The Montgomery advertiser., 1908-10-18

set that the public must expect of surgeons not absolute efficiency, but a reasonable degree of it. Such a de- gree can be acquired by any surgeon who has aptitude. a love for constant elf-irnproveinent, and readiness to make sacrifices to his ideals Of this type there are4many in your country. as well as mine. The masters of surgery. on the other. hand, . are few In number. It is to them that we of the rank and file must look for the -in- strucfion and inspiration which should constitute large and by no means unimportant part of their work. It Is only a relatively small propor-s ton or the phople that can have the direct benefit of their skill. To their teachings the medical as well as the surgical practitioner must listen. and In the light of the Accomplishments or the advanced surgical clinics of the world 1t is not an exaggeration to .as- sert that diagnoses. especially of ab- dominal and cerebral diseases, are more accurately made by the surgeon or by his medical confrere who fol- lows his own cases to the, operating taote than by the internist who limits his observations to, laboratory, per sonal, and post-morteni examinations. The failure of the public to realize this fact accounts in great measure Tor the many sometime cura ble dis eases that are brought to the surgeon after they, have reached the incurable stage.'', asgts e.., ,,-..
 In the first place. therefore, says pr. Munro, the patient has a right to expect that his family physician will keep faith with him-wilI not conceal the ignorance. of surgery, of which he need not be ashamed, but will give his patient the benefit of the, surgical ,ad- vice obtainable. Suppose, however. that the patient relying on this ad- vice. decides to undergo an operation; i; what then, Says pr: Munro: E
 After a patient has; decided upon operative treatment he ilae the right to demand. first of all. asepsis, proper anesthesia, and intelligent after-care. He should realize. however, that, altho absolute asepsis is the ideal to which all surgeons aspire practical asepsls aione can be guaranteed in the light ot our knowledge at the present time. We should teach the public that the highest degree of ,asepsis, is best at- tained by permanent corps of surgI- cal workers trained. under responsible heads; that properly equipped hos pital with, such trained assistants er,. tails less risk to sthe patient than the haphazard equipment of the private house or. the irresponsible regime of A@NNAS OA NACf VEiNAlbF HOSplIA1H which are open indiscriminately' to opera tors. each with his own methods of operative technic. The ~' patient must be- willing to take certain chances provided the result sought by operation ifs going to lessen the suf- ferings and dangers that are inherent in the existing lesion or dsiease. -
 The public should realize that the dangers. immediate and remote, from anARfhA0No
 dangers do. exist however, and 1t is the surgeons duty to 'tmtnirnize them in every possible way. Ass skilled anesthetist, preferably , permanent member of the surgical. corps. will cause far less damage than the stu dent orSthe frfendly,sfamily- practition- CT who etherizes occasionally, and Wno Is more interested in5 the opera tton than in giving the anesthetfc.
 "An unskilledsi etherizer will make certain of ethe difficult operations. fnl- possible, he willvprolong beyond safety an operation that should be short. and he will increase in any case the chances of a. past-operative pneu- monia- These facts are not generally known by the laity. but that does not warrant neglect on the surgeons part just as much right to demand a skilled anethetist as to. demand skilled surgeon" ,4
 Unskilled assistance at an.operation is in general the source of trouble, Dr. Munro tells us, and no matter how skilled or how eminent the chief operator may be. he may be forced to give up or seriously modify his plans because of the absence of sufficiently skilled helpers. ''The amateur surgeon who operates now: and then for the excitement or for the fee" comes in for share of pr. Munro's condemna- ton. Serious. surgical problems, for this reason. should not, he thinks. be undertaken by small town hospitals, invaluable as these institutions may be in many respects. The time will come, he. thinks. when no physician will assume the responsibilities Of major surgery unless he has had the benefit of special courses of training and practice. If surgeons themselves do not demand this, the public, he says. should do so. as one of their rights in the matter. Next Dr.. Munro takes up the important matter of fees, in which both surgeon and patient, he says. have rights that are not always held in- violate. for we have injudicfous. char ity. on the one hand. and outrageous charges on the other:|
 All patients except paupers and some ,wage-earners should be compell- ed to pay fee for medical and sur gical care commensurate with their earning capacity, just as they are obliged to pay for their provisions. their luxuries, or their dissipations. The wealthy should pay literally for major aperations; they should not be robbed. The self-respecting wage earner, whether on daily wages. a salary, or in Independent business, should not be. treated as pauper. Re should be compelled to pay some fee in proportion to his earnings. the number dependent on his income, etc. The public has abused over and over again the medical charity that hourishes to such degree in our large cities. May 1t not be because to this abuse that tho struggling surgeon is guilty at times of squeezing all that he can from his wealthy client? Our practises need re- forming without doubt, but the abuse in this respect Is infinitely less than that practised by the public which Is competent to pay.
 "That surgeons divide fees with the family doctor bringing them surgical cases Is a wellrecognized evil. For tunately 1t exists to a much smaller extent in the East than in the West. That 1t Is fundamentally wrong and ,arnicSoUs 1oea without saving. It Is