icle. It is almost as dangerous to leave behind as infected glands. It is my invariable practice to drain the axilla for twenty-four hours, and for this purpose I prefer a tube. In five years I have but once failed to secure primary union of a breast case. As you will see, I am enabled to bring together the flaps I have made without tension. The wound is covered with sterile silverfoil and should heal under one dressing. A hole is cut, through which the tube can be reached and removed in twenty-four hours. My cases are nearly always out of the hospital in a fortnight. ** * I have another case,- -one of rectal disease,-and will ask Dr. Laws to say something about it and demonstrate the use of his instrument, which can be used to advantage in this case. I have the pleasure of introducing Dr. Laws, Demonstrator of Surgery in the Medico-Chirurgical College. that surgery offers. I shall do a very complete operation after the method of Halsted as modified by Warren; that is to say, I shall remove gland, muscles, and lymphnodes en masse, just as Halsted does in his operation, but will undertake to close the necessarily large wound made in this case by a plastic operation suggested by Dr. Warren, of Boston. In my three cases previously operated by this method the result was everything to be desired. Large wounds were closed and primary union secured in each. As you see, I make a very free incision, including a large amount of skin, for it is my belief that this is a "conditio sine qua non," and we owe this teaching to the friend of many of us here, the late S. W. Gross. More than twenty years ago I heard him insist upon this, and he, even then, had most positive convictions that cancer of the breast could be cured by a timely and rightly done operation. I see at once that the wound left will be very large, and one that may be covered in with difficulty by the method proposed. It is, however, no larger, if so large, than one of the three cases referred to, though I have the disadvantage of operating now in an older person, and one whose resisting power is less than in the case referred to. The husband of this patient, as I have said, is a medical man, and he took comfort in the fact that he could not feel enlarged glands in the axilla. He spoke of this when they came to me a few days ago. I told him then that, while enlarged glands could not be felt very distinctly, he would see when the axilla was opened that they were there unmistakably. I am glad that he is not present to see, as we do, how advanced this growth is, and how infection of all the axillary glands has already occurred. It is not possible, in my judgment, for any man to feel enlarged glands with any accuracy in the axilla of a fleshy person. It is my practice to remove not only all visibly enlarged glands, but every vestige of fat as far up as the clav-justifiable to make even a digital examina GENTLEMEN: This patient gives a history of having severe pain, and with an occasional loss of a small quantity of blood on defecation. She has suffered with this condition for some months; therefore we will take the advantage of this opportunity to make a thorough examination of both the anus and rectum. I will ask the patient to lie upon her left side and to flex her lower limbs. Now, by retracting the buttocks we notice a small tab of skin near the verge of the anus, which looks very much like the so-called "sentinel pile," which very often accompanies an anal fissure; and, by making still firmer traction. upon the buttocks, we separate the folds of the anus, and bring into view a longitudinal ulcer, quite short and rather broader at the orifice of the anus than toward the upper end. This ulcer is indurated, and grayish in color, indicating that it has existed for some time. Under ordinary circumstances the pain would be so great that it would be un tion with an ulcer of this nature within the grasp of the sphincter-muscle, but, as the patient is under the influence of the subarachnoid injection of cocaine, we will proceed to examine the entire rectum by using the Laws pneumatic procto-sigmoidoscope. The end of the instrument being introduced through the sphincter-muscles, the obturator is removed, the lamp placed in position, and the glass window is tightened. Now, by turning on the electric light and inflating the bowel by the use of the bulb, the tube can be inserted to its full length under the guidance of the eye and without any possibility of doing any damage to the walls of the bowel. If you gentlemen will kindly step down and look through the glass window of the instrument you will get a comprehensive view of the entire rectum. You will see the rectal folds, the so-called rectal valves, beautifully demonstrated in this case. The mucous membrane seems to be normal, and, as I fail to detect a lesion of any kind in the ampulla of the rectum, we will conclude that the anal fissure is the cause of all the patient's symptoms, and will proceed to operate, first by snipping off the little "sentinel pile" with the scissors, and then by forcible dilatation of the sphinctermuscles. I believe that stretching of the sphincter-muscles is the most simple, the quickest, and the most satisfactory method of treating anal fissure. Address. INTRODUCTORY ADDRESS, MEDICOCHIRURGICAL COLLEGE, SESSION OF 1901 TO 1902. BY PROF. JOHN C. HEISLER, M.D. LADIES AND GENTLEMEN: It is my privilege, as well as my pleasure, speaking for the Board of Trustees of this College and for its Faculties of Medicine, of Dentistry, and of Pharmacy, to extend to you, our in vited guests, a most cordial welcome to this formal opening of another collegiate year. Permit me, also, to express our appreciation of the interest you manifest in the institution by your presence. And to you, the students of the three departments, our welcome is not less heartfelt. Both those of you who come here for the first time and those who are but resuming their work with us, will, I am sure, be interested in learning of such improvements in our teaching facilities as have been and are being effected. We are glad, too, for the opportunity of acquainting our guests with the progress of the institution. I shall therefore preface my remarks with brief reference to certain improvements in the several departments. In the addition of new features to the curriculum the governing principle has been to conform to the demands of modern professional education for more and more laboratory training; hence the improvements that have been made consist largely in an increase in the laboratory equipment of the institution. In the department of dentistry one of the most noteworthy improvements is the addition of a new infirmary, which occupies the second floor of the new building. This is fully equipped with the most modern appliances, including a number of the latest pattern operating-chairs, and affords means for handling a very large clinic. It includes also a special room for the extraction of teeth, which is provided with facilities for using the various anæsthetics that may be required, and which is thoroughly modern in its appointments. The special equipments for practical instruction in crown- and bridge- work and in porcelain work have been amplified and improved. A feature of the course is the Saturday-afternoon clinics, conducted by visiting specialists in the various branches of dental surgery. The changes in the departments of chemistry, pathology, anatomy, and physiology affect the work of students in the three the advantages of exceptionally good light, Schools of the College. In the department of chemistry entirely new and very complete laboratories will, in a short time, be available. These afford accommodations for one hundred and fifty students working at the same time, and comprise a general lecture-laboratory, a metallurgical laboratory, a laboratory of clinical chemistry, a laboratory of toxicology, and a research laboratory. Supplied with blast and vacuum equipment, with centrifuge equipment, with apparatus for the physical testing of materials, and with storage, weighing, and locker rooms, these laboratories leave nothing to be desired. In the department of pathology the laboratory accommodations have been increased to such an extent that it will now be possible to give to each student in pathology a total of one hundred and .fifty hours of laboratory-work, instead of fifty hours as heretofore, and to each one pursuing the study of bacteriology one hundred and fifty hours instead of twenty-four hours as formerly. This arrangement permits the abandonment of the old system of instruction by didactic lectures, and the teaching in this department will now be by means of conferences and recitations, in addition to the laboratory-work. Suitable research laboratories for post-graduate work have also been provided. The professor of physiology contemplates, in the near future, a very great extension of his laboratory instruction. In the department of anatomy we shall have at our disposal a new and thoroughly well-appointed laboratory of histology, abundantly provided with proper light, and capable of supplying working space for forty-eight students at a sitting. Our present plans look to the establishing, in the very near future, of a course of practical instruction in embryology. An improvement that will fill a long and deeply felt want is the new anatomical laboratory. This laboratory will present of ample size, of thorough provision for cleanliness, and of special rooms for the accommodation of post-graduate students. An adjoining room has been set apart for the care of anatomical specimens and preparations, and it is hoped that, in time, the collection may be of such value and may be so classified as to constitute an important adjunct to the means of instruction. An equally important addition is the equipment of a refrigerating plant for the preservation of anatomical material. Gentlemen, I wish to speak to you for a short time of your student-life, making such reference as may be to your future careers. And if I shall be able to say anything to you that will tend to raise to a higher plane your estimation of your chosen profession, or that will stimulate you to greater effort in preparation for your lifework, I shall feel that I have done you some slight service. What I shall say is intended. to apply, not alone to the students of medicine, but to those of dentistry and pharmacy as well, for a dentist is to be no mere artisan, no mere adept in "tooth-carpentry," but a dignified and high-minded professional gentleman and scientific worker. Nor is the pharmacist to be nothing more than a mixer of drugs and a tradesman-like vendor of bric-a-brac, but he, likewise, in his best estate, is a worker in the field of science, and the indispensable ally and coadjutor of the practitioner of medicine. As the horizon of medicine is ever widening, and as its field of usefulness as an elevating social agency is constantly expanding, so are the two sister-professions constantly advancing in dignity and importance. As you may surmise from what I have already said, I have chosen for my theme to-night "The Ideal Physician," or, to extend the application, "The Ideal Professional Man." I deem this to be appropriate to the present occasion, despite the fact that you are not, as yet, physicians, or pharmacists, or dental surgeons, but merely students, qualifying for these respective callings, for as "the boy is father to the man," so the professional student may be said to be father to the full-fledged professional practitioner; or, to put the proposition in another form, the habits of study that you form during your student-life, and the moral and intellectual character you cultivate now, will determine your future social and professional status. We hear much concerning the harmlessness of sowing wild oats in youth, but it is well to remember, in this connection, that "men do not gather grapes of thorns, nor figs of thistles." A sowing of wild oats can, in the very nature of things, yield only a harvest of wild oats. The text for my remarks you may find in the First Act of the Book of Hamlet: "See thou character." This subject of character, as applied to the professional man, we may consider to be divided, like "All Gaul," into three parts: the social, the intellectual, and the moral aspects of character. The first of these I shall pass over, with only the reminder that the professional man, and the professional student no less, must be a gentleman in the best sense of that much-abused word. The intellectual character of the professional man may be briefly expressed by saying that he is to be an educated man, not only in the technical or special sense, but in the broad general sense. While, in other words, he should know everything about some one thing, he should aim to know something of everything. There exists much diversity of opinion as to the true meaning of the word education. Not long ago Professor Butler, of Columbia, proposed five tests of education: 1. Correctness and precision in the use of the mother-tongue. 2. Those refined and gentle manners which are the expression of fixed habits of thought and of action. 3. The power and habit of reflection. 4. The power of intellectual growth. It is noteworthy that in this enumeration. nothing is said of knowledge; but the necessity of knowledge as a prerequisite is implied, for, without knowledge and culture, it would be manifestly impossible for one to measure up to these tests. Education is to be distinguished, therefore, from knowledge, from the mere cramming of the mind with facts, useful and necessary as facts are; it means the drawing out or developing of the mental faculties and the training of those faculties to action, the mind being incidentally stored with such knowledge as will tend to more orderly and efficient action. Since, then, the acquisition of knowledge, although it goes hand in hand with education, is, in a sense, preliminary to it, it behooves the student to give his attention to the acquirement of general knowledge and culture. And what is culture? Matthew Arnold defines culture as "an acquaintance with the best thoughts of the best minds of all ages." The fulfillment of this condition implies a wide range of reading. The definition, however, has one consoling feature: it eliminates a vast deal of present-day fiction, including the modern historical novel. "Correctness and precision in the use of the mother-tongue," Professor Butler's first point, may appear, at first thought, scarcely an adequate or fair test of education. To those of a utilitarian bent, it may seem a mere elegance, an adornment which, for practical purposes, may be dispensed with. Many educated people, indeed, fall into this way of thinking; men who would consider themselves disgraced if they used a Latin or a French word incorrectly often show a surprising indifference to their English. If you reflect that language is the vehicle of thought, you will appreciate the fact that, if the vehicle be ramshackle and loosely constructed, the thought will be inadequately conveyed or may even be entirely |
