The English surgeons may similarly claim priority in proposing certain operations, as for example, that of perforation of the os unguis for establishing an artificial passage for the tears, by Woolhouse; Cheselden created the operation of the artificial pupil; he is also to be credited with the operation of perforating the duct of Steno, on the inside of the mouth and some distance from its natural orifice, for the relief of salivary fistula; Pott’s description of and treatment for what is known as Pott’s disease of the spine; etc.
Then, passing from what may be termed the history of ancient English surgery, Roux devotes his attention next to the work which was being done, at the time of his visit to London, by some of the leading surgeons of that city; and among his most striking brief comments I find the following: “There are many able surgeons in London at the present time”; and “The English seem to have a strong taste for surgery.” Farther on, he discusses at greater length the reasons why the English surgeons maintain such pleasant relations with one another, and notes with pleasure how greatly the prevalence of such professional harmony conduces to the general advancement of the science and art of surgery—or, for that matter, to the advancement of any art or science. His words read as follows:—
If anything can contribute to keep alive the taste for an art or science, to extend its progress, and to make a greater number of men excel in it, is it not that those who cultivate it should live in perfect intelligence together; that they should compose one family; that they have frequent meetings with one another, in which each one, sacrificing his own private interest, brings, without pride or without presumption, the fruit of his own reflections; that, strangers to the arts of intrigue, and, never giving their minds to the vile insinuations of envy, they should rival one another only in zeal and knowledge? Well, this fraternal spirit, this absence of all jealous rivalry; and more, an ardent desire to communicate, reciprocally, their views, their thoughts, exists in a very high degree amongst the men who are at this moment the honour of medicine and surgery at London. This is what I have observed by being amongst them, I will not say with surprise, but with the highest satisfaction. To these common sentiments is joined, on the part of those men already advanced in their career, an esteem altogether peculiar, for those whose reputation is but beginning; and, on the part of the latter, the greatest regard, the most sincere respect for those who were their masters.
At this point I beg to remind my readers that effective surgical anaesthesia had not yet at that early period been discovered, and this fact, I scarcely need to add, must have deterred many men from undertaking some of the more serious surgical operations.
At the end of Roux’s account he sums up the results of his observations of English surgery in the following words:—
If I must conclude by a summary opinion, I would say that, with respect to the art of surgery, as with respect to its habits and institutions; in whatever light we consider it, England is the place for contrasts. By the side of the most brilliant features, English surgery exhibits glaring imperfections—French surgery is more generally good.
While we are now considering various matters relating to the condition of surgery in England and her colonies during the early part of the nineteenth century, it may not seem out of place to mention here a discovery which was announced just about that time, and which, I suspect, is known to-day to comparatively few American physicians. During the eighteenth century the opinion was widely held that gonorrhoea is simply one of the manifestations of syphilis and that consequently mercury is required for its cure. The existence of such a belief among the physicians of that day explains the following statement which I find printed in Vol. I. of the Quarterly Journal of Foreign Medicine and Surgery for 1818:—“Dr. Francis Balfour, a physician highly esteemed in Calcutta, states that when he was a student in Edinburgh he attempted to establish the idea that gonorrhoea is a disease distinct from syphilis and does not require mercury for its cure. He put forward this doctrine in a paper which he presented to the Medical Society of Edinburgh, and which still, we believe, graces its records. This was as early as the year 1766. Next year he made it the subject of his inaugural dissertation.... It was nearly twenty years after this period that Benjamin Bell, by his ingenious and able investigations, supported and further confirmed the opinion, and thus contributed much to bring it into public notoriety and favour.”
At the time of Dr. Roux’s visit to London Charles Bell, who had taken up his residence in that city in 1804, was already well advanced on the high road to distinction as a surgeon. Born at Edinburgh, Scotland, in 1774, he had attained considerable reputation as an anatomist and physiologist by the publication (1798–1800) (in association with his brother, John Bell) of a very useful “System of Dissection of the Human Body,” in which he describes not only the normal conditions but also the alterations produced by disease. The text is interspersed with instructive remarks concerning human physiology. Particularly clear and interesting—says his biographer—are the descriptions which Bell gives of the structure of the heart and blood-vessels. He refutes in strong terms the teachings of Hunter regarding the vital force of the blood and the doctrine of Crawford with regard to animal heat; and “his explanation of the physiology of respiration is the clearest and most satisfactory of any of the accounts that are to be found in the textbooks.”
In the domain of experimental physiology Charles Bell discovered, at a later date, that, in the case of certain nerve trunks (e.g., the trigeminus), what appeared to be a single nerve was in reality made up of two entirely different (physiologically speaking) nerves, one of which is now termed the portio major, while the other bears the name of portio minor. Bell also demonstrated experimentally the important law that the anterior roots of the spinal cord nerves are the outgoing (centrifugal) motor nerves, the posterior the incoming (centripetal) sensible nerves. These results were subsequently fully confirmed by the great German physiologist, Johannes Mueller. In ancient times the question was often discussed whether one and the same nerve might not carry both sensory and motor impulses. The discovery just mentioned is one of the most important ever made in physiology.
Great as was the reputation attained by Charles Bell as an experimental physiologist,—a reputation which won for him the honor of knighthood on the accession of William IV. to the throne,—he soon, as was predicted by Roux, became one of the most celebrated surgeons of London. His work as an operator was carried on chiefly at the Middlesex Hospital. Roux speaks of him as a “graceful operator without being affected.”