an eminent scientific commission to report on the alleged discovery.* Pasteur furnished them with 23 vaccinated dogs. These 23, and 19 others unprotected, were all inoculated from rabid animals. Of the 19 unprotected, 14 died. Of the 23 protected dogs, 1 died of diarrhoea, and all the others escaped. It has yet to be tried on a man suffering from hydrophobia, but, should our reasonable hopes be realized, what a boon it will be!†

With this brief summary of a few of the recent practical benefits from vivisection, I must close. I have given you only ascertained facts for your future use in the communities in which you may settle. They may assist you in forming public sentiment on a basis of fact, of reason, and of common sense. The sentiment of our own profession, so constantly and so conspicuously humane, are always against inflicting pain; but if in yielding to sentiment we actually increase disease, and pain, and death, both among animals and men, our aversion to present pain is both unwise and actually cruel.

* Medical News, August 30, 1884.

In the last twenty years "Pasteur Institutes" for the treatment of hydrophobia and some similar diseases have been established in nearly every civilized country in the world. Of persons bitten by animals believed to be rabid, heretofore about sixteen per cent. developed hydrophobia, and every one died. In the thousands of such cases treated by Pasteur's method even those bitten by animals known to be rabid the mortality is less than one per cent.-(W. W. K., 1905.)

RECENT PROGRESS IN SURGERY.*

N no department of medicine has there been more rapid

recent years than in surgery. This progress is due chiefly to two things-the introduction of antiseptic methods, and to what we have learned from laboratory work and experiments upon animals.

It has long been known that a "simple" fracture, in which the skin is unbroken, and a "compound" fracture, in which the skin is broken and the air has easy access to the fractured bone, were vastly different in their dangers; but why the communication with the air was so dangerous was a mystery. Of late years, however, the germs existing in the atmosphere, and on every material coming into contact with the wound, such as dirty clothing, ordinarily clean instruments, the skin of the patient, the hands of the surgeon, and the dressings, have been investigated by a large number of observers, and it has been abundantly proved that infection comes not from the wound itself, but from the exterior, and that this infection from without is the cause of inflammation and of its speedy sequel, the formation of "pus" (that is,"matter"). Once that the pus begins to form, fever, abscesses, bloodpoisoning, gangrene, erysipelas, one or all, may start up into ominous and fatal activity. Inflammation and suppuration (that is, the formation of pus), then, are the causes of all these evil processes. They are all called briefly "septic" (that is,

* Reprinted from Harper's Magazine, October, 1889, by the kind consent of Messrs. Harper & Brothers.

"poisonous") processes. Hence "antiseptic" methods are those that prevent inflammation and suppuration.

Now we see why a compound fracture, or any other "open" wound (that is, one in which the protective defense of the skin is destroyed), is so much more dangerous than a simple fracture, or a subcutaneous wound. It arises from the fact that these septic germs, or "microbes," have easy access to the tissues, and, once there, multiply with almost incredible rapidity, and quickly set up inflammation and suppuration and their consequences. At first it was thought that the chief danger lay in atmospheric germs, but later investigations have proved that the skin of the patient, and especially the hands of the surgeon, and his instruments and sponges, and even his dressings, are far more frequent sources of infection.

Perhaps I cannot better illustrate the difference between the old, or "septic," and the new, or "antiseptic," surgery than by describing two amputations, one such as was commonly done, for instance, during the Civil War, and the other such as is done now by every good surgeon. In fact, it is only within the last ten or fifteen years that antiseptic surgery has become generalized in the profession.

Let us suppose an amputation above the elbow, and the operator the best surgeon of the Civil War. The arm was not specially prepared, except that it would be cleaned of its coarse dirt arising from the accident, but that would be all. The instruments were taken out of an ordinary case and placed on a table, and during the operation were frequently placed upon the patient's clothing, soiled often by the accident necessitating the operation, as well as by more or less wearing. If the instruments or sponges fell upon the floor, they would be picked up, dipped into water, and then used with innocent equanimity. The sponges, washed and dried from the last operation, were simply thrown into a basin of ordinary water. The hands of the surgeon were as clean as a gentleman would

always keep his hands. The amputation having been done, the arteries were tied with silk threads (called "ligatures"), one end of each being left long. These ends were left hanging out of the wound at any convenient place, and in an amputation of a muscular thigh might number a score or more. Hæmorrhage having been checked, the two flaps were sewed together with wire or silk threads, called "sutures." In threading the needle, the thread would often be shaped into a point by the lips, or, after being wetted with septic saliva, would be rolled between septic fingers. A piece of lint, or often a piece of soft, old linen "rag," spread with some grease, was placed upon the stump, and a suitable bandage applied. The next day the dressings were removed, and the wound was redressed in a similar manner. At the end of twenty-four or forty-eight hours a fever would set in, called in our text-books "surgical fever," thus assuming that a surgical operation always resulted in such a fever; nor was the assumption erroneous. This would continue for several days, the temperature ranging from 102° to 104° or 105° F. In a few days, when suppuration became established (and this was always expected by the surgeon), the fever would gradually subside, and later the suppuration also would diminish. At the end of a week or ten days the surgeon would pull gently on each silk ligature, to see if it had rotted loose from the blood-vessel and could be removed. If the wound became unduly inflamed, poultices would be applied; and finally, after three or four weeks, the ligatures would all have been removed, and the wound would soon be healed. Very rarely, indeed, would a wound heal without suppuration. If it did, it always excited remark, and would be recounted as a surgical triumph. Often, on the other hand, grave complications arose by the formation of abscesses; erysipelas and gangrene were fertile sources of danger, and very often of death; while secondary hæmorrhage —that is, hæmorrhage following premature rotting of the ligatures on the blood-vessels-was always a possible and fre

quently an actual and formidable danger to life. A serious operation from which the patient recovered in less than a month was a "remarkable case."

Contrast this with a similar operation performed to-day by any ordinarily well-instructed surgeon. The day beforehand, the skin in a wide area around the site of the proposed operation will first be scrubbed by a nail-brush with soap and water, then with ether, then with some antiseptic solution, most frequently at the present day a solution of corrosive sublimate, one part to one thousand of water, and then covered with an antiseptic dressing until the operation is begun. The object of this is to free the skin from dirt and fatty matter, making it surgically clean and free from germs. The instruments will have been boiled in a covered vessel for fifteen minutes, or disinfected by carbolic acid or some equivalent germicide, and are then placed in a tray filled with an antiseptic solution. In the cleaning of them after the last operation all rough and more or less inaccessible places where germs may accumulate (especially, for instance, the joints) will have been scrupulously disinfected. If during the operation an instrument is laid down, it is never placed on the clothing of the patient, but either is replaced in the tray, or laid upon towels or sheets which have been disinfected and spread all over the patient's person and clothing all around the field of operation.

After an operation the sponges are thrown away if they have become infected from pus; but, if not, they are very carefully disinfected, and then kept permanently in a carbolic solution. At the next operation they are placed in a tray containing some antiseptic, or at least water which has been boiled, for heat has been found to be one of the best antiseptics. If a sponge or an instrument fall on the floor, it is laid aside, or before being used again is thoroughly disinfected. The hands of the surgeon will next receive especial care. First they are scrubbed with soap and water