CHAPTER XX.

MEDICINE, SURGERY, SANITATION. DISCOVERY OF CIRCULATION OF THE BLOOD BY HARVEY--VACCINATION BY JENNER--USE OF ANÆSTHETICS THE GREAT STEP OF MEDICAL PROGRESS OF THE CENTURY--MATERIA MEDICA--INSTRUMENTS--SCHOOLS OF MEDICINE--DENTISTRY --ARTIFICIAL LIMBS--DIGESTION--BACTERIOLOGY, AND DISEASE GERMS-- ANTISEPTIC SURGERY--HOUSE SANITATION. In the early gropings through the uncertain light of first progress, man was accustomed to ascribe the ills of his flesh to the anger of the gods, and in his craven and abject superstition made peace offerings. Later he learned to locate the cause within himself, and constructed the theory that the fluids of the body had become disordered. The characteristic feature of progress in the Nineteenth Century, in this field, has been in the accurate tracing of the relation of cause and effect, and with the discovery of true causes has grown efficient means of treatment. The old expedients of charms, incantations, conjuration and exorcism gave place first to intelligent medication, and this in turn is rapidly giving way to the prevention of disease by improved conditions of sanitation and right living. The ounce of prevention has been found to be worth more than the pound of cure. With the improved knowledge of physiology, anatomy, chemistry and biology, which the century has brought, the intelligent physician was able to make a logical and for the most part a correct diagnosis, but supplemented with the microscope, that great revealer of the unseen world of small things, corporeal existence itself becomes an open book, and from the principles of organic evolution to the germ theory of disease the mystery of life and death is being slowly revealed. When the Eighteenth Century gave birth to the Nineteenth, its great natal gift in medicine was vaccination. Jenner in 1798 for the first time announced his discovery of this great boon to the human race. In 1799 Dr. Benjamin Waterhouse, in Boston, obtained virus from Jenner and vaccinated four of his children, and in 1801 Dr. Valentine Seaman obtained virus from Dr. Waterhouse and performed the first vaccination in New York. During the Seventeenth and Eighteenth Centuries the annual death rate from smallpox in London ranged from 2 to 4 per 1,000 of population. In 1892 it was only 0.073 per 1,000. It is also stated on good authority that the mortality from smallpox in England alone, was 20,000 a year less after the introduction of vaccination than it was in the preceding century, and that its benefits to the world at large have been so great that the lancet of Jenner has saved more lives than were sacrificed by the sword of Napoleon. Each century in modern history has been marked by some important discovery in the field of medicine. The Seventeenth Century was notable for the discovery of the circulation of the blood by Harvey; the Eighteenth Century brought with it vaccination by Jenner. The Nineteenth Century’s greatest gift in this field has been anæsthesia, or insensibility to pain. Nature has wisely endowed man with nerves of sensation as danger signals for the conservation of life. Accident and disease, however, are the inseparable concomitants of human existence, and suffering and pain the ineffaceable legacies of mortality. Sometimes these nerves of sensation are no longer useful as monitors, and in the unavoidable emergency of accident, surgical operations, child birth, and certain diseases, suffering can do no good, and then pain--that Prince of Terrors--thrusting his presence upon the hapless victim, racks body and limb, calling forth groans, and shrieks and writhings, till the poor sufferer, possessed with a dominating agony which displaces all thought of life, memory of friends, and love of God, breaks down in unutterable distress, and prays for death and oblivion. To this poor sufferer insensibility is next to heaven. For the past half century all the formidable operations of the surgeon have been performed with the aid of anæsthetics and without suffering to the patient, producing happy recoveries, and greatly contributing to the success of the result by relieving the surgeon of the distraction of the patient’s pain, and the interference of his involuntary movements. Quite a number of anæsthetics are known and used to-day. Those more generally employed are--naming them in the order of their first application--nitrous oxide gas, ether, and chloroform. Nitrous oxide gas is chiefly used for the extraction of teeth. Sir Humphrey Davy, in 1800, was the first to observe the peculiar quality of nitrous oxide gas, which gave it the name of “laughing gas,” from the fact that it caused those inhaling it to act in a manner exhibiting an abnormal exhilaration. Dr. Horace Wells, a dentist of Hartford, Conn., in 1844, had the gas administered, experimentally, to himself during the operation of extracting a tooth, and was the discoverer of its useful application as an anæsthetic. The greatest discovery, however, in anæsthetics is the application of ether for this purpose. Ether as a chemical product has been known for several centuries, and as early as 1818 Faraday pointed out the similarity between the effects of ether and nitrous oxide gas. Dr. Morton, a dentist, of Boston, first applied it as an anæsthetic Oct. 16, 1846, being guided largely in its selection and use by Dr. Jackson, an eminent chemist of the same city. On Nov. 12, 1846, U. S. Pat. No. 4,848 was issued to them for this invention. In the latter part of December of the same year Dr. Liston, an eminent English surgeon, performed the operation of amputating the thigh while the patient was under the influence of ether. Chloroform, discovered by Guthrie in 1831, was first applied as an anæsthetic by Sir James Y. Simpson, of Edinburgh, in 1847. Of the two leading anæsthetics, ether is more generally used in the United Sates and chloroform in Europe. Ether is less dangerous, but its administration is more difficult and disagreeable. It is said on the highest authority that in the Crimean War chloroform was administered 25,000 times without a single death, and ether is even safer than chloroform. In the hands of a skillful physician practically no danger is to be apprehended from the use of either of the two agents. A little over fifty years ago any severe or prolonged surgical operation involved such irresistible pain that the patient’s writhings were required to be restrained by powerful muscular assistants, and by straps which bound the patient to the table, and when it is remembered that a false cut of a hundredth part of an inch might be fatal, the haste, the disquieting influence upon the surgeon, and the interference with the accuracy of his hand, added greatly to the percentage of unsuccessful operations, as well as to the prolonged agony of the patient. Contrast this with the present methods of using anæsthetics, and we find the patient dropping into a quiet and peaceful sleep before the operation, and awakening thereafter to find, to his astonishment, that it is all over, and that recovery is only a question of careful nursing. _Materia Medica._--Many important contributions have been made to the pharmacopœia in the century. In 1807 the remedy known as ergot was brought to the notice of the profession by Dr. Stearns, and named by him pulvis parturiens. Iodine was first used as a medicine in 1819 by Dr. Coindet, Sr., of Geneva. Quinine was discovered by Pelletier and Caventou in 1820, although Peruvian bark had long been used for the same purpose. Chloral hydrate, discovered by Liebig in 1832, was applied in medicine in 1869 by Dr. Liebreich, of Berlin. Carbolic acid was discovered in 1834 by Runge. Artificial seidlitz powders were first put up under Savory’s British Pat. No. 3,954, of 1815. Veratrum viride, lobelia, worm seed, and chloroform were all introduced in the first part of the century. The sulphates of morphia, strychnia, atropia and other alkaloids are of comparatively recent addition to the pharmacopœia, and the iodide of potash, tincture of iron, digitalis, bichloride of mercury, sub-nitrate of bismuth, boracic acid and gallic acid, chlorate of potash and Dover’s powders have become standard remedies within a hundred years. In the latter part of the century the new remedies derived from coal tar have occupied an important place. Of these may be mentioned antipyrine, by Knorr (pat. Oct. 28, 1884), phenacetin, by Hinsberg (pat. March 26, 1889), salol, by Von Nencki (pat. Sept. 28, 1886), sulfonal, by Bauman (patented Jan. 22, 1889), antikamnia (acetanilide), and many others, besides new and valuable antiseptic compounds, such as salicylic acid and formalin. A characteristic feature of the modern practice of medicine is in improved forms of its administration. Sugar-coated pills, gelatine capsules and cod liver oil emulsions make the remedy much less disagreeable to take, and very ingenious and effective machines have been devised for putting up remedies in such forms. [Illustration: FIG. 174.--THE OPHTHALMOMETER.] _Instruments._--Laennec’s discovery in 1819 of auscultation, and the stethoscope, for determining internal conditions by sound, was a great step in diagnosing diseases. The binaural stethoscope was invented by Cammann in 1854, and a later improvement is the phonendoscope, by Bianchi. The opthalmoscope is an instrument for inspecting the interior of the eye, which was invented by Prof. Helmholtz, and described by him in 1851. The laryngoscope, for obtaining a view of the larynx, was said to have been constructed by Mr. John Avery, of London, as early as 1846. The opthalmometer, Fig. 174, is a comparatively recent invention. It is designed to ascertain variations in corneal curvature for the correction of corneal astigmatism. Electric lights with reflectors are arranged on each side of the patient’s head, while the operator looks into the eye with a telescope. The sphygmograph, a little instrument to be strapped on to the wrist to record the action of the pulse, was first reduced to a practically useful form by Marey in 1860. A later development of these devices, by Verdin, known as the sphygmometrograph, is shown in Fig.