SUIIGKRY 



AntylluH (300 A.D.) tied their vessels above anil 

 below the point of section ; and PauluH removed 

 them by MMM0Mfl| them at their l>a-e by a liga- 

 ture. Cancerous tumours after Celsus' time came 

 within the category of .Y./i me tnnqere. Aneur- 

 isms line I no place in Hipixxrates, andC'eUns refers 

 only to the extirpation of varices. Antyllus seems 

 tii-t to have classified and dealt with the former 

 in true aneurism isolating the artery with a liga- 

 ture above and below the sac, which lie then opened 

 and emptied. Amputation after Celsus is described 

 by Arcnigenes, haemorrhage being obviated by 

 ligature of the great vessels or constriction of the 

 limb. Flap-amputations were performed by Helio- 

 dorus and Leonides. Resection of the linmerus, 

 the femur, and the lower jaw proves (according to 

 Haser) the high development to which surgery 

 under the empire had attained, as also do the 

 plastic operations which Antyllus describes with 

 a fullness and freedom unknown to Celsus. A 

 word may l>e added here for the medico-military 

 service of that time, afloat and ashore, apparently 

 quite as well organised as the combatant arm. 

 Under the Byzantine emperor Maurice (582-60*2) 

 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 Paul us ^igineta, even more 

 slavishly than their medicine. Their neglect of 

 anatomy and their oriental repugnance to opera- 

 tions 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. 



Salerno did incomparably less for surgery than 

 for medicine, partly because its representatives 

 being mostly ecclesiastics held aloof from manual 

 intervention, partly liecause its copyist monks 

 reproduced from the classic authorities only the 

 medical writings, leaving out those which had 

 little or no interest for men of the cloister 

 gynaecology, surgery, pnediatry, &c. Still there 

 is evidence that from the loth to the first half 

 of the 13th century they did take cognisance 

 theoretical at least of wounds, burns, abscesses, 

 fractures, dislocations, cancer, urinary calculi, and 

 external applications. 



Surgery continued to be looked down upon 

 by physicians, all the more that the recently 

 founded universities gave the latter the prestige 

 of a culture denieu 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 mediaeval 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, laboured to bridge the chasm 

 between surgery anil other branches of medicine. 

 For all that, the mediipval surgeon in eastern Euro|ie 

 remained far behind his predecessors of the Roman 

 and Byzantine empires.' Traumatic hn'morrliage 

 was arrested by the cautery and styptics, though 

 the ligature had not quite fallen into oblivion. 

 Operation* for hernia and vesiral calculus ranked 

 highest in import-ance. Plastic surgery was a 1'ith- 

 century revival of the ancient procedure, carried to 

 rare perfection a century later by Tagliaco/./i. again 

 to sink into disase. Similar fate befell the narcot i<- 

 drinks (see ANESTHESIA ), resuscitated in the same 

 century, to dull the pain of surgical operations. 

 The active principle of these had been inhaled even 



in the 13th century, and Guy de Chauliac also used 

 opium internally for the same end. 



With the 16th century we find surgery sharing 

 tin- advance communicated to every art by the 

 Renaissance, while its practitioners improved their 

 social standing. In this the way had Men led liy 

 Paris with her College of Surgeons (College de St 

 Cdme, 1279), which in the teeth of the university 

 ' faculty ' conquered the right to create licentiates in 

 surgery. Other qualifying corporations (in London, 

 for example, and Edinburgh) arose gradually on 

 similar lines. But what crowned the recognition 

 of surgery as a liberal profession was iu steady 

 progress as a beneficent public agent in peace as 

 in war. Skill in treating gunshot wounds, in sub- 

 stituting the ligature for the cautery in amputa- 

 tions, and in dealing with the cutaneous iill'eetion.s 

 dne to pestilences like that of syphilis reinforced 

 the claims to respect already established by fuller 

 anatomical, chemical, and botanical knowledge. 

 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 Part (1517-90). Galileo, 

 Bacon, and Descartes revolutionised scientific 

 method, among the fruits of which wits 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 Chintrgical Treatise* may be gathered 

 the great accessions he made to sound practice, 

 particularly in tumours, wounds, fractures, and 

 dislocations. The lines of scientific surgery were 

 now laid, and her advance liecame at once safer 

 and swifter. In the 18th century Paris improved 

 upon her College de St Cdme by her Academic de 

 Chirurgie, long the headquarters of the highest 

 professional and literary culture. England con- 

 tributed Cheselden and Pott, Scotland James 

 Douglas, the three Monros, Benjamin Rell, and 

 above all John Hunter to the promotion of a more 

 enlightened practice, based on anatomical and 

 physiological research. London, Edinburgh, and 

 Dublin became centres of surgical education, which, 

 by the admission of Haser, 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 -(.'hirurgicum in Berlin, 

 and Austria only in 1780 and 1785 obtained the 

 means of training surgeons of the higher grade, 

 civil and military ; while America by Tier school, 

 under Dr Shippen in Philadelphia, laid the founda- 

 tions of her subsequent and nobly sustained pro- 

 ficiency. 



To the distinguished anatomists Mascagni and 

 Scarpa in Italy, Breschet and Geoffrey St Hilaire 

 in France, the brothers John and Charles Bell in 

 liicat Britain, the Meckels, Berres, Tiedemann, 

 C. M. Langenbeck in Germany, seconded by physio- 

 logists like the Italian Pani/xo, the Scottish Charles 

 I Sell, the English Marshall Hall, the French 

 Magendie, Floiirens, Duchenne, and Bernard, the 

 ( M-rman Prochaska, Purkinje, the brothers Weber, 

 and Joannes Miiller, surgery owes the mighty 

 advance she made in the first decades of the liuli 

 century. Of these pioneers some were themselves 

 surgeons of the first rank, such as Scarpa and the 

 brothers Bell ; while among those who were equally 

 great as teachers or writers and operators must 

 be noticed Desault, Dupuytren, Roux, Delpech, 

 ami Lallemand in France ; Lizars, Allan Burns, 

 Liston, and Syme in Scotland ; Abernethy, Astley 

 Cooper, Brodie, and Lawrence in England ; Warren, 

 Mott, and Gross in America ; Wattman, Siebold, 



