ACHIEVEMENTS IN SURGERY.
It will not do to disparage the work of the ancients. The old world, long since fallen below the horizon of the past, had races of men and individuals who might well be compared with the greatest of to-day. In a general way, the ancients were great as thinkers and weak as scientists. They were great in the fine arts and weak in the practical arts. This is true of the Hindus, the Egyptians, the Greeks, the Romans, even of the Aztecs and the Peruvians.
The art work of these old peoples, whether in sculpture, painting or poetry, surpassed, if it did not eclipse, corresponding periods of modern times. In some of the practical arts the old races were proficient. In architecture, which combines the æsthetic and practical elements, the man of antiquity was at least the equal of the man of the present. In one particular art—a sort of humanitarian profession based on natural science and directed to the preservation of life—the ancients had a measure of proficiency. This art was surgery. The surgeon was even from the beginning, and he will no doubt be even to the end.
The great advance which has been made in surgical science and practice is shown in two ways: first, in a great increase of courage, by which the surgeon has been led on to the performance of operations that were hitherto considered rash, audacious or impossible; and secondly, by the immunity which the surgeon has gained in the treatment of wounds through the increased knowledge he possesses of putrefaction and the means of preventing it. It were hard to say whether the surgeon's increase of skill and courage in performing operations has equalled his increased skill in the after treatment of wounds.
These improvements have all proceeded from scientific investigation. They have come of the application of scientific methods to the treatment of surgical diseases. With the investigations of Pasteur and the development of the science of bacteriology, it was seen at a glance how large an influence such investigation must have in the work of the surgeon. The publication of Tyndall's "Essays on the Floating Matter of the Air in Relation to Putrefaction and Infection," in 1881, gave a great impulse to the new practice; but that practice had been already confirmed by the great and original work of Sir Joseph Lister, an English surgeon who as early as 1860 had introduced the antiseptic method of bandaging.
It is within the last forty years that the greatest marvels of modern surgery have been performed. It would seem that no part of the human body is now beyond the reach of surgical remedy. Almost every year has witnessed some new and daring invasion of the fortress of life with a view to saving it. Old opinions with respect to what parts of the human economy are really vital have been abolished; and a new concept of the relation of life to organism has prevailed.
Until recently it was supposed that the peritoneal cavity and the organs contained therein, such as the stomach, the liver, the bowels, etc., could not be entered by the surgeon without the certain result of death. To do so at the present time is the daily experience in almost every great hospital. The complexity of civilization has inflicted all manner of hurts on the human body, and the malignity of disease has spared no part. It was supposed that the cranial cavity could not be entered or repaired without producing fatal results. It was taken for granted that certain organs could not be touched, much less treated capitally, without destroying the subject's life. But one exploration has followed another and one successful adventure has been succeeded by another still more successful until the surgeon's work is at the present time performed within a sphere that was until recently supposed to be entirely beyond his reach.
As to the liver, that great organ is freely examined and is treated surgically with considerable freedom. This is true also of the stomach, which until recently was supposed to be entirely beyond the surgeon's touch. Within the last two decades sections of the stomach have been made and parts of the organ removed. Not a few cases are recorded in which subjects have fully recovered after the removal of a part of the stomach. Sections of the intestinal canal have also been made with entire success. Several inches of that organ have in some cases been entirely removed, with the result of recovery! The spleen has been many times removed; but it has been recently noted that a decline in health and probably death at a not distant date generally follow this operation.
The disease called appendicitis has either in our times become wonderfully frequent or else the improved methods of diagnosis have made us acquainted with what has long been one of the principal maladies of mankind. The appendix vermiformis seems to be a useless remnant of anatomical structure transmitted to us from a lower animal condition. At least such is the interpretation which scientists generally give to this hurtful and dangerous tube-like blind channel in connection with the bowels. That it becomes easily inflamed and is the occasion of great loss of life can not be doubted. Its removal by surgical operation is now regarded as a simple process which even the unlearned surgeon, if he be careful and talented, may safely perform. The surgical treatment of appendicitis has become so common as to attract little or no notice from the profession. Even the country neighborhood no longer regards such a piece of surgery as sensational.
The use of surgical means in the cure, that is the removal, of tumors, both external and internal, has been greatly extended and perfected. The surgeon now carries a quick eye for the tumor and a quick remedy for it. In nearly all cases in which it has not become constitutional he effects a speedy cure with the knife. The cancerous part is cut away. It has been observed that as the recent mortality from consumption has decreased cancerous diseases have become more frequently fatal. Whether or not there be anything vicarious in the action of these two great maladies we know not; but statistics show that since the beginning of Pasteur's discoveries the one disease has diminished and the other increased in almost a corresponding ratio. Meanwhile, however, surgery has opposed itself not only to cancers but to all kinds of tumors, until danger from these sores has been greatly lessened. The removal of internal tumors such as the ovarian, is no longer, except in complicated and neglected cases, a matter of serious import. Such work is performed in almost every country town, and the amount of human life thus rescued from impending death is very great. The work of lithotomy is not any longer regarded with the dread which formerly attended it. In fact, every kind of disease and injury which in its own nature is subject to surgical remedy has been disarmed of its terror. The eye and the ear and all of the more delicate organs have become subject to repair and amendment to a degree that may well excite wonder and gratify philanthropy.
But it is not only in the actual processes of surgery that this great improvement in human art may be noted. The treatment of wounds with respect to their cure by preserving them from bacterial and other poisons has been so greatly improved that it is now regarded almost as a crime to permit suppuration and other horrible processes which were formerly supposed to be the necessary concomitants of healing. The hospital, whether military or civil, was formerly a scene that might well horrify and make sick a visitant. It was putrefaction everywhere. It was stench and poisonous effluvia. The conditions were such as to make sick if not destroy even those who were well. How then could the injured sufferers escape?
It is one of the crowning glories of our time that no such scene now exists in any civilized country. No such will ever exist again, unless science should lose its grip on the human mind and the civilized life subside into barbarism. The surgeon would now be held in ill-repute that should permit to any considerable degree the processes of putrefaction to take place in a wound of which he has had the care. The introduction of antiseptic and aseptic methods has made him a master in this respect. The skillful surgeon bids defiance to the microbes that hover in swarming millions ravenous for admission to every hurt done to the human body. To them a wound is a festival. To them a sore is a royal banquet to which through the invisible realm a proclamation goes forth, "Come ye! Come to the banquet which death is preparing out of life!" All this the modern surgeon disappoints with a smile and a wave of his hand. The invisible swarms of invading animalculæ are swept back. Not a single bacterium can any longer enter the most inviting wound while the surgeon stands ready with drawn sword to defend the portals of life.