Finding credible sources

Second source material by modern historians – this is a good way to get a grounding in some

procedures and notable surgeons of a particular time. Check the bibliographies and notes for titles of

primary sources even if they are not in a language you know. You can use that to find translations. If you

find something noteworthy, be sure to reference against additional works, preferably with more details.

I have found much disagreement over incidents and dates in broad surveys of the history of medicine.

Journals of the history of medicine - three good ways to use journals: 1) Specific subject: especially now

that current researchers are looking in manuscripts, letters, journals and court or civic documents, 2)

Book lists: often journals will list books they have received, these can be very specific, but rich in detail,

3) Peer book reviews: reviews by other historians or doctors can highlight mistakes or missed

opportunities in a particular book. They can help you find information that is new and relevant rather

than yet another book that repeats what you have already found. A list of mostly English language

journals is listed in the Resources section.

Primary source material in the form of surgical texts – These are the most easily obtainable through

reproductions and modern translations. A caveat for in-period translations is to be aware that the

translator may change text or images to reflect their point of view. If you can find modern translations of

period texts, check for journal book reviews, and use them. If you gain access to legal, civic or guild

records, build up lists of names, procedures or titles used (barber, bather, barber-surgeon, man-

midwife, cunning woman, physician, physicker, etc.)

Common misunderstandings and myths about early modern surgery

Education of surgeons Myth – Surgeons were professionals with similar education as physicians.

Reality – Surgery was a trade dealing with the physical aspects of the human body. Aside from the

variations in Table 1 and specific individuals, surgeons generally enters some kind of apprenticeship and

trained under one or more master surgeons. Age of apprenticeship, prior education, exactly where the

masters were located and how many masters a budding surgeon had varied by time and geography.

Myth – Surgeons were ignorant quacks who were more a danger than a help

Reality – While itinerant and ignorant healers existed (and in some cases flourished), trained and

licensed surgeons sought to avoid unnecessary harm and better understand the human body. As

ignorant as many treatments and procedures may seem, experience in both practice and learning from

other healers is often emphasized in surgical texts. Such hints at empiricism help many innovations

during the early modern period.

Alcohol as anesthesia

Myth – patient should be drunk before cutting begins

Reality – fictional literature often calls out the patient, and even the surgeon, having several stiff drinks

to help alleviate the ensuing pain. I regret that I have not been able to find my original primary sources

on this subject (learn from my lesson and catalog your research as you are doing it), but I recall

admonishments that drunk patients are excitable and prone to physicality. These are not traits to induce

while wielding a sharp knife attempting a quick and accurate cut. For better information, this article may

offer better sources:

J. D. WHITBY (1980) Alcohol in anaesthesia and surgical resuscitation Anaesthesia 35 (5) , 502–505

Summary: The anaesthetic and analgesic properties of alcohol have been known for several thousand

years, but there is little evidence that surgeons were employing it frequently for these purposes in the

days before the discovery of reliable inhalation anaesthesia. Its main use was as a stimulant for

resuscitation. Attempts to introduce its use into anaesthetic practice in this century have not been

successful.

Prohibitions against dissection Myth – The catholic church forbad dissection of the human body and this lead to underhanded methods

of obtaining bodies.

Reality – This stems from a papal bull issued at the turn of the 14thC prohibiting crusaders from

reducing Christians to bones to be shipped back to Europe for burial. From the catholic point of view,

this did not inhibit dissections, but from a historian’s view it seems to have had a chilling effect reducing

the numbers of dissections performed.

Rough timeline of anatomy prohibitions and legislation. Because many sources seemed to have biases

each is listed:

- Pre-14thC popes who may have spoken out against dissection - Pope Innocent III (1198-1216), Pope

Gregory IX, (1227-1241).

- Papal bull, de sepultris (Hagens, 15) or Detestandae feritatis (Carlino, 182), issued by Pope Boniface VIII

(1294-1303) Sept 27, 1299. "forbade anyone to boil, cut up or dry the bodies of the dead" (Hartwell, 5)

Misinterpreted by later historians as papal prohibition against any form of dissection. (Hagens, 15)

Hartwell makes it clear that the purpose was not aimed at anatomists, but it had a chilling effect

(Hartwell, 6)

- Carlino points to a decree issued April 19, 1303 that extends the prohibition against boiling of cadavers

to "dissection, evisceration and cremation" (Carlito, 183). He further points to E.A.R. Brown, "Death and

the Human Body" for more information. Also states that the main motivation was "piety that the faithful

owed to the dead" and not ideas about resurrection of the flesh. (Carlino, 184)

- 1308, Venice city officials called for one public dissection per year for the benefit of city physicians.

(http://www.newadvent.org/cathen/01457e.htm)

- Mondino dei Lucci (1275 - 1327), dissected several cadavers, though acknowledged these were by local

authority.

- 1345, Guido da Vigevano, physician to Philip VII (France), wrote that "it is prohibited by the Church to

perform anatomies on the human body". (Carlino, 181)

- In 1410, the body of Pope Alexander V (1409 - 1410) was dissected. (Hagens, 15)

- In 1482, Pope Sixtus IV (1471-1484) expressly gave permission to University of Tübingen to dissect

cadavers to advance their knowledge of medicine (Hartwell, 6)

- Pope Clement VII (1523-1534) expressly permitted the dissection of human cadavers in Padua and

Bologna (Hagens, 15)

- in 1740s, Pope Benedict XIV (1740 - 1758) supported anatomical dissections at Museum (or School) of

anatomy in Bologna. (Hagens, 15)

- Ercole Lelli (1702 - 1766) credited with founding of Bolognese School (Düring, 12)

- In England, Murder Act 1752 stipulated that only the corpses of executed murderers could be used for

dissection (wikipedia)

- Wendy Moore details the situation in 18thC London where competition between private anatomy

schools, guild halls and hospital medical schools created a need for cadavers to the extent that unlawful

methods were used. When rogue methods turned into murder in Great Britain the late 1820’s, the

Anatomy Act of 1832 expands legal access to unclaimed corpses and requires licensing of anyone

practicing anatomy.

Hollywood amputations

Myth – Surgeons amputated at the drop of a hat

Reality – Before mid-19thC surgeons focused on healing the wound and used amputation as a last resort

if the wound failed to heal and threatened the life of the patient or if the bones were so shattered that

they would not allow a clean healing stump.

Myth – Saw through the whole limb

Reality – No one *ever* sawed through flesh. Since Roman times and to this day, the basic methods of

amputation has not changed. Only the particulars of how a surgeon in a time period handled each step

changed.

1. Compress the limb to slow/stop blood flow

2. Slice through the flesh with a knife around the limb and down to the bone

3. Retract the flesh toward the body to expose the bone

4. Saw through the bone

5. Release the retraction and staunch bleeding

6. Release compression to find missed blood vessels

7. Bandage and attend to healing

Specific Procedures

General wound care and recovery from surgery

General notes

General wound care and post-operative wound care carry the greatest risk of death mainly because of a

lack of understanding of infection and how to abate fever.

1. Very often deep wounds were prevented from closing so they may drain.

a. In the 16th/17thC, tents of rolled cloth were places in wound to keep it open, sometimes

with medicines (usually some kind of resin or turpentine which was thought to be a

styptic)

b. In 18th/19thC, dry lint was used.

2. Deep cuts across the grain of muscles and tendons would likely be sutured. Sutures tended

to not dissolve, but were left hanging from the wound and gently tugged at over time to see

f they would loosen and pull out. Sutures tended to not be used on the lip of a wound. In

places where the wound could not be bound (cheek), two pieces of adhesive dipped linen

were attached to either side of the wound and the linen stitched together to draw the

wound closed. Around the 18thC, adhesive bandages were recommended for binding “flap

amputation” wounds.

3. Healing by the “first intent” means using no salves and just pressing the lips of the wound

together and binding it, often with bandaged moistened with, water and vinegar or with

warm wine. In the 18thC there are some instances recommending using milk soaked bread

against the wound.

4. Healing by the “second intent” means using salves or oils in the wound with the thought

that this assisted healing. All manner of stuff might be employed though it tended to

prolong healing. Ironically, one surgeon (William Clowes?) recommended finding the

weapon causing the wound and treating it as though it were the wound with salves and

bandages, but merely washing and bandaging the actual wound. In seeking ingredients,

consulting primary source case histories, even translated will be your best bet.

5. Suppuration (puss) was considered a sign of healing until the mid-18thC when more

surgeons were documenting success by avoiding suppuration.

6. Bleeding was commonly used after bandaging a wound. In the 16thC, a general cut was

made above the wound or based on a part of the body ruled by the zodiac. By the 18thC, a

vein above the wound would be cut. It’s not clear how much blood would be let, but it

seems 1-2 pints or until the wound seemed to “feel” less swollen.

7. If the patient developed a fever, more bleeding would be ordered. How much and if to the

point of unconsciousness (and what we know as shock) varies by surgeon.

8. If the wound is in the abdominal region (and the patient hasn’t developed peritonitis), they

may have difficulty keeping food down. A diet of broth and perhaps wine with attempts at

eating every few days would be established until food could be kept.

9. Constipation may also occur and so the surgeon may “throw up a clyster” (using a large

syringe to deliver an enema -- a phrase used at least until 1800).

10. Complications are the norm. Wounds can spontaneously reissue blood and abscesses can

form once the wound can closed. These will be treated as their own, usually with bleeding

and a change of bandage (to reintroduce styptics). Abscesses will likely be drained with a

scalpel.

Majors cuts as by blades If the wound is minor, it will be treated as above.

If the wound cuts across muscle, surgeons since the 16thC have recommended suturing the muscles to

heal together and maintain mobility of the portion of body. If a wound in in line with muscles, they will

not be sutured.

Removing arrows and gunshot (debridement)

Removing arrows – Mainly an issue of the 16thC

1. If the arrow head is close to the skin, cut the flesh and “push” the arrow head forward.

2. If this is not easily accomplished, enlarge the wound by cutting up to an inch on either side

of the shaft.

3. Protect the barbs from catching as it’s removed.

a. Bend the barbs to the shaft

b. Use a special forceps to cover the barbs. Goose quills pushed over the barbs also has

been used.

4. Pull the arrow out the way it came.

5. Treat the wound as above

Gunshot

1. Similar to arrows, if the ball can be felt under the skin, cut through the shortest distance to

the ball and remove it. Forceps and fingers are all used to this purpose.

2. Otherwise, enlarge the wound and remove. Special ball screws existed throughout the early

modern period, but seem to have been used if the ball was lodged against bone.

3. Treat the resulting wound as above.

In the early 16thC, it was generally considered that gunshot was poisoned because of the gun powder.

Despite both Paré and Clowes providing demonstrations that the fire leaves no residue on the ball,

these ideas persisted into the 17thC. As the concept that suppuration was necessary for healing

subsided, efforts focused on removing bits of clothing drug into the wound by the ball.

However, John Hunter in the mid-18thC advocated and demonstrated that sometimes leaving the shot

in the patient and simply treating the wound provided no worse a treatment. An example is in case

studies by Desault where in once case a man is shot in the side (lower abdominal so the ball only pass

through muscle and fat). The surgeon felt the ball under the skin and cut to remove it. The wound made

by that cut infected faster and took longer to heal than the entry wound.

Fractures and dislocations (luxation)

General treatment of dislocations:

1. Start before inflammation starts or wait until is subsides

2. Put the joint back in place (reduction) usually with some form of leverage device. The 16thC

seems to have advocated a number of mechanical devices (“engines”). By the 19thC, these

were used less often and methods using tables, or using the patient’s body to assist in

replacing the limb.

3. Prevent the limb from moving until healed.

General treatment of broken limbs

1. Diagnose the degree of the fracture

2. If the fractured bones have broken the skin (compound fracture), treat the wounds as

above. Amputation is likely if the healing does not go well.

3. Extend the limb so the portions of bone may be fitted together.

4. Bind the limb tightly.

Aftercare as above. One case of a leg fracture caused by a gunshot wound (not shattering the bone, just

fracturing it) required 175 days before the patient could walk out of the hospital with the first ~100 days

devoted to tending to an infected wound. (Desault)

Special problems with fractures

During the 16thC/17thC fractures of the upper arm and thigh were difficult to reduce. It seems to be a

problem with not being able to stretch the limb without potentially causing the elbow or knee to

dislocate.

Gunshot that strikes a bone can shatter the bone leaving fragments that can cause infection. In the

16thC, the tendency voice by Paré was to still try to reduce and bind the fracture and amputate only if

the patent exhibited unrelenting fever. By contrast, the case presented in Desault of a gunshot passing

by the bone (it would have had enough kinetic force to cause the muscle to break the bone), the

fracture was reduce and the wounds tended to regardless fever, renewed bleeding or abscesses.

Head trauma – (trepanning)

General treatment

1. Check the fracture to see if the skull depresses inward and if bits of skull seem to be free.

2. Cut the scalp (no need to shave), either in a square with one side still attached or as an “X”

pulling back the four triangles.

3. Lift out any completely loose pieces

4. Use a saw (trepan) to cut the skull, but not so deep as to cut through the skull (do not cut

the membrane that lines the skull -- Dura Mater).

5. Use an “s” shaped lifter (elevator) to remove the pieces.

6. After 1700, a lenticular was used to scrap the rough edges of the hole. The lenticular has a

smooth flat tip that presses the brain away from the skull while the sharpened inner edge

removed the inner lip of bone not cut away with the trepan).

7. After ~1750, brush the bone dust from the wound.

8. In the later period, a small plate might be mounted to the skull before closing, but, more

likely, the skin was replaced and treated as any cut for that time period. Trepanning was

quite a survivable give the alternative of swelling possibly rubbing against a sharp bone

fragment which could quite quickly lead to brain damage and death.

Trepan or Trephine?

What’s the difference between a trepan and a trephine? Is there a difference between trepanning and

trephining? Why not call it trephination?

A trepan is any surgical saw that is used to cut into the skull. The shape may be that of a hand cranked

borer or a small saw on the end of a long shaft. To trepan is to use a the surgical saw on a skull. Both of

these terms were widely used in English during the early modern period. You cannot go wrong with

“Trevor trepanned with the trepan”.

A trephine is a very specific type of trepan. It has a “T” shaped handle so the sawing can be done with

one hand and came into use about mid-17thC. When “Trevor trepans with the trephine”, he is using a

very specific instrument. It would not be correct to say, “Trevor cranked the trephine using both hands”.

To trephine, is to trepan with a trephine. (I hope you are still with me.) However, this did not come into

general use until the trephine can become widely used and replaced the crank borer. Trevor cannot

trephine using any instrument during American or French revolutions.

Trephination is right out. This is a 20thC word to describe the procedure of cutting a circular hole in the

skull. Trevor never performed a trephination because he died before 1900.

Timeline of Surgery in Early Modern Europe

Surgical General Eras

1500 - 1628 Gunshot, Vesalius, Pare

1628 – 1800 Harvey to Nitrous Oxide

1800 – 1850 Nitrous Oxide, Ether, antiseptics (Lister), budding of elective surgery

(Some) Royalty and Their Surgeons and Physicians

England

1457 – 1509 Henry VII – Thomas Linacre (1460 – 1524), physician

1491 – 1547 Henry VIII – Thomas Vicary (1495 – 1561), surgeon

10xx – 1603 Elizabeth I – Wiliam Clowes (1540 – 1604), surgeon

1683 – 1760 George II – John Ranby (1703 – 1773), surgeon

1738 – 1820 George III – Matthew Baille (1760 – 1823), physician;

William Heberden the Younger (1767 – 1845), physician

1744 – 1818 Queen Charlotte, George III’s wife attended to by William Hunter 1718 – 1783

France

1470 – 1498 Charles VIII - Symphoien Champier (1472 – 1539), physician

1462 – 1515 Louis XII - Symphoien Champier, physician

1519 – 1559 Henry II – Jean Fernel (1506 – 1588) physician to royal family

1519 – 1589 Catherine de Medici – Jean Fernel, physician

1544 – 1560 Francis II – Jean Fernel, physician

1550 – 1574 Charles IX – Jean Fernel, physician

1551 – 1589 Henry III – Jean Fernel, physician

1638 – 1715 Louis XIV – Charles-François Félix (1650 – 1703), surgeon;

Georges Mareschal (1658 – 1736), surgeon;

Gui-Crescent Fagon (1638 – 1718), physician

1710 – 1774 Louis XV – Georges Mareschal, surgeon;

François Gigot de la Peyronie (1678 – 1747) , surgeon

OTHER

1443 – 1513 Pope Julius II – Giovanni deVigo (1460 – 1525), surgeon

1500 – 1558 Emperor Charles V – Dionisio Daza Chacon (1503 – 1580?), surgeon

People

1443 – 1524 Antonio Benivieni, Italian physician

1460 – 1524 Thomas Linacre, English, personal physician to Henry VII and Henry VIII (Rutkow, p 123)

1460 – 1525 Giovanni de Vigo, Italian surgeon, wrote one of the earliest treaties on gunshot wounds

asserting the wound was poisoned by the gun powder.

1480 – 1540 Hans von Gersdorff, German surgeon

1490 - 1562 Thomas Vicary, English, Chief Surgeon to Henry VIII, and Master of the new Company of

Barber-Surgeons in 1540, established the formal teaching of anatomy at the Company Hall.

1493 – 1541 Paracelsus, Swiss surgeon and physician

1500(?) – 1548 Walter Ryff, German surgeon

1507 – 1587 Thomas Gale, English surgeon. Second Master of Company of Barber-Surgeons and

prominent military and civilian surgeon.

1510 – 1590 Ambroise Paré, French surgeon

1514 – 1564 Andreus Vesalius, Belgian surgeon.

1523 – 1562 Gabriele Falloppio (Fallopius), Italian physician and anatomist

1531 – 1597 Bartolome Hidalgo De Aguero, Spanish surgeon

1535 – 1606 Georg Bartisch, German physician and ophthalmologist

1537 – 1619 Hieronymus Fabricius, Italian surgeon, first described valves in veins

1540 – 1604 William Clowes, English surgeon

1547 – 1599 Gaspare Tagliacozzi, Italian surgeon. Published procedures for rhinoplasty.

1550 – 1612 Peter Lowe, Scottish surgeon

1554 – 1643 John Woodall, English surgeon. First Surgeon General to East India Company, 1612

1560 – 1634 Wilhelm Fabry von Hilden, German surgeon. Wrote post-mortem case histories on many of

his life-long patients.

1560(?) – 1640(?) Marie Colinet, German midwife-surgeon. Wife of Wilhelm Fabry von Hilden and

coucher of cataracts. Suggested the use a lodestone to draw iron silvers from the eye.

1578 – 1657 William Harvey, English surgeon

1586 – 1641 Alexander Read, English surgeon

1595 – 1645 Johannes Scultetus, German surgeon

1624 – 1689 Thomas Sydenham, English physician, used “Jesuit bark” or cinchona bark, which contains

quinine, as treatment for malaria.

1632 – 1723 Antony van Leeuwenhoek, Dutch scientist, improved microscopes and was the first to

describe microorganisms and blood flow in the capillaries.

1650 – 1703 Charles-François Felix, French surgeon

1666 – 1709 William Cowper, English surgeon

1668 – 1738 Herman Boerhaave, Dutch physician

1674 – 1750 Jean-Louis Petit, French surgeon

1675 – 1742 James Douglas, Scottish anatomist and man-midwife

1677 – 1761 – Stephen Hales, English

167x – 1743 John Douglas, Scottish surgeon and brother to James Douglas

1688 – 1752 William Cheselden, English, surgeon to many famous Londoners including Alexander Pope.

1697 – 1767 Alexander Monro (“primus”), Scottish surgeon.

1703 – 1773 John Ranby, English surgeon. Sergeant Surgeon to George II

1707 – 1782 John Pringle, English, established principles of military Surgical sanitation including

“ventilation of hospital wards” (Rutkow 239)

1710 – 1801 William Heberden the Elder, English physician

1712 – 1792 William Bromfield, English surgeon – Senior-surgeon at St. Georges and was John “Hunter’s

examiner for surgeon’s diploma”. He held that there was “no cure;” for popliteal aneurysm (not even

amputation).

1714 – 1788 Percival Pott, English surgeon

1716 – 1794 James Lind, English surgeon. Published his treatise on scurvy and it’s cure with citric acid

(oranges and lemons) in 1758. This was all but ignored until lemon juice was issues as a cure for scurvy

after 1794, but not used as a preventative until after 1800.

1718 – 1783 William Hunter, Scottish surgeon and man-midwife

1723 – 1792 Antoine Louis, French, Pioneer of medical jurisprudence – distinguished differences

between hanging as suicide from hanging as murder.

1728 – 1793 John Hunter, Scottish surgeon

1728 – 1813 Charles White, English surgeon

1733 – 1817 Alexander Monro (“secundus”), Scottish surgeon

1736 – 1819 William Hey, English surgeon

1744 - 1826 Jessé Foote, English surgeon. Practiced on island of Nevis in West Indies until 1769. Became

house surgeon of Middlesex Hospital and now most notable as a jealous biographer of John Hunter.

1744 – 1831 Henry Park, English surgeon

1745 – 1813 Benjamin Rush, United States surgeon

1749 – 1806 Benjamin Bell, Scottish surgeon

1749 – 1823 Edward Jenner, English surgeon, pioneered vaccinations against smallpox

1750 – 1827 Henry Cline, English surgeon

1753 – 1815 John Warren, United States surgeon. Surgeon for the Continental Army and founded

Harvard Medical School.

1754 -1755 Albrecht Von Haller, Swiss, published quite a lot on human anatomy (Moore 70-76)

1756 – 1805 James Currie, Scottish physician, published “Medical Reports on the Effects of Water, Cold

and Warm, as a Remedy in Fevers and Febrile Diseases” 1797.

1756 -1832 Everard Home, English physician, served as assistant surgeon at the naval hospital in

Plymouth. Brother-in-Law and assistant to John Hunter.

1759 – 1840 Paolo Assalini – Italian surgeon

1760 – 1823 Matthew Baille, English physician

1763 – 1820 John Bell, Scottish surgeon

1766 – 1842 Dominique-Jean Larrey, French surgeon

1767 – 1845 William Heberden the Younger, English physician who attended to King George III during his

final illness.

1768 – 1837 Philip Syng Physick, United States surgeon bled dislocation patients from both forearms to

the point of collapse making them insensitive to pain and relaxed enough to replace the dislocation.

1768 – 1841 Astley Cooper, English surgeon

1774 – 1842 Charles Bell, Scottish surgeon and younger brother of John Bell.

1794 – 1847 Robert Liston, Scottish surgeon, considered the fastest British surgeon of his day.

1827 – 1912 Lord Joseph Lister, English surgeon who experimented successfully with antiseptics during

surgical procedures.

Specific Dates

1462 Company of Barbers is granted a charter of incorporation by Edward IV making legal over 100

years of practice in London.

1500-1600 – Universities teaching medicine: Bologna, Ferrara, Padua in Italy; Montpellier, Paris in

France; and Oxford in England. (Rutkow, p122, 123, 131)

1540 Company of Barbers and Surgeons (or Company of Barber-Surgeons) chartered by Henry VIII

1588 80+ surgeons and 2 hospital ships are a part Spain’s Armada (Lindemann, 144)

1602 Hospital named “Charité” founded in Paris

1603 Paris officially recognizes Barber-Surgeons (instead of just barbers)

1628 William Harvey publishes “title of circulation work”

1650ish – Leyden and Amsterdam, Netherlands attracting students of surgery from all over Europe

(Rutkow 216)

1655 In Paris, College of St. Comê and Barber-Surgeon guild sign contract of union

1656 Hôspital General founded to clear Paris of beggars and indigents

1674 Military hospital, Invalides, founded in Paris

1700s France, Prussia, Spain Russia formalize medical corps. England, not so much.

1700s John Hunter and others participate in vivisection of animals (specifically 1 dog, 3 sheep and 1 ass).

Samuel Jonson launches a tirade against animal vivisection in his magazine the “Idler”. (Moore 82-83)

1700s transformation of surgery from trade to profession via science and technical innovation. Rise of

anatomical specialties: pathological anatomy, comparative anatomy, embryology (Rutkow 235)

1711 William Cheselden (1688 – 1752) begins private anatomy courses in England.

1718 Army hospitals placed under military regulation in France

1719 Surgeons and Barbers are formally separated in Glasgow

1719 Westminster Infirmary est. (London)

1721 Work begins on Guy’s Hopsital (London)

1726 Guy’s Hospital est. (London)

1728 Jervis Street Hospital est. (Dublin)

1729 Edinburgh Royal Infirmary est.

1730 – 1735(?) George II of England established a new university at Göttingen

1731 Academie de Chirurgie founded in Paris

1731 over 2000 unlicensed surgical schools exist in Paris (Rutkow 241)

1731 Royal Academy of Surgery established in Paris

1733 Saint George’s Hospital est. (London)

1733 Stephen Hales Measures blood pressure

1736 Hospital medical school established at Edinburgh Hospital

1740 London Hospital est.

1743 French royal decree requires that surgical candidates in Paris must complete master of arts from

French university and surgeons are separated from barbers and wigmakers (Rutkow 243) (Zimmerman

361)

1744 John Ranby (1703 – 1773) publishes Method of Treating Gunshot Wounds.

1745 London surgeons separate from the Company of Barber-Surgeons and found the Company of

Surgeons

1745 Middlesex Hospital est. (London)

1749-50 Surgeons in Paris no longer subordinate to physicians by royal decree

1753 Identification of scurvy by James Lind (1716 - 1794)

1754-55 Albrecht von Haller, Swiss, published many anatomical findings (Moore, pp 70-76)

1756 Hospital medical school established at Dublin’s Meath Hospital

1761 Giovanni Moragini publishes Book on how “Disease could be correlated with site specific damage

found in the patient’s body on autopsy” (Burnham, p95)

1762 Army hospitals placed under military regulation in England

1764 Systematic lectures on surgery start to be delivered in London hospitals in addition to medical

schools (Rutkow, 261)

1767 Leopold Auenbrugger (1722 – 1809) introduces auscultation, the tapping of the chest to

determine fluids in the chest.

1775 - 84 William Withering documents 156 cases of treating dropsy with foxglove which contains

digitalis.

1785 Hospital medical school established at London Hospital

1788 Royal College of Surgery in Madrid, Spain established. (Lindemann, 115)

1790 Hospital medical school established at St. Bartholomew’s

1790 Post-Revolution Committee of Health in France declares that physicians and surgeons are to have

the same education exams.

1790s Dominique-Jean Larrey (1766 – 1842) successfully experiments with resuscitation of drowned and

asphyxiated people by pumping a bellows through their nose.

1790s Elisha Perkins, quack used “two pointed pieces of metal [directed] at the seat of an illness [to]

cure the illness” (Burnham, p101)

1791 Parisian Universities start to close their medical schools

1792 France abolishes guild charters, corporations, scientific societies and both College of Surgery and

Academy of Surgery. The quality of military surgery and health of soldiers declines rapidly.

1794 France founds new military medical schools. Additionally, Ecole De Santé (School of Health) is the

first school to offer medicine and surgery as one degree.

1798 Smallpox vaccination using cowpox by Edward Jenner (1719 – 1823)

1800 Humphry Davy (1778 – 1829) suggests nitrous oxide use in surgical operations. This is little

regarded and it is not used in practice for several decades.

1800 Royal College of Surgeons est.

1806 George Guthrie publishes a treatise on gunshot wounds advocating “prompt amputation”

(Rutkow, p367)

1816 R.T.H. Laënnec (1781—1826) develops stethoscope in Paris

1818 H(enry) Home Blackadder, Scottish surgeon, publishes "Observations on Phagedæna Gangrænosa"

a history and treatment of gangrene originating in wounds.

1832 Anatomy Act of 1832 expands legal access to unclaimed corpses and requires licensing of anyone

practicing anatomy. Enacted after two series of murderers selling corpses to anatomists (William Burke

& William Hare, 1828, Edinburgh; William & Bishop, 1831, London)

1845 Demonstration of nitrous oxide in tooth extraction at Harvard medical school. The application was

too light and Horace Wells (1815 – 1848) was discredited as a fake.

1846 First surgical operations using Ether performed at Massachusetts General Hospital. In October,

removal of a neck tumor and, In November, an amputation.

1858 Rudolf Virchow (1821 – 1902) publishes “Die Cellularpathologie In Ihrer Begrundung auf

Physkologische Und Pathologische Gewebelehre“ stressing changes to cells and their function as the

source of disease. (Thus ending the humor model of pathology once and for all.)

1864 Louis Pasteur (1822 – 1895) publishes results of dust from the air contaminating sterile fluids

demonstrating that purification is caused by minute organisms in the air.

1870 Joseph Lister publishes “On the Effects of the Antiseptic System of Treatment upon the Salubrity of

a Surgical Hospital” contrasting the mortality rate of amputations. Before antisepsis: 45%. After: 15%

Bibliography

Bennion, Elisabeth. Antique Medical Instruments. London (Russell Chamber, Covent Garden, W.C.2):

Philip Wilson Publishers Ltd for Sotheby Parke Bernet Publishers Ltd, 1980.

Burnham, John C. What Is Medical History? Cambridge, UK: Polity, 2005.

Carmichael, Ann G., and Richard M. Ratzan. Medicine: A Treasury of Art and Literature. New York: H.L.

Levin Assoc. : Distributed by Macmillan Pub. Co, 1991.

Clendening, Logan. Source Book of Medical History: Compiled with Notes by L(ogan) Clendening. New

York: Dover publications, etc, 1960.

Desault, M. and Robert Gosling. Parisian Chirurgical Journal. Translated into English by Robert Gosling.

Vol II. London: 1794. (available via google books)

Gersdorff, Hans von, and Johann Schott. Feldtbuch der Wundtartzney. [New York]: Editions Medicina

Rara, 1971.

Königer, Ernst. Aus der Geschichte der Heilkunst: von Ärzten, Badern und Chirurgen. München: Prestel,

1958.

Lindemann, Mary. Medicine and Society in Early Modern Europe. New Approaches to European history,

16. Cambridge, UK: Cambridge University Press, 1999.

Moore, Wendy. The Knife Man: Blood, Body Snatching, and the Birth of Modern Surgery. New York:

Broadway Books, 2005.

Nuland, Sherwin B. Medicine: The Art of Healing. New York: H.L. Levin Assoicates : Distributed by

Macmillan Pub. Co, 1992.

Paré, Ambroise. The Apologie and Treacse of Ambroise Paré, Containing the Voyages Made into Divers

Places with Many of His Writings Upon Surgery. New York: Dover Publications, 1968.

Paré, Ambroise. Three and Fifty Instruments of Chirurgery / Ambrose Paré. English experience, its record

in early printed books published in facsimile, no. 141. Norwood, N.J.: W.J. Johnson, 1975.

Porter, Roy. The Greatest Benefit to Mankind: A Medical History of Humanity. New York: W.W. Norton,

1999.

Richard Swinney and Scott Crawford, “Medical Reality of Historical Wounds” from Spada 2 Anthology of

Swordsmanship. Chivalry Bookshelf, 2005.

Rutkow, Ira M. Surgery: An Illustrated History. St. Louis: Published by Mosby-Year Book Inc. in

collaboration with Norman Pub, 1993.

Wangensteen, Owen H., and Sarah D. Wangensteen. The Rise of Surgery: From Empiric Craft to Scientific

Discipline. Minneapolis: University of Minnesota Press, 1978.

Wilbur, C. Keith. Antique Medical Instruments: Price Guide Included. West Chester, Pa: Schiffer Pub. Co,

1987.

Wilbur, C. Keith. Revolutionary Medicine, 1700-1800. Old Saybrook, Conn: Globe Pequot Press, 1997.

Zimmerman, Leo M., and Ilza Veith. Great Ideas in the History of Surgery. New York: Dover Publications,

1967.

Gregory, Andrew. Harvey's Heart: The Discovery of Blood Circulation. Revolutions in science. Cambridge,

UK: Icon Books, 2001.

Recommended References

The quick picks – if you need a place to start or need quick secondary source info right now.

Duffin, Jacalyn. History of Medicine: A Scandalously Short Introduction. Toronto: University of Toronto

Press, 1999. [Note: Burnham calls attention to her “Instructions on Sleuthing and Science: How to

research a Question in Medical History”]

Moore, Wendy. The Knife Man: Blood, Body Snatching, and the Birth of Modern Surgery. New York:

Broadway Books, 2005. [Note: This isn’t a source for quick information, but if you have an interest in

Georgian medicine, I recommend starting with this narrative with excellent citations.]

Wangensteen, Owen H., and Sarah D. Wangensteen. The Rise of Surgery: From Empiric Craft to Scientific

Discipline. Minneapolis: University of Minnesota Press, 1978.

Wilbur, C. Keith. Antique Medical Instruments: Price Guide Included. West Chester, Pa: Schiffer Pub. Co,

1987. [Note: This will give you a quick understanding how specific surgical procedures were performed

with notes on how to use the instruments. It will also give you a quick survey of what kind of instrument

might be (or won’t be) available for your time period.]

Kiple, Kenneth F. The Cambridge Historical Dictionary of Disease. Cambridge, UK: Cambridge University

Press, 2003. [Note: This does not contain any citations, however, it is derived based on a larger work by

the same editor and it’s easier to carry or borrow and cheaper to purchase.]

Additional Resources

History of medicine and surgery covering multiple periods.

Dobson, Jessie, and Robert Milnes Walker. Barbers and Barber-Surgeons of London: A History of the

Barbers' and Barber-Surgeons Companies. Oxford: Blackwell Scientific Publications for the Worshipful

Company of Barbers, 1979.

Duffin, Jacalyn. History of Medicine: A Scandalously Short Introduction. Toronto: University of Toronto

Press, 1999. [Note: Burnham calls attention to her “Instructions on Sleuthing and Science: How to

research a Question in Medical History”]

Elmer, Peter. The Healing Arts: Health, Disease and Society in Europe, 1500-1800. Medicine and society

in Europe, 1500-1930. Manchester: Manchester University Press, 2004.

French, R. K. Medicine Before Science: The Rational and Learned Doctor from the Middle Ages to the

Enlightenment. Cambridge, UK: Cambridge University Press, 2003.

Gerber, David A. Disabled Veterans in History. Corporealities. Ann Arbor: University of Michigan Press,

2000.

Hæger, Knut. The Illustrated History of Surgery. New York: Bell Pub. Co, 1988. [Note: Approach this

survey with a grain of salt as it very much focuses on “firsts” and “discoverers”.]

Loudon, Irvine. Medical Care and the General Practitioner, 1750-1850. Oxford: Clarendon Press, 1986.

Norman, Jeremy M., and Fielding H. Garrison. Morton's Medical Bibliography: An Annotated Checklist of

Texts Illustrating the History of Medicine (Garrison and Morton). Aldershot, Hants, England: Scolar Press

; Brookfield, Vt., USA : Gower Pub. Co, 1991.

Risse, Guenter B. Mending Bodies, Saving Souls: A History of Hospitals. New York: Oxford University

Press, 1999.

Young, Sidney. The Annals of the Barber-Surgeons of London, Comp. from Their Records and Other

Sources. London: Blades, East & Blades, 1890.

Sawday, Jonathan. The Body Emblazoned: Dissection and the Human Body in Renaissance Culture.

London: Routledge, 1995.

Whitby JD. "Alcohol in Anaesthesia and Surgical Resuscitation." Anaesthesia. 35. 5 (1980): 502-5.

Journals (list cribbed from Burnham enhanced from SFPL)

American Association for the History of Medicine, and Johns Hopkins University. Bulletin of the History

of Medicine. Baltimore, MD: Johns Hopkins University Press, 1939.

<http://muse.jhu.edu/journals/bulletin_of_the_history_of_medicine/>.

Australian Society of the History of Medicine, and University of Melbourne. Health and History. West

Leederville, WA, Australia: Australian Society for the History of Medicine, 1998.

<http://www.historycooperative.org/hahindex.html>.

Canadian Society for the History of Medicine. Canadian bulletin of medical history Bulletin canadien

d'histoire de la médecine : Journal of the CSHM/SCHM.. [Waterloo, Ont.]: Published by Wilfrid Laurier

University Press for the Canadian Society for the History of Medicine, 1984.

<http://bibpurl.oclc.org/web/12425>.

International Society for the History of Medicine. Vesalius: Official Journal of the International Society

for the History of Medicine = Revue Officielle De La Société Internationale D'Histoire De La Médecine.

Brussels: International Society for the History of Medicine, 1995.

Royal Society of Medicine (Great Britain). Journal of Medical Biography. London: Royal Society of

Medicine, 1993.

Schweizerische Gesellschaft für Geschichte der Medizin und der Naturwissenschaften. Gesnerus. Aarau:

Verlag Sauerländer, 1943.

Society for the Social History of Medicine. Social History of Medicine: The Journal of the Society for the

Social History of Medicine. Oxford: Oxford University Press, 1988. <http://www3.oup.co.uk/sochis>.

Wellcome Trust (London, England). Medical History. [London]: Wellcome Trust Centre for the History of

Medicine at UCL, 1957. <http://bibpurl.oclc.org/web/11318>.

Early science and medicine. Leiden [Netherlands]: E.J. Brill, 1996.

<http://www.jstor.org/journals/13837427.html>.

Prohibitions against dissection

Carlino, Andrea. Books of the Body: Anatomical Ritual and Renaissance Learning. Chicago: University of

Chicago Press, 1999. ISBN:0226092879

Düring, Monika von, Marta Poggesi, and Georges Didi-Huberman. Encyclopaedia Anatomica: Museo La

Specola Florence. Köln: Taschen, 2006.

Hagens, Gunther von, and Angelina Whalley. Gunther Von Hagens' Body Worlds: The Anatomical

Exhibition of Real Human Bodies. Heidelberg, Germany: Institute für Plastination, 2006.

Hartwell, Edward Mussey. The Study of Anatomy, Historically and Legally Considered. Boston: Tolman &

White, 1881.

Merrigan, Thomas. "Anatomy." The Catholic Encyclopedia. Vol. 1. New York: Robert Appleton Company,

1907. 29 Jun. 2008 <http://www.newadvent.org/cathen/01457e.htm>

Diseases, Epidemics and Afflictions

Kiple, Kenneth F. Plague, Pox & Pestilence. London: Weidenfeld & Nicolson, 1997.

Kiple, Kenneth F. The Cambridge Historical Dictionary of Disease. Cambridge, UK: Cambridge University

Press, 2003.

Kiple, Kenneth F. The Cambridge World History of Human Disease. Cambridge: Cambridge University

Press, 1993.

Women’s Health

American Association for the History of Medicine, and Johns Hopkins University. Bulletin of the History

of Medicine. Special issue: Women, Health and Healing in Early Modern Europe. Spring 2008/ Vol 82, No

1 Baltimore, MD: Johns Hopkins University Press, 1939.

Broomhall, Susan. Women's Medical Work in Early Modern France. Gender in history. Manchester:

Manchester University Press, 2004.

Furst, Lilian R. Women Healers and Physicians: Climbing a Long Hill. Lexington, Ky: Univ. Press of

Kentucky, 1997.

Harley D. "Historians As Demonologists: the Myth of the Midwife-Witch." Social History of Medicine :

the Journal of the Society for the Social History of Medicine / SSHM. 3. 1 (1990): 1-26.

Rankin, Alisha M. Medicine for the Uncommon Woman: Experience, Experiment, and Exchange in Early

Modern Germany. Thesis (Ph.D., Dept. of the History of Science)--Harvard University, 2005, 2005.

Ancient and Medieval (see General Medicine)

Mitchell, Piers D. Medicine in the Crusades: Warfare, Wounds, and the Medieval Surgeon. New York:

Cambridge University Press, 2004.

16thC

Clowes, William. A Profitable and Necessarie Booke of Obseruations: For All Those That Are Burned with

the Flame of Gun Powder, &C. and Also for Curing of Wounds Made with Musket and Caliuer Shot ...

Last of All Is Adioined a Short Treatise, for the Cure of Lues Venerea, by Vnctions and Other Approoued

Waies of Curing. London: E. Bollifant, for T. Dawson, 1596.

Fuchs, Leonhart. The new herbal of 1543 = New Kreüterbuch. Köln: Taschen, 2001.

Gregory, Andrew. Harvey's Heart: The Discovery of Blood Circulation. Revolutions in science. Cambridge,

UK: Icon Books, 2001.

Paré, Ambroise, and Janis L. Pallister. On monsters and marvels: Translated with an introduction and

notes by Janis L. Pallister. Chicago u.a: Univ. of Chicago Press, 1982.

Ryff, Walther Hermann. New Kochbuch für die Krancken. Lindau: Antiqua-Verl, 1979.

Siraisi, Nancy G. Medieval & Early Renaissance Medicine: An Introduction to Knowledge and Practice.

Chicago: University of Chicago Press, 1990.

Malgaigne, J.-F., and Wallace B. Hamby. Surgery and Ambroise Paré. Tr. from the French and Ed. by

Wallace B. Hamby. Norman: Univ. of Oklahoma Press, 1965. [Note: Very good overview of history of

surgery from ancient times to 1600)

17thC - mid18thC

Culpeper, Nicholas. Culpeper's Complete Herbal. 1653 London: W. Foulsham, 1950.

Woodall, John, and John Kirkup. The Surgions Mate. 1617 Bath [Eng.]: Kingsmead, 1978.

Georgian and Regency

Gray, Ernest A. The Diary of a Surgeon in the Year 1751-1752, by John Knyveton. New York: D. Appleton-

Century Co, 1937. [Note: Very likely a work of fiction based on the real diaries of Thomas Denman, 1733-

1815. The descriptions and attitudes are not keeping with 18thC surgical views, but more a 20thC

impression of 18thC surgery.]

Larrey, D. J., and Richard Wilmott Hall. Memoirs of Military Surgery, and Compaigns of the French

Armies On the Rhine, in Corsica, Catalonia, Egypt, and Syria, at Boulogne, Ulm, and Austerlitz; in Saxony,

Prussia, Poland, Spain, and Austria. From the French of D.J. Larrey. Baltimore: Joseph Cushing, 1814.

Pain, Stephanie. “The Coachman’s Knee”. New Scientist. 04 Dec. 1999: 46-. London: New Science

Publications. 01 Jul. 2008 <http://environment.newscientist.com/article/mg16422155.400-the-

coachmans-knee.html>

Porter, Roy, and Dorothy Porter. In Sickness and in Health: The British Experience, 1650-1850. New York:

B. Blackwell, 1988.

Ramsey, Matthew. Professional and Popular Medicine in France, 1770-1830: The Social World of

Medical Practice. Cambridge: Cambridge University Press, 1988.

Smith, Leonard D. Lunatic Hospitals in Georgian England, 1750-1830. Routledge studies in the social

history of medicine, 28. New York: Routledge, 2007.

Smollett, Tobias George. The Adventures of Roderick Random. Rendered into HTML by Steve Thomas.

Adelaide: University of Adelaide Library, 2004.

http://ebooks.adelaide.edu.au/s/smollett/tobias/random/ [Note: Although a work of fiction, at least

Smollett was an accomplished surgeon and his depiction of advising and treating a fractured leg is in

keeping with his time.]

Stanley, Peter. For Fear of Pain, British Surgery, 1790-1850. The Wellcome series in the history of

medicine. Amsterdam: Rodopi, 2003.

Post Regency

Druitt, Robert. The Principles and Practice of Modern Surgery. Philadelphia: Blanchard and Lea, 1867.