Monday, October 18, 2010

Health Care Reform in 1655 - Surgical Ward

by Stephen J. Gertz

SCULTET, Jean (Johannes Scultetes). L'Arcenal de Chirurgie.
A Lion: Aux despens du traducteur, 1672.
First edition in French

We think we have health care problems. People in the mid-Seventeenth century actually paid for the medical and surgical procedures below out of their own pocket, performed with pictured instruments into their own flesh.

The doctor is in. Run for your life!

Method for reducing dislocations.
Leg Splint.
Bracing for the arm.

Apparatus for reducing dislocations.

Apparatus for reducing dislocations.

The imagery here is from Armamentarium Chirurgicum by Johannes Scultetes, the most influential and widely read illustrated surgical treatise of the seventeenth century.

Method for reducing a dislocated arm.

The Armamentarium... provides the best record of 17th-century surgical practice, illustrating such procedures as amputation of the breast, reduction of dislocations, forceps delivery, anal-rectal  procedures, neurosurgery, etc.

Urological and anal-rectal procedure.

Urological and gynecological procedures.

"One of the great illustrators of surgery and surgical instruments" (Garrison and Morton).

"It is the work of the most comprehensive description of the instruments, organizations and equipment of that era, and at the same time contains many interesting observations, the testimony of this enterprising surgeon. Boldness and skill" (Hirsch-H. V, 299)

How to expand head wounds into a triangle,
to pierce the skull,  and bandaged head.

John Scultetus (1595 -  1645) was one of the first academically trained physicians and surgeons in Germany in the 17th century, who, after his studies at the University of Padua under  Fabricius ab Aquapendente,  worked from 1625 until his death as Stadtphysicus (City Doctor, i.e. chief medical examiner), in Ulm, responsible for the general health of the population, and overseeing hygienic conditions in the city and medical personnel, including  barber/surgeons (shave and haircut, two bits. Amputations, 5) and midwives. He was also the city coroner, performing autopsies, which greatly enhanced and improved his understanding of anatomy and pathology.

Instruments and methods for treating various diseases
The Armamentarium... was published ten years after his death by his nephew, Scultetus the Younger. The work includes a complete catalog of all known surgical instruments of the day, and bandaging and splinting methods. The  procedures  are illustrated in graphic detail by forty-three plates which were never again published in their original folio size, all subsequent editions and translations in quarto.

This was the state of the art of surgery.

If the instruments seem to have been lifted from David Cronenberg's  Dead Ringers and the procedures from Dr. Mengele's medical malefactory they would nonetheless be an improvement over practices and procedures from just a short time before.

Now, thankfully, surgery has made great strides. Non-invasive procedures are increasing in number and performance. 

But few can afford them. Things haven't changed much.

SCULTETES, Johannes (1595-1645). Cheiroplotheke, seu armamentarium chirurgicum. Ulm: Balthasar Khnen, 1655. Folio. Title printed in red and black with printer's woodcut vignette, text in double column, errata statement on last leaf. 43 numbered engraved plates, woodcut tail-pieces and initials. First edition.

BM/STC 17th century S1741. Garrison-Morton 5571. Heirs of Hippocrates 466. NLM/Krivatsy 10746. Zimmerman & Veith, Great Ideas in the History of Surgery, pp. 249-53.

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