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making of starchy material; no fooling with plaster-of-Paris, and the nasty muss on furniture, clothing and things in common, and yourself in particular.
From the dressing of a fractured finger to that of the leg, or inferior maxillary bone, or as a jacket for spinal curvature, this dressing has no equal. If you find a weakened part in your dressing you can touch it with the liquid at any time and apply and re-apply stiffening material until you have perfected your appliance. If you wish to invade the parts covered by the dressing you can do so in a moment, by placing a sponge, moistened in hot water, examine, and re-apply fresh material, and your dressing remains perfect. An incision made in the dressing will allow of its being removed and replaced at will. In cases of extensive burns I immediately apply the solution with the brush, and the pain disappears as if by magic.
THOUGHTS ON SURGICAL PRACTICE.
By CHARLES Band, M. D.
The aim of an enterprising medical student when he begins studying, or rather, perhaps, when he enters the medical college, is proficiency in the knowledge of Surgery. In the case of medical institutions, superior teachers and instruction in the Practice of Medicine, Materia Medica, and Pharmaceutic Science are very often regarded as secondary considerations. A thorough knowledge of Surgery is esteemed the absolute necessity, to which all else must give way.
This view of the matter is probably derived, as we too generally in this country derive our ideas of science and fashions, from the other Continent. If we scrutinise the improvements made or suggested by European periodicals, we find that medical treatment is held at a relative lower value and surgical manipulations are placed in the foreground. Emphatically is this the case in France. Therapeutics seem to be regarded as savoring strongly of empiricism and uncertainty, and therefore to be in a great degree surrendered to the more definite
action of the vis medicatrix nature; while every novel operation of a surgeon of distinction is proclaimed as a brilliant achievement. It is said that a distinguished French surgeon once asked Sir Astley Cooper how often he had performed a a certain difficult operation. "Only five or six," replied the Englishman. "I have performed it over a hundred and fifty times," said the Frenchman. "And how about the patients?" Cooper enquired. "Ah!" was the reply, "they all died; but the operation was very magnificent."
It may be remarked, in passing, that if a rigid enquiry be made in regard to the patients subjected to surgical operations in the Hospital Cliniques of our large cities, it is more than probable that a rate of mortality would be disclosed not so much less than the above as may be imagined. There is a great deal of human vivisection done in many of these institutions for which there is no benefit derived by the patients. The operations are performed to illustrate some surgical question, and the patients are wheeled out of the room to die. It is a plain matter of morals that such performances are criminal.
This superior popularity of surgical over ordinary medical study is of comparatively modern growth. It is not so very long since surgery was regarded as constituting no part of the healing art. The barber used to practice it as a part of his trade, and the peculiar bands painted on his pole have been indicated as his surgical sign. Indeed, at the present day, the English surgeon is not a physician. Sir Astley Cooper was plain Mister till royal power made him a baronet. The same thing is true of Paget and others. If we are to include the whole category of diseases heretofore called surgical in the department of therapeutic practice, this exception is very proper. A man whose art and skill are in the direction of manipulation and dexterous section, is rather a mechanic than a scientist, and he has little right to the classification and distinction of a physician. I am very sure that our accomplished President, whose eminence as an operator as well as his professional and scholastic attainments is every where acknowledged in our ranks, will agree with this judgment.
We are not, however, in this country at least, doing business in this way. Every medical college and department has its Profession of Surgery, and no student in medicine is regarded as justly entitled to a degree who has not made reasonable proficiency in that branch of study. It is the right view of the case. In order to be a skillful surgeon the individual must of necessity understand human anatomy thoroughly and be proficient in physiological science. The same conditions are indispensable for the physician. The diseases which have borne the designation of surgical are not so distinct from other maladies as to exonerate the practitioner from the need of a complete medical education. Indeed, it is not possible to declare intelligently the limit where the surgical department ends and the physician's function begins. They overlap so completely, or rather are incorporated together so intimately, that a proper knowledge of the one implies proficiency in the other. The surgeon must be a scholar in remedial science whether the physician be a surgeon or not. It is this conviction, together with the exigencies of a newer country, that has led to the blending of the two callings into one, to continue such till some caprice in regard to specialties shall put them asunder.
Medical practitioners who make no pretense to surgical skill have no right to complain. It is their proper function to enlarge their sphere of knowledge and activity by the improvement of their methods and the discovery of better ones, by means analogous to those of the surgeon. If the skepticism which exists among medical men in regard to the actual benefit of drugs, which has given to surgery a certain factitious superiority, is to be removed, this is the way to do it. There has been too great a tendency to narrowness, from which springs much of the intolerance and bigotry of which we justly complain. There is also too general a disposition to ignore botanical knowledge and to be superficial in chemistry and physiology. An empirical acquaintance with drugs and their operation in certain forms of disease has been too often allowed to constitute the principal attainments of a physician. Alongside with this narrow range of knowledge there
has been almost sedulously disseminated the notion that if a medical man possessed a broad intelligence beyond the limits of his profession he knew little practically in it. It is a mischievous notion, and one which must be "stamped out" in our ranks, or else we must consent to take our place at the bottom in the professional scale. In these days those who would stand high socially can hope to do it only in virtue of their culture and intelligence. It is complained that the Codes of Medical Ethics, like other Trade-Union devices, tend to create privileged orders, whose members obtain social and even civil and political advantages, superior to those enjoyed by better and even more skillful and scholarly men who happen to stand outside the pale. There is a degree of justice in this. There has not been proper vigilance exercised to prevent it. When men prosper and have abundant means of enjoyment they often neglect giving attention to matters of principle, and find themselves hampered and their liberties encroached upon when they suspected no danger. Much of the obnoxious legislation which we protest against, as well as the disqualifications under which we live, is chargeable to such neglect. Men sleep and the enemy sows tares.
The physician who is an adept in surgical knowledge is far more likely to exceed the narrow professional limitations. He is obliged to know what the routine doctor is often too prone to neglect. He must delve into the intricacies of anatomical knowledge and the various departments of physiology, which the other so frequently considers himself exonerated from learning. He is not permitted to content himself with being able to pass a college examination, and a diploma hardly serves the purpose of giving him a start in his vocation. He has much more to learn than that usually signifies. The man who is really intelligent in these departments is generally superior in other information, and accordingly takes rank socially and professionally by virtue of superior attainment. If the great majority of practitioners represented by this National Association come up to this rank, or should reasonably approximate toward it, they would soon be so powerful a
factor in society that every endeavor to proscribe and degrade them would be paralysed in its inception.
The present condition of our modern civilisation has given to the surgeon his eminence above his professional brethren. The exigencies of commerce have made railroads indispensable; and manufacturing has necessiated the fabrication and employment of machinery. The art of war has shared in the general innovation. We have as a necessary result incurred infinitely-increased peril to life and limb. The common practitioner of medicine is none the less important, but the surgeon has become more necessary. The casualties of battle, the disasters incident to railway and manufacturing operations, and the various accidents and mishaps in other callings, have produced an imperative necessity for surgical skill, perhaps never before known.
Our false modes of living must also be taken into the A host of local disorders are produced from our fashions of dress. Women are suffering from maternity to a degree without a precedent in history. Lacerations and fistula are not unfrequent. The new science of gynæcology depends on surgery as its right hand and medical hygiene as the auxiliary. Cancers and tumors require a skill and attention which cannot be too efficient. They appear to be largely on the increase; so that treatment and operations, that were formerly unheard of are now quite common occurrences. Doubtless if observations are made upon the other sex as sad a record will be obtained.
With the great multitude and variety of accidents and other mechanical troubles, it has become necessary that in every place of considerable size there shall be a skilled surgeon accessible. It would be an interesting study to determine how this or that practitioner gained a reputation in that way. The envious will say that it was by "cheek." It is certain that many individuals do put on airs that are decidedly quackish and charlatanic. I can hardly believe that, however, of the real surgeon. It may be that he has no better educational qualifications than his brother physicians; but he is very certain to have tact, assurance, confidence in his own