tion conscious of having done some good; of having, at least, contributed your mite to the mass of medical knowledge which will go on record as landmarks for the guidance and encouragement of coming generations, with your interest in your professional work aroused, perhaps, to an enthusiasm to which fatigue and failure and disappointment have long made you a stranger, and you renew your vows to excel, and anew consecrate yourself and whatever of talent God has given you, with your best and noblest endeavors, to the cause of humanity. Who has not, returning from some such meeting, where the paralyzing routine of thought and feeling has been broken, earnestness engendered, and a fresh impulse given to action, forgotten, for the time, the tedious night vigils; the death-bed scenes, where science has stood, with drooping pinions, powerless before the grim destroyer; the long, dark, dangerous night-rides; the pitiless storm, and the colder charity of a thankless clientèle? It would be tedious to enumerate the reasons why the medical profession should be thoroughly organized. Every other class of people on the face of the globe, in every civilized country, are organized for mutual protection, interest, assistance or defence, or for the purpose of advancing some cause or calling. In addition to the few reasons which have been thus faintly suggested, might be mentioned that for mutual defence and assistance. The medical profession seem to have few rights which any feel obliged to respect. It does seem to me that one right that educated medical men have, or should have, is the right to be protected from bastard competition. You who have invested your means, time, labor, and the prime of your youth to acquiring knowledge which shall fit you for the exercise of your high and responsible calling, are compelled daily to encounter the competition, in the struggle for bread and butter, of those who have invested neither money, time, nor labor in the pursuit of medical or other knowledge. But the hope of relief is Utopian at present. Another right which is trampled under foot is the right to demand and receive your fee for an opinion on the witness stand. You are summoned as a medical witness, and put on the stand. You are asked to tell, not what you know, but what you think. Your opinion is thus extorted from you under penalty for refusal. You are in no sense a witness; a witness testifies to facts-what he knows. If an ordinary witness dares to say "I think," "I believe," "It is my opinion," he is hushed up, and told his opinion is not wanted; that he is put there to tell what he knows. But you, gentlemen, are made to give an opinion in a matter of no moment to you, but of much to another; you are subject to the galling crossexamination of insolent, upstart attorneys; subject to be taken from your office, your practice, your family; detained, perhaps, in attendance on court for days, and being called a "witness," you are paid, if anything, a dollar and a half a day. I say it is an outrage, and should not be submitted to. Yet every effort to secure a law to meet the requirement has failed for want of unanimity of thought and action on our part; because the demand has not been made as the sentiment of an organized profession. There is still another, and a most urgent reason why we should organize at once and completely—and as pronounced as are those hinted at, that of which I shall now speak is of more vital importance, perhaps, than any-to procure needed legislation in the interest of the public health. That physicians, individually and collectively, true, conscientious, self-sacrificing physicians, are not appreciated, alas, we all know too well. It is only a physician himself can appreciate what a physician is, and should be, and what his life is. He can look back upon his profession ever advancing with the circling centuries; can contemplate with pride its record, emblazoned with the genius that in every age has added to its treasures; can behold it, great in great names, grand in grand achievements, and can appreciate the surpassing beauty of its principles of charity and beneficence. He can realize, as none others can, that there is no calling or profession, no business in life, save that alone which deals with man's eternal and immortal interests, embodies in its nature and workings so much that is good, so much that is useful, so much that is honorable, as the science and practice of medicine. And though no laurels be entwined in the presence of applauding multitudes, yet to its devotees belong a fame far more enduring. "By the lone couch of suffering, in the still hour of night, when the world's great eye sees not, and its ear is shut, there, with the tears, the sorrows, the gratitude of helpless ones, the faithful physician's crown is begem- | the Simon-pure "quack" who knows he's a med and sanctified." The world knows not a quack, don't pretend to deny it, and does these things, and for shame be it said, when not pretend to be anything else but a quack. we come, earnestly and conscientiously, actu- He is perhaps the most respected, or rather the ated by the purest motives, in the interest of a less contemptible, of any of them, for these suffering and outraged humanity, and ask that first named add hypocrisy to their other sins; the State interpose its strong arm, and save its and last, but not least, we are blessed with that people from the ignorant pretender and the rare bird the so-called "faith doctor;" but mercenary fraud, lo! we are accused of "inter- where the "faith" comes in we can't see, as ested motives," and of wanting "protection he professes to rub disease down, down, befor ourselves." Mounts the hot blood of indig-ginning at the top, till he gets it all finally nation to crimson the cheek of every physician concentrated in the toe, then he "cunjures" at the intimation of such an insult ! it out, we suppose, or amputates the toe, at any It is not very creditable to the medical pro-rate he dupes his dozens a day for a dollar each, fession of Texas that, as numerous as are its and drives a thriving business in the "rubmembers as a class, though composed of men bing" or "rubber trade." But, gentlemen, of more than ordinary intelligence, and of the worst of all is the abortionist, that vilest, better education, they have so little influence. most execrated of all God's creatures (if God This is partly due to the fact, as just stated, did make him), he who sets a price on the that the laity have no conception of the labors, life of an unborn babe, and takes pay for dethe sacrifices, the charities, the beneficences of stroying it! He flourishes elsewhere than in a physician's life, nor of the great responsibility the slums; he is heard of "up-town," somehe assumes in dealing with life and death. times. And yet, gentlemen, we see and know Neither do they wot of the danger of a daring these things as no one else does, and fail to and ignorant pretender; but, in my judgment, bring them to the bar of justice, for fear of it is more due to the want of concert of action having our motives impugned as they surely and thought on our part-the want of organi- would be! Aye, by our tolerance of this state zation. of things, the people look upon us all alike— regarding these as our competitors-and, indeed, by our inaction, we give consent to be so considered. We see them pocketing money for what we would not touch with a pair of tongs, and, by and by, with plenty of money they do attain a kind of respectability; do become, indeed, formidable competitors in the struggle for existence, and the un"fittest survive." Texas was a long while a border State and a frontier people, a place of refuge for all kinds of malefactors, and was characterized rather by a want, than by a wealth of civilization. It is not a matter of surprise, therefore, that the medical profession to-day is, from the force of circumstances and association, of a very heterogeneous nature. In addition to our own supply of ignoramuses and irregulars, we have within our borders the refuse of neighboring States, who, driven out by the enforcement of stringent laws on the subject of medical practice, have sought refuge on these hospitable shores-in this land of gigantic liberty and "do-as-you-please.' Here we have the homoeopath in all the luxuriance of his hot-house growth, loaded with mustardseed shot for all game; see him swell with a how-we-apples-do-swim" air-the prince of charlatans!—with his smooth tongue, devious ways, and infinitessimal nothings, aping the physician! Here, too, is the hydropath, the all-paths, and the no-paths, and the any-andevery-pathy-that-mit-pay, is here. The physiomedical fraud blossoms out serenely, and pretends that he is a physician. Then, there is Would we be considered one of these fellows? God forbid! Then, our only remedy and recourse is behind the bulwarks of organization; to come out and declare to the world that we are physicians, practitioners of the science of rational medicine, and versed in its grand truths; that we have, within our own hearts, taken the Hippocratic oath, and have laid upon the altars of medicine the freewill offering of our life's services, and whatever of talent we possess, devoted heart and soul to the accomplishment of good and the relief of suffering. Let all who feel that they wear not unworthily the mantle of the brotherhood speak and declare themselves, that by a perfect organization of the profession all over the State into societies the people of Texas may know who are and who are not physicians: and when that glorious day shall dawn, which so surely as tomorrow's sun will rise, it will come, when the profession of Texas, organized in every remote section of this favored land, shall send up the flower of its intellect as delegates to a grand State association; then, and not until then, will we ever be able to secure the co-operation of the people in the passage of a law for their own protection, for no matter how urgent may be the necessity for such law-or a law for the suppression or abatement of some sanitary evil -so long as we are without organization so long will we meet with refusal and disappointment in our appeals to the Legislature. Contrast our great State, great in all save sanitary and medical progress, with some of our sister States, and let us see how far behind Texas is in such matters. Already Illinois, Tennessee, and some other States are famous for the quantity and quality of the sanitary work so far accomplished. The law regulating the practice in Illinois has had the effect of causing many colleges to raise their standard of education in addition to purifying the State of incompetents. Thus by the activity of neighboring States, and by our failure, we suffer doubly we have their share of the chaff. In those States failure attended their first efforts, and these laws, now so salutary to their people, were only procured after and directly in consequence of organization. In those States the profession is a unit, and when they speak the Legislature heeds, for it is no longer the voice of one man, or of one part of the profession, but that of a powerful, organized body of intelligent, thinking men, and it is the magic of organization that gives them the dignity to command the respectful ear of the assembled Commonwealth. True, Texas has a State Association, but as good as has been its work, as commendable as have been its efforts at medical legislation, it at present numbers less than ten per cent. of the members of the profession of the State, and I speak by the book when I say that the effort of last year was killed by our men and friends, and it was only by reason of the fact that those who opposed the particular bill which was presented were not members, were not in accord with the association, for the sequel proved that these gentlemen, who were reported as opposing medical legislation, were, in reality, petitioning for the passage of a bill far more thorough and sweeping in its scope than the committee believed it expedient to ask for in any hope of securing its passage. peat, organization is not only advisable in order to collate and make available as statistics the abundance of valuable experience and observation of the many qualified practitioners of Texas, but it is absolutely necessary, if we ever hope or expect to place our State in the foremost ranks of sanitary medical matters; if we ever hope or expect the medical profession to obtain recognition as an integer of the State government, or to have a voice in the enactment of sanitary or any other laws for the protection of the health and lives of the people; for, although, as stated, physicians are everywhere respected, are, as a rule, better educated, and socially stand higher than the average citizen-a certain amount of deference being everywhere shown to our calling, which ranks next that of the man of God-I tell you, for lack of concert of action, for want of a "pullall-together," they are as powerless to influence legislation for the public weal as is the humblest, untutored son of the soil. Our recent experience proves this, and hence I am glad to be with you to-day in this initiatory work. am proud to know that the good county of Williamson has caught the slogan note of reform, and has so gallantly wheeled into line. Thorough organization can be accomplished only by such beginning. Organize your society if you only enroll half a dozen good men. Meet regularly, and endeavor to make your meetings interesting, adopt a constitution and by-laws, and live squarely up to them. Diffusiveness is a potent factor of disorganization, a disposition to prolixity of detail to wander from the subject or point under discussion. Do not allow any discussion out of time and place. Observe strict parliamentary rules, and do all things by rule and time. Appoint an essayist at each meeting, whose duty it shall be at the next to read an essay or report on some topic connected with the science and practice of medicine. Give notice to the members what the subject will be, so that if any member feels incompetent to participate in an extemporaneous discussion of that subject he may read up. In that way you will find habits of observation, and study will be established, and a spirit of emulation will be engendered. Limit each participant in a debate to so many minutes. By the observance of these things you will find THE USe of sutureS IN PERFO- BY M. LANDESBERG, A.M., M.D. Pave always been considered, and justly your meetings will increase in interest as the society grows in numbers and in years; they will be a source of profit, too, to your younger members, and, by the by, none of us are so wise that we may not learn something from our neighbors. Invite the older and more expe- DERFORATING wounds of the sclerotic rienced to report cases, exhibit and describe pathological specimens. In April the State Association meets at Dallas. Each county society is entitled to one delegate for every five members or fraction of five. Be prepared when the time comes to elect yours, and I advise you to send your best men if possible. Should you at any time have before the society any subject or paper which you think would benefit or interest your brethren and many are cut off from such intercourse as you will enjoy-send a copy to the Journal for publication, and let me assure you you will ever find in its editor a cordial sympathizer who will watch your career with a friendly eye. In conclusion, you have cause to be proud of your county. Foremost in the glorious cause of education, her university sheds lustre upon you and upon your people, as well as credit upon the State of Texes. Rich in agricultural industries and resources, she stands conspicuous in the annals of the State. Does she not expect something of her "wise men "? Strive, then, I beseech you, that the cause of medicine the bride of your mature manhood -to whom you have not only consecrated your vows, but have wedded your lives, shall advance, pari passu, in the march of civilization, and keep step to the music side by side with her other institutions, and, as "tall oaks from little acorns grow," may the genial sun of prosperity, now peeping over the horizon with the dawn of the new-born year, warm into vigorous life this "germ" of organized medi cine, and stimulate its growth and development till it shall become, what I predict it will be, if you will but cherish the precepts I have endeavored to inculcate, the "Banner Medical Society" of "The Empire of Texas." so, as among the most serious injuries which may befall the human eye, mostly on account of the frequent occurrence of prolapse of the ciliary body and the vitreous, which so often. lead to cyclitis and hyalitis, with all its fatal consequences. The prognosis in such cases is always unfavorable in regard to the injured eye, and doubtful in regard to the safety of its fellow; in the latter instance on account of the impending danger of the sympathetic ophthalmia. In view of these facts, competent oculists, especially of the English school, do not hesitate to advise instant excision of the injured eyeball, in which the wound passes through the ciliary region, their only aim being, in this sad state of affairs, to secure the other eye from mischief. The usual treatment in perforating wounds of the sclerotic has always been a protracted and tedious one, taxing severely the patience of both the patient and the physician. Confinement to bed, antiphlogistic measures, and compressive bandages have been regarded of supreme necessity, from which any deviation would seem to bring its own punishment. The application of sutures in wounds of the sclerotic is a more recent venture in ophthalmic surgery, and it has generally been resorted to only in instances of clean and slightlygaping wounds of the membrane. Lacerated, ragged wounds of the sclerotic, complicated with protrusion of ìris or vitreous, especially if situated near the region of the ciliary body, are still considered, on the whole, as a noli me tangere, as any surgical interference may only produce greater trouble. I was induced, as far back as 1871, from sheer despair, to apply sutures in a case of lacerated wound of the sclerotic, with prolapse of vitreous, in which the patient had flatly refused regular treatment. This was the case of a man, who came to me a few hours after he had received injury to his left eye-the only one he had. Outwards from the insertion of the external rectus, there was an irregular, gaping wound of the sclerotic, with jagged edges, running from below upwards. Vitreous protruded, keeping apart the edges of the wound. Eyeball was soft; perception of light only dim. On the second day after admission to the hospital, the patient would not submit to any further application of the compressive bandage, and demanded his discharge on account of business obligations. In this emergency I proceeded as follows: I detached widely on both sides of the wound the conjunctiva, drew one flap of the latter over the gaping wound of the sclerotic, so as to cover both the wound and the prolapsed vitreous, and united it by sutures to the other flap of the conjunctiva. I did not dare to place a suture in the sclerotic itself, for fear of the considerable traction which would have taken place by the closure of the broad wound with its ragged edges. Recovery was rapid and complete, notwithstanding the patient had reassumed at once his trade of peddling, exposing himself to all injuries connected with the latter. In the last nine years I had occasion to use sutures in eleven instances of perforating wounds of the sclerotic. The wound was not complicated in seven instances, and involved prolapse of iris, of ciliary body, and vitreous in the others. Of the former, the injury was caused by a penknife in three cases (in one case outside from the insertion of the inferior rectus, and in two cases of the inner corneal margin); in two, by a piece of broken glass (along the insertion of the external rectus); in one by a shoemaker's awl, and in another by a pointed, dagger-like hair-pin. In the last two instances, the wound extended from the inner lower quadrant of the sclerotic to and beyond the lower border of the cornea. The edges of the wound were ragged in three cases. In the four uncomplicated cases, perfect recovery was obtained by the application of catgut sutures through the superficial layers of the sclerotic and through the conjunctiva, in combination with an antiseption monoculus, although patients were allowed to follow their out-door occupations. In three instances of lacerated wounds, treatment consisted in confining the patients to bed, in applying catgut sutures through the conjunctiva, and in closing the eyes by a compressive bandage. Two made a good and permanent recovery. In the patient, however, who received injury by the dagger-like hair-pin, irido-cyclitis developed six weeks after he had been discharged, leading ultimately to serious impairment of vision. The history of the four complicated cases was briefly as follows :— CASE I. A boy, 12 years of age, came under my notice about eighteen hours after he had been struck upon his left eye by a splinter of wood. The eyeball was soft and congested; the conjunctiva oedematous, the pupil contracted; the anterior chamber contained a small hemorrhage. The sclerotic showed a lacerated wound of about 5'' in length, which ran in an oblique and tortuous direction from the lower outer sector to the corneal border; ciliary body and vitreous protruded between the ragged edges of the wound. Vision was reduced to quantitative perception of light. On applying atropia the pupil dilated but slightly. Background of the eye could not be seen. I cut off the protruded part of the ciliary body, which was followed by a loss of a few drops of vitreous, and closed the wound by catgut sutures, laid through the conjunctiva only. No reaction followed, and there was a speedy recovery. At discharge from treatment vision was 10. Vitreous contained fine, filiform opacities, and retina was engorged. In the further course, vitreous cleared up entirely, and vision increased spontaneously to 18. This condition remained unchanged during a further observation of five years. 15 CASE II.-A laborer, 23 years of age, was stabbed in his right eye with a pointed knife. About ten hours later I ascertained, at the inner, lower quadrant of the sclerotic, a lacerated wound, involving the cornea up to the pupillary region. Iris protruded from the corneal wound, and vitreous from that of the sclerotic. Lens was opaque; eyeball soft; quantitative perception of light very doubtful. There was a gash on the inner side of the nose, and a penetrating wound of the lower lid. Patient had been advised in two eye dispensaries to have the eye removed at once. During my attempt to cut off the prolapse of iris, the lens substance freely escaped through the corneal wound, and the prolapse of vitreous increased. The latter was also cut off close to the sclerotic wound, and the latter united by two catgut sutures, leaving alone only the middle part of the wound, where the loss of substance was the largest. Then I loosened the conjunctiva on either side of the wound, drew the flaps over the latter, and united them by catgut sutures. No sutures were applied to the cornea. Under atropia and compressive |
