MAY 18 1053 LIBRARY PRESIDENT'S ADDRESS. SURGERY AND FACTS. BY JAMES F. W. ROSS, M.D., TORONTO. ALLOW me to thank you for the very great honor you have done me by electing me to preside over this Association at its tenth annual meeting. To me the associations of these years have been among some of the most pleasant of my life. Many changes have occurred in our ranks as a consequence of death and resignation, but changes must occur in every association. We have been sorry to lose Fellows by resignation, and we mourn over those who have been removed by death. New life has been imparted to our ranks by the introduction of new material. I am sure that we all wish these younger Fellows every success as they struggle up the ladder of science, and we trust that they may climb higher than those who have gone before them, that they may achieve greater things than their predecessors. The young should be encouraged and guided by their seniors. All of us must have some pleasant reflections as we look back upon the action of some one of the older men in our profession. We may, perhaps, have some unpleasant reflections, because, unfortunately, some of the older men are unable to tolerate the advance of the youths among us. with age It ought to be pleasant for any of us, when our hands shake and our eyes are dimmed as a consequence of senile changes, to be able to point to one of the younger men and say: "This is one of my pupils. See what he has done. He is a credit to all who have been connected with him." And the And the young men should never fail to retain a certain amount of fatherly respect and reverence for those to whom they owe so much. Opinions of others demand respect; it is sometimes difficult to under stand their meaning, because we put our own interpretation upon that meaning. Unfortunately for us, the men among us, the men of genius, are oftentimes unpleasant companions. They are oftentimes bumptious and arrogant, but still they are useful members of society, and must be tolerated with all their faults. Ten years have passed since first we met. Time is moving ever onward; the throb of the human heart is just as it was hundreds of years ago, and we hear the same cry of anguish and observe the same thrill of joy as were observed by the ancients. To the family physician are intrusted the lives of the people. He owes his ability to fulfil this very sacred trust to his teachers. As the teacher moves on to "that mysterious realm where each shall have his chamber in the silent halls of death," his words are remembered and his writings read. All that he says should, therefore, be said with judgment; when he writes he should write down facts. We are all of us teachers: we speak and we write. We have met again to compare our notes of another year of work and observation. We, as teachers, are gathered together to teach one another. For ten years we have been meeting together. Nine records have been scattered to the four quarters of the earth to guide and to teach the healers and to assist and allevaite the suffering. These books are the milestones of our progress, and they have already become a living monument of the thrift and labor, order and literary attainments, of our indefatigable secretary, Dr. Potter. If I may be allowed to express myself in modest language, I may surely say that our work has been creditable. We are none of us seeking personal renown or mercenary reward from the work that we do in this Association. When we meet we are like pebbles on the ocean beach, washed to and fro by the turbulent waves of thought, deprived of useless particles of mould and seaweed, burnished by friendly attrition with one another, and when the surface is highly polished each is shown in his true light of worth. Our medical literature is in no respect different from general literature. In general literature we have our poets and our prose writers. Many prose writers write volumes that are soon forgotten, and our ablest poets in the whole cycle of their lives are only able "to spin one or two sunbeams into gold." It is impossible for us to take note of all the advance of modern science; much is written, much forgotten, much disappears into the depths of the unheeded past. But progressive thought is moulded on thought that has gone before, and our present utterances may effect a perhaps imperceptible influence in moulding the thought of the future. In our department we set the measures of the march; let us see to it, then, that it is not too fast, heedless, and rushing, like a mountain torrent bursting from all control, but that it pursues a calm and even course like the navigable streams that bear the commerce of the busy world. Science must progress so that benefit to mankind ensues. Some facts are facts, and some facts that we think are facts are not facts. The scientist gives forth to the world something that he claims as a scientific fact; another soon disproves the assertion. But the very discovery of the fallacy guides scientific thought into other channels, and we are brought thereby much nearer in our approach to the truth. How much sometimes depends on a simple truth! One of the best examples that we have of this is our knowledge that we are enabled to do much if we observe the "law of cleanliness" in its strictest sense. It should be a simple law, but we find it difficult to carry it out in all the preciseness of detail required. Asepticism was for a long time disguised and concealed by the mask and robes of antisepticism, until the hand of science robbed her of her mask and tore away the robes and left her standing as a naked truth, the greatest truism of the nineteenth century. Lister will be looked upon as one of the greatest men of the nineteenth century. In other avenues of thought we have been slothful. There are clouds floating about us that we cannot penetrate, and depths that we cannot fathom with all our boasted wisdom. As in the days of Hippocrates, so now, tubercle, cancer, and sepsis fill the tombs. We know that tubercle and sepsis are due to germ growth, but we are unable to prevent the ravages of these germs. Of cancer we know but little more than the ancients. We know what it looks like, but we do not know what it is. Surgery can carry us no further in the war we wage against these three dread scourges, and relief must come from some other quarter. The limit to which our knowledge may attain has not yet been defined, but it must have a limit, or we would be able eventually to prolong life indefinitely. We will never be able to prevent ultimate death. This is the one cloud that hangs over us that we can never dispel. Our work in this Association is confined between the diaphragm, the perineum, and the abdominal walls. We are met together to cultivate and promote a "knowledge of whatever relates to abdominal surgery, obstetrics, and gynecology." You will be called upon during the session to express your views and to critcise or support the views of others. We do not wish to deal with questions that are already settled, but with those that are unsettled. Though the criticism should be friendly, I trust that it will be severe; no rash statements should be allowed to go from this Association unchallenged. I would like for a few moments to call your attention to some unsettled questions. First, let us consider the question of peritonitis. Are we able to do more to save the lives of patients suffering from peritonitis in its acute form than we were ten years ago? Are we not but little better off, with all our antiseptic and aseptic washes, gauze- and tube-drains, and PE with this disthat surgery can carry us no thrives? I am satisfied ease. further when Something else must come to our assistance. Perhaps it may come through serum therapy or through materia medica in the form of an antidote. We know that a poison is formed, that it is rapidly absorbed into the system and know that we may wash it on stem re-formed. We unable to prevent its re-formation. We know that in some cases we are able to minimize its effect by using the two drainways-namely, the drainage-tube and the intestinal canal. But in spite of this drainage large numbers die. I intend to try direct venous infusion of salines. The sulphate of magnesia seems to produce a peculiar effect in some of these cases. We know that ordinary salt is a preservative of meat and other albuminous materials. It may be that absorption of these salines into the blood may act as a harmless antiseptic and may destroy the ptomaïn poison present. I am speaking now, of course, of the peritonitis that we are unable to prevent, or peritonitis from contamination from within. When least expected, the post-mortem examination will frequently reveal some hidden source of internal contamination. I operated on a child for fecal fistula following the necrosis of a large portion of the ascending colon. The opening was closed with as little disturbance of the parts as possible and the abdominal wall closed over. The patient did not do well, appeared to be intensely |