TIFFANY 1148 TILDEN Faculty of Maryland, of the American Surgical Association and of the Southern Surgical and Gynecological Association. Tiffany was a pioneer in many domains of surgery ; with him, modern antiseptic surgery had its birth in Baltimore. He calls the newer methods "Listerism"' in a paper published in 1882. He contributed much to surgical litera- ture. In the "Reference Handbook of the Medical Sciences," the "International Encyclo- pedia of Surgery," the "International Textbook of Surgery," and in Dennis' "System of Sur- gery," he furnished articles on appendicitis, breast tumors, surgery of the blood vessels, cranial surgery and surgical diseases of the jaws and teeth. In Sajou's Annual for a num- ber of years he supplied the chapters on sur- gical diseases. His most characteristic writ- ings are his addresses before surgical societies. Let me list some of his surgical achievements for the decade 1882-1892. An article on the treatment of irreducible epiplocele (1882) throws an interesting light on the surgical problems of a period when surgery was just coming out of her swaddling clothes; an im- portant question here is whether or not the vessels of the amputated herniated omentum ought to be ligated. Tiffany ligated and re- moved the omentum four times, twice he tied in mass, when both patients died of a rapidly spreading peritonitis, and twice he tied the individual vessels when both recovered. He operated successfully for renal calculus in 1885. He remarks that "exploration and catheteri- zation of the ureter from the bladder in the female has been attempted not over success- fully," but he says that "the territory between the kidney and the bladder, 'the dark continent,' is not beyond the reach of surgical investiga- tion." In 1887 he wrote a suggestive but too brief statistical account of the differences in the surgical diseases of the white and colored races. Keloid is very common in the negro and carcinoma very rare; hetleclares that there is not recorded a single instance of epithelioma of the face or lip of a negro. Various congeni- tal malformations have not been met in the dark negro. On the whole, surgical injuries are better borne by the negro, while surgical diseases of the lymphatic system are more fatal. In 1887 Tiffany operated for stone in the kidney in the fifth month of pregnancy, opening an abscess, touching the stone with a needle, using this to guide a grooved director, and then on this sliding in a slender forceps he opened the forceps and enlarged the hole, and so made room for his finger, which at once touched the stone. This obviated any bad heinorrhage. In 1887 he sutured an oval area of the liver to the abdominal wall, and through this opened up an extraperitoneal route for the evacuation and drainage of a liver abscess ; the patient re- covered. He also in a like manner extracted gallstones through the liver substance in a case where the liver was enlarged and intes- tines adherent along its margin. An elab- orate article is that on "Pregnancy and Opera- tive Surgery and their Mutual Relations" (1889), where, building upon the work of Venieuil (1889) he adds the more recent liter- ature with his own work. He was also a pioneer in gastric surgery, doing the first gas- troenterostomy in Baltimore, in 1892. On resigning his chair of surgery in 1902, his active career came to an end on account of ill health, and he devoted his remaining years to his farm interest and to hunting. He was ambidextrous and a most graceful operator. His lectures were always delivered informally, sitting on the rail of the amplii- theatre in a conversational manner and without a logical sequence of subjects, but interesting and impressive because of the speaker's ex- perience and personality. After a short illness he died of angina, Octo- ber 23, 1916, at his farm in Virginia. Fr.NIC M.-MiTIN. Tilden, Daniel (1788-1870). Daniel Tilden was born in Lebanon, Grafton County, New Hampshire, August 19, 1788. The boy was compelled to share in the general work of the family. Nevertheless, by perse- verance he was able to secure the A. B. from Clinton College, New York, and in 1807 began to study medicine with Dr. Joseph White of Cherry Valley, New York. His first course of medical lectures was taken in the College of Physicians and Surgeons of the Western District of New York, just organized at Fair- field, Herkimer County. In 1812 Dr. Tilden was examined by the State Board of Regents of the State of New York and received their diploma; in 1826 he was granted an hon- orary M. D. by the Berkshire Medical Insti- tution of Massachusetts. In 1817 he removed to Oliio and settled first in Erie County at a place now known as Cooke's Corners, but in 1825 removed to Nor walk, Huron County, and in 1839 to Sandusky, where he continued in practice until a short tiine before his death. Dr. Tilden was a fine specimen of the doctor of the old school as developed on the western reserve, ready, staunch, faithful to dnty. He was president of the Ohio State Medical So- ciety in 18.^6, president of the Erie County
