---------------------------------------- -------------------------------- ,,! ,,hospital ,,bullet9 ,publi%$ ,mon?ly 9 ! ,int]e/ ( ! ,m$ical ,dep>tm5t ( ! ,univ]sity ( ,m>yl& ,,price #a4jj ,,p] ,,ye> ,contributions invit$ f ! ,alumni ( ! ,univ]sity4 ,bus9ess ,address1 ,baltimore1 ,md4 ,ent]$ at ! ,baltimore ,po/-(fice z ,second ,class ,matt]4 ,,vol4 ,v ,,baltimore1 ,md41 ,,april #ae1 #aiji ,no4 #b ---------------------------------------- -------------------------------- ,,! ,,e?ics ,,( ,,! ,,g5]al ,,practition]4 ,an ,address deliv]$ ,be=e ! ,univ]sity ( ,m>yl& ,m$ical ,association1 ,m>* #af1 #aiji1 ,,by ,,guy ,,/eele1 ,m4 ,d4 ,( ,cambridge1 ,md4 ,a celebrat$ div9e once said t ! mo/ difficult "p ( a s]mon 0 ! selection ( a prop] text4 ,i mu/ ?ank ! ,presid5t ( ?is society = sav+ me ?is tr\ble4 ,:51 h[ev]1 ,web/]'s is consult$ = a prop] def9ition ( ! ^w ,e?ics1 & x is f\nd to mean ,! sci5ce ( human duty1 x w\ld seem t he has *os5 a text almo/ too compreh5sive = ! limits ( a %ort pap]1 ev5 :5 re/rict$ to ! e?ics ( ! m$ical pr(ession4 ,x may n be out ( place to ?ank him = ! honor he has conf]r$ ^u me by deem+ "o ^: /ud5t days are sc>ce twelve ye>s beh9d him wor?y ( pres5t+ ?is subject to y1 = a pap] on ?is topic is almo/ ( itself a s]mon1 & we naturally look up to ^?1 ^: _m ye>s ( exp]i5ce & works h br\ght !m prom95ce1 = in/ruction 9 morals & duty4 ,/ill1 ,i take x1 :e!r "y or old1 all ( u l to prea* on fitt+ occasions1 & n ! lea/ "p ( ! inspiration to ef=t is ! "* ( ! audi5ce4 ,my invitation 0 to read a pap] be=e ! ,cl9ical ,society1 & incid5tally ,i 0 told t "s ( ! /ud5ts _h express$ a desire to be pres5t4 ,little1 h[ev]1 did ,i anticipate su* a flatt]+ att5dance f !m :5 exam9ation "t s ne>ly approa*$1 & x is evid5ce ( a mo/ comm5dable _s :5 !y c br+ !mselves to take ev5 an h\r ( _! mo/ valuable "t f /udy to devote to a consid]ation ( ! moral duties & responsibilities :i* %all be !irs :5 !y %all h pass$ ?r\gh ! ,april ordeal4 ,mu* t ,i h to say tonight w be direct$ especially to !m1 & if !y or _! eld]s 9 ! pr(ession may 9 ! ye>s to come look back ^u ?is night ) ! recollection t ,i h m =cibly br\ght to m9d "s ( ! old & half-=gott5 maxims & axioms t make = a bett] & pur] pr(essional life1 ,i w h be5 m ?an repaid = ! "t ,i h exp5d$ 9 ! prep>ation ( ?is pap]4 ,9 discuss+ ! e?ics ( ! g5]al practition] t[>ds 8 pati5t1 ,i w\ld h y rememb] t y\r fir/ & mo/ important duty is to give to ^? :o tru/ y ! v be/ t is 9 y4 ,to y "y m51 full ( en?usiasm = y\r new pr(ession1 & imbu$ ) ,utopian ideas ( ! mission :i* y h und]tak5 = ! good ( mank9d1 x w\ld seem almo/ fooli% = me to m5tion ?is z ! fir/ advice ,i w\ld (f] y4 ,b ,i ?9k ,i c see a smile ( und]/&+ flit across ! faces ( ^? :o h = "s ye>s f\ght ! battle ( life1 & :o h _h ! wire edge ( e>ly ambitions & det]m9ations blunt$ by contact ) unappreciative pati5ts & unwor?y pr(essional competition & ! daily incid5ts ( a busy life4 ,!y "k t x is v easy to feel too tir$1 or be too busy1 or h "s o!r engross+ affair 9 m9d :i* prev5ts t entire devotion to duty :i* all admit is ess5tial to success 9 m$ic9e4 ,half ( success 9 life or 9 any und]tak+ is due to a successful />t2 !re=e1 let me ask y to firmly det]m9e on "o or two fix$ pr9ciples1 & to /ick to ^? pr9ciples ?r\gh ?ick & ?94 ,be fully assur$ t no halfway devotion to y\r pr(ession w ev] br+ y prom95ce or success4 ,! "t-worn phrase t ,m$ic9e is a jeal\s mi/ress loses none ( its tru? by frequ5t repetition4 ,rec5tly ,i saw 9 a prom95t m$ical j\rnal ! advice giv5 t doctors %\ld take a prom95t "p 9 politics & br+ !mselves =w>d 9 o!r ways1 & t !reby 9 "s way unkn[n to me ! glory ( ! pr(ession w\ld be enhanc$1 & mu* b5efit result to ! community4 ,f> be x f me to disc\rage a prop] civic _s & a prop] int]e/ 9 public affairs1 or to advise an avoidance ( any duty :i* good citiz5%ip imposes ^u e hone/1 patriotic man1 :atev] 8 bus9ess or pr(ession4 ,b ,i take x t no m baneful1 no m dang]\s advice c be giv5 to our "y pr(essional man ?an ?is4 ,y _c be successful 9 bo? politics & m$ic9e1 & :ile we c po9t to "o memb] ( our pr(ession 9 ! ,unit$ ,/ates ,s5ate1 & to "s notable exceptions 9 our own ,/ate1 :]e m5 ( our pr(ession h1 = a "t1 ab&on$ m$ic9e & return$ to x to w9 success1 y c re/ assur$ t ! m$ical politician possesses little beyond a mu/y diploma to rem9d ! _w t he 0 once ( our cult4 ,s don't be a halfway politician & halfway doctor4 ,success 9 ei!r field w take all ( y\r be/ ef=t & all ( y\r "t4 ,:at ,i h said ( politics w apply1 ?\gh n q s =cibly1 to any o!r engross+ bus9ess or pleasure4 ,"t =bids me to elaborate ?is idea1 & 9 conclud+ x let me say t y _c be a successful politician1 m]*ant1 sport or :at n & c>ry m$ic9e z a side l9e4 ,x may seem useless to rem9d y t1 9 ord] to give ! be/ t is 9 y1 y mu/ keep abrea/ ) :at is new & be/ 9 pr(essional lit]ature & sci5tific progress4 ,y all h det]m9$ to be /ud5ts1 & ev5 ^? :o pride !mselves on hav+ pass$ ?r\gh ! ,univ]sity )\t hav+ op5$ a book h a half-=m$ desire to really "k some?+ beyond spott+ a possible exam9ation "q1 & :5 once exam9ations are ov]1 & !y h reluctantly )drawn !mselves f ! delights ( ! city by gaslight = ! p9e woods & m\nta9 trail1 !y w burn ! midnight oil & br[se dilig5tly ?r\gh _! mu/y tomes4 ,may ,i tell y t no?+ is h>d] ?an to f9d "t = /udy4 ,_m ( u1 ev5 ?\gh city m51 ) ! be/ & late/ lit]ature at our elb[s1 are a%am$ to ?9k h[ ?or\ghly we abhor ! sight ( a m$ical book or magaz9e1 & h[ easily we c p]suade ourselves t we are too tir$ & /ale1 & s engross$ dur+ ! day ) sc5es ( sickness & suff]+ t we mu/ h our brief h\rs ( release f duty = recreation4 ,we d ne$ our h\rs ( relaxation & re/ & our too infrequ5t holidays1 & !y are absolutely ess5tial to good heal? & good "w4 ,don't1 h[ev]1 confuse ! words re/ & relaxation ) slo? & idl5ess1 & don't ?9k y\r pr(essional "w complet$ :5 y\r r\nd ( daily visits is done4 ,inde$1 if y w\ld "k m$ic9e y mu/ woo y\r mi/ress 9 ! small h\rs ( ! night1 & 9 _m ( ! leisure mom5ts t ! day may br+ y4 ,mu* has be5 spok5 ( ! man :o practices by common s5se1 & ^: s*ool has be5 t ( obs]vation & h>d exp]i5ce4 ,a mo/ wor?y bro!r he is at times1 & _m are 8 fri5ds & wond]ful 8 success4 ,b if ! sci5ce ( m$ic9e is to advance1 m is requir$ = progress ?an m]e common s5se1 & obs]vation untra9$ & exp]i5ce undirect$ & unguid$ by ! obs]vation & exp]i5ce ( o!rs w r>ely discov] a new bacillus or elaborate a side *a9 !ory4 ,s1 to be truly e?ical 9 ! duty y owe to give ! be/ t is 9 y1 y %\ld be read+ m54 ,take "o or m ( ! m$ical j\rnals4 ,buy = ref]5ce ! late/ & be/ text-books4 ,make ! opportunity to read ! daily pap]s & some?+ ( curr5t lit]ature4 ,a well-r\nd$ man c af=d to d no?+ less4 ,besides ! in=mation y obta91 x pays 9 ! respect ( ! community to h ! reputation ( be+ po/$ 9 y\r pr(ession4 ,(t5 ! c\ntry man simply hasn't "t at home to read4 ,a busy life1 ) its miles ^u miles ( du/y roads to travel1 precludes all *ance = ! easy *air4 ,!n cultivate ! habit ( read+ :ile driv+4 ,_m are ! useful & happy h\rs ,i h sp5t 9 my c>riage ) my j\rnals & magaz9es4 ,i am frank to say t1 b = ?is habit1 ,i nev] c\ld h f\nd "t = "o-half ( ! read+ ,i h done4 ,la/ ye> ,i 0 some:at amus$ :5 a mo/ wor?y1 well-educat$ & well-po/$ man summ$ up 8 op9ion ( ano!r by say+ t he 0 "o ( ^? :o read magaz9es 9 8 c>riage4 ,if ,i mi/ake n1 ?is indictm5t 0 br\ght aga9/ ! late ,dr4 ,milt5b]g]1 :o z a "y & busy man 0 =c$ to =m ?is habit1 & ,i c\ld b ?9k t1 c\ld ,i die ) half ! honor & respect & love t 7 81 ,i c\ld plead guilty to ev5 ?is m>k ( devotion to my pr(ession & desire to advance 9 x4 ,w\ld y be e?ical 9 giv+ ! be/ t is 9 y to y\r pati5ts1 y mu/ give ungrudg+ly ( y\r "t4 ,?is may aga9 seem a useless piece ( advice1 & yet almo/ all ( u are famili> ) ! man ^: motto is ,v5i1 ,vidi1 ,vici--,i came1 ,i saw1 ,i conqu]$4 ,?is intuitive diagno/ician is by no means a my?4 ,! man :o comes 9 a ru% & goes 9 a ru%1 & :o1 ) p5cil 9 "o h& & prescription pad 9 ! o!r1 feels ! pulse :ile ! !rmomet] is "u ! tongue2 :o sees at a glance1 )\t necessity ( p]sonal or family hi/ory or ( physical exam9ation1 j :at is ! matt]1 & :o1 giv+ f\r or five prescriptions1 ru%es out1 tru/+ t some?+ 9 8 %otgun !rapy may hit ! enemy4 ,p]haps ! next day he prescribes f\r or five m rem$ies or comb9ation ( rem$ies1 & %\ld ! pati5t beg9 to improve1 prides himself t he has made & confirm$ a diagnosis by 8 exp]im5tal !rapy4 ,is x necess>y = me to say t no e?ical man ) any reg>d = ! rights ( 8 pati5ts & 8 obligation to 8 pr(ession c really practice m$ic9e 9 ?is mann]8 ,! plea t y are too busy to give ! prop] "t to y\r cases is no ju/ification = y\r neglect4 ,any?+ less ?an a c>eful inquiry into family & p]sonal hi/ory1 foll[$ by a pa9/ak+ & ?or\gh physical exam9ation1 is unju/ to y\r pati5t & unju/ to y\rself4 ,no e?ical man c give ! be/ t is 9 him by do+ less ?an ?is4 ,if y hav5't ! "t to d y\r "w ?or\ghly1 make a clean brea/ ( ! matt] & take few] cases4 ,b y w say t a man1 ev5 9 l>ge practice1 _c af=d to give any ( x up4 ,he ne$s e doll> t hone/ly comes 8 way1 & to say t he hasn't "t = 8 "w is only ano!r way ( ?r[+ practice into ! h&s ( a rival4 ,?is is1 inde$1 a proposition h>d to solve1 z mo/ ( u d ne$ e doll> t hone/ly comes our way2 b if our "w is only half done1 if we h neglect$ "s important po9t 9 diagnosis1 & !reby omitt$ "s equally important measure 9 treatm5t1 h our doll>s be5 hone/ly e>n$8 ,let u />t out ) & c>ry 9 m9d ?is axiom ( a truly e?ical life1 t success 9 m$ic9e _c be measur$ by comm]cial success2 t1 :ile no s5sible man c neglect ! bus9ess side ( 8 vocation1 or refuse to dem& & collect j comp5sation = 8 s]vice1 su* comp5sation _c be measur$ 9 doll>s & c5ts alone2 t a good consci5ce & :ole-s\l$ devotion to duty1 giv+ ungrudg+ly ( ! v be/ t is 9 y to ^? t h confid$ 9 y1 w be y\r v be/ asset :5 ! f9al acc\nt is made up4 ,may ,i impress ! fact ^u y t an e?ical man1 ) a j appreciation ( 8 duty to 8 pati5ts1 c nev] be a v5dor ( pat5t or un(ficial m$ic9es4 ,inde$1 ,i w\ld be lack+ 9 my duty if1 ) ! opportunity ?is pap] (f]s me1 ,i did n1 f ! /&po9t ( exp]i5ce1 impress ^u y ) all ( ! =ce at my comm& ! necessity ( be+ w>y ( ! detail man & ! allur+ adv]tis+ lit]ature ) :i* y\r mail w be flood$4 ,y w sc>cely h op5$ y\r (fice1 & be wait+ ) :at pati5ce y c comm& t ru% ( ! halt1 ! lame & ! bl9d to :i* y feel t y\r tal5ts entitle y1 be=e ! suave detail man1 hav+ he>d ( ! new field1 puts 9 8 appe>ance4 ,:at y lack 9 !rapeutic exp]i5ce he c supply y by draw+ lib]ally on ! exp]i5ce ( o!rs :o h work$ little less ?an miracles 9 an adjo9+ t[n by ! use ( 8 pills & potions1 8 elixirs & t9ctures4 ,y w f9d him smoo? & oily1 placid & plausible4 ,he kn[s 8 /ory well1 & ev5 by 8 mu* speak+ c almo/ p]suade y t :at y knew1 or ?\ght y knew1 or :at y _h rec5tly be5 taught1 7 all out ( date2 t by "s /roke ( g5ius ! *emi/ ( 8 h\se _h discov]$ "s way by :i* compatibles w\ld comb9e ) incompatibles into ! =mation ( a new & /aple mixture1 possess+ all ( ! virtues & none ( ! defects ( its orig9al con/itu5ts1 r5d]+ *loral z soo?+ z ! /r+s ( a lute & z h>mless z ! coo+ ( a dove1 extract+ f cod-liv] oil e disagreeable feature & leav+ no?+ b its suppos$ virtues beh9d4 ,he w %[ y ! %ort road to =tune & success4 ,treat him k9dly2 ! e?ical man %\ld n be rude1 & brusqu5ess is n a sign ( ,roman hone/y or virtue4 ,be assur$ he feels 8 position ke5ly1 & is dread+ ! cate*ism :i* w soon] or lat] display 8 ignorance ( ev]y?+ b ! /ory t has be5 drill$ into him l a p>rot4 ,!re has be5 no great] %ame 9 our pr(ession ?an ! influ5ce ^! m5 & _! h\ses h ex]cis$1 & incid5tally ! indorsem5ts & recomm5dations t ?\ghtless m5 h furni%$ !m4 ,! blame is all ours1 & we _c %un x4 ,we pride ourselves on our sci5tific atta9m5ts2 t we take no?+ = grant$2 &1 n[ t ! age ( empiricism has pass$1 we accept no?+ t does n be> ! /amp ( sci5tific approval4 ,& yet1 be=e ! campaign ( ! ,am]ican ,m$ical ,association & ! revelations ( ,colli]'s & ! ,ladies' ,home ,j\rnal1 we accept$ our treatm5t f ! h&s ( ! manufactur+ h\ses1 & dos$ our pati5ts ) no/rums ab\t :i* we knew no?+ except ! /atem5ts ( ^? ^: sole purpose x 0 to sell4 ,!re are few ( u :o h be5 _m ye>s 9 practice to :om a blu% ( %ame does n come at ! recollection ( our gullibility & our guilty innoc5ce4 ,c any man deem x e?ical to give ev5 to a good dog some?+ ab\t :i* he 0 totally ignorant8 ,& yet ?is is j :at we 7 do+4 ,a %ort "t ago a p>ticul>ly %rewd detail man 0 discuss+ ?is v po9t ) me1 & claim+ t1 z ! =mula 0 n[ requir$ by law to be pr9t$ 9 ea* bottle & package1 ?is mo/ =midable objection c\ld n n[ hold good4 ,h&+ me a bottle ( 8 pat5t cure-all1 he glibly call$ my att5tion to ! six or sev5 +r$i5ts1 ) ! am\nt ( ea* conta9$ 9 ! fluid ounce4 ,among o!r pot5t quantities ,i c recall #a-dh gr4 ( morphia & #a-bdj gr4 ( /ry*nia4 ,! dose 0 a teaspoonful ?ree times a day4 ,any man c imag9e ! m ?an homeopa?ic effect ( #a-dh gr4 ( morphia divid$ into eight doses4 ,^! well-kn[n & well-tri$ drugs 7 n1 h[ev]1 ! life ( ! no/rum1 & pres5tly we came to ! tw5ty m9ims to ! fluid ounce ( ! fluid extract ( ! drug f :i* ! rem$y d]iv$ its "n4 ,some?+ ,i _h nev] he>d (4 ,some?+ unli/$ 9 ! ,u4 ,s4 ,p4 ,some?+ discov]$ & own$ & controll$ by ?is h\se alone4 ,z my ignorance became m app>5t 8 eloqu5ce increas$1 & ,i h no d\bt t a few ye>s ago1 be=e my moral consci5ce _h become ar\s$ to ! !rapeutic s9 ( prescrib+ some?+ ^: botanical family1 ^: *emical =mula1 & ev5 ^: physiological effects 7 totally unkn[n to me1 ,i w\ld gladly h accept$ a sample & w\ld h tri$ x on "s poor s\l too poor to pay = a prescription4 ,x is no?+ %ort ( a %ame to ?9k ( :at we h done 9 ?is l9e4 ,! s9 has be5 "o ( c>elessness & laz9ess r ?an ( ignorance4 ,"h we _h ready to h& "s rem$y1 beautiful to ! eye1 palatable to ! tongue2 !n :y take ! "t & tr\ble to bo!r ab\t con/ruct+ a =mula ( our own :5 someone else ( equal exp]i5ce _h con/ruct$ "o = u8 ,i am ready to ?ank ,god t mo/ ( ^! no/rums are z h>mless z !y are beautiful1 &1 :ile ,i may n h done good1 ,i r>ely did h>m by _! use4 ,i am n discuss+ ! opium & coca9e lad5 classes4 ,i wi% to emphasize incalculable h>m t mu/ result to ! physician himself :o all[s someone to d 8 ?9k+ = him4 ,i am also ref]r+ to ! attitude ( ! e?ical man to 8 pati5t1 & beg to ask if we are do+ ev5 "p ( our duty :5 we are do+ no h>m4 ,all[ me to conclude ?is topic by ask+ y to sp5d an h\r "s day 9 casually glanc+ ov] 7a deep /udy w\ld fully repay y7 ! pages ( ! ,u4 ,s4 ,p41 or a li/ ( ! rem$ies t h 9 "o ye> receiv$ ! sanction ( ! ,c\ncil on ,ph>macy ( ,am]ican ,m$ical ,association4 ,if y don't f9d en\gh drugs & comb9ations to meet e case & e conceivable situation1 y _h bett] des]t practice & exploit "s wond]ful cure-all z a detail man4 ,if we1 z physicians1 _h no?+ b our duty to our pati5ts to consid]1 & incid5tally our own pr(it & glory1 ! practice ( m$ic9e w\ld soon deg5]ate into a m]e trade4 ,i may ev5 say t1 _h we no?+ b ! prompt+s ( our consci5ces to keep u 9 ! /raight & n>r[ pa?1 if we _h no?+ b ! k ( "w well done1 & if ! desire & det]m9ation to give ! be/ t is 9 u 7 our only inc5tives to an e?ical life1 ! pr(ession w\ld be s beset by ! temptations ( comm]cialism1 & ! notoriety & prom95ce :i* comm]cial success br+s1 t ! halls ( ,esculapius w\ld soon ne$ a sc\r+ & purg+ great] ?an ,h]cules gave ! ,augean /ables4 ,despite ! high inc5tive to all t is be/ & pure/ 9 life :i* our noble/ ( call+s %\ld beget 9 u1 physicians are only human1 & human weakness1 l disease1 is no respect] ( p]sons or ( call+s4 ,x may h be5 t ! m$ical fa!rs1 ) a k ( ! temptations to :i* !y 7 subject$1 & a desire to save o!rs f ! pitfalls :i* beset _! pa?s1 7 imbu$ ) a det]m9ation to place _! pr(ession on a high] plane ?an o!rs2 or x may h be5 ! natural evolution :i* inevitably result$ f & foll[$ ! prompt+s ( man to help 8 fell[-man1 to devote himself to ! relief ( pa9 & sickness1 to sacrifice 8 com=t & ease & almo/ e pleasure 9 ord] t o!rs might h ease ( body & peace ( m9d & s\l1 :i* f ! e>lie/ days h plac$ m$ic9e z a pr(ession ap>t1 & h impos$ ^u ^? :o h ent]$ its ranks c]ta9 /&>ds ( conduct & insi/$ on c]ta9 e?ical relations :i* h lift$ x above m]e que/ions ( ga9 & ! va9 acquisition ( r5[n4 ,we h be5 taught t ,hippocrates himself 0 great n only z a physician1 b great] /ill z an e?ical tea*] :o has left ) u c]ta9 maxims & prov]bs :i*1 ?\gh h&$ d[n ?r\gh ! ages1 h lo/ none ( _! tru? & none ( _! spotless morality4 ,ev5 9 ! ,middle ,ages1 :5 le>n+1 n to say sci5ce1 _h sunk into su* an abyss ( ignorance t ! ability to write "o's "n lift$ "o into ! ranks ( ! educat$1 :5 human ills 7 reliev$ m (t5 ) ! sword ?an ) ! scalpel1 ! lee* 0 a man ap>t4 ,8 education1 8 sci5tific inve/igations1 & ev5 8 suppos$ communion & p>tn]%ip ) ! evil "o1 plac$ 8 on a p$e/al above o!r pr(essional call+s4 ,!n1 z n[1 ?\gh m5 might sc(f at our pr(ession ( sup]ior k & skill1 :5 pallida mors /alk$ abroad or knock$ at ! hovels ( ! poor or palaces ( ! ri*1 all arose to call u bless$4 ,x has be5 (t5 said t1 c\ld a m$ical man live up to ! e?ical /&>ds ( 8 pr(ession1 8 *ances )\t cre$ or prie/ w\ld n be small at ! la/ great day4 ,b ) all ( our high ideals we are only mortal1 & we "k & h sorr[$ at ! fact t _m ( our e?ical /&>ds are n liv$ up to1 & t ! ,hippocratic law is frequ5tly m honor$ 9 ! brea* ?an 9 ! obs]vance4 ,we h 9 e community :]e "o or two are ga!r$ toge!r 9 ! "n ( m$ic9e ! man :o is ev]y?+ to y\r face & ev]y?+ else beh9d y\r back2 :o damns by fa9t praise2 :o sympa?izes ) y 9 y\r sorr[s & trials1 :o visits ! family ( ! pati5t y h lo/ to assure !m ( y\r skill & to insi/ t ev]y?+ 0 done t c\ld h be5 done1 b----& t "o h>mless little conjunction1 mean+ no?+ 9 itself1 is m eloqu5t ?an a ?\s& t]rible adjectives or burn+1 bli/]+ adv]bs or p>ticiples4 ,s _m ?+s c be said by ! pi\s uplift+ ( ! eyes1 ! sanctimoni\s upturn+ ( ! palms4 ,he w\ld n = ! _w leave a d\bt 9 ! m9ds ( y\r p1 &1 no matt] :at 9 8 inmo/ he>t he ?9ks ( y\r mi/akes 7f 8 /&po9t71 x is n 8 place to injure a bro!r1 b1 alas6 he is n responsible = ! ungu>d$ tongues ( 8 fri5ds1 & he usually sees t !y d 8 "w well = him4 ,(t5 x is if ,i c\ld only h rea*$ him e>li]1 :i*1 be+ int]pret$1 means a miracle w\ld h be5 wr\ght4 ,almo/ e community has its miracle work]1 its m$ical resurrectioni/4 ,8 cases are always a little worse ?an o!rs1 8 victories a little m wond]ful4 ,:]e y h a bron*itis1 he has a desp]ate pneumonia1 y\r transitory album9uria is ) him acute ,bright's1 & hopeless cases foll[ him to undo him1 only to meet defeat at 8 skillful h&s4 ,y he> t ,mr4 ,a4 is desp]ately ill ) pneumonia on ,monday1 & on ,friday y meet him on ! /reet1 look+ hale & he>ty1 firmly believ+ t1 _h ,dr4 ,x4 be5 "o h\r lat] 9 rea*+ him1 he w\ld ere ?is h be5 ga!r$ to 8 fa!rs4 ,%\ld y mildly sugge/ t "s error 9 diagnosis might h be5 made1 t ev5 ! be/ ( u at times g wrong1 & t resolution 9 true pneumonia c\ld h>dly be expect$ 9 f\r days1 y w f9d t he has be5 prep>$ = y1 feel+ t ,dr4 ,x4 has us$ "s pot5t rem$y z yet unkn[n to y & 8 less skillful bre?r51 & firmly conv9c$ t y\r suspicions ( 8 case are bas$ ^u y\r ignorance or y\r jeal\sy ( poor ,dr4 ,x41 :o 0 n !re to def5d himself1 :o _h always spok5 s k9dly ( y1 & _h utt]$ no?+ worse ?an ! h>mless little conjunction b---- ,a little bragg+ is n a s91 & inde$ is usually h>mless1 & 9 ! long run reacts on ! miracle work]4 ,b ! e?ical man does frequ5tly suff] f x1 & x is a fact1 absurd z x may seem1 t ! av]age man or woman w\ld mu* pref] to be consid]$ at dea?'s door ab\t ?ree-fif?s ( ! "t--inde$1 almo/ a walk+ ,laz>us--?an to be deem$ ! picture & p]sonification ( vigor\s heal?4 ,dr4 ,x4 kn[s ?is1 & plays ^u ! cr$ulity ( 8 pati5ts4 ,he fright5s !m to dea?'s door1 works a miracle1 & has ti$ !m to himself =ev]4 ,we all h suff]$ f ?is1 & w cont9ue to d s until ! little gra9 ( tru? has gr[n f ! t9y mu/>d se$ to ! vigor\s bu%4 ,dr4 ,x41 ) 8 faults1 has 8 virtues4 ,he aspires to be ! busie/ man1 ! ri*e/ man1 ! mo/ popul> man 9 8 community4 ,all ( ^! ambitions1 if prop]ly guid$1 are laudable1 &1 inde$1 :ile enhanc+ 8 p[] & pre/ige1 may be r$\nd+ to ! good ( 8 p1 = a man to be ! busie/ & mo/ popul> man 9 8 pr(ession mu/ usually be ! be/ po/$1 ! mo/ highly educat$1 ! h>de/ work+ man1 n only = himself1 b = ^? he s]ves4 ,s1 :ile we may smile at ,dr4 ,x4 & 8 big ways1 we may love him = 8 virtues & =give 8 small faults4 ,b = ! man :o delib]ately goes to "w to und]m9e ano!r2 :o takes advantage ( "s tempor>y abs5ce ( ! regul> physician to +ratiate himself2 :o1 appreciat+ ! fact t p worri$ ne>ly to dea? by ! illness ( a lov$ "o1 w =get e obligation & des]t e old fri5d 9 ! hope t ! new "o may (f] "s enc\ragem5t or ext5d "s hope1 is ready = ^! em]g5cies4 ,he c>ries sat*els full ( hope = all cases & occasions4 ,he prescribes x lib]ally1 dilut$1 h[ev]1 to ! po9t ( despair because he 0 call$ 9 an h\r too late1 or because ! case _h already be5 damag$ beyond 8 p[] ( repair4 ,?is g5tleman advances n only by 8 own deceit1 b uses ! p[] ( *ur*1 ( politics1 ( family influ5ce & social opportunity1 to lift himself along4 ,v]ily he has 8 rew>d1 b x is n 9 peace ( m9d1 n 9 ! honor & respect ( 8 community1 b ! contempt ( e hone/ man1 be he ( ! pr(ession or laity4 ,n ! lea/ ( ! p]plex+ que/ions :i* beset ! man :o is try+ to lead an e?ical life is 8 duty 9 8 relation z consultant4 ,inde$1 !re is sc>cely a situation 9 pr(essional life t at times pres5ts m emb>rass+ possibilities1 or calls = ! ex]cise ( m tact4 ,x is a pleasure to be able to be> witness to ! ability ( ! man :o has call$ y to 8 aid1 to assure ! family t ev]y?+ has be5 done t c>e 9 diagnosis & skill 9 treatm5t c\ld dem&4 ,b :at ( ! cases :]e gross c>elessness or bl9d ignorance h ha/5$ :at might easily h be5 delay$ or av]t$8 ,!re is only "o way "h1 only "o duty4 ,treat ! man z 8 c>elessness or 8 ignorance des]ves4 ,aga91 y are call$ 9 consultation ) a ?or\ghly good man :o has giv5 ungrudg+ly ( ! be/ t is 9 him4 ,p]haps y\r sup]ior skill 9 c]ta9 l9es1 p]haps y\r sup]ior opportunity to obs]ve a c]ta9 l9e ( cases1 h taught y some?+ t he has n _h ! *ance to le>n4 ,z be=e x 0 y\r duty to expose ! c>eless ignorance ( "o1 n[ x is y\r place to s give y\r op9ion & expla9 y\r position t no possible reflection c be ca/ ^u ! o!r4 ,don't approa* a consultation ) ! mann] ( a prie/ ( ,delphi4 ,don't pose z ! f\nta9 ( all wisdom & ( all exp]i5ce4 ,inde$1 9 ?is "w y w be surpris$ h[ (t5 y w le>n f him y are call$ ^u to assi/4 ,he has se5 ! case = days1 :]e y c sp5d b m9utes ) x4 ,x is 8 "p to be> ! blame1 y\rs to %>e 8 fame %\ld success cr[n y\r comb9$ ef=ts4 ,frequ5tly y w be call$ ^u :5 a resort to surg]y is dem&$--n s mu* to p]=m ! op]ation z to give y\r op9ion z to ! advisability ( a c]ta9 l9e ( proc$ure4 ,hav+ det]m9$ :at is to be done1 don't assume ! place ( prom95ce4 ,y h little by way ( reputation to ga9 by p]=m+ an op]ation t y 7 kn[n to be compet5t to p]=m or y w\ld nev] h be5 call$4 ,let him d ! "w ) y\r assi/ance & advice4 ,9 ?is way y w h ga9$ a fa/ fri5d = future consultations1 & y w h en%r9$ him 9 ! e/eem & confid5ce ( 8 p4 ,!re=e1 help him & uplift & be> witness to 8 wor?1 & don't humiliate him by y\r airs & assum$ sup]iority4 ,z a la/ ^w1 don't consult ) an unwor?y man1 = be assur$ t y\r reputation is wor? m to y ?an any consultation fee1 h[ev] badly y may ?9k y ne$ x4 ,! "q ( fees is "o t mu/ be consid]$4 ,we hate to ?9k ( ! comb9ation ( m$ic9e & money1 & our pati5ts abhor x ev5 m4 ,! days once 7 :5 only ! sons ( ! ri* s\ght ! lib]al pr(essions4 ,x 0 ?\ght unwor?y 9 ! days ( ! dim ages = a pupil ( ,esculapius to *>ge = 8 s]vices4 ,any remun]ation t came to him 0 an (f]+ ( gratitude--inde$ an honor>ium :i* might be t5d]$ or )held at ! w ( ! pati5t4 ,a truly noble conception ?is1 t ! good we (f]$ 0 beyond a m]e "q ( price4 ,equally com=t+ 0 ! belief t ! ill :i* result$ despite our be/ ef=ts 0 no reflection on our skill1 b an evid5ce ( ! wra? ( ! ,gods4 ,w\ld t we 7 z ne> ,olympus n[ z !n1 & t ! ,gods walk$ ) m5 to rew>d ! wor?y & puni% ! unju/4 ,w\ld also t ! mann]s & co/umes & climate ( ,anci5t ,greece 7 /ill ) u1 s t man ne$ take little he$ ( raim5t beyond a robe & s&als2 t he requir$ no exp5sive outlay = in/rum5ts1 no intricate electric outfit1 & no automobile4 ,:at a life ours w\ld be if n[ z !n our grateful pati5ts s\ght u1 & we pass$ our _m h\rs ( leisure 9 eloqu5t discussion or 9 lazy l\ng+ amid ! leafy groves or %ad$ porticos ( ! temples6 ,b ! times h *ang$1 & we h *ang$ ) !m1 & abhor z we w ! comb9ation ( m$ic9e & money1 we are =c$ to take ?\ght ( ! morr[ & to sp5d _m1 _m anxi\s mom5ts 9 ?is ?\ght & 9 try+ to evolve ways & means by :i* a balance c be ma9ta9$ betwe5 ! honor>ia ( pati5ts1 bo? grateful & ungrateful1 & ! claims ( p]si/5t cr$itors4 ,p]haps x is be/ ?us1 z ! av]age man ne$s "s inc5tive to good "w beyond ! acquisition ( honor & glory4 ,an axiom 9 ! "q ( fees is ?is1 t 9 ord] to be respect$ we mu/ respect ourselves1 & no "o c respect himself unless he holds 8 call+ above a trade & bases 8 *>ges ^u ?is feel+ ( respect = himself & 8 pr(ession4 ,?is axiom %\ld be held 9 m9d 9 arrang+ any fee table1 & %\ld be insi/$ ^u 9 our settlem5ts ) ^? :o ?9k a doctor's bill %\ld be disc\nt$ f "o-qu>t] to "o-half4 ,i h (t5 wond]$ h[ ?is "r to a disc\nt 9 a doctor's bill ev] got su* a firm hold 9 ! public m9d4 ,p]haps ! city man _c appreciate ?is fact l 8 c\ntry bro!r4 ,! poor1 hone/ old f>m]1 "p ( ! bone & s9ew ( ! l&1 expects ! highe/ ca% price = ev]y?+ t he sells4 ,if anybody has ev] he>d ( "o :o :5 t5 b>rels ( corn at #c4ej p] b>rel comes to #ce1 (f]+ to take #be = 8 bill1 he %\ld corral & cage ?is r>a avis4 ,b hundr$s ( u f ! rural di/ricts h be5 deem$ mean & close-fi/$ & extortionate because we g5tly insi/ t #ce wor? ( pr(essional s]vices r5d]$ are wor? #ce & n #be4 ,?is is l>gely our own fault1 = s _m ( u pres5t a bill 9 "o h& & an apology 9 ! o!r4 ,we collect our bills n z if !y 7 our j dues1 b ) a half-he>t$ insi/5ce1 induc+ our debtor to believe t we h scruples ourselves z to ! value ( our s]vices1 & t a lib]al disc\nt f ! face ( ! bill w ab\t br+ u to a fair settlem5t4 ,x w be bett] = all--= pati5t z well z physician--to realize t ! sci5ce ( human duty implies a duty to oneself z well z a duty to ! public1 & t a small proportion ( ! *>ity ( our pr(ession %\ld beg9 at home4 ,to ! "y m5 ,i w\ld especially give ?is advice3 ,hav+ settl$ on a fair & hone/ fee = y\r s]vices1 d n dep>t f ?is fee4 ,) u1 z a rule1 prosp]ity 9 ! =m ( a num]\s cli5tage comes soon] ?an to ! o!r pr(essions4 ,y w n long h op5$ y\r (fice be=e y w be surpris$ at ! numb] :o dem& y\r s]vices4 ,!re w be no d\bt ( ! dem&1 = ^? :o pay ! lea/ inv>iably dem& ! mo/4 ,don't turn !m away1 = if y prop]ly employ y\r "t1 y w ga9 9 exp]i5ce & occasionally a doll> or two4 ,y w soon be enlight5$ z to y\r popul>ity1 = ! fir/ pay day w s5d mo/ ( !m to ano!r & x is presum$ easi] man4 ,_m ( ^? :o /ick w tell y t ,dr4 ---- nev] *>g$ b #ej c5ts a visit1 :5 ! regul> fee is #a4jj4 ,dr4 ---- w vigor\sly d5y ?is & produce 8 books to prove 8 tru?4 ,"h is ev]y?+ pla9 be=e y4 ,e visit is li/$ at ! e/abli%$ figure4 ,y w r>ely see 8 ca% book1 = !n ! :ole transaction w\ld be pla91 & y w\ld discov] ! simple mann] by :i* 9 e community "s suppos$ly e?ical man is supplant+ 8 truly e?ical bro!r by *>g+ full fees & settl+ = half4 ,dr4 ---- w cut #ej c5ts or a doll> f ! e/abli%$ fees = out-(-t[n "w1 & imm5sely increase 8 practice by x4 ,= be x und]/ood ! bone & s9ew ( ! l& de>ly love ! :oles & halves1 & w flock to sell 9 ! de>e/ & pay 9 ! *eape/ m>ket4 ,don't envy ?is man 8 prosp]ity &1 above all1 don't foll[ 9 8 foot/eps4 ,bide y\r "t ) ! assurance t ! man :o *>ges #a4jj = #b4jj wor? ( s]vice r>ely gives m ?an a doll>'s value1 & t :5 a real em]g5cy arises & a capable1 hone/ man is dem&$1 "o :o respects himself & 8 call+1 if y h prep>$ y\rself & are kn[n to give ! be/ t is 9 y1 ! *eap man w g to ! wall & y\r m]it w receive its rew>d4 ,if by *ance any ( y h n se5 ,dr4 ,mc,cormick's pap] on ?is "q ( fees & collections1 let him by all means f9d ! prop] ,a4 ,m4 ,a4 ,j\rnal & read x4 ,x is a classic wor? any man's "t & att5tion4 ,9 conclud+ ?is subject1 let me endorse :at he says ab\t ! *eap man1 ! price-cutt]4 ,:atev] 8 *>ge may be1 he is usually gett+ full value = 8 s]vices4 ,realiz+ 8 lack ( education or ability or temp]am5t1 or :atev] x is t puts him bel[ 8 pr(essional competitor1 he cuts 8 fees 9 ord] to live4 ,x is n our place to meet 8 competition1 b to pity him1 to ext5d to him ! help+ h&1 to endeavor to elevate him to our /&>d1 & nev] to l[] ourselves to 84 ,i h only a few words to say on ! subject ( pr(essional confid5ces4 ,s sacr$ is ! relation betwe5 ! physician & pati5t reg>d$ t ! c\rts w n compel a physician1 :ile on ! witness /& & "u oa?1 to tell ! tru?1 & n only ! tru?1 b ! :ole tru?1 to reveal :at is imp>t$ to him 9 confid5ce by 8 pati5t4 ,if 9 ?is exalt$ function ( do+ ju/ice betwe5 man & man ! c\rts w n compel ! recital ( "s important piece ( evid5ce1 h[ c>efully %\ld we reg>d our pr(essional relation1 & see to x t nei!r 9 /rict confid5ce or 9 idle gossip d we betray ! secrets t suff]+ man has confid$ 9 u4 ,x may be some:at out ( place 9 a pap] deal+ ) ,! ,e?ics ( ! ,g5]al ,practition] to speak ( ! t5d5cy1 or p]haps bett]1 ! half-=m$ det]m9ation ( ! majority ( e class to be speciali/s4 ,i mu/ conf9e myself to ! pr$ilection ( ! av]age m$ical /ud5t = surg]y4 ,x 0 s 9 my day1 & ,i suppose x is s n[1 t almo/ #ge p] c5t4 ( ! graduat+ classes are ?or\ghly satisfi$ t ! end & aim ( m$ic9e is surg]y2 t practice & ! less spectacul> bran*es are p>ts ( ! pr(ession ess5tial to x z a :ole1 & fitt$ = ^? :o int5d to lead ! plodd+ life1 b too sl[ & too prosaic = ! man bur/+ ) ! k ( 8 own brilliancy & 8 own special fitness4 ,!re is no "q b t ?is t5d5cy has done mu* to l[] ! av]age fitness ( _m classes4 ,m5 become li/less & c>eless1 neglect+ ev]y?+ b _! hobby1 & :ile ! surgical amphi!atre is cr[d$1 ! m$ical cl9ics w be %unn$1 ev5 des]t$ 7 x n t ! sections are su* t ! abs5tees c be spott$ & w>n$4 ,!re is no "q also b t indiff]5ce to ev]y?+ b surg]y is responsible = _m ( ! failures be=e ! ,/ate ,exam9+ ,bo>ds4 ,we mu/ h surgeons1 & !y mu/ beg9 _! tra9+ 9 m$ical s*ools1 & x is n my purpose to disc\rage e>ne/ "w & hone/ ef=t to ?is end4 ,i wi%1 h[ev]1 to say t e e?ical speciali/ ne$s a ?or\gh gr\nd+ 9 ! g5]al bran*es ( m$ic9e1 & he %\ld n 9 8 /ud5t days neglect ! o!r ess5tials to a well-r\nd$ man4 ,mo/ he>tily d ,i wi% to condemn ! c>eless1 happy-g-lucky mann] 9 :i* s _m m5 totally unprep>$ & totally unsuit$ by temp]am5t = ?is bran* ru% 9 :]e angels fe> to tread4 ,i wi% especially to draw y\r att5tion to ! fact t !re is a va/ diff]5ce betwe5 ! op]ator & ! surgeon4 ,almo/ any "y man ) a disreg>d ( ! sight ( blood1 ) n]ves unaffect$ by human suff]+ & a he>t unt\*$ by a k ( 8 p[] to d h>m1 c 9 six mon?s' practice on ! cadav] le>n to cut1 to sew & to ligate ) neatness & despat*4 ,inde$1 !re may be _m be=e me ( ! /ud5t body ^: "y & nimble f+]s c\ld tea* dext]ity to ! be/ surgeons ( ! city4 ,v _m ) no pret5se to ?is dext]ity1 & no equipm5t b a sup]abundance ( assurance1 graduate z surgeons & assume & aspire to a position ( prom95ce t x has tak5 ! true surgeon ye>s ( ! h>de/1 close/1 mo/ untir+ /udy1 obs]vation & "w to rea*4 ,we are told z an excuse = ?is rem>kable evolution f ! /ud5t to ! surgeon t ! "y man ( today is taught s mu* m ?an ! old m5 72 t ! v mann] ( tea*+1 ! equipm5t ( ! s*ools & ! sup]ior requirem5ts = matriculation _c b turn out bett] po/$ & m compet5t m54 ,!re is mu* tru? 9 ?is4 ,!re is mu* tru? also 9 ! fact t :ile m is taught1 m1 inf9itely m1 is dem&$ ( ! /ud5t1 & ! k t w\ld h secur$ him a diploma fifty ye>s ago w n[ sc>cely c>ry him ?r\gh 8 fre%man ye>4 ,we also he> t ,i want to be a surgeon1 because surg]y accompli%$ positive results4 ,?is is v true also1 & x is evid5t t if y amputate a leg y\r pati5t w be m9us a memb]4 ,don't lose sight ( ano!r fact1 h[ev]1 t if )\t be+ compet5t to meet any un=ese5 em]g5cy t may arise1 y lightly op5 ! abdom9al cavity1 y w h a positive result 9 ! %ape ( y\r own little private gravey>d4 ,! newly graduat$ surgeon is n z dang]\s z ! man :o left m$ical s*ool ye>s ago1 be=e ! /ud5ts receiv$ "o-?ird ( ! surgical tra9+ t !y d n[4 ,_m ( ^! m5 h n tak5 a po/-graduate c\rse1 h nev] be5 associat$ ) a hospital1 nor h !y _h ev5 an opportunity = mod]ate surgical obs]vation2 & yet !y are attempt+ to d ! "w t only a skill$ speciali/ %\ld und]take4 ,i am n speak+ ( em]g5cy surg]y = :i* any man %\ld try to prep>e himself1 & be brave en\gh to und]take :5 human life is at /ake4 ,i am ref]r+ to op]ations ( election :5 ! s]vices ( a compet5t man c be secur$4 ,! po9t is j ?is1 g5tlem51 t m$ic9e z a sci5ce is ! result ( evolution & n ! creation ( "s brilliant bra92 t :at has be5 done 9 x has be5 accompli%$ n s mu* by inspiration z by close plodd+ "w1 exhau/ive exp]im5t & cont9ual obs]vation2 t surg]y z "o ( its bran*es _c be ma/]$ 9 ! f\r ye>s ( /ud5t life1 b t to be surgeons y mu/ be work]s & obs]v]s4 ,x w n d to settle ! matt] by say+ t a man mu/ make a />t4 ,?is tru? is too self-evid5t to be sm>t1 nor is x entirely conv9c+4 ,an answ] equally true w be t y w n all[ ! embryo surgeon to />t on y1 & be=e y put y\rself or y\r wife or y\r "m 9 8 h&s y w dem& t he possess "s o!r qualification = 8 specialty besides 8 conceit1 8 gall & 8 ne$ ( ! fee4 ,!re may be "s exceptions :]e ! man is born & n made1 b ,i beg to assure y t ! surgeon r>ely spr+s full-fl$g$ & fully fitt$ f ! bra9 ( ,m9]va4 ,our pr(ession is no?+ if n altrui/ic4 ,x dem&s daily & h\rly m ( self-sacrifice1 m ( self-devotion1 ?an any secul> call+4 ,inde$1 ! comp>ison is (t5 drawn betwe5 ! nobility & necessity ( ! duties :i* we p]=m & ^? ( him :o by div9e inspiration & lay+ on ( h&s has be5 call$ to succor ! diseas$ s\l4 ,x is n my place nor is x my purpose to ent] into a discussion ( ?is po9t1 & ,i m5tion x only to %[ t we are m>k$ m5 9 e community2 t we are plac$ on a high] plane & t m is expect$ ( u ?an ( our bre?r5 ( ! o!r lib]al pr(essions4 ,?is1 inde$1 is "r1 = no man1 ! prie/ possibly except$1 ent]s into su* intimate relations ) 8 p4 ,he is ev] pres5t ) !m to %>e _! sorr[s & _! joys1 & 9 8 position ( family fri5d & family confessor x is 8 place to b9d & salve w\nds m deadly ?an ^? made by ! h& ( man4 ,x is a popul> impression t ?is close relation%ip betwe5 ! physician & 8 p is "o evolv$ by ! bra9 ( ! noveli/ or "o possess$ by t mo/ belov$1 b n[ ext9ct1 old family physician4 ,let u get ?is impression f our m9ds & let u realize t our duties1 our responsibilities & our relation%ip to ^? we s]ve are j ! same1 are j z close1 & are j z engross+ z !y 7 :5 t de> old patri>* ( ! pr(ession made 8 r\nds1 scold+ "s1 *id+ o!rs & advis+ all to bett]1 pur] & nobl] lives4 ,*ang$ z our relation%ip to ! community may be 9 "s respects by ! translation ( _m ( ! brighte/ & be/ ( our cult into ! ranks ( ! speciali/1 x is /ill & always w be ! g5]al practition] :o is look$ up to z ! physician1 & by 8 "w 9 pr(essional & private life our pr(ession w be judg$4 ,9 ! beg9n+ ( my pap] ,i /at$ ,i c\ld d little m ?an rehe>se to y "s ( ! old axioms & maxims t h be5 h&$ d[n to u = g5]ations4 ,i am aw>e t ,i h taught y no?+ new tonight1 & t ,i h n tapp$ t f\nta9 ( inspiration f :i* g5ius gu%es 9 poetic or oratorical /reams4 ,i tru/ ,i may h conv9c$ y t x is n amiss = u at times to hold close communion ) our s\ls1 & to take /ock ( our moral & pr(essional assets4 ,! fur!r ,i h advanc$ ! m fully ,i h realiz$ h[ impossible x is to evolve new ideas or elaborate new cre$s to sup]s$e ^? by :i* ! fa!rs liv$ & di$ & e>n$ honor = !mselves & our pr(ession4 ,s we face today1 g5tlem51 j ab\t ! same propositions t h always be5 ours to meet1 & :at 0 e?ical "o hundr$ ye>s ago is e?ical n[4 ,! sci5ce ( human duty simply dem&s t y be hone/ to y\rselves1 hone/ to ^? y s]ve2 t y may look e man squ>ely 9 ! face & n z if y fe>$ he _h he>d some?+ y _h said beh9d 8 back4 ,may ,i quote to y ! words ( ! ,e>l ( ,/4 ,v9c5t to ! immortal ,nelson3 ,x is giv5 to u all to des]ve success2 mortals _c comm& x4 ,,! ,,/udy ,,( ,,rectal ,,surg]y ,,9 ,,new ,,york ,,city4 ,,by ,j4 ,,dawson ,,re$]1 ,m4 ,d41 ,lectur] on ,o/eology1 ,univ]sity ( ,m>yl&1 ,baltimore1 ,md4 ,hav+ decid$ to take a c\rse 9 ,rectal ,surg]y1 ,i arriv$ 9 ,new ,york & matriculat$ at ! ,new ,york ,polycl9ic ,hospital on ,octob] #a/ = a c\rse ( in/ructions "u ,pr(4 ,james ,p4 ,tuttle1 & desire to h]e) describe briefly my reception3 ,pr(essor ,tuttle is a f9i%$ surgeon ( ! old s*ool ( g5tlem51 a ma/] ( 8 art1 &1 "u all conditions & circum/ances1 adh]es /rictly to ! e?ics ( ! pr(ession4 ,i 0 n only mo/ cordially receiv$ by him socially1 b 0 mo/ =tunate 9 be+ honor$ by reque/+ me to assi/ him1 or be pres5t1 on op]ations ^u 8 private pati5ts at an upt[n hospital4 ,?is unexpect$ & fri5dly honor gave me an opportunity to obs]ve closely ! "w ( ?is great surgeon 9 detail1 & ,i _h ! pleasure ( witness+ e case "u 8 c>e dur+ my ?ree mon?s' visit4 ,z to 8 colossal "w on canc] ( ! rectum & sigmoid1 8 results are too well kn[n = me to dwell ^u at ?is "t1 & he has an enviable record :i* makes him ! au?ority ( ?is di/ress+ malady :i* is s preval5t 9 ! cases ref]r$ to ! ,rectal surgeon1 & h s long be5 unrecogniz$ by ! g5]al pr(ession4 ,i _h ! pleasure ( witness+ him extirpate ! rectum by 8 bone-flap & p]9eal r\te1 & 9 "s ( ^! cases 0 honor$ by be+ 8 assi/ant4 ,z to ! me?od & te*nique 9 ea* ( ! above m5tion$1 ,i w endeavor to give lat]4 ,ano!r v important po9t ga9$ by association ) ?is surgeon 01 t my own !ory z to ! m]its ( ! ,:itehead op]ation 7 simply an endorsem5t ( 8 tea*+s1 namely1 t ?is p>ticul> op]ation1 :ile classical1 0 only ju/ifiable 9 select$ cases ( hemorrhoids1 :ile ! ,clamp & ,caut]y or ! ,ligature me?od _h no re/rictions z to v>iety or location ( ! pile mass4 ,ano!r important subject 0 ! "q ( treatm5t ( ,tub]cul> fi/ula4 ,= a numb] ( ye>s ,dr4 ,tuttle said he 0 mo/ disc\rag$ 9 8 results & _h almo/ ab&on$ any attempt to cure ?is class ( infections1 b ( late he _h obta9$ mo/ excell5t results by introduc+ 8 s(t flexible probe & foll[+ ?is tract ) a groov$ director2 op5+ ?is ?r\gh\t its entire ext5t1 & !n completely caut]iz+ at dull r$ heat ) ! actual caut]y4 ,?is is !n pack$ ) iod(orm gauze1 & s9ce us+ ! caut]y1 8 results h be5 decid$ly bett]4 ,"u ! direction ( 8 assi/ant1 ,dr4 ,j4 ,m4 ,lyn*1 a class ( ?ree 0 =m$1 ) regul> "w & in/ructions 9 ! disp5s>y ( ,/4 ,b>?olomew's ,cl9ic1 :]e we 7 giv5 cases to diagnose & treat4 ,?is c\rse consi/$ 9 introduction ( proctoscope & sigmoidscope diagnosis ( ulc]ations specific & b5ign1 & local treatm5t ?r\gh ?is in/rum5t4 ,to ! inexp]i5c$ ! results & probabilities ga9$ ?r\gh ! use ( ?is pneumatic in/rum5t ( ,tuttle's1 :i* is a modification ( ! ,laws proctoscope1 are surpris+4 ,by ! electric illum9ation ) :i* x is equipp$ "o is able to introduce ! in/rum5t ) absolute safety to ! pati5t = a di/ance ( #aj to #ad in*es1 explor+ ! entire circumf]5ce f ! anus up ?r\gh ! sigmoid4 ,my next c\rse ( in/ructions 0 "u ! direction ( ,pr(4 ,samuel ,gant at ! ,new ,york ,po/-,graduate ,m$ical ,s*ool4 ,dr4 ,gant likewise 0 mo/ cordial 9 8 reception1 & on sev]al occasions honor$ me by ent]ta9m5ts1 includ+ lett]s ( memb]%ip to 8 club1 & at 8 home ) 8 family4 ,dr4 ,gant1 also a ma/] ( 8 art1 has made a reputation ( r5[n1 & is a mo/ successful op]ator4 ,:ile ( an entirely diff]5t "* f t ( ,dr4 ,tuttle he is equally attractive4 ,dr4 ,gant argues t ! majority ( cases ( canc] :5 se5 by ! speciali/ are too f> advanc$ to (f] any hope by radical op]ation1 & g5]ally limits 8 attempts at relief to a colo/omy4 ,z to ! m]its ( ?is proc$ure1 ,i am n suffici5tly v]s$ to (f] criticism fur!r ?an to say t ! results ( ,dr4 ,tuttle are c]ta9ly enc\rag+ to ! surgeon :o w und]take ?is ordeal ( extirpation 9 hopes ( eradicat+ ! disease1 :ile ,dr4 ,gant's op]ation ( colo/omy1 ( c\rse1 is only palliative1 he mak+ no claims ( a cure1 except :5 ! gr[? is se5 v e>ly & is freely movable2 !n he w extirpate4 ,z to ! op]ation = hemorrhoids1 ,dr4 ,gant uses ligature & /]ile wat] ane/hesia 9 ne>ly e case1 & ! pati5t is !reby cur$ )\t ! adm9i/ration ( a g5]al ane/hetic4 ,! diff]5ce 9 ! "t ( recov]y is a "q to be always consid]$1 9 my own judgm5t1 & is z foll[s3 ,dr4 ,tuttle uses ! clamp & caut]y almo/ univ]sally1 & ! pati5t is dis*>g$ )9 ! p]iod ( "o week1 :ile ! ligature me?od requires local treatm5ts to ! ulc]ations produc$ by ! sluff+ ( ! l95 ?reads1 & takes f #aj days to ?ree weeks4 ,con/ipation & ,ob/ipation are treat$ surgically by bo? ( ^! g5tlem5 by ! op]ation ( ,sigmoidopexy or ,colopexy1 :i* consi/s 9 an*or+ ! gut to ! abdom9al p>ietes aft] hav+ fir/ /ripp$ back ! p]itoneum ov] ! area cov]$ by _! sutures4 ,*ronic di>rheas & ,ambic ,dys5t]y are likewise treat$ by ,app5dico/omy & ,caeco/omy4 ,! diff]5ce 9 ?is op]ation be+ t ! =m] consi/s 9 deliv]+ ! app5dix ^u ! abdom5 & fix+ ! same ) catgut sutures until ! p]itoneal cavity is wall$ (f by adhesions1 & !n amputat+ lat]1 s t ! /ump may be dilat$ to p]mit ( regul> colonic irrigations4 ,dr4 ,gant p]=ms a simil> op]ation1 to :i* he has appli$ ! "n ( ,caeco/omy1 & hav+ devis$ an +5i\s director consi/+ ( "o metal rod )9 a tube ( slightly l>g] calibre1 he is able to pass ! obturator ?r\gh ! ileo-caecal valve1 & !n1 by )draw+ ! rod or obturator1 is able to pass a rubb] ca!t] into ! small inte/9e4 ,! metal tube is !n )drawn & a %ort] ca!t] is plac$ p>allel ) ! long "o1 :i* necess>ily is 9 ! caput1 & aft] plac+ clips ^u ea* tube to prev5t leakage1 he is able to flu% out bo? l>ge & small b[el at desir$ int]vals4 ,z to ! irrigations ?r\gh ^! newly-made op5+s1 x is a matt] ( *oice ) diff]5t op]ators1 ^? 9 greate/ favor1 ,i ?9k1 be+ ,ice ,wat]1 ,aq4 ,ext ,kram]ia & ,qu99e ,solution4 ,a v int]e/+ case br\ght be=e u by ,dr4 ,tuttle 0 "o ( ,specific ,/ricture ( ! ,rectum1 & ! treatm5t anticipat$ is z foll[s3 ,he p]=m$ a ,maydl-,reclus ,colo/omy 9 ! transv]se colon1 9 ord] fir/ to treat ! ulc]ations & infect$ area locally1 &1 secondly1 s t he w\ld h suffici5t gut above ! /ricture to d a ,p]9eal extirpation lat] & br+ d[n new heal?y inte/9e f ! upp] ,sigmoid = a new p]man5t anus2 !n lat] he w\ld close ! artificial anus 9 ! transv]se colon1 & 8 pati5t %\ld h a p]fect result4 ,! p]iod requir$ = ^! ?ree op]ations w\ld cov] a p]iod ( n less ?an n9e mon?s2 & if aft] ?is !re is n p]fect ,sph9ct]ic action1 ,dr4 ,tuttle does a pla/ic op]ation to repair 8 sph9ct]4 ,be=e cont9u+ ) a brief description ( ! te*nique ( ,extirpation z above ref]r$ to1 ,i wi% to h]e) express my s9c]e gratitude & appreciation ( ! _m honors & c\rtesies ext5d$ to me by ^! g5tlem51 & am q sure t ! same 0 n all p]sonal1 b honor to ! ,univ]sity ( ,m>yl&'s ,faculty ( ,physic1 :o h aid$ s mat]ially ?is y\ng] specialty by su* m5 z ,hemmet]1 ,p5n+ton & ,e>le1 :o are con/antly quot$ by all inte/9al & rectal surgeons4 ,,extirpation ,,( ,,rectum4 ,! op]ation ( remov+ ! rectum is n[ almo/ two c5turies old4 ,faget p]=m$ x 9 #agci1 b ,li/frane fir/ successfully extirpat$ ! rectum = canc] 9 #ahbf4 ,! results ( ! op]ation 9 n9e cases 7 embodi$ 9 a !sis by "o ( 8 /ud5ts 7,p5ault1 ,!sis1 ,p>is1 #ahbi71 & 9 #ahcc ! great surgeon himself gave to ! _w a complete acc\nt ( 8 op]ation & me?od1 ?us e/abli%+ ! proc$ure z a surgical measure4 ,! results 9 ^! cases 7 n calculat$ to create any great en?usiasm1 = ! mortality 0 high ow+ to ! lack ( aseptic te*nique4 ,! me?ods describ$ 9 old] books give u five v>ieties ( op]ation = extirpation--! p]9eal1 ! sacral1 ! vag9al1 ! abdom9al & ! comb9$4 ,9 ?is pap] ,i %all only endeavor to describe briefly ! two me?ods us$ by ,dr4 ,tuttle4 ,be=e describ+ ^! me?ods 9 detail x may be well to consid] ! prep>ation ( ! pati5t1 :i* is practically ! same 9 ea*4 ,9 ord] to obta9 ! be/ results1 x is necess>y to increase ! pati5t's /r5g? z f> z possible by =c$ fe$+ = a "t1 to empty ! inte/9al tract ( all h>d & putrify+ faecal masses1 to e/abli% z f> z we may inte/9al antisepsis & to *eck1 9 a measure1 ! purul5t secretion f ! gr[?4 ,x requires f #g to #aj days1 or long]1 to prop]ly prep>e a pati5t = ?is op]ation4 ,! diet be/ calculat$ to obta9 a prop] condition ( ! inte/9al tract is g5]ally conc$$ to be a nitrog5\s "o4 ,! absolute milk diet is n s satisfactory z a mix$ diet compos$ ( meat1 /rong bro?1 milk & a small quantity ( bread & ref9$ c]eals4 ,! pati5t %\ld be f$ at frequ5t int]vals1 & z mu* z he c dige/4 ,along ) ?is =c$ fe$+ "o %\ld adm9i/] daily a sal9e laxative :i* w produce two or ?ree ?9 movem5ts1 & to dis9fect ! inte/9al canal "o %\ld give ?r\gh ! /oma* ?ree or f\r times a day sulpho-c>bolate ( z9c1 grs4 iiss41 9 =m ( an ent]ic pill4 ,on ! day previ\s to ! op]ation ! p]9aeum1 sacral region & pubis %\ld be %av$1 dress$ ) a soap p\ltice = two h\rs1 !n wa%$ & dress$ ) bi*loride dress+1 :i* %\ld be reta9$ until pati5t is ane/hetiz$4 ,not)/&+ all ( ^! prep>ations1 x is impossible to obta9 absolute asepsis ( ! affect$ area1 & s _m fatalities occur f infection t x is deem$ wise by _m surgeons to make an artificial +u9al anus z a prelim9>y proc$ure 9 all extirpations ( ! rectum4 ,,p]9eal ,,me?od4 ,"u ?is me?od may be includ$ c]ta9 op]ations = small epi!liomas l[ d[n 9 ! rectum done ?r\gh ! anus4 ,! pati5t hav+ be5 prop]ly prep>$1 ! sph9ct] is ?or\ghly dilat$2 a circul> incision ?r\gh ! entire wall ( ! gut is made1 & ! segm5t is caught ) traction =ceps & dragg$ by an assi/ant :ile ! op]ator frees1 by scissors & blunt dissection1 to a po9t at lea/ "o-half in* above ! canc]4 ,! free end ( ! gut is !n ti$ ) /rong tape1 z ! temptation is v great to put y\r f+] 9 ! b[el z a guide1 & !reby invite infection4 ,a deep dorsal incision is !n made1 go+ d[n to ! "r ( ! coccyx ?r\gh ! po/-rectal tissue4 ,! h& is !n plac$ 9 ! sacral fossa & ! /ructures lift$ out into ! pelvis1 aft] :i* ?is space is ?or\ghly pack$ ) gauze to control ! ble$+ & hold ! /ructures out ( ! fossa4 ,! edges ( ! w\nd1 includ+ ea* half ( ! sph9ct] :i* has be5 cut po/]iorly1 are held by flat retractors1 :ile ! op]ator proce$s to dissect ! ant]ior portion ( ! rectum loose f its atta*m5ts4 ,a s\nd %\ld be held 9 ! ure?ra 9 m5 & an assi/ant's f+] 9 ! vag9a 9 wom5 to prev5t w\nd+ ^! organs4 ,aft] ! gut has be5 dissect$ out well above ! tumor1 x is caught by clamps & cut (f bel[ ^!4 ,ble$+ is controll$ by ligatures & equal p>ts ( hot wat] & alcohol4 ,?is newly-expos$ gut is !n /]iliz$ by pure c>bolic acid & alcohol1 or may be se>$ ) caut]y4 ,sometimes ! p]itoneum c be /ripp$ (f f ! rectum & its cavity ne$ n be op5$2 x is bett]1 h[ev]1 to op5 ! cavity at once :5 ! gr[? ext5ds above ?is po9t4 ,! p]itoneum is incis$1 cut loose f its atta*m5ts close to ! rectum1 back to ! mesorectum1 :i* %\ld be cut close to ! sacrum1 9 ord] to avoid ! inf]ior mes5t]ic art]y4 ,:5 ! gut has be5 loos5$ suffici5tly above ! tumor1 x may be /ill fa/5$ by two lat]al p]itoneal reflections1 :i* are ! lat]al rectal ligam5ts1 & %\ld be cut at once4 ,! gut is !n br\ght d[n & sutur$ to ! anus1 & ! op]ator %\ld proce$ to close ! p]itoneum & re/ore ! planes ( ! pelvic floor d[n to ! levator ani by f9e catgut sutures4 ,aft] ?is has be5 accompli%$1 ! anus1 :i* is n[ well outside ! op]ative field1 %\ld be reop5$1 ! gauze remov$1 & ! gut flu%$ ) a solution ( bi*loride or p]oxide ( hydrog54 ,qu5u advises t 9 amputat+ ea* lay] %\ld be cut sep>ately1 9 ord] to avoid hemorrhage1 b !re appe>s to be no advantage 9 ?is2 9 fact1 we are m likely to meet ) defici5t blood supply1 caus+ subsequ5t sl\gh+ ( ! gut1 ?an ) hemorrhage4 ,! po/]ior & ant]ior portions ( ! p]9eal w\nd are pack$ ) gauze & left op5 to assure dra9age1 & ! p>ts are cov]$ ) aseptic pads1 held 9 position by a well-fitt+ ,t b&age4 ,a l>ge dra9age tube is pass$ well up into ! rectum1 its l[] end ext5d+ outside ( ! dress+s1 9 ord] to convey ! dis*>ges & gases beyond ! op]ative w\nd4 ,,tuttle',s ,,bone ,,flap ,,op]ation4 ,! ,kraske ,op]ation is appli$ to v>i\s me?ods 9 :i* access to ! rectum is obta9$ by remov+ ! coccyx or cutt+ (f c]ta9 portions ( ! l[] end ( ! sacrum4 ,!y are all modifications ( ,kraske's orig9al me?od1 ) :i* we are all famili>4 ,dr4 ,tuttle has modifi$ ?is plan1 z x furni%es a rapid & adequate approa* to ! rectum2 x facilitates ! control ( hemorrhage & re/ores ! bony floor ( pelvis & atta*m5t ( ! anal muscles1 & involves injury ( ! sacral n]ves & lat]al sacral art]ies on "o side only4 ,! te*nique :i* he employs is z foll[s3 ,! pati5t is previ\sly prep>$ z h]et(ore describ$1 & an artificial anus e/abli%$ or n1 z ! conditions indicate2 be=e ! f9al scrubb+ ! sph9ct] %\ld be dilat$ & ! rectum irrigat$ ) bi*loride #a-bjjj or hydrog5 p]oxide4 ,x %\ld !n be pack$ ) absorb5t gauze1 s t ! f+] _c be introduc$4 ,! pati5t is !n plac$ 9 ! prone position on ! left side1 ) ! hips elevat$ on a h>d pill[ or s&bag2 an oblique incision is made f ! level ( ! ?ird =am5 on "r side ( sacrum d[n to ! tip ( ! coccyx1 & ext5d+ half-way betwe5 ?is po9t & ! po/]ior m>g9 ( ! anus4 ,?is incision %\ld be made boldly ) "o /roke ?r\gh ! sk91 muscles & ligam5ts into ! cellul> tissue po/]ior to ! rectum2 ! rectum is !n rapidly sep>at$ by ! f+]s f ! sacrum1 & ! space ?us =m$ & ! w\nd %\ld be firmly pack$ ) /]ile gauze4 ,a transv]se incision d[n to ! bone is !n made at a level ( ! #d? sacral =am51 ! bone is rapidly *isel$ (f 9 ?is l9e1 & ! triangul> flap is pull$ d[n to ! left side & held by retractor4 ,at ?is po9t x is usually necess>y to cat* & tie ! "r lat]al & middle sacral art]ies4 ,frequ5tly ^! are ! only vessels t ne$ to be ti$ dur+ ! entire op]ation1 al?\gh if "o cuts too f> away f ! sacrum1 ! "r sciatic may be sev]$4 ,! fir/ /ep 9 ! actual extirpation ( ! rectum consi/s 9 isolat+ ! organ bel[ ! level ( ! resect$ sacrum1 s t a ligature c be ?r[n ar\nd x1 or a long clamp appli$ to control any ble$+ f its walls4 ,if ! neoplasm ext5ds above ?is level & x is necess>y to op5 ! p]itoneal cavity to extirpate x1 "o %\ld d ?is at once1 z x w be f\nd mu* easi] to dissect ! rectum out by foll[+ ! c\rse ( ! p]itoneal folds4 ,by op5+ ! p]itoneum & incis+ its lat]al folds close to ! rectum1 ! dang] ( w\nd+ ! uret]s is greatly decreas$ & ! gut is mu* m easily dragg$ d[n4 ,:5 ! po/]ior p]itoneal folds or meso-rectum is rea*$1 ! incision %\ld be c>ri$ z f> away f ! rectum1 or1 r1 z close to ! sacrum1 z possible 9 ord] to avoid w\nd+ ! sup]ior hemorrhoids art]y1 & to remove all ! sacral gl&s4 ,! gut %\ld be loos5$ & dragg$ d[n until its heal?y portion easily rea*es ! anus or heal?y segm5t bel[ ! gr[?4 ,a /rong clamp %\ld !n be plac$ ^u ! inte/9e ab\t "o in* above ! neoplasm1 b %\ld nev] be plac$ 9 ! area involv$ by x2 = 9 s do+ ! friable walls may rupture & ! cont5ts ( ! inte/9e be p\r$ out into ! w\nd4 ,z soon z ! gut has be5 suffici5tly lib]at$ & dragg$ d[n1 ! p]itoneal cavity %\ld be cleans$ by wip+ ) dry /]iliz$ gauze & clos$ by sutures :i* atta* ! membrane to ! gut4 ,by ?is proc$ure ! entire intrap]itoneal "p ( ! op]ation is complet$ & ?is cavity clos$ be=e ! inte/9e is incis$4 ,aft] ?is is done ! gut %\ld be cut across betwe5 two clamps or ligatures above ! tumor1 ! ends be+ caut]iz$ ) c>bolic acid & cov]$ ) rubb] protective tissue4 ,! l[] segm5t conta9+ ! neoplasm may !n be dissect$ f above d[nw>d 9 an almo/ bloodless mann] until ! l[e/ portion is rea*$4 ,x is mu* m easily remov$ 9 ?is direction ?an f bel[ upw>d1 & !re is less dang] ( w\nd+ ! o!r pelvic organs4 ,if ! neoplasm ext5ds )9 "o in* ( ! anus1 x w be necess>y to remove ! entire l[] portion ( ! rectum4 ,if1 h[ev]1 m ?an "o in* ( p]fectly heal?y tissue rema9s bel[1 ?is %\ld always be pres]v$4 ,hav+ remov$ ! neoplasm1 if "o in* or m ( heal?y gut rema9s above anus1 "o %\ld unite ! proximal & di/al ends ei!r by ,murphy button or end-to-end suture4 ,all ooz+ is *eck$ by hot compresses1 & ! concavity ( ! sacrum is pack$ ) a l>ge mass ( /]iliz$ gauze1 ! end ( :i* protrudes f ! l[] angle ( ! w\nd4 ,?is s]ves to *eck ! ooz+1 & also furni%es a support to ! bone-flap aft] x has be5 re/or$ to position4 ,f9ally ! flap is fa/5$ 9 its orig9al position by silk-worm gut sutures1 :i* pass deeply ?r\gh ! sk9 & p]io/]num on ea* side ( ! transv]se incision4 ,sutur+ ! bone itself is n necess>y4 ,! lat]al portion ( ! w\nd is clos$ by simil> sutures d[n to ! level ( ! sacro-coccygeal articulation2 bel[ ?is x is left op5 = dra9age 7,tuttle1 ,diseases ( ,rectum1 ,page #hbi-aijc74 ,,report ,,( ,a ,,case ,,( ,,gangr5\s ,,app5dicitis1 ,,f ,,! ,,s]vice ,,( ,,pr(4 ,r4 ,,w9sl[4 ,,by ,c4 ,c4 ,,sm9k1 '#ji1 ,s5ior ,m$ical ,/ud5t4 ,9 select+ a case ,i h n tak5 "o t is a surgical curiosity1 or at all an unusual "o1 b ,i h tak5 ?is because x is j 9 ^! cases t a d\bt sometimes exi/s z to ! treatm5t :5 diagnos$1 & (t5 ! condition ( ! app5dix & surr\nd+ p]itoneum is 9 d\bt1 ev5 if a diagnosis ( tr\ble orig9at+ 9 ! app5dix is made4 ,hi/ory ( ,case--,pati5t1 a boy1 ,l4 ,w41 age #i ye>s1 s*oolboy2 admitt$ ,decemb] #bf1 #aijh1 ) a diagnosis ( app5dicitis4 ,family ,hi/ory--,p>5ts well2 "o bro!r di$ 9 infancy1 cause unkn[n2 two bro!rs liv+ & well2 only hi/ory ( any family disease is tub]culosis 9 "o uncle2 no rheumatism1 syphilis1 g\t1 haemophilia or o!r disease be>+ on ! case4 ,pa/ ,hi/ory--,measles at #e ye>s1 ) unev5tful recov]y2 :oop+-c\gh at #f1 no complications2 badly burn$ two ye>s ago2 has _h indige/ion 787 s9ce he 0 #c ye>s old2 pa9 b no t5d]ness dur+ ^! attacks2 treat$ by diff]5t physicians & got bett] = a "t2 no hi/ory ( sc>let fev]1 influ5za1 pneumonia1 typhoid or o!r disease ( *ildhood4 ,habits--,a normal *ild4 ,pres5t ,illness--,on #bj? ( ,decemb]1 #aijh1 pati5t came home f *ur* compla9+ ( pa9s 9 ! "r side4 ,?is 0 ,sunday4 ,next day he compla9$ ( sev]e pa9 all ov] abdom51 b on ,tuesday ^! became localiz$ 9 ! "r l[] quadrant ( ! abdom54 ,_h "s fev]4 ,b[els con/ipat$4 ,no nausea or vomit+4 ,!re 0 a localiz$ t5d]ness 9 ! "r l[] quadrant f ! />t4 ,pa9s got bett] on ,friday1 b temp]ature & pulse /ill /ay$ up1 & pati5t came into hospital on ,saturday1 ,decemb] #bf4 ,! unusual feature 0 t !re 0 no nausea or vomit+4 ,x is also to be not$ t ! pa9 subsid$ sudd5ly on ! #bd?4 ,! *ild ent]$ hospital on ! #bf?1 & on entrance ! :ole "r side 0 rigid1 :ile ! left side 0 comp>atively s(t4 ,a lump c\ld be felt 9 ! app5dical region1 ! c5tre ( :i* 0 above ,mc,burney's po9t4 ,temp]ature 0 #ii & pulse #gh4 ,! leucocyte c\nt1 h[ev]1 0 #cj1bjj2 ur9e negative4 ,*ild 0 put to b$2 an ice cap plac$ on ! abdom54 ,liquid diet4 ,! next day1 ,decemb] #bg?1 leucocytes /ood at #ce1bjj4 ,temp]ature un*ang$1 b ! pulse _h ris5 to #aaj beats4 ,a hypod]mic ( morph9e & atrop9e 0 giv51 & pati5t tak5 to ! op]at+ room1 ane/hetiz$1 & abdom5 clean$ = an aseptic 7if possible7 op]ation4 ,pr(4 ,w9sl[ made an incision 9 ! abdom9al wall1 well out t[>d ! cre/ ( ! ilium1 us+ ! gridiron incision4 ,! caecum 0 f\nd & pull$ ov] t[>d ! middle l9e1 & 9 look+ = ! app5dix1 :i* 0 suppos$ to be beh9d ! caecum1 a great quantity ( pus 0 f\nd4 ,?is na/y smell+1 grayi% pus well$ up into ! w\nd & 0 spong$ away4 ,sev]al pieces ( muc\s membrane & presumably ! tip ( ! app5dix 7 f\nd 9 ! pus4 ,also sev]al faecal secretions4 ,! pus 0 spong$ away & c>efully a se>* 0 made = ! app5dix1 or r :at rema9$ ( x4 ,x 0 f\nd ti$ d[n by adhesions & dissect$ loose4 ,x broke away 9 pieces1 & x 0 unnecess>y to ligate any ( ! art]ies ( ! meso app5dix4 ,! /ump ( ! app5dix close to ! caecum 0 cru%$1 caut]iz$ & ligat$4 ,no attempt 0 made to inv]t x1 z ! tissues w\ld n /& x4 ,! pus cavity 0 f\nd to ext5d up beh9d ! caecum & ov] t[>d ! m$ian l9e = "s di/ance4 ,! puncture1 :i* ,i w ref] to lat]1 0 !n made 9 ! "r lumb> region1 & two cig>ette dra9s 7 introduc$ ext5d+ cle> back into ! bottom ( ! abscess cavity4 ,!n a gauze dra9 0 introduc$ into ! ant]ior w\nd1 & ?is sutur$ up4 ,! w\nd 0 !n dress$ & ! pati5t tak5 to ! w>d4 ,recov]y f ane/hetic )\t ill effects4 ,! next morn+ ! pati5t 0 unable to pass 8 wat]1 & _h to be ca!t]iz$4 ,aside f ?is no ill effects 7 se51 & 8 temp]ature & pulse rema9$ practically at ! same place4 ,at ! end ( #dh h\rs ! dra9s & dress+s 7 *ang$ & ! pati5t 0 do+ well & ! w\nd dra9+ pr(usely4 ,at no "t 0 ! b$ elevat$ & at no "t 0 a /imulant adm9i/]$1 ) ! exception ( a hot normal salt enema on ! day foll[+ ! op]ation4 ,sev]al times dur+ 8 /ay a dose ( ca/or oil 0 giv51 b no o!r m$ication 0 necess>y4 ,z ! dress+s 7 reappli$ & dra9s introduc$ daily ! w\nds 7 f\nd to be granulat+ up1 & gradually ^! clos$1 fir/ ! "o 9 ! lumb> region & !n ! "o 9 ! abdom54 ,by ! t5? day a normal temp]ature 0 pres5t1 & he sat up on ! twelf?4 ,! *ild w5t on to an unev5tful recov]y1 & w5t home on ,janu>y #ba/ fully cur$4 ,?is 0 und\bt$ly "o ( ^? cases ( gangr5\s app5dicitis :]e1 ow+ ei!r to ! int5sity ( ! infection or to a ?rombosis ( ! vessels supply+ ! app5dix1 ! vitality ( ! tissues is lo/ & gangr5e results4 ,n[1 ev5 9 ?is1 ! grave/ =m ( app5dicitis1 ! g5]al p]itoneal cavity is (t5 protect$ aga9/ infection by wall+ (f ! pus1 & ! app5dix1 deta*$ 9 ! =m ( a sl\gh1 is (t5 f\nd on op5+ ! localiz$ abscess4 ,b 9 o!r cases !re is f ! beg9n+ ! symptoms ( p]itoneal sepsis & p]itonitis4 ,n[1 x seems to me t a great deal dep5ds on ! k9d ( infection--or1 r1 ! k9d ( organism infect+--& (t5 ! diff]5ce betwe5 a localiz$ abscess & a g5]al p]itonitis is really ! diff]5ce betwe5 a colon & a /reptococcus infection4 ,aga91 %\ld a g5]al p]itonitis develop1 ,i h notic$ f a numb] ( cases 9 ! w>ds t ! prognosis practically dep5ds on ! organism1 al?\gh we all "k t a g5]al p]itonitis is a mighty grave condition1 no matt] :at x is due to4 ,ano!r po9t 9 favor ( ! *ild 0 ! fact t ! gangr5\s process seem$ to />t 9 ! tip ( ! app5dix1 & x seems t :5 x />ts !re1 !re is great] likelihood ( localization1 & :5 x />ts 9 ! base a great] likelihood ( g5]al p]itonitis4 ,i said t !re 0 (t5 d\bt z to ! condition 9 ! abdom5 9 ^! cases4 ,n[1 !re c be no d\bt t ! two ma9 po9ts 9 ! diagnosis ( a localiz$ abscess are tumor & an aggravation ( ! symptoms pres5t4 ,b ?is case exemplifi$ ! fact t !re may be cases :]e !re is no aggravation ( symptoms1 & 9 a great _m cases x may be impossible to feel ! tumor until x has become v l>ge1 ow+ to its situation1 viz41 po/ caecal4 ,ev5 9 ?is case1 f :i* a great quantity ( pus 0 evacuat$1 !re 0 no absolute c]ta9ty ( f9d+ pus on op5+ ! abdom51 al?\gh x 0 suspect$ /rongly4 ,i h se5 a pati5t walk into ! hospital on ,sunday ) a temp]ature ( #ajj & a pulse ( #ii1 & :5 ! abdom5 0 op5$ on ,monday morn+ a mo/ virul5t =m ( g5]al /reptococcus p]itonitis 0 f\nd1 f :i* ! pati5t di$ ! next day4 ,x is said t x is mu* bett] to dep5d on ! pulse & its v>iations ?an on ! temp]ature4 ,i w\ld l to call att5tion to sev]al po9ts 9 ! treatm5t ( ?is case also4 ,fir/1 ! place ( incision 01 z ,i said1 well up t[>ds ! iliac cre/1 & n 9 ! "t-honor$ ,mc,burney po9t4 ,! wisdom ( ?is is self-evid5t4 ,second1 ! c>e us$ 9 n break+ up ! wall ( ! abscess =m$ by ! p]itoneum4 ,also1 ! fact t ! app5dix 0 c>efully dissect$ up & ti$ (f & all[$ to heal by itself1 obviat+1 z mu* z possible1 ! dang] ( a faecal fi/ula4 ,! old] books advis$ evacuat+ ! abscess & leav+ ! app5dix to sl\gh (f1 &1 :ile ,i h se5 sev5 cases :]e ?is me?od 0 us$ & n a s+le faecal fi/ula1 yet x seems to me ! m rational treatm5t to remove ! (f5d]1 z ,i h also assi/$ 9 ?ree op]ations :]e ! app5dix 0 remov$ at ! second op]ation4 ,t is1 an op]ation suppos$ly an app5dectomy 0 done1 & lat]1 at a subsequ5t p]iod1 ! diseas$ app5dix 0 f\nd /ill caus+ ! same old tr\ble4 ,aga91 ! use ( ! lumb> puncture1 s z to dra9 ! abscess cavity f its v bottom4 ,i wond] ?is is n done (t5]1 z x appeals to me z be+ a mo/ s5sible ?+4 ,!n ! abscess cavity 0 spong$ out ) gauze1 & n wa%$ out ) ! antiseptic fluid t books advise1 ?us spread+ bact]ia all ov] ! p]itoneal cavity1 & really do+ no good4 ,nature 0 all[$ to ?r[ (f su* ?+s z %e deem$ necess>y1 an av5ue ( escape hav+ be5 provid$4 ,&1 la/ly1 ! om5tum 0 f\nd & br\ght d[n1 cov]+ 9 ! cavity z mu* z possible1 & ?us aid+ 9 ! wall+ (f process4 ,,direct ,,l>yngoscopy4 ,,by ,,ri*>d ,h4 ,,john/on1 ,m4 ,d4 ,read ,be=e ! ,baltimore ,city ,m$ical ,society1 ,section on ,m$ic9e & ,surg]y1 ,febru>y1 #aiji4 ,direct l>yngoscopy1 z ! "n implies1 is ! inspection ( ! l>ynx ?r\gh a holl[ tube )\t ! use ( a mirror4 ,! exam9ation is made ) ! pati5t 9 ! sitt+ position1 "u local ane/hesia1 or 9 ! prone position1 "u g5]al ane/hesia4 ,to exam9e ! l>ynx 9 ! sitt+ position x is practically always necess>y to give a hypod]mic injection ( morphia & atropia a half h\r be=eh&1 to relax ! muscles & to prev5t excessive secretion4 ,! pati5t is seat$ ^u a l[ /ool ) ! head ext5d$ & support$ by an assi/ant4 ,) curv$ =ceps #bj coca9e or #be alyp9 solution is quickly pass$ into ! ?roat1 ane/hetiz+ ph>ynx1 tongue & epiglottis4 ,jackson's slide speculum is !n introduc$ & ! base ( ! tongue1 ) ! epiglottis1 g5tly pull$ =w>d4 ,at ?is po9t x is usually necess>y to use m coca9e directly 9 ! l>ynx1 :i* is introduc$ by means ( special cotton c>ri]s4 ,9 a few m9utes ane/hetization is complete1 & ! exam9ation c be made at leisure4 ,x w be f\nd easi] to inspect ! diff]5t p>ts ( ! l>ynx if ! head is held ab\t halfway betwe5 ! erect position & complete ext5sion4 ,9 "s pati5ts ) %ort1 ?ick necks & l>ge middle incisor tee? ! slide w h to be remov$ f ! speculum to enable "o to see well4 ,! exam9ation 9 ! prone position "u g5]al ane/hesia is made ) ! pati5t's head ov] ! end ( ! table support$ by an assi/ant4 ,! speculum is introduc$ & ! base ( ! tongue & ! epiglottis pull$ upw>d =cibly4 ,9 ?is position direct l>yngoscopy1 ev5 9 *ildr51 is unsatisfactory1 & op]ative proc$ures are well-nigh impossible on acc\nt ( ! muscul> rigidity4 ,! =ce requir$ to lift ! tissues is s great & ! position ( ! arm is s cramp$ t x is difficult to get a cle> view ( ! field4 ,! difficulty has impress$ all :o h work$ 9 ?is p>ticul> l9e4 ,x rema9$ = ,dr4 ,h4 ,p4 ,mo%]1 ( ,bo/on1 to discov] a me?od ( direct l>yngoscopy :i* makes x z simple "u e!r ane/hesia z 9 ! sitt+ position4 ,9 ,april1 #aijh1 he describ$ 9 ! ,bo/on ,m$ical & ,surgical ,j\rnal ! left lat]al position = exam9+ ! l>ynx & ! upp] end ( ! esophagus4 ,he design$ c]ta9 in/rum5ts :i* ,i believe are too cumb]some to meet ) popul> favor4 ,9 ,mo%]'s position ! pati5t lies on ! table ) ! head turn$ t[>d ! left until ! *eek almo/ re/s on ! table2 ! *9 is flex$ on ! *e/4 ,9 our "w at ! ,presbyt]ian ,hospital we h f\nd a modifi$ ,mo%]'s position & ,jackson's *ild speculum ! ideal comb9ation = ! exam9ation 9 ! prone pati5t4 ,9 *ildr5 ! proc$ure is c>ri$ out ) or )\t ane/hesia4 ,)\t ane/hesia ! head1 h&s & feet are held1 ! *9 is flex$ on ! *e/ 9 a normal position by plac+ a pill[ "u ! head1 ! speculum is introduc$ & ! l>ynx inspect$4 ,9 adults "u ane/hesia ! same proc$ure is us$1 & w be f\nd mu* simpl] ?an ! ext5d$ position4 ,9 adults1 aft] ! speculum is 9 position1 if ! ant]ior "p ( ! l>ynx is n se51 g5tle pressure on ! ?yroid c>tilage w br+ ! ant]ior commissure into view4 ,op]ations c be done ?r\gh ! tube satisfactorily4 ,) ! diff]5t me?ods ( direct l>yngoscopy x is possible to remove any gr[? f ! l>ynx4 #iai ,n4 ,*>les ,/reet4 ,,items4 ,! ,bo>d ( ,tru/ees ( ! ,p]man5t ,end[m5t ,fund ( ! ,univ]sity held its annual meet+ on ,janu>y #aa4 ,judge ,/ockbridge 0 re-elect$ presid5t & ,mr4 ,j4 ,h>ry ,tregoe secret>y-treasur]1 &1 ) ,dr4 ,samuel ,c4 ,*ew & ,judge ,sams1 con/itute ! executive committee = ! ye> #aiji4 ,! funds & securities 9 h& total ! gross sum ( #ah1fce4gd4 ------- ,a special meet+ ( ! ,wa%+ton ,bran* ( ! ,g5]al ,alumni ,association 0 held at ! (fice ( ! presid5t1 ,dr4 ,monte ,griffi?1 ,m>* #aa1 #aiji1 to consid] ! advisability ( petition+ ! ,bo>d ( ,reg5ts to e/abli% a ,bo>d ( ,alumni ,c\nsellors1 a paid presid5t & a ,bo>d ( ,tru/ees1 indep5d5t ( ! tea*+ faculties4 ,resolutions 9 favor ( ^! measures 7 adopt$4 ------- ,dr4 ,l\is ,w4 ,knight1 class ( #ahff1 ( ,baltimore1 has pres5t$ to ,loyola ,college a valuable collection ( papal m$als4 ------- ,drs4 ,h4 ,o4 & ,j4 ,n4 ,reik h remov$ _! (fices to #ejf ,ca!dral /reet4 ------- ,drs4 ,w4 ,d4 ,scott & ,w4 ,e4 ,wieg& att5d$ ! banquet ( ! ,virg9ia ,milit>y ,in/itute ,alumni ,association ( ,baltimore1 held at ! ,new ,h[>d ,h\se1 ,m>* #b1 #aiji4 ,dr4 ,w4 ,d4 ,scott respond$ to ! toa/ ,! ,y\ng] ,g5]ation & ! ,spl5did ,"w ( ! ,virg9ia ,milit>y ,in/itute ,today4 ------- ,major ,william ,f4 ,lewis1 class ( #ahic1 ,u4 ,s4 ,a4 ,m$ical ,corps1 has be5 reliev$ f duty at ,=t ,?omas & ord]$ to sail on ,june #e1 #aiji1 = ! ,philipp9e ,isl&s1 via ,san ,francisco1 = duty4 ------- ,dr4 ,hugh ,a4 ,maughl91 class ( #ahfd1 ( #aba ,nor? ,broadway1 an (ficial 9 ! ,unit$ ,/ates ,cu/om ,s]vice1 :o 0 assi/ant surgeon 9 ! ,six? ,m>yl& ,regim5t dur+ ! ,civil ,w>1 is dang]\sly ill ( pleurisy at 8 home4 ,dr4 ,maughl9 is a memb] ( ,wilson ,po/1 ,g4 ,a4 ,r4 ------- ,dr4 ,james ,a4 ,nydegg]1 class ( #ahib1 pa/ assi/ant surgeon1 ,unit$ ,/ates ,public ,heal? & ,m>9e ,hospital ,s]vice1 has be5 promot$ to ! rank ( surgeon4 ------- ,dr4 ,eug5e ,h4 ,mullan1 class ( #aijc1 assi/ant surgeon1 ,unit$ ,/ates ,public ,heal? & ,m>9e ,hospital ,s]vice1 has be5 commission$ a pa/ assi/ant surgeon1 to rank z su* f ,febru>y #b1 #aiji4 ------- ,dr4 ,samuel ,t4 ,e>le1 ,jr41 ( ,baltimore1 ,md41 records ! case ( ,mrs4 ,f4 ,h4 ,d41 :o1 ! latt] "p ( ,augu/1 #aijg1 :ile eat+ ham1 swall[$ a plate ) two false tee?4 ,t5 days lat] %e _h a viol5t attack ( pa9 9 ! abdom51 foll[$ by a *ill & fev]4 ,!re 0 no recurr5ce ( ?is = "o & a half mon?s4 ,s9ce !n !y h recurr$ f "t to "t1 b n z sev]e1 nor h !y be5 att5d$ ) *ill & fev]4 ,a diagram tak5 ( ! l[] abdom9al & pelvic regions %[$ ! plate 9 ! sigmoid flexure ( ! colon1 on a level ) ! promontory ( ! sacrum4 ,exam9ation ?r\gh ! sigmoidoscope br\ght x into view at ! po9t %[n by ! ,x-ray4 ,!re 0 consid]able t5esmus1 & ! passage ( a good deal ( muc\s1 also a t5d5cy to con/ipation4 ,"u ! influ5ce ( two hypod]mics ( morph9e1 gr4 #a-d1 hyosc9e hydrobromate1 gr4 gr4 ,l-#ajj1 & cact9a1 :i* produc$ satisfactory ane/hesia1 ,dr4 ,e>le 0 able to grasp ! plate ?r\gh ! sigmoidoscope ) a pair ( long alligator =ceps1 & )draw x imm$iately beh9d ! sigmoidoscope4 ------- ,at ! ,conf]5ce on ,m$ical ,legislation1 held 9 ,wa%+ton1 ,d4 ,c41 ,janu>y #ah-bj1 #aiji1 resolutions 7 adopt$ provid+ = a committee compos$ ( "o memb] ea* f ! m$ical dep>tm5ts ( ! ,army & ! ,navy1 "o f ! ,public ,heal? & ,m>9e ,hospital ,s]vice1 "o memb] f ! ,di/rict ( ,columbia & "o memb] f ! ,c\ncil on ,m$ical ,legislation1 to pres5t to ! m$ical pr(ession ! conditions "u :i* ! wid[ ( ,major ,james ,c>roll is n[ plac$1 & to devise su* plans z might seem advisable = h] relief4 ,! foll[+ committee 0 appo9t$3 ,major ,m4 ,w4 ,irel&1 ,u4 ,s4 ,a42 ,surgeon ,w4 ,h4 ,bell4 ,u4 ,s4 ,n42 ,dr4 ,john ,f4 ,&]son1 ,u4 ,s4 ,public ,heal? & ,m>9e ,hospital ,s]vice2 ,dr4 ,john ,d4 ,?omas1 ,wa%+ton1 ,d4 ,c41 & ,dr4 ,a4 ,s4 ,von ,mansfelde1 ( ,a%l&1 ,nebraska4 ,mrs4 ,c>roll has be5 grant$ a p5sion ( #abe a mon? on :i* to support h]self1 sev5 "y *ildr5 & ! ag$ "m ( h] husb&4 ,! h\se1 :i* ,major ,c>roll _h p>tly paid =1 is mortgag$ = #e1jjj4 ,s9ce ! conf]5ce adj\rn$ ! m$ical (fic]s ( ! ,army h rais$ en\gh to pay ! taxes on ! h\se1 "o mon?ly note ( #ej & ! ov]due int]e/ on ! fir/ mortgage1 am\nt+ to #abe4 ,believ+ t ! memb]s ( ! m$ical pr(ession w wi% to contribute t[>d a fund = ! purpose ( pay+ ! balance due on ! h\se1 ! committee reque/s contributions ( any am\nt4 ,!y may be s5t to ,major ,m4 ,w4 ,irel&1 ,unit$ ,/ates ,army1 ,wa%+ton1 ,d4 ,c4 ,! editors ( ,,! ,,bullet9 s9c]ely hope our alumni w honor ! memory ( our mo/ di/+ui%$ alumnus by contribut+ lib]ally to ?is mo/ wor?y cause4 ------- ,at ! la/ regul> meet+ ( ! ,univ]sity ( ,m>yl& ,m$ical ,association1 held 9 ! amphi!atre ( ! ,univ]sity ,hospital1 ,tuesday1 ,m>* #af1 #aiji1 ! program 0 z foll[s3 #a1 ,! ,g5]al ,practition]3 ,8 ,relation to ,8 ,pati5ts1 to ,8 ,fell[ ,practition]s & to ! ,community 9 ,:i* ,he ,lives1 ,dr4 ,guy ,/eele1 ,cambridge1 ,md42 #b1 ,m$ical ,e?ics1 ,dr4 ,samuel ,c4 ,*ew4 ,dr4 ,a4 ,m4 ,%ipley1 ! presid5t1 0 9 ! *air1 & call$ ! meet+ to ord] promptly at #h4cj ,p4 ,m4 ,! att5dance 0 l>ge & appreciative1 & li/5$ to two rem>kably able addresses4 ,^? :o _h ! privilege & pleasure ( li/5+ to ! words ( wisdom & advice bo? ( ,dr4 ,*ew & ,dr4 ,/eele w5t away ) a cle>] conception ( _! duties to _! pr(essional bre?r5 & ! public4 ,imm$iately aft] ! adj\rnm5t ( ! ,m$ical ,association ! ,adjunct ,faculty1 ) its presid5t1 ,dr4 ,joseph ,w4 ,holl&1 9 ! *air1 held a v important meet+1 ! gi/ ( :i* is z foll[s3 ,resolv$ by ! ,adjunct ,faculty ( ! ,m$ical ,dep>tm5t ( ! ,univ]sity ( ,m>yl& t ! ,bo>d ( ,reg5ts be implor$ to effect su* *anges 9 ! *>t] z to make possible ! election ( a presid5t ) a fix$ sal>y1 & ) ! duties usually associat$ ) t (fice 9 /&>d univ]sities1 & a ,bo>d ( ,adm9i/rators indep5d5t ( tea*+ faculties4 ,! ,adjunct ,faculty also endors$ t5tative plans look+ t[>ds ! =mation ( an advisory bo>d ( alumni c\nsellors4 ------- ,at ! meet+ ( ! ,section on ,oph?almology & ,otology1 ,?ursday1 ,m>* #aa1 #aiji1 at ! ,faculty ,hall1 ! foll[+ ( our alumni read pap]s3 ,rod5t ,ulc] ( ! ,cornea 7,ulcus ,rod5s ,moor571 ) ,exhibition ( ! ,case1 ,dr4 ,r4 ,l4 ,r&olph2 ,purul5t ,otitis ,m$ia ( ,infancy & ,*ildhood1 ,dr4 ,h4 ,o4 ,reik4 ------- ,at ! meet+ ( ! ,section on ,neurology & ,psy*iatry1 ,friday1 ,m>* #ab1 #aiji1 ! foll[+ p>ticipat$3 ,hi/ory & ,=ms ( ,*orea1 ,dr4 ,n4 ,m4 ,ow5sby2 ,etiology ( ,*orea1 ,dr4 ,h4 ,d4 ,mc,carty2 ,treatm5t ( ,*orea1 ,dr4 ,w4 ,s4 ,c>swell4 ------- ,! ,baltimore ,/> ( ,m>* #bg?1 #aiji1 has ?is to say conc]n+ ,pr(4 ,r&olph ,w9sl[3 ,pr(4 ,r&olph ,w9sl[1 head ( ! ,dep>tm5t ( ,surg]y ( ! ,univ]sity ( ,m>yl&1 is "o ( ! be/-kn[n lectur]s & demon/rators 9 ! ,ea/4 ,he is a close /ud5t1 & has ! faculty ( impress+ ! "y m5 ( ! ,univ]sity ) ! =ce ( & practicability ( 8 k4 ,pr(essor ,w9sl[ /&s high 9 m$ical & surgical circles ( ! c\ntry1 & ranks ) ! be/ surgeons4 ,"u ! caption ( ! lead+ m5 ( ,m>yl& ,! ,/> also includ$ a photograph ( ,pr(essor ,w9sl[4 ,by honor+ ,dr4 ,w9sl[ ,! ,/> also honors ! ,univ]sity ( ,m>yl&1 ^: au?orities feel a natural pride 9 ! em95t position held by its pr(essors4 ,dr4 ,fitz ,r&olph ,w9sl[1 class ( #aijf1 a =m] resid5t physician 9 ! ,univ]sity ,hospital1 & a resid5t ( ,baltimore1 has locat$ at ,h9ton1 ,virg9ia4 ------- ,! ,phi ,sigma ,kappa ,frat]nity _h an at-home ,saturday1 ,m>* #bg1 #aiji4 ------- ,ab\t sixty memb]s ( ! ,!ta ,nu ,epsilon ,frat]nity1 ,univ]sity ( ,m>yl&1 att5d$ a banquet at ! ,belv$]e rec5tly4 ,x 0 s]v$ 9 ! ma9 hall1 & ! tables1 :i* =m$ a semicircle1 7 beautifully decorat$ ) trail+ asp>agus & cut fl[]s4 ,dur+ ! meal a /r+ or*e/ra r5d]$ popul> selections4 ,dr4 ,ar?ur ,m4 ,%ipley1 toa/ma/]1 introduc$ ,mr4 ,fr$]ick ,w4 ,rank91 :o made ! address ( welcome4 ,mr4 ,rank9 0 foll[$ by ,dr4 ,c4 ,h4 ,ri*>ds1 :o respond$ to ! toa/ ,pa/ & ,pres5t2 ,dr4 ,w4 ,d4 ,scott _h z 8 subject ,! ,frat]nity ,man2 ,dr4 ,r4 ,dorsey ,coale1 ,! ,und]graduate2 ,dr4 ,r&olph ,w9sl[1 ,! ,ne> ,doctor2 ,dr4 ,john ,c4 ,hemmet]1 ,our ,univ]sity1 & ,mr4 ,c4 ,b4 ,ma!ws1 ,! ,ladies4 ,! reception committee 9 *>ge ( ! arrangem5ts 0 z foll[s3 ,fr$]ick ,w4 ,rank91 *airman2 ,ross ,s4 ,mc,elwee2 ,john ,w4 ,rob]tson1 ,john ,s4 ,m&igo1 ,ar?ur ,l4 ,fehs5feld1 ,j4 ,f4 ,&]son4 ------- ,,dea?s4 ,dr4 ,joseph ,r4 ,ow5s1 class ( #ahei1 mayor ( ,hyattsville1 ,md41 & treasur] ( ! ,m>yl& ,agricultural ,college1 di$ at 8 home1 9 ,hyattsville1 ,m>* #ae1 #aiji1 aft] a l+]+ illness ( six mon?s4 ,dea? came peacefully1 & at ! b$side 7 8 wife1 :o 0 ,miss ,g]trude ,e4 ,c\ncilman1 ( ,wor?+ton ,valley1 ,baltimore c\nty1 ,md42 8 daught]1 ,mrs4 ,geo4 ,b4 ,luckey1 & 8 son1 ,*>les ,c4 ,ow5s1 ( ,new ,york4 ,besides ^! he is surviv$ by 8 "m1 ,mrs4 ,p]cilla ,ow5s1 #ij ye>s ( age2 a son1 ,mr4 ,l4 ,ow5s1 ( ,new ,york1 & a daught]1 ,mrs4 ,a4 ,a4 ,turbeyne1 ( ,engl&4 ,dr4 ,ow5s 0 born 9 ,baltimore1 ,febru>y #bj1 #ahci1 & 0 #gj ye>s old4 ,8 p>5ts remov$ to ,we/ ,riv] :5 he 0 sev5 ye>s ( age4 ,:5 he 0 t5 ye>s old he ent]$ ,newton ,academy1 ,baltimore1 & 9 #ahei 0 graduat$ f ! ,m$ical ,dep>tm5t ( ! ,univ]sity ( ,m>yl&4 ,imm$iately aft] leav+ ! ,univ]sity he 0 appo9t$ resid5t physician at ! ,baltimore ,city ,alm%\se1 & s]v$ 9 ?is capacity to #ahfa1 :5 he return$ to ,anne ,arundel c\nty & began f>m+ on ,we/ ,riv]4 ,9 #ahhe he remov$ to ,hyattsville & accept$ ! position ( cl]k ( ! ,claims ,division ( ! ,treasury ,dep>tm5t1 ,wa%+ton4 ,he held ?is (fice until #ahij1 :5 he 0 nam$ z treasur] ( ! ,m>yl& ,agricultural ,college1 :i* position he fill$ until dea?4 ,= sev]al ye>s ,dr4 ,ow5s 0 collector ( taxes 9 ,anne ,arundel c\nty4 ,:5 ! municipal gov]nm5t ( ,hyattsville 0 *ang$ f a bo>d ( commission]s to a mayor & common c\ncil1 ,dr4 ,ow5s 0 elect$ c\ncilman f ! ,?ird w>d1 & s]v$ ) m>k$ ability until ,may1 #aijf1 :5 he 0 elect$ mayor4 ,he 0 elect$ = ?ree consecutive t]ms )\t opposition1 & 0 =emo/ 9 e move t5d+ to ! advancem5t ( ! t[n4 ,z treasur] ( ! ,m>yl& ,agricultural ,college he became acqua9t$ ) _m ( ! lead+ m5 ( ! ,/ate1 by :om he 0 held 9 ! highe/ e/eem4 ,he 0 secret>y ( ! ,vansville ,f>m]s' ,club = _m ye>s1 a director ( ! ,fir/ ,national ,bank ( ,hyattsville4 ,int]m5t 0 9 ! cemet]y adjo9+ ,old ,/4 ,james' ,prote/ant ,episcopal ,*ur*1 ne> ,we/ ,riv]1 ,anne ,arundel c\nty4 ,! c(f9 0 borne f 8 late resid5ce1 ,hill ,top ,lodge1 by sev5 cadets ( ! ,agricultural ,college--,cadet-,major ,mayor1 ,capta9s ,burr\gh & ,jassell1 ,lieut5ant ,j>rell & ,s]geants ,fre]e1 ,saund]s & ,cole4 ,a squad ( #be cadets1 five f ea* class ( ! ,college1 "u comm& ( ,capta9 ,gorsu*1 escort$ ! body to ,p9key ,memorial ,*ur*1 :]e ! ,episcopal burial s]vice 0 read by ,rev4 ,h5ry ,?omas1 rector ( ,/4 ,mat!w's ,p>i%1 ( :i* ,dr4 ,ow5s _h be5 regi/r> & a memb] ( ! ve/ry = sev]al ye>s4 ,! body1 prec$$ by ! college cadets1 0 tak5 to ! ,*esapeake ,bea* ,railway ,/ation & %ipp$ to ,lyons ,creek1 & !nce to ,/4 ,james' ,*ur*4 ,rev4 ,h5ry ,?omas (ficiat$ at ! grave4 ,! pall-be>]s 73 ,messrs4 ,wirt ,h>rison1 ,h>ry ,w4 ,dorsey1 ,e4 ,b4 ,ow5s1 ,o4 ,h4 ,c>r1 ,t4 ,sellman ,hall & ,e4 ,a4 ,full]4 ,a special meet+ ( ! ,mayor & ,common ,c\ncil 0 held 9 ,heptasophs' ,hall ,m>* #bb1 #aiji1 to take action ^u ! dea? ( ,dr4 ,joseph ,r4 ,ow5s1 late ,mayor ( ,hyattsville4 ,act+ ,mayor ,john ,fa9t] ,jr41 0 *airman & ,t[n ,cl]k ,g4 ,h4 ,c>r 0 secret>y4 ,=m] ,mayor ,dr4 ,c4 ,a4 ,wells eulogiz$ ! late ,mayor1 bo? z a public (ficial & a private citiz54 ,dr4 ,joseph ,a4 ,mudd1 ,w4 ,p4 ,magrud]1 ,r4 ,e4 ,:ite1 ,j4 ,w4 ,aman & ,edw>d ,devl91 all memb]s ( ! ,c\ncil :o s]v$ ) ,dr4 ,ow5s1 & ,r4 ,w4 ,wells1 ,m4 ,j4 ,smi? & ,s4 ,j4 ,kelly1 ! la/ nam$ z memb]s ( ! pres5t ,c\ncil1 also made appropriate addresses4 ,x 0 resolv$ t 9 ! pass+ away ( ,dr4 ,joseph ,r4 ,ow5s1 ,mayor ( ,hyattsville1 we h lo/ a consci5ti\s (ficial1 a valu$ associate & a p]sonal fri5d1 & ! citiz5s ( ,hyattsville at l>ge1 z well z 8 (ficial associates1 h exp]i5c$ a b]eavem5t1 ! effects ( :i* !y w ev] feel4 ------- ,dr4 ,asa ,s4 ,l9?icum1 class ( #aheb1 a =m] memb] ( ! ,bo>d ( ,c\nty ,commission]s ( ,anne ,arundel c\nty1 di$ at 8 home1 9 ,jessup1 ,md41 ,sunday1 ,m>* #bh1 #aiji1 f apoplexy1 ag$ #gh4 ,ab\t #be ye>s ago ,dr4 ,l9?icum retir$ f ! active practice ( m$ic9e to engage 9 iron ore m9+4 ,dr4 ,l9?icum's wife1 :o di$ ab\t five ye>s ago1 0 ,miss ,nettie ,crane1 ( ,clifton ,spr+s1 ,n4 ,j4 ,int]m5t 0 9 ,l\don ,p>k ,cemet]y1 ,baltimore4 ------- ,dr4 ,john ,bailey ,mull9s1 class ( #ahhg1 ( ,wa%+ton1 ,d4 ,c41 a memb] ( ! ,am]ican ,m$ical ,association & ! ,am]ican ,society ( ,l>yngology & ,otology1 =m]ly ( ,norfolk1 ,va41 di$ at 8 home1 9 ,wa%+ton1 ,d4 ,c41 f c]ebral hemorrhage1 ,febru>y #aa1 #aiji1 ag$ #db4 ,resolutions on ! dea? ( ,dr4 ,john ,bailey ,mull9s3 ,,:]eas1 ,x has be5 ,god's purpose to sudd5ly call h5ce "o ( our mo/ useful & belov$ memb]s2 be x ,resolv$1 ,by ! ,wa%+ton ,bran* ( ! ,g5]al ,alumni ,association ( ! ,univ]sity ( ,m>yl&1 t we are deeply griev$ by ! premature dea? ( our honor$ associate4 ,by 8 dea? ! public1 especially ^? wor?y ( *>ity1 :om he 0 ev] ready to s]ve1 h lo/ a mo/ useful citiz51 ! m$ical pr(ession a skill$ & pa9/ak+ physician & surgeon1 & ! ,univ]sity ( ,m>yl& an able & active work]4 ,& be x fur!r ,resolv$1 ,t ! sympa?y ( ?is ,association be ext5d$ to 8 daught]1 :om he lov$ be=e all else on e>?1 & to :om he 0 ev] a dutiful fa!r4 ,& be x fur!r ,resolv$1 ,t ^! resolutions be spread ^u ! m9utes ( our ,association & a copy ( ! same be s5t to ! p>5t ,alumni ,association 9 ,baltimore4 ,committee--,i4 ,s4 ,/one1 ,william ,l4 ,robb9s1 ,h>ry ,hurtt1 ,monte ,griffi?1 presid5t2 ,w4 ,m4 ,simpk9s1 secret>y4 ------- ,dr4 ,samuel ,groome ,fi%]1 class ( #ahed1 ( ,port ,deposit1 ,md41 di$ at ! home ( 8 son1 9 ,port ,deposit1 ,febru>y #bb1 #aiji1 ag$ #gg4 ,= m ?an #ej ye>s ,dr4 ,fi%] 0 a practition] ( ,*e/]t[n1 ,md4 ------- ,dr4 ,*>les ,brew]1 class ( #ahee1 ( ,v9el&1 ,n4 ,j41 di$ at 8 home1 9 ,v9el&1 ,m>* #c1 #aiji1 ag$ #gf4 ,f #aheh to ! outbreak ( ! ,civil ,w> he 0 a memb] ( ! ,m$ical ,corps ( ! ,army1 & dur+ ! w> a surgeon 9 ! ,conf$]ate ,/ates s]vice4 ,"u ,presid5t ,clevel& he 0 po/ma/] at ,v9el&1 ,n4 ,j41 & resid5t physician at ! ,/ate ,prison1 ,tr5ton1 f #ahia to #ahif4 ------- ,dr4 ,william ,f4 ,*5ault1 class ( #ahhh1 ( ,clevel&1 ,n4 ,c41 a memb] ( ! ,m$ical ,society ( ! ,/ate ( ,nor? ,c>ol9a1 di$ at 8 home1 9 ,clevel&1 ,n4 ,c41 ,febru>y #bd1 #aiji1 f c]ebral hemorrhage1 ag$ #df4 ------- ,dr4 ,james ,b4 ,r4 ,purnell1 class ( #ahej1 ( ,sn[ ,hill1 ,m>yl&1 di$ at 8 home1 9 ,sn[ ,hill1 ,m>* #g1 #aiji1 f s5ile debility1 ag$ #hj4 ,he 0 vice-presid5t ( ! ,m$ical & ,*irurgical ,faculty ( ,m>yl& 9 #aijj-aija1 =m]ly physician to ! c\nty alm%\se & heal? (fic] ( ,worce/] c\nty4 ------- ,dr4 ,b5jam9 ,frankl9 ,laughl91 class ( #aijd1 ( ,k+wood1 ,we/ ,virg9ia1 di$ at ! home ( 8 fa!r1 9 ,de] ,p>k1 ,md41 f p>alysis1 ,m>* #i1 #aiji1 ag$ #ca4 ,,9 ,,pneumonia ! inspir$ air %\ld be ri* 9 oxyg5 & comp>atively cool1 :ile ! surface ( ! body1 especially ! ?orax1 %\ld be kept w>m1 le/1 becom+ *ill$1 ! action ( ! phagocytes 9 _! battle ) ! pneumococci be inhibit$4 ,antiphlogi/9e 7,inflammation's ,antidote7 appli$ to ! *e/ wall1 front1 sides & back1 hot & ?ick1 /imulates ! action ( ! phagocytes & (t5 turns ! scale 9 favor ( recov]y4 ,cr\p4--,in/ead ( dep5d+ on an emetic = quick action 9 cr\p1 ! physician w d well to apply ,antiphlogi/9e hot & ?ick f e> to e> & d[n ov] ! int]clavicul> space4 ,! results ( su* treatm5t are usually prompt & gratify+4 ,antiphlogi/9e hot & ?ick is also indicat$ 9 ,bron*itis & ,pleurisy 99 99 99 99 99 ,! ,d5v] ,*emical ,mfg4 ,co4 ,new ,york 99 99 99 99 99 ,c]ta9 z x is t a s+le act+ cause c br+ ab\t any "o ( ! sev]al anomalies ( m5/ruation1 j s c]ta9 is x t a s+le rem$ial ag5t--if prop]ly adm9i/]$--c effect ! relief ( any "o ( ^? anomalies4 ,! s+ul> efficacy ( ,ergoapiol 7,smi?7 9 ! v>i\s m5/rual irregul>ities is manife/ly due to its prompt & direct analgesic1 antispasmodic & tonic action ^u ! entire female reproductive sy/em4 ,ergoapiol 7,smi?7 is ( special1 inde$ extraord9>y1 value 9 su* m5/rual irregul>ities z am5orrhea1 dysm5orrhea1 m5orrhagia & metrorrhagia4 ,! creators ( ! prep>ation1 ! ,m>t9 ,h4 ,smi? ,company1 ( ,new ,york1 w s5d samples & exhau/ive lit]ature1 po/ paid1 to any memb] ( ! m$ical pr(ession4 ---------------------------------------- -------------------------------- ,transcrib]'s ,note ,! orig9al spell+ & punctuation has be5 reta9$1 accept = confirm$ typos4 ,v>iations 9 hyph5ation & comp\nd words h be5 pres]v$4 ,italiciz$ words & phrases 9 ! text v]sion are pres5t$ by surr\nd+ ! text ) und]scores774 ,bold words & phrases 9 ! text v]sion are pres5t$ by surr\nd+ ! text ) equals sign 774