The introduction of the clinical thermometer revolutionised clinical observation and practical therapeutics. By its means we are enabled to observe accurately the course of a fever, and to control it to a great extent by medicines and methods whose effects can be carefully registered. In another respect medicine has made progress by the more accurate diagnosis of disease. We can now decide when the physician may and ought to give place to the surgeon; the physician determines when his medical treatment has reached its limit, and calls in the aid of a surgeon to deal with such forms of disease as do not come strictly within his province.

One of the faults found with medical practice in London at the beginning of the century by a noted French doctor was, that there was a great tendency to specialism, and hospitals for special diseases. However much of a disadvantage this may be, the advantages to the community are great, as putting at their command the services of persons skilled by long-continued study and experience in special complaints.

Great as has been the advance in medicine, the progress in surgery far outshines it. Previous to the introduction of anæsthetics, practically the methods and results of our ancestors were unaltered. Surgery was limited by the deftness of the operator and the endurance of the patient. Dirt, bad ventilation, and worse nursing made the surgical wards of hospitals hotbeds of erysipelas and gangrene, and the consequent mortality was very great.

In the year 1800 Sir Humphry Davy made experiments with nitrous oxide gas (laughing gas) in the production of insensibility, and advised its employment in surgery, but it was not much used. Faraday, in 1818, made similar experiments with sulphuric ether. Several physicians, especially in America, pursued these experiments, but with little good results, until, in 1844, a surgeon-dentist named Wells, in Hartford, Connecticut, applied ether in the extraction of teeth. It was Dr. Morton, however, in Boston, U.S.A., who first applied it, in 1846, to general surgical operations. Sir James Simpson used ether in the beginning of 1847, and towards the end of that year he employed chloroform, preferring the latter. Ether is much used in America, and chloroform in the British Isles.

The wonderful effects of this discovery can only be gauged by the enormous impetus it gave to surgery; surgeons, whose main aim had been rapidity of operating, could now turn skill and attention to matters previously out of their reach.

In the present day we can have little conception of the torture by anticipation alone which patients had to endure in nerving themselves up to undergo an operation in cold blood for

some growth or disease which was sapping their vitals and must be operated upon to save life, followed as it was by the dreadful torture on the operating table. When we consider the trifling honours so grudgingly bestowed upon a man who was the means of saving so much suffering and so many lives, and compare it with the free showering of favours on those in other walks of life whose efforts are directed towards destruction of comfort and happiness and life itself, we can hardly help questioning the boasted advance of the nineteenth century in civilisation.

With the freer performance of operations, it became more apparent that wounds did not always heal as they ought to do, and some sort of poisoning of aerial origin was suspected. Professor Lister, of Edinburgh, taking advantage of the knowledge gained in other directions on the subject of germs, applied this knowledge to his own department. He introduced the antiseptic method of operating and treating wounds (the application of substances which check or prevent putrefaction, such as carbolic acid) associated with his name, and his success caused others to think and observe; but although his methods are not carried out now in their entirety, to a large extent the most important points of his teachings remain, especially with regard to perfect cleanliness in all those who come in contact with open wounds, and in all the surroundings.

By the aid of chloroform and antiseptic methods it has become possible to explore the most important organs and cavities of the body, previously a sealed book to surgery. Opening the abdominal cavity before antiseptic precautions were observed was often a fatal proceeding; afterwards such operations became practically safe, and the death-rate fell to a mere fraction. A surgeon of great eminence, early in the century, expressed himself as thankful that the kidneys were out of reach; but even these can be reached, and surgical affections treated. In like manner the skull and its contents, which were held sacred from interference, have been invaded by the surgeon; tumours of the brain and abscesses have been dealt with in many cases satisfactorily, but not as yet with as much safety and success as could be desired. At present the most brilliant results are obtained in the surgery of the abdominal organs, notably the stomach and bowels, from which diseased portions have been removed, and the defective portion healed in a manner little short of miraculous. Even the gall bladder comes in for a share of attention where it is at fault, and its calcareous contents are removed with freedom. Cavities caused by disease in the lungs can be opened and drained, and even small portions of diseased lung have been removed.

The chief progress of surgery has not been altogether confined to the performance of brilliant operations. There has been at the same time a conservative influence exercised to prevent the security which anæsthetics and antiseptics have conferred being abused by the too frequent resort to the use of the knife. The power and inclination of nature to repair wounds and defects have been recognised in their relation to surgery as well as medicine. The great value of time and rest as curative agencies has been constantly instilled into the minds of young surgeons, whose inclination generally is to set nature right at once wherever she may be at fault. Conservative surgery finds its province more especially in dealing with diseases of bones and joints, for many of which conditions. limbs were formerly sacrificed. Now the tendency is, by the use of rest, and by securing absolute fixity of the diseased limb in ingeniously contrived splints, to permit of nature effecting a cure. In this manner diseased states of the hip, knee, and ankle joints can be treated so as to preserve the use of the leg when treatment is undertaken in early stages of the disease of these joints. By the artful nature of the contrivances the treatment can be carried on whilst the patient is allowed exercise and free access to the fresh air.

Somewhat after the same method, that terrible complaint, spinal disease, so fatal and deforming in children, can now be treated so as to save a great deal of the life sacrificed, grievous pain, and much of the deformity. The chief part of the credit for this advance is due to an American surgeon named Sayre, whose invention, the plaster-of-Paris jacket, by its cheapness and ease of application, brings the treatment within the reach of the poorer classes, amongst whom the ailment is most

common.

Another specific advance was made about the year 1870 by the introduction of skin-grafting by a Frenchman named Reverdin, for use in large sores where the healing process of the skin fails, owing to the extent of the wound to be closed, as in large burns or scalds. Mr. Pollock introduced the process into England, and it was rapidly adopted here.

In painless methods of performing smaller surgical operations, the employment of cocaine very rapidly gained ground, coming into use in the year 1884, and extending more espe cially in operations on the eye. Some modifications of the form in which to use it have been made to eliminate the smarting sensation, and render it as nearly absolutely painless as possible. Ether, besides its anæsthetic properties, possesses the power, by its rapid evaporation, of freezing the part on which it evaporates, especially when sprayed on in a finely divided

vapour; and this quality was taken full advantage of by Dr. B. W. Richardson, who found that it allowed of minor operations being done rapidly and painlessly.

In the year 1869 the same eminent observer, Dr. (now Sir) B. W. Richardson, read a paper in Norwich on the subject of transmitting strong light through the less dense portions of the body, and made experiments with various methods of illumination. Passing the light through the hand and fingers, he could fairly define the bones; and even a foreign body buried in the hand was located by means of this transmission method. his hands the magnesium light gave the best results.

In

In 1875 Dr. Ultzmann, of the Vienna University, made a further step in advance, and in a paper on the use of photography in medical studies, mentioned among other things, on the authority of Dr. Vogel, that an eruption of smallpox had been made evident by photography before it actually came out. Although no one could observe as yet anything on the skin of the patient, the negative plate showed stains on the face which perfectly resembled the variolous eruption, and twenty-four hours afterwards the eruption became clearly evident.

With the beginning of the year 1896 came a new development, in the application of Professor Roentgen's discovery of the possibility of photographing hidden structures by means of the rays (X) from an electrically excited Crookes' tube. For use in surgery this discovery seems to have great possibilities. The softer structures are transparent to the rays, allowing the more dense, such as bones or foreign substances, to stand out clear and distinct. Already the discovery has been applied to the defining of the exact position of bullets, needles, &c., in the limbs (see Plate), making their extraction a much easier process; and even the body has been penetrated so as to disclose the presence of calcareous deposits in the bladder and kidneys, but it is still doubtful whether the gall-bladder will reveal its contents, whilst cancerous growths are undefinable, as they transmit the rays with the same ease as sound tissues. It is to be hoped that this aid to diagnosis may not lead to surgeons resorting too freely to interference with safely located foreign bodies, where these are giving rise to no trouble, nor likely to do so.

It was thought by some that these X rays might be found to have some specific power over bacteria in destroying them, but after several tests carefully applied this hope does not seem to be justified. The discovery is, however, likely to lead to new developments day by day, and, as already stated, it has great possibilities in the future.

Previous to the present century anything like general care of

matters of public health did not exist. Scarcely any organised effort had been made for the diminution of sickness or rendering

the filthy homes of the people more cleanly or their dirty habits better. The earliest sanitary laws had been passed against such general epidemic diseases as plague, cholera, and smallpox, but