MEDICAL SCIENCE AND PEACTICE. 



555 



halent. The more correct principle of local 

 anesthetization, in which the disturbance of 

 the system is avoided, has been successfully 

 adopted in the application of the freezing 

 effect of the ether-spray. The physical and 

 mental quietude induced by inhalation must, 

 however, always keep a place for it in appro- 

 priate cases. 



Modern surgery has shown a tendency to 

 become more conservative to dispense with 

 the knife, and rely more upon the recuperative 

 and compensatory capabilities of the body; 

 and in this respect lias distinctly approached 

 medical practice. Medicine, on the other hand, 

 is tending toward the adoption of manipulative 

 measures ; and thus the line of demarkation 

 between the two branches of the healing art 

 is becoming more and more faint. Such de- 

 partments as obstetrics, and affections of the 

 eye, ear, larynx, and skin, are both medical and 

 surgical ; and the two branches are inseparably 

 blended in the general study of disease, as is 

 exemplified in the introduction of instrumental 

 means of diagnosis and treatment, the object 

 of which is to bring diseased structures within 

 manipulative reach. By the invention and 

 improvement of means of this kind, our gen- 

 eration has made much disease of internal 

 structures to be seen, felt, and handled. Thus 

 has arisen a large body of special knowledge 

 and practice around many organs. The eye, 

 ear, and larynx, for instance, have respectively 

 a peculiar art and science. It is not to be 

 expected that specialisms of this character will 

 die out of medicine. As the study of each 

 organ increases in extent and profundity, and 

 the treatment of its diseases and defects be- 

 comes more complex and delicate, special tal- 

 ent and culture will always be recognized. 

 Recent progress in the " special " developments 

 of practice has been sound and sure, in so 

 far as it has traced its researches on sound 

 pathological principles. 



Of the relations of some of these special 

 investigations to general medical practice, Dr. 

 George Johnson said, in his address before the 

 section on Diseases of the Throat, that among 

 the most interesting and important of the 

 scientific and practical gains which have re- 

 sulted from the use of the ophthalmoscope 

 and the laryngoscope, " is the fact that, by the 

 inspection respectively of the interior of the 

 eye and of the larynx valuable light is often 

 thrown upon the diseases of remote but physi- 

 ologically correlated organs. If, for example, 

 the ophthalmoscopist sees in the eye a retinitis 

 significant of renal disease, a neuritis indicat- 

 ing cerebral tumor, or an embolism the result 

 of valvular disease of the heart, so, in like 

 manner, the laryngologist is often led by the 

 observation of the paralytic or spasmodic con- 

 dition of one or more laryngeal muscles to the 

 diagnosis of a general neurotic condition to 

 which the term hysteria is often applied, or of 

 a special local disease in the nervous center, 

 or, it may be. of a tumor, cervical or intra- 



thoracic, pressing on the pneumogastric nerve 

 or its branches. It is obvious that all clinical 

 facts of this kind, indicating, as they do, the 

 interdependence and the close physiological 

 relationship between various tissues and organs, 

 are of great scientific and practical importance. 

 There is reason for the belief that the more 

 thorough and profound is the investigation of 

 any disease or class of diseases, the more nu- 

 merous and intimate will be found to be the 

 relationship with other morbid states." 



Of the modern development of surgery, Sur- 

 geon John Eric Erichsen remarked : " The 

 continuous advance in our art is undoubted. 

 The gain that thus results has been definitely 

 secured to surgery and to mankind. It can 

 never be lost. Every conquest that has been 

 made has been permanent. Year after year 

 some new position has been won often, it is 

 true, after a hot conflict of opinion. But, once 

 occupied, it has never been abandoned. Thus 

 our stand-point has ever been pushed on in 

 advance." 



Modern conservative surgery is marked by 

 the care that is taken for saving blood in opera- 

 tions, which is strikingly in contrast with em- 

 ployment in former practice of bleeding to 

 subdue or prevent inflammation attendant upon 

 surgical treatment. By the new practice of 

 the excision of diseased joints in cases where 

 the whole limb would formerly have been 

 removed, an arm or leg can be preserved with 

 a degree of impairment of movement that 

 makes it only less useful than the limb before 

 it was diseased. Resection has of late years 

 come to be extensively applied in the treat- 

 ment of cases of articular disease which for- 

 merly were subjected to procedures of a less 

 heroic character a course the expediency of 

 which, Dr. Erichsen suggests, should be well 

 weighed before it is entered upon. The most 

 important advance in surgery is the adoption 

 of the antiseptic process and the rigid exclusion 

 of the surrounding air from wounded surfaces. 

 Whether all putrefactive processes in wounds 

 are caused by the development of living organ- 

 isms, as is generally believed, or partly result 

 from other poisonous agencies, concerning 

 which some differences of opinion may still 

 exist, a substantial agreement prevails that the 

 use of antiseptics renders innocuous certain 

 poisonous matters which are met with in a 

 wound exposed to the air. The effect is practi- 

 cally the same if the purification of the air is 

 attained by thorough sanitary measures. Pro- 

 fessor Volkmann said of the antiseptic method 

 in his address before the International Medical 

 Congress: "By rescuing from the domain of 

 chance the results of our labors, . . . the anti- 

 septic method has elevated surgery to the rank 

 of the latest experimental science. Never has 

 a discovery been made in surgery which has 

 even approached this in its benefits to hu- 

 manity in general. . . . To-day we may say, 

 with the deepest conviction, that the surgeon 

 is responsible for every disturbance which oc- 



