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CHIRURG1A.

given to the care of the persons concerned. By the Canonists, Blackstone remarks, the word syn- graplia or syngraphus \vas employed in the same way, and hence gave its name to these kind of writings. [B. J.]

CHIRURGIA (xeipovpyla), surgery. ^ The practice of surgery was, for a long time, considered by the ancients to be merely a part of a physician's duty; but as it is now almost universally allowed to be a separate branch of the profession, it will perhaps be more convenient to treat of it under a separate head. It will not be necessary to touch upon the disputed questions, which is the more cmcient, or which is the more honourable branch of the profession ; nor even to try to give such a definition of the word cldrurgia as would be likely to satisfy both the physicians and surgeons of the present day; it will be sufficient to determine the sense in which the word was used by the ancients ; and then, adhering closely to that meaning, to give an account of this division of the science and art of medicine, as practised among the Greeks and Romans, referring to the article medicina for further particulars.

The word chirurgia is derived from x*'lP the hand, and epyov a work, and is explained by Celsus (De Med. lib. vii. Praefat.) to mean that part of medicine quae manu curat, " which cures diseases by means of the hand ;" in Diogenes Laertius (iii. 85) it is said to cure Sia rov Te^v^iv teal Kcuetj/, "by cutting and burning;" nor (as far us the writer is aware) is it ever used by ancient authors in any other sense. Omitting the fabulous and mythological personages, Apollo, Aesculapius, Chiron, &c., the only certain traditions respecting the state of surgery before the establishment of the republics of Greece, and even until the time of the Peloponnesian war, are to be found in the Iliad and Odyssey. There it appears that surgery was almost entirely confined to the treatment of wounds ; and the imaginary power of enchantment was joined with the use of topical applications. (II. iii. 218, xi. 515, 828, 843, &c. &c.) The Greeks received surgery, together with the other branches of medicine, from the Egyptians; and from some observations made by the men of science who accompanied the French expedition to Egypt in 1798, it appears, that there are docu­ments fully proving that in very remote times this extraordinary people had made a degree of pro­gress of which few of the moderns have any con­ception : upon the ceilings and walls of the temples at Tentyra, Karnack, Luxor, &c., basso-relievos are seen, representing limbs that have been cut off with instruments very analogous to those which are employed at the present day for amputations. The same instruments are again observed in the .hieroglyphics, and vestiges of other surgical opera­tions may be traced, which afford convincing proofs of the skill of the ancient Egyptians in this branch of medical science. (Larry, quoted in Cooper's Surg. Diet.)

The earliest remaining surgical writings are those of Hippocrates, who was born b.c. 460, and died b. c. 357. Among his reputed works there are ten treatises on this subject, only one of which however is considered undoubtedly genuine. Hip­pocrates far surpassed all his predecessors (and indeed most of his successors) in the boldness and success of his operations ; and though the scanty • knowledge of anatomy possessed in those times

CHIRURGIA,

prevented his attaining any very great perfection, still, we should rather admire his genius, which enabled him to do so much, than blame him be­cause, with his deficient information, he was able to do no more. The scientific skill in reducing fractures and luxations displayed in his works, De Fracturis, De Articulis, excites the admira­tion of Haller (Biblioth. Chirurg.]^ and he was most probably the inventor of the ambe, an old chirurgical machine for dislocations of the shoulder, which, though now fallen into disuse, for a long time enjoyed a great reputation. In his work De Capitis Vulneribus he gives minute directions about the time and mode of using the trephine, and warns the operator against the probability of his being deceived by the sutures of the cranium, as he confesses happened to himself. (De Morb. Vulgar, lib. v. p. 561, ed. Klihn.) The author of the Oath, commonly attributed to Hippocrates, binds his pupils not to perform the operation of lithotomy, but to leave it to persons accustomed to it (epyar?7<n avSpdffi irp^ios r^trSe); from which it would appear as if certain persons confined them­selves to particular operations.

The names of several persons are preserved who practised surgery as well as medicine, in the times immediately succeeding those of Hippocrates ; but, with the exception of some fragments, inserted in the writings of Galen, Oribasius, Aetius, &c., all their writings have perished. Archagathus de­serves to be mentioned, as he is said to have been the first foreign surgeon that settled at Rome B. c. 219. (Cassius Hemina, apud Plin. H. N. xxix. 6.) He was at first very well received, the jus Quiritium was conferred upon him, a shop was bought for him at the public expense, and he re­ceived the honourable title of Vulnerarius. This, however, on account of his frequent use of the knife and cautery, was soon changed by the Ro­mans (who were unused to such a mode of prac­tice) into that of Carnifeoc. Asclepiades, who lived at the beginning of the first century b. c., is said to have been the first person who proposed the operation of bronchotomy, though he himself never performed it (Cael. Aurel. De Morb. Acut. i. 14. iii. 4) ; and Ammonius of Alexandria, sur-named Aidor6imos, who is supposed to have lived rather later, is celebrated in the annals of surgery for having been the first to propose and to perform the operation of Lithotrity, or breaking a calculus in the bladder, when found to be too large for safe extraction. Celsus has minutely described his mode of operating (De Med. vii. 26. § 3. p. 436), which very much resembles that lately in­troduced by Civiale and Heurteloup, and which proves, that however much credit they may de­serve for bringing it again out of oblivion into public notice, the praise of having originally thought of it belongs to the ancients. " A hook," says Celsus, " is to be so insinuated behind the stone as to resist and prevent its recoiling into the bladder, even when struck; then an iron instru­ment is used, of moderate thickness, flattened towards the end, thin, but blunt ; which being placed against the stone, and struck on the further end, cleaves it; great care being taken, at the same time, that neither the bladder itself be in­jured by the instrument, nor the fragments of the stone fall back into it." The next surgical writer after Hippocrates, whose works are still extant, is CelsiiSj who lived at the beginning of the first

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