656
SURGERY.
he does not mention their being at all consulted. Nay, what isstill more strange, though he sometimes mentions his heroes hav-ing their bones broke, he never takes notice of their being reducedof cured by any other than supernatural means ; as in the case of.(Eneas, w hose thigh-bone was broken by a stone cast at him byDiomed. The methods which these two famous surgeons used incuring the wounds of their fellow-soldiers seems to have been theextracting or cutting out the darts which inflicted them, and ap-plying emollient fomentations or styptics to them when necessary ;and to these they imuoubtedly attributed much more virtue thanthey could possess as appears from the lines, w here Homer de-scribes Eurypyliis as wounded and under the hands of Patroclus ,who would certainly practise according to the directions of thesurgeons. Till the days of Hippocrates we know very little ofwhat was the practice of the Greek surgeons. From him, how-ever, we learn, that the practice of blood-letting, cupping, andscarification, was known to them ; also the use of warm and emol-lient fomentations, issues made with hot irons, pessaries, injections,fumigations, &c. Hippocrates also gives directions with regard tofractures, luxations, ulcers, fistulas. He directs the extension, re-duction, bandages, and splints, proper l<> be used in fractures andluxations of different bones, with several machines to increase theextension when necessary. Surgery appears not to have existed inRome , notwithstanding the warlike genius of the people, formore than 500 years. Archagalhus, a Greek, was the iirst profes-sor of that art in the city ; and so frequently employed the knife,hot irons, and other cruel methods of cure, that lie was brandedwith the opprobrious title of carnifex, and expelled the city,where no physician or surgeon of eminence made his appearancefor 180 years. At this time Asclepiades undertook the professionof medicine; but seems to have dealt little in surgery. Neitherhave we any thing of importance on that subject till the time ofCelsus, who flourished under Augustus and Tiberius. In Celsus ’ssurgery, all the improvements from Hippocrates to his own daysare collected ; the most minute and trilling diseases are not omit-ted, and he is very minute in describing diseases of the differentparts of the body, and in prescribing a multitude of remedies andapplications, 'lhe last writer of consequence who nourished atRome was Galen, physician to the emperor Marcus Am elins. Hisworks are for the most part purely medicinal; although he wroteelso on surgery, and made Commentaries on the Surgery of I lip-pocrates. He opened the jugular veins, and performed arterio-tomy at the temples; directed leeches, scarification, and cuppin.;-glasses, to draw blood. lie also described with accuracy the dif-ferent species of hernix or ruptures. Aetius flourished, A. 1).500. In his works we meet with many observations unnoticed byCelsus and Galen , particularly on the surgical operations, thediseases of women, the causes of difficult labours, and modes ofdelivery. lie also takes notice of the dracuncuUis or Guineaworm. Aetius , however, is greatly excelled by Paul us iKgineta,who flourished in 640; whose treatise on surgery is superior tothat of all the other ancients. From the time of Paulus TEgmetato the year 900, no writer of any consequence, either on medicineor surgery, appeared. At this time the Arabian physicians llhazesand Avicenna revived in the east the medical art, which, as wellas others, was almost entirely extinguished in the west. About thebeginning of the ]6th century, surgery was held in contempt inthis island, and was practised indiscriminately by barbers, farriers,and sow-gclders. Barbers and surgeons continued 200 years after,to be incorporated in one company in London, Paris, and Edin-burgh. In Holland and some parts of Germany , even at Ibisday, barbers exercise the razor and lancet alternately. Till solate as 1720, the surgeons and barbers of Edinburgh formed butone incorporation ; but after a process at law, they were separatedby decreet of the Court of Session ; and the surgeons were foundentitled to retain the charter and privileges. See Barbers . Thesurgeons have ever since ranked as the first of the 14 Incorpora-tions; and send their Deacon , or Prxses, annually or biennially,to represent them in the town-council. The surgeons of Edin-burgh also form a Royal College; and have an elegant hall and afine library in Surgeon ’s Square. It is within the last three cen-turies, that we have any consult ruble improvement in surgery,which, during the 17th century, was enriched with severalsystems, and with detached or miscellaneous observations. . Theprincipal authors are, M. A. Severinus , V. Vidius, R. Wiseman,
9
he Clerc. J. Scultelus, J. Matigetus, C. Mugatus, Spigelius, F.li.ldanus, T. Bartholin, and P. de Marchett,
For the cure of wounds , the ancients imagined balsams, thejuice o herbs, &c. to be a kind of specdics. In after-ages, and incountries where balsams are not easily procured, salves have beensubstituted in their place ; and there are many who still reckon asalve essentially necessary for healing the slightest cut. It is cer-tain, however, that the cure of wounds cannot be effected, nay',not even forwarded in the least, by ointments, unless in particulari ascs, or by accident. That power which the human frame hasof repairing the injuries done to itself, which by physicians is calledvis medicatrix natura-, is the sole agent in curing external injuries;and without this the most celebrated balsams would prove ineffec-tual. But this power, this vis medicatrix, is not an imaginary orideal power; it exists in the blood, which is the principal of life,and possesses this medicating or healing power, in every animalthat is in a state of lniaith. When a wound has been made witha sharp instrument, and is not extensive, if it be immediatelycleaned, and all the extravasated blood sucked out, (See J. Bellon Wounds , part I. Disc. v. p. 215,) it will almost always heal bythe lirst intention Si a very short time. Indeed the cures per-formed by this simple process are so surprising that they would beincredible were we not assured of their reality. When this pro-cess is either neglected, or proves unsuccessful by improper treat-ment, there are three stages to be observed in the cure of awound ; the lirst, called digestion, lakes place when the ends ofthe wounded vessels contract themselves, and pour out tiie liquorwhich is converted into pus. As soon as this appears, the secondstage, in which the flesh begins to grow'up, lakes place ; and asthis proceeds, the edges of the wound acquire a fine bluish or pearlcolour, which is that of the new skin beginning to cover thewound as far as Hie flesh has tilled it lip. This process continues,and the skin advances from all sides towards the centre, which iscalled the cicatrizing of the wound. For the promoting of eachof these processes, several ointments were formerly much in vogue.But it is now found, that no ointment whatever is capable of pro-moting them, but rather retards the cure ; and that it is only ne-cessary to keep tiie wound clean, and to prevent the air from hav-ing access to it. This, indeed, nature takes care to do, by co-vering the wound with a cake of coagulated blood ; but if a wound'of any considerable magnitude should be left entirely to nature,the pus would form below the crust of coagulated blood insuch quantify, that it would most probably corrupt, and thewound degenerate into a corroding ulcer. It is necessary,therefore, to cleanse the wound frequently ; and for this pur-pose it will be proper to apply a little ointment spread on softscraped lint. For the first dressing, dry lint is usually applied, andought to be allowed to remain for two or three days, till the pus isperfectly lormed ; after which the 'ointment may be applied asjust now directed; and, in a healthy body, the wound will heal'without furtlier trouble. As to the ointment employed, it is ahmost indillerent what it be, provided it lias no acrid or stimulatingingredient in its composition. Although, in general, wounds tintseasily admit of a cure, there are several circumstances which re-quire a different treatment, even in simple divisions of the fleshyparts, when neither the membranous nor tendinous parts are in-jured. These are, 1. Where tiie wound is large, and gapes verymuch, so that if allowed to heal in the natural way, the patientmight he, greatly disfigured by tiie scar. It is proper to bring th elips of the wound near to each other, and to join them either byadhesive plaster or by suture, as the wound is more superficial,lies deeper. ■ 2. When foreign bodies are lodged-in -the wound,^when a cut is given by glass, &c. it is necessary by all meansextract them, Before the wound is dressed ; for it will never hqa*until they are discharged. When these bodies are situated i 11such a manner as not to be capable of being extracted without la-cerating the adjacent parts, which would occasion violent pain an*-,other bad symptoms, it is necessary tp enlarge the wound, so lb®,these offending bodies may lie easily removed. This treatment*however,, is chiefly necessary in gunshot-wounds. 3. When lb®wound is made in such a manner that it runs for some length b e 'low the skin, and-the bottom is much,lower than the orifice, th
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