NEGLECT OF MEDICAL HISTORY It is little short of astonishing that in a presumably learned profession, whose doctrines are inspired and its conduct governed to so large an extent by conservatism and tradition, there should be such a lamentable ignorance of medical history. Quite aside from any considerations of educational thoroughness and practical utility, one might suppose that among a class of men representing more than the average degree of intellectual culture, there would be a goodly proportion of purely esthetic interest in the history of their own science and profession-rich as it is in the most absorbing and significant lore pertaining to both men and processes. One of the oldest, if not the very oldest, of human avocations, as old as man himself, antedating even religious cults, many of which flowed out of the physical needs of mankind-it would seem that the history and development of medicine would offer an attractive field of reading sheerly on the ground of its own innate relationship to the humanities. And when one further considers that it is directly concerned, and has always been closely associated, with the most elemental and intimate experiences of individual, family and national life, it is hard to understand how any physician with the least glimmering of philosophic interest in his craft can have escaped its spell. Yet the fact appears to be that, as a class, the medical man is not only profoundly ignorant but utterly indifferent to the historcial aspects of his calling.

But it is not merely the esthetic or literary viewpoint that makes an appeal to the medical profession for a wider and better acquaintance with its own history. Against that appeal by itself it might be urged that the average practitioner, busy with the practical phases of his vocation, has but little time, even if he had the inclination, to browse among its historical lore; and that this dilettante indulgence of the esthetic faculty must, in the nature of things, be restricted to the favored few who have both the taste and the leisure. Such a summary disposition of the matter, however, will not avail, even from the most practical and materialistic quarters, because both

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the science and the practice of medicine are of such a nature that it is impossible to divorce their historical and their pragmatic aspects. As a science, medicine did not spring, Minerva-like, from the brain of Jove, but is a composite product of a slow evolutional process, to which every age, almost every people, and certainly every scientific and philosophic epoch, has contributed. Into its crucible have been thrown the theories and empiricisms of hundreds of centuries, all of which have been subjected to the inexorable smelting process by which the noble metals are separated from the base. The process, advanced as it is, has not been perfected-it is still a process

and it is hard to see how the present contents of the melting pot can be intelligently evaluated or adequately utilized without some little knowledge, at all events, of the flux of which they are the net resultant-at least of the salient stages and their significance. It does not seem that any man can be thoroughly equipped to the task of interpreting the physical maladies of mankindin which are included all the agencies of etiology and diagnosis-or of applying remedies-in which are embraced all the resources of modern therapeutics-who is not at least on speaking terms with the history of medicine.

If a real and valid excuse be sought for the ignorance of and the lack of general interest in medical history among the profession at large, it might, we think, be found in the almost utter lack of the right kind of literature on the subject. We are not overlooking or belittling the fact that there are several histories of medicine in the field which, regarded from the standpoint. of sheer historical accuracy and wealth of data, satisfy the most exacting standards. There are even works extant which attempt, after a fashion, a more or less philosophical interpretation of the data. But we must confess our feeling that they are not such histories as the average man in the profession could be expected to read with any degree of interest or understanding. What is needed and badly needed-is a historian with a proper sense of proportion, a keen discrimination between the essential and incidental, and a charm

2

THE RISE OF MEDICAL GYNECOLOGY It is gratifying to note a decided and steady return to sanity on the part of our friends, the gynecologists. For many years there seemed to be no place at all in this branch of medical science for therapeutic principles and practice. Its alpha and omega was expressed in the one word, Surgery. No remedy was offered for the simplest ailment of the most useful pelvic organ except the very obvious recommendation to lop it off, and no better subject appeared for discussion among gynecologists than the most workmanlike method of lopping. Nor was that the worst feature of the matter. Not only was Ephraim joined to his surgical idols, but he actually gloried in his idolatry, so that the high places of gynecology, in this country at all events, became temples of skilled mechanism, where men worshipped, awestruck at the marvels of manual dexterity.

ship of the false gods of surgery in the ranks of gynecology-false, be it understood, only in respect of their exaggerated significance-there remained a thousand knees that had not bowed to Baal and all the lips that had not kissed him, and that the counsels of these saner men are now beginning to prevail. We are coming to recognize that there are other and better ways to the female pelvis than through the vagina and the abdominal wall, and other and better means of controlling the genital functions than by suppressing them. We are beginning to realize the significant truth that nature designed the vaginal opening for an outlet and not for an inlet.

own.

The hour has struck-and we are glad to hear it sound-for all the dazzling butchery to cease, and physiological gynecology is coming into its The tide has turned, and whereas there were formerly no internists in gynecology except among the smaller and less daring men, now it is the latter who resort in every instance to the knife, while the gynecological leaders are giving more and more attention to therapeutic and plastic measures. We have no more desire than anyone else to witness a return to the old state of affairs, when the youthful graduate armed himself with a speculum and a glycerine-and-iodine tampon and set out to practice gynecology. But there is a wide pathologic and therapeutic range between the glycerine-and-iodine tampon and a pan-hysterctomy-and this middle ground represents the genuine science of gynecology, the rational control and therapeusis of the female genital organism.

Now we have no thought of belittling the value of surgery, nor questioning the desirability, so long as the surgical expedient has to be employed, of impressing into its performance all the mechanical and executive skill that is available. Nor need we deny that, in individual cases, surgery of the most radical type is often a necessity; even Nature performs amputations when other means fail. Nevertheless, the central truth remains that surgery at least amputative surgery, whatever may be true of plastic surgery-is not an ideal or scientific measure, but a dernier resort, furthest removed from proximate principle of all the courses open to us, and in its essential performance it bears no relation to the progress of medical science, i. e., in the understanding of and proximate assault upon disease. He who designs a superior surgical technique, or demonstrates how a hitherto unmanageable lesion may be successfully extirpated, renders a signal service to individual suffering that may be freely admitted. But he who succeeds, in ever so humble a way, in turning back, to ever so slight a degree, the surgical indicator achieves a far more real and permanent contribution to medical science, and renders a fundamental service to the race.

Hence, we repeat, we are unfeignedly glad to know that amid the widespread and fatuous wor

We rejoice to see that the exploration and development of this hitherto untrodden territory in gynecology is at last being seriously undertaken by those who are most competent to work it out-that our great gynecologists are shaking off the spell which has so long held them enslaved to the dazzlements of brilliant surgery, and are going about to establish, deep upon the foundations of physiology and proximate principles, a system of gynecology whose development and administration will reduce the element of surgery to a minimum, if indeed it does not cancel it from the equation altogether.

of the professions or from the public looking toward a reform of the present pernicious state of affairs. Massachusetts still remains the solitary exponent of intelligent progress in this direction. In every other state in the Union the coroner's office seems to be hopelessly joined to its political idols.

That the present condition is a pernicious one needs only a most cursory knowledge of the facts to render it a self-evident proposition. Indeed, so far as we have seen, nobody has ever disputed it. The failure to realize it to the point of reformatory action has been altogether due to indifference and inertia. Yet it is a matter in which the public at large is most vitally at interest. Every day brings forth some fresh illustration of the injustices and inequities pertaining to the present slipshod system-or lack of system, rather—and no man in the community knows how soon he may be the victim of its vicious workings, or how severely he may be hit by the encounter. No one realizes the situation more keenly than the men who are entrusted with the administration of the coroner's office, and it is greatly to the credit of these men that they have not spared, but have cried aloud concerning its dangers and defects-but apparently to deaf ears.

Only the other day a case in point came under the direct observation of the writer which made him wonder that the medical profession, at least, if not the public (who are proverbially slow to be aroused), did not rise up as one man and demand the abolishment of so obsolete and manifestly unjust a method of procedure. The case in question was a suit brought by a widow to recover insurance upon her husband's death. The insurance company fought the claim and rested their case upon the post-mortem report of the coroner's physician, made a year ago. Every other feature of the evidence was favorable to the claimant and indicated beyond a doubt, at least in any medical man's mind, that death had been due to a pulmonary embolism immediately induced by the accident in question. But the report of the coroner's physician showed no such lesion-doubtless had never been looked for by the young and inexperienced man who, under the present political system, was at that time performing the coroner's work. The report did show the presence of a mitral insufficiency and slight myocarditis, which the medical witnesses were obliged to admit might account for the decedent's death. The defending company rested their case implicity upon the coroner's report, which naturally carried official weight with the jury, and the claimant lost her insurance money, amounting to several thousand dollars.

Sometimes the mafter works out a little more

fortunately for the ends of justice as in another damage suit which recently came within the writer's ken. In this instance a widow was suing a gas company for compensation for the death of her husband, who succumbed to the fumes of illuminating gas which escaped from a defective gas pipe, the result of criminal negligence on the part of the company. Here, for some reason or other, the prosecuting counsel quite overlooked the resport of the coroner's physician until almost the end of the trial. The case went overwhelmingly against the plaintiff, and a verdict for the defendant was practically a foregone conclusion, when a sudden inspiration of recollection moved the woman's counsel to unearth the coroner's report and to subpoena the physician who made the post-mortem to the witness stand. His testimony and the filed report completely turned the tide of justice, showing conclusively that the deceased had died of carbon monoxide poisoning, and won the widow her just compensation.

These are but two illustrative cases gleaned from a record of many hundred similar ones. We repeat, they occur every day. In one instance the outcome was disastrous to the manifest interests of justice; in the other it was happily advantageous. But disaster and advantage alike preach the same lesson. If there had been a proper legal procedure at the coroner's inquest, an embodiment of its findings in an authentic report, and a compulsory introduction of the coroner's proceedings as a routine part of the suit, whether civil or criminal, based upon the death of the decedent, then there would have been no miscarriage of justice in the one case, and no narrow escape from such a denouement in the other.

It is astonishing that such a glaring abuse should be permitted to continue in our medicolegal system without a sign of protest from those who suffer under it-or it would be astonishing if we did not see the same indifference in other quarters. The public press can hardly be looked to in such a matter, since it is almost invariably bound up with political intrigues, and without the public press it is hard to get the ear of the people. The bar is the proper source of reform activity, but the bar has known of the abuse for many years and has not moved to abolish it, from which we must conclude that it is as indifferent as the public. It appears to be left to the medical profession to inaugurate a sentiment and a campaign which shall sweep away this nefarious mode of procedure. Let us take up the gauntlet thus thrown at us and see the thing through.