SEMICENTENNIAL ADDRESS IN SURGERY.*

MR. PRESIDENT AND GENTLEMEN OF THE AMERICAN MEDICAL ASSOCIATION:

IT

T is always proper to acknowledge an honor, but when it comes unsolicited from so large and distinguished a body of men, representative of the entire profession in the United States, and on an exceptional occasion, I feel it a double honor to have been chosen to deliver the Semicentennial Address in Surgery. I beg to return you my very hearty thanks for your extreme kindness.

As we celebrate on this occasion the Semicentennial of the organization of the American Medical Association, in this city, in 1847, it is very natural and proper that the Address in Surgery should be a review of the work done in the last fifty years, and, by contrasting the state of surgery and of surgical teaching in 1847 with that which exists in 1897, to see what progress has been made. To recount what has been achieved in these "fifty years of science" far better than a "cycle of Cathay" is not only a pleasure, but it is an immense incentive, since by the progress made in the last fifty years we can in some measure anticipate the enormous, and probably even still greater progress, that will be made in the next half-century.

The time, also, is opportune. Last year was celebrated the centennial of vaccination and the semicentennial of the first public administration of ether. Sydney Smith's bitter

* Delivered at the Semicentennial Meeting of the American Medical Association at Philadelphia, Pa., June 3, 1897. Reprinted from the Journal of the American Medical Association, June 12, 1897.

query in 1820, "In the four quarters of the globe, who reads an American book, what does the world yet owe to American physicians or surgeons?" was answered a quarter of a century later and made all these "four quarters of the globe" our grateful and everlasting debtors for the gift of anæsthesia. It was the discovery of an American dentist, was first used by an American surgeon, was christened by an American physician and littérateur, and the recent celebration awakened throughout the world the interest not only of the profession, but also of the entire public. The strains of our still living poet, novelist, physiologist, and, as we all best love to remember him, neurologist, Dr. S. Weir Mitchell,-nihil tetigit quod non ornavit,-as he sung of the "Birth and Death of Pain," have scarce died away before we begin anew our round of celebrations in the anniversary of this now almost venerable association.

A most important factor in the improvement not only in surgery, but also in all departments of medicine, has been the immense advance made in Medical Teaching. The educational plane of the profession has been steadily elevated. If the teachers of fifty years ago were to revisit the scenes of their early labors they would scarcely recognize the medical colleges in which, in their day and generation and with the meagre appliances then at their command, they did what we must still recognize as yeoman's work in education. Apparently, at that time, the entire instruction consisted in lectures, no text-books even being advised. In reply to a letter addressed to the deans of the Jefferson Medical College and of the Medical Departments of the University of Pennsylvania, Harvard University, and Columbia University, I am told that no lists of text-books whatever appear on the catalogues of fifty years ago. In the "catalogue" of the Jefferson for 1857-a mere catalogue of names of the faculty and students, instead of the present elaborate "Announcement"-for the first time appears a list of "Books of Refer

ence," and the Dean of Harvard states that there "the first mention whatever made of text-books appears in the announcement of the summer session, beginning March 12, 1866," four years after I graduated! At first the text-books generally recommended on surgery were Drewitt and Erichsen; Malgaigne and Pancoast on "Operative Surgery," and, for collateral reading, Brodie and Holmes.

The course of didactic lectures then began on the second Monday of October and ended soon after the middle of February, and if we take out the holidays, and remember that not a few made up for coming late by leaving early, it was quite a possibility for a man to receive his authorization to practice, a diploma which alleged him to be "Virum probum in arte medica, æque ac chirurgica dignum amplissimis honoribus academicis," after practically only two sessions of little more than three months each! The examination was a farce and the diploma a falsehood. Even so late as 1860, when I began the study of medicine, there were no laboratories, except that of anatomy-the dissecting-room. I doubt whether of the two hundred and odd men who graduated with me in 1862, 10 per cent. had ever looked through a microscope or handled a test-tube, palpated a tumor, or auscultated a chest. There were no recitations; neither were there ward classes nor other means for actual contact of the student with disease. We can but wonder that any of us who graduated in the first twenty years of the halfcentury we are celebrating ever learned enough to prevent some from being rivals to Saul, who had slain his thousands, and the more nimble from rivalling David, who slew his ten thousands. That we have become respectable practitioners, or possibly more than respectable, is due not so

* The names of American surgeons are printed in italics, to point out more distinctly some of those Americans who have aided in the development of surgery. The limits of the address only allowed me to name a few, and I must apologize for all the necessary omissions.

much to our early opportunities as to later incessant midnight labors.

Now we may congratulate ourselves that the majority of the Medical Schools of the country have a graded course of four years, each covering not less than six, and often eight months; not only lectures, but in many instances constant and searching recitations; a dozen laboratories in which each student actually does the work of observation and experiment; ward classes in which every man is obliged to train his eyes, his ears, his fingers, and his judgment in the examination of patients in every department of medicine; to ferret out the history of the cases brought before him, ascertain symptoms, seek for physical signs, reach a diagnosis, determine the treatment, and often actually to prescribe and to assist at operations.

Not only, however, is the advance marked in our medical schools, whose diploma now really means almost what it says, but also all over the land since 1847 there have been established, partly from philanthropic motives and partly for the purpose of medical teaching, an enormous number of Hospitals, in which a very large proportion of the young men, after receiving their diplomas, spend a year or more in the actual practice of their profession, under the eyes of accomplished teachers. It is impossible to describe the immense benefit thus obtained by large numbers of nascent practitioners, from such familiarity with all the phases of disease which they will meet in their after-lives. Not a few of them also, by being brought in contact with energetic, enthusiastic, and wise teachers, receive their first stimulus, both literary and scientific, a stimulus which will influence their entire future course, and is of far more value than any amount of mere scientific knowledge they may acquire.

What untold good these hospitals do, not merely to the patients who are cured and the internes who are taught, but equally to the older medical staff who are still further trained

and educated by them! Not only in great metropolitan centres, but in small towns, and sometimes even in rural communities, this growth of hospitals has been within the last twenty years one of the striking features of our civilization. It is not too much to say that every city or town. establishing a hospital is repaid a hundredfold by the immediate improvement of its medical men from those opportunities for experience and exact study. No one can visit a modern hospital without being struck by the immense improvements of the last few years. The noisome hotbeds of contagion, of fever, of suppuration, of erysipelas, of bloodpoisoning, and of "hospital" gangrene-could irony wield a sharper weapon than such a name?-have given way to neat and trim wards, the home of cleanliness itself, with iron bedsteads, glass-topped tables, cement or marble, tiled or tessellated floors and walls, with trained nurses whose jaunty caps and pretty uniforms and often winsome faces almost make one half wish to be sick, and when one is sick half loth to be well.

I mentioned a moment ago the Text-books in use forty years ago. Except Pancoast's "Operative Surgery," every one of them, it will be observed, was the work of a European. Gross's "System of Surgery," which has probably had a wider influence in educating the profession than any other general surgical text-book issued up to the present time—a monument of surgical knowledge and indefatigable laborwas first published in 1859. This was far in advance of most of the surgical text-books then in use. The literary labors of American surgeons consisted chiefly in translating foreign surgeries or in annotating American editions of English textbooks.

Within the last two decades, and especially the last, we all know, without my undertaking the invidious task of naming them, how many distinctly American surgeries have been written, and we may say, without undue national vanity,