trust that his success in these experiments will encourage him in other practical work of similar nature, and have no doubt of his success in other fields of repairative surgery, should he choose to invade with his needle and scalpel. "THE LIMITATIONS OF MODERN SURGERY." We make no apology for reprinting in this issue the masterly article of Professor Senn, under the above title. We regard it as one of the soundest contributions to modern surgical literature, and coming from the pen of such an authority as Doctor Senn, it must do a great good especially at a time when every new graduate in medicine regards himself as a surgeon and when so many who occupying positions as teachers would fain make us feel that modern surgery scarce has any limitations. Few men have done as much for American surgery during the last decade as has Doctor Senn; perhaps no one man has ever done as much for American surgeons as "THE RESTORATION OF NERVES AF-he, and all honor is due him for his boldness TER INJURY." We are much pleased to be able to publish in this issue a most excellent paper by Professor A. H. Levings of Milwaukee, under the above title. We take an especial pride in this paper, for the reason that it describes a lot of valuable experimental work which was performed as a preparation for an original thesis to be read at the ninth annual meeting of the National Association of Railway Surgeons. Only those who have been engaged in such research can fully appreciate the amount of toil which Doctor Levings has performed in working out his experiments and making his modest report. We feel sure that all our friends who favored us with papers at the St. Louis meeting of the association will forgive us when we say that we regard this paper as the most valuable, from a purely scientific standpoint, of the papers which were read at that time. Dr. Levings is certainly to be congratulated upon his paper as a whole, and especially upon his successful establishment of the fact that the adjacent muscle affords the most suitable material for bridging the defect in resected nerves. We and his honesty in taking the stand for rational conservatism which he has taken in the article above referred to. THE SURGEON'S ARMAMENTARIUM. Of course the prime essential in the practice of modern surgery is a man of sound judgment and individual skill. Scarcely second in importance, we would say, comes thorough scientific preparation. Certainly the third pre-requisite for success must be the equipment, for without the best tools even the most skilled workman cannot do his best. We publish in other columns of this issue a paper by Professor Arthur Dean Bevan of Chicago, in which he describes a most complete, and some will say, elaborate outfit for emergency surgery, and suggests that every surgeon, and especially those engaged in railway work, prepare himself, as he has already done, to pick up his grips at a moment's notice and go to any case, no matter how serious, fully equipped with instruments, dressings, and other appliances. He makes the statement that with such an outfit any well trained surgeon may perform in a farmer's kitchen as aseptic an operation as can be done in any modern hospital. We also reprint in this issue a short paper by Doctor A. J. Ochsner, which originally appeared in The Corpuscle, in which he describes his method of performing a thoroughly aseptic operation amidst the filthiest surroundings. We know from personal experience the comfort and feeling of security which comes from being ever ready, and cheerfully endorse the advice of Doctor Bevan that everyone who does surgical work should provide himself with a complete outfit suited to the work which he is called upon to perform, and always have it in order and within easy reach. The outfit described in Doctor Bevan's article may seem to many surgeons altogether more elaborate than is necessary, but we feel sure that his paper will be a helpful guide to many, especially of the younger men, in the selection or preparation of an emergency outfit which will save them many annoyances and make their practical work much simpler and more successful. We can also testify from familiarity with Doctor Ochsner's work and from personal experience, that it is possible to do aseptic work in the way and under the circumstances which he describes, but it requires constant care and thoughtfulness in regard to many details and a carefully prepared outfit which is constantly replenished and kept in order. A PROPOSED MONUMENT TO PASTEUR. The following letter and announcement have been received by the secretary of the National Association of Railway Surgeons. Dr. Wescott has made reply, stating that proper announcement would be made in the columns of The Railway Surgeon and that all subscriptions received would be duly forwarded to the committee at Washington. All remittances may be forwarded to Dr. Cassius D. Wescott, 31 Washington St., Chicago. Washington, D. C., July 24, 1896. Dear Sir: There is enclosed herewith a circular concerning the international subscription for the erection, at Paris, of a monument to M. Pasteur. I have been requested to correspond with you and to secure the co-operation of your association, which our committee desires should be represented in this popular movement. Will you kindly act as an associate member of our committee, and collect and forward the subscriptions? The necessary blanks for this purpose are enclosed, and I trust you will inform me promptly of the action you take in this matter. Thanking you in advance for your interest and co-operation, I remain, Very sincerely yours, GEO. M. STERNBERG. To the secretary National Association of Rail. way Surgeons: ANNOUNCEMENT. It has been decided to erect in one of the squares of Paris a monument to the memory of M. Pasteur. Statues or busts will also, no doubt, be located at his birthplace and in other cities. The Paris committee has, however, wisely determined that the statue obtained through international effort shall be located at Paris, where it will be seen by the greatest number of his countrymen and also by the greatest number of his admirers from other lands. The Paris committee has for honorary members the President of the Republic and his cabinet, together with about one hundred and sixty of the most prominent officials, scientists and other distinguished citizens of France. The active members of the committee are: J. Bertrand, president, member of the French Academy, perpetual secretary of the Academy of Sciences; J: Simon, vice-president, member of the French Academy, perpetual secretary of the Academy of Moral and Political Science; Grancher, secretary, member of the Academy of Medicine, professor in the Faculty of Medicine; Bruardel, member of the Academy and of the Academy of Medicine, dean of the Faculty of Medicine; A. Christophle, honorary governor of the Credit Foncier, deputy from l'Orne; Count Delaborde, perpetual secretary of the Academy orf Fine Arts; Duclaux, member of the Academy of Science and of the Academy of Medicine; Magnin, governor of the Bank of France, vice-president of the Senate; Baron A. de Rothschild, banker; Roux, assistant director of the Pasteur Institute; Wallon, perpetual secretary of the Academy of Inscriptions and Belles-Lettres. The Paris committee has kindly extended the opportunity to the people of the United States to assist in this tribute of appreciation and love and have authorized the organization of the Pasteur Monument Committee of the United States. The members of this commitee gladly accept the privilege of organizing the subscription, and of receiving and transmitting the funds which are raised. We believe it is unnecessary to urge anyone to subscribe. The contributions of Pasteur to science and to the cause of humanity On Some of the Limits of the Art of Surgery. Delivered at the Forty-Seventh Annual Meeting of the American were so extraordinary, and are so well known Extracts and Abstracts. and so thoroughly appreciated in America that our people only need the opportunity in order to demonstrate their deep interest. All can unite in honoring Pasteur. He was such an enthusiastic investigator, so simple, so modest, so lovable, and yet, so earnest, so great, so successful-his ideals were so high and his efforts to ameliorate the condition of humanity were so untiring that we anticipate an enthusiastic response from the whole civilized world. The United States will vie with the foremost of nations in this tribute. Chemists, zoologists, physicians and all others interested in science will wish to be represented. No one is expected to subscribe an amount so large that it will detract in the least from the pleasure of giving. A large number of small subscriptions freely contributed and showing the popular appreciation of this eminent. Frenchman is what we most desire. This committee supplies subscription blanks, which should be returned in the accompanying envelope, together with a money order, check or draft covering the amount subscribed. All checks, etc., should be made. payable to "Treasurer Pasteur Monument Committee," and when received by the secretary a numbered receipt will be forwarded to the sender. The original subscription papers will be forwarded to the Paris committee for preservation. It is our purpose to do our work as largely as possible through societies or other organizations. We prefer to have each organization appoint one of its members as an associate member of this committee with authorization to collect and forward subscriptions. The amounts thus far subscribed by individuals vary from fifty (50) cents to ten (10) dollars. It is hoped that no one who is interested will hesitate to place his name upon the list because he cannot give the maximum amount. Please let this receive your early attention and in that way assist our committee which must conduct correspondence with the societies of the entire country. REVIEWS. The Nursing World Bedside Record for the use of physicians and trained nurses, designed by the editor of the Nursing World, Providence, Rhode Island, supplied by Messrs. John Carle & Sons, New York. This is a neat little book of record blanks and temperature charts for use in the sick room, and will be found a convenient time saver both for the nurse and physician. The physician can cure the sick, but he cannot cure the dead.-Chinese. Mr. President and Members of the American Medical Association:-Modern surgery has attained a degree of development which entitles it to the distinction of a science and an art. As a science, surgery is of recent date, having been founded and perfected during the last half of the present century. As an art, it has been practiced for centuries by our ancestors with credit to themselves and benefit to the injured, the crippled and the sick. When Boyer wrote the introduction to his classic work on surgery he expressed the conviction that surgery had reached perfection. How little did he dream of the great changes that would be brought in the practice of his cherished profession by the progressive pathologists and surgeons of the next few generations! How innocent and absurd does such statement appear in the face of the labors of such men as Virchow, Rokitansky, Rindfleisch, Klebs, Recklinghausen, in pathology; Pasteur, Koch, Ogsten, Rosenbach, Baumgarten, in bacteriology; Lister, Langenbeck, Billroth, Hueter, Esmarch, Czerny, Gussenbauer, Nelaton, Verneuil, Terrier, Macewen, Gross, Agnew, in surgery; Terrier, Hitzig, Horsley, in cerebral localization; Spencer, Wells, Keith, Winckel, Martin, Péan, Ségond, Pozzi, Sims, Emmet, Battey, in gynecology, and a host of other faithful, unselfish workers who have made surgery what it is to-day and what it is intended to be-the most honored, respected and beneficent branch of the healing art. What a contrast between the standing of the surgeon of to-day in the community, the profession and from a scientific aspect as compared with his colleagues of only a century ago! It is not long since the art of surgery was limited to bleeding, cupping, leeching. setting of a broken limb, reducing a dislocation, stanching hemorrhage, opening an abscess or amputating a limb for injury or disease beyond the reach of conservative measures. He was the subordinate, almost slave, of the pompous, arrogant and self-confident physician of that time. He subsisted from the crumbs that fell from time to time from his master's table. The betterment in the standing and sphere of the members of the surgical craft during the last century is entirely due to the enormous progress that has been made in the science and art of surgery. During this time the legitimate field of medicine has gradually diminished before the advancing columns of progressive and aggressive surgeons. The physician no longer has a monopoly over the diseases of all the internal organs. The physician's distinctive apparel and gold-headed cane of but few years ago no longer intimidate the surgeon; they have disappeared from the scene and the surgeon stands on the same level, if not higher, in every respect with the physician in the eyes of the masses and the estimation of the scientific world. Modern pathology and the new science of bacteriology have laid a permanent foundation for the steady and progressive advance of surgical thought and work. The inflammatory complications of wounds and the etiology of most of the chronic infective surgical diseases have been cleared up by bacteriologic investigations during the last twenty-five years, and the knowledge thus gained has enabled the surgeon to prevent in a large measure the former and to treat intelligently and with increased success the latter. Many of the most noted surgeons who have left a strong and permanent impression on surgical literature and practice during the last quarter of a century have been enthusiastic and practical bacteriologists and competent pathologists. The wonderful development of operative surgery during the same time is one of the earliest and richest fruits reaped from the vast and fertile field sown and cultivated by bacteriologists of every civilized nation. To the immortal Lister belongs the honor of having opened a systematic and successful crusade against the surgeon's most treacherous enemies-the pathogenic microbes. The great principles which he conceived and introduced into practice created a new era in surgery. Antiseptic surgery is one of the many fruits of his genius and the one to whom we, as a profession, and humanity owe more than to any other surgeon dead or living, has been permitted to live long enough to see the creation and blessings of aseptic surgery, the handiwork of his innumerable enthusiastic followers. Antiseptic and aseptic surgery have smoothed the rough and rugged pathway of the practical surgeon. Ordinary cleanliness has given way to surgical cleanliness. The almost universal introduction of antiseptic and aseptic precautions in the treatment of wounds in private and hospital practice has nearly eradicated the three greatest enemies of the surgeon of old, namely, hospital gangrene, erysipelas and secondary hemorrhage, and minimized the occurrence of suppuration and its manifold immediate and remote complications. No wonder that a sense of security created by such wonderful changes made the surgeon In consequence of such revolutionary changes wrought in the practice of surgery new territories were invaded and organ after organ, the seat of injury or disease, were subjected to direct surgical intervention. Step by step the scalpel found its way into localities where formerly the physician had reigned alone and supreme, and where its presence would have been regarded by him as convincing proof of homicidal intent. No better evidence can be advanced to show the difference in the kind and scope of work of the surgeon of to-day with the one before the pre-antiseptic time than a comparison between the works of operative surgery of now and then. The sense of safety which took possession of the surgeon and an earnest desire to extend his skill to the successful treatment of affections which had heretofore baffled the efforts of the physician, brought on a warfare on almost every organ the seat of real or imaginary disease. The physician found himself suddenly out of his long time, honored routine. practice. The specialist utilized the opportunity and left no stone unturned to extend their sphere of activity. Brain surgeons, abdominal surgeons, neck surgeons appeared on the scene and filled the medical press with accounts of their wonderful surgical feats. The old-fashioned gynecologist, whose chief occupation consisted in introducing and removing pessaries, cauterizing so-called ulcers of the cervix, swabbing out the uterus and inserting medicated vaginal tampons, became restless and anxious to exchange harmless, bloodless measures for the knife and scissors. sire for bloody operations was not satisfied by sewing lacerations of the cervix and perineum. He felt that in order to keep abreast with the spirit of the present age he must increase his range of action, and in due course of time the ovaries, the Fallopian tubes and uterus became the theater of his aggressiveness. Even the acquisition of this additional territory did not satisfy his ambition. The adjoining great abdominal cavity, with its many important organs, was looked upon with a jealous eye and it has been made the common camping ground of the general surgeon and the gynecologist for several years. His de The throat and nose specialist, under the same influences, became disgusted with his brush, powder-blower and atomizers; sharp spoons, chisels, and saws came into requisition, and the number of deflected septa, hypertrophic turbinated bones and third tonsil increased alarmingly and were attacked most energetically. The rectal specialist, who made a modest living by stretching the sphincter ani and ligating piles, saw a fortune in adding to his limited sphere of activity, resection of the rectum, and later, emboldened by his efforts, carried his crusade to the topmost limits of the large intestine. The average orthopedist is no longer satisfied to correct deformities by the use of bloodless manual and mechanical measures; he has acquired a fondness for the knife, saw and chisel, so as not to be left behind in the procession. The genito-urinary surgeon has become tired of treating gonorrhea, strictures and syphilis; he can see no reason why he should not cut for stone, extirpate, kidneys and perform plastic operations on the ureters. The furor operativus manifested in these and other special departments of surgery, and its obvious results, render the standing and legitimate scope of the general surgeon very uncertain and indefinite at the present time. Let the general surgeon turn to the right or to the left, advance or retreat, and he finds himself on reserved territory. As for the physician, he is expected to answer night calls, prescribe for diarrhoea and whooping cough, watch cases of typhoid fever, measles, scarlatina and smallpox, and should complications arise and he does not report to the proper authority he renders himself liable to censure. Much of this ill-applied energy in the surgical world has resulted in detriment to patients and in retarding actual surgical progress. Operative surgery has been carried to extremes. A calm inspection of the ground that has been gone over will show "Some of the Limits of the Art of Surgery," the subject which I have chosen for this address. Antisepsis and Asepsis.-The marvelous reduction in the mortality following injuries and operations which the present generation has witnessed is largely due to the prevention of wound complications by the employment of efficient antiseptic and aseptic precautions. Improved means of hemoitasis and the more efficient treatment of shock might reasonably claim a certain share in bringing about such a desirable change in the results of surgical practice, but what has made our work more satisfactory and the statistics of various operative procedures more encouraging is the prevention of infection, the protection of the patient against the immediate and remote effects of sepsis and suppuration. The treatment of wounds with these objects in view has been simplified and rendered more efficient from year to year, but it cannot be said that perfection has been reached. We are not yet in possession of an ideal absorbable ligature and suture material The person who will show us how to prepare the animal ligature and suture in such a way that it will not only be absolutely aseptic, but also antiseptic and without loss of its tensile strength, will be entitled to the lasting gratitude of the entire profession. The disinfection of hands and field of labor is open to future improvement. The important matter of drainage remains in anything but a satisfactory condition, and the questions frequently raised, when to drain and how to drain, must be definitely settled by future experience and research. There are surgeons to-day who do not take into account the possible failure of antiseptic and aseptic precautions in estimating the dangers incident to operative procedures. Have we not all heard so-called abdominal surgeons say that an exploratory laparotomy is devoid of danger: Is it not a fact that the abdomen is being opened daily by men who have not the faintest idea of what they may have to do, simply because they regard such a step as harmless and free of danger and the shortest and easiest way to make a diagnosis? To say that such a blind confidence in the efficiency and safety of aseptic precautions is not in accord with the work of the conscientious surgeons is to put it mildly. It is fortunate for the patients of such ever-ready and self-confident operators that the peritoneum under ordinary circumstances can dispose of more pathogenic microbes without harm resulting than any other tissue of the body. If it were not such a serious matter it would be amusing to see how such men explain an occasional death that occurs in their practice in cases where it was least expected. If, perchance, a post-mortem examination was held, the first statement made is that the peritoneum showed no evidence of inflammation, consequently death must have occurred in consequence of shock, exhaustion, bronchitis, edema of the lungs. or heart failure. Very recently a prominent surgeon in giving his testimonial in recommending a certain kind of cat-gut, made the statement that he had performed one hundred consecutive major operations without having seen a single drop of pus. I have no reason to doubt the veracity of this gentleman's statement, but I am firmly convinced that it would be difficult, if not impossible, to duplicate such an experience in the practice of the average general surgeon. I have made it a duty on my part to familiarize myself with the advances made in the technique of aseptic surgery and have the good fortune to perform all my operations in two of the best hospitals in Chicago, and in a fairly equipped college clinic, and yet I am only too willing to confess that I never finish my day's work without seeing pus. I have a painful recollection of two amputations for carcinoma of the breast on private patients. in both of which every possible precaution was carried out, and yet to my utmost disappointment, both of them died of the most virulent form of sepsis I ever encountered. To offset these cases, I might refer to perhaps over two hundred similar operations in which, under much less rigid precautions, with few exceptions, faultless wound healing was obtained. I remember, too, a case of genu val |