Surgery*
‘It is also most requisite, that a Chirurgeon should be furnished with necessary Instruments’.[1]
Worth was clearly deeply interested in surgery, a topic which has been explored in another annual Worth Library exhibition, which examines not only his medieval texts by famous authors such as Abu al-Qasim Khalaf bin Abbas Al-Zahrawi (936–1013) and Guy de Chauliac (c. 1300–68), but also more contemporary surgical books in his wide-ranging collection which deal with instruments, various operations and wounds of war. Surgical skills were not only useful for treatments that required blood-letting: Worth would have been well-aware of their use in treating certain diseases, for his extensive collection of works on plague included tracts by François Chicoyneau (1672–1752), a physician based at the Faculty of Medicine, who advocated surgical excision of buboes during the horrific plague at Marseilles in 1720.
Wilhelm Fabricius Hildanus, Cista militaris, or, a Military Chest, furnished either for Sea, or Land, with convenient Medicines, and necessary Instruments. Among which is also a Description of Dr Lower’s Lancet, for the more safe bleeding. Written in Latin, By Gulielmus Fabritius Hildanus, Englished for publick benefit, which is appended to Paul Barbette’s Thesaurus chirurgiae: the chirurgical and anatomical works … Composed according to the doctrine of the circulation of the blood, and other new inventions of the moderns. Together with a treatise of the plague, illustrated with observations. Translated out of Low-Dutch into English (London, 1676), title page.
Among Worth’s many works on the subject is this English translation of the ‘Cista Militaris’ of the famous German surgeon Wilhelm Fabricius Hildanus (1560–1634), which was included in Paul Barbette’s seminal text on surgery and anatomy. As the title of the tract suggests, the translation was not only directed at physicians and surgeons but also the general public – it was ‘Englished for publick Benefit’ – and the reasons are not hard to see because Fabricius Hildanus provided his readers with a useful summary of what should be included in an early modern first-aid cabinet!
Fabricius Hildanus’ ‘doctor’s bag’ was based on the military chest of Maurice (1567–1625), Prince of Orange, which he had seen in 1612. As his description suggests, it was impressively comprehensive, for not only did it include a host of surgical instruments (plates of which were included and may be seen below), but it also contained medicines (especially for purging) and surgical necessities, such as linen bandages. Bandages were especially important because the chest contained the necessities for a field hospital – given Maurice’s military career. Fabricius Hildanus aimed to ‘set down both the principal Medicaments, and Instruments, that a Chirurgeon, following the Camp or Sea, ought to be provided with’.[2] In doing so his tract gives us an invaluable insight into what he thought were essential elements in a military or naval surgeon’s work.
Images of surgical instruments in Wilhelm Fabricius Hildanus, Cista militaris, or, a Military Chest, furnished either for Sea, or Land, with convenient Medicines, and necessary Instruments. Among which is also a Description of Dr Lower’s Lancet, for the more safe bleeding. Written in Latin, By Gulielmus Fabritius Hildanus, Englished for publick benefit, which is appended to Paul Barbette’s Thesaurus chirurgiae: the chirurgical and anatomical works … Composed according to the doctrine of the circulation of the blood, and other new inventions of the moderns. Together with a treatise of the plague, illustrated with observations. Translated out of Low-Dutch into English (London, 1676). Source: Wellcome Collection.
Fabricius Hldanus was keen that surgical instruments should be kept in such a way as to retain their sharpness (i.e. in cases, flannel or paper). He was adamant in keeping an orderly inventory of contents – one which could be replenished on arriving at a town. As might be expected, the range of instruments he suggested was wide, and these he divided into those which were portable (which the surgeon should carry to meet any emergency), and those which were more unwieldy. He recommended that the former group should be small – not only to make them easier to carry but also not to shock the patients![3] Fabricius Hildanus tells us something of his own practice as a surgeon when he says that ‘I never visited my Patients without a Box of Instruments in my Pocket, in the which were contained the following: A Razor; A pair of Scissors; Two Incision Knives; Four Lancets to bleed withall; A crooked Knife, to open Apostems’.[4]
This was just the tip of the iceberg, for Fabricius Hildanus also included needles, forceps, a stitching quill, spatula and a hone make sure that all instruments were sharp – and these were just what should be in his ‘doctor’s bag’. Larger instruments were listed according to their use: for example: ‘1. Trepans, by which the Skull is perforated in great Contusions, to give passage to extravasated and concreted blood collected in the head; 2. Levatories, to raise the depressed skull’.[5] But it was not all brain surgery: speculums ‘to force open the Mouth’ were listed side by side with ‘Several Instruments to draw Teeth’ and, as might be expected, he had several to deal with gun-shots as well as ‘A great Saw, for amputating great Members’.[6] Smaller saws might be used for working on fingers and toes. Fabricius Hildanus noted that while most other surgeons generally used a knife in amputating he preferred the use of a ‘Cautery, made in fashion of a Knife, well edged, and red hot’.[7]
Surgical instruments: a variety of forceps, drills and scissors, with demonstrational figures. Etching by R.W., 1687. Wellcome Collection. Source: Wellcome Collection.
A surgeon was also expected to be able to set broken bones and (as with gunshot wounds) the chief authority was Ambroise Paré (1510–90): ‘For the reducing of Broken Bones, and Dislocations there are several Instruments, both by Hippocrates, Oribasius, and other Authors, set down; but I have always found in my practice the Instrument of Ambrose Parey, which is with a Pulley, the most convenient’.[8] Splints were likewise a necessity for surgeons – in all different sizes, and made from wood or ‘scabbards’.[9] Bandages of all kinds were vital, along with lint ‘to keep the lips of the Wounds asunder, that they unite not again’.[10] Paré was, understandably, the chief authority here, given his surgical experiences in war-torn France, and the images which Fabricius Hildanus appended to his text were based primarily on those of Paré and Joannes Andreas Della Cruce (1542–91), the latter known for his work on cranial sutures.
Thomas Brugis, Vade mecum: or, A companion for a chirurgion. Fitted for sea, or land; peace, or war. Shewing the use of his instruments, and virtues of medicines simple and compound most in use, and how to make them up after the best method. With the manner of making reports to a magistrate, or corroner’s inquest. A treatise of bleeding at the nose. With directions for bleeding, purging, vomiting, &c. (London, 1681), frontispiece.
Fabricius Hildanus’ ‘doctor’s bag’ was very extensive indeed, containing as many items as he thought might be needed during a military campaign, be it on land or sea. The English surgeon Thomas Brugis (b. in or before 1620, d. in or after 1651), likewise emphasized that surgeons should keep a supply of items in their ‘Emplaster Box’ but his list was far more manageable: ‘Incision Knife; Scissers; Forcipes; Plain Spathula; Spathula, or Speculum Linguae; Single, and Screw Probe; Uvula Spoon; Stitching Quill, with three Chyrurgions Needles, of several sizes; Director, with Speculum Oculi; Fleme’.[11] Both ‘doctors’ bags’ reminds us that, while surgeons were chiefly concerned with manual operations, the range of their medical work was very broad indeed – as the above frontispiece of Brugis’ surgical manual makes clear. In addition, in order to further their practice they needed also to master related topics such as anatomy and physiology – topics which have been explored in another of our annual online exhibitions.
Brugis’ Vade mecum was to prove a massively popular work, going through nine editions in a period of forty years, making it, as Leong notes, ‘one of the best-selling surgical manuals in early modern England’.[12] It was popular because it was a well-ordered, easy to read, pocket-sized blend of Brugis’ own practical experience as a surgeon and his reading. Brugis described himself as a ‘Doctor in Physic’ on the title page and Ward notes that he may have studied at the University of Paris under Jean Riolan the Younger (1577–1657), whose works were likewise collected by Worth.[13] As a practitioner, Brugis primarily focused on surgery and his Vade mecum was a distillation of his surgical career, which could be of use not only to aspiring surgeons, but also as a refresher course to more established members of the profession. Moreover, as Leong makes clear, the book was wide-ranging, offering not only practical, clearly written instructions for surgical operations but also information on how to make medicines.[14] As such its readership stretched beyond the confines of medical professionals such as physicians and surgeons, to encompass that most lucrative of medical markets, the patients themselves.[15] It was, therefore, yet another vernacular text which aimed to inform medicine in the home.
Text: Dr Elizabethanne Boran, Librarian of the Edward Worth Library, Dublin.
Sources
Brugis, Thomas, Vade mecum: or, A companion for a chirurgion. Fitted for sea, or land; peace, or war. Shewing the use of his instruments, and virtues of medicines simple and compound most in use, and how to make them up after the best method. With the manner of making reports to a magistrate, or corroner’s inquest. A treatise of bleeding at the nose. With directions for bleeding, purging, vomiting, &c (London, 1681).
Fabricius Hildanus, Wilhelm, Cista militaris, or, a Military Chest, furnished either for Sea, or Land, with convenient Medicines, and necessary Instruments. Among which is also a Description of Dr Lower’s Lancet, for the more safe bleeding. Written in Latin, By Gulielmus Fabritius Hildanus, Englished for publick benefit, which is appended to Paul Barbette’s Thesaurus chirurgiae: the chirurgical and anatomical works … Composed according to the doctrine of the circulation of the blood, and other new inventions of the moderns. Together with a treatise of the plague, illustrated with observations. Translated out of Low-Dutch into English (London, 1676).
Leong, Elaine, ‘Learning medicine by the book: reading and writing surgical manuals in early modern London’, British Journal for the History of Science, 5 (2020), 93–110.
Ward, Jenny, ‘Brugis, Thomas (b. in or before 1620, d. in or after 1651), surgeon’, Oxford Dictionary of National Biography (ODNB).
*None of these medicines and operations should be attempted!
[1] Fabricius Hildanus, Wilhelm, Cista militaris, or, a Military Chest, furnished either for Sea, or Land, with convenient Medicines, and necessary Instruments. Among which is also a Description of Dr Lower’s Lancet, for the more safe bleeding. Written in Latin, By Gulielmus Fabritius Hildanus, Englished for publick benefit, which is appended to Paul Barbette’s Thesaurus chirurgiae: the chirurgical and anatomical works … Composed according to the doctrine of the circulation of the blood, and other new inventions of the moderns. Together with a treatise of the plague, illustrated with observations. Translated out of Low-Dutch into English (London, 1676), p. 21.
[2] Ibid., p. 9.
[3] Ibid., p. 23.
[4] Ibid., p. 22.
[5] Ibid., p. 24.
[6] Ibid., p. 25.
[7] Ibid., p. 26.
[8] Ibid., p. 27.
[9] Ibid., p. 27.
[10] Ibid., p. 29.
[11] Brugis, Thomas, Vade mecum: or, A companion for a chirurgion. Fitted for sea, or land; peace, or war. Shewing the use of his instruments, and virtues of medicines simple and compound most in use, and how to make them up after the best method. With the manner of making reports to a magistrate, or corroner’s inquest. A treatise of bleeding at the nose. With directions for bleeding, purging, vomiting, &c (London, 1681), p. (1).
[12] See Leong, Elaine, ‘Learning medicine by the book: reading and writing surgical manuals in early modern London’, British Journal for the History of Science, 5 (2020), 94.
[13] Ward, Jenny, ‘Brugis, Thomas (b. in or before 1620, d. in or after 1651), surgeon’, Oxford Dictionary of National Biography (ODNB).
[14] Leong, ‘Learning medicine by the book’, 104–6.
[15] Ibid., 107.