present century. Like many great surgeons, even down to the eighteenth century, PARÉ stepped from ordinary day labor to his studies. He acquired his early medical education in the Hotel Dieu. The story of his early struggles, and the many barriers placed in his path, also his final successes, is a most interesting study. He enjoyed the distinction of having held the position of surgeon successively to three kings. He was the first, as far as I know, to use the ligature in amputation. He was also a successful operator in the field of gynecology, and is credited with having been the first to use the suture in the operation of perineorrhaphy, although GUILLEMEAU, a student of his, was the first to really describe the various steps of the operation in 1612. Time will not allow me to trace the brilliant achievements of the French school. They seem to have been in the ascendency during the sixteenth and a part of the seventeeth century, especially in surgery, and this was undoubtedly due to the vast experience which they were privileged to get from the many wars in which their nation was involved. But I want to confine myself as far as they are concerned to their achievements in gynecology. Following PARÉ, we owe much to JULES CLEMENT, a famous obstetrician in the early part of the eighteenth century, who was accoucheur to the Queen of Spain and other noble ladies, and who greatly aided the transfer of midwifery into the hands of men. Still later we find that MAURICEAU, who died in 1719, was a man of great experience, but his teachings were confined principally to the obstetrical art. He objected, however, to the operation of cesarian section on the living woman, and in this he was supported by PIERRE DIONIS, who wrote about the same time and whose writings were translated into many languages, even the Chinese. Another vigorous French writer whose works were published prior to those of RÉCAMIER was VIGAROUS. This author writes upon the subject of electricity and describes its manner of use as one of the modes of curing sterility; but the impetus which was given to the progress of practical gynecology by RECAMIER and his followers. in the early part of the century was succeeded by such brilliant results that one might almost believe that to him was due the title of the Father of Modern Gynecology, did we not know that such a mantle was destined to fall upon the shoulders of one of our own countrymen.

I have thus far hastily reviewed the history of medicine and surgery in a few of its branches from Biblical times to the beginning of the present century, and noted the doings up to that time of a few of that vast number of faithful and patient workers who have devoted themselves to the relief of human suffering and the good of their fellow-men. I have told you of some of their peculiarities, their struggles, the hardships and religious creeds they had to contend with, and also, to some extent, of their successes and the marvelous skill and ingenuity they must have been endowed with to have accomplished what they did so many centuries before the Chris

tian era, especially as they were obliged to work without the aid of that greatest of blessings to living man, anesthesia, a product of the nineteenth century, and of our own country, without which we of to-day, as did they, might dwell in ignorance of a proper knowledge of internal diseases and the art of relieving many of them by surgical methods. The study was so pleasant and I found so many to whom I wished to give honor and praise that I fear I have allowed myself to dwell too long upon it, and you are already weary before I have touched upon the accomplishments of the present century, or what is designated as the modern method of treatment. You are all so familiar with it that anything I can say will undoubtedly prove prosy; but here I find, as in the centuries that have passed (although I think no one will dispute the belief that the present century has produced more great men than any previous one) the mantle of true greatness-that which shall endure and be handed down to future generations and designate them as lasting benefactors to mankind is destined to fall upon but few in our profession. Even so, should they alone receive all the praise? Certainly not; rather should it go to their co-workers, whose name is legion; who, although not the originators of the idea, method, or invention, have at once taken it up, worked it over, added to it, or pruned it, until it has taken its place among the great benefits to the people of this world, and then, and not till then, crowned its originator with lasting distinction among his fellow-men.

I have said that progress in our profession has seemed to occur in epochs; and the medical history of so much of the present century would seem to bear me out in that statement, for the present modern art of both medicine and surgery, if I am not mistaken, is the outcome of three great evolutions that have taken place, possibly within the memory of many of those present. I refer to the discovery and introduction of anesthetics by MORTON and SIMPSON, the bacteriological works of PASTEUR, and the antiseptic methods of LISTER.

It is needless for me to discuss them-you know what a lasting benefit was given to us with the coming of each of them. With the discovery of ether and chloroform and their introduction into medicine and surgery in 1846 the greatest enemy to the advancement of our profession in all the past centuries vanished-dread of pain. The skillful surgeon at once undertook and performed feats in surgery which he had never dreamed of before, and the practical obstetrician had a silent friend at the bedside who helped him save many a mother and child whom he would otherwise have lost. The mind of the layman was put at rest-if he suffered, he could have relief without pain, even though the knife cut deep, and he no longer bore with resignation the results of accident, disease, and deformity. At about this time there appeared among us one whom we are to-day proud to recognize as the Father of Modern Gynecology - MARION SIMS-because he justly earned the distinction by his genius and skill, energy

and perseverance; for he brought the practice of gynecology out of darkness into the light, and placed it upon a firm foundation. In his southern town he first worked as a successful general surgeon, operating without the aid of ether. And accident, as with many another surgeon, caused him to stumble upon his method of curing vesico-vaginal fistula. The instrument with which he achieved his success and which remains associated with his name, owed its origin to the necessity of making use upon one occasion of a bent kitchen spoon, and thus originated the now world-renowned Sims speculum.

At this point I want to call attention to the one great factor, and, I may say, the only one, aside from the discovery of ether, that has been instrumental in giving us of the nineteenth century advantage over our ancestors; one which has enabled us to improve upon their methods, to make certain of what they were not sure of, in fact to regenerate, so to speak, every method of practice known to them, and to add for ourselves many methods they could not possibly have been capable of doing; and that aid has been mechanics, as applied to medicine and surgery. was SIMS's skill and ingenuity in the invention of instruments with which to do his work that brought him success and reputation. And so, on down to the present moment, the surgical-instrument maker has been an indispensable aid to the progress of surgery.

It

Although the works of SIMS did not produce an epoch in the history of medicine and surgery, he so improved, elaborated, and renovated the practice of gynecology as to create an era for that specialty in this country, and place us in the position of teachers of other nations. Working in the same line with him were many others who have placed their names high on the roll of honor. In this country may be mentioned MCDOWELL, discoverer of ovariotomy; DUDLEY, of Kentucky; BATTEY, EmMET, ATLEY, THOMAS, and GOODELL; while of those in foreign countries with whom we are all familiar I may mention KEITH, TAIT, HAGAR, FREUND, SCANZONI, SIMON, SEGOND, MARTIN, and SÄNGERall men of brilliant minds and skillful dexterity, who have aided in bringing the art of gynecology to its present state of perfection. But even they with all their skill did not begin to get the results that the younger men of to-day secure. And why was this? It remained for PASTEUR, with his culture-mediums and his microscope, to show them the reasons of their failures, and why so many of their cases died of sepsis, and to again revolutionize the methods of treating disease. But he was not a practical surgeon; therefore, it became necessary for someone else to apply his theories to the treatment of disease of a surgical nature, and Sir JOSEPH LISTER was destined to be the man who should advocate and put into practice a method of doing surgical work that, although it has been changed and improved, has not only revolutionized the art, but has brought it to a state of perfection which, it seems to me, it is almost impossible to improve upon.

Of the present moment I need not speak, as you all are familiar with the doings of the day. I have attempted to make a few comparisons between ancient and modern methods in our profession, and show you that the only advantages which we have to-day over our predecessors are due to the aid of anesthesia, a perfect knowledge of germ disease, and mechanics, which have brought to our aid methods of doing absolutely clean work. Let us hope that the successes attending our work will not lead us to deal a blow to further advance, by causing us to become hobbyists and caterers to faddism. Let us also hope that our efforts in the future will be directed toward saving to our fellow-men many of those organs which we now feel it necessary to sacrifice. Let us not remove the appendix for the price there is in it; let us not bring ourselves to believe that every woman who has a pain in her side. must necessarily have a kidney fastened; let us make every effort to cure prostatic disease before resorting to castration; let us not take from woman her generative function, if we can, by further study and increased skill, successfully battle with diseased conditions within the pelvis, for which we now so readily sacrifice her uterine appendages.

And now, before closing, let me give expression to the hope that we are at the dawn of another epoch in science which we can apply in our profession, that will accomplish the desired object and again revolutionize for our benefit much of the work of the present day. I refer to the application of electricity, as applied by the Röntgen rays, to the diagnosis of internal disease. It is but an infant, but it is a vigorous one already, and if, with further development, it will show to us diseased conditions for which we are now obliged to make exploratory incisions, or make plain to us the early stages of internal disease for which we can now only comfort our patients with a good guess, or stand as a barrier against the reckless use of the knife for mercenary purposes, we shall greet it with thanksgiving and call it blessed.

New York; 678 Madison avenue.

"Kresochin" is the name given the article which was briefly described under the name of "Quinosol" on page 1320 of volume VIII of the BULLETIN. Further details are now at hand, and are here given. This substance is said to be a compound or neutral quinoline tricresylsulphonate and a loose combination of quinoline with tricresol. It is said to contain 33 per cent. of quinoline and 17 per cent. tricresol, and characterized by the absence of alkalies; to be a good bactericide; not to irritate, bite, or make the hands slippery, and make a clear 5-percent. solution in water.

The Lay Reporter and Coroner Inquests.-The London Lancet objects, even as the BULLETIN has repeatedly, to the appearance in the lay press of the unsavory and sensational details which too frequently surround coroners' inquests. The only way

out of this is for the coroners in their discretion to

give facts to the reporters, and this is in accord with

the intention of at least one of the coroners of this \county.

ing to the internal oblique muscles were cut through and the flaps liberated, except where they joined the ring, and turned over the opening accurately abutting the edges, in which position they were stitched with buried silk sutures. The convex borders coincided with the margins of the ring to which they were made fast.

Fourth. The recti muscles were brought in direct

very naturally arise. Its applicability must be confined to such points as will permit flap taking without permanent injury to the transversalis fascia, as it must be relied upon to give strength to the abdo

men.

As for efficacy, the simple fact that the strong flap of fibrous tissue and recti muscles relieved of their sheaths and firmly united to each other have

apposition by surrounding them with large catgut, thus adding another strong layer of dense tissue over the hernial opening.

Fifth. The skin and fatty tissue were then brought together and the tension sutures tied over all, the wound was dressed antiseptically, with firm pad, roller bandages, etc.

proven sufficient to effectually close a hernial opening equivalent to about twelve square inches in extent should be sufficient to establish it, so far as the hernia per se is concerned.

With reference to the parts from which the flaps were taken, no fears need be entertained regarding the liability of hernia there, as they are protected

impinging nail, flabby, pulpy granulations press up against the nail-edge, the part becomes swollen and tender, and if walking is attempted the result is like drawing a file from time to time over an unhealthy sore. This condition often gives rise to chronic misery, varied by acute pain on attempting to walk; frequently the shoe cannot be worn unless cut over the toe; so that the sufferer may be completely disabled, and unfit for work, for an indefinite period. That relief is not always readily furnished may be inferred from the large and increasing literature, and from the new methods of treatment brought forward from time to time. Volume IX of the Index Catalogue, published 1888, gives the titles of 17 monographs and 153 journal articles on this subject. Most methods of treatment recognize the paramount importance of protecting the ulceration from the pressure of the nail-edge. The various operations recommended aim to do this by excising the whole or a part of the nail, the granulations, or both, or by so altering the shape of the parts that the nail-edge and the ulceration do not meet. The best operations have the advantage under favoring conditions of furnishing tolerably speedy and certain relief; they have the disadvantage of inflicting more or less mutilation.

A

preference as a suture, and I am glad to say that I have never had occasion to regret its use. Besides its value as a permanent suture, the exudate that is thrown around the wire organizes into dense tissue that very materially increases the strength of the parts.

Atlanta, Ga.; 186 South Pryor street.

INGROWN TOE-NAIL MECHANICALLY TREATED * HENRY LING TAYLOR, M.D.

T

HE condition known as ingrowing or ingrown toe-nail consists essentially in an infected, and irritated ulceration of the soft parts at the margin of the nail. Improper shoes, a careless toilet of the nails, or accidental causes, may produce an abrasion, which in most situations would be trivial, but here becomes readily infected by the imprisoned germs, which greatly thrive in the genial warmth, moisture, and darkness of that ideal incubator, the swathed foot. Under these conditions and with the constant irritation of the *Read at the annual meeting of the American Orthopedic Association, Buffalo, N. Y., May 20, 1806.

The mechanical methods consist in raising the impinging edge of the nail by inserting bits of gauze, lead foil, or other substance beneath it, or by pressing away the granulations by a small and carefully adjusted compress. If the nail has not been cut short at the corner the first plan will often succeed. Better protection can usually be given by using the following method, slightly modified from that used by Mr. H. T. MASTERS, of Whitechurch, England, and mentioned in Pye's Surgical Handicraft," vol. II, p. 523. A flat strip of silver, one-onehundredth inch thick, one-eighth inch or more wide, and an inch long, is bent by means of small forceps into the shape of a fish-hook. The hook will usually fit the toe better if shaped from a strip of metal slightly curved on the flat, and so bent that the shorter edge will be in front. In this case the hooks are of two kinds, rights and lefts; for many toes the straight hooks answer perfectly well and can be used on either side.

66

After cleansing the toe with hydrogen peroxide and placing a pledget of cotton soaked in a 4-percent. solution of cocaine in contact with the granulations the hook is inserted beneath the lateral edge of the nail in such a manner that the latter rests in the depression answering to the barb, while the shank of the hook curves over the side of the toe and close to it (see figure). With a little knack the hook is readily put in place; the more the ulceration the less the pain, since there will be more room for the hook. A little gauze is placed over the toe to absorb discharge, and the hook is held in place and pressed upward against the lateral edge of the