SOCIATION AS TO SPECIALISTS.

BY DR. JAMES THOMPSON, OF HARRISON, O.

Some time has elapsed since the last meeting of the American Medical Association, and I have waited in vain, expecting to read some comments or criticisms in regard to the measures adopted and laws enacted by the same.

Shortly after the meeting of the above Association in 1868, not a few were the comments and strictures which appeared in the various medical journals of the land concerning the proceedings of said Association. Most of the writers then contended that the valuable time of a learned, liberal and dignified Association should not be spent in conviviality, but that it should have been spent in the discussion and elucidation of occult subjects. But now, after said Association has discussed subjects and enacted laws which are calculated to affect the well being of thousands now in and yet to enter the profession, not one word of comment or criticism do we hear.

We find, on perusing the August number of your journal, that on the first day of the meeting Dr. E. L. Howard, chairman of the "Committee on Specialties in Medicine, and the Propriety of Specialists Advertising," reported, and made the special order for Wednesday, at twelve M. Accordingly on Wedensday, Dr. L. P. Yandell, Jr., of Kentucky, introduced the following resolution:

"Resolved, That private handbills addressed to members of the medical profession, or advertisements in newspapers, calling the attention of professional brethren to themselves as specialists, be declared in violation of article —, of section of the Code of Ethics of the American Medical Association."

Dr. N. S. Davis of Chicago, said:

"It had been the practice to publish cards in medical journals for the purpose of informing the medical fraternity that the advertiser devotes himself to special diseases. These cards were not so much for the information of the public as for the medical fraternity. He hoped that now the question was up, it would be discussed fully."

Dr. L. P. Yandell, Jr., of Kentucky:

"We have allowed physicians to violate the code of ethics by advertising in the medical journals that they are specialists in the treatment of certain diseases. In Europe they are stricter in regard to specialists than here. There, where a physician wins a reputation in the treatment of certain diseases, his professional brethren send cases to him for treatment; but advertisement is prohibited. If we are allowed to resort to advertisement, not as a question of merit, but of money, the

Association should so declare. I am sure I am right in this principle, and want an expression from this Association."

Dr. Sayre, of New York:

"Let those who understand the best mode of treatment in special diseases, instruct their professional brethren through the proper channels, as the honorable way of preferment, not by advertising as a matter of dollars and cents. Let us look the matter square in the face and sustain the resolution of Dr. Yandell. May my hand be paralysed if I make any attempt to profit by advertising knowledge I have gained in my profession.”

"Dr. Mussey, of Ohio, moved to amend by inserting or in medical journals." Said amendment was accepted.

Dr. Yandell:

"The question is, shall we associate with professional prostitutes and medical outlaws?"

"Dr. Yandell's resolution was unanimously adopted."

The resolution of Dr. Yandell is so worded that, at first glance, it looks partly reasonable; but when we refer to his comments subsequently, the objectionable features are apparent. He first speaks of "private handbills or advertisements in newspapers." To this portion we take no exception; but when he states that "We have allowed physicians to violate the code of ethics by advertising in our medical journals that they are specialists in the treatment of certain diseases," the question arises, what reasonable objection can be urged against either of the following modest advertisements?

"E. Williams, M. D., Eye-Surgeon, north-east corner of Fourth and Race streets, Cincinnati, O."

This is copied from the Lancet and Observer, 1861.

"Dr. Edward L. Holmes, 28 North Clark street, Chicago, Illinois. Special attention to diseases of the Eye and Ear."

The above appeared in the Chicago Medical Journal, for 1861, 1862 and 1863. Or to this one:

"Drs. Taliaferro & Buckner, treat diseases of the Eye and Ear, north-west corner, &c."

Many more similar advertisements could we add from the various medical journals of the land.

Is there an unprejudiced member of the medical profession, who will agree with Dr. Yandell in branding and ostracising such men as "professional prostitutes" and "medical outlaws," who resort to such advertisements "not as a question of merit, but of money?"

Permit me to state that in your journal for the month of August, I noticed the following:

"L. P. Yandell, Jr., M. D., Professor of Materia Medica and Clinical Medicine."" Is it a "question of money" with him?

The next gentleman whose name we notice in connection with this subject is Dr. Sayre of New York, who embellishes the subject after the manner of Holy Writ:

"May my hand be paralyzed if I make any attempt to profit by advertising knowledge I have attained in my profession."

Pardon me for digressing in this place. The case of paralysis reminds me so much of the many eloquent bores who are constantly jumping from their seats to explain something. We meet them in every walk of life, in the most insignificant township caucus of the rural district, as well as in the legislative halls of our country; in our county medical societies, as well as in the American Medical Association. Our desire is that their tongues instead of their hands may be paralyzed.

I notice in a back number of the Chicago Medical Journal the name of

"Lewis A. Sayre, M. D., Professor of Orthopedic Surgery."

Is it a "question of money" with him, also?

Next comes Dr. Mussey of Ohio, who was not content with the original resolution, but "moved to amend by inserting 'or in medical journals.'" In your journal for August I notice the following advertisement:

"W. H. Mussey, M. D., Descriptive and Operative Surgery."

Is it a "question of money" in his case?

If I mistake not, Prof. Gross had a good deal to say on "specialists" at a former meeting of the Association, and then and there contended that he was just as competent to treat the eye as were those who made it a specialty.

It is the opinion of your humble servant that, notwithstanding his claim to competency to treat the eye, his writings do not corroborate his statement; for, although an excellent writer on Surgery in general, he makes terrible blunders when writing on the eye.

In support of the above, let us take a cursory glance at Dr. S. D. Gross' writings on the eye, in vol. II, published 1864, page 197:

"In either case the pupil must be dilated with atropia in the proportion of

one-twentieth of a grain to the ounce of water, a small quantity of which is applied several times to the eye a few hours before."

The experience of specialists is, that in a great majority of cases it is at least twenty times too weak, unless we have time to drop it in every few minutes for several hours; but that a single drop of a solution containing from one to four grains to the ounce of water is usually used.

Page 222. Recommends nitrate of silver, oxide of zinc, &c., to cases of ulcerative keratitis. Would the Doctor be responsible should his students cause permanent metallic deposits between the lamina of the cornea? "Specialists" particularly avoid using such dangerous articles. Page 231-Iritis:

"Mercury, then, is the great remedy par excellence."

"Specialists usually cure their patients in a shorter period than three weeks by the use of anodynes, local and constitutional, and contend that mercury is not needed except in syphilitic cases.

Page 235. Recommends the hook in Iridectomy-says nothing about iridectomy forceps. Is there less danger of wounding the lens with the hook than with the forceps?

Page 247. In speaking of the various methods of operating upon hard cataract, the Doctor remarks:

"It is said of Wenzel that he spoiled a whole hatfull of eyes before he had learned the art of extracting, which affords an excellent illustration of the diffi culties which attend this operation, and reason why so few practitioners are found who are ready and willing to undertake it."

He still prefers couching in cases of hard cataract. "Specialists" almost invariably extract hard lenticular cataracts, and if these cases are well chosen, their successes preponderate over their failures in the proportion of five to one. They look upon couching as an abominable operation, owing to the retained lens remaining in the eye; for so long as it remains we never know what irritation it may cause.

Page 289. "Diseases of the Lachrymal Apparatus." He recommends the old and almost obsolete method of inserting the style into the nasal duct through an opening made below the lid. "Specialists" usually insert the point of a scissors into one or other puncta lachrymalia, usually the upper, slit up the canal, and pass the style through the natural passages, thereby making a much more elegant and useful operation.

Page 285. Speaks concerning the operation for Entropion, as fol

lows:

"Much judgment is required in order accurately to proportion the amount of substance to be removed; the great danger generally is, that the operator takes away too little, thus favoring speedy relapse."

"Specialists" caution operators against taking away too much of the integument, contending that it is far more easy to repeat the operation than it is to remedy the ectropion or the inability to close the lids, which often follows the operation for entropion, where such advice is given by Dr. Gross is adhered to. I will add that several such unfortunate cases have come under my observation after having been operated upon by surgeons for the relief of entropion.

Page 292. While speaking of the division of the internal Rectus for the relief of Convergent Strabismus, he says:

"The moment this is accomplished, the eye, from the traction exerted upon it by the hook, springs towards the nose, and the muscle retracts within its sheath, especially if it has been thoroughly liberated from its connections."

The question arises: If the muscle retracts within its sheath, or the Capsule of Tenon, how does it get back again?

"Specialists" carefully avoid such retraction, knowing as they do, that if such retraction takes place, divergent strabismus usually results, a complication which is anything but desirable. That which they aim to produce is simply a setting back of the muscle on the globe outside, but never inside the Capsule of Tenon.

We will notice but one more error and pass on.

Page 270. In describing the anomalies of refraction, the Doctor confounds with it a natural failure of accommodation. After describing Myopia or short-sightedness, he speaks of Presbyopia as follows:

"Presbyopia, foresightedness. In Presbyopy the converse of Myopy, objects can be discerned distinctly only at a considerable distance; hence the person, in reading, holds the book or paper at arm's length."

He states that it is the result of a

"Gradual flattening of the cornea, thus causing divergence of the rays of light before they reach the retina."

Is not his description just as "clear as mud?" Presbyopia is not the converse of Myopia. It is simply a failure of accommodation, occasioned by an increase of hardness of the crystalline lens, so that its form can no longer be readily changed, and its convexity increased by the action of the ciliary muscle.-(Donders.)

Hypermetropia, instead of Presbyopy, is the anomaly of refraction