In another address,* sparkling with the characteristic genius and brilliancy of its distinguished author, which, once heard, is never forgotten, and the like of which we scarcely expect to hear from other lips, we are presented with a vivid picture of the potency of many drugs for harm; and, in view of the awful destruction of human life by these powerful agents when unskilfully administered, the conviction. is brought home to every judicious mind, that it would be a less evil even to abjure their use, than to countenance their indiscriminate employment by ignorant and unprincipled men.

Yet another paper,† addressed to us in the form of a paternal letter from our Nestor, whose presence we always welcome, and to whom we delight to point as a living ideal of the good and wise physician, shows us that the very drugs which are often perverted to the greatest harm are also among our most potent agents for good: like sharp tools, they are only dangerous in the hands of those who have not learned how to use them.

The last of these addresses (in point of time) is, in some sense, a summary of the whole matter. Recognizing the fact that many self-limited diseases end in recovery, we are shown, that in other diseases, equally self-limited, the natural tendency is often to the destruction or permanent injury of the affected organs; and that, in many of these very diseases,

* Currents and Counter-currents in Medical Science. By OLIVer Wendell HOLMES, M.D. Boston: 1860.

+ Jackson on the Utility of Medicine. Boston: 1861.

The Reality and Certainty of Medicine. By MORRILL WYMAN, M.D. Boston: 1863.

the attendant phenomena may be so far modified by rational treatment as to make all the difference between life and death to the patient. Secondly, many diseases are not self-limited; that is, they do not appear to have any definite and predetermined period of incubation, progress, and decline: and it is in this class especially, as well as in the early or formative stages of many usually included in the former class, that great and beneficial changes may be wrought, or even the disease cut short altogether by the application of the established principles of the healing art. Medicine, therefore, is a real and a beneficent art, although its most useful instruments may be capable of being perverted to mischief by charlatans and pretenders. The lesson of the last year is, the reality and certainty of the healing art. It should encourage each one of us to labor to improve himself in the knowledge of the principles of that art.

The influence of modern improved theories of pathology and therapeutics, although generally associated in the mind with the practice of medicine, has been almost equally felt in nearly every department of surgery. The intimate connection between the two sister branches of the healing art, illustrated in the last generation by Abernethy, and just enforced anew from the same chair by his most distinguished successor, renders it impossible for any improvement in the one to remain long unfelt in the other. Especially are these changes seen in the present treatment of chronic surgical diseases, and in the amelioration of the severe discipline which was formerly con

sidered essential to prepare a patient for an operation, or to protect him from its supposed consequences.

While these great improvements have been in progress in the general or constitutional management of surgical patients, it may seem to a casual observer, that, in local treatment, we in this neighborhood have possibly retrograded from the practice of our fathers. I remember the time, when, after an amputation, or the excision of a breast or a large tumor, it was the universal rule to bring the edges of the cut integuments together nicely with straps, compresses, and a bandage, with the full assurance of finding the wound nearly healed on the removal of the dressings. At the present day, however, such a result is seldom attained in city practice; union by first intention being, for the past twenty years, the rare exception. Occasionally, the margins of the skin seem at first to unite, and promise a speedy cure; but suppuration almost always ensues in the deeper parts, and it soon becomes necessary to give vent to the secretions, either by breaking up the newly-formed adhesions, or by making a new opening.

The causes of the change which has taken place here in the processes of repair are found in the impaired hygienic condition of our city, arising out of the great increase, and consequent crowding, of its population; for it is only necessary to travel a few miles into the country to find again the same favorable influences which we formerly enjoyed. This explains, also, what must have struck every one as an anomaly in Parisian surgery: I allude to the fashion, which, until within the past few years, almost exclu

sively prevailed there, of taking effectual measures to prevent union by first intention. The obvious explanation of this practice is, that, in the hospitals of a crowded city like Paris, immediate union of the deeper tissues is of the rarest possible occurrence. The early union of the integuments, therefore, if it occur, can only aggravate the trouble by impeding the escape of the sloughs and débris from the granulating surfaces beneath; but it cannot be denied, on the other hand, that the means taken to prevent the confinement of the discharges often produced so much irritation as greatly to increase the extent of the destructive action.

At the period when I was prosecuting my studies in Paris, M. Roux was almost the only surgeon of note in that city to break in upon this routine of irritating dressings. He had visited England, and had there seen the good effects of the simpler treatment adopted in the London hospitals, upon which he had written a valuable treatise. But the classical doctrines of the French school were not to be subverted in a day; and it is only within the past few years that a new generation of surgeons, working in the midst of more favorable hygienic influences, have been able to raise Parisian practice, in this respect, to the English and American standard.

The possibility of obtaining union by first intention lies at the foundation of the art of plastic surgery; and it is in a great measure owing to the general introduction of modes of treatment favorable to this result that the department of operative surgery has of late made such remarkable progress.

But another even more conspicuous change presents itself when we contrast the operative surgery of to-day with that familiar to all but the very youngest among us. I refer to the present universal employment of artificial anesthesia; and it is with especial pride that we reflect that it was in our own city, and under the auspices of members of our own body, that the full value of this immortal discovery was first demonstrated and published: and it is truly remarkable, that, at the present day, artificial anæsthesia is best attained by ether, used in substantially the same manner as when it was first tried in surgical operations at the Massachusetts General Hospital. While chloroform has killed its hundreds, and while hardly a journal arrives from Europe without some notice of new cases of death from the use of this potent agent, wonderful to relate, out of the hundreds of thousands of cases of etherization, the first victim to its action is yet to be recorded. It is not pretended by this statement entirely to abjure the use of chloroform, which, in some exceptional cases, is certainly preferable to any known anæsthetic agent; being far more concentrated in form, more agreeable, and more active in administration, than any of the many substitutes which have been proposed for it. On the battle-field, especially, its greater portability is likely always to secure the preference for it over safer but more bulky anæsthetics.

The first, and perhaps the most important, application of ether is in producing unconsciousness of pain; and it is for this boon that the patient will ever be chiefly thankful. To the surgeon, also, the