Surgery and vernacular print in early modern England

In 1692, a barber-surgeon in Newcastle upon Tyne named Henry Shaw died, leaving his shop, medical practice and a wealth of worldly goods to his wife Jane and, upon her death, to his sons.Footnote ¹¹ Surgery was undeniably a family business for the Shaws. Among the usual items listed on a probate inventory were surgical instruments and ‘twenty Bookes of Chirurgery & Physick’, valued at five pounds, earmarked for his son John.Footnote ¹² Stored in the high chamber of the house alongside the silver and fine linens, Shaw's books were clearly considered objects of substantial worth.Footnote ¹³ The collection included works by contemporary physicians such as John Gerard, Lazare Rivière, Jean Riolan, Philip Barrough, Nicholas Culpeper and Daniel Sennert.Footnote ¹⁴ Also present were a number of books on surgery and anatomy, including titles by Ambroise Paré, John Banister, William Clowes, Thomas Vicary, Peter Lowe, John Woodall, Alexander Read, Edward Edwards and Johann Vesling, and – crucially for our story – Thomas Brugis's Vade mecum.Footnote ¹⁵ As the pairing together of books and instruments in the will suggests, both were considered central features of a surgeon's working life as well as valued objects in the Shaw family practice. Printed books played a key role in surgical instruction, whether in structured father–son and shop-based training practices or in self-directed learning.Footnote ¹⁶

Henry Shaw's library is notable not only because it includes the who's who of early modern medical authors but also because the publication dates span a long time period, with the earliest volume, Banister's The History of Man, dating from 1578. Many titles listed had complex circulation histories and had been reissued in multiple editions over decades. Consequently, we need to take a long-view history of surgical publication in order to understand the kinds of instructional manuals surgeons like Henry Shaw passed on to their sons or were circulating more generally in early modern England.

The first fifty years of English medical print consisted largely of translations from Latin and European vernaculars, including manuscripts by medieval authors and printed offerings from contemporary writers.Footnote ¹⁷ As Ann Coldiron and others have suggested, working with new technology while cultivating a market for new products, early printers likely tried to minimize their financial risk by printing reliable titles with a strong circulation history either locally or in other linguistic contexts.Footnote ¹⁸ William Caxton, for example, entered medical publishing in 1490 with the Gouernayle of Helthe – a translation of Latin treatises written by the physicians John of Burgundy and Bartolomeo da Montagnana.Footnote ¹⁹

In surgery, most early titles were translations of Latin, French, Italian and German texts, for example The Noble Experyence of the Vertuous Handy Warke of Surgeri (1525), a translation of Das buch der cirurgia: hantwirckung der wundarztny (1497) by the Strasbourg-based medical practitioner Hieronymus Brunschwig (c.1410–c.1512), or translations of works by late medieval figures such as Lanfranc of Milan (c.1250–1306) and Guy de Chauliac (d. 1368).Footnote ²⁰ Chauliac's works appeared as The Questyonary of Cyrurgyens with the Formulary of Lytell Guydo in Cyrurgie in 1542. Compiled from four separate tracts, The Questyonary of Cyrurgyens included a partial translation of de Chauliac's Chirurgia magna, a treatise on the treatment of leprosy attributed to the thirteenth-century Montpellier physician Bernard of Gordon, a formulary of wound and abscess remedies attributed to de Chauliac, popularly known as ‘le petitie chirurgerie’ or ‘petit Guydon’, and a partial translation of the fourth book of Galen's De Methodo medendi.Footnote ²¹

By the mid- to late sixteenth century, the translating ventures of London book producers turned to the works of popular authors from Italy, France and the German-speaking lands, including the surgeons Giovanni da Vigo (1450–1525), Jacques Guillemeau (1550–1613) and Johann Jakob Wecker (1528–86).Footnote ²² Translations were also marketed under the names of local English surgeons, often as part of a larger collection of tracts. The 1570s and 1580s witnessed the entry of William Clowes (1543/4–1604) and John Banister (1523/3–99?) into the London medical publishing scene. Both were active as practitioners, authors, compilers and translators whose works enjoyed continued popularity. Clowes published extensively on the pox both as an author and as a translator, bringing the Spanish physician Joannes Almenar's (fl. 1497–1502) popular treatise to English readers.Footnote ²³ Among other titles, John Banister offered readers a ‘needefull, new and necessary treatise of chyrurgerie drawn foorth of sundrie worthy wryters, but especially of Antoinius Calmeteus Vergesatus and Iohannes Tageltius in 1575 and another book which ‘gathered and translated’ the works of the Basel-based physician Johann Jacob Wecker in 1585.Footnote ²⁴

As Banister's works demonstrate, aside from translation, other practices of paper, pen and scissors were also central to the production of surgical texts, often warranting a mention in book titles. For instance, together with other surgeons of St Bartholomew's Hospital in Smithfield, Clowes ‘reuiued, corrected and published’ the anatomy of Thomas Vicary, titled as The Englishemans Treasure, or Treasor for Englishmen with the True Anatomye of Mans Body, Compiled by that Excellent Chirurgion Maister Thomas Vicary (1586), another work owned by the Shaws.Footnote ²⁵ It is notable that Vicary was described as a ‘compiler’ rather than an author, emphasizing the work of reading and collating in the work's production.Footnote ²⁶ Other authors who openly advertised their skills as compilers and translators on title pages include Stephen Hobbes, a translator of medical texts, who offered English readers versions of Hipporcrates’ Aphorisms and the works of the Antwerp surgeon Cornelius Schylander.Footnote ²⁷ On the title page of his Margarita Chyryrgica (1610), Hobbes described the work as ‘a compendious practise of chyrurgerie. Selected, and Translated, out of the Works of the most Famous physitions, and Chyrurgians of this Age … for the benefite of all those that doe either studie, or loue the noble and worthie Arte of Chyrurgerie’.Footnote ²⁸

Working firmly within this tradition of surgical publishing, Thomas Brugis, the author at the centre of this case study, also identified compilation and translation as key practices in communicating knowledge. Brugis was somewhat unusual in offering instructional texts on both physic and surgery, working across occupational expertise and identities. While little is known about his life, paratextual materials in his publications suggest that he was a medical practitioner in Rickmansworth, Hertfordshire, and may have studied at the University of Paris under Jean Riolan the younger (1577–1657).Footnote ²⁹

Brugis's first publication, The Marrow of Physick (1639), was an all-in-one medical guide. Comprising two parts, the first consisted of a theoretical exposition, beginning with an account of the biblical creation of the world, then progressing through explanations of naturals, non-naturals and counter-naturals. The second part opened with a discussion of the various kinds of medicines followed by roughly 170 recipe-filled pages. Also included was a list of the different weights and measures, a ‘Catalogue of such instruments as are requisite in private houses’ and a glossary of ‘hard words’.Footnote ³⁰ In other words, the book offered readers both the theory and the practice of medicine in one handy volume, or, as Brugis called it, a ‘pocket book’, designed to be carried around or used at the bedside.Footnote ³¹

Like many contemporary didactic texts, The Marrow of Physick drew on Brugis's extensive reading of ancient and contemporary medical sources, which he listed in a long ‘Catalogue of such Authours, whose helpe I have used in this worke’. The list ran from ancient authorities such as Galen and Hippocrates, to medieval authors like Albertus Magnus and Arnald of Villanova, to contemporary writers like Jean Riolan and Jacob Wecker. He also consulted contemporary English authors such as John Banister and Philip Barrough and ‘divers old Manuscripts, both Greeke, Latin and English, of sundry approved Authours, for Iudgement and Practice’.Footnote ³² Twelve years later, when composing the Vade mecum, Brugis again took pains to acknowledge that his work represented the fruits of his reading and study. Assuming the role of the humble author, he unashamedly confessed, ‘what I have written is meerly stolne from others, the cream of other mens wit, flowers taken out of other mens gardens … I have laboriously collected these few flowers into one bundle, the Composition onely mine, and after that manner as never any yet was published in English’.Footnote ³³ In both books, Brugis openly connects his authority as a medical writer with his work as a tireless reader and gatherer of knowledge.

The emphasis that these historical actors placed on the practices of compilation and translation in the production of early modern surgical manuals is significant in a number of ways. First, it reminds us that early modern surgeons and authors saw their works within a long tradition of surgical writing going back to the efforts of ancient authorities such as Galen and further developed by medieval authors such as Guy de Chauliac and Lanfranc of Milan. As scholars have noted, generations of surgeons wrote down their art because they wanted to both communicate knowledge and skills to others and demonstrate that, aside from being a manual art, surgery was also a learned one.Footnote ³⁴ It was not uncommon for this kind of prescriptive literature to counsel young surgeons to acquire a particular level of proficiency in reading and writing Latin. For instance, in the Vade mecum, Brugis recommended that surgeons possess Latin skills so ‘that he may not onely understand any Latine Authours, but also any Physitians Bill, and may be able to write a Bill himselfe’.Footnote ³⁵ Moreover, the emphasis on long-standing practices more commonly associated with scholastic authors and humanists, such as compilation and translation, further situates these manuals within book-based learning, aligning it with the processes through which knowledge about physic was communicated.Footnote ³⁶ Other scholars have pointed to the rhetorical and literary devices used by early modern English surgeons to blur the boundaries between physic and surgery as a means of bolstering their occupational identity. I suggest that such overt demonstrations of scholarly reading and writing practices served a similar function.Footnote ³⁷ Surgeons instrumentalized vernacular print to elevate their status within the medical hierarchy, and printed surgical books played a crucial role within medical economies and politics, reflecting the hard-fought battles between different factions – physicians, surgeons, apothecaries – over control of the medical ‘marketplace’.Footnote ³⁸

Second, the translation, compilation and repackaging of existing works, whether medieval or contemporary, into local vernaculars involved multiple changes to the text and paratextual materials. Since translation and compilation, by definition, involved information selection, commentary and reshaping knowledge to suit particular needs, each case was shaped in terms of the author/compiler's individual interests and local politics.Footnote ³⁹ For example, in preparing Johan Jakob Wecker's works to be published as A Compendious Chururgerie: Gathered & Translated (especially) out of Wecker, John Banister ‘founde that parte of Wecker ... [was] defective in many points … so [he] thought good (that this worke might be the fuller) partly from other his books, partly from the most approved Authors, olde and newe, (in this point, taking so [him]selfe some larger libertie) to supplye that wanted’. Banister's annotations, which resemble modern endnotes, were designed to ‘give light to the understanding of the texte, to furnish further with medicines … and to preserve soundness of doctrine’.Footnote ⁴⁰ The chapter on the carbuncle, for instance, contained annotations offering explanations, additional recipes and references to the works of authorities such as Galen, Oribasius, Jean Fernel and Giovanni da Vigo.Footnote ⁴¹ Thus, through processes of selecting and assembling, translators and compilers shaped considerably the knowledge within early modern surgical manuals.

In addition to highlighting their learning, writers of surgical manuals also emphasized their experiential knowledge. Given their status as practitioners-turned-authors and the fact that surgery required hands-on training, it is not surprising that many underscored their lived experience and practice in the field to establish their medical authority. In A Needefull, New, and Necessarie Treatise of Chyrurgerie, for example, John Banister claimed that the work included text ‘drawen foorth of sundrie worthy wryters’, as well as an annex containing, as described by the author, ‘certaine experimentes of mine owne inuention, truely tried, and daily of me practised’.Footnote ⁴² Decades later, Brugis adopted similar language in the Vade mecum, contending that his contribution rested not only on collecting together well-known surgical writings and translating these into English, but also on his efforts to test this know-how himself. After all, as he claimed, he had used these methods and cures for ‘seven years in these late unnautrall Civil-wars’, linking his experience with that of other well-known surgical authors such as Ambroise Paré and Fabricus Hildanus who openly referred to their military experiences on the battlefield.Footnote ⁴³

While this combination of authority claims extended across the different subfields of medicine, it was particularly important in areas such as surgery where technical skills played a key role. In the case of English surgery, Celeste Chamberland has shown that the Barber-Surgeons’ Company adopted a multi-modal education programme to train young surgeons and help construct occupational boundaries. Unlike the education of physicians, which took place primarily in universities, surgeons learnt their craft within a master–apprentice programme, much like other trade guilds did.Footnote ⁴⁴ Apprentices of around fourteen to twenty years of age trained for at least seven years in the household of a senior company member before being examined by senior members of the company. It also offered lifelong training to senior members, who were expected to attend weekly surgical lectures and anatomical dissections.Footnote ⁴⁵ In some cases, these lectures found their way into print and other more permanent media. Alexander Read's (c.1570–1641) anatomical lectures, for example, were published as The Chirurgicall Lectures of Tumors and Ulcers (1635) and A Treatise of the First Part of Chirurgerie (1638).

Many authors of surgical manuals were renowned practitioners and members of the Barber-Surgeons’ Company. Both John Banister and William Clowes, whose works have been examined above, were active members of the company, serving as master (Clowes) and delivering anatomical lectures (Banister). John Woodall (1570–1643), whose Surgeon's Mate (1617) was issued in three editions and was a key source for Brugis's Vade mecum, served in a number of roles in the company, including master and anatomy master, and was responsible for training and examining apprentices.Footnote ⁴⁶ It is reasonable to assume that the need to create training materials for new practitioners in part drove surgeons’ writing and translating activities. Clowes, for example, claimed that his A Prooved Practise for All Young Chirurgians (1588) was penned ‘for the benefit of all yong Students in the Art, whose Readings and practises, [he] wish[ed] most willingly that God may prosper’.Footnote ⁴⁷ Relatedly, Mary Erler has argued that the publication of The Questyonary of Cyrurgyens (1542) coincided with the amalgamation of the barbers’ and surgeons’ companies in 1540 and was part of the company's efforts at advanced training.Footnote ⁴⁸ Significantly, in 1616, lectures were read aloud ‘out of Guoydoes Surgery’, likely a reference to The Questyonary of Cyrurgyens, indicating that the work was still part of the training schema decades after its debut in English.Footnote ⁴⁹ Such efforts make clear that book production was an integral part of the company's training scheme, whether for young or experienced members.

This brief survey of surgical manuals preceding the publication of the Vade mecum underscores the strong continuities in the genre across time and space. Like other medical genres, the first hundred years of surgical print in early modern London were dominated by translations and compilations of key medieval texts circulating in manuscript as well as contemporary popular printed works in Latin and in European vernaculars. Many of the titles produced in this period were written by practitioner–authors active in the Barber-Surgeons’ Company who used print to bolster their occupational identity within a crowded medical market. By showcasing their scholarly credentials, they sought to establish surgery as a scholarly field of learning as well as a manual art. The flourishing field of surgical manuals, authored, compiled and translated by prominent members of the guild, suggests that these books were part and parcel of a surgeon's learning across his ‘life-course’, many offering advanced instruction designed to complement and extend the basic training offered in apprenticeships.Footnote ⁵⁰ Equally important, the centrality of textual practices such as compilation and translation meant that the content of surgical manuals continually shifted through practices of selection, omission and expansion, lending a dynamic edge to these texts.

A handy guide to surgery

As suggested by the title, Thomas Brugis's Vade mecum was designed to be a ‘pocket book’ containing

That is, despite its portable size, the Vade mecum contained the entirety of the surgical art. Unlike his earlier Marrow of Physick, Brugis did not include a theoretical section. Instead, after a lengthy preface, he opened the work with a list of instruments a surgeon ought to have in his ‘handsome Plaister Box and Salvatory’, including incision knives, probes, quills, forceps, razors, headsaws, trasine, catheters, cupping glasses, cauterizing irons, sponges and a range of plaisters, unguents, oils and salves.Footnote ⁵² He then described the most important instruments and medicines one by one, offering concise explanations on selection criteria and use, and on the maintenance of the instruments.Footnote ⁵³ This was followed by a collection of detailed recipes for making various medicines and the virtues of simples; further step-by-step instructions on how to use specialist tools such as the trasine, headsaw and various syringes; and an overview of how to treat wounds, ulcers and fractures.Footnote ⁵⁴ Brugis then offered a list of simples and their operations as astringents, corrosives and so on, and a list of quid pro quos; that is, suggested substitutions for unavailable simples or materia medica.Footnote ⁵⁵ The work ended with instructions for making ‘Reports before a Judge of Assize, of any one that hath come to an untimely end’, and a list of critical days.Footnote ⁵⁶ The wide range of information presented in the book is exemplified by the frontispiece, which shows a portrait of the author (we assume) in the centre surrounded by four vignettes depicting surgery and medicine production (top left and right) and distillation equipment and surgical instruments (bottom left and right) (Figure 1). A visual epitome of the book's contents, it not only reinforced the book's purpose, but also showcased the breadth of activities that early modern surgeons performed.

Figure 1. Thomas Brugis, Vade mecum (London, 1651), frontispiece. Engraving by Thomas Cross. See https://wellcomecollection.org/works/kmp8rb8t.

The Vade mecum's focus on instrument use and medicine production departed from the usual form and content of surgical manuals across Europe since the Middle Ages. As Michael McVaugh and Nancy Siraisi have shown, surgery became ‘text-based’ in northern Italy in the twelfth and thirteenth centuries when a new tradition of surgical writing emerged that was distinct from writing in other areas of medicine.Footnote ⁵⁷ McVaugh contends that Guglielmo da Saliceto likely started this practice of writing for surgical ‘colleagues’ and his efforts marked ‘transformation of surgical training from private – oral and personal – instruction to public, almost collective teaching’.Footnote ⁵⁸ Authors like Guglielmo were attracted by the ‘authoritative knowledge of authors such as Galen, Avicenna and Albucasis’ in the craft and the ‘possibility of structuring and ordering that knowledge into the kind of teachable doctrina characteristic of other kinds of more prestigious schools – of arts, medicine and law’.Footnote ⁵⁹ Consequently, although there was some diversity among early learned surgical manuals, they all covered a common set of materials in a finite number of arrangements. Many of these late medieval and early Renaissance texts, such as those by Chauliac or Lanfranc, began with a chapter devoted to anatomy and detailed the causes and signs of conditions such as wounds, ulcers, dislocations and fractures, and their treatments, including medicinal remedies.Footnote ⁶⁰

As part of a larger effort to revive medieval surgical texts and practices of compilation and translation, most early modern English surgical publications also followed this general form.Footnote ⁶¹ For example, the popular Mellificium chirurgiae (1648) by James Cooke offered readers ‘the Art of Chyrurgery in its foure parts, with all the severall diseases unto them belonging. Their Definitions, Causes, Signs, Prognosticks and Cures, both generall and particular’. It included instructions for dealing with tumours, ulcers, fractures and wounds as well as advice on how to separate ‘parts unnaturally joyned’, such as in cases of tongue-tie or when removing ‘things superfluous’ like moles, wens or kidney stones.Footnote ⁶²

In the Vade mecum, however, Brugis decided to go another way. After all, ‘the definition of wounds’ had been ‘so much treated of already in all Authours’ and rather than repeat information that was readily available, he wanted to ‘shew the Artist what he ought to do, when he is called to a wounded Patient’. For Brugis, this kind of practical instruction ‘shall suffice for this Discourse … for if [he] should set down all particulars, [he] should increase [his] book far beyond the bounds of a pocket book, for which [he] intended it, that it might be ready upon all occasions to re-in-force a weak memory’. If a reader required additional information, he could, ‘as he meets with Authours to his purpose, to collect notes of what he finds wanting here’.Footnote ⁶³ In other words, Brugis imagined the Vade mecum as serving a function similar to that of a modern reference book, offering concise, practical instructions for surgeons who might need to brush up on particular operations. While Brugis addressed the text to ‘yong artist[s]’, experienced surgeons would also have found the information it contained helpful in unfamiliar situations. Its portable size meant that it could easily be brought along to consultations, and its simple organization made for quick and easy informational retrieval. Brugis's encouragement to readers to ‘collect notes’ suggests that his ideal reader was one who might complement the Vade mecum by reading other texts to further their surgical education.

The contents of the Vade mecum reflect the kinds of knowledge Brugis considered pertinent to everyday surgical practice and essential for those new to the trade, including instructions for the use and care of instruments; directions for tricky procedures; treatment advice for wounds, ulcers, fractures and dislocations; and detailed recipes for medicine production. Throughout the volume, he prioritized advice and know-how gained from personal, lived experience.Footnote ⁶⁴ For example, in the section on the use and care of instruments, the entry on incision knives informed readers that the instrument is used to ‘cut the skin or flesh upon needfull occasions, in paring away the putrid part of a gangrenous member’. The instrument should always be kept ‘cleane and bright, by being rubbed dry after it hath been used and sharp as any rasour’. Crucially, surgeons should ‘hide it from Patients sight with a cloath, and also all other sharp instruments, for divers reasons’.Footnote ⁶⁵ In prompting readers to be mindful of patients’ anxieties and fears of sharp knives and such, Brugis's advice went beyond the maintenance of surgical tools to the management of medical encounters.

Brugis's instructions demonstrate a keen awareness of the different materials used to make surgical tools, their specific applications and their requirements for maintenance. For instance, using detailed and carefully worded instructions, he advised surgeons to keep on hand ‘very clean’ syringes made of tin or silver and ensure that one is used for ‘watry injections, another for oyly’.Footnote ⁶⁶ He paid similar attention to materials in his instructions for using the stitching needle, another must-have tool for surgeons, directing practitioners to keep at least three different-sized, well-oiled and rust-free needles in their box, all of which should be ‘well set, and ready armed with green, or red silk oyled’. If the practitioner found himself out of silk, he could use thread, but then he would need to rub it with ‘some kinde of emplaister’.Footnote ⁶⁷

Apart from advice on the care and maintenance of instruments, Brugis also offered his readers detailed descriptions of how to employ them, which often entailed relating how surgeons could use their senses to gauge the different stages of use. Guidance of this kind was especially pronounced in the instructions for using the trephine, an alternative to the trepan advocated by John Woodall in his Surgeon's Mate.Footnote ⁶⁸ Modelled on Woodall's text, Brugis's instructions for using the trephine were particularly comprehensive, presumably because the procedure was likely rarely performed and step-by-step instructions would aid new practitioners as well as serve as an aide-memoire to experienced surgeons. Designed to perforate the skull, the instrument consisted of a long shaft with a toothed wheel armed with a steel pin in the centre. The surgeon was instructed to place the instrument on the head, using the steel pin as a guide to position the trephine and secure its teeth onto it. This first step served to mark the point at which the tool would perforate the skull. Once completed, the surgeon should take the instrument off, clean the teeth of the wheel and remove the pin, returning the screw to the head and ‘by the agitation of his hand onely to and fro to pierce’ until the teeth of the wheel go halfway through. At this point, Brugis advised the practitioner to pull the instrument out and clean it again before reapplying it to the head and ‘pierc[e] by the motion of his hand to and fro, untill he have in all parts gone through the cranium.’ Throughout the process, the practitioner should ‘diligently regard in the tender observant motion of his own hands’ the precise moment this phase of the procedure was completed; that is, when ‘he that pierceth shall sensibly feel when the bone is penetrated through on each part’.Footnote ⁶⁹ At this point, the instrument could be withdrawn with the piece of cranium attached.

It is telling that while Brugis's instructions are detailed and clear, there are still silences. For instance, there is no mention of the practitioner needing to shave the patient's head before the procedure or pointers on whether to remove the skin flap before attaching the instrument or with the bone when withdrawing it. How should the practitioner position the patient and what kind of pain-management strategies should be employed? These silences remind us of the vast amount of assumed knowledge required in these kinds of procedures and that in surgery, as with other knowledge fields, textual knowledge rarely conveyed all the required know-how for action.Footnote ⁷⁰

Trepanning was a risky procedure and was acknowledged as such at the time. Brugis warned readers that ‘there is a great care to be taken by the Artist in the manner of the piercing’, taking pains to specify the various ways of removing a piece of bone. Of all the dangers involved in drilling into a skull, the most serious one was to go too deeply into the brain matter when trying to press the instrument through the bone. This was the reason Brugis recommended using the trephine over the traditional trepan: its ‘ragged raper head’ offered more points of contact than the trepan, which relied on a single small screw to fasten the instrument to the head, thereby increasing the chances of inadvertently going too deep, too fast. Even with the trephine, however, surgeons could still forget to remove the guiding pin in the centre of the instrument before returning it to the head. Because the pin was longer than the teeth of the wheel, it would also pierce into the brain matter. Multiple removals of the toothed wheel for ‘cleaning’ enabled the surgeon to gauge how far he had penetrated through the cranium. Ending this section with warnings of the danger and precariousness of this particular operation, Brugis ‘adviseth the young Artist to make trial on a Calves-head, or the like subject, before he put it in practice upon a man; for indeed a Surgeon can never be too fearful of omission, or of over-doing’.Footnote ⁷¹

Brugis's precise and practical instructions extended beyond the use of surgical instruments to processes of medicine production. In the entry on making ‘Sir Philip Paris Emplaister’, for example, readers were not just given a list of ingredients and a bare-bones description of production methods, as was customary.Footnote ⁷² Instead, Brugis spelled out exactly what kind of vessel to use (‘earthen pan, well glased’), what heat source to employ (‘gentle fire of coales’), what changes to look for in the material (‘encrease fire till the red turne grayish’) and how to determine at what moment a recipe was complete (‘drop a little upon a trencher, if it cleave not thereto, then it is enough’). Paying similar attention to detail, Brugis also urged surgeons to ensure that all the gums used in the recipe were ‘finely powdered, dissolved in sacke or Vineger, and strained through a canvas, and the vinegar or sacke evaporated at the fire’, and warned them not to over- or under-boil, which would result either in hard plasters with evaporated ingredients or plasters that would not stick. Reading the vivid instructions, readers might feel as if an experienced practitioner were standing next to them as they performed these tricky procedures, guiding them along the way with warnings about potential pitfalls.

Like many other multi-editioned instructional works, the Vade mecum was by no means a static text. Early modern book producers were sensitive to changes in current medical ideas and attuned to market needs, and reworked titles accordingly. In so doing, they also continually shaped and reshaped the parameters of instructional medical literature. In preparing the second edition of the Vade mecum in 1657, in addition to adding an appendix on the ‘rules for vomiting and purging’, Brugis openly aired his frustration about his local medical landscape, warning readers against visiting ‘Empericks, silly impudent women and fools’, particularly an ‘illiterate, bold, impudent’ woman living nearby in ‘Ruslippe’ who was clearly in competition with him for patients.Footnote ⁷³ In this manner, he deftly positioned his text within squabbles in local medical markets and attempted to reinforce traditional hierarchies of medical authority.

Decades later, the title underwent another transformation in the hands of the physician Ellis Pratt, who produced a new, expanded edition featuring his notes on surgical practices. Although he retained the same title, Pratt made a number of changes, including adding the theoretical part of surgery and physic, rendering it less of a ‘vade mecum’. The title page of the 1679 edition boldly claimed that it now contained ‘an Institution of PHYSIC with seven New Treatises. Viz. of Tumours, Wounds, Ulcers, Fractures, Dislocations, Lues Venerea, Anatomy’.Footnote ⁷⁴ In one fell swoop, Pratt negated the distinctiveness of Brugis's practice-oriented text, rendering it similar to others on the market. It was this edition that the Hamburg-based medical practitioner and translator Johann Lange wrought into German in the 1680s.

Reading and using the Vade mecum

From its conception, the Vade mecum was designed to appeal to both surgeons and general readers. In addition to the pedagogical functions described above, the book also served as a self-help guide for patients, aiding them in basic healthcare and shaping their medical encounters. In the section of the preface explicitly addressed to patients, Brugis warned them to stay away from ‘Mountebanks, Empericks, Quacksalvers, Paracelsians (as they call themselves) Wizards, Alcumists, Poor-vicars, cast Apothecaries, and Physitians men, Barbers, and Good-wives that professe great skills, go with the name of Doctor’. Instead, if they needed to see a surgeon, they should turn to Brugis's handy guide to identify good practitioners and for advice on how to engage with them to ensure they receive aid.Footnote ⁷⁵

In gearing the Vade mecum towards users of medical services, Brugis was participating in a broader contemporary movement. English medical authors often used print as a medium to forward their political agendas, and instructional manuals occupied a central place within many of these debates. As scholars have demonstrated, authors of didactic literature across different knowledge fields employed the rhetoric of utility or the ‘common good’ as a way of justifying their works and as a marketing strategy. This strategy was particularly common in the 1650s in the aftermath of the English Civil War when authors in a number of fields instrumentalized print to advocate open access to knowledge. Alongside theology and law, medicine was targeted as an area where crucial knowledge was often transmitted in Latin and kept from the ‘common man’. The use of vernacular print enabled the everyman to take charge of his own health.Footnote ⁷⁶ In this manner, instructional texts, such as the Vade mecum, formed both the basis of primary care within the household and the very foundation of patient–practitioner relationships, influencing the power dynamics between the two parties. Informed patients were able to interpret the bumps and boils on their own bodies, empowering them to design and direct their own programmes of surgical care, commission practitioners for different tasks and, crucially, avoid ‘the cut’ when possible.Footnote ⁷⁷

Whether as practitioners or as patients, readers eagerly took to Brugis's Vade mecum, as evidenced by the heavily annotated copies of the book that survive in archives and libraries.Footnote ⁷⁸ The previously mentioned Austin–Leathes volume in the Wellcome Library, for example, contains assorted marginal notes written in by owners over hundreds of years after publication. Judging by the handwriting, a seventeenth-century owner added a recipe for elderberry or blackberry wine on the front flyleaf. The same reader added a number of manicules and other signs to mark out passages throughout the book and noted his/her experiences with particular cures. For example, under a nosebleed remedy that involved blowing the ashes of egg shells or paper into the nose, he/she noted that powder of ‘bole armanake’ ‘hath been experiemented’.Footnote ⁷⁹ Another reader, possibly the nineteenth-century reader who signed ‘GDH 37’, covered a blank front opening with scrawls, including medical terms such as sinew and issue, nursery rhymes such as ‘Rub a dub dub’ and drawings of Chinese crackers.Footnote ⁸⁰ Additionally, aside from signing his name, Leathes also sketched a small box labelled ‘Mr Symes Pocket case of operating knives’ on the front pastedown, thereby connecting the work with contemporary surgical culture.

Marks in copies of the Vade mecum also suggest that users read the book in conjunction with a range of other works. For example, the early modern reader of the Austin–Leathes volume noted under the section on oil of vitriol that ‘In Mr Ramseys Treatise of poysons he speaks of the danger of Taking oyl of vitrioll inwardly’. He/she was referring to William Ramesey's De Venenis, or A Discourse of Poysons Their Names, Natures and Uses (1663), in which Ramesey included vitriol as a poison, citing examples from Johannes Crato von Krafftheim's collection of medical cases and letters.Footnote ⁸¹ In some instances, readers required more space than the margins for their notes and annotations. A copy of the 1652 edition of Vade mecum now in the Huntington Library was bound with additional paper filled with information about herbs and recipes, much of which was gleaned from other printed or manuscript works.Footnote ⁸² One recipe added by a reader was for making the popular ‘Lucatellies Balsum’. Brugis named this unguent as one of eight medicaments crucial for any surgeon's ‘salvatory’, but did not provide any production information.Footnote ⁸³ Lucatella's balsam was a popular medicine in the period, and different recipes to make the drug circulated widely in contemporary printed and manuscript recipe books. The ubiquity of the recipe may account for Brugis's omission of it, having likely assumed that readers would either use their preferred formula to produce the salve or purchase it ready-made.Footnote ⁸⁴ Aside from writing out the entire recipe, the reader also used his/her notes to refer to information contained in other printed works. For example, one entry reads, ‘sow thistle for a 100 things see 500 . 208. In Culpeper’, and another ‘piamounts secrets see 186 for ye eyes and for ye iandise .285. 307 see for st johns oyle 184 pills of turpentine for ye stomake’.Footnote ⁸⁵ These entries referred to two well-known publications – Nicholas Culpeper's The English Physician (1652) and Girolamo Ruscelli's The Secretes of the Reuerende Maister Alexis of Piemount (1558). In both cases, the page numbers provided suggest that the notes were part of a note-taking system designed to allow easy return to entries on particular materia medica or ailments in different books within a library, a practice which hints at wider activities of medical reading.

The myriad surgical titles featured in this article, along with Brugis's Vade mecum, were part of a broader medical book culture which crossed the constructed boundaries between physic, surgery and pharmacy. For instance, the breadth of Henry Shaw's library not only brings to the fore a family with wide-ranging medical knowledge but also reminds us of the multifaceted medical role taken on by barber-surgeons during this period.Footnote ⁸⁶ As Brugis articulated in the preface,

Published in the 1650s and read until the late 1800s, copies of Thomas Brugis's Vade mecum document dynamic conversations over time and space. Earlier sections outlined how book producers saw the Vade mecum as a malleable text, open to additions and other changes. Readers also viewed the text in much the same way. To many, it was a compendium of useful knowledge, ready to be personalized and updated with their other medical readings and experiences. Practical knowledge about surgery was continuously kept in use by processes of textual and epistemic adjustment. In order for knowledge, particularly instructional knowledge, to remain relevant and useful, it had to be updated. The text and individual copies of the material book, then, became active sites of negotiation between existing knowledge and subsequent revisions.