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Francisco Arceo de Fregenal and the treatment of clubfoot up to the sixteenth century

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The correction of clubfoot as a subject of study is somewhat unusual, especially if one considers that up until the Renaissance only a pair of authors dealt with the subject of this inherited disorder. On the one hand is Ambroise Paré, whose contributions to trau-matology and orthopaedics are staggering, and on the other, Francisco Arceo de Fregenal, also known as the Ambroise Paré of Spain. Both men developed a method for treating this condition, and a special orthopaedic shoe. So, why is it that in the Spanish literature the French surgeon was considered the pioneer in the development of an orthopaedic boot from the start and not Arceo? Why was the work of the Spaniard not studied in depth, as it deserves to be? These questions troubled us and led us to write this paper, in which as the primary objective we decided to highlight Arceo’s contributions to the field of orthopaedics. Concrete arguments and works exist today that have led to common agreement among scholars of the subject that the Spanish surgeon was a Jewish convert. The social, economic and political conditions in Europe at that time may give us some idea of the difficulties for a Jewish convert in the sixteenth century, and clearly, it was difficult for a scientist to have followers who would defend his methods and technical ideas. Nevertheless, we believe that Francisco Arceo de Fregenal deserves more recognition and his work should continue to be studied in more depth.
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FRANCISCO ARCEO DE FREGENAL
AND THE TREATMENT OF CLUBFOOT
UP TO THE SIXTEENTH CENTURY
FRANCISCO ARCEO DE FREGENAL I
LIJEČENJE PRIROĐENOG UVRNUTOG
STOPALA DO . STOLJEĆA
José Ramón Vallejo, Marina Mesa, José Miguel Cobos-Bueno*
S
The correction of clubfoot as a subject of study is somewhat unusual, especially if one con-
siders that up until the Renaissance only two authors dealt with the subject of this inherited
disorder. On the one hand is Ambroise Paré, whose contributions to traumatology and or-
thopaedics are staggering, and on the other, Francisco Arceo de Fregenal, also known as the
Ambroise Paré of Spain. Both men developed a method for treating this condition, and a
special orthopaedic shoe. So, why is it that in the Spanish literature the French surgeon was
considered the pioneer in the development of an orthopaedic boot from the start and not
Arceo? Why was the work of the Spaniard not studied in depth, as it deserves to be? These
questions troubled us and led us to write this paper, in which as the primary objective we
decided to highlight Arceo’s contributions to the eld of orthopaedics. Concrete arguments
and works ex ist today that have led to common agreement among scholars of the subject that
the Spanish surgeon was a Jewish convert. The social, economic and political conditions in
Europe at that time may give us some idea of the diculties for a Jewish convert in the six-
teenth century, and clearly, it was dicult for a scientist to have followers who would defend
Original s cientific article Acta Med Hist Adriat 2018; 16(1);19-48
Izvorni znanstveni ~lanak
* Departamento de Terapéutica Médico-Quirúrgica, Facultad de Medicina, Universidad de
Extremadura, Badajoz, Spain.
Correspondence address: José Ramón Vallejo, Área de Didáctica de las Ciencias
Experimentales, Equipo de Historia de la Ciencia y Antropología de la Salud, Facultad
de Educación, Universidad de Extremadura. Avda. de Elvas s/n.  Badajoz, Spain.
E-mail: joseramonvallejo@unex.es.
19
his methods and technical ideas. Nevertheless, we believe that Francisco Arceo de Fregenal
deserves more recognition and his work should continue to be studied in more depth.
Keywords: History of orthopaedics, clubfoot, Renaissance, Ambroise Paré, Arceo
IntroductIon
Although in most dictionaries the word “orthopaedics” is said to derive
from orthos (straight) and paideia (education), in the sense of the art of corre-
cting or avoiding deformation of the human body, its origin is in fact rather
dierent. The French doctor Nicolas Andry coined the term orthopédie in
1741. For this author the word paideía had the original Greek meaning “of
children or relating to children”, rather than the modern meaning of “educa-
tion”. This is how Andry explained the origin of his neologism:
“[…] I formed it from two Greek words: from orthos, which means straight,
not deformed, correct, and from paidon, which means child. From these
two words I constructed the word orthopaedics, to express a single term;
my plan is to teach various methods for the prevention and correction in
children of deformities of the body”.
This author used the image of a twisted tree which, in order to correct its
growth, is tied rmly to a stake, to symbolise this branch of medicine.
Orthopaedic Surgery, like many other specialities, has developed on the
basis of necessity. The necessity to correct deformities, restore function and
relieve pain. Orthopaedic surgeons have developed the ability to prevent a
substantial loss of bodily function and in some cases they can avoid the de-
ath of a patient. They seek perfection in their art, to ensure that the patient
reaches optimal condition in the shortest time possible by using the safest
method available. However, it has taken many centuries to reach this point,
to learn from the certainties and, more especially, from the errors of the past.
Since the beginning of time, people have struggled to survive, hen-
ce the need to confront any adversities that encounter. Palaeopathology
has revealed the existence of fracture calluses, bone tumours and skeletal
The original text states: “[…] je l’ai formé de deux mots grecs, sçavoir, d’Orthos qui veut dire
droit, exempt de diormi, qui est selon la rectitude, & de Paid on, qui signie Enfant. J’ai com-
posé de ces deux mots, celui d’Orthopédie, pour exprimer en un seul terme, le dessein que je
me propose, qu i est d’en seigner divers moyens de prévenir & de corr iger dans les enfants, les
diormités du corps” Andry, N. L’orthopédie ou l’art de prévenir et de corriger dans les enfants,
les diormités du corps (Paris: Rue Saint Jacques, -), vol. , ij. Available from: https://
books.google.es/books?id=oKMUAAAAQAAJ&printsec=frontcover&hl=es#v=onep-
age&q&f=false [consulted //].
Ibid., .
20
malformations such as clubfoot or syndactyly since ancient times, in pre-
historic sites in both Europe and Africa. It is therefore inevitable that at
some point a prehistoric man created a splint to alleviate anatomical pro-
blems, and it is also very likely that he or she was a pioneer in performing
amputations or using therapeutic ointments. These methods were part of
the rites and beliefs about death and illness, since a combination of empirical
elements and magic are typical of this primitive form of medicine.
If we look at ancient Egypt, mummied bodies, paintings, murals and
hieroglyphics have been found which show that the Egyptians suered from
as many complaints as we do today. We can also see orthopaedic practices
such as splints depicted on mummies, made from bamboo, cane or wood.
Moreover, texts using crutches are shown in an engraving from the year 2830
BC.
However, it is the ancient Greeks who can be considered the rst people
to take a scientic view of the world, and so Homer (800 BC), in his tale of
the Trojan War, tells us of the injuries of those times and their treatment.
The Iliad also contains references to various musculoskeletal deformities.
Hippocrates (460-370 BC) also deals with these problems in his works, and
from among these we can cite “On the Articulations” - peri arthron-, “On
Fractures” -peri agmon- and “On the Instruments of Reduction”-mokhlikós-
as signicant examples. Thus, in the book “On Fractures” he introduced
techniques for continuous traction, immobilisation using splints, and pro-
gressive compression using bandages which allow for extension and coun-
ter-extension of the limbs. His works also include notes on paediatric ortho-
paedics (he describes the correction of clubfoot, amongst other things). The
rst description of clubfoot (talipes equinovarus, supinatus or adductus)
was made by Hippocrates more than 2,000 years ago and he made the rst
attempt at a treatment by manipulation. In order to maintain the correction
obtained, he applied a strong bandage. He was later able to state that most
cases of clubfoot could be corrected by manoeuvring and that this should be
performed as soon as possible. He also called clubfoot “killopodie” and he
treated it with a leather boot with a lead sole. However, neither the boot, nor
its design or construction has appeared to date in any source.
It was during the Graeco-Roman period that people started to design and
produce prostheses to replace amputated limbs. The oldest reference to am-
putation is from the Greek historian Herodotus (484-425 BC).
21
In the Middle Ages, Galen’s concept of “laudable pus” prevailed, i.e. the
quest for a substance that would make it possible to destroy any infection
and induce healing. So, German “healers” gave massages, reduced dislocati-
ons and fractures, and healed wounds. Guy de Chauliac (1290-1368) is anot-
her great mediaeval surgeon, from the Montpellier school, who introduced a
novel contribution to the eld of traumatology and orthopaedics: the use of
continuous traction, using weights and pulleys to reduce and treat femoral
fractures. Guglielmo de Saliceto (1210-1278) wrote his principal work, “La
Chirurgia” [“Surgery”], divided into six books, which included one dedica-
ted to fractures and dislocations, another to wounds and bruising, and yet
another to anatomy. Finally, there was Lanfranco de Milán (1240-1306), who
used complicated winding of bandages and strips on to which a solid plaster
was applied.
The social, economic and political conditions in Europe led to inter-
nal developments in this eld which ended in the fteenth century in the
Renaissance. Leonardo da Vinci (1452-1519) was crucial in the development
of western culture. Paracelsus (1493-1541) chose to intervene as little as po-
ssible when treating wounds, fractures and dislocations, and the Flemish
Andreas Vesalius was without doubt the greatest anatomist of all time.
However, the most outstanding surgeon of the sixteenth century was the
Frenchman Ambroise Paré (1510-1590). Paré’s contributions to traumatology
and orthopaedics are staggering. He was the rst to describe femoral neck
fracture and epiphyseal detachment in children. In addition, he designed a
great variety of forceps, instruments and splints of all kinds. With the help
of weapons manufacturers, he designed articial limbs from iron, rened the
Hippocratic bench to reduce dislocations, and designed a corset for scoliosis
and a boot for clubfoot.
A historical analysis of the descriptions of club foot is quite complex and
at times an orthopaedic problem is involved that is dicult to determine.
Currently, the identication of clubfoot is performed using a diagnosis of ex-
clusion, and so it is necessary to nd a cause before dening it. Nevertheless,
the aetiology of clubfoot and its true cause are unknown, since there is un-
certainty about both the pathogenesis and the internal mechanisms that
See Parker, R.W. and Shattock, S.G. ‘The pathology and etiology of congenital club-foot,
Trans Path Soc Lond,  (), -; Strach, E.H. ‘Club-foot Trough the Centuries’,
in Rickham, Peter Paul (ed.), Historical Aspects of Pediatric Surgery, , series Progress in
Pediatric Su rgery (Berlin , Heidelberg: Springer-Verlag, ), - and Carrol l, Norris.
‘Clubfoot Trough the Ages’, in Raensp erger, John G. (ed.), Children’s Surgery: A Wo rldwide
History (North Carolina: McFarland, ), -.
22
lead to the deformity. Three theories seeking an explanation now exist: a)
the postural theory, or extrinsic compression by positional anomaly; b) the
neuromuscular theory, which considers the existence of a pathological pro-
cess which alters the muscle to cause surrounding brosis; and c) the malfor-
mation theory, which proposes an abnormal conformation of the talus, espe-
cially of its neck and head, i.e. total subluxation of the talus, calcaneus and
navicular bones. Yet we must not forget the ideas of Carl Hueter (1838–1882)
and Richard von Volkmann (1830–1889) on the inhibitory eect of pressure
on growth and ossication that were revived by Bohm in 1929 to explain the
aetiology of clubfoot and were the subject of discussion. An environmental
aetiology due to teratogenic agents was also suggested, and even a hereditary
explanation.
Retrospectively, it is interesting to consider Antonio Scarpa (1752–1832).
Scarpa and Paré agreed with Hippocrates that the cause of the deformity was
postural, mechanical pressure in the uterus. Above all, because this theory
was revived in 1884 by Parker and Shattock, who believed with other au-
thors that the foetal feet are inverted and that the increased pressure could
lead to muscle damage and deformity. Antonio Scarpa can be seen as the
key gure on this matter, because his observations led him to think of an
Nordin, S. et a l. ‘Controversy in congenita l clubfoot: Literature Review , Malaysian Journa l
of Medical Sciences, ,  (), -; Dimeglio,A. andCanavese,F.TheClubfoot: An
Overview of Current Procedures’, Rev Ortop Traumatol, (), - and Kelly, D.M.
‘Congenital anomalies of the lower extremity, in Canale S.T., Beaty J.H. (eds.),Campbell’s
Operative Orthopaedics, th edn (Philadelphia, PA: Elsevier Mosby, ).
Ibid., - and Álvarez, C., et al. ‘ReviewofCurrent Methods Usedin the Treat-
mentofClubfootatInitial. Presentation and at Recurrence’, Journal of Surgical Orthopae-
dic Advances, ,  (), -.
Mehlman, C.T.,Araghi, A. and Roy, D. R.‘Hyphenated history: theHueter-Volkmann
law, Am J Orthop(Belle Mead NJ),  (), -; Willy, C. et al. ‘Richard von Volk-
mann: surgeon and Renaissance man, Clinical Orthopaedics and Related Research, , 
(), -; Gamboa M árquez, Alejandro and Ga rzón-Alvarado, Diego Alexa nder. ‘Fac-
tores mecánicos en enfermedades osteocondrales, Rev Cubana Invest Bioméd, ,  (),
- and Hernigou, P. ‘Authorities and foundation of the orthopaedic school in Ger-
many in the th c entury: part II : Richard von Volkmann, Jul ius Wo l, Albert Hoa, Frie-
drich Trendelenburg and other G erman authors, International Orthopaedics (SICOT), ,
 (), -.
BohmM. ‘Embryologic origin of clubfoot’, J Bone Joint Surg,  (), – and Gruber,
H. et al. ‘Thedierent growth zonesof thefetal foot, Ann Anat, , (), -.
Nordin et al., op. cit.
Adams, Francis. The Genuine Works of Hippocrates Translated from the Greek, (Sydenham
Society, ), ; Carroll, op. cit. and Nordin et al., op. cit.
 Parker and Shattock, op. cit. and Hjelmstedt, A. and Sahlstedt, B. ‘Talar deformity in con-
genital clubfeet. An anatomical and functional study with special reference to the ankle
joint mobilityActa Orthop Scand, ,  (), -.
 Carrol l, op. cit.
23
alteration in the tissues that caused the dislocation, and he designed an or-
thosis. During the 19th century both conservative and surgical techniques
were used, as well as manual corrections, braces or gradual stretching, and
tenotomy was performed. It should be noted that, with the arrival of anaes-
thesia (1846) and Lister’s antiseptic methods (1862), the surgery became more
aggressive, to the extent of bone surgery such as astragalectomy, or remov-
al of the talus bone, in the last third of the nineteenth century. However,
the appearance of plaster was a major boost for conservative treatments in
this century. Throughout the twentieth century, most orthopaedic surgeons
were in agreement with the Hippocratic idea of starting treatment as soon as
possible after birth. Yet at rst, severe corrective measures such as those used
in the previous century were favoured. The use of a splint was also popular,
following strong corrective measures, or other treatments involving repeat-
ed gentle manipulation and the use of serial plaster casts; in addition, subcu-
taneous tenotomy was performed on the Achilles tendon, and together with
conservative techniques such as the Ponseti method, more aggressive surgery
was performed in many centres. However, nowadays surgical treatment is
only used when orthopaedic treatment does not produce any improvement
and is ineective. There is also full consensus that immediate and urgent
rehabilitation is essential. The conservative treatments used these days are
varied, but they all share the same fundamental objectives as in earlier times.
Basically, functional rehabilitation and manipulations with splints or serial
casts are used now. The results of any treatment depend on the severity of
the deformity, the philosophy of the surgeon regarding the deformity, the
experience in rehabilitation and manipulation, and the daily eort regarding
treatment that usually lasts more than a year. Finally, we would emphasise
the philosophies contained in the methods such as the Ponseti technique
in which it is better to retain some residual deformity in a mobile foot than
have a foot that is sti and painful even if totally corrected. The advance in
all these factors, taking into account the historical context, marks the dierences
compared with the conservative methods of the past.
Correction of clubfoot has not been a subject much studied in the course
of human existence, and moreover, until the Renaissance only a couple of
authors dealt with the subject of this inherited disorder. These were the
above-mentioned Ambroise Paré and Francisco Arceo de Fregenal, who
 Scarpa, A. A Memoir on the Congenital Club foot of Children and the Mode of Correcting that
Deformity (Edin burgh: Constable, ).
 Carroll, op. cit.
 Dimeglio andCanavese, op. cit. and Álvarez, op. c it.
24
developed both a method for treating this condition and a special orthopae-
dic shoe. In spite of all this, it is astonishing to nd that in the Spanish lit-
erature Ambroise Paré appears as the pioneer in designing an orthopaedic
boot, leaving Francisco Arceo completely out of the picture: even though
he was Spanish, his compatriots have never accorded him sucient recogni-
tion. While it is true that for some time now the work and gure of Francisco
de Arceo have been studied in depth by Spanish scientists, for the interna-
tional community he continues to be a little-known gure and is given only
supercial treatment. While it is true that some publications can be found
that summarise his work or describe and analyse some relevant aspect of
it, this is insucient, given the calibre of the man. Our interest in him has
led us to establish the importance of his work in numerous elds, and one of
these is orthopaedics. In this respect, we have observed that in the interna-
tional context the general literature dealing with the history of orthopaedics
does not usually include Francisco de Arceo, although brief mentions can
be found of his orthopaedic methods and practice, basically citing the use of
iron in splints, followed by a special shoe to treat clubfoot. Consequently,
we set as our primary objective in this paper to highlight his contributions
to the eld of orthopaedics, and to help make his exceptional work more
widely known internationally. For this, we will start from the contributions
of Ambroise Paré, then, after a brief biography of Arceo, we will set out in
detail the treatment for clubfoot that appears in his book, and highlight a
 See Oyola Fabián, A. and Cobos Bueno, J. M. Método verdadero de curar las heridas y otros
preceptos de e ste arte. Método d e curar las ebres. Francisco Arceo d e Fregenal. Prefacio d e Benito
Arias Montano (Huelva: Servicio de Publicaciones de la Universidad de Huelva, Biblio-
theca Montaniana, ); Cobos Bueno, J. M., Oyola Fabián, A. and García Ávila, J.F. ‘El
Bálsamo de Francisco Arceo de Fregenal’, Llull, ,  (), -; Montero Cartelle,
E. ‘Benito Arias Montano y Francisco Arceo: la redacción del De recta curandorum vul-
nerum ratione Asclepio, Revista de Historia de la Medicina y de la Ciencia, LXIV,  (),
-; Cobos, J. M. and Vallejo, J.R . Francisco Arceo, m édico del Sant Oc io de la Inquisici ón
de Llerena, in XV Jornadas de Historia de Llerena, ‘Inquisición’, Llerena,  and  Octo-
ber  (Llerena: Sociedad Extremeña de Historia, ), - [see www.sociedadex-
tremeñadehistoria.es].
 Moulin, Daniel de A history of surgery, with emphasis on the Nethe rlands, (Dordrecht, Boston
and Lancaster: Martinus Nijho, ).
 Muñoz-Sanz, A., García-Ávila, J.F., Vallejo, J.R. ‘Cases of aphasia in a work on medicine
from the th century’, Acta Medico-Historica Adriatica, ,  (), -.
 Peltier, L .F. Orthopedics: a history and iconography, Norman Orthopedic Series , Norman
Surgery Series . (San Francisco: Norman Publishing, ); Mosto, S.B. (ed.), Who ’s
Who in Orthopedics (Springer Science & Business Media, ).
 Walsh, James J. Th e Century of Columb us (New York: Catholic Summer School Pre ss, ),
; Fixsen, J.A. Children´s orthopaedic Surgery, in Leslie Klenerman (ed.), The evolution of
orthopaedic surgery (London: Royal So ciety of Medicine Press,  ), ; Hefti, F. Pediatric
Orthopedics in Practice (Berlin Heidelberg, Springer-Verlag, ), .
25
plagiarism of his work. Finally, we will end with a discussion about the dis-
semination of his methods through history.
C  A P
Paré was born around 1510 in Bourg-Hersent, Laval, and died in Paris on
20 December 1590. He was an apprentice barber in his village. In 1532 he
moved to Paris, working as a simple barber while increasing his knowledge
of surgery. He was a military surgeon in the French army and to the French
Kings Henri II, François II, Charles IX and Henri III. He introduced the use
of ligatures on arteries (rst-line treatment) to stop bleeding, rejected the
practice of cauterising wounds with boiling oil and promoted the use of ar-
ticial limbs. Without any formal education, he was the rst surgeon to de-
scribe his technical work in his mother tongue rather than in Latin.
In his “Livre Des Monstres et Prodiges” [“Of Monsters and Marvels”],
chapter XI, Paré says:
“Sometimes it also happens by chance that the womb is naturally quite wide,
but if the woman is large, from almost always being seated during pregnan-
cy, and the sewing ladies, as seamstresses often do, or those who work away
at tapestry on their knee, or if the belly is bandaged and too tight, the children
are born bent, hunchbacked and deformed, some with twisted hands and
feet, as you can see in this gure”.
In the margin he wrote: “these children are said to have clubfoot, and club-
hand”. It is accompanied by a plate showing a child with these deformities, with the
following caption: “Figure of a child who was pressed against his mother’s belly, with
his hands and feet twisted”, which we have reproduced below (Fig. 1).
 Vincelet, L. () Ambroise Paré et la religión H istoire des sciences mé dicales, , , -.
Available from: http://www.biusante.parisdescartes.fr/sm/hsm/HSMxxx/
HSMxxx.pdf [consulted //].
 “Or quelquefois aussi il advient par accident que la matrice est asses ample naturellement,
toutefois la femme étant grosse, pour s’être tenue quasi tousseurs assise pendant sa gros-
sesse, et les cu ises, comme volontaires , comme volontiers font les couturières , ou celles qui
besognent en tapi sseries sus leurs génoi s, ou s’être bandée, et trop ser ré le ventre, les enfants
naissent courbé, bossus, et contrefaits, aucuns ainsi les mans et les pieds tortus, comme
tu vois par ceste gure” Paré, Ambroise Les Oeuvres d’Ambroise Paré. Quatriesme Edition.
Paris: Gabr iel Buon, Avec privi lege du Roy (), . Available from: htt p://www.biu-
sante.parisdescartes.fr/livanc/?cote=&do=chapitre [consulted //].
26
Fig. 1: Original drawing published by Ambroise Paré.
In 1575, Ambroise Paré dedicated a chapter in his
work to varus and valgus feet, making a distinction
between the two manifestations. We have two interpre-
tations. In the 1840 edition, of J.-F. Malgaigne, we read:
“It seemed to me a good idea to state that the condi-
tion is called varus in Latin, that is to say, when the
foot is turned inwards… In contrast, when the foot is
turned outwards in the patient who has this condi-
tion, it is called valgus”.
However, in the edition of 1585, it says:
“It seemed to me a good idea to describe a condition, in which the patient
is said in Latin to be aicted with Varus, or Valgus, that is to say, when
the foot is turned outwards, the ancients called it Varus… When the foot is
turned inwards, the patient is said to have Valgus”.
Yet, in both editions, he wrote: “… and both conditions are popularly called
clubfoot: and this does not only refer to the feet, but also to the knees.
He sets out two causes for this malformation: on the one hand, during
pregnancy with the child, and on the other, during nursing. He says:
“… and this condition sometimes arises in the belly of the woman: during her
pregnancy she sometimes sits too long with her legs crossed. Or from the poor
attitude of the wet nurse towards the child, from not holding the child cor-
rectly or from having pressed and turned the foot out of its natural shape”.
 Ibid.,  (taken from Paré, Ambroise).
 “Il m’a semblé bon d’escrire selon la disposition est nommé en latin varus, à savoir, quand
le pied est tourné vers le dedans… Au contraire, quand le pied est tourné vers la partie
extérieure, on nomme le patient qui a tel vice, valgus” Malgaigne, J.-F. Oeuvres complètes
d’Ambroise Paré, volume II (París: Chez J.-B. Baillière, -), -. Available from:
books.google.es/books?id=WOESAAAAYAAJ [consulted //].
 “Il m’a semblé bon d’escrire un v ice, dont le patient selon la disposit ion est nommé en lat in
Varus, ou Valgus, à savoir, quand le pied est tourné vers le dehors, les anciens ont appelé le
malade Varus… Or quand le pied est tourné vers la partie intérieure, on nomme le patient
qui a tel vice, Valgus” Paré, op. ci t., .
 “… et l’un et l’autre vice est nommé du vulgaire pied-bot: et n’advient pas seulement au
pied, mais aux genouillés pa reillement” Malgaigne, op. cit., ; Paré, Ambroise op.cit., .
 “… et ce vice vient quelquefois du ventre de la mère: laquelle pendant sa grossesse s’est
tenue trop longuement as sise les jambes croisé es. Ou pour la mauvais e gure qu’aura tenue
la nourrice envers l’enfant, pour ne l’avoir tenu bien droit, ou pour avoir pressé et tour né le
pied contre sa gures naturelle” Malgaigne, op. c it., ; Paré, Ambroise op.cit., .
27
His treatment was to reduce the deformity; if it was varus, to try to turn it
into valgus, and vice versa. He writes:
“To cure these conditions, and reduce the bones in situ, one must push them
into their natural position. And it is important to note here that if the pa-
tient’s condition is Varus, the foot must be pushed, and held as if one wished
to make it Valgus. On the other hand, if it is Valgus, one must push it as
if one wanted to make it Varus; and they must be held for a considerable
length of time, in order for the bones to remain in their rightful position”.
For this condition, bandages and compresses would be applied and le-
ather boots used, split at the front and under the foot, and they would be
attached comfortably and a “remedy” applied. Paré wrote:
“Because they have to be pushed more, and held in place by bandages and
compresses applied to the problem area, and by suitable small boots, which
should be of the thickness of a teston coin, made of boiled leather and with a
split at the front and underneath the foot, so that they open better when put-
ting the foot in, and tied and attached comfortably; and when this remedy
applied, it is excellent in such cases (see Fig. 2)”.
Fig. 2: Original text of the paragraph published in
Les Oeuvres d’Ambroise Paré.
He also says that turpentine can be added so that it does not dry out too
soon. He recommends that the child with valgus or varus should not be made
to walk under any circumstances until the joints are fully set. However, he
 “Pour remédier à tels vices, et réduire les os en leur lieu, il les faut poulser en leur situa-
tion naturelle. Et faut ici noter, que si la malade est Varus, il faut pulser le pied, et le te-
nir comme si on le vouloir rendre Valgus. Au contraire, s’il est toit Valgus, le faut pulser
comme si on le vouloit rendre Varus: et les y faut tenir assez long temps, à n que les os
puissent demeurer en leur deüe situation” Malgaigne, op. cit. ; Paré, Ambroise op.cit.,
.
 “Parquoi il faut d’avantage les poulser, et les y faut tenir tant par bandages et compresses
appliquées au lieu vers lequel tend le vice, et aussi par petites bottines propres à ce faire,
lesquelles seront de l’espesseur d’un testons, faites de cuir boui lly, et fendues par le devant
et soubs le pied, à n qu’elles s’ouvrent mieux pour y mettre le pied, et seront liees et at-
tachees commodément: et y sera appl iqué ce remède, qui en tal cas est excellent (ver g. )”
Paré, Ambroise op.cit., .
 See the original text: “Il faut ici noter qu’on ne doit aucunement faire cheminer les enfants
Varos, et Valgos, que premierement les jointures ne foient bien aermies, de peur qu’ils ne
se luxent de rechef”, Paré, op.cit., .
28
makes clear that some children are born with twisted feet,
a condition popularly called clubfoot, and for these he says
the same remedy should be applied as for those with varus
or valgus, and the boots he mentions used. He says:
“There are also children born with twisted feet, popular-
ly known as clubfoot: they are to be treated as those with
varus or valgus: apply compresses gently, and place boots
made of boiled leather (just as one handles casings for
vessels of gold or silver) in order to keep the feet straight: as in the gure”.
Fig. 3: Original drawing of Paré’s boot.
B   F A  F
It was the Italian-born doctor Juan Bautista Juanini (Giovanni Battista
Giovannini) who, in the middle of the seventeenth century, undertook a re-
appraisal of this surgeon from Fregenal, considering him to be the nest in
Europe in his day:
“… many Spaniards of great learning and universal acclaim have written…,
it was surprising to observe that this Court was not aware of the book written
by Francisco Arceo, a native of Fregenal de la Sierra in Extremadura, enti-
tled Francisci Arcaei, de recta curandorum Vulnerum ratione. He was
the nest Spanish author practising and writing about surgery in the opinion
of all of Europe, and as Father Arias Montano proclaimed in the Preface
with these words: “Francisci Arcaei, Doctoris Medici Hispani, in omni Artis
huius parte dexteritatem, ac felicitatem admirabilem, sed in Chirurgiae
praeci…, atque usu obtupendam quandam praestantiam”. His work con-
tains dierent remedies, or recipes invented and used by him, including one
called balsam, which, in the north is used as an alternative remedy for head
wounds… and among the remedies for stula with which he treated the King
of France… He nally won appreciation and esteem in far o countries, yet
was forgotten, through lack of curiosity, by the Surgeons of his own land”.
 “Pareillement il y a des enfants qui naissent les pieds tortus, appelez vulgairement pieds
bots: ils seront reduits comme les Varus et Valgus, puis liez commodémente avec com-
presses, et posez en petites botines faites de cuir boüilli (comme lon fait estuits à mettre
vaisselles d’or ou d’argent) à n de bien tenir les pieds droits: dont tu as ici la gure”. Ibid.
 Taken from Paré, op.cit., .
 “Y en prueba de lo poco que se aplican algunos a esto, sin hacerles argumentos con Au-
tores Estrangeros, porque hay muchos españoles que han escrito con gran magisterio, y
universal estimación, que omitiendo el nombrar muchos, por no dilatar el Discurso, ha
extrañado el haber visto, no se conoce en esta Corte el libro que escribió Francisco Arzeo,
29
We are not directly aware of any document that refers to our author
regarding the Spanish element of his name, as he does not appear in the
Fregenal sacramental record books of that time. Therefore we decided on
the Latinism “Arceo”. We also considered the possibility that Arcaeus was
the Latinised form of the surname Arcos, present in the Fregenal personal
name and in particular in the family of Arias Montano. From now on we
will call him Francisco Arceo de Fregenal, which we believe to be the most
accurate translation of the name that the author used for himself at the top
of his work.
He must have been born in Fregenal de la Sierra, if we consider this ad-
jectivised place name as it appears on the cover of his work De recta curan-
dorum..., which reads: Francisco Arcaeo Fraxinalensi. In a passage from this
book he refers to Arias Montano as our, i.e. to a “man from my own town”.
There is a unanimous agreement that he was born in the year 1493:
“Francisco Arceo is alive and still with us, about to turn eighty, and he prac-
tises both areas of medicine with the same skill that he possessed before he
reached the age of forty”.
natural de Fregenal de la Sierra en Estremadura, cuyo título es Francisci Arcaei, de recta
curandorum Vulnerum ratione. Este es el mejor Autor Español que ha practicado y escri-
to la Cirugía, como lo conesa toda Europa, y lo proclamó el Padre Arias Montano en la
Prefación del mismo donde dize estas palabras: Francisci Arcaei, Doctoris Medici Hispa-
ni, in omni Artis huius parte dexteritatem, ac felicitatem admirabilem, sed in Chirurgiae
praeci…, atque usu obtupendam quandam praestantiam. Contiene su obra diferentes re-
medios, o recetas que inventó y practicó por su mano y entre ellas, una que llama Bálsamo,
con el qual, en la parte del Nor te no usan de otro remedio par a curar las heridas de Cab eça
(y el Suplicante lo ha puesto en esta Corte en la Botica de Gabriel Manchini) y entre los
remedios con que se c uró la stula el Rey de Fra ncia, después de manifest ada, fue el princi-
pal este Ba lsamo, como lo dixo el Cirujano que obró esta cura. Finalmente él se mereció el
aplauso, y estimación en los Países remotos, y el olvido, de la poca curiosidad de los Ciru-
janos de su Patria. Parece que por los de aquel tiempo juzgava a algunos de este (aunque ha
mas de cien años que murió” Juanini, J.B. Señor, el Doctor D. Juan bautista Juanini, cirujano
de Camara, que fue de S.A. el Señor D. Juan de Austria… (Madrid, ?), fols., v–. Avai-
lable from: books.google.es/books?id=-q-PzhC [consulted //].
 Oyola Fabián, A. and Cobos Bueno, J. M. Método verdadero de curar las heridas y otros pre-
ceptos de este arte. Método de curar las ebres. Francisco Arceo de Fregenal. Prefacio de Benito
Arias Montano (Huelva: Ser vicio de Publicaciones de la Universidad de Huelva, Bibliothe-
ca Montaniana, ).
 Oyola Fabián, A. El año de nacimiento de Benito Arias Montano el Mayor, IV Jornadas de El
Humanismo Extremeño (Trujillo, Badajoz: ), -.
 “Viuit adhuc hoc tempore Franciscus Arcaeus, anunn agens fere octogesimum eademque
desteritate vtramque Medicinae partem fdacit ac si quadragesimum aetatis nondum ex-
cessisset” Arcaeo, F. De recta curandorum vulnerum ratione et aliis eius artis praeceptis
libri II … Eiusdem De febrium curandarum ratione (Antverpiae, Ex ocina Chistophori
Plantini, ), -. Available from: https://books.google.es/books?id=UGsnioFuGIC
[consulted //].
30
As this is what Arias Montano wrote in 1573, in the prologue to the work
De Recta curandorum..., it lends credibility to the date of birth. Arceo died in
1580.
All the authors who have studied him say that he studied medicine at the
University of Alcalá de Henares and in Guadalupe. The author himself says:
“In the year 1516 in Guadalupe, in my presence, an event occurred as
follows:…”.
This fact means that we can be sure he was already a doctor in 1516, so
he must have started his university course very late, in 1513. This has not
been veried, because the rst document from the University of Alcalá,
which is available, is the “Libro de registro de actos, grados y provisiones”,
which dates from 1523, whereas the rst book of matriculations is from 1548.
Nor does he feature as a member of the college in the works of Gutiérrez
Torrecilla [1995]. What is not in doubt is his academic status: he was a doctor
of medicine, as his work indicates.
He practised medicine in Llerena, where he was called to surrounding
towns to attend to the sick. There he had as a guest the honorary Biblical
scholar Arias Montano, a man from his home town:
“I agreed willingly to this request… especially, because of my great aection
for the messenger [Arceo], who oered me… his home… and promised to
teach me the art of surgery that he practised…”.
Six years before he died he published, in Antwerp (Plantin, 1574), the
work De Recta cvrandorum vvlnervm ratione, et alii eius artis praeceptis libri
II… e Iusdem de febrium curandorum rationes, which was re-edited in Latin
in Amsterdam in 1658: De Recta cvrandorum vvlnervm ratione, et alii eius artis
praeceptis libri II... e Iusdem de febrium curandorum rationes, Amstelodami, Ex
ocina Petri Van de Berge.
The publication by Plantin was no accident, as Arceo was to edit his work
on the insistence of Arias Montano, and it was to coincide with the stay of
the latter in Antwerp, co-ordinating the publication of the Bible Regia, or
Plantin Polyglot.
 “Res Guada lupae me praesente accidit anno a christo nato millesimo quingentesimo deci-
mo sexto. Ea huiusmondi es” Arcaeo, op. cit., .
 Alonso Muñoyerro, L. La facultad de Me dicina en la Universidad de Alcalá de Hen ares. (Ma-
drid: C.S.I.C., ), .
 Ibid., .
 Oyola Fabián and Cobos Bueno, op. c it., .
31
The importance of th is work becomes clear if one considers its rapid dissemi-
nation across Europe. An edition in English published in London is dated 1588:
A most excellent and compediovs method of curing woundes in the head, and
in other partes of the body, with other precepts of the fame Arte, practised and
written by that famous man FRANCISCVS ARCEVS, doctor in Phisicke &
Chirurgery: and translated into English by Iohn Read, Chirurgion... Imprinted
at London by Thomas East, for Thomas Cadaman. log.
It was also published in German in 1600, 1674 and 1717. In 1634 it appeared
in French, in Paris, and in 1667 the rst edition was published in Dutch in
Leeuwarden (Kortbondige, ende rechte middel, en kunst; om allerhande zooten
van wonden op de kortste ende zeekerste manier te geneezen... in’t Latijn besche-
reeven... Met aanteekeni . ngen op een yeder hooftdeel veryijkt ende overgezet door
Jacobus Geusius... Leeuwarden, Yvo Takes Wielsma), and almost simulta-
neously in Roermond. These Dutch editions were so successful that a re-
printing was issued the following year. A re-edition of the work in Latin in
Amsterdam in 1659 is also worthy of note.
The work is in two parts; in the rst, we mainly nd surgical topics and
in the second medical problems. However, the author divided the rst
part into two books: in the rst, consisting of seven chapters, six of these
are devoted to the eects of cranial surgery and the nal one to wounds of
the face. The second book consists of two chapters: the rst eight describe
certain surgical procedures on the chest, abdomen and limbs, and various
types of ulcer, while the remaining four deal with the so-called “French dis-
ease” (syphilis). He devotes an unnumbered chapter – to some authors one
of the most interesting of all – to the study and treatment of children who
are born lame. The two books mentioned were followed by three examples
taken from professional practice, preceded by a short text written by Benito
Arias Montano. The second part, also preceded by a text by Arias Montano,
consists of a substantial “Antidotario” – or list of pharmacological resources
– and ends with eight chapters on febrile processes.
This work can be considered as a collection of medical histories, corre-
sponding to his own professional practice, brilliantly displaying a style typi-
cal of the Renaissance medical “observatio”. It is not an academic text, but it
 Sánchez G.-Mora, Ar turo; Revuelta Ram írez, Juan ‘Histor ia del Monasterio de Gua dalupe
y de su Escuela de Medicina (Trabajos de la Cátedra de Historia Crítica de la Medicina,
), III, -; Riera, J . ‘La obra de Francisc o Arceo’, Cuade rnos de Histor ia de la Medici-
na,  (), -; Moulin, Daniel de A history of surgery, with emphasis on the Netherlands,
(Dordrecht, Boston and Lancaster: Martinus Nijho, ).
32
is the product and testimony of his long experience in the practice of surgery,
which makes it special. Francisco Arceo almost always names each of the
patients that he treats, “his accounts are clear, objective and precise: in them,
he only tells us what the doctor has been able to observe”. In addition to
the patient’s name, he gives the place where he or she was treated, the in-
juries suered, the length of the surgical or medical procedure and, nally,
the result obtained after therapeutic intervention. It is an almost universal
opinion of the authors who have studied the work of Arceo that the rst part
of this work is the most important and the most original.
T       
As mentioned above, Arceo devoted an unnumbered section to the case
of a child born with a deformity that we would nowadays call clubfoot.
The author tells us how it frequently occurs that a child is born with one
or both feet twisted, curved or deformed, in such a way that they very easily
fall over. He says:
“It sometimes happens that a child is born with one or both feet twisted,
curved or at, so that the child can hardly walk properly. So I want to de-
scribe a method that I have used to treat many very lame people, one of
whom was a neighbour in Llerena who was dicult to treat, yet who nally
regained his health by way of the method that I shall explain”.
It begins with a preparation:
“First, the child must follow a strictly controlled diet and bathe his feet gently
by hand for thirty days using the following concoction:
R/ One pound of mallow root; fenugreek seed and linseed, four ounces of
each; one bunch of chamomile owers, and another of melilot; the head and
 Granjel, L. S. Cirugía Española del Renacimiento (Salamanca: Ediciones del Seminario de
Historia de la Medicina Española, ) .
 “sus relatos son cl aros, objetivos y precisos; solamente se nos dice en ellos lo que el médico
ha podido observar” Riera, op. c it., .
 Arcaeo, op. cit., -.
 “Saepe accidit vt i nfans nascatu r aut altero aut vtroque pe de distorto aut incur vo aut repan-
do ita vt aegr e admodu[m] possit incedere eaq[ue] de causa hoc loco volui met hodum tradere
qua plurimos valde claudos liberaui, inter quos exstitit vnus curatu dicillimus Llerenae
incola sed tame[n] dice[n]da industria tandem sanitati fuit restitutus” Arcaeo, F. De recta
curandorum vulnerum ratione et aliis eius artis praeceptis libri II … Eiusdem De febrium
curandarum ratione (Antverpiae, Ex ocina Chistophori Plantini, ), . Available
from: https://books.google.es/books?id=UGsnioFuGIC [consulted //].
33
legs of a wether with its eece and hide, slightly crushed. Boil all in sucient
water until the bones fall apart”.
This mixture is taken from Giovanni da Vigo. This author writes, in
Book eight, Chapter viii, “of the medicines that ease any hardening of the
nerves and hard abscesses and poorly restored fractures of the bones and
joi nts”:
“The softening bath for any hardness of the above materials is composed
as follows: Take the crushed head of a ram and its legs and some roots of
marshmallow, two pounds of each; chamomile: king’s clover [or melilot] and
dill, two handfuls of each; fenugreek and linseed, half a pound of each. Boil
all together in sucient water until the meat falls away from the bones, and
afterwards bathe and wash the hardened limb with this broth…”.
Arceo continued:
After doing this for thirty days, the helper sits down and places the child on
his knees, with his hands and knees tied or holding his hands; next, the sur-
geon acts by dislocating the lame foot with all his strength and attempting to
place it in its correct position and at the desired aspect, which must be done
quickly, both in the preparation beforehand and because of the tender age of
the child himself. Once this procedure is done, the entire joint is immediately
covered in a piece of ne linen, previously steeped in warm myrtle oil and
tautly, to remove any wrinkles, so that the tie does not cause any pain; he
then place upon it bandages impregnated with the following liniment:
R/ The whites of three eggs, oil from green olives and myrtle oil, an ounce and
a half of each; wheat our and barley, two drachms of each; an ounce and a
half of ground Armenian bole; three drachms of snake’s blood; an ounce and
 “Imprimis ergo vtatur puer debita victus institutione lauenturque pedes per triginta dies
blanda ma nu cu[m] subiuncta decoct ione: R/ Radicum althe ae libram vnam; s eminis foeni
graeci, seminis lini ana vnc. iiij; orum chamaemeli et meliloti ana man. j; caput et pedes
veruecis vna cum lana et cute aliquantulum contusi. Deinde bulliant in aqua sucienti
ad separationem ossium” (Arcaeo, F. De recta curandorum vulnerum ratione et aliis eius artis
praeceptis libri II … Eiusdem De febrium curandarum ratione (Antverpiae, Ex ocina Chis-
tophori Plantini, ), . Available from: https://books.google.es/books?id=UGsnio-
FuGIC [c onsu lted //].
 “Balneum mollicaris vnuanquan quez duriciem de pronominatis c t: R/ caput vnius
castrati aliquantulum incisum et pedens eins: radicum alice, lib. ij. camomille mellilosi
aneti ana ij lib. fenugresi integri et seminis lini ana lib. .. oia bulliant simul cum aqua
sucientti usquez ad euz a carne separationez deindes remosis ossibus a carne mem-
brun induratuz balneeten et sussumigeten et cum residuo rerum lauando membrum fri-
cetur” Vigo, Giovanni. Practica in Chirurgia (Rome: E. Guillery and E. Nanni, ), fol.,
clxxxiiv. Available from: https://books.google.es/books?id=qK-AFcLae-C [consulted
//].
34
a half of the powder that we will describe imminently, and which it would be
best to have prepared for the whole treatment process. Mix all together. The
powder consists of the following:
R/ An ounce and a half of Armenian bole, tragacanth and snake’s blood,
four drachms of each; barley our and broad bean our, a drachm and a
half of each. This is made into a very ne powder.
These bandages, already moistened in the aforementioned linen, are mois-
tened again with rose water and vinegar, and are stretched tightly over the af-
fected area at a moderate temperature. Then a wooden sole must be placed
upon the sole of the foot, carefully measured to match the size of the foot
and a little larger than the insole that is to be placed upon it. A band meas-
uring three inches wide must be attached to it, but one must try to pull the
foot in the other direction, starting with the inside of the foot with just a few
attempts. Again, on the bandages, tied as described previously, three splints
must be used which will not bend easily in any part, made of willow, ve
inches long and about a thumb’s width across. When they are stued full
of the linen, they should be moistened again, like the bandages, with vinegar
and water: the rst one should be placed on the rear part, so that it can be
seen that it has been inserted into the wooden sole; and the other two, from
the sides, on which all the ties have to be made, neither too loose or too tightly,
in the manner indicated”.
 “His vero per triginta dies confectis, sedeat minister ac recipiat puerum super genua
manibus ac cruribus reuinctis aut manibus prehensis. Deinde accedens chirurgus, pedem
claudum primum luxet magna vi nitaturque reponere in debitum locum et guram op-
tatam, quod et promptissime tum ob praegressam praeparatione[m], tu[m] praeterea ob
ipsius pueri tenerrimam aetatem. Facta repositione mox apponatur linteum tenue oleo
myrthino madens calenti super totum articulum absque rugis ne dolore fatiget deligatio;
deinde vero desuper ponantur splenia in sequenti linimento intincta et debite expressa:
R/ Trium ouorum album ina; olei omphacini, myr thini ana vnc . j [et] dim.; poll iniss tritice-
ae farinae et hordeaceae ana dr. iij; pulveris statim describendi, quem decet esse praepara-
tum pro tota curatione, vnc. dim. Misce. Ex his autem constar puluis:
R/ Boli armenii vnc. j dim; thuris, mastichis, sarcocollae a na dr. ij [et] dim.; myrrhae, aloes
ana dr. j [et] dim; tragacanthi, sanguinis draconís ana dr. iiij; farinae hordei fabarum ana
dim. Fiat puluis subtilis.
Haec itaque splenia in d icto linteo madentia mad eant iterum in aqua rosac ea et aceto atque
expressa super particulam extendantur mediocri calore; mox plantae pedis adhibe[n]da
est solea lignea, compar quidem ac paulo maior quam culcitra desuper posita. Deliganda
est fascia trium digitorum latitudine, quamquam in co[n]trariam partem trahere contend-
at pede[m], ab interiori parte exorsa paucis admodum circumuolutionibus. Rursum super
splenia, dicto modo deligata, adhibendae sunt tres ferulae, quae neutiquam facile ectan-
tur ex salice concinnatae quinque digitorum longitudine, vnius vero pollicis latitudine
extentae” Arcaeo, F. De recta curandorum vulnerum ratione et aliis eius artis praeceptis
libri II … Eiusdem De febrium curandarum ratione (Antverpiae: Ex ocina Chistophori
35
While on the other foot:
“On the following day the other foot is treated in the same way for seven days,
with a period of waiting afterwards without doing anything. After this, one
or the other foot must be treated, if either of the feet is lame, as follows:
R/ Two and a half ounces of turpentine; two ounces of myrtle oil; one of rose
oil; frankincense and mastic, a drachm and a half of each; myrrh and aloes,
two drachms of each; snake’s blood and Armenian bole, half an ounce of
each; ne our and the red powder described previously, an ounce and a half
of each. Mix all together, and apply, warm, to the bandages, with the splints
and ties, as described”.
Later he continues by indicating the length of treatment and describing
an “instrument”. We have transcribed the relevant section here as follows:
After this, the medication must be repeated every seven days until the twen-
ty-rst day from the rst week. The treatment must be performed with the
utmost care, so that the feet remain completely straight, after constructing
the following instrument together with the boots:
Take a piece of sheet iron measuring an inch wide, of the thickness of a silver
tremis coin and of the same length as the child’s foot, more or less. This is
to be folded over in the shape of a heel and adjusted to t the shoe, to which
two more sheets are sewn on either side of the ankles, six inches wide, and a
similar third one in the rear part. Then these three long pieces, which go up
the leg itself, t around the leg at the top, in such a way that the front part
is open and the back is closed, keeping the whole apparatus rm. The other
two, from both sides of the heel, must be turned towards the other two lateral
pieces. Upon this iron ankle must be placed the shoe for the lame foot, which
should be made of goatskin on the outside and of sheepskin on the inside,
with a double sole, but in such a way that the heel can stay in between the
two types of leather and the head of the shoe should reach up to the upper
circular part. It should be noted that the shoe should be open at the front and
Plantini, ), -. Available from: https://books.google.es/books?id=UGsnio-
FuGIC [consulted //].
 Altero autem die medeberis pedi alteri eadem methodo vsque ad septimum diem subi-
ende praestolat us ne quidquam aliud molit us. Quo transac to sequenti ratione aut alter pes
aut ambo, si vtroque claudicauerit, sunt curandi:
R/ Terebinthinae vnc. ij [et] dim.; olei myrthini vnc. ij; rosati vnc. j; thuris, masticis [ana]
dr. j [et] dim. myrrhae, aloës, ana dr. ij; sanguinis draconis, boli armeni ana der. j; pollinis
et pulueris rubei antea descripti ana vnc. j. Misce et applicetur tepidum in spleniis, cum
ferulis et ligaturis, vt dict um est” Arcaeo, op. cit. , .
36
where it touches the instep, and it must be attached with an appropriate cord
for this purpose”.
Francisco de Arceo marks the treatment stages precisely and rigorously.
He continues:
“Therefore, before putting th e shoes on the feet, the easing plaste r of Giovanni
da Vigo is placed all over the joint, so that the inammation and humours
produced within the joint are got rid of and the joint itself is rmer. Once the
shoes are on the feet over the plaster, the patient must not remove the shoes
for any reason, for up to four days, then on the fourth day the plaster must be
cleaned and softened. And if it has disintegrated in the meantime, apply it
anew. The patient will now be able to walk in this way, for six months; after
this time, once the plaster has been removed, he should not stop wearing the
shoes described. Moreover, for a further six months the shoes must be worn
day and night, apart from when he is bathing.
He ends the therapeutic protocol with a detailed description of how to
make the pharmaceutical preparation used.
 “Deinceps vero repetenda est ista medicatio septenis quibusq[ue] diebus vsque ad esimum
primum diem a prima septimana curandumque est summopere quem modu[m] pedes recti
prorsus maneant sequenti machinamento cum calceis istructo:
Cape laminam ferream vnius digiti longitudinis, crassitudinis trientis argentei, longitudi-
nis pedalis ipsius pueri paulo minus. Hanc ectes instar calcaris calciq[ue] adaptabis, cui
ex vtroq ue latere qua malleol li insunt duas al ias laminas as sues longitudine sex di gitorum,
tertiam consimilem in parte posteriori. Has deinde tres longas et quae sursum per crus
ipsum ascendunt, cinges circulari alia parte summa ita tamen vt parte anteriori aperta sit,
posteriori vero clausa ac totum machinamentum sit rmum. Aliae duae ex vtroque latere
calcar is dirigendae sunt in dua s illas laterales; s uper hoc calcar ferreum s trui debet calceus
pro pede claudo, ex pelle hircina exterius et ruina interius, duplice solea, ita tamen vt cal-
car inter vtramque pellem intersit et ad circularem illam laminam calcei collum attingat.
Vnde co[n]stat calceum apertum esse debere parte anteriori et qua pedis pectini insidet
ligandum esse ligamento ad eam rem conueniente” Arcaeo, op. cit., -.
 “Ergo antequam calcentur pedes, substituatur emplastrum Ioannis de Vigo co[n]forta-
tiuum super vniuersum articulum, quo tumores atque humores intra articulum adhaer-
entes dissoluantur et ipse articulus rmior reddatur. Facta deinde calceatione super em-
plastrum, neutiquam discalceabitur aeger nisi quarto quoq[ue] die in quo mundari debet
emplastrum atque mollicari. Quod si illud interea te[m]poris dissolutum fuerit, denuo
admoueatur aliud poter itq[ue] aeger ea ratione iam incedere, donec sex menses tra nsierint
quibus etiam transactis emplastroq[ue] tum amoto no[n] proinde relinquendi sunt calcei
iam dicti, imo vero per alios sex menses noctu atque diu calceatus degat excepto tempore
illo in quo lauari placeat” (Arcaeo, F. De recta curandorum vulnerum ratione et aliis eius artis
praeceptis libri II … Eiusdem De febrium curandarum ratione (Antverpiae, Ex ocina Chisto-
phori Planti ni, ), -. Ava ilable from: https://books.google.es/books?id=UGsnio-
FuGIC [consulted //].
37
As follows:
Description of the easing plaster:
R/ Using myrtle oil, rose oil and oil from green olives, take half a pound of
each; two pounds of the juice of mallow roots. Of ash leaves and roots, leaves
and roots of lesser comfrey, of myrtle and its leaves, and of willow leaves,
take two handfuls of each. Boil all together, after mashing the mixture a
little, in an equal quantity of red wine and of water until it is reduced to
half the amount, with half a drachm each of myrrh and frankincense. Next,
strain it and add half a pound of liqueed goat fat, two ounces of turpen-
tine and a drachm of mastic. Boil all together once more until fully cooked.
Finally, strain, and add three ounc-
es of litharge, of gold and of silver;
two ounces of very nely ground
Armenian bole, and of terra sigil-
lata, and ten drachms of minium.
Cook all together on a low heat,
stirring continuously with a spat-
ula, and make a paste, by adding
wax”.
The section is accompanied by a
plate showing the “instrument” descri-
bed (see g. 4).
Fig. 4: Plate showing the prosthesis
invented by Arceo.
 “Emplastri confortatiui descriptio: R/ Olei myrthini, rosati, omphacini ana lib. ij; succi
radicum altheae lib ij; radicis fraxini et foliorum, radicis symphyti minoris et foliorum,
myrthi et foliorum eius, folior um salicis ana m. ij. Bul liant omnia prius a liquantulum con-
tusa in vini nigri et aquae pari mensura ad medietatis co[n]sumptionem, cum myrrhae et
thuris ana dr. dim. Deinde in colatura addas seui hircini liquifacti lib. dim, terebinthinae
vnc. ij; masticis dr. j. Bulliant iterum simul ad consumptionem decoctionis postremoq[ue]
in colatura adde lithargyrii, aurei et argentei a na vnc. iij; boli armeni i triti subtiliter, terrae
sigillatae ana vnc. ij; minii dr. x. coquanturq[ue] simul lento igne et agitatione perpetua
cum spatha atque cerotum, addita cera” Arcaeo, F. De recta curandorum vulnerum ra-
tione et aliis eius artis praeceptis libri II … Eiusdem De febrium curandarum ratione (Ant-
verpiae, Ex ocina Chistophori Plantini, ), . Available from: https://books.goog-
le.es/books?id=UGsnioFuGIC [consulted //].
 Taken from Arcaeo, F. De recta curandorum vulnerum ratione et aliis eius artis praeceptis libri
II … Eiusdem De febrium curandarum ratione (Antverpiae, Ex ocina Chistophori Planti-
ni, ). Available from: https://books.google.es/books?id=UGsnioFuGIC [consulted
//].
38
P  B H  A
Bartolomé Hidalgo de Agüero was born in 1531 in Seville, where, in addi-
tion to studying medicine he practised it as a profession, largely as a surgeon
at the Hospital del Cardenal. He died in the city in 1597. Seven years after
his death, in 1604, his son-in-law, the Sevillian doctor Francisco Ximenez
Guillen, published his work Thesoro de la Verdadera Cirugia y vía Particular
contra la Comun, including Avisos de particulares de syrurgia contra la comun
opinion, a sheet printed in two column, with no date or place of publication,
although it is known that this occurred in Seville in 1584.
In his work, Thesoro de la Verdadera Cirugia y vía Particular contra la
Comun, sect ion one, chapter 76, “On the twis ted foot, or clubfoot from birth”,
Hidalgo de Agüero deals with the problem of this deformity. In this section
we found that its author clearly plagiarises Arceo’s treatment for clubfoot.
To demonstrate this, one only has to transcribe some of the paragraphs from
the text of Arceo and that of Hidalgo de Agüero and compare them, as
can be seen in Tables 1 and 2.
Table 1. Chart to compare a fragment of the work of Arceo and of Hidalgo
de Agüero.
Arceo Hidalgo De Agüero
It sometimes happens that a child
is born with one or both feet twisted,
curved or at, so that the child can
hardly walk properly. So I want to
describe a method that I have used to
treat many very lame people, of whom
one was a neighbour in Llerena who
was dicult to treat, yet who nal-
ly regained his health by way of the
method that I shall explain
It happens often that a child is
born with one foot, or both, twisted,
or with clubfoot, such that he can
barely and only with diculty walk
on them, because they are twist-
ed, so it seemed to me it would be
a good thing to devise a method to
treat them, not only because of the
great clumsiness in walking, but
also because of the unsightliness
that it causes
 Arcaeo, F. De recta curandorum vulnerum ratione et aliis eius artis praeceptis libri II …
Eiusdem De febrium curandarum ratione (Antverpiae, Ex ocina Chistophori Plantini,
), -. Available from: https://books.google.es/books?id=UGsnioFuGIC [con-
sulted //].
 Hidalgo de Agüero, B. Thesoro de la verdadera Cirugia y vía particular contra la común (Se-
villa: F. Pérez, ), fols., v–v. Available from: books.google.es/books?id=QxQD-
gOD_mkC [consulted //].
39
Table 2. The treatment to be followed: another comparative test illustrating
the plagiarism by Bartolomé de Hidalgo Agüero.
Arceo Hidalgo De Agüero
First, the child must follow a strictly
controlled diet and bathe his feet for
thirty days gently by hand with the
following concoction:
R/ One pound of mallow root; fenu-
greek seed and linseed, four ounces of
each; one bunch of chamomile owers,
and another of melilot; the head and
legs of a wether with its eece and hide,
slightly crushed. Boil all in sucient
water until the bones fall apart.
and to this end, this embrocation or
wash should be used for twenty or thirty
days:
R/ One pound of mallow roots, fen-
ugreek seed and linseed, four ounces of
each; one handful each of chamomile
owers and melilot owers; the head
and feet of a ram together with its eece
and hide, all somewhat crushed and
then cook all in water, until the bones
fall apart.
T    
 A  
Francisco de Arceo developed his profession at a very favourable time,
since the Renaissance facilitated the appreciation of great experts and uni-
versities that were open to new methods. He was recognised as a prestig-
ious surgeon throughout Europe among his contemporaries, as was noted by
Juanini in the seventeenth century. In this regard, it is interesting to note a
remedy that he invented, known as Bálsamo de Arceo, or Arceo’s balm, the
fame of which as an excellent antiseptic and wound healer, gradually spread
across Europe. Indeed, many patients from various places in Europe visited
Llerena to restore their health using Arceo’s methods. There is an evidence
that it was used very successfully by the physician to Queen Elizabeth I of
England, Roderigo Lopes (Portugal c. 1525 Tyburn 1594), to treat serious gun-
shot wounds. Although some authors did not lend much support to this
remedy, the fact is that further studies have conrmed that it was included
until the twentieth century in various pharmacopoeia and other documents
 Oyola Fabián and Cobos Bueno, op. cit.
 Kottek S. ‘Doctor Roderigo Lopes - Some Items of Medico-Historical Interest’, Medical
History,  (), -.
 Griths, Adrian ‘Dr. Rodrigo Lopez’, Saint Bartholomew’s Hospital Journal,  (),
-.
40
such as the Spanish Military Pharmacy Formulary of 1975. Although it has
now fallen into disuse, the survival of this remedy over such a long time is
testimony to its therapeutic ecacy, which would certainly merit ethnophar-
macological validation prior to potential application in the pharmaceutical
industry. Clearly, the eectiveness of the methods and remedies used in the
treatment of diseases is critical in the transmission of therapeutic practices,
although historical context and the evolution of scientic knowledge must
be taken into account. In the case of Arceo’s balm, its use spread at a time
when economic development was driven by the spice trade, and the exist-
ence of organisations that promoted the spread of plant-based remedies and
medicines, such as the Jewish families that had a monopoly on raw materials
arriving from the Americas; a time when there was also a signicant scientif-
ic exchange in medicinal plants.
The ecacy of Arceo’s methods can also be seen in the description of two
cases of aphasia and its treatment, recently published in the international
literature. Unlike the use of the balm, the surgery involved in treating these
episodes of speech loss as a result of brain injury did not last over time.
Another critical factor for professional dissemination to be successful
would be the existence of scientic debates about these tools or resources
to deal with the illness. So, we can see that Arceo, like Paré, would not, as a
surgeon, have been motivated to discuss the signs, symptoms and causes of
an illness or disease. In the cited example on aphasia, without any debate on
the causes and subject to paradigm shifts, the conceptual evolution of this
 Formulario español de farmacia militar, ª ed. Vol II (reimpresión), (Madrid, ) ; Co-
bos Bueno, J. M., Oyola Fabián, A. and García Ávila, J.F. ‘El Bálsamo de Francisco Arceo
de Fregenal’, Llull, ,  (), -.
 Heinrich, M., Kufer, J., Leonti, M., Pardo-de-Santayana, M. ‘Ethnobotany and ethnophar-
macology – Interdisciplinary links with the historical sciences Journal of Ethnopharma-
cology’,  (), -; Pardo de Santayana, M., Quave C.L., Soukand R., Pieroni P.
Medical Ethnobotany and Ethnopharmacology of Europe, in Michael Heinrich, Anna K. Jäger
(ed s.), Ethnopharmacology (Wiley, ), -.
 Barona, J. L. ‘Clusius’ exchange of botanical information with Spanish scholars’, in Eg-
mond, F.; Hoftizer, P.; Visser, R. (eds.), Carolus Clusius, Towards a Cultural History of a Re-
naissance Naturalist (Amsterdam, Koninklijke Nederlandse Academie van Wetenschap-
pen, ), -; Pardo Tomás, J. Two glimpses of America from a distance: Carolus Clusius
and Nicolás M onardes, in Egmond, F., Hofti zer, P.; Visser, R. (eds .), Carolu s Clusius, Towards
a Cultural Histo ry of a Renaissance Naturalist (Amsterd am, Koninklijke Nederl andse Acad-
emie van Wetenschappen, ), -; Pardo-Tomás, J. East Indies, West Indies: Garcia
de Orta an d the Spanish Treatise s on Exotic Materia Medica, in Palmira Fontes da Costa (ed.),
Medicine, Trade and Empire: Garcia de Orta’s Colloquies on the Simples and Drugs of India in
Context (Farnham: Ashgate, ), -.
 Muñoz-Sanz, García-Ávila and Vallejo, op. cit.
 Ibid.
41
speech disorder would prevent both the dissemination and any subsequent
medical historiographical analysis.
We should also consider the existing disputes between those who dis-
seminated their knowledge in Spanish and those who did so in Latin, and
bear in mind that Arceo was a surgeon, as was Paré although he had no
university education, and Hidalgo was a doctor. The attitude of preserving
elitist knowledge as against a concern to promote the training of profession-
als who did not understand Latin, can also be observed in the case of other
surgeons, such as Dionisio Daza Chacón. Consider, too, that the work De
recta curandorum… is written in exquisite Latin that would seem, rather, to
have been written by someone of exceptional stature; this fact has led to the
hypothesis that it was written by Arceo’s great friend, the humanist Arias
Montano. However, in comparing the spread of the practices and writings
of these authors, we nd that independence exists between the dissemina-
tion of knowledge and professional status.
Nevertheless, the method of using herbal medicine, and using splints and
boots designed by Arceo, made an important contribution to the correction
of clubfoot. It was a very practical innovation, which an eclectic professional
such as Hidalgo de Agüero – a doctor who performed surgical operations
– claimed as his own, plagiarised and disseminated knowledge of it through-
out Spain. However, both the work of Arceo and that of his plagiarist took
place under historical, economic and political circumstances from which
there was no follow-up. In fact, Hidalgo de Agüero’s plagiarism suggests a
narcissistic personality, a desire to play the leading role, and individualism.
Moreover, Hidalgo does not generate any discussion about the deformity or
any methods for correcting clubfoot; he simply copies. This context, and the
lack of any continuing education based on the study by Spanish surgeons
meant that Arceo’s invention was to remain forgotten in his own country.
So, why did it not nd success in Europe where the surgeon enjoyed prestige
and renown? Conversely, why did the works and methods used by Paré gain
acceptance? To answer this question we can look at the way of life, beliefs,
personality and capacity for leadership of them both, but particularly at their
attitude towards a professional discussion aimed at improving practice. On
the one hand, the French surgeon has been described as a man with a big
 Conde Parrado, Pedro. ‘ Por el orden de Celso: aspectos de la inuencia del De medicina en
la cirugía europea del Renacimiento’, Dynamis [online],  (), -. Available from:
<http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S-&l-
ng=es&nrm=iso> [consulted //].
 Oyola Fabián and Cobos Bueno, op. cit.
42
personality, with a very independent mind, and with political skills. A lot
of information exists about the life of Ambroise Paré, which shows that he
argued with much common sense and simplicity, that he spoke in favour of
new methods, and criticised those with whom he did not agree. Certainly,
many of Paré’s characteristics are very relevant to our discussion: pragma-
tism and a talent for debate, together with leadership concerning his prac-
tice. So, at this point, what do we know about the personality of Francisco de
Arceo, also curiously known as the Ambroise Paré of Spain? Well, until now,
merely deductions based on his works and the prologue written by his good
friend Benito Arias Montano. However, he learned medicine in Guadalupe
and practised it in Llerena as a doctor to the Inquisition and the Council. In
2009, Oyola suggested that he was a Jewish convert, in addition to other hy-
potheses regarding his origin as a native of Fregenal rather than of Llerena,
and whether Arcos was his actual surname. Fortu nately, the next publication
of documents obtained by Rafael Caso, chronicler of Fregenal de la Sierra,
was to conrm these hypotheses (pers. comm. A. Oyola Fabian). It is obvious
that in sixteenth century Spain, a Jewish convert would be concerned above
all to play a discreet role in society and to erase any traces of his past because
of the need for approval under the statutes of purity of blood and the work
of the Inquisition against false converts, or those suspected of being one. All
this was to make for a characteristic personality incompatible with that of a
charismatic leader. It is very unlikely that Arceo’s knowledge and methods
would have been passed on from a School where his followers would defend
his practices and ideas; for that, it was obviously not enough to have prestige
and social recognition as a scientist. Moreover, the possibility for a convert
in sixteenth century Spain to form a scientic school is also unlikely, since
the sciences were very much subject to the control exerted by the Church
and the Inquisition, which, for example, issued an index of banned books in
which all the latest new ideas, especially foreign ideas, were listed. In Europe,
perhaps, particularly in the more “progressive”, more bourgeois environ-
ments that were less tied to obedience to the Vatican or openly Calvinist,
Lutheran or Anglican (and not without problems). We can therefore rule out
the idea that Arceo had a role as a scientic leader and developed a school.
All the indications are that his Avicenna-like Galenism was extremely
 Kneys, G. (ed.) The Apologie and Treatise of Ambroise Paré (London: Falcon Educational
Books, ); Drucker, Charles B. ‘Ambroise Paré and the Birth of the Gentle Art of Sur-
ge ry ’, The Yale Journal of Biology and Medicine, ,  (), –; Hernigou, Philippe.
Ambroise Paré II: Paré’s Contributions to Amputation and Ligature’, International Ortho-
paedics, ,  (), –.
 Oyola Fabián and Cobos Bueno, op. cit. and Cobos and Vallejo, op. cit.
43
eective, which makes the fact that his balm continued to be used until the
twentieth century understandable, although the change to a hegemonic bio-
medical model was a decisive factor in its eventual abandonment. Moreover,
the scientic literature conrms the importance of the medical heritage of
plant and animal-based remedies in Europe, and until the Enlightenment
it was essential for surgeons to make their own ointments. However, these
factors do not apply in the case of the passing on of his method for treating
clubfoot and it could have been hampered by both the scientic context of
the time and the surgeon’s personality.
F 
The slow, gradual accumulation of scientic knowledge, its usefulness
and eectiveness, paradigm shifts, and the introduction of any dominant
models or professional status could be factors to explain the survival, loss
or disuse of knowledge, its diusion and breadth in a later historiographical
study; however, the fact that Arceo himself has not had the recognition he
deserves can be explained by Arceo’s mentality, as a result of his family ori-
gins. Nevertheless, Francisco de Arceo’s creativity and pragmatism are won-
derful. On ly to think of how the way of treating clubfoot, even up to a decade
ago, was to correct the deformities using surgery, therefore the conservative
treatments of Arceo should be seen in due perspective. Undoubtedly, he is
one of those gures in the history of science who, during the Renaissance,
anticipated modernity.
There is no doubt that the popularisation of science is vital for both the
scientist and the public in general in any period in history, and therefore we
consider it as another mission of the historian of science. In this respect, the
gure and work of Arceo should continue to be examined in greater depth
and promoted, given the stature of the man. For example, his pharmacologi-
cal knowledge could lead to great surprises given the existing scientic evi-
dence in herbal medicine.
 Vallejo, José Ramón and González, José Antonio ‘Los anbios en la medicina popular
española, la farmacopea de Plinio y el Dioscórides Hist. cienc. saude-Manguinhos, , 
(), -. Available from: http://www.scielo.br/scielo.php?script=sci_arttex-
t&pid=S-&lng=en&nrm=iso and Pardo de Santayana et al., op.
cit.
 Moulin, Daniel de A histo ry of surgery, with emphasis on the Netherlands, (Dordrecht, Boston
and Lancaster: Martinus Nijho, ), .
 Dobbs, M.B. and Gurnet C.A. ‘Update on Clubfoot: etiology and treatment’, Clin Orthop
Relat Res, ,  (), –; Horn, B.D. and Davidson, R.S. ´Current treatment of
clubfoot in infancy and childhood’, Foot and Ankle Clin, ,  (), -.
44
A
We would like to express our thanks to the Sociedad Extremeña de Historia and to
Felipe Lorenzana, Andrés Oyola Fabián, Luis Garraín Villa, Antonio Cestero and
Ángel Bernal for their contributions to the dissemination of Arceo’s methods. We
would also like to thank Rachel Fell for her English technical support.
R
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. Vigo, Juan da Libro o práctica en cirugía del doctor… Translated by Miguel Juan
Pascual (Valencia: ) Available from: http://books.google.es/books/about/
Libro_o_practica_en_cirugia_del_doctor_J.html?id=_wB-L_ARXIC&redir_esc=y
[consu lted //].
. Vincelet, L., ‘Ambroise Paré et la religión’, Histoire des sciences médicales,()
, -. Available from: http://www.biusante.parisdescartes.fr/sm/hsm/
HSMxxx/HSMxxx.pdf [consulted //].
. Walsh, James J. The Century of Columbus (New York: Catholic Summer School
Press, ).
. Wil ly, C. et al., ‘Richard von Volkmann: su rgeon and Renaissance man’, Clinical
Orthopaedics and Related Research, ()  (), -.
S
Ispravljanje prirođenog uvrnutog stopala (eng. clubfoot) nije uobičajena tema istraživanja,
posebice uzme li se u obzir da se do razdoblja renesanse samo nekoliko autora bavilo tim
naslijeđenim poremećajem. S jedne je strane Ambroise Paré, čiji su doprinosi traumatolo-
giji i ortopediji zapanjujući, a s druge Francisco Arceo de Fregenal, poznat i kao španjolski
Ambroise Paré. Obojica su razvili metodu liječenja ovog stanja i specijalne ortopedske cipele.
Zašto je, dakle, u španjolskoj literaturi francuski kirurg od početka smatran pionirom koji je
razvio ortopedske cipele, a ne Arceo? Zašto se rad Španjolca nije duboko proučavao, kao što
zaslužuje? Ta su nas pitanja potaknula na pisanje rada u kojem smo kao glavni cilj odlučili
istaknuti Arceov doprinos u ortopediji. Danas postoje konkretni argumenti i radovi koji su
doveli do zajedničkog zaključka znanstvenika, koji se bave ovom temom, da je španjolski ki-
rurg bio židovski obraćenik. Društveni, ekonomski i politički uvjeti u Europi u to doba mogu
nam dati neke predodžbe o teškoćama prilikom židovske konverzije u 16. stoljeću pa je za
znanstvenika, očito, bilo teško imati sljedbenike koji bi branili njegove metode i tehničke za-
misli. Ipak, vjerujemo da je Francisco Arceo de Fregenal zavrijedio više priznanja i da njegov
rad treba nastaviti proučavati.
Ključne riječi: povijest ortopedije, prirođeno uvrnuto stopalo (clubfoot), renesansa,
Ambroise Paré, Francisco Arceo de Fregenal
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... Clubfoot deformity (talipes equinovarus, supinatus and adductus) was first described by Hippocrates more than 2000 years ago (about 400 years before Jesus Christ) (1). In China, traditional Chinese medicine (TCM) considers the clubfoot deformity a teratological defect (teratology: the branch of anatomy studying abnormalities of physiological development). ...
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Congenital clubfoot (CF) was first described by Hippocrates in approximately 400 B.C. In ancient China, manipulations were widely used to correct CF, but the outcomes were frequently unsatisfactory with residual deformity even if corrective devices were used. The advent of aseptic surgery and anesthesia has favored the development of different surgical procedures to manage children with CF. Surgical treatment became extremely popular in China during the years 1960-1990 due to the good clinical foot appearance post-surgery. However, the poor mid- to long-term results of surgical treatment facilitated the return of conservative treatment, i.e., the Ponseti technique. Over the past decade, the Ponseti technique has become very popular in China. The Ponseti technique is essentially conservative and it is based on a good understanding of CF pathophysiology. Casts are changed once a week and Achilles tenotomy is performed if equinus persists at the end of treatment. Although highly successful on the short to mid-term, the Ponseti technique is not able to completely eradicate surgery, and recurrence is still possible. As the etiology of CF is still unclear, the first mission for doctors and researchers all over the world is to truly understand the pathogenesis of the deformity. Even though genetics seems to play an important role, successful gene therapy is still a distant goal. This narrative review aims to investigate the history of CF treatment in China, to describe its tortuous process and to potentially inspire new ideas to create new effective methods of treatment.
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