xxxiv INTRODUCTION
joint tuberculosis (paper by Randolph, "American Journal of the Medical Sciences," 1830-31, vol. vii, p. 299). He was without question far in advance of his time in this matter. About the middle of the nineteenth century, the importance of rest not only in conditions which we now know to have been surgical tuberculosis of the bone, but in other diseases, was strongly advocated by Hilton in his classic book " Rest and Pain." How much, if any, of the suggestion of the value of rest Hilton got from Physick it is impossible to tell, but his work no doubt pro- foundly influenced British surgeons of that date and ever since. How- ever, even as late as 1874, Sayre in his " Lectures on Orthopedic Surgery" states that continental surgeons were at that time still opposed to rest in such cases, then a generally recognized principle of practice by Ameri- can surgeons. Sayre credits Harris with introducing extension in the treatment of joint tuberculosis and calls attention to the fact that in this way pressure of the opposing joint surfaces is prevented. Sayre's recommendation as to the importance of rest, fresh air, and abundant nourishing foods, including cod liver oil, cream and milk, leaves little to be added in the general treatment of bone tuberculosis, now thirty-five years after the time that these important matters were emphasized by Sayre.
F. H. Hamilton, in his little monograph, " Ekloplasty and Anaplasty " (1854), was probably the first to advocate skin grafting, many years before the procedure of Thiersch and others whose names are commonly linked with the introduction of skin grafting. This was a very important advance, which perhaps failed to attract more general notice because of the curious title which he gave to his little monograph.
The most important contributions to the principles of surgery — the introduction of antisepsis and anesthesia — remain to be mentioned. In both of these indispensable principles, early American surgeons had an important part.
In the development of modern aseptic and antiseptic surgical technic, three ideas are of fundamental importance: First, that the infectious material may be transferred from the diseased to the healthy person by direct contact or carried indirectly by the hands of doctors or nurses; second, that the infectious material is a living organism; third, that the infectious material may be destroyed or its action checked by certain chemical or physical means.
The second of these great facts — the fact that infection is caused by living organisms — is undoubtedly of greatest importance, and the credit for this epoch-making discovery is due to Pasteur. But the first and third of these principles are also indispensable, and our American profession deserves credit for advocating them at probably an earlier date than the workers in any other country. Oliver Wendell Holmes's
