175. The endoscope, for looking into the urethra, and the cystoscope,

for looking into the bladder, are other useful instruments of the modern practitioner. Greater than them all, however, is the modern X-ray apparatus, for locating foreign substances in the body and making visible the bones through the flesh, for which see special chapter. The use of the thermometer in recording the progress of fevers is also a valuable modern application, and the list of instruments and small tools is beyond enumeration. There are series of obstetrical appliances, instruments relating to bone surgery, to the taking up of arteries, cupping instruments, trepanning instruments, speculums, hypodermic syringes, electric cauteries, fracture appliances, instruments for lithotrity, bandages for varicose veins, atomizers, breast pumps, inhalers, nasal douches, trusses, pessaries, catheters, abdominal supporters, and an endless variety of proprietary articles, such as electric baths and belts, plasters, chest protectors, liver pads, and so forth, all of which are practically the products of the Nineteenth Century. The surgeon of to-day can straighten the eyes of a cross-eyed man, or take the bow out of his bandy legs, can make him a new nose of his own flesh, patch his skull with a silver plate, remove the stone from his bladder, supply him with a wind-pipe, wash out his stomach, and perform many other operations even more difficult. Among such more important operations may be mentioned ovariotomy, which was first performed by Dr. Ephraim McDowell, of Danville, Kentucky, in 1809, and the tying of the great arteries. The operation of lithotrity, for removing stone from the bladder by crushing the stone, was introduced by Civiale, 1817-1824, who devised successful instruments and modes of using them. In 1836 to 1840 Richard Bright, an English physician, made important researches and discoveries in relation to the functions and diseases of the kidneys, and established the nature of the so-called “Bright’s disease.” [Illustration: FIG. 175.--VERDIN’S SPHYGMOMETROGRAPH, FOR RECORDING THE ACTION OF THE PULSE.] _Schools of Medicine._--While the regular school of medicine (called by some “Allopathy”) has held the leading place in medicine, various other schools have sprung up in the Nineteenth Century, all of which represent advances in a knowledge of the laws of health, and the modes of preventing and curing diseases. Hahnemann, in his “_Organon der Rationellen Heilkunde_,” in 1810, gave homœopathy its name, and reduced it to a system. The doctrine of _similia similibus curantur_ (like cures like), has gained great popularity in the latter part of the century. Hydropathy, as a school, also made its appearance in the early part of the Nineteenth Century. Priessnitz was its first disciple, and the _Grafenberg cure_, established in 1826, was a noted institution for many years. The useful application of water in the form of baths and cold packs, has been known for centuries, and will always be used as a valuable agency in sickness and in health. The “Thompsonian” system of treating diseases was covered by patents in 1813, 1823 and 1836, and attained considerable notoriety in the early half of the century. Sweating by hot bricks and hot tea made of “Composition Powders,” vomiting with lobelia to produce relaxation, and a fiery liquid for cramps, called “No. 6,” were the chief remedies, and very few boys who had once taken the treatment were ever willing afterwards to admit that they were sick. In the latter part of the Nineteenth Century _electro-therapeutics_ has received a large share of attention, many forms of medical batteries have been devised, and probably no more promising field of study and research exists in the whole domain of medicine. _Dentistry._--George Washington had false teeth, and it is said that the teeth of some of the mummies of Egypt had gold fillings, but it remained for the Nineteenth Century to establish dentistry as an art, and its influence in securing better mastication and digestion of food, more sanitary mouths and shapely faces, cannot be estimated. Few people can be found to-day who have not either filled teeth, bridge work, gold caps, or artificial sets of teeth. The most important advance in the art was in the invention of the rubber plate for holding the porcelain teeth. This was the invention of J. A. Cummings, and was covered by him in his patent No. 43,009, June 7, 1864. In more recent years “bridge-work” represents the most important advance. In this practice one or more artificial teeth are firmly held in the place of missing teeth by a strong bridge-piece of metal, which at its ends is anchored to the adjacent natural teeth. This was first done by Bing (British Pat. No. 167, of 1871), and was afterwards patented in somewhat different form in the United States by J. E. Lowe, No. 238,940, March 15, 1881, No. 313,434, March 3, 1885, and Richmond, May 22, 1883, No. 277,933. Porcelain and gold crowns and dental pluggers run by electricity represent other important advances in this art. It is said that there are 20,425 dentists in the United States, and that in 1899 they employed in their practice 20,499,000 false teeth. _Artificial Limbs._--With the successful work of the surgeon came the effort to repair, as far as possible, the loss of the limb. Until about the middle of the Nineteenth Century the survivor of an operation was an unsymmetrical, unique, and pitiful object. The peg-leg of Peter Stuyvesant lives in history, and the arm-hook of Capt. Cuttle is familiar to every reader. The first United States patent for an artificial leg was granted to B. F. Palmer, Nov. 4, 1846, No. 4,834. Wooden legs with a restricted back and forward ankle motion and a spring, were constructed by A. A. Marks from 1853 to 1863. On Dec. 1, 1863, a patent, No. 40,763, was granted to Mr. Marks for the use of sponge rubber for constructing artificial feet and hands that dispensed with the articulated joints, and made a great improvement. In patent No. 366,494, July 12, 1887, to G. E. Marks, the foot and leg portion of a wooden leg are made from wood which grows with a crook, as at the root of a tree, where the strength and lightness of a continuous natural grain is obtained at the instep. About 300 patents have been granted for artificial legs and arms. Modern improvements have extended to every detail of construction, and so perfect to-day is the average wooden leg that it is hardly to be detected. Men with wooden legs ride horseback, are expert users of the bicycle, and have even performed feats on the tight rope. The inventor’s genius has not stopped at repairing limbs, however, for artificial eyes, artificial ear drums, the audiphone, foot extensions for short legs, crutches, braces, abdominal supporters, and various other applications to supplement the defects of the body have been devised. _Digestion._--The physiology of digestion had, perhaps, the first real light shed upon it by Beaumont’s observations from 1825 to 1832. A Canadian boatman, Alexis San Martin, was wounded in the abdomen from a charge of buckshot, and the wound healed, leaving a permanent opening in the stomach, through which the operation of digestion could be observed. This furnished visible evidence of the relative digestibility of different kinds of foods, and the general functions of the stomach. The peculiar and different conditions governing the digestion of the starch foods, the albumenoids (such as meat and fish), and the sugars and fats, have been clearly ascertained, and “what is one man’s food is another man’s poison” is now susceptible of intelligent diagnosis and effective adjustment. Of late years the stomach has been greatly aided in its functions by prepared or predigested foods. The action of diastase, in converting starch into grape sugar, has been taken advantage of, and cereals treated with diatase, malted milk, lactated and peptonized foods, have proven a boon to the enfeebled digestion, while the intelligent study of dietetics has done much to relieve the physician and promote the health of the individual by right living. _Bacteriology._--Although Leeuwenhoeck discovered the bacterium in 1668-1675, up to 100 years ago disease and death were largely regarded as dispensations of Providence, and with fatuous resignation were accepted as inevitable. The microscope and the study of bacteriology, however, have revealed to us the presence of minute living organisms or germs, which are everywhere around us, infesting the air, the earth, the water, our food, our bodies, and all organic matter in countless millions. These infinitely small beings multiply with a rapidity and fecundity that bewilders the imagination. Their method of multiplication is by fissiparism--that is to say, each splits into two independent beings that separate and afterwards lead independent lives. It is said that there is one species in which not more than six or seven minutes are required for the division to take place. A single individual might consequently produce more than a thousand offspring in an hour, more than a million in two hours, and in three hours more than the number of inhabitants on the globe. They are known as micro-organisms, of which the bacteria are the most important. The bacteria are further divided into species, and names are given them to distinguish the different forms. The little rod-shaped ones are called _bacilli_: the spheroidal ones _micrococci_ or _cocci_. If they cling together in chains they are called _streptococci_; if of a spiral or corkscrew form they are called _spirallae_. The curved bacilli are called “_comma_” _bacilli_, from their resemblance to the punctuation mark of that name. The presence of peculiar forms of these bacteria in diseases has so suggested the relation of cause and effect as to have given rise to the so-called “germ theory” of disease. Now we know with reasonable certainty that cholera, diphtheria, typhoid fever, whooping cough, mumps, cerebro-spinal meningitis, pneumonia, tuberculosis, hydrophobia, and many other diseases have each its specific cause in the form of a microbe. [Illustration: FIG. 176. BACILLUS OF TUBERCULOSIS IN SPUTUM. BACILLUS OF DIPHTHERIA (KLEBS-LOEFFLER). BACILLUS OF TYPHOID FEVER. (Photo-Micrographs, 1,000 diam., by William M. Gray, M. D.)] [Illustration: TERTIAN FORM. AESTIVO-AUTUMNAL FORM. FIG. 177.--BLOOD OF MAN. SHOWING PARASITE OF MALARIA (LAVERAN). (Photo-Micrographs, 1,000 diam., by William M. Gray, M. D.)] Henle, a German physiologist, as early as 1840, maintained the doctrine of _contagium vivum_, or contagion by the transmission of living germs. Certain classes of diseases have also long been known as zymotic, or ferment diseases. Louis Pasteur’s work, however, marks the first definite and important results in the study of bacteriology, and he is the father of the “germ theory” of disease. He exploded the previously held theories of scientists concerning the spontaneous generation of living things, and clearly established and promulgated the knowledge of disease germs. Commencing his great work about 1865 with the investigation of the silk worm plague in France, he discovered it to be due to parasites, and checked it. He also gave great attention to the subject of fermentation, proving it to be caused by micro-organisms. Taking up the diseases of men and animals, he gave practical value to the truths of his theory in the treatment of hydrophobia, diphtheria, and other diseases, using the principle of vaccination to destroy or render innocuous the toxins or disease-producing poisons derived from living germs. Working along the same lines must be mentioned Dr. Koch, whose success in detecting the microbes which cause consumption and cholera has made him famous the world over. Of the great variety of these little microbes which have been separately identified, many are innocuous, and, in fact, subserve many important and useful purposes in nature, while others are to be as much dreaded as the deadly cobra or the rattlesnake. A few typical examples of the latter are given in Figs. 176 and 177, multiplied 1,000 diameters. The illustrations represented in Fig. 177 show the parasites that cause malaria, or fever and ague. The dark bean-shaped cells are the normal blood corpuscles, and the few speckled cells are those infested with the malarial parasites. It is now believed that the mosquito is the active factor in the dissemination of malaria, and it is, therefore, to be remembered that this pestiferous little insect not only inflicts a painful and disagreeable sensation with his puncture, but innoculates the system with poisonous malarial germs at the same time. [Illustration: FIG. 178. TUBE CONTAINING CULTURE OF BACILLI OF TUBERCULOSIS. TUBE CONTAINING CULTURE OF COMMA BACILLI OF CHOLERA.] For the study of bacteria they are propagated artificially in a test tube--_i. e._, a substance called a “culture” is prepared from some organic material which, like the substances of the human body, is favorable to their propagation. Such culture media are found in beef blood, gelatine, beef extracts, meat broth, milk, etc. An ordinary test-tube is supplied with some of the culture medium, and is then sterilized over the fire to destroy all interfering germs. Material infected with the microbe is then placed in the test-tube by a sterilized platinum wire and the tube closed by raw cotton. It is then placed in an incubator oven and is subjected to a gentle heat. In a little while the microbes begin to develop and increase, forming colonies, in which they swarm by the million, and present the clotted appearance seen in Fig. 178. The separation of different bacteria existing in the same material, so as to isolate each species and get what is called a “pure culture,” has been greatly promoted by Prof. Koch’s method of _plate culture_. In this the propagation of bacteria is effected upon a sterilized glass plate under a bell jar in such a thin layer as to facilitate the segregation of species, enabling them to be counted under the microscope and picked out and sown in another culture to get an unmixed crop of a definite species. Such a culture so multiplies the same microbe, to the exclusion of others, as to permit it to be easily identified and studied. According to the practice in modern municipal health regulations, the test as to when a child recovering from diphtheria is incapable of disseminating the disease is by test culture. A swab of cotton is rubbed against the interior walls of the child’s throat to secure the germs (if present), and the swab is then placed in a “culture” in a test-tube and the tube put in an incubator. If, after the period of incubation, no colonies of the germs develop, it is accepted as evidence that the diphtheria germs are no longer present in the throat, and the child is released from quarantine. It is the presence of these specific microbes in the fluids or solids of the system which constitutes the disease, and for the cure of the same the intelligent physician of to-day looks less to medication, and more for some agent that will destroy the germ, neutralize its effect, or render the body tolerant thereto. Out of the knowledge of disease germs has grown the great era of antiseptic surgery, inaugurated by Sir Joseph Lister, about 1865. Carbolic acid, the bichloride of mercury, and formalin are the most efficient weapons against the dreaded microbe. To-day every surgeon in the civilized world sterilizes his knife, and conducts the treatment of wounds and all operations by antiseptic methods, in accordance with a knowledge of the deadly influence of the ubiquitous microbe, and the result has been to so reduce the risk to life that even capital operations are no longer coupled with the apprehensions of death. Every hospital, board of health, and organized medical and sanitary body predicates its laws and modes of treatment upon the principles of bacteriology. _House Sanitation._--The permanent home of the microbe is the sewer, and sanitary plumbing, designed to exclude from the house the germ-laden and disease-breeding gases from the sewer, constitutes one of the great advances of the century. About 3,500 patents have been granted for water closets and bath appliances, and about 900 patents on sewerage alone, the most of which are directed to improved conditions of sanitation. [Illustration: FIG. 179A.--STREET CONNECTIONS, MODERN SANITARY HOUSE PLUMBING.] [Illustration: FIG. 179.--MODERN SANITARY HOUSE PLUMBING.] An illustration of the plumbing and sewer connections of a modern house is given in Figs. 179 and 179A. The sewer pipes are shown in solid black, the unshaded pipes (in outline only) are air ventilation pipes, the single black lines are cold water pipes, and the dotted lines hot water pipes. The important sanitary feature in modern plumbing is to keep all sewer gas and disease germs out of the house. For this purpose traps have long been used under the wash basins, closet hoppers, and sinks; but the back pressure of sewer gas would sometimes bubble through the trap into the house, and besides the water in passing out from a basin would sometimes, by a siphon effect, pass entirely out of the trap, leaving it unsealed. Both these results are prevented by the air ventilation pipes which connect with the discharge side of every trap in the house and lead to a stack extending out through the roof. This prevents pressure of sewer gas on the water seal of the trap, destroys the siphon action of the trap and allows a circulation of air to be taken in from the sidewalk on the house side of the running trap and through the sewer pipe of the house, and thence through the air vent pipes to the roof. The great science of bacteriology, dealing with these smallest of living things, only came into existence with the microscope, and it was a field which was not only wholly unknown and unexplored a few years ago, but there was no suggestion visible to the eye to direct attention to it, until the lens began to reveal the secrets of microcosm. What development the future may bring no one can predict, but to the biologist and the physician no more promising field exists. Certain it is that the knowledge already gained is of incalculable benefit, and constitutes one of the greatest eras of progress the world has known, for with the noble army of patient, devoted, and self-sacrificing physicians, the discoveries of the scientist, our boards of health, our hospitals and asylums for the insane, our quarantine laws, our modern plumbing and improved sanitation in the home and public departments, there is no reason why the life of man should not be extended far beyond the three-score and ten years, and the 50 per cent. of population dying in childhood saved for useful lives and citizenship.