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The Evolution of Surgery.

such cases were operated upon: in 1908 we operated upon 92. The liver and its ducts are not mentioned in the registers of 1883: in 1908 there were 52 operations for such painful and dangerous conditions as gall stones and other affections of these organs. The thyroid gland, whose swellings constitute so great a source of disfigurement, of general ill-health, and of fatal pressure, was equally neglected in the early period, while 27 cases were operated upon in 1908.

True you may say the fact that we operate does not prove that we cure, but I could show you, were it not that I should weary you with details, how, in every case the safety of the operations themselves has also increased. As an illustration we will take a single instance. In 1883 there were removed 29 cancers of the breast, and of the patients 3, or say ten per cent., died: in 1908 we removed 62, by a far more radical method giving far better ultimate results, and we had no deaths at all.

I hope I have succeeded then in showing you by these figures—figures eloquent in themselves however ineloquently presented—the gain in the saving of life and in the removal of causes of life-long suffering.

Let us next see what has been done as regards the saving of limbs. In a great manufacturing centre like ours there are constantly occurring severe accidents, some of which will always necessitate the amputation of damaged limbs, while amputation has also to be resorted to as the only hope of saving life in some incurable diseases. So common were such cases in the recent past that many people still regard a surgeon as a man "who cuts off legs." But yearly he is becoming more and more a man who prevents the necessity for cutting off legs. In 1883 one-sixth of all the operations performed were amputations, and of these again one-sixth died. In 1908 only one operation in fifty was an amputation, and the death-rate had fallen to one in twenty-five, so