William Fergusson
1872 The Lancet  
GENTLEMEN,-In commencing the business of the Surgical Section of the meeting of the British Medical Association for the year 1872, and on assuming the position of your chairman, it may be naturally expected that I shall begin our special business by an address appropriate to the work which we now inaugurate. It would indeed, in my opinion, be a great defect were such a ceremonious beginning neglected ; but it would be equally inappropriate were one in my position to offer you any semblance to
more » ... any semblance to those addresses in surgery to which we have been so long accustomed, from those who have been specially appointed to deliver them at each annual meeting. At our present concourse the Address in Surgery is to be given by one of the foremost of our surgical brethren of the day, Mr. Oliver Pemberton, whose name, as a pathologist and practical surgeon, is known wherever the history of modern surgery extends. It would, therefore, be as unbecoming as uncalled for were anyone in my position to encroach upon the duties which belong to , , a gentleman so thoroughly able to do all that has been asked of him by our Association; more particularly as most, if not all, of us are honoured visitors in that town where his laurels have been won, his fame is sacredly cherished, and his fortunes are centred. There seems little before me then, gentlemen, than to express my sincere appreciation of the honour conferred upon me by the authorities of our Association in offering me the chair which I now assume. It is assuredly the foremost place which the British Medical Association could offer to one in my special department ; it is, in addition, an expression of kind and brotherly love, which I accept with the same heartiness with which it has been offered. I am sure that I shall not be trespassing on our friend Pemberton's department, when I offer such of you as mean to devote your energies to our Surgical section, a presidential congratulation on the work you are about to undertake. It would be invidious in us to draw distinctions as to the merits of our different sections; but all of us here, devoted as we are to surgery, must feel that we are assembled on a noble occasion, where we can interchange thought and speech in our great department of the healing art, and when each and all can, with becoming grace, show what the last twelve months have added to the progress of the profession in which we are so deeply interested. As your president, I cannot but anticipate that a choice I .repast of information is before us, and I cannot doubt that, like true searchers after knowledge, you are eager that the flood-gates should be opened at once, to permit the ready How of the streams which have been in a manner pent up during the last year. it 1 na.d not ilad a predilection for surgery, gentlemen, I should not now have been in this chair; and I am sure that my fellow sectional presidents cannot take offence when I congratulate you on your choice of department or section in our profession. The grandest feature of surgery is precision. In our present knowledge, and I fear it ever must be, there are doubts, hesitations, and great imperfections; yet there are accumulated stores of facts which may justly make us proud of our profession. A history of surgery would be as inappropriate from this chair as an interference with the yearly address; yet a brief glance at the results of the course of surgery during somewhat more than a generation by one like myself, who for more than forty years has been devoted heart and soul to the subject, may possibly fill the measure of expectation on the present occasion. In my younger days, the surgeon had few sources of alarm greater than that of inflammation of veins, phlebitis as the term went, Abernethy had added greatly to his re-putation by his celebrated essay on the occasional evil consequences of the operation of venesection. Every good surgeon did his best, by suggestion and action, to prevent injury to veins during operations ; above all, we were restricted from putting ligatures on veins, such a step being deemed wellnigh fatal, although there was ample proof that some thirty or forty years further back our predecessors were by no means nice in excluding veins from nooses which were intended for arteries chiefly. It is doubtful if their operations were less successful than ours. At all events, we have so far changed in regard to the probabilities of phlebitis, that we, in the present day, think as little of applying ligatures to veins as to arteries, when there seems need, and we take all sorts of rough liberties with them when in a, varicose state. True, we have a modern bugbear in the shape of pysemia, for which the veins are greatly blamed, a disease about which there prevails more questionable physiology than common sense should admit. This subject is closely allied with what was called secondary deposit in former times, and this last-named condition was itself closely allied with Hunter's views and theories regarding inflammation. Any one who is watching the spirit of the times must see that there are strange views afloat regarding Hunterian doctrines, which seem totally to ignore our great surgical philosopher-most notably in this respect, that what Hunter thought was developed by Nature from within, is now alleged to have origin in external influences and agencies which have no dependence on what has heretofore been considered life and life-like action within the frame. Gentlemen, there must ever be theories in surgery as in medicine, and when these are propounded by men of undoubted character and consideration, it behoves us all to wait cautiously to see the influence of time in the development of facts for or against what may be called the fashionable doctrines of the day. But, gentlemen, as I have said, one of the grandest features in surgery is its precision. This applies more to the art than to the science of our department, and one fact is worth a volume of theory. That a new operation has been added to our list of operations-that at the ankle, as developed by Syme and Pirogoff, is a fact that surgery may justly be proud of. As much may be said regarding ampution at the knee, the most recent and greatest stimulus having been given in that direction by one of the foremost of British surgeons, our respected member, Mr. Carden, of Worcester. I maintain it as a fact, that even amputation itself, the direst of all surgical operations, has been largely superseded by more judicious methods of treatment. It seems a fact, that statistics of amputations are no longer so fashionable as they once were, because it has been proved by fact that a more limited use of the long knife might have greatly diminished the numbers of those operations which have been justly called the opprobria of surgery. When ovariotomy was first propounded, it was little else than a theory-a rash visionary scheme for notoriety; but, thanks to the well-directed efforts of Brown, Wells, Keith, ! and a host of others, the proceeding is a well established , fact, which ranks among the best and safest efforts in survery to save human life. Ansesthesta is another fact in modern surgery ; perhaps, in reality, the most surprising of all. We are often told that the facts in real life are more surprising than those which the novelist delights to depict in fiction ; and, in my opinion, the fact of ansesthesia, by whatever means it is brought about, by far surpasses all that has yet been done in regard to practical surgery. Gentlemen, my mind has perhaps been naturally inclined to refer to " facts " on the present occasion, from the circumstance that, in my own professional career, I have been always more influenced by facts than by suppositions or questionable agencies; by the positive than by the speculative. I fear that it must be admitted that, despite all the skill of medicine from the earliest times to the present, the disease stone in the bladder must still be admitted as one of the "ills which flesh is heir to" as a fact. We know it, however, as a fact, that our skill is such that we can combat that fact, and even assume the supremacy by surgically doing away with it. It is a matter of theory whether or not we can combat successfully with a diathesis to stone; but it is a matter of fact that we can combat manfully, aye, even successfully, with that painful enemy, when he once
doi:10.1016/s0140-6736(02)52191-7 fatcat:jhsmysc6bjbcvgrxepc2x2bqdi