sequence are, I believe, often very indifferently effected. In a short time the patient is as bad as ever, and remains so until something different from "minor surgery" is applied. Operations for nævi, for small vascular tumours, pass amongst the proceedings of minor surgery; yet how often vigorous treatment is required in such after some "minor" peddling! There is an old adage, that "fools should not play with edged tools;" but there are more dangers in surgery than from cutting instruments. I have known both forearm and leg lost by too tight bandaging for simple fracture; and I have seen a young lady's face disfigured for life by the reckless, careless use of nitric acid to destroy a nævus on the lower eyelid. It was applied so lavishly that it ran to the cheek, and did irreparable mischief.

From year to year, as I occasionally meet such tumours of the mamma as this (fig. 66), which weighed

Fig. 66.

nineteen pounds when I removed it; or like this

(fig. 67); some monster form of disease, of which you see so many specimens around [pointing to casts and drawings], which has been permitted to assume that condition by the obstinacy of the person, possibly by a persistence in dealing with charlatans, possibly from

Fig. 67.

maltreatment by surgery, I fancy that I have seen the last instance of the kind; but again and again one observes repetitions of the surgery as with the poor, cease out of the land. impression that surgery makes progress in respect of these cases, and that diseases which, if left, through ignorance or improper treatment, to run their course, and assume the monster aspect referred to, are in reality checked in early development by an improved skill in surgery, founded on scientific and practical data, which result from increasing age and experience. Here are

same, and we may say in that bad cases will never Yet withal I have a strong

two examples illustrative of these views.

In this

instance (fig. 68), through folly and charlatanry, the

Fig. 68.

patient's life was in a manner sacrificed; even amputation was of no avail. But here (fig. 69), by taking a disease of a somewhat similar kind in a much earlier stage-although the tumour (of a fibroid sort) originated in the soleus-both limb and life were saved by early local removal.

Two-thirds of a century have increased our resources in such matters; and among modern improvements for disseminating knowledge, there is none greater, in my estimation, than that practical style of public teaching which is an essential feature in every well-conducted general hospital of the present day. Private operations in large public hospitals are now in a manner eschewed;

personal friends and apprentices are not now solely the on-lookers; the days of "hole-and-corner surgery," to use the term of the greatest medical reformer of

Fig. 69.

modern times,* have passed away; practice in wards and theatres is now so patent to all that it behoves the best of us to look to such laurels as we may chance to have, and to see and show that "minor surgery' requires and deserves as much skill and attention as even the best among us can bestow upon it.

LECTURE VIII.

ON LITHOTRITY.

WHEN I lectured last year on the subject of lithotrity my chief object was to bring under notice a method of practice which in my opinion was little known. From personal experience I had learnt, that although stones might be broken ever so small, the fragments would not come away spontaneously in all instances, and that unless they were removed, patients might be left after lithotrity actually in a worse condition than if nothing had been done, with a number of stones instead of one, and consequently with a greatly increased surface for the deposit of new material. I had found out the uselessness of most of the instruments for the extraction of small calculi or of fragments, and the chief object of that lecture was to recommend small lithotrites and scoops, with a view to render the cure of stone by crushing both more precise and more rapid with lithotrites of a comparatively small size. I fancied that small stones, and particularly fragments, could be more easily attacked, and that with small scoops fragments of considerable size, or even small stones entire,