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A METHOD OF DETERMINING THE EFFECTS OF SYSTEMS OF TREATMENT IN CERTAIN DISEASES.
157
ophthalmoscope and dissection after death prove to take generation. The Greek schools of medicine pursued the same An course. place in the optic nerve, retina, choroid, sclerotica, &c. It is a great mistake with the sceptic to suppose that he e is acquaintance with these pathological phenomena, he said, exwhich the uncertainty myopic persons experience certainty, and that no satisfactory judgments of the effects great plained in their powers of vision, and the subjective symptoms of conges- of treatment can be formed under this system. The effects of taking up an artery are evident ; so are the tion to which they are prone ; also the not unfrequent occurrence effects of some other methods of arresting hmoiorrhage. The of amblyopia, and sometimes of amaurosis. The author contended that the infrequency of non-hereditary diarrhceal and choleraic discharges are also frequently stopped staphyloma posticum, unattended by atrophy of the choroid by medicine. Recovery from drowning is often the direct pigment, favoured the opinion that the choroid, and not the effect of Marshall Hall’s VIethod. The relief of constipation sclerotica, was primarily affected in the production of elonga- by aperients, and of retention of urine by the catheter, are intion of the antero-posterior axis of the globe. It was evident, stances of the direct cure of disease by removal ; so are several he remarked, from all we know of the pathology of myopia, amputations, and the. cutting away of various tumours ; the that whatever surgical operation we may adopt for the relief extraction of teeth, tapping for hydrocele, and the operation the
no
for hernia. Pain is assuaged by opium or by chloroform ; ague is cured by quinine; scurvy by lemon-juice; anaemia by iron. These are examples of the medicaments which prevent and with that state. Observations made at one of the most nume- also cure diseases. And the evidence of their therapeutical rously attended provincial ophthalmic hospitals, and which had efficacy is almost as incontrovertible as the evidence of the sucextended over a period of nearly two years and a half and em- cessful reduction of dislocations, of the setting of compound braced an experience of upwards of forty operations, had led fractures, of the extraction of the impacted foetus, or of the the author to the conviction that the said desiderata are more healing of ulcers. The effects of bloodletting in cutting short inflammation; supplied by intraocular myotomy than by any other method. Indeed he knew of no treatment, which is equally of mercury in syphilis; of colchicum in gout, were judged in safe and easy of execution, that exerts the same amount of the same way, and were in past times considered equally cercurative power in cases of subacute and chronic posterior cho- tain. In this class of cases, in fever, in the exanthemata, in rheumatism, in consumption, and in diathetic diseases, the roiditis. After describing the ciliary muscle and his method of dividing processes go on for many days, and a certain number of them it, Mr. Solomon said the most striking results from his plan ofare fatal under any system of treatment. Here, then, judgtreatment were afforded by patients under the age of puberty. ment is difficult ; the opinions of the past are questioned ; and The operation enabled children to see features with as much although right results are, no doubt, arrived at by sagacious distinctness, and at the same distance, as persons whose accom- men, a great deal of uncertainty and diversity of opinion necesmodation was normal. It prevented their acquiring the habit sarily prevails. The utility of medicine is denied by the sceptic ; of dropping the lids, and of that distrait demeanour which the expectant does nothing ; the empiric vaunts his cures ; and myopics commonly exhibit. It also enabled them to thread a amidst the conflicting methods of treatment the conscientious needle, pick a pin from the floor, and read a book at a mode- man finds it difficult to select the best. rate distance from the eye. A boy of eleven years, who could The power of the physician of these days over the phenomena of life, and over life itself, is vast ; for with diet, regimen, and see features with distinctness at six yards only, in two years after the operation saw them with clearness at forty yards, the potent chemicals of the materia medica, he can,act on the and the figure of a man and all his movements at 500. lie patient in a thousand ways. He is indeed ta60Eos. In some He is the read small pica at thirty-three inches, instead of at six, as be- cases he stills disease ; in others he gives life. fore operation. In adults whose eyeballs are not very wide in healer. But he is not allowed to assume that he cures every their transverse diameters, or their optic nerve completely case he treats; or that because, with M. Bouillaud, he extracts encircled by a wide horned staphlyoma posticum, or their four pounds of blood from the veins, he cures rheumatism ; or choroids spoiled by extensiveatrophy, a normal range for featuresI that salivation to the extent of three pints daily is a specific was frequently acquired. A man who two years ago could for syphilis. Some few practitioners still believe that when read small pica at nine inches and a half only, and see features! they treat a patient, either in the usual way, or heroically, or distinctly at five yards, now reads at twenty-four inches, seesI homceopathically, and his recovery follows, it is the inevitable features at thirty yards, and trees with distinctness at a mile! and direct result of the treatment. Quacks live, too, upon this fallacy; but it misleads no rational observer of the progress and a quarter. The paper was illustrated by diagrams of the ciliary muscle, of disease. Some method, then, of measuring the effects of systems of coloured drawings, and mathematical formulse, illustrative of, the value of the operation in the accommodation of eyes which treatment is required ; and that method-while it does not had been treated upwards of one or two years. supersede intuition-is necessarily founded on induction. It is based on observation and records. "Therapeutics,"saysBoerhaave," is that part of medical A METHOD OF DETERMINING THE EFFECTS OF institutions which teaches us to discern in sick persons what SYSTEMS OF TREATMENT IN CERTAIN distemper they labour under, and thence to learn what is reDISEASES. quisite to their cure." Therapeutics presuppose pathology. And for the purpose of BY W. FARR. M.D., F.R.S. our method diseases must be taken of which the correct diaTo heal the sick is the of the physician; and as there gnosis is possible under ordinary circumstances. The method are various kinds of diseases, the treatment varies. Our meansI supplies the formula for the prognosis. of judging of the effects of treatment also vary. In some casesI The sick persons are to be saved from death, and to be rethese effects are obvious; in other cases they cannot be appre- stored to health. To test the efficacy of two systems of cure ciated. There is a large intermediate class of cases which can we have then to determine the time that the sick persons rebe judged accurately by a method which I now beg to submit main ill. If it is found that 100 patients healed in one way to your notice. are cured in seven days, and that none die ; while of 100 Our knowledge exists in different states. For instance, the; treated in another way-or not treated at all-illness lasts knowledge of the stars which guides the mariner is in form thirty-six days, and ten or twenty die, the efncaoy of the treatvery different from the knowledge which the astronomer hasI ment is placed beyond doubt. But practically the great majoof the same objects. The husbandman knows a great deal rity of diseases-like small-pox-can only be cut short in a about wheat-plants, but it djes not exist in the form whichL limited number of cases ; while of the rest, some terminate in the knowledge of that plant assumed in the system of Linna-us. death, others terminate in recovery after several weeks of illLincaeus seized certain characters which served the purposes ofness. The cure is really the diminution of the danger-that is, his method, and the same course is pursued in all the sciences. the reduction of the mortality, and the acceleration of recovery. Medicine was, not many years ago, taught in this country Now, rates of mortality and the durations of illness cannot be somewhat in this fashion. The apprentice learned the nature accurately measured by the naked eye. if I may venture to use of drugs by compounding them; and he became acquainted the expression. Hence the necessity of observation, of records, with disease by visiting the patients of his master, either at of instruments, and of a method to assist the mind in its detheir homes or in hospitals. He distinguished diseases by their terminations. All diseases haveasort of natural life ; that is, they begin, characters, precisely as the farmer distinguishes the various kinds of grain ; and he followed up the plan of treatment which ex- grow. attain maturity. decline, terminate. Their evoution, * --Nletiiod of perience and tradition had handed down from generation toI study ingI’hy&ic. near sight must contain within it not only the power of decreasing the excess of refraction of the drioptric media, but of removing intraocular congestion, which is commonly connected
of
completely
’
.
"
office
.
.
.
’
,
’
,
158 like that of an animal, requires a certain term for its comple- ties and the instruction of the inhabitants of the district, an. and that differs from their actual duration-as the actual annual report of the results of jurisdiction, as also a quarterly life and the mean lifetime of mEn fall short of the speculum in summary of the deaths and diseases, with their causes, accordwhich their physiological development goes through its round. to forms to be determined by the Registrar General for A small-pox patient may die before the appearance of the Ireland. 6. That in the local reports of mortality and sickness it is eruption ; and an inflammation may not go on to suppuration. The death of the patient is the death of the disease ; for important to specify age and occupation, to record meteorological disease is a living process. Now, we find that the danger- observations, and to note local events and circumstances affecting which is accurately expressed by the mortality-changes in the public health. different stages of the same disease ; and the chances of illti7. That it is desirable to require the authentication of themate recovery change every day. I will proceed to describe a cause or mode of death by a certificate from a legally qualified. construction, which will enable you to measure the chances of medical practitioner : and that where no such certificate is to large numbers, and also delivered the sub-registrar be required to inform the superinrecovery and of death, when to calculate the after-sicktime. tendent, who should forthwith make inquiry into the case. 8. That the registration of births should be compulsory, and [The tabular construction is here described ; and it is derived directly from the observed numbers dying, and recovering that still-births after the sixth month of utero-gestation, when in each period of the disease. It shows the chances of reco- not certified by a legally qualified medical practitioner, should very, the duration of cases, and the mortality. It gives an be subject to the regulations stated in the last resolution. exact measure of disease, from the therapeutic point of view. 9. That the boundaries of registration districts and subIllustrations from a table of 8000 cases of natural small-pox.]] districts ought as nearly as possible to conform to the limits of The diagnosis of some diseases is uncertain. But I have existing districts for the relief of the poor and for the adminishere a list of the diseases which might be investigated in the tration of medical aid, having due regard to the jurisdictions of present state of pathology :-Small-pox, measles, scarlatina., local sanitary authorities. 10. That the proposed scientific superintendents, as statistical diphtheria, croup, whooping cough, typhus, erysipelas, metria, carbuncle, &o. inquirers and reporters for national purposes, should be made The observations for this method are made in nearly the independent of local and party influences, debarred from private same schedule as that employed by Hippocrates in his reports medical practice, and paid out of the national funds. of cases. The form of disease, its point of origin, and its ter11. That the Council of this Association be requested to open mination, are defined, so as to leave no doubt about the thing communications with the Government and with the Poor Law to be investigated. Commissioners of Ireland, for the purpose of laying before them The varieties of the disease-if they can be clearly distin- the suggestions of the Association, and of conferring with them guished, as in small-pox, modified and unmodified-are sepa- as to the best mode of embodying them in a legislative enactrately investigated. The results of treatment in hospitals, and ment. in the homes of the poor, are ascertained. The Resolutions were seconded by Dr. Richardson, and unaniThe age and sex of patients are found to be important ele- mously adopted. ments, and enter into the analysis. IN SURGERY. Finally, the method is applied to measure the effects of BY J. PAGET, F.R.S. systems of treatment. It is not necessary, and I think it would be impossible and wrong, to endeavour to determine the Mr. President and Gentlemen,-I have chosen as the subject duration and mortality of diseases left to themselves. The obof my address, " The Treatment of Patients after Surgical: ject should be to determine these elements under the present and I venture to think that I shall best dischargesystem of treatment. Every new method could be tested by Operations," if I deal with this subject, not merely in retrospect, asthis standard. my duty To heal the sick is the aim of Medicine, and pathology as if there were only some great achievements over which we might well as physiology are subsidiary to this grand object. The rejoice, but rather with the view of indicating some of the things: public come to you for relief, for life ; and you, in the schools which yet remain to be done, and which may be done if the of this country, have ever kept that end in view. You are now here in a position to make a great step in advance ; and the members of this great Association will make it their chief business progress of pathology since Hunter’s time, in England, in to do them. There is, indeed, nothing in the retrospect from which France, and in Germany, throws the field open to the thera- we need avert our faces; rather there are many things over which we peutist ; so we shall perhaps see, by the side of the Pathological might boast as good work achieved ; and if I had to name them Society, a Therapeutical Society flourishing, and doing incal- all, or to illustrate the chief of them by one, I would take the, culable good. This branch is of such paramount importance, and so entirely within its province, that I do not despair of security and soundness of our practice, founded on a wider re-seeing the College of Physicians taking it in hand, and enlist- cognition of the principle that the recovery from an operation, ing in its support every practitioner in the kingdom who has the as from any other injury, is so natural a process, that, except in interest of medical sciencs at heart. You can, by a combined certain exceptional cases, it should not be at any time or in any system of observation, determine the mortality and duration of way interfered with ; for we are so constructed that injuries by every definite form of disease ; you can, at the same time, violence, from whatever source, do of themselves, and naturally, measure disease, and the relative power of remedies in cutting it short and diminishing its dangers. bring about the processes for their own amendment. We are fitted, not only for the calm of life, but for the storms of it ; 1B11’. Rr}1SEY brought forward the following resolutions with not only for the things which are certain, but for those which are reference to the Act for the Registration of Births, Deaths, and probable ; nay, almost for all that are possible as events that. occur in our life ; and among these probable events are injuries Disease in Ireland. 1. That in any measure of legislation for the registration of by violence. Among these, and not widely different from them, in regard to some of the conditions in which patients births and deaths in Ireland, this Association deems it highly important that the local machinery for such registration should be come before us, are the injuries inflicted by surgical operations. Nevertheless whatever be our fate in the natural process of altogether ciistinct from that for the registration of marriages,
tion ;
ing
applied
ADDRESS
I
except
and is happy to perceive that this principle has been recognised recovery from injuries, there are certain things left for us to do in the Bilts introduced into the House of Commons during this or to watch, or in some respects to guide. And first of all we have to decide in every case the method by which the surgical and the preceding sessions of Parliament. 3. That it is most desirable to introduce into any such mea- injury shall be healed. We have long been settled in a just. sure the principle of local scientific supervision of the return of preference for the most speedy mode of union, that is for union births and deaths. by the first intention, whether there be healing by immediate 3. That the office of Superintendent Registrar of Births and union or by the union by adhesion. And there are many obvious Deaths ouht to be held by persons well acquainted with physical reasons for this ; but the most potent of them, to my mind, is, that and biological sciences, versed in sanitary and vital statistics, and long as a wound is unhealed, there is some risk, however accustomed to make legal investigations. small, that the patient, may fall into pyæmia or erysipelas, or 4. That it is desirable to combine with the superintendance of some other of the sore plagues of surgery. But the manner of the registration of births and deaths the registration of all sickthe wound being decided, there yet remain many things be done, even by those that have the most full faith in the ness attended in public institutions, or at the public expense. 5. That each Superintendent Registrar should be required to natural processes of recovery. They may, however, perhaps beup in comparatively very few words-namely, repose publish, for the iuforma.tion of the local administrativeauthori-
so
healing
to
summed
ophthalmoscope and dissection after death prove to take generation. The Greek schools of medicine pursued the same An course. place in the optic nerve, retina, choroid, sclerotica, &c. It is a great mistake with the sceptic to suppose that he e is acquaintance with these pathological phenomena, he said, exwhich the uncertainty myopic persons experience certainty, and that no satisfactory judgments of the effects great plained in their powers of vision, and the subjective symptoms of conges- of treatment can be formed under this system. The effects of taking up an artery are evident ; so are the tion to which they are prone ; also the not unfrequent occurrence effects of some other methods of arresting hmoiorrhage. The of amblyopia, and sometimes of amaurosis. The author contended that the infrequency of non-hereditary diarrhceal and choleraic discharges are also frequently stopped staphyloma posticum, unattended by atrophy of the choroid by medicine. Recovery from drowning is often the direct pigment, favoured the opinion that the choroid, and not the effect of Marshall Hall’s VIethod. The relief of constipation sclerotica, was primarily affected in the production of elonga- by aperients, and of retention of urine by the catheter, are intion of the antero-posterior axis of the globe. It was evident, stances of the direct cure of disease by removal ; so are several he remarked, from all we know of the pathology of myopia, amputations, and the. cutting away of various tumours ; the that whatever surgical operation we may adopt for the relief extraction of teeth, tapping for hydrocele, and the operation the
no
for hernia. Pain is assuaged by opium or by chloroform ; ague is cured by quinine; scurvy by lemon-juice; anaemia by iron. These are examples of the medicaments which prevent and with that state. Observations made at one of the most nume- also cure diseases. And the evidence of their therapeutical rously attended provincial ophthalmic hospitals, and which had efficacy is almost as incontrovertible as the evidence of the sucextended over a period of nearly two years and a half and em- cessful reduction of dislocations, of the setting of compound braced an experience of upwards of forty operations, had led fractures, of the extraction of the impacted foetus, or of the the author to the conviction that the said desiderata are more healing of ulcers. The effects of bloodletting in cutting short inflammation; supplied by intraocular myotomy than by any other method. Indeed he knew of no treatment, which is equally of mercury in syphilis; of colchicum in gout, were judged in safe and easy of execution, that exerts the same amount of the same way, and were in past times considered equally cercurative power in cases of subacute and chronic posterior cho- tain. In this class of cases, in fever, in the exanthemata, in rheumatism, in consumption, and in diathetic diseases, the roiditis. After describing the ciliary muscle and his method of dividing processes go on for many days, and a certain number of them it, Mr. Solomon said the most striking results from his plan ofare fatal under any system of treatment. Here, then, judgtreatment were afforded by patients under the age of puberty. ment is difficult ; the opinions of the past are questioned ; and The operation enabled children to see features with as much although right results are, no doubt, arrived at by sagacious distinctness, and at the same distance, as persons whose accom- men, a great deal of uncertainty and diversity of opinion necesmodation was normal. It prevented their acquiring the habit sarily prevails. The utility of medicine is denied by the sceptic ; of dropping the lids, and of that distrait demeanour which the expectant does nothing ; the empiric vaunts his cures ; and myopics commonly exhibit. It also enabled them to thread a amidst the conflicting methods of treatment the conscientious needle, pick a pin from the floor, and read a book at a mode- man finds it difficult to select the best. rate distance from the eye. A boy of eleven years, who could The power of the physician of these days over the phenomena of life, and over life itself, is vast ; for with diet, regimen, and see features with distinctness at six yards only, in two years after the operation saw them with clearness at forty yards, the potent chemicals of the materia medica, he can,act on the and the figure of a man and all his movements at 500. lie patient in a thousand ways. He is indeed ta60Eos. In some He is the read small pica at thirty-three inches, instead of at six, as be- cases he stills disease ; in others he gives life. fore operation. In adults whose eyeballs are not very wide in healer. But he is not allowed to assume that he cures every their transverse diameters, or their optic nerve completely case he treats; or that because, with M. Bouillaud, he extracts encircled by a wide horned staphlyoma posticum, or their four pounds of blood from the veins, he cures rheumatism ; or choroids spoiled by extensiveatrophy, a normal range for featuresI that salivation to the extent of three pints daily is a specific was frequently acquired. A man who two years ago could for syphilis. Some few practitioners still believe that when read small pica at nine inches and a half only, and see features! they treat a patient, either in the usual way, or heroically, or distinctly at five yards, now reads at twenty-four inches, seesI homceopathically, and his recovery follows, it is the inevitable features at thirty yards, and trees with distinctness at a mile! and direct result of the treatment. Quacks live, too, upon this fallacy; but it misleads no rational observer of the progress and a quarter. The paper was illustrated by diagrams of the ciliary muscle, of disease. Some method, then, of measuring the effects of systems of coloured drawings, and mathematical formulse, illustrative of, the value of the operation in the accommodation of eyes which treatment is required ; and that method-while it does not had been treated upwards of one or two years. supersede intuition-is necessarily founded on induction. It is based on observation and records. "Therapeutics,"saysBoerhaave," is that part of medical A METHOD OF DETERMINING THE EFFECTS OF institutions which teaches us to discern in sick persons what SYSTEMS OF TREATMENT IN CERTAIN distemper they labour under, and thence to learn what is reDISEASES. quisite to their cure." Therapeutics presuppose pathology. And for the purpose of BY W. FARR. M.D., F.R.S. our method diseases must be taken of which the correct diaTo heal the sick is the of the physician; and as there gnosis is possible under ordinary circumstances. The method are various kinds of diseases, the treatment varies. Our meansI supplies the formula for the prognosis. of judging of the effects of treatment also vary. In some casesI The sick persons are to be saved from death, and to be rethese effects are obvious; in other cases they cannot be appre- stored to health. To test the efficacy of two systems of cure ciated. There is a large intermediate class of cases which can we have then to determine the time that the sick persons rebe judged accurately by a method which I now beg to submit main ill. If it is found that 100 patients healed in one way to your notice. are cured in seven days, and that none die ; while of 100 Our knowledge exists in different states. For instance, the; treated in another way-or not treated at all-illness lasts knowledge of the stars which guides the mariner is in form thirty-six days, and ten or twenty die, the efncaoy of the treatvery different from the knowledge which the astronomer hasI ment is placed beyond doubt. But practically the great majoof the same objects. The husbandman knows a great deal rity of diseases-like small-pox-can only be cut short in a about wheat-plants, but it djes not exist in the form whichL limited number of cases ; while of the rest, some terminate in the knowledge of that plant assumed in the system of Linna-us. death, others terminate in recovery after several weeks of illLincaeus seized certain characters which served the purposes ofness. The cure is really the diminution of the danger-that is, his method, and the same course is pursued in all the sciences. the reduction of the mortality, and the acceleration of recovery. Medicine was, not many years ago, taught in this country Now, rates of mortality and the durations of illness cannot be somewhat in this fashion. The apprentice learned the nature accurately measured by the naked eye. if I may venture to use of drugs by compounding them; and he became acquainted the expression. Hence the necessity of observation, of records, with disease by visiting the patients of his master, either at of instruments, and of a method to assist the mind in its detheir homes or in hospitals. He distinguished diseases by their terminations. All diseases haveasort of natural life ; that is, they begin, characters, precisely as the farmer distinguishes the various kinds of grain ; and he followed up the plan of treatment which ex- grow. attain maturity. decline, terminate. Their evoution, * --Nletiiod of perience and tradition had handed down from generation toI study ingI’hy&ic. near sight must contain within it not only the power of decreasing the excess of refraction of the drioptric media, but of removing intraocular congestion, which is commonly connected
of
completely
’
.
"
office
.
.
.
’
,
’
,
158 like that of an animal, requires a certain term for its comple- ties and the instruction of the inhabitants of the district, an. and that differs from their actual duration-as the actual annual report of the results of jurisdiction, as also a quarterly life and the mean lifetime of mEn fall short of the speculum in summary of the deaths and diseases, with their causes, accordwhich their physiological development goes through its round. to forms to be determined by the Registrar General for A small-pox patient may die before the appearance of the Ireland. 6. That in the local reports of mortality and sickness it is eruption ; and an inflammation may not go on to suppuration. The death of the patient is the death of the disease ; for important to specify age and occupation, to record meteorological disease is a living process. Now, we find that the danger- observations, and to note local events and circumstances affecting which is accurately expressed by the mortality-changes in the public health. different stages of the same disease ; and the chances of illti7. That it is desirable to require the authentication of themate recovery change every day. I will proceed to describe a cause or mode of death by a certificate from a legally qualified. construction, which will enable you to measure the chances of medical practitioner : and that where no such certificate is to large numbers, and also delivered the sub-registrar be required to inform the superinrecovery and of death, when to calculate the after-sicktime. tendent, who should forthwith make inquiry into the case. 8. That the registration of births should be compulsory, and [The tabular construction is here described ; and it is derived directly from the observed numbers dying, and recovering that still-births after the sixth month of utero-gestation, when in each period of the disease. It shows the chances of reco- not certified by a legally qualified medical practitioner, should very, the duration of cases, and the mortality. It gives an be subject to the regulations stated in the last resolution. exact measure of disease, from the therapeutic point of view. 9. That the boundaries of registration districts and subIllustrations from a table of 8000 cases of natural small-pox.]] districts ought as nearly as possible to conform to the limits of The diagnosis of some diseases is uncertain. But I have existing districts for the relief of the poor and for the adminishere a list of the diseases which might be investigated in the tration of medical aid, having due regard to the jurisdictions of present state of pathology :-Small-pox, measles, scarlatina., local sanitary authorities. 10. That the proposed scientific superintendents, as statistical diphtheria, croup, whooping cough, typhus, erysipelas, metria, carbuncle, &o. inquirers and reporters for national purposes, should be made The observations for this method are made in nearly the independent of local and party influences, debarred from private same schedule as that employed by Hippocrates in his reports medical practice, and paid out of the national funds. of cases. The form of disease, its point of origin, and its ter11. That the Council of this Association be requested to open mination, are defined, so as to leave no doubt about the thing communications with the Government and with the Poor Law to be investigated. Commissioners of Ireland, for the purpose of laying before them The varieties of the disease-if they can be clearly distin- the suggestions of the Association, and of conferring with them guished, as in small-pox, modified and unmodified-are sepa- as to the best mode of embodying them in a legislative enactrately investigated. The results of treatment in hospitals, and ment. in the homes of the poor, are ascertained. The Resolutions were seconded by Dr. Richardson, and unaniThe age and sex of patients are found to be important ele- mously adopted. ments, and enter into the analysis. IN SURGERY. Finally, the method is applied to measure the effects of BY J. PAGET, F.R.S. systems of treatment. It is not necessary, and I think it would be impossible and wrong, to endeavour to determine the Mr. President and Gentlemen,-I have chosen as the subject duration and mortality of diseases left to themselves. The obof my address, " The Treatment of Patients after Surgical: ject should be to determine these elements under the present and I venture to think that I shall best dischargesystem of treatment. Every new method could be tested by Operations," if I deal with this subject, not merely in retrospect, asthis standard. my duty To heal the sick is the aim of Medicine, and pathology as if there were only some great achievements over which we might well as physiology are subsidiary to this grand object. The rejoice, but rather with the view of indicating some of the things: public come to you for relief, for life ; and you, in the schools which yet remain to be done, and which may be done if the of this country, have ever kept that end in view. You are now here in a position to make a great step in advance ; and the members of this great Association will make it their chief business progress of pathology since Hunter’s time, in England, in to do them. There is, indeed, nothing in the retrospect from which France, and in Germany, throws the field open to the thera- we need avert our faces; rather there are many things over which we peutist ; so we shall perhaps see, by the side of the Pathological might boast as good work achieved ; and if I had to name them Society, a Therapeutical Society flourishing, and doing incal- all, or to illustrate the chief of them by one, I would take the, culable good. This branch is of such paramount importance, and so entirely within its province, that I do not despair of security and soundness of our practice, founded on a wider re-seeing the College of Physicians taking it in hand, and enlist- cognition of the principle that the recovery from an operation, ing in its support every practitioner in the kingdom who has the as from any other injury, is so natural a process, that, except in interest of medical sciencs at heart. You can, by a combined certain exceptional cases, it should not be at any time or in any system of observation, determine the mortality and duration of way interfered with ; for we are so constructed that injuries by every definite form of disease ; you can, at the same time, violence, from whatever source, do of themselves, and naturally, measure disease, and the relative power of remedies in cutting it short and diminishing its dangers. bring about the processes for their own amendment. We are fitted, not only for the calm of life, but for the storms of it ; 1B11’. Rr}1SEY brought forward the following resolutions with not only for the things which are certain, but for those which are reference to the Act for the Registration of Births, Deaths, and probable ; nay, almost for all that are possible as events that. occur in our life ; and among these probable events are injuries Disease in Ireland. 1. That in any measure of legislation for the registration of by violence. Among these, and not widely different from them, in regard to some of the conditions in which patients births and deaths in Ireland, this Association deems it highly important that the local machinery for such registration should be come before us, are the injuries inflicted by surgical operations. Nevertheless whatever be our fate in the natural process of altogether ciistinct from that for the registration of marriages,
tion ;
ing
applied
ADDRESS
I
except
and is happy to perceive that this principle has been recognised recovery from injuries, there are certain things left for us to do in the Bilts introduced into the House of Commons during this or to watch, or in some respects to guide. And first of all we have to decide in every case the method by which the surgical and the preceding sessions of Parliament. 3. That it is most desirable to introduce into any such mea- injury shall be healed. We have long been settled in a just. sure the principle of local scientific supervision of the return of preference for the most speedy mode of union, that is for union births and deaths. by the first intention, whether there be healing by immediate 3. That the office of Superintendent Registrar of Births and union or by the union by adhesion. And there are many obvious Deaths ouht to be held by persons well acquainted with physical reasons for this ; but the most potent of them, to my mind, is, that and biological sciences, versed in sanitary and vital statistics, and long as a wound is unhealed, there is some risk, however accustomed to make legal investigations. small, that the patient, may fall into pyæmia or erysipelas, or 4. That it is desirable to combine with the superintendance of some other of the sore plagues of surgery. But the manner of the registration of births and deaths the registration of all sickthe wound being decided, there yet remain many things be done, even by those that have the most full faith in the ness attended in public institutions, or at the public expense. 5. That each Superintendent Registrar should be required to natural processes of recovery. They may, however, perhaps beup in comparatively very few words-namely, repose publish, for the iuforma.tion of the local administrativeauthori-
so
healing
to
summed