rise by the mistakes of others, or by climbing a ladder, every round of which is the blasted reputation of some other doctor. If you do, you will fall to the ground, no matter to what height you attain, and you will deserve the fall. If you cannot speak well of your fellows in the profession, keep silent. Let your work and not your words advertise you. Finally, keep this principle in mind always in the treatment of disease: Follow the leading of nature; this is the pole-star of successful practice. Do not claim to cure disease, but instruct the families into which you are called, as speedily as possible, concerning the relation which a true physician occupies in the management of disease. Teach them the self-limited nature of many morbid conditions, and how little curative power drugs possess. Show to them that as the pilot who is powerless to quell the storm, is still able to guide the ship to safety, so the skillful physician prevents the wreck of human life, as he carefully watches the progress of disease, guarding against the approach of death at this point, and at the other shutting a sluice-way from which life is in danger of escaping. If you know anything about the case you are treating, be not afraid to instruct and make plain to all interested the nature of the departure from the physiological condition, and the course you intend to pursue to bring this pathological state back to the condition of health. "Be instant in season and out of season to impress this truth on the minds of men—that it is impossible for the doctor to give health to those who are daily transgressing the laws of being, and still more impossible to make strong and perfect bodies for such as are reeking in the consequences of the sins of gener ations before them. This leads us to speak of the preventive medication, or the preventive practice of the future. It is my desire that every graduate from this institution shall constitute himself a committee of one to labor most heartily to bring in the glorious day when it shall be the duty of the physician to keep the people in health, rather than restore to health the sick. Not only must you study with your microscope the secretions of the body, but the air your patients breathe, the food they eat, the water they drink, and even the paper on the walls where they live. The doctor of to-day should know as much about the relations of sewer-traps as of stethoscopes, and labor more earnestly to prevent epidemics than to suppress them. Finally, gentlemen, you must labor in the practice of your profession as you have in the attaining of it. Remember the true physician is first learned, then brave, next generous, chaste and pious-without these ad eundem qualifications, your degree will be of little worth; but, if you add to your knowledge virtue, and unite temperance, chastity and faith, then, when it is said, as it will one day be said of each of you, "Doctor is dead," may the same sweet influence gather about your names as to-day adorns the memory of the great and good man who welcomed you in the beginning of your professional career, but who, before you received the honors of this evening, had himself taken, at the hand of the Almighty and All-glorious Chancellor of the Universe, the last and highest degree attainable— that of a just man made perfect in the Kingdom of our God. The crowning glory of Professor Charles C. F. Gay was not his professional skill, which was acknowledged; but his most kind and loving bearing towards his professional brethren. When at last the purple current curdles in your veins; when your hearts cease to beat, and you gather up your feet to die,—may those who knew you best mourn you most deeply, and this be said of each of you: "He was a wise, skillful and conscientious physician.” ELEPHANTIASIS OF THE HAND-AMPUTATION-RECOVERY. Physician to the Erie County Penitentiary, Buffalo, N. Y. Elephantiasis is one of the rarest of lesions observed by American physicians. A few cases are occasionally reported in ! our medical journals, and are looked upon as curiosities. In India and some other tropical countries, however, the disease is not rare. Hirsch, in his Pathologie Hist.-Geograph., mentions a district in India where, among 486,000 inhabitants, 2,133 individuals, or 41⁄2 per cent. of the population, were affected with elephantiasis. In the great majority of cases, the lower extremities, or genitalia, are affected. Many writers describe only two varieties of the disease-elephantiasis cruris and elephantiasis genitalium. On the other hand, Rokitansky, Kaposi and Hebra have described elephantiatic enlargement in other locations-the cheek, nose, hand and arm. In these cases, where a great number of blood vessels have been observed in the swelling, the disease has been denominated telangiectatic elephantiasis. In these cases, according to Geber, the filaria sanguinis is not necessarily present. The diagnosis is made (1) from the great hypertrophy of the tissues; (2) diminution or destruction of sensation and motion; (3) pale, shiny appearance of skin, with exudation of milky lymph; (4) the clinical history-the disease is usually preceded by nervous disturbances, followed by erysipeloid inflammation and progressive enlargement of the superficial tissues, with marked changes in the lymphatic system; (5) in tropical climates the filaria sanguinis hominis is usually found, but that this is the case in temperate regions is by no means demonstrated. In regard to treatment, amputation or excision were among the earliest methods adopted in the East. When the genitalia were affected, a complete cure was often obtained, but the result was generally unfavorable when the leg was amputated. Some died of pyæmia, others survived the operation, but there was a recurrence of the disease. Surgeons who believed the hypertrophy to be due to an excessive blood supply have ligated the femoral or iliac artery. Of 69 cases treated in this way, 40 recovered, thirteen improved, and the condition remained unchanged in 16. Others regarding the affection as a nutritive disturbance have attacked the sciatic nerve instead of the blood vessels. Martin reported a case successfully treated in this manner. Muncorvo, of Rio Janeiro, obtained some success in the treatment of these cases by electrolysis. The case which we are about to report presents all the characteristic symptoms of elephantiasis, excepting the presence of the embryonal filaria in the blood. Repeated searches were made for these by competent microscopists, but always with a negative result. Charles F. A., aged 26, of English parentage, entered the Erie County Penitentiary June 25, 1885. About one month after his admission, there was a sudden loss of sensation in the right hand, followed by motor disturbances and enlargement. His condition steadily grew worse until December. At this time erysipelas, involving the hand and forearm, occurred, lasting about a week. As the erysipelas subsided there was a slight increase of sensation and motion. The hypertrophy, however, increased, and sensation again disappeared. Jan. 1, 1886, the patient began to have epileptiform convulsions, lasting from five to eight minutes, and attended with tonic spasms of the legs and arms. The convulsions usually appeared about sunset, occurring at intervals during several hours. Bromide and other antispasmodics were given to ward off these attacks, but without any apparent beneficial result, for the convulsions only increased in frequency and severity. The kneejoint became affected. For many days all power of motion was lost, although there was no inflammation or swelling. The hand was now enormously enlarged, the integument presenting a shining white appearance, from which a milky lymph at times exuded, and the structural changes were so great that amputation seemed to be the only feasible means of arresting the progress of the disease. The hand had become a burden to its owner, and he earnestly requested that the operation be performed. Drs. Park and Tremaine were consulted, and considered the operation proposed perfectly justifiable, since all the ordinary therapeutic measures had been tried in vain. Antisyphilitic treatment, arsenic, tonics, bandaging and electrolysis had all been equally unsatisfactory, and it was deemed too late to attempt nerve stretching or neurotomy, as advocated by some authors, or ligation of the brachial artery, since this would almost necessarily produce sloughing and gangrene. On Feb. 22d, with the assistance of Drs. Campbell, Clark, Thornton and Baker, I amputated the arm at the insertion of the deltoid muscle. Esmarch's bandage was used, and circular |