INTBODUCTION. 5 



not to refrain entirely from active measures. The result of his 

 decision will afford a good test and gauge of the extent to which 

 he has profited by his clinical and theoretical study. He is a 

 soimd philosopher who can wisely determine when to let alone, in 

 opposition to the temptation to do something. 



The acquisition of manual dexterity is an accomplishment of 

 prime importance and should be acquired, and can only be earned 

 by diligent practice upon the cadaver, or, what perhaps is more 

 effectual, besides being in itself real work, by utilizing every op- 

 portunity of performing minor operations, under suitable instruc- 

 tion, upon actual patients. Of course, expertness without practice 

 is impossible. It is not fully correct, perhaps, to speak of tnanual 

 dexterity in the singular number. The dexterity required should 

 be bi-manual or ambi-dexterity, and any surgeon who has not 

 mastered the art of using both hands indifferently, though he may 

 have learned all else pertaining to his profession, lacks yet one 

 thing. Cases will continually arise in which the inability to change 

 hands may interrupt the progress of an operation and involve the 

 practitioner in great inconvenience, if not embarrassment, and 

 possibly prejudice the case itself. 



Courage and coolness, with patience, are essential qualities of 

 temper in an operating siirgeon. To become alarmed and lose his 

 balance on the occurrence of some untoward incident, or the ap- 

 pearance of some unlooked-for abnormal development or compli- 

 cation, or to give way to a spirit of impatience because of unex- 

 pected delays, or, especially, to resent the fractious movements of 

 the suffering animal, writhing under the knife or the glowing 

 cautery, is both unprofessional and unmanly. The terms cour- 

 age, coolness, patience and kiudness shoidd describe his state of 

 mind while operating. 



The whole axiom of Asclepiades, cito, tuto and Juctmde, re- 

 veals the entire scheme of conduct proper for the surgeon under 

 all circumstances. Every movement of the surgeon should be 

 prompt and precise. -Indeed, by operating rapidly he shortens 

 the duration, and consequently the sum of the inevitable pain, 

 and thus diminishes the anguish of a long and torturiug mfliction 

 on behalf of the patient. The maintenance of his own self-possession 

 will make him master of the situation, and assure a neat and ar- 

 tistic finish to his task, with no unnecessary divisions of tissues, 

 no mistaking of localities, and generally with no betrayals of 



