SURGERY. There can be no rational doubt that surgery (Gr. cheir, the hand; ergon, work, signifying the manual interference, by means of instruments or otherwise, in cases of bodily injury, as distinguished from the practice of medicine, which denotes the treat ment of internal diseases by means of drugs) is as old as man himself. Passing over the very little that is known regarding the state of surgery among the early Egyptians and the Jews, and the skill ascribed to Chiron and other mythical personages among the early Greeks, we may regard the true history of surgery as commencing with Hippoc rates, who flourished in the 5th c. B.C. He was acquainted with the ordinary means of counter-irritation, as issues, a kind of moxa, and the actual cautery. He seems to have performed the capital operations with boldness and success; he reduced dislocations and set fractures, but clumsily and cruelly; extracted the fetus with forceps when necessary, and both used and abused the trepan. He did not perform lithotomy, the practice of which seems at that time to have been well known, but to have been confined to a few, who made it their exclusive study. From the time of Hippocrates we may pass over a couple of centuries, when, on the death of Alexander the great, Alexandria bocame the great school of anatomy, surgery, and medicine. Herophilus and Erasistratus (300 B.c.) were as distinguished for their surgical skill as for their anatomical knowledge. One member of this school, Ammianus, invented an instrument by which he broke down stones in the bladder, thus anticipating by about 2,000 years Civiale's discovery of lithot rity. When the great Alexandrian library was destroyed by fire, Rome became the headquarters of science in all its departments. The early Romans of all ranks held surgeons and physicians in abhorrence, and trusted for cures, even in cases of disloca tion and fracture, to spells and incantations. The first regular surgeon who settled in Rome was Archagathus (220 u.c.), a student of the Alexandrian school. At first his skill procured for him a high reputation, but the old prejudices soon revived, and lie was banished from the Roman capital. The first Roman surgeon of real merit was Celsus, who flourished at the beginning of the Christian era, who improved the mode of performing lithotomy and amputation, described the operation for cataract, and first recommended the application of ligatures to wounded arteries, for the purpose of arrest ing hemorrhage. His works contain an exact representation of surgical knowledge up to his own time. Aretteus of Cappadocia, who practiced in Rome during the latter half of the 1st c., was the first to employ blisters, using cantharides (as we still do)Tor that purpose. Rufus of Ephesus, who lived half a century later, first tied an artery which had become aneurismal in consequence of being wounded in venesection. Galen, who practiced in Rome in the latter part of the 2d c., mainly obtained his great reputation by his medical practice. His surgery was confined for the most part to fomeutations, ointments, and plasters for external application; to the art of bandaging, and to the employment of complicated machinery in fractures and dislocations. There is little to record for several future centuries. Aetius, in the 6th c., recommended scarification of the legs in dropsy, tried to dissolve urinary calculi by internal remedies, studied the dis eases of the eye, and is the first writer who notices the guinea-worm. Paulus tEgineta, in the 7th c., opened internal abscesses by caustics, improved the operation of lithotomy, described several varieties of aneurism, extirpated the breast, performed laryngotomy and tracheotomy, and was the originator of the operation of embeyotomy. His sixth book is regarded as the best body of surgical knowledge previous to the revival of letters. Rhazes, an Arabian, who had charge of an hospital at Bagdad, at the end of the 9th c., was the first to describe spina bifida, but he did not understand its real nature; he cau terized the bites of rabid animals, and gave a better account of hernia than any of his predecessors. To Avicenna, who lived a century later, we probably owe the first use of the flexible catheter, and of the instrument now generally known as Hey's saw. Albucasis (died 1122) describes an instrument for the cure of fistula lachrymalis, the removal of tumors by ligatures when the knife is inexpedient, the suture of wounded intestines, the use of the probang in obstruction of the gullet, etc., and is the only ancient writer on surgery who describes the instruments used in each special operation. In 1271 Pitard, an eminent surgeon of his time, laid the foundation of the college of surgeons of Paris. In our own country, Gilbertus Anglicanus, who lived about the beginning of the 14th c., is the first known surgical writer; he was shortly followed by John of Gaddesden, author of the Rosa Anglica. In the middle of that century Guy de Chauliac, the first to describe the Cmsarian operation, practiced at Avignon; and con temporary with him was John of Ardern, who is regarded as the first surgeon of his time. During the 15th c. the local application of arsenic for cancer was proposed by Taranta, a Portuguese surgeon practicing at Montpellier; and lithotomy was removed from the hands of itinerant quacks into the department of pure surgery, by Colot, a surgeon to the French court. Moreover, the college of surgeons dates from this century, having been founded in 1460-61; while at the commencement of the next century (1505) the Edinburgh college was founded. The surgery of the 16th c. may be said to be represented by Ambrose Pare (q.v.). His works, first published in 1535, exerted a most beneficial influence on the profession. Toward the close of this century, Fabricius ab A.cquapendente (q.v.), to whom we are indebted for the modern trephine, and for the use of the tube in tracheotomy, published his Opera Chirurgica, which passed through 17 editions. Early in the 17th c. (1612), a Scotchman named Lowe published A Discourse on the whole Art of Chirurgery; and about 50 years later Wiseman, who has been appro priately termed "the Pare of England," and "the true father of British surgery," flourished. He was sergeant-surgeon to Charles II., and his surgical works, published in 1676, may still be read with interest. He was the first to dispel the dangerous belief
that gun-shot wounds were of a poisoned nature, and had consequently to be treated with the most painful kinds of dressing. Contemporary with him were James Young of Plymouth, who first performed the flap-operation in amputation; Scultetus (a Ger man). the author of Armamentarium Chirurgicum; frere St. Cosme, commonly known as frere Jacques, a French monk, who considered himself specially commissioned by heaven to cut for stone, and who has the merit of having converted the tearing into a cutting operation; Rau of Leyden, one of the most successful lithotomists of any age, and a pupil of frere Jacques; and Roonhuysen, who divided the sternomastoid muscle for wry-neck, and may thus be regarded as the inventor of tenotomy. The 18th c. pro duced, in England, White, the originator of excision of joints; Cheselden and Douglas, famous as lithotomists; Percival Pott, John Hunter, and Hey of Leeds; in Scotland, )Ionro, Benjamin Bell, and John Bell; in Ireland, O'Halloran and Dense; in France, Petit and Desault—the former celebrated for his work on diseases of the bones, and the latter distinguished for his improvements in surgical instruments of various kinds: in Germany, Richter and the illustrious Haller; and in Italy, Lancisi, Morgagni, and Scarps. Moreover, in this century (1784) the royal college of surgeons in Ireland was founded. Never was surgery so brilliantly represented as during the present century. The London medical schools can point with equal pride to the names of Abernethy, Blizard, Brodie, Astley Cooper, Dalrymple (the oculist), Earle, Guthrie and Hennen (the great military surgeons), Aston Key, Liston, Stanley, Travers, Tyrrell (the oculist), Ware (the oculist), James Wilson, and many other nearly equally celebrated surgeons of au earlier date; and to the more recent ones of Arnott, Bowman, Erichsen, Fergusson, Prescott Hew ett, Hilton, Lane, Lawrence, Luke, Paget, Spencer Wells, and a host of others. In Edin burgh were sir Charles Bell, Lizars, Miller, Syme (whose name will ever be associated with a special amputation of the foot, and with the operation for stricture), and Simpson, dis coverer of the application of chloroform to surgical practice. Among the most recent inno vations and improvements in surgical practice may be mentioned the practice of a nteseptis surgery, with which the name of Joseph Lister is so worthily associated. The principle of prof. Lister's method consists in the exclusion of septic matter—usually existing in the form of germs, and derived from the atmosphere—from raw or wounded surfaces. Wounds are dressed under carbolic acid spray, and with other preparations of this and other antiseptic substances, care being taken in dressing the wound to exclude ordinary atmospheric air. The results of this practice have been on the whole surprising; and recoveries from many serious operations have taken place in remarkably short periods, and with an absence of suppuration and other secondary effects of the inflammatory process. Among the surgical celebrities of Dublin must be mentioned Peile, the inventor of Peile's lithotome and staff; Todd (the father of the late eminent Dr. Todd, of Lon don), who was the first to successfully revive the treatment of aneurism by compression; Colles, the first to describe the fracture known as Colles's fracture of the radius; Car michael, distinguished for his opposition to the indiscriminate use of mercury in syphilis; Bellingham, and Hutton, whose names are associated with the full development of the revived treatment of aneurism by compression; Cusack, Porter, McDowel, and sir Philip Crampton; Adams (well known for his treatise On the Diseases of the Joints, and Chronic Rheumatism), R. W. Smith (celebrated for his researches on fractures and neuroma), and Jacob (the discoverer of the membrana Jacobi). It would be impossible to mention a tithe of the names of those who have attained high surgical celebrity in the provinces during the present century. The barons Dupuytren and Larrey, and MM. Aniussat, Chassaignac, Civiale, Brasdor, Broca, Desmarre (the oculist), Nelaton, Roux, Sichel the oculist), Velpeau, etc., have honorably sustained the reputation of French surgery. Beer (the oculist), Chelius, Dieffenbach, Von GlIfe (the oculist), Gurlt, Jager (the ocu list), Langenbeck, Stromeyer, and Wiitzer, constitute but a small portion of the eminent surgeons of Germany. Callisen of Copenhagen, Porta of Pavia, and Perogoff of St. Petersburg, may be taken as the surgical representatives of their respective countries. Among American surgeons, the names of Valentine Mott, the 'Warrens, Marion Sims, and Gross deserve special notice. To understand what surgery now is, and to trace its recent progress, the reader should study the standard surgical treasures of Erichsen, Fer gusson, Miller, and Syme; and the comprehensive and most valuable System of Surgery, edited by Mr. Holmes, and contributed to by many of the most eminent authorities on surgery. He will also do well to read Fergusson's Lectures on Conservative Surgery, and Syme's Address on Surgery, delivered before the members of the British Association in Aug., 1865.
With the increase of knowledge, specialities naturally develop themselves; and such has been the case in surgery. The diseases of the eye, the diseases of the ear, the diseases peculiar to women, the diseases of children, and deformities (the treatment of which is termed orthopedic surgery), more or less separate themselves, at least in large towns, from general surgery, and constitute special departments, of which dentistry may be considered one; as most of the eminent dentists of the present day are regularly edu cated and qualified surgeons.
It is deserving of record that within recent years nearly all the British universities have commenced to give surgical as well as medical degrees.
For further information on the history of surgery, the reader is referred to the old histories of Le Clerc (Geneva, 1696) and Freind (Lond. 1725), to Moir's Outlines of the Ancient history of Medicine, to Sprengel's voluminous history of Medicine (in German), and to the admirable " Historical Notice of Surgery" in the late prof. Miller's Principles of Surgery, from which we have borrowed many of . the details incorporated in this article.