Draining loop colostomy.

Correspondence loum 779 his loss of time and waste of hospital time could have been avoided. Also the expenses of the numerous tribunals would have been lessened. The second example concerns a man whose carcinoma of the colon I removed several years ago. About two years before death, I removed the prostate. About two months before death he was readmitted with urinary infection. Cystoscopy, after dilating a urethral stricture, showed that the bladder was so inflamed that an accurate diagnosis was not possible. Urine was sent for examination and after treatment he was discharged to await the report. Later he was admitted to an outlying hospital and rapidly transferred to the main hospital. The house physician's notes read, " The patient is moribund and unable to give a history." What now seems to be the routine investigation was set in motion, and this included chest x-ray, blood Wassermann, gonococcal complement fixation test, blood cholesterol, complete blood chemistry, and some others I cannot remember. By the time these reports had been collected and typed the man was safely interred, and death was certified as secondary carcinoma of the lungs. The radio-logists' opinion was that the lung changes were those of miliary tuberculosis. By the time I had learned of his death the result of the urine examination was available and this showed heavy growth of tubercle bacilli. One might ask what purpose could be served by these extensive, expensive, and time-wasting investigations in a dying man. A few hours' delay for a search of the records would have made no difference to the ultimate result. It would seem that the old-fashioned teaching which depends on the senses we have been given-hearing, speech, vision, smell, tactile appreciation, and memory-has been abandoned and a diagnosis cannot be made without routine investigation of every fluid in the body, supplemented by x-rays of various organs. From this sheaf of typewriting it is hoped that some clue may be given which may fit in with the patient's symptoms-if he has been questioned about them.-I am, SIR,-The poignant case cited by Mr. A. Dickson Wright (15 February, p. 440) seems to typify a trend in contemporary therapy in which the enthusiasm of some physicians for modern scientific methods blurs their imaginative faculty in respect of the patient's condition. One would like to suggest that an "advance declaration," copies of which could be deposited with one's family doctor, …