medicine was much affected in the 15th, 16th and 17th centuries. As described by Hans von Gersdorff, it was compounded of honey, vinegar, verdigris and alum; but, as the years went on, each successive practitioner adopted a more complex formula, until at last the Egyptian unguent lost all semblance of its original composition.

Gersdorff referred to amputation, but he considered the only indication for it to be the onset in the injured limb of St Anthony's fire or, as it is now called, erysipelas. Wounds of heart, lung, stomach, intestine and bladder, he regarded as invariably fatal. Depressed fractures of the skull he did not apparently treat with the trephine, but with a fearful mechanical elevator, whose mode of action ensured certainty as regards the immediate results of the operation. Hans von Gersdorff adds to Brunschwig's 'Stork-beak' several other instruments specially designed for the extraction of bullets. He used also a 'Hock' or long bullet spoon, a Borer' or instrument to thrust into sinuses, a 'Sclang' or thick-toothed curved forceps, another form of special ball forceps, the Klotzzang,' a speculum or 'Loucher,' besides special instruments for the extraction of arrowheads. Not the least interesting part of the Feldtbuch is the inclusion of a disease he calls Lepra, but which the modern medical reader will regard as comprising cases of syphilis. The treatment of this disease was regarded until recent years as the special field of the army surgeon.

In those days, as in these, among the most difficult cases that the military surgeon encountered were contracted limbs with stiff or disorganised joints following gunshot wounds. Gersdorff illustrates for us some of the instruments used in correcting these faults. One such device appears to have been called the Narr,' a cognomen which gives him an opportunity for a punning allusion (see Fig. 1; Narr = fool, jester).

By far the most popular of the early writers on gunshot wounds was, however, Giovanni de Vigo (1460-1520), the medical attendant of Cardinal Giuliano della Rovere, afterwards Pope Julius II. De Vigo's book, Practica in Arte Chirurgia copiosa,' was first printed at Rome in 1514, a few years before Gersdorff's 'Feldtbuch'; and one of its chapters is entitled, De vulnere facto ab instrumento quod bombard nuncupatur et omnibus instrumentis

6

currentibus eorum.' It is evident that Vigo had had practical experience of the treatment of gunshot wounds, though he does not inform us that he ever served in the field. He tells us that these wounds are always round, contused, scalded and poisoned. It has been suggested that the burning or scalding that he describes may have been partly due to the very short range at which actions were fought; more probably the burns were in many cases the work of incendiary arrows. In emphasising the idea that gunshot wounds were necessarily more poisonous than others, Vigo, who was a very influential writer, became responsible for an immense amount of mistaken treatment and unnecessary suffering. He claimed to be a learned surgeon, and professed that his treatment was based on an aphorism of Galen, contusio et combustio indigent humefactione, venositas exsiccatione.' The wound, he advised, should first be seared with a red-hot iron or heated with boiling oil, and then subjected to the action of a variety of ointments, the number and composition of which provide evidence of more erudition than good sense. The method of treating wounds by means of hot irons (Fig. 2) was not the invention of Vigo. It had its roots in antiquity, and the tradition was doubtless greatly reinforced by the mediæval belief in the curative influence of 'branding,'* a method of treatment still extensively practised by numerous savage and semi-civilised African and Asiatic races. Vigo, however, added the full weight of his influence to the practice; and it was a great misfortune for surgery that his writings were exceedingly popular, and were re-edited in numerous editions and frequently translated into the vernaculars of Europe-English, French, Italian, German, Spanish, and Portuguese.

In Italy, notably, Vigo's doctrine of the poisonous character of musket wounds was closely followed by the Neapolitan Alfonso Ferri (1515–1595), who brought out at Rome in 1552 probably the earliest work entirely devoted to the subject of gunshot wounds, 'De sclopetorum sive archibusorum vulneribus.' Ferri, like Vigo,

* Cf. K. Sudhoff, "Tabellen, Bild- und Merkschemata zur Kauterienanwendung bei Erkränkungen,' in 'Beiträge zur Geschichte der Chirurgie im Mittelalter,' erster Teil, Leipzig, 1914, p. 75.

[To face p. 458.

FIG. 2.—CAUTERIZING A WOUND (FROM GERSDORFF).

Below is a brazier in which a cautery is being heated. Above are various

forms of cautery.

was physician to a Pope-Paul III. Although a follower of Vigo in his belief in the poisoned character of gunpowder, he gives an impression of wider experience, sounder common sense, and greater independence of mind than his more influential predecessor. He observed that small pieces of clothing and fragments of mail were often driven into the wound by the bullet or bomb, and gave rise to obstinate suppuration. He advises, therefore, the routine use of a sound or probe to explore the wound for such foreign bodies; but he points out that the best and most delicate of all probes is the finger of the surgeon himself, which should be used when possible. For the extraction of the bullet he adopts a simple and ingenious instrument, the 'Alphonsinum' (Fig. 4 (2)). This consists of three long rods which are drawn together over the bullet or other foreign body by means of a movable ring. Ferri also adopted a method of ligaturing a cut vessel by underpinning. Being without knowledge of the circulation of the blood, surgeons at that date sometimes failed to distinguish between arterial and venous hæmorrhage ; and Ferri advises ligature above the wound in both cases. His method, however, is neat and practical, and must often have been of value. Seeing the skill he thus brought to bear on the control of hæmorrhage, it is disappointing to find him yielding to the popular fashion of blood-letting. He shows, however, his good sense by his comparative moderation in the use of such depletory measures. He is also sound and modern in his view that purulent matter must always be given free vent, and that a foreign body buried in a part where it is doing no harm is, like a sleeping dog, best left to lie.

Towards the middle of the 16th century appeared two works which, though not devoted to our subject, were yet destined to have a great influence on its development. The 'Grosse Wundartzney' of Philippus Aureolus Theophrastus Bombastus von Hohenheim, better known as Paracelsus (1491-1541), was published in 1536 in two parts, the first at Ulm and the second at Augsburg, both bearing the dedication to the Emperor Ferdinand I.*

* The third part promised in the preface never appeared. The publication of certain other works of Paracelsus as the third part of this work has introduced much confusion into the already sufficiently confused bibliography of this writer.