the birth of anesthesia. In the "Twentieth Century Practice of Medicine" are mentioned ERICHSEN's observations that of forty-one deaths after surgical injury no less than twenty-three subjects presented signs of pneumonia. In contrast to this, modern surgery, as shown by SILK, presents only one case in 5,000 operations. This estimate may be larger than other statistics might justify, and yet the conclusion seems reasonable that the anesthetic protects from rather than predisposes to this serious complication. CONTEMPORARY. THE EVOLUTION OF SPECIALISM. IN the good old times, the written and unwritten ethics of professional relations made it distinctly understood with all parties concerned that when once a patient put himself under the care of a physician, the latter necessarily owned him body and soul. It became, then, a matter of as much importance to the sick one to choose his medical adviser once and for all time as to embrace an article of faith in his religion. The family physician, when the stray sheep entered his fold became responsible for his safe-keeping until the time when the absolute and inevitable decree of nature made longer possession impossible. Under ordinary circumstances, the advantages to both physician and patient were obvious enough in bringing them in constant and confidental relations with each other, and in enabling each to discharge those mutual obligations of trustfulness which should properly exist between them. Thus, the old family physician was as much the general adviser on all matters medical as was the priest or clergyman on matters spiritual. It would be hard to prove, even in these days of advanced specialism, that the patient was much worse off then than now, if the actual statistics of general mortality are seriously taken into account. There was one element of safety in the treatment by the old-fashioned method, and that consisted in the practice of a forced and judicious conservatism, which was not so prone to interfere with nature's method of cure in the commoner diseases, and which thus offset some of the failures in the rarer ones. The family doctor became thus a good all-round man for ordinary emergenHe could operate for hernia, tracheotomize a strangling infant, set a fracture, and perform version as effectively as he could blister a pleurisy, treat typhoid, venesect for pneumonia, or "physick" for dysentery. Hence he was the only one consulted when sickness visited his district. cies. Of course, some of his patients died for want of special skill, which he did not possess. On the other hand, no one was apt to suffer from overtreatment. The possession of too much skill is in itself an element of danger. The deft operator is apt to use the knife too frequently. Any one who follows the discussion concerning the new operative procedures of the day need not be convinced of this fact. While some patients are saved, how many are lost as the result of absolutism in extremes? In the evolution of a new idea-a so-called improvement on nature--the scales are constantly shifting with the counter weights which are used. What physician. or surgeon long in practice has not gone through countless epidemics of remedies and operative methods that have in the end made him immune against any undue enthusiasm? We have had notable exceptions to the rule, it is true; but the rule exists nevertheless. The mistakes in attempting to evolve the principle have equaled the triumphs of its establishment. The ovaries are not extirpated as of old, and even the appendix is sometimes left in its place to take its chances against the knife of the eager theorist. The everyday practitioner is oftentimes justly constrained, while reading the claims of rival disputants, to thank his stars that he can take the middle ground, and not be sorely tempted to be fashionably progressive and go beyond the range of his common sense. From this point of view, his function as general adviser to his clients is magnified rather than minified, and his hold on the confidence of his patient becomes correspondingly confirmed and safely impartial. If he makes himself worthy of such trust, he deserves to maintain his old-time function. His only interest, then, is to advise as to the best course, and to shift his responsibility only in such cases as circumstances may warrant. He thus becomes the true and rightful conservative element in deciding between inordinate zeal in one direction and absolute safety in another. The claim is made by the general practitioner that specialism is robbing him of his business. This is certainly true to some extent, and is one of the inevitable results of the survival of the fittest. Taking into account the prevalent practices of patients to consult specialists at first hand and decide for themselves their needs in given cases, there are many chances of making wrong selections. The ordinary expert is usually a man of one idea, a hobbyist by force of habit and by virtue of his education. He is not inclined to look beyond the special sphere of his work. As a gynecologist, his first thought is of the uterus as the pivotal point of his real interest in the patient. So with the throat man, the neurologist, the ophthalmologist, and the laparotomist. He need not look long in the direction of his favorite trend without finding something important to treat. Thus the part becomes greater than the whole, and so long as given and desirable symptoms exist, the patient is his, and the general practitioner looks on from the outside. When mere business is the consideration, the specialist is tempted to hold on so long as he can, and to force the refinements of his skill into unnecessary directions. The question with the general practitioner is where such practices are likely to end. Obviously, the line must be drawn somewhere between the greed of the expert and the rights and privileges of the ordinary all-round man. In the treatment of general diseases, the family physician should have some voice in deciding upon cases actually requiring the skill of the specialist. He should certainly be better qualified to do so than the patient himself, and the recognition of relative rights in this respect would do much to combat the spirit of apparent antagonism between both classes of practitioners. If it is conceded that in cases requiring special operations the expert should have full temporary charge of the patient; it should likewise be granted that the general physician should not be blamed for treating the minor ailments of diseased organs when they present themselves in his ordinary line of work. There is ample room and abundant opportunity for both general practitioner and specialist, only the line has not yet been definitely drawn between the two. MEDICAL NEWS. THE STATE SOCIETY MEETING. THE thirty-seventh annual meeting of the Michigan State Medical Society will be held at Port Huron, June 26 and 27, 1902. The following subjects have been selected for discussion: Section on Medicine"Diseases of the Kidneys;" Section on Surgery and Ophthalmology— "Surgery of the Kidneys;" Section on Gynecology and Obstetrics"Abortion and Miscarriage." Papers are confined to the subjects stated and are limited to fifteen minutes each. Titles of papers must be sent to the secretaries of the sections not later than March 1. The addresses of these officers are: Medicine-Doctor Willis S. Anderson, 912 Chamber of Commerce, Detroit; Surgery-Doctor William A. Spitzley, 270 Woodward avenue, Detroit; Gynecology-Doctor Casper K. LaHuis, Kalamazoo. The committee in charge of the pathologic exhibit is desirous of securing specimens, photographs, skiagraphs, et cetera, for this feature of the meeting, and requests members who are willing to loan material for the occasion to communicate with the secretary, Doctor Preston M. Hickey, 32 Adams avenue west, Detroit. THE BEAUMONT MONUMENT. THE illustration which accompanies this notice represents the monument erected on Mackinac Island to the memory of the distinguished investigator, William Beaumont, M. D. The view is from the south, facing the straits, and shows a portion of the east end of the stone quarters occupied by Beaumont when serving the government as post surgeon. In the background part of the parade ground is brought in view, and beyond, northward, may be seen the stairway leading to the flagstaff and next elevation. The site of the monument is one hundred and thirtythree feet above Lake Huron-the same height as the parade ground. The dimensions of the monument are as follows: Height, 7 feet 4 inches. (1) Base 6 x 6 feet, in two stones, each 6 x 3 feet. (5) Boulder 2 feet 6 inches high; face recedes 5 inches, sides and back project over fourth stone. The three lower stones are Minnesota granite; the two upper ones are Wisconsin granite. Among the articles deposited in the monument is a copy of the "Beaumont Memorial Number" of The Physician and Surgeon, which was placed in the box by Doctor John R. Bailey, a practician at Mackinac Island since 1854, who conducted the ceremonies. A NEW COLLEGE AND HOSPITAL BUILDING. THE Michigan College of Medicine and Surgery and the Detroit Emergency Hospital Association will erect a commodious new building for college and hospital purposes. Plans have already been prepared and excavation for the structure will be commenced on the corner of Porter and Second streets as early as practicable in the spring. The building will be 50 x 130 feet, four stories high, and crowned with a tile roof. The walls, to the sills of the first story, will be of cut limestone, above this line they will be of brown pressed brick with trimmings of white pressed and molded brick and terra cotta. The clinical department, dispensary, laboratories, et cetera, will be located in the basement; the hospital will occupy the wing fronting on the alley which traverses the entire length of the block; and the college will have quarters in that portion of the building forming the corner of Porter and Second streets, the main entrance to which will be on Porter street. The hospital will contain one hundred and ten private rooms, besides several wards. The college apartments will include lecture rooms, class rooms, auditorium, library, and offices for professors. The operating room, which is already being constructed, is designed to be a model in appointment. The anatomical department will be on the fourth floor. It is the intention of the college authorities to have the entire plant equipped with modern improvements. AN EXPRESSION OF ESTEEM. DOCTOR T. GAILLARD THOMAS, of New York City, was given`a dinner at Sherry's, November 21, 1901, by a number of professional friends and admirers, the occasion being the seventieth anniversary of his birthday. Speeches were made by Reverend Doctor Greer, rector of Saint Bartholomew's Church; Judge Henry E. Howland; Doctor S. Weir Mitchell, of Philadelphia; Doctor William H. Welch, of Baltimore; Doctor G. C. Shattuck, of Boston; and Doctor Thomas. During the course of the latter's remarks expression was given to the following: * * * You entertain me at a most charming banquet, invite gentlemen whom princes would be proud to own as sponsors, to speak kindly of my past, and you make me happy by friendly glances which shall be forever engraved upon the tablets of my heart! Even this is by no means the full measure of your kindness to me. Deep down in the depths of the heart of every man of proper feeling there lurks the desire to have at the close of his career the approval of the fellows of his guild, be that guild a common trade or one of polite learning. You who have borne to me the relation of brother practitioners and have striven beside me shoulder to shoulder in the keen battle of life; and you, who as students have judged me as teacher, writer, and clinical lecturer, have tonight sealed my past career with the imprimatur of your approval! Than this no act of yours could have conferred upon me more real pride and pleasure. Through the whole length of a laborious career which has now reached a half-century; in bright periods and in dark ones, in fair weather and in. tempestuous, this approval has ever been the beacon light upon which mine eyes have rested, the prize for which I have striven. Without it all other success would have been like Dead Sea fruit in my hands, and distinction would have been like dross. Thanks to you, this night will, with its pleasant memories, be ever cherished as the proudest era of my existence! |