Among the contemporaries of Sir Benjamin Brodie there were several London surgeons who, by reason of the important parts which they played in building up this branch of the science and art of medicine, fully deserve such consideration in the present review as my limited space will permit, and also as the sources of information upon which I am forced to depend for guidance may or may not prove helpful. Most fortunately for me at this juncture of affairs was the finding—among the rich treasures of the Medical Library of the former Transylvania University, at Lexington, Kentucky—of Professor Roux’s account of a visit which he made to the English metropolis in 1814 for the purpose of learning at first hand precisely how the English surgeons of that day were dealing with the more important problems which they were called upon to solve. A more competent and fair-minded authority than Dr. Roux could scarcely have been found at that time for the task which he set before himself. In the first place he was himself an eminent surgeon, in fact the Professor of Anatomy, Physiology and Surgery at the FacultÉ de MÉdecine of Paris, and at the same time he was wholly free from the animosity which most naturally pervaded a large part of the French nation in 1814 (just before the battle of Waterloo). And the very best evidence that he performed his judicial task to the entire satisfaction of the medical men of Great Britain is to be found in the fact that an English translation of his elaborate report reached a second edition in 1816. I therefore feel confident that, in basing my rÉsumÉ largely upon Dr. Roux’s report regarding the condition of English surgery in the second decade of the nineteenth century, I shall not go far astray from the truth.

In his review of past events in the broad domain of surgery Roux says that the English attribute the first idea of the circular amputation of limbs to Cheselden, whereas the French give the credit for this operation to J. L. Petit. Then there are other operations which were devised or revived simultaneously by English and French surgeons—as, for example, in external aneurism, the tying of the diseased artery above the tumor (Desault and John Hunter), and the operation for Fistula in ano—an operation which was brought to the greatest degree of simplicity by Pott, Desault and some others.

On the other hand, there are many operations which were devised or perfected exclusively by French surgeons—for example, the method of extracting the crystalline lens, by Daviel; the treatment of fistula lachrymalis by dilating the nasal canal; the treatment of strangulated hernia by Goursand, Pipelet, Louis and others; the lateral operation (perinaeal) for removal of a calculus in the bladder; the operation of FrÈre Jacques; hypogastric lithotomy by Pierre Franco, and perfected by FrÈre CÔme; etc.

The English surgeons may similarly claim priority in proposing certain operations, as for example, that of perforation of the os unguis for establishing an artificial passage for the tears, by Woolhouse; Cheselden created the operation of the artificial pupil; he is also to be credited with the operation of perforating the duct of Steno, on the inside of the mouth and some distance from its natural orifice, for the relief of salivary fistula; Pott’s description of and treatment for what is known as Pott’s disease of the spine; etc.

Then, passing from what may be termed the history of ancient English surgery, Roux devotes his attention next to the work which was being done, at the time of his visit to London, by some of the leading surgeons of that city; and among his most striking brief comments I find the following: “There are many able surgeons in London at the present time”; and “The English seem to have a strong taste for surgery.” Farther on, he discusses at greater length the reasons why the English surgeons maintain such pleasant relations with one another, and notes with pleasure how greatly the prevalence of such professional harmony conduces to the general advancement of the science and art of surgery—or, for that matter, to the advancement of any art or science. His words read as follows:—

If anything can contribute to keep alive the taste for an art or science, to extend its progress, and to make a greater number of men excel in it, is it not that those who cultivate it should live in perfect intelligence together; that they should compose one family; that they have frequent meetings with one another, in which each one, sacrificing his own private interest, brings, without pride or without presumption, the fruit of his own reflections; that, strangers to the arts of intrigue, and, never giving their minds to the vile insinuations of envy, they should rival one another only in zeal and knowledge? Well, this fraternal spirit, this absence of all jealous rivalry; and more, an ardent desire to communicate, reciprocally, their views, their thoughts, exists in a very high degree amongst the men who are at this moment the honour of medicine and surgery at London. This is what I have observed by being amongst them, I will not say with surprise, but with the highest satisfaction. To these common sentiments is joined, on the part of those men already advanced in their career, an esteem altogether peculiar, for those whose reputation is but beginning; and, on the part of the latter, the greatest regard, the most sincere respect for those who were their masters.

At this point I beg to remind my readers that effective surgical anaesthesia had not yet at that early period been discovered, and this fact, I scarcely need to add, must have deterred many men from undertaking some of the more serious surgical operations.

At the end of Roux’s account he sums up the results of his observations of English surgery in the following words:—

If I must conclude by a summary opinion, I would say that, with respect to the art of surgery, as with respect to its habits and institutions; in whatever light we consider it, England is the place for contrasts. By the side of the most brilliant features, English surgery exhibits glaring imperfections—French surgery is more generally good.

While we are now considering various matters relating to the condition of surgery in England and her colonies during the early part of the nineteenth century, it may not seem out of place to mention here a discovery which was announced just about that time, and which, I suspect, is known to-day to comparatively few American physicians. During the eighteenth century the opinion was widely held that gonorrhoea is simply one of the manifestations of syphilis and that consequently mercury is required for its cure. The existence of such a belief among the physicians of that day explains the following statement which I find printed in Vol. I. of the Quarterly Journal of Foreign Medicine and Surgery for 1818:—“Dr. Francis Balfour, a physician highly esteemed in Calcutta, states that when he was a student in Edinburgh he attempted to establish the idea that gonorrhoea is a disease distinct from syphilis and does not require mercury for its cure. He put forward this doctrine in a paper which he presented to the Medical Society of Edinburgh, and which still, we believe, graces its records. This was as early as the year 1766. Next year he made it the subject of his inaugural dissertation.... It was nearly twenty years after this period that Benjamin Bell, by his ingenious and able investigations, supported and further confirmed the opinion, and thus contributed much to bring it into public notoriety and favour.”

At the time of Dr. Roux’s visit to London Charles Bell, who had taken up his residence in that city in 1804, was already well advanced on the high road to distinction as a surgeon. Born at Edinburgh, Scotland, in 1774, he had attained considerable reputation as an anatomist and physiologist by the publication (1798–1800) (in association with his brother, John Bell) of a very useful “System of Dissection of the Human Body,” in which he describes not only the normal conditions but also the alterations produced by disease. The text is interspersed with instructive remarks concerning human physiology. Particularly clear and interesting—says his biographer—are the descriptions which Bell gives of the structure of the heart and blood-vessels. He refutes in strong terms the teachings of Hunter regarding the vital force of the blood and the doctrine of Crawford with regard to animal heat; and “his explanation of the physiology of respiration is the clearest and most satisfactory of any of the accounts that are to be found in the textbooks.”

In the domain of experimental physiology Charles Bell discovered, at a later date, that, in the case of certain nerve trunks (e.g., the trigeminus), what appeared to be a single nerve was in reality made up of two entirely different (physiologically speaking) nerves, one of which is now termed the portio major, while the other bears the name of portio minor. Bell also demonstrated experimentally the important law that the anterior roots of the spinal cord nerves are the outgoing (centrifugal) motor nerves, the posterior the incoming (centripetal) sensible nerves. These results were subsequently fully confirmed by the great German physiologist, Johannes Mueller. In ancient times the question was often discussed whether one and the same nerve might not carry both sensory and motor impulses. The discovery just mentioned is one of the most important ever made in physiology.

Great as was the reputation attained by Charles Bell as an experimental physiologist,—a reputation which won for him the honor of knighthood on the accession of William IV. to the throne,—he soon, as was predicted by Roux, became one of the most celebrated surgeons of London. His work as an operator was carried on chiefly at the Middlesex Hospital. Roux speaks of him as a “graceful operator without being affected.”

As an author he should be credited with the following treatises:—“Anatomy of Expression” (1806); “System of Operative Surgery”; “Animal Mechanics” (1828); “Nervous System” (1830).

Sir Charles Bell’s death occurred in 1842.

Sir Charles Bell’s older brother, John Bell, born at Edinburgh in 1763, was also a distinguished anatomist and surgeon. After traveling for a short time in Russia and the north of Europe he returned to Edinburgh in 1786 and began to deliver lectures on surgery and midwifery. From this time forward his private practice as a consulting and operating surgeon steadily increased, until finally, in 1796, he was obliged to discontinue his lectures and devote his entire time to his patients and to the preparation of the several publications of which he was the author. Early in 1816 he was thrown by a spirited horse, and was so seriously injured that he never entirely recovered from the effects of the accident. His death occurred in 1820.

Among the works which he published the following deserve to receive special mention: “The Anatomy of the Human Body” (1793–1802), in the third edition of which work (1811) are to be found a number of plates that were drawn by his brother, Charles Bell; “Engravings of the Bones, Muscles and Joints,” drawn and engraved by himself (1794); “The Principles of Surgery” (1801–1808); and “Letters on Professional Character.”

Speaking of the second volume of the first-mentioned work (“The Anatomy,” etc.) Sprengel, the author of an important German history of medicine, says: “It is remarkable in two respects, viz., for the unusual number of interesting facts which it contains and also for the marked excellence of the plates that accompany the text.”