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 MEDICINE

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MEDICINE

of valuable special investigations we are indebted to Tilbury Fox (1836-79; impetigo contagiosa, dermatitis herpetiformis), and on lepra to D. C. Daniellssen (1S15-94) and Karl Wilhelm Boeck (ISOS- 75). In recent times we notice an endeavour to define more closely the course of the disease, a move- ment started by Paul Gerson Unna in Hamburg (b. 1850; histodermatology, histotherapy, bacteriol- ology of acne, eczema, impetigo, and favus).

Ophthalmnlogi/, as an independent branch, was established in Germany first at Vienna and Gottingen. In Vienna the anatomist Josef Barth (1755-1818) gave ophthalmological lectures as early as 1774, but two of his pupils, Johann Adam Schmidt (1759-1809; studies on iritis xerophthalmus and the lachrymal organs) and Georg Josef Beer (1763-1821; method of extraction of cataract, staphyloma, pannus), were the first to receive special professorsliips, the former in 1795 at the military academy and the latter at the university. Of Beer's school may be mentioned among others Konrad Johann Martin Langenbeck (1776- 1851; ceratonj-^xis, formation of the pupil, amaurosis, entropium), Karl Friedrieh von Grafe (1787-1840; teleangiectasis in the eye), Friedrieh Jager (1784r- 1871; upper cutting of the cornea in the operation for cataract), Johann Nepomuk Fischer (1787-1847; pyie- mic inflammation of the eye), and finally the most eminent English ojjhthalmologist of his time, William Mackenzie (1791-1868; choroiditis, accommodation, asthenopy, scotoma). A contemporary of Beer was Carl Hirnly of Gottingen (1772-1837; introduction of mydriatics). Among liis pupils were PViedrich August von Ammon (1799-1861; iritis) and Christian Ueorg Theodor Ruete (1810-67), who deserves credit chiefly for the introduction into practice of the specu- lum oculi. In Italy the progress of ophthalmology be- gins with Antonio Scarpa (1747-1832; staphyloma of the cornea). We must also mention Paolo Assalini (1759-1840; extraction of cataract, artificial pupil, Egyptian inflammation of the eye, 1811), Giovanni Battista Quadri, the first professor in Naples (1815), and likewise the professors of the clinics established at Padua and Pavia in 1819, Anton von Rosas (1719- 1855), a pupil of Beer, and Franz Flarer, (trichiasis, iritis, 1841). In England, besides Mackenzie, John Cunningham Saunders (1773-1810) of the German school, John Vetch (Egyptian inflammation of the eye, 1807), George James Guthrie (artificial pupil, ex- traction of cataract, ISIS), and William Lawrence (1785-1867), author of a textbook, deserve mention. In North America are George Frick of the Viennese school, author of a textbook (Baltimore, 1823), and Isaac Hays of Philadelphia. More than anywhere else was German influence felt in France, and here we must mention in the first place the pupils of Jiiger; Viktor Stober (1803-71), professor at Strasburg, and Julius Sichel of Paris (1802-58 ; choroiditis, glaucoma, cataract, staphyloma). Besides these we have Carron du Villards, a pupil of Scarpa and author of a textbook (1838), and Desmarres.

Helmholtz, .\rlt, and Grafe are regarded as the founders of modern ophthalmology. Hermann Lud- wig Ferdinand von Helmholtz (1821-94) opened an entirely new field for diagnosis by inventing the specu- lum oculi in 1851. Just as important is his theory of accommodation and sensation of colours. Ferdinand von Arlt of Vienna (1812-87), an eminent operator (trichiasis symblepharon) and teacher, founder of ophthalmopathology, recognized the true cause of myopia (elongation of the eye-ball) and introduced a chart of letters, later impro\ed by Snellen. Albrecht von Grafe (1828-70) of Berlin, a pupil of Arlt but in many respects outshining his master, is known princi- pally through his work on the connexion between brain and blinflness, on glaucoma, iridectomy, and linear extraction of the lens. Besides the above- mentioned Bonders we must call attention to .Mexan-

der Pagenstecher (1827-79; operation for cataract), Eduard Jiiger von Jaxthal (1818-84; letter chart), Karl Stellwag von Carion (1823-1904; defects of accommodation, innervation of the iris), Julius Jacob- son (1828-89; diphtheritis conjunctiva;), Otto Becker (1S2S-90; pathological topography of the eye, lens), Josef Ritter von Hasner (1819-92; forensic injury of the eye), Ludwig Mauthner (1840-94; optical defects of the eye, glaucoma), Albrecht Nagel (1833-95; strychnia in the case of amblyopia), Rudolf Berlin (1833-97; word-blmdness), Richard Forster (1825- 1902; perimeter, glaucoma, general diseases and maladies of the eye), William Bowman (1816-92; diseases of the lachrymal sac), George Critchett (1817- 82; iridodesis), Cornelius Agnevv, New York (1830-88; strabismus, paracentesis of the cornea, canthoplas- tics), the Russian Alexander Ivanoff (1836-80; inflammation of the retina and the optic nerves, glass eye), and Victor Felix Szokalski (1811-91 ; textbook). The introduction of local ana-sthesis by means of co- caine in 1884 by Rudolf Koller of Vienna, gre.atly facili- tated operation on the eye.

Obstetrics. — One of the most eminent obstetricians was Lukas Johann Boer of Vienna (1751-1835), who upon the request of the emperor studied in Paris and London from 1785 to 1788. He represented the so- called "waiting method", using instruments as rarely as possible, taught rational dietetics during pregnancy and confinement, and was the first to employ electric- ity for reviving asphyxiated children. Work of a similar nature was done by his contemporary, Wil- helm Josef Schmitt (1760-1S24; forceps operation in the longitudinal position, methods of examination, mechanism of parturition). In contradistinction to Boer, Friedrieh Benjamin 0.siander (1759-1822) represented the most extreme operative tendencies, while Adam Elias von Siebold (1775-1828) took a middle course. Mechanism of parturition and pely- cology was treated by Ferdinand Franz August von Ritgen (1787-1867) and Franz Karl von Nagele (1778-1851); physiology of pregnancy by Franz Ki- wisch von Rotterau (1814-52) and Johann Christian Gottfried von Jorg (1779-1856). The founder of the modern theory of labour pains is Justus Heinrich Wigand (1769-1817). A new period of development begins in 1847 with James Young Simpson (1811-70), the inventor of the English forceps and cranioclast; he was the first to employ narcosis (first with ether and in the same year also with chloroform) for women in labour, but at present this is done only in case of operations. Of far greater importance is the simul- taneous discovery of the cause of puerperal fever (pyaemia) by Ignaz Philipp Semmehveiss of Vienna (1818-65). He introduced the practice of disinfecting hands and instruments with a solution of chloride of lime, and thereby reduced the mortality of lying-in women from 992 to r27 per cent. This mo.st im- portant discovery that external infection causes puerperal fever was utilized in general practice only at a late period. Propositions similar to those of Sem- melweiss had been made as early as 1843 by Oliver Wendell Holmes of Boston, but they were not known in Europe. Important advances in modern times are marked by descriptions of the narrow pelvis by Gus- tav .\dolph Michajlis (1798-1848) and Karl Konrad Theodor Litzmann in 1S51, and of the oblique oval pelvis by Litzmann in 1853; artificial premature birth in the case of such a pelvis by Spiegelberg in 1870; the manual removal of the placenta in 1853, and prophy- laxis against blemorrhoea of the newly bom by Cred6 in 1884; axial traction forceps by Cha.ssagny in 1861; combined turning by Braxton Hicks in 1860-3; the mechanism of delivery by Leishman and Hodge in 1864; placenta praevia by Hofmeier in 1888; preg- nancy of the oviduct by Veit in 1884 ; extra-uterine pregnancy by Werth in 1887; asphyxia of the new- born by Schwartz in 1858 and by Schultze in 1864.