discovery of an?sthetics.—medical literature.—nursing reform.—history of the treatment of the insane.

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 surgical 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 hemp 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 opium were well understood, and other narcotic drugs were used for the same purpose. patients were also sometimes stupefied by strong drink, and among some savage tribes banana wine was copiously administered so as to intoxicate 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 oxide 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 inhaling 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 determined its composition in 1834. jacob bell in london, and dr. simpson in edinburgh, first applied chloroform experimentally. the late professor465 james miller 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 hydrocarbon, 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 vessel, about a teaspoonful 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 volatile. holding the mouth and nostrils over the vessel’s orifice, inhalation was proceeded with, slowly and deliberately, 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 hazardous work in dr. simpson’s dining-room. having inhaled several substances, but without much effect, it occurred to dr. simpson to try a ponderous material, which he had formerly 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 vocation. immediately an unwonted hilarity seized the party; they became bright-eyed, very happy, and very loquacious—expatiating on the delicious aroma of the new fluid. the conversation was of unusual intelligence, and quite charmed the listeners—some ladies of the family, and a naval 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 prostrate on the floor, and that among the friends about him there was both confusion and alarm.” each of the investigators 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 anecdote which he heard from the poet coleridge, which illustrates 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 paralysis; 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 ascertain the degree of animal temperature, with a view to future comparison. the paralytic 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 talisman was in full operation, and in a burst of enthusiasm declared that he already experienced the effect of its benign influence throughout his whole body. the opportunity was too tempting 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 botanist, but his immortal 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 hastings (1794-1866), the founder of the british medical association.

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 advancement 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 metropolitan asylums. mr. hart’s labours in connection with many questions of social and sanitary 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 blessing 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 exterminator 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 superintendent of the nightingale school of nursing, and the original trainer of technically educated nurses for hospitals and infirmaries.

the treatment of insanity.

it is customary to divide the treatment of the insane into three periods—the barbaric, humane, 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 afflicted in ancient egypt and in greece was not only humane, but was probably remedial. in the temples of saturn 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 advent 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 malady. 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 peculiar treatment in cases of suicidal mania. “give the patient a draught 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 lodged 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 ingenuity of the torture which they sought to inflict upon their patients. some of them advocated the use of machinery, by which a patient, on first entering an asylum, was to be first drawn with frightful 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 cavern. these practitioners avowed, 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 spine of the patient, who was firmly fixed in a bath made for this apparatus.” 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 plunged them into “the bath of surprise” underneath. dr. darwin is credited with having invented “the circulating swing” for lunatics; it was worked by a windlass, and was capable of being revolved 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 faculty 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 licensed 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 bedlam. 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 christian 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 demons. this grievous blunder is one of many illustrations which might be given of the necessity of making an accurate470 diagnosis 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 anatomy of melancholy, 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 fable 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.