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or not a given wound in this region had MEDICAL MONTHLY. involved the intestines or other viscera.
Ile found himself many times in a seriW. C. WILE, A. M., M. D., - EpitoR.
ous dilemma, for whether he performed Danbury, Conn.
abdominal section at once for diagnosASSOCIATE EDITORS:
tic purposes or delayed it until late in I. N. LOVE, M. D., St. Louis, Mo.
the history of the case, he must lay John J. Berry, M.D., Portsmouth, N. H. himself open in either event, to a charge L. S. MCMURTRY, M. D., Danville, Ky. Max J. STERN, M. D., Philadelphia, Pa. of malpractice. The method of Senn, A. M. OWEN, M. D., Evansville, Ind. therefore, if proven reliable, will be of Robert T. MORRIS, M. D., N. Y. City. inestimable importance, as a means of W.F.HUTCHINSON, M.D.,Provldence, R.I. avoiding or overcoming these difficulGUSTAVUS Eliot, M. D., New Haven, Ct. ties. Under it explorative laparotomy
will seldom be indicated. It will serve DANBURY MEDICAL PRINTING ('0., PUBLISHERS.
to render the discovery of multiple
openings in the intestine comparatively DANBURY, CONN., NOVEMBER 15, 1888.
easy and certain and will render the EDITORIAL.
operation for their closure thorough and
complete. The advantages of the proHYDROGEN GAS IN ABDOMINAL ceedure are well set forth by the author WOUNDS.
in the June issue of the Journal of 'HIS important diagnostic procedure the American Medical Association. as devised by Dr. Senn has but re
few of the conclusions arrived at are as cently been brought to the attention of follows: “The entire alimentary canal the profession, yet we may safely state is permeable to rectal insufflation of air that few discoveries in the department or gas. The ileo-coecal valve is rendered of surgery have given promise of greater incompetent and permeable under a result than this one. Punctured wounds pressure varying from one-fourth of a of the abdomen have been for many pound to two pounds. Rectal insufflayears the bete noir of the surgeon, and tion of air or gas, to be both safe and justly so, for in no other region of the effective must be done very slowly and body is diagnosis attended with so without interuptions. Ilydrogen gas is many difficulties. From the moment a devoid of tonic proporties, non-irritating foreign body penetrates the abdominal when brought in contact with living walls its direction is, to a great extent, tissues and is rapidly absorbed from a matter of conjecture. The signs and the connective tissue spaces and all of symptoms of such injury are often mis- the serous cavities. In puncture or gun leading. Some of the most fatal cases shot wounds of the gastro-intestinal may give for awhile little or no evidence canal, insuflation of hydrogen gas of their true nature; while others of a enables the surgeon to demonstrate posmore trivial character are often accom- itively the existence of the visceral inpanied by severe manifestations. For- jury without incuring the risks and merly the surgeon was obliged, in many medico-legal responsibilities incident to instances, to wait a day or two before an explorative laparatomy.” The rebeing able to convince himself whether | sults attained by the author are the
result of a long series of carefully con- tice those treading in the highest ducted experiments upon animals and walks of the doctor's life are the most thus deserve careful consideration at exacting both as to the amount of the the hands of all progressive surgeons. fees as well as their prompt collection, It is gratifying to note that in the few and the rank and file will do well to cases of punctured and gun shot wounds copy after them more closely, and of the abdomen in which insufflation has in this way steadily increase in their been employed, the results have been worldly goods, as
in the all that could be desired. We have no self-respect of the community. А hesitation in allowing it a prominent doctor would be considered mord if he place among our surgical resources. should ask the grocer, the aker and
the candlestick maker to trust him for THE AMERICAN ASSOCITIAON one, two or three years' supplies, and OF OBSTITRICIONS AND
yet by custom in many parts of the GYNECOLOGISTS.
country that is just what is demanded HIS is one of the several special as- of the doctor. Charge what your ser
sociations that held its first meeting vices are honorably worth and collecin Washington in September, at the tion should be the invariable rule. meeting of the congress of Physicians We cannot do better in this connecand Surgeons. We have carefully tion than quote from a recent editorial observed the reports in the medical in the New York Tribune which will press of the proceedings of all the show us how "others look at it." special societies that met at this time, “We venture to suggest that the and though this society is young and most remarkable, and for various reacomposed mainly of the young but pro- sons the most instructive, feature of gressive element of the medical profess- this transaction is not the size of Dr. ion, its work speaks for itself, and is s—'s bill, but the fact that he should not surpassed in scientific and practical have been allowed to give his services work by that of any other society. We during eight years without any compencongratulate the members of this asso sation. We all know that Mr. T ciation
upon their auspicious beginning loved the pleasures of procastination and urge them to continue their good with a love surpassing that of woman, work in the interests of obstetrics and but this was certainly a most surprising gynecology
exhibition of his favorite weakness. To
receive during so long a period, and at AS OTHERS LOOK AT IT.
times to monopolize the attentions of a ANY times in the editorial columns successful physician without paying for
of The MONTHLY we have advo-them, was an exceptional and exaggercated the plan of early presentation of ated instance of a bad habit which is doctors' bills, and insisting on their only too widespread. Mr. T—- did prompt liquidation. Men may talk all the not sin alone in this matter, though he poetry they like about the noble, self-made a record which it would be hard to sacrificing calling of the doctor, the beat. His fellow sinners, if they could charitable work he does, and that his is be gathered together, would make a a profession and not a trade, but we no- large, and, it might be said, a select
company. Almost any physician, we thing, as every one knows, for a physiventure to assert, will confirm the state- cian who has held a leading place in the ment that there is no bill which is so profession, and who has popularly been long neglected, or so often left unpaid supposed to be in receipt of a splendid altogether, as the doctor's bill; and this income, and be solidly rich as well, to is true of those who find it easy to pay, die poor, as the world finds to its great as of those who find it hard. The gro- surprise. . cer and the butcher are settled with “One of the remedies often proposed among the first, of necessity. The law- for this state of things is that the docyer takes his toll, like the miller, out of tor should get his fee at every visit, as the grist before it passes out of his in England, or as specialists do from hands. Even the tailor often gets his office patients here. There can be no money before the doctor, for the man doubt that the adoption of such a syswho wants to be presentable must keep tem would save the doctors a good up, at least, a reasonable rotation of many bad debts, but they might not new clothes, whereas there is no telling find it an agreeable method of collecfrom a man's external appearance, or tion. The social position of the ordifrom the condition of his health, nary medical practitioner is not so good whether he has squared up accounts in England as here, and this fact may with his physician or not.
have something to do with his willing“There seems to be an unformulated
ness to collect his
goes theory that doctors and their wives and along. The American is likely to prechildren can live on air, as the came fer the present system, with all its leon was once supposed to do. A cer faults, for a certain reserve and delitain class of people feel apparently that cacy he finds in it.” the philanthropic nature of the profession requires the doctor to be ready at THE FATAL ILLNESS OF FREDall times to give up his time and skill,
RICK THE NOBLE.
'HIS work of Sir Morell Mackenzie if any at all, not troubling themselves will be read with the deepest interest to reflect that he can hardly settle his by every member of the medical proown debts so easily. The result is that fession. It may be stated that no topic no class of workers, except the clergy, has been so freely discussed in medical give so large a proportion of their circles for many years. At the same labor for nothing. This is so, partly time none has offered such insufficient because physicians are constantly doing data. The official bulletins gave little good deeds of which the world hears enlightenment as to the progress of the nothing, not only tending the poor with case or its pathological lesions. The out charge, but even buying their medio daily press was still less satisfactory recine and food. There is no nobler garding the personal relations existing record of unselfishness in our modern between the royal patient and his physilife than that of the medical profession. cians or between Mackenzie and his But it is also true in part because they medical brethren. While we knew they are continually imposed upon. The re were not harmonious, we were ignorant of sult of all this is that it is a common their true cause or the circumstances to
with only the faintest hope of reward, THIS
which they were due. Yet it must be answerable for its subsequent transforadmitted that among many there existed mation into cancer; if it was malignant a conviction that Mackenzie was in some from the first, the disease was undoubtway at fault as regards the diagnonis edly aggravated by the treatment.” and treatment of the case. By the study In the absence of any clinical eviof his book however, all existing doubts dences of cancer during the first months will be dispelled and the varied features of the disease, Mackenzie seems to have of the case more fully understood. Few been justified in relying wholly upon can appreciate the position in which he the microscopic examinations of excised found himself during his attendance at portions by Virchow, who in no instance a foreign court-a position which was
found decided evidences of malignancy. trying both from medical, poiitical and
He himself was really the first to diagsocial points of view. He may be said nosticate cancer from laryngoscopic ap
pearances alone. Although it was the to have stood practically alone as re
good fortune of Mackenzie to save his gards disinterested professional advice
patient from the extreme measures proor assistance.
posed by Von Bergman, yet we shall all Ilis antagonists Gerhardt and Von
agree in ascribing the final grave Bergman are shown up in a most unen- symptoms of the Crown Prince to the viable light both as men and as scientific tracheotomy and the introduction of surgeons. Their grossly unprofessional unsuitable tubes by Bramann. The bad conduct will suprise the reader no less results were further intensified by the than the expose of their ignorance of bungling, as well as unwarranted atthroat therapautics and their lack of tempts of Von Bergman to introduce a skill in the use of laryngoscopic instru- canula, by which a false passage was ments and proceedures. Indeed it was made in front of the trachea. not until a comparatively late day that All the arguments and misrepresentathe throat of the patient was examined tious of the German doctors are satisby any other noted specialist besides factorily met and controverted by the Mackenzie and then only by his own de-author in the latter portions of his work. sire and suggestion. Considerable space Space will not admit of their discussion, is devoted to the early treatment of the but it will be apparent to every reader case by Gerhardt which, judging from that, as a rule, the treatment of the case the report at hand, seems like an instance by the German surgeons was improper of malpractice. Suffice is to say that and injurious from first to last while for the cure of a minute and apparently their professional conduct was, with one innocent growth on one vocal cord Ger- or two exceptions, a disgrace which will hardt made applications of the galvano be not easily effaced. cautery, every day for a fortnight. The On the other hand, the consummate author is thus justified in making this skill and good judgment of Mackenzie statement:"If the growth was benign which stands forth so pre-eminently in in the first instance there is, in my
reflects honor upon the proopinion, only too much reason to think fession and affords a valuable contributhat Gerhardt's burnings must be held tion to scientific medicine,
DR. MCKENZIE'S DEFENSE.--THE and Van Tabak's fine treatment of the ETHICAL SIDE.
shades in an evening landscape makes HERE is a time in the flood of hu- the other artists gag when they happen man events when it becomes neces
to get caught in the room in which the sary for every great man to show his painting is displayed. No attention is weakness or his strength; and Dr. Me paid to this by the people because they Kenzie's failure to overlook the criti- know too much about bridges and paintcisms of the German Surgeon is to us a ings. But when it comes to a question cause for disappointment.
of right or wrong surgical procedure A squabble of the Von Bergmann, the people know nothing about the matMcKenzie sort is a misfortune for the people and for the profession, because ter
, and when McKenzie and Von Berg
mann call each other incompetent the the people do not get their money's worth for the show, and neither of the people don't know any better than to
believe the nonsense. The two fighters combatants win anything.
will lose nothing in a professional way Jealousy is a common emotional dem
because each will remain standing on onstration, and the emotional Germans
his own merits, the quality and quantity were intensely jealous of McKenzie.
of which are appreciated by the proTne latter gentleman in deigning to re
fession at large. And it is only a ply to their accusations showed the weakness which belongs in one form or
matter of regret to us that they handed
their professional dignity to the nearanother to all great men.
est man in the crowd when they pitched Almost all great men are childish in so many things that their mothers-in-law into each other. The whole outcome of and the servants in the house think that
the matter will be the production of a they haven't anything else to recom
few cases of dyspepsia among disturbed mend them, but it is a sad spectacle
patriots. when home discourtesies are indulged
Among medical men of the first class in among people who are not obliged to among whom we look for the best of
human attributes it is painful to obstand it. The case over which the dispute arose
serve the mental atavism that has ocwas not particularly interesting except curred at the bedside of so many emifrom the fact that there was a certain
nent patients. patient attached to it, and this patient,
The conception and delivery of Melike the postscript to a woman's letter, Kenzie’s book occurred under such surwas the biggest feature of the case.
rounding circumstances that the child It is difficult for any illustrious pa
is too weak and deformed for entrance tient to get as good treatment as a pau- | into healthy social circles. per usually receives, because so many We should like to write a book for cooks are allowed at the broth.
the purpose of vindicating ourselves in Physicians are not more jealous of some four hundred cases in which we each other than are men in other pro- have been slandered, and if McKenzie's fessions. When an engineer who had work receives favorite notice by the no part in the building of the Brooklyn lay press we siall issue early in the bridge is obliged to cross that structure spring a large volume profusely illushe takes a parachute under each arm; trated at the low price of two dollars