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Surgery (Manual intervention meinu)
manual intervention, meinu diate and immediate, in all lesions or SURGERY putation, long before the date of the Ebers papyrus (3500 в. c.). Castration (to supply eunuchs for the royal harem) was also a frequent operation. Preserved in museums may be seen surgical instruments contemporary with votive offerings of the remotest Egyptian epoch-lancets, tweezers, catheters, uterine specula, iron rods for the actual cautery, etc. Among other indications of early proficiency in ophthalmic surgery, couching cataract must have been known to them.
Jewish surgery, like Jewish medicine, was an importation from the Egyptians.
The sexual regulations characteristic of the Jews affected their surgery, from simple circumcision up to the Cæsarean section, which very early in their history was practiced on pregnant women in death as in life.
Without entering into the controversy as to the Greek origin of the Indian healing art, we find surgery enjoying high esteem among the Indians in very remote times. Surgical instruments skillfully made of steel, to the number of 127, still attest their proficiency in cutting and cauterizing. Their surgeons were trained to operate by practicing not on animals or on the dead human subject, but on wax-covered boards, on beasts' skins, or on succulent plants and fruits. Hemorrhage they checked by cold, by compression, and by styptics. The ligature they seem not to have known. Amputation was confined to the hand in cases of intractable hemorrhage. Lips or surfaces of wounds they smeared with an arsenical salve. For intus-susception, volvulus, and such abdominal lesions they practiced laparotomy, while fistula in ano (diagnosed by the speculum) they treated with the knife and corrosives.
As to the surgery of the other Orientals we possess but obscure notices. Among the Persians we find Greeks in general practice under King Cambyses. The Chinese 6 centuries B. c. performed surgical operations. In Greece surgery had attained high development before Hippocrates put medicine on a rational basis, and in the Hippocratic books we find a rich collection of surgical doctrine and practice drawn from centuries of experience.
Even modern appliances were in great part anticipated by him-splints, for example and bandages of various kinds The gem of the Hippocratic surgery (according to Häser) is the treatise on injuries of the cranium-fractures, fissures, and contusions with or without depression. For such cases trepanning is the sovereign operation, to be performed as early as possible, less to get rid of effused blood, pus, etc., than, by SURGERY removal of the injured osseous structure, to prevent inflammation of the scalp.
The removal of extremities which had become gangrenous shows again the Hippocratic surgery in a wonderfully favorable light.
The post-Hippocratic school (its greatest surgeon being being Praxagoras of Cos, noted for his cure of volvulus) has little to detain us; but the Alexandrians left a distinct mark on every branch of the healing art-surgery included. Our best knowledge of them comes from Celsus, who names as the most celebrated surgeon of Alexandria Philoxenus, a voluminous writer on the subject.
Roman surgery can hardly claim M.
Porcius Cato (234-149 B. c.) as more than a shrewd amateur who left some handy rules for the treatment of fractures, ulcers, nasal polypi, fistulæ, strangury, etc. Archagathus (218 в. c.) was a regular practitioner, known for his skillful handling of dislocations, fractures, and particularly particularly wounds, as the "Vulnerarius." But when from such practice he proceeded to operate with the knife his popularity fled, he was nicknamed the "Carnifex," and had to leave the city. Celsus, the patrician dilettante in medicine, is really the highest name in Roman surgery, though it is doubtful whether he ever operated. Of the eight books of his admirably written work the last two treat of surgery, including plastic replacement of defects in the outer ear, the nose, and the lips; lithotomy as practiced on boys (a celebrated chapter); amputation, previously described by no other author; diseases of the bones, with the operation of trepanning, fractures simple and compound, and dislocations.
Galen, though a master of surgery, and, before his settling in Rome under M. Aurelius, a practitioner of it, seems to have contributed nothing of his own to its doctrine of practice. As he found it (with some notable additions) it remained to the close of the Byzantine period. An intimate knowledge of its modus operandi during these centuries may be inferred from the collection of surgical instruments dug up at Pompeii and now on view at Naples. These are about 300 in number, consisting of some 60 different kinds. The treatment of fractures and dislocations was practically the same from Hippocrates to Paulus Ægineta (A. D. 650). Trepanning received several modifications in practice up to Galen's time, while tracheotomy (introduced by Asclepiades, 1st century) was by Paulus restricted to cases of choking, when the deeper air passages were free.
The operation for hernia, perfunctorily dealt with by Hippocrates, had by by the 1 SURGERY skillfully 200), who epoch of Celsus assumed the practical development in which it is found during the later empire, Heliodorus, under Trajan, being noted for jan, being noted for his radical cure of In Paulus we find a well nigh exhaustive list of operations for disease or malformation of the genitals, even itals, even including syphilis (Häser), while rectal and anal affections (hemor- , etc.) were treated treated by Leonides (A. D. 200), who seems to have used the écraseur as well as the knife and the cautery. Large tumors in the neighborhood of great vessels were untouched by Hippocrates or Celsus, though the latter makes mention of the surgical cure of goîter. Amputation after Celsus is tation after Celsus is described by Archihemorrhage being obviated by ligature of the great vessels or constriction of the limb tion of the limb. Flap-amputations were performed by Heliodorus and Leonides. the humerus, the femur, and the lower jaw proves (according to Häser) the high development to which surgery under the empire had attained as also do the plastic operations which ned , Antyllus describes with a fullness and which freedom unknown to Celsus. A word may be added here for the medico-military service tary service of that time, afloat and quite as well organized as the combatant arm. Under the Byzantine Emperor Maurice (582-602) the cavalry had an ambulance company whose business it was to bring the sewounded out of action, and who were provided with water flasks and cordials to relieve the fainting.
The Arabs borrowed their surgery from the Greeks, chiefly from Paulus Ægineta, even more slavishly than their medicine. Their neglect of anatomy and their Oriental repugnance to operations involving the effusion of blood serve to explain the fact that except Abulcasim (died 1122) they contribute no memorable name to this branch of the healing art.
Surgery continued to be looked down on by physicians, all the more that the recently founded universities gave the latter the prestige of a culture denied to the adventurers who healed wounds, reduced dislocations, and set fractured limbs. Throughout the Middle Ages surgical literature seems to have shared the fortunes of medical literature-first the Greeks were in the ascendant then their servile imitators the Arabs. The earliest mediæval writers in surgery were Italians, superseded in the 14th century by the French, while the same period English, Dutch, and German books on the subject. Guy de highest name in that century, labored tury, labored to bridge the chasm be- SURGERY tween surgery and other branches of medicine. For all that, the mediæval surgeon in Eastern Europe remained far of the Roman and Byzantine empires. sharing the advance communicated to With the 16th century we find surgery every art by the Renaissance, while its practitioners improved their social standing. In this the way had been led by lége de St. Côme, 1279), which in the Paris with her College of Surgeons (Colteeth of the teeth of the university "faculty" conright to create licentiates in surgery. Other qualifying corporations (in London, for exam burgh) arose gradually on similar lines. example, and Edin- But what crowned the recognition of surgery as a liberal profession was its steady progress as a beneficent public agent in peace as in war. The powerful genius of Paracelsus was signally instrumental in this direction; still more so the sound sagacity and nobly philanthropic inspiration of Ambrose Pare (1517-1590). Galileo, Bacon, method, among the fruits of which was and Descartes revolutionized scientific Harvey's discovery of the circulation of the blood.
With the diffusion of juster and more comprehensive notions of structure and function surgery took bolder and more effective flights, reaching her highest point in the 17th century under , the father of English surgery, from whose "Seven Chirurgical Treatises" may be gathered the great accession he made to sound practice, parand dislocations. ticularly in tumors , wounds, fractures, Paris improved on her Collége de St. ons.
In and dislocations. In the 18th century century Côme by her Académie de Chirurgie, long the headquarters of the highest professional and literary culture. England contributed contributed Cheselden and Pott; Scot- James Douglas, the three Monros, Benjamin Bell, and above all John Hunter, to the promotion of a more enand physiological research. London, lightened practice, based on anatomical Edinburgh, and Dublin became centers of surgical education, which, by the admission of Häser, no continental school, not even Paris, could equal in the sovof sagacity in diagnosis and assured boldness in operation.
Prussia came far behind with her Col- -Chirurgicum in Berlin, and Austria only in 1780 and 1785 obtained the means of training surgeons while the United States by her school, of the higher grade, civil and military; under Dr.
Shippen in Philadelphia, laid the foundation of its subsequent and proficiency. cagni and Scarpa in Italy, Breschet and To the distinguished anatomists Mas- SURGERY SURREY Geoffrey St. Hilaire in France, the species is propagated in an extremely brothers John and Charles Bell in Great curious manner. When the eggs are laid, are laid , Britain, the Meckels, Berres, Tiedemann, the male impregnates then them, takes them C. M. Langenbeck in Germany, seconded in his paws, and places them on the by physiologists like the Italian Panizzo, back of the female, where they adhere by the Scotch Charles Bell, the English means of a glutinous secretion, and be- Marshall Hall, the French Magendie, Flourens, Duchenne, and Bernard, the German Prochaska, Purkinje, the brothers Weber, and Joannes Müller, surgery owes the mighty advance she made in the first decades of the 19th century. Of these pioneers some were themselves surgeons of the first rank, such as Scarpa and the brothers Be Bell; while among those who were equally great as teachers or writers and operators must be noticed Desault, Dupuytren, Roux, Delpech, and Lallemand in France; Lizars, Allan Burns, Liston, and Syme in Scotland; Abernethy, Astley Cooper, Brodie, and Lawrence in England; Warren, Mott, and Gross in the United States; Wattman, Siebold, Walther, Chelius, Langenbeck (already mentioned), Stromeyer, Graefe, and Dieffenbach in Germany; Kern, Pitha, and Linhart in Austria; Pirogoff and Szymanovsky in Russia. Anatomico-pathological museums and clinical instruction, displaying a wealth of object lessons impossible before, are among the chief causes of the perfection to which the surgical profession is rapidly attaining. Add to these the introduction of anæsthetics, of the antiseptic ligature and dressing, of the galvano-cautery, of the transfusion of blood, and of the engrafting on patients of tissue taken from the healthy subject, and we can realize the revolution that has so altered the surgeon's art as to make its present position one of the greatest triumphs of human intellect, energy, and resource. The science of surgery received great impetus during the World War. Under the greatest difficulties surgeons in all the armies performed operations of marvelous skill and ingenuity.