Some of the Wonders of Modern Surgery
THERE is not one man in a hundred outside of the medical profession, and scarcely one man in ten in it, who understands and appreciates the marvels of modern surgery.
The improvements that have, within the past quarter of a century, been almost daily introduced into surgical science are so numerous, so complex, and so very varied in character, that to properly understand them requires entire concentration of thought and study. Even in the profession of medicine, unless the doctor makes surgery a specialty, unless he devotes his whole attention to the subject, unless he carefully reads all the best medical literature — and, above all, the periodical literature -—of the day, he cannot properly estimate the enlightened practice of our times, as compared with that of days gone by.
But things pertaining to the chirurgeon’s art which would scarcely surprise a tolerably well-educated physician will no doubt strike with amazement unprofessional readers ; for the mind of the former is in a measure prepared for innovations by novelties that have preceded them, and has been raised step by step from the wretched old-fashioned ideas and antiquated notions of our ancestors to those more in accordance with common sense and human reason; whereas the ideas of the latter upon the subject are vague, imperfect, and traditional, because for the most part foreign to the daily routine of their lives.
Surgery is very ancient; it is as old as man. Before disease was entailed upon the human race, our great progenitor was the subject of an operation. By the intluence of some anaesthetic agent a deep sleep is said to have fallen upon Adam, and a bone was excised from his body, — a rib was taken away, from which grew that beautiful frailty whose name is Woman, in whose gustatory nerves the love of forbidden fruit culminated. She took the apple and did eat, and gave it to Adam, and he did eat; but the attempt to swallow it so choked him that his male descendants still bear in their throats an hereditary projection, — the pomum A da mi, — the technical term, dear reader, in medical nomenclature, by which that hillock in the throat of man is known.
Everybody is acquainted with that celebrated old doctor, zEsculapius, to whom professors in medical colleges still allude in the opening sentences of their introductory lectures. This medical gentleman is supposed to have read medicine with Apollo, and to have been the father of old-fashioned surgery, and of two sons, Machaon and Podalirius, both of whom Homer, in the twelfth book of the Iliad, has seen fit to immortalize. Nestor thus speaks of the former: —
And great Machaon to the ships convey:
A wise physician, skilled our wounds to heal,
Is more than armies to the public weal.”
Patroclus was another surgeon of antiquity, and one most decidedly of the military order; Ins exploits are thus related: —
Patroclus cut theforky steel away ;
Then with his hands a bitter root he bruised,
The wound he washed, the styptic juice infused-
The dosing flesh that instant ceased to glow,
The wound to torture and the blood to flow. ”
After these renowned gentlemen six whole centuries passed away, when Hippocrates became the modern surgeon of his time, which, you must remember, was about three hundred years before Christ. He held it as a maxim, that “where medicine failed, recourse must be had to the knife, and when the knife was unsuccessful, to fire.” This latter method became very fashionable ; and a surgeon’s apparatus was a sort of blacksmith’s shop, resembling those that followed our batteries through the war. Sores were then burned out with fire ; conflagrations were raised upon the skin; redhot irons, shaped much like the modern poker, were thrust into the deep recesses of wounds; and the soothing application of boiling tar covered bleeding and raw surfaces. A very favorite method of using fire with this distinguished individual and others of his school was to saturate small pieces ot wood with oil, pile them upon the surface of the body, and set them ablaze. However, palmam qui meruit, ferat, Hippocrates assisted surgery considerably in his time, and his descriptions ot certain surgical diseases, and of the operations performed for their relief, do him great credit.
It is not the intention of this paper even to begin to consider in detail the ancient upholders of the art of surgery, or to relate a long catalogue of names and dates ; and therefore suffice it to say that surgery improved and retrograded, and was as often then as now impeded in its progress by the bigotry of those whose preconceived notions and reverence for bygone forms and shades of men prevented either investigation or adoption of important, though often novel, truths.
In modern times the first great, very great, step forward in surgery, was the introduction of what the doctors call anaesthetic agents, or the use of chloroform and ether. A just idea ot this inestimable boon to suffering humanity cannot be better arrived at than by first imagining one’s self in a surgical amphitheatre twenty-five years ago, during an operation, — an amputation, for instance. Observe the writhing of that human form as the keen two-edged knife pierces the quivering flesh ; listen to the harsh grating of die surgeon’s saw as it separates the living bone, and hear those agonizing groans, and shrieks, and prayers for mercy ! Then, visit to-day any well-conducted hospital or college, and witness a similar operation. The patient is placed upon his bed, a handkerchief saturated with the anaesthetic is applied to the nostrils, and a slumber steals over him so deep, so profound, that not a muscle moves as the knife goes through his flesh, not a quiver passes through his frame, not a prayer to God or man for help, not a groan escapes him. He wakes from his slumber to find himself comfortably arranged in his bed, without a single unpleasant sensation of any note, and totally unconscious of the operation he has undergone. I can recall instances wherein the sufferer has awakened from his lethargy, and, looking up with imploring eyes, has asked: “Are you not almost ready to begin?” “Begin? Why, my dear sir, the operation is over, is successful, and you will soon be well again.” I can see now, while I write these lines, the tears of gratitude and of hope that slowly trickle down the cheeks of the unfortunate victims of disease or accident, and forthwith I turn to my big bottle of chloroform (Ducan and Lockhart’s best Scotch), and take a congratulatory sniff from pure admiration, respect, and thankfulness.
But there are other very great advantages to be derived from these anaesthetics. No surgeon in the olden time could have performed those difficult and protracted operations on the living body which are, from the frequency of their occurrence now, justly considered the triumphs of modern surgery; and simply because it would have been utterly impossible for the patient to keep himself, or be kept by others, in a quiet position during a prolonged and painful dissection, where knives and probes and forceps are thrust in and out of gaping and bleeding wounds. The human system in most cases would succumb to the shock of the prolonged agony, in an operation of two, three, or four hours’ duration, when every second seems a minute,and every minute an hour.
The two ansethetic agents which are now most in use among surgeons are ether and chloroform, — some preferring one, and some the other; others using a compound of both. From time immemorial the surgeon’s knife has possessed such terror for mankind, that many have been the attempts to diminish the torture of operations. Even as far back as the thirteenth century the idea of painless operations was carefully considered. In a curious old surgical treatise by one Theodoric, the recipe is found for the preparation of an article called spongia somnifera, which was said to accomplish the desired result. Pliny and Dioscoricles speak of the mandragore, or mandrake, as being steeped in wine to cause insensibility to pain.
The discovery ol ether as an anaesthetic belongs to America. On the 30th day of December, 1846, at No. 19 Tremont Row, in Boston, a man named Frost had a tooth extracted without pain by Dr. Morton, and a new era commenced in the surgical world. Chloroform belongs to England. On the 4th of November, 1847, it was discovered by Sir J. Y. Simpson of Edinburgh ; Drs. Keith and Ducan being present at the time. The blessings ot the appropriate application of these agents are not fully appreciated, because those outside the pale of the profession rarely have time or opportunity to witness the wonderful effects produced thereby. Think, dear reader, of a man having on his back an excrescence larger than a knapsack, and occupying the same position that accoutrement would on the human body, — a tumor that had bowed his head upon bis breast for twenty years, and had never permitted him to sleep in any position except lying on his face, — a tumor filled with blood-vessels, and the growth of which was attended with excruciating pain. Think of such a man in the hands oi two surgeons, — one on each side of the table,—with their shining knives cutting deeply into the flesh, — think of him lying thus for three consecutive hours, and finding the horrible burden gone when he awoke from his insensibility !
But modern surgery has opened another field. The fumes ot chloroform, ether, and nitrous oxide narcotize the brain, and sometimes produce dangerous and even fatal results. What does modern surgery do to avoid such misfortune ? Simply this : A man with a wen on his arm, or an exquisitely painful “ felon on his finger, can now look down quietly upon the knife as it enters his own body, and smile at a most remarkable coincidence, and one peculiarly agreeable to himself, namely, — he does not feel the slightest degree of pain. This condition of things is effected by the absence of heat; otherwise, cold. It is well known to everybody, that if a part be frozen or benumbed with cold, its sensibility is for the time being lost.
Now, there are several methods by which cold is produced, one of which is evaporation,— that mighty process constantly going on in the great universe, whereby the waters which have passed into the sea are returned to be purified for the use of man. Evaporation is Nature’s colossal filter. The evaporation of any liquid which is more volatile than water will immediately produce cold. Tour a little common ether on the back of your hand, and the sensation of cold is at once apparent; but the chemists tell us that vapors have a greater capacity for heat than when their particles are condensed into either a solid or a liquid form; therefore modern surgery, being aware of these few facts, constructs an instrument whereby a vapor of ether or other very volatile substance is injected in the form of spray, — or, as the doctors say, atomized — upon a part, and so rapidly absorbs the heat generated by the chemical action going on within the body, that in a very few minutes the part becomes entirely insensible to pain, while the patient still retains volition and consciousness. This evaporation is so potent, that the great Faraday was able to freeze mercury in a red-hot crucible. it is not my intention to enter into a minute description of the very simple apparatus by which this spray is produced. Nature is said to abhor a vacuum; and if by any means such a condition is produced in a tube one end of which is inserted into a liquid, the atmospheric pressure from without will cause the liquid to ascend into the vacuum ; and if as it rises in obedience to nature’s law it is met with a stream of air projected against it with a moderate degree of force, the volatile liquid will be broken into fragments or atoms, thus constituting a vapor, the rapid evaporation of which will speedily take away heat. Without the least trouble, in any temperature, and at any time of day, the surgeon has it in his power, by means of a little instrument he can carry in his pocket, of producing cold several degrees below zero. It is to Mr. Richardson, of London, that the world is indebted for the introduction of this method of causing local insensibility bymeans of ether. Dr. Henry J. Bigelow, of Boston, has discovered that a similar result may be attained by a substance called rhigolcne, which is a very volatile product of petroleum, and which, with a boiling point at 70°, will, when atomized, congeal the skin and the textures beneath in from five to ten seconds ; 1 5” below zero being easily produced in a few minutes. With such ryi apparatus (and a great furore it has created in the medical world) a man maystudy anatomy on his own person, and dissect himself with comparatively trifling inconvenience.
We are told by a well-known and undoubted authority, that the rich Miss Kilmansegg once met with a serious accident ;
When the femoral bone of her dexter leg
Has met with a compound fracture ? ”
asks the historian ; and he further states, that as “the limb was doomed, and it could n’t be saved,” it was cut off, and that after its removal there was an immense amount of trouble in fitting to the remaining portion of the member any kind of an extremity. If the lady had lived in our advanced days, no apprehension would have been felt. A letter to one of those manufactories where legs and arms — in the shape and motion of which Apollo or Venus might exult, and which in nineteen cases out of twenty are far more beautiful to look upon than nature’s own — are turned out to order by steam would have caused to be sent by return train a perfectly suitable leg.
The very wonderful and perfect mechanism which is introduced into these patent extremities is only equalled by the facility with which they are used. They are light, have all the movements of the natural joints, and, by .means of springs, wires, cords, and wheels, work with a precision which 5s very surprising. Not long since I had the pleasure of being accosted in the street by a welldressed soldier, who in nobly' doing battle for his country had been shot through the knee, the lower parts of his leg being so severely shattered that it was necessary to remove it. The poor fellow had a hard time of it. I did not know him to be the same individual whom 1 had treated in the hospital; the flush of health was upon his cheek, the sparkle of life in his eye, the elasticity of manhood in his step. He looked first into my face, and then, glancing downward, said, with a curious twinkle in his eye, “ Doctor, which leg is it ? ” For a moment I was dumfounded with the question, but clapping his hand upon his thigh he said with exultation ; “ This is the leg with which I was born, and this one,” pointing to the other, “is the one which Uncle Sam gave me”; and he stepped off with only a slight halt in his soldier’s gait. One ot the most celebrated of the Bridgewater treatises is that of Sir Charles Bell on the human hand. The essayis replete with thought and study, and gives the reader a true idea of the mechanism and the precision of adaptation which is found in that portion of the human body. Raley in his “Natural Theology,” alluding to the same subject, says : “ Let a person observe his own hand while writing; the number of muscles which are brought to bear upon the pen, how the joint and adjusted operation of several tendons is concerned in every stroke. Not a letter can be turned without more than one or two or three tendinous retractions, definite, both as to the choice of the tendon and as to the space through which the retraction moves ; yet how currently does the work proceed, how faithful have the muscles been to their duty, how true to the order which endeavor or habit hath inculcated! ” II we were to take the celebrated surgeon and theological essayist, and show to the one a man sawing wood and to the other a person engaged in writing, and were to tell them that neither of the industrious individuals was possessed ot any but wooden hands, which are nightly taken off, greased, and prepared for the next day’s service, somewhat after the fashion of boots and shoes, they most undoubtedly would be petrified with amazement, if not completely stunned by an apparent impossibility. Yet modern surgery can accomplish this result. Let me give some extracts, authenticated ones, from letters written to one of the manufacturers of artificial hands. One person thus writes : “ I am very much pleased with my artificial arm and hand. 1 find it useful in a great many ways. I can carry a pail of water with ease. I can carry an armful of wood quite handily. I can handle my knife and fork,” &c. Another says : “ I was fitted with a PAIR of artificial hands made by I. S. Drake, and I find them of great use to me. I can feed myself very well with them; also can write so it can be read,” &c. Another writes : “ I am getting along finely with my artificial hand. I have already learned to sew with it, and can do a great many other things. I find it quite convenient at table, and in fact it is useful to me in everything I undertake.” A gentleman from Providence gives the following testimony: “I frequently carry a pail of water, and oftentimes a basket of marketing, with my artificial hand. In walking through the streets, I defy any one to tell which is my artificial hand.” A letter from Concord concludes thus : “ It ” — the hand — “is a most convenient thing to drive with. I have driven twenty miles in the coldest day, without calling upon my other hand for assistance.” Is not this an improvement upon the oldfashioned, clumsy, and unsightly ironhook which old surgery affixed to the unfortunate stump of a man’s superior extremity ?
There are some operations in surgery that are dangerous on account of hemorrhage from the smaller vessels, and others which are performed by means of strangulating a part, allowing it to die and be cast off by the law of nature ; the latter procedure being necessarily protracted, and often excessively painful. A French surgeon, by name Chassaignac, being aware of these facts, devised an instrument which he called the icraseur, or crusher, to obviate both the difficulties alluded to. It is formed of a fine chain, gathered into a loop, which loop encloses the part to be removed ; by turning a screw the chain is gradually tightened until the parts are separated. There is not a cutting edge to this contrivance ; the chain is blunt, and in its passage through the structures so turns up or twists the ends of the blood-vessels that hemorrhage is prevented. The working of this instrument is truly surprising. I know of a girl, an amiable young lady, who was unfortunate enough to have been born with a tongue so much too long that it protruded from her mouth from four and a half to five inches ; she could neither masticate her food nor articulate a single sentence ; life was kept in her for nearly fifteen years by liquid nourishment sucked through a tube; her appearance was naturally revolting, and upon the slightest exposure to cold or atmospheric changes she was wellnigh suffocated by the tremendous enlargement of this congenital hypertrophy. To cut off this tongue with a sharp knife would have been to expose her life to danger from hemorrhage, to twist a string around it, and allow it to die by slow degrees, was a torture to which neither her friends nor herself would submit; yet with the application of chloroform and the ccraseur it was taken away, — the superabundant portion of it, — trimmed to a point; and today she sings, talks, and eats with perfect control of the remaining portion of the organ. She went to sleep, and awoke with her jaws closed for the first time in her life, and with but the loss of a few drops of blood.
The greatest revolutions also have taken place in that branch of surgery known as ophthalmology, or that portion of it which treats of diseases of the eye ; indeed, the improvements in this department are so very numerous that it now-a-days constitutes a separate and special science. There are few physicians in general practice that understand the orthography of this specialty. How do you spell dac-ry-o-cysto-syringo-ka-ta-klei-sis (dacryocystosyringokatakleisis) ? would be a puzzle for many wise heads, and its pronunciation dangerous to any but a woman’s tongue.
The eye — the study of which alone, old Sturmius tells us, is a cure for atheism — is perhaps one of the most marvellous constructions in nature. Its movements, its expressions, its protection, its chambers, its lenses, and the great delicacy of all its component parts, have been the study of anatomists of all times. How I wish I could show to the readers of this paper one single portion of the human eye, — that part called the vitreous humor ! It resembles half-molten crystal in its purity and its brilliancy. And, above all, could I show you the beautiful adaptation of every structure to the office it performs in the animal economy, you would probably be lost in amazement. Imagine yourself for a single moment standing on a mountain eminence, with an autumn landscape of twenty mites in extent before you : every constituent which goes to make up the beauty and harmony of the scene is fully appreciated by your sense of vision, — the great variety of color, the fields, the hedges, the foliage, the cottages, and the village spire in the distance, the river as it curves around the gentle slopes, the clouds that float overhead. That landscape of twenty miles you take in, and are able to see entire through an aperture an eighth of an inch in diameter!
Is not the smallness of the visual tablet, as compared with the extent of vision, one of the most singular and remarkable adaptations of means to ends which can be found in nature ?
There are several compartments and chambers within the globe of the eye ; there is a curtain which divides these chambers ; there is an elastic doorway, which expands and contracts in accordance with the quantity of light to be admitted. Take a candle and endeavor to look into those mysterious recesses, and you can see nothing; and the reason is obvious, — the rays are reflected back again, and are brought to a convergence at the flame ol the candle ; In other words, the flame is the focus of reflection, and the eye cannot occupy the same position as the flame, nor see through it. But modern surgery has explored these hitherto unknown and mysterious regions, and has invented an instrument by which the rays of light coming from a lamp placed behind and at one side of the head can so be caught, reflected, and brought to a focus, that the chambers and depths of the globe of the eye can be fully and readily explored ; and the result has been that this instrument (called the ophthalmoscope) tells the surgeon of to-day, that four fifths of what was written and surmised concerning the diseases affecting these hitherto unexplored regions is conjectural and wrong ; its introduction has rendered obsolete nearly all that was taught by our grandfathers on the subject. How many eyes have been blinded by treatment based upon conjecture and ignorance may only be imagined; it is well for us that no data can be found, and that forever such unsatisfactory information will be buried in oblivion.
The use of reflected light, once introduced, was eagerly applied to many other cavities of the body. The intricate labyrinth of the ear, and the passages of the nose and the lungs arc now carefully explored ; the entire windpipe can now-a-days be laid before the eye of the surgeon. No doubt, in years to come, the obdurate peg in the boot-heel of a patient may be found and carefully examined by a combination of lenses inserted in the mouth. But I must hasten on. The items that have been detailed as relating to the present position of modern surgery are a few of innumerable facts. The wonders revealed by the microscope alone would fill a volume twice the size of the Atlantic Monthly; and when every week in every medical periodical some new instrument or new method of treatment is introduced, to attempt to relate them in a paper of this kind is perfectly useless.
But there is a branch of surgery to which attention should undoubtedly be called, and that is what is termed conservative surgery. Now, the rule of the conservative surgeon is to save all he possibly can, and to do away with the wholesale cutting and slashing of the older masters. In other words, place as much in the hands of Nature as is practicable ; and it is astounding what she can accomplish with gentle handling and persuasive treatment! Attack her roughly, interfere with her processes, disturb her in her silent and mysterious workings, and she retires in disgust. The doctors, as well as the surgeons, are beginning to understand this, and the vis medicatrix natures is being acknowledged by medical as well as by surgical science. During the late war, thousands and thousands of limbs were saved to their owners by the proper understanding of conservative surgery. One of the most distinguished surgeons of the world has lately written : "At King’s College it is a rare thing to see an amputation ; in nine cases out of ten excision should be performed in its stead.” Bv excision is understood cutting OUT the diseased part instead of cutting OFF the entire limb. Let me explain a little more in detail, that the understanding of this important point may be perfectly clear. Suppose a man be shot with a minicball through the shoulder-joint, and the missile shatters the bone to a considerable extent: old surgery sees no resource but to amputate the entire arm ; modern conservative surgery says, “ Not so,” and cuts out the shattered joint, takes away the pieces of bone, and leaves the balance to Nature; and she, good soul ! fills up the gap with a substance which, if not entirely resembling bone, is still of sufficient firmness and strength to allow the patient a tolerable motion at the shoulder, and a perfect motion at the elbow, wrist, and fingerjoints. I can illustrate this conservative surgery by another instance. There was once a bright, active boy, whose father was a settler in the far-off regions of the Western country. The family were poor, but hard working, and had come West to cultivate a small portion of land which they had raised money enough to “ locate.” The boy was driving a truck-wagon, drawn by four oxen, on which was suspended a huge log of wood. As he walked beside his team the chain on his wagon broke, and the log rolled over; he ran, but his leg was caught by the heavy wood, and severely crushed, — the bones protruding through the skin, and the lower part of the leg being bent and twisted upon itself. He was carried senseless to his home ; and there being no physician to attend the sufferer, he lay with his crushed and mangled leg at right angles with his thigh. Weeks passed away; by degrees Nature assumed her sway; youth and previous health, with a good constitution, sustained the boy under the shock. So soon as it was deemed practicable, be was brought—in an open wagon without springs, and through a drenching rain—to a hospital in. the nearest city. There he was attacked with typhus fever, and again for weeks his life was despaired of. Suddenly one morning — a beautiful day in April — the doctor found his fever gone; but bis patient was almost dead from the terrible prostration that injury, protracted fever, poor attendance, and continued suffering had induced. God in his mercy saved him ! Life came back again, — strength, hope, and, above all, sleep. That gentle slumber, so different from the restless tossings of feverish somnolence, refreshed him ; and he began to look into the open air from his hospital window, and teel it as with life-giving power it fanned his pale and emaciated cheek. But the leg was still in its unnatural position, the bones were still through the flesh, the foot twisted sideways on the leg. For such a case as this the oldfashioned surgery would have had no remedy but amputation of the entire limb ; but modern conservative surgery tried another expedient. It sawed off the protruding extremities of the bones, twisted the leg to its place, put it in an apparatus to keep it the same length as the sound limb ; and to-day that boy stands, runs, and jumps, with legs of equal length,—a living monument to conservative surgery, and a witness to the truth of the description I have given.