All

and usefulness of the limb or body afterwards. these, and many other things, might be brought attractively and usefully under the notice of pupils,-for it

must ever be borne in mind that they are intended wholly for pupils. In contrast to this, I shall tell how

T

I have seen an hospital surgeon conduct himself. He has entered the theatre, addressed himself to his work, got it over to the best of his power,—that is, as best he could,-washed his hands (perhaps not), regaled himself with a snuff, nodded, winked here and there, and shaken hands with an acquaintance or two; then gone on with another case in a similar manner, and finally left the theatre without any indication of consciousness that pupils have been present!

Some may deem all these things unworthy of special notice. My own impression is that they are of considerable importance. To be a teacher is one of the attributes of a modern hospital surgeon. His general usefulness in the hospital will depend greatly on his powers of giving good instruction to pupils; and of this I am certain, that much of his own success in life will depend upon the manner he acquits himself at his public post.

Simplicity in regard to the performance of operations is important. All ostentation, excepting the demonstrations to pupils, should be avoided. It is ridiculous to see an old hospital surgeon hold a stone above his head, still clutched in the forceps as he has just taken it from the bladder. It looks as if, in his estimation, such a thing had never been done before, or as if he had never done the like, and gives the impression, too, that he considers the extraction of the stone as the grandest thing in all his management of the case. Now, whilst I consider lithotomy, when well performed, as one of the finest of the surgeon's opportunities for

displaying operative skill, I look upon the mere extraction of the stone as only one step-a great one, certainly -in the treatment of the case; but it is unworthy the character of a first-class surgeon to show special exultation at this particular crisis. Better that the stone should be quietly laid aside until the patient is taken to bed, and that the operator should address himself to the wound, instead of flaunting his trophy over his head, with his back still to the onlookers. Part of Hamlet's advice to the players might, with some slight modification, be appropriately given to such surgeons:—

"Suit the word to the action,

The action to the word,

Nor saw the air with your hand."

Next to good demeanour on the surgeon's part, I place that of his assistant. The best of operators may make but indifferent work if he is ill supported by those near him; but the manner of the assistant is, in truth, a tolerable criterion of the skill of the principal. He cannot always have the same, and he will generally be aided in accordance with the instructions which he lays down beforehand. Assistants, like principals, vary much in quality. Whatever responsibility may be put upon them, I always consider that the surgeon has the chief. When errors or failures happen, they depend almost invariably upon the surgeon himself; and I have never felt much sympathy with any one who has attempted to lay blame on those near him to excuse some bungling or blunder of his own. For my part, I

have had much reason to be satisfied with the efficiency of my assistants; and if I had fault to find, it has been with some outsiders, who have stood in need of the Harrow School custom of having their trousers-pockets sewed up, in order to let their hands be loose and ready for the work before them.

Simplicity of instruments I take to be a good indication of an operator's skill. Even in the most complicated proceedings few comparatively are required; and the best operators I have seen have invariably trusted more to head and hands than to a great number and variety of articles from a surgical armamentarium. Surgeons will always hold varieties of opinion as to number, shape, size, and other features regarding the instruments they like to use. But in an indifferent hand the best instruments will fail; and the trite and homely saying, that a bad reaper never has a good sickle, is, with due modification, equally applicable to the surgeon who has not the proper use of his hands. In these observations it may be noticed that almost everything I have said has reference to forethought and prearrangement with regard to surgical operations. It is often a test of a surgeon's worth when he is called upon to give an opinion upon a case just as it is first brought before him. To form his opinion, give it, and act upon it, comprises the principles and practice of surgery as regards that case. At a glance, it seems as if there were nothing preliminary in all this; but, in reality, the man's whole knowledge and experience have in a manner constituted the prearrangements for the appli

cation of his skill under the circumstances. It is seldom, indeed, that a surgeon is called upon to operate at a moment's notice. Generally he has hours, days, or months to think upon what may be required. Now, it seems to me unpardonable that there should be serious neglect when there is full time to prepare. I have heard of a surgeon being called to the country to perform lithotomy who, when about to see his patient, asked the village practitioner "if he happened to have any lithotomy instruments by him," having neglected to bring his own! It is not difficult to understand how a gentleman of this stamp has, with even large opportunities, made but an indifferent figure in the surgical world.

There is scarcely a thing done in our social relations in which forethought and pre-arrangement are not absolutely requisite. Much of our comfort in life, our meals, our meetings, our business transactions, are all so regulated. What spectacle, from "Punch" to a grand review, does not depend upon these? What great battle has ever been fought on chance? A great surgeon has been not inaptly compared with a great general: both have to do largely with human life. A battle, if one there must be, is a grand crisis with the soldier. An operation, if one cannot be avoided, is a grand crisis with the surgeon. What would we think of a general who went into battle without pre-arrangement, and what should we think of a surgeon who neglectfully stumbles unprepared upon his crisis? These observations are not made without reasonable grounds. There