[Reprint from The Canadian Practitioner, Toronto, 
February, 1888.] 
ON SOME OF THE SURGEONS 
OF THE LAST CENTURY. 
BY 
JOHN H. PACKARD, M.D., 
PHILADELPHIA. 
(Read before the Meeting of the Ontario Medical Association, 
June 8th.) 
J. E. Bryant & Co., Publishers, Toronto, Canada. ON SOME OF THE SURGEONS OF 
THE LAST CENTURY. 
A recent writer has said that among the 
commonest tricks played upon us by the asso- 
ciation of ideas, is that which leads us to as- 
sume that ancient times were populated by 
ancient people. And among the earliest terms 
of disparagement which children are apt to 
hear, as applied to men and things, is the word 
“ old-fashioned.” This conveys the impression 
of slow, awkward and feeble mental and phy- 
sical action, such as generally characterizes the 
old, and which the observant eye of childhood 
is quick to note with impatience. 
A superficial acquaintance with the writings 
of the surgeons of former days—say of the 
last century—is very apt to give the idea that 
they were grave and formal men, slow of speech, 
uncouth in dress, and awkward in action. Many 
of the portraits and other illustrations found 
in their works would confirm this view. We 
read their text, with its curious type, its quaint 
diction and roundabout phrases, its antiquated 
spelling, and it seems to us that their manners 
must have been as set and precise, their move- 
ments as slow, and their very thoughts as dull, as their pages look when contrasted with those 
of modern books. We imagine the old-school 
physician or surgeon as having a gravity, a 
stately politeness, incompatible with quick and 
dexterous movement. When he travelled, he 
went on horseback, in a chair, a chariot, or a 
stage-coach, taking two days for a journey 
which we now make in two hours. The presses 
on which his works were printed would bear 
just about the same relation, as to rapidity, with 
those which are now teeming with the multi- 
tudinous literature of the present day. 
Let it not be forgotten, however, that in those 
times every gentleman was a master of sword- 
play ; that machines had not yet made manual 
dexterity a matter of comparatively small im- 
portance ; and that for a surgeon rapid and 
skilful movement meant the shortening of tor- 
ture for his patient. I make no doubt that 
those antiquated and, in our view, clumsy in- 
struments, were wielded by hands as deft as 
the best of those of our time. The eyes which 
looked upon them as new inventions were as 
keen, the tongue which explained their merits 
to admiring students as ready, as those which 
now note their defects or extol later improve- 
ments upon them. The fact is, that this is 
simply a world of recognitions and combina- 
tions. When the wise man of old said, “ There 
is nothing new under the sun,” he uttered a 
truth far deeper than most of us realize. For 
millions of years the materials of the world and 
its surrounding atmosphere, under the forces 3 
of nature, have existed and undergone their 
appointed changes. How long ago we know 
not; how, we know not; we know only the 
bare fact, that man came upon the scene, be- 
gan to observe, to criticise, to make and to 
write history. What he first observed we know 
not; but the first recorded combination was 
when he sewed fig leaves together to make 
himself an apron. This was only an adapta- 
tion of existing things to a purpose. Since 
then he has simply gone on recognizing and 
combining; and not one individual of the race 
has lived long enough to be more than an 
ephemeral witness of the results thus induced. 
With a perpetual change of actors, and a grad- 
ual increase in their number, the play has been 
one and the same, ever repeating and repeating 
itself. The boys and girls have sported, the 
youths have loved, the men and women have 
schemed, lost and won in the game of life, the 
old have drivelled and faded away, in continual, 
never-ending succession. Nothing has really 
changed since the days of the patriarchs ex- 
cept relatively. Morally, man is the same ; his 
passions, his ambitions, his jealousies, his mean- 
nesses, and his generosities, are set forth in the 
earliest known records of the race just as in the 
latest newspaper. Physically, he is the same; 
could we obtain the fresh body of one of 
the ancient shepherd-kings of Egypt, it would 
answer as well for anatomical study or demon- 
stration as that of the pauper who died yester- 
day in one of our almshouses. It is only in his 4 
wider acquaintance with the world around him, 
in his increased power through discovery, that 
he has changed. Materials and forces were 
everywhere in the time of Adam and Noah, 
just as they are now; but they were hidden. 
Gradually the knowledge of these things dawned 
upon men, and new combinations were made; 
not new things, but revelations of the possi- 
bilities contained in what had always existed. 
When 
“Terah, Nahor, Haran, Abraham, Lot, 
The youthful world’s gray fathers in one knot, 
Did with intentive looks ” 
gaze in admiring awe upon the rainbow, they 
saw just what we see now in the sky after a 
summer shower, no more and no less; but we 
have to some extent solved the mystery which 
to them was absolute. 
In the course of the revelations of existing 
things, a combination of materials and forces 
was developed which gave us the art of printing, 
and thenceforward the spread of knowledge was 
vastly aided. But a few centuries and we come 
to our own time, the age of steam and electricity, 
and of popular education. Now w.e find at once 
an immense increase in the body of workers, 
and in their means of utilizing their results. 
Wider views brought more accurate classification, 
clearer ideas of the natural history of health and 
disease; modern methods of research, also 
brought about simply by new combinations of 
forces and things which have existed since the 
world was m ade, have placed the science of 5 
medicine on a plane far higher than that which 
it occupied at the beginning of this century. 
But I imagine that some of you may begin to 
ask what all this tends to, and why all this array 
of truisms should be presented? I do not think, 
however, that I am wide of my subject. We, 
of the nineteenth century, are apt to plume our- 
selves upon the wonderful achievements of our 
age, and to think, if not that wisdom shall die 
with us, at least that it began with us. We look 
at the books and periodicals which pour forth 
from the press—more in bulk than any one 
man can find time to read, even if nothing else 
claims his attention. We catch the hurrying, 
bustling, commercial spirit of the day, the mis- 
called “ practical” man’s idea that the great point 
is to know the latest views, to be up in all the 
newest things, so far as they will help him to 
take the lead of his rivals, and to build up a 
lucrative business. 
This is one way to look at the matter ; but 
there is another, and I think a better. We are 
not merely a fleeting generation of midges, 
dancing in the sunshine for our little day, come 
from the night, and to pass away into deeper 
night. We are not even actors who appear in 
solemn procession on the stage, strut through 
our parts, and make our exit. We are the heirs 
of the ages, and have work to do in order that 
we may transmit to those who come after us the 
legacy which came into our hands, with such 
increase of value as may be fairly required of 
us. Surely it is well that men engaged in such 6 
a task should occasionally look back and trace 
the steps of their predecessors; that they should 
mark the points reached by the great climbers 
of past times, and the different outlooks gained 
by them over the field of scientific truth. 
I wish then, to-day, to ask you to go back with 
me into the last century, and to survey the work 
done by some of the eminent men who were 
then the leaders of thought in our profession. 
Three of them particularly—men whose names 
are known wherever surgery is taught, but who 
are unfortunately only names to the vast majority 
of even the more educated among medical men 
—will engage our attention. They are Lawrence 
Heister the German, Jean Louis Petit the 
Frenchman, Percival Pott the Englishman. In 
the brief time at my disposal, I can do but scant 
justice to the claims of these worthies to the 
respect and even veneration of their successors. 
Enough if evidence is afforded of the value of 
their labors, and of their title to high place in 
the republic of science ; more than enough, if 
what I shall say may lead others to share with 
me the pleasure and profit of occasional inter- 
course with them in the writings by which alone 
the world now knows them. 
I have selected these three because they were 
nearly contemporary. They represented the three 
leading nations of the world in their time ; they 
embraced in their works nearly the whole scope 
of surgery as then known; and they seem to me 
to have been men who fitly closed what may 
perhaps be called the middle age of that science. 7 
Curiously enough their lives extended over 
almost exactly similar periods, Heister and Pott 
living 75 years each, and Petit 76. 
Heister was born in 1683, and his System of 
Surgery was published in German in 1718, in 
Latin in 1739. An English translation of it 
appeared in 1742, and the sixth edition in 1757. 
In his preface he gives an account of his 
studies, and of his experience in military sur- 
gery. In 1710, being then 27 years of age, he 
was, he says, “ beyond all expectation, called by 
the Republic of Norimberg to teach anatomy 
and surgery, as public professor in the Uni- 
versity of Altorf. In order to qualify himself 
for the duties of this position, he made a tour 
into Great Britain, where he says he was “ from 
spring to autumn, collecting everything new in 
the several branches of physics.” On beginning 
his labors, he found himself perplexed for want 
of a convenient manual of surgery; and you 
will pardon my detaining you by a quotation, 
asking you to bear in mind that its date is 1739, 
not quite 150 years ago—less than twice the 
life of many persons whom we know. 
“ If any one,” says he,” examines the best 
books, such as the Microtechnia of VanHoorn, 
the Operations of Nucke, etc., which were at 
that time consulted not only by our surgeons, 
but also by our university professors, for teach- 
ing and learning the art, it will readily appear 
how imperfect and insufficient they are to give a 
just notion of any one branch, much more of 
the whole system or body of surgery, since 8 
they describe only a few operations, and those 
too imperfectly ; taking little or no notice of the 
doctrine and treatment of wounds, fractures, 
luxations, tumors and ulcers, which make the 
most considerable part of surgery, and in which 
a learner ought to be the most fully instructed. 
It is true, the works of Guido Cauliacus, Aqua- 
pendens, Parey, Scultetus, Solingen, and some 
other writers of the last century, are very full 
and explicit in all or most of the operations, 
and the five kinds of disorders before-mentioned. 
But even in these we must not expect to find 
the many improvements, emendations, and dis- 
coveries made by the moderns ; and their 
practice being mostly obsolete, they must con- 
sequently be allowed to be unfit for the instruc- 
tion of learners. And it is an objection to 
many of our books on surgery, of a more 
modern date than the preceding, that they have 
either been compiled by physicians little con- 
versant in chirurgical dissections and operations, 
as those of Barbet, Verduc, Bonteck, Doley, 
Blancard, Chaniere, Juncken, Vauguion, Le- 
Clerc, etc., in which many of the old errors are 
continued, and not a few things stated otherwise 
than will be found in practice; or else they 
have been restrained to but one or two subjects 
only, as the bones, wounds, tumors, bandages, 
operations, etc., besides their being written 
either in a rude, or a foreign language, unknown 
to most of our surgeons.” 
The system of surgery which was intended 
to supply the defects thus set forth was pub- 9 
lished in German in 1718. “And,” says the 
ingenuous author, “ from this time it is that 
we have had better or more expert surgeons in 
Germany than before, many of whom have 
since often declared to me, that they had 
drawn most of their knowledge from my Sur- 
gery.” 
In the following year, Heister “received a 
most gracious call to the public Professorship 
of Anatomy and Surgery in the Julian Univer- 
sity of Helmstadt, from his Britannic Majesty, 
as Duke of Brunswick and Lunenburg.” The 
“ care and trouble of packing up and removing 
his goods, and the fatigue of a long journey, 
added to the multitude of business, and many 
avocations consequent upon his new office,” are 
now urged as the reasons which compelled him 
to postpone the issuing of his work in Latin, an 
event which did not take place till 1739, or 
about twenty years later. 
Now, when the really recent date of this 
writing is considered, you will, perhaps, scarcely 
be ready to believe that the Julian University at 
Helmstadt was abolished, as such, seventy-eight 
years ago, in 1809—just ninety years after the 
time when Heister was called to professorial 
honors in it. Of the Republic of Norimberg, or 
the University of Altorf, I can find no other men- 
tion anywhere. Altorf seems to be known chiefly 
as the alleged scene of William Tell’s feat with the 
apple ; but even this, as everybody is aware, is 
now suspected to be a mere myth. As to the 
authors spoken of, the only one with whom there 10 
is, at the present day, any general acquaintance 
is Pare, whose quaint pages have for some 
reason or another always found friends, and it 
seems likely that they always will. But of Guy 
de Chauliac, Fabricius ab Acquapendente, 
Scultetus, it may safely be said that while most 
educated men have heard their names, scarcely 
one in a thousand could be found who has ever 
read a line of their works. Still deeper obscu- 
rity envelops the other authors who had, in 
Heister’s opinion, failed to give a just notion of 
the body of surgery, or of the many improve- 
ments, emendations, and discoveries made by 
the moderns. Not yet 200 years ago, men of 
sufficient note to have written and published 
works for the guidance of their professional 
brethren, yet of most of them we have really 
less information than of some of the Egyptian 
or Assyrian kings. To what a depth of oblivion 
must most of the writers of the present day, 
contributing their drops to the ocean of litera- 
ture, look forward ! 
Of Petit we know much less. Born in 1674, 
he died in 1750; and for some unexplained 
reason it was not until twenty years after- 
ward that his pupil, Lesne, undertook the 
publication of the works his master had left in 
manuscript. That the latter had intended to 
place them before the world himself, appears 
from the fact that he had had ninety plates 
engraved and printed to the number of 2,000. 
He had not, at the time of his death, written all 
of the text corresponding to these plates, but 11 
they were issued, as the editor tells us, because 
“ he judged of the surplus that it would always 
be an advantage to young surgeons to have so 
complete an arsenal of instruments, most ot 
which had been invented or improved by M. 
Petit.” 
M. Lesne gives us to understand that his 
illustrious teacher had contemplated the pre- 
paration of a general treatise upon surgical 
maladies and the operations for their relief. He 
adds, with a charming simplicity of faith : “One 
would judge, from what he has left us of his 
work, that this treatise would have availed to 
establish forever the principles of the art.” 
A simple instance may show how little 
foundation existed for such confidence. In 
Vol. III. of the works, at p. 180 et seq., this 
eminent man gives an account of a case in 
which he amputated the thigh of an officer of 
distinction, for the effect of a gun-shot wound 
received twenty years previously; on the separa- 
tion of the ligature bleeding occurred, and was 
checked for a time by a button of vitriol, but 
when this came away, and fresh bleeding took 
place, a bandage was put on and the stump 
watched by four surgeons, relieving one another 
at intervals of an hour. Finally an apparatus 
suggested itself, with a body belt, a sort of 
tourniquet, and a plate to cover the face of the 
stump; all this being held in place and con- 
nected by straps and buckles. 
At the present day, the merest tyro would 
simply apply another ligature; and why such an 12 
expedient did not occur to the great French 
surgeon would seem to me unaccountable, ex- 
cept on one ground. He cautions his readers 
against tying the vessels too tightly, for fear of 
cutting them through, and thus causing hemorr- 
hage either at once or shortly afterward. Hence, 
as a matter of course, when the ligature came 
away by slipping off, the vessel not being 
occluded, there would be no more reason for 
trusting to another tying; this resource seemed 
to have failed. It appears that he always after- 
ward regarded the ligature as a thing to be 
avoided, except in cases of emergency, as in 
dealing with large numbers of cases in military 
surgery. His compression apparatus was, in 
his view, the acme of security against hemorr- 
hage. 
It is a curious coincidence that Percival Pott’s 
works were also published after his death by his 
pupil and son-in-law, James Earle. Pott was 
born in 1713, and was apprenticed at the age 
of 14 to Mr. Nourse, one of the surgeons to St. 
Bartholomew’s Hospital. “ At that time,” says 
his biographer, “the art was miserably defective; 
the instruments were clumsy and unmanageable; 
the operations unscientific and unnecessarily 
painful; the established mode of practice, en- 
cumbered with a farrago of useless medicines 
and applications, tended rather to mislead than 
direct the enquirer; prescription too frequently 
held the place of reason, and want of real know- 
ledge was concealed under a pompous garb and 
specious demeanor.” . Painful and 13 
escharotic dressings were continually employed, 
and the actual cautery was in such frequent use, 
that, at the times when the surgeons visited the 
hospital, it was regularly heated and prepared 
as a part of the necessary apparatus. In the 
works of several authors who flourished in the 
early part of our author’s life, we have con- 
trivances for improving these dreadful instru- 
ments. Mr. Pott’s tutor rigidly adhered to the 
established practice, and treated with supercilious 
contempt the endeavors of his pupil to recom- 
mend a milder system.” 
In 1744, Pott became an assistant, and in 
1749, full surgeon at St. Bartholomew’s. In 
1756, he sustained a severe fracture of his leg, 
and it was during the enforced idleness con- 
sequent upon this injury that he began to turn 
his attention to authorship, preparing his essay 
on ruptures. About 1765, he undertook the 
work of teaching, giving his lectures at first in 
his own house. The efforts by which his name 
has been principally distinguished, are his work 
on fractures, published in 1768, and that on 
curvature of the spine, which appeared eleven 
years later. He closed his long, busy and useful 
life in 1788, carrying on a very active practice 
to the last. 
Heister’s work is in the nature of a cyclopaedia, 
and full of evidence of the study of the writings 
of his predecessors and contemporaries. 
Petit’s editor says of him : “ He only read 
books on surgery in order to get a general idea 
of the progress made, by the art down to his 14 
time; he made little account of the erudition 
which gives a learned air to mediocre talents; 
when he treated of a subject, he always sought 
to widen the limits placed upon it by his pre- 
decessors.” 
“ Mr. Pott,” says Earle, “ always professed 
great value and respect for the early writers on 
the art, and perused their voluminous works 
with great diligence and sagacity. He frequently 
observed that, though no great advantage could 
be derived from them in the practical part, yet 
whoever studied them would be amply repaid 
by their accurate description of diseases which 
they portrayed from nature.” 
I do not propose to take up systematically the 
study of these works, but merely to dip into 
them here and there, and to note the points of 
difference and of resemblance, those in which 
they may seem to us to have been in the dark, 
and those in which they touch very closely the 
views and practice of the present time. 
Heister and Petit both had opportunities of 
somewhat wide experience in military surgery. 
Pott’s field of action was wholly civil, and he 
appears to have been largely engaged in private 
practice as well as in that of the hospital, with 
which, as he himself said, he was connected as 
man and boy for fifty years. 
We cannot but be impressed with the differ- 
ence between the last century and the last half 
of this, in the character of military surgery. 
Sword and bayonet wounds were then extremely 
common ; now they are very rare. Then again, 15 
the round balls, the clumsy and inefficient fire- 
arms, and the less powerful explosives, made 
the nature of the wounds often much less seri- 
ous than those with which we are now familiar. 
Another curious fact has impressed itself upon 
me within the last few years. Surgeons in civil 
life, and especially those connected with large 
hospitals, have at present more experience in 
wounds from firearms than many army surgeons 
formerly had. So common is the use of the 
pistol, that shot-wounds are among those which 
most frequently present themselves. And I 
need not dwell upon the very analogous char- 
acter of railroad and machinery crushes to that 
of the injuries from cannon-shot which so im- 
pressed the military surgeons of the sixteenth 
century. 
Modern life, along with many comforts and 
luxuries, has brought new sources of suffering 
and danger. It has also, however, seen the 
introduction of vastly improved appliances for 
the relief of one and the prevention of the 
other. 
Perhaps I need hardly dwell upon the fact, 
which is patent on almost every page of the 
books I am now discussing, that the sovereign 
anodyne, in the view of all these men, was 
blood-letting. They had, indeed, the syrup of 
poppies, the theriaca, the confectio mithridatii, 
but it is amazing to see how diligently they 
opened veins whenever they found their patients 
in pain. 
Another curious matter is the vagueness of 16 
the knowledge of anatomy which is shown by 
our authors. Of course their opportunities for 
dissection were limited, and, in fact, many 
students of that day learned all the little they 
knew of the structure of the human frame by 
the mere seeing of the demonstrations made 
upon two bodies a year in an amphitheatre. 
Still less did they know of pathology. They 
looked upon disease with a sort of myopia, and 
failed to get any general view of the classifica- 
tion of disorders. Hence it would be un- 
reasonable to expect that their treatment, based 
upon an imperfect anatomy and physiology, 
and without any system of pathology, should 
be otherwise than empirical. Yet they were 
shrewd observers, and no doubt did a sort of 
rough justice to their cases, such as possibly 
may not compare unfavorably with the practice 
of some of our graduates, who are learned in 
all the mysteries of the metric system, bacteria, 
and microscopic appearances. 
Pott closed his eyes upon this world just at 
the dawning of a new era—the era of general- 
ization. Thirty-seven years before this time, 
Pott being one of the senior surgeons at St. 
Bartholomew’s Hospital, John Hunter had been 
for a short period one of the students in attend- 
ance upon the lectures there. Hunter was then 
a young fellow of twenty-three, and probably 
was scarcely known by the lecturer, who little 
thought what a genius sat before him listening 
to his words. Whether they ever came into 
contact in after life I do not know. Hunter, of 17 
course, became connected with St. George’s 
Hospital, where, three years before Pott’s death, 
he performed what was, it seems to me, one of 
the most brilliant operations the world ever 
saw,—the ligation of the femoral artery for 
popliteal aneurism. Consider all the circum- 
stances—the fact that such cases had previously 
been condemned to amputation, that the course 
pursued by Hunter was the result of deduction 
from an observation made in one of the lower 
animals, and that it opened the door to a wide 
field of life-saving surgery—and I do not think 
you will regard my expression as extravagant. 
Moreover, this was but an incident in the life 
of the man who, I think more than all others, 
was active in the widening of the scientific 
basis of surgery. He led the van in bringing 
in all the teachings of human and comparative 
anatomy and physiology as aids to the treat- 
ment of surgical disease. 
But I have been drawn into a digression. 
All I meant to have said was, that the three 
great men who are the special subjects of this 
desultory talk must not be judged by the 
standards of the brighter light and wider view, 
of the independent and comprehensive thought, 
which their successors enjoyed. Possibly, for 
such is sometimes the working of human nature, 
they would have resented the rough encroach- 
ment of new views and theories upon those 
they had set up and taught. Men are apt to be 
charitable to those who have had no chance 
to oppose them, and I note that both Heister 18 
and Pott speak with much more respect of their 
departed predecessors than they do of their 
contemporaries who held contrary opinions. 
With regard to injuries of the head, we find 
that Petit left but a portion of his article com- 
pleted ; but his editor refers to a memoir pre- 
sented by him to the Academie Royale de 
Chirurgie, in which he pursues the subject; 
and from the plates (without corresponding text) 
in the work before us, it is clear that he had 
intended to discuss the operation of trephining. 
On the Continent it is plain also that the in- 
struments used for this purpose were immensely 
large and clumsy, resembling the brace and bit 
now commonly employed by carpenters. For 
Heister also represents them of this form • and 
in speaking of the method of procedure, advises 
that the surgeon, setting the point of the per- 
forating trepan, a sort of awl or gimlet, on the 
skull, should place his left hand on the top 
of the instrument, and then rest his chin or his 
forehead on his hand, while with his right he 
slowly revolves the borer. Having made such 
a puncture as he desires, he then puts the 
trephine itself in place, with a central spindle, 
which is inserted into the hole previously bored. 
It is worth while to note the shape of the 
trephine itself. Both Heister and Petit repre- 
sent it as like that of modern times, the frustum 
of a cone, and with spiral grooves on its outer 
surface. This shape was for a time abandoned 
for the cylindrical, and has been within the 
last fifty years re-introduced as a novelty. 19 
Pott does not speak of the exact shape of 
the trephines used by him. In Scultetus (1741) 
we find representations of the modern form of 
the instrument, with simply a handle. When 
this became the prevailing style I cannot say. 
As to the indications for trephining, it is well 
known that the views held in the sixteenth and 
seventeenth centuries were in favor of a very 
free resort to the operation, which, in spite 
of Pott’s advocacy, as well as of that of Gooch 
and other able writers, subsequently came to be 
regarded with much timidity. At present the 
pendulum of opinion is swinging back again, 
and surgeons are far more ready with the tre- 
phine than they were twenty years ago. 
Heister spoke of this matter more cautiously 
than did Pott. He refers to the danger of 
injury to the dura mater, and says : “ For this 
reason I am induced to condemn the advice of 
those, as very unsafe, who direct to trepan the 
cranium immediately upon every slight disorder 
of it.” 
One point seems to me curious, and that is, 
that none of these surgeons had noted the fact 
of irregularity of the pupil of the eye as a result 
of intra-cranial pressure. 
Another singular fact is, that while Heister 
advises that the incision to lay the bone bare 
should have the form of a cross, or of the 
letter X, V, or T, Pott speaks uniformly of 
cutting away a circular piece of the scalp. 
And we find in Hey’s Surgery, published in 
1807, an argument against this practice, which 20 
would seem up to that day to have generally 
prevailed among English surgeons. 
I cannot pass from this subject without one 
more reference to Petit, who would, in the 
opinion of his editor, have settled for all time 
the principles of surgery. He is quoted as dis- 
cussing “ the nature of the polypous fleshy 
masses sometimes found in ancient contusions ” 
(of the head), “ the opening of which has been 
long delayed.” He does not think that these 
masses, which he believes to be formed from 
the blood clots constituting the tumor, are 
different from the polypi which are found adher- 
ing to the inner surface of the ventricles of the 
heart, nor from the fleshy masses found within 
true aneurisms, nor from the clots of false 
aneurisms. He says, further, that these polypous 
masses “ can absorb nourishment, grow more or 
less, and even become adherent to all the sur- 
face of the cavity enclosing them.” This must 
remind us of the elaborate steel plate given by 
Tulpius, of a polypus of the heart—nothing 
more or less than such a clot as may be noted 
in the autopsy of any one who has died slowly. 
It seems to me that the wonder is that these 
ancestors of ours, with such rudimentary ideas 
of physiology and pathology, should have built 
up their surgery as soundly as they did. 
Heister, like all his contemporaries, hesitated 
to place entire confidence in the ligature as a 
means of controlling hemorrhage. And in 
speaking of wounds in the neck, he gives what 
must seem to us a most extraordinary piece of 21 
advice. If the internal jugular vein is exten- 
sively divided, he recommends that it should be 
tied; but if the carotid artery or any of its 
branches, he would have us trust wholly to 
pressure, kept up by compresses held in place 
with the fingers. Yet, when the matter is 
looked at more closely, the explanation seems 
evident. The idea of the men of that day was 
that the current of blood in the arteries, by its 
force, detached the ligature, while the more 
sluggish flow in the veins was easily controlled. 
With regard to wounds of the chest, there is 
but little to note, in view of the fact that 
auscultation and percussion were unknown in 
the last century, and hence that the study and 
treatment of these injuries were carried on at a 
great disadvantage. 
Coming now to the diseases and injuries of 
the abdomen, I would call your attention to the 
article in Petit’s work on tumors formed by the 
retention of bile in the gall bladder, often mis- 
taken for abscesses of the liver • and to another 
on the parallel existing between the retention of 
bile and biliary calculi, and retention of urine 
and stones in the bladder. There is, in these 
two papers, much that may be read with profit 
by any one at the present day; much that would 
show, if such proof were needed, that the author 
was a man of bold and independent habit of 
mind. 
In a recent article published by myself, on a 
case of pistol-shot wound in which laparotomy 
was performed, I stated that this course was 22 
“dimly foreshadowed” in 1855 by Guthrie. 
Soon after this was written, I was not a little 
surprised to find that the foreshadowing had 
taken place 135 years earlier; for Heister wrote 
as follows:— 
“ When the intestines are wounded, but not 
let out of the abdomen, and therefore their 
wounds are out of reach, the surgeon can do 
nothing but keep a tent in the external wound, 
according to the method of dressing laid down 
at chap, v., and after this bleed the patient if 
his strength will admit of it, advising him to 
rest, to live abstemiously, and to lie upon his 
belly. The rest is to be left to Divine Provi- 
dence and the strength of his constitution. But 
the question may be asked here, Whether a 
surgeon may not very prudently in this case 
enlarge the wound of the abdomen, that he may 
be able to discover the injured intestine, and 
treat it in a proper manner? Truly I can see 
no objection to this practice, especially if we 
consider that upon the neglect of it certain death 
will follow, and that we are encouraged to make 
trial of it by the success of others. Schacherus, 
in Programmate Publico, Lipsiae, ed. 1720, 
mentions a surgeon who performed this opera- 
tion successfully. So Cheselden, of London, 
gives us a history where, in the hernia incar- 
cerata, he laid open the abdomen, returned the 
intestines, and perfectly cured his patient. See 
his ‘ Treatise on High Operation,’ ” etc. 
Very possibly, on looking up these cases, it 
will appear that there was a good deal more 
than foreshadowing of the modern practice. 23 
Let me give another instance. We are apt 
to think of nephrotomy and nephro-lithotomy 
as among the latest developments of surgery. 
But Heister has the following passage at the 
conclusion of his chapter on lithotomy by the 
apparatus minor :— 
“ Lastly, as there are many cases in which a 
stone in the kidney can by no means be resolved 
or removed by medicines, and the patient being 
continually in the most extreme torture, is desir- 
ous by any means to be freed; it may not be 
inconsistent with our design in this place to 
resolve the question, whether a stone in the 
kidney may not be cut out in such a case. This 
is a subject seldom treated of in books of sur- 
gery, and which I choose to treat of in this place, 
as the operation may be performed by the 
apparatus minor, either with the scalpel alone, 
or with the hook and forceps. The generality 
of those who have said anything upon the sub- 
ject in their writings, think it a proposal too 
dangerous to be practicable, and therefore treat 
it with neglect,—when at the same time there 
are extant many arguments, both from reason 
and experience, which recommend such a prac- 
tice to be absolutely necessary, especially under 
particular circumstances. For we have many in- 
stances of patients who have been freed from the 
stone in the kidney by a wound in that part, 
received accidentally in the back; and that, in 
some cases, without any dangerous symptoms. 
Among other instances which have come under 
my own observation, I shall only mention a late 24 
one, of a man who was wounded by another with 
a knife, upon the region of the right kidney, in 
his back, in the year 1735, in such a manner 
that blood and bloody urine was voided in great 
plenty for several days through the wound and 
through the urethra. But after he was trans- 
mitted to my care at Helmstadt, he was happily 
cured within the space of four weeks. It is 
therefore most certain that wounds of the kid- 
neys are not always mortal, as some have im- 
agined, but frequently curable; especially those 
inflicted on the back, without penetrating into 
the cavity of the abdomen. And Hippocrates, 
though he interdicts his pupils from performing 
the operation of lithotomy, does yet direct them, 
in treating of disorders in the kidneys, ‘ to make 
an opening where they are elevated and tumified; 
that after extracting the gravel and discharging 
the matter, they may be healed with diuretics. 
For by such an opening or incision there may be 
hopes of a recovery; otherwise, the patient is a 
dead subjectAnd in the same book he says : 
‘ When there is a suppuration of the kidney, and 
it forms a tumor near the spine ; in that case a 
deep incision is to be made upon the tumor near 
the kidney,’ or as he says in another place, ‘ into 
the kidney itself.’ From whence it appears that 
he did not think an incision in this part so 
greatly to be feared as a wound in the bladder. 
Rossetus also, and the accurate anatomist Riolan, 
and others, are induced by many reasons to 
think that nephrotomy may be often practised 
with success, if the incision be made in that 25 
part where the calculus is perceptible, taking 
care to avoid wounding the emulgent artery, 
veins, or the ureter, and to prevent the wound 
from penetrating into the cavity of the abdomen. 
But nothing can be more reasonable than to 
perform nephrotomy, when we are directed to it 
by nature, pointing out the place, by a tumor 
and abscess formed in the loins from a calculus 
in the pelvis or kidney. In such a case we are 
also supported by the advice and authority of 
Schenkius, Wedelius and Meekren, together 
with Lavaterus, formerly an eminent physician 
and surgeon of Helvetia, with whom I amicably 
cohabited for some time, in the year 1710, he 
then practising surgery at London with great 
applause. He at that time told me that he had 
not only performed this operation with success 
in the above mentioned case, but had also pub- 
licly declared: ‘ I perform the operation of 
nephrotomy, on either of the kidneys, when 
nature directs to that practice by forming an 
abscess.’ There is therefore no apparent reason 
why this operation should be condemned under 
the forementioned circumstances, as it is by a 
great many. I should rather advise, according 
to my own practice, never to omit nephrotomy, 
when nature thus points out the road to it.” 
I trust the interest of this quotation may ex- 
cuse its length; and will only mention that in 
Petit’s third volume may be found detailed two 
cases of nephro-lithotomy, one of which was 
entirely successful, and in the other the opera- 
tion could not by any means be assigned as the 26 
cause of the death of the patient. Petit rarely 
gives the dates of his cases, so that we cannot 
tell by how long a time he anticipated the 
operators of the present day. 
It would be interesting, did time permit, to 
go somewhat into detail as to the views of our 
authors on the subject of hernia. Part of the 
vagueness of their ideas must be ascribed to 
the fact that the rationale of the descent of the 
testicle was at that time unknown, having been 
first demonstrated by Hunter at a later period. 
Both Pott and Petit discuss the question of 
herniotomy without the opening of the sac, and 
Heister briefly refers to it. They also are 
greatly concerned as to the best method of 
dealing with protrusions of omentum. A curi- 
ous fact may be noted here, viz., that Pott does 
not once use the term “ taxis.” It may also be 
mentioned that he recommends the inversion 
of the patient for the reduction of hernia—a 
plan more than once brought forward as new in 
our day. 
I have before spoken of the want of classi- 
fication in the nomenclature of disease, as 
shown in the writings of these eminent men. 
A striking instance of this may be noted in 
their discussions of the various fistulae. “ The 
fistula lachrymalis ” seems to have been to 
them an entity by itself; “ the fistula in ano ” 
another. As to the former, we find that Pott 
and Heister could devise no better remedy than 
breaking through the wall of the orbit and 
forcing a passage into the nasal cavity. Petit, 27 
on the other hand, very justly condemns this 
rough practice, and recommends dilatation of 
the canal by bougies. 
The mention of fistula in ano, which Petit 
discusses under the head of “ ulcers,” reminds 
me to quote from him a passage illustrating a 
curious feature of human nature. “ It is 
known,” says he, “that after the operation 
which was performed upon Louis XIV, this 
procedure became very common, not because 
there were more fistulas than before, but be- 
cause many people who had concealed infirmi- 
ties of this kind ventured to declare them; 
some even submitted to the operation by way 
of gaining favor. It became, so to speak, the 
fashion, and, as the city copies the court, it was 
so frequently performed in Paris, that for a time 
no one talked of anything but fistula; it alone 
seemed to be worthy of the attention of sur- 
geons ; yet, in spite of all the care given to the 
perfecting of the operation, cases were often 
heard of in which it had failed and in which it 
had to be repeated.” 
Another singular statement is made by Petit 
in connection with the subject of hemorrhoids, 
which also, by the way, he places under the 
general head of “ ulcers.” He says : “ Of the 
patients whom I have treated for internal hemorr- 
hoids, the Americans and the inhabitants of 
British ports have furnished the larger number; 
and among these I have found few who had not 
as the source of their malady either scurvy or 
syphilis, and often both.” I must confess my- 28 
self puzzled to know who and of what class these 
“ Americans” were. They certainly had nothing 
in common with the travelling Americans of our 
own day; they cannot have been either Indians 
or negroes, of whom even now many educated 
Frenchmen are convinced that the population 
of this hemisphere mainly consists, and I have 
no theory to suggest on the subject. 
At the present day the pathology and treat- 
ment of hydrocele are matters of no special 
discussion, and the condition itself is one of the 
minor troubles with which surgeons are called 
upon to deal. It is somewhat interesting to see 
what opinions were held by our authors, especi- 
ally with regard to the best method of treatment. 
Heister mentions five plans: free incision and 
stuffing the cavity; caustic ; the seton ; the wax 
tent; and finally, with just indignation, “ the 
method practised by itinerant medicasters, by 
which they make an incision in the inguen, and 
tearing the scrotum off the testicle, they extirpate 
it together with the process of peritonaeum, not- 
withstanding both of them are in a sound state.” 
Petit speaks only of puncture with the trocar, 
or of free incision. Pott speaks of puncture as 
a palliative, and refers also to a plan of injection 
of the sac for the radical cure as having been 
“ quite laid aside ” as useless; he does not say 
what was the nature of the liquid employed. 
He advises a large incision of the tunica vagin- 
alis, but is said by Earle to have abandoned this 
plan for the last twenty years of his life. He 
speaks very favorably of the seton. 29 
We have all heard of “ Heister’s screw ” for 
opening the mouth, and most of us have used 
it or seen it used. Now let me quote what he 
himself says : “ But in my opinion every pru- 
dent surgeon will reject these instruments as 
pernicious.” He afterward speaks with approval 
of the use of the speculum oris—a much less 
powerful instrument—“for inspecting the mouth, 
in examining several disorders of its parts, or in 
performing any operation on the palate, tonsils, 
or teeth.” No doubt two articles were con- 
founded by some careless compiler. 
In most text-books, and by teachers of sur- 
gery, it is customary to speak of the tourniquet 
in common use as Petit’s. And we hear also 
commonly the term “ Spanish windlass ” as 
applied to the well-known handkerchief twisted 
up with a stick. But in fact the latter was “ the 
tourniquet,” “which,” says Heister, “we use 
with great success after amputations.” Petit 
modified this, but the instrument produced by 
him was not by any means that which we know 
by his name. The double bridge seems to 
have been a German invention; when the four 
rollers were introduced I have been unable to 
ascertain. 
Did time permit, I should be glad to say 
something of the views of our authors on the 
subject of fractures and dislocations ; the views, 
that is, of Heister and Pott, for neither in the 
text nor in the plates of Petit’s work does it 
appear that he meant to take up this topic. I 
must, however, content myself with calling your 30 
attention to the sound sense of Pott’s remarks 
on the relaxation of muscles by position, in 
broken limbs. His deductions as to treatment 
are not borne out by experience, or, at least, 
have not been thus far, but it is not impossible 
that appliances may yet be devised by which 
the theory may be made available. As to the 
fracture just at and above the ankle joint, with 
which his name is still associated, I need say 
nothing, as it is familiar to every student of 
surgery. 
I have said that Petit left nothing in regard 
to the matter of fractures; but in Heister’s work 
he will be found credited with the invention of 
an apparatus which, in a modified form, the 
whole civilized world knows as the “fracture- 
box.” I think very few of the vast number of 
surgeons who have used this appliance have had 
the slightest idea of its origin. 
Of course, the name of Pott is best known 
now, and in all probability it always will be, in 
connection with the subject of spinal curvature 
from caries. His paper on this subject, in the 
third volume of his works, seems to me admir- 
able—a piece of sound reasoning from accurate 
observation, and extremely modest in its tone. 
I think such writings as this are beyond the 
reach of decay with time; they have a merit of 
their own, and although they may be forgotten, 
their value remains. A fact, or a sound explana- 
tion of facts, added to the sum of human 
knowledge, is worth much; if it is a fact from 
which may be deduced results of wide and 31 
permanent benefit to a class of sufferers previ- 
ously without relief, there is no standard by 
which to estimate the service rendered to man- 
kind by its discoverer. The pointing out of 
the causal relation of caries of the vertebrae to a 
condition which had, up to that time, been 
classed among the palsies, was the laying of the 
corner-stone of the present treatment of disease 
of the spine, although Pott’s therapeutical ideas 
were of the crudest. 
I had noted many other points to which it 
was my intention to refer at more or less length, 
but I fear I have taxed your patience too largely 
already. My object has not been either to 
criticise or to eulogize. These departed worthies 
loom up among their contemporaries, and chal- 
lenge the attention of all who would trace the 
progress of our beneficent science. 
Heister had the advantage of both Petit and 
Pott, in that he published his own finished work, 
and gave it to the world himself; while they had 
gone over to the majority, and their control could 
no longer be exercised in correction and addition. 
We all know that one of the ancients exclaimed, 
“ Oh that mine adversary had written a book !” 
If his adversary had not only written a book, 
but had had it posthumously published, he 
would have had the game in his own hands. 
■ I have already spoken of the vast increase in 
medical literature at the present day, as com- 
pared with that which the men of the last 
century had at their disposal. Growth in this 
respect may be looked for in the future with 32 
certainty, but its extent is a matter beyond 
calculation. We are now the moderns; we 
shall soon be the ancients. Our work will 
be left to the criticism of those who are now 
unborn, and our discoveries and theories, our 
instruments and methods of treatment will be 
commended, rejected or modified, established 
or superseded, just as has happened to those of 
all the generations before us. 
When the great Napoleon was engaged in 
making history, and in the course of the process 
found himself and his army in Egypt, it is said 
that he sought to stimulate them by telling them 
that from the heights of the pyramids forty 
centuries looked down upon them. Whether 
he ever said this or not is doubtful; but if he 
did, he simply uttered an absurdity. The forty 
centuries were past and gone, and before the 
dead eyes of their monuments, tragedy and 
comedy, heroism and cowardice, glory and dis- 
grace, were one and the same. The past may 
appeal to us in trumpet tones by the examples 
left us by its mighty ones; but it is the future 
which must pronounce its verdict as to what we 
have done or left undone. 
“ Time is the judge; time has no friend nor foe; 
False fame must wither, and the true must grow.”