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disease, taken together, as are due to intrinsic diseases of the stomach. We may find in any case slight flexion or marked flexion in acidity of the stomach. At one time we may find hyperchlorhydria, and at other times almost absence of hydrochloric acid. We attach so much importance to this, yet no one speaks of defective secretion of the saliva, or of insufficient saliva. We hear little or nothing about too much or too little secretion of the intestinal juices. This must be of quite as much importance as defective secretions or alteration in the secretions of the stomach. The intestinal juices are of more importance. These cases, when they go to the stomach specialist, are examined for their stomachs alone. An examination is made of the lungs and kidneys, or with a view to finding a floating kidney, causing a breakdown of the whole peritoneum, which goes over the pyloric end of the stomach and causes sagging of the end of the stomach.

There may be dilatation of the stomach, but the physician does not recognize a floating kidney as the cause. Perhaps the urine is not examined with a view to discovering chronic Bright's disease, or the appendix is not examined to see whether appendicitis exists or not. I have seen so many cases that have gone through the hands of stomach specialists and have been subsequently operated on for appendicitis or for floating kidney, and have been relieved only by that means.

Dr. S. A. Visanska, of Atlanta: This discussion reminds me very much of one I heard on proprietary medicines, in that there is some good and some bad in it. We can not reform the world. It is hard to reform physicians, who constitute a great part of the world, especially here in Georgia. When we send a case to a specialist for examination, we must make suggestions, and in the selection of a specialist it requires judgment on the part of the

practitioner. The fault often lies in the fact of who you are selecting as a specialist. He should be a man who treats you and the patient right. We do not examine our cases thoroughly enough. We are too lazy to make an accurate diagnosis in many instances, and as a consequence very often patients go to or are sent to specialists. Of course, there are certain cases that should be sent to a specialist, or at any rate a specialist should be consulted in regard to them. I do not think it is wise to send patients direct to specialists, unless they are surgical cases, or the patients have some disease that requires a special operation. The specialist should be consulted in order to help us in making an accurate diagnosis.

I was taught in a medical college, from which I graduated, that if a man could diagnose a case he could treat it. That is all right to a certain extent. There are many cases, however, that can not be cured, while there are others that can be greatly benefited if not entirely cured. One of the best points in treating any case is to know what we are doing, and very often it is the duty of the general practitioner to call in a specialist in a certain line to assist him in diagnosis. It is also the duty of the specialist to call in the general practitioner, because the general practitioner is better posted on some diseases than is the specialist. Every general practitioner has the reputation of being a specialist in some line. One man is good in treating fevers. He can treat fever cases better than another practitioner. Another man is noted for his skill in treating diseases of the kidney, although he may be a general practitioner. He is a specialist in that line, and is known to the public as such. Of course, a great many errors will be made by the specialist sometimes, because, inasmuch as his attention is confined to one particular line, he be

comes necessarily narrow in that line, and hence errors in diagnosis will occur.

I recall a case of lobar pneumonia which was diagnosed as appendicitis, and was operated on. The case was looked at purely from a surgical standpoint, and the lungs were not examined at all. It is true the patient had some fever. The patient was operated on, and the next day pneumonia developed.

Dr. McHatton (closing the discussion): I am very much obliged to the members for the free discussion they have given my paper. It is one of the most important subjects before the medical profession in our State today. There can be no question as to where the fault lies. It lies with the general practitioner, the specialist, and I may say more especially with the patient, because it has got to a point now, as I remarked in my paper, where a great many people make their own diagnoses and go directly to a specialist. He is working in that special line and he is liable to accept a diagnosis, with the presumption that somebody else has had charge of the case, without inquiring whether it is such and such a case, or not.

It is impossible to take this subject up in a manner in which it should be, as it is so vast. We can very materially better the condition of our patients by sending them to specialists with our diagnosis, thus assisting the patient and having the specialists inquire in regard to other local lesions, and who is their physician and who has charge of them.

In regard to a patient having tuberculosis without tubercle bacilli being found in the sputum, I will say that while the finding of tubercle bacilli in the sputum is pathognomonic generally of pulmonary tuberculosis, the man who depends upon this evidence entirely will make a serious mistake some time, for the reason that in many

cases we do not find tubercle bacilli in the sputum in cases of tuberculosis. According to one of the latest reports from Germany, in 50 per cent. of cases of tuberculosis in that institution, they did not find tubercle bacilli, and I do not hesitate to make a diagnosis of tuberculosis where I have not been able to find tubercle bacilli after repeated examinations.

In regard to the remarks of Dr. Jones, about making a careful and thorough examination of patients, I think it is very important that we should do this. We should not hesitate to tell patients what is the matter with them. Patients are taking this thing up themselves now, and in this connection I will say I had a beautiful illustration of it since my paper was written.

A lady came into my office-a very intelligent woman -who stands high in educational circles-and after asking her a few questions I told her it would be necessary for me to make an examination of her lungs. She said, "Doctor, I think that will be unnecessary, because my lungs have been examined by Dr. So-and-so and Dr. Soand-so. Each one of them has told me that there is no trouble with them." I said to her, "Madam, you came to me for my opinion, and I will be compelled to examine them." I told her to remove everything but her undervest. I examined her lungs, and found that she had tuberculosis. When I finished the examination she said, "Doctor, I have unintentionally deceived you. I have told you that which was not so. I told you that my lungs were examined by two or three physicians, but I find now that they have never been examined before."



The State has competent men who test the oil we use for lights, are careful that every barrel comes up to the fire test of 1.40. The interest of the farmers are carefully guarded by the guano inspector, who sees that every sack has all the plant-food the cotton-grower expects for his money, and these are good laws.

Yet, Georgia, with all of her enterprise, is far behind many other States in the protection of her people by allowing foodstuffs that are debarred by other States turned loose on her people with no protection. There is no law to prevent the sale of adulterated flour or tainted meat, and poultry kept in the undrawn state for years in cold storage, reeking with bacteria. Not many of the people understand the danger to health and life in this kind of food.

I quote from investigations of Dr. McArrow, of Oneida, N. Y., on cold-storage poultry. In the slaughter and preparation of poultry for cold-storage and market, the major portion is killed in October and November. After slaughter the feathers are removed and the carcasses packed in barrels and shipped to storage plants without further dressing. The heads, feet and legs, as well as craws full of partially digested food, the decomposing livers and lungs and the intestines with their filth and

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