that total arrest of the intestinal contents ensues, a condition incompatible with life. There are other causes for such "intestinal obstruction," which are too technical to be described in detail, but this may be taken as a type of all. It is impossible, of course, to tell before opening the abdomen precisely the cause of the obstruction, but the fact is readily determined in most cases. If we open the abdomen promptly we can cut such a band or remove the other causes of obstruction in the majority of cases, and if the operation has not been too long delayed the prospect of entire recovery is good. The mortality which has followed such operations has been considerable, and by that I mean, say, over 20 per cent.; but a very large number of the fatal cases have been lost because the operation has been delayed. In fact, it may be stated very positively that the mere opening of the abdomen to find out precisely the nature of any disease or injury is attended with. but little danger. If further surgical interference is required the danger will be increased proportionately to the extent and gravity of such interference. But "exploratory operations," as we call them, are now undertaken constantly with almost uniform success.

Even in cancer of the bowel we can prolong life if we cannot save it. Cancer of the bowel sooner or later produces "obstruction" and so destroys life; but in such cases we can either make a permanent opening in the bowel above the cancer and so relieve the constant pain and distress which are caused by the obstruction, or in a great many cases we make two openings in the bowel one above the cancer and another below it and by uniting the two openings, if I may so express it, "side-track" the contents of the bowel. If the cancer has no adhesions and the patient's condition allows of it we can cut out the entire portion of the bowel containing the cancer, unite the two ends, and thus re-establish the continuity of the intestinal canal. As much as eight feet, nearly one-third of the entire length of the bowel, have been

removed by Shepherd, of Montreal, and yet the patient recovered and lived a healthy life.

Similarly in gunshot wounds, stab wounds, etc., involving the intestine the modern surgeon does not simply stand by with folded hands and give opium or morphine to make the patient's last few hours or days relatively comfortable, but he opens the abdomen, finds the various perforations, closes them, and recovery has followed even in cases in which as many as seventeen wounds of the intestine have been produced by a gunshot wound.

The kidney, until thirty years ago, was deemed almost beyond our reach, but now entire volumes have been written on the surgery of the kidney and it is, one might say, a frequent occurrence to see the kidney exposed, sewed fast if it is loose, opened to remove a stone in its interior, drained if there be an abscess, or if it be hopelessly diseased it is removed in its entirety. The other kidney, if not diseased, becomes equal to the work of both.

Of the pelvic organs, it would not be becoming to speak in detail, but one operation I can scarcely omit; namely, ovariotomy. One of my old teachers was Washington L. Atlee, who, with his brother, was among the first ovariotomists in this country who placed the operation on a firm foundation. I heard a very distinguished physician in 1862, in a lecture to his medical class, denounce such men as "murderers"; but to-day how differently does the entire profession look upon the operation! Instead of condemning the surgeon because he did remove such a tumor, the profession would condemn him because he did not remove it. The operation had its rise in America. Ephraim McDowell, of Kentucky, in 1809 first did the operation which now reflects so much credit upon modern surgery. The mortality of the Atlees was about 1 in 3. Now, owing to the immense improvement introduced by the antiseptic methods, the deaths in competent hands are not over 5 per cent. or even 3 per cent.

The limits of this article compel me to stop with the story very imperfectly told, but yet, perhaps, it has been sufficient in detail to show somewhat of the astonishing progress of surgery within the century, but especially within the last quarter of the century.

About two decades ago one of the foremost surgeons of London, Mr. Erichsen, said in a public address that "surgery had reached its limits." How short was his vision is shown by the fact that surgery at that very time was just at the beginning of its most brilliant modern chapter.

We have reached in many respects, apparently, the limits of our success, but just as anæsthesia and antisepsis and the Roentgen rays have opened new fields to us wholly unsuspected until they were proclaimed, so I have no doubt that the twentieth century will see means and methods devised which will put to shame the surgery of to-day as much as the surgery of to-day puts to shame that of thirty years ago, and still more of a century ago. The methods by which this will be attained will be by the more thorough and systematic study of disease and injury, so as to better our means of diagnosis, and so prepare us for immediate surgical interference, instead of delaying it, as we now do in many cases for want of certain knowledge; by the use of new chemical and pharmaceutical means to perfect our antisepsis and possibly to introduce other methods of treatment; but above all, we shall obtain progress by the exact experimental methods of the laboratory. We can never make progress except by trying new methods. New methods must be tried either on man or on animals, and as the former is not allowable, the only way remaining to us is to test all new methods, drugs, and applications first upon animals. He who restricts and, still more, he who would abolish our present experiments upon animals is, in my opinion, the worst foe to the human race, and to animals as well, for they, as well as human beings, obtain the benefit derived from the methods. He may prate of his humanity, but he is the most cruel man alive.

THE MISSION OF A MEDICAL COLLEGE.*

TW

WELVE years ago I had the honor of delivering the introductory address at the opening of the session of the Jefferson Medical College. I took as my topic "The New Era in Medicine, and its Demands upon the Profession and the College." In it I pointed out the demands which this new era in medicine made on our medical colleges. To-day I purpose supplementing that address by considering an allied topic, "The Mission of a Medical College."

A mission is defined as "that with which a messenger or agent is charged," and I find in Webster an apt illustrative quotation from Milton:

"How to begin, how to accomplish best,

His end of being on earth and mission high."

There are missions for individuals, as for Columbus, Washington, and Lincoln, and in medicine for a Vesalius, a Jenner, and a Lister. There are missions for nations, as for the Hebrews in religion, the Greeks in art, the Romans in law, England and America in civil and religious liberty. But there are also missions for institutions, especially for institutions of learning, such as the Universities of Bologna, Oxford, Edinburgh, Harvard, etc. Has not the Medical College a mission? If so, what is its nature and how is it being accomplished? The mission of institutions of learning, among which may be classed the medical school, is

* Address delivered at the Seventy-sixth Commencement of the Jefferson Medical College of Philadelphia, May 15, 1901. Reprinted from American Medicine, May 25, 1901.

threefold: First and foremost the development of the character of its students; secondly, the education of its students; and, thirdly, the encouragement of original research.

First, the development of character; that is "the sum of the moral and mental qualities which distinguish an individual viewed as a homogeneous whole." The school which instructs the intellect, but does not develop the moral character of its students, fails in its most important duty. "Intellect alone is cold, heartless, and selfish; it must be lighted up by moral and spiritual principles to reveal its beauty or fulfill its high mission."

Character is partly the result of heredity and of environment. Those who are so fortunate as to possess parents to whom they can look up with reverence, even after they have passed away, are most happy. They have had a training which nothing else can replace. The environment which they have had at home and the subtle influences of the family life will influence their whole subsequent career. The preliminary education which they have had, the physical health with which they have been endowed, the mental stimulus that they have received from their parents, all these count for much. Then there are undoubtedly individual differences; for example, the slothful, the vicious, the brave, intelligent, hard-working, and virtuous. It would be a trite saying to assert that the last are those who will win the prizes in the struggle of life.

But when a young man has left his home and enters the medical school, he comes under a different set of influences, partly from his fellow-students, but chiefly from his teachers. He is moved by their example, observes their industry, acknowledges their ability, and recognizes their success in life as due to a sturdy character which in turn develops the character of the student. The College is a center for those projectile moral forces which, once set in action, prolong their effects for many years afterward in well-nigh every student.