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 re mained to the close of the Byzantine period. An intimate knowledge of its modals 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 )Egineta (A. D. 650). Trepanning received several modifications in practice up to Galen's time, while tracheotomy (intro duced 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 the epoch of Celsus assumed the practical development in which it is found during the later empire, Heliodorus, under Tra jan, 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 gen itals, even including syphilis (Fraser), while rectal and anal affections (hemor rhoids, fistula, etc.) were skillfully treated by Leonides (A. D. 200), who seems to have used the ecraseur as well as the knife and the cautery. Large tumors in the neighborhood of great ves sels were untouched by Hippocrates or Celsus, though the latter makes mention of the surgical cure of goiter. Ampu tation after Celsus is described by Archi genes, hemorrhage being obviated by ligature of the great vessels or constric tion of the limb. Flap-amputations were performed by Heliodorus and Leonides. Resection of the humerus, 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 be added here for the medico-mili tary service of that time, afloat and ashore, apparently quite as well organized as the combatant arm. Under the Byzan tine Emperor Maurice (582-602) the cavalry had an ambulance company whose business it was to bring the se verely wounded out of action, and who were provided with water flasks and cor dials to relieve the fainting.
The Arabs borrowed their surgery from the Greeks, chiefly from Paulus IEgineta, 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 memor able 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 medieval 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 cen tury, labored to bridge the chasm be tween surgery and other branches of medicine. For all that, the medieval surgeon in Eastern Europe remained far behind his predecessors of the Roman and Byzantine empires.
With the 16th century we find surgery sharing the advance communicated to every art by the Renaissance, while its practitioners improved their social stand ing. In this the way had been led by Paris with her College of Surgeons (Col lege de St. Come, 1279) , which in the teeth of the university "faculty" con quered the right to create licentiates in surgery. Other qualifying corporations
(in London, for example, and Edin burgh) arose gradually on similar lines. But what crowned the recognition of sur gery 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 Am brose Pars (1517-1590). Galileo, Bacon, and Descartes revolutionized scientific method, among the fruits of which was Harvey's discovery of the circulation of the blood. With the diffusion of juster and more comprehensive notions of struc ture 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 ac cession he made to sound practice, par ticularly in tumors, wounds, fractures, and dislocations. In the 18th century Paris improved on her College de St. Crime by her Academie de Chirurgie, long the headquarters of the highest profes sional and literary culture. England contributed Cheselden and Pott; Scot land, James Douglas, the three Monros, Benjamin Bell, and above all John Hun ter, to the promotion of a more en lightened practice, based on anatomical and physiological research. London, Edinburgh, and Dublin became centers of surgical education, which, by the ad mission of Haser, no continental school, not even Paris, could equal in the sov ereign qualities of sagacity in diagnosis and assured boldness in operation. Prussia came far behind with her Col legium Medico-Chirurgicum in Berlin, and Austria only in 1780 and 1785 ob tained the means of training surgeons of the higher grade, civil and military; while the United States by her school, under Dr. Shippen in Philadelphia, laid the foundation of its subsequent and nobly sustained proficiency.
To the distinguished anatomists Mas cagni and Scarpa in Italy, Breschet and Geoffrey St. Hilaire in France, the brothers John and Charles Bell in Great Britain, the Meckels, Berres, Tiedemann, C. M. Langenbeck in Germany, seconded 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 Miiller, surgery owes the mighty advance she made in the first decades of the 19th cen tury. Of these pioneers some were them selves 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, and Lallemand in France; Lizars, Allan Burns, Liston, and Syme in Scotland; Abernethy, Astley Cooper, Brodie, and Lawrence in England; War ren, Mott, and Gross in the United States; Wattman, Siebold, Walther, Che lius, Langenbeck (already mentioned), Stromeyer, Graefe, and Dieffenbach in Germany; Kern, Pitha, and Linhart in Austria; Pirogoff and Szymanovsky in Russia. Anatomico-pathological mu seums and clinical instruction, displaying a wealth of object lessons impossible be fore, are among the chief causes of the perfection to which the surgical profes sion is rapidly attaining. Add to these 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 dif ficulties surgeons in all the armies per formed operations of marvelous skill and ingenuity.