Three years ago only was he rewarded with the LL.D. by his Alma Mater.

And so with Lister; thoroughly educated to use the tools of his trade, profoundly versed in the science of his time, he spent his youth in acquiring and perfecting himself in what the world already knew of surgery. In his prime a skillful operator because operating was part of his business, an accomplished clinician because clinical surgery was his forte, he appreciated that the greatest work in science is creative work. His genius grasped at a breathless possibility, never before conceived by conservative minds; and so, following those sound inductive methods known to science through the ages, he launched us upon an era which is truly the most brilliant in the history of surgery.

TEACHINGS OF THE OLD SURGEONS1

On the Continent and in England many men read the old masters, and in our own country their writings are known to not a few.

Recently a new impulse has been given to such studies by the publication in Paris of Nicaine's editions of the works of Guy de Chauliac and Henri de Mondeville.

The latter, born in the thirteenth century, composed his Surgery about 1310. He was surgeon to Philip the Fair and Louis X. He was exposed to the obloquy so commonly poured out on reformers in those days. His great heresy consisted in his adherence to the familiar teaching vis medicatrix naturæ. His work for six hundred years was disregarded.

De Chauliac died an old man in 1365. His work, composed in his later years, remained for two centuries a great text-book of surgery.

The thought of the rational studies of those two men, working on lines centuries in advance of their contemporaries, furnishes me with a text for this essay.

One seldom goes to a large general medical meeting, attends a medical dinner, or listens to a formal professional speech without being told, by the orator, of the wonderful recent advances in surgical science, of the ignorance of our fathers, of the brilliancy of ourselves;

1

1 From the Boston Medical and Surgical Journal, October 3, 1895.

so that one would almost think, as many do think, that surgery is a modern science.

W. Watson Cheyne, in his chapter on "The History of Antiseptic Surgery," says that all the old surgeons were governed by one thought -the desire to make the wound heal, as they said; and that the feeling was universal that wounds left to themselves went to the bad. That is not true, as I read the old writers. It is the error which the best of them constantly were preaching against. To be sure, their voices may have been lifted in the wilderness, and doubtless the practice of the times was often bad among the rank and file; but this is true of all ages. "Give nature a chance," "Leave more to nature," was frequently said. Paul of Ægina, even in the seventh century, taught it, and Rogerius in the thirteenth. So did Bouve about the same time, and later De Vigo and Paracelsus. That most entertaining writer, Le Dran, in the second quarter of the eighteenth century, taught his Parisian students to assist nature and not to thwart her; and Napoleon's great surgeon, Baron Larrey, taught to close a simple wound and leave it to nature for a first intention, as even the savages knew that.

We do better now than that, to be sure. We guard nature without interfering with her—at least, that is our effort; but one is sometimes inclined to think that our asepsis accomplished, we care for little else. Surgical rest, comfort, and support are almost equally important; discomfort and pain are still serious complications. They used to be danger signals. They must be thought so still.

Not only did Larrey teach local but general support, the sustaining of the general strength, a stimulating and nourishing diet. We are apt to think that those surgeons confined themselves to bleeding and purging. So far was Larrey from this that he was fertile in devices for forced feeding. The stomach tube was in common use; and when that would not serve, he advised a soft-rubber catheter passed through the nose and well down into the esophagus. He remarks that this method is especially valuable with hysterical patients and those whose fauces are paralyzed. His contemporary, Benjamin Bell, in 1804, said that with patients exhausted by suppuration a full diet, supplemented by an abundance of alcohol, was absolutely needful. The danger of superficiality was keenly appreciated by such men; and Bell says: "Accordingly, in different hospitals we daily meet with good operators, but we do not often find surgeons possessed of that knowledge in the prognosis of chirurgical diseases which might be expected, that attention being seldom bestowed which is necessary to attain it." Indeed, Bell thought that his success was more largely due to his prescribing wine, food, and Peruvian bark than to his operative skill. This use of wine and spirits with alcoholic subjects was especially urged by Sir Astley Cooper, who may be considered almost a modern. He said: "When a drunkard is injured, don't cut off his rum too soon; it keeps up his strength and acts as an antidote to the infective poison of the wound." Indeed, Sir Astley, in making his prognosis as regards sepsis, laid more stress on the patient's general condition than do we

ordinarily. He most emphatically recognized that, whatever the immediate cause might be, a patient in wretched general condition offers a better field for a rapid septic infection, whether from traumatism or any other cause, than does a person in robust health. It is interesting that his exception to this general rule is in the case of an "acute peritonitis, so severe and commonly fatal in vigorous young men." This parallels our own experience with rapidly fatal appendicitis.

The grand principle in the cure of disease, says he, is that all the secretions must be restored. "If the bowels, the kidneys, and the sweat glands are working, the poison will be eliminated and the patient recover." Though we seek our object by other methods and for better understood cause, this maxim is the same with us to-day.

Emotional causes of disease were greatly considered one hundred years ago. White's recent suggestive article on the "Operation, per se" recalls many of the experiences of Sir Astley, who had no doubt that general conditions and mental impressions entered more largely into surgical therapeutics than was or is believed.

Even for those in health he preached a carefully regulated life, and says that in his own case he always employed temperance, early rising and cold morning baths, for the cold bath is especially valuable in an increased irritability of the nervous system; and Benjamin Bell says that in persons afflicted with chilblains or tuberculous tumors "the only good is from cold bathing and tonics."

"There are few satisfactions greater than being