Here’s a history quiz.
The Romans used the root word for “amputate” to mean:
A. removing a seriously diseased or injured limb
B. chopping off a crook’s hand
C. slicing away bits of enemy territory in wartime
If you answered “B,” go to the head of the class.
“Amputatio, the Latin noun from the verb amputare, to cut off or
cut away, derived from amb, about, and putare, to prune or lop, was little used
in Roman texts and never, it is believed, to indicate a surgical
amputation,” John R. Kirkup wrote in A History of Limb
Amputation. “However, the verb amputare was employed with reference to
cutting off the hands of criminals.”
Seldom before the 17th century did surgeons refer to the removal of an
arm, leg, hand or foot, or parts thereof, as an “amputation,” the
author added. “One of the first to record the word in English, in a
written work, was Lowe in A Discourse of the Whole Art of Chirurgerie
(1612) when he headed a chapter, ‘The maner of amputation,’”
Kirkup wrote.
“Lowe” was Scottish-born Peter Lowe, a surgeon who in
1598 founded what became the Royal College of Physicians and Surgeons in
Glasgow. The work was apparently the first systematic treatise ever published
in English on the general types of surgery, “or indeed in any language in
this country,” wrote James Finlayson, MD, in Account of the Life and
Works of Maister Peter Lowe.
Lowe’s discourse was published in 1597. The perhaps better known,
revised, and updated second edition appeared in 1612.
Based on the way he wrote his treatises, Lowe must have admired
Socrates, the famous Greek philosopher. They feature a form of teaching by
dialogue known as the “Socratic method.” The works read like “an
examination, at the college of surgeons in Paris,” Finlayson wrote.
“In the first edition…, the two ‘Interlocuutors’ are Cointret,
the Dean of the Parisian College, and Peter Lowe himself. In the second
edition…, they are changed to Peter Lowe and ‘Iohn Lowe, his
Sonne,’ who is represented as being prepared for the Paris
examination.”
The French connection
Lowe was about 15 years old when he went abroad to learn medicine. After
completing his studies in Paris, Lowe, a Catholic, became a surgeon in the
French-Spanish Catholic League army during Protestant King Henry IV’s
unsuccessful 1590 siege of the capital city. (When he could not beat the
Catholic Leaguers, Henry joined them. He converted to the Catholic faith,
supposedly claiming “Paris is well worth a Mass.”)
In the 1590s, Lowe became the “ordinary chyrurgion” to Henry
IV.
While Lowe was in France he admired the work of pioneer European surgeon
Ambroise Paré, who reintroduced the ligature, or tying off, of arteries
during amputation. The practice was almost lost after the fall of the Western
Roman Empire. Afterwards, surgeons sealed up residual limbs by dipping their
ends in boiling oil or by searing them with red-hot irons. The shock was often
fatal to the amputee.
Peter Lowe wrote what is believed to be the first systematic treatise on the general types of surgery.
Image: Wikimedia Commons public domain. Source: http://ihm.nlm.nih.gov/images/B18119.
Paré invented a surgical tool he called “the crow’s
beak,” or “bec de Corbin” in French. His name choice is
interesting because a bec de Corbin was also a popular medieval weapon
consisting of a hammer head and spike stuck on one end of a long pole. Of
course, Paré’s aim was to save lives, not end them. His gadget is
considered a forerunner of the modern hemostat.
In his works, Lowe recommended cauterization or ligature, depending on
the patient’s condition. “…Where there is putrefaction, we stay
the fluxe of blood by Cauters actuals, and where there is no putrefaction,
malignity, not humor venomous, we vse the ligatour.” He added, “In
amputation without purification, I find the ligatour reasonable sure, prouiding
it be quickly done. To doe it, first thou shalt cause the assister as I haue
said, to hold his fingers on the vaines, letting one loose, on which thou shalt
take hold with the back Decurbin [crow’s beak], taking a little of the
flesh or muscles with it: then put through a needle with a strong thread, knit
with a double knot, tying a little of the flesh with the vaine, which will make
it hold the better, etc.”
Below the knee
Before the 16th century, legs were seldom amputated above the knee and
Lowe apparently “preferred not to go above the knee-joint,”
Johanna Geyer-Kordesch and Fiona MacDonald wrote in Physicians
and Surgeons in Glasgow: The History of the Royal College of Physicians and
Surgeons of Glasgow 1599 – 1858.
“He advised surgeons ‘to cut four inches from the joint in all
amputations, saving only if the mortification or pulling apart of the bone end
in the joint, then it may be cut in the joint, chiefly in the
knees.’” Lowe specified how to do it, the authors added.”Two men
were to hold the patient and the surgeon ordered him to bend and stretch out
the limb so that the veins would become more prominent and make cauterization
or knitting easier.”
Geyer-Koresch and McDonald quoted Lowe — but modernized his prose
— as to what should happen next: “The surgeon shall pull up the skin
& muscles, as much as he can, afterwards he shall take a strong ribbon, and
bind the member fast, above the place two inches where the amputation shall be
… The bandage thus made, we cut the flesh with a razor or knife, that is
somewhat crooked like a hook, the flesh being cut to the bone, it must be
scraped with the back of the said knife made purposely for that effect, to the
end the periosteum, that coverth the bone, be not painful in cutting the bone,
otherwise it tears with the saw, and causes great dolour, and also hinders the
cutting. This done, saw the bone, & being cut, we loose the [ribbon]…and
draw down the skin to cover the bone in all parts.”
Ultimately, Lowe returned to his native Scotland, ending up in Glasgow
about 1598. Determined to root quackery out of Scottish medicine, he asked
James VI — the future James I of England — for a charter to create,
in effect, a professional association for qualified doctors, surgeons and,
later, dentists.
Lowe died of natural causes in Glasgow in 1610. He is buried in the
churchyard of Glasgow Cathedral.
References:
Finlayson, J. Account of the life and works of Maister Peter Lowe:
the founder of the Faculty of Physicians and Surgeons of Glasgow. Glasgow,
Scotland: J. Maclehose and Sons; 1890.
Kirkup JR. A history of limb amputation. London: Springer-Verlag
London Limited; 2007.
Lowe, Peter. A Discovrse of the VVhole Art of Chyrvrgerie.
London: Thomas Purfoot; 1634.
