Although men professing special skill in certain operations, and doubtless possessing it, flourished in old times, and left more or less of their impress on the surgery of the present day, for that matter, it was not until the second half of the Nineteenth Century that regional surgery (which is what specialism virtually amounts to) was systematically cultivated. Now there is hardly a portion of the body to which practitioners who make its ailments a specialty do not direct their searching methods of examination or on which they do not practise their ingenious devices in the way of treatment. Specialism has always been decried by a large section of the medical profession. On the other hand, it has been and is still overrated by the laity. The true estimate lies between the two. The specialists have advanced surgery immensely, but, with many honorable exceptions, they have laid too much stress on their several specialties, making too wide a range of ailments fall within them. As for the community at large, their shortcoming lies in the fact that most of them would seek for a specialist in mumps in case that painful but transitory infliction were to come upon them, and in their underrating of the family physician.
To change for a moment to a topic akin to the germ theory of disease, the reader may be reminded that the antitoxine treatment of infectious disease involves in almost every instance the use of some product contained in the serum (that is to say, the watery part of the blood). This leads to the subject of the use of natural and artificial serum in the treatment of disease. To quote again from the article entitled, "The Nineteenth Century in Medicine" ("New York Medical Journal," Dec. 29,1900): "It has been observed that the normal serum of certain animals that are insusceptible to particular infectious diseases, if injected into the human blood current or even into the subcutaneous tissue, confers more or less of immunity against those diseases.... Artificial serum seems to have been first employed by Edmund R. Peaslee as a benign application to the peritonaeum in the operation of ovariotomy. His conception of its mode of action is not very clear, but he was a very successful ovariotomist, and we can only conjecture that he builded better than he knew, like many another man. A few years ago much was expected from transfusion of blood, but gradually the conviction has forced itself upon us that it is wellnigh useless, and indeed that, on the whole, it is worse than useless. It has virtually been abandoned.... But experiments in transfusion have not been fruitless; they have culminated in demonstrating the inestimable value of infusions of 'normal,' or 'physiological,' solutions of sodium chloride, and not only of infusions, but also of peritoneal irrigation with such solutions. Many a life has been saved by resorting to this measure, even in apparently desperate cases."
Within about a decade of the close of the century, Robert Koch, whose discoveries and ingenious studies in bacteriology had brought him world-wide renown, announced that he had produced a derivative of the tubercle bacillus, which he termed tuberculin, that he thought might prove curative of tuberculous disease. It was to be injected beneath the skin. If the subject was really tuberculous, he would "react" by manifesting a certain degree of fever, and repeated injections would bring about elimination of the tuberculous deposits and thus effect a cure. The world was carried away with such an announcement coming from such a man, and it was thoroughly believed that at last "the great white plague," consumption, was to be conquered. Tuberculin did, indeed, cure certain minor forms of tuberculous disease, such as the skin affection known as lupus, but it soon became evident that it was almost impotent in the treatment of pulmonary consumption. It has, however, served to enable the veterinarian to make out the existence of tuberculous disease in cattle at an early stage of its course, and it is probable that by the slaughter of cattle thus found to be tuberculous much infection of human beings has been prevented.
Tuberculin failed of its prime purpose, but it does seem to have marked the initiative of a campaign against consumption which has already proved of incalculable benefit, and bids fair to put that omnipresent disease toward the foot of the list of causes of death. We have made substantial advances in our knowledge of the disease, and we no longer regard it as incurable. We have learned that it is communicable from one person to another, but also that its communication can easily be prevented, so that there is no reason to shrink from association with tuberculous persons. We have learned, too, that consumption in one's progenitors, immediate or remote, hardly makes it even probable that he himself is doomed to suffer with it; the only tuberculous heredity that we now recognize is that of defective ability to withstand the infection, and even this we regard as in most instances readily surmountable. We have learned, furthermore, that pulmonary tuberculous disease is by no means so fatal as it was formerly esteemed, for men whose business it is to make great numbers of post-mortem examinations, such as coroners' physicians and hospital pathologists, assure us that in a very large percentage of cases of death from other causes they find indubitable signs of past tuberculous disease of the lungs which had ceased its activity--been, in fact, cured, either spontaneously or by medical intervention. Such intervention, it has been abundantly proved, is altogether likely to be successful if it is of the right sort and employed early. There is, to be sure, no cure-all. Powerful as the climatic treatment is, it must be supplemented by measures accurately adapted to the individual case, and failure to comprehend this fact still leads many a phthisical person to his grave. But information is rapidly being diffused, sanatoria for such of the tuberculous as can take advantage of them are multiplying, and those who are shut off from their aid are growing more and more cognizant of how they should live in order to give themselves the best chance of recovery and save their associates from infection. The era of consumption-cures--meaning drugs--is past; but the disease is cured in an ever-increasing proportion of instances, and that, too, by medical though not medicinal measures.
At almost every turn medicine has been powerfully assisted by the sciences which should rather be termed correlative than subsidiary. Notable among them is chemistry. The isolation of the active principles of medicinal plants--such as morphine, quinine, strychnine, and cocaine--has been a remarkable service rendered by chemistry to medicine. How should we be handicapped if we still had to fight malarial disease with the crude Peruvian bark instead of its chief alkaloid, quinine! And how impracticable if not impossible would it be to render the eye insensitive to pain with any extract of coca leaves, no matter how concentrated--a purpose that we accomplish almost instantly with cocaine! Of minor importance, perhaps, but not to be despised, is the resulting liberation from the old slavery to bulky and nauseous drugs. The isolation of active principles long antedated the synthetical preparations, but the latter came at last--the marvellous array of hypnotics, anodynes, and fever-quellers that are now at our command, largely coal-tar products. But it is not to pure chemistry alone that we are indebted for the elegant dosing of the present day; progressive pharmacy, with its tablets, its coated pills, and its capsules, has put to shame the old-time purveyor of galenicals. Right jauntily do we now take our "soda mint" in case of slight derangement of the stomach, happily oblivious of its vile prototype, the old rhubarb and soda mixture. Even castor oil has been stripped of its repulsiveness by the combinations which the soda water fountain affords.
It was but a step, we can now realize, from the employment of isolated vegetable principles to that of preparations of certain glandular organs of the animal economy, but the doctrine of "internal secretions" had to intervene, and its evolution took time; not till toward the close of the century did the venerable Brown-Séquard lead up to it. We have not yet come to "eye of newt and toe of frog," but what we have incorporated into modern therapeutics in the way of animal products lends at least some theoretical justification to the ancient use of the dried organs of various animals. It is but a few years since the "ductless glands"--such organs, as, for example, the thyreoid gland (an organ situated in the front of the neck, a small affair in its normal state, but prominent and even pendulous when by its permanent enlargement it comes to constitute a goître)--were looked upon as puzzles, as structures destitute of any known function. Some observers even affirmed that they had no function, though the constancy of goître in cretins ought to have shown the fallacy of this allegation in the case of the thyreoid. We do not now need to be told that the thyreoid gland plays a very important part in the economy, for we know that its surgical removal gives rise to a special disease known as myxoedema, which, in addition to its physical manifestations, is characterized by impairment of the mental powers. Consequently, this ductless gland--a gland, that is to say, which has no obvious canal by which it throws off any product of its activity--must elaborate some material that is necessary to the health of the organism and is imparted to the blood. That material, whatever it may be, is termed an "internal secretion." Some of the internal secretions have turned out to be of singular value medicinally. It is apparently not the ductless glands alone that furnish internal secretions; the glands that are provided with ducts and yield a definite and observable product secrete also a substance (perhaps more than one) which they give up to the blood.
Prominent among the therapeutic advances of the century is the direct reduction of the high temperature of sunstroke and certain fevers by the use of cold. Although foreshadowed by Currie early in the century by his use of cold affusion in the treatment of scarlet fever, it did not come into general use until the closing decades. It is employed principally in typhoid fever, on the theory that a condition of high fever is in itself a source of danger quite distinct from the other injurious effects of a febrile disease. On the other hand, the employment of high degrees of heat has of late been shown to be a potent agency in the treatment of certain forms of disease, notably in various affections classed as rheumatic. Applications of very hot air, provided it is thoroughly dry, are borne without serious discomfort, and their employment promises to be of greater service in the conditions in which it is resorted to than that of any other agent.
A revelation in the treatment of heart disease has been effected by the Bad Nauheim system of effervescent baths and resisted exercises. It is not only functional disorders of the heart that are relieved, but grave organic diseases also. Somewhat elaborate explanations of the way in which the treatment proves beneficial have been given, but they are not altogether satisfactory.
Thus far we have dealt chiefly with those developments of medicine that seem to have been the outgrowth of much thought and experiment, but there was one that can hardly be viewed as other than a happy discovery, yet it was one that was fraught with unspeakable mitigation of human suffering, and that wrought a boundless extension of the field of surgery. It was that of anaesthesia. The first to discover an efficient surgical anaesthetic was Crawford W. Long, of Georgia. It has been established that he performed several minor operations with the patient anaesthetized with sulphuric ether, but he did not proclaim his discovery, and so it was reserved for William T. G. Morton, of Boston (then a dentist, but subsequently a physician), to make the first public demonstration of the efficiency of ether as an anaesthetic, which he did in the operating theatre of the Massachusetts General Hospital, in Boston, in the year 1846. The news of Morton's achievement spread broadcast, and it was at once realized that it was destined to revolutionize surgery. It certainly has done that, and in no less degree than was afterward accomplished by Listerism. Ether did not long remain the only anaesthetic known; Simpson, of Edinburgh, soon discovered that chloroform was possessed of even more decided anaesthetic properties. The inhalation of ether is disagreeable, and it is slow in producing the desired effect, whereas that of chloroform is not unpleasant, and it acts more rapidly. Consequently chloroform soon came to be generally preferred; but abundant experience has finally shown that ether is much the safer agent of the two, and improved methods of administration have almost entirely done away with the objections to its use, so that now it is looked upon as the preferable general anaesthetic. But general anaesthesia--meaning the suspension of sensibility in the whole organism, including unconsciousness--is not always necessary, and sometimes it is undesirable. We have now trustworthy local anaesthetics, the chief of which is cocaine, wherewith we are able to anaesthetize the part to be operated on without rendering the patient unconscious, and the co-operation that a conscious patient may be able to render is sometimes valuable. It was not alone in the direct saving of human suffering that anaesthetics proved a boon to the world; they have made possible an amount of experimental work on animals in the way of vivisection that humane investigators would otherwise have shrunk from, necessary as it has been and still is for the advancement of the healing art.
The operation of ovariotomy, first performed by Ephraim McDowell, of Kentucky, can hardly be classed with the happy accidents; but so little had been said about it or thought concerning it that when the news of it reached Europe "from the wilds of America" the editor of a ponderous English quarterly journal of medicine recorded his incredulity in the words "Credat Judoeus, non ego" An ovarian tumor inevitably proves fatal in the long run if it is not removed. In a certain percentage of cases it is malignant and will kill whether it is removed or not, but the general result of ovariotomy has been the saving of thousands of women from untimely death. Bell, of Edinburgh, had imagined the operation and had mentioned it in his lectures, but none the less to McDowell is due the credit of demonstrating its feasibility.