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tion, and on his application of that rule may depend the life of his patient; and the recollection that the three longitudinal muscular bands of the colon each and all lead to the vermiform appendix will simplify marvelously the search for that little and often very offensive relic of a herbivorous ancestry. In the neck, how very brilliant, how complicated, are the operations that sound anatomy and aseptic methods have made possible.

That tuberculous glands may be successfully dissected off the internal jugular vein, carotid sheath, and vagus nerve from end to end, and the internal jugular be removed with them from its origin at the base of the skull to near its junction with the subclavian vein. is surely a triumphal product of the union of anatomy and surgery. I know no more beautiful application of good anatomy to the practice of surgery than the enucleation of infected glands in the neck. Till lately it was thought impossible completely to remove the parotid gland, but I have recently shown that a little anatomic study enables one to formulate an operation which makes its complete removal comparatively simple. The Casserian ganglion is now removed successfully for persistent trifacial neuralgia, and the surgeon scorns the old blunderbuss method of destroying Meckel's ganglion through the. maxillary antrum for the same affection; nay, it has been proposed to cut the sensory root of the fifth nerve before it joins the ganglion, and this has been done and promises to be the better operation.

Surely, the day is past when the would-be surgeon may belittle anatomy, and it is noteworthy that most of our leading surgeons have at one time been demonstrators of anatomy. And how much safe rapidity, how much security, how much caution at the right time, will an accurate knowledge of anatomy give the surgeon. Other things being equal, it will be the accurate anatomist who will cut boldly and rapidly where such a procedure is safe; who will recognize every structure as he comes on it, and know what to expect next; who will dissect slowly and carefully where important vessels, nerves or organs are to be found or avoided; who, in fact, will be the safest, surest, quickest surgeon.

Having, as I doubt not you will admit, made out a good case for my subject, how are we best to teach it to medical students? First, last and all the time the teaching must be practical. I care nothing for the man who can rattle off a page of Gray, still less for him who has his quiz-compend at his tongue's tip. I want the man who is personally familiar with bone, muscle, artery and nerve, thorax, abdomen, head and brain; who can recognize an inch of ureter at the bottom of an abdominal incision; who can tell a muscle from its depth and the direction of its fibres; but he must know his book work too. And there is little anatomy that we can cast aside as useless. First, let us make general anatomists before we make specialists, and let us take some time to the process. There is a tendency in modern medical schools toward what is called concentration in teaching. Now, it must not be forgotten that there is a limit to the possibilities of concentration if the student is to retain with any permanency the knowledge that he is gaining by observation. I doubt if any student can do more than two hours good practical anatomic study continuously, and the facts slowly accumulated by eight months work, of two hours daily, will be more firmly fixed in the memory than they would be were they crammed into four months of four hours daily work. The student slowly develops in an anatomic atmosphere. He imbibes it, digests it, makes it his own; and, therefore, our students spend two hours daily through two scholastic years of eight months each, learning practically the general anatomy of the human body. In his third year he should study anatomy as applied to surgery and medicine, and that, also, should not be a lecture, but a practical course. It will now be his business to cut down on the carotid or brachial or other artery as he would meet it in operation; to recognize it and its relations through a three inch incision. He will outline on the scalp the fissure of Rolando and verify the correctness of his outline by cutting down on it; he will study the extremities by sections where the most important amputations are performed, and see where to get his flaps and what will be their blood supply; he will study muscular actions for their effect on fractures, joints for the anatomy of dis

location, the abdominal wall for surface relations, and the most suitable incisions to reach desired organs and avoid subsequent ventral hernia. Such is the course of practical surgical anatomy I have outlined for the third year's work in our university; but to carry it out I want more anatomic material, and it is just here, gentlemen, that I want your assistance. I use thirty bodies every year in teaching anatomy. I require fifty to teach it as it should be taught. In three successive legislatures we have vainly tried to get an anatomic law passed, a law carefully framed to be a hardship to no man, to hurt the feelings of no possible survivors of the unclaimed dead. And three times we have failed. Twice the Governor vetoed it, and this time the Senate failed to pass it. Now, gentlemen, I appeal to you, for the sake of our State institution, for the sake of the profession in Texas, for the better teaching of those young men who are to have in their charge the lives of your children and children's children, lose no opportunity in impressing your representatives with the need of a law justly and wisely framed to enable us to use for teaching purposes the bodies of the unclaimed and friendless dead. Surely, it is the very reverse of sacrilege, and it is strange that the State should compel its own school to break its own laws. It is only by steady work long ahead of the time that our legislators can be taught our dire necessities.





I might have entitled my paper "A Case of Left-Side Appendicitis," but I have preferred not to do so, for the reason that I am not absolutely sure that it was a case of appendicitis, and if it was, I do not believe the cæcum and appendix were abnormally situated on the left side, but that the appendix was long enough to reach from the right to the left side, where a perforation occurred, or, at any rate, an infection of the peritoneum took place. My reason for so thinking will appear in the course of the paper.

The patient, D. S., a boy 12 years old, is the son of a large, healthy man whose mother and another near relative died of pulmonary tuberculosis. The patient's mother is perfectly healthly, and her family history is free from any hereditary diesase. The personal history is negative, with the exception of an attack of dysentery at the age of three, from which he recovered without any sequelæ. Up to the time of onset of the disease under consideration, he was an unusually healthy boy and large for his age. On July 13, 1902, he was taken ill, and Dr. J. L. Hall was called in, and to him, as well as to Drs. J. B. Smith, W. C. Lipscomb and J. S. Wootters, I am indebted for the history of the earlier part of the attack. He had eaten heartily of peaches, watermelon and canned sardines at different times during the day, and the attack began suddenly with a severe pain in the right iliac region, followed quickly by nausea and vomiting, which did not relieve the pain. The next day the temperature reached 102° F., and he had severe pain in the left iliac and right hypochondriac regions, as well as in the right iliac region. Difficulty was experienced in getting the bowels to act; the abdomen was distended and tender, and the legs

drawn up. The fever ran an irregular course, of low degree, and the pulse kept pace with the temperature. The pain was felt at one time, early in the first week, most severely under the left nipple. Later, it became diffused over the abdomen, and became less acute. At the end of a week the temperature became normal for two days, then recurred, resuming its irregular course. About this time—the ninth day-a hard lump was felt in the right hypochondrium, and a few days later a similar tumor was discovered in the left iliac region. The former slowly disappeared, but the latter increased in size, was tender and the physicians in attendance suspected that pus had formed therein. It was about this time, a little more than two weeks from the beginning of the attack, that I saw the case first in consultation with Drs. J. B. Smith, J. S. Wootters, and W. C. Lipscomb, of Crockett, Texas, and A. D. DuPuy, of San Antonio. He was emaciated and anæmic; the bowels were slightly constipated, the abdomen distended with gas, the temperature 100° F. and the pulse about 80. In the left iliac region, and extending somewhat into the hypogastrium, was a distinct mass, the most prominent point of which lay about two inches to the left of the median line and one and a half inch below the umbilicus. The tenderness in and around this mass reached the right side but not as far as McBurney's point. No other abdominal tumor could be made out at this time. On August 1st the patient was brought to my private sanitarium, with a view of operating as soon as the circumstances seemed favorable. Ten days were spent in an effort to improve his general condition, and during this time a careful record was kept of all the functions, and the following data may be of interest: The temperature ranged from normal to 102.4° F., usually below 102°. There were no chills or sweats, and the pulse rate was increased. Occasionally the pulse rate fell as the temperature rose, and once an increase of one degree F. of temperature was attended by an increase of thirty beats of the pulse, without any other unusual symptoms. He passed an average of twenty ounces of urine daily, of a high specific gravity, highly colored but containing no albumen or sugar. There were no casts

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