SURGERY 487 gical writer and practitioner in England. His recommendation of immediate amputation in military practice, when the preservation of the limb was impossible, has been followed from that time to the present. He left eight trea- tises on surgery, which are not without value even at the present day. The flap operation in amputation is claimed for James Young, an English surgeon contemporary with Wiseman, and also for two French surgeons, Verduin and Sabaurin, of the same period. In Ger- many during this century, Hildanus, Scultetus, Purmann, and Heister were the principal sur- gical writers and practitioners. In Italy the principal names of note toward the close of the 16th and in the 17th century were Talia- cotius, the originator of the restorative surgery in Europe ; Caesar Magatus, who greatly sim- plified the treatment of wounds ; and M. A. Se- verinus, who banished the salves and plasters which in Italy had usurped the place of opera- tions. The 18th century witnessed a still greater advance in the science. In England, Percival Pott, well known for his investigation of that form of caries of the vertebra known by his name (see SPINAL DISEASES), and the most judicious writer of modern times on fractures, amptitations, injuries of the head, and diseases of the spine; John and William Hunter, the former the greatest master of the principles of surgery in the profession ; Cheselden and Douglas, both famous as lithotomists ; and the two Monros, father and son, are among the great names of the surgical profession. In France flourished La Peyronie, at whose in- stance Louis XV. in 1731 founded the acad- emy of surgery ; Jean Louis Petit, the greatest French surgeon of the 18th century; Ledran, Garangeot, and the illustrious Desault, the ori- ginator of clinical surgical instruction and the inventor of numerous admirable apparatuses for the treatment of fracture. Among the cel- ebrated surgeons of other European countries were Molinelli, Morgagni, Scarpa, Bertrandi, and Moscati in Italy; Deventer, Albinus, and Camper in Holland; and Platner, Roderer, Rambilla, Theden, and Richter in Germany. During the 18th century the ligature of aneu- rismal arteries of large size, the treatment of hernia and fistula in ano, the cure of fistula lachrymalis, and the skilful manage- ment of dangerous and difficult parturitions, were the most important branches of surgery in which fliere was a material advance from the preceding century; the proper construc- tion of instruments also received great atten- tion. The 19th century has, however, done more for the improvement of this science than all the centuries which have preceded it. In England, Abernethy, Sir Astley Cooper, Listen, and others of the highest reputation have passed away, and others hardly less eminent remain ; in France, Dupuytren, Roux, Lisfranc, and Larrey have had no superiors either before or after them. The following may with propriety be particularized as among the improvements of the age in surgery: the introduction of anaesthesia; resection of the bones at the joints ; the preservation of the periosteum and conse- quent development of new bone ; partial am- putations of the foot, as instanced in the op- eration of Lisfranc for the removal of the meta- tarsus, and of Chopart, Symes, Malgaigne, and Pirigoff for disarticulation of tarsal bones ; the amputations at the thigh and shoulder joints ; the ligature of arteries within the trunk and immediately at their departure from it; the resection and removal of portions or even the whole of the upper or lower jaw ; the opera- tions for cleft or deficient velum palati or pala- tine vault ; the opening by longitudinal section of the air passages at different points to avoid asphyxia; the resection and extirpation of the uterus, of the ovaries, and of the lower por- tion of the rectum; the introduction of the silver suture, especially in operations on the viscera, as for recto-vaginal and vesico-vaginal fistulse; the adoption of the immovable ap- paratus for fractures ; the processes for reme- dying disunited fracture; the substitution of milder means for the trephine in all except the most serious cases; the improved treatment of ulcers and abscesses; the cure of the most formidable aneurisms by the ligature of the carotid, subclavian, axillary, humeral, and ex- ternal and internal iliacs; the treatment of varicose veins ; the successful treatment of cal- culus by lithotrity, in consequence of the great improvements made in the processes and in- struments; the diagnosis and treatment of tumors, whether encysted, fatty, vascular, or malignant; the cure of strabismus, and the generally improved treatment in diseases of the eye, including the invention of the oph- thalmoscope by Helmholtz in 1851, and the reformation of ophthalmic medicine and sur- gery carried on by Von Graefe, Donders, Bow- man, Toynbee, Wilde, Von Troltsch, Politzer, and others; the restorative processes, by which the nose, lip, and other parts are re- formed from adjacent tissues; the treatment of harelip and of club-foot; and the notable advance consequent upon the conservative treatment of gunshot and other wounds of the brain. As from the nature of their duties suits for malpractice are more often brought against surgeons than against physicians, it will be appropriate here to speak of their legal obligations, though the same laws apply to practitioners in any of the branches of medicine. In undertaking the treatment of a patient, the surgeon enters into a legal obligation and as- sumes legal liabilities, which, though seldom expressly defined, are yet, in the apprehension of the law, fixed and certain. The law holds that he contracts for the possession of that rea- sonable degree of learning, skill, and experi- ence which the members of his profession or- dinarily possess. Those also who, like oculists, aurists, or dentists, claim to be particularly conversant with and skilful in the treatment of the diseases of single organs, must be held
