HISTORY OF MEDICINE IN AMERICA.
The Colonial Physicians. Medical Study under Preceptors. Inoculation against Small-pox. Military Surgery during the Revolutionary War. Earliest Medical Teaching and Teachers in this Country. The First Medical Schools. Benjamin Rush. 1745-1813. The First Medical Journals. Brief List of the Best-Known American Physicians and Surgeons.
The history of medicine in America commences with the early struggles of the physicians in the American colonies. One Dr. Wootton came to Virginia in 1607 as Surgeon-General of the London Company. The following year Dr. Russell was with Captain Smith in his exploration of Chesapeake Bay. Neither of these men stayed long in the country, since, in 1609, Captain Smith, after being wounded, was compelled to return to England for treatment, for lack of medical aid.
When, in 1626. Peter Minuit purchased the island of Manhattan for the sum of twenty-four dollars, there was probably no physician there at the time. Undoubtedly the first physician, in what is now New York, was Lamontagne,—a Huguenot, who arrived in 1637, and who seems to have been a man of great capability for his time. It would appear that men of no little eminence left the Old World for the New during the early days of the American colonies, and that the medical services which the early colonists received were on a par with those received by those whom they left behind in their old homes. During the seventeenth century a number of reputable physicians emigrated to this country, among them Dr. John Clark, of Boston, in 1638, whose son and grandson followed him in his profession and became prominent in their chosen calling. In 1644 came Dr. Child, a graduate of Padua, who seems to have been a man of great learning.
A number of younger Americans also went abroad to study,—Leyden, Paris, Padua, and the British universities being those most eagerly sought. In Virginia, so early as 1619, the Colonial Assembly discussed the erection of a university or college. In 1637 a public college was established in Cambridge, and in 1638 the Rev. John Harvard left to it his library and half his fortune, after which it was called Harvard College. William and Mary College was chartered in Virginia in 1693. Probably the first lectures in anatomy given in this countrv were those of Giles Firman, which were given previous to 1647 at Harvard College.
It was in this early day that arose the custom, continued until very recently, of studying medicine with a preceptor. This was necessary at that time, and until comparatively recently, because of the scarcity of institutions of learning and the expense connected with an education. The form of apprenticeship was often gone through with for a term of years varying from three to seven, during which time the young student performed the most menial duties, had very meagre opportunity for anatomical study, and acquired his knowledge rather by contact with and absorption from his preceptor than in any other way. In this method of teaching the personal element was so pronounced that everything, in fact, depended upon the preceptor, save what natural talent and industry might accomplish, With such meagre opportunities the means for doing were equally scant. Nevertheless, emergency made many of these early American practitioners self-reliant and competent to treat, according to the knowledge of that day, the various accidents then so common. In 1636 the Assembly of Virginia passed a fee-bill for surgeons and apothecaries, fees, however, being often paid in tobacco, powder, lead, wampum, etc. Not a few combined ministry of the body and the soul, and a number of eminent physicians were also preachers of more or less renown,—among them John Rogers, John Fisk, and others.
Probably the only medical work published in America during the seventeenth century was A Brief Rule to Guide the Common People of New England how to Treat Them-selves and Others in the Small-pocks or Measels. This was printed and sold in 1677, by John Foster, of Boston. It was printed upon one side of a single sheet in double columns, and described both of these diseases as due to the blood endeavoring to recover a new form and state.
The old English distinction between physician and surgeon was for many years quite generally preserved, but could not persist, because of the different conditions under which men practiced. During this century, also, a number of midwives made excellent practitioners,—among them the wife of Dr. Fuller, one of the May Flower pilgrims. Those colonial days, however, seem to have been free from the ravages of itinerant specialists and charlatans, who so abundantly infested Europe at the time. It is also to the everlasting credit of the American profession that it took no part in the horrible delusions and scandalous transactions connected with the Salem witchcraft.
By the beginning of the eighteenth century the population of the United States was about three hundred thousand whites; by the end of the century it had increased to a total of about four millions. During this century a larger proportion of educated medical men came from abroad and settled in various parts of the country, while the Colonial and the Revolutionary Wars offered ample opportunity for the development and study of military medicine and surgery. Commerce between the two continents increased; communication became more free, and the people of the Old World and the New were constantly brought into closer relation. The most lively medical controversy of the century was, probably, that excited over the introduction of vaccination against small-pox. In previous sketches I have had to intimate that the greatest enemy of the medical profession in time past has been the clergy. In this particular instance, however, it was to the Rev. Cotton Mather, of Boston, that the profession is largely indebted for the favor with which the new method was received in this country. In 1721 he called the attention of various American physicians to the method, then in vogue in Turkey, of inoculation with virus from the active disease. Dr. Boylston, of Brookline, Mass., who settled in Boston, corresponded with members of the British Royal Society and finally determined to put the method to actual proof. In 1721 he inoculated his own son with the virus of natural small-pox, and within the next year had inoculated two hundred and forty-seven persons, of whom about two per cent, died of the disease; while, of nearly six thousand persons attacked by the disease in the natural way, more than fourteen per cent. died. In spite of this, the man and the method were violently attacked by the people and the profession, and found their warmest defenders among the ranks of the clergy. Benjamin Franklin, then only sixteen years of age, joined with the rabble in opposing the inoculation method. Boylston was threatened with hanging, and had even to hide himself for a time, he died in 1766.
After the great discovery of Edward Jenner societies were formed for the promotion of vaccination all over the world. The earliest vaccination in the United States was performed by Dr. Waterhouse (born 1754, died 1846), who operated upon four of his own children in 1800.
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It was during the eighteenth century that a number of our best-known educational institutions were founded in the different colonies,—among them, Yale College, in 1701; Princeton (College of New Jersey), in 1746; University of Pennsylvania, in 1749; Columbia (King's College), in 1754; and others, only a little less known. In most of these latter were established medical departments, but the method of apprenticing students to physicians was still in general observance, no preliminary education whatever, as a rule, being demanded. In 1766, however, the New Jersey Medical Society ordained that no student be taken as an apprentice by any member of the society unless he had competent knowledge of Latin and some initiation in the Greek. About the middle of the century Drs. Bard and Middleton, in New York, and Dr. Cadwallader, in Philadelphia, began giving lectures in anatomy, while at Newport, Rhode Island, Dr. William Hunter, between 1754 and 1756,—a near relative of the famous Hunters of London, and a pupil of the elder Monro,—gave a course of lectures on human and comparative anatomy. Dr. William Shippen. Jr. (1736-1808),—a student of John Hunter's,—returned in 1762 to America, and gave his first course of lectures on anatomy and midwifery during the years immediately following. His lectures led to the formation of a Medical Department of the College of Philadelphia, in 1765, in which lectures were continued regularly until the winter of 1775, when the War of the Revolution interfered. In July of 1776 Shippen was made Chief-Physician of the Continental Army, and in the following year was elected by the Provincial Congress Director-in-General of army hospitals. During the latter years of the war he returned to Philadelphia each winter, and delivered a course of lectures, shortened by the necessities of the case. Thus he was the first public teacher of midwifery in this country. He was ably seconded in his work by Dr. John Morgan (1735-1789),—also a pupil of Hunter and Monro, who received a prominent army appointment in 1775, but who, two years later, was unfortunately dismissed on charges subsequently proved false. Shippen and Morgan were for some time the only professors in the Medical Department of the College of Philadelphia. In 1768 Kuhn—a pupil of Linnæus—was made Professor of Materia Medica and Botany; and Benjamin Bush, a year later, was given the Chair of Chemistry. The commencement of this institution occurred in 1768, when the degree of M.B. was given to seventeen graduates. In 1779 political reasons led to the abolition of the College of Philadelphia, the University of Pennsylvania taking its place. Ten years later the former institution was restored, and in 1791 the two institutions were united. The present Medical Department of the University of Pennsylvania is, therefore, the legitimate continuation of the first medical school in America.
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The Medical Department of King's College, New York, now Columbia College, was organized in 1767, by Clossey, an Irishman; Middleton, a Scotchman; James Smith, a graduate of Leyden; Tenant, an alumnus of Princeton College; and Bard, who was by far the most eminent of the group, a Philadelphian by birth, who had studied under the best masters in England.
The Medical Department of Harvard University was organized in 1783. Most prominent in connection with it was Dr. John Warren, the first teacher of anatomy and surgery, and the founder of a family of eminent medical men, whose descendant, Dr. J. Collins Warren, is to-day an occupant of the chair of surgery in the same school. The Medical Department of Dartmouth College was organized in 1798 by Dr. Nathan Smith,—a man of great energy and unusual versatility.
While these medical colleges were developing their strength the medical profession were not idle, and institutions and libraries sprang up in various places. The Pennsylvania Hospital, for instance, founded in 1762, is to be credited with the oldest medical library in this country, many of its volumes having been selected especially for it by Louis, of Paris, and the famous Lettsom, of London. It now contains nearly fifteen thousand volumes. The library of the New York Hospital, not quite so large, was founded in 1776; that of the College of Physicians, in Philadelphia, in 1788. The profession of New Jersey organized the State Medical Society in 1765. In 1781 was founded the Massachusetts Medical Society. In 1787 arose the College of Physicians of Philadelphia.
In 1789 the profession of Maryland organized the so-called Medical and Chirurgical Faculty of Maryland, constituting thereby the same organization as the societies of other States. Before the close of the century, Delaware, New Hampshire, and South Carolina had also organized societies. In the larger cities extensive hospitals were also founded,—the Pennsylvania Hospital, in Philadelphia, in 1751, inside of which the first clinical instruction in this country was given by Dr. Thomas Bond. The New York Hospital began in 1769, simultaneously with the organization of the Medical Department of King's College. The first insane-asylum in America was built at Williamsburgh, Va., in 1773, although the charter of the Pennsylvania Hospital, dated 1751, provided for the care of lunatics, though not at that time in a separate institution.
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The most conspicuous medical character of the century in American history was undoubtedly Benjamin Rush (1745-1813). He was one of Shippen's earliest students in anatomy, studied widely abroad, was a member of the Continental Congress, and one of the signers of the Declaration of Independence. After him is named Rush Medical College of Chicago. He was an extensive writer on a variety of subjects, not only professional, but political, philosophical, etc. He recognized but two kinds of remedies,—stimulants and depressants,—and held it to be the principal duty of the physician to decide as to which were most advisable in a given case. He called calomel the "Samson" of the materia medica, and his opponents contended that he was right, since it had undoubtedly slain its thousands. As an accurate observer of disease, he was correct and exact, and his descriptions are to-day both classic and reliable.
The study of practical anatomy lias always been carried on in this country under great disadvantages. At first only the bodies of executed criminals were sparingly furnished.
In 1788, in New York, occurred the celebrated "doctor's mob," which attested the vehemence of public objection to dissection, and which for two days defied the control of all the authorities. Secret dissections had been practiced in Harvard College so early as 1771, but the practice was against the law even for sixty years later in Massachusetts. Physiology, as such, was not taught in any medical school in this country during the century, and experimental physiology was practically unknown. Surgery was eagerly studied, especially during war times, and Dr. John Jones (1729-1791), of the King's College School, was, perhaps, the most eminent of the surgeons of his day. Others who vied with him were William Shippen, Jr., the first teacher of surgery in the College of Philadelphia; John Warren, of Boston; Richard Bayley, of Connecticut; Baynham, of Virginia; and McKnight, of New York.
The position of midwifery during the earlier years of the country may be, perhaps, understood by the following extract from the New York Weekly Post-Boy, of July, 1745:—
"Last night died, in the prime of life, to the almost universal regret and sorrow of this city, Mr. John du Puy, M.D., man-midwife," etc.
The first practitioner of obstetrics in New England was Dr. Lloyd (1723-1810), a pupil of Hunter and Smelley; while Dr. Shippen, in Philadelphia, endeavored to organize a school for the instruction of midwives, in which, however, he met with insuperable difficulties.
The first attempt to regulate practice in colonial times was an act passed by the General Assembly of 1760, providing for at least a form of examination in physic and surgery, registration, etc. The first medical journal to appear in the United States appeared about 1790. It was entitled A Journal of the Practice of Medicine and Surgery and Pharmacy in the Military Hospitals of France, consisting merely of translations from the French journals of military medicine. The first real American medical journal was the Medical Repository, begun in 1797 and discontinued in 1824.
The present century, now drawing to its close, saw in its earlier half the rise of a large number of American physicians and surgeons who have made their names illustrious for all time by their teachings, their writings, and their invention and originality. While it is, of course, invidious to select names, the following certainly deserve honorable mention in this list, without the slightest disrespect or intentional slight to many others whose names must be omitted for want of space.
John R. Cox (1773-1864), an early student of Benjamin Rush, filled the chair of Materia Medica and Pharmacy in the University of Pennsylvania, and published the American Dispensatory in 1806. Caspar Wistar (1761-1818) was the author of a System of Anatomy,—held in great favor in his day as a text-book. Nathaniel Chapman (1780-1853) was Professor of Theory and Practice in the University of Pennsylvania until 1850. John Eberle held the similar chair of the Jefferson School from 1825-1831. The former wrote on Materia Medica and Therapeutics, the latter on the Practice of Medicine, both works being exceedingly popular. John W. Francis (1789-1861) taught obstetrics in the College of Physicians and Surgeons from 1826-1830. Franklin Bache (1792-1864) was one of the authors of the Dispensatory of the United States of America, published in conjunction with George B. Wood, who was Professor of Materia Medica in the University of Pennsylvania, and who wrote also extensively on his chosen subject in monographs and large works.
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Robley Dunglison (1789-1869) taught for a number of years in the University of Virginia, but removed later to the Jefferson School in Philadelphia. He was a man of great industry and versatility, and wrote on a variety of subjects, his best-known work being his Medical Dictionary.
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W. E. Horner (1793-1853) taught anatomy and histology in the University of Pennsylvania, and will long be remembered for his researches in these branches. John W. Draper (1811-1882) made himself eminent as well by his researches in photography and in general science, as by the publication of his treatise on Human Physiology, which first appeared in 1853. Better known as physiologist was John C. Dalton (18251889), whose text-book is to-day studied in many colleges and who first introduced the method of vivisectional classroom demonstrations in our own school here in Buffalo.
Alonzo Clark (1807-1887) was one of the most eminent teachers of medicine that this country has produced. Austin Flint (1812-1886) was also a famous teacher of medicine in New York, who made his first reputation in the then small school in Buffalo.
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His text-book on Practice is the most popular American work on the subject that has ever appeared, and is still in general use. William P. Dewees (1768-1841) was the author of a treatise upon Diseases of Children, which reached a tenth edition and which rivaled the similar treatise of John Forsyth Meigs. The best-known teacher of dermatology and venereal diseases was Freeman J. Bumstead (1826-1879), author of the most popular work upon the latter subject that has been issued from the medical press. He wras professor of these diseases at the College of Physicians in New York. His text-book vied with that produced by William H. Van Buren (1819-1883), who, in connection with Dr. Keyes (still living), wrote a treatise upon the Surgical Diseases of the Genito-Urinary Organs, including syphilis, which has been, since its appearance, exceedingly popular with the medical profession.
Among the best-known neurologists and alienists of the century since Benjamin Rush wrote his Inquiries and Observations upon Diseases of the Mind (1812) was Dr. Isaac Ray, who, in 1838. published a work upon the medical jurisprudence of insanity.
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Dr. Brigham ( 1798-1849) was superintendent of the Utica Insane-asylum for some years before his death; and Dr. Kirkbride, who died in 1883, had been superintendent of the Philadelphia Asylum for over forty years. Dr. John P. Gray followed Brigham as superintendent of the Utica Asylum, where he remained for thirty-two years, and founded the Journal of Insanity.
The first independent writer upon diseases of the eye was Dr. Frick (1793-1870), of Maryland. As illustrating how little our present specialties were then separated, it is worth while to remark that Dr. Edward Delafield (1794-1875), who, in 1826. was Professor of Obstetrics and Diseases of Women and Children in the College of Physicians and Surgeons, New York, delivered at the same time a special course of lectures upon diseases of the eye. The first man in the United States to make these diseases his exclusive specialty was Dr. Williams (1822-1888), of Cincinnati.
It would be very wrong, in this connection, to omit the mention of the name of Oliver Wendell Holmes, the genial "Autocrat of the Breakfast Table," but recently dead at a ripe old age, who used to say that he was "seventy years young." who was for a long time Professor of Anatomy at Harvard Medical College, but who was much more widely known and endeared to the English-speaking public by his beautiful poems and most attractive prose writings.—who, as author of the Chambered Nautilus, for instance, will be remembered so long as the English language has a literature and is read, he rendered a great service to the medical profession by first calling attention to the contagiousness of puerperal fever. Of his prose writings, his medical essays—entitled Currents and Counter-currents—make perhaps the most delightful reading.
Not a few Americans deserve special mention as surgeons and surgical teachers of eminence during the past hundred years. Without being invidious, there must, nevertheless, be mentioned John Collins Warren (1778-1856), first Professor of Anatomy and Surgery in the Harvard School, under whose auspices ether was first administered for the purpose of surgical anæsthesia, and who was the founder, in 1828, of the Boston Medical and Surgical Journal. He wrote an extensive treatise upon tumors, and, it is stated, first successfully tapped the pericardium.
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Philip S. Physick (1768-1837), a pupil of Hunter, has been spoken of as the "father of American surgery," which he taught in the University of Pennsylvania. He was a tremendous worker, but wrote very little. He employed animal ligatures made of buckskin. John Syng Dorsey (1783-1818) was a nephew of Physick; taught anatomy in the University of Pennsylvania; wrote a treatise on surgery, which was the second surgical text-book published in this country, and was the first in the United States to tie the external iliac artery. He died at the age of thirty-five, at a time when he was giving promise of exceeding eminence. Nathan Smith taught in Dartmouth, Yale, and Bowdoin Colleges, and 'was considered the best man of his day in New England.
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To him is justly due the great honor of having performed the first rational and deliberate ovariotomy, which he did in 1809, his patient living for thirty-two years. The operation was performed without an anæsthetic, and considering the circumstances under which it was carried out has shed a lustre upon his name and brain which nothing can ever dim. By this performance he became practically the father of modern abdominal surgery, and to him Americans and Europeans alike are delighted to render all the honor that is his due.
Perhaps the most eminent surgeon of the country was Valentine Mott (1785-1865), a pupil of Cooper and Bell, who taught in the College of Physicians and Surgeons, New York, until 1840, and in the University Medical School until 1860. He was a man of exceeding boldness and brilliancy, whose operations were performed at a time when anaesthesia was unknown, or was in its infancy, and who probably did more work in the surgery of the vascular system than any other surgeon who has ever lived. He was the first to tie the arteria innominata,—in 1818. As Gross wrote of him, he had a record of one hundred and thirty-eight ligations of various large arteries,—a record probably never equaled. He was also the first to do a successful extirpation of the clavicle for tumor,—an operation which at that time was considered very formidable. Though not a great writer himself, he is best known among students as the translator and editor of Velpeau's large work upon operative surgery.
Dr. George McClellan (1796-1847) was the founder of the Jefferson Medical School, and its first Professor of Surgery. He was followed later by Dr. Thomas D. Mutter, who left his surgical museum to the College of Physicians of Philadelphia and endowed a lectureship there. J. K. Rodger, of New York; John Rhea Barton, of Philadelphia; William Gibson, of Philadelphia; Gurdon Buck, of New York; Willard Parker, of New York; Frank H. Hamilton, of New York, who made his reputation while teaching in our Buffalo school, author of a most popular and valuable treatise upon fractures and dislocations; and Henry B. Sands, of New York, were men of greatest prominence during the middle and latter portion of the present century, each of whom has contributed in his way either to the science or to the literature of surgery. The most prominent figure in American surgery of the past forty years was Samuel D. Gross, of Philadelphia, professor in the Jefferson School, to which he moved from Kentucky, where he laid the foundation for his attainments and reputation.
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He was an early writer upon surgical pathology and anatomy, but is best known for his elaborate System of Surgery, in two large volumes, which has survived several editions and is still most highly esteemed. Among others who ought to be mentioned are Nathan R. Smith, of Baltimore, the inventor of the anterior splint; Paul F. Eve, of Nashville; John T. Hodgen, of St. Louis; Daniel Brainard, of Chicago, and his successor, Moses Gunn; Alden March, of Albany; Henry J. Bigelow, of Boston, who performed the first excision of the hip in this country, in 1852, and who invented the method of crushing and removing stone from the bladder at a single operation, known as litholapaxy; and D. Hayes Agnew, of Philadelphia, who finished, before his death, a large and elaborate treatise on surgery, in three thick volumes.
Of obstetricians and gynaecologists America has had no lack, and, in fact, the United States may almost be said to be the first home of gynaecology. Dr. Bard was the first Professor of Midwifery in King's College, now Columbia, New York, and the author of the first work upon the subject published in this country. In Philadelphia, Dr. Thomas C. James (1756-1835) was the first distinct teacher of obstetrics, his chair falling later to Dewees, already mentioned, who wrote extensively on midwifery and the diseases of children and of women. The same chair in the University of Pennsylvania was filled later by Hugh L. Hodge (1796-1873), a man of great originality and independence, who published a most elaborate and beautiful work upon his branch, which will always remain a classic. Charles D. Meigs, professor in the Jefferson School, Philadelphia, was the first to direct attention to thrombosis as a cause of sudden death in childbirth. He wrote both on gynaecology and midwifery. Bedford, of Baltimore, was another popular teacher and writer, with whom deserves to be mentioned William H. By ford, of Chicago, who wrote on both obstetrics and gynaecology.
Gynaecology owes much to the efforts of American schools and practitioners. The first successful attempt of McDowell's, already alluded to, was imitated by Nathan Smith in 1821; and during the next forty years thirty-six ovariotomies had been performed by eighteen different surgeons, with a record of twenty-one recoveries.
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Probably the most prominent passed figure in American gynaecology is J. Marion Sims (1813-1883), born in the South, where he invented his well-known speculum in 1852, whose introduction marked an epoch in the treatment of the pelvic diseases of women. It was also in South Carolina, among poor negro patients, that he perfected his method of plastic operations in the vagina for the relief of vesical fistulæ, which he later demonstrated in Paris to the astonishment of incredulous Parisian surgeons, who had almost uniformly failed in their attempts, and which he later successfully and brilliantly performed in all the capitals of Europe, where, as in this country, he enjoyed the greatest reputation. He was the founder of the great Woman's Hospital in New York, in 1855, an institution from which has proceeded more good gynæcological teaching than from any similar institution in the world Other ovariotomists and gynaecologists of great merit were John L. Atlee, and his brother Washington Atlee, of Pennsylvania; Dunlap, of Springfield, Ohio; Peaslee, of New York, who wrote the first American treatise on ovarian tumors; Kimball, of Lowell, Massachusetts; and D. H. Agnew, of Philadelphia, who is, perhaps, yet better known as a general surgeon because of his magnum opus,—his Treatise on Surgery, in three large volumes, already mentioned.
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After this brief résumé of the names and achievements of the best-known American physicians and surgeons no longer living, it remains only to say a few words with regard to the general character of their work and attainments. It certainly was the case, during the earlier and middle portions of this century, that men had much to gain, beside addition to their vernacular, by study in foreign countries. Edinburgh and London were, at first, the centres to which men flocked; during the middle of the century they gathered in Paris, attracted by such men as Broussais, Velpeau, and others; after which the tide of travel turned toward Germany, where the government does more for the education of medical men and the furnishing of distinct opportunities than is done in any other part of the world. But, thanks to the influence of the foreign schools and the receptivity and natural quickness of the American mind, we have reached a point in this country when it is no longer necessary for American students to visit the foreign centres for this purpose, advantageous as these may be in many respects. The only feature in which we are yet lacking is the matter of government aid and the government control of medical institutions, by which better opportunities may be afforded for pathological study. Aside from this, and the centralization of cases which government control permits, it may be said that the Americans are in all respects as good practitioners as—and in most respects better than—their foreign colleagues. They evince more of humanity, more of real interest and care in their patients, and more consideration for their comfort and welfare; while, in all that pertains to fertility of invention, to originality of performance, and accuracy of work, they, as a rule, excel. Divested of glamour, American surgery, both general and special, is ahead of most of that which one can see abroad, and the therapeutics of the American profession certainly surpass those of any other nationality. No one need feel, then, that it is necessary to go abroad for any purpose, unless it may be that polish and wide range of general information that necessarily come from travel and observation among other nations and peoples. In practical medicine, then, as in practical living, America leads the world.