In reference to the surgery of our own country in the 18th century, one of the most in teresting works, which was of great service to American surgeons during the Revolution, was that of John Jones, 'Plain, Practically Precise Remarks on the Treatment of Wounds and Fractures.' The 19th century witnessed great advances and from 1838 was one continuous chapter of investigation toward the development of the parasitic or germ theory. Of all the many names associated with this immense work, one can refer to but few: Pasteur, Klebs, Koch, Lister, Tyndall (qq.v.) and others, in their de velopment of bacteriology, have done more to advance the principles of technique in surgical operations and have placed the art and science of surgery upon a more lasting foundation, than any of their predecessors.
The first half of the 19th century was a period of great success for the French sur geons. The English surgeons, in their superior knowledge of gross anatomy, also made great advances in their diagnosis and surgical treat ment. This century became noted as the period during which general surgery developed more into an exact science. Its writers did much to eradicate erroneous ideas and to end the trans of meaningless sentences from one text book to another. The introduction of anes thesia in 1846 enabled some of the bolder men to perform operations heretofore deemed quite impossible; yet the ratio of mortality continued high and it was not until the dawn of antisepsis, more particularly the period of true asepsis, that general surgery advanced so rapidly. The death-rate in major operations, in many in stances, was in a short time reduced from 66 to 6 per cent, and this ratio was soon applied to all departments of surgical work. As technique became more perfect, all manner of operations were suggested and carried out with great suc cess. Hence to-day there is no part of the human body that the surgeon is unable to reach for the relief of injuries or pathological con ditions.
In operative surgery much help has been re ceived from the use of cocaine, eucaine, su prarenal extract, ethyl chloride and other prep arations for local and spinal anesthesia. Bac teriology has taught the surgeon the cause of inflammation, suppuration of wounds and sepsis. New hospitals, aseptic operating-rooms and fur niture, thorough sterilization of instruments, hands and the field of operation and cleanliness of person, together with the wearing of rubber gloves, coupled with aseptic dressings, have enabled the surgeon to perform operations un known before the last decade of the 19th cen tury, reducing mortality to a much lower figure.
An important factor which has been of much aid to general surgery is the art of nursing, first recognized in 1840. Too much credit can not be given to the training schools of to-day for their development of trained nurses who have aided so much in the care of surgical cases.
During the 19th century the microscope be came of more and more value. The anthrax bacillus was classified in 1850 and then followed classification of the various micro-organisms known to-day. Koch's identification of the tubercle-bacillus has aided the general surgeon as much in the treatment of osseous tubercu losis as it has the physician in tuberculosis in other parts of the body.
For the past two decades general surgery has presented a mass of material, largely ex perimental, and much of it bacteriological and pathological. The latter has assumed a better position because of some real practical dis coveries, but, during that time there has been a large sifting out of much that was thought of great value, experience, however, demon strating to the contrary. Let us consider the treatment of fractures. The various methods of plating and suturing, by means of silver wire, have had very strong advocates, yet the use of splints, extension and position have re tained their well-recognized effectiveness. There would seem to be a consensus of opinion that when the X-ray shows the fracture has been reduced and the parts brought into a fairly normal position, these cases do fairly well with out operative intervention; however, when the positions are faulty, and, even though an anaesthetic is employed, reduction cannot be accomplished satisfactorily, there can be little doubt that they do very much better and more perfect results obtained, by operative proce ure. It is now becoming recognized the frac tures of the clavicle and other irregular bones demand operative intervention, by employment of plates and like methods.
The knowledge of the anatomical relations of the various joints, especially that of the hip and shoulder, with the aid of X-ray, manipula tion, becomes more perfect and more reliable in results.