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splint material, devised by the writer. In this paper I shall briefly describe the material, its properties, the method of applying it, and relate a few accident cases for which splints were extemporised. In connection with the relation of these cases the improvised splints shall be shown. They will demonstrate, I trust, the wide adaptability and practical usefulness of the new method.

The Material.-The splint material is crushed woodfibre, rolled in a rugose manner, in which gauze is imbedded.

Properties of the Material.-When dry it is rigid like board; when moistened, semiplastic. It is light and tough, the toughness due to the imbedded gauze. It is durable-splints made of it having been worn, to my personal knowledge, for fourteen months, for the fixation of tuberculous joints.

The Method of Applying the Material.-A properly shaped splint blank should be cut from a sheet of the splint material; the splint blank should be moistened with water, then applied to the parts for which designed, and snugly bandaged thereon.

The proper shaped splint blank is obtained by cutting a paper pattern so as to enfold the parts in the same manner we intend the splint to enclose them; this pattern is laid upon a sheet of the splint material, to serve as a guide in cutting the rightly shaped splint blank.

To cut the dry splint material use a sharp knife, after the material is moistened use a scissors.

If a single layer of the material is not strong enough to maintain fixation, apply an extra layer, or two if need be.

In most cases the moistened splint blank can be applied directly next the skin. Immediate fixation results if the proper shaped blank has been cut and rightly bandaged over the limb.

CASES EXEMPLIFYING THE EXTEMPORANEOUS USE OF THE SPLINT MATERIAL.

Case 1. Traumatic Synovitis of the Hip-joint.J. T., male, 21 years old, fell from a tree, twenty feet to the ground, while in the employ of the Mass. Gypsy Moth Commission. The accident caused synovitis of the left hip-joint, and probable rupture of some fibres having attachment to the lesser trochanter of the left femur. I was called to the patient's house and extemporised the splint here shown. In a half hour, without assistance, efficient immobilization of the hip joint was produced. The splint was worn for three weeks. It was easily removed several times during that period to allow the inspection of the parts.

Case 2. Compound Fracture of the Toes.-Male, about 30 years old, out patient department of Boston

JOURNAL OF SURGERY.

City Hospital, treated by me through the courtesy of Dr. Paul Thorndike. Soaked the foot (the right) in an antiseptic solution; applied moist antiseptic dressing; covered the dressing with oiled paper, and moulded over it the slipper-shaped splint, here shown. It produced complete fixation of the broken toes, and was readily removed when necessary to renew the dressing. The splint was worn twelve days.

Case 3. Traumatic Synovitis of the Knee-Joint.— J. B., athlete, about 28 years old, fell, producing traumatic synovitis of the left knee-joint. Moulded the splint here shown, over the internal lateral and posterior aspects, of the leg and thigh. By its means complete immobilization of the knee was produced. and maintained for two weeks.

This splint form well illustrates the mechanical principle by which the breaking strain of any piece of flat material is greatly increased, as it is made to assume the tubular form, or by having a flange in its form. A piece of the splint material, moulded over the posterior aspect of the limb only, could not be expected to serve for the fixation of a joint controlled by such powerful muscles as is the knee. But by simply widening the blank so that it can be moulded over a lateral aspect of the limb as well as over the posterior aspect, the needful element of tensile strength is increased in far greater proportion than to the extra amount of the material employed. Another advantage is that the splint so moulded and applied to the limb cannot move from side to side; its flange moulded over the side of the limb prevents this; it therefore gives a fixation superior to any posterior or ham splint. It permits also elastic compression of the joint to hasten fluid absorption in the joint, without necessitating the removal of the splint to apply the compression.

Case 4. Colles' Fracture.-Mrs. S., aged 73 years, fell down a flight of stairs, breaking her right collar bone, and right wrist (a Colles' fracture). The fragments were adjusted and a splint, similar to the one. here shown, was moulded over the back of the forearm, wrist, and hand. The splint was worn twentyone days. Two months later, I called on the old lady and found her scrubbing a floor, using her right wrist, thus demonstrating in a very practical manner the complete restoration of its functions.

In a paper presented to the American Medical Association at the Philadelphia meeting, 1896, the writer formulated the treatment of Colles' fracture thus: 1, reduction, not always easy; 2, protection, by a simple retentive appliance while correct reunion of the bone takes place; 3, passive motion of the thumb and fingers from the first day; of the wrist carefully, from the fifth day. This treatment I believe the most efficient in practice; it is the logical outcome

JOURNAL OF SURGERY.

of a consideration of the lesions of the tissues involved in this fracture.

Case 5. Fracture of Internal Condyle of the Humerus.-Harry M., aged 7 years, fell, breaking the internal condyle of the left arm. Moulded the splint shown, over the external aspect of the arm and forearm, flexed to a little more than a right angle. The internal aspect of the joint was thus accessible to inspection without the removal of the splint. Careful passive movements of the injured joint were made from the seventh day; the splint omitted from the eighteenth day. Complete recovery of form and motions of the joint in two months.

Case 6. Fracture of the Shaft of the Right Humerus at its Upper End.-Mrs. C., aged 80 years, fell on kitchen floor, breaking right arm at surgical neck, and bruising tissues on right side of body so as to produce an ecchymosis the extent of which I have not seen before nor since. I was called the third day after the accident. I moulded a splint to embrace the shoulder and arm (the splint shown), and a separate piece over the inner aspect of the arm; bandaged the splints to the arm, and then bandaged the splinted arm to the side of the body with a wide roller bandage in such a manner that the bandage, when looked at from in front or behind, had a triangular form, the apex being in the axilla opposite the injured side, the base extending from the elbow to the outer end of the clavicle on the injured side. There was union in twelve days; the splints were discarded in twenty three days. Considerable callus then; motions in shoulder, fair. Examined one year later, motions of arm normal, thickening felt over surgical neck in arm pit; no shortening shown by measurement. This form of splinting for fracture of the humerus at the surgical neck is essentially Hamilton's. He recommended leather, and was of the opinion that the smaller piece over the inner aspect of the arm did not support the upper fragment, but served to prevent excoriation near the arm pit by the bandage retaining the outer splint, in his opinion a very important use. In the case which I have related I believe the piece of wood-fibre material moulded over the inner aspect of the arm did reach high enough to support the upper fragment, and thus contributed to the perfect result attained.

Case 7. Fracture of the Shaft of the Left Humerus at its Lower End.-Timmy H., aged 5 years, fell while playing on the street; he was brought to my office twenty minutes after. There was free motion of the elbow-joint; the range of extension was greatly increased, about 30 degrees. The shaft of the humerus was broken a short distance above the elbow-joint, the lower fragment tilted forwards, possibly a separation at the epiphysis. Pulling in the

direction of the line of the shaft and flexing the arm to an acute angle I put the fragments into correct apposition. The splint here shown was moulded over the external aspect of the arm and forearm, and tip of shoulder, acutely flexed in this position. It was bandaged upon it, and the splinted elbow bandaged to the front of the chest. The splint was omitted in sixteen days; union perfect. The arm let hang in a sling. After the first the arm could be extended from acute flexion (the position when splinted) to an angle a little greater than a right angle. There was speedy recovery of all motions. I report the case to show that a splint is easily made from wood-fibre splint material to hold the elbow in acute flexion-a position now advocated by several able surgeons as the best for fractures of the elbow into the joint. Though this case was not of that nature, none the less the indications calling for complete flexion and were best met by the splint extemporised for its treat

ment.

Case 8. Fracture of the Tibia-Ambulatory Treatment.-Albert H., aged 13 years, fell while skating, breaking the right shin bone across, three inches from the ankle. He was carried home. No doctor was then called, a sapient neighbor telling his mother that the injury was a sprain. The only treatment then was hot fomentations and rest, enforced, because of his inability to bear his weight upon the ground. After eight days the inability continuing, his mother became alarmed and sent for me. Fracture of the right tibia found three inches above the ankle, crepitus being distinct. I moulded upon his leg the splint here shown. It embraced his leg, except the posterior aspect. He was encouraged to use the splinted leg at once, and six days after he could go upon the street without using a cane. The splint was worn about three weeks.

Case 9. Fractured Ribs.-J. C., aged 55 years, fell into an excavation, across a rail, breaking eighth and ninth ribs on his right side. The splint shown was moulded upon the lower half of his right side. It was retained in position by a swathe for twelve days. I have similarly splinted four other cases of fractured ribs, and find that this treatment protects the broken bones from external pressure, and adds to the comfort of the patient, being, therefore, superior to adhesive plaster or a simple swathe.

Case 10. Fixation of the Thumb.—Mrs. F., aged 30 years, presents herself with obscure signs of trouble in base of right thumb, attributed by her to a scrubbing accident. Extemporised the splint shown for fixation of the thumb and wrist joints. It enclosed the thumb and radial side of the lower half of the forearm-and produced complete immobilization of the thumb and wrist. It was worn for ten days.

CONCLUSION.

The facts upon which this paper is based justify the conclusion that the surgeon, with wood-fibre splint material, can mould upon the spot a splint to meet the indications of each individual case; a splint that will produce immediate fixation of the parts; that admits of easy inspection of the parts; and that because of the resiliency of the material, will permit the maintenance of an efficient fixation, despite subsidence of swelling or tissue atrophy.

DISCUSSION.

Dr. R. S. Harnden, Waverly: One point in regard to the use of this material I wish to bring up. It seems to me an ideal material for splinting but for one objection, which is that in warm weather it might lose its shape by absorbing moisture.

Dr. Tracy: An excellent spinal jacket can be made with this material, which is so light, and it can be applied by the general practitioner right in his office. The technique for a jacket is not so easy as for making splints; but the result-a ventilated, rigid, removable jacket, lasting two years, well repays the trouble. This jacket is admirable in the treatment

of Potts' disease.

In regard to fractures and their treatment, from observation of the results from my practice, I always immobilize the fracture immediately and then watch it carefully, not because I believe that the only way for the tissues to unite is by keeping them at rest, but by so doing they grow in a normal manner. There is always want of fixation if plaster-of-Paris is used, partly because of the interposed layers of cotton. This applies particularly to leg fractures. The tibia is a bone that is accessible to the fingers, and the slightest deviation of form in the line of fracture should be perceived and corrected on the spot by the surgeon, and kept in the correct line until union is complete. In the ordinary way of using plaster-ofParis, union often takes place with some degree of deformity; and often, when the plaster is taken off, the fractured bone must be rebroken in order to make it straight. This can be obviated if the bone be kept under our eyes and under complete fixation by some splint or method which can get as near to the bone as possible.

I have used this material for five years, and advocated its use during that time. I don ot now recall a single case in which the splint softened and I believe it is due to the fact that the material is porous and the moisture is carried off because of capillarity.

Coxa vara, during the progressive stage, corresponds, in its symptoms and physical signs, so closely to fracture of the neck of the femur during the stage of repair that but for the history it could not, in many instances, be distinguished from it in patients of the same age, either by examination or by the X-ray photograph.-R. Whitman.

JOURNAL OF SURGERY.

SUBOUTANEOUS NAILING OR WIRE SUTURING OF UNUNITED FRACTURES.

BY W. L. HUGHLETT, Cocoa, Fla.
Continued from the December Number.

In summing up it seems the whole weight of testimony is in favor of freely opening up the seat of injury. By this means (and modern methods of cleanliness) we can with comparative safety remove all intervening tissues, or foreign substances which may have been carried in by a gunshot or punctured wound, and we may then choose, with the parts all in sight, which of the methods under discussion is preferable. It has occurred to me that in the shaft of long bones a very good method would be to saw out a V-shaped piece out of the end of one fragment, and point the other end of the other fragment so as to fit into itjust as small trees are grafted-saving the periosteum during the sawing. When the bones have been fitted, bring them together, fix with a single wire suture, cover the seat of injury if possible by bringing together the periosteum, close the wound and put on the limb a plaster-of-Paris dressing. The plaster dressing will prevent a lateral giving way, the single suture will hold the bones in apposition, and the contraction of the muscles with the bones fitting snugly end to end will promise the best possible results.

Some confusion may come through the use of the word subcutaneous. As applied to tenotomy and other operatious it would mean working in the dark, and through the smallest possible skin incision. I have not construed it to apply in this way and the sense of the paper would perhaps be better if the simple words "nailing or wiring" were used.

I should not think favorably of driving nails through skin and tissues into a fracture out of sight. A procedure of this kind might be pardonable in fractured condyles, separation of the epiphyses, or fractures about the neck of the bones, but certainly not in the shaft.

When the master minds of our profession are not agreed as to which is the preferable method, those of us who follow must in consequence fall back on our general knowledge of natural law, and depend on our own ingenuity for the solution of this as well as other difficult problems ever and anon claiming our attention. From a careful study of this matter I have concluded that the best results will follow the simplest procedure. Sooner than use a multiplicity of nails or wires I would put the fractured ends in apposition and confine them with a single wire or nail, fixing the limb as for an ordinary fracture. Let me again impress upon you also the great importance of saving the periosteum. When this has been separated from. the ends of the bones non union may result when every other method and condition favorable to restoration has been successfully carried out.

Monthly Index of Surgery and Gynecology.

Abscess of the Lungs (Med. Rev., Nov. 11, '99). W. Porter.
Amputation of the Cervix Uteri, Technique of (Int. Jour. Surg.,
Dec., '99). A. H. Goelet.

Anesthetics. Further Experimental Researches on the Effects
of the Different, on the Kidneys (N. Y. Med. Jour., Nov.
18, 25, Dec. 2, '99). R. C. Kemp.
Anesthesia, General Surgical, andAnesthetics (Medicine, Dec.,
'99). E. J. Mellish.

Appendicitis (Am. Jour. Med. Sc., Dec., '99). M. H. Rich-
ardson.

Appendicitis (Phila. Med. Jour., Dec. 2, '99). J. O. Conor.
Appendicitis. A Review of the History and Literature of (Med.
Rec., Nov. 25, '99). G. M. Edebohls.
Appendicitis, The Prognosis and Modern Treatment of (Brit.
Med. Jour., Nov. 25, '99). D'Arcy Power.

Bladder Troubles in Old Men and the Treatment (Maryl. Med.
Jour., Dec. 9, '99). J. H. Billingslea.

Bone and Joint Diseases, Chronic, in Children, The Early Diag-
nosis of (The Plexus, Nov., '99). J. L. Porter.
Brain, Observations on the Surgery of the, Based on 47 Opera-
tions (Int. Jour. Surg., Dec., '99). G. W. Crile.
Cancer, The Destruction of, by Electric Currents (Kans. City
Med. Index-Lanc., Dec, '99). H. E. Pearse.
Cancer, The Pathology and Therapy of, with Special Refer-
ence to Cancer of the Stomach (Phila. Med. Jour., Nov.
17, 25, '99). A. C. Bernays.

Cancer of the Uterus, Prevention and Treatment of (Jour. Am.
Med. Assoc., Nov. 25, '99). L. Smith.
Celiotomy, Exploration of the Abdomen as an Adjunct to
Every (Med. News, Dec. 16, '99). H. A. Kelly.
Chronic Joint Diseases and Traumatic Neuroses, Differential
Diagnosis between (Med. Rec., Dec. 9, '99). R. H. Sayre.
Club-foot, The Necessity of Post-operative Treatment of (Maryl.
Med. Jour., Dec. 2, '99). R. T. Taylor.
Cutaneous Cancer, Nature and Treatment of (Jour. Am. Med.
Assoc., Nov. 18, '99). A. Ravogli.
Dislocation of the Cuneiform Bones (Cinc. Lanc.-Clin., Nov.
25, '99). B. H. Blair.

Extirpation of the Uterus, Its Appendages, Tumors, etc., With-
out Ligatures, or Retention Clamps (Jour. Am. Med.
Assoc., Dec. 9, '99). H. P. Newman

Fractures Involving the Elbow Joint, Treatment of (Occid.
Med. Times, Nov. 15, '99). G. H. Aiken.

Fractures of the Bones of the Leg, Treatment of (Int. Jour.
Surg., Dec., '99). W. L. Estes.
Fractures, Ununited, Which is Preferable, the Subcutaneous
Wiring or Nailing of? (Int. Jour. Surg., Dec., '99). W.
L. Hughlett.

Gall-stones, Four Recent Cases of, with Remarks (Va. Med.
Semi-Mo., Nov. 24, '99). Hunter McGuire.

Gelatin, The Hemostatic Value of (Med. News, Dec. 2, '99). J.
B. Nichols.

Gonorrheal Arthritis, The Surgical Treatment of (Lancet, Dec.
9, '99). J. O'Conor.

Gunshot Wound of the Brain through the Mouth, Bullet Re-

moved on the Sixty-ninth Day through the Vertex; Re-
covery (Lancet, Dec. 2, '99). A. E. Barker.

Hallux Valgus, The Radical Cure of (N. Y. Med. Jour., Dec.
16, '99). R. S. Fowler.

Hemorrhoids and their Treatment (N. Carol, Med. Jour., Nov.
20, '99). J. R. Irwin.

Hemorrhoids, Modern Surgical Treatment of (Int. Jour. Surg.,
Dec., '99). G. M. Blech.

Hernia in the Aged, Treatment of (West. Med. Rev., Nov. 15,
'99). C. C. Allison.

Herniæ, Special Preparations of Patient, Surgeon, Instruments,

Sutures, etc., and Points of Technique of Operations for
(Bost. Med. and Surg. Jour.. Dec. 7, '99). J. C. Stinson.
Hour-glass Stomach (Stomach en bissac), A Case of Operation.
Recovery (N. Y. Med. Jour., Dec. 9, '99). C. G. Cumston.
Hyperthrophied Prostate, The Operative Treatment of (Va.
Med. Semi-Mo., Dec. 8, '99). H. H. Young.
Inguinal Hernia in the Young, The Etiology and Treatment of
(Lancet, Nov. 18, '99). R. H. Russell.
Intestinal Obstruction from Biliary Calculi (Louisv. Mo. Jour.
Med. and Surg., Dec., '99). J. W. Bovée.
Intestinal Suture with the Use of a Potato Cylinder (Tex. Med.
Jour., Dec., '99). M. B. Saunders.

Lacerations, Old, of the Pelvic Floor (Jour. Am. Med. Assoc.,

Dec. 9, '99). M. L. Harris.

Laparotomy, Saturation Method in the Management of (Phila.
Med. Jour., Dec. 9, '99). S. Lewis.

Operations on the Stomach, A Brief Summary of the Indica-
tions for (Med. News, Nov. 25, '99). M. Einhorn.
Pancreatic Cysts (Jour. Am. Med. Assoc., Dec. 2, '99). L. L.
McArthur.

Perineal Resection of the Rectum for Carcinoma, Three Cases
of (Chicago Med. Rec., Dec., '99). A. E. Halstead.
Peritonitis, Acute, Treatment of (Yale Med. Jour., Dec., '99).
T. H. Russell.

Prostatic Examination, Value of (Med. Mirror, Dec., '99). J.
L. Boogher.

Pulmonary Embolism following Injuries or Operations in the
Pelvic Region, Report of Cases of Sudden Death from (N.
Y. Med. Jour., Nov. 25, '99). G. P. Biggs.
Pus in the Pelvis (Buf. Med. Jour., Dec., '99). H. E. Hayd.
Pyelonephritis of Pregnancy (Phila. Med. Jour., Dec. 9, '99).
C. B. Reed.

Pyloroplasty for Stricture of the Pylorus (Bost. Med. and
Surg. Jour., Nov. 30, '99). M. H. Richardson.

Pylorus, Obstructive Growths of the, with Report of a Suc-
cessful Case of Pylorectomy (Jour. Am. Med. Assoc., Nov.
25, '99). J. Allaben.

Rectal Adenomas (Phila. Med. Jour., Dec. 16, '99). W. M.
Beach.

Regional Minor Surgery, The Lips, Upper Jaw, Tongue, Ton-
sils (Int. Jour. Surg., Dec., '99). G. G. Van Schaick.
Sarcomata of the Jaws, A Report of Some (Ala. Med. and
Surg. Age, Nov., '99). W. H. Hudson.

Seminal Vesicles, The Operative Routes to the (Jour. Cutan.
and Genito-Urin. Dis., Dec., '99). P. R. Bolton.
Skin-grafting, A New Method of (Lancet, Nov. 25, '99). T. H.
Kellock.

Spina Bifida, Value of Operative Treatment in, with the De-

scription of a New Method of Closing the Cleft in the
Spine (Int. Jour., Surg., Dec., '99). W. B. Reid.
Spina Bifida, The Most Successful Treatment of (Am. Jour.
Surg. and Gynec., Nov., '99). W. O. Henry.

Stone, On the Choice of Operation for (Therap. Gaz., Nov. 15,
'99). J. H. Brinton.

Supra-pubic Lithotomy, Remarks on (Tex. Med. Jour., Dec.,
'99). G. F. Lydston.

Suprarenal Gland, Primary Tumors of, and their Removal by
Operation (Brit. Med. Jour., Nov. 11, '99). H. Morris.
Surgical Tolerance and Results (Louisv. Jour. Med. and Surg.,
Dec., '99). F. F. Bryan.

Transplantation, Anterior, of the Round Ligaments for Dis-
placements of the Uterus (Jour. Am. Med. Assoc., Nov.
18, '99). A. H. Ferguson.

Tuberculosis of the Kidney, A New Method of Diagnosis of
(Am. Gyn. and Obst. Jour., Dec., '99). C. P. Noble, W.
W. Babcock.

Tuberculous Joint Disease, The Early Diagnosis of (Med. Rec.,
Dec. 16, '99). L. W. Ely.

Tumors of the Mammary Gland, The Importance of Early Diag-
nosis and Operation in (Lehigh Val. Med. Magaz., Nov.,
'99). W. L. Rodman.

Ureters, Surgical Injuries to the, The Management of (Am.
Jour. Med. Sc., Dec., '99). B. Mac Monagle.

Uterine Displacements Resulting from Lacerations of the
Pelvic Floor, Surgical Treatment of (Jour. Am. Med.
Assoc., Nov. 25, '99). C. K. Fleming.

Uterine Displacements, The Etiology and Significance of (Med
Stand., Dec., '99). H. D. Niles.

Uterine Fibroids, Pregnancy Complicated by (N. Y. Med. Jour.,
Nov. 25, '99). H. C. Coe.

Uterine Fibroids, The Operative Treatment of (Am. Gyn. and
Obst. Jour., Dec., '99). F. A. Lockhart.
Vaginal Hysterectomy for Carcinoma Uteri, The Results of
107 Cases, performed during the last 7 years (Lancet, Nov.
18, '99). F. B. Jessett.

Varicosities of the Internal Saphenous Vein. A Modified Pro-
cedure for the Radical Cure of (Brookl. Med. Jour.. Dec.,
'99). R. Fowler.

Ventral Fixation of the Uterus Without Laparotomy (N. Y.
Med. Jour., Dec. 9, '99). F. Suggs.

X-Rays and Injuries of the Head, Notes upon (N. Y. Med. Jour.,
Dec. 2, '99). J. Rudis-Jicinsky.

Journal of Surgery

Vol. XIII.

Original Articles.

FEBRUARY, 1900.

SOME DANGERS THAT FOLLOW IN THE WAKE OF MODERN SURGERY.

BY ROBERT H. COWAN M.D., Professor of Operative Surgery, New York School of Clinical Medicine. Asst. Chief Surgeon N. & W. R. R.

In no department of the healing art have greater strides been made than in the wide domain of surgery. From the day the master mind of Marion Sims conceived his speculum, operative work, hitherto impossible, was rendered comparatively easy of accomplishment, and a new field opened to the the gynecologist. The discovery of anesthesia, the evolution of the germ theory, and a knowledge of the laws of asepsis and antisepsis, have simplified and lessened the dangers of operations. Exploratory incisions have enabled the surgeon to invade the abdomen with a degree of impunity which once would have seemed marvelous. Wyeth's transfixion pins have robbed the once dangerous hipjoint amputation of its greatest danger-hemorrhage, and consequent shock. The stethoscope, the urethroscope, and the Roentgen ray have wonderfully aided us in correct diagnosis.

I might go on at length and draw a glowing picture of fin de siecle surgery, as compared with the more restricted, and possibly less scientific work of the past. But there is, I fear, another side to the picture. The very facility with which operations can be done, may be productive of danger, alike to operator and patient. If there is one requisite of paramount importance to the surgeon, it is diagnostic ability. The older surgeon, without the aids to diagnosis we possess to-day, was not so far behind us in arriving at correct conclusions. The necessities of the case developed his senses. Experience and a habit of close observation seemed to have given him almost prophetic ken. Notwithstanding his meagre facilities, a reference to musty volumes affords us indisputable evidence that, pardon the slang, "he

No. 2

got there all the same." It seems to me the temptation to-day is to rely too much on aids to diagnosis; the contributions of modern science and ingenuity. Valuable indeed in obscure cases, or to confirm a diagnosis; but too often a barrier to the cultivation of our perceptive and reasoning faculties.

Before the days of anesthesia, the surgeon prided himself on the celerity with which he could operate. This was a matter of vital importance then; and equally so to-day. For it is to be remembered, prolonged anesthesia is productive of shock. Of course, haste at the expense of thoroughness and safety is wrong; but, I am satisfied loss of time is not appreciated by many of us, as it was by the men who had to work without the aid of an anesthetic. Asepticism and germicidal agents come in, too, as elements of danger to the young surgeon and to his patient. Unskilled in diagnosis, plenty of gauze, hemostatic forceps, and a sharp knife at hand, what is easier than an exploratory incision, certainly fraught with some degree of danger, and which a better diagnostician might have found unnecessary.

The technique of modern surgery is attractive. Manual dexterity may be acquired without particular mental effort, and, as a result, we too often find men of meagre intellectual and educational qualifications, and but scant knowledge of the principles of surgery, undertaking operations of the gravest nature. How often do we hear doctors who have attended a clinic at the meeting of some society, or in one of our city hospitals, dilating on the skill of the surgeon; but, apparently, uninterested in the result. The operator did his work well. He was, as on one occasion I heard an onlooker remark, an artist, and the operation was probably necessary. I say "probably," advisedly; for I am sure some of our most famous surgeons are responsible for much unnecessary mutilation of "the human form divine;" and another unfortunate part of the business is, that the host of absolutely unqualified imitators they inspire to similar effort is rapidly increasing the ranks of surgery with recruits as deadly to human life as the much abused microbe.

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