It is very impressive to note how willingly communities have accepted going from their homes to the hospitals for treatment. Research work has brought out many surgical conditions associated with illnesses heretofore considered medical, such as lesions of the bones following typhoid fever, also tubercular conditions of the joints, syphilis, actinomycosis and other ob scure lesions of internal organs, this advance being conducive to recoveries of cases formerly doomed to a long, painful sickness. Our lab oratories have been of incalculable value in the preparation and standardization of absorbable ligatures; in the examination of the blood, and various secretions, and, especially, in the de velopment of tetanus, antitoxin and other se rums.
One great advance made by American sur geons has been the surgical treatment of the thyroid gland; another the energetic manner in which they have attacked the gall-bladder, the stomach, the intestinal tract, the spleen, pancreas and the reproductive organs within the pelvis, for conditions considered quite hope less in the past. Operations upon the appendix, and intestinal tract, with the ability to remove portions of the latter, yet allow normal func tions to follow in a healthy manner seem won derful. This same confident development of surgical procedure has eliminated much of the distress due to lesions of the kidneys, the ure ters, the bladder and prostate gland. All of this work could not have been accomplished without our knowledge of pathological micro organisms, and the employment of sterilization of the operating-room, the field of operation, the operator and dressings.
American surgeons had much to do with the evolution of this chapter in surgery. From the introduction of the carbolic spray, as taught by Mr. Lister, through all the various experi ments in the use of antiseptics. and, finally, of asepsis, much has been accomplished. The battle has been to control suppuration — i.e., the formation of pus — and when every precaution has been carried out, when no link in the chain of technic of procedure has been omitted, to the public at large the recovery of patients becomes very noticeable.
In successful work surgery made a stride that commanded the respect and attention of wealthy citizens with a benevolent trend of thought, so that hospitals and laboratories were endowed, and in America we were able to do what for some time seemed only to be known in Europe.
Through the study of germs, in the various laboratories, and their danger to operative sur gery, and with the employment of absorbable ligatures, the science and art of surgery has been brought up to a very high plane of activity. The advances made in operations upon the spine, and the transferrence there of splinters from the long bones of the body, for the treatment of curvatures, has been one of the most decided advances in surgery. This is also to be observed in the immobilization of wounds, as illustrated in the fixation of fractures of the extremities.
Very much credit is due the American sur geon for discoveries and advances in local an esthesia in operative surgery, in hospital con struction and for the persistent use of rubber gloves, particularly when operating in septic cases.
Some of the most brilliant advances made in surgery of the nerve trunks, in the removal of the Gasserian ganglia, for relief of neuralgia, has been accomplished by the American sur geon. The investigation, study and progress made in the department of genito-urinary sur gery is one of the most convincing arguments that surgery has become more of a fixed sci ence than ever in its past history.
The genius of the American surgeon is well shown, in so many ways, by the invention of new instruments, as well as the improvements made in those long in use, and in hospital fur niture.
History of The abolition of pain is in itself a matter of such vast interest and humanitarian importance that a brief his tory of the introduction of anesthetics should be much appreciated, especially in a rehearsal of American achievements. Strictly speaking, the term anesthesia refers to the abolition of sensation of all kinds, whereas for the preven tion of pain the term analgesia should be used. The distinction is an important one in certain cases; for instance in the injection of cocaine solution into the spinal canal, it produces the latter without the former, whereas by the use of the anesthetics now in use general anesthe sia is produced. By general consent the term is restricted to complete loss of consciousness produced by such drugs as ether, chloroform and nitrous oxide, and not to the intoxication produced by drugs like opium, hashish or the mandragora of the old writers. The substance
known as sulphuric ether had been known by the medieval alchemists in 1540, and was spoken of as sweet oil of vitriol. It was not called ether until 1730. In the earlier years of the previous century it was often inhaled for ex periment or diversion because of its peculiar exhilarant effects. Nitrous oxide gas had been previously used for the same purpose, and even for the production of anzsthesia. It will be seen, then, that these two amesthetics had been well known for some of their properties. chlo roform, on the other hand, was not discovered until 1831, and not recommended as an atues thetic until 1847. The honor of the introduction of ether into surgery is claimed for at least four men, Long, of Georgia; Jackson of Massa chusetts, who were physicians; Wells, of Ver mont, and Morton, of Massachusetts, who were both dentists. The first public demonstration of the value of ether as an amesthetic agent, for the prevention of pain during surgical oper ations, was made 16 Oct. 1846 by Morton, at the Massachusetts General Hospital, before a group of men including some of those already mentioned in this article, especially Warren and Bigelow. In all probability Long antedated this event bv its use for a similar purpose in 1842, but in those days in this country the population was sparse, means of travel very slow and no public record of the event was ever made; in fact no account of Long's work appeared until 1849. To Wells probably belongs the credit of first producing armsthesia by nitrous oxide gas, when he took it himself in 1844. After his own happy experience with it he began its manufac ture and introduction to the profession. In 1845 Wells visited Boston, and even called on his old partner, Morton, endeavoring there to introduce his new compound for surgical pur poses, but met with no encouragement. In Hartford there stands to-day a monument erected by the public, bearing the following in scription: *Horace Wells, who discovered an wstliesia, November 1844.* Morton had been a student in Wells' office, but not being a good chemist he consulted Jackson, whose office he later entered, and by whom he was advised to experiment with ether. Jackson told him, for instance, that the students at Cambridge often inhaled it for amusement, and in 1846 he first gave it for the extraction of a tooth, the patient stating that he felt no pain. Then came efforts to patent the new anmsthetic which were not to the credit of either Jackson or Morton. Finally came the public demonstration above alluded to, when Morton administered his sletheon,* and Warren removed without pain a tumor from the neck of a young man. At this time Morton endeavored to disguise the odor of the substance he was using so as to prevent its recognition, and it was not until the hospital staff declined to use any substance whose composition was kept secret that Morton revealed his discovery. During the ensuing years there took place a most active and acrid controversy between the partisans of the men cnost concerned in the introduction of ether into surgical work, as to the respective merits of their various champions.
A dispassionate judgment of the whole indi cates that to Wells, doubtless, the credit of the introduction of nitrous oxide belongs. Long probably was the first to use ether in a surgical way, but was slow in making his results lcnown. Morton finally became the promoter of the new agent, partly by virtue of his own energy and partly because of his acquaintances and sur roundings. Chloroform, although discovered independently by Guthrie, of Sacketts Harbor, N. Y., in 1831, was introduced into surgical work by Simpson, of Edinburgh, who advised it especially for the relief of the pangs of child birth, and who was, in consequence, violently a.ssailed by the Scottish clergy as interfering with the spirit of the primal curse which read, *In sorrow shalt thou bring forth children.* Simpson, however, disarmed his opponents by a quotation, also from the Scriptures, to the effect that when God created Eve from one of Adam's ribs, he *caused a deep sleep to fall upon Adam.* It will hence be seen that, at the date of this writing, it is almost 70 years since it became possible to malce surgical opera tions painlessly. What this means both for the surgeon and the patient will be appreciated, while what it has made possible can be easily realized by contrasting the resources of the sur geon of to-day with those of the middle of the 19th century. See VivisEcnox —Its INFLU ENCE ON SURGERY.