ing Allingham's rectal speculum and, exposing the internal orifice of the fistula, touch the opening with a stick of nitrate of silver where it enters the rectum, and place the patient in bed with a sheaf of three soft rubber catheters lying side by side in the rectum to give exit to the gases and mucus. The bowels should be previously emptied with a cathartic. spect inevitable in all such efforts, and, more serious still, the retrospect must be personal. I am reminded that it is exactly twentyseven years since I entered the University of Edinburgh as a medical student, and I have been trying to recall to mind, as accurately as I can, my impressions of what I then saw, to contrast them with what I see now; to recall the teaching and practice of 1860, and compare them with those of 1887, and to see wherein and how far we have improved. In such a retrospect there will be this advantage, that I shall speak of events and contrasts which most of you have witnessed, and which can, therefore, be in no way regarded as ancient history. There has been a very general opinion in the profession that it is not expedient to cure a fistula where the patient is inclined to tuberculosis. Dr. E. E. Glover, of Terre Haute, Ind., has taken the pains to ascertain of a large number of surgeons, on both continents, their opinion on this subject by which he dis covers that there is apparently a very great My earliest surgical recollection is still very change of opinion on this question. He finds vivid. The operating theater of the old in that those who reply to the question as to firmary was crowded, every seat even of the whether they would operate in tuberculosis top gallery was occupied. There were prob. cases the following who say yes: Allingham, ably seven or eight hundred spectators, for Agnew, Andrew, Brinton, Brodie, Bonteson, Syme was to operate on a gluteal aneurism. Solis-Cohen, Cole, Francis Delafield, East He was then in the zenith of his fame, and in man, Engelmann, Gunn, Hamilton, E. F. In- the very best of his powers, his hand as gals, Lane, Linthicum, McGuire, Mathews, steady and his eye as true as it had ever been Moore, Owens, Peck, Ramey, Sayre, T. G.-incomparably the best surgeon I have ever Richardson, of New Orleans, Roberts, of seen. He entered the theater with the recog Philadelphia, Wight, Wilson, Varich and nized procession of assistants, house surgeon Taylor. and dressers, and was greeted with a subdued murmur of applause. The spectators included men of all ages and ranks in the profession. Very many who had come from great dis tances to see the great feat-like Bickersteth, of Liverpool, who came specially to assist, if I remember rightly-and, of course, there were many boys like myself from fifteen upwards. The patient was put to sleep, Syme buttoned up his dress-coat, turned up his sleeve, I saw a rush of blood, and in a few minutes the placing of the patient in the carrying chair and and a round of applause announced the conclusion of the operation. do so. On My own opinion is that there is no objection to curing the fistula in such cases. the contrary, it is beneficial to the patient to But it is true that where it is done by incision the wounds do not always heal well, and if the patient has but a year or two to live on account of his tuberculosis it seems scarcely worth while to submit to the annoyance of the operation. But this would be no reason why he might not be advantageously treated by gentle and non-operative methods, such as we have described.-Chicago Med. Jour. and Exam. THE DEVELOPMENT OF SURGERY AND BY LAWSON TAIT, F. R. C. S., The I have often wondered since, and now I wonder still more deeply, why we gathered in such numbers to see that operation. boys did so from curiosity and in ignorance. I am sure I did, and my ignorance was in no way lessened, for I saw little of the operation and I understood less. The older and more Surgeon to the Birmingham and Midland Hospital for experienced spectators went mostly from cu Women; President of the Branch. riosity, and perhaps to be able to say that they had seen the great surgeon do this great deed. Some six or eight men were there, like Bickersteth, who might some day be called upon to operate for a gluteal aneurism, and they were the only legitimate spectators. All the others had far better have been away. In those days the first year students were turned into the operating rooms, and I believe this practice is still continued, to learn how operations are done before they know the names, far less the relations, of the structures concerned. In the dissecting rooms our greatest feats were to display skilfully the fancifully numerous layers of fascia which, if we had been really operating for hernia, we certainly would never have troubled about; or to remember the varieties of troublesome perineal arteries with which not one per cent of us would ever have any practical anxiety. The strange thing was that this nonsense was encouraged by our teachers-nay, it was carried into the examination hall. At that time, as now, the College of Surgeons was the great manufacturing agency for those practitioners in England and Wales who had the care of all the ordinary ailments of British humanity, as well as the smaller number who operated on gluteal aneurisms. In order to receive a certificate which enabled the candidate to deal with scarlet fever and pneumonia, he had to answers questions about the internal iliac artery and how it might be tied. Such a trifling accident as that upon which many of you depend for your night work, the process of parturition, had not been regarded as of nearly so much importance as the relations of the pelvic fascia. Now all this is greatly changed, but it is not changed enough, and there is still room for improvement. It is perfectly true that a great bulk of surgical work (with which for precision and brilliancy of result, as well as for difficulty of detail, even Syme's gluteal aneurism cannot for a moment compare) is now done in small rooms before audiences restricted to a few post graduate pupils. All this, a quarter of a century ago, even if it had been possible, would have been the object of spectacle. Now two facts are recognized that were apparently hidden from our fathers; that the great bulk of human ailments are such as do not require operative interference, and that the acquisition of a surgical diploma is no guarantee of the possession of the manipulative skill necessary to be an operating surgeon. In my youth the great object of the schools seemed to be to turn out men able to cut for stone and tie arteries, and the more solid and more frequently exercised qualities of the general practitioner were neglected. To some extent the reason of this was that the great bulk of the students went to the university with so large an amount of experience gained by the old-fashioned apprentice ship system, that many of them could really claim to be already accomplished practition ers. But the changes of the last quarter of a century have almost ended that most excellent method of training, and I find now that our young men leave the schools in large numbers in just such a state that they are ready to begin to learn the profession they have to follow. My business at present is not so much with the process of medical education as with some of its results, but I cannot help joining may voice in the wail, which is getting pretty general, concerning the destruction of the old method of education by aprenticeship, and I most emphatically condemn the attitude taken by two Royal Colleges in relation to the Apothecaries' Company, to which, whatever may be said to its detriment, we owe most assuredly the more solid and useful elements of education for very many past generation. During the time covered by my retrospect, some of the changes effected have resulted undoubtedly in making our students more learned, but I sometimes wish that the coming generation had less about them of the savant and more of the doctor. In 1860 the battle of anesthetics was nearly ended, and no one ever thought of performing a surgical eperation without chloroform, though its application to midwifery practice was still stubbornly resisted by some of the old folk; but the traditions of the old surgeons of the days before chloroform still sur vived, centring chiefly round the memory of Liston, who must have been a man fulfilling the requirements of the operative surgery of his day more fully than any other of modern times. In those terrible days, when the operation had to be done in spite of the shrieks and struggles of the poor sufferer rapidity was everything, and accuracy had sometimes to be sacrificed to speed. But Liston seemed to excel everyone in his lightning-like movements, with all the accuracy of Syme. Thus he made a reputation, and leaves a memory more like that of an actor than a man of science, as he really was. Now-a-days, when accuracy is everything and speed a matter of little moment, advantaged as we are by our slumbering patient, we can form no notion of the work of such a man as Liston. As boys, we always spoke of him as of a hero. All the stories of him were treasured and handed down, and he formed the standard of comparison to the detriment of all his successors. We then spoke of a lithotomy not in relation to its results, but by the number of seconds it took to finish. Now a days, the man who hurries an operation for show is no credit to his art. By this, however, I do not mean that men with slow minds and shaky hands are to be encouraged to engage in operative work. In a retrospect such as this it is an easy matter to speak of the wonderful advances made by the discovery of the anesthetic properties of certain volatile drugs, as contrasted with the horrors of the days before this greatest blessing to mankind; but we do not as yet fully recognise the indirect advantages it has conferred upon ourselves. It is, like Mercy, twice blessed; it blesses the surgeon as well as the sufferer, and it has made possible operations which no surgeon could have faced without it. The whole realm of ab dominal surgery gives an illustration of what I say. It is true that a few abdominal operations were done before the days of chloroform; but, in this country at least, they were nearly all removals of simple parovarian cysts. The first ovariotomy by Charles Clay did not occur till September 27, 1842. Baker Brown had slumbering patients, and, without the unconsciousness to which we now safely reduce them, not one of those many advances with which the name of Birming ham will ever be closely associated could ever have been possible. It is true that the deep sleep was first cast upon man in the Massachusetts Hospital; but the battle was fought in the island, and the victories which have followed it are due to the pluck and pugnacity of James Young Simpson. "It is not," says Sydney Smith, "the man who first says a thing who deserves the credit, but he who says it so long and so loud that at last he peruades the world it is true." SO Having thus been able to do something more than snatch an occasional victory by sleightof hand like Liston's, the art of the surgeon made rapid progress, and about 1862 Simpson began to insist that we should know something about surgical results; that we should know, indeed, not only whether we were doing as much as we could do for the welfare of patients upon whom we had to operate, but whether the results obtained were at all in proportion to the labour, expense, and suffering involved. Curiously enough, the research was at first not made on the main lines, but on a side-issue that of inquiry as to the best method of closing bleeding points. Simpson collected a mass of statistics which excited amazement at the terrible mortality of such simple operations as removals of the leg and forearm. He blamed the old method of ligature, and he led us astray about acupressure; but even that mistaken divergence was of infinite use, for it led us to discontinue the long ligature-an advance which has never been acknowledged, and never accredited to Simpson's work as it ought to have ben long ago. It was an advance as great as Ambrose Paré's introduction of the thread itself. In my youth every stump had a number of threads hanging out of it, and after a week they were pulled by the house surgeon or dresser day by day until they came away. Sometimes they never came. Simpson's attack led to a reconsideration of the whole question; in fact, we owe to him an enormous debt for the whole advance of modern surgery in the three directions which I have in dicated-anesthetics, statistical research, and the arrest of bleeding. For all of these rich fields were lying ready. Baker Brown showed that we had no need to fear that for which we had all such a mortal dread-a little piece of dead stump inside the abdomen. The rivalry between Baker Brown and Spen cer Wells induced the latter to adopt a method of recording his cases which has been followed ever since, and the method of proper statistical research was begun. Finally, the battle of torsion and ligature was decided in favor of short ligatures of animal tissue, and our present perfect methods were established. But this was not all. Simpson's research on the mortality of amputations and hospitalism showed that enormous advances might be made in our hospitals, and the conclusion was established that, just as in a town, the larger and more crowded the population, the greater the factors of danger, the greater need for precautions of many kinds. Vast improvements in our hospital systems have followed; the old careless nursing has been banished; and where dirt and untidiness reigned su preme, all is now care and cleanliness. Here, again, I am carried back to the morable day when I saw Syme operate on the gluteal aneurysm. One of his assistants was his son-in-law, the recently appointed Profes sor of Surgery in the University of Glasgow, Joseph Lister, a man who has exercised an enormous influence for good on the progress of surgery during the last twenty years-a verdict which will be accepted the more readily from me as one known to be hostile alike to his doctrines and his practice. [TO BE CONTINUED.] NOTES AND ITEMS. "A chiel's amang you takin' notes, And, faith, he'll prent 'em." -Dr. R. W. Shufeldt, of the U. S. Navy, who is well known as an ornithologist, has had his indignation aroused to such a pitch by the wanton destruction of herons that he has written a strong letter of remonstrance to "Science," asking if naturalists cannot combine to rescue them. At the present rate of destruction the species will be extinct in two or three years. -Dr. Daniel G. Brinton, the celebrated archeologist, and formerly editor of the "Med. and Surg. Reporter," has a volume in press entitled "Ancient Nahantl Poetry," containing a large number of songs in the Aztec language with translations and notes. -The American Medical Editors' Association has decided to tender a banquet to the editors and distinguished guests to the International Congress at Washington, to be held Monday evening, Sept. 5, 1887. The price of tickets is placed at the good round sum of $15. -As an act of great courtesy on the part of the proprietors of the "Medical Record" of New York, we may mention their offer to send to all journals signifying their desire, a stenographic report of the proceedings of the Ninth International Congress. We fully appreciate the courtesy, and commend the enterprise of its proprietors, William Wood & Co. -It is said that a cold in the head immediately after its inception, can be averted by the administration of from 1-100 to 1-200 of a grain of atropiæ sulphat. This is the 17,000th sure remedy for averting colds proposed during the last few years. -The Norwegian Cetti, who during his Berlin fast was under the observation of Prof. Virchow, began a thirty days' fast in London, which was soon brought to an end by the discovery about his person of a quantity of gelatine articles of diet. -In a fit of anger at his wife, an Illinois farmer struck her with a hammer and killed her. The unfortunate woman had provoked his rage by giving birth to three children with supernumerary fingers and toes, a deformity with which she was likewise afflicted. -“Puck" has figured the thing out about right, when it says that the best course for a patient to pursue while waiting for the doctor to come, is to get his money ready for him. --Among the frantic attempts to muddle medecine with jaw-breaking technicalities, we find one which resulted in the word "syggignoscism." If we had found it as coming from Sweden or the Sandwich Islands, our astonishment would have been less. -An exchange relates the story of a squirrel which amputated its own leg. The first amputation proving unsatisfactory in its results to this rodential surgeon, owing to insufficiency of flaps, it pushed back the soft tissues with its nose and gnawed the bones off higher up. This story is probably the companion-piece to that recorded a short time since, in which is related the attempt of one bird to cure a fracture of the leg of another by wrapping hair about it, and when the splint was purposely taken off by a man who saw the procedure, it was reapplied by the persistent aviarian surgeon. buttons of bone removed by trephining, may be --According to Dr. E. C. Spitzka, of New York, re-inserted under such antiseptic precautions that even if union fails to occur, no harm will result; and also that union may occur in young persons even when perfect coaptation is not secured. -A Definition of Life.-Life is that principle and force inherent in organized bodies by which are formed their ultimate molecules, and through the power of which these primary centers are so united and developed as to produce a complex organism, and by which this organism is endowed with inherent functions, and a power to resist decomposition. --At the meeting of the Anatomical Society of Great Britain and Ireland, a specimen was exhibited which distinctly showed a pair of strong ligaments suspending the thyroid gland to the cricoid cartilage. -In the fifteen years ending with 1883, there were killed by lightning for every million men in Prussia, 4.4; in Baden, 3.8; in France, 3.1; and in Sweden 3.0. It is said the capacity of the ground for water has an important influence on the effects of lightning. -The University of Pennsylvania has taken a radical step in the way of reform by prohibiting the use of tobacco in any form among its students.-A dissecting room free from smoke would be a strange sight. -A clergyman writing his thoughts upon medicine and the mind-cure says: The benefit of medcine is often not its direct action upon the disease or upon the body, but its action on the mind, and through that upon the nervous system and the whole body, stimulating faith, hope, expectation of recovery, good cheer, which are probably nature's mightiest remedial assistants. THE WEEKLY MEDICAL REVIEW VOL. XVI. No. 8. ST. LOUIS, AUGUST 20. 1887. In July, 1885, a young lady of 19, came to my office with a history of cough of nine months duration. I found signs of phthisis in one lung. Her father was a very strong man; her mother had died of some nervous trouble after child-birth. There had been ten children, five of whom died in infancy, none of them with any brain or lung disease. There had been also six half-brothers and sisters, one of whom had died in infancy. Of the uncles and aunts on both sides, only one uncle had died of phthisis. The patient gradually declined, and died April 15, 1887. She was accompained in her visits to my office by an older sister, twenty-three years of age, who had given up everything to attend to her. This sister, while not robust-looking, appeared well, and said that she had always been so. She occupied the same room and bed with her sister. This I protested against, and advised her to go out regularly every day for walks in the fresh air. The last record made of their visits to me was in the latter part of October, when the phthisical patient became too sick to come to me and went under the care of her family physician in a neighboring city; she died, as I said, on the 15th of April. On the 19th of April the sister came into my office with the following history. She had continued to attend closely upon the invalid all winter, and TERMS: $3.50 A YEAR. had disregarded all my advice. She had even slept with her sister up to within five weeks of her death. She was with her night and day. During the latter part of her sister's life her breath was so offensive that she could eat almost nothing, and only kept herself up by the free use of stimulants. She stated that she had had a little dry, hacking cough for a month. She breathed rapidly, but said there was no dyspnea. On examination her pulse was found to be 140. Temperature, 104°. On examination of the chest,subcrepitant râles were heard in both upper lobes,front and back, and the diagnosis of acute pulmonary tuberculosis was made. Examinations, April 26th and May 3d confirmed the diagnosis. On the 21st of May, she came to my office so weak that she had to be assisted from the carriage to the house. She reported hemoptysis of several ounces two weeks before. She was so weak that I did not examine her chest. Pulse ,160; temperature, 103. 4°. I Pulse,160; did not see her again, and she died June 17, 1886, about two mouths after I first examined her, and three months after the beginning of the dry cough. Who can fail to believe that the disease and death of this patient was caused by attendance upon her sister? Hardly any one will deny this. Admitting it, would she have succumbed to acute pulmonary tuberculosis, if she had attended upon a sister ill with some other disease? As she had no such hereditary tendency I do not think so. How often do we see patients worn out with much longer attendance upon the sick, and yet not become tuberculous! And how often do we see strong women without the slightest hereditary tendency succumb to attendance upon tuberculous patients. It is useless to allege in this connection, that |