556 



MEDICAL SCIENCE AND PRACTICE. 



curs in a wound ; that it is his fault if even the 

 slightest reaction or redness is developed in it, 

 or if an amputation is not healed by first in- 

 tention " ; and, speaking of the simplification 

 of processes that has attended the employment 

 of this method, he remarked that " it would 

 appear that in association with anaesthetics 

 and the bloodless method antiseptic surgery has 

 deprived all important operations of their ter- 

 rors." "While for the forty years previous to 

 the adoption of the antiseptic treatment fatal 

 wound-diseases raged, patients with compound 

 fractures most frequently died of them, and 

 even those with the slightest injuries often suc- 

 cumbed to them, and erysipelas and abscesses 

 were matters of daily occurrence, and during 

 later years hospital gangrene became very prev- 

 alent and fatal, now, operations are conducted 

 which would have been regarded then as mad- 

 ness, or as crimes ; and even young doctors are 

 able with impunity to venture upon operations 

 which the most daring surgeon did not think 

 of. While Dr. Yolkmann and his predecessor 

 in the hospital with which he is connected had 

 experienced a loss of forty per cent of the cases 

 of compound fracture that they had treated, 

 and Dr. Volkmann's last cases before he adopted 

 the antiseptic treatment had all died of pya?- 

 mia or septicaemia, he has since lost none 

 from wound-diseases and only two from other 

 causes out of 135 cases of compound fracture, 

 and only four or five per cent in direct conse- 

 quence of the operations out of 400 cases in 

 which the larger limbs were amputated. Thus 

 amputation of the larger limbs has become 

 almost free from danger ; certainly less danger- 

 ous than many small operations were formerly, 

 the mortality of which was never discussed. 

 The adoption of the antiseptic system has 

 made it possible to counteract the noxious 

 qualities of the " infected air " of hospitals, and 

 to perform operations in the most crowded insti- 

 tutions of large cities almost as safely as in the 

 open country. With the aid of the new method, 

 operations of an increasingly formidable char- 

 acter are carried on with diminished mortal- 

 ity and almost assured safety, and are made 

 to confer life and health upon thousands who 

 must otherwise have suffered for years or have 

 miserably perished. Among the most striking 

 operations of this kind may be named the 

 extirpation of deep-seated and important or- 

 gans, such as the pancreas, spleen, kidney, and 

 thyroid gland; the removal of a part of the 

 stomach and pylorus by Billroth, and of a part 

 of the small intestine by a surgeon of Stras- 

 burg, both with perfect recovery. The opera- 

 tion of cutting for stone has been practically 

 abolished since the introduction of Bigelow's 

 method for crushing the stone and securing 

 its removal by natural ways, at a single op- 

 eration, a method which Dr. Erichsen says 

 has effected a complete revolution, and has 

 wholly changed the character of lithotrity, and 

 which, he adds, there is every reason to be- 

 lieve " coijstitutes one of those real advances 



in a method which marks an epoch not only 

 in the history of the operation itself, but in the 

 treatment of the disease to which it is appli- 

 cable." The larynx has been more than once 

 successfully removed and replaced by an arti- 

 ficial voice-organ ; and the use of the laryngo- 

 scope has made the easy removal of morbid 

 growths and foreign bodies an every-day pro- 

 ceeding. In regard to the treatment of an- 

 eurisms, the ligature and compression still 

 have their partisans, and improvements in 

 either process seem to keep pace with those in 

 the other. Compression was most in favor a 

 few years ago. The invention of improved 

 ligatures, made of various kinds of animal 

 tissue and applied with antiseptic precautions, 

 once more inclined the balance of professional 

 opinion in their favor; but now again the 

 practice of compression has received renewed 

 strength from the employment of Esmarch's 

 elastic bandage. Wounded joints are now free- 

 ly opened and successfully treated. Among 

 new operations in plastic surgery may be named 

 skin-grafting, and the transplantation of the 

 cornea of the eye. 



In the category of the development of 

 medicine by the adoption and absorption of 

 means and principles of other arts and sciences, 

 may be placed the adoption of new drugs 

 whose action has been investigated, either by 

 physiological experiments or by study of their 

 chemical effects. The isolation of the active 

 principle of a drug is a decided approximation 

 to scientific precision; but the clinical gain 

 from this source is not always indubitable, 

 for the entire drug is often seen to act with 

 more advantage than the simple alkaloid, even 

 though the alkaloid is practically the therapeutic 

 power of the drug. It is not yet clear whether 

 this difference is due to the chemical or molecu- 

 lar condition in which the active principle is 

 present in the plant, or to the modifying influ- 

 ence of other slightly powerful substances. 

 The vegetable kingdom has supplied the great 

 bulk of the recent additions to the list of 

 drugs, and chemistry has given some most 

 important remedies, but the animal kingdom, 

 where many favorite remedies were formerly 

 'found, is now hardly regarded. A great power 

 has always been recognized in the enlightened 

 practice of hydropathy, but it can not be said 

 that its therapeutic function has as yet been 

 definitely established. Good results have been 

 obtained in the application of gymnastics for 

 its decided remedial value in particular affec- 

 tions as well as, and quite distinct from, its 

 beneficial effect as exercise and in the culture 

 of the physical powers. Many nervous and mus- 

 cular disorders, and other disorders in which 

 the main defect seems to be in the control- 

 ling power of the brain, are certainly benefited 

 by such treatment ; and the brain can often be 

 thus educated so as to establish a normal func- 

 tional action in the place of one that is aber- 

 rant or altogether wanting. The study of 

 climatology has been carried on without yield- 



