probably as good a dressing as any that was applied to gunshot wounds until the days of Lister and Pasteur.

A character somewhat similar to Paré, but far inferior, was that of the Swiss, Felix Wirtz (1514–1574) of Basel, whose 'Practica der Wundartzney' first appeared in 1563 and went through numerous editions, some of which were edited by his son. Wirtz was a friend of his great and scholarly countryman, Conrad Gesner, who collected into a volume some of the most interesting of the 16thcentury treatises on gunshot wounds. Wirtz himself had travelled much in Italy, France, and the Low Countries, but we have no information as to what were the campaigns in which he gained his experience. He was an ignorant man and proud of his ignorance, but as a surgeon he was skilful and efficient. Wounds involving the great cavities of the body he regards as always fatal, and he therefore dismisses them as beyond his province. Gunshot wounds he considers to be poisonous only when severely burnt. He advises that they should be washed out and afterwards dressed with a salve compounded of gum tragacanth and the old German folk-medicine 'Ehrenpreis' (speedwell). In those days the soldiers themselves had many rough remedies for their own wounds; and one of these, which savours of sympathetic magic, was a draught of gunpowder and water. This is probably the origin of a potion recommended by Wirtz, consisting of a solution of saltpetre. In other cases he gave 'aqua vita'-a mixture of myrrh and spirit of hartshorn (which in those days was really made from the horn of the hart), or one of those ever reappearing marvels of medieval therapeutic ingenuity, the Mithridate or the Theriac. On the whole, Wirtz does not seem to us worthy of the praise that has been lavished on him by Billroth and other German writers; but he appears at his best, to modern eyes, in his opposition to all undue interference with wounds, such as probing, tamponage or the use of tents, to which resort was so frequent in his time.

In England the general level of surgery during the 16th century was, it must be admitted, below the best Continental standards. There was no Elizabethan surgeon who made any addition to knowledge; and the work of the only two who may be mentioned here

shows little independence of thought and no originality. Thomas Gale (1507-1587) served in the army of Henry VIII in 1544 and in that of Philip of Spain in 1557. Later he settled in London, and became Master of the Barber Surgeons' Company in 1561. In 1563 he published 'An excellent Treatise of wounds made with Gonneshot, in which is confuted bothe the grose errour of Jerome Brunswicke, John Vigo, Alfonse Ferrius and others, in that they make the wound venemous, whiche commeth through the common pouder & shotte: And also there is set out a perfect & trew methode of curyng these woundes.' There is nothing of special value in Gale's work, the limitations of which may be gathered from his advice that surgeons may know perfectly when to trepan by the following signs: 'Yf he haue vertiginem, or thinketh he seeth many lyghtes, yf he haue alienation of mynde, or swellynge & tumour of the eyes wyth rednesse, or bleedyng at the nostrelles or eares, also vomityng, resolution of some one parte & appoplexie.' If he followed his own teaching, a very high percentage of his patients must have undergone the trephine. Wounds of the abdomen Gale held to be always fatal if the viscera were penetrated; but he considered that there was a group of wounds of the belly in which the shot remained harmlessly in that cavity. In such a case:

'you shall labour to get out the shot, placyng the pacient upon the wound, & roll him from part to part, prouoking thereby the shot to come to the orifice of the wound. Then wyth a probe made apte & conuenient for the same use, take out the shot. But if so be that you cannot wythout great payne & much searching fynde the shot, it is much better to let it remayn within, then wyth prouoking of mortall accidentes labour the takynge of it out.'

At a somewhat higher level than Gale stands William Clowes the elder (1540-1604). In 1563 Clowes was surgeon in the army commanded by Ambrose, Earl of Warwick, in France. Later he served also in the navy, and about 1569 he settled in London, where he was a very successful practitioner. He became surgeon both to St Bartholomew's and to Christ's Hospital. In 1585 he went to the Low Countries to attend the Earl of Leicester in command of the English forces, and later he

served in the fleet that defeated the Armada. In 1588 appeared his work 'A prooued practise for all young Chirurgions, concerning burnings with Gunpowder, & wounds made with Gunshot, Sword, Halbard, Pike, Launce or such other.' Clowes was a master of vituperative controversy. He writes very hardly of the 'wicked brood of beastly abusers of Phisicke and Chirurgie, daylie more and more increasing, to the utter undoing of many'; and he describes his consultations with more than one such 'shameless beast.' His text is thus more entertaining than scientific; but a valuable element is the description that he gives of actual cases treated, though his style deteriorates and becomes more involved as he turns from abuse to the description of mere surgical procedure.

We may terminate our subject with a description of an amputation in which Clowes gives a good idea of the conditions under which operations were then performed:

The maner & order of the taking or cutting off a mortified or corrupt legge or arme, which commeth oftentimes by reason of wounds made with gunshot. . . . If a legge is to be cut off beneath the knee, then let it be distant from the joynt iiij inches, & iij inches above the knee; & so likewise, in the arme as occasion is offered. These things being obserued and noted, then through the assistance of almightie God, you shall luckelie accomplish this work by your good industrie & diligence. . . . After his bodie is prepared & purged, then the same morning you doe attempt to cut off the member, be it legge or arme, let him haue two houres before some good comfortable Caudle . . . to corroborate his stomache. And in any wise omit not that he haue ministred unto him some good exhortation by the Minister or Preacher. . . . All which being well considered, you shall haue in a readinesse a good strong fourme & a stedie, & set the patient at the very ende of it; then shall there bestride the fourme behinde him a man that is able to hould him fast by both his armes. . . . Let there bee also an other strong man appoynted to bestride the legge that is to be taken off; & he must hould fast the member aboue the place where the incision is to be made, very stedily without shaking; & he that doth so hould should haue a large hand & a good gripe, whose hand may the better stay the bleeding. . . . And I haue knowne through the skilfulnesse of the houlder not much aboue iiij oz, of bloud lost at a time' (pp. 25, 26).

After describing the operation itself, and the preparation of 'buttons' or pads to stop the bleeding, he goes on:

'And when the houlder of the member aboue doth partly release the fast holding of his hand by little & little, by which meanes you may the better perceiue & see the mouthes of the veynes that are incised & cut, upon the endes of those large veynes that are incised & cut, you shall place the round endes of these small buttons, & upon them presently, without tariance, place a round thicke bed of Tow made up in water & vinegar.... . . And you shall tye the large bed to, with a ligature which they call a choke band, . . . & after it hath remayned on a small time, being thus fast tyed, then you shall place upon these a double large bedde of soft linnen cloth; & then with a strong rouller of foure inches broade, & three or foure yards long, let it bee artificially roulled; & whereas the bloud beginneth to show through all in that place, you shall specially lay a good compressor or thick bolster made of Towe wrought up in water and vinegar the thickness almost of a man's hand. . . . Thus let him lye with as much quietnesse as may be' (pp. 28, 29).

Who can measure the misery and pain from which we have been delivered by surgical progress? Who can compute the honour that we owe to the memory of Florence Nightingale and Lister, of Simpson and Pasteur, who have removed most of these horrors from the circumstance of war, have at once steeled and softened the surgeon's hand by changing agony into oblivion, and have magically transformed our hospitals from houses of pain into palaces of hope?

CHARLES SINGER.

Art. 9.-THE STUDY OF BRITISH FOREIGN POLICY.*

ONE result of the war has been to turn our attention from domestic to foreign affairs. For a long time the British electorate had been so wrapped up in our own constitutional struggles that it was almost completely blind and deaf to other issues. It has been brought back to the affairs of Europe as it were by an earthquake. People who never thought seriously about the relations of England and the Continent, and were content to leave foreign policy to our Foreign Secretaries, begin to form opinions of their own, and will in due season express them at the poll. A new period of our history has begun, in which a democracy, hitherto indifferent to external problems and exceptionally ignorant about them, will demand information about these problems, and cannot without great peril to national interests be left as uninformed as it is.

First of all, what is the origin of this indifference or this ignorance? It is no new thing; it did not begin with the triumph of democracy in the 19th century, although it was aggravated by that fact. The smaller and narrower electorate of the 17th, the 18th, and the early 19th centuries was no better informed on these subjects than the electors of to-day. Nor was Parliament itself any better informed than it is now; on the contrary, judging from the debates, it was more ignorant. Chesterfield, in a letter written on Feb. 9, 1748, says:

Lord

'We are in general in England ignorant of foreign affairs and of the interests, views, pretensions, and policy of other Courts. That part of knowledge never enters into our thoughts nor makes part of our education; . . and when foreign affairs happen to be debated in Parliament it is incredible with how much ignorance.' ('Letters,' I, 247, ed. 1827.)

Compare another complaint, written about a century and a half later, after three Reform Bills had raised the electorate from one to five millions:

'We are too much in the habit in this country of attending only to one subject at a time; and, when we are thinking about

* An address delivered to the Royal Historical Society on Feb. 17, 1916.