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UNITED STATES  OF AMERICA
WASHINGTON, D. C
OPO  16—67244-1
 
 
 
             OBSERVATIONS

                   ON THE

 SURGERY OF THE  ANCIENTS,

     VINDICATING THErB CLAIMS TO MANY OF THE RE-
        PUTED DISCOVERIES AND IMPROVEMENTS
                OF MODERN TIMES.

                   DELIVERED AS

      AN INTRODUCTORY DISCOURSE

                 TO. A COURSE OF

  LECTURES ON SURGERY AND MIDWIFERY.
               S"   i ■■■#■»" » Jo
              ■r., T TT-T> f. T"»">  C5
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                     ■MM
              BY DAVID HOSACK, M. D.
Professor of the Theory and Practice of Physic and Clinical Medicine in the University of
     the State of New-York, Member of the American Philosophical Society,
            of the New-York Historical Society, &e.
       NEW-YORK.
PRINTED BY C. S. VAN WINKLE,
     No. 122 Water-street
1818. 
 
OBSERVATIONS, &c.
  To those in pursuit of knowledge, it is no less interesting
to observe  the rise and fall of the empire of learning than of
states.
  In like manner, introductory to a course of lessons upon
any art or  science, we are naturally led to inquire into th«
first  beginning or source  whence it arose, and to trace its
progress as it advances to  perfection.
  Introductory to the other parts of the course, I therefore
propose, at this time, to call your attention to the most im-
portant facts which the history of surgery presents; more
especially,  as it was practised among the  Greeks and  Ro-
mans : we  shall  thence learn  that the writings of the an-
cients have not only given origin to most modern improve-
ments,  but that very many of  them that have been claimed
as original inventions, if they have  not been copied,  are, at
least, anticipated  in these  fruitful sources of instruction.
  In the early ages of society, external accidents constitut-
ed the greatest evils to  which man  was exposed.  Intempe-
rance,  luxury, and the refinements of civilized life, had not
then impaired his bodily constitution, nor debauched his
mind.   He passed his days in the exercise which was neces-
sary to  procure the means of  his subsistence, and devoted
his nights  to rest, undisturbed by  care, or those anxieties 
4
 which at present  occupy  the civilized portion of the human
 race.
   Man, in a state of nature, was therfore subject  to, com-
 paratively, but few  diseases;  though  he was probably not
 less exposed to the common casualties of life than at the pre-
 sent day.  In climbing the tree to procure its fruits; in tra-
 versing the  forest,  he was necessarily exposed to ordinary
 accidents ; his attention,  therefore,  would be first directed
 to the discovery of such  remedies as were calculated to re-
 move the evils thus induced.    To restore to its socket the
 dislocated bone, or to replace it when broken;  to  heal the
 wounds inflicted by the beast of the field, or the venomous
 serpent, must necessarily have been  among the  first objects
 of his attention.  Accordingly, it is observed  by Celsus and
 other ancient writers, that  surgery was cultivated before any
 other branch of medicine.
  The  first writers upon  physic trace the  origin of  their
 art, in  common with all other branches  of knowledge, to the
 Egyptians.   But  the history of surgery, as practised by
 that people, is so involved in fable, so blended with the pa-
 gan mythology, that notwithstanding the labours of Prosper
 Alpinus, it is impossible to ascertain their knowledge of medi-
 cine, or of any other branch of  science.  The operations of
 surgery, stated by the professor of Padua, as having been per-
 formed by the Egyptians,  namely, the extraction of the stone
 from the bladder; bleeding in  the veins and arteries; the
application of the actual cautery, and the paracentesis of the
abdomen,  in dropsy,  must probably have been  the opera-
tions of the modern and not of the ancient Egyptians.
  Let  us, therefore,  pass  over  the  stories  of Hermes and
the Egyptian iEsculapius ;  the fabulous accounts of Osiris,
Serapis, Isis, Horus, and Thonis, who were reputed the  first
practitioners in medicine, and ranked among their divinities, 
a
to the more authentic history of the surgery of the Greeks,
as related by Homer and Hippocrates.
  The first Greek surgeons, on record, are yEsculapius and
his sons Machaon and  Podaliriiis.   jEsculapius  flourished
about fifty years before the Trojan war; in that war his two
sons distinguished themselves, not only by their valour, but
by their skill in curing wounds.
  In the Iliad, Machaon is spoken of as one of the most dis-
tinguished surgeons at the siege of Troy.   He is  called the
preserver of the Greeks ;  and when wounded by Paris, he is
lamented,  as deprived of  the benefit of that skill which he
had so often exercised for the benefit of others.

         " The great Machaon, wounded in his tent,
         " Now wants that succour which so oft he lent."*

   On another occasion, Homer shows the high estimation in
which the profession was held :—

        " A wise physician, skilled our wounds to heal,
        " Is more than armies to the public weal."t

Of Podaliriiis too, it is said, that on his return from the de-
struction of Troy, he was driven upon the coast of  Caria,
and that he cured the daughter of Damaethus of a severe and
dangerous illness, by bleeding her in both arms. This is the
first authentic  record of the operation of  blood-letting.   It
is also stated, as an evidence of the value attached  to the
          * ------_____—.——. Maf^osiwv,
Toy /tc£V !v) xA<c-i'>j<r;v cioy.a.1 eXKog 'e%e*rx,
Xgr/igovrct icui aurlv uf^.vy.ovai lyrqgoi,
Kile-Detf
  \'1xtpo9 y<*(> un}g ffo?\Xm ctvTct^tos xXXav,
']«v$ T £XT«,W.VftV, iff I T' r.fflct. tpxgHKK* ffxr-riiv. 
G
profession, at that early day, that the prince, as a reward to
Podaliriiis, for his skill and services, gave him his daughter in
marriage, with half of his kingdom as her portion.
   Notwithstanding these testimonies of the skill of Machaon
and Potlalirius, it appears that their practice was very much
confined to the removal of the  darts or arrows with which
their wounds were inflicted, and afterwards to the application
of fomentations  and styptics to  the wounded parts ;  for,
when the heroes, recorded by Homer, were in other respects
severely injured, as in the case of Mnezs, whose thigh bone
was broken by a stone thrown by Diomedes, he makes no
mention  of any other than supernatural means employed for
(heir relief.
   In the writings of Hippocrates, we have a full and circum-
stantial  detail of the state of medicine and surgery among the
Greeks  in his  time.   He lived about 400 years before the
birth of Christ ;   and  was the first who  treated of  medicine
in a regular or systematic manner.   Prior to his time, even
among the Greeks, the practice of medicine was confined to
their priests  and philosophers.  According  to Celsus, the
healing  art became  united  with the duties of religion, from
the consideration, that diseases were inflicted upon mankind
as punishments for their crimes ; and were only to be avert-
ed or removed by the intercession of their priests, and the
remedies they prescribed.   The  connection which exists
between the study of medicine and the works of nature, also
led their philosophers to unite the healing art with their fa-
vourite  pursuits  ; and it is related of Pythagoras, that he
travelled from place to place, not so much to teach the pe-
culiar  doctrines  of his philosophy  as  to  practise  physic.
Thalcs,  Empedocles,  Heraclitus,  and  Democritus,  were
among the most distinguished of the Grecian philosophers.
They were also celebrated, as eminent practitioners of me-
ilicine and sur<rerv. 
1
  Such was the unsettled state of medicine, until the time
of Hippocrates.   In his hands it assumed the form of a dis-
tinct  science, and was practised as a separate profession.
By his labours it became  enriched with his valuable and nu-
merous observations on the symptoms, causes, and cure of
diseases ; and since his time, has been respected and culti-
vated, as among the most important of human pursuits.
   Hippocrates  not only rescued the  profession from the
hands of ignorance and superstition, but in his works he has
left a legacy of great value to the surgeon, as well  as to the
physician ; and although they are the writings of the most
ancient author,  whose pages are preserved, and written at a
period, when the structure of the human body, and the func-
tions of the animal economy, were but  imperfectly under-
stood ; they are the writings of a master, and like the tablets
whence he collected many of his observations, they deserve,
even at this day, a place in the temple of science, where all
can read and profit from  the valuable truths  they contain.
   Among the surgical works of Hippocrates, are a treatise
on Wounds, a book on Ulcers, another on Fistulas, a fourth
on Fractures, and a fifth on Dislocations.   His observations
on abscess, ulcers, and wounds, show  him  to have been an
accurate clinical observer.   His work on the joints and dis-
locations, contain many practical remarks of great value  on
 those subjects.   His aphorisms contain principles which are
 received as so many axioms in physic and surgery ; and, at
 this day, constitute the subjects of academic exercises in the
 most distinguished universities.
    He performed the operation of bloodletting in different
 parts of the body ; and  although he did not understand the
 circulation of the  blood,  his observations on the  effects of
 this  evacuation, and the  diseases in which it is most useful,
 are judicious  and correct.   In apoplexy,  palsy, inflamma-
 tory diseases, iliac passion, quinsy, pleurisy, and  inflamma- 
3
 tionof the abdominal viscera, &c. he made free use of this re-
 medy.   In quinsy, and in injuries occasioned by falls, he at-
 tached so much importance to bloodletting, that he, in some
 instances, bled his patient  in  both arms,  and frequently ad
 deliquum.
   In the treatment of fevers, he was no less cautious in the
 use of the lancet, than he was bold to employ it in  those
 diseases  in which it was decidedly indicated.   At the same
 time  that his ignorance of the circulation of the blood  occa-
 sionally  led him into  error, the  indications of bloodletting,
 and the  circumstances in which it was most advantageous-
 ly performed, did not escape his notice.   The  season of the
 year,  the age of the patient, and habit of body, were no less
 regarded by Hippocrates than they are by physicians and
 surgeons of  the present day.   But he was not confined to
 the use of general bloodletting ;  he also  made use  of cup-
 ping and scarification for the removal of local diseases.
  Hippocrates  also performed many other operations, which
at this time,  notwithstanding the present  improved state of
anatomy, call for  considerable skill and  judgment  in the
operator.
  He opened deep seated abscesses ; he performed the ope-
ration of tapping in dropsy, and of trepanning in fractures of
the skull and injuries of the brain.   His aphorism upon the
comparative pain and  fever, before and after the formation of
matter, and which  he  made the guide of his practice, abun-
dantly shows his accurate knowledge of this subject.   His
observations on wounds of the  head, teach us the great cau-
tion with which he  formed  his prognosis of the  event.
However small or inconsiderable the injury may appear, he
 observes, they require attention in their treatment, and care
 in the practitioner, not to  hazard a hasty  prognosis of the
 issue.  This observation would  do  credit to the most en-
 lightened surgeon of modern times ; and  cannot fail to im- 
9
  press us with an exalted opinion of the talents and experi-
  ence of Hippocrates.
    The actual cautery was also one of his favourite remedies,
  in the treatment of chronic diseases.  In a case of ascites,
  he cauterized the belly eight times, during the forming state
  of this complaint.  The physicians and surgeons of this day
  have yet to  learn many valuable lessons from Hippocrates,
  and  other ancient physicians, relative  to the use of this re-
  medy.  The successful practice of Pouteau, of Lyons, (see
  his surgical essays) who has revived the  use of this external
  application ;  and the  advantages which  have resulted from
  the use of  caustics, as prescribed by Mr. Pott, in diseases
  of the spine, tend  to  establish the  importance of the prin-
  ciple upon which the actual cautery  was  prescribed, and has
  been found useful.
   Many other local applications were made  use  of in the
 practice of Hippocrates, that are still employed by the phy-
 sicians and surgeons of this day.
   In an inflammation of the throat, he caused his patients to
 inhale the steam arising from the  infusion of  stimulant and
 aromatic herbs :  upon other occasions, he directed fomen-
 tations to be applied  to  the  parts  affected.    The warm
 bath, fomentations, gargles, ointments, cataplasms, and col-
 'yria, were  also among  the local remedies  prescribed by this
 celebrated physician.
   The important operation of lithotomy appears, also, to
 have been performed in the time of Hippocrates ; for, in the
 oath  administered to his pupils, he exacts from  them the
 obligation, that they would not cut for the stone.
   Although the operation, as performed by the surgeons of
 that day, was  apparently simple, compared with the present
 lateral operation ; still, from  their imperfect knowledge of
 the structure of the  human  frame, it must necessarily have
been attended with considerable danger.  Even, a? improv
                            n 
iu
 ed at this time, ii is an  operation frequently productive  of
 dangerous consequences ; and, in some instances, proves fa-
 tal in the hands of the most skilful  surgeon.   The conduct
 of Hippocrates, therefore, in prohibiting his pupils from per-
 forming so important an operation, at  the  time the anatomy
 of the body was imperfectly understood, must give us a high
 Opinion of the correctness of his judgment and his prudence ;
 at the same  time, that it  attaches an additional value  to his
 works.
   Such was the state of surgery, in the days of Hippocrates :
 after a life spent in  the duties of his profession, to which he
 devoted himself, with  unwearied industry,  he died,  in the
 101 si year of his age ; but in his works, he still lives.
  In the interval of time, between Hippocrates and Celsus,
 many surgeons are recorded, by Galen and other historians :
 but as they appear to  have made but few and inconsiderable
 improvements in the  art, we  will pass over this period, to
the Augustan age ; which may also be denominated the Au-
gustan age of medicine, as well as of science.  Such  it  was
rendered by Celsus, the Roman Hippocrates.
 Celsus was not only distinguished for his professional acquire-
 ments, but ranks among the most celebrated writers of anti-
quity.   Whoever, therefore, wishes to become acquainted
 with the state of medicine and surgery, prior to the fall of
 the Roman empire,  or to read the Latin language, which, in
 that day, attained its greatest purity and elegance, will pe-
 ruse his valuable pages ;  which  have  gone  through  almost
 innumerable  editions,  and have been translated into almost
 every language employed as the vehicle of learning.  Celsus
 not only exhibits an historical view of the state of medicine,
 as practised before his time, but has added much original ob-
 servation, and many improvements to those of his predeces-
 sors.   Although he has copied much from the writings of
 Hippocrates, he was not so blindly attached to his works, as 
11
not to discriminate between his merits and his defects.  On
the contrary, while he gave  the  opinions and  practice of
others, he thought for himself. His works are accordingly es-
teemed the most valuable repository of the medical learning of
his time.   He treats of the healing art, in all its  branches of
diet, medicine, and surgery.   His seventh and eighth books
are exclusively devoted  to the latter subject, and contain a
systematic view of most of the diseases and operations which
fall to the province of the surgeon.
   In  his observations on wounds, abscesses,  and ulcers, he
describes the various appearances they assume,  and adapts
his remedies to  the different  stages,  with as much correct-
ness as is done by the surgeons of this day.  To wounds, ac-
companied with hemorrhage, he  applied  constant pressure,
by means of a sponge, wet with vinegar.   If necessary, he
applied the ligature to the bleeding vessel, or closed its ori-
fice, by the ac.ual cautery.  When attended with inflamma-
tion,  he enjoined abstinence  upon  the patient, and covered
the part affected with cold applications.  In contusions, he
freely opened the brtiised part, or dilated the wound for the
evacuation of the blood effused, when there was no danger
of injuring the larger blood-vessels, or important nerves. In
•mngrene, occurring in the extremities, he cut down to the
sound parts ; and if he failed, by that and other efforts, to
conquer the disease, he recommended the amputation of the
limb.  To promote the suppuration of abscesses, he employ-
ed poultices, composed of barley, meal, marsh  mallows, or
linseed and fenugreek ; but when  opened, he prescribes sti-
mulant food and drinks, and  to the parts  he applied honey
and other  digestives.  When the  lips of the  wound  became
callous, its surface spongy and insensible, and the discharge
of an unhealthy appearance, he washed the wound and the
surrounding parts with wine.    From this practice  of Cel-
sus the surgeons of the present day may learn an important 
12
lesson in the treatment of wounds.   He also describes the
symptoms of that dangerous abscess, the carbuncle, and ad-
vises the actual cautery to corrode the gangrened part.  This
practice is now superceded by the internal and external use
of the peruvian bark, and other stimulants.  In erysipelas, he
applied  cerussa,  with the juice of solatium, a powerful seda-
tive.  In the  treatment of the callous  ulcer, he removed
the hard edges with the knife, or corrosive applications.  In
cancers, and in the cancerous ulcer, he prescribed the auri-
pigmentuui or arsenic.    In  fistulous ulcers, if tortuous in
their course, with the probe as his guide, he ascertained their
direction ;  divided them freely with the knife ; and, upon
exposing their internal surface to view, he removed the cal-
lous portions, and applied such dressings as were calculated
to promote the growth of new parts.  In other instances, he
effected a cure, by the use of stimulant and corrosive injec-
tions.   In caries of  the bones, he directs them to be perfo-
rated as deep as the disease extends, and afterwards a hot
iron to be passed into the foramina, made by  the perforator,
for the  purpose  of drying and separating the diseased por-
tions :  but if the caries and  blackness  extend through  the
body of the bone, he advises a total  separation of the part
affected.
  In his chapter on tumours, he described them according to the
nature of their contents, and advises their extirpation.  The
steatom<tous tumour, from  the firmness of its  consistence, he
directs  to be carefully separated from the skin and surround-
ing parts, and to be removed entire, without dividing the sac
inclosing it.  He then directs the lips of the wound to be
brought together, and an application made to agglutinate the
tlivided parts ;  at the same  time, making use  of wine  and
other external stimulants, to promote their union.  In this
treatment, we see the improvements of the present time, of
saving  skin, and healing by first intention. That this was the 
13
object of Celsus, appears evident, from a subsequent direction
which he gives, in case any portion of the sac should be left
behind, as in the removal of the melicerous or atheromatous
tumour;  in which case, he orders the wound to be left open,
and digestives to be applied, for the purpose of throwing off
the remaining portion of  the sac.  In the atheroma of the
eye-lids,  in which the  sac adheres very slightly to the sur-
rounding parts, he directs  the teguments to be divided,  with-
out wounding the sac, and the tumour to be  removed by the
fingers, without further dissection ; for, he adds, it easily
separates.   The same mode of treatment you will find re-
commended in the work of Mr. Hey, as a valuable improve-
ment of the present time.  In his chapter, on diseases of the
eyes, Celsus treats of  the cataract,  and directs  it to be de-
pressed by the needle ; and if it  rises again, to be broken
into pieces ; the practice recently adopted by the most emi-
nent surgeons. In ophtlialmia, he prescribes venesection, pur-
gatives, abstinence, low diet, rest,  and a dark  room.  He
washes the eye  with  collyria,  composed of an  infusion  of
roses and the poppy.  When attended with defluxion, he
employs astringents, cupping, and the actual cautery, to the
temple and forehead, analogous in its affects to* blisters and
issues, as at present prescribed, under similar circumstances.
   Celsus also performed the operation of the hare-lip.  He
extirpated the polypus from the nose ;  he removed, by ex-
cision, the enlarged and  indurated  tonsils  ; he  diminished
the elongated uvula ;  and he  removed the bronchocele, by
caustics  and the knife.   But the skill  of Celsus was not
confined to the smaller operations of surgery.
   In diseases of the bones of the head, and  in injuries of the
brain, his practice was such as the most eminent  surgeons of
the present day must approve.   The symptoms which are
occasioned by a fracture of the skull, are  minutely detailed.
He is the first who notices the rupture of the vessels of the 
M
 •drain, and the other effects produced  by a concussion with-
 out fracture of the cranium.   He  also observes, that the
 evidence of such  injury, is generally a  pain  immediately
 above the  part affected; and, upon  exposi.-g  the bone to
 view, he adds, it is found of a pale colour.  This character-
 istic  symptom of effusion of blood, or of the formation of mat-
 ter between the cranium and the membranes of the brain,
 you will find contained in the works of Mr. Pott;  but with-
 out the credit due to that accurate observer.  In cases of
 this sort, and in fractures of the skull, it was the practice of
 Celsus to make a free crucial  incision of the integuments  ;
 by which, alone, in many instances,  the patient was relieved.
 At the same time, he condemns the precipitate conduct of his
 predecessors, in proceeding to the use  of the trepan, without
waiting  to observe the effects of other remedies.
  The  practice of Celsus is,  at  present,  pursued  under
similar  circumstances,  by that  celebrated  surgeon, Mr.
Abernethy,  of Bartholomew's  hospital ;  who has,  in nu-
merous  cases,  dispensed with  the  trephine,   having re-
lieved his  patient by  the application  of other remedies.
But if the symptoms became more  formidable,  and the pa-
tient experienced no benefit from the first operation,  Celsus
then directed such portions of the bone to be removed, as the
extent of the injury appeared  to require.  In those cases,
where the fracture or depression was small, he employed the
instrument called the modiolus; which, in its construction is
similar  to the  trephine.  But when  the fracture was ex-
 tensive, or of an irregular shape, he made use of a perforator,
 so as to surround the part affected with holes  ; and after-
wards employed the chisel and mallet  to cut out the portion
of bone  inclosed within them.  In this operation, laro-e por-
 tions were removed, which the  modiolus could not cover un-
less frequently applied.   Mr. Hey,  of Leeds, has lately in-
 troduced a substitute for the trephine  ; by which the same 
15
advantages are obtained, as by the perforator and chisel ot
Celsus.
   As anatomy, in those days, was very imperfectly under-
stood,  we cannot be surprised that Celsus was less success-
ful in some of the more complicated operations of surgery.
Accordingly,  in reducing strangulated hernia, he experi-
encedjgreat embarrassment:  but it is to be recollected, that.
this operation requires an accurate knowledge of the struc-
ture of the parts concerned, to guide the knife of the opera-
tor.   This  knowledge has only been acquired within a few-
years.  In the hands of John and  Charles Bell, Mr.  Astlej
Cooper, of London, and Mr. Hey, of Leeds, this operation
has received  its best and most  important  improvements.
But  in the  history given  by Celsus,  of the  symptoms  and
causes of hernia, and of the nature of its contents, he is no
less perspicuous than upon most other subjects that came un-
der his notice.  He describes, writh great accuracy, most of
the species of hernia, now found in books of surgery, except
such  as  occur under Poupart's  ligament, and  that  which
takes place between the abdominal muscles.  The umbilical
hernia he distinguishes into  the omental and intestinal, ac-
cording  as  the omentum or intestine  is contained  in  the
hernial sac.   In like manner, he  describes the scrotal  her-
nia,  as containing  omentum, intestine, or both combined,
with the symptoms which characterize  each species.
   He  also distinguishes scrotal rupture, as it occurs in the
young child,  and in the adult.   In the former, he directa
a compress to be applied to the part,  and retained by means
of a roller ; by which application, he observes, the intestine
is oftentimes forced in, and the coats agglutinated :  but in
the adult, when the intestine is protruded in a large quantity,
and  attended with  symptoms of danger, it appears that he
Mas unacquainted with the  mode  of replacing it within the 
If)
 abdomen.   He observes, it can only be reduced as far as the
 groin ; thereby producing a change, but not a  termination
 of the disease : and in those  cases, where he considered an
 operation necessary, he did not restore the displaced intes-
 tine, but by means  of a ligature or the knife, he diminished
 the quantity of loose  skin,  and  by the  inflammation  and
 thickening of the parts induced, formed a cicatrix, which
 was calculated to prevent an increase of the prolapsus. Upon
 the same principle, in  umbilical hernia, when the parts pro-
 truded  were  restored to their  natural situation, he excited
 inflammation by ligature and  caustics ;  which so changed
 the structure of the parts, as to prevent a return of the rup-
 ture.   Thus far his operation  was successful ; but in some
 instances, from want of anatomical knowledge, he considered
 it necessary to remove parts which  have  no connection
 with  the disease.   In  hernia of the intestine, he sometimes
 removed not  only a portion of the hernial sac, but also extir-
 pated the testicle itself.
   In  hernia  of the omentum,  if small, he  replaced it by
 the hand alone ;  and  to prevent  it from being again pro-
 truded,  he applied a compress to the part, and secured it
 by a bandage passed round the loins:  but if large, he  did
 not attempt to reduce it.  He then, to effect a  separation
 of the mortified parts, made use of escharotics or  ligatures,
 preferring them to the  scissors  or  knife,  on account of the
 hemorrhage  which attends the use of cutting instruments.
 The same observation is made,  and a similar practice adopt-
 ed by Mr. Hey, of Leeds.
   Celsus also performed many  other operations  in diseases
of the abdomen and pelvis, including the organs of genera-
 tion.  In wounds of the intestines, he performed the opera-
tion of gastroraphy ;  and his description of the mode of per-
forming it, corresponds with the directions given by the he^t 
11
   writers of the present time.  In the treatment of dropsy, he
   performed the operation of tapping, not  only on the side of
   the belly, but, in some instances, he  perforated the navel  ;
   which is considered, at this day, as the  latest improvement
   in the manner of performing paracentesis.   The hydrocele,
   circocele, and the inflammation of the testicle, are also well
   characterised by this accurate observer.   He cured hydro-
   cele by incision.  The varix of the spermatic  cord, as well
   as the varices of the veins of the  legs,  he cured by laying
   bare the  vein thus enlarged, and by applying the actual caute-
   ry ; or removed it by  excision,  having previously separated
   the vein, and inclosed it with ligatures, above and below  the
* ;>part to be removed.  He divided the prepuce in phymosis ;
   he  introduced the  catheter in retention  of urine, both in
   males and females.  Celsus  also  performed the  important
   operation of lithotomy;  but  considered it as attended with
   great danger.  He very judiciously prepared his patient for
   this, as for every other capital operation, by abstinence from
   solid food and stimulating  drinks.   His  mode  of operating,
   was,  in some respects, peculiar to himself; and was hence
   denominated lithotomia Cclsiana ; but, in most circumstan-
   ces,  it  agreed  with that afterwards adopted  by  Paulus
   ^gineta, and others, by the apparatus minor, or cutting on
   the gripe.   When the operation was finished, he bled his pa*-
   tient, enjoined abstinence,  made use of a  warm bath, and oily
   fomentations, to diminish  inflammation: but he advised the
   operation to be  performed only in the  spring  of  the year,
   and confined it to patients between nine and fourteen years
   of age.
      These facts teach us, that Celsus was not sufficiently ac-
   quainted with anatomy to perform this operation, without
   great hazard to the patient.   At this we cannot be surpris-
   ed, when we recollect  that it is  only within a few years that
   it has been  perfprmed with general success   Our only sur-
                              c 
18
 prise should be, that  the  art of surgery  was so well um
 derstood as it  appears to  have  been in his day.   Among
 other operations,  he  extracted the dead foetus  from the
 womb, by means of the crotchet ;  and when difficulty pre-
 sented,  he divided the child, and  removed  it piece-meal/
 To restrain hemorrhage, or to remove any inflammation, in
 duced by the operation, he applied  soft cloths, wet with an
 infusion of vinegar  and roses.  Condylomata  (or  tubercles
 of the anus) and hemorrhoidal tumours, he removed with the
 knife and ligatures.  The  same treatment  you  will  find
 adopted and recommended by Mr. Ware, in his valuable es-
 say on that subject ; but which contains no reference to the
practice of Celsus.   Fistula in ano, he  also cured by liga-
ture, making use of a linen  thread instead of the leaden wire,
employed by the moderns.  This mode  of treating fistula,
was revived by Foubert, and has been frequently practised
in France since that time.  Professor Camper has also made
use of ligatures, in those whom he found fearful of the knife ;
or when the patient could not submit to the necessary con-
finement which  the incision requires.  But the great incon-
venience which arises from the  long continued irritation of
 the ligature, and the prolapsus ani, which it sometimes pio-
duces, have occasioned it to be laid  aside.
   Celsus was no less successful in the treatment of fractures
 and dislocations.   His  directions for reducing the fracture
 of the clavicle, and his  treatment of fracture of the ribs, cor-
 respond with those contained in  the present systems of sur-
 gery ; and in fractures of  the extremeties, although he did
 not employ the many  tailed bandage, or  place the broken
 limb in a flexed position, but confined it to the fracture box
 he remarks, that the smaller bones were  generally united be-
 tween fourteen and twenty-one days ;  those of the leg and
 fore-arm, between twenty and thirty ; and those of the arm
 and thigh-bone, between twenty-seven and forty days.   Few 
19
surgeons of the present time, I believe, can boast of greater
success.
   An eminent modern physician, emphatically exhorts eve
ry person, in the study of  medicine, to keep Celsus  in his
hands, by night and by day.  I trust the outlines I have ex-
hibited of his practice of surgery, and the evidences I have
adduced of his skill in that art, will also induce the pupil in
surgery to give his writings an attentive perusal.
   Galen, the physician of  the Emperor  Marcus  Aurelius,
also holds a distinguished place  in  the history of surgery.
He was born at Pergamus, a city of Asia, about 130 years af-
ter  Christ, and during the  reign of the Emperor Adrian.
He was celebrated, not only as a practitioner in physic and
surgery, but as the most  accurate anatomist that  had then
appeared.   His knowledge  of anatomy, at  the same time
that it furnished  him with  more correct views of the func-
tions of the human body, and of the general principles of
surgery, also enabled him to perform some operations,  un-
known  to his predecessors.  By some who profess to give
an account of  his works,  he is  considered as the mere com-
mentator on the  writings of Hippocrates ;  especially upon
those subjects which relate  to surgery.   But  although Ga-
len selected every thing  he  considered valuable in the works
of those who had gone before him, he has left the evidence
of great original  genius,  not only as a physician, but as a
practitioner of surgery.  I may remark,  that his writings,
like those of Celsus, have been  plundered  by the moderns,
without the least acknowledgment of the  source whence
 they derived  the materials  of what  they afterwards denomi-
nated discoveries and improvements.
   Without going  into a detail  of the practice of Galen, 1
 shall confine my remarks to a few of those subjects in which
 he appears to have added to the stock of knowledge  he had
 received from his predecessors. 
26
    In his chapter oh  ulcers, he distinguishes their several
 apecies with so much correctness, that it has evidently been
 the basis of Mr. Benjamin Bell's treatise upon this subject.
 Not only the names by which they were designated, by Ga-
 len, are retained ; but even his definition of an ulcer has
 been adopted by our late systematic.   " A solution of con*
 tinuity, in any of the softer parts of the body," is the  defini-
 tion given of an ulcer by Mr. Bell.  " Unitatis solutio est
 in carnosa parte," is the language of Galen.  I may also add,
 that in the treatment of ulcers, there is scarcely what is call-
 ed an improvement in  the practice  of the moderns that was
 not  known  to Galen.   During the inflammatory  stage  of
 phlegmon, he carefully enjoined upon his patient to abstain
 from wine and stimulants  generally.   He also made use  of
 the lancet, purgatives,  and warm bathing, to diminish the in-
 flammation ;  but when the ulcer was formed, and a free dis-
 charge of matter obtained, he  directs  his remedies accord-
 ing to the character of the wound.   In the simple purulent
 ulcer, his practice was to bring the edges as nearly as possi-
 ble into contact.   In the sordid ulcer, he made  use of ho-
 ney, verdigris, and terebint hinate applications,  to change its
 condition, and to promote the growth of healthy parts.  Oily
 dressings and relaxing cataplasms, he very properly proscrib-
 ed as injurious in those cases.  With the same view of re-
 storing a healthy action in the part, he directs it to be wash-
 ed with wine ;  and, as an evidence that he had in view its
 stimulant qualities, he observes, that the Falernian, which
 was a sweet wine, was  useless in this respect.  " Nam que-
 cunque dulcia pariter et fulva sunt, ut Falernum, ad id inuti-
lia existunt."
  But one of the most approved modes of treating ulcers, in the
present day, is by bandage.   This, also, was the practice of
Galen"; and in his  direction  upon the application of the roll-
er, he observes, it should not be so loose as to give no sup- 
21
 port to the limb, nor bound so tight as to excite pain by it*
 pressure.   " Circumducts etiam ipsa non ita  laxa  sit ut
 nihil efficiat nee ita vehemens ut dolorem premendo exci-
 tet."   In punctures of the nerves, the practice of Galen was
 also original.   If the wound be large, he advises it to be kept
 open ; but if small, he directs it to be dilated, and terebin-
 thinate and other stimulating dressings to be applied, for the
 purpose of obtaining a free discharge from the surface of the
 wound.    " Ubi aliquis  nervus est punctus, cutem ipsam
 servari oportet, aut  quod tutius est  latius incidere."   In
 warm climates, the same practice is successfully pursued un-
 der similar circumstances, in the present day.
   For the purpose of suppressing hemorrhage, when the ex-
 ternal application of cold water and astringents failed, such
 as  unripe galls, balaustines, and the stronger  austere wines,
 it was the praciice of Galen to raise the bleeding vessel,  by
 means of a hook, and to secure it by  a vinculum or ligature.
 Ambrose Pare, in the sixteenth century, therefore unjustly
 claimed  the use of the  ligature as his discovery.
   The aneurismal tumour is also well characterized in the
 writings of this celebrated  surgeon.  From  some expres-
 sions contained in his work, I am also induced to believe,
 that in the treatment of fractures, he placed the  broken limb
 in a flexed position.   It was certainly his practice, when
 the bones were secured by bandage, to place the  limb in that
situation which occasioned the least pain to his patient;  and
in the application of the bandage, he was aware of the  incon-
venience and  injury arising from too severe  pressure upon
the part  affected.   To aid the generation of bony matter, in
forming a callus, he also,  as in wounds of the soft  parts, made
use of wines and other stimulating applications.
  Two other writers of respectability, among the ancients,
merit our  attention,  ./Etius and Paulus  /Egineta.  I pass 
22
over the works of Oribasius, as they contain nothing import-
ant, but what  is  to be found in the writings of Galen.
   jEtius flourished at the end of the fifth and beginning of
the sixth century.  He was  born at Amida, in Mesopota-
mia, and was educated at  the celebrated  medical school of
Alexandria.   Although his works are not so well digested
or arranged as those of Paulus, his chirurgical writings con-
tain many valuable observations, not to be found in Celsus or
Galen, and were even omitted by his successor,  Paulus.
His account of the diseases of the eyes, is much more mi-
nute and complete, than  the chapter  of  Celsus upon  the
same subject.  In the treatment of anasarca, he prescribes
scarification of the extremities ; not merely for the purpose
of a temporary evacuation of the water  contained  in  the
cellular membrane,  as  had been  recommended by Hippo-
crates, but  made his incisions so bold and extensive, that he
thereby,  according to his  own observation, not only reliev-
ed  his patient of anasarca, but  frequently  cured him of
ascites.  Sylvius de la Boe, afterwards proposed to perform
this species of tapping, by means of a  needle,  and claimed
the discovery as his own.
   I have already remarked, that  Hippocrates  and  Celsus
made frequent use of caustics, especially in the  treatment of
dropsy, epilepsy,  sciatica, and phthisis.   iEtius  also  em-
ployed them, not only in the same complaints,  but in many
other diseases.   In asthma, palsy, empyema, and affections
of the head ;  in obstinate head-aches, or  in  injuries of the
brain, he applied them to the nape of the neck, and to differ-
ent parts of the head.  He  directed them to be long con-
tinued, to be applied in great numbers, and made of a circu-
lar shape, that they might be slow to heal, and thereby af-
ford a large discharge.  In the bite of a mad  dog, he direct-
ed them to be kept open forty or sixty days  ; and if, in  that
time, they should,  by accident, be closed, he renewed their 
23
application.  In this free use of caustics, he was followed by
Paulus.  The issues, as employed at this day, are found use-
ful in the same diseases, for which the caustics were so suc-
cessfully applied by the ancients.   It  is said by some, that
the use of the seton was known to .'Etius :  this does not ap-
pear.  Roland, of  the tenth century, was the first who de-
scribed this species of issue.   It was  afterwards spoken  of
by Rhazes and Albucasis, as much in use in their day.  Dr.
Freind remarks,  that whoever reads the  chapter of Rhazes
on this subject, will find that the ancients understood the
value of this remedy as well as the moderns.
  iEtius also treated of the diseases of women.   He notices
the causes  of difficult labour, and directs the mode of delive-
ry, which  should accordingly be pursued.   In one respect,
his work is imperfect ;  as he takes no  notice of an important
branch of surgery, fractures and dislocations.
  Paulus iEgineta, so called from his birth-place, the island
iEgina, flourished about the middle  of the seventh century.
He also was a pupil of the Alexandrian school.  After finish-
ing his education, he travelled into different countries, and
thereby had more  extensive opportunities  of becoming ac-
quainted with diseases than most of those who had preceded
him.   His works, accordingly, contain much original matter.
His  chirurgical writings, in which he devoted a book  exclu-
sively to the operations of  surgery, have  been  universally
considered as more complete than any that appeared before
the revival of  learning in the fifteenth century.    It is suf-
ficient evidence of the value of the works of Paulus, that his
writings, with  those of Celsus, became the  text  books of
Fabricius,  a celebrated surgeon of the sixteenth century.
  In his treatise on ruptures,  the different species of hernia
are more minutely  detailed, and the operation more circum-
stantially described than by Celsus.   That species of aneu-
rism,  arising from  a wound or rupture of an  artery,  which 
24
was  known  to Galen, he  describe*  with great accuracy,
as well  as  the circumstances by which it is distingu.shed
from other tumours.   This is not  all.  In the treatment of
the disease,  he performed  the operation for  its removal, m
the same manner as is done at this day, by securing the ves-
sel  above and below the part affected,  and dividing it be-
tween the ligatures.   He also describes the fracture of the
patella,  which was not noticed before his time.  In chronic1
affections of the head, and in  diseases of the eyes, he open-
ed the jugular veins;  and, in  some instances, the arteries be-
hind the ears.  To render the operation of cupping more ef-
fectual,  he  improved the scarificator in such manner as to
make several incisions at the same time.   In cases of quinsy,
threatening suffocation, he performed  the operation of bron-
chotomy.    He directs it to be performed about  the third or
fourth ring of the trachea, being a part which he observes is
less  covered with flesh,  and where  there is the least danger
of dividing many vessels.  He is also careful not to make the
aperture larger than is sufficient for the purpose of  respira-
tion. In this operation,  Albucasis afterwards copied Paulus,
without an acknowledgment.
   Paulus also improved  much upon his predecessors, in the
mam er  of performing some of the  more usual operations  of
surgery.   In extracting the  stone from the bladder, he did
not, like Celsus, confine the operation to childhood, but per-
formed  it at any period of life.   He also directs the incision
to be made, not in the middle of the  perineum,  as was done
by Celsus, but upon the left  side of it,  nearly where the in-
cision for the lateral operation is at this day made.  Upon
this subject, he also  gives another important direction ;  to
make the external incision free and  large, by which both the
sufferings of the patient  and  the danger of the operation are
diminished.   Paulus also treats of the  diseases of pregnan
 cy, and was skilled in the practice of midwifery. 
25
  Such was the state of surgery among  the  ancients; and
from the progress they had made, much  also  was to  be ex-
pected from the labours of their successors : but a long in-
terval of ignorance and darkness now ensues.
   The civilized parts of Asia and Africa were overrun by
the Saracens, under Mahomet and his successors.   Being,
from their  religious tenets,  the professed enemies  to all
knowledge not contained in the Koran, they ordered the ce-
lebrated library of Alexandria to be destroyed;  and  with it
all the liberal arts had nearly perished.
   About the same period, the Goths and Vandals overran
the Roman empire.  They also were the enemies of science,
because  they were strangers to it.  But after the fury of the
Saracens had somewhat subsided, the love of health and life,
which  is natural to man, induced them  to revive the  heal-
ing art ;  which had, in a great  degree, shared the general
fate of learning.  The works of Hippocrates and Galen were
sought for, and translated first into the Syrian,  and  thence
into the Arabian language :  in a few  centuries, the Ma-
homedan governments abounded in schools of physic.   Al-
though the works  of the most celebrated  Greek and Ro-
man writers were  transcribed  by  the Arabian  physicians,
Rhazes and Avicenna,  the science of medicine received lit-
tle improvement from their hands.  In like manner, the
knowledge of surgery, among the Arabians,  was preserved,
but not  improved.   The precept of Mahomet, which forbad
the opening of dead bodies, must necessarily have prevent-
ed improvements in anatomy,  and consequently retarded
their progress in the practice of surgery.  Notwithstanding
the  labours of Rhazes, Avicenna, Albucasis,  and other emi-
nent practitioners and teachers of medicine among the east-
ern nations, surgery received few or no  additions, from the
time of Paulus until the sixteenth century; when Fabricius,
of Aquapendens, published his celebrated system, contain-
                             n 
2ti
ing, not only the surgery of the ancients, but many original
observations, which may be perused  with much  interest,
even at this day.   Of Fabricius, Boerhaave observes, " ille
superavit omnes ;" " omnibus potius quam hocce carere pos-
sumus."
  Upon some future  occasion, I propose to  take  a view
of the progress of this art, from the revival of learning to the
present period ; in which I  shall enumerate the advantages
which the practice of surgery  has derived from the discove-
ry of the circulation of  the  blood, and the subsequent im-
provements in anatomy and the other branches of the heal-
ing art. 
 
 
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