Vol. XXII. No. 3.] 



POPULAE SCIEN"CE IsTEWS. 



45 



iilelitcine anii pibarmacp. 



THE HEALING ART. 



It is a common remark that physicians are 

 mere experimentalists, and that medical prac- 

 tice is purelj' empirical. It is easy to cite 

 cases in which the doctor has evidentl3- been 

 working in the dark, and the autops3- proves 

 that, in feeling his way, he has got far off from 

 the proper course. When we consider what a 

 complicated organism the human bod}' is, and 

 how almost infinitely varied are the causes 

 which may disturb its normal action, and that 

 these causes may act, not only singly, but in 

 countless combinations, each modifying the 

 outward manifestation of the disturbance, we 

 cannot wonder that occasionallj- the diagnosis 

 of disease is a peculiarlj- obscure and perplex- 

 ing problem. It is nevertheless true that medi- 

 cine is daily becoming more and more an exact 

 science. When we review what has been done 

 in the past fifty years for the alleviation of 

 disease, we can see a long series of medical 

 triumphs. We limit the retrospect to the half- 

 century, because so manj- of the greatest dis- 

 "coveries in medicine and surgery have been 

 made within that period, and a large propor- 

 tion of these within the memory- of compara- 

 tively young practitioners. Macaulaj- has 

 somewhere said that the poorest man of our 

 day has the advantage of medical skill such as 

 monarchs could not command a century or two 

 ago ; and if we should cut down the time 

 mentioned to the limit suggested above, the 

 statement would still be strikingly true. Fifty 

 years ago there was no anassthetics to produce 

 insensibility to pain, no antiseptics to promote 

 the healing of a wound, no chloral to produce 

 sleep, no anti-pyretic in general use to control 

 fever. 



The first of these great improvements — the 

 use of anaesthetics in surgery — is perhaps the 

 most important since the introduction of vac- 

 cination in 1799; and it ma}- be a question 

 whether it has not relieved a larger amount of 

 human misery than even Jenner's famous dis- 

 covery. It has rendered possible many surgical 

 operations that were before wholly impracti- 

 cable ; and the antiseptic treatment, for which 

 surgery is indebted to Lister, has added im- 

 mensely to the number. 



The healing art is largely empirical still ; 

 for, though the symptoms of disease and the 

 remedies to be applied are far better under- 

 stood than formerly, much yet remains to be 

 learned, both in pathology and therapeutics ; 

 and the next half-century may be expected to 

 show a greajgy.- progress in these and all other 

 departments of medicine than the past fifty 

 years. Chemical science is continually adding 

 fresh and potent agents to the armory of the 

 physician, to say nothing of the fact that he 

 is constantly gaining knowledge of the enemy 

 against which he fights. He is becoming bet- 

 ter and better acquainted with the vulnerable 

 points of his adversary, while the weapons he 

 can wield in the battle are more numerous and 

 more efficient. Besides, so much more is now 

 known than formerly concerning the laws of 



health and disease, that the modern doctor, if 

 he is unable to cure, has at least sense enough 

 not to kill. 



"Preventive medicine," which is but an- 

 other name for sanitary science, has been 

 wonderfully developed in these latter years. 

 Medical men are learning that more can be 

 done for the general health by removing the 

 causes of disease than by efforts to cure it 

 after it is once in existence. In the case of 

 contagious diseases there has been a marked 

 advance in the methods of arresting their dif- 

 fusion. 



With the increase of his knowledge, the 

 modern physician has, moreover, become the 

 more conscious of his ignorance, and conse- 

 quentlj- is disposed, as far as he can, to wait 

 on nature, trusting to her help, and removing 

 obstacles from her path. The histor}- of the 

 healing art shows that this principle was not 

 so much recognized in former daj's. Then 

 the doctor, instead of trusting to nature, in 

 cases where he reallj' did not know what to 

 do, was inclined to try drug after drug, in the 

 hope of hitting upon the right one, verj- much 

 as people who " doctor themselves " nowadays 

 experiment with one patent medicine after an- 

 other. In the olden time the medical man 

 rarely failed to write a prescription when he 

 was called in, and the dose was apt to be 

 " heroic " withal : now he gives advice oftener 

 than medicine ; and if the patient, as some- 

 times happens, is not satisfied without the 

 latter, a mere placebo is administered, and the 

 " mind-cure " left to do the rest. 



The real advance that has been made in the 

 healing art in recent times is shown b}- vital 

 statistics. These prove that medical and 

 sanitarj' science have diminished the death- 

 rate to such an extent as to add two years to 

 the mean duration of life in Great Britain ; 

 and the average result has probably been about 

 the same in our own and other enlightened 

 countries. This is in itself a great gain, and 

 it is one that we may reasonablj- expect will 

 steadily increase. It would be interesting to 

 know what share of it is thus far due to medi- 

 cal and what to sanitary progress, but it is 

 impossible to determine this from the statis- 

 tics. The diminished mortalitj- that has re- 

 sulted from hygienic precautions can, of course, 

 be demonstrated in many instances ; but to 

 trace out their entire effect in this direction is 

 at present bej-ond our abilitj'. 



[Spccinliy compiled for the Popular Science JiTewa.] 



MONTHLY SUMMARY OF MEDICAL 

 PROGRESS. 



BY W. 8. WELLS, M.D. 



A CASE of hydatids in hone is reported, in a re- 

 cent issue of the Australasian Medical Gazette, by 

 Dr. C. G. Leacock, M.R.C.S.E. This somewhat 

 rare disease of bone occurred in a man, aged forty, 

 who had been troubled, off and on, with his left 

 knee since he was twelve years old, when he re- 

 ceived a blow from a cricket-ball. This disabled 

 the limb for some time, but he ultimately recovered 

 the full use of the joint. Some years later he was 

 kicked by a horse on the same knee; and from 

 this he never fully recovered, the joint being always 



weak, swollen, and at times painful. Subsequent 

 sprains of the joint occurred, and other injuries, 

 keeping the unfortunate joint in a chronic con- 

 dition of irritation. About four months ago the 

 patient came under the care of Dr. Leacock, through 

 having struck the knee violently against a post, 

 inducing acute synovitis. Treatment seeming of 

 no avail, and the health of the patient beginning to 

 break down from constant pain, referred particu- 

 larly to a spot on tlie inner condyle of the femur, 

 an operation was suggested, — resection, or ampu- 

 tation if found necessary. On opening the joint, 

 there were the usual evidences of chronic inflam- 

 mation, but no pus. On digital examination, a 

 perforation was found, admitting the tip of the 

 finger, between the condyles of the femur. On 

 applying the saw to the condyles of the femur, there 

 was scarcely any resistance; the bone, in fact, was 

 a mere shell, in some parts scarcely thicker than 

 paper. Amputation was performed, as the only 

 resource, at the lower third of the thigh. On 

 examining the removed limb, the lower end of the 

 femur was found hollowed out into one large cavity, 

 stuffed full of hydatid cysts, from the size of a 

 small pea to nearly an inch in diameter. The 

 cancellous structure in the head of the tibia was 

 undergoing fatty degeneration, and in the popliteal 

 space was an ounce or more of broken-down soft 

 tissue. The stump healed almost entirely by first 

 intention. 



The diseased joint had been subjected to a series 

 of injuriesduring a period of twenty-eight years, but 

 there were no means of knowing how long the 

 changes in the femur had been going on. Dr. 

 Leacock is of the opinion that a correct diagnosis 

 could have been arrived at only by trephining the 

 bone at the seat of pain. 



In his day, the celebrated French surgeon 

 Ndlaton made some experiments to show that 

 in chloroform narcosis the re.^piratory and cardiac 

 centres are weakened by an anseniic condition of 

 the brain. The exposed brains of animals ex- 

 perimented upon wore noticed to bleach as chloro- 

 form vapor was inhaled by them to complete 

 anaesthesia. 



When this whitened appearance indicated in- 

 sufiicient blood-stimulus to the great nerve-centres, 

 their functions ceased, first in volition, next in 

 voluntary movement, then in general sensation, 

 and finally in the an est of involuntary or organic 

 movements, including the action of the heart and 

 lungs, and then death promptly ensued. 



Nelaton found that, when a number of rats had 

 become thoroughly narcotized with chloroform, 

 those which he would immediately hang up by the 

 tail would slowly revive, while those which were 

 left supine on the table died. 



If, when animation commenced to show itself in 

 the hung-up rat, the animal was lain down too soon, 

 breathing would again cease, and the rat would 

 die unless immediately suspended, whereupon the 

 respiratory and cardiac actions (the breathing and 

 beating of the heart) would be resumed. 



It was only after a sutRciently long suspension — 

 giving the brain and heart ample time to have 

 supplied them, by gravity, the requisite amount 

 of blood -- that death could be prevented. If the 

 animal was not already dead, suspension, head 

 downward, alone would restore animation. 



The suspending of the human body, feet up- 

 ward, to restore animation in chloroform narcosis 

 or poisoning, was Ndlaton's great discovery ; and it 

 is known as his method of restoring persons to life 

 when, under the influence of chloroform or other 

 anaesthetic, respiration has suddenly ceased. The 

 knowledge of and faith in this method has served 

 Dr. Julian J. Chi^olm of Baltimore, Md., remark- 



