RELATIONS TO OTHER SCIENCES 469 



nose, or ear, unpleasant sensations are experienced in these parts, 

 which can only be effectually treated by attending to the systemic 

 conditions which underlie these local sensations. On the other hand, 

 actual organic lesions occurring in these parts often enough are of the 

 greatest importance for the diagnosis and proper treatment of grave 

 general diseases. To give but a few examples : paralysis of one vocal 

 cord may for a long time be the only actual sign discoverable, with 

 the means at present at our command, of aneurism of the aorta, or 

 of other mediastinal tumors, of affections in the posterior cavity of 

 the skull, of pleuritic thickening of the apex of the right lung, of 

 cancer of the gullet, and a host of other grave organic affections; cer- 

 tain laryngoscopic appearances may enable us to diagnose the exist- 

 ence of pulmonary tuberculosis at a time when all other signs fail; 

 Killian's bronchoscopy, one of the most valuable modern additions 

 to our diagnostic and therapeutic equipment, permits us to remove 

 foreign bodies from the interior of even smaller bronchial tubes - 

 chronic obstruction of the nose undoubtedly exercises a very unfav- 

 orable influence upon the general health, a fact which is most clearly 

 demonstrated by the surprising improvement of well-being which 

 follows removal of adenoid vegetations in much-developed cases 

 a cerebral abscess is nowadays known to be much more frequently 

 due than w r as suspected only a few years ago to diseases of the middle 

 ear and mastoid process, and has become infinitely more accessible 

 to treatment than one could venture to hope in previous times. I 

 may further remind you of the frequency with which the throat, nose, 

 and ear are affected in infectious diseases, such as measles, scarlet 

 fever, small-pox, typhoid, and influenza; again, of the manifestations 

 of gout, rheumatism, and syphilis in these parts, and this list could be 

 easily extended. The above examples, however, will suffice, I hope, 

 to show the intimacy of the relations between our specialties and 

 internal medicine. 



Surgery. ' If I just said that it was almost superfluous to insist on 

 the intimacy of our relations with internal medicine, this certainly 

 applies in an even higher degree to their connection with surgery, for 

 indeed they are daily becoming more and more branches of surgery 

 itself. I have on another occasion stated my own conviction that it 

 is in the nature of things, when a part of the human body has been 

 made more accessible to eye and hand by the progress of science, that 

 the treatment of affections of that part should gradually change from 

 the medical to the surgical side. So much has this been the case of 

 late with regard to the development of laryngology, otology, and 

 rhinology, that if there be any danger in its further progress it would 

 certainly not be in the direction of underrating but of over-emphasiz- 

 ing the idea that the existence of an affection of the ear, nose, and 

 throat must be invariably associated with the idea of surgical inter- 



