was by obliterating all the visible openings within the sac, by a continued suture." He obliterated them, using a silk suture, which closed completely the thick margins of the openings; and when he removed the tourniquet not a drop of blood escaped from the sutured orifices; the hæmostasis was complete. The wound healed promptly, and ten years later Matas saw the man in sound health. Pulsation in the radial artery had returned, and the patient was working at heavy labor as a plantation hand. For twelve years Matas did not repeat this operation, though he had several opportunities to do so. In those years he turned back to the old-time methods. because he shrank from employing his new and radica'i procedure in so grave a disease. But on two occasions the old methods failed him. Ligature and extirpation in his hands were followed by gangrene; and in one of the cases he was forced to amputate a thigh in order to save the patient's life. Nothing could be worse than that. - Beginning in 1900 he had a succession of cases in which he operated by his new method, by suture of the aneurismal openings, and always successfully. In 1902 he reported his results. Other surgeons adopted his plan, until to-day nearly thirty cases have been reported, with this astonishing record: Immediate mortality, zero; percentage of subsequent gangrene, zero. In this brief summary I may not discuss at length the details of Matas' method; but ask you to observe certain points, often misapprehended, misquoted, or ignored :— The fundamental purpose in his scheme of operating all cases is to close by suture all the arterial openings ithin the aneurism. Many writers have assumed at Matas plans a reconstruction of the artery out of e sac, in fusiform aneurism. He plans no such detail s part of his routine operation. He merely suggests uch a step; but so far as I know he has as yet taken it in no case. That step is not necessary. One asks, if Matas contemplates suture occlusion merely of all arteries opening into the aneurism, wherein does his method differ essentially from the method of Antyllus? It differs radically, and in this respect; — that Antyllus, by tying the main artery above and below the aneurism, left to chance the settlement of two important elements in the problem. In certain cases he ran the risk of cutting off by his ligatures small but essential collaterals, whose presence would safeguard against gangrene. On the other hand, he failed to eliminate those extra arterial feeders of the aneurism, those supernumeraries, which, as well as the main artery, pour blood into the sac. Moreover, a large aneurismal sac is closely adherent to surrounding structures; its walls are vascular, and carry often in their substance arterioles, veins, and nerves whose existence may be essential to the preservation of structure and function in the limb. We must not, therefore, remove the sac or any part of it. Matas explains how he folds it in upon itself and preserves it entire, as a crumpled but vital mass. Thus all possible tissue of value is preserved, all harmful arterial streams are held in check, and every vascular avenue, which may share in bearing needed supplies of blood, is encouraged to take up its vicarious duties. Matas' studies and his operation for aneurism furnish our latest advances in this fascinating subject. In rough and fragmentary fashion we have traced the history of this disease through many centuries. Its pathology, its characteristics, its fatal outcome, its treatment, gradually have unfolded themselves. With it are associated the names of the greatest surgeons since surgical literature began; and now in this twentieth century we see a radical and perhaps a final stride forward made in the solution of the world-old problem. PRESENT PROBLEMS AN ADDRESS TO THE NURSES OF THE LAKESIDE HOSPITAL1 GOOD nurses are born for their work. Poeta nascitur, non fit is as true of you as it is of the lawyers, doctors, ministers, and politicians. You can manufacture out of the most unpromising material a good engineer, or carpenter, or sailor, or even janitor; but when it comes to those persons whose work depends on their contact with other people, who deal in personal equations and not in impersonal figures then there enters into the problem a new and wonderful group of elements which are a part of the birthright of some, while the others without them stagger through life, blind, puzzled, indignant with the fates: tact, humanness, womanliness, manliness, the appreciation of proportion, the attribute of sweet reasonableness, the rare sense of humor. And of course you are to take this reflection as meaning that some of us are better workmen than are others. To him that hath, is as true as ever it was, but we should have to despair indeed if we were to believe that from him that hath not shall be taken away even that which he hath. You trained nurses have had your place in the world's work now for more than a generation, and it seems to me it is time to look about occasionally and ask what you have made of yourselves. 1 Cleveland, Ohio, May 25, 1903. I have heard and read many addresses given to nurses on such occasions as this, and in the main the speakers have devoted themselves to two topics your usefulness and your education. Nurses have been told a thousand times that theirs is the noblest of professions; that nursing is woman's true sphere. Poets have been invoked to demonstrate that by day you comfort the sick, by night you soothe the dying. Weeping willows have been made to rhyme with lonesome pillows, and the rest of it. It's all true enough. No one appreciates it all more than I do. It is a noble profession, and the good you do is beyond measure. Then there is that other subject, your education. That is a great subject. You have begun it well here in this training school, but the most important part is to come, and I want to talk with you in some fashion. about that. At the outset of your work in life after leaving the training school, you are in a position quite different from that of any other professional people known to me; you are equipped for practice and you assume at once the full standing of the experienced workman. You are deemed for so tradition has arranged it for you as competent as the women who have grown gray in harness. You expect as a right the maximum wage, twenty-one or twenty-five dollars a week, or whatever the sum may be in your particular locality, - and as a general thing you get no less. Did it ever occur to you what that state of affairs may mean? Try to apply the same principle to other professions |