Petit traité, contenant une des parties principales de chirurgie, laquelle les chirurgiens hernieres exercent, ainsi quil montre en la page suivante. Des VIII. especes des hernies & des accidens qui leurs suruiennent. De la pierre en la vessie. De la cure de cataracte. De ungula. Des bouches & leures fendues. De la maniere d'extirper une jambe ou bras. Des luppies, & des autres absces flegmatiques.

Lyon: Antoine Vincent, [1556].

First edition, in an untouched contemporary binding and with a fine provenance, of this exceptionally rare work which “includes the first recorded description of an operation for strangulated hernia” (Garrison-Morton). This work is absent from many major medical collections, which regard the expanded second edition of 1561 as the first. “Pierre Franco, creator of suprapubic lithotomy cataract operation and surgical repair of hernia with preservation of the testis, is considered to be one of the greatest surgeons of the Renaissance and a forerunner of urology” (Androutsos, p. 255). “Considered from the point of view of the performance of operations, Franco should be considered the premier surgeon of the sixteenth century. Paré was an active man, observant, a man of genius, but he left aside what made the success of Franco, that is the operations of hernia, bladder stones, and cataracts. Franco spent his life in a completely different and modest setting compared to Paré, but he invents operations that should remain in the practice of surgery; there is no surgeon who has given more discoveries to surgery” (Nicaise, Introduction). “The first book published by Paré was his Dix livres de chirurgie – a small book of ten chapters – in 1564. In it he more or less copied, without credit, the sections of Franco’s book on lithotomy and cystostomy. However, Paré acknowledged this later in his 1575 Oeuvres de Chirurgie” (McDowell). “Franco was influential in bringing operative surgery back into the realm of regular surgical practice, recapturing it from the ignorant hands of charlatans and itinerant “cutters.” His major interest was in hernia surgery, to which he introduced several important innovations including an operation preserving the testicle (which was usually removed), a less risky incision at the base of the scrotum and methods for the surgical release of strangulated hernia. Franco was also the first surgeon to address himself seriously to the removal of bladder stones; he gave an account of perineal lithotomy and was the earliest to describe and perform the suprapubic incision” (Norman). No other copies listed on ABPC/RBH, and we know of no other copy having appeared in commerce. OCLC list copies in US at Chicago, Harvard, Mayo Clinic, Minnesota and NLM.

 

Provenance: Signature of F. Athenosiis on title (crossed out), and of P. Guisonij on front fly-leaf; from the library of Jean Blondelet.

 

“A less well known French-born contemporary of Paré, but one who well deserves our recognition as a shining star of Renaissance surgery, was Pierre Franco (?1500-1561). He was born in Provence of humble parents and had little schooling, but was early apprenticed to a barber-surgeon. As a Protestant, he was forced to flee from France and practiced his calling in Lausanne in Switzerland, although he eventually returned to Orange in France … He deplored the fact that surgeons of his day rejected the use of open operations. This was because of the risks involved in such procedures, which they would often leave in the hands of charlatans. Franco was obviously a bold surgeon who carried out a wide range of the operative procedures known at that time. He describes in great detail his method of radical surgery for strangulated hernia, devising an incision at the base of the scrotum which he claimed was less dangerous than the higher incision. He also carried out cataract surgery and plastic operations on the face and described a new method for operating on cleft lip. In the surgery for bladder stone he was equally inventive … [he was] the first surgeon to remove a bladder stone successfully via an abdominal approach” (Ellis, p. 44).

 

“Although not an academic, Franco decided to write a surgical text based on his many years of experience, which he modestly called a Petit Traité, even though this was a substantial work that contained, as the author stated on the title page, “excellent sections on surgery” …

 

“In sixteenth century France surgery was practiced in urban areas by barber surgeons, while the inhabitants of the countryside had to rely on itinerant practitioners known as inciseurs. These untrained surgeons were ready to turn their hand to anything from hernias to cataracts, and even pulling teeth. Franco began as one of these modest practitioners, but possessed sufficient ability and charisma to rise in the world socially as well as professionally for he eventually married Claudia Borrel, a member of the aristocratic family Dauphiné, les Seigneurs d’Albon. Joseph François Malgaigne (1806-1865) contended that it was these skilled inciseurs rather than the Parisian barber surgeons who contributed most to the French school of surgery in this early period.

 

“The treatment of cleft lips takes up four chapters in Pierre Franco’s text. He states that “the entire skin of the margins which are to be joined must be cut with a razor, or a scissor, or with the cautery.” If cauterization is used, he warned that after two days, “the eschar will have to be loosened with fresh butter [before suturing] … otherwise it will generally be a waste of effort and hurt the patient needlessly, especially when the margins are far apart” (Santoni-Rugiu & Sykes, p. 222).

 

“[Franco] describes, in minute detail, the technique of radical operation for inguinal hernia. Like all who preceded him (except for William of Salicet) after the time of Celsus, he removed the testicle as part of his usual procedure. However, for patients who had but one testis he devised an operation in which the organ was spared. Considering the usual incision at the level of the pubis to be unduly dangerous, he “invented” a low incision at the base of the scrotum which, he claims, was used in more than 200 persons by others and himself in the twelve or fifteen years since he first devised it. The clinical picture of strangulated hernia is clearly and vividly described, and methods for the surgical release of strangulation, both with and without opening the sac, are presented. Thus, for the first time, this life-saving procedure became part of the surgical armamentarium.

 

“In the surgery for bladder stone he was equally enterprising and inventive. He described and pictured a number of instruments for catheterization and lithotomy, and pioneered in the introduction of several incisions, including the suprapubic approach.

 

“Ophthalmic surgery and facial plastic operations also came within his scope, and he developed a new technique for certain forms of harelip. Whatever subject he dealt with was enriched and advanced through his ingenuity. It is with perfect justification that Nicaise said, “Where Franco appeared with all his genius, it was in operative therapeutics; it suffices for us to recall successively his operations to make evident the role that he has played, and to show that no surgeon has attached his name to so many lasting discovered” (Zimmerman & Veith, pp. 194-5).

 

“Franco recorded precise instructions for dismembering a leg or arm in his Petit traité of 1556. He recommended the following: (i) ingestion by the patient of a mixture of syrups and herbs for several days both before and after surgery; (ii) attachment of the patient when lying on a bench; (iii) application of a tight ligature applied two or three fingers-breadths above the proposed incision, to control haemorrhage and cause numbness below; (iv) marking the proposed incision on the skin in ink; (v) use of a razor with the handle tied securely to prevent it buckling when cutting the flesh in one sweep down to bone; (vi) pulling on the soft tissues by means of the ligature to expose the bone as high as possible; (vii) section with a bow saw; (viii) loosening the ligature to allow discharge of “corrupted’ blood; (ix) application of hot iron cauteries to the flesh and bone to stop bleeding and ‘cleanse’ the tissues; (x) application of a linement to assuage pain; (xi) dressing with an emplaster; and (xii) a firm bandage left untouched for 2 or 3 days. Franco also mentioned an alternative to the razor, a heated sickle-shaped knife, with the object of cauterizing haemorrhage during incision” (Kirkup, p. 59). The instruments used in this procedure are illustrated on p. 129.

 

Garrison-Morton 3573; Waller 13221; Wellcome 2408; not in Norman. Androutsos, ‘Pierre Franco (1505-1578): famous surgeon and lithotomist of the 16th century,’ Progress in Urology 14 (2004), 255-9; Ellis, A History of Surgery, 2002; Kirkup, A History of Limb Amputation, 2007; McDowell, ‘Commentary on Franco’s Classic Reprint,’ Plastic & Reconstructive Surgery 57 (1976); Nicaise, Pierre Franco: Chirurgie. Nouvelle édition avec une introduction historique, une biographie et l’histoire du collège de chirurgie, 1895; Santoni-Rugiu & Sykes, A History of Plastic Surgery, 2007; Zimmerman & Veith, Great Ideas in the History of Surgery, 1993.



8vo (160 x 103 mm), 72 leaves, A4 - I4, pp. [vi] 1-10 17-144 [pagination jumps but complete], with woodcuts in text illustrating a variety of surgical instruments for the procedures discussed. Corner torn from G2 (no text loss), small whole to right margin of title with old paper repair. Contemporary limp vellum. A very fine and clean copy. Custom morrocco box. Exceptionally rare in any form.

Item #4021

Price: $55,000.00

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