tection against what was then regarded as one of the most formidable of diseases. The "Inquiry" of Jenner, resulting in the most momentous and beneficent discovery in medicine in modern times, was made by following out ideas derived from the observation of certain remarkable coincidences and by experiments made first upon living animals and afterward applied to the human subject. It is the privilege of our generation to witness the inauguration of a grand revolution in medical science. Following upon the results obtained by a study of the natural history, or the physiology of diseases, the adoption by pathologists of certain of the methods, long employed in physiology, in the investigation of pathological problems is affording information of a positive and definite character hitherto unknown. I refer to recent observations with regard to the pathological relations of microorganisms. Twenty years ago (in 1865) Villemin succeeded in producing a disease analogous to pulmonary tuberculosis, by inoculating rabbits and guinea-pigs with tuberculous matter; and the success which attended his experiments on these animals revived at once the old question of the contagiousness of phthisis. In 1882, Koch made the most remarkable advance in pathology since the discovery of vaccination. By a series of investigations made after an entirely new method-the artificial culture of micro-organisms-he succeeded in isolating the contagious organism of tuberculosis, now known as the bacillus tuberculosis. It is unnecessary to follow out the processes by which the micro-organism characteristic of tuberculous disease. was isolated and its pathological relations established. There is no discovery in medicine, within the recollection of the present generation, that has produced so profound an impression; and the readiness with which the conclusions arrived at by Koch have been adopted indicate alike the exact scientific character of the observations on which they rest and the high standard of culture of physicians of the present day. Followed, as it has been, by the demonstration of micro-organisms characteristic of many other constitutional diseases, the discovery of the bacillus tuberculosis has opened a field of study that is yet in its infancy so far as results are concerned. The pathologist would be bold indeed who would venture to indicate the probable limits of the information to be derived in the near future from investigations of the same character as those made by Koch. The discovery of micro-organisms which produce certain diseases must, in the course of time, lead to a knowledge of measures which will prevent or cure the diseases in question; and even now, the recog nition of the bacillus tuberculosis is a positive and important factor in diagnosis. I have thus ventured to draw from the great domain of pathology and the practice of medicine, a few of the most striking illustrations of the relations of physiology to the positive knowledge which the practical physician daily uses in the diagnosis and treatment of disease. Physiological discoveries have made a scientific system of pathology possible. The greatest discoveries in the history of practical medicine have been made by those methods of investigation which have been found most useful in the study of physiology. One of these, the discovery of vaccination, is characterized as physiological, by its author, in the dedication of the second edition of his book to the king: "When I first addressed the public on a physiological subject, which I conceived to be of the utmost importance to the future welfare of the human race, I could not presume, in that early stage of the investigation, to lay the result of my inquiries at your Majesty's feet." In the remarkable observations by Koch and his followers, the active principles of contagious matters were isolated, as physiologists have isolated the active principles of the digestive fluids. The methods of study were essentially those which have been most fruitful in results in physiology. Who can say that the processes of culture of micro-organisms, now employed in pathology, may not be useful in physiological research; and that so-called physiological ferments, such as the active principles of the digestive fluids, may not be found to contain minute organisms upon the multiplication of which the peculiar properties of these substances are dependent! In the advancement of medical knowledge, physiology and pathology go hand in hand. The ideal physician is profoundly versed in physiology; and the ideal physiologist is no less deeply versed in the practice of medicine. RECTO-LABIAL AND VULVAR FISTULE. By ISAAC E. TAYLOR, M. D., of New York County. Read November 18, 1885. My friend Professor J. W. S. Gouley, whose master spirit of thought and action "called into being" this Association, requested me to present a paper for this meeting. Desirous of giving countenance to the efforts of other gentlemen who are solicitous to advance the interest of this Association and promote its success, small as my efforts may be, I most cheerfully acquiesced in his wish. Recto-anal fistula is of frequent occurrence. I have selected the last of the three different forms of fistulæ, the recto-labial and vulvar, for a few remarks. The subject is one which merits more attention and consideration than it has received from the profession. The nature of the disease, and the importance of the surgical treatment required to relieve the exceedingly unfortunate and disagreeable sequence of the primary abscess, appear to have been overlooked, or, if not, it must have been considered of very little moment and interest to the medical man, but it is certainly of great importance and consideration to the patient herself. The various diseases arising from the glandular system of the female organs of generation have been and are credited with but slight or no mention by the gynæcologist, and appear to be also by only a few surgical authorities, and those more particularly who have devoted their principal attention and experience to the diseases of the rectum. The subject is one akin to recto-anal fistula, for which affection, as a general rule, a surgical operation is deemed advisable. Doubts as to the correct method of treating recto-labial or vulvar fistula are as vague and uncertain at the present day, by some of the highest surgical authorities, as in years "gone by," judging as I do from the history of the subject, and from my own experience. In private practice this form of fistula is considered as seldom met with. I find no gynecologist who has referred to it, although the origin and cause of it are of frequent occurrence, arising as they do most generally from the glands of Bartholinus or Duverney. As illustrative of the few surgical writers who have promulgated their views and the method of operating for this class of fistulæ, I recognize Copeland, Brodie, Curling and Quain. Allingham and Van Buren, Mollière and Gosselin make no mention of the difficulty whatever. Copeland, during his day, was the first to mention the supposed correct surgical treatment for recto-vaginal fistula; none of his cases, however, were of the true recto-labial class. Sir Benjamin Brodie, who accepted and sustained the treatment recommended by Copeland, says that "during a period of twenty-five years he had seen but two cases, one of those being a direct recto-vaginal, and the other a recto-labial and vulvar." Curling refers to one case of recto-labial, and Quain also to one. Reference to the few historical surgical facts of this class of fistulæ is of some moment and interest, as showing the infrequency of the form. I can not believe that other surgeons or medical men have not met with them; but, if they were recognized, no reference by publication has been made, or they have been passed over in silence, with the thought probably that Nature would in time establish a cure. In 1866 I presented a short paper on the same subject to the New York State Medical Society, and I now offer before this Association some further remarks relating to the locality, of the frequent cause, and the simplicity of the thought which prompted the surgical operation, apropos to the nature of these cases, |