{"collection":"philosophy-ethics","full_text_available":true,"graph_url":"https://unchartedknowledge.5gfusion.net/v2/api/page/gutenberg_53827/graph","html_url":"https://unchartedknowledge.5gfusion.net/v2/page/gutenberg_53827","id":"gutenberg_53827","license":"Public Domain (US)","rights_basis":"gutenberg_metadata_copyright_false","source":"gutenberg","source_url":"https://www.gutenberg.org/ebooks/53827","summary":null,"tags":["Category: Health & Medicine","Category: Journals","Category: Philosophy & Ethics","Category: Teaching & Education","Medical colleges -- Alumni and alumnae -- Maryland -- Baltimore -- Periodicals","Medicine -- Periodicals"],"text":"------------------------------------------------------------------------\n\n\n\n\n                         THE HOSPITAL BULLETIN\n\n\n      Published Monthly in the Interest of the Medical Department\n                     of the University of Maryland\n\n                          PRICE $1.00 PER YEAR\n\n        Contributions invited from the Alumni of the University.\n                    Business Address, Baltimore, Md.\n\n                  Entered at the Baltimore Post-office\n                        as Second Class Matter.\n\n            VOL. V BALTIMORE, Md., APRIL 15, 1909      No. 2\n\n------------------------------------------------------------------------\n\n\n\n\n                THE ETHICS OF THE GENERAL PRACTITIONER.\n\n             _An Address delivered Before the University of\n                     Maryland Medical Association,\n                            March 16, 1909_,\n\n                          BY GUY STEELE, M. D.\n                           Of Cambridge, Md.\n\n\nA celebrated divine once said that the most difficult part of a sermon\nwas the selection of a proper text. I must thank the President of this\nsociety for saving me this trouble. When, however, Webster's is\nconsulted for a proper definition of the word \"Ethics,\" and it is found\nto mean \"The science of human duty,\" it would seem that he has chosen a\ntext almost too comprehensive for the limits of a short paper, even when\nrestricted to the \"ethics of the medical profession.\" It may not be out\nof place to thank him for the honor he has conferred upon me by deeming\none whose student days are scarce twelve years behind him worthy of\npresenting this subject to you, for a paper on this topic is almost of\nitself a sermon, and we naturally look up to those, whose many years of\nexperience and works have brought them prominence, for instruction in\nmorals and duty. Still, I take it, whether young or old, all of us like\nto preach on fitting occasions, and not the least part of the\ninspiration to effort is the character of the audience. My invitation\nwas to read a paper before the Clinical Society, and incidentally I was\ntold that some of the students had expressed a desire to be present.\nLittle, however, did I anticipate such a flattering attendance from them\nwhen examination time so nearly approached, and it is evidence of a most\ncommendable spirit when they can bring themselves to take even an hour\nof their most valuable time from study to devote to a consideration of\nthe moral duties and responsibilities which shall be theirs when they\nshall have passed through the April ordeal. Much that I have to say\ntonight will be directed especially to them, and if they or their elders\nin the profession may in the years to come look back upon this night\nwith the recollection that I have more forcibly brought to mind some of\nthe old and half-forgotten maxims and axioms that make for a better and\npurer professional life, I will have been more than repaid for the time\nI have expended in the preparation of this paper.\n\nIn discussing the ethics of the general practitioner towards his\npatient, I would have you remember that your first and most important\nduty is to give to those who trust you the very best that is in you.\n\nTo you young men, full of enthusiasm for your new profession, and imbued\nwith Utopian ideas of the mission which you have undertaken for the good\nof mankind, it would seem almost foolish for me to mention this as the\nfirst advice I would offer you. But I think I can see a smile of\nunderstanding flit across the faces of those who have for some years\nfought the battle of life, and who have had the wire edge of early\nambitions and determinations blunted by contact with unappreciative\npatients and unworthy professional competition and the daily incidents\nof a busy life. They know that it is very easy to feel too tired, or be\ntoo busy, or have some other engrossing affair in mind which prevents\nthat entire devotion to duty which all admit is essential to success in\nmedicine. Half of success in life or in any undertaking is due to a\nsuccessful start; therefore, let me ask you to firmly determine on one\nor two fixed principles, and to stick to those principles through thick\nand thin. Be fully assured that no halfway devotion to your profession\nwill ever bring you prominence or success. The time-worn phrase that\n\"Medicine is a jealous mistress\" loses none of its truth by frequent\nrepetition. Recently I saw in a prominent medical journal the advice\ngiven that doctors should take a prominent part in politics and bring\nthemselves forward in other ways, and that thereby in some way unknown\nto me the glory of the profession would be enhanced, and much benefit\nresult to the community. Far be it from me to discourage a proper civic\nspirit and a proper interest in public affairs, or to advise an\navoidance of any duty which good citizenship imposes upon every honest,\npatriotic man, whatever his business or profession. But I take it that\nno more baneful, no more dangerous advice can be given to our young\nprofessional man than this. You cannot be successful in both politics\nand medicine, and while we can point to one member of our profession in\nthe United States Senate, and to some notable exceptions in our own\nState, where men of our profession have, for a time, abandoned medicine\nand returned to it to win success, you can rest assured that the medical\npolitician possesses little beyond a musty diploma to remind the world\nthat he was once of our cult. So don't be a halfway politician and\nhalfway doctor. Success in either field will take all of your best\neffort and all of your time.\n\nWhat I have said of politics will apply, though not quite so forcibly,\nto any other engrossing business or pleasure. Time forbids me to\nelaborate this idea, and in concluding it let me say that you cannot be\na successful politician, merchant, sport or what not and carry medicine\nas a side line.\n\nIt may seem useless to remind you that, in order to give the best that\nis in you, you must keep abreast with what is new and best in\nprofessional literature and scientific progress. You all have determined\nto be students, and even those who pride themselves on having passed\nthrough the University without having opened a book have a half-formed\ndesire to really know something beyond spotting a possible examination\nquestion, and when once examinations are over, and they have reluctantly\nwithdrawn themselves from the delights of the city by gaslight for the\npine woods and mountain trail, they will burn the midnight oil and\nbrowse diligently through their musty tomes. May I tell you that nothing\nis harder than to find time for study. Many of us, even though city men,\nwith the best and latest literature at our elbows, are ashamed to think\nhow thoroughly we abhor the sight of a medical book or magazine, and how\neasily we can persuade ourselves that we are too tired and stale, and so\nengrossed during the day with scenes of sickness and suffering that we\nmust have our brief hours of release from duty for recreation. We do\nneed our hours of relaxation and rest and our too infrequent holidays,\nand they are absolutely essential to good health and good work. Don't,\nhowever, confuse the words rest and relaxation with sloth and idleness,\nand don't think your professional work completed when your round of\ndaily visits is done. Indeed, if you would know medicine you must woo\nyour mistress in the small hours of the night, and in many of the\nleisure moments that the day may bring you.\n\nMuch has been spoken of the man who practices by common sense, and whose\nschool has been that of observation and hard experience. A most worthy\nbrother he is at times, and many are his friends and wonderful his\nsuccess. But if the science of medicine is to advance, more is required\nfor progress than mere common sense, and observation untrained and\nexperience undirected and unguided by the observation and experience of\nothers will rarely discover a new bacillus or elaborate a side chain\ntheory. So, to be truly ethical in the duty you owe to give the best\nthat is in you, you should be reading men. Take one or more of the\nmedical journals. Buy for reference the latest and best text-books. Make\nthe opportunity to read the daily papers and something of current\nliterature. A well-rounded man can afford to do nothing less. Besides\nthe information you obtain, it pays in the respect of the community to\nhave the reputation of being posted in your profession. Often the\ncountry man simply hasn't time at home to read. A busy life, with its\nmiles upon miles of dusty roads to travel, precludes all chance for the\neasy chair. Then cultivate the habit of reading while driving. Many are\nthe useful and happy hours I have spent in my carriage with my journals\nand magazines. I am frank to say that, but for this habit, I never could\nhave found time for one-half of the reading I have done. Last year I was\nsomewhat amused when a most worthy, well-educated and well-posted man\nsummed up his opinion of another by saying that he was one of those who\nread magazines in his carriage. If I mistake not, this indictment was\nbrought against the late Dr. Miltenberger, who as a young and busy man\nwas forced to form this habit, and I could but think that, could I die\nwith half the honor and respect and love that were his, I could plead\nguilty to even this mark of devotion to my profession and desire to\nadvance in it.\n\nWould you be ethical in giving the best that is in you to your patients,\nyou must give ungrudgingly of your time. This may again seem a useless\npiece of advice, and yet almost all of us are familiar with the man\nwhose motto is \"Veni, Vidi, Vici\"--\"I came, I saw, I conquered.\" This\nintuitive diagnostician is by no means a myth. The man who comes in a\nrush and goes in a rush, and who, with pencil in one hand and\nprescription pad in the other, feels the pulse while the thermometer is\nunder the tongue; who sees at a glance, without necessity of personal or\nfamily history or of physical examination, just what is the matter, and\nwho, giving four or five prescriptions, rushes out, trusting that\nsomething in his shotgun therapy may hit the enemy. Perhaps the next day\nhe prescribes four or five more remedies or combination of remedies, and\nshould the patient begin to improve, prides himself that he has made and\nconfirmed a diagnosis by his experimental therapy. Is it necessary for\nme to say that no ethical man with any regard for the rights of his\npatients and his obligation to his profession can really practice\nmedicine in this manner? The plea that you are too busy to give the\nproper time to your cases is no justification for your neglect. Anything\nless than a careful inquiry into family and personal history, followed\nby a painstaking and thorough physical examination, is unjust to your\npatient and unjust to yourself. No ethical man can give the best that is\nin him by doing less than this. If you haven't the time to do your work\nthoroughly, make a clean breast of the matter and take fewer cases. But\nyou will say that a man, even in large practice, cannot afford to give\nany of it up. He needs every dollar that honestly comes his way, and to\nsay that he hasn't time for his work is only another way of throwing\npractice into the hands of a rival. This is, indeed, a proposition hard\nto solve, as most of us do need every dollar that honestly comes our\nway; but if our work is only half done, if we have neglected some\nimportant point in diagnosis, and thereby omitted some equally important\nmeasure in treatment, have our dollars been honestly earned? Let us\nstart out with and carry in mind this axiom of a truly ethical life,\nthat success in medicine cannot be measured by commercial success; that,\nwhile no sensible man can neglect the business side of his vocation, or\nrefuse to demand and collect just compensation for his service, such\ncompensation cannot be measured in dollars and cents alone; that a good\nconscience and whole-souled devotion to duty, giving ungrudgingly of the\nvery best that is in you to those that have confided in you, will be\nyour very best asset when the final account is made up.\n\nMay I impress the fact upon you that an ethical man, with a just\nappreciation of his duty to his patients, can never be a vendor of\npatent or unofficial medicines. Indeed, I would be lacking in my duty\nif, with the opportunity this paper offers me, I did not, from the\nstandpoint of experience, impress upon you with all of the force at my\ncommand the necessity of being wary of the detail man and the alluring\nadvertising literature with which your mail will be flooded. You will\nscarcely have opened your office, and be waiting with what patience you\ncan command that rush of the halt, the lame and the blind to which you\nfeel that your talents entitle you, before the suave detail man, having\nheard of the new field, puts in his appearance. What you lack in\ntherapeutic experience he can supply you by drawing liberally on the\nexperience of others who have worked little less than miracles in an\nadjoining town by the use of his pills and potions, his elixirs and\ntinctures. You will find him smooth and oily, placid and plausible. He\nknows his story well, and even by his much speaking can almost persuade\nyou that what you knew, or thought you knew, or what you had recently\nbeen taught, were all out of date; that by some stroke of genius the\nchemist of his house had discovered some way by which compatibles would\ncombine with incompatibles into the formation of a new and staple\nmixture, possessing all of the virtues and none of the defects of its\noriginal constituents, rendering chloral as soothing as the strings of a\nlute and as harmless as the cooing of a dove, extracting from cod-liver\noil every disagreeable feature and leaving nothing but its supposed\nvirtues behind. He will show you the short road to fortune and success.\nTreat him kindly; the ethical man should not be rude, and brusqueness is\nnot a sign of Roman honesty or virtue. Be assured he feels his position\nkeenly, and is dreading the catechism which will sooner or later display\nhis ignorance of everything but the story that has been drilled into him\nlike a parrot.\n\nThere has been no greater shame in our profession than the influence\nthese men and their houses have exercised, and incidentally the\nindorsements and recommendations that thoughtless men have furnished\nthem. The blame is all ours, and we cannot shun it. We pride ourselves\non our scientific attainments; that we take nothing for granted; and,\nnow that the age of empiricism has passed, we accept nothing that does\nnot bear the stamp of scientific approval. And yet, before the campaign\nof the American Medical Association and the revelations of Collier's and\nthe Ladies' Home Journal, we accepted our treatment from the hands of\nthe manufacturing houses, and dosed our patients with nostrums about\nwhich we knew nothing except the statements of those whose sole purpose\nit was to sell. There are few of us who have been many years in practice\nto whom a blush of shame does not come at the recollection of our\ngullibility and our guilty innocence. Can any man deem it ethical to\ngive even to a good dog something about which he was totally ignorant?\nAnd yet this is just what we were doing. A short time ago a particularly\nshrewd detail man was discussing this very point with me, and claiming\nthat, as the formula was now required by law to be printed in each\nbottle and package, this most formidable objection could not now hold\ngood. Handing me a bottle of his patent cure-all, he glibly called my\nattention to the six or seven ingredients, with the amount of each\ncontained in the fluid ounce. Among other potent quantities I can recall\n1-48 gr. of morphia and 1-240 gr. of strychnia. The dose was a\nteaspoonful three times a day. Any man can imagine the more than\nhomeopathic effect of 1-48 gr. of morphia divided into eight doses.\nThese well-known and well-tried drugs were not, however, the life of the\nnostrum, and presently we came to the twenty minims to the fluid ounce\nof the fluid extract of the drug from which the remedy derived its name.\nSomething I had never heard of. Something unlisted in the U. S. P.\nSomething discovered and owned and controlled by this house alone. As my\nignorance became more apparent his eloquence increased, and I have no\ndoubt that a few years ago, before my moral conscience had become\naroused to the therapeutic sin of prescribing something whose botanical\nfamily, whose chemical formula, and even whose physiological effects\nwere totally unknown to me, I would gladly have accepted a sample and\nwould have tried it on some poor soul too poor to pay for a\nprescription. It is nothing short of a shame to think of what we have\ndone in this line. The sin has been one of carelessness and laziness\nrather than of ignorance. Here we had ready to hand some remedy,\nbeautiful to the eye, palatable to the tongue; then why take the time\nand trouble to bother about constructing a formula of our own when\nsomeone else of equal experience had constructed one for us? I am ready\nto thank God that most of these nostrums are as harmless as they are\nbeautiful, and, while I may not have done good, I rarely did harm by\ntheir use. I am not discussing the opium and cocaine laden classes. I\nwish to emphasize incalculable harm that must result to the physician\nhimself who allows someone to do his thinking for him. I am also\nreferring to the attitude of the ethical man to his patient, and beg to\nask if we are doing even part of our duty when we are doing no harm.\nAllow me to conclude this topic by asking you to spend an hour some day\nin casually glancing over (a deep study would fully repay you) the pages\nof the U. S. P., or a list of the remedies that have in one year\nreceived the sanction of the Council on Pharmacy of American Medical\nAssociation. If you don't find enough drugs and combinations to meet\nevery case and every conceivable situation, you had better desert\npractice and exploit some wonderful cure-all as a detail man.\n\nIf we, as physicians, had nothing but our duty to our patients to\nconsider, and incidentally our own profit and glory, the practice of\nmedicine would soon degenerate into a mere trade. I may even say that,\nhad we nothing but the promptings of our consciences to keep us in the\nstraight and narrow path, if we had nothing but the knowledge of work\nwell done, and if the desire and determination to give the best that is\nin us were our only incentives to an ethical life, the profession would\nbe so beset by the temptations of commercialism, and the notoriety and\nprominence which commercial success brings, that the halls of Esculapius\nwould soon need a scouring and purging greater than Hercules gave the\nAugean stables. Despite the high incentive to all that is best and\npurest in life which our noblest of callings should beget in us,\nphysicians are only human, and human weakness, like disease, is no\nrespecter of persons or of callings. It may have been that the medical\nfathers, with a knowledge of the temptations to which they were\nsubjected, and a desire to save others from the pitfalls which beset\ntheir paths, were imbued with a determination to place their profession\non a higher plane than others; or it may have been the natural evolution\nwhich inevitably resulted from and followed the promptings of man to\nhelp his fellow-man, to devote himself to the relief of pain and\nsickness, to sacrifice his comfort and ease and almost every pleasure in\norder that others might have ease of body and peace of mind and soul,\nwhich from the earliest days have placed medicine as a profession apart,\nand have imposed upon those who have entered its ranks certain standards\nof conduct and insisted on certain ethical relations which have lifted\nit above mere questions of gain and the vain acquisition of renown. We\nhave been taught that Hippocrates himself was great not only as a\nphysician, but greater still as an ethical teacher who has left with us\ncertain maxims and proverbs which, though handed down through the ages,\nhave lost none of their truth and none of their spotless morality. Even\nin the Middle Ages, when learning, not to say science, had sunk into\nsuch an abyss of ignorance that the ability to write one's name lifted\none into the ranks of the educated, when human ills were relieved more\noften with the sword than with the scalpel, the leech was a man apart.\nHis education, his scientific investigations, and even his supposed\ncommunion and partnership with the evil one, placed his on a pedestal\nabove other professional callings. Then, as now, though men might scoff\nat our profession of superior knowledge and skill, when \"pallida mors\"\nstalked abroad or knocked at the hovels of the poor or palaces of the\nrich, all arose to call us blessed. It has been often said that, could a\nmedical man live up to the ethical standards of his profession, his\nchances without creed or priest would not be small at the last great\nday. But with all of our high ideals we are only mortal, and we know and\nhave sorrowed at the fact that many of our ethical standards are not\nlived up to, and that the Hippocratic law is frequently more honored in\nthe breach than in the observance.\n\nWe have in every community where one or two are gathered together in the\nname of medicine the man who is everything to your face and everything\nelse behind your back; who damns by faint praise; who sympathizes with\nyou in your sorrows and trials, who visits the family of the patient you\nhave lost to assure them of your skill and to insist that everything was\ndone that could have been done, \"but\"----and that one harmless little\nconjunction, meaning nothing in itself, is more eloquent than a thousand\nterrible adjectives or burning, blistering adverbs or participles. So\nmany things can be said by the pious uplifting of the eyes, the\nsanctimonious upturning of the palms. He would not for the world leave a\ndoubt in the minds of your people, and, no matter what in his inmost\nheart he thinks of your mistakes (from his standpoint), it is not his\nplace to injure a brother, but, alas! he is not responsible for the\nunguarded tongues of his friends, and he usually sees that they do his\nwork well for him. Often it is \"if I could only have reached him\nearlier,\" which, being interpreted, means a miracle would have been\nwrought. Almost every community has its miracle worker, its medical\nresurrectionist. His cases are always a little worse than others, his\nvictories a little more wonderful. Where you have a bronchitis, he has a\ndesperate pneumonia, your transitory albuminuria is with him acute\nBright's, and hopeless cases follow him to undo him, only to meet defeat\nat his skillful hands. You hear that Mr. A. is desperately ill with\npneumonia on Monday, and on Friday you meet him on the street, looking\nhale and hearty, firmly believing that, had Dr. X. been one hour later\nin reaching him, he would ere this have been gathered to his fathers.\nShould you mildly suggest that some error in diagnosis might have been\nmade, that even the best of us at times go wrong, and that resolution in\ntrue pneumonia could hardly be expected in four days, you will find that\nhe has been prepared for you, feeling that Dr. X. has used some potent\nremedy as yet unknown to you and his less skillful brethren, and firmly\nconvinced that your suspicions of his case are based upon your ignorance\nor your jealousy of poor Dr. X., who was not there to defend himself,\nwho had always spoken so kindly of you, and had uttered nothing worse\nthan the harmless little conjunction \"but\"----\n\nA little bragging is not a sin, and indeed is usually harmless, and in\nthe long run reacts on the miracle worker. But the ethical man does\nfrequently suffer from it, and it is a fact, absurd as it may seem, that\nthe average man or woman would much prefer to be considered at death's\ndoor about three-fifths of the time--indeed, almost a walking\nLazarus--than to be deemed the picture and personification of vigorous\nhealth. Dr. X. knows this, and plays upon the credulity of his patients.\nHe frightens them to death's door, works a miracle, and has tied them to\nhimself forever. We all have suffered from this, and will continue to do\nso until the little grain of truth has grown from the tiny mustard seed\nto the vigorous bush. Dr. X., with his faults, has his virtues. He\naspires to be the busiest man, the richest man, the most popular man in\nhis community. All of these ambitions, if properly guided, are laudable,\nand, indeed, while enhancing his power and prestige, may be redounding\nto the good of his people, for a man to be the busiest and most popular\nman in his profession must usually be the best posted, the most highly\neducated, the hardest working man, not only for himself, but for those\nhe serves. So, while we may smile at Dr. X. and his big ways, we may\nlove him for his virtues and forgive his small faults.\n\nBut for the man who deliberately goes to work to undermine another; who\ntakes advantage of some temporary absence of the regular physician to\ningratiate himself; who, appreciating the fact that people worried\nnearly to death by the illness of a loved one, will forget every\nobligation and desert every old friend in the hope that the new one may\noffer some encouragement or extend some hope, is ready for these\nemergencies. He carries satchels full of hope for all cases and\noccasions. He prescribes it liberally, diluted, however, to the point of\ndespair because he was called in an hour too late, or because the case\nhad already been damaged beyond his power of repair. This gentleman\nadvances not only by his own deceit, but uses the power of church, of\npolitics, of family influence and social opportunity, to lift himself\nalong. Verily he has his reward, but it is not in peace of mind, not in\nthe honor and respect of his community, but the contempt of every honest\nman, be he of the profession or laity. Not the least of the perplexing\nquestions which beset the man who is trying to lead an ethical life is\nhis duty in his relation as consultant. Indeed, there is scarcely a\nsituation in professional life that at times presents more embarrassing\npossibilities, or calls for the exercise of more tact. It is a pleasure\nto be able to bear witness to the ability of the man who has called you\nto his aid, to assure the family that everything has been done that care\nin diagnosis and skill in treatment could demand. But what of the cases\nwhere gross carelessness or blind ignorance have hastened what might\neasily have been delayed or averted? There is only one way here, only\none duty. Treat the man as his carelessness or his ignorance deserves.\nAgain, you are called in consultation with a thoroughly good man who has\ngiven ungrudgingly of the best that is in him. Perhaps your superior\nskill in certain lines, perhaps your superior opportunity to observe a\ncertain line of cases, have taught you something that he has not had the\nchance to learn. As before it was your duty to expose the careless\nignorance of one, now it is your place to so give your opinion and\nexplain your position that no possible reflection can be cast upon the\nother. Don't approach a consultation with the manner of a priest of\nDelphi. Don't pose as the fountain of all wisdom and of all experience.\nIndeed, in this work you will be surprised how often you will learn from\nhim you are called upon to assist. He has seen the case for days, where\nyou can spend but minutes with it. It is his part to bear the blame,\nyours to share his fame should success crown your combined efforts.\n\nFrequently you will be called upon when a resort to surgery is\ndemanded--not so much to perform the operation as to give your opinion\nas to the advisability of a certain line of procedure. Having determined\nwhat is to be done, don't assume the place of prominence. You have\nlittle by way of reputation to gain by performing an operation that you\nwere known to be competent to perform or you would never have been\ncalled. Let him do the work with your assistance and advice. In this way\nyou will have gained a fast friend for future consultations, and you\nwill have enshrined him in the esteem and confidence of his people.\nTherefore, help him and uplift and bear witness to his worth, and don't\nhumiliate him by your airs and assumed superiority.\n\nAs a last word, don't consult with an unworthy man, for be assured that\nyour reputation is worth more to you than any consultation fee, however\nbadly you may think you need it.\n\nThe question of fees is one that must be considered. We hate to think of\nthe combination of medicine and money, and our patients abhor it even\nmore. The days once were when only the sons of the rich sought the\nliberal professions. It was thought unworthy in the days of the dim ages\nfor a pupil of Esculapius to charge for his services. Any remuneration\nthat came to him was an offering of gratitude--indeed an honorarium\nwhich might be tendered or withheld at the will of the patient. A truly\nnoble conception this, that the good we offered was beyond a mere\nquestion of price. Equally comforting was the belief that the ill which\nresulted despite our best efforts was no reflection on our skill, but an\nevidence of the wrath of the Gods. Would that we were as near Olympus\nnow as then, and that the Gods walked with men to reward the worthy and\npunish the unjust. Would also that the manners and costumes and climate\nof Ancient Greece were still with us, so that man need take little heed\nof raiment beyond a robe and sandals; that he required no expensive\noutlay for instruments, no intricate electric outfit, and no automobile.\nWhat a life ours would be if now as then our grateful patients sought\nus, and we passed our many hours of leisure in eloquent discussion or in\nlazy lounging amid the leafy groves or shaded porticos of the temples!\nBut the times have changed, and we have changed with them, and abhor as\nwe will the combination of medicine and money, we are forced to take\nthought of the morrow and to spend many, many anxious moments in this\nthought and in trying to evolve ways and means by which a balance can be\nmaintained between the honoraria of patients, both grateful and\nungrateful, and the claims of persistent creditors. Perhaps it is best\nthus, as the average man needs some incentive to good work beyond the\nacquisition of honor and glory. An axiom in the question of fees is\nthis, that in order to be respected we must respect ourselves, and no\none can respect himself unless he holds his calling above a trade and\nbases his charges upon this feeling of respect for himself and his\nprofession. This axiom should be held in mind in arranging any fee\ntable, and should be insisted upon in our settlements with those who\nthink a doctor's bill should be discounted from one-quarter to one-half.\nI have often wondered how this right to a discount in a doctor's bill\never got such a firm hold in the public mind. Perhaps the city man\ncannot appreciate this fact like his country brother. The poor, honest\nold farmer, part of the bone and sinew of the land, expects the highest\ncash price for everything that he sells. If anybody has ever heard of\none who when ten barrels of corn at $3.50 per barrel comes to $35,\noffering to take $25 for his bill, he should corral and cage this rara\navis. But hundreds of us from the rural districts have been deemed mean\nand close-fisted and extortionate because we gently insist that $35\nworth of professional services rendered are worth $35 and not $25.\n\nThis is largely our own fault, for so many of us present a bill in one\nhand and an apology in the other. We collect our bills not as if they\nwere our just dues, but with a half-hearted insistence, inducing our\ndebtor to believe that we have scruples ourselves as to the value of our\nservices, and that a liberal discount from the face of the bill will\nabout bring us to a fair settlement. It will be better for all--for\npatient as well as physician--to realize that the \"science of human\nduty\" implies a duty to oneself as well as a duty to the public, and\nthat a small proportion of the charity of our profession should begin at\nhome. To the young men I would especially give this advice: Having\nsettled on a fair and honest fee for your services, do not depart from\nthis fee. With us, as a rule, prosperity in the form of a numerous\nclientage comes sooner than to the other professions. You will not long\nhave opened your office before you will be surprised at the number who\ndemand your services. There will be no doubt of the demand, for those\nwho pay the least invariably demand the most. Don't turn them away, for\nif you properly employ your time, you will gain in experience and\noccasionally a dollar or two. You will soon be enlightened as to your\npopularity, for the first pay day will send most of them to another and\nit is presumed easier man. Many of those who stick will tell you that\nDr. ---- never charged but 50 cents a visit, when the regular fee is\n$1.00. Dr. ---- will vigorously deny this and produce his books to prove\nhis truth. Here is everything plain before you. Every visit is listed at\nthe established figure. You will rarely see his cash book, for then the\nwhole transaction would be plain, and you would discover the simple\nmanner by which in every community some supposedly ethical man is\nsupplanting his truly ethical brother by charging full fees and settling\nfor half.\n\nDr. ---- will cut 50 cents or a dollar from the established fees for\nout-of-town work, and immensely increase his practice by it. For be it\nunderstood the bone and sinew of the land dearly love the wholes and\nhalves, and will flock to sell in the dearest and pay in the cheapest\nmarket. Don't envy this man his prosperity and, above all, don't follow\nin his footsteps. Bide your time with the assurance that the man who\ncharges $1.00 for $2.00 worth of service rarely gives more than a\ndollar's value, and that when a real emergency arises and a capable,\nhonest man is demanded, one who respects himself and his calling, if you\nhave prepared yourself and are known to give the best that is in you,\nthe cheap man will go to the wall and your merit will receive its\nreward. If by chance any of you have not seen Dr. McCormick's paper on\nthis question of fees and collections, let him by all means find the\nproper A. M. A. Journal and read it. It is a classic worth any man's\ntime and attention. In concluding this subject, let me endorse what he\nsays about the cheap man, the price-cutter. Whatever his charge may be,\nhe is usually getting full value for his services. Realizing his lack of\neducation or ability or temperament, or whatever it is that puts him\nbelow his professional competitor, he cuts his fees in order to live. It\nis not our place to meet his competition, but to pity him, to extend to\nhim the helping hand, to endeavor to elevate him to our standard, and\nnever to lower ourselves to his.\n\nI have only a few words to say on the subject of professional\nconfidences. So sacred is the relation between the physician and patient\nregarded that the courts will not compel a physician, while on the\nwitness stand and under oath, to tell the truth, and not only the truth,\nbut the whole truth, to reveal what is imparted to him in confidence by\nhis patient.\n\nIf in this exalted function of doing justice between man and man the\ncourts will not compel the recital of some important piece of evidence,\nhow carefully should we regard our professional relation, and see to it\nthat neither in strict confidence or in idle gossip do we betray the\nsecrets that suffering man has confided in us.\n\nIt may be somewhat out of place in a paper dealing with \"The Ethics of\nthe General Practitioner\" to speak of the tendency, or perhaps better,\nthe half-formed determination of the majority of every class to be\nspecialists. I must confine myself to the predilection of the average\nmedical student for surgery. It was so in my day, and I suppose it is so\nnow, that almost 75 per cent. of the graduating classes are thoroughly\nsatisfied that the end and aim of medicine is surgery; that practice and\nthe less spectacular branches are parts of the profession essential to\nit as a whole, and fitted for those who intend to lead the plodding\nlife, but too slow and too prosaic for the man bursting with the\nknowledge of his own brilliancy and his own special fitness. There is no\nquestion but that this tendency has done much to lower the average\nfitness of many classes. Men become listless and careless, neglecting\neverything but their hobby, and while the surgical amphitheatre is\ncrowded, the medical clinics will be shunned, even deserted were it not\nthat the sections are such that the absentees can be spotted and warned.\nThere is no question also but that indifference to everything but\nsurgery is responsible for many of the failures before the State\nExamining Boards. We must have surgeons, and they must begin their\ntraining in medical schools, and it is not my purpose to discourage\nearnest work and honest effort to this end. I wish, however, to say that\nevery ethical specialist needs a thorough grounding in the general\nbranches of medicine, and he should not in his student days neglect the\nother essentials to a well-rounded man. Most heartily do I wish to\ncondemn the careless, happy-go-lucky manner in which so many men totally\nunprepared and totally unsuited by temperament for this branch \"rush in\nwhere angels fear to tread.\" I wish especially to draw your attention to\nthe fact that there is a vast difference between the operator and the\nsurgeon. Almost any young man with a disregard of the sight of blood,\nwith nerves unaffected by human suffering and a heart untouched by a\nknowledge of his power to do harm, can in six months' practice on the\ncadaver learn to cut, to sew and to ligate with neatness and despatch.\nIndeed, there may be many before me of the student body whose young and\nnimble fingers could teach dexterity to the best surgeons of the city.\nVery many with no pretense to this dexterity, and no equipment but a\nsuperabundance of assurance, graduate as surgeons and assume and aspire\nto a position of prominence that it has taken the true surgeon years of\nthe hardest, closest, most untiring study, observation and work to\nreach. We are told as an excuse for this remarkable evolution from the\nstudent to the surgeon that the young man of today is taught so much\nmore than the old men were; that the very manner of teaching, the\nequipment of the schools and the superior requirements for matriculation\ncannot but turn out better posted and more competent men. There is much\ntruth in this. There is much truth also in the fact that while more is\ntaught, more, infinitely more, is demanded of the student, and the\nknowledge that would have secured him a diploma fifty years ago will now\nscarcely carry him through his freshman year.\n\nWe also hear that \"I want to be a surgeon, because surgery accomplished\npositive results.\" This is very true also, and it is evident that if you\namputate a leg your patient will be minus a member. Don't lose sight of\nanother fact, however, that if without being competent to meet any\nunforeseen emergency that may arise, you lightly open the abdominal\ncavity, you will have a positive result in the shape of your own little\nprivate graveyard. The newly graduated surgeon is not as dangerous as\nthe man who left medical school years ago, before the students received\none-third of the surgical training that they do now. Many of these men\nhave not taken a post-graduate course, have never been associated with a\nhospital, nor have they had even an opportunity for moderate surgical\nobservation; and yet they are attempting to do the work that only a\nskilled specialist should undertake. I am not speaking of emergency\nsurgery for which any man should try to prepare himself, and be brave\nenough to undertake when human life is at stake. I am referring to\noperations of election when the services of a competent man can be\nsecured. The point is just this, gentlemen, that medicine as a science\nis the result of evolution and not the creation of some brilliant brain;\nthat what has been done in it has been accomplished not so much by\ninspiration as by close plodding work, exhaustive experiment and\ncontinual observation; that surgery as one of its branches cannot be\nmastered in the four years of student life, but that to be surgeons you\nmust be workers and observers. It will not do to settle the matter by\nsaying that a man must make a start. This truth is too self-evident to\nbe smart, nor is it entirely convincing. An answer equally true will be\nthat you will not allow the embryo surgeon to start on you, and before\nyou put yourself or your wife or your mother in his hands you will\ndemand that he possess some other qualification for his specialty\nbesides his conceit, his gall and his need of the fee. There may be some\nexceptions where the man is born and not made, but I beg to assure you\nthat the surgeon rarely springs full-fledged and fully fitted from the\nbrain of Minerva.\n\nOur profession is nothing if not altruistic. It demands daily and hourly\nmore of self-sacrifice, more of self-devotion, than any secular calling.\nIndeed, the comparison is often drawn between the nobility and necessity\nof the duties which we perform and those of him who by divine\ninspiration and laying on of hands has been called to succor the\ndiseased soul. It is not my place nor is it my purpose to enter into a\ndiscussion of this point, and I mention it only to show that we are\nmarked men in every community; that we are placed on a higher plane and\nthat more is expected of us than of our brethren of the other liberal\nprofessions. This, indeed, is right, for no man, the priest possibly\nexcepted, enters into such intimate relations with his people. He is\never present with them to share their sorrows and their joys, and in his\nposition of family friend and family confessor it is his place to bind\nand salve wounds more deadly than those made by the hand of man. It is a\npopular impression that this close relationship between the physician\nand his people is one evolved by the brain of the novelist or one\npossessed by that most beloved, but now extinct, old family physician.\nLet us get this impression from our minds and let us realize that our\nduties, our responsibilities and our relationship to those we serve are\njust the same, are just as close, and are just as engrossing as they\nwere when that dear old patriarch of the profession made his rounds,\nscolding some, chiding others and advising all to better, purer and\nnobler lives. Changed as our relationship to the community may be in\nsome respects by the translation of many of the brightest and best of\nour cult into the ranks of the specialist, it is still and always will\nbe the general practitioner who is looked up to as \"the physician,\" and\nby his work in professional and private life our profession will be\njudged.\n\nIn the beginning of my paper I stated I could do little more than\nrehearse to you some of the old axioms and maxims that have been handed\ndown to us for generations. I am aware that I have taught you nothing\nnew tonight, and that I have not tapped that fountain of inspiration\nfrom which genius gushes in poetic or oratorical streams. I trust I may\nhave convinced you that it is not amiss for us at times to hold close\ncommunion with our souls, and to take stock of our moral and\nprofessional assets. The further I have advanced the more fully I have\nrealized how impossible it is to evolve new ideas or elaborate new\ncreeds to supersede those by which the fathers lived and died and earned\nhonor for themselves and our profession.\n\nSo we face today, gentlemen, just about the same propositions that have\nalways been ours to meet, and what was ethical one hundred years ago is\nethical now.\n\nThe science of human duty simply demands that you be honest to\nyourselves, honest to those you serve; that you may look every man\nsquarely in the face and not as if you feared he had heard something you\nhad said behind his back. May I quote to you the words of the Earl of\nSt. Vincent to the immortal Nelson: \"It is given to us all to deserve\nsuccess; mortals cannot command it.\"\n\n\n\n\n                     THE STUDY OF RECTAL SURGERY IN\n                             NEW YORK CITY.\n\n                      BY J. DAWSON REEDER, M. D.,\n            _Lecturer on Osteology, University of Maryland,\n                            Baltimore, Md._\n\n\nHaving decided to take a course in Rectal Surgery, I arrived in New York\nand matriculated at the New York Polyclinic Hospital on October 1st for\na course of instructions under Prof. James P. Tuttle, and desire to\nherewith describe briefly my reception:\n\nProfessor Tuttle is a finished surgeon of the old school of gentlemen, a\nmaster of his art, and, under all conditions and circumstances, adheres\nstrictly to the ethics of the profession. I was not only most cordially\nreceived by him socially, but was most fortunate in being honored by\nrequesting me to assist him, or be present, on operations upon his\nprivate patients at an uptown hospital. This unexpected and friendly\nhonor gave me an opportunity to observe closely the work of this great\nsurgeon in detail, and I had the pleasure of witnessing every case under\nhis care during my three months' visit. As to his colossal work on\ncancer of the rectum and sigmoid, his results are too well known for me\nto dwell upon at this time, and he has an enviable record which makes\nhim the authority of this distressing malady which is so prevalent in\nthe cases referred to the Rectal surgeon, and have so long been\nunrecognized by the general profession. I had the pleasure of witnessing\nhim extirpate the rectum by his bone-flap and perineal route, and in\nsome of these cases was honored by being his assistant. As to the method\nand technique in each of the above mentioned, I will endeavor to give\nlater. Another very important point gained by association with this\nsurgeon was, that my own theory as to the merits of the Whitehead\noperation were simply an endorsement of his teachings, namely, that this\nparticular operation, while classical, was only justifiable in selected\ncases of hemorrhoids, while the Clamp and Cautery or the Ligature method\nhad no restrictions as to variety or location of the pile mass.\n\nAnother important subject was the question of treatment of Tubercular\nfistula. For a number of years Dr. Tuttle said he was most discouraged\nin his results and had almost abandoned any attempt to cure this class\nof infections, but of late he had obtained most excellent results by\nintroducing his soft flexible probe and following this tract with a\ngrooved director; opening this throughout its entire extent, and then\ncompletely cauterizing at dull red heat with the actual cautery. This is\nthen packed with iodoform gauze, and since using the cautery, his\nresults have been decidedly better. Under the direction of his\nassistant, Dr. J. M. Lynch, a class of three was formed, with regular\nwork and instructions in the dispensary of St. Bartholomew's Clinic,\nwhere we were given cases to diagnose and treat. This course consisted\nin introduction of proctoscope and sigmoidscope diagnosis of ulcerations\nspecific and benign, and local treatment through this instrument. To the\ninexperienced the results and probabilities gained through the use of\nthis pneumatic instrument of Tuttle's, which is a modification of the\nLaws proctoscope, are surprising. By the electric illumination with\nwhich it is equipped one is able to introduce the instrument with\nabsolute safety to the patient for a distance of 10 to 14 inches,\nexploring the entire circumference from the anus up through the sigmoid.\n\nMy next course of instructions was under the direction of Prof. Samuel\nGant at the New York Post-Graduate Medical School. Dr. Gant likewise was\nmost cordial in his reception, and on several occasions honored me by\nentertainments, including letters of membership to his club, and at his\nhome with his family. Dr. Gant, also a master of his art, has made a\nreputation of renown, and is a most successful operator. While of an\nentirely different character from that of Dr. Tuttle he is equally\nattractive. Dr. Gant argues that the majority of cases of cancer when\nseen by the specialist are too far advanced to offer any hope by radical\noperation, and generally limits his attempts at relief to a colostomy.\nAs to the merits of this procedure, I am not sufficiently versed to\noffer criticism further than to say that the results of Dr. Tuttle are\ncertainly encouraging to the surgeon who will undertake this ordeal of\nextirpation in hopes of eradicating the disease, while Dr. Gant's\noperation of colostomy, of course, is only palliative, he making no\nclaims of a cure, except when the growth is seen very early and is\nfreely movable; then he will extirpate.\n\nAs to the operation for hemorrhoids, Dr. Gant uses ligature and sterile\nwater anesthesia in nearly every case, and the patient is thereby cured\nwithout the administration of a general anesthetic. The difference in\nthe time of recovery is a question to be always considered, in my own\njudgment, and is as follows: Dr. Tuttle uses the clamp and cautery\nalmost universally, and the patient is discharged within the period of\none week, while the ligature method requires local treatments to the\nulcerations produced by the sluffing of the linen threads, and takes\nfrom 10 days to three weeks.\n\nConstipation and Obstipation are treated surgically by both of these\ngentlemen by the operation of Sigmoidopexy or Colopexy, which consists\nin anchoring the gut to the abdominal parietes after having first\nstripped back the peritoneum over the area covered by their sutures.\n\nChronic diarrheas and Am\u0153bic Dysentery are likewise treated by\nAppendicostomy and Caecostomy. The difference in this operation being\nthat the former consists in delivering the appendix upon the abdomen and\nfixing the same with catgut sutures until the peritoneal cavity is\nwalled off by adhesions, and then amputating later, so that the stump\nmay be dilated to permit of regular colonic irrigations.\n\nDr. Gant performs a similar operation, to which he has applied the name\nof Caecostomy, and having devised an ingenious director consisting of\none metal rod within a tube of slightly larger calibre, he is able to\npass the obturator through the ileo-caecal valve, and then, by\nwithdrawing the rod or obturator, is able to pass a rubber catheter into\nthe small intestine. The metal tube is then withdrawn and a shorter\ncatheter is placed parallel with the long one, which necessarily is in\nthe caput, and after placing clips upon each tube to prevent leakage, he\nis able to flush out both large and small bowel at desired intervals.\n\nAs to the irrigations through these newly-made openings, it is a matter\nof choice with different operators, those in greatest favor, I think,\nbeing Ice Water, Aq. Ext Krameria and Quinine Solution.\n\nA very interesting case brought before us by Dr. Tuttle was one of\nSpecific Stricture of the Rectum, and the treatment anticipated is as\nfollows: He performed a Maydl-Reclus Colostomy in the transverse colon,\nin order first to treat the ulcerations and infected area locally, and,\nsecondly, so that he would have sufficient gut above the stricture to do\na Perineal extirpation later and bring down new healthy intestine from\nthe upper Sigmoid for a new permanent anus; then later he would close\nthe artificial anus in the transverse colon, and his patient should have\na perfect result. The period required for these three operations would\ncover a period of not less than nine months; and if after this there is\nnot perfect Sphincteric action, Dr. Tuttle does a plastic operation to\nrepair his sphincter.\n\nBefore continuing with a brief description of the technique of\nExtirpation as above referred to, I wish to herewith express my sincere\ngratitude and appreciation of the many honors and courtesies extended to\nme by these gentlemen, and am quite sure that the same was not all\npersonal, but honor to the University of Maryland's Faculty of Physic,\nwho have aided so materially this younger specialty by such men as\nHemmeter, Pennington and Earle, who are constantly quoted by all\nintestinal and rectal surgeons.\n\n\nEXTIRPATION OF RECTUM.\n\nThe operation of removing the rectum is now almost two centuries old.\nFaget performed it in 1739, but Listfrane first successfully extirpated\nthe rectum for cancer in 1826. The results of the operation in nine\ncases were embodied in a thesis by one of his students (Penault, Thesis,\nParis, 1829), and in 1833 the great surgeon himself gave to the world a\ncomplete account of his operation and method, thus establishing the\nprocedure as a surgical measure. The results in these cases were not\ncalculated to create any great enthusiasm, for the mortality was high\nowing to the lack of aseptic technique. The methods described in older\nbooks give us five varieties of operation for extirpation--the perineal,\nthe sacral, the vaginal, the abdominal and the combined. In this paper I\nshall only endeavor to describe briefly the two methods used by Dr.\nTuttle. Before describing these methods in detail it may be well to\nconsider the preparation of the patient, which is practically the same\nin each. In order to obtain the best results, it is necessary to\nincrease the patient's strength as far as possible by forced feeding for\na time, to empty the intestinal tract of all hard and putrifying faecal\nmasses, to establish as far as we may intestinal antisepsis and to\ncheck, in a measure, the purulent secretion from the growth. It requires\nfrom 7 to 10 days, or longer, to properly prepare a patient for this\noperation. The diet best calculated to obtain a proper condition of the\nintestinal tract is generally conceded to be a nitrogenous one. The\nabsolute milk diet is not so satisfactory as a mixed diet composed of\nmeat, strong broth, milk and a small quantity of bread and refined\ncereals. The patient should be fed at frequent intervals, and as much as\nhe can digest. Along with this forced feeding one should administer\ndaily a saline laxative which will produce two or three thin movements,\nand to disinfect the intestinal canal one should give through the\nstomach three or four times a day sulpho-carbolate of zinc, grs. iiss.,\nin form of an enteric pill. On the day previous to the operation the\nperinaeum, sacral region and pubis should be shaved, dressed with a soap\npoultice for two hours, then washed and dressed with bichloride\ndressing, which should be retained until patient is anesthetized.\nNotwithstanding all of these preparations, it is impossible to obtain\nabsolute asepsis of the affected area, and so many fatalities occur from\ninfection that it is deemed wise by many surgeons to make an artificial\ninguinal anus as a preliminary procedure in all extirpations of the\nrectum.\n\n\nPERINEAL METHOD.\n\nUnder this method may be included certain operations for small\nepitheliomas low down in the rectum done through the anus. The patient\nhaving been properly prepared, the sphincter is thoroughly dilated; a\ncircular incision through the entire wall of the gut is made, and the\nsegment is caught with traction forceps and dragged by an assistant\nwhile the operator frees, by scissors and blunt dissection, to a point\nat least one-half inch above the cancer. The free end of the gut is then\ntied with strong tape, as the temptation is very great to put your\nfinger in the bowel as a guide, and thereby invite infection. A deep\ndorsal incision is then made, going down to the right of the coccyx\nthrough the post-rectal tissue. The hand is then placed in the sacral\nfossa and the structures lifted out into the pelvis, after which this\nspace is thoroughly packed with gauze to control the bleeding and hold\nthe structures out of the fossa. The edges of the wound, including each\nhalf of the sphincter which has been cut posteriorly, are held by flat\nretractors, while the operator proceeds to dissect the anterior portion\nof the rectum loose from its attachments. A sound should be held in the\nurethra in men and an assistant's finger in the vagina in women to\nprevent wounding these organs. After the gut has been dissected out well\nabove the tumor, it is caught by clamps and cut off below these.\nBleeding is controlled by ligatures and equal parts of hot water and\nalcohol. This newly-exposed gut is then sterilized by pure carbolic acid\nand alcohol, or may be seared with cautery. Sometimes the peritoneum can\nbe stripped off from the rectum and its cavity need not be opened; it is\nbetter, however, to open the cavity at once when the growth extends\nabove this point. The peritoneum is incised, cut loose from its\nattachments close to the rectum, back to the mesorectum, which should be\ncut close to the sacrum, in order to avoid the inferior mesenteric\nartery. When the gut has been loosened sufficiently above the tumor, it\nmay be still fastened by two lateral peritoneal reflections, which are\nthe lateral rectal ligaments, and should be cut at once. The gut is then\nbrought down and sutured to the anus, and the operator should proceed to\nclose the peritoneum and restore the planes of the pelvic floor down to\nthe levator ani by fine catgut sutures. After this has been\naccomplished, the anus, which is now well outside the operative field,\nshould be reopened, the gauze removed, and the gut flushed with a\nsolution of bichloride or peroxide of hydrogen. Quenu advises that in\namputating each layer should be cut separately, in order to avoid\nhemorrhage, but there appears to be no advantage in this; in fact, we\nare more likely to meet with deficient blood supply, causing subsequent\nsloughing of the gut, than with hemorrhage. The posterior and anterior\nportions of the perineal wound are packed with gauze and left open to\nassure drainage, and the parts are covered with aseptic pads, held in\nposition by a well-fitting \"T\" bandage. A large drainage tube is passed\nwell up into the rectum, its lower end extending outside of the\ndressings, in order to convey the discharges and gases beyond the\noperative wound.\n\n\nTUTTLE'S BONE FLAP OPERATION.\n\n\"The Kraske Operation\" is applied to various methods in which access to\nthe rectum is obtained by removing the coccyx or cutting off certain\nportions of the lower end of the sacrum. They are all modifications of\nKraske's original method, with which we are all familiar. Dr. Tuttle has\nmodified this plan, as it furnishes a rapid and adequate approach to the\nrectum; it facilitates the control of hemorrhage and restores the bony\nfloor of pelvis and attachment of the anal muscles, and involves injury\nof the sacral nerves and lateral sacral arteries on one side only. The\ntechnique which he employs is as follows:\n\nThe patient is previously prepared as heretofore described, and an\nartificial anus established or not, as the conditions indicate; before\nthe final scrubbing the sphincter should be dilated and the rectum\nirrigated with bichloride 1-2000 or hydrogen peroxide. It should then be\npacked with absorbent gauze, so that the finger cannot be introduced.\nThe patient is then placed in the prone position on the left side, with\nthe hips elevated on a hard pillow or sandbag; an oblique incision is\nmade from the level of the third foramen on right side of sacrum down to\nthe tip of the coccyx, and extending half-way between this point and the\nposterior margin of the anus.\n\nThis incision should be made boldly with one stroke through the skin,\nmuscles and ligaments into the cellular tissue posterior to the rectum;\nthe rectum is then rapidly separated by the fingers from the sacrum, and\nthe space thus formed and the wound should be firmly packed with sterile\ngauze. A transverse incision down to the bone is then made at a level of\nthe 4th sacral foramen, the bone is rapidly chiseled off in this line,\nand the triangular flap is pulled down to the left side and held by\nretractor. At this point it is usually necessary to catch and tie the\nright lateral and middle sacral arteries. Frequently these are the only\nvessels that need to be tied during the entire operation, although if\none cuts too far away from the sacrum, the right sciatic may be severed.\nThe first step in the actual extirpation of the rectum consists in\nisolating the organ below the level of the resected sacrum, so that a\nligature can be thrown around it, or a long clamp applied to control any\nbleeding from its walls. If the neoplasm extends above this level and it\nis necessary to open the peritoneal cavity to extirpate it, one should\ndo this at once, as it will be found much easier to dissect the rectum\nout by following the course of the peritoneal folds. By opening the\nperitoneum and incising its lateral folds close to the rectum, the\ndanger of wounding the ureters is greatly decreased and the gut is much\nmore easily dragged down.\n\nWhen the posterior peritoneal folds or meso-rectum is reached, the\nincision should be carried as far away from the rectum, or, rather, as\nclose to the sacrum, as possible in order to avoid wounding the superior\nhemorrhoids artery, and to remove all the sacral glands. The gut should\nbe loosened and dragged down until its healthy portion easily reaches\nthe anus or healthy segment below the growth. A strong clamp should then\nbe placed upon the intestine about one inch above the neoplasm, but\nshould never be placed in the area involved by it; for in so doing the\nfriable walls may rupture and the contents of the intestine be poured\nout into the wound. As soon as the gut has been sufficiently liberated\nand dragged down, the peritoneal cavity should be cleansed by wiping\nwith dry sterilized gauze and closed by sutures which attach the\nmembrane to the gut. By this procedure the entire intraperitoneal part\nof the operation is completed and this cavity closed before the\nintestine is incised. After this is done the gut should be cut across\nbetween two clamps or ligatures above the tumor, the ends being\ncauterized with carbolic acid and covered with rubber protective tissue.\nThe lower segment containing the neoplasm may then be dissected from\nabove downward in an almost bloodless manner until the lowest portion is\nreached. It is much more easily removed in this direction than from\nbelow upward, and there is less danger of wounding the other pelvic\norgans. If the neoplasm extends within one inch of the anus, it will be\nnecessary to remove the entire lower portion of the rectum. If, however,\nmore than one inch of perfectly healthy tissue remains below, this\nshould always be preserved. Having removed the neoplasm, if one inch or\nmore of healthy gut remains above anus, one should unite the proximal\nand distal ends either by Murphy button or end-to-end suture.\n\nAll oozing is checked by hot compresses, and the concavity of the sacrum\nis packed with a large mass of sterilized gauze, the end of which\nprotrudes from the lower angle of the wound. This serves to check the\noozing, and also furnishes a support to the bone-flap after it has been\nrestored to position. Finally the flap is fastened in its original\nposition by silk-worm gut sutures, which pass deeply through the skin\nand periosternum on each side of the transverse incision. Suturing the\nbone itself is not necessary. The lateral portion of the wound is closed\nby similar sutures down to the level of the sacro-coccygeal\narticulation; below this it is left open for drainage (Tuttle, Diseases\nof Rectum, Page 829-1903).\n\n\n\n\n                     REPORT OF A CASE OF GANGRENOUS\n                     APPENDICITIS, FROM THE SERVICE\n                          OF PROF. R. WINSLOW.\n\n                          BY C. C. SMINK, '09,\n                       _Senior Medical Student_.\n\n\nIn selecting a case I have not taken one that is a surgical curiosity,\nor at all an unusual one, but I have taken this because it is just in\nthese cases that a doubt sometimes exists as to the treatment when\ndiagnosed, and often the condition of the appendix and surrounding\nperitoneum is in doubt, even if a diagnosis of trouble originating in\nthe appendix is made.\n\n_History of Case_--Patient, a boy, L. W., age 9 years, schoolboy;\nadmitted December 26, 1908, with a diagnosis of appendicitis.\n\n_Family History_--Parents well; one brother died in infancy, cause\nunknown; two brothers living and well; only history of any family\ndisease is tuberculosis in one uncle; no rheumatism, syphilis, gout,\nhaemophilia or other disease bearing on the case.\n\n_Past History_--Measles at 5 years, with uneventful recovery;\nwhooping-cough at 6, no complications; badly burned two years ago; has\nhad \"indigestion\" (?) since he was 3 years old; pain but no tenderness\nduring these attacks; treated by different physicians and got better for\na time; no history of scarlet fever, influenza, pneumonia, typhoid or\nother disease of childhood.\n\n_Habits_--A normal child.\n\n_Present Illness_--On 20th of December, 1908, patient came home from\nchurch complaining of pains in the right side. This was Sunday. Next day\nhe complained of severe pain all over abdomen, but on Tuesday these\nbecame localized in the right lower quadrant of the abdomen. Had some\nfever. Bowels constipated. No nausea or vomiting. There was a localized\ntenderness in the right lower quadrant from the start. Pains got better\non Friday, but temperature and pulse still stayed up, and patient came\ninto hospital on Saturday, December 26. The unusual feature was that\nthere was no nausea or vomiting. It is also to be noted that the pain\nsubsided suddenly on the 24th. The child entered hospital on the 26th,\nand on entrance the whole right side was rigid, while the left side was\ncomparatively soft. A lump could be felt in the appendical region, the\ncentre of which was above McBurney's point. Temperature was 99 and pulse\n78. The leucocyte count, however, was 30,200; urine negative.\n\nChild was put to bed; an ice cap placed on the abdomen. Liquid diet. The\nnext day, December 27th, leucocytes stood at 35,200. Temperature\nunchanged, but the pulse had risen to 110 beats. A hypodermic of\nmorphine and atropine was given, and patient taken to the operating\nroom, anesthetized, and abdomen cleaned for an aseptic (if possible)\noperation.\n\nProf. Winslow made an incision in the abdominal wall, well out toward\nthe crest of the ilium, using the gridiron incision. The caecum was\nfound and pulled over toward the middle line, and in looking for the\nappendix, which was supposed to be behind the caecum, a great quantity\nof pus was found. This nasty smelling, grayish pus welled up into the\nwound and was sponged away. Several pieces of mucous membrane and\npresumably the tip of the appendix were found in the pus. Also several\nfaecal secretions. The pus was sponged away and carefully a search was\nmade for the appendix, or rather what remained of it. It was found tied\ndown by adhesions and dissected loose. It broke away in pieces, and it\nwas unnecessary to ligate any of the arteries of the meso appendix. The\nstump of the appendix close to the caecum was crushed, cauterized and\nligated. No attempt was made to invert it, as the tissues would not\nstand it. The pus cavity was found to extend up behind the caecum and\nover toward the median line for some distance. The puncture, which I\nwill refer to later, was then made in the right lumbar region, and two\ncigarette drains were introduced extending clear back into the bottom of\nthe abscess cavity. Then a gauze drain was introduced into the anterior\nwound, and this sutured up. The wound was then dressed and the patient\ntaken to the ward. Recovery from anesthetic without ill effects.\n\nThe next morning the patient was unable to pass his water, and had to be\ncatheterized. Aside from this no ill effects were seen, and his\ntemperature and pulse remained practically at the same place. At the end\nof 48 hours the drains and dressings were changed and the patient was\ndoing well and the wound draining profusely. At no time was the bed\nelevated and at no time was a stimulant administered, with the exception\nof a hot normal salt enema on the day following the operation. Several\ntimes during his stay a dose of castor oil was given, but no other\nmedication was necessary. As the dressings were reapplied and drains\nintroduced daily the wounds were found to be granulating up, and\ngradually these closed, first the one in the lumbar region and then the\none in the abdomen. By the tenth day a normal temperature was present,\nand he sat up on the twelfth.\n\nThe child went on to an uneventful recovery, and went home on January\n21st fully cured.\n\nThis was undoubtedly one of those cases of gangrenous appendicitis\nwhere, owing either to the intensity of the infection or to a thrombosis\nof the vessels supplying the appendix, the vitality of the tissues is\nlost and gangrene results. Now, \"even in this, the gravest form of\nappendicitis, the general peritoneal cavity is often protected against\ninfection by walling off the pus, and the appendix, detached in the form\nof a slough, is often found on opening the localized abscess.\" But \"in\nother cases there is from the beginning the symptoms of peritoneal\nsepsis and peritonitis.\"\n\nNow, it seems to me that a great deal depends on the kind of\ninfection--or, rather, the kind of organism infecting--and often the\ndifference between a localized abscess and a general peritonitis is\nreally the difference between a colon and a streptococcus infection.\nAgain, should a general peritonitis develop, I have noticed from a\nnumber of cases in the wards that the prognosis practically depends on\nthe organism, although we all know that a general peritonitis is a\nmighty grave condition, no matter what it is due to.\n\nAnother point in favor of the child was the fact that the gangrenous\nprocess seemed to start in the tip of the appendix, and it seems that\nwhen it starts there, there is greater likelihood of localization, and\nwhen it starts in the base a greater likelihood of general peritonitis.\n\nI said that there was often doubt as to the condition in the abdomen in\nthese cases. Now, there can be no doubt that the two main points in the\ndiagnosis of a localized abscess are tumor and an aggravation of the\nsymptoms present. But this case exemplified the fact that there may be\ncases where there is no aggravation of symptoms, and in a great many\ncases it may be impossible to feel the tumor until it has become very\nlarge, owing to its situation, viz., post caecal. Even in this case,\nfrom which a great quantity of pus was evacuated, there was no absolute\ncertainty of finding pus on opening the abdomen, although it was\nsuspected strongly.\n\nI have seen a patient walk into the hospital on Sunday with a\ntemperature of 100 and a pulse of 99, and when the abdomen was opened on\nMonday morning a most virulent form of general streptococcus peritonitis\nwas found, from which the patient died the next day. It is said that it\nis much better to depend on the pulse and its variations than on the\ntemperature.\n\nI would like to call attention to several points in the treatment of\nthis case also.\n\nFirst, the place of incision was, as I said, well up towards the iliac\ncrest, and not in the time-honored McBurney point. The wisdom of this is\nself-evident.\n\nSecond, the care used in not breaking up the wall of the abscess formed\nby the peritoneum.\n\nAlso, the fact that the appendix was carefully dissected up and tied off\nand allowed to heal by itself, obviating, as much as possible, the\ndanger of a faecal fistula. The older books advised evacuating the\nabscess and leaving the appendix to slough off, and, while I have seen\nseven cases where this method was used and not a single faecal fistula,\nyet it seems to me the more rational treatment to remove the offender,\nas I have also assisted in three operations where the appendix was\nremoved at the second operation. That is, an operation supposedly an\nappendectomy was done, and later, at a subsequent period, the diseased\nappendix was found still causing the same old trouble.\n\nAgain, the use of the lumbar puncture, so as to drain the abscess cavity\nfrom its very bottom. I wonder this is not done oftener, as it appeals\nto me as being a most sensible thing.\n\nThen the abscess cavity was sponged out with gauze, and not washed out\nwith the antiseptic fluid that books advise, thus spreading bacteria all\nover the peritoneal cavity, and really doing no good. Nature was allowed\nto throw off such things as she deemed necessary, an avenue of escape\nhaving been provided.\n\nAnd, lastly, the omentum was found and brought down, covering in the\ncavity as much as possible, and thus aiding in the walling off process.\n\n\n\n\n                          DIRECT LARYNGOSCOPY.\n\n                     BY RICHARD H. JOHNSTON, M. D.\n\n            _Read Before the Baltimore City Medical Society,\n                    Section on Medicine and Surgery,\n                            February, 1909._\n\n\nDirect laryngoscopy, as the name implies, is the inspection of the\nlarynx through a hollow tube without the use of a mirror. The\nexamination is made with the patient in the sitting position, under\nlocal anesthesia, or in the prone position, under general anesthesia. To\nexamine the larynx in the sitting position it is practically always\nnecessary to give a hypodermic injection of morphia and atropia a half\nhour beforehand, to relax the muscles and to prevent excessive\nsecretion. The patient is seated upon a low stool with the head extended\nand supported by an assistant. With curved forceps 20% cocaine or 25%\nalypin solution is quickly passed into the throat, anesthetizing\npharynx, tongue and epiglottis. Jackson's slide speculum is then\nintroduced and the base of the tongue, with the epiglottis, gently\npulled forward. At this point it is usually necessary to use more\ncocaine directly in the larynx, which is introduced by means of special\ncotton carriers. In a few minutes anesthetization is complete, and the\nexamination can be made at leisure. It will be found easier to inspect\nthe different parts of the larynx if the head is held about halfway\nbetween the erect position and complete extension. In some patients with\nshort, thick necks and large middle incisor teeth the slide will have to\nbe removed from the speculum to enable one to see well. The examination\nin the prone position under general anesthesia is made with the\npatient's head over the end of the table supported by an assistant. The\nspeculum is introduced and the base of the tongue and the epiglottis\npulled upward forcibly. In this position direct laryngoscopy, even in\nchildren, is unsatisfactory, and operative procedures are well-nigh\nimpossible on account of the muscular rigidity. The force required to\nlift the tissues is so great and the position of the arm is so cramped\nthat it is difficult to get a clear view of the field. The difficulty\nhas impressed all who have worked in this particular line. It remained\nfor Dr. H. P. Mosher, of Boston, to discover a method of direct\nlaryngoscopy which makes it as simple under ether anesthesia as in the\nsitting position. In April, 1908, he described in the _Boston Medical\nand Surgical Journal_ the \"left lateral position\" for examining the\nlarynx and the upper end of the esophagus. He designed certain\ninstruments which I believe are too cumbersome to meet with popular\nfavor. In Mosher's position the patient lies on the table with the head\nturned toward the left until the cheek almost rests on the table; the\nchin is flexed on the chest. In our work at the Presbyterian Hospital we\nhave found a modified Mosher's position and Jackson's child speculum the\nideal combination for the examination in the prone patient. In children\nthe procedure is carried out with or without anesthesia. Without\nanesthesia the head, hands and feet are held, the chin is flexed on the\nchest in a normal position by placing a pillow under the head, the\nspeculum is introduced and the larynx inspected. In adults under\nanesthesia the same procedure is used, and will be found much simpler\nthan the extended position. In adults, after the speculum is in\nposition, if the anterior part of the larynx is not seen, gentle\npressure on the thyroid cartilage will bring the anterior commissure\ninto view. Operations can be done through the tube satisfactorily. With\nthe different methods of direct laryngoscopy it is possible to remove\nany growth from the larynx.\n\n919 N. Charles Street.\n\n\n\n\n                                 ITEMS.\n\n\nThe Board of Trustees of the Permanent Endowment Fund of the University\nheld its annual meeting on January 11. Judge Stockbridge was re-elected\npresident and Mr. J. Harry Tregoe secretary-treasurer, and, with Dr.\nSamuel C. Chew and Judge Sams, constitute the executive committee for\nthe year 1909. The funds and securities in hand total the gross sum of\n$18,635.74.\n\n                                -------\n\nA special meeting of the Washington Branch of the General Alumni\nAssociation was held at the office of the president, Dr. Monte Griffith,\nMarch 11, 1909, to consider the advisability of petitioning the Board of\nRegents to establish a Board of Alumni Counsellors, a paid president and\na Board of Trustees, independent of the teaching faculties. Resolutions\nin favor of these measures were adopted.\n\n                                -------\n\nDr. Louis W. Knight, class of 1866, of Baltimore, has presented to\nLoyola College a valuable collection of papal medals.\n\n                                -------\n\nDrs. H. O. and J. N. Reik have removed their offices to 506 Cathedral\nstreet.\n\n                                -------\n\nDrs. W. D. Scott and W. E. Wiegand attended the banquet of the Virginia\nMilitary Institute Alumni Association of Baltimore, held at the New\nHoward House, March 2, 1909. Dr. W. D. Scott responded to the toast \"The\nYounger Generation and the Splendid Work of the Virginia Military\nInstitute Today.\"\n\n                                -------\n\nMajor William F. Lewis, class of 1893, U. S. A. Medical Corps, has been\nrelieved from duty at Fort Thomas and ordered to sail on June 5, 1909,\nfor the Philippine Islands, via San Francisco, for duty.\n\n                                -------\n\nDr. Hugh A. Maughlin, class of 1864, of 121 North Broadway, an official\nin the United States Custom Service, who was assistant surgeon in the\nSixth Maryland Regiment during the Civil War, is dangerously ill of\npleurisy at his home. Dr. Maughlin is a member of Wilson Post, G. A. R.\n\n                                -------\n\nDr. James A. Nydegger, class of 1892, past assistant surgeon, United\nStates Public Health and Marine Hospital Service, has been promoted to\nthe rank of surgeon.\n\n                                -------\n\nDr. Eugene H. Mullan, class of 1903, assistant surgeon, United States\nPublic Health and Marine Hospital Service, has been commissioned a past\nassistant surgeon, to rank as such from February 2, 1909.\n\n                                -------\n\nDr. Samuel T. Earle, Jr., of Baltimore, Md., records the case of Mrs. F.\nH. D., who, the latter part of August, 1907, while eating ham, swallowed\na plate with two false teeth. Ten days later she had a violent attack of\npain in the abdomen, followed by a chill and fever. There was no\nrecurrence of this for one and a half months. Since then they have\nrecurred from time to time, but not as severe, nor have they been\nattended with chill and fever. A diagram taken of the lower abdominal\nand pelvic regions showed the plate in the sigmoid flexure of the colon,\non a level with the promontory of the sacrum. Examination through the\nsigmoidoscope brought it into view at the point shown by the X-ray.\nThere was considerable tenesmus, and the passage of a good deal of\nmucous, also a tendency to constipation. Under the influence of two\nhypodermics of morphine, gr. 1-4, hyoscine hydrobromate, gr. gr. L-100,\nand cactina, which produced satisfactory anesthesia, Dr. Earle was able\nto grasp the plate through the sigmoidoscope with a pair of long\nalligator forceps, and withdraw it immediately behind the sigmoidoscope.\n\n                                -------\n\nAt the Conference on Medical Legislation, held in Washington, D. C.,\nJanuary 18-20, 1909, resolutions were adopted providing for a committee\ncomposed of one member each from the medical departments of the Army and\nthe Navy, one from the Public Health and Marine Hospital Service, one\nmember from the District of Columbia and one member from the Council on\nMedical Legislation, to present to the medical profession the conditions\nunder which the widow of Major James Carroll is now placed, and to\ndevise such plans as might seem advisable for her relief. The following\ncommittee was appointed: Major M. W. Ireland, U. S. A.; Surgeon W. H.\nBell. U. S. N.; Dr. John F. Anderson, U. S. Public Health and Marine\nHospital Service; Dr. John D. Thomas, Washington, D. C., and Dr. A. S.\nVon Mansfelde, of Ashland, Nebraska.\n\nMrs. Carroll has been granted a pension of $125 a month on which to\nsupport herself, seven young children and the aged mother of her\nhusband. The house, which Major Carroll had partly paid for, is\nmortgaged for $5,000. Since the conference adjourned the medical\nofficers of the Army have raised enough to pay the taxes on the house,\none monthly note of $50 and the overdue interest on the first mortgage,\namounting to $125. Believing that the members of the medical profession\nwill wish to contribute toward a fund for the purpose of paying the\nbalance due on the house, the committee requests contributions of any\namount. They may be sent to Major M. W. Ireland, United States Army,\nWashington, D. C. The editors of THE BULLETIN sincerely hope our alumni\nwill honor the memory of our most distinguished alumnus by contributing\nliberally to this most worthy cause.\n\n                                -------\n\nAt the last regular meeting of the University of Maryland Medical\nAssociation, held in the amphitheatre of the University Hospital,\nTuesday, March 16, 1909, the program was as follows: 1, \"The General\nPractitioner: His Relation to His Patients, to His Fellow Practitioners\nand to the Community in Which He Lives,\" Dr. Guy Steele, Cambridge, Md.;\n2, \"Medical Ethics,\" Dr. Samuel C. Chew. Dr. A. M. Shipley, the\npresident, was in the chair, and called the meeting to order promptly at\n8.30 P. M. The attendance was large and appreciative, and listened to\ntwo remarkably able addresses. Those who had the privilege and pleasure\nof listening to the words of wisdom and advice both of Dr. Chew and Dr.\nSteele went away with a clearer conception of their duties to their\nprofessional brethren and the public.\n\nImmediately after the adjournment of the Medical Association the Adjunct\nFaculty, with its president, Dr. Joseph W. Holland, in the chair, held a\nvery important meeting, the gist of which is as follows: Resolved by the\nAdjunct Faculty of the Medical Department of the University of Maryland\nthat the Board of Regents be implored to effect such changes in the\ncharter as to make possible the election of a president with a fixed\nsalary, and with the duties usually associated with that office in\nstandard universities, and a Board of Administrators independent of\nteaching faculties. The Adjunct Faculty also endorsed tentative plans\nlooking towards the formation of an advisory board of alumni\ncounsellors.\n\n                                -------\n\nAt the meeting of the Section on Ophthalmology and Otology, Thursday,\nMarch 11, 1909, at the Faculty Hall, the following of our alumni read\npapers: \"Rodent Ulcer of the Cornea (Ulcus Rodens Mooren), with\nExhibition of the Case,\" Dr. R. L. Randolph; \"Purulent Otitis Media of\nInfancy and Childhood,\" Dr. H. O. Reik.\n\n                                -------\n\nAt the meeting of the Section on Neurology and Psychiatry, Friday, March\n12, 1909, the following participated:\n\n\"History and Forms of Chorea,\" Dr. N. M. Owensby;\n\n\"Etiology of Chorea, Dr. H. D. McCarty;\n\n\"Treatment of Chorea,\" Dr. W. S. Carswell.\n\n                                -------\n\nThe Baltimore _Star_ of March 27th, 1909, has this to say concerning\nProf. Randolph Winslow: \"Prof. Randolph Winslow, head of the Department\nof Surgery of the University of Maryland, is one of the best-known\nlecturers and demonstrators in the East. He is a close student, and has\nthe faculty of impressing the young men of the University with the force\nof and practicability of his knowledge. Professor Winslow stands high in\nmedical and surgical circles of the country, and ranks with the best\nsurgeons.\" Under the caption of the leading men of Maryland _The Star_\nalso included a photograph of Professor Winslow. By honoring Dr. Winslow\n_The Star_ also honors the University of Maryland, whose authorities\nfeel a natural pride in the eminent position held by its professors.\n\nDr. Fitz Randolph Winslow, class of 1906, a former resident physician in\nthe University Hospital, and a resident of Baltimore, has located at\nHinton, Virginia.\n\n                                -------\n\nThe Phi Sigma Kappa Fraternity had an at-home Saturday, March 27, 1909.\n\n                                -------\n\nAbout sixty members of the Theta Nu Epsilon Fraternity, University of\nMaryland, attended a banquet at the Belvedere recently. It was served in\nthe main hall, and the tables, which formed a semicircle, were\nbeautifully decorated with trailing asparagus and cut flowers. During\nthe meal a string orchestra rendered popular selections. Dr. Arthur M.\nShipley, toastmaster, introduced Mr. Frederick W. Rankin, who made the\naddress of welcome. Mr. Rankin was followed by Dr. C. H. Richards, who\nresponded to the toast \"Past and Present;\" Dr. W. D. Scott had as his\nsubject \"The Fraternity Man;\" Dr. R. Dorsey Coale, \"The Undergraduate;\"\nDr. Randolph Winslow, \"The Near Doctor;\" Dr. John C. Hemmeter, \"Our\nUniversity,\" and Mr. C. B. Mathews, \"The Ladies.\" The reception\ncommittee in charge of the arrangements was as follows: Frederick W.\nRankin, chairman; Ross S. McElwee; John W. Robertson, John S. Mandigo,\nArthur L. Fehsenfeld, J. F. Anderson.\n\n                                -------\n\n\n\n\n                                DEATHS.\n\n\nDr. Joseph R. Owens, class of 1859, mayor of Hyattsville, Md., and\ntreasurer of the Maryland Agricultural College, died at his home, in\nHyattsville, March 15, 1909, after a lingering illness of six months.\nDeath came peacefully, and at the bedside were his wife, who was Miss\nGertrude E. Councilman, of Worthington Valley, Baltimore county, Md.;\nhis daughter, Mrs. Geo. B. Luckey, and his son, Charles C. Owens, of New\nYork. Besides these he is survived by his mother, Mrs. Percilla Owens,\n90 years of age; a son, Mr. L. Owens, of New York, and a daughter, Mrs.\nA. A. Turbeyne, of England.\n\nDr. Owens was born in Baltimore, February 20, 1839, and was 70 years\nold. His parents removed to West River when he was seven years of age.\nWhen he was ten years old he entered Newton Academy, Baltimore, and in\n1859 was graduated from the Medical Department of the University of\nMaryland. Immediately after leaving the University he was appointed\nresident physician at the Baltimore City Almshouse, and served in this\ncapacity to 1861, when he returned to Anne Arundel county and began\nfarming on West River. In 1885 he removed to Hyattsville and accepted\nthe position of clerk of the Claims Division of the Treasury Department,\nWashington. He held this office until 1890, when he was named as\ntreasurer of the Maryland Agricultural College, which position he filled\nuntil death. For several years Dr. Owens was collector of taxes in Anne\nArundel county. When the municipal government of Hyattsville was changed\nfrom a board of commissioners to a mayor and common council, Dr. Owens\nwas elected councilman from the Third ward, and served with marked\nability until May, 1906, when he was elected mayor.\n\nHe was elected for three consecutive terms without opposition, and was\nforemost in every move tending to the advancement of the town. As\ntreasurer of the Maryland Agricultural College he became acquainted with\nmany of the leading men of the State, by whom he was held in the highest\nesteem. He was secretary of the Vansville Farmers' Club for many years,\na director of the First National Bank of Hyattsville. Interment was in\nthe cemetery adjoining Old St. James' Protestant Episcopal Church, near\nWest River, Anne Arundel county. The coffin was borne from his late\nresidence, Hill Top Lodge, by seven cadets of the Agricultural\nCollege--Cadet-Major Mayor, Captains Burrough and Jassell, Lieutenant\nJarrell and Sergeants Freere, Saunders and Cole. A squad of 25 cadets,\nfive from each class of the College, under command of Captain Gorsuch,\nescorted the body to Pinkey Memorial Church, where the Episcopal burial\nservice was read by Rev. Henry Thomas, rector of St. Matthew's Parish,\nof which Dr. Owens had been registrar and a member of the vestry for\nseveral years. The body, preceded by the college cadets, was taken to\nthe Chesapeake Beach Railway Station and shipped to Lyons Creek, and\nthence to St. James' Church. Rev. Henry Thomas officiated at the grave.\nThe pall-bearers were: Messrs. Wirt Harrison, Harry W. Dorsey, E. B.\nOwens, O. H. Carr, T. Sellman Hall and E. A. Fuller. A special meeting\nof the Mayor and Common Council was held in Heptasophs' Hall March 22,\n1909, to take action upon the death of Dr. Joseph R. Owens, late Mayor\nof Hyattsville. Acting Mayor John Fainter Jr., was chairman and Town\nClerk G. H. Carr was secretary. Former Mayor Dr. C. A. Wells eulogized\nthe late Mayor, both as a public official and a private citizen. Dr.\nJoseph A. Mudd, W. P. Magruder, R. E. White, J. W. Aman and Edward\nDevlin, all members of the Council who served with Dr. Owens, and R. W.\nWells, M. J. Smith and S. J. Kelly, the last named as members of the\npresent Council, also made appropriate addresses. It was resolved that\nin the passing away of Dr. Joseph R. Owens, Mayor of Hyattsville, we\nhave lost a conscientious official, a valued associate and a personal\nfriend, and the citizens of Hyattsville at large, as well as his\nofficial associates, have experienced a bereavement, the effects of\nwhich they will ever feel.\n\n                                -------\n\nDr. Asa S. Linthicum, class of 1852, a former member of the Board of\nCounty Commissioners of Anne Arundel county, died at his home, in\nJessup, Md., Sunday, March 28, 1909, from apoplexy, aged 78. About 25\nyears ago Dr. Linthicum retired from the active practice of medicine to\nengage in iron ore mining.\n\nDr. Linthicum's wife, who died about five years ago, was Miss Nettie\nCrane, of Clifton Springs, N. J. Interment was in Loudon Park Cemetery,\nBaltimore.\n\n                                -------\n\nDr. John Bailey Mullins, class of 1887, of Washington, D. C., a member\nof the American Medical Association and the American Society of\nLaryngology and Otology, formerly of Norfolk, Va., died at his home, in\nWashington, D. C., from cerebral hemorrhage, February 11, 1909, aged 42.\n\nResolutions on the death of Dr. John Bailey Mullins:\n\nWHEREAS, It has been God's purpose to suddenly call hence one of our\nmost useful and beloved members; be it\n\n_Resolved_, By the Washington Branch of the General Alumni Association\nof the University of Maryland, that we are deeply grieved by the\npremature death of our honored associate. By his death the public,\nespecially those worthy of charity, whom he was ever ready to serve,\nhave lost a most useful citizen, the medical profession a skilled and\npainstaking physician and surgeon, and the University of Maryland an\nable and active worker. And be it further\n\n_Resolved_, That the sympathy of this Association be extended to his\ndaughter, whom he loved before all else on earth, and to whom he was\never a dutiful father. And be it further\n\n_Resolved_, That these resolutions be spread upon the minutes of our\nAssociation and a copy of the same be sent to the parent Alumni\nAssociation in Baltimore.\n\nCommittee--I. S. Stone, William L. Robbins, Harry Hurtt, Monte Griffith,\npresident; W. M. Simpkins, secretary.\n\n                                -------\n\nDr. Samuel Groome Fisher, class of 1854, of Port Deposit, Md., died at\nthe home of his son, in Port Deposit, February 22, 1909, aged 77. For\nmore than 50 years Dr. Fisher was a practitioner of Chestertown, Md.\n\n                                -------\n\nDr. Charles Brewer, class of 1855, of Vineland, N. J., died at his home,\nin Vineland, March 3, 1909, aged 76. From 1858 to the outbreak of the\nCivil War he was a member of the Medical Corps of the Army, and during\nthe war a surgeon in the Confederate States service. Under President\nCleveland he was postmaster at Vineland, N. J., and resident physician\nat the State Prison, Trenton, from 1891 to 1896.\n\n                                -------\n\nDr. William F. Chenault, class of 1888, of Cleveland, N. C., a member of\nthe Medical Society of the State of North Carolina, died at his home, in\nCleveland, N. C., February 24, 1909, from cerebral hemorrhage, aged 46.\n\n                                -------\n\nDr. James B. R. Purnell, class of 1850, of Snow Hill, Maryland, died at\nhis home, in Snow Hill, March 7, 1909, from senile debility, aged 80. He\nwas vice-president of the Medical and Chirurgical Faculty of Maryland in\n1900-1901, formerly physician to the county almshouse and health officer\nof Worcester county.\n\n                                -------\n\nDr. Benjamin Franklin Laughlin, class of 1904, of Kingwood, West\nVirginia, died at the home of his father, in Deer Park, Md., from\nparalysis, March 9, 1909, aged 31.\n\n\n=IN PNEUMONIA= the inspired air should be rich in oxygen and\ncomparatively cool, while the surface of the body, especially the\nthorax, should be kept warm, lest, becoming chilled, the action of the\nphagocytes in their battle with the pneumococci be inhibited.\n\n                           _Antiphlogistine_\n\n                      (_Inflammation's Antidote_)\n\napplied to the chest wall, front, sides and back, hot and thick,\nstimulates the action of the phagocytes and often turns the scale in\nfavor of recovery.\n\n=Croup.=--Instead of depending on an emetic for quick action in croup,\nthe physician will do well to apply Antiphlogistine hot and thick from\near to ear and down over the interclavicular space. The results of such\ntreatment are usually prompt and gratifying.\n\nAntiphlogistine hot and thick is also indicated in Bronchitis and\nPleurisy\n\n                  *       *       *       *       *\n\n\n                =The Denver Chemical Mfg. Co. New York=\n\n                  *       *       *       *       *\n\nCertain as it is that a single acting cause can bring about any one of\nthe several anomalies of menstruation, just so certain is it that a\nsingle remedial agent--if properly administered--can effect the relief\nof any one of those anomalies.\n\n\u00b6 The singular efficacy of Ergoapiol (Smith) in the various menstrual\nirregularities is manifestly due to its prompt and direct analgesic,\nantispasmodic and tonic action upon the entire female reproductive\nsystem.\n\n\u00b6 Ergoapiol (Smith) is of special, indeed extraordinary, value in such\nmenstrual irregularities as _amenorrhea_, _dysmenorrhea_, _menorrhagia_\nand _metrorrhagia_.\n\n\u00b6 The creators of the preparation, the Martin H. Smith Company, of New\nYork, will send samples and exhaustive literature, post paid, to any\nmember of the medical profession.\n\n------------------------------------------------------------------------\n\n\n\n\n                           Transcriber's Note\n\nThe original spelling and punctuation has been retained, accept for\nconfirmed typos.\n\nVariations in hyphenation and compound words have been preserved.\n\nItalicized words and phrases in the text version are presented by\nsurrounding the text with underscores(_).\n\nBold words and phrases in the text version are presented by surrounding\nthe text with equals sign (=).","title":"The Hospital Bulletin, Vol. V, No. 2, April 15, 1909","tradition":"philosophy-ethics","translated_text":null,"word_count":16390}