has permitted us to deal not only with large stones, but also with ulcers and tumors of the bladder; even large portions of the wall of the bladder have been removed successfully. The enlarged prostate is now, though always a serious danger, far less a menace to comfort and life since the introduction of McGill's and other methods of prostatectomy, and of White's operation of orchidectomy or the resection of the vas deferens.

The surgery of the pelvic organs has, one may say, been created since 1847, but its triumphs are so many that time allows only a word. Sims's treatment of vesico-vaginal fistula and his introduction of silver wire in 1852 were distinctly American triumphs, while the labors of the Atlees, Kimball, Peasley, Goodell, Thomas, Emmet, Battey, and Kelly-household names to all of us-have made pelvic surgery so successful that the danger is that it may be overdone. Many an ovary or womb, in the words of the witty toast, "absent from the body, but present in the spirit," would far better have been left in possession of their owners.

The radical cure of hernia has been the product of the last twenty years, and the operations of Halsted, Bassini, and Macewen, not to mention the many others, have taken a permanent place in the practice of the profession within the last ten years.* When we can report, as Coley† has recently done, 360 cases, with only 1 death and 7 recurrences, or, as De Garmo has reported at this very meeting, 250 cases unmarred by a single death, the question of the propriety of operating for the radical cure of hernia, even in children, is settled once for all.

Goitre fifty years ago was simply allowed to run its course, since hæmorrhage destroyed nearly all those operated on;

* Marcy informs me that he published his first paper on the use of the buried suture in 1870, and in 1881 he insisted on restoring the obliquity of the inguinal canal and using tendon sutures.

† Annals of Surg., March, 1897, 270.

but two years ago Kocher* reported a series of a thousand operations, with a mortality of but one per cent., in nonmalignant cases.

Extirpation of the larynx for malignant growths has taken its place among the justifiable and formal operative procedures. Acute intestinal obstruction, whether from bands, volvulus, intussusception or other conditions, is now dealt with as it ought to be,-surgically, and, if promptly done, with the happiest results.

A hasty and very imperfect review, such as has been above given, of the improvements in surgery within the last fifty years, does much more than show us the adroitness, audacity, and success of the modern surgeon. That is the thing which strikes us most as surgeons, but we must regard all this progress also from the standpoint of the patient and the community, and see what it means. It means a prolongation of life by operations which, while not without pain and suffering during recovery, have been robbed of all their primary terrors by anesthesia, and most of their subsequent pain and suffering and danger by antisepsis; it means that patients who in 1847 were hopelessly consigned to the grave after weeks and months of suffering are now, in the vast majority of cases, rescued from death; it means that families formerly bereft of husband and wife, parent or child, and left to spend years of sorrow, of suffering, and-in many cases-of poverty, because the breadwinners were taken away, have now restored to them their loved ones in health and strength and usefulness; it means that the hecatombs of a Cæsar, an Alexander, a Napoleon, are offset by the beneficent labors of a Morton, a Warren, a Lister, who are, and for all time will be, blessed by many a poor patient, who never heard of them, instead of being cursed as the destroyers of nations and of homes innumerable; it means that man's inhumanity to man shall be replaced by a scientific and Christian altruism, which sheds * Beilage z. Centralbl. f. Chir., 1895, 66.

blessings and benefits on the whole human race, seeing in the patient, whether saint or sinner, only a human being who is suffering from accident or disease, whom it is the province of the surgeon, in imitation of Him who went about doing good, to restore to health and happiness. Even where life cannot be prolonged, the agonies of death itself can be soothed by his gentle hand and his fruitful skill.

What the future has in store for us we can only dream. Two diametrically opposing tendencies are prominent in modern surgery: radical interference with disease so that there is now scarcely a single organ or portion of the body not within our reach; yet, on the other hand, a remarkably conservative tendency in cultivating remedial rather than radical surgery. Joints so diseased as once to require amputation are now treated conservatively with the best results; ovaries, a portion of which can be preserved, are kept in the abdomen; kidneys once doomed to total extirpation are now partially removed, and bones so destroyed that they formerly required amputation are now excised and the limb preserved. Experiments upon animals have recently given us wholly new views of infection and of the origin of many diseases, and also the little knowledge that we yet have as to either natural or acquired immunity, and to a consequent orrhotherapy.

It is, I believe, on these lines that our more immediate future triumphs will be achieved. We have discovered the actual cause of tetanus, tuberculosis, erysipelas, suppuration, and a host of other diseases and conditions, of the cause of which we were wholly ignorant a few years ago. The causes of many other disorders, both medical and surgical, still remain hidden from our view. We know almost nothing of the origin of benign tumors, and are groping to discover the origin of cancer, sarcoma, and other malignant growths. When we have discovered the cause, we are nearly half way, or at least a long way, on the road to the discovery of the

cure, and I think it not unlikely that in 1947 your then orator will be able to point to the time when a definite knowledge of the causes of these diseases was attained, and probably to a time when their cure was first instituted.

That will be a surgical Paradise, when we can lay aside the knife, and by means of suitable toxines or antitoxines, drugs or other methods of treatment, control inflammation, arrest suppuration, stay the ravages of tuberculosis and syphilis, abort or disperse tumors, cure cancer, and, it may be, so prolong human life that all of his then audience will die either of accident or of old age. Would that you and I could be alive in 1947 to join in the glorious surgical Te Deum!

THE DEBT OF THE PUBLIC TO THE MEDICAL PROFESSION.*

T is a graceful courtesy, which I very highly appreciate, that you should ask a stranger, instead of one of your own members, to address you on this festal occasion. The fact that you have completed an existence of a century as a medical society naturally suggests that the address should be somewhat of a review of the past.

I have, therefore, chosen as my subject "The Debt of the Public to the Medical Profession." I shall endeavor to indicate, in a brief outline, how much the profession has done for the community. The conclusion, therefore, is inevitable that there is an obligation on the part of the public to recognize this debt by affording enlarged facilities to a profession which has given of its time and labor so unselfishly for the good of the public.

In one respect the medical profession differs from all others, in that it is the only profession which is self-destructive. While we live by ministering to the wants of those who are suffering by accident and disease, I glory in the fact that the medical profession is foremost in the endeavor to abate disease and to prevent accident. The profession could not have attained this end by its own efforts alone, but it has been pendent very largely upon the general intelligent co-operation of the public, and of sanitary engineers, and also of legis

*The Oration delivered before the Medical and Chirurgical Faculty of the State of Maryland, at the Celebration of the Centennial Anniversary of their Foundation, April 26, 1899. Reprinted from the Philadelphia Medical Journal, April 29, 1899.