_Age of Transition (concluded).--New Vienna School (concluded):
von Hebra, 1816-1880. Czermak and Türck, Jager, Arlt, Gruber,
Politzer.--German School of Physiological Medicine:
Roser, 1817-1888.--School of Rational Medicine:
Henle, 1809-1855.--Pseudoparacelsism: Rademaclier,
1772-1849.--Hydrotherapcvtics: Priessnitz, 1799-1852.--Modern Vitalism:
Virchow.--Seminalism: Bouchut.--Parasitism and the Germ-theory: Davaine,
18111882. Pasteur, 1822-1895. Chauveau, 1827--. Klebs, 1834--. F.
J. Cohn, 1828--. Koch, 1843--. Lister, 1827--.--Advances in Physical
Diagnosis: Laënnec, 1781-1826. Piorry, 1794-1879.--Surgery: Delpeeli,
1772-1832. Stromeyer, 1804-1876. Sims, 1813-1883. Bozeman, 1825--.
McDowell, 1771-1830. Boyer, 1757-1853. Larrey, 1766-1842. Dupuy-tren,
1777-1835. Cloquet, 1790-1883. Civiale, 1792-1867. Vidal, 18031856.
Velpeau, 1795-1868. Malgaigne, 1806-1865. Nélaton, 1807-1874. Sir
Astley Cooper, 1748-1841. Brodie, 1783-1862. Guthrie, 1785-1856.
Syme, 1799-1870. Simpson, 1811-1870. Langenbeck, 1810-1887. Billroth,
1819-1894._
A few{253} of Skoda's more eminent colleagues deserve brief mention:
Oppolzer (1808-1871) was singularly gifted in diagnosis, popular, a
teacher of wide influence, and manifested in superlative degree the
characteristics that constitute a great physician; he wrote little,
but was for a long time Professor of Medicine at Prague. Von Hebra,
the elder (1816-1880), worked a complete revolution in dermatology, and
developed a classification based upon the pathological anatomy of
the skin. He instituted a new and independent line of therapeutics as
applied to this branch of our art, for which the medical world will ever
hold him in grateful remembrance. Sigmund and Zeissel during the
same period did much to clear up the problems of syphilis. To Czermak
(1828-1873) and TUrck (1807-1868) we are indebted (practically) for the
making a specialty of diseases of the nose and larynx; of like service
to ophthalmology were Jàger, Jaxtthal, Arlt, Stellwag von Carion,
Hasner, Mauthner, Fuchs, and von Reuss, while Gruber and Politzer did as
much for diseases of the ear.
An indirect offshoot of the new Vienna school is the so-called
"Physiological Medicine," founded by Eoser (1817-1888),{254} of
Stuttgart (late Professor of Surgery in Marburg), seconded by Griesinger
and Wunderlich. Their views were directed against the symptomatologists
and idealists, and particularly against the School of Natural History,
the claim being that physiology must include vital phenomena, while from
the morbid portions of these phenomena the special science should
be formed as an artificial, yet practical, division of knowledge.
'Wunderlich's book of therapeutics was for a long time the best guide
in this direction, inasmuch as it left to individual thought and
judgment--the Hippocratic method of investigation--the determination of
value and demand. Another offshoot, that differs but little from this
save in definition, is the "School of Rational Medicine," originated by
Pfeufer (1806-1869) and Henle (1809-1855), and which, since 1841,
has been represented by a special journal. While Wunderlich claimed
pathology to be the physiology of the sick, Henle considered this
questionable and made no distinction at all between the physiology of
the healthy and that of the ill. The language of the followers of this
school contrasted strongly with that emanating from other schools, and
for a time was confident and ingeniously triumphant; nevertheless, it
did not forget philosophical speculation, and Hegel may now be regarded
as indirectly the godfather of rational medicine.
The vagaries of Paracelsus led indirectly, though positively, to the
foundation of Homoeopathy, and likewise originated the doctrine that
bears the name of Rademacher (1772-1849). It is curious that this
pseudoparacelsic system should spring up alongside of the Vienna school,
its teachings being the classification of diseases by their therapy,
Rademacher's followers possessed three universal remedies,--"cubic niter
(nitrate of sodium), copper, and iron,"--and also three primary diseases
that must take their titles from the three universal medicaments.
In spite of the admission that these diseases were unknown, it was
boldly{255} asserted they were with certainty to be cured by the three
chief remedies. The three primary diseases, "sodic nitrate, copper, and
iron diseases," do not necessarily remain as such, as they may throw
some organ "into a condition of sympathy, and thus it results that iron
disease may express itself in the form of consumption, delirium tremens,
etc., while a copper disease may appear as worms, paralysis, jaundice,
etc." Besides universal diseases and universal remedies there were
diseases of organs, to be diagnosed by the efficacy of organ remedies;
thus, abdominal diseases must be relieved by corresponding "abdominal
remedies," head diseases with "head remedies," chest diseases with
"chest remedies," etc. Also for each particular viscus there must be a
special remedy. What is the most surprising about this absurd doctrine
is that it found followers, some even quite capable in their way.
Now, too, reappeared the Hydrotherapeutic System--the great apostle
of which was Priessnitz (1799-1852)--based upon gross views of humoral
pathology, according to which a disease entity was to be expelled in the
form of sweat, eruption, etc. Poultices, cold packs, and cold baths were
the principal therapeutic measures. Winternitz has made hydrotherapy
popular and, in a measure, effective in the management of certain
maladies.
Rudolph Virchow in 1858 instituted the doctrine or theory known as
"Modern Vitalism," which, in fact, was borrowed from natural scientific
medicine, and distinguished from the vitalism of the previous century in
that it breaks up the old vital force, which was supposed to be either
distributed throughout the entire body or located in a few organs, into
an indefinite number of associate vital forces working harmoniously, and
assigns to them all the final elementary principles without microscopic
seat. "Every animal principle has a sum of vital unities, each of which
bears all the characteristics of life. The characteristics and unity
of life cannot be found in any determinate{256} point of a higher
organism,--e.g., in the brain,--but only in the definite, ever-recurring
arrangement of each element present; hence it results that the
composition of a large body amounts to a kind of social arrangement,
in which each one of the movements of individual existence is dependent
upon the others, but in such a way that each element has a special
activity of its own, and that each, although it receives the impulse
to its own activity from other parts, still itself performs its
own functions." This is nothing but another way of expressing the
cell-doctrine, to which many medical men are now committed, which means
that all bodies are built up of cells and that each cell has a unity and
a purpose of its own.
In 1677 Sir Robert Hooke discovered plant-cells; later Schwann
discovered animal cells and Robert Brown cell-nuclei; but it remained
for Virchow to supply the gap which had risen between anatomical
knowledge and medical theory; that is, to supply a "cellular pathology,"
since which time the cell has assumed the rôle which the fibre occupied
in the theories of the seventeenth and eighteenth centuries. Time alone
can decide as to the ultimate validity of this theory, which has in
certain circles been most enthusiastically received. One of its weakest
aspects is, perhaps, that the so-called intercellular substance plays
an uncertain and unsatisfactory part. An important feature in which the
cellular pathology differs from other systems, and particularly from the
old humoral pathology, is in the doctrine that the blood itself is not
the proper and original cause of dyscrasiæ, and probably not the cause
of continuous alteration of the tissues; that these dyscrasiæ arise
because the blood is not an independent structure, but dependent upon
the condition of the patient in consequence of its continuous conveyance
of the noxious material from all parts of the body,--the blood is,
therefore, merely the medium for the production of the dyscrasia.
This theory has made several peculiar, new, and symptomatic or
morphological{257} forms of disease, such as leukæmia, leucocytosis,
etc. Virchow also cleared up the old and obscure ideas regarding pyæmia,
and proved that an absorption of pus into the blood, which the name
implies, is quite impossible; likewise, that pyæmia is inseparable from
thrombotic processes.
[Illustration: 0277]
Virchow was born in Pomerania in 1821, and in 1849, he distinguished
himself by attaining the highest grade in the career of the learned,--a
professorship, which he first held in Würzburg. During earlier years his
residence and labors were largely the result of necessities arising from
political views, for on account of these he was long denied a residence
in Berlin. A personal friend, now old, once an _interne_ in the great
Julius Spital, in Würzburg, at the time{258} when Virchow taught there,
tells me a light was burning every night in Virchow's room until 3
a.m., and yet the professor was always out at work by 7. It was by such
intense application that he arrived at his present position at the very
top of the professional ladder; but very few men have the physique and
constitution to stand such arduous study. In 1856 he assumed the chair
of Pathological Anatomy in Berlin, and introduced microscopical anatomy,
to which Rokitansky had not given sufficient attention. Virchow was
a former pupil of Johannes Muller, famous as a physiologist and
pathologist, and his views to-day are often tinged by the doctrines
acquired from this great teacher. He is also a great admirer of Harvey,
whose picture, at least for a long time, was the only one permitted to
hang in his study. His first edition of _Cellular Pathology_ appeared in
1858; the colossal work on _Tumors_ in 1866, in which he carried out
the division of morbid growths originally adopted by Johannes Müller in
1838, classifying them according to their microscopical elements. He is
also scarcely more celebrated for his teachings and labors than for the
number of famous pupils brought up under his influence, among whom may
be mentioned Leyden, Recklinghausen, Cohnheim, Waldeyer, Kuhne, and
Rindfieisch. As a result of his labors has arisen in Germany what has
been called the "Medical School of Natural Sciences," that seeks, by
means of pathological anatomy and microscopy, experimental physiology
and pathology, and the other applied methods, to make of medicine
an exact science; and to it belong such men as Zienissen, Gerhardt,
Notlniagel, Liebermeis-ter, Senator, Erb, Vogel, and others. An offshoot
from this is the so-called "Munich Clinical School," to which belong von
Buhl, Pettonkofer, Seitz, and Oertel.
The splitting up of medicine into specialties, and the increase of its
subordinate branches into schools.--so called,--resulted in great danger
to the unity of medical science.
A return{259} to the methods which combine science and practice--the
so-called clinical-practical method--is again sought by men who have
established the well-known _Zeitschrift fur Klinische Medicin_, under
the management of Frerichs and Leyden,--a journal which has already done
a great deal of good.
The versatile Bouchut, of Paris, has recently published a theory,--the
so-called "Seminalism,"--for which the claim is made that he grants
nothing to hypothesis, and everything to observation; its characteristic
is that this new theory is also vitalistic,--in fact, the French have
scarcely ever brought forth any other than vitalistic theories. Borden
and Barthez, during the previous century, created the first French
theory, which was followed out by Bichat, and later by Bouchut, who, as
a matter of fact, owes much to Bichat. Bouchut teaches that beasts
have an intelligence of instinct, and men one of abstraction; no beast
oversteps the limits of animal thought, which is separated by an abyss
from the productive thought of men; there is a proper kingdom of man, in
accordance with his special nature; also, that the vital forces of
men and of beasts are entirely different from each other, and that the
principle of physical identity remains in the bodies of each, since the
constantly renewed mass is formed in exact accordance with the original
plans; in all the changes of his elements man is identical with man; all
internal and external causes of disease modify, more or less, the vital
force and its impressibility in the fluids or at some point in the
economy, either increasing it or diminishing it. This theory, published
in. 1873, claimed "in the abstraction of its promise and completeness
of its conclusions to yield to none of its predecessors." Yet, even
in France, the task of transforming medicine into a natural and exact
science is far from being a _fait accompli_.
The most recent theories of disease are the result of microscopical
study of germs,--the germ-theory, in fact,--and{260} stand in the
closest possible relation with the doctrine of spontaneous generation,
fermentation, miasm, and contagion. In 1838 Ehrenberg regarded infusoria
as animals, but Dujardin in 1841 expressed doubts, and Perty in 1852
affirmed that most forms classified as infusoria should be assigned to
the vegetable kingdom, where, a little later, Naegeli relegated
them. The correctness of this conclusion was proved by Cohn, who also
perfected a classification. This particular form of investigation began
in the twenties of the present century and assumed its present direction
in the thirties and forties. Gaspard, in 1823, renewed the experiments
of Haller, and injected into the veins of animals, not alone putrescent
material, but the blood of other creatures suffering from the effect
of such injections. Bassi, in 1835, discovered the cause of silk-worm
disease, thereby giving special impulse to the theory of parasitism, and
this was quickly followed by evidence of the existence of both vegetable
and animal exciters of disease. Schoenlein, in 1839, demonstrated the
fungus of favus; Vogel discovered the Oïdium albicans in 1840; Goodsir,
the _Sarcina ventriculi_, in 1841; but the greatest influence upon
the development of the parasitic, or germ-theory was the sequel to the
discovery of the anthrax bacillus, by Davaine in 1850. In 1837 Latour
and Schwann demonstrated that the cells, which were known even to
Leeuwenhoeck, were actually vegetable forms, and Schulze had already
pointed out that fermentation of fluids could only occur in the presence
of extremely minute vegetable organisms; Chevreuil next showed that
animal solids remained free from decomposition when protected from the
access of germs; and in 1857 Pasteur demonstrated that fermentation and
putrefaction were caused, not by chemical forms, as Liebig had taught,
but simply by the agency of lower organisms, which he divided into
aerobes and anaerobes; while in 1868 Chauveau queried as to whether
morbific elements resided in the formed elements of germs or in their
fluid{261} constituents. Thus the theory of _contagium vivum_, for which
Henle contended as early as 1821, was not forgotten. In Germany Klebs
and Hueter became the prominent champions of this theory; Hallier had
designated his so-called "Microsporon septicum," and introduced a method
of fractional cultures. The views of Klebs were opposed by Billroth, who
contended for his "phlogistic ferment" and "_Coccobacteria septica_,"
upon which he wrote an elaborate and extensively illustrated treatise;
he also at that time opposed the specific character of the lower
organisms as disease agents. Hallier's _microsporon_ was refuted by
Cohn, who studied and classified the various fungi, and distinguished
between the pathogenic and the septicogenic,--that is, those which
produced disease and those which produced ordinary putrefaction. Then
came the experimental evidence of Davaine and Koch, who demonstrated the
development of bacteria from spores. It is hardly necessary to discuss
this theory further, but I may mention the labors of Panum and of
Brieger, who deeply investigated the poisons produced by bacteria, to
which are given the general titles of ptomaines and toxins.
It would be unjust, however, did I not mention the name of Lister in
connection with the inestimable benefit that has accrued to surgery
from the practical application of the theory of infection to wounds,--a
measure that brought about an entire revolution in surgery and surgical
technique, and an entire reversal of the statistics of operations;
where thousands formerly died, thousands now live, their lives being
indirectly due to the labors of this one man and his following.
I will add that it is necessary to realize the difference between life
and death to appreciate the changes that have been brought about during
the last score of years. Much that in former years was unjustifiable has
become both justifiable and feasible; to-day patients, as a matter of
course, live after operations which, so recently as when I was{262}
a student, were considered impossible, or if performed exposed the
operator to the charge of manslaughter.
I have spoken of the impulse which came from Avenbrugger's invention of
percussion, which was greatly extended through the translation of his
work by Corvisart (1755-1821); the latter also excelled as a clinical
teacher and pathological anatomist, and had much to do with the
education of others of his _confrères_ whose names are lustrous in
history. Among the most celebrated was Laënnec (1781-1826), who, though
brought up among most trying surroundings, early manifested a zeal for
medicine. He became a field-surgeon in the French army soon after the
Reign of Terror, and pushed his classical and medical studies with
restless zeal. In 1815 his first experiments were made with the
stethoscope, the invention of which was due to accident: in order
to hear the sounds of the heart more clearly, lie one day applied a
cylindrical roll of paper, and then immediately constructed the whole
form of the stethoscope upon the principle now everywhere resorted to.
In 1819 he published his work on Mediate Auscultation,--a treatise on
prognosis in disease of the lungs and heart, based principally upon this
new aid to investigation. The treatise was speedily translated into
all the languages of Europe. After enjoying a large practice Laënnec
succumbed to ill health at the early age of forty-five. He seems to have
had but slight appreciation of his own services to medicine, and to have
prided himself rather on his skill in riding horseback. Honor and fame,
however, followed closely upon the publication of his well-known work,
and the manuals of physical diagnosis which now find frequent mention
in book catalogues, and come from various and wide sources are the
legitimate outcome of Avenbrugger's and of Laënncc's pioneer treatises.
A versatile French writer who devoted especial attention to medical
nomenclature was Piorry (1794-1879), to whom we are{263} indebted
for the pleximeter. The double stethoscope, a legitimate extension of
Laënnec's simple instrument, was invented by Cammann, of New York, and
can justly be claimed for American medicine. Other methods of physical
examination--like spirometry, chest measurement, and study of expired
air--have been introduced since 1846. The ophthalmoscope, which has been
of such sterling service, and is based upon the simplest of principles,
was the invention of the famous Helmholtz, but just deceased. The
principle of endoscopy,--the illumination and visual examination of
the various cavities of the human body,--the various specula, the
spectroscope, the sphygmograph, the more accurate record of physical
sounds, the application of electricity, and the employment of
thermometry represent a few of the strides in the medical science of
the present century, thereby aiding and perfecting the art of diagnosis,
which, in turn, must ever necessarily form the basis for all rational
treatment. Let no one complain that we are still so far from certainty
in every case; the wonder is that so much has been discovered in so
short a space of time.
Wonderful as have been these advances, the greatest achievements have
accrued to the department of surgery, which Chamisso terms "the _seeing_
portion of the healing art." The sixteenth century opened the way
for checking of haemorrhages; the seventeenth accomplished great
simplifications and improvement in the way of dressing wounds; the
eighteenth gave a refining and elevating tendency to the study of
applied practice, and raised surgery to a level with other branches
of science; and now the nineteenth century has, toward its close, made
surgery as nearly, perhaps, as it ever can be, an exact science, to
which every other branch of science has been made contributory. The
chain-saw, invented in 1806 by Jeffery, alone gave an impetus to
resection, which was cultivated especially in Germany; to resection was
added osteotomy by Heine{264} and Maver; this, in turn, was succeeded
by the so-called subcutaneous osteotomy of Langenbeck in 1854; Stromeyer
introduced subcutaneous tenotomy in 1831, which was a very pronounced
advance on all that had gone before; then came the introduction of
anæsthesia, by which were made possible operations that had been beyond
human endurance; by the introduction of the rubber bandage by Esmarch in
1873 bloodless methods were made possible. Pain and haemorrhage, the
two greatest enemies of the conscientious surgeon, being thus almost
annihilated, there was left but an apparently theoretical limit to
what the surgeon might accomplish. Orthopaedic surgery, introduced
by Delpech, was unknown prior to 1816; it was first practiced
systematically by Stromeyer and popularized in France by Guerin.
Operations on nerves were studied as special methods by Schuh, Wernher,
and Nussbaum. Jobert and Simon abroad, and Sims and Emmet in the United
States, by their studies of fistulæ peculiar to the genito-urinary
tract in females, have conferred inestimable benefits upon suffering
womanhood. So late as 1839 Vidal declared there did not exist in the
history of surgery a single well-authenticated case of complete cure of
vesicovaginal tear.
It is not my intention to more than barely refer to the living surgeons
of to-day, or those who have but very recently passed away from us; but
it would be an injustice to overlook Bernhard von Langenbeck and Theodor
Billroth. The former, born in 1810 and deceased in 1887, was for a
time a teacher of physiology, but subsequently became successor of
Dieffenbach in the University of Berlin. The influence he exerted upon
surgery in Germany and (since the decline of French precedence) upon
surgery all over the world, has perhaps been greater than that of any
one man since Dupuytren's time. He it was that introduced into surgical
technique and surgical pathology the experimental method of which
Johannes Müller was the great{265} exponent; indeed, the relatively high
importance which pathology is given to-day in every surgical curriculum
is due more to his labors than to those of any other one man. Genial,
learned, indefatigable, he was the ideal accomplished teacher. It would
be impossible in any short _résumé_ of his life and labors to do justice
to so distinguished a man, to whom the profession owes so much. Perhaps
the highest testimonial that could be given would be the enumeration of
the men who were ever and always his enthusiastic admirers. Langenbeck
was the founder of the German Congress of Surgeons, and for many years
its president, and the permanent home this association has built for
itself in Berlin bears his name; the surgical journal he founded has
now passed its fiftieth volume, and is today the first periodical of its
class in any country or language.
[Illustration: 0285]
[Illustration: 0286]
Theodor{266} Billroth, who only within a few years joined the great
silent majority, was for many years the surgical sun of Austro-Hungary,
around whom revolved all the other lights of the profession in the
empire. He was as expert with the microscope as with the knife, and
equally great with both. Although his great and elaborate work on
_Coccobacteria Septica_ is now obsolete, it nevertheless marked an era
in surgical pathology, as does also his textbook on the same subject,
which reached fifteen editions and has been widely translated. He it was
who made the first resection of the larynx and of the stomach, and to
him we are indebted for many other daring operations. It was the fame of
this teacher that in recent years led young Americans to Vienna, and he
set the example in every way for a constantly growing number of students
whose names are, or ere long will be, famous. Billroth was born, in
1819,{267} in Bergen, and succeeded Schuh in Vienna, after having
taught most acceptably at Zürich. What he was to his teacher,
Langenbeck, such are the younger German surgeons, like Czerny,
Gussenbauer, Mikulicz, and others, to _him_.
Here may be recalled the pride with which Americans greet the name of
McDowell, who performed the first ovariotomy, and prepared the way for a
branch of abdominal surgery the results of which have fairly astonished
the world.
There is much to be said also for certain measures, such as the
introduction into surgery of plaster of Paris, by Larrey; of starched
bandages, by Seutin; of absorbable material for ligatures and sutures,
the latter from animal sources. Finally, antiseptic--or, better,
aseptic--methods of operating and caring for injuries and wounds have
worked a revolution in methods and results that is, perhaps, the most
important known to medical history.
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{268} 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{269} 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{270} (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{271} 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{272} 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.
[Illustration: 0292]
[Illustration: 0293]
A colleague{273} of Cooper's at St. Thomas's Hospital was Travers,
already spoken of in connection with irritation. Tyrrel, a nephew of
Cooper, was a well-known surgeon, particularly in diseases of the eye.
Others of the same name were: Samuel Cooper (1781-1848), who wrote a
voluminous treatise on practical surgery; Bransby Cooper (1792-1853),
Sir Astley's nephew and adopted son, who was well known, and who
achieved an eminence that is only dimmed by that of his uncle.
Sir Benjamin Brodie (1783-1862) was distinguished as a special
investigator and a soft-tissue operator, of whom it is said that,
basing his actions upon his statistics, the older he became, the less
frequently he operated. His bestknown writings concern diseases of the
joints. Guthrie (1785-1856), a man of noble characteristics, was the
friend and{274} companion of Wellington, whom he accompanied in all his
campaigns. Although well known as a lithotomist, his fame rests chiefly
upon studies and writings in the domain of military surgery. A colleague
of his in the Westminster Hospital, Sir William Lawrence (1783-1867),
was surgeon to the queen, highly esteemed as a dextrous operator, and an
authority on ruptures and on operative surgery. John Lizars (1783-1861)
was a pupil of John Bell, and distinguished himself as a bold operator
and fertile writer; early in the century he treated chronic
hydrocephalus by operation. Robert Liston (1794-1847) was another
remarkable surgeon and a wonderful operator. Sir Charles Bell
(1774-1842) has already been mentioned for his researches on the nerves,
and he also wrote on operative surgery, and is somewhat famed for his
opposition to venesection.
In Edinburgh James Syme (1799-1870) secured great reputation both by
his dexterity as an operator--which is spoken of by his own pupils as
marvelous--and by his introduction of resection into general practice.
Sir James Y. Simpson (1811-1870) aided to make the Edinburgh school
famous by his researches into the domain of both surgery and obstetrics.
Though the inventor of acupressure, his name will forever be associated
with the introduction of chloroform. Professor Dunn says that, u after
seeing the terrible agony of a poor Highland woman under amputation of
the breast, Simpson left the class-room and went straight to Parliament
House to seek work as a solicitor's clerk. But on second thought he
returned to the study of medicine, asking: 'Can anything be done to
make operations less painful?' The ultimate result was the discovery
of chloroform, and so the suffering of one became the occasion of the
deliverance of many. Upon his advocacy of chloroform in obstetrics he
had to defend himself against most vehement attacks of both Scotch and
English clergymen, who affected to regard such procedure as a crime that
transgressed the will of the Deity; but he successfully confounded{275}
these assailants with their own weapons, proving himself their more than
equal in knowledge of Scripture lore.
Many other British surgeons, living and dead, deserve most honorable
mention, but time and space will not permit. I cannot, however, pass by
without mentioning Curling, Annandale, Chiene, Cheyne, Macewen,
Ogston, Jonathan Hutchinson, Sir James Paget, Christopher Heath, Thomas
Langmore, Savory, Holden, Holmes, Adams, Sir Joseph Lister, and Sir
Prescott Hewitt, of the value of whose labors I have already tried to
speak; Sir William Ferguson, of whom it is said that he had the eagle's
eye, a lion's heart, and a lady's hand; John Bowman, best known for his
work in ophthalmic surgery; Sir Henry Thompson, the eminent lithotomist
and lithotritist; and Sir Spencer Wells, Keith, Lawson Tait, and
Bantock, whose names are inseparable from the history of abdominal
surgery. And what can be said of the young men who are being trained in
the methods and practice of their predecessors--trained not only in the
direction of manual dexterity, but in experimental science, to which
they make the former subservient'? All honor to these scions of Great
Britain's surgical art, who have astonished the world with their
consummate ability! I would that time permitted recapitulation of the
work accomplished in late years by the present generation of men in
London, Edinburgh, and other medical centres; but the scope of these
chapters does not cover this ground.