Vol. I

ORIGINAL ARTICLES

THE PRESIDENT'S ADDRESS BEFORE THE MINNESOTA STATE MEDICAL ASSOCIATION.*

ARTHUR J. GILLETTE, M. D., St. Paul, Minn.

Mr. Chairman, Members of the Minnesota State Medical Society, and Honored Guests: There is some good in all things, and beneath even the greatest tragedies there is hidden some divine benevolence. Even during these grim and tragic days we may find blessings.

The determined seriousness into which man

kind has been plunged is teaching us things which we only vaguely guessed before. We are becoming conscious of death, and of sacrifice and usefulness which we did not know existed. We are withstanding tests and rising to heights of achievement of which we did not think our

selves capable, and we are discovering potentialities which we might never have learned. Certainly under the stress of the present conflict something greater than ourselves has taken hold of us and uplifted us, and in our suffering and seriousness many great lessons of life have been borne in upon us. For the past few years America has grown up, as it were. As a nation she has been confronted with gigantic problems; she has been baptized by dangers and tribulations.

The medical profession has responded more liberally to the call of the nation and has sent more of its members into military service than any other profession, trade or business in the country. The medical men throughout the

*Presented at the Annual Meeting in Duluth, August 28-29 and 30th, 1918.

No. 10

country have been brought together face to face; and shoulder to shoulder the doctors are battling in unison as they have never done. They have thrown away all selfishness; they are sacrificing their business, home-comforts, and even their very lives for the benefit of humanity. And best of all it is being done in a cheerful spirit and our willingness is surprising even to ourselves. We are becoming more serious, more studious, more painstaking, and with it all we are learning great truths which will be of benefit to the health of the community. We are studying, investigating and working harder than we ever have before. The medical profession has never been so seriously united as it is today, and all for the benefit of humanity. There will be great personal benefit, as well, to the uplifting of the medical man as he works for the benefit of mankind. Thus the medical profession will be brought to the position where it should stand as the great protector of the human race from disease, prolonging human lives and alleviating human suffering.

To enumerate some of its benefits. For instance, the benefit of the preliminary examination of all our soldiers and the benefit of army life to them. The physical examination which our young men who enter into army service must undergo is going to bring about better health; lives will be saved and prolonged and a great deal of suffering relieved, as well as diseases cured. Frequently our Examining Boards discover an army applicant in ill-health who never knew he had any physical defects. Often heart lesions, enlarged glands or skin lesions are found and the aplicant is advised to consult his home doctor. The medical men identified with the draft take their work very seriously and keenly. The thorough physical examination

of the young draftees will result in much good for them and for the country, whose bulwark they are. Defects in the human mechanism have been found in thousands of cases which undetected might have gone on until the man's health was undermined. Corrective treatment has been given in many cases by the examining physicians without cost to the patient, and more than one man will be hale, hearty and whole in the future who owes his health to the

examining draft-board physician and the kindly interest taken by him. Many times we hear him offering his services free of charge to such applicants. These diseases may be incipient to be sure, and yet, when taken in the early stages, may be eliminated. Many, many times in examining a man, nose, throat and mouth infections are found which in time will probably ruin the young man's health, and here the doctor, by his judicious and painstaking treatment or advice is not only going to prolong this man's life, but improve his efficiency as well, both in the army and civil life later. Young men frequently come before the Board with hardly a sound tooth in their heads, with diseased tonsils, adenoids, etc., and these are given attention. A man may have a hernia, which is constantly placing his life in danger, even greater danger than the actual battle of war-fare. This can be remedied and will be if he so desires. Heart and lung troubles will be correctly differentiated and properly treated. Many a man who is suffering from a chronic. eczema, in his opinion, after proper physical examination may be told he has a curable skindisease; also men who are suffering from hemorrhoids, polypi, fissures or ulcers will be cured by proper diet or operation. Incidentally the doctors may discover that the man is not suffering from hemorrhoids but from a prolapse of the rectum or some malignant growth to which the patient has been applying various salves and ointments. These things properly diagnosed will be properly treated. Let us hope the army will teach both soldiers and doctors the uselessness of liniments and the importance of keeping the bowels moving regularly and daily.

It would be surprising to one not watching all these lines to learn how many men do not know how to eat or what to eat. Their diet

needs regulating and it certainly will be regulated in the army. Many do not exercise and have no idea of exercising. They do not even know how to stand properly or breathe properly. Sometimes it takes several minutes to examine a man in order to ascertain whether he can breathe or not as he stands with his shoulders drooping and tipped forward and when asked to take a full inspiration he does not seem to know how to go about it. He does not stand straight and the contents of his chest and abdomen are squeezed and distorted so that his heart, lungs and bowels have not room enough to properly act, thus interfering with his general health. He will be taught, in the army, that correct posture and a vigorous carriage are essential to health.

It is quite amazing to find how many men have eye-strain and remedial eye troubles which are interfering with their efficiency. They have had headaches but had not the slightest idea of if any, attention the cause, and paid very little, to them. Many young men come before the Examining Board who have no idea as to the value of bathing regularly. Perhaps they have no facilities at home and do not realize the important role bathing plays in the conservation of health.

This war will demonstrate the importance of properly constructed houses more forcibly than it is already understood, and boarding-houses, apartments, flats, and even private homes, will come to be constructed under the strictest government supervision. The war will at least bring more serious consideration of proper drainage, ventilation and light, especially in our industrial institutions where so many men and women are employed many hours of the day, breathing foul and vicious air. It will be emphasized more strongly that insects, flies, mosquitoes, manure, garbage and filth of every kind breed and spread disease; that they are carriers of typhoid, small-pox, diphtheria, anthrax, diseases of the glands and all kinds of infections. These values will be demonstrated in dollars and cents, which always appeals to the American people.

How little attention is paid by most recruits to the kind of water they drink, the amount they drink, and the time to drink. Little attention is paid to the amount of rest and sleep

they receive. Thus, in the army, thousands and thousands of recruits will receive fresh air, exercise, rest and labor, properly proportioned in a manner which they never knew before.

This war will do more for temperance than all the temperane lectures ever given, as it will demonstrate we can get along without liquor, and will show how much better the individual and community are without it. It is going to educate the medical profession to the fact that whiskey is a bad stimulant.

It is appalling how many young men are crippling themselves by wearing improper shoes and improper clothing for their feet. The attention which is being given to proper shoes, etc., in the army will keep many a young man from being a cripple.

It has already been shown by army statistics that great physical benefit is gained by drilling and exercising. In some of the camps over forty per cent of the young men have been greatly benefited by army life; young men whose health had been impaired somewhat when entering the camps. Army exercises, drills, diet and discipline, not only make better soldiers but make them better fitted for civil life later. They will be better citizens, more helpful and more efficient because of the army training.

While all this is true of the soldier it is no less true that great benefits are to be derived by the medical man from the army-training. He will be broader in his views upon medical subjects. Possibly no one of the medical fraternity will receive so much broadening as the socalled specialist. Certainly we must all appreciate that our specialists are becoming too much specialized. That is, the nose and throat man is likely to see very little beyond his line; the abdominal surgeon sees very little that can be wrong with his patient but possibly appendicitis. A man devoting his work largely to the heart and lungs forgets that these are merely organs which are helping to make up the human system. He is liable to forget they are greatly influenced by the other organs. This can also be said of the neurologist. His patient may have some trouble which is largely manifested in the nervous system, yet a distant organ may be the cause of the nervous symptoms. So it is with all the specialists in their particular lines. The general practitioner will learn that many of

his patient's constitutional symptoms may be due to some local condition.

Thus the army will teach us the importance of attending medical meetings more regularly than we do. It will teach us that we all benefit from each other. It will have a tendency to bring about something which is very important in the successful practice of medicine, and that is, that the various medical men throughout the State should be more united and should work together more and more. As we look over the vast field of medicine, the amount of experimental work being done and the amount of literature being written, both worthless and beneficial, we know the field cannot be gone, over carefully by any one man, and our medical journals will weed out more carefully the worthless, useless and unauthentic literature. After this war we will appreciate the importance of each other's work; we will realize the importance of being more united, standing, working and consulting together, if you please. How seldom we have consultations now as compared to what we really should have. Is it not a fact that instead of the general practitioner advising his patients where to go and whom to consult, the patient is apt to secretly consult someone whom his neighbor recommended very highly? The general practitioner often admits. this is true.

After the war doctors will know by actual experience that it requires knowledge, scientific skill and experience to build a hospital. They will learn that a hospital is not simply brick, mortar and stone and a few saintly pictures. They will appreciate that an operating room will be just as secure and sanitary even if it does not cost $10,000 to $15,000, and that good doctors, nurses and pathologists and good wholesome food, not variety, are the essentials.

One of the greatest things this war is going to bring about, both abroad and in America, will be to accentuate the part a woman can fill in this world; the part which she has so justly claimed and fought for for many years. She will fill positions as chemist, X-ray expert, pathologist and many other things, and will demonstrate that she is able to do as well as, and even better, than a man, as her hands can do more delicate work, her eyes are keener and she is a closer observer. She will demonstrate a wom

an can be just as good a doctor or surgeon as a man. In fact, she will show her efficiency in thousands of ways. It will also be shown that women are more proficient as clerks. We will no longer see full-grown, strong, able-bodied men selling ribbons and laces over the counters in department-stores. There will be plenty of work for a man to do which is more in keeping with his physique.

Few physicians ever thought psychology would play such a prominent part in the healing of the sick and wounded. Yet in this present war we have psychologists filling important fields in the army. We might say almost the most important field, one which the general

practitioner has been very loathe to recognize. The power of suggestion, environment, cheerfulness and diversion in the army will emphasize their therapeutic benefits and already these elements are occupying a very important part in the health and efficiency of our soldiers.

Certainly no medical officer will use the terms biliousness, nervous-prostration, rheumatism, weak lungs, back-ache or any such indefinite terms in reporting to his superior officer the condition of a patient. He will make some definite and positive diagnosis and send in a written report of the exact conditions found in the heart, lungs, kidneys, stomach, brain, etc. He will investigate and investigate until he actually knows. I am sure a doctor will not perform an operation, surrounded by scientific men, as he will be in the army, and simply call it an exploratory incision. He will give some plausible, sensible and practical reason for so doing.

Army doctors will also be taught the great importance of taking complete and perfect histories and keeping complete records of their patients; something the medical profession is very lax in doing. How many doctors keep any records of their private work today. How many men know anything about the results of their treatment except what they can remember? How many men make careful and systematic examinations of each and every case that comes to their office, keeping the record of their findings? How frequently a man comes to a doctor with a slight cough, arriving at the office just as he is leaving for an emergency or country call. He makes no examination what

ever, and does not even set a time for the man to return for a complete examination of his chest, heart, lungs, nose, throat, etc., to ascertain, if possible, just what causes the cough. How well we know how little, or rather how much a cough signifies. Often the hurried doctor gives some simple remedy and carelessly suggests that the man drop in at any time. The patient probably never returns until some serious condition has developed perhaps because of the doctor's carelessness. We all make mistakes more than we should because of hurried examinations and incomplete records. The army will teach us to strip our patients and keep a complete record of our findings. The army will teach us this more than anything else as each examining physician knows his report and findings will be checked up by one or more men higher up. He probably will never see the patient again, but his report will be gone over by each subsequent doctor who examines the patient. Complete records of our patient will help us should patients return years later.

Certainly the purchase of a large and expensive X-ray machine is of no assistance to us unless we know how to interpret the pictures. Hardly a man of any prominence, or one with a lucrative practice, but has spent many hundreds of dollars on an X-ray machine. Many pictures are taken but they mean absolutely nothing to anyone. In the army the interpretation of X-rays will be taught as well as the taking of them. The surgeon will have to do the interpreting to his superior officers and will perhaps have to advise as to treatment. His opinion will be verified by a number of men, and thus he will learn that it takes an expert to interpret the pictures as well as to take them. He will know whether certain shadows are simply defects in the technique of his work, or whether they mean something important. He will also be taught, by his association with others, that his blood pressure machine will only place him in a ridiculous position if he does not demonstrate to his own satisfaction, as well as to others, that a high or low blood pres sure must lead to some definite conclusion. He will not give a remedy simply to reduce or raise the blood-pressure of his patient, but will try and discover the organ that is at fault and give his attention there. The urinalyses and other