TEIR BRITIS 660 OT. 10, 1925] POETRY AND PHYSIC. I ZIAOAL JOURNAL v-vptlttnotA * wainttr *tzzt"on# POETRYAMD PHYSIC.* order no fewver than 479 names, but modestly says that Franice cannot put forward any competitors to the poet-physicians iho BY are mentionied in order, presumably of merit: Francesco Redi, SiR HUMPHRY ROLLESTON, BART., K.C.B., M.D., Bellini, Blackmore, Haller, Akenside, Grainger, Erasmus HON. D.SC.OXFORD, D.C.L.DURHAM, Darwin, Armstrong,G-arth, and others. Inhis scholarly intro- REGIUS PROFESSOR OF PHYSIC IN THE UNIVERSITY OF CAMBRIDGE; duction Daina passes in review the medical poets from classical PRESIDENT OF THE ROYAL COLLEGE OF PHYSICIANS OF LONDON. times; from Empedocles (B.c. 500) and the times when the THE present is perhaps not an inappropriate time to consid r Theriaka or pailacea for all poisons was a favourite subject for the relations between poetry and physic, for less than a year the verses of Nicander, Andromachus, and Macer Floridus, up ago (on October 23rd, 1924) we celebrated the 80th birthday to the present day. of Dr. Robert Bridges, Poet Laureate since 1913 and the only medical man among the eighteen holders of the office of Uses of Poetry. Versificator Regis, dating from Edmund Spenser in 1591. The Defined as articulated music by John Dryden, poetry is nearest approach to a medical laureate was Robert Southey, to prose what a great painter's masterpiece is to an ordinary who for a time was a medical student. photograph. It is eminently creative; medicine, thougl Newcastle-upon-Tyne, too, has its -medical poets, for Mark similarly constructive in its curative and older function, has Akenside (1721-1770) composed his successful didactic poem, as its highest aim the prevention of disease, and therefore, Pleasures of theImagination, in this his native town before like the police, plays the rather negative part of eliminating leaving for London and dropping the pursuit of "the draggle- the factors responsible for disorder and destruction. But in tailed muses "-to quote the words of another medical poet, their different ways scientific medicine and poetry both aim Oliver Goldsmith. Thomas Trotter (1760-1832), after a rather at the attainment and perpetuation of the good, the beautiful, turbulent career as a surgeon in the Royal Navy (1779-1802), and the true. retired to Newcastle a disappointed man, and in 1829 published Though it is not always recognized, poetry has a most a volume, entitled Sea-weeds, Poems Written on Various practical bearing on our work-a-day world by increasing the Occasions, Chiefly during a Naval Life, and thus, as sometimes joy of existence. With their realistic and idealist sides happens to medical men, returned to the poetic activity of medicine and poetry are complementary, and certainly poetiry early youth. provides a relief from the ugliness and drabness of life. No On grounds of ancient heredity poetry and physic should be doubt the idealism of the poet's eye " in a fine frenzy rolling." closely allied, for Apollo, the god of poetry and culture, was so remote from the sordid material details of fleshly infirmity, the father of Aesculapius, the tutelary divinity of the healing would appear to set an insuperable gulf between him and art, and those who practised medicine were dignified as "the the physician. But each of those concerned with these con- children of Apollo." In the time of the renaissance of learning trasted aspects of life may gain by adopting colouring derived medicine was one of the several branches of knowledge coming from the other. within the purview of a philosophic scholar, and these were Medical men, however, are probably more likely to gain by the days of the scholar-physicians, such as Linacre. The the culture and wide vistas opened by poetry and letters relations between literature and medicine form an interest- than are poets by a scientific or medical training. In his ing episode in the history of letters, but the connexion has of Essays in Criticism Matthew Arnold indeed insisted that necessity become less intimate with the advance and increasing without poetry science would be incomplete. Poetry implies specialization of knowledge and technique. Even in the expe- spontaneity and imagination, which should not degenerate inito rience of those now living it seems to some that poetry, in poetic licenece; and imagination, or the creative faculty, is a spite of the volumes of Georgian Verse, has less appeal and is form of divination of the greatest importance in medicine; less read than in Victorian times. indeed, according to Sir Clifford Allbutt, the responsibility of Some years ago the idea struck me that it would be interest- a university is confined to ensuring a certain development of ing to collect the works of medical men who were also poets; mind and imagination in its graduates. Imagination is a for our profession provides ample opportunity for observing necessary stimulus to really good work; especially in original man and his manners, women and their woes, human. nature research, it is as essential as is the cold logical sense of propor- and its nakedness, and the beginnings, ends, and tragedies tion which controls within proper bounds the investigations thus of our fellows. Such a hobby is. attractive for the light it inspired, for it is the most fruitful initiative to lines of pains- throws on the personalities of the past and for the pictures taking and laborious investigation. That familiarity with good of eminent physicians, such as Sir Henry Halford composing poetry should improve a medical man's literary style is so elegant Latin verse (Nugae Metricae, 1842) as he drove from obvious that one example only will be cited, and that from one noble sick room to another; Sir Richard Blackmore, the holy writ: St. Luke, the beloved physician, was, as Miss opponent and victim of the wits, rolling out his eternal epics Melian Stawell shows, a Roman and not a Greek, and modelled "to the rumbling of his coach's wheels," and thus contrasting his style in the Gospel and Acts of the Apostles on Virgil. with the humbler practitioner, John Mason Good (1764-1827), Like music, poetry of course has an effect on the mind, and translating Lucretius into blank verse as he trudged through the finer forms exert a powerful influence for good; Robert the London streets to his poor patients; this literary task, con- Graves says: " A well chosen anthology is a complete dispen- scientiously undertaken for his mental education, occupied six sary of medicine for the more common mental disorders, and years. But I had barely started when Dr. C. L. Dana of New may be used as much for prevention as cure." There can be York kindly sent me the charming catalogue of his collection little doubt of the value of poetry as a relief to the mental of poetical works written by medical men, which, covering a fatigue caused by the monotony and squalor of life such as wve period of two thousand years and containing 157 names and often see it; but it is possible that Robert Lynd is right in 295 works, compelled. admiring interest while defying reproaching us for neglecting its psychotherapeutic uses when competition. he says that we " are more accustomed to advising people to The relations of medicine and literature have often been the eat lettuces than to read poetry," and that in view .of our subject of addresses and articles, and I. would specially refer silence Graves is justified in advocating the medical applica- to Sir Edmund Gosse's brilliant Lloyd Roberts Lecture on tions of poetry " in a passage that reads like a page of " Personal relations between literature and medicine,"t to Aristotle seen through the spectacles of Dr. Freud." For which I am much indebted. In 1669 the distinguished Dutch Graves suggests that as poetry is the transformation into dream alatomist Thomas Bartholinus published a small work of symbolism of some disturbing emotional crisis in the poet's 149 pages, De iMedicis Poetis. Broeckx, in his Dissertation Bur mind, it is able to help other men similarly affected by les mgdecins-poetes belges, arranges fifty of his countrymen supplying an allegorical solution of the trouble. Not onlv may inl alphabetical order; and Achille Chereau gives in alphabetical reading, poetry soothe the jangled nerves of a jaded labourer and provide an antidote and antacid to the mental hyper- *Introductory Address (abridged) at the Universitv of Durham College material and stereotyped formulae of Medicine, Newcastle-upon-Tvrne, October 6tlh, 1925. - chlorhydria born of the too tBRITISH MEDICAL JOURNAL, Novmniber 24thi, 1923, p. 99a of medicinre, but active composition of verse is a mneans of POE AND PHYSIC. [ Taft Birtn ; OCT. 'O, 19251 TRY MEADICAL JOURNAT. 661 I relieving the overburdened mind by providinig a safe outlet for to the popular belief that the pursuit of poetry and of medical emotional excitement. practice were incompatible. The valuable property of " clinical instinct.," which, although It has long been a widespread conviction, which the ever- sometimes ridiculed as the assumed armour and decoration of increasing extension of knowledge and the resultinig specialism the ignoramus or the quack, has a certain resemblance to the would tend to strengthen, that a man cannot be first-rate in poetic faculty, and, moreover, is a real asset in practice. more than one line of work. It is true that some mlen are so Clinical instinct is the power of arriving without a conscious gifted that whatever profession they adopt they will make their logical process at a definite conclusion, and is often possessed mark at or near the top; Goethe and Albrecht von Haller in in a high degree by old nurses who know, but cannot give the past were examples of pre-eminence in poetry and medical their reasons, whether a patient is going to recover or die, and science respectively, and efficiency in their second subject. by practitioners of long experience who similarly cannot explain Benjamin Ward Richardson believed that " if John Keats had the steps by which they reach a diagnosis and prognosis. It once tasted the true spirit of medicine he would have become may be assumed that they unwittingly draw on a buried ons of her greatest sons-an addition, perchance, to the some experience which, without their conscious remembrance, recog- eight or ten of the men of all time whom medicine claims as nizes in the patient signs presented by one in the long past. her own, her poets of nature." In diagnosis, therefore, there are the two processes-the con- In the light of experience and in obedience to popuIar sciously logical, and the rarer, but not necessarily less correct, prejudice against serving two masters or mistresses, some the unconscious. In the writing of poetry there are also these medical men have concealed their poetic powers and produc- two methods-the conscious effort and the impulsive pouring tions, or have put them aside in a napkin during their active out pell-mell of verse, the meaning of which, though quite professionial life. To publish anonymously and to await the clear to others, may not at the time be obvious to the writer. verdict before declaring the responsibility is not peculiar to any professioni, and ours is no exception. There has been Poetry as a Means of Communicating Knowledge. some discussion whether the unauthorized aind anlionymous The prolific multiplication of books by printing has rendered editions of Sir Thomas Browne's J?eligio M1edici, w-hichl contains the tratnsmission of knowledge so easy that it has led to the a number of poetic fragments in the text, appeared entirely conviction that prose is the only proper method of conveying without his knowledge; but Geoffrey Keynes, in his fine technical knowledge; but, of course, it was not ever tlhus. bibliography of Sir Thomas Browne, scouts any " such sharp In early times medical, like other lore, was largely handed down practice " on his hero's part, though this is perhaps rather a in the form, convenient for memory, of ver se. In the pastc hard saying for what, after all, seems a harmless experiment. the famous Regimen Sanitatis of Salerno (? 1100 A.D. and an From internal evidence Chereau ascribes thirty-two unsigned early printed book in 1480) was the most popular poem in poems to medical men among his collection of Frenich physician- medical literature; up to 1835 there were 119 editions of the poets. Pseudonyms also have naturally been employed. Latin text, 33 German translations, 14 French, 9 English, Mark Akenside (1721-1770) brought out the Pleasutres of the 9 Italian. As recently as 1920 an edition of Sir John Imagination in his twenity-tliird year, and then, becoming a Harington's English version was published. It was much in hiaughty physiciani to St. Thonmas's and Chlrist's Hospitals, and request as a handbook of domestic medicine, and, as was so Goulstonian and Croonian Lecturer at the Royal College of frequent in the days before printed books, became much altered Physicians, reemained to all intents poetically dumb until the in the course of many copyings, successive scribes adding at year of his deatlh. Possibly he was influenced by the example their own discretion or indiscretion. Thus the early copies of his seinior at the College, Sir Richard Blackmore (1653-1729), -contained about 360 lines, and the later ones over 1,000. Phvsician in Ordinary to William III and Queen Anne, who Johann Joachim's Parnassts Mledicinalis (1663), writteIn in persisted in the practice of physic anid the publication of epics, the style of the Regimen, was, according to Dana, notable as wvith the result that he became the butt of the wits, whom, it the first systematic exploitation of opotherapy, and details the should be remembered, he had in the first instance attacked in applications of twenty-four substances in man's body usefLli a Satylr against Writ (1700). in medicine. Next in popular importance to the Reginien Garth, and John Arbuthnot (1667-1735), the only begetter of Sir William Osler placed Girolamo Fracastoro's SypAhili.s sitr the clharacter of John Bull, were both court physicians and Mlorbus Gallicus (1530), which gave us the name of a disease accepted equally by the wits and(l by the medical world of the etiological importance of which it is even now difficult to what has been called the Augustaii Age in England. That they estimate. David Kynalock was Scotland's chief Latin medical lhad personal charm is well knosvnv, and this is perhaps the poet, being the author of two volumes, De hominis procreationc reasoni why Blackmore, their apparently heavy colleague at the anatome ac mor bis internis (1596); another Scot, John College and the court, had such a different reception. At any Armstrong (1709-1779), produced The Faamous Art of Preseringl rate, Garth anid Arbutlinot's success proves that in spite of Healtht (1744), a didactic poem in four books, wlhich, with its popular prejudice it was Iiot impossible to be accepted as a personal appeal, had a great vogue. physician anid a poet at the same time, at least in those days. Evein now, with all our intensive specialization, there are not Can a Doctor be a Poet? waInting men of world-wide reputation who can write fine verse: Few, at aniy rate in the recent past, have at the same time Henry Head's Destroyer-s and Ronald Ross's poems are instances been equally distinguished as medical men and writers of that at oInce spring to mind; but it must be admitted that their poetry. Probably the best instances are the two Americans, services to medical science outshine even their poetical works. Oliver Wendell Holmes (1809-1894), professor of anatomy for Sir Donald MacAlister's Echoes (1913) are an amazing tour de forty-four years, and S. Weir Mitchell (1829-1914), thie neuro- force, for he translates R6mani into English, German into logist of Philadelphia. This association, however, has been so English and Scots verse and vice versa, Russian and modern rdtre that it has even been asked, " Can a doctor be a poet?" Greek into English and old Scots with the greatest skill and and, with a wider application, " Is there any iniherent incom- apparent ease. patibility between the lanicet and the lyre'? " Thomas Denman (1733-1815), the obstetrician, in a letter to comfort hlis former Practitioners of Both Mlbcdrine and Verse. pupil, the famous old Batlh p1lYsician Caleb) Hillier Parry, for It has been claimed for medicine by one of ourselves tile tardy advent of patients during his early years of practice, (Mitchell Banks) that it stands foremost among the professions touched on the pereninial problem why one medical man succeeds ini the number of men distinguished in literature who at least while another fails, remarking : " What is very hard, and began life in our ranks. A long list might easily be compiled, I know two or three instances of it, is that a man shall be b,ut it will be sufficient to give a few examples of those who esteemed as a friend, acknowledged to be a man of parts, but have taken up medicine for a shorter or longer time and have none of hiis friends thinks of enmployiing lhim in his profession. at one stage or another given their adhesion to the muse of Ibis I can hardly explain, unless by the old saying He is soIlng. Some have been poets who touched medicine; others, too good a poet to be a good physician.' " This was in the hIractitioners who, as a by-product or hobby, threw off verse; very e.arly years Of the nineteenth cetury,- more than a century and some, such as Georges Clemenceau in Le Grand Pant (1895), after the appearance of Samuel Garth's Dispenisary (1699), a have preferred to write poetry in the form of prose. Some medico-political satire and picture of the famous quarrel between were transient students only and never qualified; S. T. the College of Physicians and the Apothecaries, which Sir Coleridge, when less than 15 years of age, was seized wvith a Edmund Gosse rather optimistically says gave the cootp de graece passion for medicine and read many authorities, learning 062. (r?BE 190)T. 10, '9rA)21 .POETRY AND PHY8IO. I IDTOL JouaS

a Blancard's Latin Medical Dictionary almost by heart.- Southey Brazils, and was the persistent parent of plays, pamphlets, also entered on the physic line, but not for long. Francis and poems. After 1595, a year of great literary activity Thompson (1859-1907), poet, author of The Hound of Heaven, marked by the appearance of four books, he went in for and mystic, spent eight years at Owens College, Manchester, medicine and, taking the degree of Doctor of Medicine at but as a medical student he was a misfit. Avignon in 1600 and D.M. of Oxford in 1602, practised at John Keats, as is well known, qualified in July, 1816, at the first in Warwick Lane. Familiarity with the pen enabled him, Apothecaries' Hall, but this marked the close of his life's in 1603, to dedicate to the Lord Mayor and Corporation a medical chapter. George Crabbe (1754-1832), according to treatise on the plague then raging in London. Together with Byron " Nature's sternest painter, yet the best," after a Matthew Gwinne and Raphael Thorius, both poets, the great brief experience of poor practice took orders, and only exer- William Harvey, and some others, he was, on May 11th, 1604, cised his medical knowledge on the bodies attached to the souls examined at the Royal College of Physicians; Lodge failed on under his care. Medicine may be said to have refused the that occasion, but was successful in 1609. Martin Llewellyn overtures of Goldsmith, the source of whose medical qualifica- (1616-1682) also played many parts: a scholar and poet- tion has been a vexed problem of historical research; and cavalier, until he was 32, when he was ejected from Oxford Tobias Smollett, the author of odes as well as his more famous for his Royalist activity; then applying his genius to medicine novels, intermittently attempted, but never really succeeded in, he became a Fellow of the Royal College of Physicians of practice. Schiller gave up his post as a surgeon in the army London, but with the return of the Stuarts he was made as soon as he could. -physician to Charles II and Principal of St. Mary's Hall, Among those who continued to practise and publish their Oxford; after four years he moved to Great NWycombe, where metrical products were Henry Vaughan (1622-1695); his he practised and eventually became mayor; he wrote poems, Retreat appears to have stimulated Wordsworth to the ode published at intervals from 1646 to 1672. T. L. Beddoes Intimations of Immortality, and his poems were pervaded published The Bride's Tragedy when 19 years of age, wrote with an atmosphere of mystic rapture; he evidently was no dramas, became involved in political intrigues in Germany, commonplace person. James Grainger (1721-1766) was successful and remaining abroad for the rest of his life decided, in in so far as his Ode to Solitude was applauded by Johnson, 1825, to abandon literature as a profession in favour of and he gained at least sepsational attention for The Sugar medicine. He attained merit as a physiologist, took his Cane, the remarkable anticlimax in which, " Say, shall I sing doctorate in Zurich in 1835, was nominated as a professor of rats? " evoked a vehement " No " from the great lexico- but not appointed for political reasons, and did some practice. grapher and laughter from the privileged audieiuce to whom it During twenty years of his medical life he was writing and was read. He carried on his professional and poetic activities polishing Death's Jest Book or the Fool's Tragedy, published concurrently, but, though able, he did not make medical in 1850 after his death. practice lucrative. In the intervals of his more important A few born poets adopt medicine, and failing therein allow work Edward Jenner (1749-1823) wrote occasionally in verse, their true bent to come out, as in the case of Oliver Goldsmith. such as the Address to a Robin. John Ferriar (1761-1815) of It must be exceptional, if not unique, for a well established Manchester, advocate of the idea that anyone could become a poet to be summarily made M.D., eve-n by the Archbishop of genius if sufficiently industrious, was the author of a poem Canterbury-who still retains, but never uses, this power. Bibliomania recounting the joys of book collectors, and became Abraham Cowley (1618-1667), a scholar of Trinity College, prominent for his attack on Sterne, whom he accused of Cambridge, wrote in 1639 an elegy on the death of his friend plagiarisms, a failing which others in turn ascribed to the William Harvey, not to be confused with the discoverer critic. He was active as a physician to the Manchester (1578-1657) of the circulation, whom as Warden of Merton Infirmary until his death. W. H. Drummond (1854-1907), and a co-Royalist he very probably met at Oxford after who has been called " the Poet Laureate of British America," his expulsion from Cambridge in 1643. It was at Oxford, struck out a new line as the interpreter of the French onl December 2nd, 1657, that Abraham Cowley was made D.M. Canadian life and thought in The Voyageur, The Habitant, by edict of the Government in order (so his biographer, Sprat, and other poems. He was of Montreal, and so was John considers) to serve as a blind for his activities in the Royalist McCrae (1872-1918), whose untimely death in the war removed cause. Cowley never published any strictly medical work, and a well known pathologist, a physician of great promise, and there is no evidence that he was specially interested in clinics. the critical a-uthor of a number of poems, the best known Is any one branch of the medical profession more favourably of which is the exquisite rondeau In Flanders Field8. W. S. placed and prolific in verse than another? From their up- Thayer of Baltimore, another fastidious censor of his own bringing and associations it would naturally be anticipated that creations, has often written but seldom broadcasted his verse. the followers of pure physic would be more productive than Another group are those medical men whose poetic bent is the wielders of the knife; this is probably true, but perhaps not allowed to shine before men until they are on the way enough has been said about those concerned with internal to retirement, when more leisure and freedom from any anxiety medicine. Some distinguished surgeons have been poets, or at that obvious hobbies may damage their professional prospects least have ventured into verse : Richard von Volkmann wrote permit the products and remains of youthful facility in verse under the name of Richard Leander; Paul Broca was a poet to blossom forth. Weir Mitchell was a case in point; except (employing the anagram Bap. Lacour for his pseudonym) as for some unsigned verses in 1857, he published nothing for well as a surgeon and an anthropologist. Sir William Blizard, popular consumption until over 50 years of age. In spite of who was surgeon to the LoIndon Hospital for fifty-three years Sainte-Beuve's dictum that in most men the poet dies young and operated there in his eighty-fourth year, wrote an ode for while the rest of the man lives on, it is therefore probable that the opening of its Medical School in 1785, which was set to music poetic activity may lie latent and be born again in more by Samuel Arnold, but drew from Sir Normarn Moore the remark mature years, but whether the latest fruit is always the ripest that " had he been longer contemporary with Pope it woull is doubtful. Erasmus Darwin (1731-1802) was the author in have certainly secured him a place in the Dunciad." Another his fiftieth year of The Botanic Garden, a poem in two parts, President of the Royal College of Surgeons, the late Sir the Economy of Vegetation, and The Loves oJthe Plants. There Rickman Godlee, wrote poems. Sir D'Arcy Power, ever ready is a special interest about him and his speculations on evolution to share his historical lore with others, has shown me some in connexion with their possible influence on his grandson of his treasures of the sixteenth century poet-surgeons; John Charles Darwin, who entered, but soon aband9ned, the study Ilalle, Thomas Gale, Thomas Vicary, and John Read, white of medicine. Thomas Gordon Hake (1809-1895), a Victorian engaged in trying to raise the status of surgery in this country, poet, made a much cleaner cut between his professional and found time to diversify their surgical works and to produce poetic life than did Erasmus Darwin, for he left physic with occasional poems. The poetic habit of these Elizabethan the definite intention of cultivating the muses about the age surgeons was a fashion which faded away, but no doubt will of 50, after which nearly all his poems were written. be revived in due season. It is seldom that one who starts as a poet takes up medicine Of the various specialties one of the most select is that late in the comparatively life; following examples show aTi of the anaesthetist, and I have personal knowledge of some infinite variety of interests. Thomas Lodge (1558-1625) had who, possibly inspired by their environment and provided with an adventurous career; the son of a Lord Mayor of London, time for meditation while their surgeons are busy, have he went to the Bar, travelled much, was a soldier and sailor cultivated verse. Laryngology, snow such an energetic and too, not to say a freebooter, in the Spanish Main and the successful specialty, has, as indeed is- otly right, contributed O Tr.b,I9251 FIFTY-FIVE YEA-R%S Or TPRSOGRtgS 'IN' SURGERY. tmnC&IJOIUNA 6 its q'u-'ota of song. Men in general practice for'm the bulk I had the good fortune to begini my ife's work' in 1870; of the profession, and,' though not' in the limneliglt, have done whleni tlheree were great advantages in witale3sing' anid takinig their share in keeping up the scholarly and poetical reputation part in the old order of things and bei:ng able at once 'to of their, profession. Some have been mentioned already, and appreciate and participate in the reformnation that came within Df living men it is perhaps invidious to speak, for there are the next few years: of seeing the bihth and growth of the so many, and it is so difficult to keep in touch with all science of bacteriology, the key that unlocked the way to the current poetry; moreover, many hide their talent as if it knowledge of the cause .of so maniy diseases; of taking pait in were a secret vice. tbhe infancy, the adolescence, and the sturdy manhood of it1s -brilliant ofspring antiseptic and aseptic surgery; nd of ha- ing What, then, is the conclusion of the whole mlatter as shown the hononr of making a personal acquaintance with, anid of by experience? The reading of poetry is a help, comfort, and being an ardent disciple of, those two great masters-Pasteur means of culture in our hours of ease and even of disease; and and Lister. To those of my audience who are entering ol their as a hobby the writing of verse is a happy issue for our medical studies to-day, and to any other students who have niot emotions, for there is no greater pleasure than creating some- read them, let me recommend two books, which will not only thing. Surely these are enough to establish the advantages of give you the greatest pleasure to read and carefully study, the cultivation of poetry? More ambitious aims are hardly but which will stimulate you in your careers and afford you likely to tempt us, for it is fairly obvious that, as medicine great examples to live up to. They are: (1) The L;f/e of and poetry are both jealous mistresses, a busy doctor can Pasteur, by his son-in-law, Ren6 Vallery-IRadot, whichl I r.eadt hardly hope ever to be a Tennyson or a Swinburne. when first published in the original, but which I have read a second time, with equal interest, in a very good translationt by Mrs. R. L. Devonshire, with an excellent introduction by my late distinguished friend Professor Osler. (2) The Life o' FIFTY FIVE YEARS OF PROGRESS IN SURGERY.:: Lord Lister, 'by his nephew, the late Sir Rickman Godlee, for BY some time a colleague of mine on the Council of the Royal SIR ARTHUR MAYO-ROBSON, K.B.E., C.B., C.V.O., College of Surgeons, and later President, who was himi-self a D.Sc., F.R.C.S., distinguished surgeon. EMERITUS PROFESSOR OF SURGERY IN LEEDS UNIVERSITY, AND CONSULTING In the early seventies, it was possible to see hospitals ravage"I SURGEON TO THE LEEDS GENERAL INFIRMARY. with hospital gangrene, septicaemia, and pyaemia; wheni aiiy operation, however simple, might, and frequently did, assunme I FEEL it a great honour to have been asked to give the opening oinplications of the most serious import, often ending in death. address of the Medical Department of the Leeds University. For instaice, I actually saw death follow the simple 'tapping as to-day is the fifty-fifth anniversar-y of my entering as a of a hydrocele by an eminent surgeon. Secondary haemor- student, and, with short intervals for post-graduate study at rhage was of frequent occurrence, and it was usually considered home and abroad, it was my privilege to be attached, in one advisable to have tourniquets at hand or even around limbs, capacity or another, to my Alma Mater for over thirty vears ready for the attendants to tighten up when the silk ligatures before making London my centre. It is therefore not an idle were due to separate. Ordinary compound fractures often boast to lay claim to some knowledge, not only of the evolution ended in loss of life or limb or took weeks or months to heal, of the Medical Department, but of the University itself, of and not infrequently ended in shortened or crippled limibs. which I am proud to be one of its early emeritus professors, Erysipelas, pyaemia, septicaemia, and tetanus were never long and to have been considered worthy of the distinetion of absent from surgical wards. Erysipelas was explained by receiving honoris causa the degree of Doctor of Science. Not ehange of weather, tetanus by nerve irritation, tubercle by a tlhe least among the great mercies vouchsafed to me is the diathesis, and rapid deaths from septicaemnia by shock. privilege in my eighth decade of being able to accept your Abdominal diseases were treated expectantly, practically always; kind invitation to come and greet those who remain, alas too and if we refer to the hospital reports of the very few cases few, of my old friends, and to make tlhe acquaintance of those operated on in the large ILondon and provincial hospitals, we new colleagues who are still carrying on the work so w-ell shall see that it was a wise provision that sudl cases were that the *reputation of this great teaching centre is increasing handed over to the physicians by universal consent. Tlhev from year to year. considered the adoption of palliative measures and the making The Dean of the Faculty has, in his kind letter of invitation. of a diagnosis quite adequate, until Nature relieved the victilms practically fixed my subject for me in stating There are now and enabled a confirmation or otherwise of their surmises to very few persons who can, from their actual knowledge, com- he made on the post-mortem table. pare and contrast the nineteenth and twentieth centuries, or Viewed from our present standpoi-rt and our knowledge of even assess th,e causes and influences of the changes which have surgical cleanliness, can we wonder at the state of affairs in thle, occurred." But when I began to consider how impossible se+eventies, and even in the early eighties, when little care was it would be, in the course of an hour, to give any details o' Spent on cleansing the hands and nails of surgeons, assistants, even the greatest discoveries that lhave been made during my and niurses, and none in purifying the skin of the patient; lifetime, or even to describe all the changes that have trans- when peirfunctory washing was supposed to be sufficient for formed our own profession, I felt that it would be necessary the cleansing of instruments and sponges; "when silk ligatures, to limit my remarks to my own sphere of work, whiclh in itself without any preparation, were taken straight from the storage is enough to mark this period as the most wonderful in the cabinet, and often handed to the surgeon by the theatre porter, history of the world. who might at the same time be post-mortern room attendant? On looking back and reviewing the chanres that have takeo Dressinigs were used as they were delivered from the makers. place in the art and science of medicine and surgery since the Clean aind septic cases were operated on indiscriminately in thc. kceys that were to unlock the paths to progress were discovere l. same theatre, and nursed and dressed in adjoining beds. The I am lost in wonder at the perseverance and temerity, the ski. surgeons wore lonig special operating coats, made of firm cloth, and ability of those great men, whose conscientious laboul s which buttoned up to the neck like a military garment, in accomplished so much in the absence of any accurate knowled-go I rder to protect their own clothes, and not as now, sterilizedi of the causes that led to want of success and were the prelude garments, changed for each operation, to guard the patient to successes that some of them lived to see and participate in. from contamination. Among the many distinguished men of our profession of this Entering on my studies in 1870, my qualification to practise asod other countries, whose namiies will be ever remembered, arl -xas obtained in 1874 and the F.R.-C.S. in 1878. Althougl some that we of the Leeds School slhould especially bear i!l engaged in general practice by force of circumstances, 1 niind: the Heys, the Teales, Clifford AIlbutt, Alheelhouse. eceivedr the appointment of demonstrator of anatomy in the Jessop, and McGill, my teachers and later my colleagues and Medical School, later followed by a lectureship. A regular friends. Although, alas! they have passed away, their spir.t fittendance in the wards of the infirmary, and at the weeklv remlains with us to stimulate us to higher endeavours ill consultations on rare or difficult cases, held in the operating, cntinuing the work so well begun. theatre, at whichl thle whole of the surgical staff attendel r and a constant study of everything appertainingz * Addre (abridged) delivered ati the opening of the Medical Depart- aligiously-, ment of the Leeds Infirmary on October lst, 1925. to) surgery, enabled mle to keep abreast of all surgical advances t 664 OCT. 10, T9257 PIFTY-FIVE YEARS OF PROGRESS IN SURGERY, IMZuIo&A!zsu itYKJouauAl

and to attend, as occasion offered, post-graduate work at bitterest opponents. As an ardent disciple, I had the advantage other clinics. of following his work, as to the value of which I had had no doubt from the time I began my surgical studies and became Soon after receiving my- qualification in 1874 I was asked by a medical man if I would go to Glasgow to be present acquainted with the doctrines of Pasteur and Lister. at an operation-amputation of the thigh for kenile gangrene- Even in the early eighties, when I had the honour to be about to be performed on a relation of his, by a general practi- appointed honorary surgeon to the Leeds General Infirmary, tioner. The doctors arrived with two large stone -bottles of and whisky, which was poured into several washhand basins. Into my distinguished predecessor handed me with pride with one were placed the instruments and silk ligatures, into another some .ceremony his operating coat, which he was still using, sponges, and into another dressings, while another served for and which he had used for years; it was covered with soaking the hands of the surgeon and washing the patient's innumerable spots of old clotted blood. I began my work by thigh at the line of amputation. The limb was amputated expeditiously and well; the vessels were ligatured with fine silk, wearing washable garments frequently changed, and when the ligatures being cut short; the face of the stump was well requesting the same for my assistants and nurses the question sponged with pure whisky and the flaps were sutured, the of laundry expenses was - raised. At a later stage, when stump being closed without drainage. Fine towels, wet with initiating the wearing at all my operations of boiled rubber whisky, were placed over the stump so as to make a complete and well padded dressing, which was then bandaged on and sup- gloves, on the advent of aseptic in place of antiseptic surgery, ported by a short splint. The patient made a complete recovery, the complaint of extravagance was even more strongly urged, and the wound healed by first intention. and was only settled, as time wore on, by the results, which Thus I saw my first perfect aseptic-or should it be called compelled their general adoption. antiseptic?-major operation, which made a great impression on During the time that operations were limited in number my mind and served me as an example for many subsequent it was always possible to obtain the services of one of the successes. I have often thought with gratitude of that able qualified residents as anaesthetist; but when, as the result of surgeon and his great skill. During all this time I had the greater success, operative work increased, students without opportunity of doing a fair amount of surgical work, such as any special training were allowed to administer anaesthetics. occurs in general practice, and of obtaining results by anti- This, as will be readily grasped, frequently caused- great anxiety which me as much as it to the surgeon and some danger to the patient. I therefore septic methods, gave pleasure gavo I comfort and safety to my patients, whose gratitude was an brought up the subject at a faculty meeting, and proposed that ample reward. special anaesthetists should be appointed. Two specious argu- The year 1870 was the memorable and tragic year of the ments were raised against my proposal: first, that the cost of Franco-German war, which was not only accompanied by skilled and qualified anaesthetists would be a serious expense, frightful losses on the field, but by even more terrible losses- and secondly, that students could only learn by personal expe. through disease and of the wounded, who were dying in rjence; the result being that my resolution had not a single thousands, whether attended to or not; for of those operated supporter, and was not even seconded. Considering the matter upon by far the greater nLimber died of wound complications. of such great importance, my- only alternative was to ask for It was only at the end of the war that. there occurred to a special meeting of the whole weekly board, which included Alphonse Gu6rin the thought that "The cause of gunshot not only the faculty but the lay members of the board. After infections may perhaps be due to the germs or ferments dis- a full explanation of my views as to our responsibilities and covered by Pasteur to exist in the air." It occurred to him the dangers to life, were the present system continued, it was to filter the air by means of cotton-wool, and he also washed a great relief to me when my resolution was carried without the wounds with carbolic solution or with camphorated alcohol a dissentient vote in a very full meeting; and three anaesthetists before applying the wo6l. This was at the St. Louis Hospital, were appointed without any delay. There are now no fewer from March to June, 1871, in operating on the .wounded of the than nine highly qualified anaesthetists on the staff, which of Commune; and it was thought wonderful that out of 34 patients itself shows that the initial struggle was very necessary. thus treated 19 survived. In 1873 Gu6rin, now a surgeon at A comparison between the reports -of 1870 and 1925 of the the Hotel-Dieu, asked Pasteur to come and see his dressings. Leeds General Infirmary will perhaps illustrate better than any A little later I had the opportunity of visiting that famous other plan what wonderful progress has taken place in fifty- hospital and of seeing the voluminous dressings on the numerous five years, and how many new discoveries have been brought amputations, practically the only operations then performed, into our service in diagnosis and treatment during that interval and of witnessing some successes and many failures; for when of time. the were removed there were far too dressings many sloughing 1870.-Departments, 6. 1925.-Departments, 19. flaps, with spreading gangrene, accompanied by collections of Medical; Surgical; Casualty- Medical; Surgical; Casualty; offensive and even in the mass. There Ophthalmic; Out-patients; anA Out-patients; Ophthalmic-; Patho- pus, maggots, putrid Nursing. logical; Anaesthetic; Ortlio- are, of course, greater dangers than the 'germs from the air paedic; Aural, including ear, -those sponges, and throat, and nose; Gynaecological; conveyed by hands, dressings, instruments, Dental; Venereal; Bacterio- and if precautions a're not taken against them only very logical; Electric and Radio- success can follow. It was not the art of but Therapeutic- X Ray or Radio- imperfect surgery logical; Obstetric; Tutorial; the scieuce that was at fault, for there were brilliant operators Semi-convalescent; and Nursing, in those days, when rapid'ity was a legacy left by the pre- In-patients, 2,548. In-patients, 11,738. anaesthetic times, as.witnessed by the amputation of limbs in Out-patient attendances, 4,302.- Out-patient attendances, 336,462. periods of time marked by seconds. Operations, excluding ophthalmic, Operations, excluding ophthalmic, In Lister's operations, instruments, sponges, and other'articles 271, with 31 deaths=11.9% 6,525, with 255 deaths=4%. used were all taken straight out of strong carbolic solution Ophthalmic operations, 198. Ophthalmic operations, 623. and the same were Abdominal operations, 13, with Abdominal operations, 2,242, with precautions used for the hands of the surgeon 6- deaths=46.1%. 170 deaths=7.5%. and hlis assistants, and a special dressing of carbolic putty, or carbolic resin gauze, was placed immediately over the wound, Abdominal Surgery. under the outer dressings. On taking up mny appointment on the staff of the- infirmary, Although between 1867 and 1869, 34 out of 40 amputations abdominal surgery was practically confined to ovariotomy, of had survived in Lister's wards, his isolated 'voice was not which the mortality was 26.6 per cent. attended to, and not even his celebrated lecture in 1870 on Before beginning my work I thought it would be helpful to " The utility of antiseptics applied to surgical practice" received visit various clinics, from which I returned more than ever the attention it demanded. It is sad to think of the thousands impressed with the importance of strict cleanliness, as shown of young men who perished in the ambulances and hospitals by the work of the late Thomas Keith in Edinburgh, to whom of France in 1870 and 1871, who might have been saved by I owe a great debt of gratitude for his help and encourage- Lister's method. But the heads of the profession in France ment. At first, using antiseptics as advocated by Lister (which, took no interest in the rumours of the success being attained by although they kill the germs, at the same time damage the antiseptic methods; and even in his own country Lister's method tissues), I became more and more impressed with the value of was violently criticized and turned down. This opposition asepsis, or absolute cleanliness, which avoids the introduction continued year after year to my knowleage, and even pursued into wounds of any germs, thus rendering the use of strong Lister when he was appointed surgeon to King's College, poisons, such as carbolic acid, unnecessary. Metchnikoff's London, where some of his colleagues on the staff were his researches, which showed the phagocytic power of the white T }REBRTITws 665 OCT. IO, 1925] 1IFTY-FIVE YEARS OF PROGRESS IN SURGERY. I MWCAL JbUBRN# 665 corpuscles in wounds, enabled the presence of the very few the head of the pancreas, a sequel of chronic pancreatitis, com- organisms in the air to be ignored, if every care was taken by pressing the common bile duct, which in 75 per cent. of the surgeon not to introduce any by hands, instruments, cases is completely enclosed by pancreatic tissue. This at once sponges, or dressings. led me to see that by draining the gall bladder, or, better still, In 1889 I published a list of all my abdominal operatioils by short-circuiting it into the duodenum, an operation knowni from the time of beginning my work in the infirmary. This as cholecystenterostomy, another route for the bile would be paper was read at the meeting of the British Medical Associa- formed and the jaundice would be cured. My first operation of tion in Leeds in August, 1889.1 cholecystenterostomy, and the first in England, was successfully There were 61 ovariotomies with only two deaths, equal to performed in the infirmary in March, 1889, and the patient was 3.2 per cent.; 12 cases of cholecystotomy for gall stonies and 1 of seen quite well nine years later. A small decalcified bone cholecystenterostomy without a death; 28 cases of radical cure bobbin which, in various sizes, I had invented for intestinal of hernia, 6 cases of pelvic abscess, 5 cases of tuberculouis peritonitis, and 2 cases of hydatid of liver, all without a death; anastomosis, was employed, though in later cases I used simple 30 cases of strangiulated hernlaawith 5 deaths, all from gangrena- sutures with equal success. or rupture of the intestine, but none from wound complications; The successful results of operation in several cases of deep 14 cases of operation for myoma of uterus, including hysterectomy, jaundice associated with distended gall bladder confirmed my with 3 deaths; and 15 operations for malignant disease too exten- sive for removal, and cases of general peritonitis from ruptured suspicion of chronic pancreatitis being the cause, but it was not viscera, with 9 deaths. until April 1st, 1892, that the opportunity of verifying the This list serves to illustrate the great advances that had beeni pathology occurred. Other observations in the pathology of made in abdominal surgery up to 1889. the living; led to an explanation of the apparent cure of a On June 21st, 1884, I performed my first operation for gall number of cases of diabetes by the removal of gall stones fronm stones, and began to devote special attention to diseases of the the oommon duct, where they had produced irritation of the gall bladder and bile ducts. pancreas and interstitial pancreatitis, leading to interference After an experience of nearly with the glycogenic function of the islands of Langerhans in 200 operations for gall stones, in the absence of malignant of disease, profound jaundice, or infective cholangitis, with the the substance of the pancreas, which function the researchles loss of only a single patient, and even if the complications Korte, Oser, and Opie had previously discovered. The recenit above mentioned be inclu'ded, with a mortality of only 2.7 per and remarkable discovery of insulin shows the value of the cent., I decided to give my experience in book foirn, under elaborate researches on the islands of Langerhans that were made by Korte, Oser, and Opie so many years ago. the title of Diseases of the Gall Bladder and Bile Duct, in including gall stones, which was published in June, 1897. As After the accumulation of considerable experience opera- tions on the pancreas, I had the honour in 1904 of beinig showingf the extension of this branch of surgery there were no for the third time Hunterian Professor at the fewer than 205 operations on the gall bladder and appointed Royal ducts as the of lectures " The performed in the infirmary last year, as given by the report College of Surgeons, taking subject my pathology and surgery of certain diseases of the pancreas." for 1925. with The surgery of the stomacb, pylorus, and duodenum next These wvere subsequently published, along numerous addi- tions, in a work entitled Diseases of the Pancreas and th-1ir formed a very interesting and new field of work, in a class of Surgical Trcatment, in which I again had the collaboration of cases treated before the reformation of surgery entirely by the Mr. whole physiciin, with only moderate and usually temporary relief. my colleague Berkeley Moynihan. During thle time of my work on the pancreas I had had the valuable help, in The success of surgical treatment, which enabled the stomach various chemical and questions to be accurately examined in the living subject, added enor- pathological oonstantly arising, of my friend Dr. P. J. Cammidge; in 1907 we published a mously to our knowledge of the pathology, and enabled us work with the of the to put in practice a number of new operations or more efficient together, dealing largely pathology modifications of older ones. After an experience of over pancreas. I must apologize tor occupying so much time with my personal 200 gastric operations, I was again elected Hunterian Professor experiences in the progress of the surgery of the gall bladdei at the Royal College of Surgeons in 1900, and took as. my and bile of the and and for the lectures Diseases of the ducts; stomach, pylorus, duodenum; subject Stomach and their of the pancreas-subjects that I have been so much interested Surgical Treatment. As no work on gastric surgery had been in. of the advances that published, and as They are, however, only part lhave much new and original material had accumnu- been made in abdominal surgery in our time. Witness the lated for the purpose, I decided to write a work having the operation for appendicitis, which in my early professional career same title as the Hunterian Lectures, on which in fact it was was the cause of death in cases chronicled acute based. many periton- I was fortunate in securing the help and collaboration itis or typhlitis, and in which the true cause was not recognized of my colleague and former house-surgeon, Mr. Berkeley even on the table. first of hundred Moynihan, now your post-mortem My many distinguished Professor of Surgery, Sir operations was on June 8th, 1891, and to mark the progress anid Berkeley AMoynihan, Bt., whose brilliant career has been a success of surgical treatment it is only necessary to refer to the source of great pride to us all, and to me especially, since we infirmary reports for 1885 and 1925; in the former appendicitis were intimately associated when he was appointed assistant is not even whereas in the latter 788 operations are surgeon to the first mentioned, infirmary. Our edition was published in recorded, with a mortality of only 3 per cent. Of intestinal 1901, and a second edition in June, 1904, when we were able surgery there was mentioned only one operation in 1870, to report an experience of 218 posterior gastro-enterostomies in whereas in 1925 there were 180. Of renal and ureteral surgery simple diseases of the stomach, with a mortality of 3.2 per cent., there is no recorded case in 1870, but 85 operations are reported a great contrast with the year 1885, when the mortality from in 1925. Of splenic surgery and hepatic surgery there is r o all sources was 65.71 per cent., whereas in 1890 it was 47 per mention in 1870, but 6 of the former and 9 of the latter in cent. and in 1900 35.4 per cent. As showing the growing 1925. In extrauterine gestation, a rapidly fatal disease, opera- importance of surgical treatment in diseases of the stomach tion was unknown before Lawson Tait's first case in 1883, and duodenum, there were no fewer than 334 gastric operations followed by many others. In 1898, in my valedictory address performied in the infirmary in 1924, whereas only 2 were per- at the termination of my office as president of the London formed in 1884, both of which ended fatally. Gynaeoological Society, I reported 23 operatiois.- with cne deatlh My work on the gall bladder and bile ducts frequently com- from pulmonary embolism. These statistics prove the advanjces pelled me to have to manipulate and carefully examine the between 1870 and 1925. pancreas, an organ which the surgeon (with the few exceptions of obvious cystic tumours or acute pancreatitis) had had little Brain Surgery. experience in. This new method of learning pathology from the In 1874, when attending a course of lectures on mental living subject led me to recognize the frequency of chronic diseases at the Wakefield Asylum, given by Dr. (now Sir) pancreatitis. both as a concomitant of gall stones and as a James Crichton-Browne, I had the privilege of witnessing separate and distinct disease; the cause being the invasion of demonstrations on the localization of the functions of the the ducts and the infection of the gland by the colon bacillus. brain, given by Dr. (now my distinguished friend Sir) David This led to the suspicion that many cases of obstructive Ferrier, whose remarkable discoveries, along with those of Dr. jaundice hitherto diagnoAqd as cancer of the head of the Hughllings Jackson, rendered possible the subsequent brilliant pancreas, whichl ended fatally, were not cancer, but cirrlhosis of wxork of the late lamented Sir Victor Horsley, who gave his 1 BRITISH MEDICAL JOURNAL, 1889, ii, p. 1213. life for his couintry in the great war. TErz Drmsm 866 OcT. so, !9251 ?IFTY-FIVE YEARS OF PROGRESS IN SURGERY. IMEDICAL JOURtNAL

The descriptions of the evacuation of localized abscesses of bone injuries and diseases; in the discovery of calculi in the the brain, of the treatment of Jacksonian epilepsy, of the kidneys and ureters as well as in the pancreas and bile removal of cerebral tumours, of the extraction of bullets and passages; in the localization of foreign bodies in the heart, other foreign bodies, and of many other operations, would the lungs, the oesophagus, the stomach, the intestines, and in sound like a romance did time permit of a description. These various parts of the body; in the diagnosis of diseases of the operations, many of which I have been privileged to perform stomach and intestines by observing the passage of bismuth both in civil practice and during the war, especially in the test meals; in observing the size and pulsations of the heart, Dardanelles campaign, are among the great advances during and in many other ways, both for diagnosis and treatment, the past fifty years. that there is now in every well equipped hospital an x-ray The surgery of the spinal cord and of the nerves, all rendered department, in which much valuable work is being carried out possible by researches in anatomy and by Listerian methods, by experts in this new branch of medical practice. would need a volume to record, and during the war these improvements in treatment have been of infinite service. Pasteur's Influence on Medicine. The influence of Pasteur's work in medicine has been no Fractures. less than Lister's work in surgery; for the germ theory of The treatment of simple fractures, some by wiring the bones, .disease has led to a knowledge of the causes of the various from 'the first cases of fracture of the patella wired by 'Lister infective and many other' diseases, and by means of vaccination to the more frequent wiring of other bones by my friend Sir or protective inoculations to the prevention or relief or cure Arbuthnot Lane, and the innumerable cases of compound of many of them; for instance, tetanus, diphtheria,, typhoid fracture, especially of the femur, treated by Thomas's splints fever, cholera, spienic fever, malignant pustule, hydrophobia, and other special appliances, and with an infinite care in staphylococcal diseases, such as boils, carbuncle, osteomyelitis, dressings, have completely revolutionized this branch of surgery, and acne; and some of the streptococcal infections. In the leading to the saving, during the war, of many thousands of war many thousands of lives were saved by the preventive lives and limbs that must otherwise have been lost. injections of antityphoid serum, with which we were all The enormous amount of valuable orthopaedic work done inoculated before going out to the front, and by the injection during and after the war in the various war hospitals, chiefly of antitetanic serum into every wounded soldier on the battle. under the directioa o-f that master of orthopaedic surgery, Sir field before reaching the casualty clearing station. Robert Jones, has resulted in a great saving of deformities In obstetric medicine the influence of Pasteur's teaching, and among wounded soldiers. The inmportance of orthopaedics in his bold exposure of the carrying of puerperal infection by the civil life is shown by the valuable work of the orthopaedic direct conveyance of germs through dirty hands, instruments, department in the Leeds Infirmary, in which no fewer than and dressings of those attending the lying-in woman, brought 910 operations are recorded in 1924.' about such a change in the death rate as to appear almost Surgery of the Prostate. miraculous. The saving of life has been almost as great as that about the antiseptic system in surgery. Puerperal The operation of prostatectomy initiated and carried to per. brought by that terror of the lying-in woman, has been practically fection (as shown by specimens in the museum of this Medical fever, abolished. For instanlce, in the maternity department of the School) by my late colleague and friend, Arthur Fergusson Leeds during 1900 there were 547 women delivered McGill, one of the surgeons to the infirmary, whom to know was Infirmary to love, has been of infinite' service in prolonging life and without a single maternal death. Of Pasteur's other discoveries and victories there is no adding to the comfort of thousands of elderly men, the many time to but I ask audience, Was there ever such a remainder of whose lives would otherwise have been one of speak, my not to his country, but to humanity in general torment and sorrow. Had that great surgeon been spared to benefactor, only and to the world at large? His life rings with the spirit of work for a few- more years, I feel sure that' his skill as a service. surgeon and his original and fertile mind would have been of still greater service to the profession and to mankind generally. Cancer. It seemed to some of us very hard that the reward of his On December lst, 1904, I had the honour of being appointed labours should have- fallen to others; but fortunately the opera- bv the Council of the Royal College of Surgeons to give the tion was taken up later, where he left it, by the late Sir Peter Bradshaw Lecture. My subject was " Cancer and its treat- Freyer, in whose able hands it was carried out so successfully ment." Although acknowledging that we really know nothing that in 1912 he reported in the BRITISH MEDICAL JOURNAL of the true cause of cancer, I ventured to disagree with the 1,000 operations of complete prostatectomy. conclusion of the- superintendent of the Imperial Cancer Research Fund, that " it is not permissible to seek for the Surgery of the Heart and Lungs: The X Rays. causative factor outside the life processes of the cells," and The' idea that wounds of the heart are necessarily fatal was suggested' that the cause might be found in some of the ultra- exploded some years ago, when J amain collected 121 cases, microscopic organisms that are known to be the causes of of which 16 recovered. Tapping the pericardium for serous various diseases, such as nieasles, scarlet fever, small-pox, and' effusion and draining it for pus have been frequently performed. cerebro-spinal meningitis. The experiences of the war, in the repair of heart injuries The' wonderful work of Dr. Gye and Mr. Barnard, F.R.S., after lullet wounds and in the removal of bullets, have added recently published, seems to point to the possibility of t-heir considerably to our knowledge of cardiac surgery, and a number having discovered a filter-passing organism which they believe, of cases have been recorded in which wounds of the heart have as the result of much careful experiment, to be the real cause been sutured. In 1911 I reported two cases in which, after of cancer. The epoch-making discovery in microscopy that, by removing tumours of the chest wall, I had to excise consider- using the short rays of the violet end of the spectrum or the able portions of the pericardium, and in which the gaps in the x rays to illuminiate the object and a specially constructed pericardial wall were successfully closed by flaps taken from microscope, the filter-passing organisms can now be seen, may be the pectoral muscle. the key that is to unlock another pathological problem; as not Pulmonary surgery was one of the great triumphs of the only may we be able to see and possibly isolate the various surgery of the great war, and many lives that must otherwise filter-passing germs, which are no longer ultramicroscopic, but have been lost were saved in the casualty clearing stations in to isolate the cancer germ itself, and if so the possibility of France, where I saw cases treated by the radical method of finding a vaccine or serum as a preventive or cure of the removing or bending back one of the ribs, freely incising the disease. It is reasonable, therefore, to believe that successful pleura so that the hand could be passed within the chest to draw treatment may be, withlin a not far distant period, an accom- out the injured lung, in order to arrest bleeding, remove bullets, plished fact. This would indeed be a triumph of discovery to is and stitch up wounds in the lung. After washing out the the credit of this half-century. discovery

was let us that, pleural cavity the lung returned, the pleura was sutured, completely established forget by early and the outer wound closed. These and other operations on diagnosis and the complete removal growth along the luings and pleural cavities have paved the way to the more the nearest chain of lymphatics and glands, frequently radical treatment of many chest cases in civil practice. a curable disease, as I know from my personal experience The wonderful discovery of the x rays by Roentgen has in a large number of operations, in proved of so much value in the diagnosis of fractures and other there has been no return over a period years- OCT. Io, I925] OCT.THE MEDICAL CAREER. L Tar, BAsL 667 10, I9251 tAf~~~~~~~~~~~~~~~~~~~~~~~~~~E-DICAL.JorRssL following the example of his great Conclusion. matter, realized that he was In the time at my disposal I have tried to show the immense master. progress that has taken place in surgery during the past half- During their final year students would do well to devote century. I have also tried to show what a close connexion their attention to special departments, particularly those for exists between the science and art of our profession, and how diseases of the eye, ear, and throat. These important, branches very necessary it is, if we are to continue our march of progress, of surgery were usually neglected by students, to the detriment that experimental research should not only be untrammelled by of their patients later on. If every surgical examination p'aper factions and unreasoning opposition, but that it should receive contained a question on diseases of the eye, ear, and throat, greater recognition, encouragement, and support at the hands these important subjects would no longer remain in their present of the public. An even closer alliance between the physician, oomparative obscurity. Immediately after qualification and the surgeon, the pathologist, the bacteriologist, and the physicist registration, the young medical man or woman would do well to is desirable, as the time is coming when preventive measures, join one of the medical defence societies. The majority of some of which I have portrayed, will save much operative work, patients were grateful and appreciative, but now and again one and when it will be thought a greater triumph to prevent than was found who was cantankerous and litigious, and such a one to cure disease. had no difficulty in discovering a solicitor to encourage him. It is quite evident that methods which were considered The newly qualified doctor would also do well to obtain a sufficient years ago are totally inadequate to-day. We may resident appointment as house-surgeon or house-physician modify but we cannot prevent the world's advance; and while (preferably both). It was impossible to overestimate the value times change men change with them. The me'dical profession of such a post. He had never known anyone consider as wasted is imbued with a spirit that half a century ago was undreamed the time spent in holding resident hospital appointments. After of. Not only have apparently insurmountable difficulties been a profitable year as a hospital resident, the young medical man overcome, but habits of thought have been attained which have or woman would be well advised, circumstances permitting, to made such achievements possible, and a scientific attitude of study abroad for at least one session. Foreign study widened mind has become characteristic of our profession, as it has of a man's mental outlook and helped him to get rid of many of the leaders in every branch of the world's progress. the faults of insularity. It was an enormous advantage to a practitioner to have a sound knowledge of French and German -languages so important for scientific medicine. The purpose of some of those he addressed would, no doubt, THE MEDICAL CAREER: PREPARATION AND be a specialist career, but the large majority would be content EQUIPMENT. with the role of general practitioner. In the speaker's opinion a really good general practitioner represented the highest ADDRESS BY SIR HERBERT WATERHOUSE AT development of the profession. It was comparatively easy to CHARING CROSS HOSPITAL. know practically all there was to be known about one branch of THu, prize distribution at Charing Cross Hospital Medical medicine; it was far more difficult to know-as some first-rate School took place on October 5th, when Sir Herbert general practitioners of his acquaintance did know-almost as Waterhouse, M.D., F.R.C.S. (consulting surgeon to the much about every branch. Of the general practitioner three hospital), gave an address. great things were required. The first was a thorough know- ledge of medicine in all its branches. The second was the The dean of the school (Dr. W. J. Fenton) mentioned in his faculty of inspiring confidence in a patient, and in this con- report that, although a decline in the number of students nexion he urged practitioners not to be too chatty with their entering had been anticipated, there was practically no diminu- patients; they might find themselves contradicting at one tion. The students and post-graduates now in the school visit what they had said unwittingly when they visited the numbered 150, and 13 men and 19 women had qualified during patient before. " If you are certain of your ground, speak but the past year. The post-graduate class had been attended with little; if you are not certain, speak less." The third qualifica- marked success, and it was hoped to extend this work very tion was sympathy, which must never degenerate into senti- considerably. mentalism such as he had heard in consultation at some bed- Sir HERBERT WATERHOUSE, after a reference to his own long sides. Sympathy in the practitioner was an invaluable, indeed association with Charing Cross, remarked that it was a pleasant an essential, thing, but it must be blended with firmness and fact that in the study of medicine each succeeding year was decision. less of a drudgery and more interesting than the year before. During the earlier years the study of anatomy might be found The annual dinner of past and present students of Charing wearisome, and dissecting somewhat unpleasant, but this Cross Hospital Medical School took place on October 5th at the foundation of professional knowledge must not be neglected, Adelaide Gallery (Gatti's Restaurant), and was well attended; for a good knowledge of anatomy could only be acquired in the Dr. W. J. Fenton was in the chair. The only toast of the dissecting room, and surgery, as one of his old teachers used to evening was " Our most illustrious doctor, His Majesty the say, was only common-sense applied to anatomy. With regard King," which was duly honoured. There were no speeches, to lectures, he could not hold the view, popular in some but several anecdotes and fisherman's yarns were told. During quarters, that they were useless, although in his own student the evening Mr. John Goss, with the Cathedral Quartette, gave days he thought them more numerous than was necessary. He a selection of songs, and Mr. Hubert J. Foss accompanied on advised students to keep their reading always a few days ahead the piano. of their lectures so as more intelligently to assimilate the latter. It was only when a start was made on clinical work in the hospital, however, that the real fascination of the study of MEDICINE AS A CAREER FOR WOMEN. medicine began to be appreciated. It was a good plan for each student to choose his or her own physician and surgeon and ADDRESS BY SIR CHARLES SHERRINGTON AT attend the man so chosen in all his visits to the hospital. The THE LONDON SCHOOL. student who flitted from one clinical teacher to another would Tim inaugural address at the London (Royal Free Hospital) doubtless learn much of value, but he would not see the same School of Medicine for Women was delivered on October 1st cases treated throughout the whole of their stay in, hospital, and by Sir Charles Sherrington, O.M., President of the Royal he would not acquire the same personal knowledge of disease The dean of the Dame Louisa Aldrich- and its treatment as he would by the adoption of the other Society. school, plan. If a student was constant in his attendance upon the Blake, presided. visits of his chosen teacher he would insensibly follow that Sir CHABLES SHERRINGTON said that he imagined that in this teacher in his mental processes, and would find himself doing, particular school, whatever might be the case in any other, all almost instinctively, what the teacher himself was likely to do the students desired to enter the profession of medicine for no in similar circumstances. The speaker had had the good other reason than that medicine really appealed to them. That fortune to be house-surgeon to the late Sir William Macewen. in itself was a pledge of enthusiasm, and no small asset to For six months he studied his great intellect as closely and student and teacher alike. In the nature of things there were devotedly as he was able, and in later years he often found not BO many callings open to women as to men, but medicine himself doing somethjing i*tieinctively, and, on pondering the at least- offered to women the opportunity of earninlg their 668 OCT. 10, T925] MEDICINE AS A CAREER FOR WOMEN. [TTnF flRTTTSM living. The average annual earnings of medical practitioners Women seemed to be specially. fitted for team work. He had been estimated at between £500 and £600, a low figure, deprecated anything which would interfere with the freest but not a discouraging one in the present era of national co-operation between women annd men. Women and men, economy and fortitude, and a figure which applied equally to working together, eked out and amplified each other's powers. women and to men. General practice represented the main The superimposed polrtraits (on the Galton principle) of men and path of the profession, but there were other far from negligible women doctors might yield a composite prophetic picture of the ServicCs, such as consulting and specialist work, the medical ideal physiognomy of the profession. Women a?Id men were branches of Government departments, and municipal and county not wholly unlike. There was something of man in woman, posts, and all these fields also had been entered by women. and something of woman in man. The existence of that school But it was as true of women as of men that they did not live and its success showed that woman's rightful place in medicine by bread alone. Medicine lhad been termed, with some Justice, was won, not by aiming at the possession of man's particular a poor trade hut a noble profession. One of the things which qualities, but by applying to medical work her own womanly made it attractive was that it was not only an honourable art, nature. It seemed to him regrettable that the London County but a progressive science. Among the callings which were Council should have made a regulation that married medical informed by progressive science it stood almost alone in its women were ineligible for medical officerships. It had been availability for women. Engineering depended upon a science estimated that 30 per cent. of medical womeln married, though perhaps equally progressive, but engineering was hardly a field the figures for former students of 'that schlool were higher than in which women in any num-ber could enter. The woman who that. The fact that women should enter anid practise medicine yearned to be in the mid-current of progress, and to feel and freely was only another evidence of a progressive profession. understand and further that progress, could rest assured that Those who went first along any path found it more lonely medicine would give her the opportunity in the fullest and most and difficult than those who followed after, and the school did satisfying ways. He instanced some of the outstanding achieve- well to remember with pious honour those who had led the way. ments of medicine within a period much shorter than that All new social adaptations came slowly. Reform was not, as covered by living memory: for example, the control of many Rousseau thought, a simple return to nature. Perhaps, like infectious diseases in the sense of disentangling the hold of the the ancients, he was of opinion that we were descended from the particular infective agent, the progress made in the relatively gods. But after him came Darwin. The speaker, as a mere new subject of serology, the turning of the position with regard man, had had many reminders of mental kinship to primitive to deficiency diseases (in which victorious campaign women had forebears. When he kept chimpanzees in his laboratory he wvas borne a conspicuous share), the recent research in cancer, the accustomed to visit them every day, and on one occasion, after discovery of insulin-these and other modern instances, selected leaving the room and locking the door7 it occurred to him to at random, were well calculated to justify enthusiasm for turn back and see what the chimpanzees were doing immediately medicine. after his departure. Hee stooped and looked through the It was difficult (Sir Charles Sherrington continued) for the keyhole, and on the other side of the keyhole was the eye of student to find time for all he had to learn. The introductory a chimpanzee ! sciences had perforce to be curtailed because they were intro- " The convincing logic of your case stands plain to me," ductory, and economy of time was obtained by getting as much Sir Charles Sherrington concluded. " One of the things this as possible of the introductory science done in the ordinary school has proved is that women are well able to fulfil the school years; and this was the more advisable because the expanding social duties that send them forth. Every case of science subjects were to-day really essential to general educa- sickness is not only a problem for medical science and art, tion. He wished there could be found in the curriculum a but the suffering of a fellow creature, and women at least will place for teaching the principles of scientific psychology, for not forget that. There is a story of a man who, after being a grounding in the modern study of this subject was a great refused by a lady, entered a medical career to harden his help in a professionxal career. With regard to the sciences heart! But it is wholly a mistake that medical routine tends which came later in the curriculum, these must all be regarded to blunt the feelings. Egotism may harden the heart, but as a part of medicine itself. Differentia.ted as they necessarily knowledge never. Medicine enhances compassion and instru- were, and dealt with by separate specialist teachers, they were ments it. Pure science, it is true, is intellectual and abstract, essentially one. The mnore that histology, anatomy, physiology, like mathematics, but at the bedside the case is always concrete. biochemistry, bacteriology, and pathology were all made to over- Science teaches humility, and humility is close to sympathy. lap and integrate, the better would all and each of them be Sympathy armed with understanding is surely what medical grasped. women stand for. I would assure those who by reason of their Mledicine had two aspects-that of a science and that of an enthusiasm for medicine enter upon it in this school that their art. At their extremes the science and the art were clearly ernthusiasm is well founded." distinct, but in the middle region they were scarcely to be separated. As to what science was and what art was, he would take refuge in saying that all definitions were difficult and all HOSPITAL. comparisons odious. But he had seen such a thing as bandaging ST. BARTHlOLOMEW'S in some hands an art and not a science, in some an art and a science both, in others a science but not an art. Science ANNUAL DINNER. had laws which were quite unbreakable, hence Bateson's wise THz annual old students' dinner of St. Bartholomew's advice, " Cherish your exceptions," for in nature every seemiag Hospital was held this year again in the Great Hall of the exception was but obedience to another law. Art, on the other haspital, and the chairman, Mr. JoHN ADAMS, F.R.C.S., hand, had laws which changed. The laws of the Romantic wvas supported by a large and distinguished gathering. school of yesterday were not those of the Classic school of the After the health of the King, its patron, had been honoured, day before. Hence the stability of medicine, which had become the toast of " Prosperity to St. Bartholomew's Hospital " was scientific. Fashions in bandaging might change, the, principle proposed by the chairman, who remarked that no hospital in, of asepsis always remained. But the point was that science the world had such traditions as theirs, which dated back more an(I art dovetailed in medicine. It was a mistake to suppose than 800 years. In the absence through illness of the treasurer, that the division between science and art in medicine corre- Lord Stanmore, the toast was responded to by Sir William sponded to the division between the laboratory and the ward. Lawrence, Bt., senior almoner. He said that the preliminary Scienice could enter into the handling, of a case in the ward or task of the reconstruction committee was well in hand; plans in the out-patienit department just as much as into laboratory and sketches had been drawn up, and these would be submitted observation. In medicine the clinical and the laboratory studies soon to a court of governors. The plans for the rebuilding of each supported and fructified the other. The laboratory and the the hospital provided for more than 700 beds on the present site, cliinic each put its question in its own way to the problem and for a paying patients' block with upwards of 80 beds. before it, each knew its own laws, the tactics of each were The historic Great Hall, so dear to the hearts of them all, independently pursued, but the problem was common to booth. would be left undisturbed, and in the reconstruction of the Team work was the happy and proper counterpoise to the hiospital the future development of its medical college had not been forgotten, for the greatest asset of Bart's was its old students. In proposing from the chair " Prosperity to the comlpetitionofworkscientificthsatbuiltwhichmedicinethewascathedralsitsolargelywvasrearingoftheaformersomethingrulenotoflessage,life.glorious.andItinlwasthisteamday Aledical College," Mr. John Adams spoke of the splendid OCT. TO, I9251 OPENING OF THE WINTER SESSION. TDI JBam 669 record of the school from generation to generation, and of the very gratifying attendance at the post-graduate course held greait progress made since he entered in October, 1868. The during the previous week-end. One of the advantages possessed school then numbered 223 students; this year there were 700, by the hospital was the relatively great possibility of medical and of these 80 per cent. were taking university courses. students obtaining house appointments. The chairman's health Recent honours conferred on St. Bartholomew's men were Sir was proposed by Dr. R. H. Miller in a witty speech. Thomas Horder's K.C.V.O. ; the well merited knighthood cf Mr James Berry; Sir Humphry Rolleston's appointment to the Regius Chair of Physic at Cambridge; and Professor Lovatt Evans's election as F.R.S. Mr. McAdam Eccles, in responding LONDON HOSPITAL. to the toast, said how glad they all were that this should be proposed by John Adams, a beloved old student and still a Bart's man. The departments of Physics, Physiology, and OLD STUDENTS' DINNER. Pharnmacology were now established in the new building on the THE annual dinner of the old students of the London other side of Giltspur Street, but Anatomy still awaited better Hospital was held on October 1st at the Trocadeiro quarters. The staff now included four professors of the Restaurant. The chair was taken by Sir Hugh Rigby, University of London, and he looked forward to seeing these K.C.V.O., senior surgeon to the hospital, and nearly 200 chairs endowed for research. Lastly, he mentioned the work old students were present. The chairman congratulated of the deep x-ray therapy department, second to none in the the hospital on its 'great and increasing prosperity. He country, -and the aid given in this and other directions by the said that the school showed no signs of " birth control," plhysicist to the hospital, Professor Hopwood. The health of and though labour might sometimes be difficult her sons the guests was submitted by Sir Anthony Bowlby, Bt., who were more numerous than ever, and as devoted as ever to said of the representatives of the governing body that, like the mother who gave them birth. Financially, thanks to their predecessors, they loyally co-operated with the staff in all the wizard hand of Lord Knutsford, the hospital had never work for the hospital and college. He welcomed the presence been more prosperous, and the appreciation which laymen of the medical heads of the three Services-Lieut.-General Sir felt for its work was well illustrated by the generous gifts William Leishman, D.G.A.M.S. (the first who had ever climbed of £10,000 each from Lord Bearsted and Mr. Barron for a to the top of the tree through his purely professional work), clinical theatre and a pathological laboratory respectively, Surgeon Vice-Admiral Joseph Chambers, Medical Director- as well as by the latest gift of £50,000 from an anonymous General R.N., and Air Commodore David Munro, R.A.F. donor for research. With the development of the Medical Another guest, Sir Archibald Garrod, though one of themselves, Unit, of the system of annexe hospitals, and of changes in was present that evening as Regius Professor of Medicine at the organization of the receiving room and the out-patient Oxford. Sir John Bland-Sutton, Bt., in reply, recalled some department, many old traditions were passing away, but personal associations with Bart's: his deep affection and regard he hoped that nothing would ever be done to disturb the for the memory of Sir James Paget, his honorary membership responsibility with which the residents were entrusted, to of the Abernethian Society, his appreciation of the help given which they so largely owed the splendid type of practitioner to him on the Council of the Royal College of Surgeons by whom everyone associated with the hall-mark of the London Bart's men, notably by his predecessor in the presidential thair, Hospital. Team work was the great demand of the present Sir Anthony Bowlby, and his long friendship with John Adams. day, but nowhere could be found a more united or a more The last toast, received with great enthusiasm, was that of devoted team than the past and present students of the " The Chairman," proposed by Dr. W. Langdon Brown, who hospital which he and his audience were proud to own as described John Adams as the youngest of old students, and one their mother. who, amid all the pressure of a long life of busy general practice, had found time for scientific work and study. After a few words in warm acknowledgement from the chairman the WESTMINSTER HOSPITAL. company broke up, to meet again in the library for coffee and gossip. AT the opening meeting, on October 1st, of the session of the Westminster Hospital Medical School, after the intro- ductory address, of which a report appeared in our last ST. MARY'S HOSPITAL. issue (p. 623), a memorial tablet was unveiled by Professor E. A. Gardner, Litt.D., Vice-Chancellor of the University of ANNUAL DINNER. London, in the pathological laboratories to record the gift of £20,000 by Mr. A. J. H. Carlill for the promotion of THF, annual dinner of St. Mary's Hospital Medical School pathological research. The dean, Dr. A. S. Woodwark, in was held on October 5th, at the Connaught Rooms, Great his annual report, drew attention to the fact that in the Queen Street, the chair being taken by Mr. Leslie Paton. final medical examination an average of 80 per cent. of In proposing the toast of " St. Mary's Hospital Medical the students had been successful, as compared with ail School " the chairman quoted Ecclesiasticus on the value of average of 52 per cent. for all the London hospitals. The music combined with good wine and brevity of speech. He various societies and clubs were flourishing, and there was paid a sympathetic tribute to the memory of Sir Anderson inow a possibility of obtaining a sports ground. The hospital Critchett, and spoke of his kindliness of heart and great power had been the first to start a post-graduate and Fellowship of inspiring co-operation. Of the three functions of a teaching of Medicine class, which had proved so successful that the hospital-namely, the care of the sick, research, and its teaching experiment was being repeated. A course had also been function-the last was perhaps the greatest, since it resulted in arranged for officers of the Royal Army Medical Corps, the spirit of the hospital being reflected throughout the world. and the War Office had asked that this should be continued If the teaching was well done the remaining two functions of twice a year. thl; hospital -would be similarly successful. St. Mary's had The annual dinner of past and present students was held always enjoyed a great reputation as a teaching hospital. In in the evening, with Dr. H. B. Brackenbury in the chair. reply to the toast Mr. A. R. Prideaux, chairman of the hospital The proceedings were described by the chairman as being board, referred to the financial position of the hospital, and " not prosy, but convivial," and the meeting represented to illustrate the enthusiasm inspired by a great hospital he a family gathering of those who were always proud to call related how Mr. Ottley, the late assistant engineer, had left thlemselves students of the hospital. Dr. Charles Roper, £1,200 to the hospital, the greater part of his estate, although respolnding to the toast of " Westminster Hospital students he had received a salary of no more than £3 to £4 a week. The past anid present," remarked on the gratifying increase in x-ray department was now complete and in good working order; tho percentage of old Westminster studenits oni tlhe staff of deep therapy and heliotherapy for children could now be pro- tlle hospital, and indulged in various remiiiniscences of old vided on the most modern lires. Within the next few days the times; Mr. R. G. Hodges replied for present students. hospital's wireless installation would be complete, thanks to These speeches were appropriately followed by a mixture of the readers of the Daily News. Dr. C. M. Wilson, dean of melodies popular twenity-five years ugo with familiar tunes the medical school, also replied to the toast. He mentioned thle of the present day.