PHILIP SYNG PHYSICK’S LAST MAJOR OPERATION

By ALEXANDER RANDALL, M.D., F.A.C.S.

PHILADELPHIA

T IS hardly necessary to present a for the Penn Family and custodian of biographic sketch of Philip Syng their estates. Dr. Physick took his med­ Physick. It has been performed so ical degree at Edinburgh, after study­ ably on many previous occasions ing under John Hunter in London and Ithat the man, worthy to be known havingto Jenner as one of his fellow stu­ posterity as the Father of American dents, and returned to take up his prac­ Surgery, gazes at us from a picture tice in Philadelphia in September, drawn by those who knew him, who 1792, establishing an office in Mulberry saw him in life, watched his work and Street, near Third. His son-in-law, personally received their life’s inspira­ Jacob Randolph, describes him as tion from actual contact with his per­ ... of a medium height; his counte­ sonality. From cold historical facts we nance was noble and expressive; he had a know him as the first full Professor of large Roman nose; his mouth was beauti­ Surgery at the University of Pennsyl­ fully formed, the lip somewhat thin, and vania; and though Wistar and Shippen he had a high forehead and a fine hazel preceded him in that chair, they each eye, which was keen and penetrating. His contaminated the role by being, at the personal appearance was commanding in same time. Professor of Anatomy and of the extreme. The expression of his coun­ Midwifery. Elected to the honor in tenance was grave and dignified, yet often 1805, by the pressure of student de­ inclined to melancholy, more especially mand, to whom he had lectured for four when he was engaged in deep thought, or years, at their earnest request and solici­ in performing an important and critical operation. tation, Dr. Physick held the rank with honor and increasing fame for thirteen Dr. Physick never enjoyed robust years, relinquishing it in 1819 during a health. In infancy he suffered so severe pseudo-political intrigue, and in its a reaction from his inoculation for place took over the Chair of Anatomy. smallpox that his life was despaired of. To this he gave his devoted attention In England, while working at St. and rare gift of teaching until 1831, George’s Hospital, he was again des­ when declining health forced his resig­ perately ill, and Dr. Hunter was greatly nation, and he was made Emeritus Pro­ alarmed about the health of his favorite fessor of Surgery and Anatomy. American student. In the yellow fever From a personal point of view we epidemic in Philadelphia, in 1793, he know him as having been born at a contracted the disease while working house on Arch Street, near Third, on among the destitute in the fever hos­ July 7, 1768, the son of Edward Physick, pital at Bush Hill; and he often said an Englishman who, before the Revolu­ that he did not think his constitution tion, was Keeper of the Great Seal of had ever completely recovered from the the Colony of Pennsylvania and, sub­ shock which it then received. He, never­ sequent thereto, the confidential agent theless, contracted the contagion again in 1797 and nearly died, though it is he immediately conceived and person­ recorded that Dr. Dewees bled him of a ally made a catheter with a bougie tip total of 176 ounces. In 1814 he had as a filiform guide. typhus fever, and for a number of years We know of his experimenting with had repeated attacks of kidney colic, animal tissues for ligatures that would passing several kidney stones. In his de­ be absorbed—buckstring, French kid clining years he suffered from myo­ and animal gut (1816) ; of presenting cardial weakness, and towards the end an appliance for correcting the outward hydrothorax caused great respiratory displacement in Pott’s fracture; of pre­ embarrassment, while a general ana­ ceding Baron Dupuytren in performing sarca and, later, peripheral gangrene, a successful operation for artificial anus made his terminal illness a severe trial (1809); of devising an instrument to to one so esthetic by nature, and yet tap a hydrocephalus through a trephine with such will power and self control. opening, and actually evacuating 8 He died on December 15, 1837, in the ounces of fluid; of perfecting a snare, by seventieth year of his life. a wire passed through a double cannula, Of his surgical skill and his original­ and, with it, removing hemorrhoidal ity in treatment, the qualities which ad­ tumors and performing tonsillectomies; vanced him to the exalted position of being the first to describe diverticu­ accorded him by his professional breth­ lum of the rectum, for he taught and ren, much could be written. A great personally practiced the great advan­ deal of his work was related to urolog­ tage to be gained by autopsy study; of ical surgery, as the clinical problems of designing a gorget, with interchange­ urinary obstruction and of vesical stone able blades, for severing the bladder were early developed in the history of neck in perineal lithotomy; and of shar­ surgery and formed a large proportion ing with Dr. Alexander Munro, of of the surgical work of Dr. Physick’s Edinburgh, the honor of being the first day. We find him making his own (though entirely independent of each bougies, of “fine new linen and pure other) to wash out the stomach and ac­ yellow bee’s wax,” and describing their tively lavage the same through a tube, proper taper; modifying Desault’s using for this purpose “a large flexible splint for fracture of the thigh; tapping catheter” and “a common pewter a hydrocele with a trocar, and washing syringe.” out the cavity with wine for permanent But brilliant and original as was his cure; perfecting the internal angular surgery, it was his teaching that made splint for fracture and injury at the el­ him famous and beloved by his col­ bow joint; devising an early (1795) in­ leagues. I have already pointed out that strument for internal urethrotomy in it was in 1800 that a request, in writing, stricture, by concealing a delicate lancet was made to Dr. Physick, by a number in a cannula; outlining his treatment of of gentlemen attending the medical lec­ ununited fracture by means of a seton; tures delivered in the University of showing a whip-maker how to weave, Pennsylvania, that he lecture to them with silken threads, a flexible woven on surgery. They had probably recog­ catheter, coating it with copal varnish. nized his ability and fallen under his On an occasion, being able to pass a spell at the Pennsylvania Hospital flexible bougie, but not a catheter, in a amphitheater. He responded with great man suffering from urinary retention. diligence in the preparation of each lec­ ture, and Dr. Charles Caldwell, of the tenaculum, arrested the bleeding Louisville, Kentucky, an early friend completely. This promptly led to the and associate, tells us that: invention of his celebrated armed nee­ As a public lecturer, Physick’s style and dle, contained in a curved forceps, for manner were altogether peculiar—alto­ the purpose of carrying a ligature under gether his own. He imitated no one—he such deep vessels. I find no record of attempted to imitate no one, and no one his showing unusual skill in the rapid perhaps was able to imitate him. He was removal of stone, and, apparently, it not eloquent, in the far too common ac­ was his firm control of himself under ceptation of that term. He never in­ all conditions, the directness of his at­ dulged, I mean, in a tempest of sound—in tack, his ability to avoid surgical blun­ loud declamation—or pomp of expres­ der and his judgment as to when he sion. Such arts and efforts were as far be­ had done enough that constituted the neath his standing, and as foreign from his taste as they would have been inappro­ solid foundation on which his success priate to the place he occupied and the was built. subject he taught. In a different and more I cannot help but relish the thought substantial sense of the word, however, that he appreciated the obstructive role he was eloquent. If to expound his sub­ played by the hypertrophied prostate; ject with a clearness of a sunbeam, to be for in a seventy-year-old man he passed abundant in solid matter and rich and a novel contrivance, consisting of a pertinent in illustration and argument, to small flexible catheter, over the inner command the respect and observance of end of which he had placed 3 inches of his class, to rivet their attention, to pour sheep’s cecum and fastened the edges out to them a stream of instruction which securely and smoothly to the shaft of they were eager to imbibe to the last drop, the catheter with fine silk. After its in­ to carry along with him their feeling and troduction into the bladder, the sheep’s- mould them at pleasure, to make them grave when he was grave, and light up gut sac was filled, through the catheter, their countenances with an approach to a with tepid water, and after plugging smile when his features relaxed, and to the catheter with a peg, it was gently, dismiss them brimfull of the remem­ but with some firmness, retracted. This brance of his lecture, and anxious to re­ afforded relief, long unknown, to the tain it to the minutest portion—if this patient, and the instrument was used were eloquence (and I know not by what again, after an interval of some months, other name to call it) Physick, I say, was with great advantage. eloquent. But this did not start out to be a bio­ It is said that his fame rested upon his graphic sketch of Dr. Physick alone, and skill in the extraction of cataract and fascinating as is his life and work, I on his success in removing stone from must introduce to you the other persona the urinary bladder. His first lithotomy dramatica, who, because of his unique was performed in 1797, when he had and exalted position, sought the aid of the misfortune to accidently cut the the Father of American Surgery, twelve internal pudic artery with his gorget. years after he had resigned the Chair The hemorrhage was profuse, but he of Surgery in the University of Penn­ immediately compressed the artery with sylvania, and almost a year after retir­ the forefinger of his left hand, passed a ing from all active duties because of his tenaculum beneath it and, casting a lig­ declining health. ature around the protruding ends of In 1831, John Marshall, who at that moment was seventy-six years of age, hausted troops at Valley Forge, and suf­ and rounding out his thirtieth year as fered all the wretchedness of that memo­ Chief Justice of the Supreme Court of rable encampment; he fought at Tren­ the United States, returned to Phila­ ton; he fought at Monmouth; he was delphia to consult Philip Syng Physick with Wayne at Stony Point, and with for a condition that had been diagnosed the Virginia line in South Carolina stone in the bladder. It was a purposeful (Lewis). Is it not easy to picture the pleasure to say, “returned to Philadel­ bodily and mental training that this phia”; for had he not, at the age of youngster received ere he was four and twenty-four years, walked from his twenty? We think we are making men home in Fauquier County, Virginia, to of our boys in an eight-weeks fall train­ Philadelphia, in order to be inoculated ing in football; is it surprising that the against the smallpox? It has been truly foregoing created a giant, and one with said that nothing so clearly, and so a complete mastery of his will, of his early, illustrates John Marshall’s “quiet mind and of his body? determination and pursuit of purpose, This was the man who delivered the and his mixed progressiveness and con­ opinion in 1803, while Thomas Jeffer­ servatism” (Lewis). But this was in the son, the great defender of States’ Rights, summer of 1780, and one might well was President, that the Supreme Court ask where this lad had been during the could set aside an act which had been four previous eventful years. Born on passed by Congress and signed by the September 24, 1755, the eldest of fif­ President, if such an act conflicted with teen children, the son and the grandson the Constitution of the United States. of Virginia planters, he was truly Amer­ Here we are, 134 years later, thanking ican in birth and environment. He was the Almighty for the gift and the train­ taught by his father, and urged to gain ing of such a man. Great men have no an education by assiduous reading of need that we praise them—the urge is the classics. He started in his eighteenth on us to know them, and it is a sweet year to read law, but the Revolution and simple duty. It has been said that found his father the captain, and Mar­ John Marshall found the Constitution shall, Junior, the lieutenant, in a regi­ a paper and made it a power, that he ment of Virginia Minute Men. It was found it a skeleton and clothed it with of these first citizen-soldiers that John flesh and blood and that, when he ended Randolph said they were, “raised in a his career, after thirty-four years as minute, armed in a minute, marched in Chief Justice, he had breathed the a minute, fought in a minute and con­ breath of life into its body. Well might quered in a minute.” Wearing green Gladstone declare that our Constitution hunting shirts, with the words, “Lib­ was “the most wonderful work ever erty or Death,” in large white letters on struck off at a given time by the brain their bosoms, they had bucktails on and purpose of man.” their heads, carried tomahawks and So, let me introduce you to the event­ scalping knives in their belts (Lewis). ful year of 1831, in an office on lower John Marshall served as a soldier dur­ Pine Street, Philadelphia, when the ing the gloomiest period of the war. world took note of the picture, pro­ He fought at Iron Hill, which preceded duced by fate, of the greatest of lawyers, the Battle of the Brandywine; he fought in his seventy-sixth year, calling upon at Germantown; he starved with the ex­ the greatest of surgeons to relieve him. And what was ahead of this elderly being supported by pillows in such a man­ statesman who was about to submit ner as to present the perineum in a con­ himself to the knife in these pre-anes- venient manner to the operator. In this thetic days? For several years he had posture he is to be held by two assistants who stand along side of the table (which been developing increasing distress by of course should be narrow) and place the day and by night, amounting at times to knees of the patient in their armpits, urinary strangury and acute agony. His separating his limbs and firmly holding duty and his work perhaps gave him his feet. slight surcease and diversion by day, Another assistant takes hold of the staff but a nightmare of pain might deprive with one hand and with the other raises him of all rest. the scrotum so as to expose the perineum. The operation, as performed by Dr. He is to hold the staff in such a manner Physick, is clearly outlined by John that it may project a little towards the left Syng Dorsey, Physick’s nephew and pu­ side of the perineum. . . . pil, in his “Elements of Surgery,” pub­ The surgeon being seated conveniently, lished in 1818: commences the first incision with a scal­ pel, the point of which he inserts through The patient about to submit to lithot­ the skin, at that part of the perineum omy should, if practicable, choose the which is immediately opposite the lower spring or autumn in preference to the end of the arch of the pubis, of course the cold or hot months. The operation should incision begins at the raphe of the peri­ never be performed during a paroxysm of neum just behind the scrotum; the knife stone. A temperate diet should be directed is to be carried steadily in a right line for some time previously, and if plethoric, terminating midway between the lower the patient should be bled. It is well to margin of the anus and the tuberosity of administer, on the day preceding the op­ the ischium of the left side. The first in­ eration, a dose of castor oil, and to empty cision should be deeper than it is com­ the rectum two hours before the ap­ monly made, as there is no danger to be pointed time by an injection. The peri­ dreaded at this stage of the operation, neum should be shaved, after which an except a wound of the rectum which is enema of laudanum and water may be easily avoided. This incision in an adult administered, an hour or more before the should be between 3 and 4 inches in operation, or, what is equivalent, a few length. By two or three successive strokes grains of solid opium may be introduced of the knife the incision is to be deep­ into the rectum, and the patient should ened, and the transversalis perinei mus­ void no urine for several hours before the cles completely divided—when this is time affixed for operating. done the groove of the staff is very readily The patient is to be placed on the end felt, and the prostate gland at the bottom of a common dining table, with the leaves of the wound. The surgeon now ex­ down, covered with blankets. The staff is changes his scalpel for a sharp straight to be well oiled and introduced; the dif­ bistoury the point of which he inserts ferent surgeons present take hold of it with the back towards the rectum into the and satisfy themselves that they feel the membranous part of the urethra; with this stone. A strong fillet or garter is fastened instrument he slits up the membranous by means of a noose, around each wrist, part of the urethra by cutting in the the patient is directed to grasp his feet groove of the staff from the prostate gland with his hands, and by means of the fillets to the bulb and effects in this manner by they are securely bound together. one stroke of the knife what I have known The patient is now placed close upon surgeons half an hour in accomplishing. the edge of the table, his head and back . . . The staff is now laid bare to a con­ siderable extent, and is generally visible, the grasp of the forceps, and then the but is always readily felt by the surgeon’s larger fragments are to be successively finger; it only remains now to divide the taken out by the forceps, the smaller ones prostate gland and neck of the bladder, by means of a scoop, and the detached which may be readily effected by a bis­ sandy matter is to be washed out by in­ toury, scalpel or gorget, but far most con­ jecting forcibly a stream of warm barley veniently by the last-named instrument. water into the bladder, which will be The surgeon therefore after laying bare evacuated through the wound, pleno rivo, the staff places the nail of the left index and with it all the smaller particles of finger in the groove of the staff and intro­ calculus. duces the beak of his gorget previously Sometimes the stone is too large to be dipped in warm oil, into the situation extracted, and then it is to be broken, by where his nail had been, and now rising means of a strong pair of forceps with a from his chair he takes the handle of the screw in the handles, and the pieces ex­ staff in his left hand and moves the beak tracted as we have just directed, but if a in its groove, ascertaining that no mem­ small enlargement of the wound in the brane or other substance intervenes be­ neck of the bladder will enable the sur­ tween the staff and beak of the gorget. geon to effect the extraction without re­ . . . With a gentle steady motion he course to this expedient, it will be better. passes the gorget along the groove of the . . . The surgeon should always remem­ staff into the bladder. ... In introduc­ ber, that it is better to cut than to tear, ing the gorget Dr. Physick recommends to and the maxim of Celsus should never be push the staff and gorget as far towards forgotten, “plaga, paulo major quam cal­ the right side of the perineum as possible, culus sit.” . . . in order to avoid wounding the pudic One of the chief subjects now demand­ artery. The urine gushing from the blad­ ing attention is the hemorrhage. It always der and flowing along the gorget an­ happens that some considerable blood ves­ nounces the division of the neck of the sels are divided and bleed freely in this bladder. The gorget is instantly removed operation. The arteria transversalis per- . . . and the fore finger of the left hand inei is always cut, as it runs directly across introduced and brought in contact with the perineum in the course of the in­ the stone. The staff may now be taken cision. This artery is easily secured with a out, . . . and the forceps dipped in warm ligature if it bleed freely, but commonly oil are introduced; the surgeon should it stops after the operation is completed. touch the stone before he opens them, The artery of the bulb of the urethra and then with one handle in each hand he is occasionally divided, and sometimes it separates the blades and grasps the stone. is necessary to tie it up, but the chief It is best to use small forceps at first as danger arises from the pudica interna, a they enter more easily, and in general, very large artery running along the ramus answer as well as the large ones. . . . of the ischium which is sometimes The surgeon having grasped the stone wounded by the edge of the gorget. When with his forceps, should be careful that he this happens the hemorrhage is profuse, has taken hold of it in the shortest diam­ and in many cases has proved fatal. I am eter so that it may occasion as little lacera­ happy in being able to describe a method tion as possible whilst it is extracted. . . . of securing this vessel which obviates in When this is done a regular but forcible great measure this danger from lithotomy. effort is to be made and the stone ex­ In the year 1794, although a boy, I had tracted. The extraction may often be facil­ the honour of assisting Dr. Physick in his itated greatly by moving the forceps from first operation for stone, and it happened side to side, using in this manner each that in passing the gorget he divided the blade as a lever. It sometimes breaks in pudic artery. He immediately placed a finger upon the spot, the bleeding ceased, knowing well that this would be the last and he felt distinctly the trunk of the time that he would ever perform a similar vessel pulsating between his finger and operation, I felt desirous that he should the ramus of the ischium. It was evident finish with so distinguished an individual; that if the flesh between his finger and the and accordingly urged him to do it him­ bone could be compressed, the hemor­ self. Upon the day appointed, the Doctor rhage would be commanded. He accord­ performed the operation with his usual ingly passed a tenaculum under the trunk skill and dexterity. I do not think I ever of the artery, the point of which came out saw him display greater neatness than on near the bottom of the wound. A strong that occasion. The result of the operation ligature was then passed under the pro­ was complete success. jecting point and handle of the tenacu­ It will be readily admitted that, in con­ lum, and was firmly tied, it included con­ sequence of Judge Marshall’s very ad­ sequently a portion of flesh, in which the vanced age, the hazard attending the op­ wounded artery was contained, and effec­ eration, however skilfully performed, was tually stopped the bleeding. This meas­ considerably increased. I consider it but ure, which was contrived and executed in an act of justice, due to the memory of as short a time as I have consumed in that great and good man, to state, that in describing it, can no doubt be applied in my opinion, his recovery was in a great similar cases with equal advantage. . . . degree owing to his extraordinary self Such is the technique taught and possession, and to the calm and philo­ sophical views which he took of his case, practiced by Dr. Physick which brought and the various circumstances attending him no little fame, and it is to be noted it. that Dr. Physick, following this tech­ It fell to my lot to make the necessary nique, had a patient whose perineal preparations. In the discharge of this duty wound never drained any urine and I visited him on the morning of the day healed by first intention, and that Dr. fixed on for the operation, two hours Dorsey had two such and Dr. Copeland previously to that at which it was to be one. performed. Upon entering his room I And now, let us turn to Jacob Ran­ found him engaged in eating his break­ dolph, Dr. Physick’s son-in-law, for his fast. He received me with a pleasant smile account of the events and circumstances upon his countenance, and said, “Well, surrounding the operation upon Chief Doctor, you find me taking breakfast, and I assure you I have had a good one. I Justice Marshall; thought it very probable that this might In October, 1831, Dr. Physick per­ be my last chance, and therefore I was formed the operation of lithotomy on determined to enjoy it and eat heartily.” Chief Justice Marshall. This case was I expressed the great pleasure which I felt attended with singular interest, in conse­ at seeing him so cheerful, and said that I quence of the exalted position of the hoped all would soon be happily over. He patient, his advanced age, and the circum­ replied to this, that he did not feel the stances of there being upward of one thou­ least anxiety or uneasiness respecting the sand calculi taken from his bladder. It is operation or its result. He said that he well known that for several years previous had not the slightest desire to live, labour­ to this period. Dr. Physick had declined ing under the sufferings to which he was performing extensive surgical operations. then subjected; that he was perfectly He felt somewhat reluctant to operate ready to take all the chances of an opera­ upon Chief Justice Marshall, and offered tion, and he knew there were many to place the case in my hands. Taking all against him; and that if he could be re­ the circumstances into consideration, and lieved by it he was willing to live out his appointed time, but if not, would rather so erroneous might have a prejudicial tend­ die than hold existence accompanied with ency. Under the notice of the Eulogies on the pain and misery which he then en­ the Life and Character of the late Chief dured. Justice Marshall, it is there stated that, “for After he had finished his breakfast, I several years past Judge Marshall had suf­ fered under a most excruciating malady. A administered to him some medicine; he surgical operation, by Dr. Physick, of Phila­ then inquired at what hour the operation delphia, at length procured him relief; but would be performed. I mentioned the a hurt received in travelling last spring hour of eleven. He said, “Very well; do seems to have caused a return of the former you wish me now for any other purpose, complaint with circumstances of aggravated or may I lie down and go to sleep?” I was pain and danger. Having revisited Philadel­ a good deal surprised at this question, but phia in the hope of again finding a cure, his told him that if he could sleep it would disease there overpowered him; and he died be very desirable. He immediately placed on the 6th of July, 1835, in the 80th year himself upon the bed and fell into a pro­ of his age.” found sleep, and continued so until I was Now, sir, the above quotation is incorrect in the following respect. Judge Marshall obliged to rouse him in order to undergo never had a return of the complaint for the operation. which he was operated upon by Dr. Physick. He exhibited the same fortitude, After the demise of Chief Justice Marshall, scarcely uttering a murmur, throughout it became our melancholy duty to make a the whole procedure, which, from the pe­ post mortem examination, which we did in culiar nature of his complaint, was neces­ the most careful manner, and ascertained sarily tedious. that his bladder did not contain one parti­ Chief Justice Marshall survived this op­ cle of calculous matter. Its mucous coat was eration some years, and finally died of a in a perfectly natural state, and exhibited disease of an entirely different character. not the slightest traces of irritation. The cause of his death was a very dis­ Previously to his death he laboured under eased condition of the liver, which was enor­ very unpleasant symptoms, which are fre­ mously enlarged, and contained several tu­ quently met with in advanced life; and in berculous abscesses of great size. Its pressure consequence of these, a rumour was upon the stomach had the effect of dis­ widely disseminated that he had a recur­ lodging this organ from its natural situation, rence of his old complaint, stone in the and compressing it in such a manner, that bladder. As this was the last operation of for some time previous to his death it would such magnitude performed by Dr. not retain the smallest quantity of nutri­ Physick, I felt desirous that it should be ment. By publishing this statement, you will correctly estimated; and, inasmuch as I oblige am still not unfrequently asked whether Yours, very respectfully, N. Chapman, m.d. Judge Marshall had not a return of the J. Randolph, m.d. calculus, I insert the following letter, ad­ dressed by Professor Chapman and myself When the Chief Justice came to Phil­ to the editor of the Southern Literary adelphia in 1831 to consult Dr. Physick, Messenger, in order to correct an errone­ the Bar paid due homage to his presence ous impression of this nature, given by an and prevailed upon him to sit for his article in a previous number of that able portrait, which was painted by Inman, Journal. a Philadelphia artist, and now hangs in Philadelphia, March 25, 1836. the collection of the Philadelphia Law Sir:—A mistake, evidently unintentional, Association. A copy of this painting ap­ having appeared in the February number of pears as the frontispiece in the fourth your Journal for this year, we feel convinced you will, upon proper representation, take volume of Beveridge’s “Life of John pleasure in correcting it; as an impression Marshall.” Mr. Marshall died in his eightieth us an heritage none the less valued than year, in Philadelphia on July 6, 1835, that of the Father of His Country him­ in a humble boarding house kept by self. It seems as though somewhere Mrs. Mary Crimm, on Walnut Street nearby should stand Dr. Physick, the above Fourth, within sight of Inde­ Father of American Surgery, whose skill pendence Hall; and it was while tolling and fortitude cheated Death itself to during the funeral service of this great save so valued a life. What a drama was man that the Liberty Bell developed enacted that October day in 1831, when the crack that silenced its silvery tongue two such masters played their individ­ forever. ual parts; both sustaining themselves, It is notew’orthy that at the head of though in advanced years, by that moral the Philadelphia Parkway, and on the firmness and dignity which had brought east front of our Art Museum, is the them from inconsiderable beginnings handsome equestrian statue of George to the exalted stations which they occu­ Washington, so typical of the creative pied!* man of action; while at the west front, gazing up the Schuylkill River toward * At the conclusion of this paper there was exhibited a specimen jar containing a num­ the sunset, is the seated statue of Chief ber of the calculi which were removed at this Justice Marshall—grave, thoughtful and operation upon Chief Justice Marshall. They serious, but marvelously typifying the are preserved in the Mutter Museum of the creative man and mind who has given Philadelphia College of Physicians.