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can profitably read. It is impossible to give in a review a proper idea of the contents. They should be read by every physician.

G. D.

*A Quarterly of Illustrated Clinical Lectures and Especially Prepared Original Articles. Edited by A. O. J. Kelly, A. M., M.D. Philadelphia and London: J. B. Lippincott Company, 1906.

ABDOMINAL OPERATIONS.*

IN this work are considered those abdominal operations common to the two sexes. Section I treats of the subject in general. Section II treats of operations upon the stomach. Section III of operations upon the intestines. Section IV of operations upon the liver. Section V of diseases of the pancreas and spleen. The work shows a wealth of knowledge of modern surgical technic born not only of books but of large experience on the part of the author himself. The many references indicate the former and the clear and detailed descriptions the latter. The illustrations are numerous, new, and of a high order. The entire work is a great credit to both author and publishers and should occupy a prominent place in the library of every abdominal surgeon.

F. B. W.

*By B. G. A. Moynihan, M. S. (London), F. R. S. C., Senior Assistant Surgeon to Leed's General Infirmary, England. Octavo of 695 pages, with 250 original illustrations. Philadelphia and London: W. B. Saunders Company, 1905. Cloth, $7.00 net.

A TREATISE ON SURGERY.*

As we review this work and ask ourselves its purpose and place, we are forced to admit it has both. Not every medical publication has a distinctive purpose. This one is a treatise, as its title indicates, and combines in two volumes the essentials of both the science and art of modern surgery. It has a place because it supersedes and replaces the out-of-date rehashed books of even a few years ago. Volume I now before us first takes up inflammation, then injuries and diseases of special tissues, gunshot injuries, acute wound diseases, chronic affections, tumors, and other general considerations. Regional surgery of the head, neck, and thorax complete this part of the work. The illustrations are new, the type is readable, and in every respect the book is attractive to the medical reader.

F. B. W.

*By George R. Fowler, M. D., Examiner in Surgery, Board of Medical Examiners of the Regents of the University of the State of New York; Emeritus Professor of Surgery in the New York Polyclinic, et cetera. Two imperial octavos of 725 pages each, with 888 text illustrations and 4 colored plates, all original. Philadelphia and London. W. B. Saunders Company, 1906. Per set: Cloth, $15.00 net; half morocco, $17.00 net.

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MEDICAL ETHICS AND ETIQUETTE.*

GEORGE DOCK, Sc. D., M. D., ANN ARBOR, MICHIGAN.

PROFESSOR OF MEDICINE IN THE UNIVERSITY OF MICHIGAN,

THERE is a large number of reformers going about the country longing to give medical students more work. Some think that what the young doctor needs is a course of lectures on ethics; another set think they need more lectures on practical therapeutics; others lectures on medical history, and so on. If all the propositions should go into effect the term of study would have to be nearer forty years than four, and it might be a good thing if they were carried out, but just at present it cannot be. It would be very presumptuous in me to give the idea that I can tell in a few minutes what many people would devote a series of lectures to; and I intend merely to give my opinion on certain subjects that I am often asked about and have my attention called to in other ways. While I may seem to be somewhat dogmatic, that comes from the necessity of speaking rapidly. Nobody need take my word on these things any more than on the character of a thrill or an albumin reaction or any other fact. I believe that a man ought to be his own master in all such things and not take anybody's dictum without the best reasons. What I am about to say are simply things that I have noticed in my own experience and that of others and regard as well worth thinking about, but I decline to appear as a lecturizer or an oracle.

There are two camps, the one believing that medical ethics should be gathered into a formal volume and subscribed to as the children of Israel covenanted at Sinai. The other would have every man his own judge of right and wrong. The latter view is more pleasing to persons of independent and enthusiastic mind, but not essentially safe. It

*An informal lecture to the Graduating Class of the Medical Department of the University of Michigan, April 24, 1906.

might seem that the rules of conduct that guide gentlemen, and I suppose I should say ladies, in the ordinary walks of life ought to suffice in medicine. Or at the most, the rules of gentlemanly conduct plus the Golden Rule ought to be enough to keep everyone from going wrong. But in every calling there are certain peculiar obligations that make it necessary to have a distinct code.. The soldier has his code which would by no means be proper for men of peace; the carpenter, his; the blacksmith, his; and others, theirs. There are certain things that come up in the carrying out of any kind of a calling that require certain modifications of general rules. These rules in the case of medicine have, for a long time, engaged the minds of great physicians and many of them have devoted a great deal of time to writing out what they thought right or wrong in medical life. In fact the very earliest scientific medical writer that we know handed down a set of rules that still excite the admiration of all-Hippocrates, in the Hippocratic oath. He put it in the form that we now have it, and it is interesting to think that for 2,300 years doctors have paid more or less attention to it and have tried to follow its teachings. A great philosopher has called it a monument of civilization of the highest rank. It would be a matter of interest to find out how many here have ever read the Hippocratic oath. [Hands raised.] The number is encouraging. In a good many medical schools when they hand out the diplomas they read the oath and the members of the class subscribe to it. In other cases copies of it are handed around. I have here a translation of it that I thought might be interesting to read at this time. It begins with an invocation to some of the deities. Some would consider this somewhat silly now, but we have to put ourselves in the position of the people to whom Apoilo, Aesculapius and Hygeia were still real and potent.

"I swear by Apollo, the physician, and Aesculapius, and Hygeia and Panacea, and all the gods and goddesses, that, according to my ability and judgment, I will keep this Oath and this stipulation; to reckon him who taught me this Art equally dear to me as my parents; to share my substance with him, and relieve his necessities if required; to look upon his offspring in the same footing as my own brothers, and to teach them this art, if they shall wish to learn it, without fee or stipulation; and that by precept, lecture, and every other mode of instruction, I will impart a knowledge of the Art to my own sons, and those of my teachers, and to disciples bound by a stipulation and oath according to the law of medicine, but to none others." [It is to be remembered that all this comes down from a time when the calling of medicine was limited, and we must not consider this a matter for ridicule but one that throws an interesting light on the origin of the medical profession.] "I will follow that system of regimen which, according to my ability and judgment, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous. I will give no deadly medicine to any one if asked, nor suggest any such counsel; and in like manner I

will not give to a woman a pessary to produce abortion." [The admonition about not giving lethal medicines is the earliest indication of what we look on now as the essential in the art of medicine, that is, not to destroy life but to save it.] "With purity and with holiness I will pass my life and practise my Art. I will not cut persons labouring under the stone, but will leave this to be done by men who are practitioners of this work." [There are two theories about this: One is that it was considered improper for the physician to act as a surgeon; but there is another idea, that they would not remove testes, because in those days eunuchs were made for commercial purposes; the Greeks abhorred this, and the physicians may have thought it beneath their dignity to aid in the formation of such imperfect beings.] "Into whatever houses I enter I will go into them for the benefit of the sick, and will abstain from every voluntary act of mischief and corruption; and, further, from the seduction of females or males, of freemen and slaves. Whatever, in connection with my professional practice, or not in connection with it, I see or hear, in the life of men, which ought not to be spoken of abroad, I will not divulge, as reckoning that all such should be kept secret. While I continue to keep this Oath unviolated, may it be granted to me to enjoy life and the practice of the art, respected by all men, in all times! But should I trespass and violate this Oath, may the reverse be my lot!"

I might add that the Hippocratic writings form a very interesting body of works, and anyone beginning to collect a medical library will do well to look out for a copy, or a good translation of it. A good edition was published by the Sydenham Society, and you can occasionally get the two volumes from twenty-five cents to one dollar a volume, and you can hardly spend two dollars better than for such books. Occasionally you can pick up translations in French and German, but Adams' translation in the Sydenham Society series is one of the best. Among others who have written on this subject, I would suggest Benjamin Rush, because he was not only a great physician but one of the greatest men of this country,-signer of the Declaration, fighter during the Revolution, and influential teacher. If he had anything to say it was worth listening to, and his remarks on the “Medical Life," which you can read in the university library, are extremely interesting. There is another set of rules by Stoll, a translation of which I had published a couple of years ago in The Physician and Surgeon, (1904). They were originally published about the same time as Rush's, each without knowing of the other, but having striking resemblances and some differences. Stoll's came from the most aristocratic of the despotisms of Europe and he considered his a most aristocratic profession; the other, from a democratic. country and by a man who thought he was as good as anybody else, but perhaps no better. There are many books on the subject that can be read with interest. For example, one by Doctor Cathell, of Baltimore, entitled "The Physician Himself," which has a great deal of worldly

wisdom in it, some admirable, all interesting. Another is by Doctor Mathews, of Louisville. In both France and Germany, where medical ethics, sometimes called medical deontology, is the subject of formal teaching, some large books have been published. One of the best is a German work by Albert Moll. Of course you should all read the original and the revised Code of Ethics of the American Medical Association, and, if you find an opportunity, "Percival's Ethics," from which the Code was largely taken. You will also be interested in the "Goodlye Doctrine and Instruction" of John Halle, part of which I had published in The Physician and Surgeon in February, 1905 (page 61). There are also special books on the subject; for example, some for Roman Catholic physicians, or those who practice in Roman Catholic communities; some, entitled "Pastoral Medicine," written for priests, who have to do a good deal of medical work. There are certain details in the practice of medicine among Roman Catholics that differ from the general; for example, abortion is absolutely prohibited, even if proposed with the purpose of saving the mother's life. Then there are a number of details regarding dangerous diseases that should be known, especially the importance of having the clergyman called before the patient's mind becomes obscured. Those who have acquaintances among the priesthood would do well to learn all the details of such matters. It is not my purpose to go into details at this time.

Settling. What are you to do when you settle in a place? Aside from the ordinary business formalities, one of the first things is to call on the other doctors. Very often this is not done. In ordinary society, if I am correctly informed, it is the custom for the newcomer to be called upon. In the case of the ordinary citizen, the neighborhood, or the church or whatever other affiliations he may have, calls or sends its wives to call on him or his wife, and many a young doctor has an idea that the others ought to call on him first. But there are many reasons why that should not be so. The doctors in a town are well known, their names can be learned from the directory, or telephone directory, but the newcomer is not known and unless he make himself known, he might have to wait a long time, no matter how superior he was, before other people would find out his mere existence. Therefore it is not only rational but essential for a doctor settling in a new place to call on the other doctors there because he is going to be one of them. And he should make himself known as agreeably as possible, not as if he expected them to hand over their practices, but as one man talking to others in as modest a way as possible, not boasting of his advantages or ability in any particular line, or the advance of medicine in which he has participated, because after all those things smack of the freshman, no matter how true they seem. And from the very beginning you should get on good and friendly terms with other doctors. That is very often. not done and always with unfortunate results. People working in the same profession ought to work together; if any man from the beginning

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