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but two years ago Kocher* reported a series of a thousand operations, with a mortality of but one per cent., in nonmalignant cases.
Extirpation of the larynx for malignant growths has taken its place among the justifiable and formal operative procedures. Acute intestinal obstruction, whether from bands, volvulus, intussusception or other conditions, is now dealt with as it ought to be,-surgically, and, if promptly done, with the happiest results.
A hasty and very imperfect review, such as has been above given, of the improvements in surgery within the last fifty years, does much more than show us the adroitness, audacity, and success of the modern surgeon. That is the thing which strikes us most as surgeons, but we must regard all this progress also from the standpoint of the patient and the community, and see what it means. It means a prolongation of life by operations which, while not without pain and suffering during recovery, have been robbed of all their primary terrors by anesthesia, and most of their subsequent pain and suffering and danger by antisepsis; it means that patients who in 1847 were hopelessly consigned to the grave after weeks and months of suffering are now, in the vast majority of cases, rescued from death; it means that families formerly bereft of husband and wife, parent or child, and left to spend years of sorrow, of suffering, and-in many cases-of poverty, because the breadwinners were taken away, have now restored to them their loved ones in health and strength and usefulness; it means that the hecatombs of a Cæsar, an Alexander, a Napoleon, are offset by the beneficent labors of a Morton, a Warren, a Lister, who are, and for all time will be, blessed by many a poor patient, who never heard of them, instead of being cursed as the destroyers of nations and of homes innumerable; it means that man's inhumanity to man shall be replaced by a scientific and Christian altruism, which sheds * Beiläge z. Centralbl. f. Chir., 1895, 66.
blessings and benefits on the whole human race, seeing in the patient, whether saint or sinner, only a human being who is suffering from accident or disease, whom it is the province of the surgeon, in imitation of Him who went about doing good, to restore to health and happiness. Even where life cannot be prolonged, the agonies of death itself can be soothed by his gentle hand and his fruitful skill.
What the future has in store for us we can only dream. Two diametrically opposing tendencies are prominent in modern surgery: radical interference with disease so that there is now scarcely a single organ or portion of the body not within our reach; yet, on the other hand, a remarkably conservative tendency in cultivating remedial rather than radical surgery. Joints so diseased as once to require amputation are now treated conservatively with the best results; ovaries, a portion of which can be preserved, are kept in the abdomen; kidneys once doomed to total extirpation are now partially removed, and bones so destroyed that they formerly required amputation are now excised and the limb preserved. Experiments upon animals have recently given us wholly new views of infection and of the origin of many diseases, and also the little knowledge that we yet have as to either natural or acquired immunity, and to a consequent orrhotherapy.
It is, I believe, on these lines that our more immediate future triumphs will be achieved. We have discovered the actual cause of tetanus, tuberculosis, erysipelas, suppuration, and a host of other diseases and conditions, of the cause of which we were wholly ignorant a few years ago. The causes of many other disorders, both medical and surgical, still remain hidden from our view. We know almost nothing of the origin of benign tumors, and are groping to discover the origin of cancer, sarcoma, and other malignant growths. When we have discovered the cause, we are nearly half way, or at least a long way, on the road to the discovery of the
cure, and I think it not unlikely that in 1947 your then orator will be able to point to the time when a definite knowledge of the causes of these diseases was attained, and probably to a time when their cure was first instituted.
That will be a surgical Paradise, when we can lay aside the knife, and by means of suitable toxines or antitoxines, drugs or other methods of treatment, control inflammation, arrest suppuration, stay the ravages of tuberculosis and syphilis, abort or disperse tumors, cure cancer, and, it may be, so prolong human life that all of his then audience will die either of accident or of old age. Would that you and I could be alive in 1947 to join in the glorious surgical Te Deum!
THE DEBT OF THE PUBLIC TO THE MEDICAL PROFESSION.*
T is a graceful courtesy, which I very highly appreciate, that you should ask a stranger, instead of one of your own members, to address you on this festal occasion. The fact that you have completed an existence of a century as a medical society naturally suggests that the address should be somewhat of a review of the past.
I have, therefore, chosen as my subject "The Debt of the Public to the Medical Profession." I shall endeavor to indicate, in a brief outline, how much the profession has done for the community. The conclusion, therefore, is inevitable that there is an obligation on the part of the public to recognize this debt by affording enlarged facilities to a profession which has given of its time and labor so unselfishly for the good of the public.
In one respect the medical profession differs from all others, in that it is the only profession which is self-destructive. While we live by ministering to the wants of those who are suffering by accident and disease, I glory in the fact that the medical profession is foremost in the endeavor to abate disease and to prevent accident. The profession could not have attained this end by its own efforts alone, but it has been pendent very largely upon the general intelligent co-operation of the public, and of sanitary engineers, and also of legis
* The Oration delivered before the Medical and Chirurgical Faculty of the State of Maryland, at the Celebration of the Centennial Anniversary of their Foundation, April 26, 1899. Reprinted from the Philadelphia Medical Journal, April 29, 1899.
lators, for the legal means to make effective the measures which the profession has shown to be needful for the public health.
Public hygiene or sanitation has been a very large element in arresting the ravages of disease, which, in former times, swept over entire nations, and even continents; and it is a source of pride to us that among the foremost sanitarians in every community are the doctors. It is a very striking fact that diseases which once assumed the form of veritable pestilences are now, at least in civilized countries, almost unheard of, and others, though they have not yet disappeared, have had their fangs drawn, so that the public suffers far less than it formerly did. If the voice of the profession were heeded, even the diseases which have been only abated would almost, if not entirely, disappear.
Let us briefly consider a few of these diseases:
1. The Plague.-Among the most fearful epidemics which have devastated the world, perhaps the worst has been what is known as the plague. It is represented now by the bubonic plague, of which we have had a memorable instance within the last two years in India, when over 250,000 lives have been lost. But, bad as it has been there, its recent devastation is as nothing compared with its former ravages. Those of you who have read James's novel, entitled "The Fire and the Plague," will recall the vivid and frightful picture of the plague in 1665, during which 70,000 persons perished in the then relatively small city of London alone. Still earlier, in the fourteenth century, the Black Death, as was then its horrible name, swept over Europe, and carried off 25,000,000 people, one-fourth of the entire population of that continent! This frightful destruction, it will be observed, took place in the then most civilized countries of the world. By contrast, the bubonic plague of the nineteenth century is limited wholly to peoples who are only semicivilized, among whom sanitary laws are not understood, and the grossest violation