The Meta-Encyclopedia

Surgery

Surgery names 3 different subjects across the 6 encyclopedias on this shelf. Each is set out below.

Surgery PLASTIC. The reconstruction of physiognomies

Collier's New Encyclopedia (1921)

PLASTIC. The reconstruction of physiognomies, for either utilitarian or æsthetic reasons, has been practiced by many surgeons in large cities for many years. Of course , great progress was made in this special department of surgery as the result of the World War and of the many facial wounds and disfigurements suffered by ched in soldiers. Perhaps the greatest development in this direction was reached the American army hospitals, though in both the British and the French army hospitals, too, excellent work was done . One of the latest developments is the establishment of the International Clinic of Plastic Surgery at St. Andrew's Hospital, London. Much of the success of plastic surgery depends upon dentistry. During the war, practically all of the plastic surgery was devoted to an attempt to restore lost parts and to correct mutilations. In civil life, however, facial injuries are comparatively rare . Then facial surgery is devoted chiefly to an attempt to improve on nature. In most cases it involves the soft parts in skin and tissue rather than the bony parts. The principal difficulty is the necessary slowness of the process, in many cases a large number of operations being required. In all of these operations anæsthesia and prevention of infection are of especial importance. In the new clinic at St. Andrew's Hospital plastic surgery becomes available to It will be persons of moderate means. run on a nonprofit basis and will give graduate courses to surgeons from all over the world. In order to eliminate commercialization all students must meet the severe requirements of either the Royal College of Surgeons or the American College of Surgeons. Besides two English and French members the clinical staff includes two Americans, Dr. J. Eastman Sheehan of New York and Dr. F. N. Smith of Grand Rapids, Michigan. SWEDEN. Premier Hjalmar Branting resigned in May, 1923, and was succeeded by Ernest Trygger, who was formerly chief justice. SWITZERLAND. The Federal Assembly in December, 1923, elected by a vote of 189 to 30, Ernest Shuard of Lausanne, who was vice president in 1923 and president of the Swiss Confederation for 1823, succeeding Carl Sheurer, whose term expired December 31. Jean Musy was elected vice president . T TACNA-ARICA. The final settlement of the dispute between Chile and Peru regarding the Tacna-Arica territory was postponed in September , 1923, at the request of the Chilean Government. The dispute is to be submitted eventually to the arbitration of the President of the United States and , though Chile had completed her argument, its government desired that its United States legal advisers, whom it had engaged, should be given an opportunity to study the argument as fully as possible. TANGIER. A conference to determine the political cal position of Tangier was held in July, 1923, but ended with no results. Spain wished to have Tangier incorporated in her Moroccan territory. France, however, wished it returned to the rule of the Sultan of Morocco. Great Britain and Spain objected to the French plan because it involved making Tangier a French port. As it was unable to agree, the conference adjourned. Tangier is a part of Morocco on the African side of the Strait of Gibraltar and became the property of England when it was made a part of the dowry of Catherine of Braganza on her marriage to Charles II. At the present time the town is under international tional control as fixed by the Algeciras Conference in 1906. TAXATION. The question of reducing federal taxes which had been under discussion throughout the entire year was brought to a head by a letter addressed by Andrew W. Mellon, Secretary of the Treasury, to William R. Green of Iowa, chairman of the House Ways and Means Committee, sent in November, 1923. In this letter the Secretary of the Treasury not only gave the various methods by which taxes could be reduced and the results on the entire tax-paying body of citizens, but also pointed out that "a soldiers' bonus would postpone tax reduction not for one but for many years to come." In order to make the taxpayers actually participate in the annual surplus, amounting to about $300,000,000, the Secretary of the Treasury proposes: (1) a reduction of 25 per cent on taxes on earned incomes; (2) a reduction of the normal income tax from four per cent to three per cent and from eight per cent to six per cent respectively; (3) a reduction of the surtax rates by commencing their application at $10,000 instead of $6,000 and scaling them upward to 25 per cent at $100,000; (4) to limit the deductions of capital losses to 122 per cent of the loss; (5) to put a limit on the deductions for gross income; (6) to tax the common property of husband and wife to the one having control of the income; (7) to repeal the tax on telegraph, telephone, and leased wires (the last of the War-time transportation taxes); (8) to repeal the tax on admissions; (9) to repeal miscellaneous "nuisance" taxes because they are difficult to collect or unnecessarily inconvenient for the taxpayers. As a result of the various adjustments the Government is expected to lose a total of $391,000,000 and to gain 68,000,000, leaving a net loss of $323,- 000,000, very closely approaching the present surplus. TAX EXEMPT SECURITIES. (See CONSTITUTION, AMENDMENTS TO, and TAXATION.) TELE-AUTOGRAMS. As a result of this new invention by M. Belin, it has become possible to send and have delivered an autograph telegram. The sender of the telegram writes his message on a revolving cylinder covered with paper. A special ink is used which causes the words to appear in slight relief. The obstacles made by the letters are struck by a delicate needle which is jerked upward and interrupts the electric current. These interruptions are recorded at the other end of the wire and result in an exact copy of the written telegram. This machine has been installed in all French telegraph and post offices. TRANSJORDANIA. The independence of this new state was celebrated in May, 1923. The Emperor Abdullah, ruler of the country, wrote a declaration agreed upon by the British Government which conferred the rights of self-government on Transjordania. This territory lies south of French Syria, to the east of Palestine and Hedjaz, west of Irak and north of the Emirate of Jebel Shammar. The ruler is a son of King Hussein of Hedjaz. Attempts were made in the latter part of the year by Arabs to break down the power of Transjordania, but these were resisted. TRYPARSAMIDE. A new arsenate compound for the treatment of African sleeping sickness was used during 1923 with considerable success as a remedy for paresis, which has hitherto been considered incurable. This drug was discovered in 1915 by Dr. Walter A. Jacobs, and Dr. Michael Heidelberger of the Rockefeller Institute in 1915. TURKEY. The year 1923 was an eventful one in the history of Turkey. It witnessed rehabilitation of that country as a power and saw the establishment of a republic, with Mustapha Kemal as president. The Lausanne Conference for the settlement of questions of issue between Turkey, Greece and the other powers of Europe, which failed in its first session on account of the refusal of the National Assembly to sign the prepared treaty, reconvened in April, 1923. (See LAUSANNE CONFERENCE.) The Grand National Assembly ratified the treaty on August 23 and on the day following the Allied troops began the evacuation of the territory which they had held from the time of the armistice in 1918. The last detachment of Allied troops left on October 2, and thus the Turks regained absolute control of Constantinople, which the Turkish troops reentered on October 6. The Lausanne Treaty, in addition to concluding peace between Greece and Turkey, provided for the compulsory exchange of Greeks in Turkey for Turks in Greece, but left the Armenian problem unsolved. Turkey thus gains possession of Eastern Thrace. On August 6 a treaty was signed between Turkey and the United States. A new Grand National Assembly numbering about 200 delegates met at Angora on August 13. It reelected Mustapha Kemal president. In October a new constitution was adopted proclaiming the republic of Turkey, with a president elected for The National Asfour or five years. sembly has legislative powers only, the executive power being entrusted to a cabinet which is responsible to the assembly. A Council of State, the members of which are appointed by the president, dent, perform the usual functions of a second upper house or senate. The National Assembly on April 10 ratified the so-called Chester concession granted to Rear Admiral Colby M. Chester and others which had been under negotiation for many years. Protests were made by British and French interests with they were not justly dealt with or if they had vested interests. TWELVE-HOUR DAY. In 1922 Presdent Harding asked the directors of the great steel corporations to investigate the possibility of abolishing the twelvehour day in their plants. A committee was appointed which made a report in May, 1923. This committee reported that the twelve-hour day was in no way injurious and was essential to the economic welfare of the United States. It declared also that the workmen preferred the twelve-hour day because it meant more money per day. The eight-hour day would call, it is claimed , for 60,000 more workmen, which are not available because of the stringency of the immispite of this report it gration laws. In spite was agreed, in deference to the president's wishes, to abolish the twelve-hour day as far as possible, and beginning on August 13, the United States Steel Corporation and other steel mills changed from the twelve-hour day to the eight-hour day system. TYPHOID FEVER. The steady decline of the death rate from typhoid fever in the United States for the past twelve years still continues. In 1922 a new low record was reached in large cities of the country which averaged 3.15 deaths from this disease per 100,- 000 population; less than one-sixth the rate for 1910. The two great sources of typhoid infection, polluted water and raw milk, have been practically elimiwhose concessions this clashed. The mat-nated in cities of over 100,000 populater was taken up at Lausanne and an agreement was made that all concessions should stand on their merits, and the companies could demand arbitration if UNITED STATES. tion. Typhoid is now no longer a city disease, and the chief efforts for its prevention are being directed to rural sanitation, picnic grounds, etc. U Administration. - The year 1923 was marked midway in its political history by the death of President Harding and the succession to the presidency of Calvin Coolidge, Vice President. The great change was made without any dislocation of the administrative functions and President Coolidge regovernment. tained the same Cabinet and declared his intention of pursuing the same policies which had characterized President Harding's administration. In chronological order the chief events in the executive and legislative departments of the Government for 1923 were as follows: On February 7, President Harding appeared before a joint session of Congress and urged ratification of the British Debt Funding settlement. (See DEBTS, WAR.) The President was unable to secure the action in Congress on his proposal that the United States become a member of the Permanent Court of Arbitration. In order to present his views on this and other subjects to the country, and to fulfill also a long cherished wish to visit Alaska, he started in July on the fateful trip which was to end in his death. President Harding made speeches in most of the larger cities of the Middle and Far West through which he passed. In each of these he took up one of the great questions in the public mind. These included agriculture, foreign relations, and the World Court. In Alaska the President was received with great enthusiasm, but it was evident that the tax made upon his vital energies was too great. He returned from Alaska to San Francisco, where on July 28 he was seized with the fatal illness and died on August 2, at 7.30 P. M. Vice President Coolidge was at once notified and took the oath of office at the home of his father in Vermont. He started at once for Washington and assumed the reins of government. President Coolidge steadfastly adhered to his declaration made on August 4 that he would have little or nothing to say in regard to national policies until he had received a firm grasp on questions to be considered. His first public utterance was on December 6, when he delivered his first annual message to Congress. In this he favored the World Court, the tax-reduction plan of Secretary Mellon, advocated agricultural relief, opposed the soldiers' bonus, cancellation of Allied debts and further American disarmament. In a special message, on December 10, the President further outlined his suggestions in regard to the Mellon plan and his objection to the bonus. On December 15, the President released all war offenders following a report of a special board consisting of former Secretary of War Baker, Bishop Charles H. Brent and General J. G. Harbord. Army. The year 1923 was the first since the Worl World War during which attention could be given by the War Department to normal peace-time activities. The chief accomplishments of the year were general progress in training of all military elements, the growth and further organization of the reserves and reserve headquarters, and the development of plans for mobilization. The number of reserve officers increased from 69,000 to 82,000, and the commissioned strength of the organization reserve divisions from 61½ per cent to 81½ per cent. In June, 1923, there was completed for the first time a scheme of mobilization. There was a pronounced enthusiasm in favor of military instruction carried on in accordance with the National Defence Act of 1920. Thousands of citizens took advantage of the opportunities afforded in camps, armories and lecture halls. Applications for training for members of the officers reserve corps far exceeded the number limited by appropriations, and those who attended the camps gave unceasing interest and attention. Budget. In December, 1923, President Coolidge submitted to Congress the Budget Bureau's estimates of receipts and expenditures for the fiscal year of 1925. All of the departments with the exception of four showed reductions in expenditures. The total ordinary expenditures are estimated at $1,876,611,773, the expenditures for Public Debt at $1,421,468,671, or a grand total of expenditures of $3,298,080,444. In detail these expenditures were estimated as follows: Le Legislative establishments, $13,595,448; Executive Office, $415,667; Wa 5,667; War Department, including Panama Canal, $314,190,650; Navy Department, $311,020,050; Department of Agriculture, $144,784,200; Department of Commerce, $23,710,000; Interior Department, $310,507,699; Department of Justice, $21,451,960; Department of Labor, $6,107,076; State Department, $14,988,446; Treasury Department, $228,811,090; District of Columbia, $26- 896,798; Post Office Department (deficit) $2,085,184; Veterans' Bureau, $403,369,450; Emergency Fleet Corporation, $25,852,817; Other independent offices, $18,825,238; Reduction of Principal, Public Debt, $482,277,975; Investment of Trust Funds, $49,190,696; Interest on Public Debt, $890,000,000. Against these expenditures the repts ceipts of the Government were estimated at $3,693,762,078, consisting of: Internal Revenue, $2,727,585,000; Customs, $493,- 000,000; Miscellaneous, $473,177,078. Based on these estimates the surplus for the fiscal year of 1925 would be greater by some $65,000,000 than for the fiscal year of 1924, the total surplus for 1925 being estimated at $395,681,634. Congress. The fourth session of the Sixty-seventh Congress, which began on Dec. 4, 1922, continued till March 4, 1923. In the Senate the Capper Agricultural Credits Bill, affording agricultural relief for farmers, was passed on February 5. Senator Borah introduced a bill for the purpose of doing away with the 5 to 5 decisions of the Supreme Court and requiring the concurrence of nine justices in constitutional cases. (See CONSTITU-

Surgery manual intervention

Collier's New Encyclopedia (1921)

manual intervention, mediate and immediate, in all lesions or malformations of the human body. It was already an art when medicine proper was but a phase of superstition. The earliest notices of it occur among the Egyptians, who, as we find represented inu on obelisk and in temple, practiced sions, scarifications, probably putation, long before the date of the Ebers papyrus (3500 b. 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, for 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 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 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 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 b. 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 chap- 1 ter); 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 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 his radical cure of the scrotal form. In Paulus we find a well nigh exhaustive list of operations for disease or malformation of the genitals, even including syphilis (Häser), while rectal and anal affections (hemorrhoids, fistula , etc.) were treated by Leonides (A. D. 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 described by Archigenes, hemorrhage being obviated by ligature of the great vessels or constriction of the limb . Flap-amputations were performed by Heliodorus and Leonides. Resection of 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 of that time, afloat and ashore, apparently 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 severely wounded 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 witnessed the first English, Dutch, and German books on the subject. Guy de Chauliac, the highest name in that century, labored to bridge the chasm between surgery and other branches of medicine. For all that, the mediæval surgeon in Eastern Europe remained far behind his predecessors 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 university "faculty" conquered the right 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 if eccentric 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 Richard Wiseman , 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 the 18th century Côme by her Académie de Chirurgie, long the headquarters of the highest professional and literary culture. England contributed Cheselden and Pott; Scotland, 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 sovereign qualities of sagacity in diagnosis and assured boldness in operation. Prussia came far behind with her Collegium Medico -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 nobly sustained proficiency. cagni and Scarpa in Italy, Breschet and To the distinguished anatomists Mas- Geoffrey St. Hilaire in France, the are laid brothers John and Charles Bell in Great , Britain, the Meckels, Berres, Tiedemann, Germany, seconded C. M. Langenbeck in by physiologists like the Italian Panizzo, the Scotch Charles Bell, the English 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 profesattaining. Add to these sion is rapidly the introduction of anesthetics, 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.

Surgery sur'jer-y, the performing of operations on a patient

Aiton's Encyclopedia (1910)

sur'jer-y, the performing of operations on a patient. A proper definition excludes baths, massage, etc., and confines surgery to cutting operations, the dressing of wounds, and the setting of broken or disjointed bones. Even among primitive people a certain amount of skill in stopping the flow of blood, in binding up wounds, in the application of healing herbs, in setting broken limbs with splints, and in the extraction of arrow points is to be expected. The early practice of surgery was bound up, no doubt, with magic and superstition. In a more advanced civilization, as that of Egypt, surgery was practiced by the priests. We find the early barbers of Europe combining surgery physic, shaving, and hair cutting. As late as the day of Frederick the Great it was the duty of the army surgeon to shave the Prussian officers. It is only recently that surgery and medicine have been recognized widely as separate though allied branches of the healing art. The majority of doctors are yet physicians and surgeons. The oldest literature on surgery is found in Sanskrit. It is said that Alexander the Great found an astonishing degree of surgical skill among the Hindus. A New York association of surgical specialists has taken the name of Charoka Club in honor of one of these Sanskrit writers. These Hindu writers describe or allude to a round hundred steel surgical instruments, including scalpels, lancets, saws, bone-nippers, scissors, trocars, hooks, probes, scoops, forceps, and syringes. They speak of fourteen ways of wrapping a bandage and of split bamboo or rattan splints. Hindu surgeons at the time of Christ, and possibly a thousand years earlier, amputated, set broken bones, sewed cuts, used a magnet to extract particles of iron, cut out tumors, tapped for dropsy with a trocar, removed cataract from the eye, and performed many other operations requiring knowledge and skill. Figures on the walls and monuments of ancient Egypt represent patients wearing bandages or undergoing surgical operations. In various museums of Egyptian antiquities there are considerable collections of horn cupping vessels, bronze and steel surgical instruments, artificial teeth, etc., showing that surgery had made progress. It is believed that the practice of preparing mummies led to a knowledge of anatomy. The Greeks have left a considerable list of surgical works. They were impeded by a popular prejudice against the desecration of dead bodies by surgical study. The Greeks carried their knowledge of surgery as well as of literature and oratory to Rome. The Arabians, famous in other branches of science and in mathematics, made few contributions to surgery. During the Middle Ages , little advance was made and much was forgotten. The revival of surgery kept pace with the revival of art, literature, and other forms of learning in which Italy played an important part. The remarkable advances of modern surgery are due to several causes. The chief of these are superior schools of instruction in which the bodies of the dead are studied in detail, and the bodies of the living are operated upon by specialists in the presence of students; the general establishment of hospitals in which facilities are at hand for operating and for the proper care of patients; the use of cocaine to deaden pain, and the use of ether, chloroform, and laughing gas to produce unconsciousness during the time of operation; and, lastly, the discovery that the formation of pus may be prevented by excluding bacteria, that is to say, the germs of putrefaction, from the wound. By the use of one of the anaesthetics named above, the surgeon is able to perform operations without the knowledge of the patient, so painful in their nature that otherwise human endurance would be overtaxed and the patient would die under the knife. The study of the germs of decay has led to the utmost care in performing operations. The instruments, sponges, towels, and all other appliances are sterilized or rendered free from living germs by heat or a bath in some such substance as carbolic acid . The operator and his assistant bathe their hands in carbolized water to kill germs. In some cases the operation is even performed in a spray of germ-killing vapor. The thread used in closing an incision and the bandages are sterilized. Many operations, once certain to be followed by decay and death, are now deemed under skillful treatment as not more dangerous than a cut finger. The surgeon once taught that pus was a part of healing. The complete change of view may be expressed in the surgical phrase, "There is no laudable pus." The practice of the army surgeon has undergone a revolution. His first care is to remove so far as possible all foreign, germ-carrying material from a wound. This done, he washes the wound with sterilized water, and puts on sterilized bandages to exclude germ-carrying air. Instead of dressing the wound daily, he seals it up to shut out germs and leaves nature to effect a cure. During the Cuban War intelligent army surgeons pursued this plan and sent their patients to bed to get well. The exclusion-of-germs or the let-alone theory is not always appreciated. "One poor woman who met her captain on a transport in New York Harbor cried out to the avenging heavens because the bandages of his wounds had not been changed since they had been put on in Cuba, weeks before; but her captain got well, in spite of the fact that a Mauser bullet had explored his abdominal cavity in a series of startling zigzags." The Japanese surgeons had great success in the late war. They removed bits of cloth when carried into the wound, but refrained from probing. They washed with sterilized water, bound up the wound with sterilized water, bound up the wound with sterilized cotton, and sent the sufferer to the hospital to get well. One Japanese surgeon, who subsequently related his experiences in a medical congress in Detroit, lost but thirty-two patients out of six hundred and eighty treated in this way. See Anaesthetics; Appendicitis ; Catgut ; Bacteria; Saw ; Trepanning ; Bullet ; Hospital ; Pasteur

What Has Changed in the Last Century

Collier's wrote in 1921 that plastic surgery's chief limits were slowness, anaesthesia and "prevention of infection" — this was still two decades before penicillin came into clinical use in the 1940s, and before blood banking and modern anaesthetics made long reconstructive operations routine. The Second World War repeated and vastly extended the First War's lessons, with Archibald McIndoe's burned airmen at East Grinstead (the "Guinea Pig Club") becoming as famous as the facial cases of 1918; microsurgery from the 1960s and 70s then allowed surgeons to move tissue with its own blood supply from anywhere on the body, and the first partial face transplant was performed in France in 2005, the first full one in Spain in 2010. The article's other half — surgery to "improve on nature" — has grown from a big-city speciality into an industry of millions of procedures a year, most of them now non-surgical injectables rather than the multi-stage skin operations described here. The 1921 hope of making such work available "to persons of moderate means" on a non-profit basis is one of the few parts of the entry that has not come true.

Written for this edition, 2026.