i86 



SCIENTIFIC NEWS. 



[Aug. 24, 1888. 



discovery of anaesthetics, all surgical operations have 

 been greatly improved, and many new ones have come 

 into use. The operator being no longer hurried, or his 

 feelings harassed by the sufferings of his patient, and 

 happily possessing better control of the result, is left free 

 to plan and conduct his operation without embarrassment. 

 In this progress of operative surgery amputation has 

 largely shared. The improved methods of arresting 

 bleeding, both during and after operation, have essen- 

 tially contributed to its perfection. The indiarubber 

 (1873), and more lately the spiral wire tourniquets of 

 Esmarch, and the " bloodless " system, though now 

 no longer carried out as at first practised, which these 

 appliances rendered so easy of application, have been 

 of the most eminent service in amputations and excisions, 

 as well as in all operations on bones and deep structures. 

 The old method of closing arteries by torsion — used by 

 Galen and Avicenna, but more especially studied by 

 Amussat in 1829 — was much in vogue a few years ago ; 

 but it and acupressure — described by Heister and many 

 others — which Sir James Simpson (1859) supposed 

 would supersede all other haemostatic methods, have 

 been replaced by the antiseptic ligatures now in use. 

 The modern practice of using water at a temperature 

 from 120 degs. to 160 degs. F. for the arrest of oozing is 

 in my experience admirable. 



Excision of joints and resection of shafts of bone, now 

 of daily performance, were by no means common at the 

 time of the Queen's accession. 



Within the half century aneurysm has been much 

 studied in all its aspects, and its treatment has been sim- 

 plified, though the methods of dealing with it have been 

 greatly multiplied. It has been shown to be curable by 

 the rapid coagulation of the contained blood, and not 

 alone by the lamination of fibrin and contraction of the 

 sac, a fact long denied ; and this has suggested some of 

 the most recent methods of dealing with it. 



Pathological research has done much within the half 

 century as to the large and important subject of new 

 growths. Much, however, remains to be done. Since 

 Muller, in 1838, brought neoplasms within the pale of 

 the cellular pathology, and Virchow added so much to our 

 knowledge, innumerable workers, aided by many new or 

 improved mechanical contrivances and beautiful methods 

 of preparing sections for microscopic examination, have 

 turned their attention to the subject. A simpler classi- 

 fication and arrangement have resulted, with a better 

 understanding of the clinical progress and results of 

 tumours. 



In no department of surgery has so much that is new 

 and notable been achieved as in injuries and affections of 

 the head. Much has been done, both by experiment and 

 clinical observation, in the localisation of the phenomena 

 of motion and sensation, and though much remains to be 

 done which can only be cleared up by long and accurate 

 research, still results have been garnered sufficient to 

 give a confident hope that before long a complete and 

 reliable map of the brain will be at the service of the 

 practitioner. The brain areas which supply the face, the 

 tongue, the limbs, and the muscles of respiration have 

 been clearly defined by British and foreign physiologists. 

 Clinical observations on man have supplemented experi- 

 ments on animals, and already fruitful practical results 

 have been obtained, so that the trephine has again come 

 into use, but on far different grounds from those theore- 

 tical ones which guided its application at the beginning 

 of the century. The first operation for the removal of a 



cerebral growth planned on the modern physiology was 

 performed so recently as 1885. The new American per- 

 forator is much more precise and speedy than the old 

 trephine, especially when worked by the " surgical 

 engine," which has been invented for driving saws and 

 perforators. 



The galvano-cautery was first used in England by Pro- 

 fessor Marshall in 1850, but to Middeldorpff of Breslau 

 we chiefly owe its sytematic use in a large variety of sur- 

 gical cases, where its rapid action, manageability, and 

 the very light which it emits can be utilised. It can never, 

 however, replace the knife for the mere division of 

 structures, nor the actual cautery for counter-irritation in 

 chronic inflammation. Electricity has made great ad- 

 vances as a practical agent since 1872. In experimental 

 physiology, and as a diagnostic and curative agent, Erb's 

 recent work will do much to promote its more precise 

 use. To Duchenne (1855) must, however, belong the 

 credit of having first recognised its importance ; and it is 

 probable that, with the aid of improved batteries and 

 the modern " accumulator," better work will be done in 

 the near future. Among the many ingenious and useful 

 instruments for clinical research and demonstration, the 

 ophthalmoscope stands pre-eminent. Foreshadowed by 

 Babbage in 1847, its present important position in 

 ophthalmic surgery is due to Von Helmholtz, who took 

 it up in 185 1, and with Ruete perfected it as a clinical 

 instrument. To it we owe a knowledge of the pathology 

 of the deeper structures of the eye, and the suggestion 

 of various operations which have proved of the greatest 

 service. The introduction of cocaine, since 1884, as a 

 local anaesthetic, has added largely to the progress 

 of ophthalmic surgery. The otoscope, the laryngo- 

 scope, and other similar instruments naturally 

 followed on the construction of the opthalmoscope, 

 and have been fruitful of good in their respective 

 departments. The sphygmograph, made practically 

 useful by Marey in i860, realising the idea of Hales 

 (1748) and of Herisson's sphygmometre, has largely aided 

 the diagnosis of many conditions of the circulatory system 

 and by its pictorial tracings secures permanent records of 

 their variations. The sphygmophone, which professes to 

 render the arterial sounds audible, is still of no practical 

 use. The endoscope, which was much improved by 

 Desormeaux, after 1853, has never attained a practical 

 position, from the difficulty of using it, and the limited 

 field to which it can be applied. Recently, however, 

 Leiter, by using the smallest Edison lamp, and improving 

 the construction, portability, and cost, has provided an 

 endoscope which may possibly promote its employment. 

 The thermometer, first used in medicine by Boerhaave 

 and his pupil, De Haen, has become one of the most im- 

 portant clinical guides in consequence of the researches 

 of Traube (1850), Wunderlich, and Zimmermann. 



The beautiful discovery of skin-grafting by Reverdin, 

 in 1869, provides us with a valuable resource in many 

 difficult cases of delayed repair and deformity. The per- 

 manence of such grafts is not, however, as yet fully 

 assured. The transplantation of periosteum, muscle, bone, 

 nerve, and even eye tissues, has also been achieved of 

 late years under the magic shield of aseptic surgery. 

 Hydrophobia promises to be deprived of its terrors. Ex- 

 tensive burns are no longer dangerous when kept free 

 from pollution, as the intestinal lesions which Curling 

 drew attention to (1842) are now known to be due tu 

 septic poisoning. Nerves are stretched, with or without 

 previous exposure, to the relief of many complaints ; 



