---------------------------------------- -------------------------------- ,,the ,,hospital ,,bulletin ,published ,monthly in the ,interest of the ,medical ,department of the ,university of ,maryland ,,price #a4jj ,,per ,,year ,contributions invited from the ,alumni of the ,university4 ,business ,address1 ,baltimore1 ,md4 ,entered at the ,baltimore ,post-office as ,second ,class ,matter4 ,,vol4 ,v ,,baltimore1 ,md41 ,,april #ae1 #aiji ,no4 #b ---------------------------------------- -------------------------------- ,,the ,,ethics ,,of ,,the ,,general ,,practitioner4 ,an ,address delivered ,before the ,university of ,maryland ,medical ,association1 ,march #af1 #aiji1 ,,by ,,guy ,,steele1 ,m4 ,d4 ,of ,cambridge1 ,md4 ,a celebrated divine once said that the most difficult part of a sermon was the selection of a proper text4 ,i must thank the ,president of this society for saving me this trouble4 ,when1 however1 ,webster's is consulted for a proper definition of the word ,ethics1 and it is found to mean ,the science of human duty1 it would seem that he has chosen a text almost too comprehensive for the limits of a short paper1 even when restricted to the ethics of the medical profession4 ,it may not be out of place to thank him for the honor he has conferred upon me by deeming one whose student days are scarce twelve years behind him worthy of presenting this subject to you1 for a paper on this topic is almost of itself a sermon1 and we naturally look up to those1 whose many years of experience and works have brought them prominence1 for instruction in morals and duty4 ,still1 ,i take it1 whether young or old1 all of us like to preach on fitting occasions1 and not the least part of the inspiration to effort is the character of the audience4 ,my invitation was to read a paper before the ,clinical ,society1 and incidentally ,i was told that some of the students had expressed a desire to be present4 ,little1 however1 did ,i anticipate such a flattering attendance from them when examination time so nearly approached1 and it is evidence of a most commendable spirit when they can bring themselves to take even an hour of their most valuable time from study to devote to a consideration of the moral duties and responsibilities which shall be theirs when they shall have passed through the ,april ordeal4 ,much that ,i have to say tonight will be directed especially to them1 and if they or their elders in the profession may in the years to come look back upon this night with the recollection that ,i have more forcibly brought to mind some of the old and half-forgotten maxims and axioms that make for a better and purer professional life1 ,i will have been more than repaid for the time ,i have expended in the preparation of this paper4 ,in discussing the ethics of the general practitioner towards his patient1 ,i would have you remember that your first and most important duty is to give to those who trust you the very best that is in you4 ,to you young men1 full of enthusiasm for your new profession1 and imbued with ,utopian ideas of the mission which you have undertaken for the good of mankind1 it would seem almost foolish for me to mention this as the first advice ,i would offer you4 ,but ,i think ,i can see a smile of understanding flit across the faces of those who have for some years fought the battle of life1 and who have had the wire edge of early ambitions and determinations blunted by contact with unappreciative patients and unworthy professional competition and the daily incidents of a busy life4 ,they know that it is very easy to feel too tired1 or be too busy1 or have some other engrossing affair in mind which prevents that entire devotion to duty which all admit is essential to success in medicine4 ,half of success in life or in any undertaking is due to a successful start2 therefore1 let me ask you to firmly determine on one or two fixed principles1 and to stick to those principles through thick and thin4 ,be fully assured that no halfway devotion to your profession will ever bring you prominence or success4 ,the time-worn phrase that ,medicine is a jealous mistress loses none of its truth by frequent repetition4 ,recently ,i saw in a prominent medical journal the advice given that doctors should take a prominent part in politics and bring themselves forward in other ways1 and that thereby in some way unknown to me the glory of the profession would be enhanced1 and much benefit result to the community4 ,far be it from me to discourage a proper civic spirit and a proper interest in public affairs1 or to advise an avoidance of any duty which good citizenship imposes upon every honest1 patriotic man1 whatever his business or profession4 ,but ,i take it that no more baneful1 no more dangerous advice can be given to our young professional man than this4 ,you cannot be successful in both politics and medicine1 and while we can point to one member of our profession in the ,united ,states ,senate1 and to some notable exceptions in our own ,state1 where men of our profession have1 for a time1 abandoned medicine and returned to it to win success1 you can rest assured that the medical politician possesses little beyond a musty diploma to remind the world that he was once of our cult4 ,so don't be a halfway politician and halfway doctor4 ,success in either field will take all of your best effort and all of your time4 ,what ,i have said of politics will apply1 though not quite so forcibly1 to any other engrossing business or pleasure4 ,time forbids me to elaborate this idea1 and in concluding it let me say that you cannot be a successful politician1 merchant1 sport or what not and carry medicine as a side line4 ,it may seem useless to remind you that1 in order to give the best that is in you1 you must keep abreast with what is new and best in professional literature and scientific progress4 ,you all have determined to be students1 and even those who pride themselves on having passed through the ,university without having opened a book have a half-formed desire to really know something beyond spotting a possible examination question1 and when once examinations are over1 and they have reluctantly withdrawn themselves from the delights of the city by gaslight for the pine woods and mountain trail1 they will burn the midnight oil and browse diligently through their musty tomes4 ,may ,i tell you that nothing is harder than to find time for study4 ,many of us1 even though city men1 with the best and latest literature at our elbows1 are ashamed to think how thoroughly we abhor the sight of a medical book or magazine1 and how easily we can persuade ourselves that we are too tired and stale1 and so engrossed during the day with scenes of sickness and suffering that we must have our brief hours of release from duty for recreation4 ,we do need our hours of relaxation and rest and our too infrequent holidays1 and they are absolutely essential to good health and good work4 ,don't1 however1 confuse the words rest and relaxation with sloth and idleness1 and don't think your professional work completed when your round of daily visits is done4 ,indeed1 if you would know medicine you must woo your mistress in the small hours of the night1 and in many of the leisure moments that the day may bring you4 ,much has been spoken of the man who practices by common sense1 and whose school has been that of observation and hard experience4 ,a most worthy brother he is at times1 and many are his friends and wonderful his success4 ,but if the science of medicine is to advance1 more is required for progress than mere common sense1 and observation untrained and experience undirected and unguided by the observation and experience of others will rarely discover a new bacillus or elaborate a side chain theory4 ,so1 to be truly ethical in the duty you owe to give the best that is in you1 you should be reading men4 ,take one or more of the medical journals4 ,buy for reference the latest and best text-books4 ,make the opportunity to read the daily papers and something of current literature4 ,a well-rounded man can afford to do nothing less4 ,besides the information you obtain1 it pays in the respect of the community to have the reputation of being posted in your profession4 ,often the country man simply hasn't time at home to read4 ,a busy life1 with its miles upon miles of dusty roads to travel1 precludes all chance for the easy chair4 ,then cultivate the habit of reading while driving4 ,many are the useful and happy hours ,i have spent in my carriage with my journals and magazines4 ,i am frank to say that1 but for this habit1 ,i never could have found time for one-half of the reading ,i have done4 ,last year ,i was somewhat amused when a most worthy1 well-educated and well-posted man summed up his opinion of another by saying that he was one of those who read magazines in his carriage4 ,if ,i mistake not1 this indictment was brought against the late ,dr4 ,miltenberger1 who as a young and busy man was forced to form this habit1 and ,i could but think that1 could ,i die with half the honor and respect and love that were his1 ,i could plead guilty to even this mark of devotion to my profession and desire to advance in it4 ,would you be ethical in giving the best that is in you to your patients1 you must give ungrudgingly of your time4 ,this may again seem a useless piece of advice1 and yet almost all of us are familiar with the man whose motto is ,veni1 ,vidi1 ,vici--,i came1 ,i saw1 ,i conquered4 ,this intuitive diagnostician is by no means a myth4 ,the man who comes in a rush and goes in a rush1 and who1 with pencil in one hand and prescription pad in the other1 feels the pulse while the thermometer is under the tongue2 who sees at a glance1 without necessity of personal or family history or of physical examination1 just what is the matter1 and who1 giving four or five prescriptions1 rushes out1 trusting that something in his shotgun therapy may hit the enemy4 ,perhaps the next day he prescribes four or five more remedies or combination of remedies1 and should the patient begin to improve1 prides himself that he has made and confirmed a diagnosis by his experimental therapy4 ,is it necessary for me to say that no ethical man with any regard for the rights of his patients and his obligation to his profession can really practice medicine in this manner8 ,the plea that you are too busy to give the proper time to your cases is no justification for your neglect4 ,anything less than a careful inquiry into family and personal history1 followed by a painstaking and thorough physical examination1 is unjust to your patient and unjust to yourself4 ,no ethical man can give the best that is in him by doing less than this4 ,if you haven't the time to do your work thoroughly1 make a clean breast of the matter and take fewer cases4 ,but you will say that a man1 even in large practice1 cannot afford to give any of it up4 ,he needs every dollar that honestly comes his way1 and to say that he hasn't time for his work is only another way of throwing practice into the hands of a rival4 ,this is1 indeed1 a proposition hard to solve1 as most of us do need every dollar that honestly comes our way2 but if our work is only half done1 if we have neglected some important point in diagnosis1 and thereby omitted some equally important measure in treatment1 have our dollars been honestly earned8 ,let us start out with and carry in mind this axiom of a truly ethical life1 that success in medicine cannot be measured by commercial success2 that1 while no sensible man can neglect the business side of his vocation1 or refuse to demand and collect just compensation for his service1 such compensation cannot be measured in dollars and cents alone2 that a good conscience and whole-souled devotion to duty1 giving ungrudgingly of the very best that is in you to those that have confided in you1 will be your very best asset when the final account is made up4 ,may ,i impress the fact upon you that an ethical man1 with a just appreciation of his duty to his patients1 can never be a vendor of patent or unofficial medicines4 ,indeed1 ,i would be lacking in my duty if1 with the opportunity this paper offers me1 ,i did not1 from the standpoint of experience1 impress upon you with all of the force at my command the necessity of being wary of the detail man and the alluring advertising literature with which your mail will be flooded4 ,you will scarcely have opened your office1 and be waiting with what patience you can command that rush of the halt1 the lame and the blind to which you feel that your talents entitle you1 before the suave detail man1 having heard of the new field1 puts in his appearance4 ,what you lack in therapeutic experience he can supply you by drawing liberally on the experience of others who have worked little less than miracles in an adjoining town by the use of his pills and potions1 his elixirs and tinctures4 ,you will find him smooth and oily1 placid and plausible4 ,he knows his story well1 and even by his much speaking can almost persuade you that what you knew1 or thought you knew1 or what you had recently been taught1 were all out of date2 that by some stroke of genius the chemist of his house had discovered some way by which compatibles would combine with incompatibles into the formation of a new and staple mixture1 possessing all of the virtues and none of the defects of its original constituents1 rendering chloral as soothing as the strings of a lute and as harmless as the cooing of a dove1 extracting from cod-liver oil every disagreeable feature and leaving nothing but its supposed virtues behind4 ,he will show you the short road to fortune and success4 ,treat him kindly2 the ethical man should not be rude1 and brusqueness is not a sign of ,roman honesty or virtue4 ,be assured he feels his position keenly1 and is dreading the catechism which will sooner or later display his ignorance of everything but the story that has been drilled into him like a parrot4 ,there has been no greater shame in our profession than the influence these men and their houses have exercised1 and incidentally the indorsements and recommendations that thoughtless men have furnished them4 ,the blame is all ours1 and we cannot shun it4 ,we pride ourselves on our scientific attainments2 that we take nothing for granted2 and1 now that the age of empiricism has passed1 we accept nothing that does not bear the stamp of scientific approval4 ,and yet1 before the campaign of the ,american ,medical ,association and the revelations of ,collier's and the ,ladies' ,home ,journal1 we accepted our treatment from the hands of the manufacturing houses1 and dosed our patients with nostrums about which we knew nothing except the statements of those whose sole purpose it was to sell4 ,there are few of us who have been many years in practice to whom a blush of shame does not come at the recollection of our gullibility and our guilty innocence4 ,can any man deem it ethical to give even to a good dog something about which he was totally ignorant8 ,and yet this is just what we were doing4 ,a short time ago a particularly shrewd detail man was discussing this very point with me1 and claiming that1 as the formula was now required by law to be printed in each bottle and package1 this most formidable objection could not now hold good4 ,handing me a bottle of his patent cure-all1 he glibly called my attention to the six or seven ingredients1 with the amount of each contained in the fluid ounce4 ,among other potent quantities ,i can recall #a-dh gr4 of morphia and #a-bdj gr4 of strychnia4 ,the dose was a teaspoonful three times a day4 ,any man can imagine the more than homeopathic effect of #a-dh gr4 of morphia divided into eight doses4 ,these well-known and well-tried drugs were not1 however1 the life of the nostrum1 and presently we came to the twenty minims to the fluid ounce of the fluid extract of the drug from which the remedy derived its name4 ,something ,i had never heard of4 ,something unlisted in the ,u4 ,s4 ,p4 ,something discovered and owned and controlled by this house alone4 ,as my ignorance became more apparent his eloquence increased1 and ,i have no doubt that a few years ago1 before my moral conscience had become aroused to the therapeutic sin of prescribing something whose botanical family1 whose chemical formula1 and even whose physiological effects were totally unknown to me1 ,i would gladly have accepted a sample and would have tried it on some poor soul too poor to pay for a prescription4 ,it is nothing short of a shame to think of what we have done in this line4 ,the sin has been one of carelessness and laziness rather than of ignorance4 ,here we had ready to hand some remedy1 beautiful to the eye1 palatable to the tongue2 then why take the time and trouble to bother about constructing a formula of our own when someone else of equal experience had constructed one for us8 ,i am ready to thank ,god that most of these nostrums are as harmless as they are beautiful1 and1 while ,i may not have done good1 ,i rarely did harm by their use4 ,i am not discussing the opium and cocaine laden classes4 ,i wish to emphasize incalculable harm that must result to the physician himself who allows someone to do his thinking for him4 ,i am also referring to the attitude of the ethical man to his patient1 and beg to ask if we are doing even part of our duty when we are doing no harm4 ,allow me to conclude this topic by asking you to spend an hour some day in casually glancing over 7a deep study would fully repay you7 the pages of the ,u4 ,s4 ,p41 or a list of the remedies that have in one year received the sanction of the ,council on ,pharmacy of ,american ,medical ,association4 ,if you don't find enough drugs and combinations to meet every case and every conceivable situation1 you had better desert practice and exploit some wonderful cure-all as a detail man4 ,if we1 as physicians1 had nothing but our duty to our patients to consider1 and incidentally our own profit and glory1 the practice of medicine would soon degenerate into a mere trade4 ,i may even say that1 had we nothing but the promptings of our consciences to keep us in the straight and narrow path1 if we had nothing but the knowledge of work well done1 and if the desire and determination to give the best that is in us were our only incentives to an ethical life1 the profession would be so beset by the temptations of commercialism1 and the notoriety and prominence which commercial success brings1 that the halls of ,esculapius would soon need a scouring and purging greater than ,hercules gave the ,augean stables4 ,despite the high incentive to all that is best and purest in life which our noblest of callings should beget in us1 physicians are only human1 and human weakness1 like disease1 is no respecter of persons or of callings4 ,it may have been that the medical fathers1 with a knowledge of the temptations to which they were subjected1 and a desire to save others from the pitfalls which beset their paths1 were imbued with a determination to place their profession on a higher plane than others2 or it may have been the natural evolution which inevitably resulted from and followed the promptings of man to help his fellow-man1 to devote himself to the relief of pain and sickness1 to sacrifice his comfort and ease and almost every pleasure in order that others might have ease of body and peace of mind and soul1 which from the earliest days have placed medicine as a profession apart1 and have imposed upon those who have entered its ranks certain standards of conduct and insisted on certain ethical relations which have lifted it above mere questions of gain and the vain acquisition of renown4 ,we have been taught that ,hippocrates himself was great not only as a physician1 but greater still as an ethical teacher who has left with us certain maxims and proverbs which1 though handed down through the ages1 have lost none of their truth and none of their spotless morality4 ,even in the ,middle ,ages1 when learning1 not to say science1 had sunk into such an abyss of ignorance that the ability to write one's name lifted one into the ranks of the educated1 when human ills were relieved more often with the sword than with the scalpel1 the leech was a man apart4 ,his education1 his scientific investigations1 and even his supposed communion and partnership with the evil one1 placed his on a pedestal above other professional callings4 ,then1 as now1 though men might scoff at our profession of superior knowledge and skill1 when pallida mors stalked abroad or knocked at the hovels of the poor or palaces of the rich1 all arose to call us blessed4 ,it has been often said that1 could a medical man live up to the ethical standards of his profession1 his chances without creed or priest would not be small at the last great day4 ,but with all of our high ideals we are only mortal1 and we know and have sorrowed at the fact that many of our ethical standards are not lived up to1 and that the ,hippocratic law is frequently more honored in the breach than in the observance4 ,we have in every community where one or two are gathered together in the name of medicine the man who is everything to your face and everything else behind your back2 who damns by faint praise2 who sympathizes with you in your sorrows and trials1 who visits the family of the patient you have lost to assure them of your skill and to insist that everything was done that could have been done1 but----and that one harmless little conjunction1 meaning nothing in itself1 is more eloquent than a thousand terrible adjectives or burning1 blistering adverbs or participles4 ,so many things can be said by the pious uplifting of the eyes1 the sanctimonious upturning of the palms4 ,he would not for the world leave a doubt in the minds of your people1 and1 no matter what in his inmost heart he thinks of your mistakes 7from his standpoint71 it is not his place to injure a brother1 but1 alas6 he is not responsible for the unguarded tongues of his friends1 and he usually sees that they do his work well for him4 ,often it is if ,i could only have reached him earlier1 which1 being interpreted1 means a miracle would have been wrought4 ,almost every community has its miracle worker1 its medical resurrectionist4 ,his cases are always a little worse than others1 his victories a little more wonderful4 ,where you have a bronchitis1 he has a desperate pneumonia1 your transitory albuminuria is with him acute ,bright's1 and hopeless cases follow him to undo him1 only to meet defeat at his skillful hands4 ,you hear that ,mr4 ,a4 is desperately ill with pneumonia on ,monday1 and on ,friday you meet him on the street1 looking hale and hearty1 firmly believing that1 had ,dr4 ,x4 been one hour later in reaching him1 he would ere this have been gathered to his fathers4 ,should you mildly suggest that some error in diagnosis might have been made1 that even the best of us at times go wrong1 and that resolution in true pneumonia could hardly be expected in four days1 you will find that he has been prepared for you1 feeling that ,dr4 ,x4 has used some potent remedy as yet unknown to you and his less skillful brethren1 and firmly convinced that your suspicions of his case are based upon your ignorance or your jealousy of poor ,dr4 ,x41 who was not there to defend himself1 who had always spoken so kindly of you1 and had uttered nothing worse than the harmless little conjunction but---- ,a little bragging is not a sin1 and indeed is usually harmless1 and in the long run reacts on the miracle worker4 ,but the ethical man does frequently suffer from it1 and it is a fact1 absurd as it may seem1 that the average man or woman would much prefer to be considered at death's door about three-fifths of the time--indeed1 almost a walking ,lazarus--than to be deemed the picture and personification of vigorous health4 ,dr4 ,x4 knows this1 and plays upon the credulity of his patients4 ,he frightens them to death's door1 works a miracle1 and has tied them to himself forever4 ,we all have suffered from this1 and will continue to do so until the little grain of truth has grown from the tiny mustard seed to the vigorous bush4 ,dr4 ,x41 with his faults1 has his virtues4 ,he aspires to be the busiest man1 the richest man1 the most popular man in his community4 ,all of these ambitions1 if properly guided1 are laudable1 and1 indeed1 while enhancing his power and prestige1 may be redounding to the good of his people1 for a man to be the busiest and most popular man in his profession must usually be the best posted1 the most highly educated1 the hardest working man1 not only for himself1 but for those he serves4 ,so1 while we may smile at ,dr4 ,x4 and his big ways1 we may love him for his virtues and forgive his small faults4 ,but for the man who deliberately goes to work to undermine another2 who takes advantage of some temporary absence of the regular physician to ingratiate himself2 who1 appreciating the fact that people worried nearly to death by the illness of a loved one1 will forget every obligation and desert every old friend in the hope that the new one may offer some encouragement or extend some hope1 is ready for these emergencies4 ,he carries satchels full of hope for all cases and occasions4 ,he prescribes it liberally1 diluted1 however1 to the point of despair because he was called in an hour too late1 or because the case had already been damaged beyond his power of repair4 ,this gentleman advances not only by his own deceit1 but uses the power of church1 of politics1 of family influence and social opportunity1 to lift himself along4 ,verily he has his reward1 but it is not in peace of mind1 not in the honor and respect of his community1 but the contempt of every honest man1 be he of the profession or laity4 ,not the least of the perplexing questions which beset the man who is trying to lead an ethical life is his duty in his relation as consultant4 ,indeed1 there is scarcely a situation in professional life that at times presents more embarrassing possibilities1 or calls for the exercise of more tact4 ,it is a pleasure to be able to bear witness to the ability of the man who has called you to his aid1 to assure the family that everything has been done that care in diagnosis and skill in treatment could demand4 ,but what of the cases where gross carelessness or blind ignorance have hastened what might easily have been delayed or averted8 ,there is only one way here1 only one duty4 ,treat the man as his carelessness or his ignorance deserves4 ,again1 you are called in consultation with a thoroughly good man who has given ungrudgingly of the best that is in him4 ,perhaps your superior skill in certain lines1 perhaps your superior opportunity to observe a certain line of cases1 have taught you something that he has not had the chance to learn4 ,as before it was your duty to expose the careless ignorance of one1 now it is your place to so give your opinion and explain your position that no possible reflection can be cast upon the other4 ,don't approach a consultation with the manner of a priest of ,delphi4 ,don't pose as the fountain of all wisdom and of all experience4 ,indeed1 in this work you will be surprised how often you will learn from him you are called upon to assist4 ,he has seen the case for days1 where you can spend but minutes with it4 ,it is his part to bear the blame1 yours to share his fame should success crown your combined efforts4 ,frequently you will be called upon when a resort to surgery is demanded--not so much to perform the operation as to give your opinion as to the advisability of a certain line of procedure4 ,having determined what is to be done1 don't assume the place of prominence4 ,you have little by way of reputation to gain by performing an operation that you were known to be competent to perform or you would never have been called4 ,let him do the work with your assistance and advice4 ,in this way you will have gained a fast friend for future consultations1 and you will have enshrined him in the esteem and confidence of his people4 ,therefore1 help him and uplift and bear witness to his worth1 and don't humiliate him by your airs and assumed superiority4 ,as a last word1 don't consult with an unworthy man1 for be assured that your reputation is worth more to you than any consultation fee1 however badly you may think you need it4 ,the question of fees is one that must be considered4 ,we hate to think of the combination of medicine and money1 and our patients abhor it even more4 ,the days once were when only the sons of the rich sought the liberal professions4 ,it was thought unworthy in the days of the dim ages for a pupil of ,esculapius to charge for his services4 ,any remuneration that came to him was an offering of gratitude--indeed an honorarium which might be tendered or withheld at the will of the patient4 ,a truly noble conception this1 that the good we offered was beyond a mere question of price4 ,equally comforting was the belief that the ill which resulted despite our best efforts was no reflection on our skill1 but an evidence of the wrath of the ,gods4 ,would that we were as near ,olympus now as then1 and that the ,gods walked with men to reward the worthy and punish the unjust4 ,would also that the manners and costumes and climate of ,ancient ,greece were still with us1 so that man need take little heed of raiment beyond a robe and sandals2 that he required no expensive outlay for instruments1 no intricate electric outfit1 and no automobile4 ,what a life ours would be if now as then our grateful patients sought us1 and we passed our many hours of leisure in eloquent discussion or in lazy lounging amid the leafy groves or shaded porticos of the temples6 ,but the times have changed1 and we have changed with them1 and abhor as we will the combination of medicine and money1 we are forced to take thought of the morrow and to spend many1 many anxious moments in this thought and in trying to evolve ways and means by which a balance can be maintained between the honoraria of patients1 both grateful and ungrateful1 and the claims of persistent creditors4 ,perhaps it is best thus1 as the average man needs some incentive to good work beyond the acquisition of honor and glory4 ,an axiom in the question of fees is this1 that in order to be respected we must respect ourselves1 and no one can respect himself unless he holds his calling above a trade and bases his charges upon this feeling of respect for himself and his profession4 ,this axiom should be held in mind in arranging any fee table1 and should be insisted upon in our settlements with those who think a doctor's bill should be discounted from one-quarter to one-half4 ,i have often wondered how this right to a discount in a doctor's bill ever got such a firm hold in the public mind4 ,perhaps the city man cannot appreciate this fact like his country brother4 ,the poor1 honest old farmer1 part of the bone and sinew of the land1 expects the highest cash price for everything that he sells4 ,if anybody has ever heard of one who when ten barrels of corn at #c4ej per barrel comes to #ce1 offering to take #be for his bill1 he should corral and cage this rara avis4 ,but hundreds of us from the rural districts have been deemed mean and close-fisted and extortionate because we gently insist that #ce worth of professional services rendered are worth #ce and not #be4 ,this is largely our own fault1 for so many of us present a bill in one hand and an apology in the other4 ,we collect our bills not as if they were our just dues1 but with a half-hearted insistence1 inducing our debtor to believe that we have scruples ourselves as to the value of our services1 and that a liberal discount from the face of the bill will about bring us to a fair settlement4 ,it will be better for all--for patient as well as physician--to realize that the science of human duty implies a duty to oneself as well as a duty to the public1 and that a small proportion of the charity of our profession should begin at home4 ,to the young men ,i would especially give this advice3 ,having settled on a fair and honest fee for your services1 do not depart from this fee4 ,with us1 as a rule1 prosperity in the form of a numerous clientage comes sooner than to the other professions4 ,you will not long have opened your office before you will be surprised at the number who demand your services4 ,there will be no doubt of the demand1 for those who pay the least invariably demand the most4 ,don't turn them away1 for if you properly employ your time1 you will gain in experience and occasionally a dollar or two4 ,you will soon be enlightened as to your popularity1 for the first pay day will send most of them to another and it is presumed easier man4 ,many of those who stick will tell you that ,dr4 ---- never charged but #ej cents a visit1 when the regular fee is #a4jj4 ,dr4 ---- will vigorously deny this and produce his books to prove his truth4 ,here is everything plain before you4 ,every visit is listed at the established figure4 ,you will rarely see his cash book1 for then the whole transaction would be plain1 and you would discover the simple manner by which in every community some supposedly ethical man is supplanting his truly ethical brother by charging full fees and settling for half4 ,dr4 ---- will cut #ej cents or a dollar from the established fees for out-of-town work1 and immensely increase his practice by it4 ,for be it understood the bone and sinew of the land dearly love the wholes and halves1 and will flock to sell in the dearest and pay in the cheapest market4 ,don't envy this man his prosperity and1 above all1 don't follow in his footsteps4 ,bide your time with the assurance that the man who charges #a4jj for #b4jj worth of service rarely gives more than a dollar's value1 and that when a real emergency arises and a capable1 honest man is demanded1 one who respects himself and his calling1 if you have prepared yourself and are known to give the best that is in you1 the cheap man will go to the wall and your merit will receive its reward4 ,if by chance any of you have not seen ,dr4 ,mc,cormick's paper on this question of fees and collections1 let him by all means find the proper ,a4 ,m4 ,a4 ,journal and read it4 ,it is a classic worth any man's time and attention4 ,in concluding this subject1 let me endorse what he says about the cheap man1 the price-cutter4 ,whatever his charge may be1 he is usually getting full value for his services4 ,realizing his lack of education or ability or temperament1 or whatever it is that puts him below his professional competitor1 he cuts his fees in order to live4 ,it is not our place to meet his competition1 but to pity him1 to extend to him the helping hand1 to endeavor to elevate him to our standard1 and never to lower ourselves to his4 ,i have only a few words to say on the subject of professional confidences4 ,so sacred is the relation between the physician and patient regarded that the courts will not compel a physician1 while on the witness stand and under oath1 to tell the truth1 and not only the truth1 but the whole truth1 to reveal what is imparted to him in confidence by his patient4 ,if in this exalted function of doing justice between man and man the courts will not compel the recital of some important piece of evidence1 how carefully should we regard our professional relation1 and see to it that neither in strict confidence or in idle gossip do we betray the secrets that suffering man has confided in us4 ,it may be somewhat out of place in a paper dealing with ,the ,ethics of the ,general ,practitioner to speak of the tendency1 or perhaps better1 the half-formed determination of the majority of every class to be specialists4 ,i must confine myself to the predilection of the average medical student for surgery4 ,it was so in my day1 and ,i suppose it is so now1 that almost #ge per cent4 of the graduating classes are thoroughly satisfied that the end and aim of medicine is surgery2 that practice and the less spectacular branches are parts of the profession essential to it as a whole1 and fitted for those who intend to lead the plodding life1 but too slow and too prosaic for the man bursting with the knowledge of his own brilliancy and his own special fitness4 ,there is no question but that this tendency has done much to lower the average fitness of many classes4 ,men become listless and careless1 neglecting everything but their hobby1 and while the surgical amphitheatre is crowded1 the medical clinics will be shunned1 even deserted were it not that the sections are such that the absentees can be spotted and warned4 ,there is no question also but that indifference to everything but surgery is responsible for many of the failures before the ,state ,examining ,boards4 ,we must have surgeons1 and they must begin their training in medical schools1 and it is not my purpose to discourage earnest work and honest effort to this end4 ,i wish1 however1 to say that every ethical specialist needs a thorough grounding in the general branches of medicine1 and he should not in his student days neglect the other essentials to a well-rounded man4 ,most heartily do ,i wish to condemn the careless1 happy-go-lucky manner in which so many men totally unprepared and totally unsuited by temperament for this branch rush in where angels fear to tread4 ,i wish especially to draw your attention to the fact that there is a vast difference between the operator and the surgeon4 ,almost any young man with a disregard of the sight of blood1 with nerves unaffected by human suffering and a heart untouched by a knowledge of his power to do harm1 can in six months' practice on the cadaver learn to cut1 to sew and to ligate with neatness and despatch4 ,indeed1 there may be many before me of the student body whose young and nimble fingers could teach dexterity to the best surgeons of the city4 ,very many with no pretense to this dexterity1 and no equipment but a superabundance of assurance1 graduate as surgeons and assume and aspire to a position of prominence that it has taken the true surgeon years of the hardest1 closest1 most untiring study1 observation and work to reach4 ,we are told as an excuse for this remarkable evolution from the student to the surgeon that the young man of today is taught so much more than the old men were2 that the very manner of teaching1 the equipment of the schools and the superior requirements for matriculation cannot but turn out better posted and more competent men4 ,there is much truth in this4 ,there is much truth also in the fact that while more is taught1 more1 infinitely more1 is demanded of the student1 and the knowledge that would have secured him a diploma fifty years ago will now scarcely carry him through his freshman year4 ,we also hear that ,i want to be a surgeon1 because surgery accomplished positive results4 ,this is very true also1 and it is evident that if you amputate a leg your patient will be minus a member4 ,don't lose sight of another fact1 however1 that if without being competent to meet any unforeseen emergency that may arise1 you lightly open the abdominal cavity1 you will have a positive result in the shape of your own little private graveyard4 ,the newly graduated surgeon is not as dangerous as the man who left medical school years ago1 before the students received one-third of the surgical training that they do now4 ,many of these men have not taken a post-graduate course1 have never been associated with a hospital1 nor have they had even an opportunity for moderate surgical observation2 and yet they are attempting to do the work that only a skilled specialist should undertake4 ,i am not speaking of emergency surgery for which any man should try to prepare himself1 and be brave enough to undertake when human life is at stake4 ,i am referring to operations of election when the services of a competent man can be secured4 ,the point is just this1 gentlemen1 that medicine as a science is the result of evolution and not the creation of some brilliant brain2 that what has been done in it has been accomplished not so much by inspiration as by close plodding work1 exhaustive experiment and continual observation2 that surgery as one of its branches cannot be mastered in the four years of student life1 but that to be surgeons you must be workers and observers4 ,it will not do to settle the matter by saying that a man must make a start4 ,this truth is too self-evident to be smart1 nor is it entirely convincing4 ,an answer equally true will be that you will not allow the embryo surgeon to start on you1 and before you put yourself or your wife or your mother in his hands you will demand that he possess some other qualification for his specialty besides his conceit1 his gall and his need of the fee4 ,there may be some exceptions where the man is born and not made1 but ,i beg to assure you that the surgeon rarely springs full-fledged and fully fitted from the brain of ,minerva4 ,our profession is nothing if not altruistic4 ,it demands daily and hourly more of self-sacrifice1 more of self-devotion1 than any secular calling4 ,indeed1 the comparison is often drawn between the nobility and necessity of the duties which we perform and those of him who by divine inspiration and laying on of hands has been called to succor the diseased soul4 ,it is not my place nor is it my purpose to enter into a discussion of this point1 and ,i mention it only to show that we are marked men in every community2 that we are placed on a higher plane and that more is expected of us than of our brethren of the other liberal professions4 ,this1 indeed1 is right1 for no man1 the priest possibly excepted1 enters into such intimate relations with his people4 ,he is ever present with them to share their sorrows and their joys1 and in his position of family friend and family confessor it is his place to bind and salve wounds more deadly than those made by the hand of man4 ,it is a popular impression that this close relationship between the physician and his people is one evolved by the brain of the novelist or one possessed by that most beloved1 but now extinct1 old family physician4 ,let us get this impression from our minds and let us realize that our duties1 our responsibilities and our relationship to those we serve are just the same1 are just as close1 and are just as engrossing as they were when that dear old patriarch of the profession made his rounds1 scolding some1 chiding others and advising all to better1 purer and nobler lives4 ,changed as our relationship to the community may be in some respects by the translation of many of the brightest and best of our cult into the ranks of the specialist1 it is still and always will be the general practitioner who is looked up to as the physician1 and by his work in professional and private life our profession will be judged4 ,in the beginning of my paper ,i stated ,i could do little more than rehearse to you some of the old axioms and maxims that have been handed down to us for generations4 ,i am aware that ,i have taught you nothing new tonight1 and that ,i have not tapped that fountain of inspiration from which genius gushes in poetic or oratorical streams4 ,i trust ,i may have convinced you that it is not amiss for us at times to hold close communion with our souls1 and to take stock of our moral and professional assets4 ,the further ,i have advanced the more fully ,i have realized how impossible it is to evolve new ideas or elaborate new creeds to supersede those by which the fathers lived and died and earned honor for themselves and our profession4 ,so we face today1 gentlemen1 just about the same propositions that have always been ours to meet1 and what was ethical one hundred years ago is ethical now4 ,the science of human duty simply demands that you be honest to yourselves1 honest to those you serve2 that you may look every man squarely in the face and not as if you feared he had heard something you had said behind his back4 ,may ,i quote to you the words of the ,earl of ,st4 ,vincent to the immortal ,nelson3 ,it is given to us all to deserve success2 mortals cannot command it4 ,,the ,,study ,,of ,,rectal ,,surgery ,,in ,,new ,,york ,,city4 ,,by ,j4 ,,dawson ,,reeder1 ,m4 ,d41 ,lecturer on ,osteology1 ,university of ,maryland1 ,baltimore1 ,md4 ,having decided to take a course in ,rectal ,surgery1 ,i arrived in ,new ,york and matriculated at the ,new ,york ,polyclinic ,hospital on ,october #ast for a course of instructions under ,prof4 ,james ,p4 ,tuttle1 and desire to herewith describe briefly my reception3 ,professor ,tuttle is a finished surgeon of the old school of gentlemen1 a master of his art1 and1 under all conditions and circumstances1 adheres strictly to the ethics of the profession4 ,i was not only most cordially received by him socially1 but was most fortunate in being honored by requesting me to assist him1 or be present1 on operations upon his private patients at an uptown hospital4 ,this unexpected and friendly honor gave me an opportunity to observe closely the work of this great surgeon in detail1 and ,i had the pleasure of witnessing every case under his care during my three months' visit4 ,as to his colossal work on cancer of the rectum and sigmoid1 his results are too well known for me to dwell upon at this time1 and he has an enviable record which makes him the authority of this distressing malady which is so prevalent in the cases referred to the ,rectal surgeon1 and have so long been unrecognized by the general profession4 ,i had the pleasure of witnessing him extirpate the rectum by his bone-flap and perineal route1 and in some of these cases was honored by being his assistant4 ,as to the method and technique in each of the above mentioned1 ,i will endeavor to give later4 ,another very important point gained by association with this surgeon was1 that my own theory as to the merits of the ,whitehead operation were simply an endorsement of his teachings1 namely1 that this particular operation1 while classical1 was only justifiable in selected cases of hemorrhoids1 while the ,clamp and ,cautery or the ,ligature method had no restrictions as to variety or location of the pile mass4 ,another important subject was the question of treatment of ,tubercular fistula4 ,for a number of years ,dr4 ,tuttle said he was most discouraged in his results and had almost abandoned any attempt to cure this class of infections1 but of late he had obtained most excellent results by introducing his soft flexible probe and following this tract with a grooved director2 opening this throughout its entire extent1 and then completely cauterizing at dull red heat with the actual cautery4 ,this is then packed with iodoform gauze1 and since using the cautery1 his results have been decidedly better4 ,under the direction of his assistant1 ,dr4 ,j4 ,m4 ,lynch1 a class of three was formed1 with regular work and instructions in the dispensary of ,st4 ,bartholomew's ,clinic1 where we were given cases to diagnose and treat4 ,this course consisted in introduction of proctoscope and sigmoidscope diagnosis of ulcerations specific and benign1 and local treatment through this instrument4 ,to the inexperienced the results and probabilities gained through the use of this pneumatic instrument of ,tuttle's1 which is a modification of the ,laws proctoscope1 are surprising4 ,by the electric illumination with which it is equipped one is able to introduce the instrument with absolute safety to the patient for a distance of #aj to #ad inches1 exploring the entire circumference from the anus up through the sigmoid4 ,my next course of instructions was under the direction of ,prof4 ,samuel ,gant at the ,new ,york ,post-,graduate ,medical ,school4 ,dr4 ,gant likewise was most cordial in his reception1 and on several occasions honored me by entertainments1 including letters of membership to his club1 and at his home with his family4 ,dr4 ,gant1 also a master of his art1 has made a reputation of renown1 and is a most successful operator4 ,while of an entirely different character from that of ,dr4 ,tuttle he is equally attractive4 ,dr4 ,gant argues that the majority of cases of cancer when seen by the specialist are too far advanced to offer any hope by radical operation1 and generally limits his attempts at relief to a colostomy4 ,as to the merits of this procedure1 ,i am not sufficiently versed to offer criticism further than to say that the results of ,dr4 ,tuttle are certainly encouraging to the surgeon who will undertake this ordeal of extirpation in hopes of eradicating the disease1 while ,dr4 ,gant's operation of colostomy1 of course1 is only palliative1 he making no claims of a cure1 except when the growth is seen very early and is freely movable2 then he will extirpate4 ,as to the operation for hemorrhoids1 ,dr4 ,gant uses ligature and sterile water anesthesia in nearly every case1 and the patient is thereby cured without the administration of a general anesthetic4 ,the difference in the time of recovery is a question to be always considered1 in my own judgment1 and is as follows3 ,dr4 ,tuttle uses the clamp and cautery almost universally1 and the patient is discharged within the period of one week1 while the ligature method requires local treatments to the ulcerations produced by the sluffing of the linen threads1 and takes from #aj days to three weeks4 ,constipation and ,obstipation are treated surgically by both of these gentlemen by the operation of ,sigmoidopexy or ,colopexy1 which consists in anchoring the gut to the abdominal parietes after having first stripped back the peritoneum over the area covered by their sutures4 ,chronic diarrheas and ,ambic ,dysentery are likewise treated by ,appendicostomy and ,caecostomy4 ,the difference in this operation being that the former consists in delivering the appendix upon the abdomen and fixing the same with catgut sutures until the peritoneal cavity is walled off by adhesions1 and then amputating later1 so that the stump may be dilated to permit of regular colonic irrigations4 ,dr4 ,gant performs a similar operation1 to which he has applied the name of ,caecostomy1 and having devised an ingenious director consisting of one metal rod within a tube of slightly larger calibre1 he is able to pass the obturator through the ileo-caecal valve1 and then1 by withdrawing the rod or obturator1 is able to pass a rubber catheter into the small intestine4 ,the metal tube is then withdrawn and a shorter catheter is placed parallel with the long one1 which necessarily is in the caput1 and after placing clips upon each tube to prevent leakage1 he is able to flush out both large and small bowel at desired intervals4 ,as to the irrigations through these newly-made openings1 it is a matter of choice with different operators1 those in greatest favor1 ,i think1 being ,ice ,water1 ,aq4 ,ext ,krameria and ,quinine ,solution4 ,a very interesting case brought before us by ,dr4 ,tuttle was one of ,specific ,stricture of the ,rectum1 and the treatment anticipated is as follows3 ,he performed a ,maydl-,reclus ,colostomy in the transverse colon1 in order first to treat the ulcerations and infected area locally1 and1 secondly1 so that he would have sufficient gut above the stricture to do a ,perineal extirpation later and bring down new healthy intestine from the upper ,sigmoid for a new permanent anus2 then later he would close the artificial anus in the transverse colon1 and his patient should have a perfect result4 ,the period required for these three operations would cover a period of not less than nine months2 and if after this there is not perfect ,sphincteric action1 ,dr4 ,tuttle does a plastic operation to repair his sphincter4 ,before continuing with a brief description of the technique of ,extirpation as above referred to1 ,i wish to herewith express my sincere gratitude and appreciation of the many honors and courtesies extended to me by these gentlemen1 and am quite sure that the same was not all personal1 but honor to the ,university of ,maryland's ,faculty of ,physic1 who have aided so materially this younger specialty by such men as ,hemmeter1 ,pennington and ,earle1 who are constantly quoted by all intestinal and rectal surgeons4 ,,extirpation ,,of ,,rectum4 ,the operation of removing the rectum is now almost two centuries old4 ,faget performed it in #agci1 but ,listfrane first successfully extirpated the rectum for cancer in #ahbf4 ,the results of the operation in nine cases were embodied in a thesis by one of his students 7,penault1 ,thesis1 ,paris1 #ahbi71 and in #ahcc the great surgeon himself gave to the world a complete account of his operation and method1 thus establishing the procedure as a surgical measure4 ,the results in these cases were not calculated to create any great enthusiasm1 for the mortality was high owing to the lack of aseptic technique4 ,the methods described in older books give us five varieties of operation for extirpation--the perineal1 the sacral1 the vaginal1 the abdominal and the combined4 ,in this paper ,i shall only endeavor to describe briefly the two methods used by ,dr4 ,tuttle4 ,before describing these methods in detail it may be well to consider the preparation of the patient1 which is practically the same in each4 ,in order to obtain the best results1 it is necessary to increase the patient's strength as far as possible by forced feeding for a time1 to empty the intestinal tract of all hard and putrifying faecal masses1 to establish as far as we may intestinal antisepsis and to check1 in a measure1 the purulent secretion from the growth4 ,it requires from #g to #aj days1 or longer1 to properly prepare a patient for this operation4 ,the diet best calculated to obtain a proper condition of the intestinal tract is generally conceded to be a nitrogenous one4 ,the absolute milk diet is not so satisfactory as a mixed diet composed of meat1 strong broth1 milk and a small quantity of bread and refined cereals4 ,the patient should be fed at frequent intervals1 and as much as he can digest4 ,along with this forced feeding one should administer daily a saline laxative which will produce two or three thin movements1 and to disinfect the intestinal canal one should give through the stomach three or four times a day sulpho-carbolate of zinc1 grs4 iiss41 in form of an enteric pill4 ,on the day previous to the operation the perinaeum1 sacral region and pubis should be shaved1 dressed with a soap poultice for two hours1 then washed and dressed with bichloride dressing1 which should be retained until patient is anesthetized4 ,notwithstanding all of these preparations1 it is impossible to obtain absolute asepsis of the affected area1 and so many fatalities occur from infection that it is deemed wise by many surgeons to make an artificial inguinal anus as a preliminary procedure in all extirpations of the rectum4 ,,perineal ,,method4 ,under this method may be included certain operations for small epitheliomas low down in the rectum done through the anus4 ,the patient having been properly prepared1 the sphincter is thoroughly dilated2 a circular incision through the entire wall of the gut is made1 and the segment is caught with traction forceps and dragged by an assistant while the operator frees1 by scissors and blunt dissection1 to a point at least one-half inch above the cancer4 ,the free end of the gut is then tied with strong tape1 as the temptation is very great to put your finger in the bowel as a guide1 and thereby invite infection4 ,a deep dorsal incision is then made1 going down to the right of the coccyx through the post-rectal tissue4 ,the hand is then placed in the sacral fossa and the structures lifted out into the pelvis1 after which this space is thoroughly packed with gauze to control the bleeding and hold the structures out of the fossa4 ,the edges of the wound1 including each half of the sphincter which has been cut posteriorly1 are held by flat retractors1 while the operator proceeds to dissect the anterior portion of the rectum loose from its attachments4 ,a sound should be held in the urethra in men and an assistant's finger in the vagina in women to prevent wounding these organs4 ,after the gut has been dissected out well above the tumor1 it is caught by clamps and cut off below these4 ,bleeding is controlled by ligatures and equal parts of hot water and alcohol4 ,this newly-exposed gut is then sterilized by pure carbolic acid and alcohol1 or may be seared with cautery4 ,sometimes the peritoneum can be stripped off from the rectum and its cavity need not be opened2 it is better1 however1 to open the cavity at once when the growth extends above this point4 ,the peritoneum is incised1 cut loose from its attachments close to the rectum1 back to the mesorectum1 which should be cut close to the sacrum1 in order to avoid the inferior mesenteric artery4 ,when the gut has been loosened sufficiently above the tumor1 it may be still fastened by two lateral peritoneal reflections1 which are the lateral rectal ligaments1 and should be cut at once4 ,the gut is then brought down and sutured to the anus1 and the operator should proceed to close the peritoneum and restore the planes of the pelvic floor down to the levator ani by fine catgut sutures4 ,after this has been accomplished1 the anus1 which is now well outside the operative field1 should be reopened1 the gauze removed1 and the gut flushed with a solution of bichloride or peroxide of hydrogen4 ,quenu advises that in amputating each layer should be cut separately1 in order to avoid hemorrhage1 but there appears to be no advantage in this2 in fact1 we are more likely to meet with deficient blood supply1 causing subsequent sloughing of the gut1 than with hemorrhage4 ,the posterior and anterior portions of the perineal wound are packed with gauze and left open to assure drainage1 and the parts are covered with aseptic pads1 held in position by a well-fitting ,t bandage4 ,a large drainage tube is passed well up into the rectum1 its lower end extending outside of the dressings1 in order to convey the discharges and gases beyond the operative wound4 ,,tuttle',s ,,bone ,,flap ,,operation4 ,the ,kraske ,operation is applied to various methods in which access to the rectum is obtained by removing the coccyx or cutting off certain portions of the lower end of the sacrum4 ,they are all modifications of ,kraske's original method1 with which we are all familiar4 ,dr4 ,tuttle has modified this plan1 as it furnishes a rapid and adequate approach to the rectum2 it facilitates the control of hemorrhage and restores the bony floor of pelvis and attachment of the anal muscles1 and involves injury of the sacral nerves and lateral sacral arteries on one side only4 ,the technique which he employs is as follows3 ,the patient is previously prepared as heretofore described1 and an artificial anus established or not1 as the conditions indicate2 before the final scrubbing the sphincter should be dilated and the rectum irrigated with bichloride #a-bjjj or hydrogen peroxide4 ,it should then be packed with absorbent gauze1 so that the finger cannot be introduced4 ,the patient is then placed in the prone position on the left side1 with the hips elevated on a hard pillow or sandbag2 an oblique incision is made from the level of the third foramen on right side of sacrum down to the tip of the coccyx1 and extending half-way between this point and the posterior margin of the anus4 ,this incision should be made boldly with one stroke through the skin1 muscles and ligaments into the cellular tissue posterior to the rectum2 the rectum is then rapidly separated by the fingers from the sacrum1 and the space thus formed and the wound should be firmly packed with sterile gauze4 ,a transverse incision down to the bone is then made at a level of the #dth sacral foramen1 the bone is rapidly chiseled off in this line1 and the triangular flap is pulled down to the left side and held by retractor4 ,at this point it is usually necessary to catch and tie the right lateral and middle sacral arteries4 ,frequently these are the only vessels that need to be tied during the entire operation1 although if one cuts too far away from the sacrum1 the right sciatic may be severed4 ,the first step in the actual extirpation of the rectum consists in isolating the organ below the level of the resected sacrum1 so that a ligature can be thrown around it1 or a long clamp applied to control any bleeding from its walls4 ,if the neoplasm extends above this level and it is necessary to open the peritoneal cavity to extirpate it1 one should do this at once1 as it will be found much easier to dissect the rectum out by following the course of the peritoneal folds4 ,by opening the peritoneum and incising its lateral folds close to the rectum1 the danger of wounding the ureters is greatly decreased and the gut is much more easily dragged down4 ,when the posterior peritoneal folds or meso-rectum is reached1 the incision should be carried as far away from the rectum1 or1 rather1 as close to the sacrum1 as possible in order to avoid wounding the superior hemorrhoids artery1 and to remove all the sacral glands4 ,the gut should be loosened and dragged down until its healthy portion easily reaches the anus or healthy segment below the growth4 ,a strong clamp should then be placed upon the intestine about one inch above the neoplasm1 but should never be placed in the area involved by it2 for in so doing the friable walls may rupture and the contents of the intestine be poured out into the wound4 ,as soon as the gut has been sufficiently liberated and dragged down1 the peritoneal cavity should be cleansed by wiping with dry sterilized gauze and closed by sutures which attach the membrane to the gut4 ,by this procedure the entire intraperitoneal part of the operation is completed and this cavity closed before the intestine is incised4 ,after this is done the gut should be cut across between two clamps or ligatures above the tumor1 the ends being cauterized with carbolic acid and covered with rubber protective tissue4 ,the lower segment containing the neoplasm may then be dissected from above downward in an almost bloodless manner until the lowest portion is reached4 ,it is much more easily removed in this direction than from below upward1 and there is less danger of wounding the other pelvic organs4 ,if the neoplasm extends within one inch of the anus1 it will be necessary to remove the entire lower portion of the rectum4 ,if1 however1 more than one inch of perfectly healthy tissue remains below1 this should always be preserved4 ,having removed the neoplasm1 if one inch or more of healthy gut remains above anus1 one should unite the proximal and distal ends either by ,murphy button or end-to-end suture4 ,all oozing is checked by hot compresses1 and the concavity of the sacrum is packed with a large mass of sterilized gauze1 the end of which protrudes from the lower angle of the wound4 ,this serves to check the oozing1 and also furnishes a support to the bone-flap after it has been restored to position4 ,finally the flap is fastened in its original position by silk-worm gut sutures1 which pass deeply through the skin and periosternum on each side of the transverse incision4 ,suturing the bone itself is not necessary4 ,the lateral portion of the wound is closed by similar sutures down to the level of the sacro-coccygeal articulation2 below this it is left open for drainage 7,tuttle1 ,diseases of ,rectum1 ,page #hbi-aijc74 ,,report ,,of ,a ,,case ,,of ,,gangrenous ,,appendicitis1 ,,from ,,the ,,service ,,of ,,prof4 ,r4 ,,winslow4 ,,by ,c4 ,c4 ,,smink1 '#ji1 ,senior ,medical ,student4 ,in selecting a case ,i have not taken one that is a surgical curiosity1 or at all an unusual one1 but ,i have taken this because it is just in these cases that a doubt sometimes exists as to the treatment when diagnosed1 and often the condition of the appendix and surrounding peritoneum is in doubt1 even if a diagnosis of trouble originating in the appendix is made4 ,history of ,case--,patient1 a boy1 ,l4 ,w41 age #i years1 schoolboy2 admitted ,december #bf1 #aijh1 with a diagnosis of appendicitis4 ,family ,history--,parents well2 one brother died in infancy1 cause unknown2 two brothers living and well2 only history of any family disease is tuberculosis in one uncle2 no rheumatism1 syphilis1 gout1 haemophilia or other disease bearing on the case4 ,past ,history--,measles at #e years1 with uneventful recovery2 whooping-cough at #f1 no complications2 badly burned two years ago2 has had indigestion 787 since he was #c years old2 pain but no tenderness during these attacks2 treated by different physicians and got better for a time2 no history of scarlet fever1 influenza1 pneumonia1 typhoid or other disease of childhood4 ,habits--,a normal child4 ,present ,illness--,on #bjth of ,december1 #aijh1 patient came home from church complaining of pains in the right side4 ,this was ,sunday4 ,next day he complained of severe pain all over abdomen1 but on ,tuesday these became localized in the right lower quadrant of the abdomen4 ,had some fever4 ,bowels constipated4 ,no nausea or vomiting4 ,there was a localized tenderness in the right lower quadrant from the start4 ,pains got better on ,friday1 but temperature and pulse still stayed up1 and patient came into hospital on ,saturday1 ,december #bf4 ,the unusual feature was that there was no nausea or vomiting4 ,it is also to be noted that the pain subsided suddenly on the #bdth4 ,the child entered hospital on the #bfth1 and on entrance the whole right side was rigid1 while the left side was comparatively soft4 ,a lump could be felt in the appendical region1 the centre of which was above ,mc,burney's point4 ,temperature was #ii and pulse #gh4 ,the leucocyte count1 however1 was #cj1bjj2 urine negative4 ,child was put to bed2 an ice cap placed on the abdomen4 ,liquid diet4 ,the next day1 ,december #bgth1 leucocytes stood at #ce1bjj4 ,temperature unchanged1 but the pulse had risen to #aaj beats4 ,a hypodermic of morphine and atropine was given1 and patient taken to the operating room1 anesthetized1 and abdomen cleaned for an aseptic 7if possible7 operation4 ,prof4 ,winslow made an incision in the abdominal wall1 well out toward the crest of the ilium1 using the gridiron incision4 ,the caecum was found and pulled over toward the middle line1 and in looking for the appendix1 which was supposed to be behind the caecum1 a great quantity of pus was found4 ,this nasty smelling1 grayish pus welled up into the wound and was sponged away4 ,several pieces of mucous membrane and presumably the tip of the appendix were found in the pus4 ,also several faecal secretions4 ,the pus was sponged away and carefully a search was made for the appendix1 or rather what remained of it4 ,it was found tied down by adhesions and dissected loose4 ,it broke away in pieces1 and it was unnecessary to ligate any of the arteries of the meso appendix4 ,the stump of the appendix close to the caecum was crushed1 cauterized and ligated4 ,no attempt was made to invert it1 as the tissues would not stand it4 ,the pus cavity was found to extend up behind the caecum and over toward the median line for some distance4 ,the puncture1 which ,i will refer to later1 was then made in the right lumbar region1 and two cigarette drains were introduced extending clear back into the bottom of the abscess cavity4 ,then a gauze drain was introduced into the anterior wound1 and this sutured up4 ,the wound was then dressed and the patient taken to the ward4 ,recovery from anesthetic without ill effects4 ,the next morning the patient was unable to pass his water1 and had to be catheterized4 ,aside from this no ill effects were seen1 and his temperature and pulse remained practically at the same place4 ,at the end of #dh hours the drains and dressings were changed and the patient was doing well and the wound draining profusely4 ,at no time was the bed elevated and at no time was a stimulant administered1 with the exception of a hot normal salt enema on the day following the operation4 ,several times during his stay a dose of castor oil was given1 but no other medication was necessary4 ,as the dressings were reapplied and drains introduced daily the wounds were found to be granulating up1 and gradually these closed1 first the one in the lumbar region and then the one in the abdomen4 ,by the tenth day a normal temperature was present1 and he sat up on the twelfth4 ,the child went on to an uneventful recovery1 and went home on ,january #bast fully cured4 ,this was undoubtedly one of those cases of gangrenous appendicitis where1 owing either to the intensity of the infection or to a thrombosis of the vessels supplying the appendix1 the vitality of the tissues is lost and gangrene results4 ,now1 even in this1 the gravest form of appendicitis1 the general peritoneal cavity is often protected against infection by walling off the pus1 and the appendix1 detached in the form of a slough1 is often found on opening the localized abscess4 ,but in other cases there is from the beginning the symptoms of peritoneal sepsis and peritonitis4 ,now1 it seems to me that a great deal depends on the kind of infection--or1 rather1 the kind of organism infecting--and often the difference between a localized abscess and a general peritonitis is really the difference between a colon and a streptococcus infection4 ,again1 should a general peritonitis develop1 ,i have noticed from a number of cases in the wards that the prognosis practically depends on the organism1 although we all know that a general peritonitis is a mighty grave condition1 no matter what it is due to4 ,another point in favor of the child was the fact that the gangrenous process seemed to start in the tip of the appendix1 and it seems that when it starts there1 there is greater likelihood of localization1 and when it starts in the base a greater likelihood of general peritonitis4 ,i said that there was often doubt as to the condition in the abdomen in these cases4 ,now1 there can be no doubt that the two main points in the diagnosis of a localized abscess are tumor and an aggravation of the symptoms present4 ,but this case exemplified the fact that there may be cases where there is no aggravation of symptoms1 and in a great many cases it may be impossible to feel the tumor until it has become very large1 owing to its situation1 viz41 post caecal4 ,even in this case1 from which a great quantity of pus was evacuated1 there was no absolute certainty of finding pus on opening the abdomen1 although it was suspected strongly4 ,i have seen a patient walk into the hospital on ,sunday with a temperature of #ajj and a pulse of #ii1 and when the abdomen was opened on ,monday morning a most virulent form of general streptococcus peritonitis was found1 from which the patient died the next day4 ,it is said that it is much better to depend on the pulse and its variations than on the temperature4 ,i would like to call attention to several points in the treatment of this case also4 ,first1 the place of incision was1 as ,i said1 well up towards the iliac crest1 and not in the time-honored ,mc,burney point4 ,the wisdom of this is self-evident4 ,second1 the care used in not breaking up the wall of the abscess formed by the peritoneum4 ,also1 the fact that the appendix was carefully dissected up and tied off and allowed to heal by itself1 obviating1 as much as possible1 the danger of a faecal fistula4 ,the older books advised evacuating the abscess and leaving the appendix to slough off1 and1 while ,i have seen seven cases where this method was used and not a single faecal fistula1 yet it seems to me the more rational treatment to remove the offender1 as ,i have also assisted in three operations where the appendix was removed at the second operation4 ,that is1 an operation supposedly an appendectomy was done1 and later1 at a subsequent period1 the diseased appendix was found still causing the same old trouble4 ,again1 the use of the lumbar puncture1 so as to drain the abscess cavity from its very bottom4 ,i wonder this is not done oftener1 as it appeals to me as being a most sensible thing4 ,then the abscess cavity was sponged out with gauze1 and not washed out with the antiseptic fluid that books advise1 thus spreading bacteria all over the peritoneal cavity1 and really doing no good4 ,nature was allowed to throw off such things as she deemed necessary1 an avenue of escape having been provided4 ,and1 lastly1 the omentum was found and brought down1 covering in the cavity as much as possible1 and thus aiding in the walling off process4 ,,direct ,,laryngoscopy4 ,,by ,,richard ,h4 ,,johnston1 ,m4 ,d4 ,read ,before the ,baltimore ,city ,medical ,society1 ,section on ,medicine and ,surgery1 ,february1 #aiji4 ,direct laryngoscopy1 as the name implies1 is the inspection of the larynx through a hollow tube without the use of a mirror4 ,the examination is made with the patient in the sitting position1 under local anesthesia1 or in the prone position1 under general anesthesia4 ,to examine the larynx in the sitting position it is practically always necessary to give a hypodermic injection of morphia and atropia a half hour beforehand1 to relax the muscles and to prevent excessive secretion4 ,the patient is seated upon a low stool with the head extended and supported by an assistant4 ,with curved forceps #bj cocaine or #be alypin solution is quickly passed into the throat1 anesthetizing pharynx1 tongue and epiglottis4 ,jackson's slide speculum is then introduced and the base of the tongue1 with the epiglottis1 gently pulled forward4 ,at this point it is usually necessary to use more cocaine directly in the larynx1 which is introduced by means of special cotton carriers4 ,in a few minutes anesthetization is complete1 and the examination can be made at leisure4 ,it will be found easier to inspect the different parts of the larynx if the head is held about halfway between the erect position and complete extension4 ,in some patients with short1 thick necks and large middle incisor teeth the slide will have to be removed from the speculum to enable one to see well4 ,the examination in the prone position under general anesthesia is made with the patient's head over the end of the table supported by an assistant4 ,the speculum is introduced and the base of the tongue and the epiglottis pulled upward forcibly4 ,in this position direct laryngoscopy1 even in children1 is unsatisfactory1 and operative procedures are well-nigh impossible on account of the muscular rigidity4 ,the force required to lift the tissues is so great and the position of the arm is so cramped that it is difficult to get a clear view of the field4 ,the difficulty has impressed all who have worked in this particular line4 ,it remained for ,dr4 ,h4 ,p4 ,mosher1 of ,boston1 to discover a method of direct laryngoscopy which makes it as simple under ether anesthesia as in the sitting position4 ,in ,april1 #aijh1 he described in the ,boston ,medical and ,surgical ,journal the left lateral position for examining the larynx and the upper end of the esophagus4 ,he designed certain instruments which ,i believe are too cumbersome to meet with popular favor4 ,in ,mosher's position the patient lies on the table with the head turned toward the left until the cheek almost rests on the table2 the chin is flexed on the chest4 ,in our work at the ,presbyterian ,hospital we have found a modified ,mosher's position and ,jackson's child speculum the ideal combination for the examination in the prone patient4 ,in children the procedure is carried out with or without anesthesia4 ,without anesthesia the head1 hands and feet are held1 the chin is flexed on the chest in a normal position by placing a pillow under the head1 the speculum is introduced and the larynx inspected4 ,in adults under anesthesia the same procedure is used1 and will be found much simpler than the extended position4 ,in adults1 after the speculum is in position1 if the anterior part of the larynx is not seen1 gentle pressure on the thyroid cartilage will bring the anterior commissure into view4 ,operations can be done through the tube satisfactorily4 ,with the different methods of direct laryngoscopy it is possible to remove any growth from the larynx4 #iai ,n4 ,charles ,street4 ,,items4 ,the ,board of ,trustees of the ,permanent ,endowment ,fund of the ,university held its annual meeting on ,january #aa4 ,judge ,stockbridge was re-elected president and ,mr4 ,j4 ,harry ,tregoe secretary-treasurer1 and1 with ,dr4 ,samuel ,c4 ,chew and ,judge ,sams1 constitute the executive committee for the year #aiji4 ,the funds and securities in hand total the gross sum of #ah1fce4gd4 ------- ,a special meeting of the ,washington ,branch of the ,general ,alumni ,association was held at the office of the president1 ,dr4 ,monte ,griffith1 ,march #aa1 #aiji1 to consider the advisability of petitioning the ,board of ,regents to establish a ,board of ,alumni ,counsellors1 a paid president and a ,board of ,trustees1 independent of the teaching faculties4 ,resolutions in favor of these measures were adopted4 ------- ,dr4 ,louis ,w4 ,knight1 class of #ahff1 of ,baltimore1 has presented to ,loyola ,college a valuable collection of papal medals4 ------- ,drs4 ,h4 ,o4 and ,j4 ,n4 ,reik have removed their offices to #ejf ,cathedral street4 ------- ,drs4 ,w4 ,d4 ,scott and ,w4 ,e4 ,wiegand attended the banquet of the ,virginia ,military ,institute ,alumni ,association of ,baltimore1 held at the ,new ,howard ,house1 ,march #b1 #aiji4 ,dr4 ,w4 ,d4 ,scott responded to the toast ,the ,younger ,generation and the ,splendid ,work of the ,virginia ,military ,institute ,today4 ------- ,major ,william ,f4 ,lewis1 class of #ahic1 ,u4 ,s4 ,a4 ,medical ,corps1 has been relieved from duty at ,fort ,thomas and ordered to sail on ,june #e1 #aiji1 for the ,philippine ,islands1 via ,san ,francisco1 for duty4 ------- ,dr4 ,hugh ,a4 ,maughlin1 class of #ahfd1 of #aba ,north ,broadway1 an official in the ,united ,states ,custom ,service1 who was assistant surgeon in the ,sixth ,maryland ,regiment during the ,civil ,war1 is dangerously ill of pleurisy at his home4 ,dr4 ,maughlin is a member of ,wilson ,post1 ,g4 ,a4 ,r4 ------- ,dr4 ,james ,a4 ,nydegger1 class of #ahib1 past assistant surgeon1 ,united ,states ,public ,health and ,marine ,hospital ,service1 has been promoted to the rank of surgeon4 ------- ,dr4 ,eugene ,h4 ,mullan1 class of #aijc1 assistant surgeon1 ,united ,states ,public ,health and ,marine ,hospital ,service1 has been commissioned a past assistant surgeon1 to rank as such from ,february #b1 #aiji4 ------- ,dr4 ,samuel ,t4 ,earle1 ,jr41 of ,baltimore1 ,md41 records the case of ,mrs4 ,f4 ,h4 ,d41 who1 the latter part of ,august1 #aijg1 while eating ham1 swallowed a plate with two false teeth4 ,ten days later she had a violent attack of pain in the abdomen1 followed by a chill and fever4 ,there was no recurrence of this for one and a half months4 ,since then they have recurred from time to time1 but not as severe1 nor have they been attended with chill and fever4 ,a diagram taken of the lower abdominal and pelvic regions showed the plate in the sigmoid flexure of the colon1 on a level with the promontory of the sacrum4 ,examination through the sigmoidoscope brought it into view at the point shown by the ,x-ray4 ,there was considerable tenesmus1 and the passage of a good deal of mucous1 also a tendency to constipation4 ,under the influence of two hypodermics of morphine1 gr4 #a-d1 hyoscine hydrobromate1 gr4 gr4 ,l-#ajj1 and cactina1 which produced satisfactory anesthesia1 ,dr4 ,earle was able to grasp the plate through the sigmoidoscope with a pair of long alligator forceps1 and withdraw it immediately behind the sigmoidoscope4 ------- ,at the ,conference on ,medical ,legislation1 held in ,washington1 ,d4 ,c41 ,january #ah-bj1 #aiji1 resolutions were adopted providing for a committee composed of one member each from the medical departments of the ,army and the ,navy1 one from the ,public ,health and ,marine ,hospital ,service1 one member from the ,district of ,columbia and one member from the ,council on ,medical ,legislation1 to present to the medical profession the conditions under which the widow of ,major ,james ,carroll is now placed1 and to devise such plans as might seem advisable for her relief4 ,the following committee was appointed3 ,major ,m4 ,w4 ,ireland1 ,u4 ,s4 ,a42 ,surgeon ,w4 ,h4 ,bell4 ,u4 ,s4 ,n42 ,dr4 ,john ,f4 ,anderson1 ,u4 ,s4 ,public ,health and ,marine ,hospital ,service2 ,dr4 ,john ,d4 ,thomas1 ,washington1 ,d4 ,c41 and ,dr4 ,a4 ,s4 ,von ,mansfelde1 of ,ashland1 ,nebraska4 ,mrs4 ,carroll has been granted a pension of #abe a month on which to support herself1 seven young children and the aged mother of her husband4 ,the house1 which ,major ,carroll had partly paid for1 is mortgaged for #e1jjj4 ,since the conference adjourned the medical officers of the ,army have raised enough to pay the taxes on the house1 one monthly note of #ej and the overdue interest on the first mortgage1 amounting to #abe4 ,believing that the members of the medical profession will wish to contribute toward a fund for the purpose of paying the balance due on the house1 the committee requests contributions of any amount4 ,they may be sent to ,major ,m4 ,w4 ,ireland1 ,united ,states ,army1 ,washington1 ,d4 ,c4 ,the editors of ,,the ,,bulletin sincerely hope our alumni will honor the memory of our most distinguished alumnus by contributing liberally to this most worthy cause4 ------- ,at the last regular meeting of the ,university of ,maryland ,medical ,association1 held in the amphitheatre of the ,university ,hospital1 ,tuesday1 ,march #af1 #aiji1 the program was as follows3 #a1 ,the ,general ,practitioner3 ,his ,relation to ,his ,patients1 to ,his ,fellow ,practitioners and to the ,community in ,which ,he ,lives1 ,dr4 ,guy ,steele1 ,cambridge1 ,md42 #b1 ,medical ,ethics1 ,dr4 ,samuel ,c4 ,chew4 ,dr4 ,a4 ,m4 ,shipley1 the president1 was in the chair1 and called the meeting to order promptly at #h4cj ,p4 ,m4 ,the attendance was large and appreciative1 and listened to two remarkably able addresses4 ,those who had the privilege and pleasure of listening to the words of wisdom and advice both of ,dr4 ,chew and ,dr4 ,steele went away with a clearer conception of their duties to their professional brethren and the public4 ,immediately after the adjournment of the ,medical ,association the ,adjunct ,faculty1 with its president1 ,dr4 ,joseph ,w4 ,holland1 in the chair1 held a very important meeting1 the gist of which is as follows3 ,resolved by the ,adjunct ,faculty of the ,medical ,department of the ,university of ,maryland that the ,board of ,regents be implored to effect such changes in the charter as to make possible the election of a president with a fixed salary1 and with the duties usually associated with that office in standard universities1 and a ,board of ,administrators independent of teaching faculties4 ,the ,adjunct ,faculty also endorsed tentative plans looking towards the formation of an advisory board of alumni counsellors4 ------- ,at the meeting of the ,section on ,ophthalmology and ,otology1 ,thursday1 ,march #aa1 #aiji1 at the ,faculty ,hall1 the following of our alumni read papers3 ,rodent ,ulcer of the ,cornea 7,ulcus ,rodens ,mooren71 with ,exhibition of the ,case1 ,dr4 ,r4 ,l4 ,randolph2 ,purulent ,otitis ,media of ,infancy and ,childhood1 ,dr4 ,h4 ,o4 ,reik4 ------- ,at the meeting of the ,section on ,neurology and ,psychiatry1 ,friday1 ,march #ab1 #aiji1 the following participated3 ,history and ,forms of ,chorea1 ,dr4 ,n4 ,m4 ,owensby2 ,etiology of ,chorea1 ,dr4 ,h4 ,d4 ,mc,carty2 ,treatment of ,chorea1 ,dr4 ,w4 ,s4 ,carswell4 ------- ,the ,baltimore ,star of ,march #bgth1 #aiji1 has this to say concerning ,prof4 ,randolph ,winslow3 ,prof4 ,randolph ,winslow1 head of the ,department of ,surgery of the ,university of ,maryland1 is one of the best-known lecturers and demonstrators in the ,east4 ,he is a close student1 and has the faculty of impressing the young men of the ,university with the force of and practicability of his knowledge4 ,professor ,winslow stands high in medical and surgical circles of the country1 and ranks with the best surgeons4 ,under the caption of the leading men of ,maryland ,the ,star also included a photograph of ,professor ,winslow4 ,by honoring ,dr4 ,winslow ,the ,star also honors the ,university of ,maryland1 whose authorities feel a natural pride in the eminent position held by its professors4 ,dr4 ,fitz ,randolph ,winslow1 class of #aijf1 a former resident physician in the ,university ,hospital1 and a resident of ,baltimore1 has located at ,hinton1 ,virginia4 ------- ,the ,phi ,sigma ,kappa ,fraternity had an at-home ,saturday1 ,march #bg1 #aiji4 ------- ,about sixty members of the ,theta ,nu ,epsilon ,fraternity1 ,university of ,maryland1 attended a banquet at the ,belvedere recently4 ,it was served in the main hall1 and the tables1 which formed a semicircle1 were beautifully decorated with trailing asparagus and cut flowers4 ,during the meal a string orchestra rendered popular selections4 ,dr4 ,arthur ,m4 ,shipley1 toastmaster1 introduced ,mr4 ,frederick ,w4 ,rankin1 who made the address of welcome4 ,mr4 ,rankin was followed by ,dr4 ,c4 ,h4 ,richards1 who responded to the toast ,past and ,present2 ,dr4 ,w4 ,d4 ,scott had as his subject ,the ,fraternity ,man2 ,dr4 ,r4 ,dorsey ,coale1 ,the ,undergraduate2 ,dr4 ,randolph ,winslow1 ,the ,near ,doctor2 ,dr4 ,john ,c4 ,hemmeter1 ,our ,university1 and ,mr4 ,c4 ,b4 ,mathews1 ,the ,ladies4 ,the reception committee in charge of the arrangements was as follows3 ,frederick ,w4 ,rankin1 chairman2 ,ross ,s4 ,mc,elwee2 ,john ,w4 ,robertson1 ,john ,s4 ,mandigo1 ,arthur ,l4 ,fehsenfeld1 ,j4 ,f4 ,anderson4 ------- ,,deaths4 ,dr4 ,joseph ,r4 ,owens1 class of #ahei1 mayor of ,hyattsville1 ,md41 and treasurer of the ,maryland ,agricultural ,college1 died at his home1 in ,hyattsville1 ,march #ae1 #aiji1 after a lingering illness of six months4 ,death came peacefully1 and at the bedside were his wife1 who was ,miss ,gertrude ,e4 ,councilman1 of ,worthington ,valley1 ,baltimore county1 ,md42 his daughter1 ,mrs4 ,geo4 ,b4 ,luckey1 and his son1 ,charles ,c4 ,owens1 of ,new ,york4 ,besides these he is survived by his mother1 ,mrs4 ,percilla ,owens1 #ij years of age2 a son1 ,mr4 ,l4 ,owens1 of ,new ,york1 and a daughter1 ,mrs4 ,a4 ,a4 ,turbeyne1 of ,england4 ,dr4 ,owens was born in ,baltimore1 ,february #bj1 #ahci1 and was #gj years old4 ,his parents removed to ,west ,river when he was seven years of age4 ,when he was ten years old he entered ,newton ,academy1 ,baltimore1 and in #ahei was graduated from the ,medical ,department of the ,university of ,maryland4 ,immediately after leaving the ,university he was appointed resident physician at the ,baltimore ,city ,almshouse1 and served in this capacity to #ahfa1 when he returned to ,anne ,arundel county and began farming on ,west ,river4 ,in #ahhe he removed to ,hyattsville and accepted the position of clerk of the ,claims ,division of the ,treasury ,department1 ,washington4 ,he held this office until #ahij1 when he was named as treasurer of the ,maryland ,agricultural ,college1 which position he filled until death4 ,for several years ,dr4 ,owens was collector of taxes in ,anne ,arundel county4 ,when the municipal government of ,hyattsville was changed from a board of commissioners to a mayor and common council1 ,dr4 ,owens was elected councilman from the ,third ward1 and served with marked ability until ,may1 #aijf1 when he was elected mayor4 ,he was elected for three consecutive terms without opposition1 and was foremost in every move tending to the advancement of the town4 ,as treasurer of the ,maryland ,agricultural ,college he became acquainted with many of the leading men of the ,state1 by whom he was held in the highest esteem4 ,he was secretary of the ,vansville ,farmers' ,club for many years1 a director of the ,first ,national ,bank of ,hyattsville4 ,interment was in the cemetery adjoining ,old ,st4 ,james' ,protestant ,episcopal ,church1 near ,west ,river1 ,anne ,arundel county4 ,the coffin was borne from his late residence1 ,hill ,top ,lodge1 by seven cadets of the ,agricultural ,college--,cadet-,major ,mayor1 ,captains ,burrough and ,jassell1 ,lieutenant ,jarrell and ,sergeants ,freere1 ,saunders and ,cole4 ,a squad of #be cadets1 five from each class of the ,college1 under command of ,captain ,gorsuch1 escorted the body to ,pinkey ,memorial ,church1 where the ,episcopal burial service was read by ,rev4 ,henry ,thomas1 rector of ,st4 ,matthew's ,parish1 of which ,dr4 ,owens had been registrar and a member of the vestry for several years4 ,the body1 preceded by the college cadets1 was taken to the ,chesapeake ,beach ,railway ,station and shipped to ,lyons ,creek1 and thence to ,st4 ,james' ,church4 ,rev4 ,henry ,thomas officiated at the grave4 ,the pall-bearers were3 ,messrs4 ,wirt ,harrison1 ,harry ,w4 ,dorsey1 ,e4 ,b4 ,owens1 ,o4 ,h4 ,carr1 ,t4 ,sellman ,hall and ,e4 ,a4 ,fuller4 ,a special meeting of the ,mayor and ,common ,council was held in ,heptasophs' ,hall ,march #bb1 #aiji1 to take action upon the death of ,dr4 ,joseph ,r4 ,owens1 late ,mayor of ,hyattsville4 ,acting ,mayor ,john ,fainter ,jr41 was chairman and ,town ,clerk ,g4 ,h4 ,carr was secretary4 ,former ,mayor ,dr4 ,c4 ,a4 ,wells eulogized the late ,mayor1 both as a public official and a private citizen4 ,dr4 ,joseph ,a4 ,mudd1 ,w4 ,p4 ,magruder1 ,r4 ,e4 ,white1 ,j4 ,w4 ,aman and ,edward ,devlin1 all members of the ,council who served with ,dr4 ,owens1 and ,r4 ,w4 ,wells1 ,m4 ,j4 ,smith and ,s4 ,j4 ,kelly1 the last named as members of the present ,council1 also made appropriate addresses4 ,it was resolved that in the passing away of ,dr4 ,joseph ,r4 ,owens1 ,mayor of ,hyattsville1 we have lost a conscientious official1 a valued associate and a personal friend1 and the citizens of ,hyattsville at large1 as well as his official associates1 have experienced a bereavement1 the effects of which they will ever feel4 ------- ,dr4 ,asa ,s4 ,linthicum1 class of #aheb1 a former member of the ,board of ,county ,commissioners of ,anne ,arundel county1 died at his home1 in ,jessup1 ,md41 ,sunday1 ,march #bh1 #aiji1 from apoplexy1 aged #gh4 ,about #be years ago ,dr4 ,linthicum retired from the active practice of medicine to engage in iron ore mining4 ,dr4 ,linthicum's wife1 who died about five years ago1 was ,miss ,nettie ,crane1 of ,clifton ,springs1 ,n4 ,j4 ,interment was in ,loudon ,park ,cemetery1 ,baltimore4 ------- ,dr4 ,john ,bailey ,mullins1 class of #ahhg1 of ,washington1 ,d4 ,c41 a member of the ,american ,medical ,association and the ,american ,society of ,laryngology and ,otology1 formerly of ,norfolk1 ,va41 died at his home1 in ,washington1 ,d4 ,c41 from cerebral hemorrhage1 ,february #aa1 #aiji1 aged #db4 ,resolutions on the death of ,dr4 ,john ,bailey ,mullins3 ,,whereas1 ,it has been ,god's purpose to suddenly call hence one of our most useful and beloved members2 be it ,resolved1 ,by the ,washington ,branch of the ,general ,alumni ,association of the ,university of ,maryland1 that we are deeply grieved by the premature death of our honored associate4 ,by his death the public1 especially those worthy of charity1 whom he was ever ready to serve1 have lost a most useful citizen1 the medical profession a skilled and painstaking physician and surgeon1 and the ,university of ,maryland an able and active worker4 ,and be it further ,resolved1 ,that the sympathy of this ,association be extended to his daughter1 whom he loved before all else on earth1 and to whom he was ever a dutiful father4 ,and be it further ,resolved1 ,that these resolutions be spread upon the minutes of our ,association and a copy of the same be sent to the parent ,alumni ,association in ,baltimore4 ,committee--,i4 ,s4 ,stone1 ,william ,l4 ,robbins1 ,harry ,hurtt1 ,monte ,griffith1 president2 ,w4 ,m4 ,simpkins1 secretary4 ------- ,dr4 ,samuel ,groome ,fisher1 class of #ahed1 of ,port ,deposit1 ,md41 died at the home of his son1 in ,port ,deposit1 ,february #bb1 #aiji1 aged #gg4 ,for more than #ej years ,dr4 ,fisher was a practitioner of ,chestertown1 ,md4 ------- ,dr4 ,charles ,brewer1 class of #ahee1 of ,vineland1 ,n4 ,j41 died at his home1 in ,vineland1 ,march #c1 #aiji1 aged #gf4 ,from #aheh to the outbreak of the ,civil ,war he was a member of the ,medical ,corps of the ,army1 and during the war a surgeon in the ,confederate ,states service4 ,under ,president ,cleveland he was postmaster at ,vineland1 ,n4 ,j41 and resident physician at the ,state ,prison1 ,trenton1 from #ahia to #ahif4 ------- ,dr4 ,william ,f4 ,chenault1 class of #ahhh1 of ,cleveland1 ,n4 ,c41 a member of the ,medical ,society of the ,state of ,north ,carolina1 died at his home1 in ,cleveland1 ,n4 ,c41 ,february #bd1 #aiji1 from cerebral hemorrhage1 aged #df4 ------- ,dr4 ,james ,b4 ,r4 ,purnell1 class of #ahej1 of ,snow ,hill1 ,maryland1 died at his home1 in ,snow ,hill1 ,march #g1 #aiji1 from senile debility1 aged #hj4 ,he was vice-president of the ,medical and ,chirurgical ,faculty of ,maryland in #aijj-aija1 formerly physician to the county almshouse and health officer of ,worcester county4 ------- ,dr4 ,benjamin ,franklin ,laughlin1 class of #aijd1 of ,kingwood1 ,west ,virginia1 died at the home of his father1 in ,deer ,park1 ,md41 from paralysis1 ,march #i1 #aiji1 aged #ca4 ,,in ,,pneumonia the inspired air should be rich in oxygen and comparatively cool1 while the surface of the body1 especially the thorax1 should be kept warm1 lest1 becoming chilled1 the action of the phagocytes in their battle with the pneumococci be inhibited4 ,antiphlogistine 7,inflammation's ,antidote7 applied to the chest wall1 front1 sides and back1 hot and thick1 stimulates the action of the phagocytes and often turns the scale in favor of recovery4 ,croup4--,instead of depending on an emetic for quick action in croup1 the physician will do well to apply ,antiphlogistine hot and thick from ear to ear and down over the interclavicular space4 ,the results of such treatment are usually prompt and gratifying4 ,antiphlogistine hot and thick is also indicated in ,bronchitis and ,pleurisy 99 99 99 99 99 ,the ,denver ,chemical ,mfg4 ,co4 ,new ,york 99 99 99 99 99 ,certain as it is that a single acting cause can bring about any one of the several anomalies of menstruation1 just so certain is it that a single remedial agent--if properly administered--can effect the relief of any one of those anomalies4 ,the singular efficacy of ,ergoapiol 7,smith7 in the various menstrual irregularities is manifestly due to its prompt and direct analgesic1 antispasmodic and tonic action upon the entire female reproductive system4 ,ergoapiol 7,smith7 is of special1 indeed extraordinary1 value in such menstrual irregularities as amenorrhea1 dysmenorrhea1 menorrhagia and metrorrhagia4 ,the creators of the preparation1 the ,martin ,h4 ,smith ,company1 of ,new ,york1 will send samples and exhaustive literature1 post paid1 to any member of the medical profession4 ---------------------------------------- -------------------------------- ,transcriber's ,note ,the original spelling and punctuation has been retained1 accept for confirmed typos4 ,variations in hyphenation and compound words have been preserved4 ,italicized words and phrases in the text version are presented by surrounding the text with underscores774 ,bold words and phrases in the text version are presented by surrounding the text with equals sign 774