I FULLY appreciate the honor your Secretary has conferred on me in selecting me to address you upon this occasion. It is with many misgivings on my part, I assure you, that I come before you today, feeling as I do the responsibility that must be assumed by one who undertakes to do my subject justice. I most earnestly crave your kind indulgence if I fail to meet your expectations and shall ask you to wreak vengeance on the one who so justly deserves your condemnation—the Secretary.

From the time of the discovery of general anesthesia may properly be reckoned the conception of modern surgery, and from the discovery of the principles of asepsis and antisepsis dates its birth. During the past decade surgery has progressed and developed more than it had for a whole century prior to that time. One of our chief factors which has been the means of giving impetus to the growth of modern surgery is the bacteriological laboratory. The laboratory is to surgical pathology what anatomy is to the study of physiology-the foundation.

* Annual Address in Surgery delivered before the Tri-State Medical Association (Miss. Ark. & Tenn.) Memphis, November 19, 1901.

Vol. XXII-1

From patient and long-continued laboratory research were evolved the principles of asepsis and antisepsis. But for the guiding compass of asepsis and antisepsis the bark of progressive surgery had been wrecked on the shoals of suppuration, gangrene and peritonitis. With the proper appreciation and application of the principles of asepsis in modern surgery we have succeeded in relegating "laudable pus" into the obscurity of a corner of oblivion; and the expression ouce so common on the lips of the surgeons is now found only in the realms of the obsolete. Thus we have been able to successfully invade the hitherto sacred domain of the abdominal cavity, which fact has been the means of creating a new surgery commonly known as abdominal. The peritoneal cavity, once so sacred as to be invaded by only the few, is now fearlessly yet successfully opened by surgeons in almost every hamlet throughout the civilized world. Unquestionably do we note greater advancements in abdominal surgery than in any other department of our science. In no other branch have our ideas undergone such revolutionary changes. During the civil war of 1861-65, gunshot wounds of the bowel were considered inevitably fatal. No attempt was made in the great majority of instances to do anything, from a surgical standpoint, for those poor unfortunates. Good surgery now demands that all cases of gunshot wound of the intestines receive immediate surgical interference, and the results under such conditions are usually considered favorable.

As before stated the bacteriological laboratory has done signal service in promoting the growth of modern surgery. The recognition of the kind of germ contained in the pus of a pelvic abscess often determines the indication for the application of drainage following operation. The blood count is regarded by many of vital import as indicating the character of the inflammatory condition of the appendix. By the use of the microscope we are enabled to make an early diagnosis in malignant diseases, thus assuring a more favorable prognosis as the result of early surgical intervention. Particularly does this hold true in the diagnosis and treatment of carcinoma of the cervix uteri. In this connection it might be well to mention the fact that the subject of cancer is receiving no lit

tle attention and consideration at the hands of not a few of our ablest and most scientific men. Let us hope that in the near future their efforts may be crowned with success, and mankind thereby receive a blessing second to none that our worthy profession has ever been able to bestow on their fellow man, as the result of their unceasing and indefatigable energy.

Brain surgery, because of the scientific precision of the cerebral localization methods perfected only during the past few years, is rapidly developing. We are now able to diagnose. and successfully remove tumors of the brain and treat abscesses and other diseases which but a few years since were recognized only in the dead house.

Intubation, though a simple procedure, has been the means of saving the lives of many precious babes dying of the asphyxia of diphtheria. Especially is it of service in tiding the case over, as it were, until the administration of antitoxin may have the desired effect. For the discovery of the cause and specific treatment of diphtheria we are obliged to again acknowledge our indebtedness to laboratory research.

In the field of intestinal surgery there has recently been much of value given to the profession. It is extremely interesting to study the evolution of intestinal surgery from the time that Abbe began to experiment with his catgut rings, followed later by Senn's decalcified bone plates, and finally reaching a climax in the invention of the Murphy button for intestinal anastomosis. For a long while this device, being an improvement over any former method or device, has served the profession most admirably, although the results have not been such that would not inspire us to endeavor to seek for more perfect methods. It was found that an occasional complication, such as an obstruction of the bowel, would occur, necessitating a secondary operation for the removal of the button. Endeavoring to obviate the necessity of introducing a foreign body into the bowel, Maunsell devised an ingenious method of suturing the bowel in end to end anastomosis, which was received with some degree of favor. The special points of interest to recommend this method were the rapidity with which the operation could be made, and the fact that a greater portion of the suturing could be knotted within the

lumen of the gut. But it remained for F. Gregory Connell to give to the profession what seems to be a perfect method, both in rapidity and technique; the results as reported by him in a paper read before the American Medical Association at the St. Paul meeting and published in the Journal of Oct. 12th, 1901, justify a careful consideration of his method at the hands of the profession. I have demonstrated to my own satisfaction by experiments on the dog the superior merits of the Connell suture.

The subject of appendicitis continues to engage the attention of the profession. The concensus of opinion is now greatly in favor of early operation, which is fully sustained by the results. The best method of operation is that of amputating the appendix close to the bowel and treating the opening as any ordinary hole in the bowel. This simplifies the operation and reduces the danger to a minimum.

Modern surgery has achieved as much in the treatment of hernia as in any other pathological condition. The time is not far distant we hope when the manufacture of trusses will be a lost art as the result of our modern technique in the treatment of hernia. The improvement of modern instruments and surgical appliances is marvellous, and is no small factor in the improved results obtained by our modern surgeons. Who has amputated at the shoulder or hip joint, with and without the use of the Wyeth pin, without failing to note the comparative ease with which the operation may be effected by its use? What abdominal surgeon has not found the Trendelenburg posture of great service in certain operations?

Shock-the indefinable but easily recognized condition so familiar to all surgeons of experience-is much more successfully treated by the modern surgeon since the adoption of intravenous saline infusion. The surgeon who fails to utilize this useful remedial agent in the treatment of surgical shock from loss of blood or what not, is open to severe criticism, and deprives his patients of one of the most useful agents at his command.

Cocain as an anesthetic agent in the hands of the surgeon has assumed much importance. Minor surgery is no longer dreaded by the patient, and becomes a pleasure to the opera