case he recovered morphine from the viscera of a body that had been buried for thirteen months. Many instances have occurred since, however, in which, even under more favorable conditions, there has been a total failure to recover this alkaloid from any part of the body. So, also, in 1851, Stas detected nicotine in the blood of a dog poisoned by that substance, employing his ether process for the extraction of the alkaloid.

Perhaps no one circumstance did so much to call the attention of toxicologists to the subject of the detection of the vegetable poisons in the blood and tissues, as the remarkable trial, in London, of Palmer for the poisoning of Cook by strychnine, in 1856. Prior to May, 1856, according to Prof. A. S. Taylor, in no instance had strychnine been recovered in an absorbed state from the blood, tissues, or soft organs of the body. This trial directed special attention to this poison, and led to its more careful investigation, and from that time instances of its recovery after absorption have become quite frequent. In fact, under the recent improved methods of analysis, a failure to recover this poison in its absorbed state, should rarely happen. Since this time, chemists have been gradually adding to their triumphs in this important department of research, and now authentic instances have been recorded of the recovery and identification by chemical tests, of at least the following alkaloids: morphine, nicotine, strychnine, brucine, atropine, daturine, veratrine, jervine, and conine. It may be added, that considerable difference exists in regard to the readiness with which the different poisons just mentioned may be recovered when in the absorbed state.

That all poisons, except those endowed with corrosive action, have to enter the circulation in certain quantity before producing their peculiar effects, is now universally conceded. We may now inquire what is known of the mode or manner in which when diffused in the blood they destroy life. It is well known that some poisons produce an appreciable change in the physical and chemical properties of the blood, as shown in the difference of color and consistency of that fluid. These changes are well marked in the cases of sulphuretted hydrogen, prussic acid, carbonic acid, chloroform, and conine, under the action of which the blood becomes more liquid and of a darker color. In most of these cases the poisoned blood, when examined by the spectroscope, gives the spectrum of deoxidized blood.

It was long since observed that certain poisons on being introduced into the blood were either wholly, or in great part, decomposed. Thus, Sir R. Christison failed to obtain any chemical evidence of the presence of oxalic acid in the blood of the vena cava of a dog, killed in thirty seconds by the injection of eight grains and a half of that poison into the femoral vein. Even with the improved methods of analysis, chemists have never yet been able to recover this poison, as such, from the blood. In some cases we can very clearly trace the changes which take place in the substance absorbed by the blood. Thus Erdmann and Marchand, in 1842, found that cinnamic acid was converted during its progress through the animal system into hippuric acid; and in 1862, Dr. Letheby found that under like conditions nitro-benzole was changed into aniline. In like manner it has been found that hydride of benzole is changed into benzoic acid, which in its turn becomes converted into hippuric acid. In 1832, Liebig showed that hydrate of chloral under the action of an alkali, was changed into chloroform and formic acid; and in 1868, Liebrich showed that the same change took place when this substance

entered the blood by absorption, and to this change is attributed the peculiar sedative effects of chloral.

Even in regard to the action of strychnine, brucine, morphine, veratrine, nicotine, and certain other organic poisons, which may be recovered from the blood in their unchanged state, it has been claimed by some that they are changed in part at least before they produce their toxic effect, but of this there is no direct proof. When we consider the extremely minute quantity of substances of this kind which may destroy life (a quantity sometimes certainly not exceeding in weight the one three hundred thousandth part of the blood), and the ready demonstration of their presence in the blood after death, it would appear that in certain instances at least, the fatal issue is not dependent upon the decomposition of any part of the toxic agent.

Although the various facts that have been presented are of great value and interest, yet it must be admitted that the whole subject of the final action of poisons is left in great obscurity. While it is believed by all that poisons are absorbed and taken into the circulation, it is found that only some produce any marked changes, physical or chemical, in the blood; and on the other hand, while some poisons are themselves decomposed in that liquid, yet others equally fatal, appear to suffer little or no change. We may trace the destroyer in all its subtle insinuations through the blood and tissues, and see life quickly driven from the body, but we know not where nor how the fatal stroke is given. These are questions which modern science, with all its refined methods of research, has left unanswered.

In conclusion, it may be said that the field in which the toxicological chemist labors, is one of the highest responsibility. He must not only be consecrated to his science, know all its best methods, and be able to practise them in all their most delicate and skilful manipulations; but he should have a higher consecration to truth, ever remembering that in toxicological jurisprudence his words should be weighed in balances even more delicate and exact than those in which he weighs his material substances. Human life on the one hand, and the security of society and the vindication of law on the other, may hang upon the slender thread of a chemical reaction, or tremble in the final adjustment of a most delicate instrument. The highest skill, and a regard for truth that knows no shadow of turning, can alone fit the toxicological chemist to meet the grave responsibilities of his profession.

ADDRESS ON SURGERY.

BY

PAUL F. EVE, M.D.,

PROFESSOR OF OPERATIVE AND CLINICAL SURGERY IN THE UNIVERSITY OF NASHVILLE.

GENTLEMEN OF THE INTERNATIONAL MEDICAL CONGRESS:

THE language of the Aborigines of America has ever been admired for its simplicity and significance. In the State of Mississippi, itself implying the father of all waters, is a County called Itawambi, derived from the title given an Indian Chief, upon whom all possible honors had been. conferred, so that nothing more could be done for him. Standing here this day, the representative of the most demonstrative and efficient department of the healing art; the recipient too of many unmerited favors; fully conscious of the inability to do justice to the subject proposed, or satisfactorily improve the illustrious occasion-an event without precedent, and which no living man will ever see again-language fails to convey or words express what is now felt. With all the simplicity of the Indian and the sincerity of the Christian, I would say to you, my professional brethren, who have done so much for me, Itawambi

Precisely fifty years ago, he who is now to address you, landed on Chestnut Street wharf of this city, enquiring for the office of the late distinguished accoucheur, Charles D. Meigs, to become his private pupil; fifty years before that, his father, born in Philadelphia, had been the associate of Rush, Shippen, and James; and now, at the end of those hundred years, the son is invited back to declare before this International Medical Congress, and at the celebration of the first Centennial of these United States, what his countrymen have done for Surgery. Here too in the Medical Department of the University of Pennsylvania, the first chartered Medical College on this Continent, where so many have been taught by Rush and Chapman, Hare and Jackson, Physick and Gibson. To me it is but the coming back to my dear old Alma Mater. Surely "There's a divinity that shapes our ends, rough hew them how we will."

"God moves in a mysterious way,

His wonders to perform;

He plants his footsteps in the seas,
And rides upon the storm."

A mere enumeration of what we have contributed to Surgery, even were that possible during the hour assigned to the subject, might not prove the most profitable occupation of it; and moreover, while this may be the Centennial of our National existence, it is not that of our profession; for, as is well known, the War of Independence left us an impoverished people, almost destitute as regards the sciences, certainly without any peculiar medical literature. Even the reputed father of American Surgery was not admitted a house-surgeon in St. George's Hospital, London, though a private pupil of the celebrated John Hunter, until

1790; nor was he elected Professor of Surgery in the University of Pennsylvania until 1805. It was as late, too, as 1820, forty-four years after the Declaration of Independence, that the taunt was uttered, with probably as much truth as sarcasın, "what does the world yet owe to an American Physician or Surgeon!" Then again, all our early teachers had of necessity to be educated abroad, so that in the very nature of things no national characteristics could have been given to medicine until years after the colonies became the United States. Notwithstanding all this, in a little over fifty years, the sarcasm of Sydney Smith was answered by a professor of Surgery in the city of Paris, M. Chassaignac, remarking as is said to an American medical student, "Sir, you ought to be proud of your country, for at this moment she holds the sceptre of Surgery in the world."

He whom we have ever regarded as the father of American Surgery, PHILIP SYNG PHYSICK, was born in Philadelphia in 1768, and was therefore only eight years old at the declaration of our Independence; he graduated in the literary department of the University of Pennsylvania, received his diploma at the Royal College of Surgeons, London, and the degree of doctor of medicine in Edinburgh, in 1792. Returning home soon after, the appearance of yellow fever, for the first time in Philadelphia, brought him prominently before the public. For services rendered the city hospital in 1794, Dr. Physick was presented with silver plate valued at one thousand dollars.

As early as 1794, he recommended curved forceps holding a needle to secure deep seated arteries. In 1802, he proposed the seton for ununited fractures. In 1836, Mr. Liston gave him credit for this valuable suggestion; and in the Contributions to Practical Surgery, published by Dr. Norris, formerly Surgeon to the Pennsylvania Hospital, in 1873, the seton and its modifications are declared to be safer, speedier and more successful than resection or the caustic.

In 1809, Dr. Physick by a suture removed the projecting duplicated portion of the intestine in Artificial Anus, and thus re-established the integrity of the alimentary canal. Dupuytren's enterotome has since somewhat supplanted the seton.

Physick improved Desault's splint by extending it higher up on the fractured side, thus making extension and counter-extension more in the axis of the broken limb. He was among the first to apply animal ligatures; employing buckskin for this purpose, while his nephew and favorite pupil, Prof. Dorsey, preferred French kid deprived of its tanned cuticle, a substance with which he successfully ligated the femoral artery. Deer sinew torn into shreds of suitable size for the vessel to be ligated, is preferred by others, though silk is generally employed. Animal ligatures certainly irritate less, are readily absorbed, and thereby promote reunion of wounds. In the use of them for some forty years, though not exclusively, the knot of a deer sinew has never been seen, while the metallic ligature or suture ever remains a foreign body in the flesh.

Dr. Physick was the first to employ blisters in gangrene threatening mortification, as in anthrax, or over au inflamed vein The late Prof. Chapman, long his colleague in the University of Pennsylvania, published a case in which he attributed the life of the patient to this suggestion. He improved the gorget, an instrument employed in his day in lithotomy.

He invented the tonsillotome, in 1848, by which a hazardous operation

has been greatly simplified and made safe. Formerly, attempts were made to cut out the entire tonsils at the imminent risk of fatal hemorrhage, or they were painfully strangulated with a double canula. Fortunately the day has passed for the total excision of these bodies, except when malignant. Intra or extra-oral this is a dangerous proceeding. În a recent attempt twelve arteries had to be tied; now we are content to remove the projecting portion beyond the lateral half arches of the fauces. When reminded that it is the internal carotid which is exposed in these operations, the value of Dr. Physick's method must be greatly enhanced. Of course the recent modifications of the tonsillotome, some of them quite ingenious, are due to the original forceps containing his concealed blades.

Dr. Physick early advocated putting inflamed joints and diseased bones, as in cases of coxalgia, caries of the spine, etc., in perfect repose, as if in splints.

To him also Monsieur Reybard, then surgeon to the hospital of Lyons, France, declares that the profession is indebted for the first accurate account of cystic or sacculated rectum, which he described in the early part of the present century; Reybard moreover asserts that to Dr. Physick was due the starting point of all improvement which has been made in the treatment of abnormal anus.

It fell to his lot to remove successfully, in one case, a greater number of urinary calculi than has ever been done before or since in Surgery. They amounted to upwards of a thousand, varying in size from a small bean to a bird shot. The patient, who was quite aged, held at the time the office of Chief Justice of the United States, and subsequently resumed his seat on the bench.

A striking proof of Dr. Physick's great influence even in Europe was the fact that, when his nephew, then the Professor of Anatomy in the University of Pennsylvania, published his Elements of Surgery, in two volumes, containing, as was well known, the peculiar views and practice of his uncle, that work, the first of the kind ever issued from the American press, actually became the text-book of Surgery in the University of Edinburgh; which was certainly a high compliment to our distinguished countryman.

Physick's name has ever been the most familiar and favorably known of all American surgeons in Europe; and, in 1825, he was elected a member of the Royal Academy of Medicine of France. He was also an early advocate of conservative Surgery; was a favorite pupil of the renowned John Hunter, the great anatomist, physiologist, and surgeon. As he grew older, Dr. Physick became more chary with instruments, and trusted more to the recuperative powers of nature. Of him, it has been said, that he never spilt a drop of blood uselessly, nor wasted a word in his lectures. With the simplicity of a child, the modesty of a maiden, the industry and integrity of a martyr, he quietly worked out a surgical character which will endure so long as his loved science shall be cultivated.

Intimately connected with the origin, rise, and progress of Surgery in America, were four other professional gentlemen, the contemporaries of Dr. Physick, who were long spared beyond the allotted period of man on earth, as if to illustrate in their lives and characters the benefits of temperance, industry, and benevolence. These were Warren, Mott, Dudley, and Gibson, whose average age was eighty-three years.