Conservative Surgery.
What is known as “conservative surgery” is the distinguishing feature of the art as practised at the present day. Whatever Lord Tennyson may have had in his mind in his lines on the children’s hospital, the highest surgical1 practice now is to save diseased and injured parts as much as possible, instead of removing them. Antiseptic surgery and the discovery of an?sthetics have alone made this possible.
Discovery of An?sthetics.
The Chinese have a drug named Mago, by which they have been able, so they maintain, to destroy pain for thousands of years past. The vapour of hemp2 seed and the drug mandragora have for ages been employed for an?sthetic purposes previous to surgical operations. In Homer’s time the properties of opium3 were well understood, and other narcotic4 drugs were used for the same purpose. Patients were also sometimes stupefied by strong drink, and among some savage5 tribes banana wine was copiously6 administered so as to intoxicate7 the patient. It was not, however, until the discovery of the true an?sthesia produced by sulphuric ether and chloroform that grave surgical operations could be performed without causing pain to the patient. Nitrous oxide8 gas, discovered by Priestley in 1776, was recommended as an an?sthetic by Davy in 1800, and its use was begun in America by Wells, the dentist, in 1844. The discovery that by inhaling9 ether the patient is rendered unconscious of pain is due to Dr. C. T. Jackson, of Boston, U.S. Mr. T. Morton, of the same city, first introduced it into surgical practice in 1846. Chloroform was discovered by Souberain in 1831, and independently by Liebig in 1832. Dumas determined10 its composition in 1834. Jacob Bell in London, and Dr. Simpson in Edinburgh, first applied11 chloroform experimentally. The late Professor465 James Miller12 thus describes the discovery of the an?sthetic effects of chloroform:1035 “The trial proceeded, and the safety as well as suitableness of an?sthesia, by ether, became more and more established. But a new phase was at hand. My friend, Dr. Simpson, had long felt convinced that some an?sthetic agent existed superior to ether, and, in the end of October, 1847, being then engaged in writing a paper on ‘Etherization in Surgery,’ he began to make experiments on himself and friends in regard to the effects of other respirable matters—other ethers, essential oils, and various gases; chloride of hydrocarbon13, acetone, nitrate of oxide of ethyl, benzine, the vapour of iodoform, etc. The ordinary method of experimenting was as follows: Each ‘operator’ having been provided with a tumbler, finger glass, saucer, or some such vessel14, about a teaspoonful15 of the respirable substance was put in the bottom of it, and this again was placed in hot water, if the substance happened to be not very volatile16. Holding the mouth and nostrils17 over the vessel’s orifice, inhalation was proceeded with, slowly and deliberately18, all inhaling at the same time, and each noting the effects as they advanced. Late one evening—it was the 4th November, 1847—Dr. Simpson, with his two friends and assistants, Drs. Keith and Matthews Duncan, sat down to their somewhat hazardous19 work in Dr. Simpson’s dining-room. Having inhaled20 several substances, but without much effect, it occurred to Dr. Simpson to try a ponderous21 material, which he had formerly22 set aside on a lumber-table, and which, on account of its great weight, he had hitherto regarded as of no likelihood whatever. That happened to be a small bottle of chloroform. It was searched for, and recovered from beneath a heap of waste paper. And, with each tumbler newly charged, the inhalers resumed their vocation23. Immediately an unwonted hilarity24 seized the party; they became bright-eyed, very happy, and very loquacious—expatiating on the delicious aroma25 of the new fluid. The conversation was of unusual intelligence, and quite charmed the listeners—some ladies of the family, and a naval26 officer, brother-in-law of Dr. Simpson. But suddenly there was a talk of sounds being heard like those of a cotton-mill, louder and louder; a moment more, then all was quiet, and then a crash. On awaking, Dr. Simpson’s first perception was mental. ‘This is far stronger and better than ether,’ said he to himself. His second was to note that he was prostrate27 on the floor, and that among the friends about him there was both confusion and alarm.” Each of the investigators28 related his experience of the new drug, and the experiments were repeated, always, however, on this first occasion, stopping short of unconsciousness. They were all convinced that the new agent had466 full an?sthetic power when pushed. Thus was it satisfactorily proved that chloroform was something much better than ether. Dr. Simpson continued to pursue his experiments upon himself until he had perfected the method he had so happily discovered.
A curious incident connected with an?sthesia is mentioned by Dr. Paris in his well-known work Pharmacologia.1036 He relates an anecdote29 which he heard from the poet Coleridge, which illustrates30 the curative influence of the imagination.
“As soon as the powers of nitrous oxide were discovered, Dr. Beddoes at once concluded that it must necessarily be a specific for paralysis31; a patient was selected for the trial, and the management of it was intrusted to Sir Humphry Davy. Previous to the administration of the gas, he inserted a small pocket thermometer under the tongue of the patient, as he was accustomed to do upon such occasions, to ascertain32 the degree of animal temperature, with a view to future comparison. The paralytic33 man, wholly ignorant of the nature of the process to which he was to submit, but deeply impressed, from the representation of Dr. Beddoes, with the certainty of its success, no sooner felt the thermometer under his tongue than he concluded the talisman34 was in full operation, and in a burst of enthusiasm declared that he already experienced the effect of its benign35 influence throughout his whole body. The opportunity was too tempting36 to be lost; Davy cast an intelligent glance at Coleridge, and desired his patient to renew his visit on the following day, when the same ceremony was performed, and repeated every succeeding day for a fortnight, the patient gradually improving during that period, when he was dismissed as cured, no other application having been used.”
Medical Literature.
The greatest historians of medicine are the Germans. Especially valuable are the works of—
Kurt P. J. Sprengel (1766-1833), of Pomerania, professor of medicine at Halle. He was a great botanist37, but his immortal38 work on the History of Medicine eclipsed all his other labours for medical science.
Heinrich Haeser (1811-1885), the author of the learned Lehrbuch der Geschichte der Medicin und der Epidemischen Krankheiten, which is one of the most popular works of this class.
Dr. Joh. Hermann Baas, who is the author of the valuable and encyclop?dic Grundriss der Geschichte der Medicin, excellently translated into English by Dr. H. E. Handerson, of Cleveland, Ohio (1889).
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Dr. Theo. Puschmann’s History of Medical Education has recently been translated into English by Mr. E. H. Hare (1891).
Amongst those of our own countrymen who have rendered great services to medical literature are—
Sir Charles Scudamore (1779-1849), one of the greatest authorities on gout, who popularised Hydro-therapeutics by his writings.
Sir John Forbes (1787-1861), founder of the Sydenham Society.
Sir Richard Quain, M.D., editor of the Dictionary of Medicine which bears his name.
Mr. Ernest Hart (born 1836), editor (since 1866) of the British Medical Journal, which, by his great literary ability and scientific knowledge, has become the chief agent in the advancement40 of the British Medical Association to its present proud position amongst the scientific societies of the empire. Mr. Hart has rendered great public services in improving the condition of the sick poor in workhouses, and the creation of the metropolitan41 asylums42. Mr. Hart’s labours in connection with many questions of social and sanitary44 progress have been pre-eminently crowned with success.
Nursing Reform.
When the nineteenth century had run half its course, Florence Nightingale (born 1820) was providentially raised up to reform the working of hospitals, schools, and reformatory institutions, after the mismanagement of our military hospitals in the Crimea had led to terrible suffering amongst our wounded soldiers. Her noble devotion and self-sacrifice amongst the troops earned her the blessing45 of the nation, and her name will for ever be gratefully remembered in all questions connected with hospital reform and the improvement of nursing.
Mrs. Wardroper (died 1892), the exterminator46 of Mrs. Gamp and her sisterhood, made her mark in the Crimean War, and put her finger on some of the most flagrant abuses of the nursing system of the day. She was the first superintendent47 of the Nightingale School of Nursing, and the original trainer of technically48 educated nurses for hospitals and infirmaries.
It is customary to divide the treatment of the insane into three periods—the barbaric, humane50, and remedial. We must not, however, suppose that in ancient times the treatment was everywhere barbaric,468 and that only in recent times has it become humane and remedial; nothing could be further from the truth. The treatment of persons mentally afflicted51 in ancient Egypt and in Greece was not only humane, but was probably remedial. In the temples of Saturn52 in Egypt, and in the Asclepia of Greece, which were resorted to by lunatics, Dr. J. B. Tuke thinks1037 the treatment was identical in principle with that of the present day. He praises the sound principles on which Hippocrates and Galen treated insane patients, and there is no doubt that it was directed towards a cure. With these exceptions little is known as to the treatment of the insane before the advent53 of Christianity. The earliest recorded case of the administration of medicine to an insane patient is that in which Melampus was the physician, and the neglect of the worship of Bacchus the cause of the malady55. As Mr. Burdett well remarks,1038 nowadays the worship of Bacchus is responsible for much of the insanity which exists. From several accounts in the Greek poets we may assume that insanity prevailed in classic times in the forms with which we are now familiar. Hippocrates adopted a peculiar56 treatment in cases of suicidal mania57. “Give the patient a draught58 made from the root of mandrake, in a smaller dose than will induce mania.” He remarks that although the general rule of treatment be “contraria contrariis curantur,” the opposite rule also holds good in some cases, namely, “similia similibus curantur.” It is evident therefore that in some degree the Father of Medicine was in accord with Hom?opathy.1039
Whatever may have been the practice of the ancients, it is certain that in the Middle Ages the treatment of lunatics, up to the middle of the last century, was simply disgraceful. Little or no effort was made to cure or even to take proper care of the mentally afflicted. Some few were lodged59 in monastic houses, many in the common jails. In 1537 a house in Bishopsgate Street came into the possession of the Corporation of London, and was used to confine fifty lunatics. This was the first Bethlehem Hospital; it was removed in 1675 to Moorfields, and in 1814 the present hospital was built in St. George’s Fields. St. Luke’s was instituted in 1751.1040 Many lunatics were executed as criminals or witches. It was not till the efforts of Pinel, Tuke, and Conolly were directed to the proper care and treatment of the insane that the barbarous period of European practice in regard to lunacy was happily ended.
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Mr. Bennett says:1041 “The Germans seem to have excelled all other nations in the ingenuity60 of the torture which they sought to inflict61 upon their patients. Some of them advocated the use of machinery62, by which a patient, on first entering an asylum43, was to be first drawn63 with frightful64 clangour over a metal bridge across a moat, and then to be suddenly raised to the top of a tower, and as suddenly lowered into a dark and subterraneous cavern65. These practitioners66 avowed67, according to Conolly, that if a patient could be lowered so as to alight among snakes and serpents, it would be better still.” “One humane doctor invented an excruciating form of torture in the shape of a pump, worked by four men, which projected a stream of water with great force down the spine68 of the patient, who was firmly fixed69 in a bath made for this apparatus70.” Patients were taken to a bath in the ordinary way and allowed to bathe, but the bath had a bottom which gave way under their weight and plunged71 them into “the bath of surprise” underneath72. Dr. Darwin is credited with having invented “the circulating swing” for lunatics; it was worked by a windlass, and was capable of being revolved73 a hundred times a minute. Esquirol approves this horrible instrument of torture, and speaks of it as having passed from the arts into medicine. Terror, cold water, shower baths, horrible noises, smells, darkness, were employed by the faculty74 in the treatment of insanity up to the beginning of the nineteenth century. The leaders of the French Revolution added starvation to the treatment. In England, in 1846, the diet in some of the licensed75 houses was starvation fare. Cruelty was identical in form in all the countries of Europe. Esquirol, in 1818, said the insane were either naked or in rags, no bedding was allowed but a little straw, the stone cells were dark and damp, and the wretched patients were chained in caves not good enough for wild beasts. They wore iron collars and belts, and had no medical treatment but baths of surprise and occasional floggings. Even up to 1850 this state of things still existed in England.
In England, in 1820, one of the great sights of London was Bedlam76. The keepers were allowed to add to their income by exhibiting the patients at one penny or twopence per head.
Doubtless the chief reason of the neglect and cruelty to which lunatics were thus subjected in Christian54 Europe, so long fruitful in all other works of mercy, was the theory of possession by an evil spirit; conjurations and exorcisms were considered the only safe and efficacious methods of expelling the demons77. This grievous blunder is one of many illustrations which might be given of the necessity of making an accurate470 diagnosis78 before attempting to treat disease. Dr. Baas says1042 that lunatic asylums were established first at Feltre in Italy. The next were those of Seville, established in 1409; Padua, 1410; Saragossa, 1425; Toledo, 1483; Fez, 1492.
Burton, in his Anatomy79 of Melancholy80, thus describes Lycanthropy, “which Avicenna calls cucubuth, others lupinam insaniam, or wolf-madness, when men run howling about graves and fields in the night, and will not be persuaded but that they are wolves or some such beasts. ?tius (lib. 6, cap. 11) and Paulus (lib. 3, cap. 16) call it a kind of melancholy; but I should rather refer it to madness, as most do. Some make a doubt of it, whether there be any such disease. Donat. ab Altomari (cap. 9, Art. Med.) saith, that he saw two of them in his time. Wierus (De Pr?stiv. Demonum, l. 3, cap. 21) tells a story of such a one at Padua, 1541, that would not believe to the contrary but that he was a wolf. He hath another instance of a Spaniard who thought himself a bear. Forestus (Observat. lib. 10, de Morbis Cerebri, c. 15) confirms as much by many examples; one among the rest, of which he was an eye-witness, at Alcmaer, in Holland. A poor husbandman that still hunted about graves, and kept in churchyards, of a pale, black, ugly, and fearful look. Such belike, or little better, were King Pr?tus’ daughters (Hippocrates, lib. de insania), that thought themselves kine; and Nebuchadnezzar, in Daniel, as some interpreters hold, was only troubled with this kind of madness. This disease, perhaps, gave occasion to that bold assertion of Pliny (lib. 8, cap. 22, homines interdum lupos fieri; et contra), some men were turned into wolves in his time, and from wolves to men again: and to that fable81 of Pausanias, of a man that was ten years a wolf, and afterwards turned to his former shape; to Ovid’s (Met. lib. 1) tale of Lycaon, etc. He that is desirous to hear of this disease, or more examples, let him read Austin in his eighteenth book, de Civitate Dei, cap. 5,” etc., etc.
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1
surgical
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| adj.外科的，外科医生的，手术上的 | |
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hemp
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| n.大麻；纤维 | |
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opium
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| n.鸦片；adj.鸦片的 | |
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narcotic
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| n.麻醉药，镇静剂；adj.麻醉的，催眠的 | |
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savage
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| adj.野蛮的；凶恶的，残暴的；n.未开化的人 | |
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copiously
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| adv.丰富地，充裕地 | |
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intoxicate
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| vt.使喝醉，使陶醉，使欣喜若狂 | |
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oxide
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| n.氧化物 | |
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inhaling
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| v.吸入( inhale的现在分词 ) | |
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determined
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| adj.坚定的；有决心的 | |
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applied
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| adj.应用的；v.应用，适用 | |
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miller
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| n.磨坊主 | |
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hydrocarbon
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| n.烃，碳氢化合物 | |
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vessel
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| n.船舶；容器，器皿；管，导管，血管 | |
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teaspoonful
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| n.一茶匙的量；一茶匙容量 | |
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volatile
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| adj.反复无常的，挥发性的，稍纵即逝的，脾气火爆的；n.挥发性物质 | |
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nostrils
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| 鼻孔( nostril的名词复数 ) | |
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deliberately
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| adv.审慎地；蓄意地；故意地 | |
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hazardous
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| adj.(有)危险的，冒险的；碰运气的 | |
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inhaled
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| v.吸入( inhale的过去式和过去分词 ) | |
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ponderous
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| adj.沉重的，笨重的，(文章)冗长的 | |
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formerly
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| adv.从前，以前 | |
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vocation
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| n.职业，行业 | |
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hilarity
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| n.欢乐；热闹 | |
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aroma
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| n.香气，芬芳，芳香 | |
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naval
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| adj.海军的，军舰的，船的 | |
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prostrate
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| v.拜倒，平卧，衰竭；adj.拜倒的，平卧的，衰竭的 | |
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investigators
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| n.调查者，审查者( investigator的名词复数 ) | |
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anecdote
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| n.轶事，趣闻，短故事 | |
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illustrates
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| 给…加插图( illustrate的第三人称单数 )； 说明； 表明； （用示例、图画等）说明 | |
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paralysis
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| n.麻痹(症)；瘫痪(症) | |
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ascertain
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| vt.发现，确定，查明，弄清 | |
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paralytic
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| adj. 瘫痪的 n. 瘫痪病人 | |
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talisman
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| n.避邪物，护身符 | |
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benign
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| adj.善良的，慈祥的；良性的，无危险的 | |
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tempting
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| a.诱人的, 吸引人的 | |
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botanist
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| n.植物学家 | |
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immortal
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| adj.不朽的；永生的，不死的；神的 | |
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Founder
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| n.创始者，缔造者 | |
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advancement
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| n.前进，促进，提升 | |
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metropolitan
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| adj.大城市的，大都会的 | |
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asylums
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| n.避难所( asylum的名词复数 )；庇护；政治避难；精神病院 | |
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asylum
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| n.避难所，庇护所，避难 | |
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sanitary
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| adj.卫生方面的，卫生的，清洁的，卫生的 | |
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blessing
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| n.祈神赐福；祷告；祝福，祝愿 | |
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exterminator
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| n.扑灭的人，害虫驱除剂 | |
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superintendent
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| n.监督人，主管，总监；(英国)警务长 | |
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technically
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| adv.专门地，技术上地 | |
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insanity
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| n.疯狂，精神错乱；极端的愚蠢，荒唐 | |
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humane
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| adj.人道的，富有同情心的 | |
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afflicted
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| 使受痛苦，折磨( afflict的过去式和过去分词 ) | |
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Saturn
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| n.农神，土星 | |
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advent
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| n.(重要事件等的)到来，来临 | |
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Christian
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| adj.基督教徒的；n.基督教徒 | |
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malady
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| n.病，疾病(通常做比喻) | |
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peculiar
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| adj.古怪的，异常的；特殊的，特有的 | |
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mania
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| n.疯狂；躁狂症，狂热，癖好 | |
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draught
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| n.拉，牵引，拖；一网（饮，吸，阵)；顿服药量，通风；v.起草，设计 | |
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lodged
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| v.存放( lodge的过去式和过去分词 )；暂住；埋入；（权利、权威等）归属 | |
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ingenuity
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| n.别出心裁；善于发明创造 | |
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61
inflict
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| vt.(on)把…强加给，使遭受，使承担 | |
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machinery
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| n.(总称)机械，机器；机构 | |
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drawn
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| v.拖，拉，拔出；adj.憔悴的，紧张的 | |
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frightful
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| adj.可怕的；讨厌的 | |
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cavern
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| n.洞穴，大山洞 | |
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practitioners
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| n.习艺者，实习者( practitioner的名词复数 )；从业者（尤指医师） | |
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avowed
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| adj.公开声明的，承认的v.公开声明，承认( avow的过去式和过去分词) | |
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spine
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| n.脊柱，脊椎；(动植物的)刺；书脊 | |
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fixed
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| adj.固定的，不变的，准备好的；(计算机)固定的 | |
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apparatus
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| n.装置，器械；器具，设备 | |
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plunged
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| v.颠簸( plunge的过去式和过去分词 )；暴跌；骤降；突降 | |
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72
underneath
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| adj.在...下面，在...底下；adv.在下面 | |
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73
revolved
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| v.（使）旋转( revolve的过去式和过去分词 )；细想 | |
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74
faculty
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| n.才能；学院，系；(学院或系的)全体教学人员 | |
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75
licensed
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| adj.得到许可的v.许可，颁发执照(license的过去式和过去分词) | |
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76
bedlam
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| n.混乱，骚乱；疯人院 | |
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77
demons
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| n.恶人( demon的名词复数 )；恶魔；精力过人的人；邪念 | |
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78
diagnosis
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| n.诊断，诊断结果，调查分析，判断 | |
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79
anatomy
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| n.解剖学，解剖；功能，结构，组织 | |
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80
melancholy
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| n.忧郁，愁思；adj.令人感伤（沮丧）的，忧郁的 | |
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81
fable
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| n.寓言；童话；神话 | |
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