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LEFT SUBGEBY 176 SUBGEBY Dutation, long before the date of the Ebers papyrus (3500 B. c)- Castration (to supply eunuchs for the royal harem) was also a frequent operation. Preserved in museums may be seen surgical in- struments contemporary with votive offerings of the remotest Egyptian epoch — lancets, tweezers, catheters, uterine specula, iron rods for the actual cautery, etc. Among other indications of early proficiency in ophthalmic sur- gery, couching cataract must have been known to them. Jewish surgery, like Jewish medicine, was an importation from the Egyptians. The sexual regulations characteristic of the Jews affected their surgery, from simple circumcision up to the Caesarean section, which very early in their history was practiced on pregnant women in death as in life. Without entering into the controversy as to the Greek origin of the Indian heal- ing art, we find surgery enjoying high esteem among the Indians in very remote times. Surgical instruments skillfully made of steel, to the number of 127, still attest their proficiency in cutting and cauterizing. Their surgeons were trained to operate by practicing not on animals or on the dead human subject, but on wax-covered boards, on beasts' skins, or on succulent plants and fruits. Hemor- rhage they checked by cold, by compres- sion, and by styptics. The ligature they seem not to have known. Amputation was confined to the hand in cases of in- tractable hemorrhage. Lips or surfaces of wounds they smeared with an arseni- cal salve. For intus-susception, volvulus, and such abdominal lesions they prac- ticed laparotomy, while fistula in ano (diagnosed by the speculum) they treated with the knife and corrosives. As to the surgery of the other Orientals we possess but obscure notices. Among the Persians we find Greeks in general practice under King Cambyses. The Chinese 6 centuries B. C. performed sur- gical operations. In Greece surgery had attained high development before Hippocrates put medicine on a rational basis, and in the Hippocratic books we find a rich col- lection of surgical doctrine and practice drawn from centuries of experience. Even modern appliances were in great part anticipated by him — splints, for ex- ample, and bandages of various kinds. The gem of the Hippocratic surgery (ac- cording to Haser) is the treatise on in- juries of the cranium — fractures, fis- sures, and contusions with or without depression. For such cases trepanning is the sovereign operation, to be per- formed as early as possible, less to get rid of effused blood, pus, etc., than, by removal of the injured osseous structure, to prevent inflammation of the scalp. The removal of extremities which had become gangrenous shows again the Hippocratic surgery in a wonderfully favorable light. The post-Hippocratic school (its greatest surgeon being Praxagoras of Cos, noted for his cure of volvulus) has little to detain us; but the Alexandrians left a distinct mark on every branch of the healing ai't — surgery included. Our best knowledge of them comes from Celsus, who names as the most celebrated surgeon of Alexandria Philoxenus, a voluminous writer on the subject. Roman surgery can hardly claim M. Porcius Cato (234-149 B. c.) as more than a shrewd amateur who left some handy rules for the treatment of frac- tures, ulcers, nasal polypi, fistulas, strangury, etc. Archagathus (218 B. c.) was a regular practitioner, known for his skillful handling of dislocations, frac- tures, and particularly wounds, as the "Vulnerarius." But when from such practice he proceeded to operate with the knife his popularity fled, he was nick- named the "Carnifex," and had to leave the city. Celsus, the patrician dilettante in medicine, is really the highest name in Roman surgery, though it is doubtful whether he ever operated. Of the eight books of his admirably written work the last two treat of surgery, including plas- tic replacement of defects in the outer ear, the nose, and the lips; lithotomy as practiced on boys (a celebrated chap- ter) ; amputation, previously described by no other author; diseases of the bones, with the operation of trepanning, fractures simple and compound, and dis- locations. Galen, though a master of surgery, and, before his settling in Rome under M. Aurelius, a practitioner of it, seems to have contributed nothing of his own to its doctrine of practice. As he found it (with some notable additions) it re- mained to the close of the Byzantine period. An intimate knowledge of its modus operandi during these centuries may be inferred from the collection of surgical instruments dug up at Pompeii and now on view at Naples. These are about 300 in number, consisting of some 60 different kinds. The treatment of fractures and dislocations was practically the same from Hippocrates to Paulus ^gineta (a. D. 650). Trepanning received several modifications in practice up to Galen's time, while tracheotomy (intro- duced by Asclepiades, 1st century) was by Paulus restricted to cases of choking, when the deeper air passages were free. The operation for hernia, perfunctorily dealt with by Hippocrates, had by the