Aug. 24, 1888.] 



SCIENTIFIC NEWS. 



185 



BRITISH MEDICAL ASSOCIATION IN 

 GLASGOW. 



Abstract of an Address by Sir H. B. Macleod, M.D., 

 " On the Progress of Surgery During the Last 

 Half Century." 



SINCE 1837 all the collateral sciences on which medi- 

 cine so largely leans have been in a great measure 

 reconstructed, and the very foundations on which our art 

 is built have been in no small measure relaid. In 1837 

 the doctrines of Broussais, which had been accepted with 

 the enthusiasm of a revelation, and had deeply imbued 

 the surgical as well as the medical practice of the day, 

 had spent their force. Hahnemann and Brown, Gall 

 and Spurzheim had come and gone with their disturbing 

 influence, and men turned wearily from the discussion 

 of mere doctrines and the dogmas of authority to a care- 

 ful study, aided by experiment, of facts. Many remark- 

 able discoveries in mechanical science, especially that of 

 the achromatic microscope (1824 and subsequent years), 

 the spectroscope, and the applications of electricity, 

 powerfully contributed to the rapid progress of biology, 

 morbid anatomy, pathology, and chemistry. In 1838 

 Henle and Mandl made known what their countrymen 

 had then accomplished, and the members of the German 

 school have ever since been the most enthusiastic and 

 competent workers on these subjects. 



The most distinguishing features of the period under 

 review (1837 to 1887) have undoubtedly been an- 

 aesthetics and antiseptics. They are both "epoch-making " 

 discoveries. Each has done almost as much for surgery 

 as the discovery of haemostatics, and when combined 

 may, I think, be said to excel even steam and electricity 

 in their gracious benefits to mankind. Though from the 

 earliest times men sought for the means of allaying pain 

 during operation, and numerous imperfect methods (as 

 that of Dr. James Moore of this city, the younger brother 

 of Sir John Moore, by compressing the nerves) had been 

 tried to effect it, yet the statement of Velpeau, published 

 in 1839, may be taken as expressing the opinion held 

 seventeen years before the great discovery: "All 

 research for an agent to destroy pain in operations is a 

 mere chimera, and unworthy of further consideration." 

 Suddenly, however, the riddle was solved by one who, 

 recalling the experiments of Humphry Davy with nitrous 

 oxide and sulphuric ether, dimly perceived the use they 

 might be put to in surgery. Whatever credit in this 

 matter may belong to the unfortunate Horace Wells, it 

 was really Mr. Mcton who worked out the practical 

 application of e >u -' , and in the theatre of the Boston 

 Hospital may st .1 be seen the sponge by which it was 

 administered on that memorable October morning in 

 1846. After the abortive trial of various other agents 

 chloroform was brought into use by Sir James Simpson, 

 within a year of the time when attention was directed to 

 the subject. This, the most valuable of anaesthetics, was 

 di. c covered by Soubeiran in 1831, and had been shown 

 to be a powerful anaesthetic by Flourens some years 

 afterwards. 



Local anaesthesia in its present form is also a conquest 

 of the last half century, and though many agents possess 

 this power, and some of them, like cocaine, are specially 

 valuable for particular purposes, the finely divided ether 

 spray introduced by Dr. Richardson (a distinguished 

 student of the Glasgow school) in 1866, is more efficient 

 and easy of application than any other for practical pur- 

 poses. I need hardly say that anaesthesia has changed 



the whole face of surgery. " The lion heart " is no longer 

 the requisite of a surgeon. Finesse and manipulative 

 skill now take the place of force. Innumerable opera- 

 tions are rendered possible which could not before be 

 attempted, and the surgeon has benefited almost as much 

 as his patient. 



There is no more interesting study in surgical history 

 than the development of our present practice as regards 

 wounds, from the blind groping of the surgeons of last 

 century, to discover the secret enemy which baffled their 

 best efforts, to the brilliant dawn which we have been 

 permitted to see. The proper use and best form of deep 

 and superficial stitches and dressings are also now well 

 established, and the reign of dirty sponges and foul in- 

 struments and hands has passed away for ever. Modern 

 pathology has put an end to the keen controversy which 

 for 150 years bulked largely on surgical attention 

 regarding purulent infection. The direct absorption 

 doctrine of Boerhaave held the field to the middle of the 

 eighteenth century, and was followed by the hydraulic, 

 the metastatic, the spontaneous generation, the phlebitic 

 (in various forms), and other theories, till Virchow 

 (1846-56) threw a new light on the subject by his re- 

 searches on thrombosis and embolism, after which the 

 investigations on sepsin, blood ferment, and micro- 

 organisms explained what was still unintelligible. 



As a result of the misfortunes of the Crimean war, 

 and to a less extent perhaps from the alarm caused by 

 the cholera epidemic of 1852, the construction and 

 organisation of hospitals and other public institutions 

 have received more attention during the last twenty-five 

 years than during the previous seventy-five which had 

 elapsed since Tenon wrote. 



Of the advances in doctrine and practice since 1837 

 much might be said. Not only has general anatomy 

 been greatly advanced, but pathological anatomy has 

 been created, while physiology has become a new and 

 practical science under the influence of experiment. 

 Chemistry has also been reconstructed. Experimental 

 and microscopic research have elucidated in a remarkable 

 manner the whole phenomena of inflammation and the 

 febrile condition. The blood and its vessels, the re- 

 action of the tissues involved, the part played by the 

 nerves, the nature of the exudations, with their desti- 

 nations and changes, as well as the growth, degeneration, 

 and metamorphosis of structures, have all been labori- 

 ously studied by the aid of the microscope and by 

 chemical processes. It was within the years 1838-39 that 

 the cellular pathology was born. It took the scientific 

 world by storm. Though no doubt it can be plausibly 

 asserted that bcth John Hunter and Raspail dimly fore- 

 shadowed it, certain it is that Schleiden, Schwann, and 

 Miiller laid its true foundations, while Virchow and his 

 pupils worked it out. Constant advance continues to be 

 made, by the use of new and improved methods of re- 

 rearch, so that our knowledge of the ultimate elements 

 of the tissues is daily increasing. An immense scientific 

 activity followed the year 1840. Within a few years 

 almost all the tissues and organs and the secretions of 

 the body, both in their normal and altered conditions, 

 were laboriously studied, and the phenomena of the re- 

 spiratory, digestive, and nervous systems, as well as the 

 great subject of embryology, which throws so much light 

 en congenital deformities, were largely investigated, and 

 by none with more ability than by my late colleague, 

 Professor Allen Thomson. 



Within the last half century, and especially since the 



