COLLATION CHATS* The surgeons Dr. Johnson: I am glad it is all over. were certainly busy during the past week. Dr. Snear: Surgeons evidently do not have to have an epidemic in order to become busy. They are true to their calling, they are always the masters of the situation. Dr. J.: What do you mean? Dr. S.: The surgeons do not have to depend upon some invisible power to increase their business. They get together and decide to become busy at a certain time. They make all the necessary preparations, advertise extensively and when the time comes they certainly prove that their efforts were not in vain. Dr. J. It is only a question of concentration, for most of the patients would have been operated sooner or later. Dr. S.: Mostly later. If not for the competent messenger service in the Metropolitan district a great many patients would have escaped a free sojourn of two weeks or longer in a hospital. Dr. J.: These patients had definite indications for gotten-up communications and addresses have so far not their operations. benefitted either the medical profession or the public. Dr. J.: The "College" is only dealing with surgeons. Dr. S. Their plans and principles affect everyone in the practice of medicine. Dr. J. It is too big a problem to deal with the entire medical profession. Dr. S. That is why they will never meet with complete success. The medical men on hospital staffs not infrequently question the authority of the surgeons to interfere with the management of the hospitals. They resent very much the fact that they are not consulted on questions like "fee splitting," etc. : Dr. J. Medical consultants are not confronted with the problem of fee splittings as are the surgeons. Dr. S.: The medical consultants have no problem, for they can split fees in the "open," while the surgeons must keep it a secret; otherwise the hospital's superintendent will not be able to reply to the "College" that they have no surgeons on their staffs who divide fees. Dr. S.: Judging from the daily bulletins one must come to the conclusion that the surgeons suddenly became most expert diagnosticians; no case seemed to baffle them, the diagnosis was clear and certain. This is surely a remarkable accomplishment, considering the short time the surgeons had at their disposal to prepare their cases. Dr. J. A good many patients were kept under observation for some time. Dr. S. The diagnoses of quite a number of cases were forwarded to Headquarters before the patients finished undressing for admission into the hospital beds, and certainly not much time was wasted in doing that. The nurses and orderlies, and even the "house staff," were very civil and polite to anyone who showed the remotest possibility of having a chronic appendix. The question of "fee" was entirely eliminated; everyone, poor or rich, was treated alike—they could be operated on for the mere asking. Not a few of the surgeons will have to work hard to make up for lost time. Dr. J. A city like New York could not afford to have it said that it is behind other cities in the matter of clinical material; besides, there were thousands of visiting surgeons from all over the country who came to see the New York surgeons operate. Dr. S. Many surgeons come very quickly to the conclusion that watching operations at a long distance is time not profitably spent and, besides, they discover that the average surgeon of a metropolitan district does not display unusual brilliancy at the operating table. It is the clever man, not the clever surgeon, who breaks the monotony of an operating room. The real surgeons, from the other cities, were seldom seen in the operating rooms; they were busy behind closed doors, discussing not only plans for the present but also for the future. It requires a great deal of organization work to keep so many surgeons in check. Dr. J.: The actual work of organizing is always done by a few men. Dr. S.: Too few to suit the average fellow. A great many "members" are beginning to feel that there is considerable work left undone and that the numerous finely *This chat took place about October 29, 1919, just following the close of a clinical congress which was held in New York City at that time. Dr. J.: Members of the "College" have pledged themselves not to split fees. Dr. S.: The less said about that the better. Dr. J. I am certain the older members of the "College" do not split fees. Dr. S. They do not have to; they were already : established when the "College" was organized. But the young struggling surgeons-what are they to do? They are certainly up against it, particularly when the older men gobble up everything in sight by operating for "any old fee." What provision has the "College" made for the young surgeon? Dr. J.: No one helped the older surgeons to establish themselves. Dr. S. Some of our best-known surgeons, in the various Metropolitan districts, have gained their practice and reputations by the very methods which are being condemned by them now. Dr. J. It is certainly an evil and it is degrading the profession and, therefore, must be stopped some time. Dr. S. Quite true, but the surgeons do not go about it in the right way. As long as the surgeons will not take into their calculations the family doctors, who have to struggle to make a decent living in the practice of medicine, so long will they not succeed in eliminating the secret division of fees. The family doctors have learned to shun some of the surgeons with self-bestowed degrees. They find many a competent surgeon who never did, and never will, make an application for admission to the "College." Dr. J.: The aim of the "College of Surgeons" is to have every competent surgeon as one of its members and then to educate the public to the fact that only those who are fellows of the college are competent to do surgery. : Dr. S. That will never happen as long as we have anti-trust laws on our statute books. The surgeons must realize that they are not the "whole show" in any surgical operation, and not dismiss the services of the family physician for two or five dollars while they ask for themselves a fee which is as much as the patient "can afford to pay"-and nowadays everyone is able to pay at least two-hundred and fifty dollars for an operation. Dr. J.: Why do not the family doctors insist upon better pay for their services? Dr. S. They try hard enough, but the public won't stand for it. It takes a surgeon to frighten a sick man, and not infrequently a patient will pawn a month's salary to pay for the removal of a normal appendix or ovary. : Dr. J. Wrong diagnosis cannot always be avoided. Dr. S.: A mistaken diagnosis by the family physician only costs two or three dollars, while that by the surgeon costs usually two hundred or three hundred dollars; at least, in such cases the surgeon ought to give a part of the fee to the family doctors, in order to equalize things for those responsible for the mistake. Many a family physician would not wish for more from many a surgeon. Dr. J.: The eradication of the secret division of fees is not the only function of the "College." Dr. S.: The conclusion one arrives at after attending the annual meetings, and also from reading some of the literature, is that it is the most important problem the "College" is called upon to solve, and so far they have not accomplished it. Dr. J.: They are also trying to raise the standards of medical education and to improve the hospitals throughout the country. Dr. S.: Good hospitals will always try to keep up the standard, poor hospitals will never have a proper standard; for as long as the state authorities perform their duties in a perfunctory manner, so long will there be low standards in some hospitals: Besides, the small and poor hospitals can not be reached by the "College of Surgeons," for the members of their surgical staffs are not anxious to join the "College," and should they become members, they would do as they please, anyway. Dr. J. It takes time to solve any problem. : Dr. S. No problem can ever be solved unless it is approached properly. Dr. J.: What is the solution? : Dr. S. Change the entire scheme of the practice of medicine so that the family physician will get a square deal. A. J. RONGY, M. D. New York, N. Y. POETIC AND SPIRITUAL VALUES IN THE beauty of the natural world. It is with this so-called He goes to seed on III. BEAUTY VERSUS PRACTICALITY IN NATURE. HE out-doors is both the habitat and laboratory of the scientific worker. From him we have reason to expect consideration of Nature from every angle. Unfortunately it is too often true that he becomes a routine technician-a specialist with constantly narrowing vision. Eager is he to classify and tabulate data. The facts he collects are apt to cause atrophy of his imagination. He chills every sentiment suggested by Nature. He fears to violate the purity of his calling by flights of the imagination, and hence he insists upon plodding around amongst the facts. Thus he tends to become dry and unstimulating to the imagination. He loses touch with the larger circle of human kind. Instead he should let his scientific light shine not merely for his own narrow circle, but for the larger commonality of men. This he can do in the poetic, philosophic and spiritual interpretation of Nature. It is not enough that he cord up facts. Let him pour upon them the inflammable oil of imaginative suggestion which will burn them into the hearts of men. Fortunately many scientific workers do rise above the mire of drudgery and dull facts. Indeed, they make the mire to bloom with the flowers of poetry and idealism. The facts have not suffered; they have become embellished by larger visions of life. The idealist and naturalist take the larger view, that it is part of a divine plan that man should search out the secrets of Nature and apply them for his own use. To material utilitarianism, however, he adds spiritual and poetic symbolism. He contends that beauty in Nature, by giving joy, contentment and inspiration to idealism, is of the highest possible utility. The present day practical man of the world has his analogue in the realm of education. From the housetops he is proclaiming the need of vocational education. "Train a man for his job," is his slogan-to lay brick, to mold iron, to cook and farm-all the practical things which will enhance efficiency and prevent lost motion. This sounds well. It is good. But let us beware of this sordid materialistic trend; a movement fraught with danger to idealism. Was it not this very thing for which Germany bartered away her soul, lost the idealistic spirit of Goethe, the democracy of Heine? By all means vocational education, but it must be mixed with the poetic and spiritual elements. Let it be the highest function of vocational, as well as of all education, to reveal these things in the materials with which man works. Education which does not leave a man larger in soul falls short of its chief end. • The linear foot has been a unit of measurement since the days of the Romans. Boulton and Watt, in their historic studies of the steam engine, established a unit of measurement in horse-power. But has anyone ever devised a unit for the measurement of the pulling power of beauty? It has a pulling power as certainly as electricity or steam has. It works early and late. Twirl a flower before a baby's eyes; its little hand reaches for it. Already it has come under the kindly influence of beauty. You have seen the crawling child drag itself over to a splotch of sunshine upon the carpet and attempt to clutch it. You have seen the aged woman, During the century past America, as the land of opportunity, has attracted to her hospitable shores millions of the oppressed from the whole world. The energies of the people have been spent chiefly upon the physical and industrial development of the country. The pressure of necessity brought many marvelous inventions. Great enterprises and manufactures sprang into existence to meet the requirements of growth. American enterprise has astonished the world. We have boasted of being a practical nation. Obsessed with the thought of business achievement and wealth getting we have been content to leave to other nations achievement in the realm of the beautiful-in music, art and architecture-and reverence for the wonders and hovering over a plant in bloom, the hand too tremulous and weak to longer ply the needle, yet lifting affectionate touch to the petals of a rose. Even this spiritual beauty does not convert the cold utilitarian and he asks: "But, does beauty get you anywhere?" Listen to a story from real life: A friend of mine with a dear ambition worked long and patiently for its accomplishment and failed. He was discouraged, almost embittered-sick of mind and of body. A little family was dependent upon him. He had lost courage and initiative. Routine office work he did like an automaton, but others must do his thinking. The picture constantly looking at him from the chamber of his imagination was that of his failure in life. of ground forty by forty feet. Before he realized it he had become a husky man with by-products of his garden (health, happiness and enheartment) infinitely more valuable than garden products, corn or hogs or manufactured things, even at war prices. He had been pulled from sickness into health, from discouragement to enthusiasm, from pessimism to optimism-and the beauty of the green, growing things had done the work. A sixteen hundred horse-power motor bore the NC-4 from Trepassy across the Atlantic, but it could not pull a sick man into health. For years France has worshipped at the shrine of beauty-beauty of personal adornment, beauty in civic development, in public parks, in music, art and architecture. And now when the French people have been tried to the death, behold the beauty of their heroism and self-sacrifice. (To be continued.) FRANCIS BARBOUR WYNN, M. D. Indianapolis, Indiana. A lamp to my feet, my guide on the way. He brought me on his wedding morn The lass I never had. And where the father's head has lain, Into my outstretched arms; The tender cooing of his voice Will soon make glad his nestOld cradle and old heart, rejoice To welcome tiniest guest! Though I am old and my sight grows dim, A wonder sweet may I see It may look at me with the eyes of him They softly sleep from toil and strife Who the heat of the day have borneBut a rustle goes through the Tree of Life When a little child is born. F. ROBBINS, M. D. OBITER DICTA PEARLS FROM THE SPORTING PRESS. "Miss Marion Hollins has two legs on the cup.". N. Y. Times. only a small trickle of drinking Water to go over, and taking toll at their Pleasure for the Smallest Drink. There was Thirst and Sickness, to say nothing of Dirt "Shiverick's educated toe drew first blood from the Panthers."-N. Y. Sun. This was not a hospital occurrence nor yet an episode of the hunt, but just goal from the field in a football game. "Gillo, in his dashes around end, repeatedly showed a clean stern to the Crimson warriors."-N. Y. Tribune. And yet the same paper tells us the field was very muddy. Of course, position is everything, but this would be and Dust. Finally the Eldest met to devise a Remedy. called a stymie. One Sage spoke in favor of drinking Milk and saving Water. But it was found that the Wise Ones also owned most of the Cows. A Medicine Man showed that it was quite possible to sustain Life with very little if any Water. if any Water. But the Poor Ones of the Tribe could not afford even that Little. A pious Priest offered Prayers for Rain, and they were answered. But the Wise Ones raised the Dam and still the Tribe suffered. Another Sage showed that, if the Able-bodied would only work all Night pouring Water into the Springs, the Water would flow over the Dam. But the Wise Ones built the Dam still Higher. The Tribe was in Desperate Straits. Few could Wash or slake their Thirst. Finally a young Brave called upon the Members of the Tribe to smash the Dam and Save their Lives and those of their Little Ones. This caused great Consternation. Sages, Medicine Men, Priests and Warriors, agreeing for once, denounced this Act of Violence. One said it was an unpardonable Interference with the Established Business of the Wise Ones. Another that it would be a fatal Blow to all Enterprise. Another that it would ruin the sacred Trade of the Tribe. Another, preferring Evolution to Revolution, showed that, in Time, Leaks would develop in the Dam and some Water must come Through and, besides, the Wise Ones would, finally, have enough Profit and Lower the Dam themselves. When, in spite of these Economic Verities the young Brave cried for Picks and Axes to smash the Dam, they saw that he was a Dangerous Radical and Stoned him to Death. But the Wise Ones raised the Dam a Little More. THINGS WE ALL LOVE. Blotters glazed on one side. The urgent appointment at the office, which turns out to be a patent medicine drummer. The smell of spearmint. Medical talks beginning "There is very little to add" and continuing "Along these lines." The progress of mankind has often been helped, not a little, by what may be called professional poaching, in contra-distinction to the of-late-so-beloved Team Work. Thus the Physician, in the educational field; the Painter in the possibly unconscious portrayal of pathological types; the Novelist as the diagnostician of morbid psychological states, and the Poet in all of them. Diseases of the emotions, of character, and of crowds, are fit study for the Historian and Publicist, as well as for the Clin ician. Codes of Morality and Systems of Ethics may gradually have developed, quite naturally, from the idea of personal benefit and pleasure, as this idea was made to include first, the nearest and dearest, then the next of kin, and then the tribe. With a great many of us it never gets any further. THE DAM; A FABLE FROM THE There was Trouble in the Tribe. Certain Wise Ones had built a Dam just below the clear Spring, allowing It is the habit of our age to deride the contemplative mind and to deify the man who does, things, has red blood, and puts it over with pep and a punch. Sometimes there is just a little lack of discrimination in valueing what is done, and what the "goods" are that he is "there with." I do not know of any fine mechanism that does not need gauges, brakes and steering gear quite as much as motive power. P. H. F. |
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