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man had appendicitis. We called in a surgeon again, who made an incision and evacuated a large quantity of pus. He traced the track clear up to the liver. The wound was washed out thoroughly with antiseptics. The patient was taken to the hospital then, where he could have better care and attention, but he gradually declined until he died. We prevailed on the mother of the young man to let us examine his liver. She kindly consented. We removed the liver, and found about four inches of the lower margin of the liver, extending up I suppose about two inches, all swept away. I have never been able to ascertain the cause of this trouble.
Dr. Howard J. Williams, of Macon: I was very much pleased in listening to the reading of these two papers on gall-stones and gall bladder trouble. I am of the opinion that the disease is a surgical one, and the opinion of the surgeon should always be taken of this condition. I have had the pleasure of operating for gall-stones six times. In two cases the results were fatal. The gall bladder was gangrenous. I have seen two deaths from gall bladder trouble because the advice to operate was declined. One case, particularly interesting to me, was that of a prominent lady in our city, who was taken to the hospital before operation. At the time she was taken there the indications were that the operation would be successful. She improved there, and on the advice of her physician an operation was declined. Three months afterwards she had a recurrence of the trouble, followed by death in thirty-six hours from acute pancreatitis. This case convinced me that this disease should be classed among the surgical diseases, and the opinions of surgeons should be taken. While medicinal treatment may give temporary relief, I doubt whether it is permanent, and where gallstone trouble is present I believe the gall bladder should
DIAGNOSIS OF GALLSTONES.
be opened and drained. Incision and drainage in ordinary cases will give permanent relief.
Dr. William H. Doughty, Jr., of Augusta: I rise more particularly to express my thanks to these gentlemen for their interesting papers and the interesting discussion that has been added on this subject.
I am not altogether in accord with Dr. Williams, who thinks that this is a purely surgical disease, if I understood him correctly. I think most of these cases should be operated on, and possibly it might not be a bad plan if all were operated on, seeing that the mortality of early operation and operation in simple cases is very small. However, there are a good many people who have gallstones who know they have them, or are told they have them, who are not willing to submit to surgical interference, and it is well to know something can be done for these people, with some possibility of affording relief, just the same as in those cases that are operated on. We have heard that soap taken three times a day will do it.
Last winter I saw a man who weighed 325 pounds. He was swallowing a bottle of olive oil every day to keep him from having gall-stones.
I wish to tell you of another remedy that I have used quite a number of times, and apparently with benefit. That remedy is not an original one with me, but I got the idea of its use a good many years ago from Dr. Tyson. I refer to succinate of soda. I have used it often in from three to five grain doses, given three times a day, which if kept up for a long time will give great relief to patients suffering with gall-stones. More than that I can not say.
The diagnosis of gall-stones is many times exceedingly difficult. Possibly it may be of some service, in which the difficulty of the situation is very well known. I saw a man some five or six years ago who had what seemed to
be violent paroxysms of gall-stone colic. He was not operated on. He went to New York later on, and was seen by two physicians there. He had one of his attacks, and a diagnosis of gall-stones was made. He was urged to be operated on, but declined. Later on he saw a physician in Philadelphia or in Pittsburg, I forget which, who made the same diagnosis. He also saw another physician in Richmond. This man traveled about a good deal, and after going from place to place, and being troubled with gall-stones, he turned up here in Augusta to be operated on. I operated on him. He not only did not have gallstones, but so far as I could see there was no evidence that he ever had any. If there was a healthier gall bladder and gall ducts than we found in this case, I have never seen them. I could not find anything the matter with them. Possibly the best part about it is that the operation cured the man. He has never had an attack since. Before that he rarely ever went more than ten days without an attack. You can take the report of this case for what it is worth.
Let me mention a little point in the technique. Dr. Goldsmith inquired about stitching the gall bladder to the parietes in operation in drainage cases. That is not necessary. You can fasten the drainage tube in the gall bladder securely with purse-string suture and drop the gall bladder back into the abdomen. That can be done with perfect impunity, and by the time the purse-string suture is loosened up enough to permit leakage, the adhesions will have formed around the tube, so that you will have a canal leading from the gall bladder when you choose to remove the tube.
A Member: The statements of the various gentlemen in discussing this subject show conclusively that patients
frequently get well in spite of all kinds of treatment, surgical or otherwise.
In regard to the treatment of gall-stones, I have been meeting these cases frequently in my practice, and I must confess that I have never found any treatment that I thought was worth anything.
Dr. White (closing the discussion on his part): I wish to thank the gentlemen very heartily for the generous discussion they have given my paper. The only point of difference seems to be how many of these cases should be operated upon, and I do not think we can decide that off-hand. Dr. McHatton, in his paper, laid down general principles for cases of that kind. These cases come before the general practitioner. If he can give them olive oil, soap, or the succinate of soda and cure them, or make them comfortable, that is all right, and the patients may be satisfied. But if these patients are slipping away from the general practitioner, or getting worse, or having attacks of jaundice and attacks of colic, gangrene with perforation of the gall bladder is liable to occur at any time, and I would like to make an earnest plea that a surgeon be called in to cooperate with the general practitioner in order to save the patient's life, because as it is now conditions are unsatisfactory. In New York, at the Mt. Sinai Hospital, it was found that 50 per cent. of cases of gallstones coming into that institution were in a bad state, so that operation was dangerous. In ten of my cases three were practically moribund when I saw them, and I hope that condition of affairs will no longer exist among members of the profession.
Dr. Rogers (in closing): I have nothing further to say, except to thank the members very kindly for the points they have brought out.
BY M. A. CLARK, M.D., MACON.
In the discussion of this subject, it is hardly amiss to remind you that Ethics, derived from the Greek word meaning character, is the science of conduct with reference to right living and to the attainment of the greatest good. The word right is from the Latin, meaning according to rule; and it has been thought wise to lay down certain fundamental rules or principles upon which Ethics is based.
Besides these rules that pertain to the general conduct of life, it is well that we have such others as apply to the different phases or vocations of life, especially to the professions. So, we have for our consideration, as medical men, Medical Ethics.
It is argued by some that it is folly to have a code of Medical Ethics, because all medical men are gentlemen and every gentleman knows what is right and how to act. his is probably true of those who have spent years in the profession and have had the opportunity of being associated with the best men of the profession. To the young men of the profession, a Code of Ethics is a most essential and valuable guide, and when properly studied and duly practiced, it will not only add to their selfrespect and the respect of the profession, but may save them from blunders that cause much mortification and not a few heartaches.
It is not time lost to discuss this subject, even before