should be of the outer dressings only. And the reasons for this treatment are that in such burns "the serum which is thrown out is germicidal, and is destroying all the bacteria upon the skin very rapidly. This germicidal action will go on so long as the serous exudation is free, but when the coagulation of lymph begins on the surface, this action becomes very much diminished, and the bacteria are then liable to liquefy the lymph and grow very rapidly, as new portions of serum are thrown out. This leads to sepsis and sometimes to the formation of thrombi, with necrosis of the duodenum and perforating ulcer. The patient's friends complain if the dressings are left long in place, and yet I know of no wounds which do so well when ' neglected' as burns."

In the discussion that followed, the author, being asked what he would do with suppurating sinuses, said "he knew of sinuses that had been kept open week after week and month after month, and had proved veritable gold lodes to the surgeons. If the surgeon had been compelled to go away for a time, these sinuses would have healed long before they did. This might seem like a joke, but it was a fact with which he was brought face to face all the time. His rule was to leave sinuses alone, in the belief that the poorly fed granulations lining them would in time cause approximation of the walls, and healing would occur. It was true that exceptions would have to be made for some sinuses, but that did not affect the rule as given."

Such considerations give accentuation to the dictum of Velpeau, that "nature is a good physician but a bad surgeon," and dignify the bon mot of Holmes, who, seeing the smoothly healed and finely cushioned stump which resulted in time after an amputation, exclaimed:

For the surgeon's far more than the physician's successes depend upon the vis medicatrix naturæ, and he who is best versed in physiological and pathological processes, and administers the surgical art accordingly, will secure the best results.

They who neglect their surgical cases from ignorance, carelessness, or a wanton disregard of the great pathological dicta of the day, can find no justification in these teachings, for the truth, as embodied in the author's closing words, puts all such to shame and confusion: “A good deal of skill is required in order to neglect wounds well. This 'neglect' of course implies a proper understanding of the processes with which one is dealing."

Obituary.

DR. J. Q. A. STEWART.

On the 25th ultimo this accomplished physician and estimable gentleman died at his home in Farmdale, Ky. He had been in failing health for something more than a year. His ailment was Bright's disease, and the end was precipitated by uremia.

Dr. Stewart was born near Louisville, Ky., in 1829. In 1849, having secured a good common school education, and graduating in law, he went to the gold fields of California, where he sojourned for seven or eight years. Returning to his native State, he entered upon the study of medicine, and graduated from the Kentucky School of Medicine in 1859. He began practice in Daviess County, Ky., but after a few years moved to Owensboro, where a larger field of usefulness and fuller success awaited him.

In 1878 Dr. Stewart was called by Governor John B. McCreary to the position of Medical Superintendent of the Kentucky Institution for the Training of Feeble-Minded Children. It was here that the chief work of his life was done. And it was here that he served humanity and the State with honor, with ability, with fidelity, and with an earnest, self-sacrificing devotion to the welfare of these rejected waifs of humanity which entitles him to place and rank among the higher philanthropists of our philanthropic profession.

In the care of the feeble-minded Dr. Stewart added to his executive work the habits of a careful student, and became one of the best known alienists of the land. His address as retiring President of the Kentucky State Medical Society in 1894 was an able and scholarly treatise upon the management of the feeble-minded. It was received with great favor by the Fellows, and has since been the subject of high encomiums from doctors, lawyers, and political economists.

After sixteen years of State service Dr. Stewart purchased the old Kentucky Military Institute near Frankfort, where he established the Stewart Home for the Feeble-Minded." The venture was successful beyond expectation, and here in the bosom of his family he passed serenely and blissfully the closing years of his gentle, useful, and beautiful life.

Notes and Queries.

THE SURGERY OF THE THYROID FROM A NEUROLOGIC STANDPOINT.In a suggestively written paper in the January number of the American Journal of the Medical Sciences, Dr. J. J. Putnam uses the following words: "We are rather in the habit of assuming that the removal of large portions of the thyroid does no harm, provided it does not cause myxedema. But the probability is that we shall learn to recognize affections which lie between myxedema and health, as well as peculiarities of development and disorders of nutrition for which the thyroid is more or less responsible." . . . That this is a statement of fact will hardly be disputed by any neurologist, but that it expresses a truth that has as yet been insufficiently impressed on the profession generally is another fact the importance of which is not likely to be overestimated. It is only within a comparatively brief period that we have learned that the thyroid had any definite function and our knowledge of its physiology is still very far from being exhaustive. The dangers also of interference with it are as yet also only partially known, but it is certain that they are not confined to the operation itself. The cases of sudden fatal dyspnea occurring hours after an apparently prosperous operation in Graves' disease, recently reported by Debove and others, are in evidence of this, and Dr. Putnam adduces other important facts and arguments against any too venturesome surgery of the thyroid gland. Among these are the experiments of Halsted, showing that excision of the gland in dogs had a serious and very evident disturbing effect upon their offspring, and that even very slight operative interference produced hypertrophic changes and apparent increase of secretion in the gland itself; and the observations of Kocher of goiter and cretinism inherited from parents with no disease other than impaired thyroid function are also cases in point. Still another fact brought forward by Putnam is the one that removal or atrophy of the thyroid in infancy checks the growth and function of the reproductive organs, and gives rise to the various disturbances of development that follow the suppression of this very important function. The close relations of the various internally secreting glands, the thyroid, the testicles and ovaries, the suprarenal glands, and the pituitary body, for this it seems probable must be included in this category, are revealed in many pathologic conditions, and the thyroid as the largest, and presumably the most important, has apparently a larger part in the disturbances than any of the others. It seems to be involved to some extent in many cases of acromegaly; its relations with the genital development have already been mentioned, and its implication in many pathologic conditions of organs is probable and is strongly suggested by

the clinical history in certain cases of Graves' disease. Seeligmann has indeed recently reported a case of this affection apparently closely associated with genital disorder in which he obtained decided benefit from the administration of ovarian extract, thus adding another suggestion to the therapeutics of the disorder.

When any organ is removed, as Putnam says, two factors are set in operation which may have more or less important effects upon the system generally. One of these is the action of toxins, the other is the effort of the organism to adapt itself to the new and changed conditions. The first of these is important enough in the case of removal of the thyroid gland, but the other, from what we are beginning to know of its physiology, must be even more important. Because the function of the organ is already deranged, it does not necessarily follow that matters will be remedied by its removal. The operation may only make a bad matter worse. The mortality of thyroidectomy, according to Poncet, is from fifteen to thirty per cent, which is alone enough to induce caution. When the facts brought forward by Dr. Putnam are also considered, the known and the possible and hinted though yet unknown effects of thyroid ablation, there is still more reason for prudence and hesitancy in this operation.

Of course when a goiter has become a dangerous mechanical embarrassment to important functions, or when a tumor exists in the thyroid that by its growth and situation has become a threatening danger, the case is clear, and operation may not only be justifiable but necessary. It is in such affections as Graves' disease, in which thyroid operations are still somewhat popular, that we are likely to have not only useless but dangerous surgery, and the time seems to have come to emphasize the cautions implied in Dr. Putnam's paper. The theory of hyperthyroidization in this disease, though it has apparently much in its favor, is not yet sufficiently demonstrated, and even were it so, would not form a justification for any indiscriminate or frequent practice of operative interference. Graves' disease is not by any means a hopeless disorder under medical treatment, even in its advanced stages; it is therefore impossible to say when surgery is indicated as a last resort. When the facts of its absolute inefficiency in perhaps the larger proportion of instances in which it has been tried, the immediate dangers of the operation which are not slight, and the remote ones pointed out by Dr. Putnam, are all taken into consideration, it would seem that it ought to be relegated to innocuous desuetude.-Journal of the American Medical Association.

THE TREATMENT AND PROGNOSIS IN Graves' DISEASE. This short article is prepared solely with the view of eliciting from medical men who have met with cases of exophthalmic goiter in their practice, the results of their observations regarding many points of interest in connection with this curious disease. I do not intend to give a systematic description of the affection in question. This can be found in any good modern text-book.