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 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), 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 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 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 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.
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 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 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 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 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 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 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 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 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.
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Theodor 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, 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 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 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 (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 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 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.
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A colleague 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 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 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.
