486 SURGERY two great leaders of the medical school of that university, if it may be so called, were eminent both as physicians and surgeons ; with them commenced the practice of human dissections. The extirpation of the spleen, and the application of remedies direct to scir- rhosities and tumors of that viscus and of the liver, were among the bold operations of Era- sistratus. To him also belongs the invention and application of the catheter in cases of re- tention of urine. The pupils of these eminent surgeons invented bandages of peculiar forms, and introduced the tourniquet and contri- vances for reducing dislocations of the femur. One of them, Ammomus, employed an instru- ment for lithontriptic purposes, anticipating Civiale's process. Rome in the first 700 years of its history produced no surgeon of note. Celsus, who flourished about the beginning of the Christian era, was the greatest of the sur- geons of ancient Rome, and his observations on injuries of the head, on cataract, on the ligature of wounded arteries, hernia, lithoto- my, fractures and dislocations, amputations, and carbuncle, show considerable knowledge. Aretaeus, the first to use the cantharides blis- ter, Heliodorus, Rufus the Ephesian, all of whom flourished between A. D. 50 and 120, and after them Antyllus, added to the surgical knowledge of the time new views of the treat- ment of injuries of the head, the resort to arteriotomy instead of venesection in sudden emergencies of inflammatory action, bronchot- omv in some acute diseases of the throat, the radical cure of hydrocele by free incision of the parts, and a more thorough investigation of diseases of the kidneys and bladder. Galen devoted more attention to medicine than sur- gery, but his observations on hernia, on luxa- tion of the femur backward, and on the appli- cation of the trephine to the sternum in em- pyema, are of importance. In the early period of Christianity surgery languished; the early Christians opposed dissection as strongly as the pagans, and by attributing the power of healing wounds to martyrs and their relics dis- couraged all efforts at improvement in surgical science. The first eminent name among the surgeons of the dark ages is Aetius (500 to 550), whose surgical writings are numerous and valuable. He practised scarification of the extremities in anasarca, operated for aneurism, endeavored to dissolve urinary calculi by in- ternal remedies, discussed hernia with great ability, and wrote on encysted tumors, inju- ries to nerves and tendons, diseases of the eyes, &c. Alexander of Tralles, a younger contemporary of Aetius, wrote treatises, now lost, on diseases of the eye and on fractures, which were highly commended for their ori- ginality by some of his successors. Paulus ^Egineta, in the 7th century, was a surgeon of eminence and considerable originality. His sixth book has been considered by many as the best body of surgical knowledge prior to the revival of letters. lie recommended topi- cal in preference to general bleeding, as more effective in reducing local inflammation ; re- sorted to copious venesection to accelerate the painful descent of calculi through the ureters ; opened internal abscesses with caustics ; de- fined the points for performing paracentesis in ascites ; made his incision in lithotomy on one side of the raphe instead of the centre as Celsus had recommended ; practised both laryngotomy and tracheotomy, the latter as a means of carrying on respiration during oc- clusion of the larynx ; treated of fractures of the patella ; and was the originator of the ob- stetric operation of embryotomy. The Ara- bian physicians, who rose into distinction as those of the West declined in reputation, did little for surgery. Rhazes (about 900) described for the first time spina ventosa and spina bifida, cauterized the wounds from the bites of rabid animals, opposed the use of the knife in can- cer except when limited and when the Avhole tumor could be removed, and gave a clear and satisfactory description of the treatment of hernia. Avicenna (died about 1036) intro- duced the flexible catheter. Albucasis (died about 1106) introduced an instrument for the cure of fistula lachrymalis, invented the pro- bang, and in wounds of the intestine practised union of the divided parts by suture with suc- cess. In Catholic Europe medical practice and what of surgery remained was mostly in the hands of the clergy until, by the edict of the council of Tours in 1163, they were interdicted from all surgical practice. The Jews were at this period and for a century or two later in- high repute as physicians, but they seem to have had a dislike to surgery. Guy de Chau- liac, a priest, compiled from the Greek and Arabian authors the earliest work of modern times on surgery, but with very little judg- ment of what was worth retaining. For two centuries and more surgery was mainly in the hands of the illiterate barber surgeons. The revival of surgical science dates from the ap- pearance of Vesalius (died 1564) as a teacher of anatomy in Italy, followed soon after by Fallo- pius and Eustachius. Surgery was then for the first time put upon a sound and scientific basis, that of careful dissection, and Ambroise Par6, a French army surgeon who had educated him- self in anatomical science, was the first of its great lights. He was surgeon successively to four Kings of France, and was attached to the French armies as surgeon-general down to 1569. To him we owe the revival and improvement of the practice of tying the arteries after op- erations or wounds, instead of cauterizing them with hot iron or boiling oil. The pupils of Pare added little lustre to their master's name ; but in Italy at the close of the ICth century Fabricius ab Acquapendente flourished at Pa- dua, and His Opera Chirurgica, the first really valuable treatise on surgery of modern times, passed through 17 editions. He was the pre- ceptor of Harvey. Wiseman, sergeant sur- geon to Charles II., was the first eminent sur-
