Diseases which result from the Disturbance of Vol. I. 286 to 814 anic} 645 to 829 Of Diseases which consist in the Degeneration of Organic INTRODUCTION. DEFINITION OF SURGERY.-ITS I. RELATION TO THE HEALING ART IN GENERAL.-DIVISION OF SURGICAL DISEASES. ALL diseases to which the animal organism is exposed, are the object of the science of healing, the purpose of which is their prevention, cure, or alleviation. The means we employ to these ends are either dietetic or pharmaceutic, or they consist in the application of suitable mechanism, which we call surgical means, and the doctrine of their proper employment, which is called surgery. Every mechanical influence employed with skill upon the diseased organism is called a surgical operation. This influence consists either in a direct interference with the form and natural connexion of the part (Bloody operations, Akiurgie (a), Germ.); or only in a momentary or continued application of mechanism fitted to the surface of our bodies; to which belong bandages and machines, simple manipulations for restoring the natural position of parts, and the employment of suitable mechanism for repairing parts which have been destroyed (Kosmetik (b), Germ.) There are diseases which specially require the employment of one or other class of the means just mentioned: the purpose, however, of the healing art is in most cases but imperfectly attained, if the medical man be not possessed of the requisite knowledge for deciding upon the necessary connexion of these means, so as properly to conduct their operation by a sufficient acquaintance with the laws of our organism, whence it necessarily follows that there cannot be established any true separation between the so-called medical and surgical treatment. The employment of surgical means calls for peculiar dexterity and aptness which natural talents and disposition and long practice can alone confer. "Esse autem chirurgus debet," says CELSUS (c)," adolescens, aut certe adolescentiæ propior, manu strenuâ, stabili nec unquam intremiscente, eâque non minus sinistrâ quam dextrâ promptus, acie oculorum acri clarâque; animo intrepidus, immisericors, sic, ut sanari velit eum, quem accepit, non ut clamore ejus motus, vel magis, quam res desiderat, properet, vel minus, quam necesse est, secet; sed perinde faciat omnia, ac si nullus ex ragitibus alterius affectus oriretur." Only in reference therefore to the physical and psychical characters of the medical man, can there be any division in the practice of medicine and surgery in their attainment they cannot be separated, and, by the union of medical and surgical study alone, can the foundation be destroyed upon which so much bungling, and so many practices unworthy of the spirit of high art, have hitherto been supported. (a) 'Axà, the edge of a knife; gy, an opera tion. VOL. I. (b) Koruiw, to set in order. B The study and practice of Surgery are connected with great difficulty. The dexterity and exactitude with which surgical operations must be performed, can only be attained by long practice on the dead body, the opportunity for which is rare; and still rarer the perseverance necessary to overcome the various disagreeables therewith connected. How much does this practice on the dead body still leave imperfect when we have to meet operations on the living! In how many instances does the life of the patient depend momentarily on the hand of the operator; the restlessness of the patient, his cries, a peculiar sensation to which no practitioner is a stranger in operating on the living subject, and particularly in the beginning of his career, easily disturb his needful equanimity, render him anxious and incapable of perfecting his work with firmness and certainty. Therefore are we not surprised on reading the open confession of the great HALLER. "Etsi chirurgia cathedra per septemdecim annos mihi concredita fuit, etsi in cadaveribus difficillimas administrationes chirurgicas frequenter ostendi, non tamen unquam vivum hominem incidere sustinui, nimis ne nocerem veritus." In the employment of surgical means the practitioner can only be guided by the most perfect anatomical knowledge. That knowledge of the structure of our body, with which the general practitioner is content, is insufficient for the operator. He must be most intimately acquainted by careful dissection with the position of every part, its relations to others, and the variations which in this respect may occur, so that this definite knowledge may direct him in every moment of an operation. Mere descriptive anatomy is not sufficient for the surgeon without that comparative anatomy which is directed to physiology, and which has in view the early developmental periods of the several organs, by which alone a true insight into the nature of so many diseases is possible. All these difficulties connected with the acquirement and practice of Surgery, are sufficiently rewarded by the great superiority which, on the other hand, the practice of them offers. In most cases where surgical assistance is necessary, the possibility of preserving the patient depends upon it: we must, therefore, in desperate cases take bold measures, and the advance of Surgery within the last few years in this respect, has raised our astonishment at the heroism of art, as well as at the immeasurable resources of nature. In this point of view has MARCUS AURELIUS SEVERINUS most correctly entitled his book on surgical diseases, De Medicinâ Efficaci. The inadmissibility of dividing Medicine from Surgery is most palpable, when we endeavour to determine the object of the latter, and the diseases comprehended within its boundaries, as it never can have a perfectly determined limit in opposition to the other. All diseases which are cured by the application of mechanical means have been called surgical diseases, a definition at once too narrow and too comprehensive, as many so-called medical diseases are removed only by the application of surgical means, and many diseases are evidently within the jurisdiction of Surgery, which very often can be cured only by internal or external pharmaceutical means. The distinction between external and internal diseases, which has been established as the ground of division between Surgery and Medicine, is entirely without meaning. Let us endeavour to find out some general characters of disease which to a certain extent might legally serve as the law for a nosological divi sion, and to distinguish those diseases to which we would assign the name of surgical. As the phenomena of life present to us by the relative predominance of powers and organs, a dynamic, potential, and organic material phase, on the intimate harmony of which health depends, so do we observe also in the diseased states of the organism, that sometimes the power, sometimes the organ, varies more from the natural type, whence arises the difference between dynamic and organic diseases. This distinction can, however, only indicate a relatively predominant suffering of one or other phase of life, since the organic body presents in itself an entire whole, of which the several parts and phenomena are in the closest mutual connexion with each other. The organic diseases are especially those which originate in a destruction of the natural condition, form, and structure of organized tissues, and therefore may generally depend, 1. on the disturbance of organic connexion; 2. on the unnatural union of parts; 3. on the presence of foreign bodies; 4. on the degeneration of organic parts, or on the production of new structures; 5. on the entire loss; and, 6., on the superfluity of organic parts. Organic diseases must be distinguished into such as have their seat in parts inaccessible to mechanical contrivances, and to our organs of touch, and whose cure therefore can only be attempted by dietetic and pharmaceutic remedies, or whose seat permits the employment of external means and regulated contrivances, and which in most cases can be brought to heal only by these contrivances, with the assistance of dietetic and pharmaceutical aids. We may therefore distinguish as belonging to the prorince of Surgery all those organic diseases which have their seat in parts accessible to our organs of touch, or which allow of the employment of mechanical means for their cure. Although inflammation is excluded from this general definition, we must, however, still enumerate it generally, and particularly among the manifold origins of surgical diseases, when it attacks external parts. Inflammation in its course and results produces for the most part organic changes, and requires, when attacking external parts, almost always the employment of the so-called surgical means: further, among the surgical diseases soon to be more particularly described, there is not one of which the cause is not inflammation, which in its course does not produce inflammation, or the cure of which is not to a certain extent singly and alone possible by inflammation. After these observations, we therefore prefer the following division for the setting forth of surgical diseases, which, if it be open to many objections, is, however, an arrangement of diseases according to their internal and actual agreement :— I. DIVISION. Of inflammation. 1. Of inflammation in general. 2. Of some peculiar kinds of inflammation. a. Of erysipelas; b. Of burns; c. Of frost-bite; d. Of boils; e. Of carbuncle. 3. Of inflammation in some special organs. a. Of inflammation of the tonsils; b. Of the parotid gland; c. Of |