PREVENTIVE OTOLARYNGOLOGY

BURT R. SHURLY
1914 Journal of the American Medical Association  
We are suffering mentally, physically and financially from too many medical societies, too many new instruments and accessories and too many surgical operations with the name of the surgeon as the distinguishing pennant of the operation. It will soon be time to appoint a board of censors centrally located to which instruments and operations may be presented and which will approve those worthy of attention before the profession and public are subjected to so-called improvements. The practitioner
more » ... s. The practitioner and specialist of this country is particularly distinguished for a keen uplifting interest in humanity, a broad sympathy and a devotion to the greater comfort and general welfare of the patient. It is still true, however, that the most noble and skilled exponent of our special art must pay homage and reverence to the greatest queen of all\p=m-\DameNature; her ways of prevention, medication and cure must be ours. The mind of the medical man in the last two decades has originated, elaborated, improvised and invented innumerable systems, methods and instruments to eliminate pathologic or other tissue from the nose, throat or ear, yet the pages of our literature on pre¬ ventive methods of procedure in our specialty have been few indeed. The question of when not to oper¬ ate may be uninteresting, but as a valuable considera¬ tion in the saving of life it is frequently as important in otolaryngology as in the surgery of the appendix. It is unnecessary for us to follow the Mohammedan custom of daily chant, and open our office each day with a recital of the Hippocratic oath and ten laws of Dame Nature which must be obeyed, but it is fitting and proper that we should frequently ponder on the great and serious responsibilities of our calling. This applies especially to our overzealous radical colleagues who seem to consider surgery the only road to success. It takes a conscience, introspection, sympathy and a true sense of responsibility to realize that the limita¬ tions of one's individual surgical ability and training must be the guiding stars of decision and judgment. The value of any instrument, operation or method depends on proper selection and use. Are we to lígate the carotid for tonsillar hemor¬ rhage? Yes, if necessary; but if a brilliant and dex¬ terous general surgeon is in an adjoining operatingroom he should be called in as he can accomplish the work skilfully in half the time it would take a laryngologist. The old adage "An ounce of prevention is worth a pound of cure" applies to otolaryngology and may be resuscitated at this time with advantage. Prophylaxis is the text of the dentist as he merrily bores into the decayed tooth. We hear the patholo¬ gist assert that immunity and heredity explain the problem. Eugenics will reform the world, says the pediatrist. Sanitary science, hygiene and quarantine are the interesting themes of the internist. The subject of preventive otolaryngology may be classified to include a system of observances that will offer the best protection or prevention to the individ¬ ual or community of diseases of the nose, throat or ear. Preventive medicine will not be appreciated by the laity or profession until a secretary of public health in the cabinet at Washington shall organize, develop and promote this subject with its special branches for the benefit of humanity. The practical importance of the prevention of dis¬ ease in the upper respiratory tract and the accessory channels of the ear grows on one as it is viewed from the biologic, sociologie, pathologic, or therapeutic point of view. Under the subclassification of pro¬ tective otolaryngology it is possible to accomplish much of great practical value to the community at large. Your Chairman of 1910, Dr. Jackson, has called attention to the necessity for compulsory labeling of poisons sold by grocers. There are many preparations of caustic alkali that have been accidentally taken by children, and many hundred cases of cicatricial esophagial stenosis must have occurred through laxity in making and enforcing laws regulating the sale of poi¬ sons. Our delegate should be instructed to investigate this matter and present another resolution on this sub¬ ject to the House of Delegates if necessary. The problem of noise and its deleterious effects on the auditory nerve, and the effect of dust on the upper air-tract can be modified by passage and enforcement of sane laws. We should join heartily in the propaganda for med¬ ical and popular education and form a society of human animal welfare that will take precedence over that organized for the dog and the automobile. When the science of prevention fully arrives, every human machine will be examined semiannually and a careful record kept in card index form about every organ in the body including the nose, throat and ear. The greatest sign of the times that operates for the prevention of disease is the gradual elimination of medical sects and the elevating of medical educational standards. The ostéopathie, botano-eclectic or homeo¬ pathic otolaryngologist has been relegated to otolaryngologic Pompeii and is now metamorphosed into a broad, liberal-minded nose, throat and ear surgeon who can think as a pathologist, internist or therapeu¬ tist as the occasion requires. It is a well-known fact that abuses to the metabolic functions, though expressed in the apparatus under our special observation, will affect others through the medium of the connecting branches of the sympathetic system. The neuroses, psychoses and other distur¬ bances of the ductless glands and vasomotor system may be prevented only by the proper hereditary devel¬ opment of a stable vasomotor system with stable duct¬ less glands. Proper environment, education, control of the nervous system and good immunity must be added factors. The practical application of the laws of prevention concern us in a small measure at present as compared with the otolaryngologist of future decades. As infec¬ tion is the all-important etiologic factor of acute and chronic pathologic change in the structures under con¬ sideration, the prevention of disease becomes a prob¬ lem of great individual scientific interest in quarantine, sanitation, hygiene, immunity, heredity and sociology. Can we prevent deafness, hypertrophie rhinitis, pathologic tonsils, adenoids or accessory sinus dis¬ ease? How much are we interested in the study of insect carriers? Do we realize that the house-fly can carry active tuberculosis germs from the sputum and deposit active tuberculosis germs on our food? Are
doi:10.1001/jama.1914.02570230010003 fatcat:mbv6l53izrdk3ih3nnochknk4q