in constant use in the 16th and 17th centuries. They consisted of a spherical explosive or incendiary bomb, or of an explosive canister, mounted on a throwing stick and provided with a fuse.*

References to wounds by firearms are scarce in early medical literature, and find no place in the Cyrurgie' of the Belgian, Meester Jan Yperman (1295-1351); in the 'Grande Chirurgie' of Guy de Chauliac, that appeared about 1350; or in the works of John of Arderne,† who was living in 1370 and is said to have been present at the battle of Crecy. Nor is gunpowder even mentioned in the writings of such surgeons as Balescon de Tarente (Valescus de Taranta), Giovanni Matteo Ferrario da Grado (de Gradibus), and Leonardo Bertapaglia, who lived in the 15th century and saw the dawn of the revival of learning. Perhaps this absence of allusion to gunshot wounds is capable of a simple explanation. Since, as we have seen, projectiles from firearms were for long of no specialised type, the wounds caused by these arrows, darts or stones probably called for no special remark. In the 15th century, however, and still more in the following century, surgical works were frequently enlivened by pictures of so-called 'wound-men,' in which the artist attempted to depict on one figure every possible variety of injury. The wound-men' sometimes display, among other agents of injury, certain ball-like objects which we may suppose to have been hurled from the cannon's mouth.

Probably the earliest known surgical work in which a reference to our subject appears is the Vademecum of Marcello Cumano, dating from about the middle of the 15th century. In that compilation a few words are devoted to the pain caused by gunshot wounds.‡ A little more definite information is provided by the Thuringian, Heinrich von Pfolsprundt, who composed his 'Buch der Bündth-Ertznei' in 1460.§ Pfolsprundt devotes

* Peter Whitehorne, 'Certaine Wayes for the ordering of Souldieurs in Battleray,' London, 1560.

+ So I am informed by Mr D'Arcy Power.

H. Fröhlich, under heading, 'Pfolsprundt,' in E. Gurlt and A. Hirsch's Biographisches Lexikon der hervorragenden Aerzte,' vol. iv, p. 555; Vienna, 1886.

§ Edited by H. Haeser and A. Middeldorpf, Berlin, 1868.

himself mainly to arrow wounds; and, in the case of embedded arrow-heads, he advises the surgeon to await suppuration before attempting their removal, an operation which should be performed about twelve or fourteen days after the date of injury. Gunpowder should be rinsed from a wound with the milk of a woman or of a goat, the projectile, if present, being removed with the help of a sound, and the wound mollified with lotions made from gentian, turnips and other vegetables.

Towards the end of the 15th century we begin to have more extensive information touching the surgical treatment of gunshot wounds. The Buch der Cirurgia' of Hieronymo Brunschwig, printed in Strassburg in 1497,* contains both a brief description of wounds caused by firearms and advice for their treatment. Brunschwig, who was an Alsatian, relates that he learned his art of bullet extraction from a certain Hans von Dockenburg, to whom tradition attributes the cure of an obstinate wound sustained by Matthias Corvinus (1450-1490), King of Hungary, in an affray against the Moldavians. For four years, the story runs, the Hungarian monarch sought a cure and offered riches and honour to any who should heal him, until at last, in 1468, the cure was wrought by this Alsatian surgeon.†

A short chapter of Brunschwig's book tells in his quaint dialect of one who has been shot with a bullet so that the powder has poisoned the wound and the ball remains therein.' If the limb is penetrated, Brunschwig advises us to 'take a silken thread and thrust it through the sinus and draw it back and forth so as to evacuate the powder from the wound.' When the shot still remains in the wound, we must make the wound wider by cutting, . . . and then skilfully and neatly seize it with a bullet forceps (Kugelzangen) and draw it out. But, if the wound cannot be cut or enlarged, use the iron instrument called the "stork's beak" ("Storchenschnabel")' (Fig. 4 (1)). This terrible wound-dilater was in use down to modern times, and underwent modification at the hands of several surgeons in the 15th, 16th, and 17th centuries. It was often elaborated into an engine of three or four

*This work was reproduced in facsimile by G. Klein; München, 1911. †Theodor Billroth, op. cit., p. 7.

1

blades, constructed so as to stretch the wound in all directions, and thus permit the operator to gain freer access to the part.

Brunschwig tells us that if it should so happen that, in spite of manipulation, the wound should fail to suppurate, the surgeon may adopt more active measures; and he advises the insertion into the wound of an instrument smeared with ox or bacon fat, 'a procedure which will almost certainly produce the desired result.' The view that the formation of purulent matter in a wound is a favourable process can be traced far back into antiquity and lasted long after Brunschwig. Indeed the doctrine of laudable pus' did not receive its death-blow until the work of Pasteur and Lister reduced to absurdity the older theory of the evacuation of the humours.' Even Brunschwig, however, gives a hint of sounder surgical principles when he assures us that there is no healing without cleanliness.' He foreshadows, also, another great surgical advance by his use of a primitive form of anaesthetic or Toll-trank,' as he calls it, for which he gives us the prescription. The draught contains, inter alia, opium, crocus, cortex of mandrakes, ligne aloes, cinnamon, and castoreum.

Brunschwig had some idea of the ligature of vessels, and grasped to a limited extent the use of the tourniquet. His book is interestingly illustrated; and, in most of the figures, the operator or professor is shown instructing students or assistants. One of his figures is probably the earliest printed illustration of an abdominal operation.

6

A contemporary of Brunschwig was another Alsatian surgeon, Hans von Gersdorff, also called Schylhans, who gained his experience of field surgery in campaigning with his countrymen and the Swiss against Charles the Bold. He was present in 1477 at the battle of Nancy, where artillery was much in evidence. The publication of Gersdorff's Feldtbuch der Wundt-Artzney' was, however, delayed until 1517, when it appeared at Strassburg, of which town he was a burgher. The treatment for gunshot wounds advised by Gersdorff is fairly simple; the wound is to be drenched with warm hemp-seed oil to get rid of the powder, then washed with water or bland fluids, and finally treated with the universal salve ' unguentum egyptiacum.' This wonderful all-healing

[To face p. 456.