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 MEDICINE

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MEDICINE

The classical Cipsarciin operation, as previously per- formed, consisted in opening but leaving in the uterus, whereupon death usually resulted from sepsis. Porro of I'avia in 1S75 performed it, therefore, with the suhseciuent removal of the uterus and ovaries, and thus obtained much more favourable results. With the perfection of antiseptic, or rather aseptic, treat- ment in modern times, the classical Ca'sarean opera- tion is bcinr; ap;ain performed. The total removal of the ovaries (ovariotomy) on account of their degenera- tion was performed for the first time in l!S09 by Ephraim MacDowell at Danville, Kentucky, the tech- nii|U(' of th<' operation being perfected liy llutcliinsonin l.S."i'.l, Spencer Wells ami Marion .Sims in lS7:i, Freund in IsTs, and t'zerny in LS70. Total extirpation of the uterus is performed especially in the case of cancer.

Suiyi-nj. — Of all the branches of medicine, surgery made the greatest progress, first in France and Eng- lanil, later also in (iermany. Side by side with the renowned surgeon-in-chief, of the Napoleonic armies, Jean Dominique Larry (1766-1842), we have, as the most versatile, Guillaume Dupuytren (1777-1835); next to him Philibert Joseph Roux (1780-1854; resec- tions), Jacques Lisf ranc ( 1 790-1847 ; exarticulations) , Alfred Armand Louise Marie Velpeau (1795-1868; treatment of hernia by injection of iodine), Jacques Mathurin Delpech (1777-1832; studies about phage- dsenas, gangrajna nosocomialis, tenotomy of the tendo Achillis), Jean Zul^nia Amussat (1796-1856; litho- tripsy), Auguste Vidal (1803-56; varicocele), Joseph Frangois Malgaigne (1806-65; fractures and disloca- tions), Auguste N^laton (1807-73 ; lithotomy), Ed ouard Chassaignac (1805-79; teasement linc^aire, drainage), and diaries Gabriel Pravaz (1791-1S53; orthopaedia, subcutaneous injection). Of English surgeons we must mention the brothers Bell, John (collateral circu- lation after ligation) and Charles (operative surgery) ; John Abernethy (1763-1831; ligation); James Syme (1799-1870; exarticulation of the hip joint); the famous surgeon, Astley Patson Cooper (1768-1841; textbook), and William Lawrence (1785-1867). In America we may note the chief surgeon of the War of Independence, John Collins Warren (1753-1815), Philipp Syng Physiek (1768-1837; new formations), Willard Parker (1800-84; cystotomy), and Frank Hastings Hamilton (1813-86; fractures and disloca- tions). Passing to the German surgeons let us men- tion first of all Vincenz von Kern of Vienna (1760- 1829; open treatment of wounds), his successor, Joseph von Wattman (1789-1866; lithotomy), and Franz Schuh (180.5-65; new formations, hernia); in Germany Louis Strohmayer (1804-76; myotomy, tenotomy, resections), Johann Friedrieh Dicffenbach (1794-1847; plastic operations), and Albert Theodor Middeldorpf (1824-68; galvanocautery).

A new epoch of progress begins in 1846 with the introduction of narcosis. The discoverer of the nar- cotic effect of ether is the American physician and chemist. Charles Jackson (1805-80), who, together with William Morton, made experiments upon his own person. The finst narcosis was undertaken in 1846 by Warren, and in the same year in London by Roliert Liston. Simpson first employed ether in an obstetric operation in 1847, but soon afterwards intro- duced into practice chloroform. In modern times a mixtvire of ether and chloroform is generally used. Besides general narcosis we must also mention local an.Tsthesis (evaporation of ether, injection of cocaine, bronioethy!). Of still greater importance than narco- sis was the treatment of wounds ■with carbolic acid by the Englishman .loseph Lister in 1867 (antiseptic treatment of wounds). In the course of time carbolic acid was replaced by other antiseptics, as .salicylic acid, iodoform etc., until finally the antiseptic method had to j-ield to the aseptic method (careful protection of the field of operation against infecting germs). A third achievement of modern times is operating

with an artificial absence of blood (operations on the extremities), mcntioneil for the first time by Friedrieh Esmarch in 1 873. Narcosis and antiseptics now make pos.sible a series of daring ojierations, before impo.ssi- ble, with e.sMMiti.-illy better chances of success. In the recent ile\elopnieut of German surgery Bernhard von Langenbeck (1810-87), known especially as a military surgeon, holds a leading position. Of his school we have among others Adolf von Bardeleben (1819-95), author of a textbook, Karl Thiersch, (1822-95; transplantation), Johann Neponiuk von Nassljaum (1829-90; transplantation of bones, ex- tension of nerves), Theodor von Billroth (1829-94; extirpation of the larynx and struma, resection of the pylorus) and Richard von Volkmann (1830-89; sur- gery of the joints). A very important means of locating foreign bodies (e. g. projectiles), in the human body, and for the examination of fractures is the R ont- gen rays discovered by William Karl Rijntgen in 1895 (Rontgen photography).

General biblioKriiphi.vil wi.rks: Tndri malicvs (Boston, 1S79- 1909); Index (■■ii'i'"ii'- "'/'" I >'■: " m >' M,.hi,„ (Berlin, 1842-).

Biographical; 'i' i i ll;i ■ n. r.n'^n- l.<x. ihr bervarragenden Arztc alter Zril. I l, 1 1, vols, Vienna, 1884-8); Pagel, Biogr. Lex. /tr, \ r:le des 19. Jahrh. (Berlin and

Vienna, 1901) Mm ! Si'Kkngel, Versuch einer prag- malisclirn <7,,m-, 1 i.^l.unde (5 vols., Halle, 1821-8), a

fundani. Ill il vmi: .;,( written from a partisan and Protestant point 1)1 I M ] ] M Mu, Lehrbueh dcr Gesch. der Medizin u. der epiderin /. .7<7i (3 vols., Jena, 1875-82); Puschmann,

Gesch. fl ' nhrriehtes (Leipzig, 1SS9); DieMedizinin

Wien wahrinil ,l,r lelztcn 100 Jahre (Vienna, 1884); Necbuh- ger-Pagel, Handbuch der Gesch. der Medizin (Jena, 1902-5), with rich international literature on all special subjects.

Leopold Senfelder. Medicine, Pastural. See Pastoral Medicine.

Medicine and Canon Law. — In the early centuries the practice of medicine by clerics, whether secular or regular, was not treated with disapproval by the Church, nor was it at all uncommon for them to devote a considerable part of their time to the medical avo- cation. Abuses, however, arose, and in the twelfth century ecclesiastical canons were framed which became more and more adverse to clerics practising the art of medicine. The "Corpus Juris Canonici" con- tains a decree prohibiting secular clerics and regulars from attending public lectures at the universities in medicine and law (cap. Nam magnopere, 3, Ne clerici aut monachi). The reason adduced is, lest through such sciences, spiritual men be again plunged into worldly cares. They were not hereby forbidden to make private studies in medicine or to teach it publicly. The Council of Tours (1163), in is.suing a similar prohibition, had especially in view monks who left their cloisters under pretext of attending univer- sity lectures, and in this were imitated by secular priests, who thus violated their obligation of residence. This law was extended by Honorius III to all clerics having ecclesiastical dignities. It is not binding, con- sequently, on the lower clergy, or on those clerics who pursue the sciences only as private studies. The penalty imposed for violation was excommunication ipsn facto.

As to the practice of medicine by clerics, the Fourth Council of the Lateran (1215) forbade its emplojinent when cutting or burning was involved. In the decree (c. Sententiam 9, Ne cler. vel mon.), it is said: "Let no subdeacon, deacon or priest exercise any art of medicine which involves cutting or burning '. This was especially prohibited to regulars (cap. tua nos, 19, De Homicid.), and they are also forbidden to exerci.se the science of medicine in any form (c. Ad aures, 7, de ipt. et qual.). This general prohibition is extended to all clerics, inasmuch as the art of medicine is of its nature secular and, moreover, involves the danger of incurring an irregularity (c. 9, X, V, 12). Canonists, however, generally hold that in case of necessity and where danger to life is not involved, clerics can practise