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searches so rich in beneficent results would be a disaster to
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. Horsley 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 por
*The facts stated in this paper, it seems to me, are a striking vindication of the value and necessity of vivisection. Personally I have never done any such experiments, save a few some twenty years ago. Indiscriminate experimentation by untrained students I would heartily discourage, as they would lead to no good results. But as a matter of fact such indiscriminate experiments by students do not exist. They have neither the time, the money, nor the facilities for it. Only competently trained men who will make a serious and systematic investigation of definite problems, and educe the knowledge that will widen our scientific horizon and enlarge our resources in the healing art, should engage in it, and as a fact I believe only such do engage in it. Moreover, they ought to, and, so far as my knowledge extends, they do inflict no needless pain.
tions 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.
THE NEW ERA IN MEDICINE AND ITS DEMANDS UPON THE PROFESSION AND THE COLLEGE.*
N the 8th of October, thirty years ago, I entered the lower lecture-room of the College building for the first time as a medical student, and listened to the Introductory Lecture. It was given by that phenomenal encyclopædia of knowledge, Robley Dunglison, for so many years the Dean and Professor of Physiology in this School. Time has gradually obliterated its then deep impressions, and now three memories alone remain to me. The first is the place where I sat; the second the precept, which has so often since then recurred to my mind in solving the medical problems which have presented themselves to me, that I must not confound the post hoc and the propter hoc, the sequence with the consequence; and the third was the gracious welcome which that fluent master of English gave to us, the incoming class.
It is my pleasant duty to-night to repeat, after a lapse of so many years, at least the same cordial welcome then extended to me a welcome to you all, from North and from South, from the Atlantic and the Pacific, and even from far-distant foreign shores. Nor is this welcome a merely formal one; it is heartfelt and true. Not only for myself, but on behalf of my colleagues of the Faculty, do I welcome you, as kindly and as earnestly as I possibly can, to the
* Introductory Address at the opening of the Sixty-sixth Annual Session of the Jefferson Medical College. Reprinted from the Times and Register, October 18, 1890.
arduous study upon which some of you are about to enter; a welcome, quite as cordial, I also extend to those who have already trodden the thorny path of the first or second year of study, and who have now a better capacity to appreciate what they learn, and a better appreciation of the earnest efforts that will be made by every teacher of the school from the oldest of the Faculty to the latest acquisition among the assistants in the laboratories.
The welcome thus extended is saddened, however, by mournful memories. It is with feelings of deep respect and admiration that I refer, as is proper, to the teacher whose honored place I occupy, whose premature and unexpected death robbed the Jefferson College of one of its brightest ornaments; a man illustrious by his name, and not less honored for his own eminently useful scientific achievements. The warmth of admiration and affection which the older students among you bestowed upon the late Samuel W. Gross was not ill bestowed, but was well deserved. Professionally he knew but one thing-Surgery. Even from his very entrance on his profession, this was his chosen department, and to it he devoted laborious days and studious nights. As a teacher he was incisive, progressive, well read, versatile, and accomplished. He was no uncertain and hesitating teacher, but gave you, in his own clear-cut and positive way, the best results of the foremost minds of the profession, both of this country and of Europe. Many of you can testify to his devotion to his subject, his students, and his Alma Mater. He sympathized with your joys, and helped you over the rough places with the utmost gladness. Few schools have had two such ornaments in one family as the elder and the younger Gross; and in the midst of all the pleasure and hilarity of the opening of the session, it is meet and proper that we should pause a moment to lay a flower on the bier of each. A moment ago I referred to the time when I myself began the study of medicine. You can scarcely appreciate what