tion for a short time to some of the defects which I trust may serve as a stimulus to still further development in

our own art.

Looking to the teacher and surgeon of the twentieth century, we are prompted to ask, "What is the status of our medical institutions? Let me say, in our medical institutions there is too little anatomy taught, and there is too little insistence upon our familiarity with the fundamental principles, which, in the developments of the last two decades, have come to underlie the surgical art. In how many institutions of learning to-day is the student required to dissect more than one part of the body? In many of them I know they are required to dissect the whole body. More practical anatomy should be taught in the dissecting room. How many, when they pick up a knife for the purpose of dissecting or otherwise, can recall precisely what is under the tissue they are about. to dissect? We should have more practical anatomy in our medical schools. If we are to work on this great human machine, in the most responsible and careful manner, ought we not to acquire a perfect familiarity with the entire mechanism and with all of its integral parts?

Passing from that fundamental, let us go to the other. How times have changed! When we sat upon the benches, not many years ago, the fundamentals consisted of anatomy, physiology, chemistry, and a little materia medica. Now, what are they? In almost every department of the biological sciences we find some element that applies as a fundamental element to the surgical art. The whole microscopic world is levied upon. Our courses in bacteriology have become the starting-point, and occupy to-day precisely the same relation to the general surgical art, and, for that matter, the broad medical art, that anatomy does. Then comes the study of histology, for without a knowledge of tissue construction, what conception can we have of those changes which characterize the phenomena of disease that we are called upon to rectify? We find the fundamentals have changed. But how little attention is given to this subject in our medical curricula? I do not wish to stand before you as an uncharitable critic of our medical colleges. All honor to them! With a self-sacrifice that has never been equaled on the part of any profession in the world, while we have sometimes come to despise our medical schools and to look upon them as a sort of educational requirement for the community and profession, yet at the expense of much time, labor and money on part of the faculties we have procured the splendid results such as we find in organizations like this. Therefore, while fault may be found with our medical schools, this generous criticism is not intended for their embarrassment, but for their betterment, and when we emphasize in these gatherings the principles we feel should underlie them, we give them equal rights, we give expressions to sentiments that may serve as guides for them in the development of their curricula and the fulfillment of their splendid destiny.

Having spoken of the importance of devoting attention to the fundamental branches of the surgical art, to biology, bacteriology, and anatomy primarily, of course,

as well as to physiology, which should be experimentally studied, we come to consider the further status of our department.

To-day surgery is made too much of a didactic subject in our medical schools. Surgery now requires a course in manual training. Manual training should be taught students. They must be brought in contact with actual work, which they must follow when they go forth to minister to suffering humanity. Therefore, several changes ought to be made with reference to the teachings of clinical or practical surgery. What are those changes? We have too many hospitals organized to-day, and those denominational institutions that sequestrate patients and divert them from clinical purposes are damaging to the cause of medical education, for every pauper patient who is deprived of the opportunity to serve for the purpose of clinical instruction is deprived of the opportunity that patient will have to render a quid pro quo to the community for what he receives. (Applause.) What must we do? We have got to recognize the status quo, we have got to recognize that these institutions do exist, actuated by humane motives, serving excellently to develop the skill and reputation cf those gentlemen who are fortunate enough to be on their staffs, and who are fortunate to be in touch with these terrible runners all over the community who send the proverbial tide of patronage to these institutions. While that is true, we have got to accommodate ourselves to it. Too much clinical material is diverted. The sentiment of the community will not, in many instances, sustain the medical faculty in giving bedside instruction in surgery. Then, the next most important expedient which appeals to me with peculiar force is the establishment of a surgical laboratory in each of the medical schools. In this surgical laboratory students can be taught the preparation and application of bandages, the application of dressings, the manipulation of all mechanical appliances, the training of the hand in the doing of these things which they are called upon to do by daytime and by night time, under the most disressing cir

cumstances.

I understand that yesterday you had a discussion on First Aid to Injured. It is a practical and humane question in the U. S. Army, in the Marine Hospital Service, and in other branches of the service, and to my mind there is no subject more pregnant with usefulness than that topic when viewed from the standpoint of this Association. But if you put medical students in the medical schools through surgical laboratories and make them familiar with all the details of this surgical work, you will have laid the foundation for this very necessity which has forced itself upon your attention in your professional capacity. If, then, we are to recognize that these important steps forward must be taken in the preparation of the surgeon of the twentieth century, what must we say with regard to that surgeon after he has emerged from the portals of his alma mater? A duty that he owes to his community, a duty he owes to his profession. In the first place, he must become a specialist. There are too many of us already. But the tendency of specialization, I believe you will all concede, has been

developed and is to-day exemplified to a mischievous degree. The surgeon, who, going forth without the broad training I have already indicated, and applying himself in his practical work to a limited field, becomes the victim of a sort of convergent mental strabismus, and the narrowing of the field of vision works a misfortune to the individnal practitioner and to those who apply to him for relief. Now, shall specialism come to an end? No! All specialism must be recognized only as an arbitrary position assumed by the individual for his convenience, or for the promotion of his usefulness, based upon the broad general culture of his profession. (Applause.) I remember once, when the great Thomas Addis Emmet stated that no man ought to be recognized as a justifiable applicant for membership in the American Gynecological Society who had assumed to be a gynecologist under less than twelve years of general practice. That might perhaps be a broad statement, but the principle it involves stands absolutely inviolate as the essential principle of practice in our profession. It is the self-culture that follows upon which rests the future of the profession. This is best promoted by organizations such as you represent, and by the promulgation of a higher class of literature than that with which we are now flooded. We should endeavor to support the strong medical journals and pay less attention to the weaker ones. This criticism, like the one directed against medical schools, is a generous and not a captious one. We come to feel that the material is not selected with discrimination which makes a medical journal a valuable acquisition to our literature. That being true, I feel that the tendency of the times is to recognize and rally to the support of the strong medical journals, the editors of which exercise discrimination in the publication of their material, thus redounding to the real advancement of the profession.

I pause here to say that in this city there is contemplated a medical congress, projected along lines that are in consonance with what I have said with regard to medical literature, namely, to bring to this city the leading thought of the world and to invite the members of the medical profession of the world to come here and sit for a brief period under its inspiration, and with an enterprise conceived upon such exalted lines I feel that it appeals to the loyal support of the entire profession.

I feel that I have consumed much more time than I ought to have done. I am aware that your program awaits you, and that you are exceedingly anxious to finish it so that you may return to your respective fields of duty. But I cannot close without indulging the hope that so far as your influence extends-and we know both individually and collectively that influence is largeit will be brought to bear upon our medical institutions to support them in these improvements. I feel perfectly sure that they are anxious to do everything that is possible toward advancing and keeping up the progressive spirit of the profession. I indulge the hope that with the increasing esprit de corps, with the increasing catholicity of spirit manifested by our profession all over the country, under the plan of reorganization of the American Medical Association, which will be re-emphasized at Saratoga next month, I feel that with this in

creasing, broadening sympathy, that we shall draw into the fold of legitimate and progressive medicine every individual who assumes the responsibility of caring for the sick and injured, and in the course of the next century, by thus bringing all devotees of the healing art in touch with an organized progressive profession, we shall realize in the highest possible degree the surgeon of the twentieth century. (Applause.)

A NEW HEAD AND NECK BANDAGE.

BY H. ELLIOTT BLAKE.

Place the end of the bandage on the side of the vertex, let is pass obliquely to the left side of the head behind the left ear to below the occiput; continue it round the right half of the neck and obliquely under the chin to the outside of the left ramus of the jaw; thence carry

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the bandage obliquely up the left side of the face, in front of the left ear, to meet and overlie the initial end. This makes the first loop. The second loop is formed in the same way, but on the other side. Thus, starting at the vertex, the bandage is continued slantingly down the back part of the head, behind the right ear, to below the occiput, and after crossing the first loop there it passes round the left side of the neck, crosses the first loop again under the chin, and reaches the outside of the right ramus of the jaw; it is then carried obliquely up the right side of the face in front of the right ear to the vertex. This completes the second loop and finishes the bandage. The turns are repeated to cover any dressings.

The bandage is convenient and its method of adjustment easy to remember. It is self-fixing, so the constant nipping up with pins is unnecessary. It avoids any circumferential turn around the neck and is, therefore, particularly comfortable for children. With this bandage it is quite feasible to keep dressings on for a week and more at a time without alteration, loosening, rubbing or chafing of importance; besides, it permits of feeding without displacement. As a definite basis to start from, extensions of the bandage can be made as they occur to anyone, so as to cover any extra dressings, such, for instance, as under the opposite axillæ to cover the lower part of the nape of the neck, etc. It should be pointed out that the double loops are not simply figures of eight, because they cross and turn three times.-London Lancet.

NEW REGISTRATIONS.

Dr. F. H. Coe, Seattle, Wash., local surgeon N. Pac. Dr. William F. Berry, Mt. Clemens, Mich., local surgeon Rapid Ry.

Dr. E. W. Bartlett, Milwaukee, Wis., examiner C. M. & St. P.

Dr. Albert B. Deering, Boone, Ia., district surgeon C. & N. W.

Dr. Joseph Fewsmith, Newark, N. J., surgeon D., L. & W.

Dr. W. D. Wilson, Mt. Clemens, Mich., local surgeon G. T.

Dr. J. D. Bryan, Ottawa, Kan., local surgeon M. Pac. Dr. Gilbert L. Pritchett, Fairbury, Neb., local surgeon C., R. I. & P.

Dr E. E. Laurent, Montreal, Can., division surgeon G. T.

Dr. J. E. Ragsdale, Gibson City, Ill., local surgeon Wabash.

Dr. W. C. Cox, Everett, Wash., local surgeon G. N., N. P and M. C.

Dr. Leander B. Smith, Fremont, Neb., assistant surgeon U. Pac.

Dr. C. W. Stranahan, Erie, Pa., surgeon Lake Shore. Dr. M. R. Bruin, Strasburg, Va., local surgeon South

ern.

Dr. R. L. Von Trebra, Chetopa, Kan., local surgeon M., K. & T.

Dr. Edward H. Griswold, Peru, Ind., surgeon in charge Wabash Hospital.

Dr. Frank B. Ferson, Mansfield, Mo., local surgeon 'Frisco.

Dr. M. B. Mattice, Secho-Woolley, Wash., local surgeon N. Pac.

Dr. Josephus P. Stewart, Clay Center, Kan., local surgeon C., R. I. & P.

Dr. Charles C. Walsh, Merrill, Wis., local surgeon C., M. & St. P.

Dr. Clarence W. Winbigler, Harper, Kan., local surgeon S. Fe.

Dr. Lutellus L. Porter, Roslyn, Wash., local surgeon. N. Pac.

Dr. D. S. O'Brien, Beloit, Kan., local surgeon N. Pac. Dr. I. N. B. Spence, Social Circle, Ga., local surgeon C. of Ga.

Dr. Bruce L. Riordan, Toronto, Can., district surgeon G. T.

Dr. George S. Rennie, Hamilton, Ont., chief surgeon T., H. & B.

Dr. Sol. G. Kahn, Leadville, Colo., local surgeon C. M. and consulting surgeon C. S.

Dr. William W. Stuart, Clarksdale, Miss., local surgeon Y. & M. V.

Dr. Charles C. O'Brien, Groveton, N. H., district surgeon G. T.

Dr. Philip R. Fox, Madison, Wis., district surgeon C. & N. W.

Dr. Alvah Stone, Worth, W. Va., surgeon N. & W. Dr. John Pitman, Kirkwood, Mo., local surgeon Mo. Pac.

Dr. William A. Wood, Hubbard, Tex., local surgeon Cotton Belt.

Dr. S. H. Clark, Worthington, Minn., local surgeon B. C. R. & N.

Dr. Alford B. Phillips, Horse Creek, Ala., local surgeon 'Frisco.

Dr. S. C. Plummer, Chicago, Ill., chief surgeon C., R. I. & P.

Dr. R. P. De Yarto, Acambaro, Mex.

Dr. Walter A. Rose, Rochester, Pa., division surgeon P., Ft. W. & C. and C. & P.

Dr. J. A. Black, Pueblo, Colo., local surgeon D. & R. G. Dr. John Walker, Glencoe, Ont., local surgeon C. Pac.

Dr. George S. Smith, Liberal, Kan., local surgeon C., R. I. & P.

Dr. Isaiah Du Bose Morgan, Eutaw, Ala., local surgeon A. G. S.

Dr. J. E. Gilcreest, Gainesville, Tex., local surgeon M., K. & T.

Dr. Robert H. Payne, Richland, Ia., surgeon B. & W. and B. & N. W.

Dr. J. K. Stockwell, Oswego, N. Y., surgeon N. Y., O. & W.

Dr. W. H. M. Philip, Hope, N. D., local surgeon G. N. Dr. Cassius D. Westcott, Chicago, Ill., oculist C., M. & St. P.

Dr. C. V. Ellingwood, Chatsworth. Ill., local surgeon I. C.

Dr. George M. Bell, Benton Harbor, Mich., division surgeon Big Four.

Dr. J. R. Williamson, Brenham, Tex., local surgeon H. & T. C.

Dr. Adam Grim, Franklin Grove, Ill., local surgeon C. & N. W.

Dr. James A. Clyne, Joliet, Ill., local surgeon C. & A. Dr. Luther D. Jacob, Emporia, Kan., local surgeon S. Fe and M., K. & T.

Dr. W. C. Graves, South McAlester, I. T., local surgeon C. O. & G.

Dr. George C. Bryan, Alamogordo, N. M., chief surgeon El P. R. I.

Dr. Nelson A. Drake, Kansas City, Mo., local surgeon Rock Island.

Dr. D. T. Stewart, Hartley, Ia., local surgeon C., M. & St. P. and Rock Island.

Dr. M. A. Brawley, Frankfort, Kan., local surgeon M. Pac.

Dr. Otis Johnson, Quincy, Ill., local surgeon I. O. & K. C.

Dr. Walter Lathrop, Hazleton, Pa., surgeon L. V., superintendent and surgeon state hospital.

Dr. Alexander W. Acheson, Denison, Tex., local surgeon M., K. & T. and Tex. Pac.

Dr. I. H. Goss, Athens, Ga., local surgeon Southern. Dr. Thomas J. Milner, Greenville, Tex., local surgeon M., K. & T.

Dr. A. S. Sensenick, Wakarusa, Ind., local surgeon Wabash.

Dr. William L. Buechner, Youngstown, O., local surgeon Erie. Dr. W. H. Buechner, Youngstown, O., local surgeon Erie.

Dr. Howard J. Williams, Macon, Ga., chief surgeon M., D. & S.

Dr. Thomas F. Hechner, Pottsville, Pa., medical examiner P. & N.

Dr. R. W. Miller, Los Angeles, Cal., surgeon S. F. Dr. Hugh M. Taylor, Richmond, Va., local surgeon C. & O.

Dr. Allen R. Law, Madison, Wis., local surgeon I. C. and C., M. & St. P.

PERSONAL.

Dr. J. N. Jackson of Kansas City, Mo., is recovering from a severe attack of entero-colitis.

Dr. William H. Mansperger of Buffalo, N. Y., has been appointed surgeon of the Erie Railway, vice Dr. C. M. Daniels, deceased.

Dr. W. A. Adams of Fort Worth, Tex., died there suddenly on October 15. At the time of his death Dr. Adams was chief surgeon of the St. Louis & San Francisco Railroad Company in Texas, and local physician for the Missouri, Kansas & Texas, Texas & Pacific and International & Great Northern railroads.

Railway Surgeon

A Monthly Journal of Traumatic Surgery

public does not, as yet, grasp the fact that it is almost as important to select a good anesthetist as a good surgeon.

The next thing to attract attention would be the elaborate precautions to secure asepsis-the boiling of instru

tor's and assistant's hands. Some practitioners formerly had the habit of using a particular coat to wear when attending obstetric cases, and in some hospitals a similar coat was often used for operating in. Mr. Robson tells how he inherited "a stained and gory coat of many colors and many years' service" on being appointed to the staff of the Leeds Infirmary.

To give a better idea of the advances in the healing. art the author contrasts the report of the infirmary for 1870 with that of 1902. While the number of operations has increased from 469 to 4.385, the death rate has fallen from 6.6 per cent in 1870 to 2.7 per cent in 1901, though the extent of the operations has been very often infinitely greater. Many operative procedures are found in the last report which were unheard of in the former one. For instance, 109 operations for radical cure of hernia were performed and 38 osteotomies, as well as 78 appendicectomies. Operations on the gall bladder were practically unknown 30 years ago, but are represented by 38 cases in 1901. So, too, with prostatectomy, resection of the intestine and gastric operations. The latter numbered no less than 94, and as evidence of the relief afforded by modern surgery, Robson refers to a patient still living two years after the removal of nearly the whole of the stomach for cancer.

The triumphs of modern surgery are not alone confined to removing diseased parts, as many of the laity seem to think, but as the author points out, we are able to construct and build up as well. Again, many cases of disease only too common years ago are rare, or even unknown, nowadays; for example, septicemic pyemia, ery

YEARS.

In the introductory address* at the Yorkshire College, Leeds, Mr. A. W. Mayo Robson took for his subject the advances in the science and art of surgery for the past three decades. Such retrospective views are always interesting, and they are especially so when set forth by one who has taken as prominent part in the development, as has this distinguished surgeon.

Perhaps, he says, no more unfortunate remark was ever uttered than that made some twenty years ago by an eminent surgeon, since deceased, who said that surgery had about reached its limits. Could he be with us now he would see what a very poor prophet he was. Mr. Robson observes that he often wonders what one of the old masters of surgery would say could he return and spend a week in a modern hospital. His first surprise would be to see the patient sleeping quietly while the operation is being performed. Anesthesia is one of the greatest boons to humanity, and the nineteenth century would be prominent in medical history on account of this discovery, even if there was nothing else to record. The

*London Lancet, October 4, 1902.

points to tetanus, which thirty years ago was not uncommon after even slight operations, yet in the last twenty years Robson has not seen a single post-operative case, all the cases noticed coming from neglect of wounds eceived before entrance. In 1870-71 no case of abdominal section is reported; in 1901, no fewer than 569.

The average lifetime of men has been prolonged from 39.91 years in 1854 to 43.65 years in 1890, and of women between five and six years. It seems only natural that with this prolongation of life the diseases of middle and advanced life should be more prominent, and possibly this may be one of the reasons for the increasing frequency of cancer. The author advances the belief that in the future the medical man may undertake the treament of cancer, and that this will cease to be a surgical operation. Rodent ulcer and epithelioma are being cured now by the Roentgen rays, and are passing from the domain of surgery proper.

In conclusion, Mr. Robson alludes to the fact that every medical man contributes his experience for the common good, and the "great glory of our profession being that in a time of so much rivalry and selfishness it pursues a steady, philanthropic and righteous course."

Translations.

is replaced in the cast, which is fastened by a few turns of a bandage.

About the twelfth day the limb is left free in the day

(Translated for the Railway Surgeon.)

Falls on the knee, and especially wrenches, are frequently accompanied by an important effusion into the joint cavity. When confronted with a case of this kind, what should be the course to be pursued?

If the effusion is extremely abundant, some hours after the accident when the cul de sacs of the joint seem strongly distended, the best way is to make antiseptic puncture of the synovial cavity where it is most easily accessible. The field is first carefully brushed with soap and water, then washed off with ether, and lastly sublimate solution. Sterile compresses protect the operative field. The needle is sterilized by boiling in a solution of 2 parts of carbonate of soda to 100 of water. After the liquid is evacuated the needle is rapidly withdrawn and the opening sealed with cotton and collodion. With due precautions this puncture is not dangerous, and at the command of any practitioner. But all irrigation of the cavity, even of carbonized water, is to be interdicted. First it does not sensibly increase the efficacy of the procedure, then it complicates the later, and the least fault in technic, or the least error in the use of the aspirator, may lead to infection.

If the effusion is medium in amount, puncture is useless, and immobilization in a plaster cast is the absolute rule. Other methods of immobilization, notably the bandages of soluble glass, are not sufficient and always inferior to the plaster cast.

The application of revulsents to the interior surface of the knee--such as iodin, blisters, or the actual cauterywhile completely useless from a theoretic standpoint, immobilization alone sufficing, in most cases lead to rapid absorption of the effusion. Of course, this is not to be thought of when puncture is practiced. Compression alone has but little efficacy, it may be combined with the plaster cast without sensibly increasing the results.

How long should immobilization be kept up? In our opinion, it ought to be very short. In general five to six days are enough, and in no case should it exceed eight days. The effusion, as a rule, is reduced threequarters or four-fifths by the sixth day. Now is the time. to commence mobilization and massage, if you do not wish stiffness of the joint to follow, and do not want to risk atrophy of the triceps, which may embarrass the patient's gait for a long time. The plaster cast is admirably adapted to meet the exigencies of the situation. If not too heavy it can be removed and reapplied.

From the sixth to the twelfth or fifteenth day, two seances are given daily, each lasting about ten or fifteen minutes. We commence by stroking the whole region about the joint in the direction of the venous current; this is soon followed by more energetic friction, exerted especially in the muscular mass in front of the thigh. Some movements of flexion and extension, at first passive, then resisted, end the sitting. After each seance the limb

position. At night it is placed in the cast again. If there is no tendency to reaccumulation of the fluid after a couple of days' trial, walking may be authorized as a rule about the fourteenth day. From now on massage is used but once a day, and is stopped at the end of the third week. At the end of eight days of movement the patient may resume his work.-La Revue Medicale.

SAW WOUNDS OF BONE.

"Sawmill surgery" may not as nearly approach a specialty as does railway surgery, but the accidents are of a peculiar character often and sometimes require special skill in their management. Dr. J. J. Norwine of Poplar Bluff, Mo., has lately had a remarkable case of the kind. John S. was thrown against a "cut off" saw in such a manner that the spine of the scapula was divided and the head of the humerus severed from the shaft. The forearm was cut from near the elbow to the hand, much of the skin and muscle being sawed into a conglomerate

mass. The doctor cleaned the wound with a solution of pixcresol, I to 1,000, then carefully cut away all fragments and brought muscles and skin together with catgut sutures. The entire wound was filled with mixture of camphor and carbolic acid (one ounce of camphor mixed with one ounce of carbolic acid, pure) and dressed with sublimated gauze.

In spite of the filthy condition of the wound and bad. surroundings of a lumber camp, union by first intention was secured and perfect use of both arm and forearm were secured in sixty days.-Amer. J. Surg, and Gyn.

TREATMENT OF PILES.

Dr. George W. Gay makes the following deductions respecting the treatment of piles by the injection of carbolic acid:

1. Inject only internal piles. 2. The solution of carbolic acid should not exceed 10 per cent. 3. Do not repeat the operation under a week. 4. Inject only one or two minims into each tumor. 5. Inject not more than two piles at any one time. 6. Promise relief only and not a radical or a permanent cure.-So. Cal. Pract.