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

148 THE CHARLOTTE MEDICAL JODRNAL
and that if they worked hand in hand, and repeat that we should not go mad with the I
shoulder to shoulder, for the best interests idea that the laboratory tells us everj'thing i
of their patients, they would consult about and that its methods are perfect, for in every i
these cases, and not let the inevitable result case we should bring to bear common sense :
which is noticeable to me today follow, and sound judgment in our analysis of i
What is that result? It is this—that in the them. And, besides, it is a fact that sim- j
great number of cases, the patient himself, pie exploratory incisions are not so harmj
these days, is getting to be the diagnos- less as would usually be supposed. Many '
tician, and he is saying whether his case of you know that even exploratory incisions
should be referred to the physician or to in certain diseases lead to metastases that
the surgeon. Now, I believe we are largely are irremediable by the surgeon's knife or
responsible for this very state of affairs. It tae physician's pills, if that incision is left ;
has been frequently noticed, I am sure, by open even for a few days; and another !
many of you, that when the physician and thing, many a time these incisions direct a
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surgeon work independently of each other,
that the diagnosis often of the same case,
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patient's attention to himself, which is unavailing
to the patient, and is, indeed, ex-
referredfirstto the one and then to the other, ceedingly harmful in
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a majority of these!
is different, hence the skepticism of the cases. All of us will grant, I believe, that I
patient. Now, I cannot believe that if the intimate pathological knowledge is abso- I
true spirit of co-operation existed, that this lutely necessary in the practice of medicine, \
could be true, because if the medical man and yet I believe it is more important even
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knows what he should know, and the surgical
man knows what he should know, and
each worked in harmony with the other,
to the surgeon than to the physician, and
while I wish not to condemn these researches \
or methods, yet I would urge that they be
certainly it would be the same diagnosis in applied not only to the gross specimen, but I
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the same case. I believe we are led away to the microscopic specimen, and that final
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too often by the fact that we wish only to judgment should be made up, upon the data
determine whether it is mostly a medical elicited, only when a well-balanced judg-
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case, or mostly a surgical case. We are ment has been brought to play upon them
not after an exact diagnosis, and that you at the bedside. <
know, in the advancement of medicine, is I would add, also, that the question of i
what the specialists were created for, and, the mental impression, both medically and ]
acting jointly, should be able to secure. surgically speaking, in many of these cases,
Frequently, also, because of the non- when we make a wrong or inexact diagco-operation
of the physician with the sur- nosis, is of far more importance than we
geon and the surgeon with the physician, would ordinarily judge. In short, special- j
many of the most important details and ism often divides the responsibility, and
facts bearing on the future of the patient, the patient suffers; for neither the physician
as to operation or non-operation, are neg- nor the surgeon feels the interest, nor the
lected by the surgeon, especially when he intimate desire to aid the patient, that both 'I
overlooks the question of heredity, or when of them combined, and working harmoni- •
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he overlooks the question of individual con- ously together, would do. What is the i
stitution, of which he can know but little remedy then? Are physicians and surgeons
when the case is new to him. coming closer together in their work these S
When he overlooks, furthermore, the days? Is either profession capable of treat- 1
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question of the individual temperament, i"g alone many of the common diseases
which I believe every surgeon ought to be that come to us? Is it to the patient's best \
thoroughly familiar with, so as to know the interest, in other words, that this state of ii
resistant and non-resistant tendencies of his affairs should be brought about? Unhesi- j
patient, he is culpable, for I believe this tatingly, I answer affirmatively, for there is
method of rushing precipitately and hastily often a woeful lack of similarity between
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into an operation, without all of these col- the diagnosis of the physician and of the i
lateral antecedents, which are of such im- surgeon in the same case, frequently due to i
portance to the future of the patient, and, a lack of proper knowledge on the part of
often, without previous needful prepara- each, as well as proper study, together, of
tion, is as often unwarranted, as it is un- the case in question. The surgeon fre- ''
necessary. quently fails to study his case thoroughly !;
I am aware that laboratory methods in beforehand, and the physician as often fails 'i
the advancement of our profession have to follow his case to the operating table to «
taken a very high place, but I wish to say see whether or not his diagnosis has been 'I
that, from my experience, laboratory meth- confirmed by the incision of the surgeon. [
ods, unaccompanied by close clinical ob- I wish to mention very briefly in con- .1
servation, do not make diagnoses that are elusion, that the "operative" surgeon is, I ii
confirmed upon the operating table, and I believe, today, passing out from being es- il
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