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The Role of Cinchona and Modern Surgery in Healing Diseases: A Historical Perspective, Study notes of Remedies

University of Notre Dame du Lac (ND)Remedies

The idea that the distinction between cure and treatment is not inherent in the nature of things but rather a result of our limited knowledge. The author uses the example of cinchona as a specific antidote to a morbid element and the progress of modern surgery to illustrate this concept. The text also discusses the advancements in surgery, such as the use of chloroform and metallic sutures, and the cure of vesico-vaginal fistulas.

What you will learn

What advancements in surgery did the author discuss and how did they contribute to the healing of diseases?
What is the difference between cure and treatment according to the author?
How did the author use the example of cinchona to illustrate the concept of cure and treatment?

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Auo.

31,

1861.]

WELLS

ON

VAGINAL

FISTUJLA.

[BRITISH

MEDICAL

JOURNAL.

beyond

what

they

know.

Sure

and

great

results-

yet

familiar

and

common,

and

procured

at

will

and

by

certain

means,

but

in

an

unaccountable

manner

-naturally

set

us

thinking

and

forming

notions

how

they

come

to

pass

;

and

then

it

is

safest

and

best

to

fill

up

the

gaps

of

our

knowledge

from

analogy.

When

we

are

treating

a

disease,

our

aim

may

be

to

raise

the

pulse

or

to

lower

it,

to

cool

the

skin

or

to

warm

it,

to

purge

the

bowels

or

restrain

them,

to

augment

the

secretion

of

this

or

that

gland

or

to

diminish

it

or

alter

its

quality;

and

as

our

reme-

dies

do

their

appointed

work,

we

witness

the

whole

disease

brought

to

an

end.

But,

when

we

give

cin-

chona

for

an

ague,

we

have

no

single

aims;

we

give

it

for

the

whole

disease,

and

the

cure

follows.

Never-

theless,

it

is

according

to

analogy

to

believe

that

it

hits

a

mark

of

its

own,

which

is

more

particular

than

any

within

the

scope

of

our

discernment.

Thus

cin-

chona,

and

all

so

called

specifics,

may

work

after

the

same

manner

with

other

remedies,

which

are

better

understood.

They

may

all

equally

produce

their

great

results

by

intermediate

operations;

only

in

the

one

case

the

intermediate

operation

is

seen,

and

unseen

in

the

other;

aimed

at

in

the

one,

and

un-

aimed

at

in

the

other.

From

this

view

of

the

matter,

it

would

turn

out

that

our

distinction

between

cure

and

treatment

is

not

in

the

nature

of

things,

but

in

the

imperfection

of

our

knowledge.

Further,

from

the

same

analogy,

we

may

fairly

believe

that

there

is

a

certain

morbid

element,

of

which

cinchona

is

the

specific

antidote;

that

it

exists

most

pure

and

unmixed

in

ague,

but

that

it

may

add

itself

as

an

accident

to

other

elements

whose

pro-

perty

is

to

produce

other

forms

of

disease

;

and

that

wherever

it

exists,

and

in

whatever

combinations,

its

power

is

still

predominant,

and

cinchona

is

still

needed

to

bring

the

disease

to

an

end.

These

things

may

be

as

analogy

would

suggest.

But

in

practice

there

is

a

mischief

in

conceiting

our-

selves

wiser

than

we

are.

Granted

that

of

the

many

morbid

actions

and

sufferings

which

make

up

the

disease,

one

only

may

be

reached

and

swayed,

or

annulled,

or

curatively

modified,

by

the

one

special

remedy;

granted,

that

thus

the

complex

disease

may

cease

by

removal

of

some

one

main

element,

and

by

some

intermediate

operation

of

the

remedy;

but

inasmuch

as

we

know

no

such

element

of

the

disease,

and

see

no

such

intermediate

operation

of

the

remedy,

they

must

be

to

us

as

if

they

did

not

exist.

We

cannot

construct

aims

and

indications

of

practice

out

of

hidden

things,

but

must

be

content

for

the present

to

regard

the

whole

disease

as

a

single

comprehensive

indication,

and

so

prescribe

for

it

the

single

remedy

and

expect

the

cure.

We

shall

perhaps

know

better

some

time;

but

no

good

will

come

from

our

pretending

to

know

better

now.

Patience

under

imperfect

knowledge

is

no

proof

of

an

unwise

mind.

MEDICAL

REFORM

IN

AUSTRALIA.

The

new

Medical

Bill

begins

to

put

the

doctors

on

the

qui

vive.

Several

of

them

have

taken

down

their

plates,

and

those

who

do

not

happen

to

possess

diplomas,

have

substituted

the

word

"

Medical

Institution,

etc.";

but

not

one

has

ceased

to

practise.

The

Medical

Board

lately

refused

to

register

an

American

diploma,

obtained

by

a

gentle.

man

who

was

in

the

colony

at

the

time

it

was

bestowed.

(Australian

Medical

Record.)

ON

VESICO-VAGINAL

AND

RECTO-

VAGINAL

FISTULA.

DELIVERED

AT

THE

SAMARITAN

HOSPITAL,

MAY

24TH,

1861.

BY

T.

SPENCER

WELLS,

F.R.C.S.,

SURGEON

TO

THE

HOSPITAL.

GENTLEMEN,-During

the

last

few

years

surgery

has

made

great

progress

in

various

directions.

Joints

are

now

excised,

and

useful

limbs

preserved,

where

amputation

would

have

been

formerly

the

unhesitating

sentence.

Cripples

who

were

left

to

endure

hopeless

deformity

are

now

easily

restored

to

happiness

and

vigour

by

tenotomy

and

me-

chanical

after-treatment.

Hernia,

generally

left

to

the

palliative

relief

afforded

by

the

truss-maker,

may

now

be

cured

radically

by

the

surgeon.

Litho-

trity

is,

in

a

considerable

proportion

of

cases,

safely

performed

in

place

of

the

more

hazardous

operation,

lithotomy.

All

the

ill

effects

of

ruptured

perineum

and

prolapsus

uteri

are

relieved

with

certainty

by

a

simple

plastic

operation.

Women

are

no

longer

allowed

to

die,

worn

out

by

hopeless

long-suffering,

because

they

have

a

diseased

ovary;

they

are

re-

stored

to

health

and

happiness

by

ovariotomy.

We

are

reducing

the

rate

of

mortality

after

all

opera-

tions

by

securing

to

all

our

patients

the

freest

pos-

sible

supply

of

pure

air

and

pure

water,

sufficient

light,

wholesome

food,

and

clean

clothing

and

bed-

ding,

thus

avoiding

the

two

greatest

enemies

of

the

surgeon-fever

and

pymmia.

And

we

have

taken

another

step

in

the

same

direction,

by

substituting

for

silk

or

hempen

ligatures

and

sutures,

which

be-

come

receptacles

for

decomposing

and

poisoning

fluids,

the

metallic

needle

or

the

wire

of

silver

or

iron;

while,

thanks

to

chloroform,

all

surgical

operations

are

now

painless.

But

of

all

the

triumphs

of

modern

surgery,

the

cure

of

vesico-vaginal

fistula

is

perhaps

the

most

brilliant.

Ten

years

ago,

most

surgeons

believed

this

distressing

condition

to

be

incurable.

At

long

intervals

one

heard

of

a

case

successfully

treated

by

caustics

or

the

cautery,

or

of

a

spontaneous

cure

after

sloughing

and

cicatrisation;

and

occasionally,

though

very

rarely,

a

cure

was

obtained

by

surgical

operation.

I

believe

I

had

been

quite

as

fortunate

as

other

surgeons,

having

had

successful

cases

both

after

cautery

and

the

suture between

1845

and

1853.

I

and

my

colleague

Dr.

Savage

had

each

a

case

i4

which

a

small

fistula

healed

after

a

single

silk

stitch.

I

had

tried

the

lead-wire

suture,

after

Dieffenbach;

the

hare-lip

suture,

after

Wutzer;

and

various

forms

of

silk

and

metallic

sutures,

with

some

encouragement,

but

I

failed

after

several

oper-

ations

in

some

cases

which

I

feel

confident

I

could

cure

now

at

a

single

trial.

I

believe

other

surgeons

were

much

more

discouraged

than

I

was.

Many

openly

expressed

their

disbelief

in

the

possibility

of

cure,

and

attributed

the

success

in

cases

they

could

not

deny

-to

"luck".

Lecturing

thirty

years

ago

(Lancet,

June

23rd,

223

Partial preview of the text

Download The Role of Cinchona and Modern Surgery in Healing Diseases: A Historical Perspective and more Study notes Remedies in PDF only on Docsity!

Auo. 31, 1861.] WELLS^ ON^ VAGINAL^ FISTUJLA.^ [BRITISH^ MEDICAL JOURNAL.

beyond what they know. Sure and great results-

yet familiar and common, and procured at will and by certain means, but^ in^ an^ unaccountable^ manner -naturally set us thinking and forming notions how they come to pass ; and then it is safest and best to

fill up the gaps of our knowledge from analogy.

When we are treating a disease, our aim may be to

raise the pulse or to lower it, to cool the skin or to

warm it, to purge the bowels or restrain them, to

augment the secretion of this or that gland or to

diminish it or alter its quality; and as our reme-

dies do their appointed work, we witness the^ whole

disease brought to an end. But, when we give cin-

chona for an ague, we have no single aims; we give

it for the whole disease, and the cure^ follows.^ Never- theless, it is according to analogy to believe that it

hits a mark of its own, which is more particular than

any within the scope of our discernment.^ Thus^ cin-

chona, and all so called specifics, may work after the

same manner with other remedies, which are better

understood. They may all^ equally produce their

great results (^) by intermediate operations; only in

the one case the intermediate operation is seen, and

unseen in the other; aimed at in^ the^ one, and un-

aimed at in the other.

From this view of the matter, it would turn out

that our distinction between cure^ and^ treatment^ is

not in the nature of things, but in the imperfection

of our knowledge.

Further, from the same analogy, we may fairly

believe that there is a certain morbid element, of

which cinchona is the specific antidote; that it exists

most pure and unmixed in^ ague, but that^ it^ may add itself as an accident to other elements whose pro-

perty is to produce other forms of disease ; and that

wherever it exists, and in^ whatever combinations, its

power is still predominant, and cinchona is still

needed to bring the disease to an end.

These things may be as analogy would suggest.

But in practice there is a mischief in conceiting our-

selves wiser than we are. Granted that of the many

morbid actions and sufferings which make up the

disease, one only may be reached and swayed, or

annulled, or curatively modified, by the one special

remedy; granted, that thus the complex disease

may cease by removal of^ some one^ main element,

and by some intermediate operation of the remedy;

but inasmuch as we know no such element of the

disease, and see no such intermediate operation of

the remedy, they must be to us as if they did not

exist. We cannot construct aims and indications of

practice out of hidden things, but must be content

for the present to regard the whole disease as a single

comprehensive indication, and so prescribe for it the

single remedy and expect the cure. We shall perhaps

know better some time; but^ no good will come

from our pretending to know better now. Patience

under imperfect knowledge is no proof of an unwise

mind.

MEDICAL REFORM IN AUSTRALIA. The new Medical

Bill begins to put the doctors on the qui vive. Several

of them have taken down their plates, and those who do not (^) happen to (^) possess diplomas, have substituted the the word " Medical (^) Institution, etc."; but not one has ceased to practise. The Medical Board lately refused to (^) register an American (^) diploma, obtained by a gentle. man who was in the colony at the time it was bestowed. (Australian Medical Record.)

ON

VESICO-VAGINAL AND RECTO-

VAGINAL FISTULA.

DELIVERED AT THE SAMARITAN HOSPITAL, MAY 24TH, 1861. BY

T. SPENCER WELLS, F.R.C.S.,

SURGEON TO THE HOSPITAL.

GENTLEMEN,-During the last few years surgery has made great progress in various directions.

Joints are now excised, and useful limbs preserved,

where amputation would have been formerly the

unhesitating sentence. Cripples who were left to

endure hopeless deformity are now easily restored

to happiness and vigour by tenotomy and me-

chanical after-treatment. Hernia, (^) generally left to

the palliative relief afforded by the truss-maker,

may now be cured radically by the surgeon. Litho-

trity is, in a considerable proportion of cases, safely

performed in place of the more hazardous operation,

lithotomy. All the ill effects of ruptured perineum

and prolapsus uteri are relieved with certainty by a

simple plastic operation. Women are no longer

allowed to die, worn out^ by hopeless long-suffering,

because they have a diseased ovary; they are re-

stored to health and happiness by (^) ovariotomy. We

are reducing the^ rate of mortality after all opera-

tions by securing to all our patients the freest pos-

sible supply of pure air and pure water, sufficient

light, wholesome food, and clean clothing and bed-

ding, thus avoiding the two greatest enemies of the

surgeon-fever and pymmia. And we have taken

another step in^ the same direction, by substituting

for silk or hempen ligatures and sutures, which be-

come receptacles for decomposing and poisoning

fluids, the metallic^ needle or^ the^ wire of^ silver or

iron; while, thanks to chloroform, all surgical

operations are now painless.

But of all the (^) triumphs of modern surgery, the

cure of vesico-vaginal fistula is perhaps the most

brilliant. Ten years ago, most surgeons believed

this distressing condition to be incurable. At long

intervals one heard of a case successfully treated by

caustics or the cautery, or of a (^) spontaneous cure

after sloughing and cicatrisation; and occasionally,

though very rarely, a cure was obtained by surgical

operation. I believe I had been quite as fortunate

as other surgeons, having had successful cases both

after cautery and the suture between 1845 and 1853. I and my colleague Dr. Savage had each a case (^) i

which a small fistula healed after a single silk

stitch. I had tried the lead-wire suture, after

Dieffenbach; the hare-lip pin suture, after Wutzer;

and various forms of silk and metallic sutures, with

some encouragement, but I failed after several oper-

ations in some cases which I feel confident I could

cure now at a single trial. I believe other surgeons

were much more discouraged than I was. Many

openly expressed their disbelief in the possibility of

cure, and^ attributed the^ success in^ cases they could

not deny-to "luck".

Lecturing thirty years ago (Lancet, June (^) 23rd,

BRITISH MEDUAL JOURNAL.] (^) WELIS ON VAGINAL (^) FISTULA.

1828), Mr. Liston said:-" It was seldom that union took place. All, indeed, might appear to go on well for eight or ten days; but at the (^) expiration of that time the wound probably would be found to have been enlarged by having been interfered with, and would become larger and larger every time the attempt at cure was made. When (^) the communica- tion is to a large extent, but little hope remains to the patient." So in 1844, Dr. Churchill wrote in his Diseases incident to (^) Pregnantcy and C'kildbed: -" In the majority of cases, I fear we shall find but little benefit. Indeed, vesico-vaginal fistula has (^) long been considered as one of the opprobria of surgery, (^) and, with some exceptions of late years, the cure has been

given up as hopeless." (Cheurchill, 1844.)

This is but a recurrence to the (^) opinion of (^) Smellie,

published now nearly a century ago, who said (M1id-

v?fjery, vol.^ i,^ p.^ 386) :-" If the^ opening is large, close it with a double stitch (the edges of the wound having been (^) refreshed), keeping the (^) flexible catheter in the bladder until it is entirely filled up. I wish this operation (^) may not be found (^) impracticable."

(Snellie, 1766.)

Dieffenbach's (^) graphic account of his (^) own disap- pointments may be taken as representing the feeling

of most^ surgeons ten years ago. In his^ Operative

Sitrgery, published^ in^ 1845, he^ writes, that^ all he

has said^ about^ vesico-vaginal fistula he has^ learned " bit by bit" from innumerable cases. " I was once delighted to find^ a fistula extending along the whole roof of the vagina healed in eight (^) days; alnd I was filled with hope that^ I^ was^ at last able to conquer the enemy at all times; but then I was (^) again defied by a mere needle puncture remaining after an oper- ation otherwise most (^) successful, or a fistula of the size of the head of a probe resisted the most perse- vering efforts. I saw (^) openings of the size of a small pea, after the use of the suture or the cautery, attain the circumference^ of^ a^ large pea; an^ opening of the size of a silver (^) penny became as (^) large as a two-

penny-piece; one, of^ a^ threepenny-piece, as large as

a sixpence; and then I (^) stopped. I (^) operated on one woman ei,hteen^ tiines, and did not cure her after all. I collected whole wards full of these (^) unhappy creatures from all^ parts of the countrv, and gave up a (^) great deal of time to (^) them, quite liking the trouble, and^ yet I^ cured but very few. Two died of cystitis or^ peritonitis; and^ one even^ after^ suture^ had led to a complete cure of the fistula." To show how little faith some surgeons had in (^) any operative treatment of vesico-vaginal fistula, I will julst add that Mr. (^) Syme, in the last edition of his Principles of Sargery, published in 1856, does not even allude to the (^) subject. Mr. Fergusson, in his last edition (18)7), only gives one line to it; and

Mr. Skey, in the second edition of his Operative

Surgery, published a^ year later^ (1858), describes an

operation for recto-vaginal and recto-vesical fistula,

but (loes not say one word about vesico-vaginal fistula. I^ ame not^ saying this to find fault with these teachers. I simply wish to remind you how very

recent are the improvements which are now so gene-

rally accepted by the profession. It is fromn 1852 that what I will call a new era in surgery must^ date. It is quite true that metallic sutures had been used long before that year. Puttingf aside all reference to (^) hare-lip pins, and to the ento- mology pins so largely used in other plastic opera-

tions (^) (where the surgeon looked to the support the

pins afforded, and the opportunity they give of

making lateral pressure upon the opposed surfaces of the (^) wound, rather (^) than to any superiority in

metal over hemp or silk), it is well known that Mr

Gossett cured a vesico-vaginal fistula in London (^) as; early as 1834 by the use of a suture of gold wire. But his example was not followed. He (^) was even ridiculed for supposing that the material of his, suture could have had any influence on the result..

So in 1840, I heard Mr. Morgan, at Guv's Hospital,,

lecture on the Uses of Platinum Wire as a Suture,,

and illustrate the non-irritating effects of metal (^) by reference to the manner in which ladies' ears bear: ear-rings. But his example was not followed to any extent, either by his colleagues or his (^) pupils. Dief-

fenbach had been showing how successfully lead-wira

replaces silk in many cases; and I applied this wire

in cases of vesico-vaginal fistula in 1852 anid 1853,

Early in 1855, I operated upon a patient of Dr-

Simpson's in the Edinburgh Infirmary, and intended

to use lead-wire; but an (^) accident put the needle out of order, and I had to trust to silk. Mettauer, of

Virginia, also advocated Dieffenbach's suture of

twisted lead-wire; but it was left to Sims, of New

York, to make known, in 1852, the great use of

silver-wire sutures; and to Dr. Simpson, to impress upon the mind (^) of the profession the principles upon which the superiority of metallic over silk and other

absorbing materials is established. Next to his dis--

covery of the use of chloroform, I think his exposi-

tion of the use of metallic sutures is the best of the manv gifts for which medicine and mankind have to. thank this great man.

Before passing on, I may as well show you Dief-

fenbach's suture of twisted lead-wire, as it may serve

for a magnified view (^) of the essential part of the suture now used with silver or iron-wire in curing vaginal fistula.^ Here^ is^ a^ piece of soft lead-wire, which I (^) got froim Dief-

fenbach's own instrument-maker in

Berlin. This was the size lhe usedr

.X and you see hlowr; o. s>v

easily it is^ fastened^ p

by a (^) simple (^) twvist. *. (Fig. 1.) I^ have tried a (^) variety of (^) ; 4 needles for passing - a :

it, but I found.

none answer sowell!i

as this curved needle made for

me by Mr. Blaise, with an open , shaft, into^ which the lead-wire ' - i is easily twisted. (Fig. 2.) But this suture (^) is chiefly interesting in an historical point of view".

The Role of Cinchona and Modern Surgery in Healing Diseases: A Historical Perspective, Study notes of Remedies

Related documents

Partial preview of the text

Download The Role of Cinchona and Modern Surgery in Healing Diseases: A Historical Perspective and more Study notes Remedies in PDF only on Docsity!

Auo. 31, 1861.] WELLS^ ON^ VAGINAL^ FISTUJLA.^ [BRITISH^ MEDICAL JOURNAL.

beyond what they know. Sure and great results-

fill up the gaps of our knowledge from analogy.

When we are treating a disease, our aim may be to

warm it, to purge the bowels or restrain them, to

augment the secretion of this or that gland or to

diminish it or alter its quality; and as our reme-

disease brought to an end. But, when we give cin-

chona for an ague, we have no single aims; we give

hits a mark of its own, which is more particular than

any within the scope of our discernment.^ Thus^ cin-

chona, and all so called specifics, may work after the

same manner with other remedies, which are better

understood. They may all^ equally produce their

the one case the intermediate operation is seen, and

unseen in the other; aimed at in^ the^ one, and un-

aimed at in the other.

that our distinction between cure^ and^ treatment^ is

of our knowledge.

Further, from the same analogy, we may fairly

believe that there is a certain morbid element, of

which cinchona is the specific antidote; that it exists

perty is to produce other forms of disease ; and that

wherever it exists, and in^ whatever combinations, its

power is still predominant, and cinchona is still

needed to bring the disease to an end.

These things may be as analogy would suggest.

But in practice there is a mischief in conceiting our-

morbid actions and sufferings which make up the

disease, one only may be reached and swayed, or

annulled, or curatively modified, by the one special

remedy; granted, that thus the complex disease

and by some intermediate operation of the remedy;

disease, and see no such intermediate operation of

the remedy, they must be to us as if they did not

practice out of hidden things, but must be content

for the present to regard the whole disease as a single

comprehensive indication, and so prescribe for it the

know better some time; but^ no good will come

under imperfect knowledge is no proof of an unwise

mind.

Bill begins to put the doctors on the qui vive. Several

T. SPENCER WELLS, F.R.C.S.,

Joints are now excised, and useful limbs preserved,

where amputation would have been formerly the

unhesitating sentence. Cripples who were left to

endure hopeless deformity are now easily restored

to happiness and vigour by tenotomy and me-

the palliative relief afforded by the truss-maker,

may now be cured radically by the surgeon. Litho-

performed in place of the more hazardous operation,

lithotomy. All the ill effects of ruptured perineum

and prolapsus uteri are relieved with certainty by a

allowed to die, worn out^ by hopeless long-suffering,

because they have a diseased ovary; they are re-

are reducing the^ rate of mortality after all opera-

tions by securing to all our patients the freest pos-

sible supply of pure air and pure water, sufficient

light, wholesome food, and clean clothing and bed-

ding, thus avoiding the two greatest enemies of the

another step in^ the same direction, by substituting

for silk or hempen ligatures and sutures, which be-

come receptacles for decomposing and poisoning

fluids, the metallic^ needle or^ the^ wire of^ silver or

iron; while, thanks to chloroform, all surgical

operations are now painless.

cure of vesico-vaginal fistula is perhaps the most

brilliant. Ten years ago, most surgeons believed

this distressing condition to be incurable. At long

intervals one heard of a case successfully treated by

after sloughing and cicatrisation; and occasionally,

operation. I believe I had been quite as fortunate

as other surgeons, having had successful cases both

which a small fistula healed after a single silk

stitch. I had tried the lead-wire suture, after

Dieffenbach; the hare-lip pin suture, after Wutzer;