CBMH 7 2 131

Articles
https://www.utpjournals.press/doi/pdf/10.3138/cbmh.7.2.131 - Monday, September 13, 2021 2:24:40 PM - IP Address:119.160.59.201
Military Surgical Practice and the

Advent of ~ u n p o w d e rWeaponry*
KELLY R. DEVRIES
Abstract. In 1536, at the siege of Turin, French military surgeon Ambroise

Pare changed surgical history. At that time, it was the custom to treat gunshot
wounds by pouring boiling oil into them, often without removing the fragment
or bullet. Pare, having run out of this cauterizing mixture, was forced to use a
non-abrasive digestive to treat some of his wounded patients. This surgical
procedure ultimately proved that gunshot wounds should not be treated by
cauterization.
Gunpowder weapons, however, had been in use for more than two cen-
turies before Pare's discovery. During this time undoubtedly many victims
wounded with gunshot must have suffered through cauterization. This has
given rise to the belief among modern medical historians that the tradition of
treating gunshot wounds which Pare corrected was formed and developed
during the late Middle Ages.
This article takes an opposing viewpoint to that theory. Using both late
medieval surgical manuals and examples of gunshot wound treatment found
in chronicles of the fourteenth and fifteenth centuries, it shows instead that
those late medieval surgeons who treated gunshot wounds did so in a manner
not unlike their treatment of non-gunshot wounds, without cauterization.
Moreover, the responsibilityfor the harsh treatment which Pjlrk altered should
instead be laid at the feet of the early sixteenth-century surgeon Giovanni da
I Vigo. It was from his popular surgical manual that most surgeons, including
Park, had learned incorrectly their treatment of gunshot wounds.
Resume. En 1536, pendant le siege de Turin, le chirurgien militaire frangis
Ambroise Pare a bodeverse la pratique de son art. A cette epoque, on avait
coutume de traiter les blessures causeeapar des armes 21 feu en versant sur elles
de l'huile bouillante, sans en retirer les eclats d'obus ou la balle. Park, qui avait
epuise sa mixture de cauterisation, avait alors et6 force d'utiliser un condense
non-abrasif pour traiter certains de ses blessees. Cette procedure chirurgicale
finira par prouver que les plaies par armes feu ne doivent pas Otres traitees
par la cauterisation.
Kelly R. DeVries, Department of History, Wilfrid Laurier University, Waterloo,

Ontario N2L 3C5.
CBMHIBCHM l Volume 7: 1990 1 p. 131-4
132 KELLY R. DEVRIES
Toutefois, les armes B feu avaient deja et6 utilis6es pendant plus de deux
si6cles avant l'experience de Pare. Pendant tout ce temps, bien des victirnes de
blessures par balle doivent avoir souffert B cause de la cauterisation. Ceci a
suscite chez les historiens modernes de la medecine la croyance que cette
tradition de traitement des blessures par armes a feu, qui fut -modifiee ensuite
par Pare, s'etait formee et developpee au cours du Moyen Age tardif.
Le present article adopte un point de vue oppose h celui de cette tbeorie. En

vtilisant a la fois des manuels de chirurgie de la fin du Moyen Age et des
exemples de traitement des blessures par armes B feu pris dans les chroniques
des XIVe et XVe siecles, il demontre, au contraire, que les chirurgiens de ce
temps traitaient les plaies par armes B feu d'une facon qui ne se differenciait
gusre du traitement qu'ils pratiquaient pour les autres types de blessures,
c'est-B-dire sans cauterisation. En outre, la responsabilite de ce genre tres rude
de traitement que Pare a change, devrait plutbt 2tre imputke au chirurgien
Giovanni da Vigo qui exerqa au debut du XVIe siscle. En effet, c'etait B partir de
son celebre manuel de chirurgie que la plupart des chirurgiens, y compris Par6
hi-msme, avaient appris une maniere incorrecte de traiter les blessures par
armes B feu.
The year was 1536. The Peace of Cambrai, signed in 1529 between
Francis I and Charles V, had lapsed and Francis I was again embroiled
in one of his innumerable (and interminable) wars against the Habs-
burg Holy Roman emperor. That year, during the French king's
attempt to raise the siege of Turin, novice military surgeon Ambroise
Par4 came upon a surgical problem. At this time, according to medieval
tradition as found in the chief surgical manual of the age, Giovanni da
Vigo's Practica copiosa in arte chirurgica, gunshot wounds were thought
to be poisoned by the residue of gunpowder found in them. The
customary treatment of such wounds was to pour boiling oil into them,
often without removing the fragment or bullet. However, Par6 found
himself without sufficient oil to treat all the wounded soldiers under
his care. In his own words he relates the story:
It chanced on a time, that by reason of the multitude that were hurt, I wanted
l
this Oyle. Now because there were some few left to be dressed, I was forced,
that I might seeme to want nothing, and that I might not leave them undrest, to
apply a digestive made of the yolke of an egge, oyle of Roses, and Turpentine. I
could not sleepe all that night, for I was troubled in minde, and the dressing of
the precedent day, (which I judged unfit) troubled my thoughts; and I feared
that the next day I should finde them dead, or at least at the point of death by
the poyson of the wound, whom I had not dressed with the scalding oyle.
Therefore I rose early in the morning, I visited then my patients, and beyound
expectation, I found such as I had dressed with a digestive onely, free from
vehemencie of paine to have had a good rest, and that their wounds were not
inflamed, nor tumifyed; but on the contrary the others that were burnt with the
scalding oyle were feaverish, tormented with much paine, and the parts about
their wounds were swolne.'
Although by mistake, Park had found the solution to a problem that
plagued the military surgeons of his age. He concludes: "When I had
Military Surgical Practice and Gunpowder Weaponry 133
many times tryed this in divers others, I thought thus much, that
neither I nor any other should ever cauterize any wounded with
Gun-shot."2
For the correction of this "medieval" surgical practice, Pare has been
recognized by medical historians as the great surgical innovator of the
sixteenth ~ e n t u r yAfter
. ~ all, gunpowder weapons had been used in
war for nearly two centuries before Pare began to treat the wounds
made by these weapons. And while gunpowder weapons had
changed all facets of warfare, on the battlefield, in sieges, and in naval
conflicts, it seems that they did not have a similar effect on military
surgeons who undoubtedly had to treat soldiers wounded by gunshot.
Certainly this is the impression found in the writings of most medi-
cal historians; the late Middle Ages, including that portion known as
the Hundred Years War, was simply a backward and largely non-
prop-essive period of medical thought and surgical practice. Indeed,
according to George Gask, the Hundred Years War, together with the
Black Death, may have hindered the surgical advancement which
seemed to be evolving in the early fourteenth century "although the
need for help in those dark days must have been great."4
Even the advent of gunpowder weapons and the wounds they
caused had not encouraged an enlightenment in surgical practices.
Gask, for example, sees "no progress" in the history of surgery with
the appearance of gunshot wound^.^ Theodore Billroth agrees: "It is
easy to understand. . . why gunshot wounds received little attention
from the early military surgeons, although those who took part in the
campaigns of the fourteenth century were surely in a position to write
~ it is J. F. Malgaigne who is most critical of the
on the s ~ b j e c t . "But
military surgeons of this time:
The frightful lesions these new arms produced seemed to have impressed all
observers. Yet this was not entirely true, and, while it must be realized that
Guy de Chauliac did not mention it at a period when the use of firearms was
I still very rare, it is difficult to explain the long silence of his successors, except
by the general decadence into which surgery had fallen.'
It is easy to conclude that the techniques of gunshot wound repair

corrected by Pare were medieval in origin. But in reality how this repair
was undertaken remains a mystery to us. It was not until 1460 that any
surgical manual even mentions gunshot wounds, and it was even later
before these wounds are given specific and distinct treatment in surgi-
cal writings.
However, omitting gunshot wounds from their manuals and writ-
ings does not necessarily mean that the military surgeons of the four-
teenth and fifteenth centuries considered these wounds to be unim-
portant. Perhaps these omissions indicate less the surgeons' neglect of
gunshot wounds and more their belief that these wounds were not
different from other battlefield wounds and thus should not be treated
differently. This study will endeavor to show that this was indeed the
case in the late Middle Ages, and that the idea which Pare encoun-
tered, that gunshot wounds were poisonous and needed to be treated
with cauterization, was a relatively new one, propagated by the
extremely popular surgical writings of Giovanni da Vigo.

Certainly surgery during the fourteenth and fifteenth centuries was
a highly imperfect skill. To be a wounded soldier during this period
generally meant death, despite the skills of the surgical staff. Surgeons
of the fourteenth and fifteenth centuries were very superstitious, and
some relied on spells and charms in their surgical treatment.8 Surgeons
were often poorly taught and sometimes illiterate. Those who did have
some education owned few surgical manuals and those manuals
which they owned were generally out-of-date or of poor q ~ a l i t y . ~
Frequently these texts were poorly transmitted and if they contained
illustrations, in the days before printed illustrations made illumina-
tions unnecessary, these were copied by non-medically or surgically
trained scribes who often created more confusion than understanding
of human anatomy.1°In like fashion, surgeons of this period also wrote
little, and this in part causes some of the problems in interpreting what
practices were customary among them.ll
Still, surgeons of the late Middle Ages were not as ineffective as some
modern medical historians would lead us to believe. The constant
warfare of the age demanded skilled men who could dress wounds of
soldiers, and almost all surgeons of the fourteenth and fifteenth cen-
turies had seen military action. On these expeditions the surgeons
gained knowledge and experience in treating all forms of wounds and
injuries. They served as physicians and apothectiries as well as sur-
geons. They experimented with various kinds of powders, plasters,
and fomentations for closing wounds. They invented tools for extract-
ing arrows and bolts; they learned techniques for knitting fractured
I limbs, and amputating diseased ones.12
Some successes were had by these surgeons, often brought about by
quite ingenious means. On the battlefield, crossbows were used to
extract crossbow bolts,13 natural desiccating medicines, herbs, and
leaves were used to stop bleeding,14and new tools were fashioned to
perform difficult surgical operations.15 (Indeed, at the battle of
Shrewsbury, fought in 1403, the English military surgeon John Brad-
more made a new surgical apparatus to extract an arrow from the cheek
of Prince Henry, later to be crowned Henry V.16)
Gunpowder weaponry added a new destructive dimension to the
late Middle Ages. Already available in limited quantities throughout
Europe in the early fourteenth century, guns began taking on a larger
role in warfare as the century progressed. They appeared on the
battlefield of Crecy in 1346 used by Edward I11 ostensibly to create

noise and panic. Later that year they also appeared at the English siege
of Calais. By 1377 guns successfully had been used to bring down the
walls of a fortification when Philip the Bold, duke of Burgundy, con-
quered the fortress of Odruik; and in 1382they played a significant role
in a battlefield victory when the Ghentenaar forces defeated the

Brugeois troops at the battle of Bevershoutsveld fought outside the
town of Bruges. By 1400 gunpowder weaponry appeared in nearly
every engagement of the war. Large guns were used in sieges and
smaller weapons were used in battle and on ships. Eventually hand-
held gunpowder weapons were made, and these began to be used by
infantry as a more powerful, although less accurate, replacement for
archery. By the 1470s infantry units equipped with hand-held guns
often faced enemy infantry units also equipped with hand-held
guns.17
Medical personnel too were aware of these early gunpowder
weapons. Because the technology was so new, gunpowder was
supplied to Edward's army in 1344-45only by William of Staines, the
apothecarius regis , because of his skill with chemicals.ls Surgeons,
undoubtedly because they were required to repair the wounds caused
by guns, took an early interest in their use. John of Arderne, who was
present at Cr6cy and Calais, recognized the future of these weapons
and recorded a recipe for gunpowder reporting that "this is the pow-
der which will propel balls of iron or lead when placed in a weapon
which they call a gun."19 Sixty years later the English surgical writer
John of Mirfield also attached to his surgical manual a recipe for
making gunpowder, but by then the reality of the destructive power of
guns was recognized, for they had become, in Mirfield's words,
"diabolical instruments of war."20
This interest in gunpowder weaponry increased as the warepro-
gressed. As guns became more numerous and more accurate and
l
powerful, more soldiers were killed and wounded. Small guns fired
metal balls, usually made of lead or iron, and larger guns fired stone
balls, especially fashioned for that purpose. Gunshot wounds from
both these weapons could be and were often fatal; metal balls could
pierce the skin, while larger stone balls could kill on impact with the
body or by splintering into fragmentswhich would then enter the torso
or limbs. Sometimes in medieval chronicles these fatalities are
unnamed, mostly because of their low station, but on other occasions
gunshots killed more prominent victims. In 1383, at the siege of Ypres,
a "very brave English esquire," Louis Lin, was killed by a cannon shot.
In 1414, the Bastard of Bourbon was killed by gunshot at Soisson. In
1438, Don Pedro, the brother of the king of Castille, was decapitatedby
a gunshot during the siege of Capuana at Naples. Four years later,
John Payntour, an English esquire, was killed by a culverin at La Reole.

In 1450, two prominent French military leaders, Pregent de Coetivy,
lord of Rais and admiral of France, and Tudal le Bourgeois, bailli of
Troyes, were killed at the siege of Cherbourg; and, in 1453, two more
prominent individuals lost their lives by gunshot: John Talbot, earl of
Shrewsbury, who was killed at the siege of Castillon in July, and

Jacques de Lalaing, "le bon chevalier,". who was killed that same
month at the siege of Poeke, near Ghent. Finally, in 1460, James I1 of
Scotland died when one of his large cannons exploded next to him.
Perhaps the most famous death by gunshot during the Hundred Years
War occurred in 1428 when Thomas Montagu, earl of Salisbury and
leader of the English forces in France, "a worthi werrioure amonge all
Cristen men," was killed at Orleans when a stone cannon ball fired
from a bombard (the largest type of siege gun) shattered and mortally
wounded him in the head.21
The repair of these and other wounds fell to the surgeons who
accompanied each army to battle. Before 1300 surgeons generally
treated wounds in two ways. Following ancient tradition and Galenic
surgical procedure, some medieval surgeons used a hot iron to
cleanse, stop bleeding and limit the spread of infection within the
wounds. This procedure was especially prominent among Islamic
surgeons, but was also practised by some European surgeons as
The second method of wound treatment was done without cauteriza-
tion. Based on Hippocratic tradition, the medieval surgeon would
cleanse the wounds with a non-abrasive balm or ointment, clear it of
debris and then suture it unless it was left open for suppuration. This
was the most commonly practised method of wound treatment in
Europe during the Middle Ages, being practised by such eminent
surgeons as Paul of Aegina, Roger Frugard, Guillaume de Congenis,
Bruno Longoburgo of Calabria, Teodorico Borgognoni of Lucca, Gugli-
elm0 de Saliceto, and Jan Y ~ e r m a n . ~ ~
I
This latter method of treating wounds was further used and
reformed by Henri de Mondeville, court and military surgeon to Philip
IV. He determined, as was the custom, to cleanse the wound, remove
foreign objects from it and then to close it by suture. Describing the
treatment for chest wounds he writes:
Concerning the treatment of recent wounds which penetrate the cavity of the
chest: On whichever side it [the wound] may be, one treats them in the same
way as wounds penetrating the skull, that is to say in removing foreign bodies,
closing the edges of the wound, etc., and in giving powder with a balm. It
should be added only that these wounds and those of the abdomen should be
closed more quickly, should be joined more strongly, and should be sutured
with stitches closer and tighter, even though they may be smaller than wounds
of other parts, because here greater danger follows delay if they remain open or
gaping for some time.24
Milita y Surgical Practice and Gunpowder Weapony 137
Mondeville believed further that suppuration should not be induced in

these wounds, and indeed "if suppuration is produced, I know by
experience that it is not cured without difficulty, if ever."25
Mondeville's techniques for wound healing met with criticism in his
day and among his surgical descendents. Neither John of Arderne nor
Guy de Chauliac, the fourteenth-century surgeon to the papacy at
Avignon and teacher of surgery at the University of Montpellier,
followed Mondeville's instructions explicitly; however, their tech-
niques varied only slightly, and then not on the cleansing or removal
of debris. They differedonly on the healing of the wound: Arderne re-
lied on salves and powders to treat wounds while Chauliac used dry
dressings, desiccators, and balsams. Chauliac also held to the old
notion of necessary suppuration and believed that if a wound had
become infected it needed to be reopened, drained, and the process of
healing repeated. Both these surgeons lived and practised in a time
when guns were used in battle, but neither mentioned specific opera-
tions on gunshot victims.26
Mondeville's surgical methods persisted into the late fourteenth
and early fifteenth centuries. Apothecary manuals of the time always
include several recipes for the cleansing and healing of wounds, all
without cauterization. An example of these is the Liber de diversis
medicinis, written between 1422 and 1453, which contains instructions
for the making of many different salves, balms, drinks, and ointments
to cleanse and heal wounds.27
Surgical manuals also continued to follow Mondeville's, Chauliac's,
and Arderne's lead in treating wounds, both those gained in battle and
elsewhere. All urge treatment by cleansing, removing foreign objects,
and suturing the wound. (Although hot oil is sometimes prescribed for
wound surgery, this is not the boiling abrasive mixture used by Pare
and is only used to cleanse the wound and not for cauterization.) For
example, a yet unedited treatise known as Galien's Book of Operations
I describes the following process for repairing "wounds of the gut and
liver":
Yf a gutte passe out of the wounde and it be not wounded reduce him in again,
and yf you may not reduce him procede in this manner. ffirst chaufe ye guttes
that ben oute and mollifie hem with a gret sponge in water of ye decoccion of
camomulle & anys & enoynte hem with hoote oile of camomulle & when they
be chaufed with the aforeseid sponge putte him in agen as well as you may. . .
& sewe hem in ye manner as skynners sewen ther furroures, for in this case it is
ye best maner; & anone as it is sewed lay on a poudir that mo cleve together to
the g ~ t t e s . ~ ~
Two English surgical writers are even more helpful in studying
techniques of wound surgery in this period for their manuals also
address the treatment of battlefield wounds. One, a surgeon, Thomas
Morestede, wrote an early fifteenth-century manual entitled A Fair

Book of Surgery. In it he describes the procedures for cleansing wounds,
for probing them to remove debris and for making the plasters to heal
them. Morestede also describes and even illustrates the tools which he
used to perform each operation. Although he is apprehensive of oper-

ating on a wounded torso, preferring only to treat wounds of the limbs,
this is not because he was unable to do so. He, as a trained anatomist,
simply recognized the risk of operating on the chest, while other
surgeons of his day did not have knowledge enough to be similarly
afraid. Morestede does recommend the use of hot oil "of Rossys" in
surgical procedures, but this was to be used only to cleanse the wound
before plastering it.29
The second author, John of Mirfield, composed a surgical manual,
which is contained in part IX of his larger medical treatise Brevarium
Bartholomei, which aids the study of military surgery even further.
Although Mirfield does not mention gunshot wounds openly, his
manual does indicate the practices followed by surgeons of the late
fourteenth and early fifteen centuries in the treatment of wounds
throughout the body caused by all the weapons of his day. In each of
these cases he prescribes the removal of all debris and then the com-
plete cleansing of the wound, either with a concoction made of "hot
wine and honey" or with one made from the "leaves of red cabbage. . .
cooked with the stalk in water." Afterwards the surgeon should suture
the wound, a process which Mirfield describes extensively including
how to scrape the skin around the wound in order to prepare it for the
sutures and how to determine the required number of stitches to close
the wound.30
Finally, a most interesting indication of the tradition of late
fourteenth-century wound repair comes not from a surgical manual or
from an apothecary's recipe book but from a letter written in 1395 by
Philippe de Mezieres, a French bureaucrat, to King Richard 11. In this
I letter Mezieres petitions the English king for peace, describing the rift
between the two countries as that of a wound in need of repair. A balm
is needed, claims Mezieres, to be applied to the wound by the Great
Physician in an attempt to save the Christian Church from destruction
at the hands of the warring kingdoms:
Balm is a precious liquid which flows drop by drop from a little shrub,
nourished by the dew of heaven. Among its virtues, three may be mentioned
which bear on our theme.. . .
The first virtue of this balm is that as soon as it is applied to a wound, it
removes pain and cleanses the wound in such a way that neither decay nor
dead flesh can long remain, and restores the nerves, if they have received
injury, to their former vigour.
Its second virtue is that in a marvellously short time it brings together the
edges of the wound, and this much more quickly than any other medicine.
Its third virtue is that it heals and removes all traces of the scar left by a
wound, so that it seems as if there had never been one. Moreover, if any flesh is
wanting, our balm will make it grow again in its former shape, removing any
disfigurement.
Mezieres' wound must be cleansed and a "fine" healing ointment be
placed in it. No cauterization is needed.31

Still none of these sources explicitly mentions gunshot wounds, and
without these explicit records of treatment, how can we be sure that
surgeons of the Hundred Years War used similar techniques to treat
soldiers wounded by this new military technology? An answer to this
question must then be sought elsewhere.
Although records of surgeons serving in military campaigns during
the Hundred Years War are numerous, most of these documents report
only the muster and payment for services and do not reveal any of their
practices.32 Narrative sources add little to this study. One author,
Oliver de la Marche, a fifteenth-century Burgundian chronicler, does
report that surgeons took care of gunshot wounds (and also powder
bums), although he does not tell us what procedures were followed:
The Duke [Charles the Bold of Burgundy] has four surgeons: these four serve
for the Duke's person and for those of his house and others, and certainly these
are not the least busy in the house: because the Duke is a chivalrous prince and
through war exercises, there are as many wounded by handguns, powder
burns, and other things among his house and in his retinue as are wounded in
other places; so that fifty diligent surgeons would have enough to take care of
by treating the cases which occur.33
And while other chroniclers report the woundings of many indi-
viduals by gunpowder weapons, invariably these woundings led to
the quick death of the individual. No surgeons are reported to have
operated on the earl of Salisbury, for example, because of the severity
of his wound-his jaw and the lower part of his face had been
removed by the force of the The violent and non-treatable
I
slayings of others are similarly reported.35
There are three accounts which describe the non-fatal wounding of
soldiers, and in each of these cases surgeons are present and save the
life of the wounded individugl. In the first two accounts, however,
only the surgeons' presence is recorded and not the operating proce-
dures used to preserve life: in April 1422, an esquire, Michael Bouyer,
was wounded in battle, and although "gravely ill and mutilated in one
of his legs by a cannon shot, in such a way that he cannot aid himself,"
he was alive and languishing in prison at M e a u ~and,~~in 1465, at the
battle of Montlhery, a French archer was wounded in the thigh by a
hand-held culverin, "the bullet from which remained in the other
thigh," but he was taken to a surgeon in the nearby town of Binche
"where he re~overed."~'In neither case is cauterization said to be
used.
Only one account of gunshot wounding mentions more about the

life-saving operations performed by the military surgeons: in 1451, at
the siege of Bayonne, Bernard of Bearn, a low-level French military
leader, was struck in the leg by a culverin ball so that "the ball became
lodged between the two bones of his leg." The wound was potentially
fatal, but because "good surgeons" were called in to operate, and did
so by removing the ball, "the danger was soon eliminated."38 We can
assume then that it was customary for surgeons to remove bullets or
fragments from a gunshot wound. Here again no cauterization is
mentioned.
Further evidence may be found in the first surgical manual to specifi-
cally mention the treatment of gunshot wounds. In this work, the Buch
der Bundth-Ertznei, written in 1460 by Heinrich von Pfolsprundt, a
surgeon who accompanied the Teutonic Knights on their conquests in
northeast Europe, gunshot wounds were to be cleansed, and bullets,
fragments, and bone splinters were to be extracted. Pfolsprundt even
gives instructions to the reader for the use of sound in locating these
foreign objects if they cannot be found by simple probing. Wounds
should then be healed by suppuration. In binding the wound, suturing
should rarely be used. Instead, Pfolsprundt insists, a plaster made of
hot oil of turpentine and oil of roses should be placed on the open
wound. There is no indication in Pfolsprundt's writings that gunshot
wounds were poisoned and for this reason needed to be c a u t e r i ~ e d . ~ ~
It seems then that gunshot wounds were treated as any other battle-
field wounds encountered in the later middle ages. Cleansing of the
wound was important as was the removal of any foreign object or
debris. Among objects to be removed must be any balls or gunshot
fragments. Gunshot wounds were not thought to be poisonous, and
they were never cauterized. Only the method of closing the wounds
seems to have changed during this period with suturing or plastering
with herbal medicines the preferred technique in the fourteenth and
l
early fifteenth centuries and hot oils and plasters the technique grow-
ing popular in the mid to late-fifteenth century.
Who, if not medieval surgeons, is responsible then for the tech-
niques found to be inadequate by Ambroise Pare? The answer to this
may be found in Park's work itself. Park claims that he did not learn
cauterization techniques for treating gunshot wounds from fourteenth-
and fifteenth-century surgical manuals. On the contrary, he learned
it by reading the work of Giovanni da Vigo, a late fifteenth-/early
sixteenth-century Italian surgeon whose manual was first published in
1514.40By Park's time, da Vigols work was the most popular manual
used by surgeons.41In it da Vigo devoted an entire chapter to the
treatment "of wounds made by hacquebuttes, gunnes, and lyke
i n s t r ~ m e n t s . "In
~ ~this chapter da Vigo prescribes that, after deter-
mining the size of the weapon which caused the wound and whether
debris remained in the body, the surgeon was to treat it by cauteriza-
tion with a red-hot iron or by pouring boiling sambucene oil into it.
This was to eliminate the poisonous residue of gunpowder, described
by da Vigo as "the most dangerous thinge" to treat in gunshot
wounds. Da Vigo emphasizes that gunshot wounds were poisoned

and therefore needed this treatment; even deep wounds were to be
treated with cauterization.
Once the wound was cauterized, it was to be "cured by using either
melted butter or, in the case of wounds in the sinews, by melted butter,
barley-water with earthworms, hollyhock, and red sugar. Finally, the
wound was to be bandaged with a digestiva of turpentine, oil of
roses, and egg yolks under a plaster. Although some attempt should
be made to remove bullets that remain in the wound, there was to be
no effort made to remove hard-to-find fragments or bullets.
This then was the procedure practised by military surgeons who
treated gunshot wounds in Pare's day. Da Vigo's work was so popular
that in the sixteenth century it was printed in more than 40 editions and
was translated into French, Italian, Spanish, German, and English.
Even before his death da Vigo's manual proved so profitable that he
was forced to publish a shorter compendium of it (in 1517)' and this too
proved to be highly successful.43Da Vigo's prescribed surgical proce-
dure for treating gunshot wounds became so prominent in the early
sixteenth century, in fact, that surgeons sometimes eliminated probes
and suturing tools from their equipment while including in their place
several ~ a u t e r i e s . ~ ~
This was the surgical practice which Ambtoise Pare found unsatis-
factory for treating victims of gunshot wounds. But it was not a tradi-
tion which predated da Vigo. Indeed, both the belief in the poison of
gunshot wounds and the treatment of them using cauterization may
have originated in da Vigo's time and not earlier. However, the ques-
t tion still remains: why had da Vigo prescribed such a harsh treatment
for gunshot wounds and one so foreign to earlier traditions? Cauteriza-
tion was not a new surgical practice, and continued to be practised by
Islamic surgeons,45but by the fourteenth and fifteenth centuries it had
fallen into disuse among surgeons (at least among military surgeons),
few of whom even mentioned the technique in their manuals let alone
advocated its practice.
Da Vigo's motives in returning to this antiquated procedure seem
uncertain. The few medical historians who address the issue seem split
on the question. For example, while Samuel C. Harvey believes that
da Vigo's practice stemmed from his own empirical deduction about
gunshot wounds,46Arturo Castiglioni thinks that da Vigo's treatment
was derived from his use of Islamic surgical traditions which always
prescribed cauterization for battlefield wounds.47Da Vigo also could

have gained his proced,ural knowledge from his older German contem-
porary, Hieronymus Brunschwig, whose surgical manual, Das Buch
der Cirurgie, may have actually initiated the belief in the poison of
gunshot wounds and in their treatment by cauterizati~n.~~ Although
da Vigo seems unlikely to have known Brunschwig's work, the fact

that Brunschwig's manual was published in German by a Strasbourg
press in 1497 leaves open the possibility that he did. So little is known
about the transference and diffusion of medical and surgical knowl-
edge during this time that we cannot rule out the possibility that da
Vigo may have used Brunschwig's work to write his chapter on the
treatment of gunshot wounds, or indeed he may have used yet another
source, now lost, which Brunschwig himself may have used or influ-
enced.
Yet another answer to the question of da Vigo's motives in using
cauterization to treat gunshot wounds may be found in the increased
use of gunpowder weaponry by the armies of the late fifteenth and
early sixteenth centuries. Da Vigo himself had seen military surgical
duty at the siege of Saluces fought in 1485 and as personal physician
and surgeon to Cardinal Guiliano della Rovere, later to be Pope Julius
11, known as the "warrior pope."49 During these and perhaps other
military engagements da Vigo undoubtedly saw frequent and numer-
ous gunshot victims, far more than those seen by earlier surgeons.
While careful removal of debris, cleansing of the wound, and suturing
may have been the tradition among surgeons working in battles where
few received gunshot wounds, by da Vigo's time the larger number of
those so wounded may have necessitated a quicker, less painstaking,
remedy practised by military surgeons. Certainly this is attested to by
Par6 himself, for he had exhausted his supply of oil "by reason of the
multitude that were hurt."g0 Perhaps this may have been the reason for
da Vigo's new treatment of gunshot victims.
I The blame for Park's dilemma in 1536 must then be laid at the feet of
Giovanni da Vigo, a surgeon whose popular alteration of late medieval
surgical tradition for gunshot wounds caused a regression in surgical
procedure as well as what must have been the needless suffering of
many wounded in early sixteenth-century warfare. For despite the
criticism of one early sixteenth-century surgeon-the German Hans
von Gersdorff who, despite using cauterization to treat gunshot
wounds, denied da Vigo and Brunschwig's claims that gunshot
wounds were poisonousg1-it was left to Ambroise Park's chance
experiment at the siege of Turin to return to a procedure already used,
and used successfully, by late medieval military surgeons to treat
gunshot wounds.
NOTES
An earlier version of this article was delivered at the Fordham University Medieval
Conference: "Europe in the Age of the Hundred Years War," March 1989. The
author wishes to thank Professors Bert S. Hall, Suzanne Zeller, and Cynthia Co-
macchio for their helpful comments and criticisms on this work. He also wishes to
thank the University of British Columbia Department of History Faculty Colloquium

for the opportunity of presenting the initial study and for the advice and criticisms
offered there.
Ambroise Park, The Apologie and Treatise, edited by Geoffrey Keynes (Chicago:
University of Chicago Press, 1952), p. 138. Par6 discusses more extensively his
treatment for gunshot wounds in his later work, Ten Books of Surgery with the
Magazine of the Instruments Necessary for it, edited and translated by Robert White
Linker and Nathan Womack (Athens: University of Georgia Press, 1969), p. 1-47.
Pare, ~ ~ d o ~p.i 138.
e ,
For a discussion of Pad's role in surgical history see J. F. Malgaigne, Surgery and
Ambroise Park, translated by Wallace B. Hamby (Norman: University of Oklahoma
Press, 1965); Theodor Billroth, Historical Studies on the Nature and Treatment of Gun-
shot Woundsfrom the Fifteenth Century to the Present Time, translated by C. P. Rhoads
(New Haven: Nathan Smith Medical Club, 1933), p. 41-45; George E. Gask,
"Lettsomian Lectures: Historical Sketch of the Methods of Treating Wounds of the
Chest in War from 1300 to 1900 A.D.," Transactionsof the Medical Society of London, 44
(1921): 168 (also published in Gask's Essays in History of Medicine [London: Butter-
worth, 19501, p. 150); Fielding H. Garrison, Notes on the Histo y of Milita y Medicine
(Washington: Association of Military Surgeons, 1922), p. 111-13; J. Trueta, The
Principles and Practices of War Surgery (London: Hamish Hamilton Medical Books,
1943), p. 8; and Arturo Castiglioni, A History of Medicine, translated by E. B. Krum-
bhaar (New York: Alfred A. Knopf, 1941), p. 474-79.
Gask, "Lettsomian," p. 166.
Gask, "Lettsomian," p. 167.
Billroth, Historical Studies, p. 3.
Malgaigne, Surgery, p. 61-62.
Pierre Huard and Mirko Drazen Gnnek, Mille ans de chirurgieen accident: Ve-XVesi2cles
(Paris: Roger Dacosta, 1966), p. 42, 43, 47, 50, 58, lists specific cases of astrological
ahd magical beliefs among surgeons of the late Middle Ages. See also Sir D'Arcy
Power, "English Medicine and Surgery in the Fourteenth Century," in Selected
Writings, 1877-1930 (Oxford: Oxford University Press, 1931), p. 29-30, 32, and
Charles H. Talbot, "Medicine," in David C. Lindberg, ed., Science in the Middle Ages
(Chicago: University of Chicago Press, 1978), p. 420.
See Huard and Grmek, Mille ans, p. 38, 43-44, 57; Malgaigne, Surgery, p. 63; and
Nancy G. Siraisi, Medieval and Early Renaissance Medicine: An Introduction to Knowl-
edge and Practice (Chicago: University of Chicago Press, 1990), p. 177.
See Peter Murray Jones, Medieval Medical Miniatures (Austin: University of Texas
Press, 1984).
This supposed low number of surgical treatises may not be the fault of the surgeons
themselves, but may be the fault of modern textual editors who simply have not
edited many available manuscripts. Certainly a large number of unedited treatises
do exist. See, for example, P. Pansier, "Catalogue des manuscrits m6dicaux des
bibliothhques de France," Archiv fur Geshichte der Medizin, 2 (1908): 1-46, 385-403.
See Gask, "Lettsomian," p. 162, and Charles H. Talbot, Medicine in Medieval Eng-
land (London: Oldbourne, 1967), p. 206-08. For accounts of military surgeons serv-
ing during the Hundred Years War see Garrison, Notes, p. 87-91; Siraisi, Medieval
and Early Renaissance Medicine, p. 181-82; R. Theodore Beck, The Cutting Edge: Early
History of the Surgeons of London (London: Lund Humphries, 1974), p. 14-17, 32,
55-64; George E. Gask, "The Medical Staff of King Edward the Third," Essays in the
History of Medicine (London: Butterworth, 1950), p. 77-93; George E. Gask, "Vic-
ary's Predecessors," Essays, p. 55-76; George E. Gask, "The Medical Services of

Henry the Fifth's Campaign of the Somme in 1415," Essays, p. 94-102; and Philippe
Contamine, Guerre, itat et sociiti b La fin du Moyen age: ~ t u d e sur
s les armies des rois de
France, 1337-1494 (Paris: Mouton, 1972), p. 211, 216, 298, 622-23.
See Robert Ignatius Burns, "The Medieval Crossbow as Surgical Instrument: An
Illustrated Case History," Essays on the History of Medicine (New York: Science
History Publications, 1976), p. 64-70.
See notes 27 and 30 below.
Thomas Morstede, for one, fashioned his own surgical tools on the battlefield. See
Beck, Cutting Edge, p. 105-19.
Beck, Cutting Edge, p. 55.
There is a need for an in-depth study on gunpowder weaponry during the Hundred
Years War. Until such has been written, the historian of this period must rely on a
few articles and sections of books which discuss these weapons. See Contamine,
Guerre; Philippe Contamine, War in the Middle Ages, translated by Michael Jones
(London: Basil Blackwell, 1984), p. 137-50,196-207;M. G. A. Vale, War and Chivalry
(London: Duckworth, 1981), p. 129-46; Joseph Garnier, L'artillerie des ducs de Bour-
gogne d'aprks les documents conseds aux archives de la ~6te-d'& (Paris: Honore Cham-
pion Libraire, 1895); C. T. Allmand, "L'artillerie de Yarmee Anglaise et son organi-
sation B l'epoque de Jeanne d'Arc," in J. Glenisson, ed., leanne d'Arc: Une ipoque un
rayonnement, colloque d'histoire medievale, Orleans-Octobre 1979 (Paris:
C.N.R.S., 1982), p. 73-83; J.-F. Fino, "L'artillerie en France B la fin du moyen age,"
Gladius, 12 (1974): 13-31; and Eugene Heer, "Armes et armures au temps des
guerres de Bourgogne," Revue internationale d'histoire militaire, 40 (1978): 170-200.
0. F. G. Hogg, English Artillery, 1326-1716 (London: Royal Artillery Institution,
1963), p. 89.
This recipe has yet to be edited. See R. Coltman Clephan, "The Ordnance of the
Fourteenth and Fifteenth Centuries," Archaeological loumal, 68 (1911): 68: "C'est
poudre vault B gettere pelotes de fer oude plomb ou dareyne ove un instrument qe
lem appelle gonne."
This recipe has been edited by Sir Percival Horton-Smith Hartley and Harold
Richard Aldridge and appears in their lohannes de Mirfield: His Life and Works
(Cambridge: Cambridge University Press, 1936), p. 90-91: "Instrumenta illa bellica
sive diabolica."
See Contamine, War, p. 206, and Vale, War, p. 136-37, for original source references
on these deaths.
Cauterization was practised in Ancient Egypt, China, and India. It was also a
common practice among ancient Greek and Roman surgeons. See Castiglioni,
History, p. 91, 170, and Guido Majno, The Healing Hand: Man and Wound in the
Ancient World (Cambridge: Hanrard University Press, 1975), p. 15,96-97,150,154,
164-66, 249, 257, 269-70, 340, 364. Islamic surgeons seem to have preferred this
treatment over any other for wound healing. Indeed, more than one-third of
Albucasis' surgical manual is devoted to the cauterization of wounds. See
Albucasis, Albucasis on Surgery and Instruments, edited and translated by M. S. Spink
and G. L. Lewis (Berkeley: University of California Press, 1973). See also Casti-
glioni, History, p. 274, 336; Siraisi, Medieval and Early Renaissance Medicine, p. 162;
Trueta, Principles, p. 3; and Benjamin Lee Gordon, Medieval and Renaissance Medicine
(New York: Philosophical Library, 1959), p. 427-29, 437. Cauterization seems to
have had less impact on European surgeons, although it is evident that some did
practise it, including Lanfranco of Milan (d.1315). See Castiglioni, History, p. 337;
Gordon, Medieval and Renaissance Medicine, p. 438; and Stanley Tubin, Medieval
English Medicine (London: David & Charles Newton Abbot, 1974), p. 133-40.
For a good summary of medieval surgical history before 1300 see Castiglioni,
History, p. 288-336, and Siraisi, Medieval and Early Renaissance Medicine, p. 153-86. It
is generally accepted that Guglielmo da Saliceto (1210-77)was the first to move away
from cauterization to treatment with the knife. See Castiglioni, Histoy, p. 336.
However, other earlier surgeons also disdained cauterization, preferring less caustic
surgical procedures. See Garrison, Notes, p. 81-90, and Siraisi, Medieval and Early
Renaissance Medicine, p. 169.
"Traitement des plaies rkcentes qui pknhtrent [sic] jusqu'h la cavit6 de la poitrine de
quelque cSt6 que ce soit: on les traite tout B fait de la mCme facon que les plaies
penetrantes du crane, c'est-B-dire en enlevant les corps &angers, fermant les
Bvres, etc., et donnant de la poudre avec du pigment. I1 faut ajouter seulement que
ces plaies et celles du ventre doivent Ctre fermkes plus vite, Ctre reunies plus
fortement, et suturees par des points plus rapproches et plus serds, mCme si elles
sont plus petites, que les plaies des autres membres, parce qu'ici un retard entraine
un plus grand Hril, si elles restent ouvertes ou laches pendant quelque temps"
(Henri de Mondeville, La chirurgie de m i t r e Henri de Mondeville, edited by Edouard
Nicaise- [Paris: Felix Alcan, 18931, p. 358).
". . . s'il [suppuration] s'en produit, je sais par experience qu'elle ne se corrigera
qu'avec peine ou jamais" (Mondeville, Chirurgie, p. 358).
John of Arderne, De arte phisicali et de cirurgia, translated by Sir D'Arcy Power
(London: J. Bale Sons & Danielson, 1927); Treatises of Fistula in Ano, edited by Sir
D'Arcy Power, Early English Text Society (London: Kegan Paul, Trench, Trubner,
1910); and Guy de Chauliac, La grande chirurgie, edited by Edouard Nicaise (Paris:
Felix Alcan, 1890). See also Gerald N. Weiss, "John Arderne, Father of English
Surgery," Journal of the International College of Surgeons, 25 (1956): 247-61. On the
debate over wound suppuration see Siraisi, Medieval and Early Renaissance Medicine,
p. 169-70.
Margaret Sinclair Ogden, ed., The "Liber de diversis rnedicinis," Early English Text
Society (London: Oxford University Press, 1938), p. 71. See also Warren R. Daw-
son, ed. and trans., A Leechbook or Collection of Medical Recipes of the Fifteenth Century
(London: Macmillan, 1934), and the four pharmaceutical texts in G. Henslow, ed.,
Medical Works of the Fourteenth Century (1899; rpt. New York: Burt Franklin, 1972).
This passage is found in Power, "English Medicine," p. 39. The original is found in
B. L. Sloane MS. 2463, fol. 116.
Only a small portion of Morstede's A Fair Book of Surgery has been edited and this can
be found in Beck, Cutting Edge, p. 105-19.
John of Mirfield, Surgery, translated by James B. Colton (New York: Hafner, 1969).
The specific sections on cleansing and suturing wounds can be found on p. 15-21.
Philippe de Mezieres, Letter to King Richard 11: A Plea Made in 1395 for Peace between
England and France, edited and translated by G. W. Coopland (Liverpool:Liverpool
University Press, 1975). The passage quoted here can be found on p. 6.
An example of a surgical campaign muster, dated 29 April 1415, can be found in
Thomas Rymer, Foedera (London: A. & J. Churchill, 1704), IX:237-38.
"Le duc B quatre chirurgiens, ces quatre servent pour la personne de duc, et pour
ceux de son hostel, et autres, et certes ce ne sont point de deux, qui ont le moins
affaire en la maison, car le duc est prince chevaleureux, et de tel exercice de guerre,
que par blessure de coup de main, de trait pouldre ou autrement, il B bien souvent
tant de gens blessez en sa divers lieux blessez, que cincquante chirurgiens diligens,
auroyent assez B besoigner, B faire leur devoir des cures qui surviennent" (Oliver de
la Marche, Estat de la maison de Charles le Hardi, in Claude Bernard Petitot, ed.,
Collection complete des &moires relatifs li l'histoire de France [Paris: Foucault, 18201,
Vol. X., v . 493).
L
The death of Thomas Montagu has been recorded in many contemporary narrative
sources. Some insist that the stone cannon ball splintered with a fragment hitting
Salisbury in the face. Others say that the cannon ball hit the window frame,
breaking it off, and that it was this that hit Salisbury. See, for example, the accounts
of this death in Paul Charpentier and Charles Cuissard, eds., Journal du siege
d'Orlians, 1428-29 (Orleans:H . Hurluison, 1896), p. 9-10; Thomas Basin, Histoire de
Charles W, edited by C. Samaran (Paris:Socihte &edition "Les belles lettres," 1933),
Vol. I, p. 118-21; Jean Chartier, Chronique de Charles VII, edited by Vallet de Viiville
.. .
(Paris: P. Tannet, 1858), v . 63-64; and Robert of Blondell, De reductioneNormanniae, in
joseph ~tevenson,ed., Narratives of the Expulsion of the English from Normandy,
MCCCXLIX-MCCCCL, Rolls Series (London:Longman, Green, Longman, Roberts,

and Green, 1863), p. 196.
See note 21 above.
L. Douet d'Arcq, ed., Choix de pikces inkdites relatives au rkgne de Charles V1 (Paris: J.
Renouard, 1864), Vol. 2, p. 86.
Jean de Haynin, Memoires, 1465-77, edited by D. D. Brouwers (Liege, 1905), Vol. I,
p. 67.
"Et ainsi que ledit Bernard se retiroit, il fut frappe d'une couleurine d'un si grand
coup, qu'elle perca son pavois, & entra la plombee entre les deux OS de sa iambe, qui
depuis en fut tiree, & fut tellement gouverne, & de si bons Mires, que le peril en fut
mis dehors" (Gilles le Bouvier, Chronique, in D. Godfrey, ed., Histoire de Charles V11
[Paris, 16611, p. 465).
Heinrich von Pfolsprundt, Buch der Bundth-Ertznei, edited by H. Haeser and A.
Middeldorpf (Berlin: G. Reiner, 1868). See also Frank J. Lutz, "'Das Buch der
Buendth-Ertznei' of Heinrich von Pfolsprundt, Member of the German Order,"
]anus, 18 (1913): 109-19.
Park, Apologie and Treatise, p. 137.
See Malgaigne, Surgey, p. 176-83, and Gordon, Medieval and Renaissance Medicine,
p. 453.
There is no modern edition of da Vigo's surgical text. The most accessible one is the
reprint of the 1543 English translation published by Da Capo Press in their early
printed English books series: loannes de Vigo, The Most Excellent Workes ofchirurgey e
(1543; rpt. Amsterdam: Da Capo Press Theatrum Orbis Terrarum Ltd., 1968).
See Castiglioni, History, p. 470. This compendium is added to the end of the English
translation referred to in note 42. It should be noted that in this compen-
dium, although the section on the treatment of gunshot wounds is shortened, no
changes have been made in the prescribed treatment of these wounds or in da Vigo's
emphasis on their poisonous nature.
This is especially apparent in noting that no probes are included among the surgical
tools found on the M a y Rose, while eight of the tools were probably cauteries. See
Margaret Rule, The M a y Rose (London: Conway Maritime Press, 1982), p. 193.
Arab manuals were difficult to use and rarely appeared in vernacular translations.
Therefore, although popular in the twelfth and thirteenth centuries, they fell out of
use among surgeons in the fourteenth and early fifteenth centuries. See Siraisi,
Medieval and Early Renaissance Medicine, p. 162.
See Harvey's note on p. 6 of Billroth, Historical Studies.
Castiglioni, Histo y , p. 476. Both Malgaigne (Surgey , p. 190) and Trueta (Principles,
p. 3-4) attest to da Vigo's use of Islamic surgical sources in writing his work. Da Vigo
was not alone in his use of these sources. Indeed, two Renaissance Italian surgeons,
Leonardo Bertapaglia (d. 1460) and Antonio Benivieno (c.1440-1502), wrote com-
mentaries on Islamic surgical writings. See Huard and Grmek, Milk ans, p. 54-56,
and Castiglioni, History, p. 371.
Hieronymus Brunschwig, Das Buch der Cirurgie. Hantwirckung der Wundartzny
(Strassburg, 1497; facsimile edition, Milan: R. Lier, 1923). See also Billroth, Historical
Studies, p. 4-10.
See Harvey's note in Billroth, Historical Studies, p. 32, and Malgaigne, Surgey,
p. 177-78. Malgaigne, however, wonders whether da Vigo had indeed served as a
military surgeon or whether he simply made up the stories to gain credibility in his
profession.
Note 1 above. Nancy G. Siraisi (Medieval and Early Renaissance Medicine, p. 182),
although not directing this specifically at da Vigo's gunshot wound repair tech-
niques, does note that changes in the extent and intensity of war brought new and
more numerous surgical problems.
Hans von Gersdorff, Feldbuch der Wund-annei (Strassburg: Christian Egenhoffs
Erben, 1517). As with da Vigo's manual, there is a need for a modem edition of
Gersdorff s work. See also Billroth, Historical Studies, p. 10-14, and Malgaigne,
Surgery, p. 205-09.

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https://www.utpjournals.press/doi/pdf/10.3138/cbmh.7.2.131 - Monday, September 13, 2021 2:24:40 PM - IP Address:119.160.59.201

Military Surgical Practice and the

Abstract. In 1536, at the siege of Turin, French military surgeon Ambroise

Kelly R. DeVries, Department of History, Wilfrid Laurier University, Waterloo,

Le present article adopte un point de vue oppose h celui de cette tbeorie. En

It is easy to conclude that the techniques of gunshot wound repair

extremely popular surgical writings of Giovanni da Vigo.

battlefield of Crecy in 1346 used by Edward I11 ostensibly to create

in a battlefield victory when the Ghentenaar forces defeated the

John Payntour, an English esquire, was killed by a culverin at La Reole.

Shrewsbury, who was killed at the siege of Castillon in July, and

Mondeville believed further that suppuration should not be induced in

Morestede, wrote an early fifteenth-century manual entitled A Fair

used to perform each operation. Although he is apprehensive of oper-

placed in it. No cauterization is needed.31

Only one account of gunshot wounding mentions more about the

wounds. Da Vigo emphasizes that gunshot wounds were poisoned

prescribed cauterization for battlefield wounds.47Da Vigo also could

da Vigo seems unlikely to have known Brunschwig's work, the fact

thank the University of British Columbia Department of History Faculty Colloquium

ary's Predecessors," Essays, p. 55-76; George E. Gask, "The Medical Services of

MCCCXLIX-MCCCCL, Rolls Series (London:Longman, Green, Longman, Roberts,

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