chanical methods of diagnosing and treating chronic diseases of the stomach are among the notable and efficient innovations of the present time; much good has been, and will be accomplished, if proper conservatism be maintained.

The progress of sanitary science, for which the laudable self-sacrifice of the medical profession deserves credit, shows grand results in preventing the spread of disease and establishing better regimen. I believe, however, that some over zealous disciples are inclined to advance too far beyond the lines of the procession, and should be warned from time to time by the general medical public. Notwithstanding the great achievements of the laboratories, and other special departments, our art must practically rest upon the clinician who must possess not only an extensive knowledge of medical and physical science, but of the diverse mental propensities of humanity. It is the clinician who must test and measure the theories of observations offered by other departments. The laboratory can propose but the practitioner must dispose; not by routine conclusions nor subservient acquiescence, but by philosophical reasoning upon the phenomena presented in each case of disease. One may diagnose typhoid fever or tuberculosis by microscopic or biologic methods, but the specific conditions in their relation to the individual, and the therapeutic indications growing out of such, must be made out by the medical artist-the clinician. Therefore we ought not to abandon too readily the methods of our medical forefathers in the careful comparison of the symptoms, signs and observations presented by disease; for the time has not yet arrived when demonstrations or instruments for examination can wholly replace clinical history and the art of reasoning by exclusion for reaching the diagnosis and management of disease. Yet one must by no means underrate the value of modern methods and instruments for diagnosis. For example, the chemic and microscopic examination of the blood and other fluids of the body are most important adjunctive measures of differential diagnosis, especially in such diseases as intermittent or remittent fever, anæmia, Graves' disease, Addison's disease and other dyscrasiæ.

In truly malarial diseases the discernment of the plasmodium in the blood at once disperses a series of doubts.

The researches alluded to already have led to important changes in the plans of therapy, as might be expected. Hypodermatic medication has been found more certain in its effects than administration by the mouth, although many alkaloids show less promptly but as certainly a medicinal effect when administered by the mouth as by hypodermatic introduction. There are, however, notable differences; for instance, one may administer iodin hypodermatically for a longer time without the production of the ordinary signs of intoxication than by the mouth. The same may be said of belladonna; yet a much more permanent selective action will be obtained by the hypodermatic method.

Many agents such as iodin, strychnin, pilocarpin, etc., produce a much more potent effect when in combination with. an organic substance such as beef bouillon or milk whey, whether taken hypodematically or by the mouth. Such observations, together with the further one that animal colloid substances containing a ferment or even combined with salt and water are much more active in their effects than when administered without such agents, would lead to a strong suspicion that if the vegetable alkaloids, resinoids or glucosides were administered in a state of natural solution, as native juice for instance, and taken directly from the vascular system of the plant where probably they are mixed with a natural enzyme, that a much more permanent action, one akin to animal toxins or alexins, might be obtained. An objection might be offered that some of them are not in solution in the vascular apparatus of the plant but are the result of elaboration by a series of physiologic processes. However that may be, it is known that in the case of many fresh plants, for instance aconite, the alkaloid exists in sufficient quantity combined with its own protoplasm and enzyme to produce even in small amount very marked physiologic effects. This is a well known fact to the Indians, concerning the aconite of the plains, which when dried yields very little of alkaloid or active. principle, but when green is highly poisonous. No effect of

the juice of milk-weed upon rabbits can be obtained after alteration of the albuminous constituents, yet the fresh juice of the plant is poisonous. Hence the thought has often occurred to me that there might be the same profound and durable effects obtained in the animal body by the introduc- · tion of specific vegetable protoplasm in a fresh state, either with or without its peculiar ferment, as is done by the introduction of animal protoplasm; and that analogously, either a toxic or anti-toxic effect might likewise be obtained according to conditions. Again, by the systematic treatment of living vegetable fluids, sap, juice, oil or pectins, with bacterial or other ferments, alterations analogous to those of animal fluids (such as blood serum and lymph) might be expected. Such altered vegetable fluids if efficient in the production of specific effects in animals suffering from disease might prove of inestimable value therapeutically, just as animal antitoxins are. As the animal and vegetable albumins do not differ very much in their physical of chemical properties, and as the latter are in many instances more accessible and easier of manipulation than the former, this plan, it seems to me, offers some inducement for trial toward procuring more durable effects upon animal organisms than can be procured by administration of ordinary alkaloids. The physical differences between the two classes of substances however may be regarded as largely a matter of molecular equilibrium-for stability is the characteristic state of the alkaloid, while instability is that of the colloid. Besides we may attribute to the former a selective. affinity for formed tissues, and to the latter a selective affinity for unconstructive or histogenetic tissues, such as corpuscles, lymph, serum, etc. Problems of materia medica and vegetable physiology do not receive the attention which they should. I think practitioners generally will agree with me that oftentimes markedly different effects are observed to follow the administration of powdered drugs, infusions or decoctions when compared critically with the effects of alkaloids or resinoids. of the same drugs-for instance I will cite scutellaria, digitalis, ergot, nux vomica, etc., each of which entire may produce

a physiological action differing from that of their resinoids or alkaloids or oils.

In conclusion let us remember that the achievements of the laboratory should not be allowed to overshadow our mission of becoming proficient in the art of medicine or therapy— clinical artists so to speak. For if we but reflect upon the question we shall see that to the clinician falls the function of adapting medical knowledge to therapeutic ends. He is, so to speak, the supreme court for determining the laws and utility of the means to the ends. For although bacteriology may have discovered the microbe of rheumatism, influenza, pleuritis, tuberculosis or alopecia areata, the respective relation of these micro-organism to the pathologic process constituting the disease and its attending phenomena are problems for the clinician to solve and promulgate.

Let us then strive to improve the art of medicine, and independently study every feature of every case which may come under observation. Let us do away with fashionable polypharmacy and endeavor to ascertain the proper value of each essential of medication, to the end that law, order and some degree of certainty may attend our honest efforts. Let us heed what Epictetus says:

"What then seems to every man is not sufficient for determining what is, for neither in the case of weights and measures are we satisfied with the bare appearance, but in each case we have discovered a certain rule."

ADDRESS ON SURGERY.

THE PROBLEMS WHICH MOST PERPLEX THE

SURGEON.

ROSWELL PARK, M. D.,
Buffalo, N. Y.

The more conversant one becomes with the literature and accumulated knowledge of others concerning the topics which especially interest him, and the more he pursues his studies within restricted lines, the more difficult it becomes to select a subject of which he may legitimately treat before such an audience as this. It is therefore with not a little hesitation and yet with the highest appreciation of the honor done me in inviting me to address you on this occasion that I have concluded to invite your attention to some of the problems. which the medical profession as a class, and particularly those who practice surgery, are to-day most often called upon to confront, which still seem so obscure that when asked for explanations we have to confess absolute ignorance and state that we sadly need light from any and every source.

We have a right to view with the greatest satisfaction and pride the progress which has been made both in the theory and practice of surgery, and particularly in that branch of general surgery spoken of as surgical pathology. And just here I may be permitted to remind you that according to the best standards of the day pathology is not distinct from but must be a part of surgery, else would the surgeon lose the explanation of both the lesion which he is treating and the rea