present, except one region, which is the centre for sight. Injury to this produces blindness of the half of each retina on the same side as the injury to the brain. But it is extremely difficult to obtain in the lower animals any evidence of the special senses other than that of touch, the abolition of which produces loss of feeling, of which we can get exact evidence. Motion and sensation, therefore, are the two things that can be most readily determined.

Having now ascertained in animals the location of the particular centres, the next step is to apply this knowledge to the human brain in judging of the processes of disease. But it will be easily seen that the experiments that disease performs in a human brain are clumsy, spread over a wide area, and therefore often difficult of interpretation. Instances affecting a single little area of brain surface one-twelfth of an inch in diameter are almost unknown, and a tumor has been removed of such size that it produced direct pressure upon more than twelve hundred such squares, and indirectly produced pressure upon many distant parts of the brain. This is, of course, very clumsy experimentation. The familiar game of "shouting proverbs" will well illustrate the difficulty of interpreting the answers of disease to our question, "Where is it located?" Imagine 1200 persons, each assigned a single word of a proverb of 1200 words. At a given signal each shouts his own word. What a Babel of sound! How utterly impossible of disentanglement and proper arrangement! This is the answer of disease as represented by such a tumor. Take each of the 1200 persons in the proper order and question him separately and repeatedly, write down the answers accurately and in their proper sequence, and behold the proverb! This is the answer of scientific investigation as seen in vivisection.

Instead of there being a tumor, a blood-vessel will sometimes break in the brain, and produce a clot, affecting similarly a large area; or softening of the brain will in the same way invade an equal or a greater number of centres. It is therefore extremely rare that we can find a small area, such as that for speech, or for the hand, or for the arm, or for the face, or for the leg, or for sight, that is involved entirely by itself. But such cases do occasionally occur, and they are extremely valuable in fortifying the conclusions derived from the exact experiments of the laboratory. While some of the cases have introduced confusion and uncertainty from the character of nature's experiments, it can be broadly asserted that generally they have absolutely confirmed them. The results obtained by the surgery of the brain have more than confirmed them; for, as indicated already, the brain has been opened, and that portion which, according to experiment, is believed to be the centre for the wrist, or for the shoulder, etc., has been cut out, and paralysis of the corresponding part (a paralysis which, however, is only temporary) has proved positively the exactness of the inference from animals.

We are still a little uncertain as to the exact functions of large portions of the brain, but we have made a reasonable beginning; we have found firm ground to stand upon, and the results already obtained in the relief of human suffering and the cure of disease are such as readily encourage the hope that in the near future we shall be able to do vastly more. The opponents of vivisection have stoutly contended that it has shown no useful results. Let us wholly ignore the researches of Sir Charles Bell, of Harvey or Hunter, or other experimenters of the past. Here is a field in which the last ten years have opened wholly new ground for modern surgery, in which already the operations of the last four years have been marvellously successful, and have startled even surgeons themselves. Had vivisection done nothing else than this, it would be amply justified, and to obstruct re

searches so rich in beneficent results would be a disaster to humanity.*

But not only has the brain been opened and compelled to give up its secrets, and to yield itself to the successful assaults of the surgeon, but the spine has also of late been the field of some remarkable work. About a year ago Mr. Horslèy reported a remarkable case, in which a tumor by pressure on the spinal cord had been the source of most frightful pain for a long time, and of paralysis of all the lower half of the body. Once that an accurate diagnosis, not only of its existence, but of its actual locality, was made, he made an incision in the back, exposing the backbone, cut away the bone down to the membrane, and even to the spinal marrow itself, and removed the tumor. When last reported the patient was able to walk three miles, and even to dance. Since then there have been numerous successful operations upon the spine in this country, in England, and in France, and the near future will doubtless show even better results. Already severe fractures of the spine have been operated upon by removal of the fragments sticking into the spinal marrow, and recovery has followed instead of a lingering and certain death.

We are only just beginning to interfere surgically with the lungs; to open abscesses in them, and to remove portions successfully; and several ribs have been removed in cases of chronic pleurisy and deformed chests.

Formerly one of the most dangerous operations known was the removal of goitres. Hæmorrhage, inflammation, and blood-poisoning destroyed a very large number of such cases, and when Kocher, of Berne, in 1882, reported 58 operations, with a mortality of only 14.3 per cent., it was deemed a triumph. But improved methods of operation reduced the mortality until, in 1884, he reported 43 more operations, with a mortality of only 6.9 per cent., and in 1889 he has just reported 250 additional operations, and all but 6 patients recovered-a mortality of but 2.4 per cent., or, if we exclude the 25 cases of cancer, which gave 4 of the deaths, we have 225 cases and only 2 deaths, a mortality of but 0.8 per cent.

We see few cases of severe knock-knee and bowlegs in this country, but among the ill-fed lower classes of Europe they are common. Formerly almost nothing could be done; but a few years ago surgeons began to operate upon them in this way: A small cut is made through the skin and muscles down to the bone, and by a saw or a chisel the bone is divided. The limb is then straightened, and the case treated precisely as if it were an ordinary fracture. It heals without fever or serious pain, and the patient is well. With modern methods this is not a dangerous operation, as will be seen by the remarkable paper read by Macewen, of Glasgow, at the International Medical Congress of 1884, in Copenhagen, when he reported 1800 operations on 1267 limbs in 704 patients, and only 5 died, in spite of the fact, too, that most of them, from deformity in several limbs, had to have multiple operations. Even these deaths were not due to the operation, but followed from pneumonia, typhoid fever, consumption, and diphtheria.

We have learned, too, that portions of the body can be entirely severed, and, if suitably preserved, can be replaced,

and they will adhere and grow as if nothing had happened. When a wound is slow in healing, we now take bits of skin, either from the patient's own body or provided by generous friends, or even from frogs, and "graft" them on the surface of the wound. They usually adhere, and as they enlarge at their margins, they abridge by one-half the time required for healing. Even a large disk of bone, one or two inches in diameter, when removed from the skull, can be so treated. It is placed in a cup filled with a warm, antiseptic solution. This cup is placed in a basin of warm water, and it is the duty of one assistant to see that the thermometer in this basin shall always mark 100° to 105° F. The bone may be separated from the skull so long as one or two hours, but, if properly cared for, can be replaced, and will grow fast and fulfill its accustomed, but interrupted, duty of protecting the brain.

The remarkable progress of surgery which I have so imperfectly sketched above has been, as I have shown, the result chiefly of experimental laboratory work. To Mr. Carnegie, of New York, is due the credit of establishing the first bacteriological laboratory in this country, and from studies in this laboratory arose the brilliant and beneficent results in the treatment of compound fractures which I have quoted. If one laboratory can give such beneficent results in one single surgical accident, what will not many do, each vying with all the rest in investigating different important surgical and medical questions as yet unsolved? Could wealthy private citizens erect more useful monuments of enduring fame? In Europe the government establishes and supports such laboratories. In America we must look to private munificence, and never yet has humanity made such an appeal to my countrymen in vain.