« VorigeDoorgaan »
science, especially within the last ten years, we come to the consideration of a question, the practical solution of which, but lately discovered, has robbed surgical operations of their most formidable feature. Ever since surgery became an art, humane men have sought a means of mitigating the fearful pain attending its operations, for not even the most hardened could steel himself against the shrieks wrung from the agonized victims of the knife. Indeed, if we carry ourselves back in thought to the day when wretched sufferers were bound hand and foot to the operating table, with nerves strung to the keenest sensibility by visions of blood and torture, we cannot but hail the discovery of anæsthetics as a crowning benefaction to human kind. Berzelius was the first to direct attention to the anæsthetical properties of oxygen and hydrogen combined, the elements which enter so largely into the composition of sulphuric ether and chloroform. “Úne atmosphére composé,” he says, " de gaz oxygene ou de gaz hydrogene substitue au gaz hydrogene rend au bout de quelque temps lourd et comme engourdi mais ne produit pas d'autres signes de maladies." His experiments, however, were confined to Guinea pigs, and led to nothing permanent.
Sir Humphrey Davy succeeded, by means of nitrous oxide, in producing a partial and transient anæsthesia, and the anæsthetical power of ether was alluded to by Professor Samuel Jackson in 1833. Not, however, till the year 1846 was such a state of insensibility produced as to render a cutting operation quite painless.
In 1845, Dr. Morton experimented with sulphuric ether, and frequently by means of it extracted teeth without causing pain. In October of the following year he induced Dr. Warren to administer it in a severe surgical operation in the Massachusetts General Hospital, and the results surpassed the most sanguine hopes. Immediately a patent was granted to Dr. Morton by the United States Government, and after that few serious operations were performed in any hospital in the country till the patient was first brought under the anæsthetical influence of sulphuric ether. But Dr. Morton did not long retain the undisputed title to the discovery of this inestimable boon to sufferers; and though it is not our intention to discuss the merits of the “ Ether Controversy," we will state the general results which follow from it. Dr. Jackson contended that he had made success. ful experiments with ether inany months prior to Dr. Morton's first recorded attempts, and the Paris Medical
Academy gave the semblance of truth to this claim by awarding a prize to Dr. Jackson, a judgment it shortly after reversed by the bestowal of a similar prize on Dr. Morton. Many, however, are even yet of opinion that Dr. Horace Wells is the true discoverer, and that Morton treacherously wrested the secret from him. Those pretensions, put forward by the widow of Dr. Wells, could not, however, be sustained before a court of law.
Like many great discoveries which have stamped epochs in the history of the world, the introduction of anæsthetical agents in surgery may be considered a combined result of minds operating at different times and places. In 1847, Dr. Simpsor., of Edinburgh, substituted chloroform for sulphuric ether, having found it a far more powerful, though more dangerous anæsthetic. True, it does not fill up the air passages, thereby causing danger of suffocation, as does sulphuric ether, but it reduces the activity of the circulation with great rapidity. For awhile it obtained general favor, till nearly one hundred fatal cases occurring in quick succession caused it to be regarded with great dread, and a general cessation of its use followed. It was resumed when a few experiments proved its efficacy in difficult cases of parturition, an efficacy all the more wonderful as the peculiar condition of the system at the time of labor renders the administration of it very much safer. Here, however, the use of chloroform met many and vehement adversaries, some contending that it diminished the safety of instrumental delivery, while others maintained that it nullified the divine injunction, “In sorrow shalt thou bring forth,” and even today many practitioners of the old school would be horrified at the mention of chloroform in connection with parturition. A more enlightened sentiment, however, recognises the inestimable blessings which have flowed both from chloroform and ether in the hands of prudent and educated men, and attaches no .weight to the puerile objections urged against their use.
Though the introducton of anæsthetical agents may be viewed as the most important advance in modern surgery, other and later improvements bespeak for their authors much greater skill and ingenuity. And as an American hospital witnessed the first painless surgical operation, so from American hospitals have issued the latest and most useful surgical improvements and appliances. Thus we find that to Americans are accredited the following among many late additions to surgery: the
simple and effective plan of adhesive strips, instead of the cumbrous and unsatisfactory apparatus before employed; elastic extension by weights and pulleys, introduced by Dr. Buck, of New York Hospital; plaster of Paris casts instead of starch splints for keeping fractures and dislocations in position ; Davis's splint for hip-joint disease; hypodermic injections of morphia, an admirable means of relieving local pain, the morphia is injected beneath the skin; scarification of the glottis for ædema, a difficult operation, but successfully performed by Dr. Buck, of New York Hospital; the operation for strangulated hernia without opening the sac; the use of water-bed in injuries of the spine. Here the credit is due to Dr. Arnott, of London. But a categorical enumeration of all late and important improvements in surgery would lead us far beyond our purpose, so we will content ourselves with a reference to one or two more. Dr. Marion Simms, of New York, at present residing in Paris, has introduced many and signal changes in the manner of treating the surgical diseases of women. The use of silver sutures in vaginal fistulas would alone entitle him to eminent rank in his profession. Dr. Emmett, of New York, is Dr. Simms' representative in
, this country, and frequently performs his most difficult operations. The other improvement acquires additional interest from the fact that it is connected with a notable event in European politics. It will be remembered that a few years ago Garibaldi was severely wounded in the foot at Aspro Monte, during an engagement with a regiment of Victor Emanuel's army. The ball lodged among the small bones of the foot, and could not at first be distinguished from the shattered fragments around. Several eminent surgeons from London and Paris vainly attempted to extract the ball, till Dr. Nélaton of the latter city devised the following ingenious means of distinguishing the lead from the bones : He adapted a small spherical piece of Sevres china to a handle, and with this probed the wound. The surface of the china was at once blackened by contact with the lead, and thus the precise position of the ball was ascertained. Though very simple, this little instrument has proved exceedingly useful during the present war; and the writer has witnessed operations of the most serious character, where, but for this ingeniously constructed probe, nothing could have been done.*
* Dr. Gouley, late Surgeon to the Central Park Hospital, discovered, by means of this probe, a bullet lodged in the substance of the brain, amid fragments of the frontal sinuses, and successfully extracted it. VOL. XI.NO. XXI.
These are a few of the numerous improvements which have lately marked the progress of surgery, and according as surgical anatomy and mechanical skill receive further developments, many other important additions will be made to this branch of medical science. Progress in the other departments of medicine has not kept pace with the rapid developments of surgery, for in the other-and especially in the practice of medicine proper—the field of view is more sipuous and obscure than in surgery. The rancor of dispute which pervaded the schools of philosophy gradually crept into medicine; and humoralism and solidism gave as wide scope for endless though not fruitless discussion, as did the question of nominalism and realism among the schoolmen. Most that has been written on the questio vexata, as to whether disease has its seat in the liquid or solid portions of the body, now moulders forgotten on library shelves, but not without having sown seed which has since borne magnificent fruit. In those tournaments of the mind, those controversies wherein solemn trifles don the imposing garb of erudition, we find the latent germ of modern practice. Medical enquirers, from Hippocrates to those of the last century, seemed to view disease as a positive entity, a formidable foe, whose expulsion from the system formed the chief aim of medicine. This theory of disease could not fail to exercise a baneful influence on therapeutics, for it became a question to dislodge an enemy by a regular siege of ditch, scarp, and counterscarp, and not to assist and support the waning powers of nature.
Hence what was called the heroic plan of treatment, which consisted in administering drugs ad nauseam, in bleeding, depressing, purging, and blistering, till the enemy had to surrender. As à result of the controversies alluded to, disease began at last to be looked upon in its proper light, as a negation of health, and not as a distinct entity residing in the system. When acute minds perceived the fallacious principle that underlay the treatment in vogue, they turned to study the means of helping nature in her efforts towards recovery. A deep and wide-spread revolution was then effected in the practice of medicine, a revolution which continues to this day, and which has worked out many changes for the better and for the worse. Among the former, happily the more numerous, a restriction to such drugs as a rational understanding of disease indicated, may be instanced as of primary importance. But this decided step in advance became the occasion of a great and growing delusion yclept Homeopathy, which has sprung up like a upas in the land. As in all radical changes of systems, the mind tends to revolutionize to excess ; so in medicine the step was brief from the moderate changes which rational practice commended to this monstrous dictum of Hahnemann, the father of homeopathy. The latest improvements in our art demonstrate that a single small sized pellet moistened with the decillionth part of the drug would have been fully adequate to perform the cure; nay, it is equally certain that the smelling of it would have sufficed! We here have the key-note to homeopathy, and since it has become a recognised powerin the country,we will set forth a few reasons which may help to explain the mystery of its success. There being few subjects on which the popular mind is less informed than the vital one of medicine, nothing is more natural than that it should fall an easy prey to the ingenious deceptions of quacks and empirics. Of this we need no stronger proof than the success of those advertisements and pamphlets in which are contained a few plausible ideas couched in half-scientific, half-popular language. In this way, no doubt, homceopathy has made rapid strides in public favor, especially when advocated by the pens of a few able writers. But this explanation does not suffice to account for the undeniable good results which have flowed from the so-called homeopathic practice; and, “though,” to use the words of Sir John Forbes, physician to the Queen's household,” it is melancholy to be forced to make admissions in favor of a system so utterly false and despicable as homeopathy, yet truth compels us to give it credit for what good it has done." Setting aside the healing effects of faith in a system, a common cause of cure in nervous complaints, we will perhaps discover the true solution of the problem in the fact that successful homeopathic practice is allopathy in disguise. Thus we frequently find employed by homeopaths such drugs as strychnine, atropine, morphine and quinine, the chief remedies used by regular practitioners, and surely this cannot be called legitimate homeopathic practice.
Moreover they purge, blister, and administer emetics where the required indications exist, and it is only when the obscurity or severity of the disease baffles their skill that they resort to the jugglery of their sect. The truth, therefore, touching homeopathy may thus be summed up: when the fraternity act in accordance with their avowed principles, they do no good; when positive good is accomplished by them, if the result be not due to the workings of an ardent imagination reposing implicit confi