At the beginning of the present century the French appeared to lead in matters surgical, and were distinguished by dexterity in operating, fertility of invention, accuracy of observation, and clearness of clinical teaching. The foundation of this reputation was laid by Desault, and upon it his successors continued to build. From his school descended the barber-surgeon Boyer (1757-1833), who became the first surgeon and trusted adviser of Napoleon, and was by him created a baron. He was the author of a work, in eleven volumes, which has survived many editions and translations, and therein he laid especial stress upon after-treatment. Richerand (1779-1840), like Boyer, was made a baron, and was a professor in Paris; but his character suffered from his overweening ambition and vanity; he was wont to exhibit most unpleasant personal traits; nevertheless his surgical ability entitles him to front rank among his contemporaries. The third surgeon honored with the rank of baron was Larrey (1766-1842), surgeonin-chief to the Grand Army, and whom Napoleon I called the most virtuous of men. In 1792 he joined the Army of the Rhine, and was the physician of the so-called "flying ambulance" for twenty-two years. He was present in sixty great battles (including that of Waterloo) and four hundred engagements, and was three times wounded. His memoirs and monographs on subjects connected with military surgery cause him to be often quoted even at the present day. It is recorded that he performed two hundred amputations in a single dav; during the march through Russia he had at one time in Smolensk ten thousand men to care for in one hospital. A wonderful organizer, he was idolized by the soldiers, and seems to have been held in nearly the same esteem as his great prototype. Ambroise Paré.
The most famous French surgeon of this century,—equally celebrated as a diagnostician, as an operator, and as a teacher,—was Baron Dupuytren (1777-1835). As a child he had been stolen, on account of his eminent beauty. His early life was one of poverty and want. He zealously devoted himself to anatomy and physiology as foundations for successful work in surgery and ultimately secured a private practice that embraced all France, and, when visiting other countries, was received like a prince. For years he devoted three hours daily to didactic lectures. He died, leaving a fortune of several millions of francs; he even offered to the exiled Charles of England a million francs as a trifling recompense for his misfortune. He was known as "The Xapoleon of Surgery,"—a title well earned, yet one which drew upon him the enmity of many of his contemporaries, particularly as he seemed inclined to persecute all who dared to tread in his path.
His death resulted from empyema, for which he declined operation, preferring, as he said, "to die at the hands of God, rather than man."
The first truly scientific practitioner of orthopædic surgery in France was Delpech (1777-1832). of Toulouse, who was likewise the pioneer in subcutaneous tenotomy of the tendo Achillis and in autoplastic operations. At his own expense he erected a large orthopaedic institute in Montpellier, and his death occurred while on his way to pay a visit to this institution, both he and his coachman being shot by an insane patient upon whom he had operated.
Dupuytren's successor in the Hôtel-Dieu was Roux (1780-1854), who earned specific reputation as a dextrous and rapid operator; his labors in constructive and plastic surgery were extraordinary. The first to apply physical investigation to surgery was Lisfranc (1790-1847),—best remembered, perhaps, in connection with amputation of the foot. Marjolin (1770-1850) was a teacher of eminence, as were also Sanson (1790-1841) and Cloquet (1790-1883), though the latter is better remembered for his works on anatomy than for his exploits in surgery. Civialc (1792-1867) is chiefly famous for revamping the operation of lithotrity, for, though a lithotrite had been invented by d'Etoilles, Civiale was the first actual operator, for which he was fiercely opposed by Larrey, Sanson, Velpeau, and others; he lived to see his rivals confounded and lithotrity accepted as a legitimate surgical procedure. Amussat (1796-1856) reinvented torsion of arteries for the repression of haemorrhage, for, although this measure had been suggested by the ancients, it was held to be suitable only for very small vessels; he never held a professorship, yet at his residence were gathered so-called "conferences" that were attended by the most eminent medical men of the time; he is specially known in connection with the operation for opening the colon in the lumbar region. Pravaz was a surgeon of Lyons, whose name has been perpetuated by the small syringe—the original hypodermatic—which he devised. Vidal (1803-1856), of Cassis, made a reputation by his work on Surgery, in five volumes, which was extensively translated and reprinted throughout Europe. Jobert de Lamballe (1799-1867) rose from abject poverty to a professorship and a seat in the Académie; he is particularly remembered for his achievements in plastic operations. Velpeau (1795-1868) in 1834 became the successor of Boyer; popular as a teacher, and an author of great fertility, he devoted attention alike to surgery and midwifery; his Operative Surgery, in three volumes, and a treatise on Diseases of the Mammary Gland are still classics. Gerdy (1797-1856), like Velpeau, was the son of poverty-stricken parents; in 1833 he became a professor, and wrote extensively on bandages, dressings, and on operation for the radical cure of hernia. Bonnet (1802-1858) rendered great service to surgery by his researches upon diseases of the joints. Malgaigne (1806-1865), made Professor of Operative Surgery in Paris in 1865, devoted great attention to surgical anatomy, operative and experimental surgery, and especially to fractures and dislocations,—his work on fractures is met with on many book-shelves to-day. Nélaton (1807-1874) was surgeon to Emperor Napoleon III, and, though he wrote little, became peculiarly eminent as a practitioner; his ingenious probe, tipped with porcelain, by means of which he located a bullet in the foot of Garibaldi, is well known. He devoted special attention to tuberculosis of bones and joints, being, perhaps, further instigated thereto by the case of the Prince Imperial; his treatise on this subject forms most acceptable reading to-day, and he taught the existence of osseous tuberculosis long before such was recognized in either Great Britain, Germany, or the United States.
Were I to refer to living contemporaries of many of the celebrities just mentioned, I should speak with special reverence and esteem of Péan, Verneuil, and Oilier, who are to-day the greatest surgeons in France; but with their lives and labors any one may easily acquaint himself from sources which are at the command of all.
I pass now to the Italians, who, since Scarpa's time, have never made any very decided impression upon surgery, although there are many most excellent practitioners of the art in Italy; the best known are Porta (1800-1875), Vanzetta (born in 1809), and Rizzoli (who died in 1880); lliberi, Tizzoni, Loreta, Durante, and others are, perhaps, equally entitled to mention.
Since the time of Gimbernat there have been no surgeons in Spain whose services have been sufficiently important to rouse special attention away from their native peninsula. The Spaniards are well educated, and well equipped for practice, but do not appear as great originators nor experimenters; doubtless because their medical schools and universities long since lost prestige, owing to clerical and Inquisitorial interference; nevertheless, Spanish medical literature has kept well abreast with that of other countries.
In Great Britain the example of John Hunter, during the eighteenth century, produced results of the greatest importance; advances were made simultaneously in physiology and pathology which the Anglo-Saxon races have been quick to utilize. While, perhaps, more conservative and less inventive than the French, the surgeons of England have ever been in the front rank, and quite early they gave great attention to careful local dietetic and hygienic measures, of which Continental surgeons were, and are, too often neglectful. English surgeons, too, while they have been specialists, have never been quite so narrow in their respective fields as the Continental surgeons, and it has always been rare to find one who was not also a good general practitioner; the immense advantages which this added knowledge confers must be apparent. The most celebrated representative of British surgery of this century was the son of a clergyman,—Sir Astley Cooper, born in Norfolk in 1748, but subsequently a resident of London. During youth he resolutely compressed the bleeding limb of a playmate who was the victim of an accident, so that time was gained for the arrival of a surgeon, who then tied the vessel; this decided his future calling, and he pursued his studies in London, Edinburgh, and on the Continent. In 1791 he settled down to private practice, which soon yielded him an income in excess of £20,000 ($100,000), for his day the equivalent of thrice that amount at present. At the age of seventy-three he succumbed to a longstanding asthma. He was a somewhat voluminous writer, and his works on fractures, dislocations, and diseases of the breast are by no means obsolete. His motto was: "First observe, and then think." Exceptionally endowed with all the graces of person, he became one of the most popular and influential men of his day; withal, he was always zealous for his profession, never unoccupied, and charitable to a high degree. Of his boldness we have evidence in the fact that in 1817 he tied the abdominal aorta, being the first to undertake this surgical feat.