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operator. This paragraph evinces much practical acquaintance with the business of the operation-room.

§ 6. The duties of the assistant are distinctly laid down and prescribed. §7. General directions are given for the application of the bandages along with a description of the characters by which to distinguish bandaging when properly applied. Names of some of the most important

fascia, or forms of bandages.

§ 8. Directions are given for regulating the amount of the compression produced by the bandages, and for securing the bandages by a thread with knots.

§ 9. Many remarks are made on the tendency of a bandage to fall off from particular parts of the body, and directions are given to obviate this tendency.

§ 10. The general characters of the bandage are again described somewhat more fully than before.

§ 11. The application of severa, forms of bandage, especially the hypodesmis and epidesmis, acccording to circumstances and the object for which they are used, is described with much precision and minuteness of detail.

§ 12. The remainder of the directions for bandaging a fractured limb is given, along with the application of the splints, and the use of cerate for giving firmness, and of selvages or slips of cloth for giving security to them. The splints also are minutely described.

§ 13. The affusion of hot water on the limb after the removal of the bandages is particularly enjoined.

§ 14. The adjustment of the limb, more especially by means of canals, or gutters for giving greater security to the inferior extremity, is particularly insisted upon.

§ 15. Directions are given with regard to the natural, that is to say, the proper position of a fractured limb while in the acts of setting and adjusting it. The fore-arm is to be placed at right angles to the arm, in a state intermediate between pronation and supination and an inferior extremity is to be laid in an extended position.

§ 16. Directions are given with regard to the force to be applied in adjusting fractured bones: it is to be in proportion to the size of the bone, and stronger in the case of young than of old persons.

§ 17. The general effects of friction are briefly defined.

§ 18. Minute and very sensible directions are given as to the appearance which the bandaging should present during the process of treatment.

§ 19. The general object of the surgical contrivances connected with the management of a fractured limb is correctly defined to be-to keep the limb in position.

§ 20. The effects of rest and exercise on the condition of the limb or member are briefly define 1.

§ 21. The strength of the bandaging is directed to be made to depend on the number of the bandages, rather than the tightness with which they are applied.

§ 22. The effects of bandaging in the treatment of ecchymosis, contusions, and swellings are described, along with other circumstances connected with the treatment of these cases.

§ 23. The application of bandages, position, and friction, in the treatment of dislocations, sprains, separation of bones, club-feet, and other surgical cases, are minutely and accurately defined.

§ 24. The treatment of limbs which have become atrophied from want of exercise and the compression of tight bandages during the process of treatment for fracture, is strikingly defined. The application of a loose bandage in a peculiar form, as here described, is well deserving of attention.

§ 25. The means to be taken in order to steady the head and chest in injuries of the same, are briefly and distinctly defined.

From this brief analysis of its contents the reader will readily perceive that the greater part of the work is devoted to the treatment of fractures and injuries of a similar nature. The rules for the management of this part of surgical practice are certainly laid down here with a degree of precision which bespeaks a minute and accurate acquaintance with the subject, and evinces a great talent for judging correctly the bearings of practical questions in surgery. It may well be doubted whether the same subject be methodized and defined with the same precision in any other work, ancient or modern. It must always be borne in mind, however, that, as stated above, the work is to be viewed in the light of a rough sketch, which, in order to be understood, must be taken in connection with the fuller exposition of the subject given in the work "On Fractures." At first, then, I was inclined to arrange the present treatise after the works "On Fractures " and " On the Articulations," believing that it would thus occupy its most suitable position, by serving as a remembrancer to the reader of the various objects which he had previously viewed in detail. But although it might, no doubt, prove very useful according to this arrangement (and indeed it is so arranged by Galen), I am not sure but that it stands more properly in its present place, as it is always of advantage to take at first, as it were, a coup-d'œil of a subject, so as to ascertain its limits, and the bearings of its particular parts upon one another, before proceeding to examine each of them in detail. There is also a great advantage to a student in having a syllabus of any subject which he intends to investigate, so that his attention may be awakened and directed beforehand to the matters which will be presented to him in going over the intended field of inquiry. For the reasons now adverted to, I am of opinion, then, that whoever would wish to make himself thoroughly acquainted with the surgical works of Hippocrates, should commence his studies with the present treatise. In a word, this work may be regarded

as the prologue, and the "Mochlicus" as the epilogue, to the great work "On Fractures and Dislocations."

I may mention, in conclusion, that although Galen in one place expresses himself rather undecidedly regarding its authenticity, it would appear that, after all, this tract was a great favorite of his, for he has not only written an elaborate Commentary upon it, but has made frequent allusions to it in other parts of his works.


1. It is the business of the physician to know, in the first place, things similar and things dissimilar; those connected with things most important, most easily known, and in anywise known;' which are to be seen, touched, and heard; which are to be perceived in the sight, and the touch, and the hearing, and the nose, and the tongue, and the understanding;' which are to be known by all the means we know other things.'

2. The things relating to surgery, are-the patient; the operator; the assistants; the instruments; the light, where and how; how many things, and how; where the body, and the instruments; the time; the manner; the place.*

'The meaning of the first clause of this sentence, according to Galen, is, that the first thing which the medical practitioner must do is to make himself well acquainted with semeiology, by comparing carefully the condition of disease with that of health. In all cases of accident, it was the practice of the ancient surgeons to compare carefully the injured part with its fellow or corresponding part on the opposite side. Galen, in his Commentary, relates an interesting case, which shows the necessity of care in making such a comparison. A patient had met with an accident, by which the acromion was torn from the scapula, and the nature of the injury was not recognized at first, owing to the appearances being similar on the opposite side: but Galen, upon inquiry, found that these had been occasioned by a previous accident. I may mention here, by the way, that Sir Charles Bell, in treating of dislocations of the hip-joint, very properly inculcates the propriety of ascertaining the previous state of matters before deciding in a case of supposed luxation.

It will be perceived that this clause is little else than an apparent repetition of the preceding one. Galen mentions several explanations which had been given to account for this; the most plausible of which appears to me to be, that the former clause relates to the senses of the physician, and the latter to those of the patient.

The last clause is illustrated by a very elaborate Commentary of Galen, in which he discusses with his usual subtilty the question respecting the criteria of human knowledge. Galen holds that our gnostic powers may all be referred to these three-sensation, understanding, and memory. These questions would now be reckoned too metaphysical for a surgical treatise.


→ This will be admitted even now to be a comprehensive list of everything that relates to the operation-room. The general meaning is quite obvious, and the

3. The operator is either sitting or standing, conveniently for himself, for the person operated upon, for the light. There are two kinds of light, the common and the artificial; the common is not at our disposal, the artificial is at our disposal. There are two modes of using each, either to the light, or from the light (to the side?). There is little use of that which is from (or oblique to the light), and the degree of it is obvious.' As to opposite the light, we must turn the part to be operated upon to that which is most brilliant of present and convenient lights, unless those parts which should be concealed, and which it is a shame to look upon;' thus the part that is operated upon should be opposite the light, and the operator opposite the part operated upon, except in so far as he does not stand in his own light; for in this case the operator will indeed see, but the thing operated upon will not be seen. With regard to himself: when sitting, his feet should be raised to a direct line with his knees, and nearly in contact with one another; the knees a little higher than the groins, and at some distance from one another, for the elbows to rest upon them. The robe, in a neat and orderly manner, is to be thrown over the elbows and shoulders equally and proportionally. With regard to the part operated upon; we have to consider how far distant, and how near, above, below, on this side, on that side, or in the middle. The measure as to distance and proximity is, that the elbows do not press the knees before, nor the sides behind; that the hands be not raised higher than the breasts, nor lower than so as that when the breast reposes on the knees he may have the hands at right angles with the arm: thus it is as regards the medium; but as concerns this side or that, the operator must not be beyond his seat, but in proportion as he may require turning he must shift the body, or part of the body, that is operated upon. When standing,


only obscurity in this paragraph consists in the reading, for which see Galen's Commentary, and the Annotations of Littré. I shall only mention that by place, in the end of the sentence, was probably meant the diseased part, or seat of the disease. The term is thus used in the Hippocratic treatise, De Locis in Homine. 'By "from the light," Galen explains is meant "turned from the light," that is to say, oblique to the light. Galen mentions that it is applicable principally in operations on the eye, such as the anabrochismus, the removing of tumors from the eyelids, excision of the pterygium, and couching the cataract.

2 Galen remarks, that in operations on the parts of generation, and on the breasts in females, it is proper that the patient should be blindfolded. He also recommends in certain cases, when the patient is remarkably timid, to deceive him by telling him that the operation had been put off until another day, and while in the act of making, as it were, preparations for it, to perform the necessary incision.

3 The ancient physicians attached much importance to decorum, and studied effect very much in the practice of their art. In the Hippocratic treatise, On Elegance, the dress of the physician is not forgotten. In this passage it will be seen that the manner in which the surgeon's robe, or mantle, should be flung over him, while in the act of operating, is graphically described.

he must make his inspection, resting firmly and equally on both feet; but he must operate while supporting himself upon either leg, and not the one on the same side with the hand which he makes use of; the knee being raised to the height of the groins as while sitting; and the other measures in like manner. The person operated upon should accommodate the operator with regard to the other parts of his body, either standing, sitting, or lying; so as that he may continue to preserve his figure, avoid sinking down, shrinking from, turning away; and may maintain the figure and position of the part operated upon, during the act of presentation, during the operation, and in the subsequent position.'

4. The nails should be neither longer nor shorter than the points of the fingers; and the surgeon should practice with the extremities of the fingers, the index-finger being usually turned to the thumb; when using the entire hand, it should be prone; when both hands, they should be opposed to one another. It greatly promotes a dexterous use of the fingers when the space between them is large, and when the thumb is opposed to the index. But it is clearly a disease when the thumb is impaired from birth, or when, from a habit contracted during the time of nursing, it is impeded in its motions by the fingers. One should practice all sorts of work with either of them, and with both together (for they are both alike), endeavoring to do them well, elegantly, quickly, without trouble, neatly, and promptly.


5. The instruments, and when and how they should be prepared, will be treated of afterwards; so that they may not impede the work, and that there may be no difficulty in taking hold of them, with the part of the body which operates. But if another gives them, he must be ready a little beforehand, and do as you direct."

1 The description of the position of the operator, and of the person operated upon, contained in this paragraph, is so clear as to stand little in need of elucidation. I may mention, that by the act of presentation, an expression which often occurs in the surgical treatises of Hippocrates, was meant the position in which the injured or diseased member of the patient is presented to the surgeon for operating upon it. By subsequent positions, it will readily be understood, is meant the state in which the limb is placed after the operation; such, for example, as the adjustment of the leg in a canal, and the suspension of the arm in a sling after bandaging for fracture. These questions we shall find fully discussed in the work On the Articulations.

? The importance of these general directions for the surgeon, in order that he may acquire skillful manipulation, is obvious. The free motion of the thumb and index-finger evidently contributes in an especial manner to the dexterity of the operator. The importance also of practicing with either hand, so as to become ambidextrous, is now generally admitted. The text in the clause of the sentence, where the impediment of the hand is described, would appear to be corrupted. See Galen, Foës, and Littré.

The directions, I need scarcely remark, are most apposite, and bespeak a familiar acquaintance with surgical practice. By instruments, as Galen in his

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