CHAPTER XXXVI. Surgery in Germany and Switzerland During the Fifteenth and

SURGERY IN GERMANY AND SWITZERLAND DURING THE FIFTEENTH AND SIXTEENTH CENTURIES

There were five men in Germany and German Switzerland who, during the Renaissance, attained distinction as surgeons, and who at the same time contributed, by their published writings as well as by the force of example, to the advancement of medical science. The names of these five surgeons are: Pfolspeundt, Brunschwig, von Gerssdorff, Fabricius of Hilden and Felix Wuertz. The first three mentioned were born in the early part of the fifteenth century, and all five of them derived their practical knowledge of surgery in large measure from their experience in warfare. Individual sketches of these men will be furnished farther on, but I believe that these will be better understood if a brief account of the state of medical education in general throughout Germany, at the period which I am now considering, be first supplied.

State of Medical Education in General Throughout Germany (1400–1600).--The University of Heidelberg was founded in 1386, but it was not until about 1550 that the first beginnings of medical teaching made their appearance in that institution. Equally feeble attempts were made, twenty years later, to organize the teaching of medicine at the University of Wuertzburg; but very little appears to have been accomplished during the immediately following years, as may be judged from the official announcement, in 1587, of what things the Professor of Surgery would teach in the three-years’ course. “First year: Lectures on the subject of tumors, in accordance with the teachings of Galen; Second year: Lectures on the subjects of wounds and ulcers, in accordance with the teachings of Galen and Hippocrates and the Arabian medical writers; Third year: Lectures on fractures and dislocations, in accordance with the teachings of Galen and Hippocrates. Then, if sufficient time is available during this last year of the course, a certain amount of anatomy is to be taught (during the winter season) from Galen’s writings on this subject. In the summer time the subject of simple remedies may be taken up advantageously, and botanical demonstrations may also be given.” Von Gurlt quotes Koelliker as his authority for the statement that throughout the seventeenth century the medical and surgical teaching at the University of Wuertzburg was very defective, “almost nothing worthy of mention being accomplished during that long period in the departments of anatomy and physiology.” In the University of Basel, Switzerland, which was founded in 1460, medical teaching was as barren as it was in all the German universities at that early period. It was only in 1542 that the first public dissection of a human body took place there. Vesalius was visiting the city at that time for the purpose of superintending the printing of his great work on anatomy, and the university authorities availed themselves of the opportunity to secure from him not only this single demonstration, but also in addition a course of lectures on anatomy. Fifteen years later, Felix Platter, a native of Basel and a man of exceptional ability (see sketch on pp. 332 et seq.), made the first postmortem examination known to have been made in that city. Two years later still (1559), following in the footsteps of Vesalius, he made a public dissection of a criminal’s corpse in the Church of St. Elizabeth. From 1581 onward, with occasional omissions, a public dissection of the corpse of a criminal was made by the professor of anatomy once every year. In 1590 the question was discussed by the Faculty whether it “might not also be practicable to secure from the hospital, for dissection, an occasional corpse.” The first body obtained from this source was dissected in 1604, but it was not until 1669 that a second one was available. There was no museum of anatomy and the medical school owned only two human skeletons--one male, that had been set up by Vesalius, and one female which had been prepared by Platter. During the first two hundred years of the existence of this university, only twenty-three copies of the different writings of Hippocrates, of Galen, of Dioscorides and of Paulus Aegineta were available for the instruction of the medical students. “These books should be diligently read aloud to the young men if their contents are to furnish the maximum of useful information.” As for clinical instruction, each student was expected to secure for himself, by private arrangement with some active practitioner, the position of assistant, or to obtain from the Archiater or City Physician an occasional opportunity of seeing patients at the hospital. According to the rules established by the Faculty the students were permitted to take private courses with different physicians. Another and very valuable source of information that was within the reach of these young men, was supplied by the public disputations which were held quite frequently.

The preceding brief account, which I have compiled from von Gurlt’s work, will serve, as I believe, to convey a fairly clear idea of the primitive and very limited opportunities of acquiring a knowledge of medicine and surgery which were afforded the student in Germany during the fifteenth and sixteenth centuries. (It should be borne in mind that Basel, although located in Switzerland, was in nearly all respects a German city.) It was not until a much later period that the schools of that country, in nearly every department of human knowledge, caught up with and eventually surpassed--at least for a number of years--the similar institutions in Italy and France.

(From a woodcut in the Surgery of Hieronymus Brunschwig, Strassburg, 1508.)

This treatise, which was written by the author in 1497, passed through nine successive editions, the last one in 1539. Probably no woodcuts of a higher order of merit than those represented in this and the two following illustrations (Figs. XIX and XX) are to be found in medical literature.]

Hieronymus Brunschwig.--Hieronymus Brunschwig was born at Strassburg during the early part of the fifteenth century, the exact date not being known. It is believed that he attained a great age, some even claiming that he was one hundred and ten years old at the time of his death. His treatise on surgery, bearing the simple title “Das buchler Wund Artzeny,” was first published in 1497, when he was already an old man, and it passed through nine editions during the following forty-two years. It was also twice translated into English. Up to the time of the discovery of Pfolspeundt’s work it was believed to be the oldest German treatise on surgery known. It was very freely illustrated with original woodcuts, not a few of which possess considerable artistic merit. (See accompanying reproduction.) The following headings of some of the more important chapters will convey at least a fair idea of the character of the book: “Definition of the Word ‘Surgeon’”; “Anatomy”; “Fatality of Wounds in Different Parts of the Body”; “Different Kinds of Wounds”; “Different Kinds of Surgical Instruments”; “Different Modes of Ligating Blood-Vessels”; “Wounds of Blood-Vessels and Nerves”; “Methods of Arresting Bleeding”; “Foreign Bodies in Wounds”; “Treatment of Wounds Inflicted by Poisoned Arrows”; “Bruised or Crushed Wounds”; “Stab Wounds”; “Bites and Stings”; “Wounds of the Head”; “Operations for Hare-Lip”; and several other chapters on wounds and pathological conditions of other parts of the body. Syphilis is not once mentioned in the book; and from this circumstance von Gurlt infers that a knowledge of the existence of this disease had not yet, at that early date (1497), reached Germany. In Brunschwig’s Liber pestilentialis, etc., however, which was printed three years later, syphilis is incidentally mentioned as the “malefrancose” or “malum mortuum.” That Brunschwig was well informed in the earlier surgical literature is shown by the fact that he quotes from the writings of Theodoric, Guillaume de Saliceto, Guy de Chauliac, Henri de Mondeville, and many others. A hasty and necessarily very superficial perusal of the text of a few of the more important chapters of this remarkable book satisfies me that Brunschwig deserves to be classed among the really great surgeons of the fifteenth and sixteenth centuries. A copy of this rare book may be seen in the Surgeon-General’s Library at Washington, D. C.

Heinrich von Pfolspeundt.--The earliest German treatise relating to surgery is that which bears the title “Buch der Bündth-Ertznei,” by Heinrich von Pfolspeundt, “Bruder des deutschen Ordens.” It was written in 1460, and was first published in printed form in 1868 by H. Haeser and A. Middeldorpf, Berlin. The text of this very early German work on the practice of surgery furnishes ample evidence to show that the author was worthy to be ranked among the leading surgeons of the fifteenth century. At page fifty-seven, says von Gurlt, may be read the remarkable statement that, in the case of a wound of the intestinal canal, one may cut through that organ at the point of injury and then introduce into the opposite ends of the divided bowel a silver tube the margins of which have been carefully bent so as not to offer at any point a cutting edge. The tube may then be tied in place with thread of green silk. (Von Gurlt speaks of this as the forerunner of Murphy’s button.) Speaking of wounds caused by arrows, Pfolspeundt says that, to insure the patient’s recovery, the planet under which he happens at that time to be, should be in favorable conjunction. In one case which came under Pfolspeundt’s care he was obliged to pay an astrologer the sum of fifty gulden in order to ascertain whether the planet in question was or was not in a favorable conjunction.

There is only one place in the entire book, says von Gurlt, where a gunshot wound is mentioned, and then only incidentally; but this is positively the first reference (about the middle of the fifteenth century) to such wounds discoverable in medical literature.

Among the topics which are treated quite fully and in such a manner as to show clearly that the author was well versed in at least this part of operative surgery, those relating to rhinoplasty deserve to receive special mention. From the viewpoint of history, this part of the book is of very great importance. In no other treatise, says von Gurlt, do we find an equally detailed and satisfactory account of the operative method employed by the Two Brancas (father and son, from Catania, Italy), who were contemporaries of Pfolspeundt. The latter learned this method from an Italian surgeon, whose name he does not mention, and he was particularly careful not to divulge the essential details to anybody except two of his brethren in the Order to which he belonged.

For anaesthetic purposes in operative cases, Pfolspeundt was in the habit of employing sponges saturated with the juices of opium, Atropa mandragora, Conium maculatum, Hedera helix or arborosa, Lactuca and Daphne mezereum; his technique resembling very closely that employed by Guy de Chauliac, Theodoric and others. (See the appropriate chapters in the earlier part of this volume.)

In his remarks upon the manner of bringing about the healing of an open wound, Pfolspeundt says that “in all cases he tries to dispense with stitches, but that, when he finds such support necessary, he first spreads a thick layer of adhesive material over both margins of the wound and afterward introduces the threaded needle through the mass into the skin. Then, in order to bring the edges of the wound together, he draws the thread taut and makes it fast by means of a very small knot.... Whether the sharp fever which sometimes sets in afterward as a complication, is due to simple inflammation or to erysipelas, is a question which cannot always be decided; and it is still more difficult to determine whether the thin watery secretion which sometimes develops in a wound may not signify--as some writers maintain--the beginning of suppuration in a joint.”

Were it not for the difficulty which one experiences in translating correctly the ancient provincial German of Pfolspeundt’s text, I might readily furnish further examples of his surgical pathology and methods of treatment. The few, however, which I have already given will have to suffice.

(From the Feldbuch der Wundarznei of Hans von Gerssdorff, first published in 1517; many later editions followed.)]

Hans von Gerssdorff.--Hans von Gerssdorff, who was also called “Schielhans” (squint-eyed Hans), was born in Strassburg about the middle of the fifteenth century. He was a bold and skilful surgeon, and acquired a wide experience and great self-confidence from his long service in connection with the army. He was present, for example, at the famous battles of Grandson (1476, in Switzerland) and Nancy (1477, in France), in both of which the slaughter was very great, and in both also Charles the Bold, Duke of Burgundy, was badly beaten. In 1517 von Gerssdorff published at Strassburg a treatise on military surgery, under the title: “Feldbuch der Wundartzney.” This book, which is illustrated with exceptionally good woodcuts, two specimens of which are here reproduced (Figs. 19 and 20), contains the earliest discussion of gunshot wounds; and, in his remarks on the proper manner of treating such wounds, von Gerssdorff leads one to infer that he shared, although somewhat hesitatingly, the at that time prevailing belief that these wounds are poisoned. He was a pronounced advocate of the use of the red-hot cautery in cases of serious hemorrhage from a wound. When it was found that the ball had penetrated the flesh to some depth, he recommended that it be cut out; and if, after the removal of the missile, the patient complained of much pain in the wound, hot oil was to be poured into it freely. Before the employment of firearms in warfare, amputation of a limb was rarely performed--that is, only in cases where gangrene had developed in the corresponding hand or foot. But von Gerssdorff assures us that, up to the time of writing his “Feldbuch,” he had personally performed “nearly two hundred amputations.” This great increase in the frequency of performing this operation is clearly to be attributed to the increased use of the new agent--gunpowder--in warfare. In this operation, according to his own declaration, von Gerssdorff was not in the habit of suturing the flaps. Instead, he brought the opposing edges together and then covered the stump thus formed with the bladder of some animal. There are a number of other interesting details relating to von Gerssdorff’s manner of conducting this important operation, but it is not practicable to give up the space that would be required for a satisfactory description of them. There is one point, however, to which I may be permitted to refer very briefly in this place, viz., the manner in which the surgeons of this and even much earlier periods secured a fairly satisfactory degree of local anaesthesia when they had occasion to perform an amputation. They produced insensibility of the part by tying a band tightly around the limb a short distance above the spot at which the amputation was to be performed. At a somewhat later period, as in the middle of the seventeenth century, artificial anaesthesia was also effected through the application of snow or ice to the part.

The date of von Gerssdorff’s death is not known.

(From Hans von Gerssdorff’s Feldbuch der Wundarznei.)

Von Gurlt says that this is the earliest known pictorial illustration of the amputation of a limb.]

Fabricius of Hilden.--Fabricius Hildanus--or Fabricius of Hilden, near Düsseldorf--was born in 1560 and received his early training in surgery from Cosmas Slotanus, a pupil of Vesalius and the first barber-surgeon of Duke Wilhelm of Guelich-Cleve-Berg (eighteen miles northeast of Aix-la-Chapelle). In 1585 he visited Geneva, Switzerland, and continued his studies in that city under the guidance of Jean Griffon, one of the most distinguished surgeons of that period. After leaving Geneva he practiced medicine at Cologne, and during that period (1591–1596) steadily increased his reputation as a skilful surgeon, particularly well versed in anatomy. But he appears to have acquired a strong liking for Switzerland and for the professional friends whom he had gained in that country; and consequently it is not surprising to learn that, during the later years of his life, he spent long periods of time in Geneva, Lausanne and Berne, in the last of which cities he filled the office of City Physician. He died in 1634, at the age of seventy-four, full of honors and greatly beloved by all who knew him.

Fabricius of Hilden laid great stress upon the importance, to the surgeon, of a thorough grounding in anatomy. He had been profoundly impressed by the fact that his instructor at Geneva, Jean Griffon, never undertook an important operation until after he had refreshed his memory by a dissection of the region involved. He was also much interested in pathological anatomy, and always availed himself of every possible opportunity for making a postmortem examination. As evidence of the slowness with which news of important scientific discoveries, particularly in the domain of medicine, traveled in those days I may mention here the fact that, up to the time of his death in 1634, Fabricius had not heard of Harvey’s great discovery of the circulation of the blood (1628). Although he gained distinction in more than one field of medicine his greatest reputation was unquestionably gained in that of surgery; and his success in this field was to be ascribed to his profound knowledge of anatomy, to his inventive genius, and to his great technical skill. He insisted very strongly upon the importance, for the surgeon, of possessing good instruments and well-constructed apparatus.

If we compare Fabricius of Hilden with Ambroise Paré we are obliged to admit that the latter, although decidedly inferior to his rival in scientific training, was the greater surgeon of the two. It is perhaps worth recording that Paracelsus and Wuertz were Fabricius’ bitter opponents.

Of his published contributions to surgical literature, the most important are to be found in the work entitled: “Observationum et curationum chirurgicarum centuriae VII.,” published at Lyons in 1641.

Felix Wuertz.--Felix Wuertz was born at Zurich, Switzerland, between the years 1500 and 1510 (the exact date is not known). As to his early life and surroundings I am only able to say that his father was a painter, that he himself took service under a barber, and that at the end of two or three years, after he had learned the details of this branch of work, he started out on his travels over Europe in the character of a barber’s apprentice, as was, in those days, the regular custom with apprentices of all trades or occupations. In this way he visited such cities as Bamberg, Pforzheim, Nuernberg, Padua and Rome, in each of which he spent a certain length of time as an aid to those surgeons who were willing to employ him. It is not unlikely that it was during this wandering period of his life that he gained some experience in the treatment of gunshot wounds. In 1536, after an absence of four or five years, he returned to his native city and was regularly enrolled as a member of the barbers’ guild. During the following twenty years he carried on the practice of medicine and surgery, but more particularly the latter, with ever-increasing success. In 1559, for reasons which are not mentioned by any of his biographers, he left Zurich and established himself in Strassburg; and then, at the end of another ten or twelve years, he again changed his residence, this time giving the preference to Basel, a Swiss city located at the boundary line between Germany and Switzerland. The exact date of Wuertz’s death is not known, but--from various facts which he mentions in his book--it may be inferred that it occurred in 1576, and that he was residing at the time in the house of his son, who had the same name as himself and was also a surgeon. The title of the treatise which he wrote and which passed through a number of editions between the years 1563 and 1651,--not to mention translations into the French and Dutch languages--was: “Practica der Wundarznei” (The Treatment of Surgical Affections).

Malgaigne--says von Gurlt, in his History of Surgery--does not hesitate to speak of Wuertz as one of the three greatest surgeons of the sixteenth century (Franco and Ambroise Paré being the other two); and von Gurlt adds that Wuertz’s “Practica” is rich in facts which he had gathered from his own experience in everyday practice, and upon which he makes comments that really represent his own views and not those of various other authors. The leading principles which guided Wuertz in his treatment of wounds of all kinds are thus formulated by him:--

Keep them as neat and clean as possible, and disturb them as little as you can; so far as may be practicable, exclude the air; favor healing under a scab; and do not give the patient a lowering diet, but feed him as you would a woman recovering from her confinement.

According to von Gurlt, Wuertz attached relatively small importance to healing by first intention, and only in rare cases did he make special efforts to secure this result. On the other hand, he availed himself of every opportunity to enter his protest against some of the bad tendencies which had somewhat suddenly made their appearance in the practice of surgery in his day, and more especially “against the almost universal employment of caustics and the red-hot iron for arresting bleeding; against the uncalled-for and positively harmful habit of repeatedly probing a wound; against the unreasonable practice of inserting tents into wounds; against the uncontrolled application of mushy poultices to wounds; and against the excessive employment of bloodletting in the treatment of wounds.” He exhibited his conservatism in still other ways. Thus, for example, he was very slow in reaching a decision to amputate a limb or to remove splinters or larger portions of loose bone from a wound, for he put greater trust in the reparative powers of Nature than did most of the surgeons of that day. Wuertz was also slower than were most of them in resorting to the operation of trephining the skull. His ideas with regard to the nature of gunshot wounds were not very clear, for he still believed that the projectile caused some burning and a certain degree of poisoning of the wound; but he condemned all unnecessary efforts at extraction, especially by means of complicated instruments. It was better, he said, to wait until the bullet or other missile manifested its presence at some easily accessible spot in the body.

The statements made above bring out some of the good features of Wuertz’s treatise. This work, however, says von Gurlt, also contains not a few bad features, and among them he mentions the fact that it abounds in repetitions and in evidences of the author’s superstitiousness.

Some of Wuertz’s comments on the symptoms which occasionally develop in cases of injury to the head, and the suggestions which he makes as to the treatment that should be adopted, throw considerable light upon his mode of procedure in the presence of certain surgical phenomena. The following clinical lesson is based upon three hypothetical developments in a case of cranial injuries:--

(1) The patient’s wound in the head, let us suppose, has to all appearances healed, when it unexpectedly becomes swollen and painful and begins to discharge again. What measures are indicated under these circumstances? The wound should at once be freely reopened, for it may confidently be assumed that such a lighting up of the local symptoms is due either to a loose splinter of bone that is trying to escape or to the presence of a small area of bone caries. If, under these circumstances, you should not establish a free opening a large abscess will surely collect in that region and will soon make for itself a new outlet.

(2) If the patient complains that he has constant pain in his head on the same side as that on which the injury was originally inflicted, that the pain is steadily increasing in severity, and that in addition he feels a sensation of pulsation in his head; and if, furthermore, you inspect closely the site of the original wound, and pass your finger cautiously over the spot, but fail to discover any appreciable external swelling, you may feel almost certain that a splinter or a spicule of bone projects from the inner table of the skull cap into the substance of the brain. Then, when the surgeon believes that the condition as just described truly represents the existing intracranial lesions, he should not hesitate to make an opening in the calvarium over the affected spot and remove the offending splinter.

(3) If the patient, after the external wound has healed, complains of a throbbing and roaring in his head, not merely in the region of the actual injury but involving the entire head, and if the symptoms tend rather to increase than to diminish, and eventually become so severe that the patient is almost beside himself with the pain, then is the surgeon justified in believing that a clot of blood is imprisoned somewhere beneath the cranium and is gradually being converted into an abscess or a condition of ulceration. And if at the same time some swelling appears in the vicinity of the eyes, or if a bloody and purulent discharge begins to flow from the nose or the ears, he may not merely entertain a belief that his diagnosis is correct, but may assert with positiveness that the lesions just named really exist. And then the proper treatment for him to adopt is [in essentials] the following: The head having first been shaved over the site of the original wound, make a crucial incision through the scalp and pericranium, turn the flaps back, apply a strong, sharp-edged chisel to the surface of the bone, and remove enough of the cranium to afford a satisfactory view of the underlying parts. [Among the effects first observed] probably pus will well up into the opening, and the patient will then experience relief; and if a spicule of bone comes into view, remove it forthwith. The plan of treatment here suggested is the only one which can be trusted to effect a cure in a case like that which is now being considered.... If a boring instrument is employed for making an opening in the bone, be careful not to allow any of the chips made by the borer to enter or remain in the cranial cavity. Some surgeons teach that, if pus be not found at the first opening, a second one should be made at the distance of a finger’s breadth from the first, and that the intervening bone should be broken down with a strong and sharp knife so as to convert the two into a single opening. [Wuertz adds that he had never found it necessary to act in accordance with this advice.] After the pus or clot of blood has been removed, one may as a rule readily discover the true cause of the pain and other symptoms. As a final step, suitable dressings should be applied to the wound.

Another important department of practical surgery, in which Wuertz appears to have gained special distinction, is that which relates to wounds and certain diseases of the abdomen. Owing to lack of space it will not be practicable to reproduce here any histories of the cases of this nature which came under his observation, but I believe that the following brief extracts from his remarks upon the best way of treating them may in some measure answer the same purpose:--

Penetrating wounds of the abdomen are universally admitted to be very dangerous, no matter what organs (stomach, intestines, liver, gall-bladder, spleen or kidneys) be involved in the injury. In the case of a wound of the liver or spleen it is not advisable to employ sutures; instead, one may use some kind of sticking plaster for bringing the edges of the wound together. Proper regulation of the diet plays an important part in the treatment of these conditions, and so also may venesection. When an intestine is the organ wounded I adopt the plan of treatment recommended by most authorities; that is, I stitch together the opposite edges of the wound and I cleanse the surface of the bowel carefully with milk that has been well saturated with the juice of anise seeds.

In his remarks about the treatment of suppurative processes involving the thigh in the vicinity of the knee, Wuertz gives the following advice:--

Do not allow the knee to remain quiet, but stretch the surrounding parts and manipulate them as much as you can, in order that the joint may not become permanently rigid; for if you wait until the healing is completed before you resort to these measures you will often find that it is already too late.

Separate chapters are devoted to such topics as would to-day receive the designations “pyaemia,” “hospital gangrene,” and “septicaemia”; and in a separate short treatise which deals with the various ailments of young children, Wuertz mentions the fact that he once suffered greatly for ten days from an attack of migraine (hemicrania) and that he experienced marked and permanent relief only after the operation of arteriotomy had been performed upon his left temporal artery. In another part of the volume he expresses himself in terms which justify the belief that he must have performed amputation of the thigh on one or more occasions. He does not, it is true, furnish any details regarding the indications that point to the necessity of resorting to this operation, nor does he state how it should be carried out; he simply makes the remark, while speaking of the employment of the red-hot cautery iron in arresting hemorrhage, that “it is useful in amputation of a limb, particularly in the thicker part of the thigh, and occasionally in other places, as in the removal of a tumor by the use of the knife.” So far as I am aware, Celsus was the first among ancient writers on surgery to say anything about amputations, and what he does say on this subject consists simply of quotations from still earlier writers--from Archigenes, Leonides and Heliodorus, surgeons whose writings no longer exist except in the form of detached extracts that appear in more modern treatises. The portions of text which Celsus quotes show clearly that the surgeons whom I have just named were in the habit of making flap operations in cases of amputation above the elbow and above the knee; and Archigenes even taught the advisability of first ligating the larger supply blood-vessels before one proceeds to the amputation of a limb.

From the remarks which Wuertz makes in one or two places it is easy to see that he was often not a little annoyed by the criticisms which his professional brethren made with regard to some of his methods of procedure. Thus, for example, he boldly declares that one’s experience is of much greater value than any rule that may have been laid down by the ancients.

There can be no doubt, he says, that the ancients occasionally displayed great ignorance and great want of judgment, just as happens in our own time.... How much do you suppose I care whether Galen’s, or Avicenna’s, or Guy de Chauliac’s opinion does or does not agree with mine? Every such opinion--it should be remembered--was, at one time or another in their day, a new [and therefore unproved] opinion.... In practical surgery much more importance attaches to the manner in which one carries out one’s manipulations, and to the amount of experience which one may have acquired, than to the length of time which one devotes to windy consultations.

Fortune conferred very few favors upon Wuertz in the course of his career; the aid granted by kings and princes played no part in the moulding of his character; his greatness was entirely due to his own unaided efforts. Paré, on the other hand, was certainly one of Fortune’s favorites. He, too, like Franco and Wuertz, began his professional life as a barber’s apprentice, but, as he was made of a much finer clay, the ultimate product of his development was a princely surgeon, perhaps no more efficient or skilful than his two distinguished contemporaries, but unquestionably more many-sided, more lovable than either of them. On the other hand, Wuertz rendered a most valuable service to the science of surgery by his close and patient study of certain symptoms which his confrères had overlooked or incorrectly interpreted (such, for example, as pyaemia, hospital gangrene and septicaemia); and he thus established the fact that these were in reality independent diseases.