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

ORIGINAL COMMUNICATIONS. 147
American medicine and surgery have ajTwell by a thorough study of the whole hujust
right to be proud of their achievements, ;< man anatomy and ohysiology, as well as
but to advance more adequately the essen-' pathology of the system, before they limit
tialpurposesof medical and surgical science, their work along definite lines. Again, the
[there must be mutual interdependence and physician, as well as the surgeon, naturally
,
I
'
,
I
co-operation. Even the best in either branch has not the ability nor the time, to cover
must admit that they are not infallible, and the broad expanse even of the field of medi-
Ithat not absolute efficiency, but only a cine on the one hand, or of surgery on the
reasonable degree of it, can be expected of other. What is the result? Naturally you
them; for if they are honest, they must ad- may have a brilliantly equipped medical
mil that the masters of medicine and sur- man, and yet it is absolutely impossible for
gery are few in number.
As a matter of fact, however, this is
him to be skilled in surgical diagnosis. On
a the other hand, you may have a man highly
diflScult and disappointing view for most of skilled and equipped in surgery, in surgical
us to assume, and rather than to admit it, knowledge and dexterity, and yet wanting
even to ourselves, we prefer to fight single- in the broad essentials of the knowledge of
handed the battles that daily arise, often- the practice of medicine. Consequently,
times forgetting that it is not all of medi- you can understand very easily that if we
cine to drug, nor all of surgery to operate, wish to accomplish the best results, there
In the new "physiologic" era which is must be an inter- dependence between the
to succeed the present, or "pathologic" era physician and surgeon in getting the clearof
medicine, we are to take less care about est diagnosis, and resultantly, the best lines
Uhe entrance of possible germs into the
system, and much more care about keeping
of treatment for their patients.
It is a fact, too, that the one on the one
: the patient in such a condition that he can side, as well as the one on the other side,
resist them, if they do get in, and to this becomes biased in his prognosis, as well as
I
j
tend we will need the freest co-operation uf in his diagnosis, and that oftentimes both
both ])hysician and surgeon for the fullest the physicians and the surgeons become
of our beneficent science. nihilists to the therapeusis of the opposed
I
•
development
Unquesiionably, tome, the apparent di- party, as we may term it, and the physician
vorce of modern medicine and surger\- is thinks that the surgeon can accomplish
, largely due to one factor, which, while it nothing, as the surgeon thinks very often
; has
probably done more to give us an inti- that the physician can accomplish nothing,
mate knowledge of certain lines of the This is obliged to result in ill effects for the
science than anything else, yet has its patient, who has certain well defined rights,
serious consequences and disadvantages, for which we ought to have the sincerest
,
j
i
I
!
What, then, is this factor? I believe it can
be summed up in the one word, "specialregard.
It is also a fact that neither one,
as a rule, follows the case from the bedside
ism," and I believe, further, that when I
• conscientiously, and carefully, and thorobservations
along, say. to the operating
table, to see whether his diagnosis is conoughly
understood and studied, specialism
has as many disadvantages, probably more,
firmed or not, or sometimes to the autopsy
table, to see whether or not his diagnosis
than it has advantages. and prognosis were well-founded. Surely,
What ar:- some of tliem? One of them is
the undeniable fact that men, unprepared
by sufficiency of knowledge and ripe experience,
rush too precipitately into the
different specialties of medicine, and as a
then, unless we have cooperative work
which is directed all along the line, and
confirmed or not confirmed, we cannot be
definite in our diagnosis, and we do not
learn from the case in question as much as
result they are not prepared to cover the we should.
broad domain of the science.
It is also a fact that many of the special-
It is also true that these opposing ideas
as to therapeusis held by the medical man
ists who go into the different branches, and the surgeon, lead at times to deplorable
while they have added infinitely to our intimate
knowledge of these branches, have,
results, and often to chronic invalidism in
a number of patients, who could be saved
because of their limited study in a certain that terrible wreck of their lives in the
direction, become biased, or in other words, future. I need not pause here one second
many of them have become "faddists," and
can see nothing outside of their special line
of work.
to dwell upon this, because it is too familiar
to you all. I am able, however, to say this
—that the exploratory' incision, often, of
It is also true that there are many "spec- the operating surgeon, and the "horse-back"
. ialists" who are not specialists, and it is guess of the practicing physician, would be
not unbecoming in us, I feel, to caution the largely done away with today, if we recog-
, young
men who gu so largely and so rapidly nized that the physician doesn't know it
, into the different lines, to prepare themselves all, just as the surgeon doesn't know it all,