THE AMERICAN ASSOCITIAON OF OBSTITRICIONS AND GYNECOLOGISTS.

THIS

HIS is one of the several special associations that held its first meeting in Washington in September, at the meeting of the congress of Physicians and Surgeons. We have carefully observed the reports in the medical press of the proceedings of all the special societies that met at this time, and though this society is young and composed mainly of the young but progressive element of the medical profession, its work speaks for itself, and is not surpassed in scientific and practical work by that of any other society. We congratulate the members of this association upon their auspicious beginning and urge them to continue their good work in the interests of obstetrics and gynecology.

those treading in the highest walks of the doctor's life are the most exacting both as to the amount of the fees as well as their prompt collection, and the rank and file will do well to copy after them more closely, and in this way steadily increase in their worldly goods, as well as in the self-respect of the community. A doctor would be considered mad if he should ask the grocer, the baker and the candlestick maker to trust him for one, two or three years' supplies, and yet by custom in many parts of the country that is just what is demanded of the doctor. Charge what your services are honorably worth and collection should be the invariable rule.

We cannot do better in this connection than quote from a recent editorial in the New York Tribune which will show us how "others look at it."

"We venture to suggest that the most remarkable, and for various reasons the most instructive, feature of this transaction is not the size of Dr. S's bill, but the fact that he should have been allowed to give his services during eight years without any compensation. We all know that Mr. Tloved the pleasures of procastination with a love surpassing that of woman, but this was certainly a most surprising exhibition of his favorite weakness. To receive during so long a period, and at times to monopolize the attentions of a successful physician without paying for them, was an exceptional and exaggerated instance of a bad habit which is only too widespread. Mr. T did not sin alone in this matter, though he made a record which it would be hard to beat. His fellow sinners, if they could be gathered together, would make a large, and, it might be said, a select

company. Almost any physician, we venture to assert, will confirm the statement that there is no bill which is so long neglected, or so often left unpaid altogether, as the doctor's bill; and this is true of those who find it easy to pay, as of those who find it hard. The grocer and the butcher are settled with among the first, of necessity. The law yer takes his toll, like the miller, out of the grist before it passes out of his hands. Even the tailor often gets his money before the doctor, for the man who wants to be presentable must keep up, at least, a reasonable rotation of new clothes, whereas there is no telling from a man's external appearance, or from the condition of his health, whether he has squared up accounts with his physician or not.

"There seems to be an unformulated theory that doctors and their wives and children can live on air, as the cameleon was once supposed to do. A certain class of people feel apparently that the philanthropic nature of the profession requires the doctor to be ready at all times to give up his time and skill, with only the faintest hope of reward, if any at all, not troubling themselves to reflect that he can hardly settle his own debts so easily. The result is that no class of workers, except the clergy, give so large a proportion of their labor for nothing. This is so, partly because physicians are constantly doing good deeds of which the world hears nothing, not only tending the poor without charge, but even buying their medicine and food. There is no nobler record of unselfishness in our modern life than that of the medical profession. But it is also true in part because they are continually imposed upon. The result of all this is that it is a common

thing, as every one knows, for a physician who has held a leading place in the profession, and who has popularly been supposed to be in receipt of a splendid income, and be solidly rich as well, to die poor, as the world finds to its great surprise.

"One of the remedies often proposed for this state of things is that the doctor should get his fee at every visit, as in England, or as specialists do from office patients here. There can be no doubt that the adoption of such a system would save the doctors a good many bad debts, but they might not find it an agreeable method of collection. The social position of the ordinary medical practitioner is not so good in England as here, and this fact may have something to do with his willingness to collect his money as he goes along. The American is likely to prefer the present system, with all its faults, for a certain reserve and delicacy he finds in it."

THE FATAL ILLNESS OF FREDRICK THE NOBLE.

HIS work of Sir Morell Mackenzie

will be read with the deepest interest by every member of the medical profession. It may be stated that no topic has been so freely discussed in medical circles for many years. At the same time none has offered such insufficient data. The official bulletins gave little enlightenment as to the progress of the case or its pathological lesions. The daily press was still less satisfactory regarding the personal relations existing between the royal patient and his physicians or between Mackenzie and his medical brethren. While we knew they were not harmonious, we were ignorant of their true cause or the circumstances to

which they were due. Yet it must be admitted that among many there existed a conviction that Mackenzie was in some

way at fault as regards the diagnonis and treatment of the case. By the study of his book however, all existing doubts will be dispelled and the varied features of the case more fully understood. Few can appreciate the position in which he found himself during his attendance at a foreign court-a position which was trying both from medical, poiitical and social points of view. He may be said to have stood practically alone as regards disinterested professional advice or assistance.

His antagonists Gerhardt and Von Bergman are shown up in a most unenviable light both as men and as scientific surgeons. Their grossly unprofessional conduct will suprise the reader no less than the expose of their ignorance of throat therapautics and their lack of skill in the use of laryngoscopic instruments and proceedures. Indeed it was not until a comparatively late day that the throat of the patient was examined by any other noted specialist besides Mackenzie and then only by his own desire and suggestion. Considerable space is devoted to the early treatment of the case by Gerhardt which, judging from the report at hand, seems like an instance of malpractice. Suffice is to say that for the cure of a minute and apparently innocent growth on one vocal cord Gerhardt made applications of the galvanocautery, every day for a fortnight. The author is thus justified in making this statement: "If the growth was benign in the first instance there is, in my opinion, only too much reason to think that Gerhardt's burnings must be held

answerable for its subsequent transformation into cancer; if it was malignant from the first, the disease was undoubtedly aggravated by the treatment."

In the absence of any clinical evidences of cancer during the first months of the disease, Mackenzie seems to have been justified in relying wholly upon the microscopic examinations of excised portions by Virchow, who in no instance found decided evidences of malignancy. He himself was really the first to diagnosticate cancer from laryngoscopic appearances alone. Although it was the good fortune of Mackenzie to save his patient from the extreme measures proposed by Von Bergman, yet we shall all agree in ascribing the final grave symptoms of the Crown Prince to the tracheotomy and the introduction of unsuitable tubes by Bramann. The bad results were further intensified by the bungling, as well as unwarranted attempts of Von Bergman to introduce a canula, by which a false passage was made in front of the trachea.

All the arguments and misrepresentations of the German doctors are satisfactorify met and controverted by the author in the latter portions of his work. Space will not admit of their discussion, but it will be apparent to every reader that, as a rule, the treatment of the case by the German surgeons was improper and injurious from first to last while their professional conduct was, with one or two exceptions, a disgrace which will be not easily effaced.

On the other hand, the consummate skill and good judgment of Mackenzie which stands forth so pre-eminently in this case, reflects honor upon the profession and affords a valuable contribution to scientific medicine.

DR. MCKENZIE'S DEFENSE.--THE

THERE

ETHICAL SIDE.

HERE is a time in the flood of human events when it becomes neces

sary for every great man to show his weakness or his strength; and Dr. McKenzie's failure to overlook the criticisms of the German Surgeon is to us a cause for disappointment.

A squabble of the Von Bergmann

McKenzie sort is a misfortune for the people and for the profession, because the people do not get their money's worth for the show, and neither of the combatants win anything.

Jealousy is a common emotional demonstration, and the emotional Germans were intensely jealous of McKenzie. The latter gentleman in deigning to reply to their accusations showed the weakness which belongs in one form or another to all great men.

Almost all great men are childish in so many things that their mothers-in-law and the servants in the house think that they haven't anything else to recommend them, but it is a sad spectacle when home discourtesies are indulged in among people who are not obliged to stand it.

The case over which the dispute arose was not particularly interesting except

from the fact that there was a certain patient attached to it, and this patient, like the postscript to a woman's letter, was the biggest feature of the case.

It is difficult for any illustrious patient to get as good treatment as a pauper usually receives, because so many cooks are allowed at the broth.

Physicians are not more jealous of each other than are men in other professions. When an engineer who had no part in the building of the Brooklyn bridge is obliged to cross that structure he takes a parachute under each arm;

and Van Tabak's fine treatment of the shades in an evening landscape makes the other artists gag when they happen to get caught in the room in which the painting is displayed. No attention is paid to this by the people because they know too much about bridges and paintings. But when it comes to a question of right or wrong surgical procedure the people know nothing about the matter, and when McKenzie and Von Bergmann call each other incompetent the people don't know any better than to believe the nonsense. The two fighters will lose nothing in a professional way because each will remain standing on his own merits, the quality and quantity of which are appreciated by the profession at large. And it is only a matter of regret to us that they handed their professional dignity to the nearest man in the crowd when they pitched into each other. The whole outcome of the matter will be the production of a few cases of dyspepsia among disturbed patriots.

Among medical men of the first class among whom we look for the best of human attributes it is painful to observe the mental atavism that has oc

curred at the bedside of so many eminent patients.

The conception and delivery of MeKenzie's book occurred under such surrounding circumstances that the child is too weak and deformed for entrance into healthy social circles.

We should like to write a book for the purpose of vindicating ourselves in some four hundred cases in which we have been slandered, and if McKenzie's work receives favorite notice by the lay press we shall issue early in the spring a large volume profusely illustrated at the low price of two dollars