PART I. HISTORY OF SURGERY

Part 6. 18th Century.

The 18th century marks the establishment of surgery Eight-on a broader basis than the skill of individual surgeons of eeutl1 the court and army, and on a more scientific basis than centur-the rule of thumb of the multitude of barber-surgeons and other inferior orders of practitioners. In Paris the Col-lege de St Come gave way to the Academy of Surgery in 1731, with Petit as director, to which was added at a later date the Ecole Pratique de Chirurgie, with Cliopart and Desault among its first professors. The Academy of Surgery set up a very high standard from the first, and exer-cised great exclusiveness in its publications and its hono-rary membership. In London and Edinburgh the develop-ment of surgery proceeded on less academical lines, and with greater scope for individual effort. Private dissecting rooms and anatomical theatres were started, of which per-haps the most notable was Dr William Hunter's school in Great Windmill Street, London, inasmuch as it was the first perch of his more famous brother John Hunter. In Edinburgh, Alexander Monro, first of the name, became professor of anatomy to the company of surgeons in 1719,

transferring his title and services to the university the year after ; as he was the first systematic teacher of medicine or surgery in Edinburgh, he is regarded as the founder of the famous medical school of that city. In both London and Edinburgh a company of barbers and surgeons had been in existence for many years before ; but it was not until the association of these companies with the study of anatomy, comparative anatomy, physiology, and pathology that the surgical profession began to take rank with the older order of physicians. Hence the significance of the eulogy of a living surgeon on John Hunter : " more than any other man he helped to make us gentlemen " (Hunterian Oration, 1877). The state of surgery in Germany may be inferred from the fact that the teaching of it at the new university of Göttingen was for long in the hands of Haller, whose office was " professor of theoretical medicine." In the Prussian army it fell to the regimental surgeon to shave the officers. At Berlin a medico-chirurgical college was founded by surgeon-general Holtzendorff in 1714, to which was joined in 1726 a school of clinical surgery at the Charité. Mili-tary surgery was the original purpose of the school, which still exists, side by side with the surgical cliniques of the faculty, as the Friedrich Willielm's Institute. In Vienna, in like manner, a school for the training of army surgeons was founded in 1785,—Joseph's Academy or the Joseph-inum.' 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. With-out attempting to enumerate the great names in surgery during the 18th century, it will be possible to introduce the more prominent of them in a brief sketch of the addi-tions to the ideas and resources of surgery in that period. A great part of the advance was in surgical pathology, including Petit's observations on the formation of thrombi in severed vessels, Hunter's account of the reparative pro-cess, Benjamin Bell's classification of ulcers, the observr-tions of Duhamel and others on the formation of callus and on bone-repair in general, Pott's distinction between spinal curvature from caries or abscess of the vertebrae and kyphosis from other causes, observations by various surgeons on chronic disease of the hip, knee, and other joints, and Cheselden's description of neuroma. Among the great improvements in surgical procedure we have Cheselden's operation of lithotomy (six deaths in eighty cases), Hawkins's cutting gorget for the same (1753), Hunter's operation (1785) for popliteal aneurism by tying the femoral artery in the canal of the triceps where its walls were sound (" excited the greatest wonder," Assalini), Petit's, Desault's, and Pott's treatment of fractures, Gim-bernat's (Barcelona) operation for strangulated femoral hernia, Pott's bistoury for fistula, White's (Manchester) and Park's (Liverpool) excision of joints, Petit's invention of the screw-tourniquet, the same surgeon's operation for lacrymal fistula, Chopart's partial amputation of the foot, Desault's bandage for fractured clavicle, Bromfield's artery-hook, and Cheselden's operation of iridectomy. Other surgeons of great versatility and general merit were Sharp of London, Gooch of Norwich, Hey of Leeds, David and Le Cat of Bouen, Sabatier, La Faye, Leclran, Louis, Morand, and Percy of Paris, Bertrandi of Turin, Troja of Naples, Palleta of Milan, Schmucker of the Prus-sian army, August Richter of Güttingen, Siebold of Würz-burg, Olof Acrel of Stockholm, and Callisen of Copen-hagen.






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