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amputation. This he performs invariably at the joint, by a circular incision. After the removal of the limb, whatever hæmorrhage occurs he arrests by the actual cautery; taking due care not to apply the heated iron to the divided extremities of
Heliodorus is also more particularly noted as a surgeon. Fragments of his writings on wounds of the head, on fractures of the skull, and other injuries, may also be found in Oribasius* and the collections of Nicetas.t His remarks on injuries of the skull are judicious, and indicative of a careful observer; and his treatment, such as might be recommended at the present day. His dressings are light, his local applications simple, usually moist compresses, roseated oil, simple cerate, and tepid water. For controlling inflammation he resorts to low diet, and occasionally to venesection. He speaks of amputating in the continuity of the long bones, but looks upon operations above the knee and elbow as extremely dangerous, from loss of blood. To obviate this danger as far as possible at other points, he makes his incision first through those parts of the limb in which the bones are most superficial ; he next saws through the bones; and he reserves his incision through the fleshy part of the limb, where the vessels are most numerous, to the last.
Antyllus, another surgeon, though not mentioned by Galen, is by some writers presumed to have preceded him, whilst by others he is placed as late as the reign of Valerian. He is frequently mentioned by the later Greeks. In the collections of Nicetas* is a fragment of his on elastic or watery tumors of the head, superficial and deep-seated; including among the last, congenital or chronic hydrocephalus. The superficial varieties he encounters with fair hope of success, but with those more deeply seated he is indisposed to interfere. He treated humid asthma with suffumigations, placing the patient in such a position as readily to inhale the fumes from particles of aristolochia or clematis previously sprinkled over burning coals in a chaffing-dish or brasier.f He operated on cataract by extraction; with Asclepiades, he recommends tracheotomy in threatened suffocation; and he treated hydrocele by incision. I Soranus of Ephesus, the second of that name, was
* Collect. lib. viii. chap. 3, 4, and elsewhere. | Page 90 to 105. pp. 124, 156.
, educated in part at least at Alexandria, and practiced with great eclat at Rome under the reigns of Trajan and Adrian. He was celebrated both as a teacher and practitioner; and is admitted to have been the ablest exponent of the Methodic doctrines, which he carried to their highest degree of popularity. He was the first to mention the Dracunculus or Guinea worm (vena medinensis.) Among the fragments of his writings still preserved, we have a treatise on the female organs of generation, and another on fractures, which is contained in the collections of Nicetas, and is mostly made up of definitions. This second Soranus is not to be confounded with still another of the same name, also of Ephesus, a writer of later date, and the reputed author of a memoir on the life of Hippocrates. The works of the second Soranus, though mostly lost, served as the model for those of Cælius Aurelianus, who is supposed to have embodied the greater part of them in a translation. To him, therefore, we must next direct our attention.*
* Page 121. + Oribasius, collect. lib. viii, cap. 12. † Sprengel, tome ii. p. 94, from Rbazes and Paulus
Cælius Aurelianus, sometimes called Lucius Cælius Arianus, was a native of Sicca in Numidia. He appears to have been a voluminous writer. Besides his work on Acute and Chronic Diseases, which is preserved entire,t he was the author of Greek Epistles addressed to Prætextatus ; of a work on Fevers, and of another on Diseases of Females; of distinct treatises on the Causes of Disease, on Surgery, on the Rules of Health, on Adjuvants or the General Remedies of the Methodic sect, and on Medicaments; besides several books of Medical Interrogations and Responses; and a book of Problems ;--all of which have perished. His work on Acute and Chronic Diseases is written in impure Latin; and much of it, as the author admits, has been borrowed from Soranus. But it can hardly be considered a translation, since much of it was evidently the result of the author's own observation and experience. Of the eight books consti
* Cælius Aurelianus, and Galen in several places.
+ Cælii Aureliani Ciccensis de Morbis Acutis et Chronicis libri viii. 4to. Amstelædami, 1722.
tuting this work, three are devoted to the history and treatment of acute, and five to the history and treatment of chronic diseases. The several maladies are arranged in the usual order from head to foot, considered in their relation to concomitant constitutional disturbances, and spoken of as accompanied or not accompanied with fever. This valuable summary of theory and practice, can scarcely be considered as advocating only the doctrines of the Methodic sect. Though its author is a favorer of these doctrines, he speaks as an independent observer, criticises the leading writers of his own party, and, in disposing of his materials, gives first his own proper opinions on the history or pathology of the disease in question, and afterwards those of the several leading writers of the other sects; drawing, however, almost exclusively from the Greeks, and furnishing a systematic exposition of the theory and practice of physic, both of his own and previous times. But in referring to his predecessors he is much more solicitous to give their treatment than their pathological opinions; which, however, he does not entirely overlook. Cælius Aurelianus, quoting from Soranus, is the first writer in whom I remember to have met with a practical distinction between what he calls the signs and the symptoms of disease, a distinction still worthy of remembrance: the signs being always present during the existence of the disease ; the symptoms being mere accidents, that may or may not be observable, without necessarily implying any essential modification in the disease itself. His chapters on diseases of the head are ably written, and evince much practical acquaintance with the subject. In his chapter on Cynanche he says, some forms of Cynanche are without visible manifestations; others are visible and manifest, either within the fauces, or externally, or both externally and internally, and in one or both sides. The transition from this description to that of the monkish writers of the middle of the thirteenth century, Roger, Roland, and the author of the Four Masters, is curious and amusing. Thus, says Roland, Squinantia is an aposthem of the throat, of which there are three sorts; and hence the verse,
“Qui (nancia) latet, squi (nancia) patet, si (nancia) manet intus et extra." While on diseases of the throat, Cælius Aurelianus takes occasion to criticise Hippocrates, particularly in reference to the inhalation of vapors medicated with hyssop, sulphur, or bitumen, by means of a tube introduced within the fauces, for the relief of threatened suffocation ; a practice against which he speaks in the strongest terms; judging it impossible to insert a tube into the fauces already so much obstructed as not to admit even air,—or to inject thick smoke where thin air is unable to penetrate.*
As Soranus and Cælius Aurelianus are considered the ablest exponents of the Methodic doctrines; and as we learn from them what would be sought in vain elsewhere concerning Asclepiades, Themison, Thessalus, and others of this sect, it may be proper here to give a summary of their practice at the period of its greatest eminence.
They confined themselves as much as possible to
* See his works, p. 191.