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422 At first Nature, so to speak, "balks", then creates a temporary tolerance of them, which processes repeat themselves. Later these conditions are recognized as formidable pathological entities, of which gastric ulcer is but a sample. With light touch (as practiced by the blind), with x-ray, and with intensive study of the symptomatology and its causes, we will—I may hope—learn to recognize these conditions in the infant, and then shall operate these conditions early and thus avert long suffering ending in final critical disease, as which alone we now treat them.

(closing): In regard to the acidity of the stomach, I made the statement that the amount of acidity was of little value in diagnosis because so many other conditions can produce hyperacidity; but that after ulcer has been diagnosed, then the amount of acid in the stomach assumes great importance in the treatment.

The discussion this morning has evidenced the general opinion of the medical profession of the state of Indiana. Two or three years ago if we had discussed a symposium like this the surgeons would have jumped all over us and said that ulcer belongs to the surgeon exclusively. Now the general opinion among the profession is that ulcer belongs to the internist for diagnosis and for early treatment at least, and if it does not respond to treatment, then surgical assistance is necessary. Even after surgery the patient must have as careful medical and dietary treatment as if no surgery had been performed.

What Doctor Porter says may be true. I said in my paper that not all cases are cured, either medically or surgically. I have had cases where the surgeon has operated and the patients have had a recurrence.

(closing): With relation to Doctor Foreman's statement that two or three years ago the surgeons would have said that every stomach ulcer is a surgical condition, I do not agree with him. Surgeons were hardly so radical as that.

I think Doctor Foxworthy is unduly alarmed at the aggressiveness of the surgeons in this particular field. I do not think the surgeons demand that they be permitted to operate in every case of gastric ulcer. As a rule we do not see these cases until there are perigastric adhesions, hemorrhage and stenosis, and then they are indeed surgical cases. There is a time for medical treatment of gastric or duodenal ulcer, and there is also a time for surgical interference. We must remember the relation of carcinoma of the stomach to ulcer. Every ulcer may become a cancer, and as was said by Dr. William Mayo, every cancer of the stomach was probably at one time an ulcer.



Perhaps there is no phase of medicine concerning which there is so much misinformation as concerning the commonly designated "Code of Medical Ethics". Almost without exception, intelligent people know of the existence of a pact amongst decent practitioners, but the knowledge is vague. Some entertain the view that it is a sort of oath; others that it is a traditional custom descended from the ancient fathers in medicine; quite general is the opinion that it is an unwritten law of the profession containing obsolete rules of conduct, neither justified in wisdom nor right, but which long usage makes it impossible to shake off. In the lay press the view is often expressed by inuendoinnuendo [sic] if not by direct words, that "Medical Ethics" is a species of folly characterized by narrowness, not at all in keeping with the spirit of modern progress. By those outside the pale of organized medical forces, this idea is held aloft and painted with ridicule. Should there not be some concerted and forceful effort made to correct these erroneous ideas entertained in the public mind?

How remote these conceptions are from the truth, all know who are familiar with the Principles of Medical Ethics. It represents a most commendable effort on the part of the intelligent and progressive elements of medicine, to conserve the idealism of the medical past. It seeks to elevate the standards of practice and scientific attainment, of gentlemanly and moral conduct, for the benefit of the patient first of all; for the mutual instruction and elevation of the profession; and in the interest of the public weal. Should we ever fall from these high standards, we will no longer be worthy the designation of a profession, but must march in the ranks of tradesmen.

Searching for the causes of public mistrust of the "Code" they are found to exist in ignorance concerning its nature and purposes. Laymen are excusable for these erroneous conceptions and misapprehensions. I never yet have talked to one who had read the Principles of Medical Ethics. His knowledge of it came through hearsay or isolated acts of physicians which he could not understand, and not comprehending the rational and moral grounds for such action, he was likely to consider it queer and senseless. And so very naturally, one might say quite justly, our "Code" has come in for gibes and sneers. Physicians themselves not rarely also show their ignorance of the scope