Let us now turn to a more pleasing picture, illustrative of the sunshine and shadow in medical endeavor as demonstrated by the direct results of professional effort in the alleviation and cure of preventable human affliction, during many years of toil of those of our calling. It is well to be reminded here that of one million human beings born a hundred years ago only about three hundred are now living, and they are living but feebly, cheered by the recollections of the past.

In this connection, you should be told that, during the last hundred years, the expectation of life has been remarkably advanced. The ubiquitous "King of Shadows" has been moved many more paces to the rear of the "shining marks" that he so much loves to demolish. The expectation of life in New York City in 1886, says Dr. Biggs, was only a little more than twenty-five years, while in 1903 (17 years after) for the same period the expectancy had nearly doubled, equaling quite forty-one years, and constituting an equivalent in the saving of life in that city of 28,000 lives annually. In the seventeenth and eighteenth centuries, according to Dr. Biggs, the average death rate of the civilized world was about 50 per 1,000. In London, from 1628 to 1635 (in the absence of pestilence), the average death rate was 50 per 1,000, and the absolute mortality there for twenty-four years (16201643) was over 70 per 1,000.

So much for shadow in medical endeavor. Now mark the sunshine. In London, in 1902, the death rate was but a fraction over 17 per 1,000. In London, from 1771 to 1780, 5 per 1,000 died of smallpox; in 1880, 2 in 1,000; in 1837, 1 in 12,500; in recent years the death rate per 1,000 from smallpox in London is expressed by an insignificant decimal.

In 1888, in the Department of Health of New York City, the initiative in the present war against tuberculosis in this country was begun. Then and for some time following, the idea was regarded by distinguished members of the medical profession of the city as being meddlesome, puerile and demoralizing and doomed to prompt and inglorious defeat. At that time the Medical Commissioner of the Department of Health of that city addressed to

cach of twenty-five of the leading physicians of the city a letter inquiring if, in their opinion, the time had not come when tuberculosis should be regarded as a communicable disease and measures be taken to combat it, based on the reporting to the Department of Health by the medical profession of the cases of this disease coming under their care. From the great majority of the twenty-five thus addressed no reply whatever has yet been received. From the small minority halting replies of the "Yes, I guess not" type came to hand and to ear. But two only of the twenty-five responded promptly and in the affirmative. Physicians of lesser rank than those already mentioned amused themselves and others of high attainment and doubting method by means of cheap writings and sayings that prompted mirthful comments on the part of those with no faith and little desire to aid in the undertaking. Since that time (1888), however, the cause has made rapid progress, and physicians who then deprecated the attempt are now convinced of its wisdom and are using the weight of their eloquence and standing to secure sufficient monetary support from the city and from citizens to provide for the care and relief of the minority host of this class of sufferers. The rewards of effort thus far gained can be no better related than by Dr. H. M. Biggs, who has been among the foremost in aggressive action and suggestion of those who have engaged in the conflict against tuberculosis. Says Dr. Biggs:

"The average death rate in the Boroughs of Manhattan and the Bronx from all tuberculosis diseases for the five-year period preceding 1888 was 4.35 per 1,000 of the population, and for the five-year period preceding January 1, 1905, was 2.83, the decrease exceeding 35 per cent.; or, going a little farther back, in 1881, the rate was 4.92, and twenty years later, in 1902, it was 2.63, or a decrease comprising only these two years of 45 per cent. Translated into lives, the difference in the rates for the five-year periods, computed on the present population of Greater New York, means a decrease in the annual deaths from tuberculosis diseases of over 5,500 in the greater city."

Nor is this but a little, my friends, of what has been accom

plished in life saving during the average age of those within this inclosure. Surgeons who labored in the hospital wards before the days of antisepsis and asepsis will recall the abundant harvest of lives and limbs gathered in by the almost omnipresent and everstrenuous and unrecognized agents of infection. It requires no effort of mine to recall that, while as an interne in Bellevue Hospital, the presence there of pyemia, septicemia, erysipelas and puerperal fever often halted the surgeon's best efforts of relief and forbade him to employ the most approved means of operative cure under the risk of increasing the death rate of the hospital. I believe that you will indulge me if I cast on this picture of unavoidable woe the resplendent sunshine of a little of the present outcome in preventive medical endeavor.

During the last twenty-five years it has been my honor and duty to be a visiting surgeon at Bellevue Hospital, a hospital devoted to the care of the unfortunate poor of the city, those whose habits and associations, in a large proportion of cases, do not fit them for the endurance incident to disease and injury. Yet, during this time, in Bellevue, plus eighteen additional years in St. Vincent's Hospital, largely devoted to the same class of patients, I have not met with as many cases of infective diseases of preantiseptic type as came under my notice in a month's time as a hospital interne before that period. And in this connection I desire to say that each of these hospitals was as successful in treatment as were any before that dark period, and since that time are unexcelled by none devoted to the same class of cases. I can say, without fear of gainsay, that hopeless cases of injury and disease for which no practical relief could be afforded before antisepsis and asepsis are now, as the result of the practical application of these remarkable agencies, rescued in large percentages (10 to 90) by the means of established operative endeavor and so it is everywhere. Please remember in this connection, however, that the astonishing differences in these results is the consequence of increased knowledge and not of greater assiduity nor of more thoughtful care.

Enough has been said to emphasize decidely the glorious results

in medical endeavor of preventive medical endeavor of the last century and a half. The brilliant sunshine of the outcome in this endeavor mingling with its unshed tears would fashion a resplendent bow of promise gloriously betokening God's choicest gifts to

man.

Vaccination, anesthesia, antisepsis and asepsis, antitoxin, the X-ray, the discovery of the tubercle bacilli and of the kinship between the mosquito and the yellow fever plague of commerce, and of malarial torments, are among the most potent and farreaching beams of sunshine in medical endeavor, and which are constantly increasing in their brilliancy and beneficent power, adding comforts and life to the inhabitants of the world, and lessening correspondingly the tears and sorrows of the earth that cast a sunless shadow on all of life's endeavors.

THE PREVENTION OF POSTOPERATIVE PARESIS

AND ADHESIONS OF THE INTESTINES.

BY L. P. LUCKETT, M. D., OF TERRE HAUTE.

In choosing a subject upon which to address you this evening I have been guided by three reasons which would seem a sufficient apology for encroaching upon your valuable time.

First, that the prevention of postoperative adhesions and paresis are still factors which enter into every operation in which the surgeon invades the peritoneal cavity.

Second, that as the etiology of the formation of adhesions and paresis of the bowels, and therefore their prevention, is a very complex problem and is yet somewhat in doubt, and if this paper elicits a free discussion of this subject it can not but be of interest and profit.

Third, that one who comes in contact with patients after they have been subjected to peritoneal operations must surely be impressed with the fact that we have still much to learn before we can invade the peritoneal cavity without leaving that delicate membrane in a crippled condition in a large percentage of cases.

In these days, when to open the abdomen is an operation which is regarded so lightly by our best surgeons who are masters of the art, and in many instances by the general practitioner, whose opportunities for major surgery must, at the best, be somewhat limited, it seems to me that a warning note should be sounded, pointing out the fact that there is more necessity for the welfare of our patients than to be able to open the belly, remove an organ or growth, and suture the wound without loss of life from hemorrhage or sepsis.

We know that we have adhesions form after the most simple and uncomplicated abdominal cases, where we get union by first intention, and no rise of temperature or tympanitis during the period of convalescence. This has been proven many times by