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SURGERY 177 SURGERY 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 (Haser), 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 .^gineta, 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 The earliest mediaeval writer^ in surgery were Italians, superseded in the 14th century by the French, while the same period witnessed the first English, Dutch, and German books on the subject.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 mediaeval 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 Pare' (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. Come 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