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demanded to be verified by practical proof, which by slow degrees, is being laid before us.

Neither must we forget to pay a just tribute to another instrument which supplies the very groundwork for all our just ideas of the ultimate anatomy and knowledge of the functions of the different organs of the human body-the microscope. By the aid of this wondrous instrument the oxyhydrogen light records permanently, by means of photography, a whole world of facts of which we only formerly caught transient glimpses. The marvellously delicate organisation hereby opened up to the physiologist only fills him with deeper wonder than ever at the delicate machinery by which life is carried on, and warns him of the rough handling nature has to fight against in the proceedings of practitioners of our yet imperfect art.

To recur, however, to the more practical portion of our subject, and dealing first with the surgical art, we may broadly state that its triumphs during the last half century may be said to be three—the use of Anæsthetics, Lithotrity, and Ovariotomy. But, although these may be said to be the leading points, yet we cannot conceal from ourselves that what are termed the minor points of surgery, which make little show, possibly confer by their wide-spread operations a still greater blessing upon humanity than the greater operations ; but we shall have ample occasion to refer to these hereafter. We shall refer 1st. To the use of anæsthetics in the performance of sur

gical operations, whilst the patient is unconscious, or

insensible to pain. 2ndly. To the invention of instruments by which a stone

in the bladder may be crushed and washed away in

fragments, instead of being cut out of the bladder whole. 3rdly. The removal of diseased ovaria. To the late Sir James Simpson, of Edinburgh, is undoubtedly due the merit of having first introduced chloroform at Edinburgh as an anæsthetic agent. As early as 1831 its composition was made known by Sonkeren, and the next year by Liebig, but by these chemists the investigation was merely made as a part of scientific inquiry. The re-discovery by Simpson in 1847 was, however, entirely independent of these previous investigations, and its use an anæsthetic was entirely due to the discrimination of our accomplished townsman.

It may be said that there is no such thing as a perfectly new invention, a discovery coming fresh at once from the brain like

as

Minerva from the brain of Jove. There are always some antecedent movements in the same direction, some play about the central idea before the final step is taken, and this was the case with chloroform. As early as 1800 Sir Humphry Davy suggested the use of nitrous oxide gas, and indeed it was used in dental surgery by Dr. Evans, in Paris, and by Dr. Horace Wells, in Halifax, United States, in 1844. Sulphuric ether was also employed at Boston in 1846; but these agents were either so disagreeable in their odour, or so inapplicable to the major operations in surgery, owing to their want of persistency, that they had no chance of establishing themselves as permanent agents in the annihilation of human suffering, either whilst under the influence of the operating knife, or during the agony of ordinary disease. It is scarcely necessary to remark that the perfect quiescence of the patient whilst under any of the great surgical operations is a matter of the utmost importance, not only to the operator, but to the patient. The very fright and terror induced by the sight of the knife, and the anticipation of the coming trial, is sufficient to depress to an alarming degree persons of a highly nervous temperament, and especially those in whom any heart affection renders the possibility of shock highly dangerous. It is well known that pain and terror prolonged for any length of time is sufficient to cause death, independently of any ill effect from the operation. Instances are indeed common in the books, in which patients have died on the operating-table, before the knife has been used, from the terrible effect of shock. Even in the natural operation of parturition, when complications or obstructions have ensued which require the aid of instruments, death is not by any means an infrequent result of the exhaustion produced by the strain upon the vital powers; and it was to obviate these mischances that Sir James Simpson first introduced this powerful agent in ameliorating the pangs of labour.

Like every new art when first introduced, it was met by some of the profession with mistrust. The world had

gone on, they said, for thousands of years without any interference with the physiological pains of labour; not only were they harmless, but necessary as a safeguard for the mother. In this instance, indeed, not only a certain portion of the medical profession set their faces against the employment of the new agent, but the clergy denounced it as a wicked interference with a divine decree: “To the woman he said, I will greatly ' multiply thy sorrow and thy conception; in sorrow thou shalt * bring forth children. This sentence was quoted as a spiritual injunction, which at once set the fiat of the Almighty against

VOL. CXXXVI. NO, CCLXXVIII.

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the supposed unnatural interference with His will. We are all too familiar with similar outcries of the ignorant made against the discovery of Jenner in the last century, and which are still repeated to this day by the peculiar people,' who, under the influence of a crass fanaticism, suffer fine and imprisonment rather than submit to the law, which, in the interest of the individual as well as of the community, makes vaccination compulsory. The best answer to these absurd objections is to be found in the fact that chloroform has now been used in thousands of instances in relieving the pangs of maternity, not only without any evil effect, but to the relief of many of the ill consequences which follow prolonged labour-pains. In fact, anæsthenisation in midwifery is now the rule, instead of the exception. The extreme agony which the parturient woman has hitherto looked upon as inseparable to her condition is now by the aid of art wholly abolished. In different surgical operations where time is required in dissecting away diseased parts, the gain to the surgeon is of equal importance as to the patient. We may safely say that many operations are now possible that would not have been attempted before anæsthesia were employed. The requisite stillness and equanimity necessary for the performance of delicate and tedious operations, without their aid, could not have been obtained. For instance, excision of the jaw, of the scapula, and the shoulder-joint, would have entailed too much prolonged suffering to have justified any surgeon in such operations. Thus the discovery of the new agent may be justly debited with new methods of operations, especially in that new but beneficent art, so justly named by Sir William Fergusson—its principal originator-as Conservative Surgery.

But the use of chloroform has its drawbacks, and is in a measure supplanted by other and more eligible sister compounds, such as methylene. The public is indebted to Dr. Richardson for the introduction of this anæsthetic agent, which has been used by Mr. Wells, distinguished for his skill and success in the operation known as ovariotomy, nearly three hundred times.

The second great operation of the past half-century must be deemed the brilliant one of lithotrity. Fifty years ago, upon the discovery of the presence of a stone in the bladder, the timehonoured operation of lithotomy, or of opening the bladder and withdrawing the stone whole, was the only method of cure for a most painful and, if neglected, mortal disease. About forty years ago the attention of surgeons in this country was drawn by Heurteloup and Costello to the simple expedient of crushing

the stone by means of a peculiar instrument passed into the bladder, seizing with its forceps-like teeth and crushing the stone, sweeping out the larger particles with a scoop, and washing away the finer dust by means of an injected stream of water. The operation was so simple, as compared with the formidable application of the knife applied to such a sensitive organ as the bladder, that the very dignity of surgery seemed lowered by its introduction.

The fight between the lithotritists and the lithotomists became exceedingly lively, and in the clash of opinions the truth itself became clouded. Now, however, that time has cooled the heat of partisans, and the race of lithotomists who prided themselves on their manipulative power has passed away, and that Weiss has so greatly improved the crushing instrument, the great merits of the new operation have been finally accepted, and in no case would a surgeon propose the operation with a knife where the lithotritite could effect his purpose. It a

. is true the operation for crushing is no longer considered so simple and harmless a procedure as at first; but the records of the two operations by the same hand show such a preponderating mortality from the use of the knife, that there is no longer any doubt as to the great gain that has accrued to surgery by the introduction of the modern mechanical process.

Sir William Fergusson, in giving his experience of the two operations, says:

I have personally treated 271 cases—162 by lithotomy, and 109 by lithotrity . . . of these 271, I have lost 47; and that shows a mortality of something more than one in seven-not a bad average as operations for stone go; but lithotrity cases included, I consider it low indeed. And I have now to state that which I look upon as of high interest in the modern history of surgery. Of these 271 cases, 219 were adults; 110 have been treated by lithotomy, and of that number 33 have died ; 109 have been treated by lithotrity, and of that number 12 have died !'

The advantage shown by these figures in favour of the crushing process is significant enough, but some manipulators may have given even a higher proportion of successful cases. Sir Henry Thompson, whose skill in this operation has become so notorious, could, we fancy, give more favourable evidence of the modern operation than the Sergeant Surgeon; but the evidence of one hand is of immense advantage, as it leaves no loophole for the argument that the advantage was due to especial skill. The question of the advisability of the use of an anæsthetic during this operation has been much discussed; but we much question if lithotrity would have attained to its

.

present success in the absence of the pain-destroying agent, considering the extreme sensibility of the part involved, and the necessity for quietude thereby necessitated. By its aid the merits of the operation, when seen at its best, afford one of the greatest triumphs of the surgeon's art. It is, however, just possible that a still less painful operation may be the boast of the coming surgeon. It has been proposed by Dr. Bence Jones to dissolve certain kinds of soluble stones by means of an electric current conducted into the bladder; and among the wonders performed by this new servant of man we should be by no means surprised to find it performing this operation in a perfectly painless manner.

The operation of ovariotomy, which may be considered one of the most heroic operations now performed, must be looked upon, like many others we have to mention, as only a re-discovery of an old method of cure under better auspices; and in more intelligent hands. Until within these last fifteen years, the desperate nature of the wound made-really the Cæsarian operation, as regards the magnitude of the incision requiredcaused it to be virtually set aside by surgeons as unjustifiable, in consequence of the impossibility in many instances of successfully carrying it through after the incision had been made, and upon the high mortality attending its performance, even in the cases most favourable to the operation. In 1838 Mr. Lawrence denounced attempts to treat diseased ovaries by surgical operation as dangerous to the character of the profession;' and the review of which Sir John Forbes was the editor said that whenever an operation so fearful in its nature was performed a fundamental principle of medical morality was outraged.'

It was under these discouraging circumstances, therefore, that Mr. Spencer Wells began to perform the operation in 1858. At that time it had only been performed once successfully in any of our large metropolitan hospitals ; and no

; case of complete success had ever occurred in Scotland. Yet now Mr. Spencer Wells' operations amount to more than 500; the mortality among the whole of the private cases is 24.23 per cent., though in a series of 100 cases it was only 14 per cent., and the mortality on total of Samaritan Hospital cases is 26.66 per cent. Dr. Keith of Edinburgh has been equally successful; and Dr. Tyler Smith, Dr. Bird, and others have performed equally good service, and done their part in adding to the stores of our knowledge. The operation is now of frequent occurrence, and is recognised as perfectly legitimate. The remedy, it must be remembered, was imperatively de

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