cles;" such articles as are given by classic the great medical journals of many lanwriters to the old and classic journals of guages. "The busy practitioner" of a Europe and America; that they must get few new cases daily is told by these little "the pith of the subject" in a few lines or words, contributed by those not known out of their precincts; those who are foolish enough to make such an exposure of their folly and ignorance.

Marvellous to say, there are thousands of physicians (at least in name) who believe that they are too busy to learn; too busy to study, and too busy to be taught by those who can teach them. They prefer to have their vanity so flattered, as to believe that they are very busy; and they prefer, thus, to read the worthless efforts of unknown men; to have such become their teachers and advisers. It is marvellous, indeed.

Most would say that such a result, such a spectacle, would be impossible; and yet, if these "brief" medical journals are to be credited, their subscribers are numbered by the five thousand, and even more.

"brief" journals that he has not time for reading "long-winded articles" from great men; that he must read miniature efforts from small men; and, marvellous to relate, stupendous as is such folly, the silly statement is believed; and men who by study might become useful to the profession at large, and prominent in their country, are frittering away existence either in idleness, or by poring over the veriest trash.

Such men, and the greater multitude who read no Journals whatever, have no conception of the fact that in their implied contract with their employers, to render the best service when employed, they have betrayed, are daily betraying, the most solemn of all the obligations which rest upon physicians

that of preparing themselves to discharge honestly the duties which they assume at the bedside.

With a look "My dear sir, When I of

If one were to behold a friend at- It is said of that noble Spartan, Dr. George tempting to learn history by study- B. Winston, of Kentucky, who recently ing the chronological table, he would died in Jefferson City, Missouri, that he justly fear that his friend was per- was once thus addressed by a friend: petrating a silly joke, or that his brain had "Doctor, what necessity is there for this begun to fail; and yet how infinitely ceaseless labor and study?" more sensible would be such a student of astonishment, he replied: than the scores, the thousands of medical I am under bonds to do it. men who, in the reading of these "brief" fered my professional services to this comjournals, are endeavoring to learn pathol-munity, there was an implied covenant on ogy, clinical history and therapeutics in the my part that, so far as God gave me myriads of silly articles presented by weak strength and ability, I would use these for men in 400 or 600 words!! gathering up and digesting all that is said Burdon Sanderson, Koch, Barnes, Jac- or written of the diseases to which human coud, Sir William Jenner, and scores of flesh is heir; and if I should lose a patient others equally able have an exhausting pri- because of my ignorance of the latest and vate practice; they have laborious cli- best experience of others, in the treatment entelles at great hospitals; they teach in col- of a case, a just God would hold me resleges; they make elaborate series of experi-ponsible, through inexcusable ignorance, for ments, physiological and pathological in the loss of a precious human life, and character; they write long and able articles punish me accordingly. And when I get for the journals; they publish medical my consent to be content with present proworks that are classic in diction, monument- fessional attainments, and trust to my own al in volume and value, that are vast store personal experience for success, I will withhouses of original facts gathered in the draw from practice, and step from under a intervals between exhausting duties; but in weight of honorable obligations, which, addition these men are close students of with my best endeavors to meet them

honestly and conscientiously, are still some- all who make such fatal and fearful errors. times heavier than I can bear." And this, in turn, must react upon all who To those who study much these noble thus trifle with themselves and the great words are commended for the support Profession of which they are members. It they must bring. To those who study not must make them worthless in their work; at all, they are equally commended for the worthless to their employers; and, instead of sterling advice and timely rebuke which being contributors to the growth of a they contain.

But above all, they are commended to those who are trifling with themselves, with their Profession, and with their employers by vaporing over the superficial trash published in those "brief" Journals, which in their teachings and their practice, are striking a fatal blow at all that is genuine and sterling and thorough in the study of contemporaneous medical literature.

noble Professional Body, they become so many parasites, destroying its vitality and bringing upon it unjust ridicule and serious injury.

These manifest truths are offered in no unkindly spirit, but as worthy of serious reflection.

it." Brave words in view of the fact that of the twenty-eight county societies of New York which have thus far expressed any opinion on this matter but two societies. have endorsed the action of the State Society. Twenty-six have directly repudiated the new code.

The New York Medical Journal says, respecting the position of its State society: "It is better that the State of New York But apart from all of these potent, and should stand aloof from the American just objections to such publications, they Medical Association forever than retreat must certainly give to every reader a most from the just stand it has made, or falter injurious conception of the scope, triumphs in the demolition of the medieval thralldom and achievements of a noble Profession in which the old code so lately shrouded and its splendid literature, to have it supposed that these can be presented, by a little magazine issuing 20 or 30 pages monthly. Of course those of matured minds would realize and do realize very promptly the absurd claim made by the "brief" Journals; but unfortunately, these are not the subscribers to such medical publications: those who do subscribe for them are the young and the CHEAP MEDICAL BOOKS.-Sir H. Thompimmature, those who do not know better, son has set a good example in issuing a and who really believe that, in these minia- cheap edition of his lectures on urinary ture periodicals, they are actually ob- disorders, and one worthy of imitation. taining in "brief" an exhibit of the grand Beyond doubt it is proving highly remonthly operations of the Medical World. munerative. If authors would bring out. There are besides such subscribers, many their works in a cheap form they would who are too lazy or too indifferent to study soon find their productions give them the truth, as it is fully presented in better pecuniary results, and their pubthe large Journals of Europe and America; lishers would not be hampered by having and who are foolish enough or willing enough their shelves burdened with slow-selling or to believe that in the little articles of con- unsold editions, which ought to be lying. tributors unknown to science, and in a on the shelves of professional private host of miscellaneous recipes from prescrip- libraries. There are hundreds of works tion worshippers, they are obtaining the unread which those who do not belong to grand monthly harvest from the magnificent a Medical Society library never can peruse field of medical literature. because they cannot afford to purchase Such conceptions, and such an indulgence them. Publishers should use fair paper of them must hopelessly dwarf the men- and paper covers; purchasers can then tal character and professional efficiency of have all books bound in a uniform manner.

GAILLARD'S MEDICAL JOURNAL.

(Formerly the Richmond and Louisville Medical Journal.)

Vol. XXXIV.

NEW YORK, SEPTEMBER, 1882.

ORIGINAL ARTICLES.

"Qui Docet Discit."

No. 3

great colonies, east and far west--wherever, in truth, the flag of England is looked upon with affection and pride. Well has our ADDRESS IN SURGERY. By WILLIAM great brotherhood fulfilled the expectaSTOKES, F.R.C.S.I., Professor of Surgery, tions of its distinguished founder, Sir Royal College of Surgeons, Ireland; Charles Hastings; for, as it had its birth in President of the Pathological Society of the "faithful city," so it has proved faithful Ireland. At the Semi-Centennial meeting in many good and noble ways-faithful in of the British Medical Association at removing professional jealousies, and softWorcester, Eng., August, 8th, 9th, 10th, ening asperities-faithful in protecting with and 11th, 1882. (Brit. Med. Jour.) its broad and strong shield those among us My first duty and real pleasure is to offer who may have been cruelly and unjustly an expression of gratitude for the honor-attacked-faithful in its efforts to raise the the great honor-that has been conferred social status of our profession-faithful in on me and on Irish Surgery in being asked its attempts to extricate public opinion from by your Council to address you on an occa- the quagmires of sentimentalism and folly sion so memorable as the present. Were I-faithful in aiding and encouraging the called on to address an audience previously scientific vanguard of our profession. unknown to me, though not insensible of its sympathy, my diffidence would be great. How much greater must it be when I know I am speaking to so many fellow-laborers whose work, life-object, and ambition are the same as mine, and many of whom have acquired and deserved far-reaching fame. However, if my diffidence is great, so is also the pleasure, as the honor of being invited to address you comes from the noblest brotherhood in a profession that has yet existed; for such-now celebrating its jubilee -is this Association, the interests and prosperity of which we all have so much at heart.

But, great as have been the results of these efforts of the Association, much yet remains to be achieved. I should like to see loyal and hearty-co-operation with the universities, the medical and surgical corporations of the United Kingdom, and the General Medical Council, to raise the standard of Arts education for all joining our profession, by establishing conjointly an examination in Arts which every one, except those with university degrees, should pass previous to commencing the study of medicine. I should also like to see a consolidation of the great medical and surgical teaching power that exists in our metropolitan centres, but which, owing to the multiplicity of small schools in them, is, to a great extent, lost to the profession and to the Public. Instead of urging the establishment of additional schools, it would be far better to endeavor to bring about such an

It must be a source of genuine satisfaction to those who for many years past have taken an active interest in the work of the Association to observe how, first taking root here in the heart of England, its branches now extend not only over the three divisions of the kingdom, but also amalgamation as I have indicated, and costretch out widely and luxuriantly to our operate with those who wisely think that

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among the chief desiderata in our profession to afford adequate material for the student is a larger amount of training in a univer- to acquire a sufficient knowledge of these sity where the first phases in the life of a subjects. The function of universities, at medical student can best be spent, viz.- least those so situated, in relation to medifirst, the preliminary general, and second, cal education especially, should be that of the preliminary scientific education. I am great scientific schools, and not centres for strengthened in this conviction by the fact practical clinical study. I feel confident that during the Visitation of Examinations the day will come, when the wise and farrecently conducted for the General Medi- reaching policy of those who have held and cal Council, in which I had the honor of maintained such views will be recognized, being associated, the Visitors frequently and acknowledged to be correct. observed candidates for the diplomas of our I am strengthened in these views from the corporations whose general and scientific knowledge that they largely coincide with culture was far below what any one joining those of one long and intimately associated our profession ought to have. with the cause of medical education in this The portals of many of the universities country-I allude to the distinguished have recently been widened, enabling those Regius Professor of Medicine at Oxford to avail themselves of the advantages, social and President of the General Medical as well as intellectual, which a university Council, whose great and unselfish devotion. affords, who a few years since would have to the best and highest interests of our probeen wholly precluded from so doing. In fession must ever command our unqualified giving these facilities, Oxford, where the admiration and respect. natural sciences were too long proscribed It has hitherto been customary for my and discouraged, is specially deserving of predecessors at the annual meetings of the gratitude. Away from the turmoil and dis- Association, either to give a résumé of the tractions of a great metropolis, the sciences most recent advances in surgery, and disauxiliary to, as well as those that are the cuss some particular theory or mode of basis or foundation of, medicine, such as practice on which surgical opinion is more human and comparative anatomy, physi- or less unsettled, or dwell on those topics ology, chemistry, and histology, can best be studied, aided by all the collateral advantages and noble traditions of an historic university. Such training would assuredly give a healthy impulse and scientific direction to the practical work of a student when he leaves the university to complete his professional studies at a metropolitan school. The universities, especially those in or near the smaller provincial towns, are quite unsuitable for complete practical schools of medicine and surgery, the available material However, though a detailed retrospect being-having regard to existing modern requirements, and especially as regards pathology-necessarily inadequate.

that have proved of special interest to himself. On the present occasion, one which should be marked meliore lapillo, to give a detailed retrospect of surgical advancement during the past half century would be a task not alone difficult, but, in truth, impossible in the time at my disposal. I purpose, therefore, to dwell on some few topics of great general interest, involving questions still unsettled, and which have more particularly engaged my attention.

of the surgery of the past half century is here impossible, let us, like travelers who enjoy the happy toil of climbing an Alpine Having for several years been a surgical ex- steep, and who at times pause to look back aminer in the Queen's University in Ireland, and take a panoramic survey of the counI was forcibly impressed with the truth of the try traversed, see the giddy heights that view that, for the practical teaching of sur- have been scaled and the difficulties overgery and pathology, universities in the come, contemplate the chief advances in smaller provincial centres, are hardly able our art, the obstacles and opposition that

in its widest sense; or on the other instruments of precision constantly made use of Memorable as these advances would make any era in the history of surgery, they all pale before three I have yet to mentionadvances which the surgical historian will doubtless point to and emphasize as the

have been swept away, and the breaking of sels, by the methods of Porter and Barwell. the fetters that so long bound it to a blind In two cases I adopted Porter's method, empiricism. What have been these ad- using a wire, deligating the femoral artery vances? The list is a goodly one, and the in one, and in the other the abdominal mere enumeration of them would alone aorta, Barwell's ligature-made from the occupy the hour at my disposal, but I may aorta of an ox-a method recently tested mention a few of those that stand out most in the Richmond Hospital by my colleague, boldly in relief: The abandonment of an Dr. Thomson, who deligated the arteria indiscriminate blood-letting in almost every innominata for subclavian aneurism. Again form of acute surgical disease, of a reckless we have in the treatment of fractures, use of mercury in the treatment of syphilis, immovable splints and improved methods and of setons and moxæ in hopelessly irre- of extension by weights, or more perfectly mediable articular and other diseases; the by screw action; of manipulation in the introduction of the pressure treatment of treatment of luxation; and in spinal disaneurism by Bellingham, Todd, and Hut- ease, the use of the plaster-jacket of Sayre. ton; of drainage in the treatment of I need not dwell on the complete revoluwounds and abscesses by Chassaignac; of tion in ophthalmic and aural surgery that metallic sutures and the perfecting of the has occurred, and of the light that the operations of vesico-vaginal fistula by ophthalmoscope of Helmholtz has shed, not Marion Sims; of lithotrity by Civiale, alone on ophthalmology, but on pathology Thompson and Bigelow, and of stricture by Syme, Wheelhouse, Maisonneuve, Perréve and Holt; the renaissance of joint resection by Crampton, Syme and Ferguson; the introduction and establishment on a firm basis of ovariotomy by McDowell, Clay, Spencer Wells, and Keith; of bloodless surgery by Esmarch; of skin grafting and sponge three giant strides that the past half cengrafting by Reverdin and Hamilton; and tury has witnessed. I allude, first, to the of osteotomy in genu valgum by Ogston; discovery of the means of banishing pain improvements in methods of amputation by during the performance of surgical operBell, Teale, Carden, Syme, and many ations; secondly, to the restoration of disothers; also the operations of gastrostomy, eased or injured bones and joints necessitaexcision of the pylorus, of the spleen, the ting resection; and, thirdly, the enunciation kidney, supra-pubic excision of the uterus of the principle and establishment of the laparotomy, and cholecystotomy. In con. practice by Pasteur and Lister of antisepnection with abdominal surgery, I would ticism in the treatment of wounds. When also allude to the recently published able we reflect that so large a part of these essays by Sir William MacCormac and Dr. changes in surgical principles and practice Marion Sims, the latter paper dealing has been due to the genius and honest mainly with antiseptics and drainage in labor of so many workers in the United gun-shot wounds, these being, in Sir James Kingdom, we may well feel a pardonable Paget's opinion, "the most important, per- pride in British Surgery, and confidence in haps, of all the provisions to be made in the coming triumphs of our art. healing wounds." Again, we have torsion. To anæsthetics, antiseptics, and osteoin the treatment of hæmorrhage-a method genesis, together with a few cognate topics, to which such an impulse has been given I would therefore now invite attention. by Mr. Bryant; and the treatment of Whatever anæsthetic the surgeon selects aneurism by arterial ligation, without whether it be chloroform, ether, or both injury to the deeper structures of the ves- combined, bichloride of methylene, or