bronchial tubes and thus to operate upon the lungs and pleura. Not long ago the diseases of the brain and spinal cord were beyond the reach of surgery but they are now attacked with no inconsiderable measure of success, although we must admit that in this branch of our work we have had many disappointments, mainly, perhaps, because diagnosis has here not kept pace with surgical requirements. And of the other great organs of the body we have said enough. Surely operative surgery had not reached finality thirty years ago, and surely we may look to the future for an evolution not less wonderful than that of the past.
But, gentlemen, there are few gains which carry no losses in their train. When we speak of our triumphs and our hopes let us not forget our perils and our pitfalls, and let us pause for one moment to ask ourselves what may be the greatest dangers of modern surgery.
In the first place we have perhaps a tendency to operate too readily, and without due care for preliminary diagnosis. Doubtless it is better to "look and see" than to "wait and see," but it is better still to look with the clearest possible certainty of what we look for. Haphazard explorations and operations undertaken because "something must be done" are a moral crime from which we are perhaps not altogether exempt. The very safety of surgery tends to diminish the sense of responsibility with which such operations are undertaken. The fact that in so many cases an operation is performed with ultimate recovery may also make us lose sight of the fact that recovery might have occurred without the operation, and that the latter is not in itself a good or a desirable thing even in the 20th century. At the outset of your career, gentlemen, I would beg of you always to ask yourselves before operating, "Is this necessary?" and to remember that unless you can answer