June 15, 1876] 



NATURE 



151 



the example in question, was that the remedy which had 

 caused solution of the coagulum had saved life by that 

 prcccFS to destroy life by the extension of the solvent 

 action to the blood corpuscles, and this opinion was so 

 fully confirmed by experimentation, that I gave up further 

 inquiry on the subject, from the feeling that its continu- 

 ance was not warranted. A period of seventeen years 

 now elapsed, in every year of which I had occasion to see 

 from five to six instances of deafh from this one cause. 

 Some of the deaths from the cause named occurred 

 after surgical operations, such as ovariotomy, some from 

 croup and other inflammatory affections, others before or 

 after childbirth. In 1870 I computed that I had wit- 

 nessed ninety- seven of these fatal catastrophes. Mean- 

 time there had been found no remedy, but I had learned 

 from the added experience one new fact, viz., that in three 

 instances, although no ammonia or other solvent of the 

 blood had been employed in treatment, the symptoms 

 of coma supervened precisely as in the case where 

 ammonia had been administered. At last I obtained one 

 clear evidence that the reason of the symptoms was a 

 separation of fibrine in the sinuses of the brain. 



Eecurring once more to the use of ammonia as a 

 solvent of the deposited fibrine, I thought it justifiable 

 now to renew experiment. It might, I felt, be the 

 best course to administer the simple liquid ammonia 

 instead of a salt of that substance, by which means I 

 hoped the solvent action would be obtained by an agent 

 that was more easily eliminated from the body when the 

 administration of it was withdrawn. 



To what extent I might administer the solvent, how far 

 I might venture to produce disintegration of the cor- 

 puscles of the blood and hope for recovery, was the point 

 to be arrived at. It could only be arrived at by one of 

 two methods — by trying the experiment on the inferior 

 animals, or by waiting for the opportunity of testing the 

 remedy directly on man in some extreme case of the 

 diseased condition specified. I chose, and I think cor- 

 rectly, the first of these alternatives. I subjected an animal, 

 a guinea pig, to the administration of ammonia diluted as 

 it might be for the human subject, and I continued the 

 administration until I found, firstly, that life was possible 

 and safe under a degree of solution of blood which in 

 the absence of such a direct test would have been thought 

 impossible ; and secondly, that on the withdrawal of the 

 solvent agent the natural state was slowly but completely 

 restored. I repeated the research in order to test the 

 best mode of administration. I tried on myself the doses 

 that could be swallowed without actual pain, and then I 

 planned the measure I would adopt when another instance 

 of obstruction of the blood in the heart came under my care. 

 I need not repeat here, in any detail, the satisfactory 

 results of this inquiry. The facts have been recorded at 

 length before the Medical Society of London, have been 

 made widely known in the profession of medicine, and 

 have gathered confirmation from others. It is sufficient 

 for me to state that in 1872, in an example of this fibrinous 

 obstruction in the heart, when the sufferer was to all 

 known observation in extremis, the treatment by am- 

 monia, in doses which would have been considered 

 poisonous had not experiment on animals proved the 

 contrary, was pushed to the full ; that the evidence of 

 solution of the obstructing mass in the heart was perfect ; 

 and that complete recovery, I have no doubt the first 

 recovery of the kind, was the result. Since then I know 

 of eight more examples in which the same rational method 

 of treatment has been applied, with the result of six re- 

 coveries. 



Experimentation for Surgical Learning. — Ovariotomy. 

 I have sometimes had occasion to perform, or take part 

 in experiments on the lower animals in order to learn some 

 important detail of surgical practice. The following ex- 

 perience of this nature is worthy of special note. 



When Mr. Spencer Wells was beginning his career in 

 performing the operation of this centur}', — the removal of 

 ovarian tumours, — a difficulty arose on the point whether 

 in closing up the wound in the abdomen the peritoneum 

 ought or ought not to be included in the stitches. At the 

 present time, when so much is known, this subject may 

 appear of little moment ; then it was of vital moment. 

 The peritoneum had been held by all authorities to be of 

 such importance in the an'mal economy that to cut or in- 

 jure it was thought to be actually a deadly act, and a man 

 who intentionally injured the peritoneum, in operation, was 

 considered, by many, as little better than a wanton and 

 wicked experimenter on human life. Ought any one, 

 therefore, to venture to put two rows of stitches through 

 this structure ? Mr. Wells wished to ask the ques- 

 tion of nature, by experiment, and I helped him. 

 Eighteen animals of three classes— guinea-pigs, rabbits, 

 and dogs — were first thoroughly narcotised. Then 

 the same incision was made into the abdominal cavity 

 as is made in ovariotomy. Afterwards the incision was 

 neatly and closely sewn up, in one set of experinents 

 with the peritoneum included in the stitches, in the other 

 set with the peritoneum excluded. The anima'.s, on 

 coming out of their sleep, were attended to and treated 

 with as much care as if they had been human until their 

 recovery, which in each case was rapid and easy. When 

 they had entirely recovered and the wound healed, they 

 were submitted to painless death, under anaesthesia, and 

 their bodies were examined to determine the results of 

 the different modes of operation. 



These were the steps of the proceeding. The lessons 

 taught were of vital value. The experimentation proved 

 beyond dispute that the introduction of the stitches 

 through the peritoneum added no danger to the operation. 

 They proved further that when the peritoneum was in- 

 cluded in the stitches, the wound healed much more firmly 

 and safely, a fact which could only have been Icarnea 

 from an operation on a subject that could be killed after 

 operation. From that time of probationary learning on 

 to this time of matured experience, Mr. Wells has per- 

 formed the great operation, with which his name is for ever 

 identified, 770 times. In every instance the patients who 

 have come under his care for operation would, presum- 

 ably from past experience, have died from the disease. 

 Of his patients operated on an average of three out of 

 four have recovered. He has, therefore, by his own hand 

 saved between five or six hundred women from one form 

 of certain and lingering death. Towards this result — a 

 result grander than has ever before fallen to the lot of 

 any operator of any age — he w^as fortified by the experi- 

 ments I have described to an extent which no one but an 

 operator himself can fully appreciate. 



I am aware there are some who would urge that he 



might have learned the facts he wanted to obtain by 



experience, that is to say he might have waited for the 



results from his operations on women. This plan would 



have made several women in the prime of life subjects of 



experimental inquiry. I am aware that some would say 



it were better the operation had been dropped than that 



any animal whatever had been subjected to suffering for 



its sake. This plan would have been an obstacle to the 



saving of over five hundred women from early and certain 



death in the practice of Mr. Wells alone. But when it is 



I remembered that his teaching and example have been 



j followed wherever surgery is practised, the numbers of 



I women saved from death and suffering during the last 



fifteen years in consequence of what was learnt by sacri- 



I ficing some eighteen dogs, rabbits, and guinea-pigs, it is 



obvious that those who estimate human life at its real 



I value and observe human suffering in its most distressing 



' forms are compelled, however painful to their own 



feelings, to think and act first for the best interests of the 



j human family. 



What Lord Selbome, one of our most distinguished 



