was opened by an incision in the median line, about six inches in length, extending from the ensiform cartilage nearly to the umbilicus.

Upon opening the peritoneal cavity it was found to be filled with blood, not less than one pint escaping through the incision. Examina-' tion revealed the fact that the ball had not wounded the gall-bladder or the duodenum, but entered the liver on its concave surface not far from the gall-bladder, and had passed entirely through that organ. Near the point where the ball had wounded the liver there had formed a large clot of blood. Upon the removal of this clot the hemorrhage started afresh from the wound. The peritoneal cavity was thoroughly cleansed by flushing it with pitcher full after pitcher full of half sterilized water, as by neglect of positive instruction no cold water which had been boiled was provided to use in cooling the boiling water, so I was compelled to use the unsterilized water for this purpose.

As fresh blood continued to well up, and it was almost impossible to get at the wound to put in a deep suture to stop the hemorrhage, I tamponed the liver wound with a long strip of iodoform gauze, bringing the strip out through the abdominal incision, leaving one suture untied.

On the second day after the operation this gauze tampon was withdrawn and the suture tied. In withdrawing the tampon a fold of omentum was adherent to the gauze and came out of the wound with it, but was carefully returned.

The patient was under the anesthetic perhaps one hour. He bore the operation well, and came out from it without shock.

On the day following the operation (14th) his temperature was 99°, his pulse 92. On the 15th, the day the wound was fully closed, temperature and pulse in the morning were normal, but in the afternoon. temperature rose to 103°, pulse 128, but by midnight temperature and pulse both had gone to normal. From this date, 15th, to August 23d, the temperature was normal in the morning, rising in afternoon on different days to 101°, 102°, 103°. Pulse ranged during this time from 75 to 100. After August 23d the temperature and pulse became nor

mal and remained so.

The case went on uninterruptedly to complete recovery in about four weeks. At the date of this writing, November 5th, he is perfectly well, and free from any discomfort.

Much credit for the after attention in the case is due to Dr. Leland, an excellent and educated colored physician, who gave much time and care to the case.

I have reported this case in the interest of the general surgeon, especially the country and small-town surgeons, who perhaps are more frequently than any others called upon to meet this class of cases, and generally under the most unfavorable surroundings.

In my opinion we are called upon to meet no more difficult and serious emergency cases than gunshot wounds of the abdominal viscera. And while very many successful cases are reported, yet unsuccessful cases are of sufficiently frequent occurrence to make the surgeon stand somewhat hesitatingly and in awe when confronted by one of these "six of the one and half a dozen of the other" mortality-rate cases.

I take it, that any report which may encourage the surgeon or throw any light upon the management of this class of cases will not be considered out of place.

GEORGETOWN, KY.

A NEGLECTED M. D.*

BY W. SYMINGTON BROWN, M. D.

On every hand we hear and read the highest encomiums on modern civilization. But even the best form of it has serious drawbacks, and one of these is the false standard of worth which society has accepted. Hereditary or political rank and the possession of wealth are the idols we worship. Beneficence and intellectual ability take a back seat.

For a long time I have been impressed by the truth of this conclusion, and I can find no better illustration than the circumstances connected with the life of Dr. Wm. Smellie, who was born in Lanarkshire, Scotland, in 1697, and died there in 1763. This highly talented man, the inventor of the long curved forceps, and also the model used in teaching midwifery, this accomplished teacher, author, and artist, has no place in any encyclopedia or biographical dictionary that I have seen. His name is not found in the Britannica, Chambers', Appleton's, or Johnson's. The name William Smellie, it is true, may be found in the eighth edition of the Encyclopedia Britannica (left out in the ninth), but it refers to an obscure printer, who performed some work for the publishers, and the truly great obstetrician, whose writings and inventions have saved thousands of human lives, is not even mentioned! All these encyclopedias are full of biographies relating to much inferior

*Read, November 6, 1895, before Middlesex-East Medical Society, and November 14th before the Gynecological Society, Boston.

men-soldiers, lawyers, and clergymen-whose efforts were mainly directed toward their own aggrandizement; so that, after all, the neglect shown true benefactors is not surprising, nor is the omission much to be regretted by those who prefer good company. The law of evolution serves to explain the low estimate in which our profession is generally held. Since the earliest historic times a strong, skillful fighter has occupied the highest place in popular estimation. To-day a wealthy man successfully competes with the mere soldier, and ages later the man of science will probably oust them both.

It is a fact worth recording that four of the greatest Britons in the medical profession-William and John Hunter, William Smellie, and William Cullen-were born in Lanarkshire within a short distance of each other, and that at least three of them were intimate friends. Dr. Smellie was about twenty years older than William Hunter, and the latter became a pupil of Smellie soon after he came to London.

During my trip to Scotland last summer I visited Lanark to find out certain particulars concerning this eminent physician. It is not known for certain whether Smellie was born in Lanark or Lesmahagow; but there is no doubt that he spent the last years of his life in Lanark, and was buried in the kirkyard of St. Kentigern, close to what remains of the wall of that ancient church. The tombstone lies flat on the grave, and contains the following legible inscription:

"This is Dr. William Smellie's burying place, who died March 5, 1763, aged 66. Here lyes Euphiam Borland, spouse to the said Dr. Wm. Smellie, who died June 27, 1769, aged 72."

Smellie was what we call to-day "an all-round man." It is probable that Levret invented the lateral curvature of the long forceps about the same time that Smellie did; but the French obstetrician kept it a secret for years, while his Scotch compeer promptly published an account of this improvement. Smellie was also the inventor of what is called the English lock, a form now used everywhere, except in France, where the ancient pivot and mortise lock is still retained. The "scissors" used in craniotomy were also invented by Smellie. Dr. Smellie excelled as a teacher. The late Dr. McClintock, of Dublin, tells us that "in ten years he had more than nine hundred pupils (exclusive of females), and gave two hundred courses of lectures. This is the more remarkable when we recollect that all these were voluntary pupils, attending his courses for sake of the information to be derived from them, and not for the 'certificate' only, as is too commonly the case in the present

day." His terms, too, were high, compared with ours, as the following extract from the syllabus proves:

"Those who engage for one course [which consisted of twelve lectures] pay three guineas at the first lecture; for two courses, five; for two months or four courses, nine; for three months, twelve; for six months, sixteen; and for a year, twenty."*

Another good feature of Smellie's teaching was the importance he attached to clinical lessons. "The pupils had to pay from five to ten shillings for each labor case they attended, and six shillings more to a common stock for the support of the parturient woman." At that time obstetrics was almost entirely in the hands of midwives. A strong popular prejudice against the employment of physicians in that capacity existed, and as a general rule they were only sent for in desperate cases. Dr. Smellie was occasionally mobbed by viragoes in the low quarters of London when he took fifteen or twenty pupils with him to witness operative manipulations, and for my part I do not wonder that he was. Smellie believed in the absolute necessity of acquiring precise anatomical knowledge as a prerequisite to successful treatment. From the time of Hippocrates downward physicians thought that the fetus lay in the womb with its head at the fundus, until the seventh or eighth month, when it performed a somersault! Smellie was the first man who publicly taught that this was an error. He was also the first to notice and point out that "there is a determinate relation between. the positions of the child's head and the pelvis throughout the whole process of parturition, from first to last." Smellie was one of the first to use nutritive enemata. Modern physicians might profitably take a lesson from him in his methods of study, candor and common-sense management of affairs. From the very commencement of his practice in the village of Lanark, he took copious notes of obstetrical cases, and studied more from nature than from books. At that time the obstetrical forceps were not known except to a very few individuals, and craniotomy was the usual resort in difficult cases. This, he tells us, gave him "great uneasiness," and he sent for a pair of French forceps soon after. He also made two journeys, one to London and another to Paris, in 1739, "in order to acquire further information on this subject, but was much disappointed in his expectations." So he set to work assiduously, made many improvements on instruments, and contrived an ingenious machine to illustrate his lectures.

*One of Smellie's certificates may be seen at the Medical Library Rooms, No. 19 Boylston Place, Boston.

Smellie lived in London about twenty years, teaching and practicing, and having saved a competency he retired to his native place, and spent the last four years of his life in revising his papers for publication. His book, "A Treatise of the Theory and Practice of Midwifery," was published in three volumes; but he died before the third volume was printed. The work has passed through several editions, the last of which, edited by Dr. McClintock, was issued by the New Sydenham Society in 1876. It has been translated into French and Dutch. Smellie also published a folio volume of Anatomical Tables, in 1754, designed to illustrate the anatomy of the gravid uterus, the positions of the fetus," etc., thirty-nine in number, several of which were drawn by himself; for he was an excellent artist, as his own portrait, now in the Royal College of Surgeons, Edinburgh, clearly testifies. Many of these plates have been copied in works on midwifery without due acknowledgment.

Dr. Smellie, in his will, left £200, all his books, maps, and pamphlets to the school at Lanark, "for to begin a library there." But, alas! for the lack of public spirit in that ancient burgh, more than a century has elapsed, and the public library has never materialized, though some of Smellie's books still remain "under lock and key in a terrible state of dust and decay." The school was closed for the summer vacation while I was there, and I did not see them. I did see a small pamphlet, recently issued, about the history and antiquities of Lanark, but it did not contain a single sentence about the great man who lived and died there the chief claim of the old town to true fame. "Such is life." STONEHAM, MASS., November, 1895.

CALISAYA DRUNKARDS.-Calisaya drunkards are stated to be rapidly increasing in number in New York. It is said that there is very little calisaya in the mixture, and that the drinker is practically drinking alcohol and quinine. There seems to be a general ignorance of what this beverage really is, persons sometimes resorting to it in the hope of a cure for alcoholic drunkenness. This calisaya drink is, however, more injurious than a purely alcoholic liquor when taken to excess-then the drunkard really suffers from the effects of an overdose of both drugs. The tinnitus aurium of the quinine is accompanied by the circulatory riot of the alcohol. This is much the same concoction as the spirit and bark which, under the name of "Peruvian," was much affected in the city referred to a quarter of a century ago.-British Medical Journal.