every-day routine. If this keeps on, I am afraid the time is not far distant when the existence of an all-around general practitioner will be a thing of the past, or only to be found in a small community. Is it not our all common experience that a new patient will ask us whether we make a specialty of something only to be favorably impressed if we say we do? They consider the general practitioner as a subordinate. class and the specialist as a superior physician, using us often as an agent for the specialist, calling on us sometimes for the diagnosis, often not even for that, and then turning around and ask us the address of a specialist. Now what must we do in order to change, or to improve such a state of affairs? The answer is very simple: We must educate our patients by showing them that they do not need a specialist right away, that we can treat and usually cure them, if they would only give us their full confidence and be patient. Dr. A. Jacobi relates a little occurrence that happened to him which is rather apropos. A man I called with his child to have it examined, and when this was done, he asked Dr. J. if he had not better go and see a specialist; Dr. J. answered "if he was not satisfied with the doctor he had better go somewhere else." That afternoon the man showed up in Dr. J.'s free clinic. When he saw Dr. Jacobi there he said "doctor you might know what is good for children. but not what is good for yourself." And now how are we going to educate our patients and teach them to be treated first by us before going to the specialist? By studying our cases more closely, devoting more time and labor to examining our patients and trying to keep up with the modern advancement of medicine. We all should spend some of our time every day in clinics doing practical work: we should go to medical meetings, and read medical literature. That some claim to be too busy to do this, is no excuse. If they would cut down their practice by dropping some of their undesirable element of their clientele, or charge bigger fees, they would have more spare time, and with more spare time, they will be able to do better work, and with better work, we can charge better fees, and not allow patients to begrudge the small remuneration we receive, whereas they do not hesitate to pay any fee to the specialist. If in spite of all our efforts we fail to cure our patient, then we should send him to the best obtainable specialist. Thus we will raise the standard of the specialists also, forcing out unworthy elements and leaving only the best men in the country to fill the highest ranks of medicine. Dr. J. Ashburton Thompson, the chief medical officer, Sydney, New South Wales, in a letter written to me October 13, 1908, says, (regarding the Nastin treatment of leprosy, which was introduced to the leprological world, with great flourish of trumpet, by Dr. Deycke Pasha of Constantinople, a treatment of inoculation with cultures of leper-bacilli, etc., and by which Dr. Mason of Wellington, New Zealand. has claimed to have effected cures): "I am much interested in your contributions, especially in that on yeast; in some such , 1910 , Vol. V., No. direction (increasing the opsonic index of lepers) that is to say in the natural forces of the body trained by one means or other to exceed the normal, will the remedy be found. You know all about Deycke Pasha's Nastin, no doubt. I should much like to have your views on it. I have been using it so far without any striking results." Dr. Thompson in his latest article on the trial of Prof. Deycke's Nastin treatment in three cases of tuberous leprosy and in one case of pure nerve leprosy (read at the Second International Conference on leprosy, Bergen, 1909,) shows that this treatment, so lauded by Deycke in his publications (Internationaler Dermatologen Kongress, Berlin, 1904; Deutsch. Med. Woch., 1905; Lepra, 1907; and British Medical Journal, 1908) utterly failed in his hands, and was without any of the claimed reactions and that it was even dangerous to use. In his article published in Internationaler Dermatologen Kongress, Berlin, 1904, Dr. Thompson deplored Hansen's law of segregation as being unworthy of the credit of being sufficient in itself of ridding any country of leprosy. He denied Hansen's claim for credit. Besides this important question of possible opsonic cure of lepers I hope to bring. to the attention of the Bergen Conference another matter equally scientifically sound. Let me briefly suggest it here. Danger is imminent and no delay is pardonable. Organized and equipped investigation-effort is immediately necessary. An International Leper-Laboratory for organized and reliable scientific work is imperatively demanded to be instituted somewhere, to stamp out leprosy from human ills. Not enough satisfactory data exist yet, to induce international philanthropic aid, in its But the behalf, in the sum necessary. medical departments of every government are able and in duty bound towards its own army and navy; and humanely towards mankind, to undertake the work. Let the medical departments of every nation communicate with Dr. J. Ashburton Thompson, of Sydney, New South Wales, the half-way country between the Orient and Occident. Let the United States departments enter into communication with the medical departments of other countries upon this subject. Individual work will be too slow to conquer the disease internationally, and is apt to be hampered by personal disagreements. Harmonious cooperation is absolutely necessary for quickest and best results. Either this or Molokai, where an international laboratory station could be quickly established by our own government's offer of it, and where the hopeless are willing to submit to all treatment, and segregation without complaint. It is as much to be commended on the part of the various governments as is their cooperation at the Hague. No time is to be lost. Private medical work will be stimulated rather than hampered by it. The suggestion as to Molokai does not contain in my mind, the importation there of alien lepers. I have in mind. a permanent station only, to be provided by this government, with residences for the internationally appointed scientific medical delegates, chosen each by his own government; these residences to be free of cost to them, their compensation to be arranged by each government for its own. This government should provide all the buildings necessary-a very small expense comparatively. The leprous subjects are already there, ready for systematic, international investi gation-treatment, and will willingly remain there, being near home, or at home, with police regulation to insure segregation. (Other details to be worked out). Nothing else will do. We have too much fake-treatment of leprosy, too many false remedies, in separated fields of our labor. Let us all follow this scientific work, by united system, and not for selfglorification. Dr. J. Ashburton Thompson's case of legally cured leprosy, a British soldier of Ceylon, departed from the asylum, in New South Wales, at the very moment when his continued presence there was of the utmost importance to leprological science. Under the British Colonial law, he was of course, entitled to his liberty as all symptoms of his disease had disappeared. But Dr. J. Ashburton Thompson says: "As yet it cannot even be claimed that the disease has entered on a stage of assured quiescence." The legal cure of leprosy is by no means scientific cure of the disease, in spite of Louisiana's claim that it is such. We all know how difficult it is to procure attendance without compulsion. The matter I suggest here, that is international treatment of leprosy, will be, I think, a work of years. The people of this land are vitally interested now-did they but know. We are on the very soil of Asia, the home of leprosy, for the Philippines are ours. The Norwegians have been a sea-going people for one thousand years. It may well be that these sea-farers have brought the Asian terror to the eastern world. The question is no longer a local question. The fifty communes of the United States will not unite and cooperate for the national welfare on this health matter. This government needs no special authorization. It has a general and unenumerated police power as has every State government for the public weal, to prevent public woes. This international action idea I hope to be able to present at the second leper conference, which will assemble next August at Bergen, Norway, and as I view it, just where organized international action against leprosy is sure to be most opposed. For Hansen has successfully conquered the plague in Norway, by unloading his burdensome problem on the United States; half his population came here. He stands proudly, therefore, for his "mixed-law," which has permitted so many of his lepers to emigrate, and the Bergen Congress will doubtless compliment him still further by declaring against any united international action, which could have interfered with Hansen's cleaning Norway of her leprosy, by allowing free emigration of lepers and leper families, to other countries. Hansen strongly opposed my ideas of international action against the disease at the Berlin Leper-Conference. It was he who killed my proposition for an international committee. SOCIETY PROCEEDINGS. numerous EASTERN MEDICAL SOCIETY. PRESIDENT'S ADDRESS. A. J. RONGY, M. D., New York City. Mr. Chairman and Members of the Eastern Medical Society. In assuming the office of President, I beg leave to state that I am fully conscious of the honor bestowed upon me. I am cognizant of the responsibilities it entails. I am entirely aware of the difficulties I shall have to encounter. I therefore ask you to cooperate with me and give me your support in my endeavor to make this society the most progressive of our New York organizations. Mr. President, to succeed you in office is quite sufficient to satisfy the ambition of any member of this society. I assure you that I shall spare no time or effort in maintaining the high ethical standards you have so firmly established. I shall try to continue to administer the office along the lines you have so ably outlined. know of the problems you have had to solve; of the obstacles you have had to overcome. With all that I feel that a great deal is yet to be accomplished. I am sure it will be, if the executive officers receive the proper assistance from the individual members. I The executive committee, as now constituted is ready to accept suggestions from the members on any question that will tend to the betterment of the society. The problems of the medical profession at large and particularly of medical men in this section of the city are too to to be brought forth night, but I believe that we are now in a position by virtue of our numerical strength alone, to enter upon certain reforms which affect us most prominently. I particularly have in view the abuse of medical charity which is constantly robbing the physician of his legitimate income and pauperising the public at the same time. I especially refer to family contract practice which I understand is prevalent among our members in certain parts of the city, and has assumed such proportion that it is almost impossible for the physician to maintain his self respect and proper dignity in the community in which he is practicing. Both of these evils can be overcome, and a heroic attempt in that direction must be made. In order for a society to gain the moral prestige and respect of a community it must constantly strive to make itself more useful to that community. Heretofore this society has taken a passive interest in affairs affecting its immediate surroundings. I would suggest that our constitution be amended, so as to establish a Committee on Legislation and a Committee on Public Health, such committees I am sure will be of great benefit to the Society and also to the public. These committees may be newly created or if on due consideration it is deemed advisable, they may supersede the House and Library committees since we have neither a house nor a library. In conclusion I wish to state that I shall concentrate my best efforts to the administration of the affairs of the society, laboring continually with one object in view, and that is to make this body of earnest men not only a power for good but of real service to its members. Tetanus, the Damoclean Sword of Surgery. There is no complication occurring in the course of surgical treatment that strikes such terror to the heart of the zealous surgeon as tetanus. To use every aseptic precaution, to safeguard a patient by every means known to modern surgical technique, to have convalescence progressing splendidly-and then a few hours later to have that selfsame patient dying in the throes of tetanus, is an experience calculated to discourage even the most philosophical and well poised. It is, as a matter of fact, the ambush-like character of its attack that makes tetanus such a fearful , 1910 , Vol. V., No. foe, and places it in such a sinister relation to every surgical operation. It delivers its blow when least expected and when the surgeon as a result of his care and technique would seem to have most right to feel confident of success. But the blow falls and then straightway the whole ground must be searched and researched to ascertain the avenue of infection. Sometimes as a result of the precision possible without modern microscopic and bacteriological methods, the source and manner of ingress of the tetanus organism and its spores can be determined. In the majority of cases, however, the source of the disease remains an unknown quantity; it simply occurs eight to fifteen days after a surgical operation performed under the most rigid precautions. One case only out of several hundred may be stricken, and the technique and care employed with that one case may not have varied one iota from the technique and care employed with all the others. The definite cause may therefore be so obscure, that the sudden development of tetanus and the death of the patient may appear as nothing less than some trick of fate. It is natural to blame something. The infection came from somewhere, and it gained its entrance and exerted its baneful influence somehow. In the past when the source of the infection was not immediately patent, the catgut was blamed. This was convenient, for the accusation could not be refuted. Tetanus organisms were occasionally found in catgut sutures and doubtless a few cases were actually thus produced. Even today indifferently selected or sterilized catgut may be a source of such danger. But with the possibility of securing and employing catgut prepared and sterilized under conditions that forever eliminate it as a carrier of tetanus, anthrax character can no longer be made the scapeor any other organism, sutures of this goat for the so-called idiopathic cases of tetanus. In more ways than one, this should mean knowing beyond the peradventure of a much to surgery. With the possibility of doubt that the catgut is guiltless, more assiduous search will have to be made of other sources of the infection. This bids fair to accomplish the real solution of the tetanus problem and it is not too much to |
