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impediment, have gently rolled its tranquil waters into the peaceful bosom of eternity, and we should have witnessed the pleasing spectacle of human beings passing, without sickness and decay, into blessed immortality. But, alas! man yielded to temptation; diseases and sufferings came, and a seal was affixed to his mortality. Commensurate with this affliction, however, as a result of sin, God gave him the power to reason and to discover the remedies with which to battle and subdue; and thus, by intuition or perhaps instinct, was born what is now known as the science of medicine.

It would take too long to trace the history of this science. A glance at the fabulous days of Esculapius, the father of medicine, and at what we know the science to be now, tells of its

wonderful progress. It is the foremost of the learned professions. The primitive surgeon had the blacksmith to forge his instruments; the physician used roots gathered in the woods. To-day great corporations get materials for medicines from nearly every quarter of the globe; the most splendid surgical instruments are manufactured at great centers in every enlightened nation. American physicians and surgeons are in the front ranks. They bring all scientific discoveries quickly into service. The X-ray and general electricity, guided by our own Edison, are used by us as by no other medical men. We have shown our general practitioners how to use instruments and medicines as no other people have done.

In railway surgery, the most brilliant gem of accidental surgery, we excell the rest of the world. This nation has nearly as many miles of railroad as all others combined. Necessity, the mother of invention, brought the railroad surgeon into existence. The frightful cases of traumatism on these roads demanded new treatment not given in the books. So the railroad surgeon was needed. The medical and surgical body politic have dubbed him a specialist. The Pan-American Medical Congress has honored his as a distinct section of surgery. Now, how can we, as surgeons, best prepare ourselves for the duties requiring such technical skill? We have the answer here. The National Association of Railway Surgeons exists because of the want of the individual surgeon to meet his fellow surgeons and learn ; of his duties. Beginning with a little band of 80, it has now over 1,000, the largest organized body of surgical workers in the world, thanks to the noble men at its head and the generous aid of the railroads. May the nineteenth century witness a standard of still higher excellence, our association weeding out quackery and dishonest practice, and our living as true and faithful men to aid suffering humanity.

The paper was discussed by Dr. Lewis, who made a very eloquent response, in which he said that surgery, thanks to the discoveries of Pasteur, and the application of his discoveries by Lister, was no longer dominated by empiricism.

The next paper was upon "Traumatic Infections and Their Treatment," by Dr. W. T. Sarles of Sparta, Wis.

This was discussed by Dr. Hoyt, Dr. Caldwell and the essayist.

Dr. Fulton offered a resolution of thanks to the publishers of the Daily Railway Surgeon for the daily report of the proceedings of the meeting. This was seconded and adopted.

Dr. Jackson then presented to the Associa


tion a paper entitled "Problems and Principles."


Modern surgery has attained its high position through its evolution as a science as well as an art. Rationalism has displaced empiricism, and practice is based on well-established theory. The study of problems and principles must therefore precede the application of methods, which must be guided by the solution of the former. In traumatic surgery, where immediate and definite action is imperative, a thorough recognition and mastery of certain problems and principles is especially necessary. Some most important ones

we note.

Shock: This condition is an almost invariable accompaniment of railway accidents. Regardless of the theories as to its physiological explanation, it is sufficient from a practical standpoint to recognize it as a serious attack on vital functions. The cardinal principle of surgery places "life first, then function, and finally form." In dealing with shock, therefore, we must recognize that life itself is hazarded and all our conduct must be directed toward its preservation, regardless of typical or finished surgical procedures. If the traumatism enhances shock, the source of irritation must be removed. If not, and yet shock is great, we should take no chances of adding to the dangers to life. The problem of shock must be weighed in the scales of vitality and action guided by the principle: Life first.

Repair: The problem of repair next engages attention. In solving it we must measure Nature's resources, the forces of construction; (1) tissue; (2) nutrition.

Tissue: Cell life has great power of recuperation and reproduction under favorable conditions and certain limitations. Modern surgery has attained its triumph through a recognition of these facts. When vitality is not absolutely destroyed Nature should be given an opportunity to manifest her powers. Cells may recover from great impairment of vitality short of actual destruction. They may further reproduce new cells to take the place of old ones destroyed. Transplantation or grafting may furnish additional means of reproduction. It must be remembered, however, that each cell but produces its own kind. It is essential, therefore, that a reasonable amount of unimpaired tissue of the variety to be reproduced be present from which the process of reproduction may have its source.

Nutrition: Adequate nutrition, both in quantity and quality, is the sine qua non of repair. Extensive injuries in which the blood vessels are preserved intact may be thoroughly repaired. Slight traumatism, accompanied by destruction of vascular channels, may lead to disaster. The cases of failure at repair, even

in the presence of apparently adequate nutrition, indicate improper quality of nutrition, and this factor should likewise be held in mind. The history of previous reparative action in injuries in individuals may furnish valuable information, both for prognosis and for action in building up the quality of the blood.

Function: The condition of function which repair will leave presents another problem. Oftimes tissue and even limbs may be saved in repair in so far as physical integrity alone is concerned; but atrophy, paralysis, anchylosis, etc., may render the linib or tissue useless and even troublesome. Such an end is not true surgery. Function should


J. N. JACKSON, M. D., KANSAS CITY, MO. rank above form and utility is of prime importance in the laboring classes among whom our work in this line is most done. done. The development of prosthetics makes apparently radical surgery conservative. We must combine utility, therefore, with possibility, and view surgery from also its mechanical aspect

Irritation: Besides the problems presented in measuring the resources of construction we have additional problems in combating the agencies of destruction, which tend to convert the problem of repair and life into one of inflammation and death. The wonderful achievements of modern surgery have come through the recognition of the source and nature of these foes. The continued action of irritants whether (1) inorganic and material or (2) organic, germ life, always results in a dangerous fight for life between the cells of tissue

and these antagonists. Germ action has formed the subject of much investigation, and has been exhaustively considered by masters for years. In the excitement over asepsis and antisepsis we have, however, somewhat overlooked the potentiality of evil in mere material irritation, cinders, foreign matter, etc. The technique of antisepsis and asepsis are known by all, and their rigid enforcement enjoined. Similarly important is it, however, to thoroughly remove dead tissue, foreign matter, loose spicula of bone, cinders, etc. The sharp curette judiciously used is most nighly commended in the primary treatment of wounds. Sepsis: Despite precaution, however, irri


tation and subsequent inflammation will sometimes occur with consequent systemic infection or sepsis. Life is here again threatened unless the surgeon is master of his principles. In addition to appropriate antiseptic measures, it is to be remembered that it is through the retention and absorption of the products of infectious inflammation that the severe systemic intoxication is produced. Drainage, therefore, free and fearless, natural and forced, becomes the channel for the escape or the expulsion of these products, and the safeguard of Nature. Hot water is an adjuvant to drainage, by establishing exosmosis or outward drainage, and thus checking the process of absorption.

To epitomize I present the following precepts, deduced from the study of these problems and principles:

I. The cardinal precept of true conserva

tive surgery is, "Life first, then function, and finally form."

2. Shock must be measured in the scales of vitality and action therein controlled by the supreme rights of life.

3. Tissue is the basis of repair, and nutrition its sine qua non.

4. The preservation of tissue or form must be regulated by the requirements of function, and aesthetics must be made subservient to the necessities of utlity.

5. Continued irritation, of whatsoever nature, retards or transforms repair; the primary removal thereof followed by subsequent precaution against, is imperative.

6. Absorption is the avenue of infection and sepsis; drainage the natural channel of purification.

The paper was discussed by Dr. Fulton. "Our Problems," by Dr. T. H. Briggs of Battle Creek, Mich., was then read by title.

"Drainage in Surgery" was read by Dr. W. S. Caldwell of Freeport, Ill., and discussed by Dr. Hamilton and the essayist.

Dr. Bouffleur's paper was called for. The doctor explained that he had no written paper. but proceeded to give the Association what he believed to be the cardinal principles of amputations. This was discussed by Dr. Hamilton and by Dr. Bouffleur in closing.

Dr. B. M. Ricketts of Cincinnati read the last paper heard by the Association, upon "The Removal of the Upper and Lower Jaws Without External Incision."

The chair announced that Dr. Murphy would conduct a clinic at 10 o'clock Friday morning at the Cook County Hospital.

Dr. Ross, the president-elect, offered the following resolution:

Resolved, That the thanks of this Association are due and are hereby gladly tendered to the local Committee of Arrangements for their zeal and efficiency in providing for this successful meeting. And the Association desires to make special acknowledgment to the editors and publishers of The Railway Surgeon for their enterprise in furnishing the members with a daily edition of that journal containing full proceedings of the convention. They feel that they cannot do less than congratulate the publishers on the artistic style in which the journal has appeared. They desire to place on record their grateful appreciation of the princely courtesy extended to them by their honored ex-president, Dr. J. B. Murphy, and his gracious wife in yesterday's memorable and most pleasurable excursion on the lake.

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