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MEDICINE

From The Nineteenth Century,

esuriens brought his physic as well as THE PROGRESS OF

DURING his philosophy to the great market of THE QUEEN'S REIGN.

Rome, and under the Empire medicine Not many months ago the Duke of men flourished exceedingly. Medicine Cambridge, speaking at St. George's itself, however, was at its best a mere Hospital on the occasion of the opening empiric art, and in this condition it reof a new operating theatre, said:- mained practically till Harvey's dis

covery of the circulation of the blood in I do not believe that amid all the in

1628 laid the corner-stone of modern provements, the advantages, and the addi. tions that have occurred during the pro

puysiology, and thus prepared a founda

tion for a scientific medicine. From the longed reign of her Majesty, anything has made so much progress as medical and

seventeenth till the early part of the surgical science. Whether we look at

nineteenth century, though many imwhat has been or is going on in this coun- provements were made in the details of try, or whether we turn to foreign lands, the art of healing, there was no great it strikes me that there has been an ad advance either in the conception of disvance made which has been of such enor- ease or in the principles of treatment. mous advantage to the human race that the discovery of vaccination itself, that alone would mark this period to

though one of the greatest practical imwhich I am alluding.

portance, was merely the observation of His Royal Highness, with the prac

a fact, not the enunciation of a law. tical sense of a man of affairs, in a few When the queen came to the throne in plain words expressed the exact state 1837, it is hardly too much to say that of the matter. It will be my purpose the average medical practitioner knew in the following pages to show how fully little more about the diseases of the justified he was in making the state- heart, lungs, stomach, liver, and kidment which has been quoted.

neys than was known to Hippocrates. It is no idle boast, but the simple un- Auscultation had indeed been introvarnished truth, that medicine - in duced some years before, but long after which term I include the whole art of the commencement of her Majesty's healing, and the scientific laws on reign elderly gentlemen might be seen, which its practice is based-has made when a stethoscope was offered to greater progress during the last sixty them at a consultation, to apply the years than it had done in the previous wrong end to their ear. Fevers were sixty centuries. The medical knowl- classified with a sweet simplicity into edge of the Egyptians, though consid- "continued” and “intermittent," and as erable compared with that of other an- late as in the 'Fifties an eminent procient peoples, was, as may be gathered fessor of surgery complained that his from the fragments of their nosology colleague, the professor of medicine, and therapeutic formularies that have had invented a number of new-fangled come down to us, but little above the varieties. Of nervous diseases nothing traditional lore in such matters with was known. The larynx was a terra which old women have in all ages been incognita; of the ear it was said by the credited. The practical mind of Greece leading medical journal of the day, began by trying with Hippocrates to see many years later than 1837, that the things as they really were, but later fell onlv thing that could be done in the way away into the making of systems and of treatment was to syringe out the exthe spinning of cobwebs of theory in- ternal passage with water. The diagnostead of observing facts. The Romans sis and treatment of diseases of the skin had for medicine and its professors a had advanced little beyond John Huntrobust contempt, akin to that which er's famous division of such affections Squire Western had for French cooks into those which sulphur could cure. and their kickshaws. In the later days those which mercury could cure, and of the Republic, indeed, the Græculus those which the devil himself couldn't

cure. Pathology was a mere note-book upon to use the knife, in the very year of post-mortem appearances-a list of ob- of the queen's accession, he says:servations as dead as the bodies on

Our patient (a woman) writhed beyond which they were made. The New the restraining power of strong and es World of bacteriology had not yet found perienced men, and groaned to the horror its Columbus.

of the terrified household, and afterwards In the domain of surgery progress to the day of her death could not think of had been far greater, and as regards the operation without convulsive shudders. operative skill and clinical insight Often did she hold up her hands, exclaimAstley Cooper, Robert Liston, Dupuy- ing, "Oh, that knife! that awful knife! that tren, and Larrey were certainly not in- horrible knife!" ferior to the men of the present day. Dr. Cotting sums up his recollections Anästhesia was, however, unknown, of such scenes as follows:and the operating theatre was a place of

No mortal man can ever describe the unspeakable horrors. Wounds were

agony of the whole thing from beginning dressed with wet rags, and suppuration to end, culminating in the operation itself was encouraged, as it was believed to be with its terrifying expressions of infernal an essential part of the process of heal- suffering. ing. broadly speaking, it may be said that sex came under the surgeon's knife in

A distinguished physician, who himthe advance of the art of healing dur- the days before anæsthesia, has left on ing the last sixty years has been along record a vivid account of his experience. two main lines—the expansion of the Speaking of the operation, he says:territory of Surgery, and the development of Pathology, which concerns it

Of the agony occasioned I will say nothself with the causes, processes and ing. Suffering so great I underwent effects of disease. It will probably help cannot be expressed in words, and thus the reader to a clearer understanding of ticular pangs are now forgotten; but the

fortunately cannot be recalled. The par the present position of medicine if each black whirlwind of emotion, the horror of of these two lines of evolution is con- great darkness, and the sense of desertion sidered in some detail.

by God and man, bordering close upon de The progress of surgery in the present spair, which swept through my mind and age is due to two discoveries of an overwhelmed my heart, I can never forimportance unequalled in the previous get, however gladly I would do so..., history of the healing art-anæsthesia, Before the days of anæsthesia a patient or the artificial abolition of pain, and preparing for an operation was like a conantisepsis, or the prevention of infective demned criminal preparing for execution. processes in wounds. The former dis. He counted the days till the appointed covery was not made until her Majesty that day till the appointed hour came.

day came. He counted the hours of had been nearly ten years on the throne;

He listened for the echo on

the the latter nearly twenty years later. street of the surgeon's carriage. He Let us take a brief glance backwards at watched for his pull at the door-bell; for what surgery was before the introduc- his foot on the stairs; for his step in the tion of these two far-reaching improve- room; for the production of his dreaded ments.

instruments; for his few grave words and of the horrors of operations before the his last preparations before beginning. discovery of anæsthesia there are men And then he surrendered his liberty, and. stiil living who can speak. Not long revolting at the necessity, submitted to be ago Dr. B. E. Cotting, ex-president of held or bound, and helplessly gave himself

lip to the cruel knife. The excitement. the Massachusetts Medical Society, con

disquiet, and exhaustion thus occasioned tributed some personal reminiscences could not but greatly aggravate the evil of pre-anæsthetic surgery to the Boston effects of the operation, which fell upon a Medical and Surgical Journal. Speaking physical frame predisposed to magnify. of the first case in which he was called not to repel, its severity.

The pain caused by operations pre- rapidity remarkable for those days, vented their being undertaken except as when as yet the telegraph was not, and a last resource, and many patients pre- the crossing of the Atlantic was not a ferred death to the surgeon's knife. trip but a voyage. On the 22nd of Sir Charles Bell used to pass sleepless December, 1846, Robert Liston, in nights before performing a critical University College Hospital, London, operation; and men like Cheselden, performed amputation through the John Hunter, and Abernethy had an al- thigh on a man who was under the inmost equal dislike of operations. It is fluence of ether, and who knew nothing related of one distinguished surgeon of what had been done till he was that when a patient, whose leg he was shown the stump of his limb after the about to cut off, suddenly bounced off operation. The "Yankee dodge," as the operating-table and limped away, Liston had contemptuously called ether he said to the bystanders, “Thank God, anesthesia before he tried it, was welhe's gone!" Men otherwise well fitted comed with enthusiasm by surgeons to advance surgery were prevented throughout Europe. In January, 1817, from devoting themselves to it by their Simpson of Edinburgh used ether for inability to inflict or witness pain. Sir the relief of the pains of labor. Not James Young Simpson in his student being entirely satisfied with it, howdays was so distressed by the sufferings ever, he sought for some other subof a poor Highland woman, on whom stance having the property of annulling Robert Liston was performing excision sensation, and in November, 1847, he of the breast in the Edinburgh Royal was able to announce that he had found Infirmary, that he left the operating “a new anæsthetic agent as a substitute theatre with his mind made up to seek for sulphuric ether" in chloroform, a employment in a lawyer's office. For- substance then unknown outside the tunately for mankind he did not carry laboratory, and within it looked upon as out his intention, but set himself to only a chemical curiosity. Chloroform grapple with the problem how sensi- for a long time held the field in Europe bility to pain in surgical operations as the agent for medicining sufferers to could be abolished.

that sweet sleep in which knife, gouge, The solution of the problem came and cautery do not hurt and the pangs from America. On the 30th of Septem- of motherhood are unfelt. With charber, 1846, W. T. G. Morton, a dentist of acteristic courage the queen submitted Boston, U.S.A., who had previously ex- to what was then a somewhat hazardperimented on animals and on himself, ous experiment, allowing herself to be made a man unconscious by breathing made insensible with chloroform at the sulphuric ether, and extracted a tooth birth of the Duke of Albany, and at that without the patient feeling any pain. of Princess Henry of Battenberg. The On the 16th of October of the same year late Dr. John Snow, who administered Morton administered ether, in the the anæsthetic on both these occasions, Massachusetts General Hospital, to a described her Majesty as model man from whose neck a growth was ex- patient, and her example had a powercised without a groan or a struggle on ful effect in dispelling the fears and his part. The doctors who came to prejudices as to the use of such agents scoff remained to praise, and the opera- which then existed in the minds of tor, Dr. John C. Warren, who had at many. first been sceptical, said, when all was These feelings were by no means conover, in a tone of conviction, “Gentle- fined to the non-scientific public. There men, this is no humbug!" A distin

was strong opposition from some surguished physician who witnessed the

geons who held that pain was a wholescene said on leaving the hospital, “I some stimulus; on this ground the use have seen something to-day that will go of chloroform was actually forbidden round the world." It did so with a

by the principal medical officer of our

а

army in the Crimea. In childbed, too, an immense step forward, but has been pain was declared by one learned the most powerful factor in the rapid obstetrical professor to be “a desirable, development of surgery during the last salutary, and conservative manifesta- fifty years. Without it the marvellous tion of life force;" another denounced victories of the knife, on which modern the artificial deadening of sensation as surgeons legitimately pride themselves, "an unnecessary interference with the would have been impossible. Nor is it providentially arranged process of surgery alone that has been revolutionlabor;" a third condemned the employ- ized by this splendid discovery; mediment of an anæsthetic "merely to avert cine, therapeutics, pathology, and the ordinary amount of pain which the physiology-which are the foundations Almighty has seen fit-and most wisely, on which the treatment of disease rests we cannot doubt-to allot to natural -have all been immensely advanced by labor.” The clergy naturally bettered it; as without anesthesia the experithe instructions of these enlightened ments on animals, to which we owe professors of the art of healing. I need much of the knowledge that has been only quote one philanthropic divine, acquired, could not possibly have been who anathematized chloroform as “a carried out. decoy of Satan apparently offering The other chief factor in the modern itself to bless women,” but “which will development of surgery has been the harden society, and rob God of the deep application of the germ theory of earnest cries which arise in time of trouble putrefaction to the treatment of for help!" Simpson answered those wounds. It had long been a matter of fools according to their folly. He common observation that very severe quoted Scripture to prove that the Al- injuries were dealt with successfully by mighty himself performed the first the vis medicatrir natura when the skin operation under anæsthesia, when he

was unbroken, whereas open wounds cast Adam into a deep sleep before re

even of a trivial character often fesmoving his rib. He fought the battle of tered and not seldom gave rise to bloodcommon sense with such convincing poisoning. Thus while a simple fraclogic and such an overwhelming mass ture of a bone was practically certain to of evidence-chemical, physiological, heal without trouble, a compound fracclinical, and statistical-that he finally ture, in which there was a breach of the shamed his opponents into silence.

skin covering the wounded bone, was It does not fall within the scope of looked upon as so sure to be followed this article to consider the advantages by evil consequences that immediate and drawbacks of the various agents amputation of the limb was the rule of that have at one time or another within surgery in such cases. The discoveries the last half-century been employed as

of Pasteur and his followers furnished anæsthetics, general or local; or to dis

a key to these facts. It was shown that cuss the dangers attending their use.

the process of putrefaction is a ferIt need only be said that the ideal mentation dependent on the presence of anästhetic—that is to say, one that shall vegetable organisms belonging to the render the patient absolutely insensible lowest class of fungi. These bacteria, of pain while leaving him fully con

as they may for the sake of convenience scious-still remains to be discovered. be termed collectively, are often present This is the dream of those—and they are

in greater or less abundance in the air; steadily increasing in number-who de- and in places where are many persons vote themselves to a special study of the with wounds the discharges from which subject; and it would be rash to

are in a state of decomposition, the prophesy that it will not be realized.

atmosphere swarms with these invisible Even with its admitted inconven- agents of mischief. They find their iences and possible risks, however,

way into the body through any breach anästhesia has not only been in itself of surface or natural opening, and they

even

are carried into wounds, abscesses, or nature of what Lord Palmerston called other cavities by the hands of those “matter in the wrong place;" and this who minister to the patient, and by in- something it is the aim of modern surstruments, dressings, clothing, and by gery to keep out, whereas to the men of water, unless means are used to destroy only a generation ago it was an unconthem. The vital importance of doing sidered trifle. The elaborate ritual of tois, and the way in which it could be purification by sprays of carbolic acid done, were indicated by Joseph Lister, a and the manifold dressings, as compliman who is justly venerated by the cated as My Uncle Toby's fortifications, whole medical world, and whom his by which at first it was sought to exsovereign has delighted to honor in a clude the enemy from the living citadel, manner hitherto without precedent in have been discarded as cumbrous and this country. His work forms, without unnecessary; but whatever change may excepting

the discovery of be made in the details of Listerism, the anæsthesia, the most conspicuous land- Listerian principle of safeguarding mark in surgical progress; indeed, it is wounds from every possible source of no exaggeration to say that the history contamination will stand forever as the of surgery now falls by a natural divi- foundation stone of scientific surgery. sion into two distinct eras: Before Lister The results of the application of the anu After Lister.

principle are seen in every department Modern surgery dates from the intro- or surgical practice. The risks of surduction of the antiseptic treatment of gery have been lessened to such an exwounds. Thirty years ago the idea was tent that the statistics of most of the just beginning to settle itself into clear- greater operations before the antiseptic ness in the mind in which it was con- treatment came into general use are ceived; twenty years ago it was still now valueless for purposes of compariregarded by many “practical men" as a son. A few figures will serve to show figment of the scientific imagination; the difference. Till a comparatively but as the evidence became irresistible, recent period the proportion of cases in unbelievers one after another found sal- which death followed amputation of a vation. Now the doctrine finds vir- limb in the large city hospitals of Great tually universal acceptance. Some Britain was at least one in three; years ago a doctor in Germany was pros. in a series of 2,089 cases collected ecuted and punished for some breach by Simpson it was as high as 1 in 2.4. of the antiseptic ordinance in an opera- In the Paris hospitals about the middle tion; and though we have not yet of the century the death rate after amreached that perfection of medical dis- putation was nearly one in two; in 1861 cipline in this country, the deliberate it was three in five, and a few years and persistent neglect of surgical clean- later it was estimated at fifty-eight per liness by a member of the staff of a cent. In Germany and Austria things public hospital would be certain to give were not much better; the published rise to strong protests on the part of his statistics of one most skilful surgeon colleagues.

show a proportion of deaths following The cardinal point in Lister's teach- amputation of forty-three to forty-six ing was that wounds will in the absence per cent. Nowadays such figures in the of any disturbing influence, constitu- practice of any hospital surgeon would tional or accidental, remain sweet and probably lead to an inquiry by the heal kindly, if contamination from proper authorities. without be prevented. The theory is

A very large number of these fatalities that such contamination is caused by was caused by septic diseases--that is to micro-organisms; in practice, it matters say, different forms of blood-poisoning nothing whether it is held to be due to due to contamination of the wound, germs or to dirt. It is certainly caused leading to constitutional infection. The by something foreign, something in the terrible frequency of such diseases a

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