The two great events in the history of American surgery in the 19th century were the introduction of anesthesia and the antiseptic technique. Both stand to the credit of the Anglo-Saxon race, the former being an Ameri can, the latter a British ' device. Theser-two measures together wrought a complete revolu tion in the practice of surgery, and show that the Anglo-Saxons have done more for it than had been accomplished in the previous 18 cen turies. By the latter the devastations of sepsis have been almost completely done away with; and by the former the tortures of pain and the agonies of serious and protracted operations have been abolished.
Period of the Civil War.— The exigencies of the Civil War made demands upon the medi cal resources of the regular and volunteer armies which at first could not be adequately met; in this as well as other respects both sides were but meagrely equipped either with men or means. It was before the days of antiseptic surgery, bad methods still prevailed and the sacrifices then made to sepsis and to bad sanita tion were fearful to contemplate. Wounds of large joints condemned the patient to amputa tion above the injury, compound fractures were very generally, fatal, hospital gangrene and tet anus were like spectres which stalked by night through the hospital camps. With characteristic readiness measures were rapidly adopted to minimize the slaughter from disease, and within a comparatively short time a well-equipped medical corps, backed by the government Sani tary Commission, had brought order out of chaos, while the Red Cross Bureau had shown what it could do, especially under the guidance of Miss Clara Barton and other devoted women. Military surgery was but emergency surgery practised under peculiar conditions, and as this fact became more greatly appreciated our wounded soldiers received better and better care. The outcome of this extended experience, in two or three different and indirect ways, was remarkable. It led to the foundation of the Army Medical Museum, in Washington, which has since grown to enormous proportions and now occupies the larger portion of a large building, wherein everything pertaining to so called military surgery finds ample illustration. It led also to the building up of the wonderfully rich and complete library of the surgeon-gen eral's office, with most extensive index cata logues, including the Index Medicus, by which the entire medical literature of the world is catalogued and made available to all. And,
thirdly, it led to the publication of the Medical and Surgical History of the War of the Re bellion, in six enormous volumes, which far exceed in magnitude and value anything of the kind ever published. In their efforts to build up these three features the names of Otis, Huntington and Billings will ever stand pre eminent.
From the Civil War to the Present Time.
The Civil War developed very many excel lent American surgeons, and within a decade after its close the good effects of their experi ence were manifested in a great many of the civil hospitals throughout the country, partic ularly in the practice of men who had located in the larger cities and towns. This, together with the development of asepsis, brought out a great deal of beneficial work in this country, in the practice of surgery. It also presented a period when specialists began to develop with greater precision than at any time in the previous history of medicine. This was espe cially true in regard to gynecologists, and, what at that time were termed, abdominal surgeons. The outcome has been the organization of several national surgical associations, which have included in their fellowship some of the ablest surgeons in the United States, thus en abling America to keep thoroughly abreast of all that was being done elsewhere. There has been a progressive development of bacterio logical, biological and pathological laboratories where much research work has been accom plished, aiding very decidedly in the better understanding of surgical lesions, and result ing in a great increase in the possible opera tions to be performed for relief of the patient. Had the elder Gross, in his early experiments, in 1843, known of or had a laboratory at his disposal, such as exists to-day, greater honors would have come to him in doing intestinal surgery.
Laboratory work, with increased surgical skill, has brought about the establishment of many hospitals in the larger and smaller cities, and it may safely be asserted that in the latter many strong surgeons in the World War just brought to an end will be found doing superior work. Many of these institutions will feel the good impulse of benevolence, excellent nursing and support from Red Cross organizations, while the larger hospitals in cities will become better endowed and less embarrassed in meet ing their financial obligations.