the sorrows, diseases, and lingering death which surely follow maternal desertion. What, then, is our plain duty as medical attendants at the birth of illegitimate children, or as advisers of parties who are interested in these unfortunate beings?

for in the great majority of cases a regular physician is consulted at some period. We should not less consider the welfare of the child than that of the mother. Though it may be for her interest and happiness to be restored to society, unsuspected of crime, let us remember that it will doubtless be effected by the destruction of the child. If we sunder the life-giving ties which bind mother and child, and place the latter where it lingers out a miserable existence of a few months or years, are we guilty of a less crime than the mother who grasps her offspring by the throat and ends its life with its birth? No, verily. Plainly then, our duty is to insist that the mother is responsible for the care and support of her child, let the social consequences to herself be what they may. To abandon her offspring is as unjustifiable as infanticide, and he who advises, aids, or abets such a course, is particeps criminis.

XVI.

CONSERVATIVE SURGERY.

S

CIENTIFIC surgery proposes as the problem of our time: How may diseased or injured limbs or parts best be preserved? The true reputation of a surgeon is now based, not on the number of limbs amputated, but on the number saved from amputation-not on the amount of deformity created, but on that relieved; and it is interesting to note the multifarious ways in which this problem is being solved by earnest and practical students. Shrewd observers of nature's resources are devising, and cunning hands are executing, in every department of practical surgery, new methods of removing diseased parts and structures, or preserving the healthy, in however close proximity. So well established and well defined are many of the more recent rules in operative surgery, that operations which were legitimate a score of years ago, would to-day be justly accounted malpractice. Let us notice some of the more important advances of conservative surgery. The regeneration of bone from the preserved periosteum enables us to save the limb in necrosis. The number of amputations in hospital practice was

formerly largely increased by those cases of necrosis which involved a considerable portion of the bone of any extremity. If the dead bone was removed by an operation, the periosteum was removed also, and the result was a useless limb. Surgeons preferred, therefore, amputation, in many cases, to the removal of the dead bone, so much would the limb be crippled by the latter operation. It now appears, however, that the periosteum has the power of reproducing the removed bone entire, and in a condition capable of supplying its functions. And very marvelous are many of the instances of the reproduction of bone. We may have the entire shaft of the tibia renewed, and the leg restored to its former serviceableness. The radius, with its complicated office of rotation, is equally capable of regeneration, both in tissue and function. The clavicle has thus been reproduced, and has proved quite as useful as in the healthy state. The most remarkable instance of regeneration is seen in the inferior maxilla, which has now been so frequently reproduced entire, with the exception of the teeth, that its renewal, when the periosteum is preserved, may always be prognosticated. The rule may be considered established on immutable principles, that in the removal of bone, we may have the vacancy supplied with the same tissue, if the periosteum is preserved. Amputation in such cases, though formerly sanctioned, would, in our day, be an unjustifiable procedure, if performed

simply because of extensive necrosis. The resection of diseased and injured joints enables us to save many limbs which, though not as useful as the originals were, still can not be compensated by any artificial contrivance. All the joints have been subjected to this operation, and with results such as render it highly encouraging, especially in the upper extremity, if not always advisable, when the question lies simply between resection and amputation. In the Crimean war, the mortality of these operations appears strikingly favorable to resections; thus, of amputations at the shoulder-joint one-third died, of resections one-thirteenth; of amputations of the arm one-fourth died, of resections of the elbowjoint one-sixth. Statistics on a larger scale give for excision of the shoulder a mortality 22.5 per cent., and amputation at the same joint 40.8 per cent.; excision of the elbow-joint a mortality of 22.15, and amputation through the arm 33.4 per cent.; showing that, as a question of safety, excision is to be preferred, at these joints, to amputation, when there is opportunity to choose. Resections of the hip and knee joints, though perhaps not as well established as the same operation at the elbow and shoulder, are well-recognized surgical expedients for saving limbs. Resection of the head of the femur for morbus coxarius has given excellent results, and in military surgery is far more successful than amputation at the hip-joint. Resection of the knee-joint

has saved scores of useful limbs, which the older surgeons would have condemned, and may to-day be set down in the catalogue of accepted operations in conservative surgery. The resection of bones is a method of avoiding amputation worthy of the attention of every surgeon. The individual bones of the tarsus or carpus, when diseased, and rendering the extremity useless, may be removed with the restoration of the usefulness of the limb. The astragalus may be removed with a percentage of about 86 cures, and the calcaneum with a percentage of about 99 cures, in cases where formerly amputation was performed with a mortality of 30 per cent. Gunshot wounds of the articular extremities of bones are now not to be treated by immediate amputation, but by resection. Esmarch has shown that resection of the head of the os brachii should be preferred to amputation when even four inches of the bone are involved, the resulting limb being useful. The free opening of joints, now so confidently asserted by some to be harmless, and as strenuously denied by others, may yet relieve us from the necessity of amputation in those cases in which the larger joints are involved in injuries. In military surgery, the rule of treatment in gunshot wounds fracturing the articulating ends of the bones entering, for example, into the kneejoint, would be immediate amputation of the thigh. But if it is proved that the joint may be freely laid open in such cases, the fragments removed,