In the interest of economy in space, it will be best, perhaps, to recount the various histor ical achievements of American surgeons with out going into further biographical details. In the department of surgery of the large blood vessels the American surgeons were almost pioneers. In 1803 Cogswell of Hartford tied the common carotid, making the first successful ligation of this vessel on record. In 1807 it was first successfully tied for secondary hem orrhage by Twitchell of Keene, thus antedating Astley Cooper's famous case by eight months. In 1813 Post of New York first tied this artery for the cure of aneurism. In 1823 MacGill of Maryland first successfully tied both carotids simultaneously, the case being one of fungus tumor in both orbits. In 1867 Carnochan of New York first tied both carotids for the treat ment of elephantiasis of the face and neck. Post, in 1817, first tied successfully the sub clavian artery in its third portion, after it had failed in the hands of some of the great English surgeons. The same artery was first tied in its first portion by Rodgers of New York, an operation hitherto considered impossible, and which was never successfully repeated until 1892, by Halsted, of Baltimore. Mott's first ligation of thiVinnominate artery has already been mentioned, an operation which made him famous all over the world. The internal iliac was first tied by Stevens in 1812, the external by Dorsey in 1811, and both internal and ex ternal by Dennis in 1886, while Davidge first tied the femoral and gluteal for the cure of elephantiasis of the lower extremity. Digital compression for the relief of aneurism was first successfully practised by Knight of New Haven in 1848. The use of the elastic bandage in the treatment of varicose veins was first successfully adopted by Martin of Boston, who preceded Estmach in the use of this expedient for controlling blood supply during amputa tions; while Wyeth recently introduced long pins for the same purpose in amputation of the shoulder and hip.
In fractures and treatment of injuries and diseases of hones and joints, Physick exceeded all men, without question. The so-called Amer ican method, which is now so widely accepted, that is, the treatment of fractures by traction with a weight and pulley, was introduced by Daniel of Georgia. Van Ingen of Schenectady added to the method the elevation of the foot of the bed, and Buck increased its value by his coaptation splints. The present universal method is, therefore, a composite of all these, but is distinctly American. So is also the use of elastic traction by the aid of rubber bands. Barton, Bond, Hamilton and Reid, the latter of Rochester, all studied assiduously the mechanism of fractures and dislocations, and described the methods for their treatment and relief. The interdental splint for the treatment of fractured jaw was also of distinctly Ameri can origin. Rodgers introduced metallic sutures in the treatment of fractures; Brainard of Chi cago, the method of drilling fragments in de layed union, while both Henry Smith of Phila delphia and Nathan Smith of New Haven did very much to improve apparatus for the reten tion of fragments in their proper place.
In the treatment of dislocations, especially in the matter of their reduction by manipula tion, the world owes a great deal to Reid and Moore of Rochester, Bigelow of Boston and Gunn of Chicago, by whose efforts it was brought about that the ponderous machinery of the clinics was completely abandoned. In the removal of diseased bones Jamieson of Balti more, in 1820, made the first resection of the upper jaw, while the upper and lowerjaws were both simultaneously removed by Rodgers of New York. The first removal of the lower jaw was by Deaderick of Tennessee in 1810. while the clavicle was first successfully re moved for necrosis by McCreary of Kentucky, in 1803, and for malignant disease by Mott in 1828, and the entire upper extremity, including the scapula and clavicle, by Crosby in 1836, and again the entire radius in the same year. Stone first removed a rib for drainage in 1862, and Mott the coccyx in 1832. Wood of New York
had a famous case of entire removal of the lower jaw with almost complete reproduction of bone. Other operations of importance on bones were the first removal of a eV' shaped piece of the hip, and also for the cure of bony anchylosis of the lower jaw. Nathan Smith of New Haven is entitled to the credit usually given Brodie for the trephining of in flamed bones for the relief of inflammation and abscess.
In the matter of amputation Richard Bailey is to be credited with the first systematic am putation of the shoulder joint, in 1762. Cros by's case of the removal of the entire extremity has already been mentioned. The first success ful amputation of the hip was made by Brash ear of Kentucky in 1806. The patient was a slave boy belonging to the monks of Saint Joseph's College. The first operation of this kind ever done was in England by Kerr in 1774; while the first done for gunshot wound was by Larrey in 1793. American surgeons also made many improvements in genitourinary surgery. The first successful plastic operation for exstro phy of the bladder was made of Philadelphia in 1858. He and other p preceded Wood and various English surgeons to whom the credit is usually given. Parker of New York introduced cystototny for the relief of chronic cystitis. The kidney was removed suc cessfully by Wolcott and by Stoddard of Mil waukee nine years before it was removed by Simon of Heidelberg, who has been credited with it. The first really successful method of operation for cleft palate was introduced by J. C. Warren of Boston, while Cheever, another Boston surgeon, was the first to remove the tonsils by external incision.
In abdominal surgery Americans have al most led the world. Had it not been for Mc Dowell's epoch-making case, in 1809, this branch of surgery would have been much re tarded. Any one practising to-day can scarcely realize the moral courage and surgical daring required during that historical incident. Atlee of Philadelphia and Kimball of Lowell were the first to successfully remove large uterine fibroids, and it is claimed that Stevens of South Carolina, as early as 1763, successfully removed the entire uterus, an operation repeated by Briggs in 1830. The first vaginal operation for extra-uterine pregnancy was made by King of South Carolina in 1813, while the abdomen was first opened for this purpose by John Baird as early as 1759. Bobbs of Indianapolis was the first to attack the gall-bladder surgically, while Willard Parker first made clear the surgical treatment of peri-appendical, or as it was then called, perityphlitic abscess. The entire eluci dation of the surgery and pathology of appen dicitis is due to Americans, especially to Fitz and McBumey. The treatment of gunshot wounds of the abdomen by abdominal section was conceived, developed and perfected in America, especially by Bull and Parkes, while Senn, Murphy and others have made valuable contributions. The first four cases of pancreatic cyst were in the hands of American surgeons. The surgery of the female genital organs owes more to the ingenuity and skill of Americans than to those of all other nationalities combined. Especially valuable in this direction were the labors of Sims and Emmet. Other procedures of distinctly American origin might be named without making the list too long; for instance, the invention of skin grafting by Dr. Frank Hamilton of Buffalo in 1854. The same pro cedure was independently instituted by Rev erdin of Geneva, Switzerland, each being inde pendent of the other. Animal ligatures were first used by Physick in 1844. The innocent character of the metallic ligature, as well as its usefulness, was first demonstrated by Levert, of Mobile. The use of plaster-of-paris splints and jackets was greatly promoted by Sayre of New York, although he was not their originator. The first abdominal section for gunshot wound of the intestines was made by Kinloch of Charleston in 1881. The discoveries and in ventions of American orthopedic surgeons have been models for the rest of the world.