More concluding, it becomes necessary to make a few observatioiis on the changes or revolutions which have taken place in the practice of the pro fession. At the beginning of medicine, all its de partments were practised by one individual, and it is evident that it was from Hippocrates's universal knowledge he so excelled, and it could have been only from a conscientious feeling of the difficulties attendant on lithotomy, that he separated it from the surgery he wrote upon and practised. Sur gery appears then to have been first partially sepa rated from medicine, which circumstance must have contributed to degrade it, as the physicians retained whatever was scientific. It appears to have continued in the most degraded condition un til the time of Celsus, who, from his writings, em bracing both departments, and evidently practising both, and since he was the companion of the first men in Rome, he must undoubtedly have raised sur gery to a high rank in the estimation of the public. In consequence of surgery having no natural foun dation at Rome, dissection of the human body being proscribed, it gradually degenerated, and particu larly after the suppression of the Alexandria school, when it was again separated from medi cine. It is presumptive from the scattered frag ments collected by Galen and Ccelius Aurelianus, that surgery must have arrived at great perfection, and been held in high estimation during the flourish ing state of that school, when dissection was publicly sanctioned by the government. It is evident from the history of surgery, that it has only flourished according as it has been founded on anatomy, and enriched with medicine or pathological doctrines. At its dawn it was combined with medicine, and in the days of Celsus, Herophilus, Erasistratus, and Galen, it was also united with medicine and founded upon anatomy. After this period, when anatomy could only be prosecuted by stealth, sur gery continued in a truly degraded and insulated condition, and in the llth century was stigmatized by the council of Tours. In' the 12th century, the school of Salernum, and also that of Naples, re quired only one year's study of anatomy for the di ploma of a surgeon. In the 15th century we find the great Pare still a barber surgeon, and controlled frequently by the physicians. At Oxford and Ed inburgh, the two first universities io Great Britain, anatomical chairs were not established until the last century, and at neither school was dissection prosecuted until this century, and that only at Ed inburgh ; and even yet throughout Great Britain, the study of anatomy is only prosecuted by stealth ; in many schools on the continent, however, its study is sanctioned by the governments, so that it has only been at the dawn or medicine, and in the present era, that surgery has been blended with physic and rendered a respectable profession ; and it is much to be regretted there exists any separation, since it only tends to degrade each department ; as physi cians must be occasionally consulted in accidents, the province of the surgeon ; and the surgeon, again, must be acquainted with the treatment of fever occurring from operations. All, therefore, ought to have the same elementary education, and be able to practise every department. The operat ing surgeon ought to dissect daily. Lately the col lege of physicians of Edinburgh have wisely re scinded a law, which prohibited their fellows from using the lancet or the scalpel. '' Etenim omnes artes," says Cicero, " qux ad humanitatem perti nent, habent quasi vinculum communem." .firrangement.
The arrangement of the different surgical affec tions nosologically, is not so essentially necessary in this place, as it has been already done under the article Medicine, for surgery ought not to be sepa rated from Physic. " La science de l'homme mal ade constitue un tout indivisible." The classification, according to the textures af fected, is objectionable, on the ground that one dis ease affects many structures, and frequently pro ceeds from the one to the other, it has been founded on the healthy division of the textures which has been carried to an extreme, and such has been the baneful influence of Bichat's divisions, that his fol lowers in the treatment of disease have conferred as many lives upon man as the vulgar attribute to the cat. The arrangements adopted by Bell, Boyer,
Richerand and Allan are all arbitrary.
As Pathology, and even the doctrines of inflam mation have been elaborately detailed under the article Medioi-ne, it is unnecessary to describe them here, particularly when we take into consideration the narrow limits allowed us to include so compre hensive a system as that of surgery. The chief ob ject which shall be kept in view shall be a practi cal detail of surgery, the grand aim to which all our attention ought to be directed.
We shall first treat of inflammation, a disease which more or less follows all the operations of surgery. Inflammation is a term familiar in com mon language, and is derived from inflammo, to burn or inflame, an expression applicable enough, when we consider the kind of pain excited by a very violent degree of it, and the ideas formerly enter tained of the temperaments of our bodies. Inflam mation is evinced by pain, increased heat, redness. and swelling, which are caused by a morbidly in creased action of the nerves, arteries and veins ; and in poisoned wounds, the lymphatics are also involved. The nerves are first thrown into action, which instantly excite the contiguous arteries and veins, and as inflammation increases, the excite ment extends to the brain and heart. The pain and heat are more dependent upon nervous than ar terial action ; in very slight degrees of inflamma tion, arising from some trifling injury, a sensation of warmth is only felt, in which case it is not com pletely established, since the phenomenon resem bles more an increased healthy action. When inflammation is fully developed from a more se vere injury, there is a thrilling pain and intolerable sensation of heat at the moment of receiving it. And if the inflammation be so severe as to threaten mortification, the pain is insufferable. The degree of pain seems proportionate to the distribution of the nerves, and to the density or unyielding nature of the structure affected, which prevents the ex pansion of the nerves, as is evidenced in toothache, diseases of the bones, &c. To prove that increase of heat is also consequent chiefly on nervous action, a sensation of warmth is experienced instantly af ter the infliction of the pain, and if a severe blow or wound he received, the sensation of heat is in tolerable at the moment of the injury ; and not until the inflammation has lasted for some time, does the increased quantity of blood contribute to form the increased heat. The redness is caused by the ar teries carrying red blood becoming enlarged in their calibre, and conveying more, for the con tractility of the arteries is soon enfeebled by over action, and also by those arteries which pre viously conducted pale blood or lymph, becoming enlarged and transmitting coloured blood. The capillaries, and communicating vessels between the arteries and veins, and even the commencements of the veins themselves, are similarly dilated. The blood flows with increased velocity, which is caused by that part of the artery which is immediately con tiguous, or leading to the inflamed or dilated por tion, being morbidly excited.
The artery of an inflamed part therefore is at first smaller than during health, in consequence of the spasmodic action of the nerves, and the disten tion of the vasa vasorum, diminishing the calibre of the vessel, but it very soon becomes enlarged, from the nerves being partially exhausted and the vessel over distended with blood ; while the por tion leading to the inflamed part is contracted in diameter. The swelling is first caused by the in creased quantity of blood circulating in the blood vessels affected, and secondly, by a deposition or effusion of coagulable lymph, which appears to oc cur very early in inflammation. In what is termed the phlegmonous inflammation, of which a common whitlow is a good example, there is generally more or less throbbing present, which is solely caused by the pulsation of the inflamed arteries.