It is a blessed boon; and in olden times the possessor of such a secret would have been the most potent wizard of which the earth has yet heard tell. What miracles might not have been performed by it! What dogmas might not have been made divine and true by its influence! Happy was it that those great powers, the magic of chemical and electrical discovery, have been brought to light in a time when they can be used mainly to enlighten and bless, and not to darken and oppress mankind!

number of individuals who have the requisite silk round the extremity of the bleeding courage to submit to operation; as of those vessel (as we shall hereafter see,) it was who will not have heart to do so, and who unknown, at all events as applicable to amwill inevitably die without benefit of surgery; putation, to any surgical writer from Hiptogether with the exact percentage to the pocrates, 400 B.C., or from Celsus, who flourpopulation of those who will, and who will ished in the first Christian century, to the not, put faith in the blessed boon of chloro- fifteenth. Consequently, the numerous inform. stances of injury and disease, in which life is now saved by a timely resort to amputation, were then always fatal. Hence, also, arose the various expedients which the more adventurous operators of the time resorted to, in order to stop fatal bleeding, with the effect only of increasing the patient's torture, and with the attainment of no good result. Thus the incisions were performed with a red-hot knife, that the divided vessels, seared and charred by the horrible contact, might contract, or become plugged, and so be prevented from bleeding (Albucasis, eleventh century.) Effective for the instant, the force of the circulation quickly overpowered the slender obstruction, and fatal hemorrhage, sooner or later, took place. Yet this plan continued more or less in vogue down to the discovery of the ligature in the sixteenth century, and was practised even later in Germany by the celebrated Hildanus (1641 ;) although he subsequently adopted the new method. According to another fashion, the surgeon, after making a tedious division of the flesh down to the bone, with studied endeavor not to divide the arteries until the last moment, relied on applications of redhot irons, or of some styptic fluid, usually a powerful acid or astringent, to arrest the bleeding. If these were not successful, a vessel of boiling pitch was at hand, ready prepared, into which the bleeding stump was plunged. Between Scylla and Charybdis, the patient rarely escaped with life; either he died from loss of blood in a few hours, or less; or if the dreadful remedies succeeded, he survived a day or two, to die of fever or exhaustion. After an earlier method, that of Guido di Caulico (1363), a bandage of plaster was made to encircle the member so tightly that mortification attacked all the parts below, which then, after the lapse of Until the last three or four hundred years, months, dropped off, a horribly loathsome amputation of a limb was very rarely per- and offensive mass. Another surgeon, Boformed, except when, from injury or disease, talli (1560), invented a machine to sever the its extremity had begun to mortify; and then, limb in an instant by a single stroke; and it few surgeons ventured to make incisions in was not uncommon at this period to effect the sound portion, but limited themselves the same purpose by the hatchet, or by a to an operation through the tissues which powerful mallet and chisel.

But that word chloroform is happily significant that it is to no scene of suffering that we would introduce our readers. There is no need to shrink, or to question the taste which exhibits the details of a surgical operation to the vulgar eye. It is not designed, even in this stirring time, after the fashion of ancient Rome, to deaden our sensibilities, or to accustom our youth to witness deeds of blood and violence without shrinking. No trace of suffering will be visible in the picture which shall pass before us. So great is the triumph which modern surgical art displays, so great the boon which it has conferred upon humanity! It is this which we propose to illustrate, by describing the single and simple process involved in cutting off a leg.

Permit us first, however, to cast a passing glance, by way of contrast, to the established and orthodox fashion of performing that operation some centuries ago. Bear with us but a moment, and in imagination hope that then, when painless surgery was unknown, no patient lacked support in his hour of trial (long hours then, in truth!) from that great and never-failing source which flows, unmeasured and unfathomable, for all humanity, alike in every age.

had already lost their vitality. This timid- It is to Ambrose Paré, the great French ity was due to the fact that they were unac-surgeon, who flourished in the sixteenth cenquainted with any effectual means of stopping the bleeding from the larger arteries divided by the knife. Certain and easy as is the control of such bleeding now, by the simple process of tying a piece of thread or THIRD SERIES. LIVING AGE.

549

tury, that we owe the application of the ligature (used long before in ordinary wounds) to the bleeding arteries in amputation. He discarded the use of the red-hot cautery, and of all the frightful adjuncts already described;

From The Cornhill Magazine.
UNDER CHLOROFORM.

operative achievement, in which perchance he assisted at the hospital. As he surveys the auditory, silent and absorbed by his heartstirring description, and complacently witnesses the admiration which such evidence of his own familiarity with harrowing scenes, and of his apparent absence of emotion, elicits, it is to be feared that its influence, associated with that of the port, a beverage appreciated by our young friend, if one may judge by the quantity he imbibes, tends to render the information obtained, as one may say almost at first hand, not so absolutely trustworthy as a man of fact is accustomed to desire.

MOST people take an interest in any authentic account of the mode in which important surgical operations are performed, whenever opportunity is offered of gratifying their very natural curiosity. Such opportunities are however somewhat rare. The columns of the newspaper press not unfrequently supply brief, and sometimes curiously incorrect, particulars of the injuries resulting from "an appalling accident" of the night previous, to some unfortunate workman who has fallen from a scaffold, or been mutilated by a railway train. Scraps of hearsay are eagerly gathered up by the penny-a-liner, who, like the fireman's dog of notorious ubiquity, is always first on the spot after the occurrence of a catastrophe; and a remarkable combination of technical phrases culled from the brief remarks of the surgeon in attendance, and from the slender stock which has accumulated in the reporter's brain from previous experiences, makes its appearance in to-morrow's daily journals, and is certain to be reproduced in all the weeklies of Saturday next. Then it is the great public learns with qualities, by the way, which are perhaps profound horror that some poor victim's shoulder-joint has been dislocated in three places, that the carotid artery was pronounced (surgeons are invariably said to "pronounce") to be fractured, or that there was great contusion and ecchymosis (always a trying word for the compositor) about the spine, and that amputation would probably be necessary..

But sometimes it happens that an overprying public, with a curiosity not much in this instance to be commended, peeps within the pages of the medical press, hoping to unravel some of the mysteries of professional craft. Ten to one that it gets nothing but error for its pains. The technicalities which medical men must necessarily employ when writing for each other, are instructive only to the initiated, and are pregnant with blunders for the simple reader. And few people make more mistakes than our medical amateur who, on the strength of a weekly perusal of The Lancet at his club, sets up as an authority in the social circle on questions of physiology and physic.

After due survey then of the varied sources from which most people obtain information respecting the topics in question, and after some observation of the character and quality of the knowledge so acquired, we have formed the deliberate conclusion that they possess very erroneous, and very inadequate notions about the nature of a surgical operation. No doubt all admire the sang-froid and skill, possession of which is necessary to make a good surgical operator

more frequently developed by training, than found already existing as a natural inheritance. But it is germane to our purpose to remember that everybody has a direct practical concern in the existence of an available supply of the necessary talent to meet a certain demand on the part of the body politic, for no one knows how soon his own personal necessities may not be such as to give him the strongest possible interest in its exercise: a demand that is absolutely inevitable ;-for be assured that, without any wish to alarm you, gentle reader, Mr. Neison will, if requested to make the calculation, inform us at once what the numerical chances are that your own well-proportioned nether limb will, or will not, fall before the surgeon's knife, or that that undoubtedly hard and welldeveloped cranium may not yet be scientifically explored by "trepan" or "trephine." He will estimate with unerring certainty the probability (to nine places of decimals, if you demand it) that your own fair person may become the subject of some unpleasing excrescence; and also what the chances are Occasionally, moreover, after dinner, when that you must seek the surgeon's aid to rethe ladies have left the table, and the men move it. While Mr. Buckle will stoutly alone remain to empty decanters and derange maintain, and you will find it hard to gainsay a dessert, one has the gratification of meet- him, that, given the present conditions of ing some very young gentleman, who, the existence, a certain ascertainable number of week before last, presented his proud father tumors, broken legs, and natural-born dewith the diploma of "the college," elegantly formities will regularly make their appearframed and glazed, in return for an educa-ance every year among the human family. tion which has cost five years and a thousand pounds, and who astonishes his elderly associates with a highly tinted sketch of some

And he will probably add, that it is perfectly within the province of possibility to calculate, if we had all the required data, the exact

It is a blessed boon; and in olden times the possessor of such a secret would have been the most potent wizard of which the earth has yet heard tell. What miracles might not have been performed by it! What dogmas might not have been made divine and true by its influence! Happy was it that those great powers, the magic of chemical and electrical discovery, have been brought to light in a time when they can be used mainly to enlighten and bless, and not to darken and oppress mankind!

number of individuals who have the requisite silk round the extremity of the bleeding courage to submit to operation; as of those vessel (as we shall hereafter see,) it was who will not have heart to do so, and who unknown, at all events as applicable to amwill inevitably die without benefit of surgery; putation, to any surgical writer from Hiptogether with the exact percentage to the pocrates, 400 B.C., or from Celsus, who flourpopulation of those who will, and who will ished in the first Christian century, to the not, put faith in the blessed boon of chloro- fifteenth. Consequently, the numerous inform. stances of injury and disease, in which life is now saved by a timely resort to amputation, were then always fatal. Hence, also, arose the various expedients which the more adventurous operators of the time resorted to, in order to stop fatal bleeding, with the effect only of increasing the patient's torture, and with the attainment of no good result. Thus the incisions were performed with a red-hot knife, that the divided vessels, seared and charred by the horrible contact, might contract, or become plugged, and so be prevented from bleeding (Albucasis, eleventh century.) Effective for the instant, the force of the circulation quickly overpowered the slender obstruction, and fatal hæmorrhage, sooner or later, took place. Yet this plan continued more or less in vogue down to the discovery of the ligature in the sixteenth century, and was practised even later in Germany by the celebrated Hildanus (1641;) although he subsequently adopted the new method. According to another fashion, the surgeon, after making a tedious division of the flesh down to the bone, with studied endeavor not to divide the arteries until the last moment, relied on applications of redhot irons, or of some styptic fluid, usually a powerful acid or astringent, to arrest the bleeding. If these were not successful, a vessel of boiling pitch was at hand, ready prepared, into which the bleeding stump was plunged. Between Scylla and Charybdis, the patient rarely escaped with life; either he died from loss of blood in a few hours, or less; or if the dreadful remedies succeeded, he survived a day or two, to die of fever or exhaustion. After an earlier method, that of Guido di Caulico (1363), a bandage of plaster was made to encircle the member so tightly that mortification attacked all the parts below, which then, after the lapse of months, dropped off, a horribly loathsome and offensive mass. Another surgeon, Botalli (1560), invented a machine to sever the limb in an instant by a single stroke; and it was not uncommon at this period to effect the same purpose by the hatchet, or by a powerful mallet and chisel.

But that word chloroform is happily significant that it is to no scene of suffering that we would introduce our readers. There is no need to shrink, or to question the taste which exhibits the details of a surgical operation to the vulgar eye. It is not designed, even in this stirring time, after the fashion of ancient Rome, to deaden our sensibilities, or to accustom our youth to witness deeds of blood and violence without shrinking. No trace of suffering will be visible in the picture which shall pass before us. So great is the triumph which modern surgical art displays, so great the boon which it has conferred upon humanity y! It is this which we propose to illustrate, by describing the single and simple process involved in cutting off a leg.

Permit us first, however, to cast a passing glance, by way of contrast, to the established and orthodox fashion of performing that operation some centuries ago. Bear with us but a moment, and in imagination hope that then, when painless surgery was unknown, no patient lacked support in his hour of trial (long hours then, in truth!) from that great and never-failing source which flows, unmeasured and unfathomable, for all humanity, alike in every age.

Until the last three or four hundred years, amputation of a limb was very rarely performed, except when, from injury or disease, its extremity had begun to mortify; and then, few surgeons ventured to make incisions in the sound portion, but limited themselves to an operation through the tissues which had already lost their vitality. This timidity was due to the fact that they were unacquainted with any effectual means of stopping the bleeding from the larger arteries divided by the knife. Certain and easy as is the control of such bleeding now, by the simple process of tying a piece of thread or

THIRD SERIES. LIVING AGE.

549

It is to Ambrose Paré, the great French surgeon, who flourished in the sixteenth century, that we owe the application of the ligature (used long before in ordinary wounds) to the bleeding arteries in amputation. He discarded the use of the red-hot cautery, and of all the frightful adjuncts already described;

and accomplished his purpose by carrying cumstances which led to an incurable disease the thread round the vessel by means of a of the left knee-joint, and the reasons why needle passed through the soft parts adjacent he decides on the operation about to be per-a method of adjustment which, although formed. He has scarcely closed, when the still in use, is now employed only in excep- unconscious patient is brought in by a couple tional instances. Richard Wiseman, some- of sturdy porters, and laid upon the operattimes styled the father of English surgery, ing table, a small, but strong and steady who practised about the middle of the sev-erection, four feet long by two feet wide, enteenth century, is believed to have been which stands in the centre of the area. The the first to employ the ligature in our own left being the doomed leg, the right is fascountry, and to relinquish the application of tened by a bandage to one of the supports heated irons. At this era also, the circula- of the table, so as to be out of harm's way; tion of the blood was discovered by the re- while the dresser, who has special charge of nowned Harvey, and the distinction between the case, is seated on a low stool at the foot arteries and veins being thenceforth clearly of the table, and supports the left. The surunderstood, the value of the ligature was geon who assists, encircles the upper part of rendered more than ever obvious. the thigh with the tourniquet, placing its pad over the femoral artery, the chief vessel which supplies the limb with blood, and prepares to screw up the instrument, thus to make sure that no considerable amount of the vital fluid can be lost. The operator, standing on the left side of the corresponding leg, and holding in his right hand a narrow, straight knife, of which the blade is at least ten inches long, and looks marvellously bright and sharp, directs his eye to him who gives the chloroform, and awaits the signal that the patient has become perfectly insensible. All is silence profound: every assistant stands in his place, which is carefully arranged so as not to intercept the view of those around.

But enough of this: let us sooth our ruffled nerves by seeing how the thing is done to-day. We will take a quiet post of observation in the area of the operating theatre at one of our metropolitan hospitals, in this year of our Lord 1860. Notice is posted that amputation of the thigh will be performed at two o'clock, P.M., and we occupy our seat ten minutes before the hour.

The area itself is small, of a horse-shoe form, and surrounded by seats rising on a steep incline one above another to the number of eight or nine tiers. From one hundred to one hundred and fifty students occupy these, and pack pretty closely, especially on the lower rows, whence the best view is obtained. For an assemblage of The words "quite ready" are no sooner youths between eighteen and twenty-five whispered, than the operator, grasping firmly years, who have nothing to do but to wait, with his left hand the flesh which forms the they are tolerably well-behaved and quiet. front part of the patient's thigh, thrusts Three or four practical jokers, however, it is quietly and deliberately the sharp blade horievident, are distributed among them, and so zontally through the limb, from its outer to its the time passes all the quicker for the rest. inner side, so that the thigh is transfixed a The clock has not long struck two, when the little above its central axis, and in front of folding-doors open, and in walk two or three the bone. He next cuts directly downwards, of the leading surgeons of the hospital, fol- in the plane of the limb, for about four inches, lowed by a staff of dressers, and a few pro- and then obliquely outwards, so as to form fessional lookers-on; the latter being con- a flap, which is seized and turned upwards fined to seats reserved for them on the lowest out of the way by the appointed assistant. and innermost tier. A small table, covered A similar transfixion is again made, comwith instruments, occupies a place on one mencing at the same spot, but the knife is side of the area; water, sponges, towels, and this time carried behind the bone; a similar lint, are placed on the opposite. The sur- incision follows, and another flap is formed geon who is about to operate, rapidly glances and held away as before. Lastly, with a over the table, and sees that his instruments rapid circular sweep around the bone he diare all there, and in readiness. He requests vides all left uncut; and handing the knife a colleague to take charge of the tourniquet, to an assistant, who takes it, and gives a saw and with a word deputes one assistant to in return, the operator divides the bone with "take the flaps," another to hold the limb, a few workmanlike strokes, and the limb is a third to hand the instruments, and the last severed from the body. A rustling sound of to take charge of the sponges. This done, general movement and deeper breathing is and while the patient is inhaling chloroform heard among the lookers-on, who have folin an adjoining apartment, under the care of lowed with straining and critical eyes every a gentleman who makes that his special duty, act which has contributed to the accomplishthe operator gives to the now hushed and ment of the task; and some one of the listening auditory, a brief history of the cir-younger students is heard to whisper to his

UNDER CHloroform.

neighbor, "Five and thirty seconds: not bad, by Jove!"

The operator now seats himself on the stool just vacated by the dresser, who has carried away the leg, and seeks in the cut surfaces before him the end of the main artery on which to place a ligature. There is no flow of blood, only a little oozing, for the tourniquet holds life's current hard and fast. Only five minutes' uncontrolled flow of the current from that great artery now so perfectly compressed, and our patient's career in this world would be closed forever. How is it permanently held in check? and what have we to substitute now for the hissing, sparkling, and sputtering iron, and the boiling pitch? The operator takes hold of the cut end of the artery with a slender, delicately made pair of forceps, and draws it out a little, while an assistant passes round the end so drawn out a ligature of exceedingly fine whipcord, fine but strong, and carefully ties it there with double knot, and so effectually closes the vessel. A similar process is applied to perhaps six or seven other but smaller vessels, the tourniquet is removed, and no bleeding ensues. Altogether the patient has lost little more than half a pint of blood! The flaps are placed in apposition, the bone is well covered by them, a few stitches are put through their edges, some cool wet lint is applied all around the stump, and the patient, slumbering peacefully, is

723

carried off to a comfortable bed ready prehence that patient will regain consciousness, pared in some adjacent ward. Half an hour and probaby the first observation he makes will be, "I am quite ready for the operation; when is it going to begin?" And it takes no little repetition of the assurance that all is over to make him realize the happy truth.

less about the process than any one conSo it is that he who loses the limb knows cerned; infinitely less, my gentle reader, than you who have shared with us the quiet corner, and have seen all without losing consciousness, or fainting. It was an early day in the medical session, and many new men were there: one at least was observed to become very-very pale, and then slowly disappear: no one knows how or where, for neither we in the area nor those elsewhere had leisure or care to inquire.

else had he been witness before these blessed What might have happened to somebody days of chloroform, can, in the nature of things, be only a matter for speculation. It may even be surmised by some theorist, and without hazarding a very improbable guess, that a similar catastrophe might, perhaps, under such aggravating circumstances, and at a greener age, have rendered utterly futile, on his part, any attempt to describe what modern skill and science now accomplish in cutting off the leg of a patient under chloroform.

ENGLAND AT THE CLOSE OF THE AMERICAN WAR.-The nation was on the brink of ruin; and it is probable that her ruin would have been consummated, but for some compensatory circumstances, which lay beyond the control of her blind and obstinate ruler. While the king's government was losing a great empire in the west, private enterprise had reared from its foundations a still greater empire in the east. While orators and statesmen were engaged in debates about election contests, matters of privilege, or questions of ephemeral or personal interest, the advancing prosperity of the nation, and its progress in the arts of civilized society, are to be traced in the private legislation of parliament. The Inclosure Acts, the Road and Canal Acts, the Paving and Lighting Acts, which are supposed to concern only the local and personal interests of the parties who solicit them, formed by far the most important part of the transactions of Parliament, from the commence

ment of the reign until the end of the American war. But, above all, it was by the inventive genius of the Lancashire artisans, that England was compensated for the fatuity of her rulers. The steam engine and the spinning jenny opened up new sources of wealth and power; and Watt and Crompton have given us a commerce of a hundred millions with free America, in lieu of a barren sovereignty which we could not have retained.-Massey's History of England.

ent CI-DEVANT JEUNE-HOMME I have a distinct DINNER ETIQUETTE.-Like your correspondrecollection of having seen the ladies go out of the drawing-room first in single file, followed by the gentlemen in the same order. My impression is that the system of hooking, like the dancing of quadrilles, was not introduced till after the peace in 1814.-Notes and Queries. MELETES.