SURGEBY. 717 SURGERY. incorrect, however, to assume that surgery con- sists entirely or even in great part in the elabo- ration of methods of treatment; the pathological processes so treated demand and receive their pro[)er degree of investigation and study. Up to the time of Hunter {1728-93) surgery, and indeed medicine, were based in their practice almost entirely upon tradition and dogma. Hun- ter, by his labors in the direction of anatomy and physiology, lifted medicine from the ob- scurity of philosophical doctrine to the firm foundation of facts and imparted an impulse th.at is still felt and is still in evidence in the meth- ods of research employed to-day in the fields of comparative pathology .and experimental medi- cine which promise most for the advancement of the medical and allied sciences. With Hun- ter's death, however, ended the active prosecu- tion of original investigation; and although the high position of English surgery at that time was preserved by the clinical and other work of Hunter's successors, notable among whom are Cliarles Bell, Astley Cooper, Abernethy, and Jen- ner, the laboratory methods emplo_yed by him were largely abandoned and have onlj' within relatively few years been revived. From Hun- ter's period to the introduction of anoesthesia there is no remarkable fact in the development of surgery. During this time the eflforts of sur- geons seem to have been directed chiefly to the perfection of the bedside methods and the in- fluence of the profession in America began to make itself felt. Ephraim McDowell, a native of Kentucky and trained under Bell in Scotland, in 1809 first successfully opened the abdominal cavity and removed an ovarian cyst, thus estab- lishing forever one of the most beneficial of op- erations. A little later Valentine Mott of New York successfully applied ligatures to some of the largest arteries, for the relief of aneurism, and demonstrated the curability of this disease in jiositions in which it had previouslj- been in- variably fatal. The introduction of general anses- thesia (q.v.) in 1846 by Warren in the Massa- chusetts General Hospital marks the greatest stride in the progress of surgery up to that time. This pro])erty of ether was discovered inde- pendently by Long of Georgia and Morton of Boston, but it remained for A'arren to popularize it by making use of it publicly, repeatedly and with success. A year later Simpson of Edinburgh introduced chloroform. The propulsion to the practice of surgery given by the employment of general anoesthesia during operations can hardly be exaggerated. Before that time operative treatment of disease was limited in its application to lesions correctible by coarse methods and in briefest time. Human beings, surgeons and pa- tients, could not endure the pain of protracted operations, nor could sufficient freedom from struggling be secured to make refined dissections possible. Under the influence of anaesthesia quiet was obtained and the necessity for great speed was greatly diminished, so that new operations were soon planned, new regions invaded, and de- tailed procedures devised and new and better results achieved. Even after the introduction of anoesthesia. however, operations and all open injuries continued to be looked upon with dread, for they were almost invariably followed by one or the other of the infectious wound diseases, and deaths from septicirmia, pya'mia, tetanus, hospital gangrene, etc., w'ere so common that the mortality after even trifling operations was not small. Pasteur then began the series of observation3 and experiments that finally enabled him to in- dicate the causes fii'st of fermentation and then of wound diseases, and to identify some of the agents as members of the class of beings known collectively as bacteria. Lister seized these facts and applied them in surgery. His notion was tliat tlic infectious wound diseases were due to the deposit ujion the raw surface exposed in open injuries 'of the bacteria floating in the air, and he therefore aimed at the sterilization of the air in the neighborhood of wounds during the course of operations, and at the exclusion of air from wounds during healing. The first was attempted by saturating the air in contact with wound surfaces with the vapor of carbolic acid, and from time to time flooding wounds with solutions of the same substance or of corrosive sublimate; the second object was accomplished by covering wounds during repair with dressings impreg- nated with the same antiseptics. The efl'ect w-as apparent at once in the results of operations, in lowered mortality, and in recov- eries with fewer complications. This plan of treatment, properly called antiseptic, was found, however, to possess serious dangers to both sur- geon and patient in the risk of poisoning by the powerful germicides necessarily employed, and the idea began to develop that it was more logical to prevent the inoculation of wounds by bacteria from any source than to attempt their destruction after they had gained entrance. IMeanwhile the rapid growth of the science of bacteriology had reached a development that led to the identification of the bacteria causing the common wound diseases and had made surgeons familiar with their distribution, the modes of growth within and outside of the body, and the means of destroying them. The adoption of methods of conducting operations and treating wounds whose purpose was absolutely to pre- vent the inoculation of denuded surfaces and tissues by bacteria followed naturally, and now has become universal; and the methods have be- come so perfect that wound diseases due to bac- teria are rare except after accidental injuries, and some of the most serious of them have vir- tiiall_y ceased to exist. Few men of the present generation of surgeons have seen hospital gan- grene, for example, a disease which has been the cause of thousands of deaths. The possibilities suggested by the relative free- dom from danger with which o]ierations were carried out were quickly appreciated by the medical profession, and the cure of disease by operative measures was soon extended to regions in which, previously, operations had been under- taken with the greatest misgiving, or not at all. In consequence, to-day the surgeon opens the cranial and spinal cavities, the thorax, the abdo- nien. and the joints with perfect confidence th.at no ill will result from the operation itself; and the benefits that have tluis been secured in the relief of lesions of the viscera contained in these cavities cannot be adequately estimated. While the attention of the surgeons during the last two or three decades has been in great part directed toward the perfection of operative technique, progress in other lines has also pone on. and during this period the knowledge of the pathol- ogy of many surgical affections has been great-
