. : ColumUia 2Jntoergttp intfjfCtipirfJfrmgork College of ipjjpgtctang anb ££>urgeonfi iUorarp Digitized by the Internet Archive in 2010 with funding from Open Knowledge Commons http://www.archive.org/details/originalcontribu1917souc Original Contributions of America MEDICAL SCIENCES BY EDMOND SOUCHON, M.D. NEW ORLEANS, LA. From the Transactions of the American Surgical Association 1917 DORNAN, PRINTER PHILADELPHIA Reprinted from the Transactions of the American Surgical Association, 19 17 ORIGINAL CONTRIBUTIONS OF AMERICA TO MEDICAL SCIENCES By EDMOND SOUCHON, M.D. NEW ORLEANS, LA. Upon reflecting on the awakening of the scientific spirit in America within the last twenty-five years, it occurred to me that it would be very interesting to study the achievements made especially in the form of original contributions by America to the medical sciences. In this essay I shall confine myself to the United States of America. America is barely more than a century and a half old, but in that century it has contributed more than any other single century of the Old World, barring the century of Pasteur and his followers; and yet with transmissibility of puerperal fever, anesthetics, general and local, gynecology, abdominal surgery, dentistry, eradication of yellow fever, and malarial fever, it follows closely in the trail of the Pasteur century. By original contribution is meant something new that has not been done before by somebody else. In some instances it is difficult, from the description, to decide if the contribution has been made in America for the first time or for the first time in the world. Doubtless a great number were made in America without any knowledge that they had been done before by somebody else, and that is quite creditable in itself. To obtain information, I have sent out over 600 circular letters to as many men occupying prominent positions, and who ought to know what has been done in the profession in this country. 2 EDMOND SOUCHON Through the courtesy of the editor the circular letter was pub- lished in the Journal of the American Medical Association. It required eight months to gather the data and write the paper. It was truly a labor of love to bring together the workers of our country. I here thank all those who assisted me in this self-imposed task for the common good and honor of America. I have received a great number of titles and publications, but many are not mentioned here because the authors have not com- plied with the request to tell in a few words in what point each publication is new and had not been done before by somebody else. I will follow the alphabetical order of the various States and the chronological order of birth date and date of achieve- ment of contributors and present to my readers their claim to originality. For details, letters may be addressed to the con- tributors still living. The town address is mentioned after the names. The names not found in the Medical Directory are deceased. Names without dates are those of contributors still living. The towns affixed to the names of the contributors are the towns in which they have done their most important work, not their birthplaces. ALABAMA Dr. J. Marion Sims (Montgomery), 1813-1883, invented the duck-bill speculum, which is the first and only instrument that will fully cause dilation of the vagina and afford a thorough view and access to its interior and the os uteri. He devised the left lateral posture for vaginal examination and operation. He was the first to make the cure of vesicovaginal fistula a success instead of the reverse. He invented all the instruments used in the operation for vesicovaginal fistula. He is the founder of gynecology, that art and science so eminently American. He was the first to write a modern book on gynecology (Clinical Notes on Uterine Surgery, 1866). He was the first surgeon in America to devote himself exclusively to the treatment of diseases of women. He advocated vaginal cystomy for chronic ORIGINAL CONTRIBUTIONS OF AMERICA TO MEDICAL SCIENCES 3 cystitis. He first cured vaginismus by removing the remains of the hymen and resection of the tissues (1861). He first ampu- tated the cervix uteri and covered it with vaginal mucous mem- brane. He first formally introduced silver wire in surgery. He devised a repositor for uterine displacements. He, in 1837, removed the lower jaw without external mutilation, the operation being done entirely from within the mouth. He performed origin- ally the operation of cholecystotomy without the knowledge of the fact that Dr. Bobbs, of Indianapolis (1868), to whom he always accorded full credit, had preceded him by a few months. He narrowed the vagina for the cure of prolapsus uteri (1856). He was one of the first to advocate the careful aseptic invasion of the peritoneal cavity for the arrest of hemorrhage, the suture of abdominal wounds and the cleansing of the peritoneal cavity and for all intraperitoneal conditions (188 1). He was the first to build a woman's hospital in the United States. He was the first American surgeon who compelled European surgeons to recognize the worth and fame of American surgery. He was the first American surgeon to receive decorations from European monarchs. He was the first physician to whom a life-size statue was erected in a public park or elsewhere in America. He was the only surgeon in the world who could go to any capital and secure a lucrative practice. His charming autobiography is unique in its kind. The late Professor T. Gaillard Thomas, of New. York, in an address said that if he were called upon to name a few men who in the history of all times had contributed the most to relieve the sufferings of humanity he would include Marion Sims. Dr. Nathan Bozeman (Montgomery), 1825-1905, devised the button suture for vesicovaginal fistula. He was the first to treat pyelitis by irrigation of the kidney by means of a catheter intro- duced up the ureter through a vesicovaginal opening (1888). He is also credited with having created a vesicovaginal fistula to cure chronic cystitis (1861). ' Dr. Josiah C. Nott (Mobile), 1804-18 73, was the first to advance the theory that yellow fever was transmitted by the mosquito (1848), but he demonstrated nothing. He was the first. EDMOXD SOECHOX to perform excision of the coccyx for coccygodynia (1844), preceding Sir James Y. Simpson. Dr. Hexry S. Leyert (Mobile) (deceased, no dates) first demonstrated the innocuous character of the metallic ligature. ARKANSAS Dr. Thibault (Scott) discovered the anesthetic properties of quinin and urea hydrochloride (Crile). CALIFORNIA Dr. Samuel Elias Cooper (San Francisco), 1822-1862, founded the first medical college on the Pacific slope (1858), called later on. by his nephew. Dr. Lane, the Cooper Medical College. He first proclaimed that atmospheric air admitted into joints or other tissues is not a source of irritation or injury; also that the only true mode of treating ulcerations of bone within a joint is to la}* the joint open freely; also that there are no known limits beyond which a tendon will or cannot be reproduced after division. He was the first to offer a course in operative surgery on animals. He announced a new cure for aneurysm, consisting of cutting down on the sac and sewing up from the outside. He advocated the ligation of arteries with their accom- panying veins as being less dangerous than ligation of the veins alone. He operated for club-foot by cutting all contracted parts down to the bone, much as was later done by Phelps, of New York. Dr. Levi Cooper Laxe (San Francisco), 1833-190 2, claims to be the first to perform vaginal hysterectomy in America. He originated an operation for craniotomy for microcephalus. He wrote a complete monograph on the Surgery of the Head and Xeck. It is said that he was the first to ligate simultaneously the two common carotids with success in the same patient (1887). ■ Dr. Thomas W. Huxtlxgtox (San Francisco) devised an' operation of bone transference, wherein the fibula is made to ORIGINAL CONTRIBUTIONS OF AMERICA TO MEDICAL SCIENCES 5 take the place of the shaft of the tibia. He believes he is the first, at least in America, to have done this. Dr. George H. F. Nuttall (San Francisco) first summarized the role of insects, arachnids as transmitters of bacteria and parasitic diseases (1899) and introduced the precipitin test for different kinds of blood (1904V COLORADO Dr. Clayton Parkhill (Denver) was the first to use plates in the treatment of fractures. His apparatus consists of two pairs of long screws partially driven into the fragments and fixed at their other extremities to two wing plates. The blades are superimposed and glide. They are fixed with a clamp when the fragments are brought in apposition. The apposition is perfect at all times. When the wound is stitched the plates are outside of the tissues, not in contact with the bone. The method is published in the Transactions of the American Surgical Association of 1897. Dr. Leonard Freeman, of Denver, was a witness to the work of Parkhill, and says that if similar work had been done abroad before Parkhill knew nothing about it. Dr. Charles D. Spivak was one of the prime movers of the medical library movement; introduced an esophagometer (1901) and other improvements in gastroenterology; method of de- termining specific gravity in the living subject (1915). Dr. E. Stuver (Fort Collins). The intrarectal injection of normal salt solution in typhoid fever is a blood-washing process, ehminating poisons or toxins from the system, and, so far as I can find, had not been before recommended for that purpose in this disease. The application of cocain and adrenalin to the inside of the nose prevents a large amount of the vomiting and shock during operation; this has been corroborated by Albert, Abrams, Crile and others, but as their work has been done since my original communication, I believe the idea was original with mvself. EDMOND SOUCHON coisnsnECTicuT Dr. Hezekiah Beardsley (1748-90) first described congenital hypertrophic stenosis of the pylorus (1788). Dr. Mason Fitch Cogswell (Hartford), 1761-1830, was the first in America to ligate primitive carotid artery for primary hemorrhage in its continuity (1803). Dr. Nathan Smith (New Haven), 1 762-1809, first trephined bones for abscess before Brodie. He first dropped the pedicle after operating for ovarian cyst. He first advised the use of bichloride of mercury. He was the first in this country to amputate the knee joint (1824). Dr. Jonathan Wright (New Haven), 1 789-1865, was the first to cure a popliteai aneurysm by digital compression (1847). Dr. Nathan Ryno Smith (New Haven), 1797-1877, was the first to reduce a hip-joint dislocation by manipulation. He devised the Smith anterior splint for fractures (i860). He ad- vocated the principle of suspension in the treatment of fractures (1827). Dr. John M. Riggs (Hartford), a dentist, 18 10-1885, was the first to devise the scraping treatment for Rigg's disease, now known as pyorrhea alveolaris, first described by Pierre Fauchard in 1746. Dr. R. Erdman (Salem, New Haven), indefinite life of the trypanosomes. By employing the plasms of the host as a culture medium either for trypanosomes themselves or the growth in vitrio of various infantile tissues of the host he succeeded in keeping trypanosoma brucei in normal condition for an indefinite period, whereas they die in a few days in other culture media. Dr. Thomas B. Osborne (New Haven), work on vegetable proteins (1907-9) and on artificial foods (with L. B. Wendel). Dr. Charles B. Davenport, work on heredity and eugenics (1906-15). ♦ Dr. William T. Sedgwick (Hartford), work on biology and sanitation. Dr. Graham Lusk (Bridgeport), important work on meta- bolism and diabetes. ORIGINAL CONTRIBUTIONS OF AMERICA TO MEDICAL SCIENCES J DISTRICT OF COLUMBIA, WASHINGTON CITY. UNITED STATES PUBLIC HEALTH SERVICE Dr. Henry R. Carter was the first to find out that a house in which a first case of yellow fever has occurred becomes danger- ous only after twelve to fifteen days of the occurrence of the first case. Dr. Walter Reed availed himself of this fact and waited fifteen days before a mosquito which had bitten a case of yellow fever was made to bite a healthy subject. Thus he succeeded in transmitting yellow fever through the mosquito when others had failed. Dr. Rupert Blue was the first to rat-proof a whole large city (San Francisco). Dr. Charles W. Stiles claims the following : Enlightenment of the sheep raisers of the country on the question of sheep scab and their deliverance from the patent dip man. The prophecy on largely theoretical grounds that a portion of the death-rate, among the seal pups of Alaska will be found to be due to hook- worm, and that his views were confirmed. The prophecy on theoretical grounds that the hookworm disease would be found to be a common infection in the Southern States, which prophecy was later confirmed by him. Hookworm in man in the United States is caused by a species of parasites distinct from that described by Dubini. The utilization of protozoon spores to prove that people eat human excrement. As a lever to prevent disease this protozoon test is very important. Issuance of an Index Catalogue of Veterinary and Medical Zoology jointly with Dr. Hassall. It will doubtless be the standard work of reference on the subject for many years to come. Description of a number of new species and new genera of parasites, including Necator americanus, the American variety of hookworm. Dr. Rupert Blue, Surgeon General of the Public Health Service, mentions especially as original contributions from the Public Health Service: Original research work done by Rosenau and Anderson on the phenomenon of anaphylaxis, as described in Hygienic Laboratory Bulletins Nos. 29, 30, 36, 50, 64 and 80. 8 EDMOND SOUCHON Standardization of diphtheria and tetanus antitoxin, as described in Hygienic Laboratory Bulletin Nos. 21 and 23. The discovery by Miller of a new animal parasite, Hepatozoon perniciosum, described in Hygienic Laboratory Bulletin No. 46. The studies on leprosy by Clegg, Brinckerhoff and McCay, described in Public Health Bulletins Nos. 26, 27, 28, 33, 39, 41, 50, 61 and 66. Studies of plague by McCay in Public Health Bul- letins Nos. 43 and 53. Stiles' identification of a new species of hookworm in America, Necator americanus. Francis's "Studies of Tetanus," described in Hygienic Laboratory Bulletin No. 95. The work consists in multiple tests of the vaccine virus of tetanus, rendered necessary by the varied flora found in vaccine virus. Goldberger's recent investigation of pellagra described in Reprint Nos. 218 and 228 from the Public Health Report. Pellagra is caused by a faulty diet. No pellagra develops in subjects who consume a mixed, well-balanced and varied diet. Rosenau and Bruer reported the transmission of poliomyelitis by the stable fly (Stomoxys calcitrans) in monkeys. Dr. John T. Anderson, director of the Hygienic Laboratory, says that in his publications on measles the part that is new is the discovery of the susceptibility of the monkey to the virus of measles, the determination of the period of infectivity of measles blood for the monkey, the first definite information as to the nature of the virus of measles, the means of exit, the virus from the blood, and the probable avenue of infection. In addition the experimental work on measles gives us our first laboratory results upon the duration of the infectivity of the secretions from the nose and throat. Also the non-infectivity of the scales of des- quamation from cases of measles was demonstrated. In the papers on typhus fever the points that are new are the demonstra- tion of the susceptibility of various species of monkey to the typhus fever of Mexico, the determination of the relationship of "Brill's disease" (what we now know as mild typhus), the transmission of mild typhus fever from monkey to monkey by the bite of the body louse and probably also by the head louse. A number of facts detailed in the publications in regard to the ORIGINAL CONTRIBUTIONS OF AMERICA TO MEDICAL SCIENCES 9 nature of the virus of typhus fever were also new and had. never been published. The papers on anaphylaxis, of which I was the joint author, give the pioneer work upon this important phe- nomenon. The first paper upon anaphylaxis to be published in the United States and the first paper ever published any- where giving an intimate account of the mechanism of ana- phylaxis was published from the Hygienic Laboratory, and of which Dr. Rosenau and I were joint authors. These three pieces of work — that on measles, that on typhus fever, and that on anaphylaxis — with all three of which I was associated, covered investigations of a pioneer character and brought forth new facts that had never previously been brought out. The Hygienic Laboratory of the United States Public Health Service is a contribution to medical science. It is perhaps the finest of its kind in the world. UNITED STATES ARMY MEDICAL CORPS Dr. Benjamin Rush, i 745-1813, published the first pamphlet on military hygiene (1777), the first American treatise on insanity (181 2), the first American contribution to anthropology (1774- 88), the first account of cholera infantum (1775), the first account of dengue in English (1780). Dr. John Jones published the first American book on surgery and military medicine (1775). Surgeon- General Tilton organized the Medical Department of the Army (181 2). Dr. Barton organized the Medical Department of the Navy (1842). Dr. James Mann, in 1821, first amputated at the elbow- joint. Dr. William Beaumont (1825-1883) made the first classical investigation of gastric digestion, 1825-33. He experimented on the famous Alexis St. Martin, who had a gastric fistula in the pit of the stomach as a result of a gunshot wound. Dr. John Shaw Billings: First excision of ankle-joint in America (January 6, 1862), with recovery of patient. Index IO EDMOND SOUCHOX Catalogue of the Surgeon-General' 's Library,' hist series (1880-95). Planning and constructing of 'the Johns Hopkins Hospital (1876-89). Wrote the best history of surgery in the English language (1895). Did most to make the United States Census Reports reliable and valuable as statistics in his time. Dr. J. M. Da Costa: First account of irritable heart in soldiers (1863). Drs. S. Weir Mitchell (1822-1904), S. R. Morehouse, and W. W. Keen : Classical investigation of gunshot and other injuries of nerves (1864). Dr. Joseph Janvier Woodward : Did the best work of his time in microphotography C1865 and subsequently). The Medical and Surgical History of the War of the Rebellion (18 70-1 888), by Joseph J. Woodward, Charles Smart. George A. Otis and David L. Huntington, is a work unique in the annals of military medicine. Dr. Willlam A. Hammond, 1829-1900 (Surgeon-General): First description of athetosis (1873). First text-book on nervous diseases (1871). Dr. Charles F. Craig in 1902 demonstrated that intra- corpuscular conjugation in the malarial plasmodia is the cause of latency and relapse, also the existence of malarial carriers. He demonstrated also, with Percy M. Ashburn, that the cause of dengue is a filterable virus transmitted by the mosquito, Culex fatigans (1907). He discovered paramoeba hominis, 1906. Dr. Alfred A. Woodhull was the first in this country to employ the British-Indian method of giving large doses of ipecac in dysentery (1875-76). Dr. George Sternberg: First isolated the bacillus of croupous pneumonia (1880). First manual (1898) text-book (1866) of bacteriology by an American writer. Dr. Walter Reed (1851-1902) was the first to transmit yellow fever by the mosquito to a human subject. He demon- strated that the Stegomyia mosquito was the conveyor. Also that the mosquito had to bite the victim of yellow fever during the first three davs of the fever. He succeeded in the trans- ORIGINAL CONTRIBUTIONS OF AMERICA TO MEDICAL SCIENCES 1 1 mission of yellow fever because he availed himself of Dr. Carter's discovery and waited twelve to fifteen days before applying the infected mosquito to a healthy subject. He demonstrated that fomites did not carry yellow fever by causing healthy subjects to stay in bed in rooms with fomites and protecting them from mosquitoes. Drs. Reed, Vaughan and Shakespeare first demonstrated that flies transmit typhoid fever (1898). Dr. James Carrol (1854-1907) is the first case of a healthy subject bitten by an infected mosquito that had been kept twelve days to develop yellow fever. Dr. William C. Gorgas: Rid Havana of yellow fever (1901). Rid the Isthmus of Panama of disease and made it habitable (1904-14). Investigated the cause of the high death-rate from pneumonia among the miners of the Rand, South Africa (1913- 1*4). Was the first American physician to be called upon by a foreign power to investigate disease in its territory (sickness among the miners of South Africa). He was the first army surgeon to hold rank of Major-General in the United States Army and to be made Surgeon-General for life. Dr. Frederick F. Russell: Rid the United States Army of typhoid fever by typhoid inoculation (191 2). Dr. Percy M. Ashburn discovered Microfilaria philippinensis with Craig (1906). The cause of dengue as a filterable virus transmitted by mosquito Culex fatigans (1907). Dr. Edward B. Vedder proved that beriberi is a deficiency disease which can be prevented by a simple change of ration; substituted undermilled for polished rice; that the disease can be experimentally produced in puppies and fowls; and that the administration of an alcoholic extract of rice polishings will alleviate some of the symptoms in infants (191 2-13). Was the first to demonstrate that emetin is a specific remedy in amebic dysentery (1911-14). Dr. E. R. Gentry and T. L. Ferrenbaugh discovered that Malta fever is endemic in southwest Texas and is transmitted by goats on the ranches thereabouts (191 1). 12 EDMOND SOUCHON Dr. Louis A. Lagarde demonstrated that microorganisms are not destroyed by the discharge of gunpowder or projectiles in the act of firing but infect the wound (1892-1902). Has written the best recent treatise on gunshot wounds (19 14). Dr. F. H. Garrison: History of Medicine (1913) contains the finest detailed account of modern medicine down to the immediate present. The Army Medical Museum is one of the finest contributions to medical science in America. It contains a unique collection of gunshot wounds of the bones gathered during the Civil War. The Army Medical Library is a still greater contribution. It is the finest of its kind in the world. The Index Catalogue and Index Medicus are most valuable contributions. Dr. George T. Vaughan (Washington City) : A new operation for the radical cure of inguinal hernia, by cutting the con- joined tendon and placing the spermatic cord behind it on the pubis. A new operation for circumcision by turning the outside skin of the prepuce which has been cut away. Stopping hemor- rhage from bone by pressing soft tissues, muscles, etc., against it, i. e., by plugging with soft tissues. Dr. George Kober (Washington City) : First to have pub- lished biographic sketches of notable physicians and surgeons of the present. First to publish notes on chronic dysentery treated with injections of a solution of chloride of potash. Also of adenitis treated with injections of carbolic acid and glycerin. Also a case of gunshot wound of the knee-joint treated with anti- septic injections of iodin and carbolic acid. Also that insects, and especially flies, are doubtless frequently the cause of spread- ing disease. Also to call attention to impure milk in relation to infant mortality. Also to have tabulated 330 milk -borne epidemics. Dr. Joseph H. Bryan (Washington City) has contributed much that is new and valuable in the treatment of accessory sinuses of the nose, without resort to internal operation. ORIGINAL CONTRIBUTIONS OF AMERICA TO MEDICAL SCIENCES 1 3 GEORGIA Dr. Milton Antony (Georgia), 1 789-1839, first excised the fifth and sixth ribs with a portion of gangrenous lung (18 21). Dr. L. A. Dugas (Augusta), 1 806-1 884, first to perform abscission of the cornea. Dr. Crawford Long (Danielsville), 1816-1878, was one of the co-discoverers of anesthesia. He removed a small tumor from a negro's neck under ether anesthesia (1842). He published nothing. He died in obscurity. Dr. Daniel, 18 19, introduced the weights and pulley in the treatment of fractures. Dr. Henry Fraser Campbell (Augusta), 1842-1891, dis- covered the excitosecretory system of nerves (1857). Invented several gynecological instruments. Devised the knee-breast position for vaginal examinations. Dr. Robert Battey (Rome), 1828-1895, advocated, in 1872, the removal of both ovaries for dysmenorrhea and other aggra- vated troubles when the patient could not be relieved by any other method. Dr. Maury M. Stapler (Macon): New instrument for the suction massage of the ear. It is an improvement on the Politzer and the use of the hard-rubber catheter. The theory, which says adenoids closing the Eustachian tubes partially or intermittently and the pathological sequence, rarification of the air in the middle ears causing unequal pressure on the tympanic mem- branes, pressing the ossicular chains upon the labyrinth, making the footplate of the stapes to impinge within the oval windows, attended by irritation, swelling, exudate of plastic serum, stretch- ing and loss of contractile power of the stapedius muscle and fixation, amounting to a luxation of the stapes, is one cause of many cases of deaf-mutism — is new. The method of reducing the luxation of the stapes, by suction applied equally and at the same time to the ears through the external auditory canals and the Eustachian tubes and the instrument used — is new. The mechanical demonstration on a model to prove the principle 14 EDMOND SOUCHON of physics, applied, is effective in moving the stapes and the entire ossicular chain — is new. The clinical proof, when a deaf- mute patient shows marked improvement after a course of treat- ment, is itself new, since the medical profession has seen no such improvement in the deaf by any other method. Samuel J. Crowe discovered that hexamethylenamin is excreted in cerebrospinal fluid (1909). ILLINOIS Dr. Daniel Brainard (Chicago), 181 2-1866, was the first to perforate the ends of fragments to wire the bones in fractures (1852). Dr. Nathan Smith Davis (Chicago), 181 7-1906, was the father of the American Medical Association. Dr. Wm. H. Byford (Chicago), 1817-1890, originated the plan of dilating the opening of pelvic abscesses discharging into the rectum in order to secure efficient drainage. Dr. Charles A. Kuford (Granville) : Work on cell lineage. Dr. Edmund Andrews (Chicago), 1824-1904, first added oxygen to nitrous gas to prolong the anesthetic effects. Dr. Christian Fenger (Chicago), 1 840-1 902, was one of Chicago's great successful surgeons and first teacher of modern pathology. He was the first in Chicago to perform vaginal hysterectomy and one of the first there to explore the brain with an aspirating needle. He contributed a number of brilliant disciples to medical science. His influence over his generation has been tremendous according to his followers and admirers. Endoscopy of gunshot wounds (1871). Introduction of Listerian methods in Cook County Hospital (Chicago). Performing plastic operations on the ureter for stricture without resection. Described ball-valve action of stones in the common duct. Dr. H. S. Jennings (Tonica): Work on animal behavior (1906). Dr. Edmund B. Wilson (Geneva): Work on embryology, zoology and heredity. ORIGINAL CONTRIBUTIONS OF AMERICA TO MEDICAL SCIENCES 1 5 Dr. Nicholas Senn (Chicago), 1844-1908. "Transplanta- tion of Omental Flap (1887)." Animal experiments proved the possibility for reinforcing a line of intestinal suture or covering the neck of an intussusception (artificially produced). The flap was taken either from the margin of the omentum or from its middle, care being taken to use some portion supplied with a vessel of considerable size. Its base was left attached to the omentum. "Treatment of Compound Fracture by Bone Ferrule (1893)." The ferrule consisted of a ring of bone which is placed around the fragments (like a ring around a finger) and thus prevents lateral and longitudinal displacement. "Bloodless Amputation of the Hip-joint by a New Method Consisting of the Straight Incision of Langenbeck; Preliminary Dislocation of the Hip-joint." Soft tissues tunneled with a hemostatic forceps on a level with the trochanter minor to a point on the inner aspect of the thigh behind the abductor muscle. Elastic constrictors passed through tunnel and tied anteriorly and posteriorly, rendering operation bloodless. Amputation then completed in the usual manner. "Healing of Aseptic Bone Cavities by Implantation of Antiseptic Bone Chips.'' Osteo- myelitic cavities first rendered aseptic and then implanted by decalcified bone chips, covered by periosteum. "Treatment of Fractures of the Neck of the Femur by Immediate Reduction and Permanent Fixation (1889)." Plaster of Paris cast of entire limbs, pelvic and opposite limb, as far as the knee. Lateral pressure over great trochanter by means of special apparatus incorporated- in cast and consisting of a leather pad and thumb screw in order to regulate pressure and keep fracture reduced. " Rectal Insufflation of Hydrogen Gas as a Test in the Diagnosis of Visceral Injury of the Gastro-intestinal Canal in Penetrating Wounds of the Abdomen (1888)." Experimental and clinical experience showed the practicability of forcing gas through the ileocecal valve from the rectum and the possibility of diagnosing gastro-intestinal wounds by insufflation. "Experimental and Clinical Study of Air Embolism (1885)." These experiments were exhaustive, having been done on horses, sheep, cats and 1 6 EDMOND SOUCHON dogs, and demonstrated positively the causes of an embolism. The great practical results of this work was the life-saving means proposed in desperate cases of air embolism; that is, puncture and aspiration of the right ventricle. The surgery of the pancreas as based upon experiments and clinical researches showed that restoration of continuity of pancreatic duct does not take place after complete section of pancreas (1886). Com- plete extirpation is invariably followed by death, produced either by traumatism or by gangrene of the duodenum. Complete destruction of the pancreatic duct uncomplicated by pathological conditions of the parenchyma of the organ never results in the formation of a cyst. " Movable Kidney." Fixation without suture. Removal of fatty capsule. Tamponnade of gauze around kidney. Healing by granulation. Gradual removal of gauze. "Gastroenterostomy and Intestinal Anastomosis by Means of Perforated Decalcified Bone Plates (1886)." New incision for arthrectomy, resection and for reduction of irreducible dislocation of the shoulder-joint. The advantage is that the scar resulting from the operation is well protected. "Intestinal Surgery with Special Reference to the Treatment of Intestinal Obstruction." He made valuable experimental contributions to the study of air embolisms, the surgery of the pancreas, gunshot wounds and intestinal anastomosis in which he introduced the use of decalcified bone plates. He was the first to use roentgen rays in the treatment of leukemia (1903). He was a great master in the treatment of intestinal surgery, especially in the treatment of appendicitis. He was the first to demonstrate the possibilities and limitations of the surgery of the pancreas. He was the great educator of the West. He contributed very much to the spread of knowledge by his numerous publications. He was justly termed by his contemporaries the greatest surgeon, medical authority, and writer the West has ever produced. His studies on tumors, including the first comprehensive writing on this subject in this, country, were enough to make him famous. He founded the Association of Military Surgeons of the United States (1891). ORIGINAL CONTRIBUTIONS OF AMERICA TO MEDICAL SCIENCES I 7 Dr. Ludwig Hektoen (Chicago) : Work in pathology ; experi- mental measles. Dr. Frank Billings (Chicago) : Focal infections. Dr. Weller Van Hook (Chicago) (deceased, no dates) : First successfully operated on a case of perforation in typhoid fever. Dr. Belfleld (Chicago) in 1886, first performed suprapubic cystotomy for hypertrophied prostate. Dr. John B. Murphy (Chicago) (deceased) : "Proctoclysis in the Treatment of Peritonitis. " "Axillary and Pectoral Cicatrices Following the Removal of the Breast, Axillary Glands, and Connective- tissue for Malignant or Other Diseases." "Arsenical Treatment of Syphilis." "Actinomycosis Hominis, with Re- port of Five Cases." "Intestinal Approximation; Pathological Histology of Reunion and Statistical Analysis." "Surgery of Arteries and Veins Injured in Continuity." "First Successful End-to-End Union of the Artery in the Human. " " Contribution to Abdominal Surgery; Ideal Approximation of Abdominal Viscera without Suture." "Clinical Significance of Cervical Ribs. " "Significance of the Scalenus Muscle. " "Fibroma of the Gastrohepatic Omentum in the Lesser Peritoneal Cavity." " Fibromyoma Telangiectaticum of the Gastrohepatic Omentum." "Fractures of the Olecranon Treated by Subcutaneous Extra- articular Wiring." "Fibromyoma Complicating Pregnancy; Fibroma of the Vaginal Wall." "Neurological Surgery." "Removal of an Embolus from the Common Iliac Artery, with Reestablishment of Circulation in the Femoral." "Surgery of the Lungs. " " Pneumothorax as a Treatment for Tuberculosis. " "Some Further Advances in Renal Surgery, Plastic on Renal Pelvis. " " Superior Accessory Thyroids. " "Tuberculosis of the Patella." "Substitution of Quadriceps Tendon for Patella." "Tuberculosis of Female Genitalia and Peritoneum." "Tuber- culosis of the Testicle, with Special Consideration of its Con- servative Treatment." "Trigeminal Neuralgia Treated by Intraneural Injection of Osmic Acid." "Ankylosis; Arthro- plasty, Clinical and Experimental. " ' 'Resection of the Rectum 1 8 ■ EDMOND SOUCHON per Vaginam. " " Osmic Acid Injections for the Relief of Trifacial Neuralgia." " Early Operation in •Perityphlitis " (in cooperation with Dr. E. W. Lee). " Operative Surgery of the Gall Tracts, with Original Report of Twenty Successful Cholecystenterostomies by Means of the Anastomosis Button." "Surgery of the Gasserian Ganglion, with Demonstration and Report of Two Cases." "Fibroma of the Mesentery." "Report of Case of Typhoid Perforation with Peritoneal Infection and Five Other Con- secutive Cases of General Suppurative Peritonitis; All Recov- ered." "A Method of Dispensing with Rubber Gloves and the Adhesive Rubber. Use of Palate Mucous Membrane Flaps in Ankylosis of the Jaw, Due to Cicatricial Formation in the Cheek. " "The Surgical Clinics of John B. Murphy, M.D. " Although the foregoing publications contain more or less novel views, Dr. Murphy states that the following work, as far as he knows, has been done by no one else. "The End-to-end Suture of Arteries. " "Proctoclysis in the Treatment of Peritonitis." "Arthroplasty of Joints with Interposition of Fat and Fascia." "The Button as a Means of Intestinal Anastomoses." Dr. L. L. McArthur (Chicago) : So far as I know I was the first to devise and recommend a muscle-splitting operation of the abdominal wall for any purpose, but especially for appendicitis. I devised a method of constructing a new urethra from the vaginal mucous membrane. I devised a method of suturing hernias with living sutures made from the tendons of the external oblique muscle: in other words, closing the hernia with living suture, which suture I demonstrated to be living for years afterward. I devised a novel method of treating the complications of bile tract diseases by utilization of the bile tracts for the introduction of fluid medicaments, etc., into the duodenum. I devised a new surgical access to the pituitary body, through an aseptic field, which method has been adopted by many operators, notably Dr. Frazier, of Philadelphia. I demonstrated the cura- bility of tuberculosis of the large intestine by an appendicostomy, or cecostomy, the originality consisting in demonstrating the applicability of this method of approach to large intestine tuberculosis. ORIGINAL CONTRIBUTIONS OF AMERICA TO MEDICAL SCIENCES 1 9 Dr. Allen B. Kanavel (Chicago) : "Experimental, Anatom- ical, and Clinical Study of Infections of the Hand." In this work I have shown where pus will lie in the hand and forearm in any infection and the most satisfactory method of producing a rapid recovery with a functionating hand. A study of experi- mental work in relation to the union of fractures and splenec- tomy. In these I showed that the removal of the spleen bore no relation to repair in union of bones. "An investigation as to the Most Feasible Method of Removing Tumors of the Hypophysis." In this work I believe I was the first to draw attention to the fact that these tumors can be removed through the inferior portion of the nose rather than going through the superior portion, as had been previously done by Schloffer, von Eiselberg and others. "A. Study of Duodenal Toxemia and Mobilization of the Duodenum." "Consideration as to the Osteoplastic Closure of the Canals through Which the Nerves Descend." Experimentally it was shown to be possible, and clinically it has been done, but the procedure has not been known long enough to determine whether or not it has established a principle that may be of value in these cases. "A Study as to the Question of the Relation of Thyroidectomy to Dementia Praecox." I believe that the investigation and report that I made on this condition, which was advocated by Halsted and others, has shown that it is absolutely of no avail. "Surgical Intervention in Leontiasis Ossea." "A Study of the Clinical Histories and Skulls in Relation to Curative and Palliative Operations, with the Report of a Case." Dr. Albert E. Halstead (Chicago) was the first to propose and use the sublabial trans-sphenoid method of approach to the hypophysis cerebri. Dr. Alex. H. Ferguson (Chicago) (deceased) devised a method of closing a vaginal fistula by cutting deeply around its periphery through the vaginal walls down to the bladder. The circular flap made in this way is inverted into the bladder and its raw surfaces approximated with buried catgut sutures after which the vaginal walls are sutured together, closing in the entire raw area. 20 EDMOXD SOUCHOX Dr. Geo. Callahan (Chicago) first used acetone as a pallia- tive to be applied to incurable cancer of the neck of the uterus. Dr. Coleman G. Bueord (Chicago) was the first surgeon in the West to perform bacteriological experiments with all kinds of gloves used in surgery, and was the first to present this ques- tion to a medical meeting in Chicago. Described a syndrome characterizing simple goitre, known as the Buford syndrome. Described the pathogenesis of goitre in children. Dr. C. 0. Whitman founded the Journal of Morphology, and did important work in embryology. Dr. Emanuel J. Senn (Chicago) : " Gastrotomy by a Circular Valve Method; Stomach Exposed." Incision \ inch in length made into its cavity as near cardia as possible. Tube introduced into stomach and then fixed by suture. A purse-string suture is passed around the tube at a distance of one-half inch from it. The suture is then tied. A second and third purse-string suture is passed in a similar manner and tied. Result, that the tube lies in a funnel-shaped inverted position of the anterior wall of the stomach. The stomach' is fixed to the anterior abdominal wall. Dr. J. Gordon Wilson (Chicago) : The publication on the nerves of the atrioventricular bundle was the first published in which there was demonstrated the ganglion cells there present and their endings. The communication on the nerves and nerve-endings of the membrane tympany contains many new facts. The article on the nerves and nerve-endings in the mem- brana tympani of man is still the only communication on that subject. The papers on the labyrinth of the ear contain a number of new data in regard to the vestibular mechanism. Dr. Franklin H. Martln (Chicago) contributed more than any other one man to the foundation of the American College of Surgeons, also to the Journal of Surgery, Gynecology and Obstetrics, which is quite a contribution to medical science. Dr. William A. Locy (Chicago) did important work in embryology. Journal of the American Medical Association is the greatest contribution of its kind. It is unexcelled anywhere. ORIGINAL CONTRIBUTIONS OF AMERICA TO MEDICAL SCIENCES 21 INDIANA Dr. John S. Bobbs (Indianapolis) performed the first chole- cystotomy (1868). Dr. Miles F. Porter (Fort Wayne) claims to have originated the method of treating hyperthyroidism by injecting boiling water into the gland. IOWA Dr. John Bell (Waterloo) (deceased, no dates) was the first to perform gastrotomy for the removal of foreign bodies. Dr. Alonzo E. Taylor (Alden) did important work on fer- mentation (1906), metabolism (191 2), and application of physical chemistry to pathology. KENTUCKY Dr. T. H. Morgan (Lexington) : Important work on experi- mental embryology, morphology, and zoology; also on heredity. Dr. Ephraim McDowell (Danville), 1771-1830, was the first to remove an ovarian cyst. He did it in Danville in 1809. He operated on 13 cases with 8 recoveries. He is the founder of abdominal surgery. Dr. Walter Brashear (Bardstown), 1778-1809, first disar- ticulated the hip- joint in 1806. Dr. Benjamin Winslow Dudley (Lexington), 1 785-1870, was the first to trephine for epilepsy (1828). Dr. Henry Miller (Louisville), 1 800-1 874, was the first to make applications of fluid caustics to the body of the uterus by using a mop. Dr. Charles McCreary was the first to remove the clavicle (1813)- Dr. John R. Wathen (Louisville) : An improved technic in goitre operations. The use of scissors has replaced entirely the knife, and all structures, beginning with the skin, and later the enlarged thyroid gland, are elevated and approached from the under surface. 2 2 EDMOND SOUCHON LOUISIANA Dr. Francois Prevost (Donaldsonville), in 1830, performed the first Cesarean section in America. He operated four times successfully, losing but one mother and operating twice on the same woman. Dr. Ditbourg (New Orleans), in 1830, was the first to perform vaginal hysterectomy in America, if not in the world. (State- ment of Professor E. S. Lewis, of Tulane.) Dr. Charles H. Luzenberg (New Orleans), 1805-1848, first removed gangrenous bowel in hernia and sutured the ends successfully. Dr. John L. Riddell (New Orleans), 1807-186 5, invented the binocular microscope. Dr. Warren Stone (New Orleans), 1808-187 2, was the first to resect a portion of rib to secure permanent drainage in cases of empyema. He first cured a traumatic aneurysm of the second portion of the subclavian artery by digital compression upon the third portion of the vessel. He was the first to apply a wire ligature to a human artery for aneurysm. He applied it to the common iliac for an aneurysm of the external iliac. Digital compression is undoubtedly an American procedure. Dr. Charles J. Faget, Sr. (New Orleans), 181 8-1884, dis- covered the lack of correlation between the pulse and the tem- perature in yellow fever. While the temperature goes up the pulse goes down. It is pathognomonic of yellow fever. Dr. Tobias Gibson Richardson (New Orleans), 1827-1892, was the first to amputate both legs at the hip- joint at one time in the same subject, the patient recovering. He was the first to write an Anatomy in which English names were substituted for the Latin names. He was the first to use strong injections of nitrate of silver for cystitis. His wife's devotion to his memory caused her to contribute magnificent buildings on Tulane Campus, devoted to medical education. Dr. H. D. Schmidt (New Orleans), 1823-1888, demonstrated the origin of the bile ducts in the intercellular spaces. ORIGINAL CONTRIBUTIONS OF AMERICA TO MEDICAL SCIENCES 23 Dr. T. W. Compton (New Orleans), in 1853, was the first to excise both the radius and ulna. Dr. Albert B. Miles (New Orleans), 185 2-1894, was the first to use a loop ligature on the first portion of the subclavian artery while operating on the third portion. Dr. Andrew W. Smyth (New Orleans) was the first to cure a subclavian aneurysm of the third portion. He first ligated simul- taneously the innominate and the common carotid and later the vertebral artery (1864). His ligation of the innominate artery is the first successful one in the world (1864). His patient sur- vived, whereas Dr. Mott's (1818) did not. It was by ligating the vertebral artery on the appearance of secondary hemorrhage in his case that he cured the case. Dr. Joseph Jones (New Orleans), 1833-1896, discovered the Plasmodium of malarial fever before Laveran. (Statement of Professor Duval, of Tulane.) Dr. Joseph Holt (New Orleans) was the first to force sul- phurous acid gas into the hold of vessels for disinfection pur- poses. He disinfected them, but he did not know how or why. He was killing the mosquitoes, but did not know it until the mosquito discovery came to light. Dr. Edmond Souchon (New Orleans) devised a new method to design colored charts for class demonstrations. The sketch is copied from a book with a pantograph, and the shading is done by black crayons and willow charcoal. The coloring is done with pastels. The drawing is made on book paper, the back of which is painted with thin Damar varnish and turpentine, which fixes the pastels and prevents its rubbing off. The paper is then pasted on large Bristol boards (30 x 40), and its surface is sized with thin gelatin and then varnished with thin Damar. Preser- vation of anatomical dissections with permanent color of mus- cles and organs by two methods. The chemical method using arsenic, calcium, chloride, and formol. The paint method, by which colorless muscles in a dissection are given permanent color by painting them with artists' paints. Founded preservative anatomy after the method described above. Founded methodic 24 EDMOXD SOUCHOX anatomy as evidenced in a plea for methodical text-book on anatomy. A single and uniform guide is strictly followed in describing each and ever}* organ, from the largest to the small- est. Founded philosophical anatomy as exemplified in the publication of philosophic anatomy of the tongue, liver, lungs. kidneys. The peculiarities only of the organs are considered, and it is endeavored to explain the reason of things, the why and wherefore. Founded esthetic anatomy by using systematically in teaching 400 large pastel colored charts and projecting on the screen a complete series of 300 colored lantern slides, the repro- duction of the atlases of Bonamy and Beau and of Hirschfeldt and Leveille. Founded the Souchon Museum of Anatomy at Tulane University. It was so named by resolution of the Board of Administrators. It contains 350 dissections, large and small. They are all natural preparations. There are no dried, wax. or papier mache specimens. All the muscles and organs present permanent color. Xo other museum anywhere presents this feature. They are prepared after the Souchon method of pre- serving anatomical dissections. Surgical collateral branch, which takes the place of the main artery when that artery has been ligated. Embalming of bodies for teaching purposes. The chemicals used are arsenic, formol, alcohol, glycerin, carbolic acid, and creosote. The originality lies in the combinations selected, in the proportions of each and the result obtained in the color of the muscles. ''First Complete History of Aneurysms of the Arch of the Aorta. " ''First Complete History of the Operative Treatment of Aneurysms of the Third Portion of the Subclavian Artery.''' "First and Only Dissection of a Subclavian Aneurysm of the Third Portion of the Subclavian Artery*, Demonstrating the Collateral Circulation after Ligature of the Main Arteries." It took place through the anastomoses of the perforating inter- costals with the branches of the subscapular in the substance of the great serrate muscle. The specimen is now in the Army Medical Museum in Washington. First to advocate simultan- eous double ligature of the first portion of the subclavian and the vertebral artery* without rupturing the coats for the cure of ORIGINAL CONTRIBUTIONS OF AMERICA TO MEDICAL SCIENCES 25 subclavian aneurysm of the third portion. First to advocate the ligation of the axillary artery above the origin of the subscap- ular for the cure of recurrent aneurysm of the third portion of the subclavian. "First Complete History of Double Aneurysm of the Same Artery." " First Complete History of the Operative Treatment of Irreducible Dislocations of the Shoulder- joint." Resection of the head is better and easier than reduction. "Com- plete History of Drilling of Holes through the Skull to Explore with Syringe and Needle." "First Complete History of Wounds of the Large Surgical Veins." When a large vein has been injured and ligated, if the collateral venous circulation is inadequate and gangrene is threatened the main artery of the region must be ligated, but below the largest collateral which will carry enough blood to nourish the parts beyond, while the ligation of the main trunk will diminish the quantity of blood or equalize the arterial and the collateral venous circulation. "First Com- plete History of the Treatment of Abscesses of the Liver by Aspiration." Small abscesses of not over one quart were often cured by single aspiration. First to write a " Complete History of the Surgical Diseases and Injuries of the Neck." Each region of the neck is considered separately. The peculiarities only of diseases are mentioned. No generalities are mentioned. First to write a "Methodic Description of a Surgical Disease." A single uniform plan or guide is adopted and is strictly followed in describing each and every surgical disease. Devised "Sou- chon's Anesthetizer," an apparatus to inject anesthetic vapor in the lower pharynx by a rubber tube introduced through the nose or the mouth. The apparatus is worked by one hand which presses a bulb and forces the vapor through the tube. Its orig- inality lies in its small size, and simplicity. Other apparatus used for this purpose are large, clumsy and worked with the foot and bellows. Devised speculum holder for Sims's duck- bill speculum. An upright with a line of nails is screwed to the side of the operating table. The outside end of the speculum is held by a loop of rubber with a string to it. The string is wound around a nail on the upright. It is quite a help and relief 26 EDMOND SOUCHON to the assistant who has only to guide the inside speculum in the proper position. "First Formal Plea for a Reform in Medi- cal Education." "First Formal Plea for a Reform in University Education." Wrote the first "Formal Sanitary Code in America for the Louisiana State Board of Health." "Reminiscences of Dr. J. Marion Sims in Paris." Designed the "Floor Plans of the Josephine Hutchinson Memorial School of Medicine of Tulane University." It is the largest and most elaborate under- one-roof medical college in America. First to write a "Formal History of the Original Contributions of America to Medical Science to Date." Dr. Rudolph Matas (New Orleans): "Drum Snares,-" solid rings for end-to-end and lateral intestinal anastomosis. "Method of Securing Circular Constriction with Fixation Pins of the Auricle to Obtain absolute hemostasis in operations for Cavernous and other angiomas of the auricle. Pins are inserted around the auricle and an elastic thread is wound around the pins. "Easy Method of Securing Hemostasis in Bleeding Injuries of the Upper Lip in Hemophilic Subjects. " "Arrest of Hemorrhage by Direct Elastic Compression." An ordinary wide elastic band (stationers') is adjusted over the lip and fixed by threads to prevent slipping up or down. "New Methods of Reducing and Securing Fixation of Displaced Fragment in Zygomatic Frac- tures." A long semilunar Hagedorn needle threaded with silk is entered one inch above the middle of the displaced fragment, is passed well into the temporal fossa, and is made to emerge one-half inch below the arch. The silk is used to pull the bone into position. A firm pad is applied externally and the wire is twisted over the pad. On the ninth or tenth day the wire, pad, etc., are removed permanently. "Adaptation and Modification of the Kraske Method for Cases of Congenital Imperforation of the Anus." "Modification of the Fell-O'Dwyer Apparatus for Direct Intralaryngeal Insufflation (first Effort to Apply Positive Pressure in the Surgery of the Thorax in the United States) Anesthesia in Overcoming Surgical Pneumothorax." "A New Gradual Air Pump for Positive Pressure in its Applica- ORIGINAL CONTRIBUTIONS OF AMERICA TO MEDICAL SCIENCES 27 tion to Medical and Surgical Practice." The Matas-Smyth pump. "An Adjustable Metallic Interdental Splint for the Treatment of Fracture of the Lower Jaw. " "An Apparatus for Massive Infiltration Anesthesia with Weak Analgesic Solutions." Original methods of blocking the nerves in regional anesthesia : (1) "Original Method of Anesthesia of the Forearm and Hand by Intraneural and Paraneural Infiltration with Cocain, Novocain and Other Succedanea into the Trunks of the Musculospiral, Median, and Ulnar. " The procedure secures complete analgesia of the forearm and hand, permitting amputations, resections, or any other operation. First case operated by this method, January, 1898. (2) "Regional Anesthesia of the Territory Supplied by Second Division of the Trigeminus by Blocking the Nerve from the Foramen Rotundum by Two Routes: (a) By Introducing the Needle through the Sphenomaxillary Fissure into the Sphenopalatine Fossa and Reaching the Nerve and Even the Gasserian Ganglion through the Foramen Rotundum. " This route to the superior maxillary division of the trigeminus was first applied by Dr. Matas in removing both upper maxillae for carcinoma April 29, 1899. This route is now known as the "Payr route" in Germany, though its application has only recently obtained in Germany, (b) The inframalar route to the second and third division appeared also at the same time (1899) to block the second and third division of the trigeminus for operations on the jaw, thus antedating Schlosser and now recognized as the "Matas route. " (See Braun, Local Anesthesia, 2d ed., 1913; also Haertel, loc. cit., 1913.) Original account of these and other procedures described by Dr. Matas. (See Philadelphia Med. Jour., November 3, 1900.) Was also the first to apply spinal subarachnoid anesthesia for surgical purposes in the United States (November 10, 1899), though Leonard Corning, of New York, had applied it for medical purposes in 1886, and had laid the foundation for the surgical procedure. A. Bier, then of Keil, Germany, first introduced and resorted to it for surgical purposes in April, 1899. (See Philadelphia Med. Jour., November 3, 1900). "An operation for the Radical Cure of Aneu- 25 EDMOND SOUCHOX rysm by Endo-aneurysmorrhaphy, with Intrasaccular Suture (the ' Matas operation '), First Applied in March, 1888. " In this three different methods are described for the first time: (1) obliterative, (2) restorative, (3) reconstructive endoaneurysmorrhaphy; 225 operations by these methods were reported up to August 17, 1913, International Congress of Medicine, London. "The Flexible, Flat, Removable Band for the Occlusion of Large Surgical Arteries (with Dr. Carroll W. Allen), the "Matas- Allen band, " for testing the efficiency of the collateral circulation in the circle of Willis and other parts (a modification of the Halsted band). "A Method of Testing the Efficiency of the Collateral Circulation as a Preliminary to the Occlusion of the Great Surgical Arteries, Hyperemia Reaction or Living Color Test (Used on the Extremities) :" Complete ischemia of the limb is obtained by elevation and application of an elastic bandage to the level of the lesion. Then a Matas compressor is applied to the proximal side and as near the aneurysm as possible until the aneurysm is absolutely stilled and is allowed to remain from six to ten minutes. Immediately on removal of the elastic bandage, the compressor being still in place, a hypodermic flush descends the limb rapidly. The digits retain a cadaveric, waxy, lifeless pallor for several seconds, which may be prolonged from ten to forty minutes, or even longer, according to the development of the collaterals. If there is no collateral cir- culation the limb will remain ischemic. The second test is based on the preliminary occlusion of the main artery, with the pliable and removable aluminum band, which can be removed in fifty- six hours without injury to the vessel in the event of manifes- tations of ischemic phenomena; for example, hemiplegia, stupor, and coma after the obliteration of the common carotid artery. "A Method for Reducing the Caliber of the Thoracic Aorta by Plication or Infolding of its Walls by Means of Lateral Parietal Suture Applied in One or More Stages." (An experimental investigation with Dr. Carroll W. Allen). "Direct Duodenal Catheterization through the Gall-bladder and Common Duct for Nutrient Medicinal Purposes" (an Extension of McArthur's ORIGINAL CONTRIBUTIONS OF AMERICA TO MEDICAL SCIENCES 20. Gall-bladder Drip). "A Simple Expedient in Treating Compli- cated Fractures of the Lower Jaw in Conditions Forbidding the Use of Sprints or Intrabuccal Prosthesis" (with Dr. L. Landry). Four or five turns of a thin Esmarch bandage are taken around the face and jaw from the bregma to the chin and under the jaw; this is fixed by a bandage passed around the forehead to prevent slipping. Immobilizes the fragments after reduction; assists materially in getting rid of swelling and edema. "The Prophylaxis of Postoperative Tetanus Based upon Proper Dietetic Measures and upon the Contamination of the Alimentary Canal, with the Tetanus Bacillus Introduced in Uncooked Vegetable Foods." Dr. Matas has devised a special rachitome which he uses with advantage in performing laminectomy for extensive spinal lesions. This is a simple but very strong chisel, with a short but powerful cutting tooth prolonged into a long curved, metallic handle. The chisel has enormous strength and leverage, and can cut a continuous linear section through the laminae in a very short time without injury to the dura. Dr. Matas has also devised and uses with advantage a special long suture carrier which greatly facilitates the tacking of the omentum or mesentery in making colonic or other visceral suspensions for prolapsed stomach, colon, etc. It permits of an extensive suturing of distant displaced organs through a comparatively small median incision. In this way a colonic suspension may be made in the course of a pelvic operation through a short and low laparotomy incision with little additional trauma or intraperitoneal manipu- lation. In an exhaustive monograph on the "Surgical Treatment of Anorectal Imperf oration " (congenital) Dr. Matas laid special stress upon the advantages of the perineococcygeal route and described a procedure which he first applied with decided success in a case of imperforate anus with a high-placed enteron. In this case the distended gut was brought down from a high position in the pelvis by a partial Kraske, which allowed it to be pulled down to the proctodeum or infundibulum, to which it was sutured by a lateral anastomosis. In this way the sphincter fibers of the anal region are preserved and a better chance of 30 EDMOXD SOUCHON rectal control is obtained. Matas says that: "My effort to simplify the cure of aneurysm by the intrasaccular suture and the principles involved in the modern treatment of aneurysms and my insistence upon the surety of studying the conditions of the collateral and peripheral circulations before attempting the permanent occlusion of the great surgical arteries, and my insistence also upon the simple and efficient method which I have devised and practised, and by which the efficiency or inefficiency of the collateral circulation can be determined, are the con- tributions which I would prefer to have recognized." Dr. Arthur W. De Roaldes was the first to establish a nose, eye, ear, and throat hospital in the South from the Atlantic to the Pacific and from St. Louis to the Gulf. Drs. F. W. Parham and E. D. Martin devised a new treat- ment for fractures. It consists in a band that fits snugly around any unevenness of the bones. Especially useful in the treatment of oblique fractures. Dr. Charles W. Duval (New Orleans) claims to be the first to obtain the bacillus of leprosy in pure culture. Subcutaneous leprous nodules are removed under sterile conditions, cut into small bits and planted aerobically on a medium of split protein products. After removal it is autolyzed by adding some proteo- lytic bacterium or allowing the tissue to slowly disintegrate under sterile conditions at 37 ° C. for several weeks, then extracting the juice by Berkefeld filtration. Dr. Duval has discovered the causal agent of infantile diarrhea or summer complaint, and proved that it is a bacillus belonging to the dysentery group. Dr. Wm. H. Harris (New Orleans) : "Production of Pellagra in the Monkey by a Berkefeld Filtrate from Human Lesions." The filtrate was injected hypodermically. Dr. Maurice Couret (New Orleans) demonstrated that the fish is the host of the bacillus of leprosy. The fish were inoculated simultaneously with a bacterial emulsion of Bacillus leprae. Fish were fed on human leprosy nodules and the flesh of infected fish. All the bacilli multiplied in the fish and were harbored by them without apparent discomfort or outward evidence of the disease. ORIGINAL CONTRIBUTIONS OF AMERICA TO MEDICAL SCIENCES 3 1 Dr. C. C. Bass and F. M. Johns (New Orleans) were the first to cultivate the plasmodium of malarial fever (191 1). They showed that when blood with plasmodium was heated to a certain temperature the plasmodium continued to live for a certain time but would eventually die. By adding some dextrose the plasmo- dium continued to live and multiplied. They have studied especially the influence of emetine and ipecac as a specific remedy against the protozoon of pyorrhea alveolaris, specially proper dose, best method of administration, duration of treatment, and prevention of relapse or reinfection. Dr. Marion Souchon (New Orleans) was the first to remove a urinary calculus from the vesical portion of the ureter through the perineal route. He was guided by the touch through the rectum and through the wound. Dr. Robert Clyde Lynch (New Orleans) claims to be the first to remove a tumor whole from the larynx. Also to be the first to have sutured a surgical wound in the interior of the larynx. Mr. Lloyd Arnold (New Orleans) is the first to demonstrate the occurrence in the human ovary of several ova in the same follicle. The work was done under the direction of Professor Irving Hardesty in the laboratory of anatomy at Tulane Uni- versity. Dr. Carrol W. Allen (New Orleans) is the first to publish the only thorough book on local anesthesia in the English language. Dr. Ansel Caine (New Orleans) devised a warm ether apparatus without using a flame. The apparatus consists of a bellows worked by foot pressure which vaporizes the ether. The vapor is driven through a coil of pipe enclosed in a metal receptacle containing acetate of soda. This receptacle is immersed in boiling water for fifteen minutes before using and the soda will retain the heat for several hours. The vapor driven through the heated coil is delivered warm to the patient. Dr. Henry D. Burns (New Orleans) was the first to devise a tucking operation for shortening any one of the straight muscles of the eye. 32 EDMOND SOUCHON Dr. Oscar Dowling was the first in the Southwest to equip a health car for the Louisiana State Board of Health and with it to travel over the country to perform the true functions of a State Board of Health, i. e., to teach the people how to preserve and improve their health. Dr. Stanford C. Jamison, by experimenting on dogs, dis- covered that when the large vessels of the spleen were ligated the organ would not slough if it were covered by the omentum. The State of Louisiana was the first State to establish and maintain a leprosarium (Leper's home). MARYLAND Dr. John B. Davldge (Baltimore), 1 768-1829, first tied the gluteal artery for aneurysm. Dr. Horatio G. Jameson (Baltimore), 17 78-1 85 5, was the first to describe animal ligature in 1827. He was the first in this country to remove the upper jaw (1820). Was the first to pro- claim non-contagiousness of yellow fever. He was the first to incise the cervix uteri. Dr. Ruben D. Mussey (Baltimore?), 1 780-1866 : Was the first to ligate the two common carotids after an interval of but twelve days (1831-37). Dr. William Gibson (Baltimore), 1 788-1868, ligated the common iliac for the first time in the history of surgery (181 2). Dr. John D. Goodman (Annapolis), 1 794-1830, produced three works of importance and originality; his treatise on the fascia, his contribution to physiological and pathological anatomy and his American natural history. Dr. John R. Young (Baltimore), published, in 1803, the first American contribution to the physiology of digestion. He demonstrated that the solvent principle of the gastric juice is an acid which is a part of the normal gastric secretion. Dr. Charles Frick (Baltimore), 18 23-1 860, was the first to show that the mere presence of albumin does not itself indicate organic disease. ORIGINAL CONTRIBUTIONS OF AMERICA TO MEDICAL SCIENCES 33 Dr. Edward Warren (Baltimore), in 187 1, first resected the head of the humerus in the case of an old, irreducible dis- location. Dr. W. K. Brooks: Work in embryology. Dr. William S. Halsted (Baltimore, Johns Hopkins): 1 880-1 88 1, introduced gutta-percha tissue as a dressing for granulating and fresh wounds, employing it later as a drainage material. Was the first to use silver-foil, rubber gloves, and gutta-percha tissue. The thin gutta-percha was first made at his request. 1884, directed attention to the effects of abduction and adduction on apparent length of limb and on measurements in fracture of the neck of the femur. 1884, performed and recommended transfusion of blood centripetally into an artery in the human subject and returned by transfusion the patient's own blood after it had been mechanically freed of the poison (CO) of illuminating gas. 1885, devised and described the dis- tention or infiltration method of employing cocain for local anesthesia; noted also that the injection of cocain into a nerve produced anesthesia in the parts supplied by that nerve, and that cutting off or diminishing the blood supply of the cocainized part increased and prolonged the anesthetic effect. 1885, discovered that local anesthesia might be produced by the injection of exceedingly weak solutions of cocain and even of water. 1886, recommended and practised the treatment of urethritis by irrigation with antiseptic solutions. 1887, directed the attention of surgeons to the submucous coat of the intestines and to the necessity of including a portion of this coat in the stitches in making an intestinal suture. Performed on animals operations of reversal of the intestines and the isolation of an intestinal loop. 1888, made the discovery, with Sir Victor Horsley and independently, that after removal of a portion of the thyroid glands in dogs there occurs a characteristic hyperplasia of the part remaining and that the glands of puppies of thyroidec- tomized parents became likewise hypertrophied. 1889, devised the buried plate-and-screw method for the treatment of fractures. 1889, introduced the teaching of operative surgery on animals. 34 EDMOND SOUCHON 1 889-1 894, described a radical operation for the cure of cancer of the breast. 1890, introduced rubber gloves. 1891-1893, devised an operation for the cure of inguinal hernia. 1891, per- formed the first successful ligation of the first portion of the left subclavian artery, also the first and for many years the only excision of a subclavian aneurysm. 1895, devised a method of skin transplantation by progressive rotation of the transferred pieces. 1896, performed the first excision of a cancer of the diverticulum of Vater of the common duct. . 1896, introduced silver-foil as a dressing for closed wounds, covering for skin grafts, etc. 1901, discovered, with Opie, in a case of acute hemorrhagic pancreatitis that retrojection of bile into the pancreatic duct might be a cause of this lesion. 1903, recom- mended the use of the cremaster muscle in the treatment of the oblique form and the sheath of the muscular rectus abdominis in the direct form of inguinal hernia. 1905, devised a method for the partial, progressive, and complete occlusion of the aorta and other large arteries by the use of metal bands, also an instrument with which to curl and apply these bands. Introduced the metal roll or band and was the first to experiment with the partial occlusion of arteries. 1906, operated upon the aortic arch in the human subject and (1906) upon the thoracic artery in animals and man, and demonstrated that after partial occlusion of the aorta (thoracic) the systolic blood-pressure might remain lowered for months. 1906, cured aneurysm of some of the principal arterial trunks by partial occlusion of the artery proximal to the aneurysm. 1906-1908, demonstrated on dogs the possibility of the transplantation of the parathyroid glands and obtained absolute proof of a vital function of these epithelial bodies. Established certain laws relative to the transplantation of the parathyroid glands. 1906, treated tetany successfully by the administration of the parathyroid glands of beeves. 1906 or 1907, made use of measurements of the mammary radii to assist in the diagnosis of breast tumors and in the determination of the age and relative malignancy of cancer of the breast. 1910, contrived, with Dr. Willis D. Gatch, the obturator or bulk- ORIGINAL CONTRIBUTIONS OF AMERICA TO MEDICAL SCIENCES 35 head method of performing end-to-end suture of the intestines. "The Transfixion Method of Controlling Hemorrhage with the finest silk embraces features and principles which are original (1913). " "An Original Method of Closing the Wound in Opera- tions for Cancer of the Breast, Obliterating the Dead Space under the Clavicle." The swelling of the arm and restriction of motion is prevented by this method (1913). 1914, employed the partial occlusion of the external iliac artery as a preliminary to excision of an iliofemoral aneurysm. Demonstrated the beneficial effect of radiation of the thymus gland in cases of Graves's disease uncured by double lobectomy. Demonstrated that a parathyroid graft too small to be visible to the naked eye was sufficient to maintain the life of a dog (191 2). First to trans- plant the parathyroid glands in dogs. Established the law that for the successful transplantation of these bodies a deficiency must be created. These experiments furnished the first functional proof of the vital importance of these organs in dogs, that tetany would follow the removal of the sustaining graft. Report first cases of open-air treatment of surgical tuberculosis. Also insti- tuted the outdoor treatment of general surgical patients. Dr. W. H. Welch has specially advanced bacteriology and pathology in America. He discovered the Staphylococcus epider- midis albus and its relation to dermal infection (1892) ; also the Bacillus aerogenes capsulatus (1892); in important studies of embolism and thrombosis, with Flexner, he demonstrated the pathological changes produced by experimental injection of the toxins of diphtheria, simultaneously with Von Behring. He is the high priest educator of the Johns Hopkins shrine. He has con- tributed a number of able and distinguished pupils to the medical sciences. Dr. Welch has contributed more than any one man to the foundation of the great Johns Hopkins Medical School. Dr. William Osler (Baltimore) is also a great educator and leader of men and thought. He has also contributed to the glory of Johns Hopkins. Dr. Howard Kelly (Baltimore) is well known as an operator and teacher. His example and success in gynecology have greatly 36 EDMOND SOUCHON contributed to the advancement of gynecology in America and make him the standard-bearer of gynecology in this Western Hemisphere (if not in both) . He has also contributed in building up the fame of Johns Hopkins. Dr. William S. Thayer (Baltimore), Johns Hopkins: "First Instances of Gonorrheal Endocarditis in which gonococci were obtained in the circulating blood during life (1896)." "Descrip- tion for the First Time of the Existence of the Third Heart Sound" (in collaboration with Dr. MacCallum (1908). "The Ameboid Activity of Megaloblasts. " Dr. Charles W. Byrnes (Baltimore): "A Study of the Axis-cylinders in Five Cases of Glioma Cerebri. " This is the first piece of work in which it has been demonstrated that the not infrequent absence of clinical symptoms in even large cerebral tumors of this type can be accounted for by the fact, that although the myelin sheath may be destroyed, numerous healthy axis-cylinders can be observed passing uninterruptedly through the midst of a large gliomatous mass. My contribution has been referred to by Sir William Osier in his System of Medicine, vol. vii, first edition. "The Intradural Administration of Mercurialized Serum in the Treatment of Cerebrospinal Syphilis." Although mercury has been previously used intradurally, this is the first paper in which this particular form of mercury ad- ministered in serum has been recorded. In other words a new method of administration has been introduced. Dr. Harvey Cushing (Baltimore, Johns Hopkins) has done much original work in experimental physiology, pathology > and surgery such as the experimental production of gall-stones, experimental production of valvular heart lesions in the dog, successful treatment of paralysis of the face in man by anas- tomosis of the spinal accessory and facial nerves. He has intro- duced nerve-blocking, a special suture, lumbar drainage in hydro- cephalus, crow-bar incision in opening the base of the brain. He has developed decompression operation, particularly in intra- cranial hemorrhages in the newborn and inaccessible tumors. He has thrown much light on the physiological actions of the ORIGINAL CONTRIBUTIONS OF AMERICA TO MEDICAL SCIENCES 37 pituitary body by experiments and by the general consideration of its disorders as "dyspituitarism." Dr. Thomas S. Cullen (Baltimore) discovered the true source of adenomyomata in the Miillerian organ. He also made the fullest investigation of fibroid tumors, hydrosalpinx, and omental disease. Dr. Llewellys F. Barker (Baltimore) described, in 1896, a unique case of circumscribed unilateral and elective sensory paralysis; also eye signs in nephritis; work in pharmacodynamics; new book on Diagnosis. Dr. Wm. G. MacCallum (Baltimore) and E. L. Opie (1897) demonstrated the sexual conjugation in malarial parasites. Dr. J. M. T. Finney (Baltimore) has contributed consider- ably to the foundation of the American College of Surgeons, of which he is the first distinguished and efficient President. Dr. William H. Howell (Baltimore) wrote the best treatise on physiology and did important work on the life history of blood corpuscles (1890) and on antithrombia and thromboplastia (1911). Professor John J. Abel (Baltimore, Johns Hopkins): 1892, discovered that carbamates are present in the urine of children, as well as in that of dogs, after the administration of lime water in excess. 1894, discovered that ethyl sulphide, (C 2 H 5 ) 2 S, is a normal constituent of dog's urine. 1896, was the first to isolate the dark pigments of the negro's skin and hair and to make chem- ical analysis of these substances. 1897-1905, in 1897, assisted by Dr. A. C. Crawford, Professor Abel described his method of isolating the active principles of the suprarenal capsules. He was the first to isolate this principle in the form of monobenzoyl salts. 1907, assisted by W. W. Ford, Professor Abel demon- strated that the hemolytic constituent of the poisonous fungus, Amanita phalloides, is a very unstable glucoside and not toxal- bumin, as Kobert and others had supposed. 1909, with L. G. Rowntree, the pharmacological properties of a number of sub- stituted phthaleins, notably phenolsulphonephthalein and tetra- chlorphenolphthalein , were first carefully investigated. 1910, 3b EDMOND SOUCHOX discovered and first prepared the compound, ethyl antimony thioglycocollate. 1910. discoA*ered that acid fuchsin causes "late" convulsions in frogs and that removal of the anterior third of the brain greatly increases the toxicity of the drug for these animals. 191 1, discovered that epinephrin is a constituent of the venomous secretion of the skin glands of the giant tropi- cal toad. Bufo agua. 1912-1913, devised the process known as "vivi diffusion." Essentially the process consists in passing the blood which has been made inoculable (by injection of hirudin) from a, cannula connected to an artery or a vein through a series of tubes made of celloidin or other suitable or artificial serum and back by another cannula into a vein of the same animal. 1914, plasmapheresis: reflecting on the drawbacks of venesection, which limits the use of this procedure in practical medicine. Professor Abel conceived the idea that the main objec- tions to blood-letting could be obviated by the speedy return into the body of the red and white corpuscles instead of throw- ing them away as has hitherto been the custom. Evidently the only thing that could be removed from the blood of a person bled in this way would be its fluid part — the plasma. Drs. L. G. Rowntree and Geraghty: Phenophthalein test in renal disease. Dr. Thomas C. Gilchrist (Baltimore) first described blas- tomycosis (1896). The Johns Hopkins Hospital is one of the greatest contri- butions of its kind in America. The Johns Hopklns School of Medicine was the first to have whole-time professors for the clinical branches. MASSACHUSETTS Dr. John Warren (Boston), 1 753-1 81 5, was the first to ampu- tate at the shoulder- joint (1781) and to excise the parotid gland (1804). He founded the Harvard Medical School. Dr. James Jackson, Sr. (Boston), 1777, published one of the earliest accounts of alcoholic nephritis which he described as arthrodynia a potu (1822). ORIGINAL CONTRIBUTIONS OF AMERICA TO MEDICAL SCIENCES 39 Dr. John Collins Warren (Boston), 1 778-1856, the founder of the Warren Museum. He was the first in this country to remove a large fibroid polypus from the base of the cranium through the hard and soft palates. He was the first in this country to perform staphylorraphy (1828). He was the first in the world to perform paracentesis. He was the first in this country to excise the hyoid bone (1804), to perform osteoclasis, to excise the head of the humerus, and external urethrotomy. He was in his sixty-ninth year when he first operated under ether in 1846, administered by Morton. He first excised the elbow-joint (1834). He was the first in this country to operate for strangulated hernia. Dr. N. C. Keep (Boston) first used chloroform in childbed in this country. Dr. Channing (1 786-1876) followed him by one month. Dr. Jacob Bigelow (Boston), 1 787-1879, was one of the first to describe that self-limitation is a law that governs many dis- eases (1835). First described paraphyblum. Dr. John Ware (Boston), 1 795-1864, was one of the first to recognize the characteristics of croup by the presence of a false membrane in the air passages (1842). He first proved that the expectant treatment is the best for delirium tremens (183 1); • that it is a self- limited disease. Dr. John D. Fischer (Boston), 1 797-1850, invented the cystoscope. Dr. Oliver Wendell Holmes (Boston), 1809-1894, was the first to discover the cause and spread of puerperal fever (1843), not Semmelweiss. He was the first American physician to write a novel. He contributed the words anesthesia and anesthetic. Dr. James Jackson, Jr. (Boston), 1810-34, first described the prolonged expiratory sound as an important diagnostic sign of incipient phthisis (1833). Dr. Morrill Wyman (Cambridge), 181 2-1903, was the first to tap the chest with a trocar and cannula with a suction pump attached. He observed that the only treatment of hay fever is to go to a place free from it. 4-0 EDMOND SOUCHON Dr. Horace Wells (Boston), 1815-1848, was a dentist. He had a tooth drawn under anesthesia by Dr. Riggs when he lived in Hartford, where he was born. He was the first to use nitrous oxide for extracting teeth, but with irregular success because he did not use a sufficient volume of gas (Bigelow). Dr. Charles Jackson, 18 15-1848, suggested to Morton to use ether instead of nitrous oxide. He was a chemist. Wells and Morton boarded at his house. Dr. Wm. F. Morton (Boston), 1819-1868, was a dentist. He was the first who used ether for a surgical operation performed by Dr. John Collins Warren at the Massachusetts General Hospital in 1846. The case of Morton was the first public case and the first published. It was given world-wide notoriety by Bigelow, Holmes and Warren. Dr. Henry J. Bigelow, 1818-1890, first demonstrated the importance of a Y-ligament in the reduction of dislocation of the hip-joint (1869). He introduced the operation of litho- lapaxy (1878). He was the first in this country to excise the hip-joint (1852). Dr. Henry P. Bowditch (Boston), 1840-1911, first investi- gated Treppe in heart muscle (1871); showed that isolated heart apex will beat in delphine (1871). He first demonstrated the indefatigability of nerves (1890), which idea led in time to the anesthetic blocking of nerves. He was the first to perform thoracentesis in America. Dr. Jonathan Wright (Boston), in 1847, first treated aneu- rysm by compression. Dr. Franklin H. Hooper (Boston), 1850-1892, contributed valuable experiments on the innervation of the larynx, with special reference to the functions of the recurrent laryngeal nerve. He introduced in America the McKenzie method of removing hypertrophied adenoids from the pharynx under general anesthesia. Dr. Charles S. Minot (Boston), 1852-1914, published a treatise on Human Embryology, which introduces many novel theories. He invented two different kinds of automatic micro- ORIGINAL CONTRIBUTIONS OT AMERICA TO MEDICAL SCIENCES 41 tomes. He made original investigation on the origin and struc- ture of the placenta. His Age, Growth and Death state the law of cytomorphism, in virtue of which these processes result from the steady change of protoplasm into more highly differentiated forms. Dr. Humphrey David Storer (Boston), (1832), first removed the uterus for fibroids. Dr. James Lloyd (Boston) (deceased, no dates) was the first to systematically begin the practice of midwifery. Dr. J. P. Maynard (Boston) (deceased, no dates) introduced collodion as a surgical dressing. Dr. Henry O. Marcy (Boston) introduced Listerism in America. Devised buried absorbable animal suture. Has con- tributed considerably and efficiently to the cure of hernia. Was the first surgeon in America to deliberately operate for biliary obstruction. He introduced antiseptic ligation in the radical cure of hernia (1878). He wrote important treatises on hernia and the surgery of the perineum. He probably antedated all others in the use of modern successful methods in the cure of reducible hernia. Dr. Theobald Smith (Boston) has been one of the pioneers in the theory of infectious diseases. He demonstrated, in 1886, with Dr. E. Salmon that immunity from hog cholera could be secured by injection of the filtered products of the specific organ- ism. This was the first experiment in immunization. He and Dr. F. L. Kilborne discovered the parasite of tick fever (1893). He demonstrated anaphylaxis from the bacterial products of diphtheria prior to 1903, a discovery which Dr. Ehrlich called the Theobald Smith phenomenon. First made clear differentia- tion between bovine and human types of tubercle bacilli in 1898. He was the first to make the discovery of pleomorphism in bacteria. Dr. W. T. Councilman (Boston) : The work on Malaria was pioneer work in this country. "The First Recognition of the Cerebral Changes in Pernicious Malarial Fever." "The Subse- quent Descriptions of Organisms was Secondary to the French and Italian Work." "Arteriosclerosis: The Recognition of this Condition as a Disease Affecting all Tissues." "Amebic Dysen- 42 EDMOND SOTJCHON tery: the first description of this as a specific disease with the differentiation from other forms (1890-91)." "Recognition of Acute Interstitial Non-suppurative Nephritis as a Definite Type of Renal Disease." "Study of Diphtheria: Some Anatom- ical Lesions not Hitherto Described." "Relations of Organisms to Lesions More Closely Studied." "Cerebrospinal Meningitis. Study of Epidemic in Boston," published by State Board of Health. "The First Thorough Study of Disease, with Refer- ence to Action of Organism, etc." " Small-pox Studies. Lesions; Relation of Vaccinia Variola Inoculata and Variola Vera ; descrip- tion of Supposed Organism, with Numerous Co-workers." Dr. R. C. Cabot (Boston) is the originator of the Massachu- setts General Hospital autopsy sheets sent to physicians who apply for them. Dr. Reed Hunt (Boston) : There are two types of reflex fall of blood-pressure: one probably due to an inhibition of the vasoconstrictor center and another to a stimulation of vaso- dilator centers. Showed that, contrary to the prevailing views at that time, the accelerator nerves to the heart are in a condi- tion of tonic activity, and that this is an important factor in maintaining the normal heart rate; that the accelerator and inhib- itory nerves are true antagonists; that the most important fac- tor in reflex acceleration of the heart, and probably in many other forms of rapid heart action, is a diminution of the tonic activity of the cardio-inhibitory nerves. Isolated cholin from the suprarenal gland and showed that it is the cause of the fall of blood-pressure caused by the injection of extracts of this gland (after removal of the epinephrin) . Dr. W. B. Cannon (Boston) says that the method of observ- ing the movements of the stomach and intestines by means of #-rays, after a meal containing bismuth salt had been given was first employed in the laboratory of physiology of the Harvard Medical School (1898). Dr. E. Cutter and Mr. G. B. Clark (Cambridge) devised a laryngoscope with two tubes, one for observation and the other for illumination. ORIGINAL CONTRIBUTIONS OF AMERICA TO MEDICAL SCIENCES 43 Dr. E. E. Foster (New Bedford) was the first, so far as I know, to confirm, by intranasal measurements, the statement often made by orthodontists, that widening of the palatal arch widens the nasal cavities. Drs. Bradford H. Osgood, J. E. Goldthwaite, Edville G. Abbott and Robert W. Lovett have done fine orthopedic work. The Warren Museum of Anatomy was the first* museum of the kind founded in America. Boston has contributed the finest medical buildings in the world, those of the Harvard School of Medicine. MICHIGAN Dr. Henry S. Cheever (Ann Arbor), 183 7-1 877. His grad- uation thesis on "Catalysis" was based on his own experiments and brought out points not previously made. Dr. F. G. Novy (Ann Arbor) discovered trypanosome of American variety of relapsing fever (1907). MINNESOTA Dr. William J. Mayo (Rochester) : " Complete Section of the Vas Deferens: End-to-end Union by a Simple Method, Which Might Be Applied to a Divided Ureter," January, 1895. This method of union over a thread is now generally practised. "Further Experience with the Vertical Overlapping Operation for the Radical Cure of Umbilical Hernia," July, 1903. This method is generally accepted at the present time for the radi- cal cure of umbilical hernia. "The Ileocecal Orifice and its Bearing on Chronic Constipation, with Report of Two Cases Relieved by Operation," March, 1900. Introduced the subject of intestinal stasis. "Some Observations on the Surgery of the Common Duct of the Liver," April, 1904. Originated cholecys- tectomy from below up, the method now generally practised. "Acquired Diverticulitis of the Large Intestines" (W. J. Mayo, L. B. Wilson and H. Z. Giffin), July, 1907. Introduces this 44 EDMOXD SOUCHON important disease. Greatest credit due to Wilson, who readily discovered the pathology in excised specimens of tumors of sig- moid. " Contributions of Surgery to a Better Understanding of Gastric and Duodenal Ulcers," May, 1907. Introduces pyloric vessels in relation to the location of the pylorus. Impor- tant in relation to differentiating ulcers of the stomach and duo- denum. "Anemic Spot on the Duodenum Which May be Mis- taken for Ulcer," June, 1908. "A Review of 500 Cases of Gastro- enterostomy, Including Pyloroplasty, Gastroduodenostomy, and Gastrojejunostomy/' July, 1905. Introduces technic of gastro- enterostomy, no-loop method to left. "Method of Anastomosis between Sigmoid and Rectum," October, 1909. "The Radical Operation for the Relief of Cancer of the Rectum and Recto- sigmoid," May, 191 2. Tube method of union following resec- tion. Generally adopted method. "The Fatty Fascial Flap in Plastic and Other Operations on the Pelvis of the Kidney," April, 1910. Very important and now accepted. "Gastro- jejunal Ulcers (Pseudojejunal Ulcers)," March, 191 1. Impor- tant in connection with the cause of recurrence of ulcer symptoms after gastroenterostomy and showing the suture ulcer defect of the operation and the necessity of discontinuing the continuous silk or linen suture for the interrupted suture. " Transgastric Excision of Calloused Ulcer of the Posterior Wall of the Body of the Stomach," December, 1910. Generally adopted. "Supra- pubic Transcystic Removal of Calculi Impacted in the Portion of the Ureter Which is Situated in the W r all of the Bladder," June, 191 1. "The Incision for Lumbar Exposure of the Kid- ney," January, 191 2. Generally adopted. " Nephrectomy with- out Drainage for Tuberculous Kidney," November, 191 2. ''Pathological Data Obtained from Ulcers Excised from the Anterior Wall of the Duodenum," May, 1913. Showing the nature of the duodenal lesion. "Accidental Injuries to the Descending Portion of the Duodenum during Removal of the Right Kidney," January, 1914. "Localized Tuberculosis of the Intestine; Report of Seven Cases Operated on," February, 1899. Attributes surgical tuberculosis to cow's milk. "Sur- ORIGINAL CONTRIBUTIONS OF AMERICA TO MEDICAL SCIENCES 45 gical Tuberculosis in the Abdominal Cavity, with Special Refer- ence to Tuberculous Peritonitis," April, 1905. Demonstrating the Fallopian tubes as being the most frequent cause of tuber- culous peritonitis in women. "Study of 534 Operations upon the Gall-bladder and Bile Passages, with Tabulated Report of 547 Operated Cases," May, 1903. Contributing to the progress of surgery of the gall-bladder and bile ducts. "Some Observa- tions on Cases Involving Operative Loss of Continuity of the Common Bile Duct with the Report of a 'Case of Anastomosis between the Hepatic Duct and the Duodenum," July, 1905. First Report of successful anastomosis of hepatic duct of duo- denum. "Radical Operations for the Cure -of Cancer of the Pyloric End of the Stomach," March, 1904. Introduction of a modern technic for the radical operation. "Duodenal Ulcer: A Clinical Review of 58 Operated Cases, with some Remarks on Gastrojejunostomy," December, 1904. Demonstrating the frequency of duodenal ulcer and introduction of the subject of chronic duodenal ulcer. "Chronic Ulcer of the Stomach and First Portion of the Duodenum, with Special Reference to the Surgical Treatment," July, 1905. "The Surgical Treatment of Gastric and Duodenal Ulcer and its Results," June, 1906. "A Study of Gastric and Duodenal Ulcers, with Special Reference to Their Surgical Cure," June, 1908. Introduces the whole question of the now accepted surgical understanding of chronic peptic ulcer. "Surgery of the Large Intestine, with a Review of 100 Resections," July, 1909. Technic of resection of colon. Important as contributing to ease and safety of these operations. "Resection of the First Portion of the Large Intestine and the Resulting Effect on its Function," June, 1914. "Mesocolic or Retrogastric Hernia," April, 1909. "Surgical Treatment of Pro- lapse of the Uterus and Walls of the Vagina," October, 191 2. Vaginopelvic fixation for prolapsus uteri. The Mayo Brothers have contributed the Mayo Clinic Founda- tion, a unique instance. Dr. Charles H. Mayo (Rochester, Minn.). (1) "Septic Diseases of Knee-joint; Open Treatment by Division of Patella, 46 EDAIOXD SOUCHOX Resuturing and Securing Motion." (2) "Varicose Veins of the Lower Extremity; Subcutaneous Stripping; Special Instru- ments." (3) "Heat in Surgery; Methods of Puncture of Nevi and Treatment of Cauliflower Cancer of the Uterus." (4) "Hypospadias; Making Xew Urethra from Prepuce, Tunneling Method." (5) "The Technic of Shortening the Round Liga- ments; Shortening Round Ligaments, Combined External and Internal Method." (6) "Peripheral Versus Intracranial Opera- tions for Tic Douloureux; Plugging of Foramen with Silver Screw or Lead Plug. External Operations." (7) "Treatment of the Posterior Capsule of the Gland in Thyroidectomy; Based on 374 Operations for Goitre; Benefits of Preservation of Posterior Capsule of Thyroid." (8) "Transperitoneal Removal of Tumors of the Bladder; Transperitoneal Removal, Obvious Benefits of Method for Radical Procedures." (9) "The Surgical Treatment of Bunion; Bunion Bursa Turned Over Cut Surfaces of Bone. Preserving Motion." (10) "Diagnosis and Surgical Treatment of Esophageal Diverticula; Two-stage Method of Removal of Large Esophageal Diverticulum." (n) " Extirpation of Tumors of Vomer through the Roof of the Mouth; Method of Approach Tumors of the Vomer through Hard Palate, with Preservation of Soft Palate." (12) "Factors of Safety in Intestinal Surgery; Methods of Suture, Provision for Temporary Secondary Gas Drainage." (13) " Cholecystitis and the Factors that Control Results of Operation; Transplanting of Fat to Prevent Adhe- sions of Stomach and Bowel to Liver." (14) "The Preparation of Dry Bony Areas for Skin Grafting; Production of Granula- tions through Multiple Drill Holes through Outer Plate into Diploe." (15) "Uterine Prolapse with Associated Pelvic Relaxa- tion; Method of Building Pelvic Floor from United Broad Ligaments so Sutured as to Support Bladder." (16) "Errors in Anatomical Development, their Cause and Surgical Signifi- cance: Xew Deductions as to Causation." Dr. J. P. Sedgwitch (Minneapolis) : The study of von Graefe's sign in myotonia congenita is the only report that I know of familial appearance in this disease. "The Study of Creatinin ORIGINAL CONTRIBUTIONS OF AMERICA TO MEDICAL SCIENCES 47 and Creatin Metabolism in Children" contains first analysis of the creatinin and creatin excretion for the first week of life and contains the first statement in regard to the high creatinin and creatin exertion in recurrent vomiting. The study on "Rela- tionship of Gastric to Pancreatic Fat Digestion in Infants" is, as far as I am able to find, the first and only discussion that has been made of that subject, except that by Davidson, which appeared two years later in the Zeitschrift f. Kinderheilkunde and was carried on by physical chemistry methods. "The Study of Recurrent or Periodical Vomiting" contains confirma- tory analysis of my earlier work, and puts forth a new view in the relation of adenoids to recurrent vomiting. The study on "Maternal Feeding" presents the results from the reports of 3000 physicians. It is the only paper discussing this matter from this stand-point in English, and, I believe, the only study of this character, except a very short study by Rietschel, of a few children of German pediatrists. "The Complement-Fixa- tion Reaction of the Blood of Children and Infants, Using the Bacillus Abortus as Antigen," is, I believe, the only study that has been made upon the subject as yet. The work on Spas- mophilia, with Special Reference to Familial Reactions and Repeated Absences, contains a new and original study of that subject. Dr. Oscar Breitenbach (Frazee, Minn.): Winter cholera has no specific bacteriological pathology, and is a synonym in nature occurring in cold weather. Meteorological conditions do not prove to be the exciting cause in these epidemics. MISSISSIPPI Dr. J. M. White (Meridian), "New Operation for Appendi- citis." The point claimed as new and never been done before is making two flaps of these appendicular stumps so they can be coapted, walling off the flaps with a second fine through and through catgut suture so that the different layers of tissues can heal by first intention. 48 EDMOND SOUCHON MISSOURI Dr. Victor C. Vaughn (Mount Aisez, Mo.), 185 1, did impor- tant work on ptomains and leukomains, cellular toxins, protein split products; discovered bacillus in poisonous ice cream and cheese (1896). Dr. John Green (St. Louis) is the first to find that hemetro- pia caused ocular or systemic disease (statement of Dr. J. H. Thorpe, of Owensberg, Ky.). He introduced the test cards in ophthalmology. Dr. L. Rosenwald (Kansas City) reported the first case of complete cleft of the glans penis. Dr. EcKLESHErMER and Schoemacher (St. Louis) are the first to publish a complete cross-section anatomy (1911). NEBRASKA Dr. C. C. Johnson (Creighton) claims priority in the advance- ment and execution of the teaching of infectious diseases and sanitation in the public schools. Dr. Williams F. Milvoy (Omaha) first described persistent edema of the legs, or Milvoy's disease (1892). NEW HAMPSHIRE Dr. Amos Twitchell, 1 781-1850, first ligated the common carotid in continuity for secondary hemorrhage (1807). In 1838 he removed successfully the arm and the clavicle for malignant disease. In 1840 he had diagnosed and operated upon 3 cases of suppuration in the medullary canal. He performed several ovariotomies before McDowell's case was published. Dr. Dixi Crosby (Dartmouth), 1801-1873, was the first in this country to remove the entire upper extremity with the clavicle and scapula, 1836. He discovered, the method of reducing dislocations of the thumb and fingers by forced extension and pressure upon the base of the dislocated bone. ORIGINAL CONTRIBUTIONS OF AMERICA TO MEDICAL SCIENCES 49 NEW YORK Dr. John James (New York), 17 29-1 791, was the first to perform lithotomy in this country. Dr. Samuel Bard (New York), 1 742-1 821, published the first book on midwifery in America (1807). Dr. Richard Bayley (New York), 1745-1801, first pointed out the difference between membranous croup and diphtheria. He first amputated at the shoulder-joint. Dr. John Bard (New York), in 1759, first performed gastro- tomy in America for removal of an extra-uterine fetus. Dr. Wright Post (New York), 1 766-1822, was the first in America to ligate the femoral successfully for popliteal aneurysm, according to the Hunterian method (1796), also the first success- fully to tie primitive carotid in its continuity, for aneurysm (18 1 3), and the subclavian outside the scaleni (181 2). Dr. John Stearns (Saratoga), 17 70-1 848, more than any other called attention to the use of ergot as an oxy toxic. Dr. Samuel Guthrie (Sackett's Harbor), 1 782-1848, dis- covered chloroform in this country at the same time that it was discovered in Europe. Dr. John S. Dorsey (New York), 1783-18 18, first tied the external iliac. Dr.* Valentine Mott (New York), 1785-1865, was the first in the world to ligate the innominate artery (18 18). Also the carotid for subclavian aneurysm (1829). Also the external iliac for femoral aneurysm (183 1). Also the right subclavian between the scaleni (1833). Also both carotids simultaneously (1833). Also the right internal iliac (1837). He was the first to resect the right side of the lower jaw after tying the carotid artery (182 1). Also the first to remove the left clavicle for sarcoma (1828) and a large fibrous growth from the nostrils by dividing the nasal and maxillary bones (1841.) He was the first to ligate the common iliac for aneurysm (1827). Dr. J. K. Rodgers (New York), 1 793-1851, was the first to wire for an ununited fracture of the humerus (1827). Was the 50 EDMOND SOUCHON first to tie the left subclavian artery inside the scaleni for aneu- rysm (1845). Also the third portion of subclavian. Dr. Willard Parker (New York), 1 800-1 884, first performed cystotomy for inflammation and rupture of the bladder. He first ligated the left subclavian inside the scaleni, together with the common carotid and the vertebral for subclavian aneurysm in 1864. He was the first in America to ligate the left subclavian artery in its third portion for a brachial aneurysm. He was the first in this country to incise through the muscular walls of the abdomen for perityphylitic abscess. He was the first to drain the bladder through the perineum in cases of hypertrophied growth. He was the first to excise the great trochanter in this country. He was the first in this country to operate for strabis- mus. His paper in 1867 was the first to compel the profession to recognize the need of operation for appendicitis. Dr. S. Pomeroy White (New York), 1801-1867, first ligated the internal iliac artery for gluteal aneurysm (1827). Dr. John Duptjy (New York), 1802-1866, was the first to emphasize the importance of diseased conditions of the tonsils. He invented an ingenious tonsillotome. He is one of the first to have established laryngology as a distinct part of regular medical practice. He first demonstrated that a foreign body could be introduced into the larynx without producing suffo- cation. He first treated laryngeal troubles with the mop long before the discovery of the laryngoscope. Dr. Charles Harris (New York), in 1807, was the first to remove the thyroid gland. Dr. Alonzo Clark (New York), 1807-1887, introduced the opium treatment of peritonitis. Dr. Gtjrdon Buck (New York), 1807-1877, was the first to introduce the well-known apparatus for the treatment of fractures of the femur, commonly known as Buck's extension apparatus. He was the first to use strips of adhesive plaster to make extension in fractures, with pulleys and weights (1861). He first ligated simultaneously the primitive and the internal carotid. He first excised the olecranon process (1842). ORIGINAL CONTRIBUTIONS OF AMERICA TO MEDICAL SCIENCES 5 1 Dr. William Detmold (New York), 1808-1900, was the first special orthopedic surgeon in this country, 1 808-1 900. He first perforated the ends of bones in ununited fractures. He first, in 1850, trephined for pus in the lateral ventricle. Dr. Gunnings S. Bedford (New York), 1808- 18 70, estab- lished the first clinic for diseases peculiar to women. Dr. James P'. White (Buffalo), 1811-1881, first established an obstetric clinic in this country. He was the first to reduce by taxis an inversion of the uterus of eight days' standing. Dr. Stevens (New York), in 18 12, first ligated the internal iliac for aneurysm. Dr. Isaac E. Taylor (New York), 181 2-1889, was tne nrst to demonstrate the non-shortening of the cervix during pregnancy, in which he anticipated Miiller, to whom credit is generally given. Dr. James R. Wood (New York), 1813-1883, was the first to perform subperiosteal resection of bone with reproduction of the bone. Was the first in America to divide the masseter muscle. Was the first to devise divisions of the peronei muscles in chronic dislocations of the tendon. Was the first to treat acute and chronic knee inflammation by division of the ham- string and tendon Achilles. Dr. Henry M. Onderdank (New York), 18 13, was the first to ligate the femoral artery for violent inflammation of the lower extremity. Dr. Frank A. Hamilton (Buffalo) was the first to publish (i860) in America a complete treatise on Fractures and Dis- locations, which has been translated into French and German and has passed through seven English editions. In 1854 he first used skin-grafting to cure ulcers. Dr. Edmund R. Peaslee (New York), 1814-1878, was the first to introduce a catheter in the peritoneal cavity through Douglas's cul-de-sac to wash it out in cases of septicemia following ovariotomy. Dr. John Murray Carnochan (New York), 181 7-1887, first ligated the carotid on both sides for elephantiasis (1867). 52 EDMOND SOUCHON He was also the first to resect the superior maxillary nerve with Meckel's ganglia for neuralgia (1858). He was the first to cure a case of ankylosis of the lower jaw by subcutaneously dividing the masse ter. He was the first to excise the ulna (1853), the radius (1854), the os calcis (1857). Dr. William H. Van Buren (New York), 18 19-1883, first excised a portion of each vas deferens as a substitute for castra- tion in cases of onanism. Dr. Lewis A. Sayee (New York), 1820-1900. He was the father of American orthopedics. He filled in the Bellevue Hospital Medical College, the first chair of orthopedics created in this country. He was the first in America to perform without any resultant deformity the operation for morbus coxarius. He contributed an illustrated treatise on Spinal Diseases and Spinal Curvature. He devised the plaster jacket for Pott's disease, 1877. He wrote a Practical Manual on Club-foot (1869), which passed through many editions and was translated into several languages, including Japanese. Dr. Beriah A. Watson (New York), 1836-1892, published an "Experimental Study of Lesions Arising from Severe Con- cussions." Dr. Watson (New York), in 1847, nrst ligated the internal iliac for gluteal aneurysm. Dr. Abraham Jacobi (New York) is the founder of American Pediatrics. Dr. Edward C. Loring (New York), 183 7-1 888, invented an ophthalmoscope which is the most convenient and widely used. Dr. Alexander J. C. Skene (Brooklyn), 1837-1900, described the para-urethral gland known as Skene's gland (1880). Dr. Joseph O'Dwyer (New York), 1 841-1898, perfected intu- bation in place of tracheotomy. The Fell-O'Dwyer apparatus was probably the first means ever used for inflating the lungs. He demonstrated that a tube could be retained continuously in the larynx without removal for months and even years. Dr. Henry G. Plffard (New York), 1 842-1890, wrote the first systematic treatise on dermatology in America (1876). ORIGINAL CONTRIBUTIONS OF AMERICA TO MEDICAL SCIENCES 53 Dr. Charles McBurney (New York), 1 845-1 893, contri- buted considerably to the treatment of hernia (1878) and appendicitis. He discovered McBurney's point in appendicitis (1889). He devised the use of hooks for the reduction of dis- located fractured heads of the humerus. Dr. George R. Fowler (New York) performed decortication of the lung as a means of treating old cases of empyema, with thickened pleura, long before Delorme (1893). Dr. Wm. T. Bull (New York), 1849-1909, contributed considerably to the performance of laparotomy in cases of gun- shot wounds of the abdomen. Dr. Alonzo B. Richardson (New York), 1852-1903, was among the foremost of those who have led in the notable ameliorations and improvements in the treatment of the insane. Dr. George M. Edebohls (New York), 1853-1908, first practised suspension of the kidney and decapsulation of the kidney in inflammatory affections (1901). Dr. Augustus P. Dudley (New York), 1853-1905: Con- servative treatment of the uterine appendages. Dr. Wood (New York) was the first to remove the upper maxilla. Dr. Frank Hartley (New York), 1 856-1913, originated intracranial neurectomy for the second and third divisions of the fifth nerve for facial neuralgia. Dr. James L. Van Ingen (Schenectady). In 1857 he was the first to practice elevation of the foot of the bed for counter extension in fractures. Dr. George Huntington (Long Island) first described hereditary (Huntington's) chorea. Dr. George M. Beard (New York), in 1868, first introduced in America the concept of neurasthenia or nervous exhaustion. Dr. Fluhrer (New York), 1872, was the first to use flexible narrow strips of tin or zinc in the management of fractures. He was the first to locate a pistol-ball within the brain by the use of his special probe. 54 EDMOND S0UCH0N Dr. Sands (New York). In 1880 he first tied the primitive iliac for aneurysm of the left external iliac by performing pre- liminary laparotomy. In 1888 he first opened the abdomen with positive diagnosis and removed the appendix successfully. Dr. Mason (New York), 188 1, was the first to cure fractures of the nasal bones by passing a curved needle under the fragments and elevating them. Dr. Wm. W. Redj (Rochester), in 1885, first systematically reduced dislocations by manipulation instead of main force. Dr. Bernard Sachs (New York), in 1887, described amaurotic family idiocy. Dr. Newman (New York), in 1888, devised an operation for shortening the round ligaments. Dr. Unterbrldge (New York), 1889, devised a speculum for dilatation of the cervix uteri. Dr. John Ball (Brooklyn), (deceased, no dates) was the first to treat strictures of the uterine cerv ix and forcible dilatation with instruments. Dr. E. Carr (Canandaigua) first suggested that the crepitation in pneumonia is due to the air rushing into and distending the bronchial vesicles which had been previously glued together by tenacious mucus. Dr. Sabine (New York) (deceased, no dates) was the first to build a nose from the phalanx. Dr. H. J. Knapp (New York), 1832-1911, devised an opera- tion for removal of tumors from the optic nerve without sacrific- ing the eye. He devised a hook to extract foreign matter from the ball. He improved the ring forceps. Dr. Samuel R. Perez (New York) (deceased, no dates) first demonstrated that spermatozoa could live as long as a week in the vagina, 1861. Dr. John G. Koehler (New York?) (deceased, no dates) was the first in this country to perform synchronous amputation of both legs and one arm. Dr. Lafayette B. Wendell (Delhi) did important work (with Osborne) on artificial foods. ORIGINAL CONTRIBUTIONS OF AMERICA TO MEDICAL SCIENCES 55 Dr. Gunning, of New York (deceased, no dates), and Dr. Bean, of Georgia, simultaneously invented the interdental splint. It is thoroughly American. Dr. Bachelder (New York) (deceased, no dates) introduced compressed sponges. Dr. Gouley (New York) has contributed considerably to the treatment of stricture of the urethra by introducing the whale- bone guide, the tunneled catheter staff, and the beaked bistoury. Dr. Sass (New York) was among the first to introduce the treatment of laryngeal troubles by the spray method. Dr. Ernest Krackowiser (New York) was probably the first physician in America to demonstrate the vocal cords. Dr. Wadsworth (New York) invented the tilting mirror of the ophthalmoscope. Dr. F. H. Bosworth (New York) first discovered the impor- tance of excrescences upon the nasal septum as factors in causing obstruction. He devised a saw for the removal of septal spurs. He contributed considerably to place the science of laryngology and rhinology upon a firm scientific basis in America and in Europe. Dr. Clinton Wagner (New York) developed the operation of thyrotomy. Dr. Morris J. Asch (New York) has done valuable original work in correcting the deformities of the nose. Dr. John C. Roe (Rochester) has done much original work for the relief of deformities of the nose. Dr. Rufus P. Lincoln (New York) was a pioneer in the removal of retropharyngeal fibromata through the natural passages instead of after extensive preliminary operation. Dr. John R. French (Brooklyn) devised a new and complete method for photographing the human larynx. Dr. Thomas A. Emmett (New York) is preeminent as the one American who placed the perineal operation for the first time upon a sound, rational basis by devising a successful widely used procedure. In complete tear of the perineum his work is also supreme. He devised and extensively practised the operation 56 EDMOND SOUCHON of the excision of the connective-tissue in the angle of a lacerated cervix associated with the denudation of the anterior and pos- terior lips and their union by suture. Dr. Emmett contributed considerably to the treatment of the ruptured vaginal out-let, including complete tear dividing the sphincter. His principal contributions are his papers on dysmenorrhea and sterility resulting from anteflexion of the uterus (1865), on the surgical treatment of lacerations of the cervix uteri (1869-74), his papers on vaginal cystotomy (1872), his monograph on vesicovaginal and rectovaginal fistulae (1868); his plastic surgery of the perineum (1882). He devised an operation for prolapse of the uterus. Dr. E. Noeggerath (New York) first reduced an inverted uterus by digital compression of both horns. He was the first to state that female pelvic inflammations were due to infection by gonococci transmitted by the male (1872); introduced "episio- tomy. " Dr. Frederick S. Dennis (New York), 1889, was the first to ligate the two internal iliacs simultaneously on the same subject for double gluteal aneurysm. Dr. A. Flint (New York) was the first in this country to call attention to the importance of distinguishing the variations of pitch elicited by percussion (1876). He was the first to state that rheumatism was a self -limited disease. Dr. Austin Flint (New York City): In 1857 ne made experiments showing that blood deficient in oxygen cannot circulate freely in the capillaries. The obstruction is in the systemic vessels and not in the lungs, in cases of asphyxiation. In 1 86 1 he was the first in this country to confirm the experi- ments of Magendie in 1837 showing that the anterior roots of the spinal nerves possessed a slight sensibility derived from recurrent fibers from the posterior roots. In 186 1 experiments on alligators of large size showed that the heart being excised from the body the valves between the cavities having been cut away, will beat powerfully with regular rhythm; while pulsations are more rapid, feeble, and irregular when the cavities are empty. The experiments on reproduction published in 1861 led him to ORIGINAL CONTRIBUTIONS OF AMERICA TO MEDICAL SCIENCES 57 think that the "respiratory sense" had also origin in the general system and was due to want of oxygen. In 1862 he published his article on "The New Excretory Function of the Liver," which received from the Institute of France a recompense of 1500 francs and an honorable mention. In 1862 he described a new substance called stercorin, which substance resulted from a change of the cholesterin of the bile in its passage through the small intestine, incident to the process of intestinal digestion. In 1863 he published a new method to estimate albumin and fibrin in the blood. In 1870 he demonstrated that unusual muscular efforts largely increase the elimination of nitrogen by the kidneys. He thinks he is justified in claiming prioritv in the method of investigating the influence of exercise upon the excretion of nitrogen by comparing the nitrogen eliminated with the nitrogen of the food. In 1879 he demonstrated that heat production was due to oxidation of carbon and hydrogen. Lavoisier and Laplace had expressed the opinion but had not demonstrated it. He thinks he was the first to demonstrate positively that under conditions, at least, when oxidation repre- sented by carbon dioxide and nitrogenous excretions is not sufficient to supply the heat required, water is produced in the body. He was the first to insist on the importance of examining the urine in all cases of application for life insurance, which was rarely done at the time (187 1). In 1889 he had devised the formula of a tonic, endeavoring to make a preparation containing the inorganic constituents of the blood in about the normal proportions with an excess of iron and sodium chloride. It is called the "Saline Chalybeate Tonic." In 1892 he was the first to use bismuth subgallate in so-called functional dyspepsia attended with gastric and intestinal flatu- lence. In 1895 he published the first case on record of filaria, with chyle in which methylene blue was employed with a view to destroying the parasite. In 1867 he was the first to recom- mend dietaries for hospitals and asylums. Dr. Robert F. Weir (New York): "Two Cases of Intra- tympanic Vascular Tumor with Pulsating Intact Drum Mem- 58 EDMOXD SOUCHON brane." "Traumatic Aneurysm of the Vertebral Artery Cured by Digital Compression." "On Fatty and Sarcomatous Tumors of the Knee-joint Affecting its Synovial Funges." "Decom- pression for Otherwise Inoperable Central Tumors." "Gastror- rhapy by Folding in the Stomach to Diminish the Size of a Dilated Stomach." For folds in the synovial membrane of the knee-joint, particularly on the surface of the patella begetting painful but temporary arrest of motion cured by opening joint and cutting off the fold. "For Relief of Acute Miliary Abscesses of the Kidney by Nephrectomy First Done by Me." "The Replacement of a Depressed Fracture of the Malar Bone." The relief was accomplished by opening the antrum above the canine tooth and by a sound there introduced the depressed bone was readily put in place. For increasing the space required for surgical work in acute or chronic cases of appendicitis it was suggested by me to enlarge the usual McBurney operation by cutting across to the median line, the front and rear layers of the rectal sheath and the peritoneum, the muscle itself being drawn strongly to the left. This avoids nerve damage. "On an Improved Operation for Acute Appendicitis or for Quiescent Cases, with Complications." "An Improved Method of Treat- ing High-seated Cancers of the Rectum by Laparotomy, being an Elaboration of the Operation Devised by Morrison." The new use for the ureter appendix in the treatment of obstructive colitis showed how easily the appendix could be drawn to and extended at the skin level and subsequently opened to furnish a route to flush out by medicated solutions the large bowel. Dr. Robert T. Morris (New York) : Description of the exper- iments showing the mechanism of Pott's fracture and of fracture of the fibula by inversion of the foot. The mechanism of these two quite different fractures was compared. Description of experiments relating to the anatomy and mechanism of sub- luxation of the radius, and showed that the condition depended upon the orbicular ligament slipping between the head of the radius and the capitellum of the humerus. I showed that recov- ery presumably occurred eventually as a result of pressure ORIGINAL CONTRIBUTIONS OF AMERICA TO MEDICAL SCIENCES 59 absorption of the interposed ligament. The idea of staining malignant tissues in situ by intravascular injections of staining agents in the hope that this might lead to a destruction of neo- plastic cells. My first report upon the experiments was made in the Medical Mirror in 1891 before anyone else had made the attempt, so far as I know. This and subsequent attempts have not been successful. They have been of negative value so far, but introduced the idea before it was out abroad. Descrip- tion of experiments relating to the prevention of secondary peri- toneal adhesions by means of the aristol film. Description of a method for making a permanent suprapubic fistula by means of turning in ribbons of skin which are fastened to the bladder, giving us a permanent epithehal-lined canal. Study of experi- ments for the removal of carious and necrotic bones by means of preliminary decalcification with hydrochloric acid followed by digestion of the decalcified bone with pepsin solution. Experi- ments upon rabbits showing the nature of repair of the wound after abdominal operations. Report upon malignant disease of the navel as a secondary complication, showing that malignant disease sometimes appeared unaccountably at this point when it occurred elsewhere in a primary focus. Experiments with trypsin, pancreatic extract, and pepsin, employed for the pur- pose of removing blood, and lymph coagula from cavities of the body and for liquefying sloughs. Description of the wick drain which has now been generally adopted everywhere. Study of the question if evolution is trying to do away with the clitoris. Experimental production of "mallet finger" showing that it was due to traumatic thinning of the extensor ligament attached to the terminal phalanx of the finger and was not due to rupture of a ligament. Endoscopic tubes for direct inspection of the interior of the uterus and bladder. These were not taken up extensively by the profession for the reason that various kinds of electrical apparatus came into the field and replaced my tubes. Use of the dowel pin for cases of dislocation of the acromial end of the clavicle, and in the following year described the use of the dowel pin in fracture of the clavicle. Experiments with rabbits 60 EDMOND SOUCHON showing that ileal intussuception might be produced as a labor- atory experiment by touching the bowel with a little carbonate of sodium, and I suggested that intussusception in infants might perhaps be explained on the ground that exteric toxins cause spasms of the muscularis in the same way as it was pro- duced experimentally with carbonate of sodium. Experiments with cargile membrane employed for the purpose of preventing peritoneal adhesion formation. The pathology of involution of the appendix and its complications. Insidious peritoneal adhe- sions occurring in the upper part of the peritoneal cavity. Lane's first paper was published in the London Lancet for January of the same year, describing the adhesions about the ileum and right iliac fossa. Studies relating to appendicitis which were perhaps new. Proliferating endarteritis of terminal arterial branches of the appendix, showing that this occurred as a result of toxic influences, that the area supplied by any one terminal artery when deprived of blood supply was then open to attack by bacteria (and that accounts for ulcerative processes in the appendix). Since that time I have shown that proliferating endarteritis of small arteries of other parts of the enteron leads to such complications as ulcer of the stomach and duodenum, and that this is apparently the most common cause for such ulcers. The process results from excretion of toxins by the mucosa of the stomach and duodenum and such toxins cause local endarteritis of terminal arteries. New methods in technic in operative work which have since been generally adopted. Action of various solvents on gall-stones, showing that it is hope- less to attempt to dissolve gall-stones within the body. Influence of remains of the embryonic vitelline duct in the production of moist navels, and of eczematoid inflammation about the navel. Experiments seeking an explanation for the reason why patients recover from tuberculosis of the peritoneum, and came to the conclusion that saprophyte toxin destroyed the bacilli in the peritoneal cavity as it did in my test-tube cultures. Since that time I have reported upon experiments showing that the destruc- tion of tubercle bacilli in the peritoneal cavity is brought about ORIGINAL CONTRIBUTIONS OF AMERICA TO MEDICAL SCIENCES 6 1 by any measure which excites a high degree of peritoneal hyper- leukocytosis. Experiments on ovarian grafting. Article on the subject of ovarian grafting, and in 1905 and subsequently have published many notes upon the subject. My own work antedated that of Chrobak and Knauer, and I do not know why they were given credit for inception of the idea, except perhaps upon the ground that it was "made in Germany." Case in which preg- nancy resulted after ovarian grafting. Account of the facts relating to the Schede method of obtaining wound repair by means of the moist blood clot. This method was one which I had worked out experimentally and which I demonstrated at the clinic of Dr. Schede, of Hamburg. Schede at first objected very much to this method, saying it was dangerous, but succeeded in publishing a report upon cases, and obtaining credit for the procedure, before my own report had been published. In cases of chronic appendicitis the right group of lumbar ganglia was hypersensitive on pressure while the left group was not hyper- sensitive. 1 910 I assembled data for the purpose of showing that we were about to enter a new era in surgery, which I called the fourth or physiological era. I showed the three previous eras consisted of the heroic, the anatomical, and the pathological. A method of examining fractures behind a fluoroscopic screen, and pinning fragments in place by means of a cannula and drill device which was described. Study in explanation for the reason why wounds in the upper part of the abdominal wall sometimes fail to make good repair. Method for quick repair of the peri- neum after exposure of the levator ani muscle. Description of an artificial synovial fluid, consisting of boroglyceride, glycerin, and normal saline solution. Method for longitudinal inversion of the bowel. This is to be tried out experimentally in the hope of replacing colectomy. Dr. John A. Wyeth (New York) : Ligation of the external carotid artery for a lesion of its branches instead of ligating the common carotid. Bloodless amputations of the hip-joint and shoulder. The cure of otherwise inoperable vascular tumors (angiomata) by the injection into their substance of water at a 62 EDMOND SOUCHON high temperature. The immunizing effect upon sarcoma of a mixed pyogenic infection. The demonstration of the process of arterial occlusion by cell proliferation after ligation in conti- nuity. Transplanting skin from the abdomen and other parts of the body to the hand and forearm. Transferring the graft by this means to the face, neck or elsewhere. Transplantation of the proximal end of the ulna to the distal of the radius in an ununited Colles's fracture. Hip-joint disease treated by com- bination of Hutchinson's high shoe and crutches and Sayre's long extension splint. A new procedure for the removal of otherwise inoperable tumors from the posterior pharynx. Novel procedure for restoring the - anterior extremity of the radius. Treatment of caries of the lumbar spine by continuous extension. Femoral hernia — a new and successful method of obliterating the femoral canal. Founding of the first polyclinic school for postgraduates in America. Dr. Lewis A. Stimson (New York) was the first to ligate the uterine and ovarian arteries preliminary to hysterectomy for fibroids and other affections. Later on Dr. Baer, of Philadelphia, substituted the mass ligature for the isolated ligature of the vessels. (Statement of Dr. Noble, of Philadelphia.) Dr. Robert Abbe (New York) : Treatment of strictures of the esophagus by the string method, in which a string is passed through the stricture and by working it up and down cuts through the stricture. Devised an operation for trigger finger. Was first (in America, at least) to cure a case of papilloma of the larynx by the use of radium. New plastic operation for the relief of deformity due to hare-lip. There was an extreme flat- ness and scantiness of the upper lip, with an enormous pouting and redundance of the lower one. The middle portion of the lower lip was transplanted into the upper. Dr. Frederic S. Lee (Canton) : Work on the physiology of muscles and fatigue (1905-13). Dr. Edward Charles Spitzka (New York) : Among original discoveries may be mentioned the interoptic lobe of the ignana, the identification of hitherto unrecognized postoptic lobes in ORIGINAL CONTRIBUTIONS OF AMERICA TO MEDICAL SCIENCES 63 birds and reptiles, of the spinal course of the cortex lemnisans in man, the marginal tract (discovered a year later by Lissauer) variously referred to as the Lissauer or the Spitzka-Lissauer tract, of the auditory tract in the cetacea, and of the superficial decussation of the pyramids in pteropus. Dr. T. Leonard Corning (New York) : Discovered local anes- thesia with cocain and hypodermic injections. Also spinal anal- gesia, but he only applied it to animals, not to the human (1885). Dr. J. Riddle Gofee (New York): Method of covering the stump with peritoneal flaps after supravaginal hysterectomy for fibroid tumors. My operation for the relief of extreme cases of procidentia complicated by rectocele and cystocele. In this second operation the uterus is removed and the broad ligaments stitched together across the pelvis upon which is spread out the bladder by stitching the trigone to it in three places, etc. My theory for support rests upon the control of intra-abdominal pressure. I have worked out this theory and described the operation in detail in two or three articles. Dr. Herbert Gillette (New York) : Case in which diphtheria antitoxin was administered to a person who had asthma, and the patient died in a few minutes. My notes called attention for the first time to the danger of administering horse serum to a subject of asthma or to one who is susceptible to the odor of a horse or stable; also, it called attention to possible danger to subjects of hay fever, bronchitis, or any form of respiratory dis- tress. It was a form of anaphylaxis in the human subject caused by horse serum as an excitor, and the immunizing dose so fre- quently administered is as dangerous as any when the above conditions are present. Dr. Willy Meyer (New York): 1888, "A Successful Case of Colocolostomy." First case published of lateral anastomosis between parts of the large intestine. 1892, "Progress of Cysto- scopy in the Last Three Years." First statement in the litera- ture of the rhythmical movements of the mouth of the ureter as they appear during cystoscopy. 1892, "Nephrotomy for the Relief of Sudden Total Suppression of Urine, Occurring Some- 64 EDMOXD SOUCHON time after Nephrectomy." First advice to perforate capsula propria of kidney in case of total suppression of urine. This advice was later enlarged by Dr. Edebohls, who recommended decapsulation. 1894. "Portable Sterilizer for Private Opera- tions." So far as I know, the first portable sterilizer for surgical purposes. 1894. "An Improved Method of the Radical Opera- tion for Cancer of the Breast." First publication in New York Medical Record, December 15, 1894. 1905, "Carcinoma of the Breast." First report on the now generally adopted radical operation for cancer of the breast, which means removal of the cancer with both pectoral muscles in toto. plus axillary and sub- clavian glands with surrounding fat, in one mass. In this opera- tion the bloodvessels are ligated and divided at their point of exit from or entrance into the main vessels, thus reducing the loss of blood to a minimum. 1896, "Early Diagnosis of Tuber- culosis of the Kidney." First statement in the literature of the cystoscopic picture of the traces left within the healthy bladder by the urine descending from a tuberculous kidney. 1900, "The Hockey-stick Incision." Description of a practical method of abdominal incision for appendicular trouble combined with dis- ease of the appendages. 1903, "The Improvement of General Anesthesia on the Basis of Schleich's Principles." 1908, "The Improvement of General Anesthesia on the Basis of the Princi- ple of Adapting the Boiling-point of the Anesthetic to the Tem- perature of the Body (Schleich) ; Ten Years' Experience." New anesthetic mixture of chloroform, ether, and ethyl chloride, the boiling-point of which is adapted to the body temperature. 1904, "Osteoplastic Gastrotomy for Impermeable Cicatricial Stricture of the Esophagus." Attacking impermeable cicatri- cial stricture of the esophagus from below, with the help of an osteoplastic flap, in the presence of a gastric fistula. 1909, " Fortschritte in Druckdifferenzverfahren f. Intrathorakale Oper- ationen." 1909, "Pneumectomy with the Aid of Differential Air-pressure; An Experimental Study." A practical combina- tion of the positive cabinet with the negative chamber, permit- ting of change from positive to negative pressure at will, leaving ORIGINAL CONTRIBUTIONS OF AMERICA TO MEDICAL SCIENCES 65 patient undisturbed in his position on the operating table. 191 1, "Inoperable Cardiospasm Successfully Treated by Thoracotomy and Eosophagoplication." Loosening the pneumogastrics from the supradiaphragmatic pouch in cases of cardiospasm, with reduction of size of pouch by single or double plication. Spon- taneous return of the ability to swallow has been observed in one patient, permanently up to the time of death, one year after operation, temporarily only in the second patient. 191 1, "Sub- cutaneous Injection of Normal Human Blood Serum to Prevent and Overcome Postoperative Hemorrhage in Patients with Chronic Jaundice." Making use of Dr. Welch's proposition of subcutaneous injection of normal human blood serum as a pre- ventive against postoperative (secondary) hemorrhages in cases of chronic j aundice . 1912," The Operative Treatment of Intract- able Cardiospasm." Making use of the Heinecke-Mikulicz method of pyloroplasty for the cardia in cases of cardiospasm. 191 2, "On Drainage after Intrathoracic Operations, with Special Reference to the Esophagus." 191 2, "Zur Drainage nach Intra- thorakalen Operationen." Draining the pleural cavity after intrathoracic operations as in abdominal cases, keeping the patient under differential pressure for fifteen to twenty hours. 1 914, "On Bronchiectasis." Proposition to spray collargol into the bronchial tree in order to improve results* of radiography (still in experimental stage). 1914, " Extrathoracic and Intra- thoracic Esophagoplasty in Connection with Resection of Tho- racic Portion of Esophagus for Cancer." Using the Beck-Jianu tube obtained by a plastic operation from the major curvature of the stomach for intrathoracic esophagoplasty, i. e., to have this tube replace the lower portion of the resected esophagus, making it pass through the foramen esophageum alongside the closed .cardia and uniting it with the proximal stump direct by suture. Dr. Irving S. Haynes (New York) : 1 796-1879. In the treat- ment of badly united Pott's fracture at the ankle, I claim orig- inality and priority for the method of treatment as set forth in my reprint, viz., "To Reproduce the Lesions of the Original 66 EDMOND SOUCHON Injury and Treat the Case as if a Recent Fracture." The opera- tion was performed in June, 1888. I claim that I was the first to devise and apply the principle of "composite photography" to determine the relations of the thoracic and abdominal vis- cera to the surface of the body and to each other. An original technic for " Drainage of the Cisterna Magna in Meningitis." An original plan for the "Treatment of Hydrocephalus by Deflecting the Cerebrospinal Fluid into the Blood Stream by Means of a Silver Tube" connect the cisterna magna with one of the sinuses, preferably a lateral. I call the method "Cisterna- sinus drainage for hydrocephalus." An original technic for the treatment of very large (giant) .ventral hernia. Dr. Hermann Knapp (New York) : Work in ophthalmology. Dr. W. B. Coley (New York): "Treatment of Inoperable Malignant Tumors by Repeated Inoculations with Living Cul- tures of the Streptococcus of Erysipelas. The Therapeutic Value of the Mixed Toxins of the Streptococcus of Erysipelas and Bacillus Prodigiosus in the Treatment of Inoperable Malignant Tumors, with a Report of 160 Cases." Dr. Charles L. Dana (New York) : "Benignity of Syphilis." The disease very often ran a benign course among a class of men who lived out-of-doors, and I believe I was among the first to call attention t'o the fact that "out-of-doors" was as good for syphilis as for tuberculosis. "Nerve Weakness." I tried to convince the people at that time of the existence of a functional neurosis (neurasthenia), of which the evidence was not at that time acknowledged. In my article on "Pathological Anatomy of Tic Douloureux" I described specimens which showed that the disease was due to a morbid condition of the vascular supply of the nerve rather than to disease of the nerve itself. That was subsequently confirmed by others, and it is my view of the pathology of the disease now. New method of treatment of the disease by massive doses of strychnin, a treatment which still retains an important position in neurological therapeutics. "Trigeminus Paralysis." All the nerves of taste came primarily from the glossopharyngeal, a view which has much support at ORIGINAL CONTRIBUTIONS OF AMERICA TO MEDICAL SCIENCES 67 the present time. Articles on combined sclerosis. Dr. Putnam and I were the first to describe this disease and to give patholog- ical records of the condition of the spinal cord. In later articles I showed its important relationship to pernicious anemia. Clin- ical study of neuralgias. I gave the first systematic picture of the location of various reflex pains. It was an elaboration of this original view of mine which Dr. Head subsequently worked up so much more completely. "Acute Transverse Myelitis with Perforating Necrosis." I gave the first description of that peculiar form of pathological disturbance. Pathological anatomy of chorea. Contributed to establish the fact that in chronic myoclonias the cortex is the main seat of the lesion. Progressive Senile Paraplegia. I reported a case which represents, so far as I know, the first record of the condition of the spinal cord in senile paraplegia. " Cerebral Hemorrhage and Softening." I showed that there was in general a difference in the temperature of the two sides in hemorrhage but not in thrombosis, and a difference in blood-pressure. These articles contained also studies of the localization of heat centers and studies of etiology showing the clinical facts regarding the importance of syphilis as a cause of cerebral hemorrhage. "Alcoholism and Inebriety." I have studied and examined the brains of many cases of so-called "alcoholic wet-brain." I think these were the first articles to call attention to what is described as "serous meningitis." "Pathology of Hereditary Chorea." I showed the cortical changes which occur in this disease. This was one of the first but perhaps not the very first article which proved that it was a cortical disorder. Changes in the shape and position of the uvula as one of the minor stigmata of degeneration. "Basedow's Disease." I reported a case which confirmed, I thought, my position that in this disease the primary lesion is bulbar and nervous and that the enlargement and over activity of the thyroid are secondary to the central neuro-pathological condi- tions. "Cerebellar Seizures." I described a peculiar form of "fit" due to extracerebellar lesions. These cerebellar fits had been described by Hughlings Jackson, but he did not, I think, 05 EDMOND SOUCHOX describe them as part of the disease in tumors of the brain. I have confirmed my original article by subsequent observation though it is only in certain types of tumors, those which grow with some rapidity and which are mainly outside the cerebellum, that the fits occur. "The Zoophil-Psychosis " is a new disease which has been received with much applause by the worker in experimental medicine, and I think its establishment has been of some use to the world. "The Pineal Gland," done by Dr. Berkeley and myself, and originated at my suggestion, in which we succeeded in, I think, proving that the pineal gland has some function. Our experiments led mainly to the view that it has some stimulus on mental and sexual and somatic growth. We particularly worked on. the mental side and we feel quite sure that the pineal gland is of some importance in certain classes of mental defectives. Dr. H. Beeckman Delatour (New York) : "New Colostomy Apparatus." I described an entirely new apparatus, designed by myself, which has given very general satisfaction to the patients about twenty-five or thirty, who are using it. Drew attention to the condition occurring at the sigmoid which was first described by myself. It obstructs the intestinal canal by angulating the bowels at one or the other end of the sigmoid. Described a series of cases in which the large intestine failed to rotate and irregular positions of the appendix were found, when operating for appendicitis. Called attention to the advantages of the early operation for the suture of the patella in cases of fracture. Described the particular method of suture shown to be most practical, the straight suture, which passes from the patella ligament to the quadriceps tendon and relieves the suture holding the bone together of all strain. Dr. A. Rose (New York): "Carbolic Acid." The treatment of dysentery (first introduced by me in 1883). "The Cure of Rectal Fistula and Dacryocystitis by Means of Carbonic Acid Gas." " Enteroptosis and Its Treatment by Means of the Plaster Belt." Facts showing the relations of enteroptosis to circulation and innervation, the relation of enteroptosis to ORIGINAL CONTRIBUTIONS OF AMERICA TO MEDICAL SCIENCES 69 cholecystitis and to mucous colitis. The plaster belt has first been introduced by me in the year 1899 and it is known under my name. "The Continuous Warm-water Bath the Rational Remedy in Tuberculosis (Phymatiasis) and Infectious Diseases in General." "The Treatment of Infectious Diseases by Means of the Continuous Warm-water Bath." "Ichthyol in the Treatment of Psoriasis." Dr. F. Kammerer (New York City) : First to contribute an article on unilateral infection of the kidney, suggesting as an etiological factor the floating kidney in women and also a method of surgical treatment. Also "Modified Incisions at the Outer Border of the Rectus for Appendicitis (Kammerer's Incision)." Dr. L. L. Nascher (New York City) claims to be the first to have given the name of geriatrics to the disease of old age. Dr. Edward' A. Spitzka (New York) : Performed autopsy and studied brain of Czolgosz, assassin of President McKinley, and published several articles on brain anatomy while a senior in medical school. Has studied the brains of many eminent men and of various races (Eskimos, Chinese, Japanese, Negroes, Papudans, Nicobarese, Anamanese, Malays, etc.). Published first accurate topographic projections of the lateral ventricles of the brain (1900). First observations of hereditary resemblances in brains of blood relatives, 1900 and 1903. Pointed out the relative redundancy of the peninsula (1901), the relatively larger size of the callosum (1906), and other cerebral character- istics in the brains of distinguished men. Described and named the postorbital limbus at the base of the human brain (1903). Established the existence of a lesion, hitherto undescribed, in the brains of persons killed by electricity. Described the occurrence in the twentieth century of epidemics of religious fanaticism (i9 3) • Dr. Simon Flexner (New York City) was the first to inject the antimeningococcus serum into the spinal subdural space, thereby obtaining a larger percentage of cures, especially in the early stages of the disease. He with Drs. Noguchi and Anos 70 EDMOND SOUCHON discovered the germ of anterior poliomyelitis. He distinguished himself by his work on terminal infection, his experimental work on venoms and the etiology and therapy of cerebrospinal menin- gitis and infantile poliomyelitis. Dr. Hidego Noguchi (Rockefeller Institute, New York City), with Drs. Flexner and Anos, has found the germ of anterior- poliomyelitis. Has discovered the method of cultivation.. He has grown the spirochete of syphilis. He has grown the virus of rabies. He also perfected a blood test for syphilis. Also per- fected a test of spinal fluid for syphilis. Dr. Peyton Rous (Rockefeller Institute, New York City): Transmission of a malignant new growth by means of a cell-free filtrate. A tumor of chicken, histologically a spindle-cell sarcoma, has been propagated in this laboratory since October, 1909, and in the past few months has developed extreme malignancy. From a bit inoculated into the breast muscle of a susceptible fowl there develops rapidly a large, firm growth; metastasis takes place to the viscera; and within four to five weeks often the host dies. The behavior of the new growth has been throughout that of a true neoplasm, for which reason the fact of its transmission by means of a cell-free filtrate assumes exceptional importance. Dr. L. G. Meltzer (Rockefeller Institute) originated intra- tracheal insufflation (1909) with John Auer; also the treatment of tetanus with magnesium sulphate (1905-6). Dr. Alexis Carrel (Rockefeller Institute, New York City) : Preservation of life in tissues and organs outside of the body. Transplantations of tissues and organs from one subject to another. "Thyroid Gland and Vascular Surgery. " The purpose is to examine what may eventually be the influence of vascular surgery on the therapeutics of the thyroid gland. "Experi- mental Operations on the Sigmoid Valves of the Pulmonary Artery." The purpose is to ascertain whether and to what extent intracardiac operations could be performed with safety. The technic of interthoracic operations. The purpose is to describe the methods by which the occurrence of pleurisy and of air emboli of the coronary arteries has been prevented. ORIGINAL CONTRIBUTIONS OF AMERICA TO MEDICAL SCIENCES 7 1 Dr. Jacques Loeb. His most characteristic work is that upon the dynamic and chemodynamic theory of living processes. He was one of the first to settle the question of what order of magni- tude is the smallest particle that can show all the phenomena of life (1893). The experiments made by himself and pupils upon temperature coefficients have established other important criteria of physiological processes. He has made extensive investigations of the effect of electrolytic, thermal and radional energy upon living matter. He founded the theory of ' 'tropisms " (1890) as the basis of psychology of the lower forms of life, purely mechanical and chemical data, displacing the old theory of purposeful instructive reactions. He caused the unfertilized eggs of the sea urchin to develop into the swimming larvae by treating them with hypertonic sea water, i. e., in which the con- centration had been raised by the addition of salt or sugar (1899). Thus the ovum can be activated just as a protozoon can be rejuvenated or an asphyxiated body resuscitated by purely physicochemical means. Dr. H. R. Gaylord and Dr. G. H. Claws (Buffalo) inoculated rats and mice with cancer. Dr. Harry Plotz discovered the germ of typhus fever (Bacillus typhiexanthematici) in 191 5. Dr. Walter W. Brickner discovered new pathology of shoulder disability (subacromial bursitis) and new mechanical and surgical treatment for same (1914-15). Dr. J. Henry Dowd (Buffalo) : The phosphatic index, or pulse of the nervous system. The phosphatous for taking the phosphatic index. A modification of the urethral sound, the Dowd sound. Dr. Max Elnhorn (New York) : Work in gastroenterology. The Rockefeller Institute for Medical Research is. the grandest contribution of its kind in the world. The Carnegie Foundation for the Advancement of Teaching is a great contribution to Medical Science. As a private munificient institution it is unique in the world. Dr. E. L. Trudeau (Saranac Lake) is the first to have intro- duced in America the open-air treatment of tuberculosis. 72 EDMOND SOUCHON Dr. Henry L. Elsner (Syracuse) published the first complete treatise on prognosis (171 6). NORTH DAKOTA Dr. E. P. Quain (Bismark): The necessity of conserving the intercostal nerves in abdominal incisions. An experimental study. OHIO Dr. Daniel Drake (Cincinnati), 1785-185 2, published one of the first accounts in literature of the local disorder known as the " trembles," or milk sickness (1841). His great work is on the Diseases of the Interior Valley of North America. The book is distinctly and peculiarly American (1850-54). It was the first book of importance on medical topography. Dr. Marmaduke B. Wright (Cincinnati), 1 803-1 879, per- formed binanual version before Hecht (1854). Dr. Phineas S. Conner (Cincinnati), 1839-1909, first per- formed a complete eversion of the stomach. He contributed monographs on gunshot wounds and injuries and diseases of muscles, tendons, and fascia. Dr. E. Watkins (Cincinnati) was the first physician in America who made ophthalmology an exclusive speciality. Dr. Rueus B. Hall (Cincinnati) : I was the first in America to remove a calculus, lodged in the ureter, by the combined abdominal and lumbar incisions. I was the first to suggest closing the pelvic peritoneum, after making a hysterectomy. I was the first to suggest that gall-stones, long neglected, had a causative relation to cancer in and about the gall-ducts. I was the first to suggest and make a bloodless operation for the removal of intraligamentous cyst of the ovary. This was done by cutting off the blood supply before enucleation of the tumor; by the ligation of the ovarian arteries; then by ligating the uterine artery on the side of the easiest approach; then cut across the neck of the uterus and clamp the second uterine artery, after ORIGINAL CONTRIBUTIONS OF AMERICA TO MEDICAL SCIENCES 73 which the tumor was enucleated from below upward. I was the first to make the bloodless operation for removal of fibroid tumors of the uterus. By cutting off the blood supply, ligating the ovarian arteries, then the uterine artery on the side of the easiest approach; then cut across the neck of the uterus and clamp the second uterine artery, thus making it possible to enucleate all such tumors from below upward, without great loss of blood. I was the first one to use the method of elevating the hips and body of the patient in pelvic and abdominal operations now known as the Trendelenburg position. The operation was made upon a patient by name of Mary Vater, of Newport, Ky., on June 17, 1889, at my private hospital, 154 W. Eighth Street, Cincinnati, Ohio. There were present at the operation Dr. Edwin Ricketts (deceased), Dr. C. A. L. Reed, and Dr. C. B. Van Meter, all of this city. The last two are living, and would be willing to testify as to the correctness of this statement. Sometime after this Trendelenburg published a paper, describing the position for operations in the pelvis. I therefore did not publish my claim at all, yet I feel that I should have done so. Before he published his paper I had used the position several times in difficult operations, and so had Dr. Reed, of this city, he having seen me use it with such great advantage to the operator and patient. Dr. Reid Hunt (Martinsville) : Book on Thyroid and Phar- macology. Dr. D. T. Vail (Cincinnati) reports what he believes to be the first case of infection of the human eye from the virus of a plague-like disease among rodents, notably the California ground squirrel, and now known as "squirrel plague." Dr. George N. Stewart : Work on Physiology and Pharma- cology. Dr. Forald Sollman, also. Drs. W. B. Wherry and B. H. Lamb (Cincinnati) believe they reported the first instance of human infection with the organism discovered by McCoy and Chapin in a plague-like disease first described by McCoy in the California ground squirrel. 74 EDMOND SOUCHON Dr. Howard Taylor Ricketts (Findlay, 0.) demonstrated wood-tick to be the vector of Rocky Mountains spotted fever (1907) and louse of Mexican typhus or tabardello (1910). Dr. F. W. Langdon (Cincinnati) : "Surgical Anatomy of the Brain." By means of six lines, based on anatomical landmarks only, without measurements in inches or millimeters, or apparatus of any kind, excepting an ordinary steel tape line, or a narrow strip of card-board, we may locate upon the living head most of the important surgical regions of the brain and its membranes: and I venture to state that the rules here laid down will be found as reliable in practice as the most elaborate systems of mensura- tion, or craniometry by more or less complicated apparatus. Dr. H. McE. Kower (Cincinnati): "Origin of the 'Nasutus' (Soldier) of Eutermes." "Pteropods with Two Separate Open- ings." "The Embryology of a Termite." "A Comparative Study of the Development of the Generative Tract in Termites." "A New and Sensitive Method of Injecting the Vessels of Small Embryos, etc., under the Microscope." "Effects of Early Removal of the Heart and Arrest of the Circulation on the Development of Frog Embryos." "The Origin and Develop- ment of the Anterior Lymph Hearts and the Subcutaneous Lymph Sacs in the Frog." "Demonstration of the Interventric- ular Muscle Bands in the Adult Human Heart." "A Compara- tive Study of Embryonic Bloodvessels and Lymphatics in Amphibia." Dr. Martin H. Fischer (Cincinnati) : Contributions to the establishment and development of the colloid-chemical theory of water absorption. Too long to summarize. Dr. George W. Crile (Cleveland): 1905, "Observations on Cancer of the Breast, with Analysis of 91 Operative Cases." "New Operations for Hernia of the Pelvic Floor (Procidentia), with Report of a Case." "Scope and Problems of Surgical Physiology." "Some Observations on Effect of Alternating Currents of Moderate Frequency on Dogs." (In collaboration with J. J. R. McLeod.) "Surgical Physiology." 1906, "Exci- sion of Cancer of the Head and Neck, with Special Reference to ORIGINAL CONTRIBUTIONS OF AMERICA TO MEDICAL SCIENCES 75 the Plan of Dissection, Based on 132 Operations." "Experi- mental and Clinical Observation upon Direct Transfusion of Blood." "Experimental Research into the Resuscitation of Dogs Killed by Anesthetics and Asphyxia." (In collaboration with D. H. Dolley.) "On the Surgical Treatment of Cancer of the Head and Neck, with a Summary of 121 Operations Per- formed upon 105 Patients." "On the Technic and the Results in the Excision of Cancer of the Head and Neck." "Report of Case of Multiple Giant-cell Sarcoma." (In collaboration with W. C. Hill.) "Technic of Operations upon the Face and Neck." "Treatment of Hemorrhage." 1907, "Effect on the Normal Dog Heart of Expressed Tissue Juice from Hearts of Dogs Poisoned with Diphtheria Toxin." (In collaboration with J. J. R. MacLeod.) "Further Consideration of Surgical Treatment of Cancer of the Head and Neck." "Further Consideration of the Treatment of Cancer of the Neck." "Further Experimental and Clinical Observations on the Transfusion of Blood." "Goitre." "On the Direct Transfusion of Blood. An Exper- imental and Clinical Research." "Transfusion in Dogs upon Which Bilateral Nephrectomy has been Performed." (In collab- oration with H. P. Cole.) "On the Plan of Excision in Cancer of the Head and Neck, and an Analysis of 132 Cases." "Pre- liminary Note on the Direct Transfusion of Blood in Pernicious Anemia, Leukemia, Carcinoma, Chronic Suppuration, Surgical Hemorrhage, Tuberculosis, Surgical Shock, and the Transfer- ence of Immune or Protective Bodies in Self-limited Diseases, Illuminating Gas-poisoning, Bleeding, and Transfusion in Tox- emia and Drug Poisoning." "Preliminary Report on the Direct Transfusion of Blood in Animals Given Excessive Doses of Diphtheria Toxins." "Summary of 1000 Cases of Appendicitis, with Observations on Etiology." "Transfusion Experiments on Dogs, showing Artificially Implanted Tumors." "Treatment of Illuminating Gas Poison by the Direct Transfusion of Blood." 1908, "The Cancer Problem." "Hemolysis, with Special Refer- ence to Cancer and Tuberculosis." "Further Observations on Its Clinical Aspect." " Hemolytic Tests for Cancer." "Hemo- 76 EDMOND SOUCHON lytic Tests for Malignant Tumors." "Hemorrhage and Trans- fusion." "Observations on Surgery of the Thyroid Gland, with Special Reference to the Psychic Factor in Graves's Disease." " On the Direct Transfusion of Blood." " Surgery of the Stomach Based on 104 Personal Cases." "Surgical Aspects of Graves's Disease, with Special Reference to the Psychic Factor." "Sur- gical Shock." "Transfusion of Blood in the Transplantable Lymphosarcoma of Dogs." (In collaboration with S. P. Beebe.) 1909, "Certain Phases of Acute Anemia." "Further Observa- tions on the Clinical Aspect of Hemolysis." "Further Observa- tions on Transfusion, with a Note on Hemolysis." "Hemorrhage and Transfusion." "Medicine and the Press." "Note on Nitrous Oxide and Oxygen Anesthesia in Comparison with Ether Anesthesia." "Observations on Cancer." "Observa- tions on Surgery of the Thyroid Gland with Special Reference to the Psychic Factor in Graves's Disease." "Pathological Cytology of Surgical Shock; a Preliminary Communication: the alterations occurring in the Purkinje cells of the dog's cere- bellum, with an introductory note on the pathological physi- ology." "Subjective Symptoms of Exophthalmic Goitre; a Per- sonal Experience." "Surgical Anemia and Resuscitation." "Surgical Shock (Harvey Lecture)." "Technic of Cesarean Section." 1910, "Address on Cancer." "Experimental and Clinical Research into Nitrous Oxide Versus Ether Anesthesia: an Abbreviated Report." "Further Observations on Hemoly- sis in Cancer." "On Cancer." "On Certain Factors that Influence the Immediate Results of Surgical Operations." "On the Direct Transfusion of Blood." "On the Factors of Safety in Abdominal Operations." "On the Neurocytological Changes in Shock, Infection, Graves's Disease, and Certain Drugs, with a Note on Fear in Rabbits." "Operations on Handicapped Patients." " Phylogenetic Association in Relation to Certain Medical Problems." "Postoperative Results in Exophthalmic Goitre." 191 1, "Anoci-association: a New Principle in Opera- tive Surgery." "Goitre: Some Biological Considerations." "Graves's Disease; a New Theory of Operations Based upon a ORIGINAL CONTRIBUTIONS OF AMERICA TO MEDICAL SCIENCES 77 Study of 3 5 2 Operations. " " Newer Methods for Further Increas- ing the Safety of Surgical Operations." "A New Principle in the Treatment of Graves's Disease." "Nitrous Oxide Anesthesia and a Note on Anoci-association ; a New Principle in Surgery." " Phylogenetic Association in Relation to Certain Medical Problems." "Phylogenetic Association on Relations to Graves's Disease and Sexual Neurasthenia." "Some of the Factors that Influence the Prognosis in Operations for Cancer." "Surgical Aspects of Painful Digestion." 1912, "Anoci-association: a New Principle in Surgery." "Anesthesia and Anoci-association." "Comparison of Anesthesia in Plants Possessing a Motor Mechanism and Animals." (In collaboration with M. L. Menton.) "End-results of Operation in Graves's Disease." "Laryngectomy for Cancer." "New Principle Underlying the Interpretation of Clinical Phenomena of the Abdominal Viscera, with Special Reference to Emotional and Painful Indigestion." "Phylogenetic Association in Relation to the Emotions." "Results of Operations, Especially Abdominal, Formed on the Principle of Anoci-associations." "Surgical Aspects of Graves's Disease." 1913, "Anesthesia and Anoci-association." "Anoci- association: a New Principle of Surgery." "Biological Inter- pretations and Surgical Aspects in Painful Digestion." "Further Control of the Morbidity and the Mortality in Abdominal Oper- ations for Pelvic Diseases." "Identity of Cause of Aseptic Wound Fever and So-called Postoperative Hyperthyroidism and Their Prevention." "Indications and Technic in Gastric Resec- tion and Gastroenterostomy." "Kinetic System: Theory." "Laryngectomy for Cancer." "Mechanistic View of Psychol- ogy." " Possible Surgical Control of Kinetic System." " Present- day Conceptions of the Pathological Physiology of Graves's Disease from the Surgeon's Viewpoint." "Relation between the Blood-pressure and the Prognosis in Abdominal Operations." "Relation between the Physical State of Brain Cells and Brain Functions. Experimental and Clinical." "Shock." "Some Newer Methods of Reducing the Mortality of Operations on the Pelvic Organs." "Successful Method of Performing Shockless 78 EDMOND SOUCHON Operations Based on a Clinical Experience of 3000 Cases." "Transfusion of Blood." 19 14, "Acidity, Alkalinity, and Anes- thesia." "Anoci-association." "Anoci-association in Relation to Operations on the Gall-bladder." "Cholecystectomy versus Cholecystostomy and Method of Overcoming Special Risks Attending Common Duct Operations." "Drainage versus Immediate Suture of the Common Duct." "Kinetic Chain for Transformation of Latent Energy." "Kinetic System." "Liver in its Relation to Operations on the Biliary Tract and Stomach." "Shock." "Two-stage Operations, Especially in its Relation to Treatment of Cancer." "Wayside Notes of Visits to German Clinics in June, 191 2." 191 5, "Emotions, Their Origin and Nature." Although the foregoing publications contain more or less original view-points, Dr. Crile states that the block exci- sion of lymphatic gland bearing tissues of the neck, including the sternomastoid muscle and the internal jugular vein, was not presented before it was devised by him ; resuscitation from recent death by the use of adrenalin and rhythmic pressure was new also; the conception of nerve-blocking for the preven- tion of shock and the elaboration of anoci-association in surgery was new, as were likewise the pathology of shock as represented by the changes in the brain, adrenals, and the liver; the concep- tion of the kinetic system and the origin of the emotions and identification of the lesions caused by them. Dr. William Townsend Porter (Plymouth) : Important Work on Physiology of Circulation. "Measurements of School Children." Financed American Journal of Physiology until 191 5. Dr. Frank E. Bunts (Cleveland): "Separation of the Colon from its Mesentery," showing that the colon would live when separated from a considerable portion of the mesentery after resection of the mesentery to the gut. Devised a pneumatic tourniquet-diverticle of the cecum following appendectomy. Dr. Edwin G. Conklin (Waldo) : Work on Zoology. Dr. J. F. Baldwin (Columbus) : The method of anchoring the kidney, for which I claim priority, is that by which a column of muscular tissue is taken from one side of the incision around ORIGINAL CONTRIBUTIONS OF AMERICA TO MEDICAL SCIENCES 79 which flaps made up of kidney capsule are brought and sewed, so as to secure complete and permanent anchorage. The making of an artificial vagina by transplanting a piece of bowel, is, I think, original from start to finish. A German surgeon, and also a Japanese surgeon, got up something of the same, or claimed to, but I had fully a year priority in point of publication, and I think at the present time priority is conceded to me by all the authors. Dr. William E. Castle (Alexandria, O.) work on heredity (1911). PENNSYLVANIA Dr. Thomas Cadwalader (Philadelphia), 1708-17 79, pub- lished a classical account of lead-poisoning in the eighteenth century (1745). Dr. John Morgan (Philadelphia), 173 5-1 789, and Dr. William Shippen, Jr., 1736-1808, founded the Medical Depart- ment of the University of Pennsylvania (1740). Dr. William Shippen, Jr., (Philadelphia), 1 736-1808, was the first professor of obstetrics. Dr. Benjamin Rush (Philadelphia), 1745-1813. He was the first after Bylon of Java to describe dengue (1780). He was probably the first to note that thermal fever occurred by drinking cold water when exhausted. His monograph on Insanity (181 2) has been pronounced by Mills to be, with that of Isaac Ray, the only systematic American treatise on the subject before the year 1883. His paper on the "Diseases of the North American Indians and Their Vices" was perhaps the earliest American contribution to anthropology (1774-98). He contributed much to the prestige of American medicine, being one of the signers of the Declaration of Independence. He was the first to lecture on jurisprudence. Dr. Caspar Wistar (Philadelphia), 1 760-1818, wrote a descrip- tion of the ethmoid bone which was praised by Soemmerring. He published the first book on anatomy in America. The Wistar Institute of Anatomy and Biology is the only institution of its 8o EDM0ND SOUCHON kind in America. It was founded by General Caspar, the grandson of Dr. Wistar, in memory of Dr. Wistar. Dr. Thomas C. James (Philadelphia), 1 766-1835, is said to have been the first to induce premature labor for a contracted pelvis. Dr. Willlam Potts Dewess (Philadelphia), 1 768-1841, exerted a powerful influence as professor of midwifery at the University of Pennsylvania. Dr. Philip Syng Physick (Philadelphia), 1 768-1837, first used animal ligatures (1816). He invented the tonsillotome (1828). He advocated rest in the treatment of hip-joint disease (1830). He w r as the first in this country to puncture the head for hydro- cephalus. He was the first to place internal urethrotomy upon a scientific basis by designing in 1795 a catheter bearing a concealed lancet w r hich could be projected at will. He was the originator of an operation for the cure of artificial anus (1826). He w r as the first in this country to devise a stomach tube to remove poison from the stomach. He w T as the father of American surgery. In 1802 he passed a seton between the ends of an ununited fracture. He was the first to practice complete and protracted rest in the treatment of affections of the joints. Dr. John Rhea Barton (Lancaster, Pa.), 1774-1871, was the first to perform osteotomy for ankylosis of the hip-joint (1826). He was the first in this country to trephine the vertebrae in cases of fractures and dislocations. He was the first to wire a fractured patella. He was the first to describe, in 1835, the fracture of the lower extremity of the radius known as Barton's fracture. Dr. John Conrad Otto (Philadelphia), 1 774-1884, published first paper on hemophilia. Dr. X. Chapman (Philadelphia), 1 780-1853, published the first book on Therapeutics and Internal Medicine in America. Dr. John S. Dorsey (Philadelphia), 17 83-1 8 18, published the first book on Elements of Surgery in America. He was the first in America to ligate the external iliac for inguinal aneurysm (1811). Dr. William Gibson (Philadelphia), 1 788-1868, w r as the first in the w T orld to divide the muscles of the eye for the cure of strabismus (1842). ORIGINAL CONTRIBUTIONS OF AMERICA TO MEDICAL SCIENCES 8 1 Dr. Alexander H. Stevens (Philadelphia), 1 789-1869, first described the abnormalities of equilibrium of the ocular muscular apparatus and the resulting disturbances. Dr. Samuel Jackson (Philadelphia), 1 790-1872, published the first book on the Principles and Practice of Medicine in America. Dr. Charles D. Meigs (Philadelphia), 1792-1869, first called attention to cardiac thrombosis as a cause of the sudden death which occurs in childbed. Dr. John Kearsley Mitchell (Philadelphia), 1 793-1858, was the first to describe the neurotic spinal arthropathies (1831). Dr. William E. Horner (Philadelphia), 1 793-1853, dis- covered the muscle of the eye that bears his name, the tensor tarsi (1824). He was the first in this country to remove almost all the upper jaw without any external incision in the cheek. He was the first to prove that the rice-water discharges of cholera were due to the stripping of the epithelium of the mucous mem- brane (1834). He investigated the odoriferous axillary glands of the negro, the muscular tube of the rectum, and the mem- branes of the larynx. Dr. George McClellan (Philadelphia), 1 796-1847, was the first to remove all the lower maxilla immediately in front of the two angles. He is the founder of the Jefferson Medical College. Dr. Isaac Hays (Philadelphia), 1 796-1899, devised a needle knife for the comminution of cataract. Dr. Robert Thompson (Philadelphia), 1 797-1865. discovered the connection between astigmatism and posterior staphyloma. Dr. Samuel George Morton (Philadelphia), 1 799-1851, is best known as craniologist, paleontologist, and phthisiographer. His book on Organic Remains is said to be the starting-point of all systematic study of American fossils (1834). Dr. Samuel David Gross (Philadelphia), 1805-1884, first advocated taking in the tough submucosa in the intestinal suture. Also the excision of the axillary lymphatic glands in cancer of the breast. He was one of the prime movers in the establishment of the American Surgical Association and the Philadelphia 82 EDMOND SOUCHON Academy of Surgery. He published the first system of surgery to receive widespread attention outside of our country. Was the first to make notable experiments on hanging. He investigated stab wounds of the abdomen. Performed the excision of the trifacial and spinal nerves. He first suggested wiring in dis- locations of the sternoclavicular and acromioclavicular. He wrote the first exhaustive treatise on Pathological Anatomy in English (1839). He wrote the first systematic treatise on Foreign Bodies in the Air Passages (1854). He made many original experiments upon the effects of manual strangulation (1836) and wounds of the abdominal walls (1834). He performed laparotomy for rupture of the bladder. He first described prostatorrhea. He first performed amputation of the ankle- joint (1851). In 1847 devised a method of enterectomy for artificial ends. Dr. Gross was preeminently a great educator, a disseminator of knowledge, standing head and shoulders above all others of his time. Since his death no other one man has attained his greatness in that line in the East. As such he fully deserved the statue erected to his memory in Washington, D. C. He contributed a number of eminent pupils and teachers to the profession, among others Dr. T. G. Richardson, of the Old University of Louisiana in New Orleans. Dr. Gross said that his greatest contribution to medicine was his son Samuel Weissel Gross. Drs. Joseph Pancoast and D. S. Gross (Philadelphia), were the first in the world to render limbs bloodless before subjecting them to operation. Dr. Joseph Pancoast (Philadelphia), 1805-188 2, performed the first successful plastic operation for the relief of exstrophy of the bladder (1858). He was the first to practice subcutaneous division of the stricture in strangulation of hernia. He is entitled to great credit for rhinoplastic operations. Dr. George Clark (Philadelphia): In 1806 he reported a case of uterine pregnancy in which the head of the child presented in the rectum; he passed his entire hand into the bowel and seizing the head extracted it. ORIGINAL CONTRIBUTIONS OF AMERICA TO MEDICAL SCIENCES 83 Dr. Cuning Bedford (Philadelphia), 1806-1870, was the first to use a patient in gynecological teaching, taking a woman in the amphitheater and using the speculum. Dr. William W. Gerhard, 1809-187 2, and M. Rufz (Phila- delphia), were the first to point out the connection of hydro- cephalus with tubercles of the pia mater (1833). Differentiated typhus and typhoid (1837). Dr. Thomas Mutter (Philadelphia), 1811-1859, was the founder of the Mutter Museum of the College of Physicians and Surgeons in Philadelphia. Dr. Henry H. Smith (Philadelphia), 18 15, was the first to treat disunited fractures by artificial limbs. Dr. Isaac E. Taylor (Philadelphia), 1817-1889, first called attention to the causation of exophthalmos and enlargement of the thyroid by excessive lactation. Dr. David H. Agnew (Philadelphia), 1818-1892, was the first to lacerate an opaque capsule of the lens. Also devised an operation for divergent strabismus. Dr. Thomas G. Morton (Philadelphia), 1835-1903, was the first to ligate the subclavian artery between the two scalene muscles. He was the first to excise the perineal nerve in a case of vaginal neuralgia. He devised a ward carriage and a hospital carriage. In 1876 he first described metatarsalgia. Dr. Joseph Leldy (Philadelphia), 1823-1891, published "Fresh Water Rhizopods of North America," which is one of our biological classics. He discovered the bacterial flora of the intestines and made the first experiments on the transplantation of malignant tumors. Dr. Milton Antony (1 789-1839) was the first to perform extensive excisions of the fifth and sixth ribs for gangrene of the lungs. Dr. Harris (Philadelphia), in 1825, first insisted upon fixation and extension in the management of inflamed joints. Dr. Theodore G. Wormley (Philadelphia), 1826-1897. His book on Microchemistry of Poisons is distinguished around the world for its thoroughness and accuracy (1867). 84 EDMOND SOUCHON Dr. Deveze (Philadelphia), 1828, was the first to state that yellow fever was not contagious. Dr. Samuel Weissel Gross (Philadelphia), 1831-1889, was the first to excise nearly two inches of the spinal accessory nerve. He performed tenotomy of the sternocleidomastoid muscle for torticollis. Dr. Silas Weir Mitchell (Philadelphia), 1830-1914, was the first in America to investigate serpent venoms (1870-86) With Edward T. Reichert he isolated the diffusible globulins of the venoms. In 1869 he pointed out the coordinating functions of the cerebellum, and with Morris J. Lewis demonstrated that the knee-jerk can be reinforced by sensory stimulation (1886). He was the first to describe erythromelalgia or red neuralgia (1872-8). He was, with William Thomson, in 1874, the first to emphasize the importance of eye-strain as a cause of headache. "Venom of the Rattlesnake." "Respiration in Chelonia. " "Discovery of the Physiological Spasm of the Larynx in Chel- onia." "Effects of Reflex Paralysis." "Use of Atropin for Spastic Cases." "First Records of Ascending Neuritis." "Antagonism of Morphin and Atropin." "Injuries of Nerves and Their Consequences." "Advocated the Use of Nitrate of Amyl to Abort Epileptic Attacks. " "Description of the Disease Called Erythromelalgia." "Snake Poison" (with Professor Rheinhert). "Rest Cure in Which Debilitated Patients and Nervous Wrecks Are Kept in Bed and Are Placed on Special Diets." Was among the first to show that a relation between certain derangements of the spine and swelling of the joints exists. First proved that as there is a postchoreal paralysis so also there is a postparalytic chorea. Drs. S. Weir Mitchell and Thomson (Philadelphia) dis- covered the part played by errors of refraction in the production of nervous symptoms, and especially of headaches. Dr. Jacob M. DaCosta (Philadelphia), 1833-1900, first described the irritable heart in soldiers (1862-71). He first called attention to the advantage of forced respiration on the part of the patient as an aid to the physician in diagnosing diseases of the chest (188 s). ORIGINAL CONTRIBUTIONS OF AMERICA TO MEDICAL SCIENCES 85 Professor Reichert (Philadelphia): Work on "Stereo- chemistry of Starches/' etc. Dr. E. Dyer (Pittsburg) instituted the gymnastic treatment of asthenopia. Dr. Frank F. Maury (Philadelphia), 1840-18 7 9, was the first to perform gastrotomy for the relief of suffering caused by organic stricture- of the esophagus. In 1837 he was the first to resect the brachial plexus of nerves for the relief of neuralgia. He was the first to amputate at the shoulder-joint. Dr. William Pepper (Philadelphia), 1843-1898, first de- scribed the changes in the bone marrow in pernicious anemia (1875). Dr. John L. and Washington L. Atlee (Philadelphia), 1 843-1 883, gave a great impetus to ovariotomy. Dr. Walter (Pittsburg). In 1857 excised portion of one or more ribs for drainage in empyema. This is also claimed for Antony in 1821 and by Stone, of New Orleans. Dr. Pennock (Philadelphia): In 1850 was the first to adapt a rubber tube to the stethoscope. Dr. Hugh L. Hodge: In 1864 he was the first to cause pre- mature labor for ossification of the bones of the head. He devised the forceps that bear his name, and which were used for many years as the best. He devised Hodge's pessary. Dr. William Hunt (Philadelphia), in 1862, introduced the use of sand-bags in the treatment of fractures. Dr. Theophilus Parvin (Philadelphia), in 1867, first closed a ureterovaginal fistula by first turning the displaced distal extremity of the ureter into the bladder and then closing the vaginal opening. Dr. J. G. Allen (Philadelphia), in 1872, was the first to use a very powerful galvanic current to destroy the extra-uterine pregnancy fetus. Dr. J. Ewing Mears (Philadelphia), in 1875, was the first to open the abdomen and wash it out in cases of peritonitis. Dr. Marks (Philadelphia), in 1893, was the first to suture a heart wound. 86 EDMOND SOUCHOX Dr. George Clark (Philadelphia) (deceased, no dates) was the first to operate a case of ectopic uterine pregnancy through the rectum. Dr. Francis X. Dercum (Philadelphia) described painful obesity (1882). Dr. Thomas Harris (Philadelphia) (deceased, no dates), was the first in this country to amputate the tongue. Dr. Albert W. Waters (Pittsburg) (deceased, no dates) was the first to perform laparotomy for rupture of the bladder. Dr. Joseph K. Swift (Easton) (deceased, no dates) was the first to use an extension apparatus for the treatment of fractures. Dr. Fahnestock (Lancaster) (deceased, no dates) has also invented a tonsillotome superior to that of Physick in general use on the continent. Dr. J. Solis Cohen (Philadelphia) contributed considerably to place the science of laryngology and rhinology upon a firm scientific basis in America and Europe. Wrote first American book on Throat Diseases (1872). First described vasomotor ataxia; gave equivalent of vagotonia and sympatheticotonia (1892). Dr. Joseph Price (Philadelphia), took a prominent and original part in the treatment of pelvic inflammatory diseases, as he dictated the practice not only of America but to some extent of the entire world. He contributed considerably to the diagnosis and treatment of ectopic pregnancy. Dr. Benjamin F. Baer (Philadelphia), ligated en masse the uterine and ovarian arteries preliminary to operate for hysterec- tomy or fibroids of the uterus. Dr. George H. Noble (Philadelphia) has devised the libera- tion and displacement downward of the rectum itself, in perineal operations to make up the deficit and obviate the need of placing suture on the bowel side. He wrote the best history of fibroid tumors. Drs. R. L. Dickinson and J. Lecomte (Philadelphia) have introduced the special direct suture of the sphincter muscles in perineal operations. ORIGINAL CONTRIBUTIONS OF AMERICA TO MEDICAL SCIENCES 87 Dr. Allen J. Smith (Philadelphia): 1886, "Isolation of a New Chromogenic Bacillus, B. ceruleus (Pseudomonas Smithii Chester)." 1890, "Formulation of an Iron-hematoxylin Stain." "Suggestion of an Organogenic Influence upon Metastatic Tumors by the Organs in Which they Develop. " 1894, "Recog- nition of Dysenteric Amebas in Urine of a Case of Acute Cystitis. " 1895, "Recognition of Ova of Hookworms in Fecal Discharge from Residents of Texas." (See article by C. M. Schaeffer.) 1 901, "Description of a Previously Unreported Anaerobic Spore-forming Bacillus in Pus of Amebic Abscess of Liver." "Recognition of Hookworms in Eight Medical Students in Galveston, Texas, Establishing Endemicity of Uncinariasis in Continental United States." 1904, "Recognition of a Sub- stance Inhibiting Coagulation of Blood in Head Glands of Uncin- aria Canina." (With L. Loeb.) " Recognition of New Species of Human Parasite. " "Ascaris Texana. " (WithR. A. Goeth). "Description of Part Taken by Cardiac Muscle in Regenerative Process in the Heart Wall." 1905, "Description of Striking Histological Changes in Thymus and Elsewhere in a Case of Congenital Hypotonia." 1908, "Proposal of New Species of Parasites in Lower Animals, as follows: Tenia paradoxuria, Cotugnia browni, Ascaris aqueillae, Ascaris ardeae, Oxyuris microtyphlon, Spiroptera incerta, Spiroptera (?) iguanas, Dis- pharagus ardeae." (With Herbert Fox and C. Y. White.) "Description of Peculiar Blastomycetoid Organisms in Two Cases of Nodular Parasitic Conjunctivitis." (With W. C. Posey, J. T. Carpenter, and C. M. Hosmer.) These are prob- ably identical or closely allied to rhinosporon. 1909, "Proposal of New Species of Ciliate, Opalinopsis nucleolobata. Parasite in Liver of Coyote." (With Herbert Fox.) 1910, "Proposal of New Species of Human Endameba, Endameba Mortinatalium. " (With F. D. Weidman.) "Proposal of New Species of Filarial Parasite. Filaria mitchelli, Found in Gila Monster and in Ticks. " "Production of Eosinophilic Granules in Leukocytes in Vitro." (With F. S. Mullin and D. Rivas.) 1912, "Recognition of Paragonimus westermani in Wild Cats of Eastern Costal Region 55 EDMOND SOUCHON of United States." (With H. Fox, F. D. Weidman, and D. Rivas.) "Recognition of the Bacteriemic Nature of Leprosy." (With D. Rivas.) 1913, "Demonstration of Transmissibility of Lepra Bacilli by Bed-bug." (With K. M. Lynch and D. Rivas.) "Demonstration of Growth Influences of Internal Secretion of Testicle (Confirmatory of Walker's Original Observa- tions)." (With W. J. Crocker.) 1914, "Description of Inflam- matory Factor in Erosion of Tissues by Aneurysm." "Recog- nition of Pathogenic Importance of Oral Endamebae in Produc- tion of Pyorrhea Alveolaris, Proposal of Emetin as Remedy in Amebic Pyorrhea." (With M. T. Barrett.) "Recognition of Oral Endamebae in Tonsils and Suggestion of Their Impor- tance in Various Systemic Complications and in Adjacent Local Inflammations." (With W. S. Middleton and M. T. Barrett.) "Revision of Various Oral and Endamebae, with recognition of Endameba gingivalis (Gross, 1849) an d Endameba pyogenes Verdum and Bryant, 1907." (With M. T. Barrett.) He con- tributed considerably to the establishment of the medical department of the University of Texas at Galveston. Dr. Jarvis (Philadelphia) first discovered the part played in nasal obstruction by enlargement of the turbinated bones. He invented the Jarvis snare. Dr. George M. Gould (Philadelphia) : All the more common symptoms of migraine are clinically caused by eye-strain and curable by scientific spectacles. "Cyclopegia as a Diagnostic Method of Proving, by the General Practitioner, whether Migraine is Due to Eye-strain or Not," was urged by me as early as 1886. If the systemic symptoms of migraine disap- pear with the instillation of atropin, then correct glasses will permanently cure, and as quickly. "Other Diseases Commonly Unrecognized as of Ocular Origin, such as Chorea, Neurasthenia, Dyspepsia, Cardiac Palpitation, Aphonia, Nocturnal Enuresis, Epilepsy, Insanity, Lateral Curvature of the Spine," etc., were added in the years since 1886, as usually caused by eye-strain. The frequent eye-strain origin of cataract, glaucoma, iritis, and other ocular diseases has long been advocated by me. "The Homing Instinct." The probable origin of the ability of animals ORIGINAL CONTRIBUTIONS OF AMERICA TO MEDICAL SCIENCES 89 to return over long and unknown distances and routes was explained by me in 1888, on the theory that it is effected by means of a living mechanism in the brain which reacts in every part of the world, as shown by the direction and dip of the magnetic needle. "Cemented Bifocal Spectacle Lenses" were devised and descriptions published by me in 1888, and have been used all over the world since. "Why Eye-strain is such a Frequent and Powerful Cause on Reflex Systemic Diseases." "Test-cards for the Oculist, with Black Background and White Letters," were made by me in 1897. "A Mechanism of Graded Prisms, in Double Series, for Diagnosing Muscle-imbalance of the Eyes (Heterophoria) , Correlated with a Method of Treat- ing the Morbid-muscle-imbalances by Means of ' Prism-gymnas- tics'," were devised by me in 1895. "The Law of the Increase and Decrease of Body Weight as Productive of Changes in Ametropia," was set forth by me in 1897. "Periodical Medi- cal Examinations" were first advised and described by me in 1900, and again in 1904, as necessary for the scientific conduct of life. "The Origins and Relations of Righteyedness and Right- handedness and of Lefteyedness and Lef thandedness " were first set forth by me in 1904. The questions relating to the eye-strain origin of the writing posture, and the lateral spinal curvature and "the Rule of the Road" were subsequently treated. "The Eye-strain Origin of the Ill-health, Invalidism, and Inefficiency of Many Men of Genius." My contributions on this subject were begun under the title, "Biographic Clinics." Six volumes of these studies include the case-histories of the lives of more than a score of the world's great literateurs, musicians, scien- tists, etc. " Ophthalmovascular Choke." The pathogenic fac- tor is the crossing of the trunks of one or more retinal arteries or veins in such positions and manners that the blood circula- tion and supply to the macula region is lessened, and the nutri- tion so reduced, by the damming, that quickly fading image, amblyopia, and retinal exhaustion, result. Dr. J. William White (Philadelphia) (deceased): "Appendi- citis." This paper called attention for the first time, I believe, to 90 EDMOXD SOUCHOX the lesser mortality in cases of appendicitis attended by diarrhea as compared with the mortality in those cases attended by constipa- tion. "Antiseptic Surgery." This paper made public for the first time the results of a series of operative cases under the use of the double or mixed cyanide of mercury and zinc. It was an important step in the history of the development of antiseptic surgery. Lord Lister was using it in London and had given it to me confidentially. His own assistants were not at that time aware of the composition of the antiseptic he was employing. '■'Dislocation of the Tendon of the Long Head of the Biceps." This paper was the first systematic analysis, based on the clin- ical facts, of the symptoms of dislocation of the tendon of the long head of the biceps. "Use of Living Bones." This was the first time living bone was used in this country as a bond of union after excision. ''Epilepsy." The first time that local topical treatment was applied directly to the affected nerve center in cases of focal or Jacksonian epilepsy. "Fractures Ununited." I think this was the first time in which metal plates were used in cases of ununited fracture. Of this I am not certain. "Influ- enza," paper gives clinical evidence of the contagiousness of influenza and advanced a new original theory as to the effect of the enlarged bronchial lymph nodes on the pseudopneumonic symptoms of that disease. "The Supposed Curative Effect of Operations per se." was certainly the first paper in which a possible curative effect resulting from operation itself was sug- gested and studied. " Hypertrophy of the Prostate." Was the first time that orchidectomy for enlarged prostate was sug- gested to the profession. "Urethral Stricture." The first paper in which attention was called to the resistance offered to the with- drawal of bulbous bougies in normal urethra by a constriction at or near the deep layer of perineal fascia. This resistance had previously led to the erroneous diagnosis of stricture in hundreds of cases. My position was demonstrated by dissection. Dr. Charles De M. Sajotjs published first treatise on disor- ders of internal secretions ^1903) with his own theory of the same. ORIGINAL CONTRIBUTIONS OF AMERICA TO MEDICAL SCIENCES 9 1 Dr. Joseph Richardson (Philadelphia) discovered that human erythrocytes, can be distinguished with certainty from the corresponding cells of nearly all lower animals. Dr. Gwilym G. Davis (Philadelphia) was the first to start a study museum of anatomy in America. Dr. Milton J. Rosenau (Philadelphia) : Work on Anaphy- laxis; treatise on Hygiene. Philadelphia is the cradle of American Dentistry. Dr. Ross G. Harrison (Germantown) gave final proof of the neuron theory by demonstrating ameboid outgrowth of nerve fiber-spore cells in an extravital culture (1910), which he was the first to employ. SOUTH CAROLINA Dr. Joseph Glover (Charleston), 1801, was the first to remove the spleen. In 1813 he was the first to perform hysterec- tomy (through an abdominal incision ?). Dr. John King (Edisto Island), 1813-1893, was the first in a case of extra-uterine pregnancy to cut through the walls of the vagina, apply the forceps, and extract the child (1816). Dr. Benjamin B. Simmons (Charleston), 18 26-1891, was the first to operate for abscess of the brain. Dr. Robert A. Kendrick (Charleston), 1826-1891, was the first to treat fractures of the lower jaw by metallic suture. Dr. R. A. Kinloch (Charleston), in 1863, deliberately opened the belly of a wounded soldier in order to repair internal abdom- inal injuries arising from a penetrating gunshot wound; the patient recovered. He was the first to suture a fracture of the lower maxilla. Dr. W. C. Norwood (deceased, no dates) ardently advocated the employment of veratrum viride. TENNESSEE Dr. Wm. Deadrick (Athens), 1 773-1858, was the first in the world to successfully remove the lower jaw (left), 1810. 92 EDMOND SOUCHON Dr. Paul F. Eve (Nashville), 1806-1878, was the first to remove a large fibroid polypus from the base of the cranium through the hard and soft palates (1836). Meigs gives him the credit of being the first American to excise the uterus in situ. Dr. George R. Livermore (Memphis) : Discovery that qui- nin administered to patients suffering from either acute or chronic gonorrhea renders their case well-nigh incurable. "Livermore Operation for Anuria." Opening through the cor- tex and packing the pelvis of the kidney with gauze saturated with 10 per cent, ichthyol and glycerin. "Modification of Dr. Eaton's Follicular Syringe Needle." VERMONT Dr. A. D. Bush (Burlington) demonstrated by scientific observations and experiments on students that the use of tobacco produces a 10 per cent, mental deficiency. VIRGINIA Dr. William Baynham (Virginia), 1 749-1814, first operated for extra-uterine pregnancy (1790-99). Dr. John S. D. Cullen (Richmond), 183 2-1 893. Experi- mental treatment of necrosed bones with sulphuric acid. Dr. Hunter McGuire (Richmond) : In 1868 he was the first after A. Cooper to ligate the aorta for aneurysm of the iliacs. Dr. Eugene L. Opie (Staunton) : Work on pancreatic diabetes. Dr. J. Sheldon Horsley (Richmond): " Surgical Repair of Bloodvessels." A new operation for the end-to-end union of bloodvessels, together with a report of the experimental work that has been done to establish this operation. "Surgical Treat- ment of Congenital Hydrocephalus." New method for the sur- gical treatment of hydrocephalus which, briefly, consists in draining the lateral ventricle through a silver cannula for a period of weeks or months and afterward making the fistula communicate with the subarachnoid space. "Experimental Transplantation of Intestine." "The Results of Experimental ORIGINAL CONTRIBUTIONS OF AMERICA TO MEDICAL SCIENCES 93 Transplantation of Intestine, together with a New Method of Making Intestinal Union with Sutures." "Experimental Devascularization of Intestine." Attempts were made to demon- strate that several inches of the intestine could be devascularized in a dog and its nutrition taken care of by suturing the omentum carefully around it. "A New Method of Lateral Anastomosis of Bloodvessels and an Operation for the Cure of Arteriovenous Aneurysm." "Transplantation of the Anterior Temporal Artery." Occasionally defects of the cheek are exceedingly extensive and sometimes require a lining in the mouth as well as external covering. In such instances, Dr. Horsley recommends that a flap be turned up from the neck so that the skin side will line the oral cavity, and that a flap be taken from the forehead, which is supplied by the anterior temporal artery. This artery is carefully dissected out, including some surrounding tissue, and is buried under an incision leading from the origin of the artery to the site of the defect. This incision should not be too deep, as it might then injure the branches of the facial nerve. The flap should be sutured loosely so as to permit slight oozing which relieves passive hyperemia. The cause of failure with such a flap would be having too much nutrition and not too little. Dr. Robert B. Bean (Gala Water) : Branches of the sub- clavian artery differ in the two sides of the body. Peculiarities of the negro brain. There are three types of forms of ears of every group of men and women in the world. The nose form likewise may be divided into three groups throughout the world. Pecu- liarities of Filipino types. Heredity in ear forms. Law of Alter- ation in Development. Eruption of the Permanent Teeth. Six types, in pairs, the two of which resemble each other, make up the morphological units of mankind. Machine to measure outlines of the heads and faces of the living. Dr. Henry Sewall (Winchester) : Work in Physiology. WISCONSIN Dr. Erastus B. Wolcott (Milwaukee), performed the first nephrotomy (1861). 94 EDMOND SOUCHON COMMENTS The number of States which have furnished original contribu- tors is 30. The number of original contributors from all the States is approximately 415. The number of original contributions furnished by all the States is approximately 645. The number of practical contributions is approximately 90 per cent, surgical against 10 per cent, medical. The States which have furnished the largest number of orig- inal contributors are approximately: New York, 125; Pennsyl- vania, 78; Massachusetts, 32; Louisiana, 26; United States Army Corps, 25; Illinois, 21; Maryland, 20; Ohio, 12. The States which have furnished the largest original contri- butions are approximately: New York, 233; Pennsylvania, 230; Maryland, 84; Louisiana, 83; Massachusetts, 58; Illinois, 52; United States Army Corps, 38; Minnesota, 27; Ohio, 25; Ala- bama, 24; United States Public Health Service, 17; Virginia, 16; California, n; Washington City, 11. The original contributions which have been adopted by the profession are approximately: Alabama, 23; Arkansas, 1; Cali- fornia, 4; Colorado, 3; Connecticut, 11; United States Public Health Service, 18; United States Army Corps, 49; Washington City, n; Georgia, 6; Illinois, 45; Indiana, 2; Iowa, 1; Kentucky, 5; Louisiana, 42; Maryland, 57; Massachusetts, 52; Michigan, 1; Minnesota, 22; Missouri, 4; New Hampshire, 4; New York, 148; Ohio, 20; Pennsylvania, 118; South Carolina, 6; Tennessee, 2; Vermont, 1; Virginia, 8; Wisconsin, 2. The dual and plural claims to priority are: "For the Removal of the Upper Jaw:" Jameson, of Maryland, 1 778-1885; Wood, of New York, 1856; Wm. H. Kendrick, of Athens, Tenn., 1773-1858; Daniel L. Rogers, New York, 1856. "For the Resection of the Lower Jaw:" Mott, of New York, 1785-1865; Wood, of New York, 1856. "For the Removal of the Clavicle and Scapula with the Upper Extremity:" Amos Twitchell, New Hampshire, 1781- ORIGINAL CONTRIBUTIONS OR AMERICA TO MEDICAL SCIENCES 95 1850; Dixi Crosby, Dartmouth, 1801-1873; Richard Bayley, New York, 1 745-1801. "For Resection of Head of Humerus:" Edward Warren, Baltimore, 1871; John Collins Warren, Boston, 1778-1856. "For Amputation at the Shoulder-joint:" John Warren, Boston, 1753-1815; F. F. Maury, New York, 1837. "For Amputation at Ankle- joint : " S. D. Gross, Philadelphia; John S. Billings, United States Army Corps. "For Resection of Elbow-joint : " John Collins Warren, Boston, 1 778-1856; James Mann. "For Resection of Ribs for Empyema:" Warren Stone, of New Orleans, 1808-1892; and Walter, of Pittsburg, Pa. (No dates.) "For the Resection of the Great Trochanter and Head of the Femur:" Willard Parker, New York, 1800-1884; Lewis A. Sayre, New York, 1820-1900; John Rhea Barton, Lancaster, Pa., 1774- 1871; Henry J. Bigelow, Boston, 1818-1890. "For the Drilling of Bones to Wire Fractures:" Daniel Brainard; J. Kearney Rodgers, New York, 1 793-1851. "For Extension Apparatus for Fractures:" Gurdon Buck, New York, 1807-1877; Joseph K. Swift, Philadelphia, (no dates); Daniel, Georgia, 18 19. "For Strips of Plaster in Fractures:" Gurdon Buck, New York, 1807-1877; J. K. Swift, Easton, Pa.; Lewis A. Sayre, New York. "For Reduction of Dislocations by Manipulation:" Nathan Ryno Smith, New Haven, Conn., 1789-1865; Wm. W. Reid, Rochester, N. Y., 1885. "For Section of the Masseter Muscle for Ankylosis of the Lower Jaw:" James M. Carnochan, New York, 1817-1887, and Valentine Mott, New York, 1785-1865; J. W. Schmidt, New Orleans, 1842. "For the Treatment of Aneurysms by Compression:" Jona- than Wright, New Haven, Conn., 1789-1805; Warren Stone, New Orleans, La., 1808-1872; Jonathan Wright, Boston, Mass., 1847. 96 EDMOND SOUCHON "For Animal Ligatures:" Philip Syng Physick, Philadelphia, Pa., 1768-1837; Horatio G. Jameson, Baltimore, Md., 1778-1855. "For the Ligation of the Common Carotid in Continuity:" Mason Fitch Cogswell, Hartford, Conn., 1761-1830; Wright Post, New York, 1 766-1822; Amos Twitchell, New Hampshire, 1781-1850. "For the Simultaneous Ligation of the Common Carotid on Both Sides:" James M. Carnochan, New York, 1817-1887; Valentine Mott, New York, 1785-1865; Reuben D. Mussey, Baltimore, Md., 1 780-1866 (after an interval) ; Levi Lane Cooper, San Francisco, Cal., 1 833-1 902. "For the Ligation of the Subclavian Outside the Scalenes:" Wright Post, New York, 1766-1822; J. Kearney Rogers, New York, 1793-1851; Willard Parker, New York, 1800-1884. "For the Ligation of the Common Iliac:" Valentine Mott, New York, 1785-1865; Gibson, Baltimore, Md., 1788-1868; Sands, New York (no dates). "For the Ligation of the Internal Iliac:" Valentine Mott, New York, 1785-1865; Watson, New York, 1847. "For the Ligation of the External Iliac:" Valentine Mott, New York, 1785-1865; John S. Dorsey, Philadelphia, 1783-1818. "For the Ligation of the Femoral for Aneurysm:" Wright Post, New York, 1766-1822; James M. Carnochan, New York, 1817-1887. "For Ligation of the Femoral to Arrest Inflammation:" Henry Fraser Campbell, Augusta, Ga., 1824-1891; Henry M. Onderbank, New York, 18 13. "For the Removal of Polypus through the Hard Palate:" Dr. John Collins Warren, Boston, 1778-1856 (?); Dr. Paul F. Eve, Tennessee. "For Difference between Membranous Croup and Diph- theria:" Dr. Richard Bayley, New York, 1 748-1801; Dr. John Ware, Boston, 1 795-1864. "For Eye-strain as a Cause of Migraine and Systemic Dis- turbances:" S. Weir Mitchell, Philadelphia, 1832-1914; George M. Gould, Philadelphia; John Green, St. Louis, Mo. (no dates). ORIGINAL CONTRIBUTIONS OF AMERICA TO MEDICAL SCIENCES 97 "For Strabismus:" Willard Parker, New York, 1800-1884; Gibson, New York, 1842. "For Irritable Heart of Soldiers:" S. Weir Mitchell, Phila- delphia, 1833-1914; Jacob M. Da Costa, Philadelphia, 1 833-1900. "For the Radical Cure of Cancer of the Breast:" William S. Halsted, Baltimore, 1890; Willy Meyer, New York, 1894. "For the Creation of a Vesicovaginal Fistula to Cure Chronic Cystitis:" J. Marion Sims, Ala., 1813-1883; Nathan Bozeman, Montgomery, Ala., 1825-1905. "For Vaginal Hysterectomy:" Dubourg, Louisiana, 1830 (?); Levi Cooper Lane, California, 1833-1902; T. Gaillard Thomas, New York. "For Reduction of Inverted Uterus by Taxis:" Dr. James P. White, Buffalo, 1811-1881; Dr. E. Noeggarath, New York. "For Skin Grafts for Ulcer:" Dr. E. P. Hamilton, Buffalo, New York; Dr. John A. Weyth, New York. "For Non-contagiousness of Yellow Fever:" Dr. Horatio G. Jameson, Boston, 1 778-1855; Dr. Deveze, Philadelphia; Dr. Wm. Reed, United States Army Corps. Dr. Reed demonstrated it. "For the Transmission of Cancer:" Joseph Leidy, Phila- delphia; Dr. Gaylord, New York. "For Operations on Animals:" L. E. Cooper, California; W. S. Halsted, Maryland. The number of the most prominent original contributors still living is approximately 27: District of Columbia, 4; Illinois, 2; Louisiana, 6; Maryland, 2; Massachusetts, 2; Minnesota, 2; New York, 9; Ohio, 2. The original contributions that are "turning points' 1 in their line of lesser or greater magnitude are as follows: Alabama. Dr. J. Marion Sims: "Invention of the duck-bill speculum; left lateral position; cure of vesicovaginal fistula; founder of gynecology; notes on uterine surgery; first gynecolo- gical specialist; vaginal cystotomy for chronic cystitis; amputat- ing the cervix and covering the stump with mucous membrane; introduction of silver wire in surgery; instruments for the operation of vesicovaginal fistula; founder of Woman's Hospital. g 8 EDMOXD SOUCHOX Arkansas. Dr. Thibault: Anesthetic property of quinin and urea hydrochloric!. California. Dr. Samuel Elias Cooper: Course in operative surgery fn animals; operation for club-foot by cutting down all contracted parts. Dr. Levi Cooper Lane; simultaneous ligation of the two common carotids in the same patient. Colorado. Dr. Clayton Parkhill: use of plates in the treat- ment of fractures. Connecticut. Dr. Mason Smith Cogswell: ligated common carotid in its continuity. Dr. Xathan Smith: first dropped the pedicle after operating for ovarian cyst; use of bichloride of mercury. Dr. Jonathan Wright; cure of aneurysm by digital compression. Dr. Xathan Ryno Smith: reduction of hip-joint dislocation by manipulation ; Smith's anterior splint for fractures; trephined bones for osteomyelitis; suspension in the treatment of fractures. District of Columbia. United States Public Health Service: Dr. Henry R. Carter: Incubation of yellow fever in the mosquito. Dr. Rupert Blue: rat-proofing a whole large city. Dr. Charles W. Stiles: work on the hookworm. Anaphylaxis: standardiza- tion of diphtheria; cause and treatment of pellagra; discoveries on measles, typhus fever; establishment of the Hygienic Labora- torv. United States Army Medical Corps: Dr. John Jones: first book on surgery and military medicine; Dr. William Beaumont; investigation on gastric digestion. Dr. James Mann: amputation at the elbow-joint. Dr. John Shaw Billings: Index Catalogue: Johns Hopkins Hospital. L T nited States Census. Drs. Woodward. Smart, Otis, Huntington: Medical and Surgical History of the War of the Rebellion. Dr. Alfred A. Woodhull: large doses of ipecac in dysentery. Dr. George M. Sternberg: isolation of the bacillus of croupous pneumonia; Manual and Text-book of Bacteriology by an American Writer. Walter Reed: transmission of yellow fever by the mosquito only to a human subject. Drs. Reed, Vaughn and Shakespeare: transmission of typhoid fever by flies. Dr. William C. Gorgas: eradication of yellow fever and malarial fever in Havana and the Canal ORIGINAL CONTRIBUTIONS OF AMERICA TO MEDICAL SCIENCES 99 Zone. Dr. Edward B. Vedder: beriberi is caused by a deficiency in diet; emetin is a specific remedy in dysentery. Army Medical Museum and Library are turning-points. Georgia. Dr. Ely Fraser Campbell: knee-breast position for vaginal examinations. Dr. Robert Battey: oophorectomy. Illinois. Dr. Daniel Brainard: drilled bones to wire fractures. Dr. Nathan Smith Davis: founded the American Medical Association. Dr. Edmund Andrews: addition of oxygen to nitrous gas. Dr. Fenger: great educator; introduced the study of pathology in the West. Dr. Nicholas Senn: great educator of the West; treatment of fractures by ferrule; rectal insufflation of hydrogen gas; surgery of the pancreas; study on tumors. Dr. Weller Van Hook: Cure of perforation in typhoid fever. Dr. Belneld: suprapubic cystotomy for hypertrophied prostate. Dr. John B. Murphy: metallic button; end-to-end suture of arteries; proctoclysis in peritonitis; arthroplasty of joints with interposition of fat and fascia. Dr. L. L. McArthur: muscle splitting operation of the abdominal wall. Dr. Alexander H. Ferguson: closing of vesicovaginal fistula by a new method. Journal of the American Medical Association is a turning-point. American College of Surgeons also. Indiana. Dr. Bobbs: cholecystotomy. Dr. John Bell: gastrotomy for the removal of foreign bodies. Kentucky. Dr. Ephraim McDowell: ovariotomy. Dr. Walter Brashear: disarticulation at the hip-joint. Dr. Benjamin W. Dudley: trephining for epilepsy. Dr. Henry Miiller: application of fluid caustics to the body of the uterus with a mop. Louisiana. Dr. Prevost: Cesarean section in America. Dr. Dubourg: vaginal hysterectomy. Dr. Charles Luzenberg: removal of gangrenous bowel in hernia and suturing ends success- fully. Dr. John Riddell: binocular microscope. Dr. Warren Stone; resection of portion of ribs for empyema; treatment of aneurysm by digital compression on the artery. Dr. Charles J. Faget: lack of correlation between the pulse and the temper- ature in yellow fever. Dr. H. D. Schmidt: origin of the bile ducts. Dr. T. G. Richardson: anatomy with English names. IOO EDMOND SOUCHON Dr. Joseph Jones: plasmodium of malaria. Dr. J. W. Schmidt: division of masseter for ankylosis of the jaw. Dr. Andrew W. Smyth : ligation of the innominate common carotid and vertebral for subclavian aneurysm. Dr. Joseph Holt: sulphurous acid fumigation of holds of vessels. Dr. Edmond Souchon: pre- servation of anatomical dissections with permanent color of muscles, vessels, and organs; first and only dissection of a sub- clavian aneurysm of the third portion; ligation of the third portion of the axillary artery for recurrent aneurysm of the subclavian. Dr. Rudolph Matas: intrasaccular suture for aneurysm; testing of collateral circulation. Dr. Charles W. Duval: leprosy bacillus in pure culture. Dr. William H. Harris: production of pellagra in the monkey by inoculation. Dr. Maurice Couret: the fish is the host of the bacillus of leprosy. Dr. C. C. Bass and F. M. Johns: cultivation of the Plasmodium of malarial fever. Dr. Ansel M. Caine: warm ether apparatus without a flame. State of Louisiana: leprosarium. Maryland. Dr. Horatio G. Jameson: animal ligatures; removal of upper jaw. Dr. Gibson: ligation of common iliac. Dr. Edward Warren : resection of the head of the humerus. Dr. William H. Welch: discovered staphylococcus epidermidis albus; the Bacillus aerogenes capsulatus; one of the founders of the Johns Hopkins Medical School. Dr. William S. Halsted: intro- duced rubber gloves; research on the thyroid glands; radical operation for the cure of cancer of the breast; cure of inguinal hernia; ligation of the first portion of the subclavian artery; use of metallic bands to occlude arteries. The Johns Hopkins School of Medicine is a turning-point. Massachusetts. Dr. John Warren: amputation at the shoulder- joint: excision of the parotid; operation for strangulated hernia. Dj. Jacob Bigelow: self-limitation of diseases. Dr. John Collins Warren: removal of pharyngeal polypi; staphy- lorrhaphy; paracentesis; first operation under ether anesthesia; external urethrotomy; excision of elbow-joint; foundation of the Warren Museum. Dr. John Ware: characterization of croup by a fibrous membrane. Dr. John D. Fischer: invented the ORIGINAL CONTRIBUTIONS OF AMERICA TO MEDICAL SCIENCES IOI cystoscope; introduced the education of the blind in this country. Dr. Morrill Wyman: tapped the chest with a rubber tube and cannula with a suction pump attached. Dr. Henry P. Bowditch: thoracentesis. Dr. Oliver Wendell Holmes: cause of puerperal fever. Dr. Thomas G. Morton: first case of etherization for a surgical operation done in public, in a public hospital and pub- lished broadcast. Dr. N. C. Keep: use of chloroform in child- bed in this country. Dr. Henry J. Bigelow: importance of the Y-ligament in the reduction of dislocations of the hip-joint. Dr. H. D. Storer: first removed the uterus for fibroids. Dr. J. P. Maynard: introduction of collodion as a surgical dressing. Dr. Henry 0. Marcy: introduced Listerism in America. Dr. Theo- bald Smith: first experiments in immunization; parasite of tick fever; anaphylaxis; differentiation between bovine and human types of tubercle bacilli. Dr. W. F. Councilman: work on malaria. Dr. W. B. Cannon: method of observing the move- ments of the stomach and intestines by means of £-rays. Michigan. Dr. F. G. Novy: cultivated the trypanosomes. Minnesota. Dr. William J. Mayo: section of the vas deferens and end-to-end suture; vertical overlapping operation for the radical cure of umbilical hernia, cholecystotomy from below; radical operation for the relief of cancer of the rectum and recto- sigmoid; fatty fascial flap in plastic and other operations on the kidney; transgastric excision of calloused ulcer of the posterior wall of the body of the stomach; incision for lumbar exposure of the kidney. New Hampshire. Dr. Amos Twitchell: ligation of the com- mon carotid in continuity; removal of clavicle and arm. Dixi Crosby: reducing dislocations of the thumb and fingers by forced extension and pressure upon the base of the dislocated bone. New York. Dr. Wright Post: ligation of femoral for popliteal aneurysm according to the Hunterian method; ligation of common carotid in continuity; ligation of subclavian outside the scalenes. Dr. John S. Dorsey: ligation of the external iliac. Dr. Valentine Mott: ligation of the innominate; ligation of the 102 EDMOND SOUCHON common iliac; ligation of external iliac; ligation of the sub- clavian between the scalenes; ligation of both carotids simul- taneously; ligation of the right internal iliac; resection of one- half of lower jaw. Dr. J. Kearney Rodgers: wired a fractured humerus; ligation of the subclavian inside the scalenes (left); also outside the scalenes; also between the scalenes (left). Dr. Willard Parker : ligation of subclavian in its third portion ; appen- dectomy; drainage of bladder through perineum in cases of hypertrophied growth; ligation of the subclavian (left) inside the scalenes, with the common carotid and the vertebral for sub- clavian aneurysm (1864); opened and drained the bladder in cystitis. Dr. Horace Green: treatment of laryngeal troubles with the mop; a foreign body can be introduced into the larynx without producing suffocation. Dr. Erastus B. Wolcott; excision of the kidney. Dr. Alonzo Clark: introduced opium treatment in peritonitis. Dr. Gurdon Buck's extension appa- ratus for fractures; use of strips of adhesive plaster to make extension in fractures with pulley and weights. Dr. Charles Harris: removal of the thyroid gland. Dr. Gunning S. Bedford, first clinic for women. Dr. William Detmold: perforated end of bone in ununited fractures; trephined for pus in the lateral ventricles. Dr. Dorsey in 181 1 ligated the external iliac. Dr. Stearnes: ligation of internal iliac for aneurysm. Dr. James R. Wood: subperiosteal resection of lower jaw with reproduction of the bone; division of masseter. Dr. F. H. Hamilton: pub- lished a complete treatise on fractures and dislocations; skin grafting to cure ulcers. Dr. Edward R. Peaslee: drainage of peritoneal cavity for ankylosis; resection of Meckel's ganglion. Dr. William H. Van Buren: resection of a portion of each vas deferens as a substitute for castration. Dr Lewis A. Sayre: resection of the head of the femur; plaster jacket. Dr. Julius F. Miner: striped off from an ovarian cyst the extension of the pedicle instead of ligating it. Dr. Daniel L. Rogers: resection of the two upper jaws. Dr. Jameson: incision of the cervix uteri. Dr. John Rhea Barton: wired a fractured patella. Dr. S. Porr.erov White: ligation of internal iliac for gluteal aneurvsm. ORIGINAL CONTRIBUTIONS OF AMERICA TO MEDICAL SCIENCES 103 Dr. David L. Rogers: resection of the upper jaw. Dr. T. Gaillard Thomas: vaginal hysterectomy; use of gravitation in cases of prolapse of the funis; vaginal ovariotomy; first book on diseases of women. Dr. Wilson: laparotomy for intussus- ception. Dr. Jorris H. Henry: organized the ambulance service in New York. Dr. Louis Elsberg : first demonstration of the use of the laryngoscope. Dr. F. F. Maury: amputation at the shoulder- joint. Dr. Joseph 'Dwyer : intubation in place of tracheotomy; apparatus for inflating the lungs; a tube could be retained continuously in the larynx without removal for months. Dr. Charles McBurney: McBurney's point in appendicitis; hooks for the reduction of dislocated fractured heads of the humerus. Dr. Watson: ligation of the internal iliac for gluteal aneurysm. Dr. Van Buren: resection of vas deferens on both sides. Dr. George R. Fowler: decortication of lungs in case of chronic empyema. Dr. George M. Edebohls: suspension of the kidneys; decapsulization of kidney. Dr. W. W. Reid: first reduction of dislocation of hip by manipulation. Dr. Frank Hartley: intracranial neurectomy for the second and third divisions of the fifth nerve for neuralgia. Dr. Van Ingen: elevation of the foot of the bed for counter-extension in frac- tures. Dr. George M. Beard: introduction of the concept of neurasthenia. Dr. Newman: shortening of round ligaments. Dr. Outerbridge: speculum for dilatation of the cervix uteri. Dr. Gunning: interdental splint. Dr. Sabine: built a nose from a phalanx. Dr. John Baird: laparotomy for extra-uterine pregnancy. Dr. J. P. Bachelder: compressed sponges. Dr. Sass: treatment of laryngeal troubles by the spray method. Dr. John Ball: rapid and forcible dilatation of the cervix uteri with instruments. Dr. Ernest Krackowiser: demonstration of the vocal cords. Dr. Gouley: filiform whalebone guide, tunnelled catheter staff, beaked bistoury. Dr. Thomas Addis Emmett: perineal and cervix operations. Dr. Clinton Wagner: thyrotomy. Dr. Rufus P. Lincoln: removal of intrapharyngeal fibromata through the internal passages instead of after extensive pre- liminary operation. Dr. F. H. Bosworth: pioneer work in rhin- 104 EDMOND SOUCHON ology. Dr. John R. French: photographing human larynx. Dr. Austin Flint: variations of pitch elicited by percussion; demonstrated the heat production to oxidation of carbon and hydrogen. Dr. Robert F. Weir: fracture of malar bone. Dr. Robert T. Morris: wick drain. Dr. John A. Wyeth: ligation of the external carotid artery for lesions of its branches instead of ligating the common carotid; bloodless operation of the hip- joint and shoulder; arterial occlusion by cell proliferation after ligation in continuity; founding of the first Polyclinic School for Post-Graduates in America. Dr. Lewis A. Stimson: ligation of the uterine and ovarian arteries preliminary to hysterectomy for fibroids and other affections of the uterus. Dr. Robert Abbe: treatment of strictures of the esophagus by the string method; operation for trigger finger. Dr. Leonard Corning: local anesthesia with cocaine; spinal analgesia applied to animals. Dr. J. Riddle Goffe: covering the stump with peritoneal flaps after supra-vaginal hysterectomy. Dr. Emil Noeggerath: reduction of the inverted uterus by digital compression of the horns; female pelvic inflammations are due to infection by gonococci transmitted by the male. Dr. Willy Meyer: radical operation for cancer of the breast. Dr. Simon Flexner: injection of the antimeningococci into the subdural space ; discovered with Dr. Noguchi the germ of anterior poliomyelitis. Dr. Jacques Loeb : produced fecundation of the ova of some fish without the intervention of spermatozoa. Dr. Peyton Rous: transmission of a malignant growth. Dr. Meltzer: intratracheal insufflation. Dr. Alexis Carrel: preservation of life in tissues and organs outside of the body; transplantation of tissues and organs from one subject to another; thyroid gland and vascular surgery. The Rockefeller Institute is a decided turning-point. Drs. H. R. Gaylord and G. H. A. Claws inoculated rats and mice with cancer. Dr. E. L. Trudeau: open-air treatment of tuberculosis. The Carnegie foundation for the advancement of teaching is a decided turning-point. Ohio. Dr. Marmaduke B. Wright: bimanual version. Dr. George W. Crile: anoci-association; the emotions; block excision ORIGINAL CONTRIBUTIONS OF AMERICA TO MEDICAL SCIENCES 105 of lymphatic gland-bearing tissues of the neck; retrolaryngeal packing prior to removal of larynx. Pennsylvania. Dr. John Morgan and Dr. William Shippen, Jr. : foundation of the medical department of the University of Pennsylvania; Wis tar Institute of Anatomy and Biology. Dr. Thomas C. James: induction of premature labor for contracted pelvis. Dr. Philip Syng Physick: animal ligatures; tonsillotome; puncture of head for hydrocephalus; use of stomach pump; seton between the ends of ununited fractures; internal urethro- tomy; cure of artificial anus. Dr. N. Chapman: first book on Therapeutics and Internal Medicine. Dr. William Gibson: stra- bismus. Dr. Horatio Gates Jameson: resection of superior maxilla. Dr. A. H. Stevens: abnormalities of equilibrium of the ocu]ar muscular apparatus. Dr. Charles D. Meigs: embolism in childbed. Dr. Charles McClelland: resection of lower jaw in front of the two angles. Dr. Wm. E. Horner: removal of upper maxilla without incision in the cheek. Dr. Samuel D. Gross: taking the submucosa in the intestinal suture; removal of axillary glands in cancer of the breast; founder of American Surgical Association; first book on Pathology in the English language; amputation of ankle-joint; operation for artificial anus. Dr. Joseph Pan coast and Dr. S. D. Gross: limbs rendered bloodless before subjecting them to operation. Dr. Joseph Pancoast: plastic for atrophy of bladder. Dr. John Rhea Barton: Barton's fracture of the radius. Dr. William W. Gerhard and Dr. M. Rufz: connection of hydrocephalus with tubercles of the pia mater; differentiation between typhus and typhoid fever. Dr. Thomas G. Morton: ligation of subclavian between the two scalenes. Dr. Joseph Leidy: bacterial flora of the intestines; first transplantation of malignant tumors. Dr. Harris: fixation and extension in management of inflamed joints. Dr. Deveze: non-contagiousness of yellow fever. Dr. Samuel W. Gross: tenotomy of the stern orr.astoid for torticollis. Dr. S. Weir Mitchell: serpent venoms; eye-strain as cause of headaches; antagonism of morphin and atrophin; nitrite of amyl to abort epileptic attacks; rest cure. Dr. Jacob M. DaCosta: irritable 106 EDMOND SOUCHON heart; forced respiration. Dr. D. Dyer: gymnastic treatment of asthenopia. Dr. Frank J. Maury: gastrotomy for the relief of suffering caused by organic stricture of the esophagus. Dr. Pennock: rubber tube to stethoscope. Dr. Walter: resection of portions for drainage in empyema. Dr. Hunt: sand-bags in the treatment of fractures. Dr. Hugh L. Hodge : premature labor for ossification of the bones of the head; forceps; pessary. Dr. Theophilus Parvin : closing of ureterovaginal fistula by first turn- ing the displaced distal extremity of the ureter into the bladder and then closing the vaginal opening. Dr. J. Ewing Mears: laparotomy to wash out the abdomen in cases of peritonitis. Dr. Thomas G. Morton: metatarsalgia. Dr. Marks: suture of heart wound. Dr. Thomas Harris: amputation of the tongue. Dr. Albert W. Waters: laparotomy for rupture of bladder. Dr. Joseph K. Swift: extension apparatus for fractures. Dr. Benjamin Bauer: ligation en masse of the uterine and ovarian arteries preliminary to operation for hysterectomy. Drs. R. L. Dickinson and J. Lecomte: special direct suture of the sphincter muscle in perineal operations. Dr. Jarvis: hypertrophy of the turbinated bones. Dr. George M. Gould: eye-strain cause of migraine and systemic dis- turbances; cemented bifocal spectacle lenses; test cards; graded prisms. Dr. J. William White: use of living bones. Dr. Joseph Richardson: human erythrocytes can be distinguished with certainty from those of the lower animals. Dr. Gwilym G. Davis: study museum of Anatomy. Philadelphia is the cradle of American dentistry. South Carolina. Dr. Joseph Glover: removal of the spleen; hysterectomy (abdominal). Dr. Benjamin B. Simmons: abscess of the brain. Dr. R. A. Kinlock: laparotomy and intestinal suture. Tennessee. Dr. William H. Deadrick: removal of lower jaw. Dr. P. F. Eve: removal of large polypi from the base of the cranium through the hard and soft palates. Vermont. Dr. A. D. Bush: the use of tobacco produces a 10 per cent, mental deficiency. ORIGINAL CONTRIBUTIONS OF AMERICA TO MEDICAL SCIENCES 1 07 Virginia. Dr. Hunter McGuire: ligation of the aorta for aneurysm of the iliacs. Wisconsin. Dr. Erastus B. Wolcott: first nephrotomy. The total number of turning-points is 323: Alabama, 9; Arkansas, 1; California, 3; Colorado, 1; Connecticut, 8; District of Columbia, 1; United States Public Health Service, 10; United States Army Corps, 15; Georgia, 2; Illinois, 18; Indiana, 2; Kentucky, 4; Louisiana, 21; Maryland, 15; Massachusetts, 28; Michigan, 1; Minnesota, 6; New Hampshire, 2; New York, no; Ohio, 4; Pennsylvania, 58; South Carolina, 3; Tennessee, 2; Ver- mont, 1 ; Wisconsin, 1 ; in a total of 23 States. Bibliography Gross, S. D., and Bigelow, H. J.: Century of American Medicine, 1876. Kelly, H. O.: Cyclopedia of American Biography, 19 12. Garrison, F. H.: History of Medicine, 1914. Keen's Surgery, 1908. Bryant and Burt's Surgery, 191 1. Dennis, F.: New York Med. Record, 1892. Pilcher, James: Jour. Am. Med. Assn. 1876 (Supplement). COLUMBIA UNIVERSITY LIBRARIES This book is due on the date indicated below, or at the expiration of a definite period after the date of borrowing, as provided by the library rules or by special arrangement with the Librarian in charge. DATE BORROWED DATE DUE DATE BORROWJJD^rtWCjATE DUE 6r b 9 % ?QG5 " - W " iftft. CZS(842)MS0