502 



SCIENCE 



[N. S. Vol. XXXIV. No. 877 



practise the nurse trained in hygienic 

 medicine is indispensable. 



The practitioner, although he must be 

 able to apply or to direct others to apply 

 appropriate hygienic measures, is himself 

 primarily responsible for physiologic medi- 

 cine, for the accurate diagnosis and medical 

 and surgical treatment of the sick indi- 

 vidual. He must be able to determine 

 accurately the condition of the more impor- 

 tant internal organs and be able to apply 

 drugs or other treatment with due regard 

 for these conditions. While many rough- 

 and-ready methods of diagnosis may be 

 used in the home or at the office, many of 

 the more refined methods are here excluded 

 by lack of time or equipment. Thus only 

 too frequently a serious condition is over- 

 looked at its inception and when discovered 

 is so far advanced as to make a cure diffi- 

 cult or impossible. A large percentage of 

 cases of tuberculosis are not recognized 

 until well advanced, in spite of the recent 

 agitation about the disease. This neglect 

 to recognize tuberculosis early will be a 

 standing disgrace to the profession so long 

 as it exists. 



Under present conditions of private 

 practise crude, rough-and-ready methods 

 of diagnosis are in many cases the best that 

 can be utilized. A refined method poorly 

 executed is worth far less than a rough 

 method carefully and intelligently used by 

 an experienced, keen-sighted, thoughtful 

 man. But the public has a right to de- 

 mand the more refined methods. "Within 

 a generation we have seen most of major 

 surgery transformed from the home to the 

 hospital. There the surgeons can depend 

 not only on the nursing staff to provide 

 better hygienic treatment than is possible 

 in the home but he can also in a well- 

 manned hospital depend on the internes to 

 utilize many of the more refined and time- 

 consuming methods of diagnosis. To these 



factors surgery owes no small part of its 

 success. 



In internal medicine the hospital is like- 

 wise becoming more and more utilized. 

 Sanitariums with highly developed means 

 for applying hygienic treatment have long 

 been popular in the treatment of chronic 

 troubles. Hospitals have not been suffi- 

 ciently used for the diagnosis and treat- 

 ment of disease in its inception and less 

 severe aspects, biit everything points to a 

 rapid development in this direction. What 

 is needed is more cooperation and less com- 

 petition among the physicians in any given 

 community. With better cooperation hos- 

 pitals fitted for diagnosis and treatment 

 could readily be established in sufficient 

 numbers to give every physician a real hos- 

 pital connection, except possibly in some 

 very small towns. Each hospital should 

 have a laboratory managed by one or more 

 men skilled in the laboratory diagnosis of 

 disease. There would then be no longer 

 an excuse for mere rough-and-ready meth- 

 ods of diagnosis. Nor would it be neces- 

 sary for the more scientifically inclined 

 physician to maintain at great personal 

 expense a private laboratory of his own. 

 A greater amount of specialization on the 

 part of the various physicians in a com- 

 munity would likewise greatly add to their 

 efficiency, provided the specialization came 

 on top of, not at the expense of, a broad 

 medical training. 



In sanitariums it is customary to make a 

 general charge for room and treatment, 

 special fees being made merely for surgical 

 operations. The physician at the sani- 

 tarium, if not the owner thereof, is usually 

 on a salary. At general hospitals the 

 charge is usually for room and nursing, 

 and other hospital care, the patient, if able 

 to pay, paying the physician or surgeon 

 caring for him directly for his treatment. 

 The medical staff of the hospital seldom is 



