My own conclusions concerning this subject may be summe up briefly as follows: I do not believe that there is any sharply defined type of disease which can be properly called traumaticneurosis, but I believe that there are many cases which are dependent entirely upon the force and conditions which are created after the physical injury. While realizing that owing to the byplay of extraordinary circumstances trivial injuries, particularly with back symptoms, can readily and easily shape themselves into neuroses, we are firm in the belief that racial differences, perfection of physical condition, and the multiplex force of surroundings, are constantly aiding and abetting factors. I believe that favorable surroundings, the influence of an unprejudiced and thoroughly impartial surroundings, the influence of an unprejudiced and thoroughly impartial medical attendant will create, cæteris paribus, the exact condition of the trauma. And if the trauma produces a condition similar to hypnosis, I cannot help but believe that the existing forcible and predetermined mental condition of the medical attendant will often force trivial conditions into serious ones. We believe that many a case of traumatic neurosis has been treated by persons unacquainted with it, and cured, simply for the reason that they have not been filled with suggestion; it would seem rather startling that the physician was competent by his intense mentality and absolute force of suggestion to create an essentially serious condition, but I candidly believe that there is, in that unknown mental influence, when exerted upon a weakened and morbidly receptive mind, a power competent to suggest, maintain and develop sequences which are serious in the extreme. There cannot be any doubt but what, if I may so use the word, "traumatized" minds absorb sensation, not only direct from the effects of injury, but they take and receive impressions produced by suggestions of an already convinced mind. If hypnosis has been used as a means of treatment in these cases, and success has occurred, it certainly seems natural that along with the conditions existing it would be competent to develop such cases. Again, we maintain that where we have physical perfections, mental strength, and proper knowledge, trauma is very rarely likely to produce the psychic conditions as developed in traumatic-neurosis. For we find that where intelligence is blunted, where surroundings have made incidental elements of danger familiar and not impressionable, physical injuries are manifested as physical injuries, and very rarely terminate in psychic troubles, unless there is intensity of

conditions, a predisposition upon the part of the individual, be it either racial, predisposing or acquired.

Doctor Swearingen again says: "When we remember that railway surgeons, as a rule, are the only ones to attend to the injured employe, it is remarkable that a single case is found of that most obnoxious of all diseases. The probabilities are that those eight cases must have, in some inscrutable manner, escaped from railway hospital, and been treated by unpretentious, old fashioned practitioners."

Now, then, we will make this assertion to the doctor, that we doubt the ability of the average medical practitioner to make a prompt and proper diagnosis of a case of traumatic-neurosis; for we claim that absolutely a special training is required for their elucidation, and that the neurologist, by his experience and special training, is the competent one to elucidate them. How many physicians in general practice are competent to interpret the multiplicity of symptoms in traumatic neurasthenia or hysteria; determine the anesthesia, the involvement of the organs of sense, to determine hemi-anesthesia, the various hyperæsthesiæs and paræsthesias? How many ordinary practitioners are there who are competent to determine if there is contraction of the visual field, the presence of achromatopsia, etc., the various conditions of the reflexes, mental elements, etc.? It is not detracting from the merit of the average practitioner when you say this, because it is plainly known by all conversant with the subject, that a special training is necessary for their determination. The doctor says:

"With the lights before us, it is now safe to assume that had either one of the eight cases been entered on the hospital book within the last year we could find opposite their names either 'traumatic-psychosis' or 'hypochondriasis.'

I desire to say that the St. Louis Hospital of the Missouri Pacific Railway has a consulting staff, composed of such eminent specialists as Dr. A. Alt, Dr. Robt. Barclay, Dr. J. K. Bauduy, Dr. Keeber, Drs. Mulhall and Loed, and others. We believe most of these gentlemen have a national reputation, and are honest and competent.

Now, as regards these eight cases which the doctor singles out, I will say that only six of these were treated in the St. Louis Hospital, and that in every instance the consulting staff were requested to see and treat them. The writer was eager to get the views of the consulting staff, and every one of these cases

was examined by such physicians as Hughes, Shaw, Bauduy, and others. In one particular case, Drs. Hughes and Shaw, Mulhall and Alt, rendered their assistance to the writer in the solution of the diagnosis.

Finally, let me say this: every statement I have made I can verify; now let the doctor disprove them. I claim to be honest in my views, and if they are false, they certainly will be disproved. I claim still further that a student of medicine, true to his calling as a physician, has neither time nor inclination to warp truth, nor is he likely to be foolish enough to imagine for an instant that anything else other than truth will prevail. I care not from what source truth may come, I will accept it with pleasure, and any truth that Dr. Swearingen, or any other confrere will announce to me, will be accepted and defended.

For Texas Medical Journal.

HOW SHALL THE REGULAR MEDICAL PROFESSION BE ORGANIZED INTO ETHICAL BODIES?

BY DANIEL PARKER, M. D., CALVERT, TEXAS.

Read before the Central Texas Medical Association, July 11th, 1894, and published by request.

F IT were within my province I should be disposed to criticise somewhat the manner in which this question is stated, but as it is not, I shall give myself such latitude as is necessary to present my views on the well worn subject of Ethics.

I understand ethics and morals, or the rules of right-doing, to be practically synonymous terms, and an ethical body of physicians to be an association of physicians who, individually and collectively, practice professional morals, and who are bound together by the talisman of right-doing in all their conduct, both as regards their intercourse with their patrons, the public and one another.

Now, the propriety of such conduct is not in question. It is just as evident that physicians should do right in all their professional relations as it is that "Thou shalt not steal," and it has been wrong to steal ever since there has been anything to be taken. The Decalogue did not create, but simply announced a principle in ethics, as inherent in morals, as gravitation is in physics.

Neither is it a question as to whether the organization of the profession into ethical bodies would be profitable or not. The advantages of organization on such a basis are evident. The question before us is, how it can best be accomplished?

In the first place, "A fountain can not rise higher than its source," neither can you "Make a silk purse out of a sow's ear," which, being applied in this case, means that no society can be better than the individual members of which it is composed, and that you can not make an ethical body out of mean or unprincipled material.

This, like everything else pertaining to morals, is self-evident, and is only mentioned here from the fact that many elementary truths are overlooked, because they are never questioned.

The first thing to do, then, is to elevate the conception of rightdoing among the individual members of which the profession is composed, and as far as possible prevent the infusion of improper material through the medium of new recruits.

The present standard to which our conception of medical ethics is required to conform, is the code promulgated by the American Medical Association. Now, while this code is a splendid exposition of the duties of physicians, both to the public and to each other, there is nothing therein commanded or demanded that would not be so maintained by all gentlemen, or which can not be kept in letter and broken in spirit, if the spirit of the gentleman is wanting. For this reason I believe much of the underbrush would be cleared away, a retreat for much unethical conduct destroyed, and our whole conception for right-doing placed on a higher plane if the written code were dropped from our literature, and the only requirement for membership in our society was that the applicant should be a gentleman and a graduate of some school recognized by the American Medical Association.

Christ, as if recognizing the impracticability of tabulating all the meanness that the human heart could practice, and of formulating therefor a "Thou shalt not," cuts the whole matter short, and makes each man his own monitor, by announcing a rule so plain, so simple of construction and so evidently correct as to command universal acquiesence: "As ye would that men should do unto you, do ye also unto them likewise."

This Golden Rule represents at the time of its promulgation the moral progress of the fifteen hundred years that had passed since the Decalogue was announced amid the thunders of Sinai. The time was when the human mind was so crudely developed

and the conception of right and wrong was so immature, that the unmistakable "Thou shalt" and "Thou shalt not" were necessary enactments; but as moral evolutions displaced the Decalogue with the Golden Rule, so I believe our written code should be displaced by the unwritten law implanted in the heart of every gentleman.

Perhaps some may say that this is letting down the bars too low; that some statutory provisions are necessary to define offenses; that without the basis of a written code, discipline would be impossible, etc.

While this is true of State and municipal organizations, which must be so framed as to govern all classes, and to which all must submit whether they endorse it or no, in organizations like ours, in which membership may be granted or refused without question, and whose cohesive power is represented by its power to mutually benefit and instruct, the standard laid down by the Great Teacher, and of gentlemanly conduct as construed by gentlemen, is, I believe, more effective-the very essence of ethics, and certainly more attractive.

For my part, I would never call upon any society of which I might be a member to discipline a fellow member for any act of a personal character. If I felt that I had been treated discourteously or unprofessionally, I would attend to the matter strictly by myself, and give it such personal attention as, in my opinion, it deserved. When you come to think of it, does it not look a little strange that any one would consult a code to learn whether he had been mistreated or not? Or would feel reconciled to misrepresentations or detractions from the fact that it was done by sly inuendos, or a significant shrug of the shoulders, offenses not named in the code?

If I knew of any conduct on' the part of a member calculated to degrade the profession or bring its members into disrepute, I should feel it to be my duty to call attention to the matter, to the end that the individual, and not the profession, might bear the odium. Otherwise, I would never call upon any society to spend its time in matters judicial.

It will no doubt be said, and with some show of reason, too, that there are certain rules the observance of which has been enjoined from time immemorial, that derive their authority not from any moral precept they inculcate, but from the tendency they are presumed to have to elevate the profession and give dignity to its membership; consequently they are peculiar, and ap