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problem seeking solution, a problem which is enough to arouse the scientific ambition of any enthusiastic mind.

Again, it is only within the last five years that an accurate knowledge of the relation of diseases of the ear to diseases of the brain has been recognized, and their scientific surgical treatment begun. The splendid results already achieved give promise that within a few years we shall know not only how to cure brain disease the result of disease of the ear, butwhat is far better-how to prevent it.

The anatomy of the nerves has been known for many years in its gross outlines, but the problems which present themselves here are many and varied. Cut a certain nerve, the ulnar, which supplies the inner part of the hand, and the results are not the same in all patients. You may abolish touch and yet pain will remain. You may even cut out one to three inches of the sensitive nerve of the face, as I have seen within the last few weeks in several cases, and it will be reproduced, and with this the frightful pain of tic douloureux, for which the nerve was removed, will return. On the other hand, by a wound or in an operation from one to three inches of a nerve may be removed, and you want the nerve to be reproduced and so re-establish sensation in the skin supplied by it and motion in the muscles to which it goes, and the nerve steadily refuses to reproduce itself. Why in the one case it will and why in the other case it will not reproduce itself we do not know. In fact, what we do not know about nerves alone would make a good-sized book.

Thirty years ago when we looked at an eye all we knew was what we could see on the outside. The trouble was that, although there was such an inviting window in front of it by which we could look in, nothing could be seen inside of the eye because the interior was totally dark. But it occurred to Helmholtz that if by a little bit of looking-glass he reflected light into the eye and then scratched a little hole in the quicksilver, he could look through the hole into the illuminated

interior of the eye and see all there was inside of it. From this simple idea has arisen the ophthalmoscope, by which the whole medicine and surgery of the eye have been revolutionized, and great light has been also thrown on the diseases of the brain.

Again, when the mouth was opened, we could see certain parts, but the whole interior of the larynx and windpipe was beyond our sight, and therefore beyond our knowledge. But soon after the ophthalmoscope was discovered Czermak and Türck found that if a little mirror were held in the back of the throat at an angle of about 45 degrees and a ray of light were thrown upon it from a small perforated bit of looking-glass, the interior of the throat, like the interior of the eye, would be illuminated, and we could look through the little hole in the looking-glass and see the reflected image of the vocal chords and the whole of the larynx in the mirror.

Similar inventions await the ingenious investigator of the future for the examination of other cavities and organs of the body, and the day is not far distant when we shall be able, I hope, to see and therefore to know the interior of the stomach as well as we do the exterior of the body. That this will illuminate our own minds as well as the stomachs of our patients is certain.

And so I might go on in one department of medicine after another, presenting to you similar problems, some of them so technical that they would not be suited to a non-professional audience, and in each show you the vast need there is for bright minds. Has the last word been said in surgery, in medicine, in the diseases of any of the special organs of the body? Nay, verily we are but at the alphabet of investigation and of cure. Great as has been the progress in the last fifty years, greater I venture to say than in all previous time, I believe that the next fifty years will far eclipse the discoveries of the past fifty. Who could have predicted the rise of Bacteriology a score of years ago? And who will

venture to say that in the next twenty years another science equally far-reaching, equally beneficent, equally brilliant in its achievements, may not arise? Even the present is a splendid time,

"An age on ages telling

To be living is sublime."

But the twentieth century in which you will live will be the most glorious time of all the ages. But you may take part in this grand march of progress, not only in the rank and file, but as a leader if you will but study and write. Or it may be, if you have the gift of imparting knowledge, you may be one of the teachers of medical science, an enviable post of honor and responsibility, but also of unequalled enjoyment.

Have I not put before you enough to arouse the ambition, the energy, the benevolence, the enthusiasm, of any young man about to choose his career? Can there be in any other department of human knowledge so fine a field for research, for discovery, for fame, and, what is far better, for serving the human race? If, in consequence of what I have said to you, some of you will select Medicine as your chosen pursuit, rest assured that if you will faithfully perform your duty, at the close of life you will have the pleasure of surveying a career which has been advantageous to yourselves, has been a means of doing good to your fellow-men, and I verily believe has approximated as near as possible to the Divine Life as is given to any man to do.

VIVISECTION AND BRAIN-SURGERY.*

10 "Harper's Magazine" for October, 1889, I contributed

T

extent the causes, of the recent marvellous progress of surgery. In this, as in an earlier publication, I attributed it to a large extent to vivisection. Both publicly and privately my statements have been called in question.

The seven years which have elapsed since my first publication on this subject have demonstrated, far more than I even hoped or expected, the truth of what I then stated, and it would seem right that some of these demonstrated facts should be laid before the public. Moreover, the recent revival of the discussion of the subject before the Church Congress at Folkestone, England,† and at the recent meeting of the Humane Society in Philadelphia in October, 1892, makes it especially timely.

I shall omit many topics which would be suitable, such as the wonderful results of Pasteur's treatment of hydrophobia, the discoveries of bacteriology, the wholly new class of remedies which medicine owes to vivisection, such as the antidotes to lockjaw and several other diseases, derived from the blood of animals inoculated with the virus of these diseases-remedies to which we already owe astonishing cures. In the present paper I propose to limit myself to brain surgery alone, and to give a glimpse of what has been done up to the present time. I shall show especially that

* Reprinted from Harper's Magazine for June, 1893, by the kind permission of Messrs. Harper & Brothers.

† Church Times, October 14, 1892, p. 1021.

without the exact knowledge of the functions of the brain, derived almost wholly from experimentation upon animals, it would be simply impossible to do what has been accomplished. I shall not restrict myself to general assertions which may easily be denied, but I shall relate actual cases, with their definite results, and the authority for each case.

In order to understand modern progress in cerebral surgery it is necessary first to understand what has been achieved by experimentation upon the brain. When I was a student of medicine, thirty years ago, the brain was regarded as a single organ, and its various functions were not thought to have any especial localized centres of action.* When the brain acted it was thought that the whole of it acted, just as the liver or the stomach acts, as a whole. Now we know that, instead of the brain being a unit, it is really a very complex organ. Just as in the abdomen, besides the other organs in its interior, we have the stomach, the liver, the pancreas, and the bowel, each of which has its part in digestion, so correspondingly in the brain, besides the portions concerned in sight, smell, thought, etc., we have four adjacent portions which are concerned in motion. One produces motion of the face; another motion of the arm; a third, motion of the leg; and the fourth, motion of the trunk.

How, it may be asked, have these facts been determined? Has it not been by observing the effects of injuries and diseases in man? To a small extent, yes. But very, very rarely does disease or injury involve only one of these very limited regions of the brain; and the moment two or more of them are involved our inferences become confused and misleading. As a matter of fact which cannot be gainsaid, nine-tenths of our knowledge has been derived from exact experiment upon animals, and in this way: A monkey is

*The "bumps" or localized centres of phrenology were always discredited by the medical profession, and experiments upon animals and observation in man have entirely overthrown them.

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