256 



SCIENCE. 



[N. S. Vol. XII. No. 294. 



owe to the researches and discoveries of 

 Pasteur. 



If we examine the old books we may find 

 again and again something very near to 

 what is the accepted doctrine of the present 

 time. History, it is said, repeats itself, and 

 so very certainly does surgery. The diffi- 

 culty of discovering anything new is as 

 great in surgery as in other branches of 

 knowledge. Hippocrates (460 B.C.), the 

 Father of Medicine, classified injuries of 

 the skull in much the same way as that 

 adopted in our modern text-books. He 

 spoke of contusions of the cranium without 

 fracture or depression, of simple fractures, 

 depressed fractures, indented fractures in- 

 volving the outer table alone, and fractures 

 at a distance from the seat of injury which 

 we now style fractures by contre-coup, a 

 classification which leaves bat a small mar- 

 gin for improvement. 



Many of the surgical instruments found 

 in Pompeii are precisely similar in principle, 

 if not quite equal in workmanship, to those 

 now in use, and Pompeii was destroyed 

 1800 years ago (A. D. 79). 



Heliodorus, who lived at the beginning 

 of the second century A. D., in the time of 

 the Emperor Trajan, was a surgeon of much 

 originality, and appears to have been famil- 

 iar with some of our modern methods and 

 discoveries. He knew, for instance, of the 

 ligature of arteries, of the radical cure of 

 hernia by extirpation of the sac, and of 

 the excision of a rebellious stricture of the 

 urethra. 



Oribasius, who flourished in the middle 

 of the fourth century, A. D., was the friend 

 and physician of the Emperor Julian. He 

 has preserved for us the work of Antyllus, 

 whose treatment of aneurj'sm by ligature of 

 the vessel above and below the sac, with 

 subsequent incision and evacuation of its 

 contents, has of late years been revived with 

 success, and is still considered by many of 

 our surgeons as the best method of treat- 



ment in certain cases. One might cite other 

 examples of old methods consciously or un- 

 consciously revived, but these may perhaps 

 suflice. 



The modern specialist finds his prototype 

 in very ancient times, and what we are apt 

 to regard as a recent development is in re- 

 ality a survival. Herodotus tells us that 

 in Egypt there were as many branches of 

 the profession as there are parts of the hu- 

 man body. 



In Europe, until the rise of the Italian 

 Universities, surgery was mainly in the 

 hands of peripatetic charlatans, who cut 

 for stone and operated on hernia. They 

 travelled from town to town, kept their 

 methods secret, and handed them down as 

 family property to their descendants. 



The Hippocratic oath restricted the per- 

 formance of lithotomy to those who had es- 

 pecially devoted their whole energies to the 

 cultivation of this operation, and may partly 

 serve to explain this remarkable survival. 

 Some of these ' cutters ' were skilful men, 

 but all were of necessity very ignorant. 



A very famous ' cutter,' whose name we 

 do not know, died in Genoa in 1510, and 

 Senerega, the Genoese historian, tells us 

 that his method was to introduce an iron 

 rod along the urethra into the bladder un- 

 til it touched the stone, which he then ex- 

 tracted through a perineal wound. It has 

 been suggested that this Genoese taught 

 his method to John of Cremona, who is 

 credited with the invention of the grooved 

 staff. 



One of the most celebrated ' cutters ' was 

 Pierre Franco, who was born in Provence 

 about 1500, A. D. He used a staff and cut 

 on the gripe as well, and employed instru- 

 ments for the purpose of crushing large 

 stones. He was a man of determination 

 and resource, for he relates a case of a 

 boy in whom having failed to remove a 

 stone by way of the perineum, he success- 

 fully performed the suprapubic operation. 



