Address in Surgery
Authors: W. Cadge
Journal: BMJ (1874)

by the favour and at the suggestion of my local friends, and with the approval of the Council of this Association, I was chosen to address you to-day, I accepted the honourable responsibility, and, in doing do, took counsel rather of my vanity than of my discretion.To some, whose menital activity is great, and whose pen moves glibly, the opportunity would be esteemed, as indeed it is, a golden one.To me, with unready thouglhts and with unpractised pen, who delight rather in reflection and contemplation than in speech or written words, the honour was-I may as well confess it-more oppressive than pleasing.Having, however, accepted the duty, I shall perhaps best explaini, I may almost say apologise for, the scope and object of my address, if I recount the thoughts which passed through my minid while in quest of a subject.A retrospect of Surgery compassing the time during which I have been in active work came first to mind; but this has been so often, so ably, and so recently done, that the intention was dismissed almost as soon as it presented itself.I turned next to the records of my own ex- perience, feeling sure that these must contain materials enough, if plio- perly set forth, to furnish an hour of interestinig commentary buLt, though, on looking througlh my notes, I found instructive illustrationis of disease and curious and important cases in abundance, they seemed to display no special features, either of pathology or of treatmi-ent, worthy to occupy such an audience.The novelties of surgical practice initroduced during the last year or two are scarcely sufficient or scarcely important eniougIh to constitute a theme.They are chiefly comprised in Esmarch's bloodless system of operating and Dittel's elastic ligature ; concerning which I will only say that the first is not a novelty, having been practised by one of our mem- bers many years ago, and that the second is, in my opinion, more curious than useful, and not worthy of a place either in the records or in the practice of surgery.One great subject there is, wlhich, if not exactly a novelty, is of recent time, and is still waiting for a solution, both as to its facts and as to the theories held to account for its facts ; I mean the germ-theory of putre- faction and antiseptic surgery.This subject, for I associate them, I deem to be of surpassing importance and interest.Underlying, if not undermining, much of the existing fabric of surgical pathology and practice, it cannot be too often brought to the bar of professiolnal criti- cism; for on its right solution, whether it be true or not, depend a multitude of points in daily practice, and even probably the lives of many of our fellow-creatures.This subject would certainly have been my choice but for two considerations.AMore than one influential mem- ber of the medical press proposed, at the commencement of the year, to make and carry out a full investigation of the entire question-a pro- posal which, however, still remains for fulfilment ; and I felt moreover that, in our sectional meetings, papers by most competent men would probably be forthcoming, and would lead to searchinig discussion.Turning, then, from these topics, my thoughts reverted towardshome, and fixed themselves on that subject which for every Norfolk surgeon possesses an undying interest, and which for all practitioners, from some point of view, may be presumed to have considerable attraction.The city in which we are now gathered is the centre of a district in which cases of renal and vesical calculus are supposed to be, and probably are, more frequent than in any other part of the world.The explanation of this frequency is so often demanded of one, both in professional and in non-professional society, and is so difficult to give, that I propose to discuss the subject from this point of view, and this alone, not touching, except incidentally, on the question of treatment, about which over much has already been writteni.I propose further to narrow the ques- tion by limiting it to one form of stone ; viz., that composed of lithic acid and its salts, which I need not say constitutes at least five-sixths, or more probably, so far as this district is concerned, niearly nine-tenths of all primary formations.While, however, I thus limit the inquiry to this one species, it will be understood to include not merely the acci- dental occurrence of vesical stone, but the diathesis out of which stone arises; indeed, I have now only to do with calculus in the bladder, in that it expresses, roughly and approximately, the relative frequency or rarity of the lithic diathesis, just as the mortality in any place or district may be taken to represent, roughly and approximately, the amount of sickness in that place or district.For one case of stone in the bladder whiclh presents itself, there are ten at least met with in which the lithic diathesis, or as it may for convenience be termed " lithuria", is fully marked in the form of lithic deposit, sand or gravel.Let us, then, in- quire-i.Is lithuria, as represented by cases of stone in the bladder, more common in this district than in any other part of the United Kingdom? and 2. If it be, what explanation can be given to account for the excess?The subject has on more than one occasion undergone investigation.