V. SURGERY

Next to the development of inoculation into vaccination, the most substantial advance in eighteenth-century medicine was in surgery. The old tie with the barber’s art survived till 1745 in England, but in France it was ended by Louis XIV. (The barber’s red-and-white-striped pole, symbolizing a bloody bandage, still recalls his surgical past.)

In 1724 Louis XV sanctioned the creation of five chairs of surgery in the Collège de St.-Côme at Paris. The Faculty of Medicine at the University of Paris protested against exalting surgery to such dignity; the physicians, decked out in their red scholastic robes and preceded by a beadle and an usher, marched to St.-Cóme, where a lecture on surgery was in process; finding the door locked, they tried to break it open, and shouted imprecations against surgeons as upstart barbers; but the crowd that had assembled turned upon the physicians and drove them away. In 1731 Georges Maréchal and François de La Peyronie secured a royal charter to found the Académie de Chirurgie (Academy of Surgery); and in 1743 the King issued an ordinance freeing the surgeons of France from union with the barbers’ guild, and requiring a college degree as prerequisite to surgical practice. Henceforth a surgeon could look a physician in the face.

A similar development took place in England. In 1745 the surgeons were formally separated from the barbers, and it was made a penal offense to practice surgery in or near London without examination and licensing by a committee of master surgeons; the Royal College of Surgeons, however, was not officially chartered till 1800. In Germany, before Frederick the Great, surgery was mainly in the hands of barbers, executioners, and strolling unlicensed practitioners who set bones, couched cataracts, bound up hernias, and cut out stones. In the army—which was Prussia’s pride—the surgeon was called Feldscherer, field cutter, because his functions included serving as barber to the officers. But a Collegium Medico-Chirurgicum was opened in Berlin in 1724.

Most of the great surgeons of the eighteenth century were French. Jean Louis Petit invented the screw tourniquet, and made improvements in amputations and herniotomy. Diderot, in The Dream of d’Alembert, made the famous physician Théophile de Bordeu describe an operation on the brain by La Peyronie. Jean André Venel of Geneva founded surgical orthopedics (1780). In England William Cheselden developed the lateral operation for stone (1727) to a point hardly improved upon since,⁴⁰ and boasted of having performed one lithotomy in fifty-four seconds. English surgery became a science when John Hunter established it on the basis of sound anatomy and physiology. He experimented on animals to find substitutes for operations often fatal in man. In 1786, having discovered, in the case of a buck, that collateral blood vessels can continue the circulation when passage through a main trunk is arrested, he saved the life of a man suffering an aneurysm of the leg by tying the artery above the swelling and relying upon the surrounding parts of the body to absorb the contents of the tumor. This operation has saved countless limbs and lives.

John Hunter’s name stands high also in the development of dentistry. In seventeenth-century England this art was mostly left to tooth pullers, who cried out their arrival and displayed strings of teeth as their coat of arms. In 1728 Pierre Fauchard proclaimed dentistry a branch of surgery, in his treatise Le Chirugien dentiste. But Hunter was the first to apply scientific methods to the study of teeth. He introduced their classification as cuspids, bicuspids, molars, and incisors; he devised appliances for correcting malocclusion; and he was the first to recommend complete removal of the pulp before filling a tooth. He summed up his views in his Natural History of the Human Teeth (1771).

Most minor operations were performed without anesthesia. The ancients had used various soporific potions—“nepenthe,” opium, henbane, mandrake, hemlock, etc.; God himself, said the Book of Genesis, put Adam into “a deep sleep” before taking out a rib. Dioscorides, in the first century of the Christian Era, prescribed mandragora wine in surgical operations.⁴¹ India used Cannabis indica (Indian hemp). Surgical sleeping draughts were mentioned by Origen in the second century, and by St. Hilary of Poitiers in the fourth. Most of the old soporifics continued in use in the Middle Ages; so the famous medical school of Salerno advocated a “sleeping sponge.” In modern Europe the favorite anesthetic was drunkenness. Only in 1799 did Sir Humphry Davy discover the anesthetic properties of nitrous oxide (“laughing gas”). The anesthetic possibilities of ether were discovered in 1839 by Dr. Crawford Long of Danielsville, Georgia.