CHAPTER XXXVIII

THE DEVELOPMENT OF SURGERY IN SPAIN AND PORTUGAL DURING THE RENAISSANCE

According to the authority of Morejon, who published (1842–1852) an elaborate history of medicine in Spain and Portugal, these countries almost rivaled Italy, during the sixteenth century, in the number and excellence of their physicians. But, so far as I am able to judge from the record, very few of these men appear to have taken a strong interest in surgery, and of these few there are only three--Daza Chacon, Francisco Arceo and Amatus Lusitanus--who left behind them treatises which seem to call for a brief notice.

Dionisio Daza Chacon, who was born in 1503 at Valladolid, about one hundred miles north of Madrid, received his early training partly in his native city and partly at the University of Salamanca. After being engaged for some time in private practice he joined the imperial army (Charles the Fifth) in the capacity of a field surgeon in charge of a corps of three thousand men. In addition to these troops there were six thousand English archers, in the pay of the Emperor. At the two sieges in which these men participated--the siege of Landrecy in 1543 and that of Saint Dizier in 1544--Daza Chacon acquired an extensive experience in the treatment of both arrow and gunshot wounds, for the number of those injured on those occasions was very great. In 1545, after he had been chosen personal physician of Charles the Fifth, he returned home by way of Madrid, and distinguished himself greatly in 1547 by his self-sacrificing attendance upon the victims of the Plague in his native city. In 1557 he offered himself as a candidate for the position of Surgeon-in-Chief of the hospital at Valladolid, and, after passing with great credit the competitive examination, he was given the appointment. During the following six years he served that institution with conspicuous ability, and then accepted the position of private physician to Prince Don Carlos, the son of Philip the Second, King of Spain. Four years later he entered the service of Don Juan of Austria (the natural brother of Philip the Second), and accompanied this prince on his sea voyages to various parts of the Mediterranean; being with him, for example, on the occasion of the bloody sea fight in the Gulf of Lepanto in 1571. On reaching the age of seventy, Daza Chacon retired from active practice and devoted himself to the writing of his great work on surgery--“Practica y teorica de cirujia, en Romance y en Latin,” Valladolid, 1600; and several later editions. The date of Chacon’s death is not known, but it certainly occurred before the publication of his book.

Von Gurlt says that Chacon’s treatise is distinguished by the systematic and clear manner in which the author treats the subjects with which he deals, and it shows him to be well versed in the teachings of other writers on surgery, that he is ready at all times to give them full credit for any contributions which they may have made to this branch of medicine, and that he is remarkably free from the superstitiousness which was so prevalent in his day. Of all the treatises on surgery which have been written by Spaniards, either during the sixteenth century or at a more recent date, this work, says von Gurlt, is unquestionably the best.

The edition of the treatise published at Madrid in 1626 contains 922 pages--a large work. Among the reports of cases published in Part II., there are several which possess features of considerable interest, but I shall be able to reproduce only one of them here:--

The young prince, Don Carlos, aged seventeen, while residing temporarily at Alcalá de Henares, plunged head foremost, in the dark, down a steep staircase and struck his head against a closed door. When the lad was picked up it was found that, at the back of his head, there was an open wound about the size of a man’s thumbnail, that the surrounding scalp showed evidences of being bruised, and that the pericranium in this region had been laid bare. During the first three days following the accident the patient manifested only a moderate degree of fever, but on the fourth day the fever became more pronounced. The wound, which by this time was discharging actively, presented at first a healthy appearance, but it soon acquired an unhealthy aspect, and the patient began to complain of numbness in the right leg. Vesalius, the private physician of Charles the Fifth, the boy’s grandfather, was one of the many physicians who were called in to consult about the treatment of this case; he was sent for on the eleventh day following the accident. On the seventeenth day the wound was enlarged and the bone carefully examined, but no evidence of a fracture or a fissure was discovered. On the following day erysipelas manifested itself on the head and neck and extended downward until it had involved both arms. At the same time the fever increased very markedly, and for five days the patient was delirious. As by this time there was ample reason for suspecting that some intracranial injury had occurred, it was decided to trephine the skull. The operation was performed on the twenty-first day, but nothing of importance was discovered. The patient’s life was now evidently in great peril, and an unfavorable prognosis was pronounced. Four days later, however, complete consciousness returned. On the twenty-ninth day a quantity of pus was evacuated from the very much swollen eyelids; and, three days later still, the patient was found to be quite free from fever. On the forty-sixth day he left his bed for the first time, and at the end of ninety-three days the wound was found to have firmly cicatrized.

Francisco Arceo was born, about the year 1493, at Fregenal in the Province of Badajoz, Spain. It is not known at what university or other educational institution he received his early training in the science of medicine. It is a well-established fact, however, that at quite an early stage of his professional career he acquired great celebrity for his skill in treating both surgical and internal maladies, and that, as a consequence, patients flocked in large numbers from all parts of Spain to consult him. Rather late in life he wrote two treatises--one on the treatment of wounds, as well as on ulcers and syphilis, and another on the management of fevers. These two works were published at Antwerp, in the year 1574, as a single volume, the author being at that time, despite his advanced age (eighty), still in vigorous health and able to practice with skill both branches of the science of medicine. In 1658 a second edition of Arceo’s two treatises was published at Amsterdam; and even at an earlier date there were published an English translation (1588) and a German version (1614). A perusal of the chapter which he devotes to the treatment of clubfoot gives the impression that Arceo was an excellent surgeon--eminently practical in his choice of means for securing certain results, and thoroughly familiar with the extent to which he might depend upon the powers of Nature to aid his efforts. The date of his death is not known.

Amatus Lusitanus is the name by which the Portuguese medical writer, Juan Rodriguez de Castel Bianco, is commonly known. He was born in the Province of Beira, Portugal, in 1511, of Jewish parents, and studied medicine at the University of Salamanca. After doing duty as a surgeon in two of the hospitals of that city, he took up his residence, for short periods of time, first in Antwerp and then in Ragusa, Dalmatia, on the eastern coast of the Adriatic. At this period of our history the Inquisition was extremely active throughout the domains that were under the rule of Charles the Fifth, and as a result Amatus soon found himself obliged to abandon all his books, instruments, etc., and flee for his life to Northern Greece. As the Turks, who were in possession of that country, were perfectly indifferent with regard to the religious beliefs of the Jews, Amatus was allowed to settle down quietly for the rest of his life at Thessalonica, in Macedonia.

During the later years of his career he published several books on topics relating to the science of medicine--two of them on materia medica and two on the cases of special interest which had come under his personal observation during the course of his practice. The latter work, which is entitled “Curationum medicinalium centuriae VII.,” was printed in its entirety in Venice, in 1556 (2 vols.). Von Gurlt speaks of Amatus as a cultivated scholar and an excellent observer. Of the seven hundred cases reported in this work only a very few are of interest to the surgeon. Von Gurlt calls attention to the fact that, during the earlier years of his practice, Amatus devoted a fair share of his attention to surgery, but that subsequently he performed no operations whatever; it being his rule to intrust this work entirely to a regular surgeon or to a specialist.

In my search among the dozen or more histories of cases selected by von Gurlt from the seven “Centuries” (700) of the complete treatise as suitably illustrating Amatus’ manner of reporting the cases which he had seen in practice, the various methods of treatment which he adopted in his efforts to relieve the diseases or injuries that came under his observation, and the demeanor of the man in the presence of the ever-changing problems presented to the physician, I have succeeded in finding only four that seem to furnish in even a slight degree the information which I have just outlined. Unsatisfactory as these four reports are in certain respects,--especially in their failure to reveal to us the more strictly surgical capabilities of Amatus,--they at least show that he was an able and conscientious practitioner, and to this extent they possess value.

The first case reported in Century I. is that of a peasant girl, aged thirteen, who, while walking barefooted in a field was bitten by a viper. Amatus did not see the patient until three hours later, but already at this early stage he observed many blue and red patches, scattered over the leg and thigh of the side on which the bite had been inflicted. Near the base of the foot there were two quite black spots corresponding to the bites of the reptile; and from the fact that there were only two such spots Amatus inferred that the snake must have been a male viper, which has only two poison fangs and is therefore less dangerous than the female which has four. The symptoms which the girl experienced were faintness, trembling and dizziness. As regards the treatment adopted, the skin in the immediate neighborhood of the bites was scarified and suction by the means of cupping glasses was employed; afterward a plaster, which was composed in part of theriaca, was applied to this region. The patient made a complete recovery.

In Century V., Amatus gives an account of a fatal case of ear disease. The patient, a sickly-looking boy of eight who had been affected for a long time with a discharge from one ear, presented a non-sensitive lump on the side of the head. “As he began to show signs of feverishness it was decided to incise the lump; and when the incision had been made, it was found that a large part of the skull in this region had been destroyed by caries, as a result of which there was left a cavity in the side of the head, and this cavity was filled with a foul-smelling pus, débris, and granulation tissue that apparently rested on the dura mater. Three days later the surgeon succeeded in removing from the cavity only a small quantity of the sanious material. On the fourth day, after an attack of convulsions, the patient died.”

In Century VII. there is given an account of a man of the wealthy class who had been exposed to an excessive degree of cold for so long a time that he was literally almost half frozen. “As he was being carried into the village he gave orders that an ox should be slaughtered and that he himself should be snugly stowed away inside the carcass of the animal as soon as its interior furnishings had been removed. Thus he escaped freezing to death.”

In the same century Amatus speaks of having seen a rather interesting case of Filaria Medinensis (called by the Arabs “vena medena”) in a negro boy, eighteen years old, who had come to Thessalonica from Memphis, Egypt. “The worm had caused the production of an ulcer close to the boy’s heel, and in this the creature’s head, which looked very much like a vein, was recognizable. After the Turks had correctly diagnosed the nature of the trouble an Arabian physician, who had managed to secure a purchase on the worm, began rolling it up on a small stick. Gradually, after the lapse of several days, he succeeded in uncoiling the animal in its entire length (three cubits), as shown by the construction of the end of the tail, and thus permanently freed the boy from his trouble. The ancient authors express doubts as to the true nature of the object found in these ulcers, but I, Amatus, having examined the slender white creature and having witnessed its curved outlines as it projected itself outside the opening, do vouch for the fact that it possesses all the characteristics of a true worm.”