Charles Creighton and Edmund Owen

“ This was the condition of affairs when Lister in 1860, from a study of the experimental researches of Pasteur into the Antiseptic Surgery. causes of putrefaction, stated that the evils observed in open wounds were due to the admission into them of organisms which exist in the air, in water, on instruments, on sponges, and on the hands of the surgeon or the skin of the patient. Having accepted the germ theory of putrefaction, Lister applied himself to discover the best way of preventing all harmful organisms from reaching the wound from the moment that it was made until it was healed. ”

“ Abdominal dropsy and hydrocele were treated by tapping with a trocar; and varieties of hernia were understood, omental hernia being removed by operation on the scrotum. Aneurisms were known, but not treated; the use of the ligature on the continuity of an artery, as well as on the cut end of it in a flap, is the one thing that a modern surgeon will miss somewhat noticeably in the ancient surgery of the Hindus; and the reason of their backwardness in that matter was doubtless their want of familiarity with the course of the arteries and with the arterial circulation. ”

“ But these excessive refinements do not seem to be generally acceptable, whilst the results of practice show that they are by no means necessary. The careful, the antiseptic surgeon of 1885 is to-day represented by the careful, the aseptic surgeon. The antiseptic surgeon was waging a constant warfare against germs which his creed told him were on his hands, in the wound, in the air, everywhere—and these he attacked with potent chemicals which beyond question often did real damage to the healthy tissues laid bare during the operation. ”

“ The Chinese appear to have been far behind the Hindus in their knowledge of medicine and surgery, notwithstanding Chinese. that China profited at the same time as Tibet by the missionary propagation of Buddhism. Surgery in particular had hardly developed among them beyond the merest rudiments, owing to their religious respect for dead bodies and their unwillingness to draw blood or otherwise interfere with the living structure. Their anatomy and physiology have been from the earliest times unusually fanciful, and their surgical practice has consisted almost entirely of external applications. ”

“ Wiseman was the first to advocate primary amputation (or operation before the onset of fever) in cases of gunshot wounds and other injuries of the limbs. He introduced also the practice of treating aneurysms by compression, gave an accurate account of fungus articulorum, and improved the operative procedure for hernia.
The 18th century marks the establishment of surgery on a broader basis than the skill of individual surgeons of the court and army, and on a more scientific basis than the rule of thumb of the multitude of barber-surgeons and other inferior orders of practitioners. ”

“ Military surgery was the original purpose of the school, which still exists, side by side with the surgical cliniques of the faculty, as the Friedrich Wilhelm's Institut. In Vienna, in like manner, a school for the training of army surgeons was founded in 1785—Joseph's Academy or the Josephinum. The first systematic teaching of surgery in the United States was by Dr Shippen at Philadelphia, where the medical college towards the end of the century was largely officered by pupils of the Edinburgh school. ”

“ But while some surgeons were thus ceasing to apply the antiseptic spray to the wound during operation, others were pouring mild carbolic lotion, or a very weak solution of corrosive sublimate (an extremely potent germicide) over the freshly-cut surfaces. These measures were in turn given up, to the advantage of the patient; for it was hardly to be expected that a chemical agent which was strong enough to destroy or render inert septic micro-organisms in and about a wound would fail to injure exposed and living tissues. ”

“ As years went on, surgeons tried to simplify and improve the somewhat complicated and expensive measures and dressings and chemists were at pains to supply carbolic acid in a pure form and to discover new antiseptics, the great object being to get a non-irritating antiseptic which should at the same time be a powerful germicide. ”

“ As to the other authorities, although we will occasionally have to explain their opinions upon particular subjects, no one has treated of surgery in a systematical manner; for even Avicenna, who treats so fully of everything else connected with medicine, is defective in his accounts of surgical operations; and the descriptions which he does give of them are almost all borrowed from our author. The accounts of fractures and dislocations given by Hippocrates and his commentator Galen may be pronounced almost complete ”

“ One great advantage which operative treatment by the knife must always have over the treatment by X-rays is that the secondary implication of the lymphatic glands can be dealt with at the same time. And this, in many cases, is a matter of almost equal importance to that of removal of the cancer itself.
The employment of radium in surgery is still in its infancy. Doubtless radium is a very powerful agent, but even if it were Radium. found of peculiar value in treatment its cost would, for the present, put it out of the reach of most practitioners. ”

“ Trephining was the measure most commonly resorted to, even where there was no compression. Numerous forms of wounds and injuries of other parts are specified. Ruptures, piles, rectal polypi, fistula in ano and prolapses ani were among the other conditions treated. The amputation or excision of tumours does not appear to have been undertaken so freely as in Hindu surgical practice; nor was lithotomy performed except by a specially expert person now and then. The diagnosis of empyema was known, and the treatment of it was by an incision in the intercostal space and evacuation of the pus. ”

“ It was in the course of 1888 that operating surgeons began to neglect the letter of the antiseptic treatment and to bring themselves more under the broadening influence of its spirit. Certain adventurous and partially unconvinced surgeons began to give up the carbolic spray gradually, by imparting a smaller percentage of carbolic acid to the vapour, until at last the antiseptic disappeared altogether, apparently without detriment to the excellence of the results obtained. ”

“ The Suśruta speaks throughout of a single class of practitioners who undertook both surgical and medical cases. Nor were Hindu. there any fixed degrees or orders of skill within the profession; even lithotomy, which at Alexandria was assigned to specialists, was to be undertaken by any one, the leave of the raja having been first obtained. The only distinction recognized between medicine and surgery was in the inferior order of barbers, nail-trimmers, ear-borers, tooth-drawers and phlebotomists, who were outside the Brahmanical caste. ”

“ The college was under the protection of St Cosmas and St Damianus, two practitioners of medicine who suffered martyrdom in the reign of Diocletian, and it became known as the Collège de St Côme. From the time that Lanfranchi joined it it attracted many pupils. It maintained its independent existence for several centuries, alongside the medical faculty of the university; the corporations of surgeons in other capitals, such as those of London and Edinburgh, were modelled upon it.
The 14th and 15th centuries are almost entirely without interest for surgical history. ”

“ The next figure in the surgical history is Celsus, who devotes the 7th and 8th books of his De re Celsus. medica exclusively to surgery. There is not much in these beyond the precepts of the Brahmanical śâstras and the maxims and rules of Greek surgery. Plastic operations for the restoration of the nose, lips and ears are described at some length, as well as the treatment of hernia by taxis and operation; in the latter it was recommended to apply the actual cautery to the canal after the hernia had been returned. ”

“ Mummies have also been found with well-set fractures. Herodotus describes Egypt, notwithstanding its fine climate, as being full of medical practitioners, who were all “specialists.” The ophthalmic surgeons were celebrated, and practised at the court of Cyrus.
Greek Surgery.—As in the case of the Sanskrit medical writings, the earliest Greek compendiums on surgery bear witness Greek. to a long organic growth of knowledge and skill through many generations. In the Homeric picture of society the surgery is that of the battlefield, and it is of the most meagre kind. ”

“ A further objection to the application of such an elastic roller-bandage was that septic or tuberculous material might by chance be squeezed from the tissues in which it was perhaps harmlessly lying, forced into the blood vessels, and so widely disseminated through the body. Esmarch's bandage is therefore but little used now in operative surgery. Instead, each bleeding point at an operation is promptly secured by a small pair of nickel-plated clip-forceps, which generally have the effect, after being left on for a few minutes, of completely and permanently arresting the bleeding. ”

“ But to-day, except in dealing with a large abscess or other septic cavity, many surgeons make no provision for drainage, but, bandaging the part beneath a pad of aseptic wool, put on so much pressure that any little leakage into the tissues is quickly absorbed. If a drainage-tube can be dispensed with, so much the better, for if it is not actually needed its presence keeps up irritation and delays prompt healing. ”

“ Between that primitive state of civilization and the date of the first Greek treatises there had been along interval of gradual progress.
The surgery of the Hippocratic Collection (age of Pericles) bears every evidence of finish and elaboration. The two treatises on Hippocratic Surgery. fractures and on dislocations respectively are hardly surpassed in some ways by the writings of the present mechanical age. Of the four dislocations of the shoulder the displacement downwards into the axilla is given as the only one at all common. ”

“ Galen's practice of surgery was mostly in the early part of his career (b. A.D. 130) , and there is little of special surgical Galen. interest in his writings, great as their importance is for anatomy, physiology and the general doctrines of disease. Among the operations credited to him are resection of aportion of the sternum for caries and ligature of the temporal artery. It may be assumed that surgical practice was in a flourishing condition all through the period of the empire from the accounts preserved by Oribasius of the great surgeons Antyllus, Leonides, Rufus and Heliodorus. ”

“ And these conditions were maintained until sound healing took place. Whenever the discharge reached the edge of the mackintosh the case required to be dressed, and a new supply of gauze was applied round the stump. Whenever the wound was exposed for dressing the stump was enveloped in the vapour of carbolic acid by means of the steam spray-producer. At first a syringe was used to keep the surface constantly wet with lotion and then a hand-spray. These dressings were repeated at intervals until the wound was healed. ”

“ Fractures were diagnosed, among other signs, by crepitus. Dislocations were elaborately classified, and the differential diagnosis given; the treatment was by traction and counter traction, circumduction and other dexterous manipulation. Wounds were divided into incised, punctured, lacerated, contused, &c. Cuts of the head and face were sewed. Skill in extracting foreign bodies was carried to a great height, the magnet being used for iron particles under certain specified circumstances. Inflammations were treated by the usual antiphlogistic regimen and appliances ”

“ Achilles is concerned about the restoration to health of Machaon for the reason that his skill in cutting out darts and applying salves to wounds was not the least valuable service that a hero could render to the Greek host. ”

“ For every emergency and every known form of disease there were elaborate and minute directions in the śâstras, which were taught by the physician-priests to the young aspirants. Book learning was considered of no use without experience and manual skill in operations ”