The Progress of the Century

by Unknown

ANÆSTHESIA

After vaccination, the most important medical event of the century is the discovery of anæsthesia. While there were some prior attempts at anæsthesia, practically it dates from October 16, 1846, when Dr. John C. Warren, in the Massachusetts General Hospital, first performed a major surgical operation, without inflicting the slightest pain. I cannot enter into the merits of the various claimants for the credit of first using an anæsthetic, but ether was then for the first time publicly administered by Morton, and the very sponge which was then used is now a precious trophy of the Massachusetts General Hospital. I may, perhaps, quote from an address which I delivered before the Medical and Chirurgical Faculty of the State of Maryland, at their centennial anniversary, in April, 1899, the following in relation to anæsthesia:

“The news went like wildfire, and anæsthesia was soon introduced into every clinic and at almost every operation throughout the civilized world. Prior to that time a surgical operation was attended with horrors which those who live in these days cannot appreciate. He was the best surgeon who could perform any operation in the least possible time. The whole object of new methods of operating was to shorten the period of frightful agony which every patient had to endure. Every second of suffering saved was an incalculable boon. To submit to any operation required then a heroism and an endurance which is almost incomprehensible to us now. All of the more modern, deliberate, careful, painstaking operations, involving minute dissection, amid nerves and blood-vessels, when life or death depends on the accuracy of almost every touch of the knife, were absolutely impossible. It was beyond human endurance quietly to submit one’s self for an hour, for an hour and a half, for two hours, or even longer, to such physical agony.

“It is a striking commentary on the immediate results of anæsthesia to learn that, in five years before the introduction of ether, only one hundred and eighty-four persons were willing to submit themselves to such a dreadful ordeal in the Massachusetts General Hospital—an average of thirty-seven operations per annum, or three per month.... During the last year, in the same hospital—a Mecca for every surgeon the world over—over thirty-seven hundred operations were performed. It is not an uncommon thing at the present day for any one of the more active surgeons of this country to do as many as four or five hundred operations in a year. I have known as many as nineteen operations to be done in the Jefferson Medical College Hospital in a single day—equalling six months’ work in Boston before the introduction of ether.”

The next year, 1847, witnessed the introduction of chloroform by Sir James Y. Simpson, of Edinburgh. Until I became acquainted with the striking figures just quoted, I had often wondered at the hospital scene in that most touching story, Rab and His Friends, by the late gifted and well-beloved physician, Dr. John Brown, of Edinburgh. Nowadays students do not rush into the surgical amphitheatre when they learn that an operation is to be done, but it is taken as a matter of course, for practically every day many operations are done in most of our large hospitals. But, at the time when Rab’s mistress was operated upon, an operation, as has been stated, was a very rare event. Few had the fortitude to endure its dreadful pangs. Now, thanks to the blessed sleep of anæsthesia, sufferers from even the most dreadful disorders can have long and difficult operations done, accurate and tedious dissections made, and yet feel not a twinge of pain.

Besides general anæsthesia by ether, chloroform, and a few other agents, there have been introduced several means for producing “local anæsthesia,” i.e., agents which destroy the sensibility of the part of the body to be operated upon while not producing unconsciousness. Freezing the part by ice and salt, or by a quickly evaporating spray of rhigolene or chloride of ethyl, are sometimes used. But cocaine and a somewhat similar substance, eucaine, have of late been more extensively used on man, after their harmlessness had been first shown by experiments on animals. In 1885 Corning, of New York, injected a solution of cocaine as near to the spinal cord as was possible, and produced insensibility of all the body below the point of injection by the effect of the cocaine upon the spinal cord. A few years ago Quincke, of Kiel, in Germany, devised a means of puncturing the spinal canal itself in the lumbar region (the lowest part of the small of the back) for the purpose of drawing off some of the fluid for examination. This suggested to Bier, then of Kiel, who was apparently ignorant of Corning’s work, that cocaine could be injected through a hollow needle inserted into the spinal canal by “lumbar puncture” and so produce anæsthesia of all the body below this point. This method was published by him in 1899, and was soon repeated in America. In France, however, it has been practised more than elsewhere, Tupper, of Paris, having successfully done over two hundred operations by “spinal anæsthesia.” All of the body below the diaphragm can thus be deprived of sensibility. The method will probably never replace ether and chloroform, but in many cases is a valuable aid to the surgeon. But it has its dangers and its inconveniences. The ideal anæsthetic is not that which destroys sensibility and yet leaves the patient perfectly conscious, as spinal anæsthesia does. A patient to whom I recently proposed it for certain special reasons rejected it, saying, with probable truth, that she could never bear the strain of lying on the table perfectly conscious of all that was being done and frightened by any surgical emergency which might easily arise in such a long, difficult, and dangerous operation. The ideal anæsthetic is that which will abolish pain and consciousness without danger to life. The twentieth century will undoubtedly see the discovery of this safe and efficient anæsthetic.

ANTISEPSIS

But the limits of surgical progress were not yet reached. Let me quote again from the address before alluded to:

“Even the introduction of anæsthesia, however, did not rid surgery of all its terrors. The acute pain of the operation was abolished, but the after-suffering, as I know only too well, in my early surgical days, was something dreadful to see. The parched lips of the poor sufferer, tossing uneasily during sleepless nights; wounds reeking with pus, and patients dying by scores from blood-poisoning, from erysipelas, from tetanus, from gangrene, were only too familiar sights in the pre-antiseptic days. Then, again, there arose one of these deliverers of the human race whose name can never be forgotten and whose fame will last so long as time shall endure. Jenner, Warren, and Lister are a triumvirate of names of which any profession may well be proud. Thank God, they all sprang from virile Anglo-Saxon loins! No praise, no reward, no fame is too great for them. That Lord Lister still lives to see the triumph of his marvellous services to humanity is a joy to all of us. And when the profession arose en masse, within the last few years, at the International Congress of Berlin, and at the meeting of the British Medical Association in Montreal, and welcomed him with cheer after cheer, it was but a feeble expression of gratitude for benefits which no words can express.

“Before Lister’s day erysipelas, tetanus, gangrene, and blood-poisoning in its various phases were the constant attendant of every surgeon. They were dreaded guests at almost any operation; and when in rare cases we obtained primary union without a drop of pus, without fever, and with but little suffering, it was a marvellous achievement. Now it is precisely reversed. The surgeon who does not get primary union without a drop of pus, with no fever, and with little suffering, asks himself—what was the fault in my technic? To open the head, the abdomen, or the chest thirty years ago was almost equivalent to signing the death-warrant of a patient. The early mortality of ovariotomy was about sixty per cent.; two out of three died. Now many a surgeon can point to a series of one hundred abdominal operations with a fatality of only two or three per cent. When Sir Spencer Wells recorded his first one thousand cases of ovariotomy it was calculated that after deducting the years which the patients who died from the operation would have lived had no operation been done the net result of the thousand cases was an addition of twenty thousand years to human life. One thousand ovariotomies under antiseptic precautions at the present would certainly add at least thirty thousand years to human life. Would not such a guerdon be enough for any man?

“This, too, is a direct result of laborious laboratory researches, beginning with the investigations of Liebig and Pasteur on fermentation. Lister went still further. Even before the discovery of the bacteria of suppuration, of tetanus, and of erysipelas he showed us experimentally how, by surgical cleanliness, we could avoid all infection and so banish these pests from our hospitals and bring life and health to many who otherwise would have perished from operations which are now perfectly safe.

“The mortality of compound fractures in the pre-antiseptic days was about sixty per cent. It was one of the most dreaded of all accidents. Its mortality now is perhaps not over three per cent., and the mortality from sepsis after such a fracture, in the hands of well-instructed surgeons, is almost nil. Prior to Lister’s day the mortality of major amputations varied from fifty to sixty-three per cent. Now it is from ten to twenty per cent. And so I might go on with operation after operation and show how they have become so safe that one need not dread any, saving exceptional cases.

“These two modern discoveries, anæsthesia and antisepsis, have utterly revolutionized modern surgery. They have made possible operations which, by reason of their length and pain and danger, were utterly unjustifiable in former days, but are now the daily occupation of a busy surgeon. And, far better than this, they have enabled us to bring to homes and hearts, which otherwise would have been broken up and wrung with sorrow, the comfort of life restored to dear ones upon whom depended the happiness and support of the families. Translate figures into happy hearts and prosperous homes if you can, and then you can tell me what Warren and Lister have done for humanity!”

The result of these two wonderful discoveries has been to separate us from the surgical past, as by a great gulf.