Title:
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Pulmonary and pleural suppuration : a review of a series of post mortem reports, with notes on the diagnosis and treatment
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There are only one or two matters arising out of the foregoing that call for comment. Statistics are notoriously unreliable and except in isolated instances are not quoted, as they did not appear relevant to the subject matter of the Thesis, and at the same time it might appear that some of the findings in a limited investigation of this sort were at variance with those of very extensive work, and usually accepted views, and it is recognised that unless a very wide review has been undertaken, opinions as to causation and relative frequency of certain conditions are not convincing. It does appear, however, that there is something to be said for the fúrther investigation of intrathoracic suppuration, as to its frequency and its causation, and much more still on the subject of its treatment. The serious mortality and morbidity of these conditions has been drawn attention to, in the course of this Thesis, and it does appear necessary that the closest co- operation between the various parties concerned is necessary, for the proper attainment/ 95 attainment of something near the ideal in treatment. It would seem, that there is a serious danger in the treatment of the conditions reviewed, of a conflict of interests, and the work of the physician overlaps to quite an extent, the work of the surgeon and it is difficult to know where the line of demarcation can be laid down. This seems to suggest that there should be no line of demarcation at all and that there should be close relationship between the various branches of the profession in treatment of these cases. Further, it might be maintained that the time is nearly ripe for the devising of a scheme, whereby the treatment of these cases becomes,not a part of the general work of the Hospital as Medical and subsequently Surgical cases,but that almost from the beginning there should be a possibility of the patient becoming the care of a team, who are specially trained in the work of dealing with these serious and difficult cases, serious at all times and often difficult beyond words. The position here is almost comparable to Neurological surgery and here the surgeon becomes a competent neurologist in the diagnosis and location of the lesion. If there is to be no proper liaison between the Physician and Surgeon in the matter of chest surgery_, it will become essential that those who deal with chest diseases, will have to become competent surgeons to cope adequately with the demand which thoracic surgery is increasingly making. It may be desirable too, but not so insistent ly urgent, to have as a part of the treatment propel institutions for the receipt of this class of patient who are non- tuberculous. These two suggestions as to close team work, and the better after treatment of these cases, are worth considering by those who deal seriously with them ,and are fraught with great possibilities for the amelioration of the immediate results in their treatment, and the warding off, of the sad and evil results of badly devised or badly carried out conceptions.
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