many times, thus closing their mouths". Galen at a later period even tells us that the best shop at which to buy ligatures was in the Via Sacra, between the temple of Rome and the Forum.

Archigenes was equally great as physician and surgeon. He described the varieties of the pulse with even more minuteness than Galen, and suggested that the different kinds of pain might serve to indicate the organs affected; he first drew the important distinction between primary and secondary symptoms in disease, and made the earliest attempt to classify mineral waters according to their composition; but he is especially memorable in connection with the history of amputation. The early Greeks shrunk from that operation, partly, no doubt, because of the formidable hæmorrhage, but partly also from the horror with which they, like the Arabs, looked upon any form of mutilation, the effects of which might, they thought, be continued in a future life. Hippocrates does not mention amputation in its true sense, but in cases of gangrene, when a line of demarcation has been formed, and the irretrievable loss of the limb is evident to the patient as well as to the surgeon, the latter may assist nature by removing the dead part, carefully avoiding to cut into living tissue, for this may cause fatal syncope. Some slight advance was made by the Alexandrines, but Celsus still describes amputation as "the last sad remedy," lawful only in cases of gangrene, though the circular incision is now made rather through living than dead tissue, and the soft parts are drawn back as far as possible before dividing the bone. But in the hands of Archigenes the operation assumes quite a modern shape. The indications include not only gangrene, but chronic ulcers, malignant tumours, severe injury, and great deformity. In some cases the whole part to be removed should be sprinkled with cold water and bandaged, the limb being then tightly constricted with a cord above the point of amputation; where this is not practicable, the chief arteries going to the part should be cut down upon and tied. Rubber bandages

HELIODORUS.-ANTYLLUS.

93

were then unknown, or Archigenes might have anticipated the "bloodless" method of Professor Von Esmarch.

The surgeons of the empire seem to have been acquainted with amputation by flaps as well as the circular method. Thus Heliodorus writes: "Amputation above the elbow or knee is very dangerous owing to the size of the vessels divided. Some operators in their foolish haste cut through all the soft parts at one stroke, but it seems to me better to first divide the flesh on the side away from the vessels, and then to saw the bone, so as to be ready at once to check the bleeding when the large vessels are cut. And before operating I am wont to tie a ligature as tightly as possible above the point of amputation." This would probably result in something like a flap operation, which is still more clearly described by Heliodorus in his directions for removing a supernumerary digit: "A circular incision is made round the digit near its base. From this two vertical incisions are made opposite one another and the flaps so formed dissected up. The base being thus laid bare, the digit is to be removed by cutting forceps, and the flaps are then brought together and sutured."

Antyllus, like Archigenes, seems to have been a general practitioner, for, besides purely surgical subjects, he wrote on hygiene, the choice of proper sites for houses, and the action of purgatives and other drugs. His name is probably better known than that of either of his predecessors, owing to its connection with the earliest operation for aneurism; this, however, is described in most works on surgery, and our brief remaining space will be better occupied by a historical sketch of the treatment of cataract. When the lens of the eye is opaque, it may be removed from the axis of vision in at least four ways, all of which seem to have been known to the Greeks: (1) It may be simply depressed or "couched". This operation, though now abandoned, is of great antiquity, having been known to the Egyptians and Hindus, and was probably the only one practised up to the Christian era. (2) It may be extracted entire, a method

first mentioned by Galen, apparently as a recent invention, for he says: "Some have taken in hand to remove cataract also". (3) The lens may be broken up and left to be absorbed. Celsus notices the division of cataract, though only as a preliminary to couching, but Galen clearly describes the operation, which he rightly confines to soft cataracts, or, as he terms it, those of more serous humor. (4) The lens may be broken up and at once removed by suction. This operation, recently introduced into modern medicine, was long practised in Persia, and, according to Albucasis, was invented there in his time (eleventh century); but Rhazes, who was himself a Persian, and who had special inducements to study the treatment of cataract, attributes the earliest mention both of extraction and suction to Antyllus, remarking: "Antyllus said, 'Some also have made an opening under the pupil, and have extracted the cataract; this can be done when the cataract is small, but if large it cannot be extracted, for the humor comes out with it. And some have used a glass instrument (concilum vitreum), and by sucking it have sucked out the cataract and the humor with it'" (Continens, ii. 3).

An account of ancient surgery would be incomplete without some notice of the interesting discoveries of surgical instruments made in recent years. The most numerous and important are those from Pompeii and Herculaneum, about 200 in number, forty of which were found in one house at Pompeii, which has therefore been called the School of Surgery, or the Surgeon's House, while five others were discovered among some cooking implements in an oil shop. They include ninety pairs of bronze forceps, the majority apparently intended for removing superfluous hair, though one has curved claws, and another spoon-like blades with dentated edges. Besides these there are forty-five probes of various shapes and sizes, thirteen bronze cupping instruments and the same number of iron bistouris; a lancet with silver blade and bronze handle; an S-shaped catheter, and, last but not least, a three-bladed uterine, and double anal

speculum. At Rheims eighteen surgical instruments were discovered, including forceps, spatulæ, scalpels, two syringes, and a little balance, of the so-called "Roman" type, all in bronze, even to the blades of the scalpels. With these was the seal of an ophthalmic surgeon, and some of his drugs which will be noticed in a future chapter.

NOTE.

I have adopted the usual theory which makes Celsus a member of the patrician "gens Cornelia," but there is no definite evidence on the subject. He may possibly have been the descendant of one of those 10,000 slaves whom Sulla enfranchised in one day, and who are called by Cicero, "Græci sacrilegi, jam pridem improbi, repente Cornelii," or even the son or grandson of Cornelius Artemidorus, physician to the infamous Verres, whom he assisted in plundering his own native town of Perga. Such expressions as "Græci vocant," "Nostri dicunt," would come readily from the descendant of a Greek freedman who was prouder of his citizenship than of his ancestors. In this case he may have been a regular physician, but it is scarcely conceivable that a genuine member of the great family of Sulla and the Scipios should have been a practitioner of what was then the homely slighted doctor's trade.

After Celsus the chief authorities on ancient surgery are Paulus and Oribasius, especially the former's sixth book, and the latter's forty-fifth, which is preserved in the "surgical collection" of Nicetas, from which the above translations are taken.

For ancient surgical instruments see Dublin Quarterly Journal, 1852, Annales d'Oculistique, 1866, and for Celsus, Finlayson, Glasgow Med. Journ., May, 1892.

XIX.--GALEN.

ACCORDING to the greatest of modern historians the second century of our era was the period in which mankind most nearly realised the fabled age of gold. The civilised world rested for a brief interval secure under the beneficent shadow of the Roman peace, and was ruled with paternal despotism by three great emperors, each of whom excelled his predecessor in wisdom and virtue. But if the age of Hadrian and the Antonines brought more happiness to mankind than that

of Pericles, as periods in the history of human development they cannot for a moment be compared. Hippocrates, great as he was, might have found more than one equal among his contemporaries, but the second century can boast of but few men of genius, the most famous of whom was far inferior to Hippocrates. This was Claudius Galen (131-200), a man who not only knew all that there was to know in his age, but possessed sufficient talent and originality to acquire the position of a medical dictator, and to maintain it for more than 1000 years.

Galen was the most prolific of ancient authors; he wrote upon philosophy, mathematics, grammar, and law, as well as medicine, and his 500 treatises equalled in number, and probably exceeded in bulk, those of Aristotle. Of the 181 which survive under his name about eighty are spurious or doubtful, or exist only in fragments and in Latin translations; but the remainder contain a complete and systematic view of Greek medicine, and gave laws to the civilised world in anatomy, physiology, and the doctrine and treatment of disease for upwards of fourteen centuries. Their influence can still be traced in many departments of modern medicine, and some of the teaching of the physician of Pergamus remains a possession for ever for the healing art. The following is a very brief outline of the more practical part of this teaching:

Galen's anatomy was based partly on that of the Alexandrines and of his immediate predecessors, Marinus and Rufus of Ephesus, but especially on his own dissections of monkeys and other animals, of which he mentions many kinds, from an elephant down to mice, birds and fishes. Among other discoveries, he first pointed out the platysma, popliteus, and interossei muscles, the ductus arteriosus, and the three coats of the arteries. He omits no opportunity of asserting the great importance of anatomical knowledge in medicine, and declares that, though he rarely operated himself, he had often saved his colleagues by timely warnings from such disasters as befell a certain surgeon who divided the muscu