Vol. 60, 1909 - University of North Carolina at Chapel Hill

ORIGINAL COMMUNICATION. 6/
cine. I am a specialist myself. My plea possible almost anywhere. This composite,
is for the doctor plus the specialist. In institutional work does not in any way rob
other words, he should practice general the surgeon of his individuality ; for has not
medicine before he becomes a specialist. St. Mary's its Mayos, Johns Hopknis its
This would not be true were the human Kellys, Finneys, etc?
body not such an interdependent constitu- In order to emphasize my contentions,
tionality. The physician, like the astrono- bear with me in the citation of a few conmer,
is constantly discovering new stars crete cases, which have come under my
and constellations of disease, and there are observation, proving the benefit of wise and
yet others undiscovered. People die yet of interested counsel.
diseases not catalogued. Case 1.—Mrs. \'. was brought to hospital
Therefore my contention is that the sur- for cancer of stomach, all syrnptoms presgeon
and gynEccologist are only a part of a ent with the exception of a diarrhoea, which
great means to accomplish certain ends, proved to be, by aid of pathologist and inviz.,
to prevent, to alleviate, and to cure ternist, amoebic dysentery. Appendicosdisease.
Surgery takes away obstruction tomy helped, but too late to cure patient,
to functions, poisonous areas, leconstructs Case 2.—R. was presented for gall bladbroken
connections, and may in a general der disease, having most of cardinal sympway
increase reaclionarv life, but in itself toms. Operation done. Normal gall bladhas
no occult power. In its field it has der found. Then passing through differmany
marvelous triumphs, but alone, un- ent hands, myxoedema diagnosed, from
guided, simple mechanical surgery is often which she shortly died, too late for treatuseless
and dangerous. The degree of Sur- ment. Thorough, competent prior examgeon,
etc., should be added to that of M. D. ination would have prevented needless
as is done in some older countries. operation, and at same time valuable time
Surgery, robbed of its stage play, is was lost for specific treatment,
brain-dexterity and conscience, and the Case 3.—Two cases of supposed appengreatest
of these is surgical conscience. It dicitis were operated upon, and both proved
required me about ten years to cultivate it, to be typhoid fever, and both died. t)pera-
—that is, to know when not to operate. .\ tion successful, but inadvisedly done. These
great row of mounds on certain hills around were not my cases.
our city are mute but impressive evidences Case -/.—Mr. C. presented all symptoms
of my educated surgical conscience. of recurrent appendicitis. Operation per-
Tlie surgeon should be surrounded by formed: while still in bed a more violent
the best means science can give, and the attack occurred, and after able consullamedical
science is so broad no one man can tion X-Ray photo proved it to be stone in
cover it. Hence 1 believe the one man sur- ureter, requiring another operation, which
geon has passed, and his l)est work of the cured him. This was my case. Here I
future must be institutional. Of course, would state that satisfactory X-Kay work
this applies to selective surgery principally, can not be done by the tyro or surgeon. He
because from tlie nature of the case emer- must be expert.
gency surgery must be done at once, but Case 5.— Mrs. P. presented every evieven
where it is possible, the first aid should dence of grave abdominal disease. Was
be given and then carried to the nearest sent in for operation. After passing through
institution. hands of competent specialist, dreaded pel-
The best surgery must be composite. The lagra was diagnosed, and she shortly died,
internist, the alienist, the microscopist, the saved from needless suffering and expense,
pathologist and the surgeon -should all act Case 6.— Mrs. U. sent in for fibroid of
in cases of obscure disease, and I don't be- uterus which she had, but after thorough
lieve the best work can be dtme by hired examination cancer of pancreas was diagassistants,
who too often do their work in a nosed, which was confirmed by an autopsy,
perfunctory manner, but a collection of Case 7.—General adenitis of neck and
specialists thoroughly in accord and with marked antemia. Of course, T. B. was the
united ideas can best evolve the highest de- diagnosis at first, but after thorough examgree
of efficiency. ination by nose specialist, polypus and
I do not mean to depreciate in any way sinusitis were found, and first treated, folthe
isolated surgeon, who has done and is lowed by excision of glands, which gave
doing such noble work. Are we not reap- complete cure. Here I must remark that a
ing today what they have sown? Times jiathologist must be of the best,
and conditions are changing. The luxury One objection 1 might surmise,— can't
of today becomes a necessity tomorrow, afford it, from money point of view, and
Enlightened humanity demands of the would answer that my field is North Caromedical
profession its best. Rapid and lina, one of the poorest and stingiest States
comfortable transit makes my contentions in the Union, they say, and yet I find no