Treating Gangrene During the Golden Age of Piracy, Page 1
“…my Chirurgeon cut off a poore creaturs Leg, a little under the knee, first cutting the living and untainted flesh above the Gangreene with a sharp knife, and then sawing off the bone in an instant; then with searing and stoopes stanching the blood, which issued aboundantly…
Miracle of the Gangrenous Leg by Duomo Milano The leg was so rotten & gangreen’d, that one might have run a straw through it; but neither did this the cure, for it not being amputated high-enough, the gangrene prevaild upon the knee, & so a second amputation of the Thigh, cost the poor Creature his life, to my very great sorrow: I do not remember that ever in my life I smelt so intolerable a stink as what issu’d from the part was cutt off, & which I ordered should immediately be buried in the Garden… This stoute man, was but a common sailer.” (John Evelyn, The Diary of John Evelyn, p. 191)
Gangrene was a much feared consequence of wounding during the Golden Age of Piracy. For, as the surgeons understood all too well, once a gangrene had overtaken a Patient, it could lead to "death of the whole microcosm..." as John Yonge explained during his examination before the Royal College of Surgeons.
Gangrene Versus Sphacelus
Gangrene was understood slightly differently during this era than it is today. Many surgeons from this period identified two different types of necrosis or dying flesh: gangrene and sphacelus (or 'sideration'). Surgeon Richard Wiseman, author of the book Eight chiurgical treatises gives a vivid description of the difference between the two types of necrosis recognized during the GAoP, explaining that “Sphacelus is distinguished from a Gangrene by the total Corruption and Stink, it being also insensible both of Knife and Fire." (Wiseman, p. 444)
Surgeon Pierra Dionis The French master surgeon and instructor Pierre Dionis provided a more tempered explanation in his book A Course in Chirurgical Operations.
"The Gangrene and Sphacele, which are two different Distempers, and differ only in the degrees of more or less, are owing to the same Cause, which is the interception of the circular Motion of the Blood; for as long as this Motion continues, and by its means the Nutritive and Spiritive Juices are convey’d to the part, it retains its Heat, Vigour and life.” (Dionis, p. 404)
In fact, Dionis was not that far off in his explanation of the difference between the two states. Today, gangrene is defined as the decay and death of body tissue due to a loss of blood flow, while sphacelus is just the irrecoverable dead flesh that results from the gangrene. So sphacelus could be thought of as a sort of 'advanced gangrene.' However, during the GAoP the two terms indicated two separate diseases, even though Dionis seems to recognize that both were caused by the same problem.
The key lay in the attitude towards healing which each diagnosis produced. As Dionis further explains,
"...we are to consider two Degrees of Mortification, the first is what we call a Gangrene, which is when the Part begins to putrify; and the second a Sphacelus, is when ‘tis entirely corrupted. There are hopes that a Gangrene may be dealt with by the Remedies which I shall immediately lay before you, but the Sphacele admits of no other Remedy besides Extirpation [that is, debridement or amputation]." (Dionis, p. 403)
Richard Wiseman agrees, giving us some greater detail on the consequences of not removing a sphacelated part.
"...in Sphacelus there is no remedy, save only by a speedy separation of the sphacelated Part: for if any of it remain, it soon creepeth up by the Nerves, &c. and infecteth the whole Member, and is accompanied with Watching, Raving, frequent Faintings, Convulsions, Hiccough, and cold Sweats; which foreshow the Patient’s approaching Death..." (Wiseman, p. 444)