Of the half-dozen surgeons who were prominent in the sixteenth century, Ambroise Pare (1517-1590), called the father of French surgery, is perhaps the most widely known. He rose from the position of a common barber to that of surgeon to three French monarchs, Henry II., Francis II., and Charles IX. Some of his mottoes are still first principles of the medical man. Among others are: "He who becomes a surgeon for the sake of money, and not for the sake of knowledge, will accomplish nothing"; and "A tried remedy is better than a newly invented." On his statue is his modest estimate of his work in caring for the wounded, "Je le pansay, Dieu le guarit"—I dressed him, God cured him.

It was in this dressing of wounds on the battlefield that he accidentally discovered how useless and harmful was the terribly painful treatment of applying boiling oil to gunshot wounds as advocated by John of Vigo. It happened that after a certain battle, where there was an unusually large number of casualties, Pare found, to his horror, that no more boiling oil was available for the surgeons, and that he should be obliged to dress the wounded by other simpler methods. To his amazement the results proved entirely satisfactory, and from that day he discarded the hot-oil treatment.

As Pare did not understand Latin he wrote his treatises in French, thus inaugurating a custom in France that was begun by Paracelsus in Germany half a century before. He reintroduced the use of the ligature in controlling hemorrhage, introduced the "figure of eight" suture in the operation for hare-lip, improved many of the medico-legal doctrines, and advanced the practice of surgery generally. He is credited with having successfully performed the operation for strangulated hernia, but he probably borrowed it from Peter Franco (1505-1570), who published an account of this operation in 1556. As this operation is considered by some the most important operation in surgery, its discoverer is entitled to more than passing notice, although he was despised and ignored by the surgeons of his time.

Franco was an illiterate travelling lithotomist—a class of itinerant physicians who were very generally frowned down by the regular practitioners of medicine. But Franco possessed such skill as an operator, and appears to have been so earnest in the pursuit of what he considered a legitimate calling, that he finally overcame the popular prejudice and became one of the salaried surgeons of the republic of Bern. He was the first surgeon to perform the suprapubic lithotomy operation—the removal of stone through the abdomen instead of through the perineum. His works, while written in an illiterate style, give the clearest descriptions of any of the early modern writers.

As the fame of Franco rests upon his operation for prolonging human life, so the fame of his Italian contemporary, Gaspar Tagliacozzi (1545-1599), rests upon his operation for increasing human comfort and happiness by restoring amputated noses. At the time in which he lived amputation of the nose was very common, partly from disease, but also because a certain pope had fixed the amputation of that member as the penalty for larceny. Tagliacozzi probably borrowed his operation from the East; but he was the first Western surgeon to perform it and describe it. So great was the fame of his operations that patients flocked to him from all over Europe, and each "went away with as many noses as he liked." Naturally, the man who directed his efforts to restoring structures that bad been removed by order of the Church was regarded in the light of a heretic by many theologians; and though he succeeded in cheating the stake or dungeon, and died a natural death, his body was finally cast out of the church in which it had been buried.

In the sixteenth century Germany produced a surgeon, Fabricius Hildanes (1560-1639), whose work compares favorably with that of Pare, and whose name would undoubtedly have been much better known had not the circumstances of the time in which he lived tended to obscure his merits. The blind followers of Paracelsus could see nothing outside the pale of their master's teachings, and the disastrous Thirty Years' War tended to obscure and retard all scientific advances in Germany. Unlike many of his fellow-surgeons, Hildanes was well versed in Latin and Greek; and, contrary to the teachings of Paracelsus, he laid particular stress upon the necessity of the surgeon having a thorough knowledge of anatomy. He had a helpmate in his wife, who was also something of a surgeon, and she is credited with having first made use of the magnet in removing particles of metal from the eye. Hildanes tells of a certain man who had been injured by a small piece of steel in the cornea, which resisted all his efforts to remove it. After observing Hildanes' fruitless efforts for a time, it suddenly occurred to his wife to attempt to make the extraction with a piece of loadstone. While the physician held open the two lids, his wife attempted to withdraw the steel with the magnet held close to the cornea, and after several efforts she was successful—which Hildanes enumerates as one of the advantages of being a married man.

Hildanes was particularly happy in his inventions of surgical instruments, many of which were designed for locating and removing the various missiles recently introduced in warfare.

The seventeenth century, which was such a flourishing one for anatomy and physiology, was not as productive of great surgeons or advances in surgery as the sixteenth had been or the eighteenth was to be. There was a gradual improvement all along the line, however, and much of the work begun by such surgeons as Pare and Hildanes was perfected or improved. Perhaps the most progressive surgeon of the century was an Englishman, Richard Wiseman (1625-1686), who, like Harvey, enjoyed royal favor, being in the service of all the Stuart kings. He was the first surgeon to advocate primary amputation, in gunshot wounds, of the limbs, and also to introduce the treatment of aneurisms by compression; but he is generally rated as a conservative operator, who favored medication rather than radical operations, where possible.

In Italy, Marcus Aurelius Severinus (1580-1656) and Peter Marchettis (1589-1675) were the leading surgeons of their nation. Like many of his predecessors in Europe, Severinus ran amuck with the Holy Inquisition and fled from Naples. But the waning of the powerful arm of the Church is shown by the fact that he was brought back by the unanimous voice of the grateful citizens, and lived in safety despite the frowns of the theologians.

The sixteenth century cannot be said to have added much of importance in the field of practical medicine, and, as in the preceding and succeeding centuries, was at best only struggling along in the wake of anatomy, physiology, and surgery. In the seventeenth century, however, at least one discovery in therapeutics was made that has been an inestimable boon to humanity ever since. This was the introduction of cinchona bark (from which quinine is obtained) in 1640. But this century was productive of many medical SYSTEMS, and could boast of many great names among the medical profession, and, on the whole, made considerably more progress than the preceding century.

Of the founders of medical systems, one of the most widely known is Jan Baptista van Helmont (1578-1644), an eccentric genius who constructed a system of medicine of his own and for a time exerted considerable influence. But in the end his system was destined to pass out of existence, not very long after the death of its author. Van Helmont was not only a physician, but was master of all the other branches of learning of the time, taking up the study of medicine and chemistry as an after-thought, but devoting himself to them with the greatest enthusiasm once he had begun his investigations. His attitude towards existing doctrines was as revolutionary as that of Paracelsus, and he rejected the teachings of Galen and all the ancient writers, although retaining some of the views of Paracelsus. He modified the archaeus of Paracelsus, and added many complications to it. He believed the whole body to be controlled by an archaeus influus, the soul by the archaei insiti, and these in turn controlled by the central archeus. His system is too elaborate and complicated for full explanation, but its chief service to medicine was in introducing new chemical methods in the preparation of drugs. In this way he was indirectly connected with the establishment of the Iatrochemical school. It was he who first used the word "gas"—a word coined by him, along with many others that soon fell into disuse.

The principles of the Iatrochemical school were the use of chemical medicines, and a theory of pathology different from the prevailing "humoral" pathology. The founder of this school was Sylvius (Franz de le Boe, 1614-1672), professor of medicine at Leyden. He attempted to establish a permanent system of medicine based on the newly discovered theory of the circulation and the new chemistry, but his name is remembered by medical men because of the fissure in the brain (fissure of Sylvius) that bears it. He laid great stress on the cause of fevers and other diseases as originating in the disturbances of the process of fermentation in the stomach. The doctrines of Sylvius spread widely over the continent, but were not generally accepted in England until modified by Thomas Willis (1622-1675), whose name, like that of Sylvius, is perpetuated by a structure in the brain named after him, the circle of Willis. Willis's descriptions of certain nervous diseases, and an account of diabetes, are the first recorded, and added materially to scientific medicine. These schools of medicine lasted until the end of the seventeenth century, when they were finally overthrown by Sydenham.

The Iatrophysical school (also called iatromathematical, iatromechanical, or physiatric) was founded on theories of physiology, probably by Borelli, of Naples (1608-1679), although Sanctorius; Sanctorius, a professor at Padua, was a precursor, if not directly interested in establishing it. Sanctorius discovered the fact that an "insensible perspiration" is being given off by the body continually, and was amazed to find that loss of weight in this way far exceeded the loss of weight by all other excretions of the body combined. He made this discovery by means of a peculiar weighing-machine to which a chair was attached, and in which he spent most of his time. Very naturally he overestimated the importance of this discovery, but it was, nevertheless, of great value in pointing out the hygienic importance of the care of the skin. He also introduced a thermometer which he advocated as valuable in cases of fever, but the instrument was probably not his own invention, but borrowed from his friend Galileo.

Harvey's discovery of the circulation of the blood laid the foundation of the Iatrophysical school by showing that this vital process was comparable to a hydraulic system. In his On the Motive of Animals, Borelli first attempted to account for the phenomena of life and diseases on these principles. The iatromechanics held that the great cause of disease is due to different states of elasticity of the solids of the body interfering with the movements of the fluids, which are themselves subject to changes in density, one or both of these conditions continuing to cause stagnation or congestion. The school thus founded by Borelli was the outcome of the unbounded enthusiasm, with its accompanying exaggeration of certain phenomena with the corresponding belittling of others that naturally follows such a revolutionary discovery as that of Harvey. Having such a founder as the brilliant Italian Borelli, it was given a sufficient impetus by his writings to carry it some distance before it finally collapsed. Some of the exaggerated mathematical calculations of Borelli himself are worth noting. Each heart-beat, as he calculated it, overcomes a resistance equal to one hundred and eighty thousand pounds;—the modern physiologist estimates its force at from five to nine ounces!

But while the Continent was struggling with these illusive "systems," and dabbling in mystic theories that were to scarcely outlive the men who conceived them, there appeared in England—the "land of common-sense," as a German scientist has called it—"a cool, clear, and unprejudiced spirit," who in the golden age of systems declined "to be like the man who builds the chambers of the upper story of his house before he had laid securely the foundation walls."(1) This man was Thomas Sydenham (1624-1689), who, while the great Harvey was serving the king as surgeon, was fighting as a captain in the parliamentary army. Sydenham took for his guide the teachings of Hippocrates, modified to suit the advances that had been made in scientific knowledge since the days of the great Greek, and established, as a standard, observation and experience. He cared little for theory unless confirmed by practice, but took the Hippocratic view that nature cured diseases, assisted by the physician. He gave due credit, however, to the importance of the part played by the assistant. As he saw it, medicine could be advanced in three ways: (1) "By accurate descriptions or natural histories of diseases; (2) by establishing a fixed principle or method of treatment, founded upon experience; (3) by searching for specific remedies, which he believes must exist in considerable numbers, though he admits that the only one yet discovered is Peruvian bark."(2) As it happened, another equally specific remedy, mercury, when used in certain diseases, was already known to him, but he evidently did not recognize it as such.

The influence on future medicine of Sydenham's teachings was most pronounced, due mostly to his teaching of careful observation. To most physicians, however, he is now remembered chiefly for his introduction of the use of laudanum, still considered one of the most valuable remedies of modern pharmacopoeias. The German gives the honor of introducing this preparation to Paracelsus, but the English-speaking world will always believe that the credit should be given to Sydenham.

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