THE HISTORY OF Tl|E WSCOYERY OF

ANESTHESIA.

By Burnside Foster, M. D.

FIFTY YEARS OF SURGERY UNDER

ANESTHESIA.

By Theodore F. DeWitt, M. D.

Papers read at the Semi-Centennial Celebratipn»Qf. the Dis¬

covery of Anaesthesia, at the University-of Minnesota,
October i (5, 1896. ; . . ^.^r-
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REPRINT FROM i
NOTITHWKSTEKN IASCK.
 I

THE HISTORY OF THE DISCOVERY OF

ANAESTHESIA.*
By Burnside Foster, M. D.
St. Paul.

It is surely an inspiring and a stimulating custom

which prevails among cultivated persons of all
countries, and which prompts them to gather to¬
gether on the anniversaries of great events, to re¬
call the memories of the past, and to honor the
names of those who have achieved great deeds,
who have made great epochs in the history of the
world We love to celebrate the birthdays of our
great soldiers and statesmen; we love to celebrate
the anniversaries of great victories on the field of
battle; what then could be more fitting than that
we should be gathered together today to celebrate
the fiftieth anniversary of the victory of science
over pain, the fiftieth anniversary of the greatest
epoch in the history of medicine, the fiftieth birth¬
day of anaesthesia.
Fifty years ago today there assembled in the
Amphitheatre of the Massachusetts General Hos¬
pital in Boston an unusually large number of the
medical students and physicians of the city; for
it was public operation day, and it had been whis¬
pered abroad that a wonderful experiment was go¬
ing to be made; that a patient was to undergo a

* Read at the Semi-Centennial Celebration of the Discovery

of Anaesthesia, at the University of Minnesota, October 16,
1896.
 2

severe operation while in a state of artificially

produced sleep; sleep so profound that no pain
could disturb it. Can you not imagine the sensa¬
tion which such a rumor must have produced?
Fortunately we can, none of us, remember the
horrors of surgery before that time; when patients
were often dragged, shrieking with fear, to the
operating table, and there were strapped down to
undergo the torture of the surgeon’s knife. No
wonder, then, that there was an eager throng of
men to witness the beginning of the end of painful
surgery. I do not suppose, however, that a single
person of all who were present on that occasion,
most of whom are now dead, fully realized what
the events of that day were destined to bring forth,
to the glory of surgery and to the happiness of man¬
kind. In that same amphitheatre, every nook and
corner of which is familiar to me, for it was there
that I received mv first lessons in surgery, the
very sponge from which ether was first inhaled is
carefully preserved in a glass case, and is regarded
as the most precious historical relic of that
venerable institution. In that same amphitheatre
today there are gathered together, as we are here,
a great assemblage of physicians, students of med¬
icine and citizens, to rehearse the story of the birth
of anaesthesia, and to do honor to the memory of
those who gave it to the world, and who robbed
surgery of its greatest terror and maternity of its
pain.
Before describing what t^ok place in that his¬
torical old amphiteatre a half century ago today,
 3
it will, perhaps, be interesting to look backwards a
little farther and to scan somewhat hastily the
events which led up to this, the grandest discovery
in the whole history of medicine. From the very
earliest times of which we have any record men
sought to produce an insensibility which would
conquer pain. The accessible literature of the
ancient Greeks, the Egyptians, the Scythians, the
Assyrians, and even of the Chinese all records at¬
tempts, some of them more or less successful, to
dull sensibility by the use of drugs.
Mandragora, a drug now obsolete and its very
nature almost unknown, is mentioned in Grecian
literature as capable of producing an insensibility
which would permit even of a painless amputation.
It has been suggested that it was this very drug
which Shakespeare had in mind when he makes
Friar Laurence prescribe a sleeping draught for
Juliet, and tell her that
“Presently, through all thy veins, shall run
A cold and drowsy humour which shall seize
Each vital spirit; for no pulse shall keep
His natural progress, hut surcease to beat.
No warmth, no breath shall testify thou livest;
The roses in thy lips and cheeks shall fade
To paly ashes; thy eyes’ windows fall,
Like death when he shuts up the day of Life,
And in this borrowed likeness of shrunk Death
Thou shalt continue two and forty hours!’’
One of the early Italian surgeons, Theodorie,
who lived in Dante’s time, practised the inhalation
of some vapor from a sponge saturated with a
mixture of opium, hyoscyamus, hemlock and
lettuce to produce insensibility. It has also been
 4

recorded that an Italian of the thirteenth century

produced an aqua ardens from red wine and com¬
mon salt, which, being inhaled, would induce a
heavy sleep. We may also read in ancient medical
writings of attempts to produce local insensibility
by mechanical means, such as the compression of
nerves, and by freezing the surface of the body.
It was not, however, until the end of the last
century that the first suggestion of modern anaes¬
thesia was made by the experiments of Humphrey
Davy, in England, with nitrous oxide gas. The
chemical and physiological properties of sulphuric
ether began to be somewhat vaguely known at
about the same time.
Another half century, however, was destined to
elapse before any practical results were achieved
towards the accomplishment of that for which
many earnest workers had striven for many cen¬
turies. There are four names which must always
be associated with the final demonstration of the
safety and practicability of surgical anaesthesia:
Horace Wells, of Hartford, Conn., Crawford W.
Long, of Georgia, Charles Thomas Jackson and
William Thomas Green Morton, both of Boston.
It is not my purpose, nor indeed would it profit us
even if I had the time, to enter into the details of
that bitter controversy between these four men as
to which of them was entitled to the honor of be¬
ing the discoverer of the anaesthetic properties of
ether. I will content myself with stating that,
while a careful study of the history of the subject
proves beyond a doubt that Crawford Long per-
 5
formed the first operations upon patients rendered
insensible bv ether narcosis, the honor of the first
public demonstration of the safety and practical
value of the use of ether in surgery belongs to
Morton! It was Morton who gave it to the world!
There is no doubt that Dr. Long, during the
years 1842, 1843 an(i 1844, performed a number
of operations under ether, but as he lived in a
part of the country remote from medical journals
and societies, and as he did not seem at first to
fully appreciate the significance and the impor¬
tance of his observations and experience,he failed
to report or to record his knowledge until some
years after Morton, who had never heard of Long
or his work, had publicly proven that operations
could be painlessly performed upon patients who
had been rendered insensible by inhaling ether.
William Thomas Green Morton was born in
Worcester county, Massachusetts, August 19, 1819,
and spent his early years upon a typical New Eng¬
land farm, receiving his preliminary education at
the famous old Leicester Academy. At the age of
seventeen he went to Boston to earn his living,
but having from his boyhood shown a great apti¬
tude for scientific pursuits, he found commercial
life uncongenial, and determined to study dentis¬
try, which was then just attaining the dignity of
an important branch of surgery, and becoming
recognized as a respected profession. He went
to Baltimore, where the first dental college in
America had recently been established, and, after
graduating, he returned to Boston, where he speed-
 6

i 1 v acquired an extensive and a lucrative practice.

His tremendous energy and capacity for work was
shown by the fact that, besides attending to a large
office practice, he found time to attend the lectures
at the Harvard Medical School, for he was desirous
of obtaining the degree of Doctor of Medicine.
From the beginning of his professional life Morton
was possessed with the idea that he was destined
to discover some method by which insensibility to
pain might be produced. He had experimented
somewhat with nitrous oxide gas, the properties of
which he had learned from Dr. Horace Wells, with
whom he had been for a time associated in the
practice of his profession. In a conversation with
Dr. Jackson, with whom his medical studies had
brought him into somewhat intimate personal re¬
lations, in regard to the manufacture of nitrous
oxide, Morton received the suggestion that sul¬
phuric ether might accomplish the same purpose.
He immediately began to experiment with it upon
animals, upon such persons as he could persuade
to submit to it, and upon himself. In spite of
many discouragements and much ridicule from
those who knew of his attempts, he persisted pa¬
tiently, until finally he became satisfied that he
could produce safely a brief period of insensibility
sufficient for the ordinary operations of dentistry.
Then came the question of its use in surgery.
Fortunately Morton counted among his warm
friends Henry J. Bigelow, who was about his own
age, and who afterwards became, as you all know,
one of the greatest surgeons our country or oth-
 7

er country has ever produced. Dr. Bigelow

had faith in Morton’s discovery, and determined
to assist him in obtaining an opportunity to give it
a public trial. Finally, on the fourteenth of Oc¬
tober, 1846, Dr. Morton received a note from the
house surgeon of the Massachusetts General Hos¬
pital, written at the request of Dr. J. C. Warren,
then senior surgeon, inviting him to be present on
the following Friday morning, and to administer
to a patient, then to be operated upon, “the prep¬
aration which he had invented to diminish the
sensibility to pain.” No wonder that his nights
were sleepless, and his days were anxious during
the brief period before the day of trial. Remem¬
ber, he was but twenty-seven years of age, and
comparatively unknown, and he was to appear
before the most distinguished and experienced
surgeons of that time to demonstrate something
which seemed to them an impossibility. On the
morning of that memorable day, the sixteenth of
October, 1846, there were assembled, as I have
said, an unusually large number of spectators in
the Amphitheatre. Of all who were present on
that occasion but three are believed to be now
living. As the hour for the operation approached
the excitement became intense, and even the sur¬
geons seemed to share it. Ten o’clock, the hour
named, had passed, and still Dr. Morton had not
arrived. Slowly the minutes, five, ten, fifteen,
dragged on, and then Dr. Warren, taking out his
watch and smiling somewhat sarcastically, said:
“Gentlemen, as Dr. Morton is not present, perhaps
 8

it will be as well to proceed with the operation in

the usual way.” The patient, a young man with
a tumor of the neck, was brought in and prepared,
when, at the last moment, Dr. Morton, who had
been delayed in his final preparations, appeared,
somewhat out of breath, but cool and self pos¬
sessed, and ready to proceed with his demonstra¬
tion. Rapidly he proceeded to pour out the fluid,
whose vapor he directed the patient to inhale, as
it was held close to his face. Not a word was
spoken. No sound broke the silence of that room,
save the deep breathing of the patient and the
restless movements of that eager and excited throng
of spectators. Presently that death like stillness
was broken by the quiet voice of Dr. Morton, who
turned to Dr. Warren and said: “Your patient is
ready, doctor,” There lay the patient, apparently
only in a heavy sleep; but there was probably no
one present, save Morton himself, who did not
expect to see him start up with a cry of pain at the
first incision of the surgeon’s knife. But no!
Swiftly and surely the knife has cut through the
skin, the blood is flowing freely, the tumor is
skillfully dissected out, the vessels ligated, the
wound closed with sutures, dressed and bandaged.
Not a sound from the patient, who is still lying in
a painless sleep! The change of sentiment from
incredulity and suspicious doubt, to belief and ad¬
miration, which took place in the minds of all those
who were present that day, was well voiced by Dr.
Warren,' who exclaimed, as the patient was being
carried away: “Gentlemen, this is no humbug!”
 9
That day’s events recall to my mind those lines of
Goldsmith, doubtless familiar to you all, in which,
describing the preacher of “The Deserted Village,”
he says:
“Truth ftom his lips prevailed with double sway,
And fools who came to scoff remained to pray!’’
What you have just listened to is believed to be
an accurate account of what took place at the first
public demonstration of anaesthesia. The account
is taken partly from the statements of Dr. Morton’s
widow and partly from the testimony of one of the
three living witnesses of that great event.
There is little to say further concerning the disr
covery of anaesthesia, which, from that day, be¬
came an established fact. Chloroform was intro¬
duced some two years later by Sir James Simpson,
in England, and being somewhat pleasanter to in¬
hale, is still preferred for short operations and for
producing anaesthesia during labor, by many sur¬
geons, although there is a certain element of danger
connected with its administration, and it is not
quite so safe for general use as ether.
It is undoubtedly true that Dr. Jackson, who was
an eminent chemist, was familiar with the prop¬
erties of sulphuric ether, as numerous other per¬
sons were, and had inhaled its vapors himself, be¬
fore Morton had ever used it, but the evidence
seems to show that he had not sufficiently the
courage of his convictions to risk his professional
reputation by publicly administering it to a human
being. Morton, however, having satisfied himself
of its safety and efficiency by numerous private
trials, undertook this task, solely upon his own re¬
sponsibility, risking not only the ridicule and
abuse, but even the greater danger of criminal
prosecution which a failure, involving injury or
death to the patient, might have brought upon him.
It seems to me that the revival, at this time, of
the details of that unfortunate and bitter contro-
versary between Jackson and Morton can add no
lustre to the fame of either. 1 would rather that
it should lie buried in their graves, and that for
this priceless boon, for which mankind is in some
measure indebted to them both, a grateful poster¬
ity should give to each his share of gratitude and
glory. VVe who are now so accustomed to pain¬
less surgery that anaesthesia has long since ceased
to excite even our wonder, can scarcely realize the
bitter opposition, the obstinate hostility which for
the first few years of its existence opposed its
general use. Even the pulpit hurled powerful and
eloquent anathemas against its advocates, declar¬
ing that pain, and particularly the pain of child
bed, was the dispensation of a Divine Providence,
and that it was sacrilege, an insult to the Almigh¬
ty, to make this attempt at interference with His
arrangements; and there were not wanting quota¬
tions from Scripture to sustain this view. But
has not this ever been the history of each great
step in the progress of the world? And, indeed,
a wise conservatism, which carefully scrutinizes
every new and unprecedented procedure, is es¬
pecially needful in medicine and surgery, to pro¬
tect humanity from ignorant and dangerous ex-
perimentation. It is wise counsel to the young
physician, and indeed to physicians in geneial,
which is found in those familiar lines of Pope:

“ Be not the first by whom the new is tried;

Nor yet the last to lay the old aside.”

Neither Morton nor Jackson ever derived any

pecuniary profit from their connection with the
discovery of ether anaesthesia, although they were
both honored by many scientific academies and
societies and received the medals and decorations
of numerous foreign orders and governments.
Morton died a poor man in 1868; Jackson be¬
came insane and died in 1880.
Upon the base of the dome of the new chamber
of the House of Representatives in the Boston
State House are inscribed the names of the select¬
ed fifty-three of Massachusetts’ most distinguished
citizens. These names have been selected in
such a way that each shall either mark an epoch,
or designate a man who has turned the course of
events. There may be read the name of William
Thomas Green Morton.
Above his grave in Mt. Auburn Cemetery
stands a beautiful monument erected shortly after
his death by physicians and citizens of Boston.
Upon it is this inscription, written by the late Dr.
Jacob Bigelow: “Inventor and revealer of anaes¬
thetic inhalation. By whom pain in surgery was
averted and annulled. Before whom, in all time,
surgery was agony. Since whom science has con¬
trolled pain.”
 FIFTY YEARS OF SURGERY UNDER
ANAESTHESIA.*

By Theodore F. DeWitt, M. D.

St. Paul.

Mr. Chairman, Ladies and Gentlemen:

The committee on arrangements have kindly in¬
vited me to address you briefly on the subject of
“Fifty Years Progress in Surgery.” This prog¬
ress, which has been unparalleled in the history of
surgery, has been mainly due to the introduction
of anaesthesia and to the recognition of the para¬
sitic theory of disease. Few of us, perhaps, real¬
ize how great the advance in our art during the
last half century has been.
Let us consider for a moment the status of sur¬
gery prior to 1846. The resources of the surgeon
for diagnosis or treatment were not what they are
today. He did not use the thermometer, micro¬
scope, laryngoscope or hypodermic, and the oph¬
thalmoscope had not been invented. He knew
nothing of the cause of inflammation, and, lastly,
he had no anaesthetic. Owing to the intense pain
and frightful mortality attending surgical proced¬
ures in those pre-anaesthetic and pre antiseptic
days, surgeons confined themselves principally to
operations of necessity, viz: ligations of arteries,

*Read at the Celebration of the Semi Centennial Anni¬

versary of the Discovery of Anaesthesia, at the University of
Minnesota, October 16, 1896.
 i3
amputations, removal of growths from the surface,
cutting for stone, etc.
The operations were so fashioned as to limit the
expenditure of time, and thus the suffering of the
patient, to the greatest possible extent. Compli¬
cated, elaborate methods of operating, such as are
now properly in vogue, would have been out of
place then.
One can but feel the highest admiration for those
who had the courage to be surgeons in those days.
Consider the fortitude required to perform a diffi¬
cult operation upon a patient shrieking with agony
and struggling to free himself from the assistants.
The surgeons of those days, by constant practice
upon the cadaver, acquired a degree of dexterity,
finish and brilliancy in the art of operating prob¬
ably never seen by us, the principal necessity for
such expertness having passed away with the dis¬
covery of anaesthesia. Thus, Liston would often
amputate the thigh with one hand, controlling the
hemorrhage by pressure on the femoral with the
other; Willard Parker, in ligation of the femoral,
would lay this artery bare with one stroke of the
knife. James R. YVood frequently amputated the
thigh in ten seconds.
After the discovery of anaesthesia it became the
practice to plan operations more with regard
to the safety and usefulness of the procedure,
rapidity becoming of secondary importance. Sur¬
geons became more deliberate, more exact and
more thorough in their work. So-called “con¬
servative surgery” soon followed, largely through
the influence of William Fergurson. This term was
applied principally to the avoidance of amputa¬
tion by resection and to the removal of the least
possible in diseased bone. Great advance in the
diagnosis and treatment of fractures and disloca¬
tions also followed the discovery of anaesthesia.
The muscles of the patient being relaxed by the
anaesthetic, it became possible to more accurately
diagnose the condition and to replace more ex¬
actly the dislocated or fractured bones.
Formerly it was the custom to reduce the dislo¬
cations by extension, a very crude and painful pro¬
cedure; now reduction is frequently effected by
manipulation. Humphrey very graphically de¬
scribes an attempt he saw made fifty years ago by
one of England’s most famous surgeons to reduce
a dislocated hip. The patient was fastened to the
table, bled, and dosed with tartar emetic to relax
th$ muscles. Ropes through pulleys were then
attached to the patient’s thigh, and an attempt,
lasting several hours, was made to pull the bone
into place by brute force. Finally the bone was
fractured, the patient exhausted and the attempt
was abandoned. This patient soon after died from
the effects of this procedure. As he (Humphrey)
truly remarks, “A modern surgeon would have re¬
duced the dislocation by manipulation, painlessly
and in a few minutes.”
Early in the “fifties” instruments designed to aid
in diagnosis, such as the ophthalmoscope and the
stethoscope, began to be used, and materially
aided in progress. Although surgery had now made
 i5
rapid strides, it was not until the scientist with his
microscope came upon the field that anything ap¬
proaching modern surgery was attained. Pain had
been abolished, methods were more accurate and
more conservative, but the mortality had not ma¬
terially lessened. Deaths from pyaemia, erysipelas,
hospital gangrene, were still the rule. It had al¬
ways been supposed that inflammation and repair
were part of the same process; that inflammation,
indeed, was necessary for repair to take place.
This was the understanding until it was shown that
inflammation was due to a microorganism, in fact,
that inflammation was a specific disease, and re¬
tarded or hindered repair.
Pasteur, of France, discovered that putrefaction
was caused by microorganisms. The immortal
Lister applied this knowledge to wound treatment.
Fie believed that the processes taking place in an
inflamed wound were akin to decomposition and
were due to microorganisms existing in the air.
He introduced the use of carbolic spray to kill the
germs in the air and used antiseptics and antisep¬
tic dressings to further prevent their entrance into
the wounds. Upon trial it was at once seen that
an enormous improvement in wound treatment
had taken place, but Lister’s theory lacked scien¬
tific confirmation. The painstaking research of
Koch soon after confirmed the Listerian theory.
By means of solid culture methods he was able
to isolate the various specific organisms of the in¬
flammatory processes and to prove by scientific
demonstration that they were the cause of inflam-
nation. Bv the combined labor of surgeons and
pathologists all over the world knowledge of the
relations of germs to disease rap idly accumulated.
This led to many changes in the methods of carry¬
ing out antiseptic surgery, until now they are quite
different from fifteen or twenty years ago, though
the principles are the same. To the immortal
Lister is due all the praise. Thus it was soon
shown that the germs in the air were in smaller
quantity and less likely to do harm than the germs
on the hands of the surgeons, on his instruments,
and upon the field of operation; and furthermore,
that the carbolic spray did not kill those that were
in the air. Accordingly the spray was abandoned
and more attention given to the removal of germs
from the skin and instruments by thorough wash¬
ing and by the use of antiseptics. After a few
years it was found that by a thorough washing of
the hands and operative field all microorganisms
could practically be removed, and that by the airj
of heat the instruments could be rendered germ
free. The use of antiseptics, therefore, became
less common, especially as it was found that the
antiseptics were somewhat irritating to the wound.
And thus was inaugurated so called “aseptic sur¬
gery.”
The knowledge possessed of the nature of repair
and inflammation after the inauguration of antisep¬
sis gave an unparalleled impetus to surgery. Sur:
geons formerly believing that inflammation and
suppuration were a necessary sequence of opera¬
tive procedures, naturally refrained from interfer-
 i7
ing with parts of the body, the inflammation of
which would cause certain death. Thus they
feared to attack the serous cavities or the organs
contained therein, contenting themselves, with rare
exceptions, with operating upon the surface of the
body. When it was found that inflammation was
due to germs which could be excluded from the
field of operation, all was revolutionized and so
modern surgery was born.
Fifty years ago wounds were closed by adhesive
plaster or sutures, and without drainage. Lint
saturated in oils was then usually applied to the
wound. Liston used water dressings. Others al¬
lowed the wound to remain open and heal by
“scabbing” as it was called. Drainage tubes were
introduced by Chassaignac in i860, and gradually
came into general use.
No further advance of any importance took
place until the introduction of antisepsis. Profuse
suppuration was the rule. Surgeons, indeed, con¬
sidered a discharge of thick, creamy pus an excel¬
lent indication that the wound was doing well and
styled the inflammatory product “laudable pus.”
Pyaemia, erysipelas and hospital gangrene were
extremely common and the mortality proportion¬
ately high.
The mortality following major amputations was,
in the pre-Listerian days, from thirty to fifty per
cent.; now it is less than ten per cent. The death
rate of compound fractures was, formerly, fifty per
cent, Dennis has recently reported 1,000 cases,
treated by himself, with a mortality from inflam-
 18

matory disease of one-seventh of one per cent.

Since the introduction of antisepsis all has been
changed. It is now possible to make a clean
wound heal without inflammation, and the inflam¬
matory diseases are almost unknown. Indeed,
hospital gangrene, so long the terror of the sur¬
geon, is now extinct. In the last few years great
progress has been made in the manner of closing
wounds, which are now united in layers, muscle to
muscle, fascia to fascia, nerve to nerve, etc., in
such a manner as to preserve as far as possible the
functions of the part.

When it is found impossible to close the wound

for lack of sufficient integument, grafts of skin
from other parts of the body are used to cover the
wound. Reverdin, in 1869, introduced the method
of transplanting small pieces of skin to granulating
surfaces, such as ulcers, but it was not until recent
years that the method of Thiersch, in which strips
of the upper layers of the skin are employed, that
it became possible to cover recent wounds with
grafts. The nature of other parasitic diseases was
also shown by the aid of the microscope. Thus
tuberculosis, so long misunderstood, having been
considered a constitutional malady practically im¬
possible to eradicate, was now shown to be a dis¬
ease due to microorganisms, and in its early stages
a local affection which could be successfully at¬
tacked.

Having taken this brief survey of the progress

of surgery in a genejal way, it may be of interest
 19

to trace its evolution more at length in certain of

its more important divisions.
Before the discovery of anaesthesia, transfixion
methods were usually employed in amputation on
account of the greater rapidity with which they
could be performed. When the factor of pain was
eliminated various “mixed flap” operations came
in use, designed to furnish a better stump. Later,
“conservative surgery” demanded that the limb be
removed at the lowest possible point, and this was
the practice until very recently. Modern surgeons
amputate at whatever point is best for an artificial
limb.
Surgeons formerly operated upon the scalp and
occasionally removed fractured bone with a tre¬
phine, Dut they left the contents of the cranium
alone. About the time that antiseptic surgery was
being introduced great advances had been made in
the physiology of the nervous system as applied to
cerebral localization. It had become possible to lo¬
cate cerebral lesions quite accurately,and antisepsis
made it possible to attack the disease successfully.
Between 1876 and 1879 MacEwen, of Glasgow,
correctly located and successfully operated upon
a cerebral abscess and a cerebral tumor. Both
patients recovered. Victor Horsley in 1887 re¬
ported ten such cases. Since that time quite a
large number of cases have appeared in literature.
In modern operations the trephine has largely
given way to the chisel and saw, and instead of
removing buttons of bone, it is more common to
reflect flaps of bone and soft parts, and subse-
 20

quently to replace and suture the flaps. This is

called the “trap door” or osteo plastic method, and
gives better exposure with less damage to the parts.
Surgeons in preantiseptic days occasionally re¬
moved pieces of fractured bone from the spine,
but left the spinal contents alone. Now fractures
and dislocations are operated upon in selected
cases, and the membranes and cord attacked for
hemorrhage, tumors, or pus. Horsley removed
the first tumor of the cord in 1887. Surgeons of
former times operated upon the chest wall, but
feared to go to greater depths. Now the pleural
and pericardial cavities are opened and drained,
and occasionally the lung is attacked. Wounds
of the heart have been successfully stitched up in
the dog, and it has been proposed to attempt the
same in wounds of this organ in man.
Formerly operators seldom went deeper than the
walls of the abdominal cavity, and when they did
go farther the result was usually fatal. Now the
abdominal cavity is opened with impunity. Every
organ contained therein can be operated upon to
the extent of its physiological function. In oper¬
ations upon the viscera above the pelvic brim since
antisepsis, Kocher, Treves, Bull, Senn, Murphy
and McBurney have contributed most largely to
the advance. Resections of portions of the bow¬
els for disease have become quite common, as have
anastomoses between various portions of the hollow
viscera. Thanks to the labors of Treves, Mac-
Burney, Murphy and others, the nature of the in¬
flammatory diseases of the appendix which so long
puzzled pathologists and surgeons is now under¬
stood, and this frequent disease is successfully at¬
tacked. The kidney is now incised or removed
for stone or disease. The spleen is occasionally
removed, its blood-forming functions being sup¬
plied by the lymphatic tissues elsewhere.
Strange as it may seem, mortality following op¬
erations for strangulated hernia has not been ma¬
terially decreased by antiseptic methods. This is
because the sac of a strangulated hernia is already
infected by the passage of the germs through the
walls of the constricted bowel. Between the dis¬
covery of anaesthesia and the antiseptic era the
radical operation for hernia was performed by the
subcutaneous methods, such as Wood’s and Span-
ton’s. After antisepsis became established the
open method which had long before been aban¬
doned owing to the frightful mortality from sepsis,
was revived. While the mortality fell to practi¬
cally nil, relapses were the rule and surgeons be¬
came discouraged. Bassini, of Italy, about eight
years ago devised an operation which is now uni¬
versally admitted to be a success. Dr. Halstead,
of Baltimore, independently devised an operation
which is nearly identical with that of Bassini.
Tumors of the uterus and its appendages,
formerly seldom attacked, and then with startling
fatality, are now removed with little danger. The
pathology of collections of pus in and about the
tubes was, until the last fifteen years, misunder¬
stood. It was supposed that the collection of pus
was a cellulitis between the layers of the broad
ligaments. The fact that it was not understood
prevented proper treatment. Through the work
of Tait and others its nature was explained, and it
was successfully treated by laparotomy. This
treatment was a distinct advance; but still the
mortality has remained very high Progressive
gynaecologists are now operating through the va¬
gina, with a greatly diminished mortality.
Antisepsis has been a great aid to the surgeon
in the ligation of arteries. Much of the fatal sec¬
ondary hemorrhage of old times was due to sepsis
and improper healing of the wound. The use of
the aseptic absorbable ligature has also contrib¬
uted in no small degree to the greater safety of
these operations today.
In 1892 Halstead, of Baltimore, first tied the
subclavian artery in its first portion for an aneurism
of the subclavian and axillary arteries. He hid
noticed that the records of preceding unsuccessful
attempts showed that secondary hemorrhage usu¬
ally occurred from the distal side of the ligature,
and he thought this was probably due to the break¬
ing down of the aneurism. Accordingly he tied
the axillary and the subclavian and its branches,
resected the clavicle and dissected out the aneur¬
ism. This was one of the greatest triumphs of
surgery ever recorded, and well illustrates the ad¬
vance that has taken place.
The treatment of varicose veins of the extremi¬
ties has also undergone a change. Formerly they
were not often operated upon, from fear of sepsis.
After antisepsis was introduced, multiple ligation
and dissection methods were in vogue. These
methods were tedious and usually unsuccessful.
Trendelenberg found that by ligation of the ter¬
minations of the internal and external saphenous
veins the disease could be cured. The evolution
that has taken place in the treatment of diseases
and injuries of the bone is also interesting. Thus
tuberculosis was first treated by incision; later by
amputation; still later the influence of conserva¬
tive surgery caused resection to be substituted for
amputation. Now, atypical resections and arthrec-
tomies, taking away the diseased structures and
no more, are preferred. Ununited or badly united
fractures are now operated upon by an open
wound with great succe. s. This in the preanti¬
septic period was, of course, not attempted.
The better understanding of the pathology of
cancer, together with the use of anaesthetics and
antiseptics, has revolutionized the treatment of this
disease. We are able to operate earlier than were
our forefathers, we have been taught by the micro¬
scope what surrounding structures should be re¬
moved with the morbid growth, and we are able to
take as much time as we like and thus be more thor¬
ough,and lastly we care very little how large a wound
we make. This is well illustrated by comparing
the old and new operation for cancer of the breast.
While formerly only the breast, and perhaps not
all of that, was removed with the growth, now the
breast, the skin covering it, the pectoral fascia,
pectoral muscles and the fat and glands of the ax-
i la are all removed. By this method, for which
 24

we are principally indebted to Halstead, the per¬

centage of recurrences has fallen from 100 per
cent, to probably 50 per cent, or less.
For many vears operations upon goitre were
considered unjustifiable, owing to the attendant
frightful mortality from hemorrhage and sepsis.
In 1862 Gross voiced the sentiment of the profes¬
sion when he called it “horrid butchery.” In 1871
Wm. Warren Green called the attention of the
profession to an improved plan of operating. His
method consisted in well exposing the tumor with¬
out cutting into it; then rapid enucleation with the
fingers until the pedicle composed of the four thy¬
roid arteries was reached. The pedicle was then
transfixed and tied, and the tumor removed. He
reported two successful cases, and subsequently
operated upon several others successfully, in this
country and in Europe. Although this method is
an improvemeht upon the old, still it required con¬
summate boldness and dexterity to successfully
follow it.
Recent pathology has taught us that these tumors
are encapsulated growths, the gland tissue proper
surrounding the growth in a thin layer. If an in¬
cision is made through this thin glandular tissue to
the tumor proper, it can then be rapidly shelled
out and with very little hemorrhage. The gland
is allowed to remain, doing away with the danger
of myxuedema, which frequently follows the extir¬
pation of this gland. By carefully studying the
history of surgery for the past twenty five years
one can see that while.the phenomenal advance
 25
has been due in some measure to improved tech¬
nique, it has been mainly due to a better>knowledge
of physiology, pathology and bacteriology. These
branches of our science have taught us when to be
conservative, as in the treatment of tuberculosis
of the joints, and when to be prompt and radical,
as in the treatment of appendicitis or of extra-
uterine pregnancy. We have learned to pay higher
regard to physiological functions. While formerly
the minimum amount of pain and danger only was
considered, now we endeavor to preserve the func¬
tions of the part, doing as little damage as possible.
We have seen that recent advances in surgery
have been due to a greater knowledge of various
sciences, and we must not lose sight of the fact
that this increase in knowledge has been made pos¬
sible by better facilities for learning. Our schools
and laboratories have never been equipped as they
are now. Never have so much time and labor
been expended upon the education of the surgeon.
This augurs well for the future of.