SURGERY, History of General. The his tory of medicine, fascinating at all times, is most valuable to the surgeon when applied to the subject of general surgery. At the present time there is much in the literature of medicine that is very instructive and it becomes more and more so as we are put in possession of facts pertaining to prehistoric man and of those presented in the study of manuscripts ante dating the Christian era.
Skulls of the prehistoric period have been discovered in caves and dwelling-places which show undoubted evidence that trephining had been performed on them and that healing of the bone had later taken place. The examina tion of these specimens is exceedingly interest ing. Again, as we study the periods between this age and the beginning of the Christian era We note a great deal that leads to the convic tion that surgery was understood in those times. The early embalmers, in their famili arity with the human body, must have acquired some knowledge of surgery, and this as far back as 1700 B.C.
While medicine as a profession was con fined to the duties of the priest, surgery suf fered,.and was more and more neglected. His torians of that time have just reason to con demn Egyptian surgery. There are some very excellent books appearing at the present time giving a full description of what little was known, bestowing full credit upon those who practised surgery, or advocated it, and who were making some progress in that branch of medicine. The Egyptians were proud and fond of their work as scribes or writers, their learn ing in that direction leading them to advise their sons to take up what was then known on the subject of medicine; but very little seems to have been developed in the way of clinical observation, or, more particularly, in surgical procedure.
In the study of medicine by the Hindu one cannot but note that in their writings there is plain evidence that surgery had reached an ad vanced stage. "Surgery;' says their great Susruta, "is the first and highest division of the healing art, least liable to fallacy, pure in itself, perpetual in its applicability, the worthy produce of heaven, the sure source of fame on earth." He also makes the very excellent ob servation that "he who knows but one branch of his art is like a bird with one wing." This writer was a very careful observer and beyond doubt did much to advance the art of surgery centuries before the birth of Christ. Some of the Hindu works and operations are yet spoken of by modern writers. They knew how to per form successfully the operation of developing a new nose by flaps taken from the forehead and were familiar with liice procedures. The sur gery of ancient India is worthy our most thorough and careful investigation. Great in terest is being manifested in its study and there can be no doubt that good will result from the recent organization of the Charaka Club in New York. This body of investigators bids
fair to give us papers of great value in the elucidation of that period when Hindu sur gery developed — and, it may be said, ceased. Why it disappeared so mysteriously has never been shown.
Through the study of manuscripts of suc ceeding centuries, and of other records of dif ferent peoples, one is greatly impressed with the difficult operations performed, now and then, by some predominating man, who, per haps having more knowledge of the anatomy of the human body, and being somewhat bolder than his fellows, would perform an operation, leaving a report of possible success. Then for centuries this work would be forgotten, then revived, perhaps modified. Possibly to the operator it was a new operation (since he was not aware that it had been performed pre viously), yet to be developed into a line of work that was to lead to greater success. Thus we see reported very important advances in the line of surgical procedure from our earliest knowledge on.
The early Greek knowledge of surgery is not so apparent or abundant as that of later periods, yet Homeric medicine gives endorse ment to the fact that there were surgeons capable of rendering aid in emergencies, such as the removal of foreign substances from the body, and who were able to control bleeding by the application of what were evidently under stood to be drugs possessing some styptic power and to bind up and dress wounds. Even fractures and dislocations were treated. In time of war these men were looked upon with reverence and the aid they were expected to render was highly valued. Of their real work there is little known before the Trojan War. The most observing student of cases in antiquity was Hippocrates (q.v.) born 460 s.c. He wrote on the treatment of articulations, luxations, fractures and also on the subject of the use of instruments, but his knowledge of anatomy must have been very meagre. The Greeks had great respect for their dead, which prevented dissection of the human body. They knew nothing of physiology and, therefore, anatom ical structures, such as arteries, veins, nerves, tendons, ligaments and membranes were hope lessly confused. Hippocrates gave classifica tions not unlike those of the present day, *in ternal medicine* and or surgical medicine,* which were convenient, but not philosophical. The period of his life marked the transition from mythology to history. His doctrine and clinical observations were received with great respect. He advanced the science and art of surgery, but only a little later ignorance again reigned in the school which he made celebrated.