Medical America in the Nineteenth Century: Readings from the Literature

Introduction

INTRODUCTION In this section it is surgeons who are commenting on their specialty. Many nonsurgical writers of the nineteenth century, however, were perhaps in a better position to evaluate surgery's position and accomplishments. The Englishman Robley Dunglison, whom Jefferson brought to the new University of Virginia to teach medicine, told medical students in the 1840's about "the present improved condition of surgery." There was much to admire, he believed. "The major operations have been simplified by the invention of appropriate instruments, and the bold daring of the modern surgeon has led him to perform operations which were totally unknown even in the middle of the last century."1 As an example, Dunglison cited the ligature of large arteries in cases of aneurysm. Heretofore these patients would have been allowed to go on to a fatal end without surgical interference.2 For the most part, surgeons and their art were exempted from the doubts and criticisms applied to their nonoperating colleagues. After the introduction of effective and relatively safe anesthesia in mid-century, and especially after the advent of antisepsis, surgeons were able to bring about more readily apparent results. The higher esteem in which the public held surgeons was not lost upon the medical men, and many, such as Elisha Bartlett in the Inquiry on the Degree of Certainty in Medicine3 dealt with it directly (see Section IV). Alfred Stille, a Philadelphia physician and author of a widely used text on therapeutics,4 agreed with Bartlett that the general immunity of surgery from detractors was owing to its mechanical processes, "which appeal so directly and forcibly to the senses of the unskilled."5 Stille further complained that: "The l The Medical Student, or Aids to the Study of Medicine, (rev. ed.; Philadelphia: Lea& Blanchard, 1844), p. 208. 2 Dunglison did not mention the post-operative mortality, which prior to antisepsiswas discouragingly high. 3 Elisha Bartlett, An Inquiry into the Degree of Certainty in Medicine (Philadelphia: Lea and Blanchard, 1848). 4 Alfred Stille, Therapeutics and Materia Medico, 2 vols. (Philadelphia: Blanchard and Lea, 1864). 5 Review of "Bartlett on degree of certainty," Am. J. Med. Sci. 16 (1848): 398-406; 404. 163 164 SURGERY surgeon is commonly judged by his operation, i.e., his prescription;.... The public form a notion of the comparative value of surgery and medicine, by contrasting the agents of the one with the results of the other. A comparison of nutritious food and strong men would be just about as rational, and lead to an equally correct idea of their respective merits."6 Henry J. Bigelow, himself a surgeon and professor of surgery, warned his students that surgeons were prone to foster and to encourage undue appreciation by the public. The exaggerated interest and adulation, he claimed, were not altogether healthy: Why is the amphitheatre crowded to the roof, by adepts as well as students, on the occasion of some great operation, while the silent working of some well-directed drug excites comparatively little comment? Mark the hushed breath, the fearful intensity of silence, when the blade pierces the tissues, and the blood of the unhappy sufferer wells up to the surface. Animal sense is always fascinated by the presence of animal suffering.7 According to the Seventh Census of the United States, 1850, the state of New York had 5,060 physicians for a population of 3,097,394. What is of greater interest, however, is that in addition to the physicians, surgeons are noted separately in the list of occupations, 54 having been counted in the state.8 Five years later, in a census of New York State, New York City claimed 1,252 physicians and 19 surgeons.9 This division between physicians and surgeons is interesting because we usually think that in this country no such distinction was made. In the absence of more knowledge about the men listed as surgeons it is difficult to say much, except that the government acknowledged the existence of specialists who called themselves surgeons. From what we do know of men who were professors of surgery in medical schools, one can surmise that the surgeons also practiced nonsurgical medicine. As late as 1876 Samuel D. Gross of Philadelphia, one of the country's best known surgeons put it quite succinctly: .. . there are, strange to say, as a separate and distinct class [of surgeons ] , no such persons among us. It is safe to affirm that there is not a medical man on this continent who devotes himself exclusively...