The first important work on minor surgery appeared during the 14th century. It was wnt• ten by Lanfranc, but although it grew into a second and larger treatise, surgery soon after this began to decline, The barber-surgeons of this time seemingly commanded considerable at tention, although it is evident that the im portance of this body of mett has been greatly exaggerated.
From the 15th century through the 19th surgery developed more and more as a science. In England, Thomas Linacre of Canterbury (1460-1524) was one of the earliest writers. Jerome Fabricius (1537-1619) was also a noted writer and authority on the practice of sur gery during this period. Benivieni during the same period was, according to Malgaigne, the first to impress upon the profession the ult. portance of searching in the cadaver for the concealed cause of disease. His observations on gall-stones and conveyance of syphilis from the mother to the fcetus were original.
Notwithstanding the progress in surgical science during the 15th and 16th centuries, the practice of surgery was largely abandoned to a class of ignorant barbers and bone-setters. Most of these operators traveled from city to city, individual practitioners limiting themselves to the operation for stont or for hernia. This condition of affairs, together with the prejudice against dissection, was most unfavorable for the profession of surgery.
France at this time presented the only spe cial college for the instruction of surgeons. To the 16th century belongs the career of that most wonderful surgeon, Ambroise Pare. He was an original thinlcer, had the courage of his convictions and did away with the use of the cautery and boiling oil in amputations, using ligatures to control hemorrhage, the latter being the most ithportant advance until the introduc tion of ether in 1&46 (see ANZSTHETICS ). At the 'beginning .of the 17th century surgery reached a higher social and intellectual plane than it had heretofore occupied. Atnphitheatres for dissection developed in many European cities, together with hospitals and dispensaries in connection with the various schools. The term *inflammation') was then introduced and from that time until the present day has been a subject for continuous investigation. From this period may be dated the beginning. of con sultation work between expert practitioners; and clinical teaching and the presentation of surgical cases then advanced their claims. Sur gical history from Valsalva on presents the names of many who became eminent operators, and in their writings did much to advance the art of surgery. Notably was this so among the Italians, who in their plastic surgery de veloped the Italian method for construction of a new nose.
In France, Morel (1674) invented the tourni quet, Denis performed the first transfusion of blood in man and other French surgeons be came very expert in the operation for lithotomy. Mareschal (1658-1736) had a record of eight lithotomies performed in half an hour. He was one of the founders of the French Acad emy of Surgery.
In Holland, Rau (1658-1719) taught prac tical surgery upon the cadaver.
Wiseman (1625-136) was the first to develop English surgery. He was also the first to do external urethrotomy for relief of stricture. At this time in France alone was instruction in surgery well regulated, as it was the only coun try which possessed a proper surgical college.
In the 18th century hospitals began to mul tiply in Germany, benefiting general surgery to a great extent. Brasdor (1721-76) developed the method of distal ligation of aneurisms, while Sabatier (1732-1811) wrote a treatise on operations and reconunended resection of the head of the humerus. DeSault and Chopart did much in developing operative surgery. In Italy Scarps (1752-1832) advanced our knowledge of hernia and aneunsms. Spanish surgeons did little to improve the science and art of surgery. In England, Clieselden (1688-1752) did much in advancing the knowledge of pathology and general surgery. White, of Manchester, devised a method of reducing dislocations of the hu merus with the foot in the axilla. A well-de fined operation for excision of the joints was also first practised in England. The investiga tion of pathology and diagnosis in France at this time had much to do in the 19th century in developing the ((new Vienna School?' Percival Pott (q.v.) did much in elaborating and classi fying diseases of the joints and especially spinal diseases. John Hunter (q.v.) was the most famous English surgeon of his day. He be longed to a family which in many ways assisted the development of pathological anatomy and surgical technique. At the close of the 18th century, Benjamin Bell was the first to make use of drainage by means of tubes of lead or silver. In France, Bichat (q.v.), although not generally so understood, became a forceful lecturer on surgery and did much to bring hos pital-gangrene under observation and control. The Dutch during the 18th century developed some eminent surgeons, and it is interesting to note how dextrous they became in the use of instruments. At the same time their knowl edge of anatomy enabled them to present some very able papers on the subjects of hernia and dislocation. Sandifort, of Leyden, first de scribed a downward dislocation of the femur.