medicine than educated practitioners. Briefly, then, we gladly acknowledge and rejoice that all educated physicians use less medicine, and less nauseous medicine than formerly, but this result has been brought about by physiological and pathological investigations. Theories have given place to facts, and improved methods of diagnosis have taught clearly what we have to cure. A better understanding of therapeutics has taught us the application of remedies to the cure of diseases, and an improvement in chemistry has given us remedies of definite and certain power. At no period in the history of medicine has the practitioner occupied such vantage-ground as today. He can determine as never before the exact stage of progress of the disease, and select his remedy with the precision that a mechanic selects his tools for a given task. And these remedies are veritable and potent, and not the flimsy pretexts obtained by the mysterious process of shaking a bottle. Let us, therefore, maintain the position firmly, that whatever improvements have been made in the art of prescribing, are not due to the teachings of empiricism, but are the fruits of science.

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XXIII.

MECHANICAL SURGERY.

S

URGERY has not made more rapid advances in the conservation of limbs hitherto doomed to destruction, than has mechanical surgery in supplying the defective parts. It is quite impossible, nowadays, to determine what part of an individual is natural, and what artificial. Of ten men who walk the street each with an artificial leg, in nine we are more liable to fix the disability upon the natural than the artificial limb. The western bride who was thrown into convulsions on seeing her bridegroom suddenly deprived of an entire leg by a waggish friend, illustrates in one of a thousand ways the present perfection of the appliances of mechanical surgery. We now have artificial teeth which baffle even dentists to detect their genuineness; and artificial eyes which flash with intelligence, sparkle with merriment, and doubtless roll with the fine fancy of the poet. Even nasal appendages are now manufactured to order so as to imitate exactly the natural tint of that organ, or the more brilliant colors of the acne rosacea (brandy nose) not infrequent in the higher circles of society. But mechanical surgery is only

in its infancy; most of the improvements which we witness date back but a score and a half of years. The clumsy apologies for legs which fifteen years ago represented the highest degree of art, would not be sold by any respectable manufacturer of our time. The same is true of artificial hands, trusses, etc. The genius of American invention once directed to this fertile field for useful and profitable effort, there is no limit to the advances which it will make. Already in the treatment of deformities, mechanical appliances are accomplishing results which lead us to anticipate that they will yet monopolize this entire field of practice. Mechanical surgery is a legitimate branch of the healing art. Whatever unprofessional men may have accomplished in the way of invention in any of its departments, has for the most part been the result of accidental circumstances. A farmer, annoyed by a hernial protrusion, has, sitting at the side of his plow, whittled a block into a form that, when applied, answered its purpose well. It is often alleged in recommendation of an artificial leg that the inventor had an amputated limb, which directed his attention to this special study, and led to the invention of the limb in question. But mechanical surgery is not a simple branch of mechanics, to which any ingenious artisan can successfully turn his attention; it requires also an accurate knowledge of anatomy, of physiology, and of surgery. Rationally, the mechanical surgeon, or the

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surgeon artist," to use an elegant phrase, must be a thoroughly educated physician as well as an inventive genius. A man might with as much propriety prescribe remedies without a knowledge of diseases as undertake to apply properly a truss without a knowledge of the anatomy of the malady. The same remark is true of every branch of mechanical surgery. Quackery in this department, or the pretensions of uneducated and unqualified men, are as gross and unmitigated as in the simple practice of physic. The medical profession have too long regarded mechanical surgery as the legitimate province of non-medical men, or medical speculators in patents. This has tended powerfully to deter worthy and competent medical men from adopting any branch of it as a specialty, and thus the art has been until recently almost monopolized by the merest pretenders. But medical men of real merit have recently entered this field of service, and already the ripe fruits of skilled labor begin to appear. We now see in every department the results of long and careful study of the anatomical or pathological abnormalities to which appliances are adapted. From medically educated mechanical surgeons the profession may obtain many practical hints, and it is important that we have a class of artisans in these several branches to whom we may with confidence refer questions of practice. The place of election for amputation of the lower, and even the upper extremity, should

always be decided by the mechanical surgeon, and hence how important it is that he be thoroughly qualified to give a just decision. But we need not multiply examples of this kind. It must be evident to every one that mechanical surgery is a branch, and a most desirable branch of surgical science and art. As such it should be fostered by the profession by every proper means. First, we should encourage educated medical men to engage in its several departments as special objects of study and practice, and then give them the most cordial support. If the profession recognize the claims of this branch of the healing art, and take under its protection those who devote themselves to it, there will be no need of patents to insure to an inventor the honest proceeds of his labor and study. Second, we should discountenance on all occasions, and under all circumstances, the uneducated pretenders in this department of surgery, who throng our cities and hawk their wares in every market. Whatever merit some may have as inventors, as a class they are not entitled to the slightest consideration, and should meet with unqualified condemnation. They not only do great harm by their competition with qualified manufacturers, but too frequently their appliances do fatal mischief to deformed limbs.