further, even though most of us are as competent, con- scientious, and well motivated as my friend above. I believe this is because many of us first don't believe we can change the direction of things or, second, don't know how to go about it.

The American College of Emergency Physicians in cooperat ion with the Un ive r s i t y Associat ion of Emergency Medicine on the na t ional scene has surely demonstrated an abil i ty to influence legislation. The public Policy Committee, the Board of Directors, and the officers of these organizat ions have cont inual ly monitored all legislation affecting the medical profes- sion. They have participated in the drafting and pro- duction of emergency medical services (EMS) legisla- tion, sponsored the in t roduct ion and passage of an amendment support ing residencies in emergency reed- icine, and are cont inual ly monitor ing and fighting for EMS appropriat ions in Washington. State chapters are showing increasing matur i ty and know-how when faced with legislative problems. Those of us active in local and regional EMS councils have also acquired expertise in dealing with local legislation.

Over the years, the membership of both organiza- tions has been bui lding a cadre of individuals capable of leading our colleagues - - emergency physicians and those of other specialties. However, to realize our pc- tential, we mus t convince those who are discouraged or who doubt our abil i ty that there is hope, and that, if we work at it, our voices will be heard. At the same time, we mus t not only use resources we already have, we must cont inual ly teach effective ways of participat- ing in our government.

We have already begun this instruction. ACEP, th rough its Public Policy Commit tee , sponsored a Legislative Leadership Conference in Washington last April. For the first time, at the Scientific Assembly in San Francisco, a postgraduate course on ~Legislative Affairs" was given. This April 24 to 26, another Legis- lative Leadership Conference, with emphasis on reim- bur semen t problems, will be given by the College through the Public Policy and Health Finance Com- mittees. State chapters such as California and Penn- sylvania cont inue the l ea rn ing process both by experi- ence and with na t ional help. It does not mat ter where the knowledge is gained or whether it comes by ex- perience or s tructured courses. The message that comes across loud and clear is tha t involvement is the name of the game. And what does involvement mean?

I n v o l v e m e n t does not m e a n s t a n d i n g up and screaming "foul" only when our terri tory is being in- fringed upon or our ox is being gored. It does mean par- ticipating in discussions, serving on committees, and becoming part of the decision mak ing that allows us and society to arrive at a mutua l ly agreeable solution.

Involvement means part icipat ing actively in the electoral process across the board from local to state to federal races. It is not good enough to say, "no one asked me to help," because working in political cam- paigns is one of the easiest ways to get politically in- volved. All you ha-¢e to do is to let a campaign worker know you are interested to be quickly absorbed in a political group, meet ing people and making contacts. It only takes a small effort, but the dividends can be enormous.

The same holds t rue with regard to politicians, whether nat ional , state or local. None are expert in all fields. They all need resources. If an expert in a field such as emergency medicine were dependable, wi l l ing

and able to supply the resource mater ial tha t a legis- lator needs, he will surely be used. Jus t imagine what could be accomplished if each member of our organiza- tions picked a local or state legislator or Congressman and arranged to meet h im and become a reference source for him. All it requires is tak ing some time to contact and inform a few more people.

Involvement means mak ing a commitment in time and effort to our cause. There is no easy way out of this commitment and there is no substi tute for it. The demands of practice, professional and staff meetings, con t inu ing medical education, etc, cause signif icant t ime pressure in phys i c i ans ' l ives. Consequen t ly , many are unwil l ing or unable to give time to anyth ing else - - they feel tha t they are depriving themselves and the i r families. Wal t Kelly, the cartoonist, put many profound words into the mouth of Pogo, his fabulous l i t t le possum. Among the most thought- provoking was, '~we have met the enemy and they are us." We must not allow this. We must realize tha t at this critical t ime in the evolution of our profession, sacrifice is necessary by us and our families - - for us and our families - - and for those who follow in our footsteps.

John P. McDade, MD

(Dr. McDade, an emergency physician in Alexandria, Virginia, is ACEP national Vice-president.)

Dog Bites

F or those critics who feel there is nothing unique about the biology of emergency medicine, Calla-

ham's paper, "Trea tment of Common Dog Bites," (p 83) should produce a change in-opinion.

Here is a problem for which " t ru th" has been based upon subjective c l in ica l impress ion, skewed populat ion experience, and a great paucity of hard data. Teaching has varied with the major experience involved, eg, plastic surgeons who see mostly facial bites have a totally different impression from someone dealing predominant ly with extremity injuries.

The principles gleaned from Callaham's retrospec- tive study are well worth having and using, although there is still need for a well controlled, prospective s tudy to assess m a n a g e m e n t wi th ant ib iot ics , de- bridement, and delayed pr imary closure.

I was surprised at the incidence of infection in un- closed wounds. This does not mirror my own experi- ence and I wonder whether factors such as pa t ient compliance, adequate debr idement and irrigation, and delayed primary closure are the cause of the variations.

I also would have liked a more complete descrip- tion of the levels of infection observed. It has been my personal experience tha t puru len t suppurat ion is a rar- ity but smoldering cellulitis tha t lingers for weeks is very common.

U n t i l control led prospect ive s tudies appear, I shall continue to recommend antibiotics (penicillin or tetracycline for penicill in-allergic patients), adequate debridement and irrigation, and delayed pr imary clo- sure for all but facial wounds, which I would close primarily. Because of Cal laham's work, I will strongly consider debridement of puncture wounds via excision and delayed pr imary closure.

7:3 (Mar) 1978 JACI=P 119/69

This paper provides an excellent baseline from which the prospective studies can depart and I hope we will be receiving the resul ts of such studies soon.

Peter Rosen, MD

(Dr. Rosen is director of the Emergency Department, Denver General Hospital and a JACEP contributing editor.)

Jack Carey, MD m We'll Miss Him

L ast month in the pages of' JACEP we noted with deep regret the passing of Wil l iam J. (Jack) Carey,

MD, who died in the prime of his life. Jack was a hard-working, devoted member of both the American College of Emergency Phys ic ians (ACEP) and the U n i v e r s i t y A s s o c i a t i o n for E m e r g e n c y Medic ine (UA/EM). He served both organizations in many ways.

He was an early active member, serving on com- mittees when funds were not available and participat- ing at his own expense. Jack made valuable contribu- tions to these committees and to ACEP and UA/EM. His calm, cool, well thought out remarks often served as ~'stabilizers '' for the committees and as sage advice for the participants. He had a knack for br inging the subject into focus and cut t ing to the quick of the prob- lem.

Among the many contr ibut ions which Jack made to medicine, and especially to emergency medicine, three s tand out because of their last ing effects. The first was his leadership and s t imula t ion in the de- velopment of an emergency medicine residency at the Univers i ty of Kentucky School of Medicine. His stu-

dents in this early program have gone on to assume leadership roles in emergency medicine - - a fact Jack was extremely proud of.

Second, Jack s t imulated the development of the emergency medical services (EMS) system in the state of Kentucky. Under his leadership and tutelage, Ken- tucky has a s sumed a p r o m i n e n t role in the EMS world. Finally, Jack served on the Certification Task Force and assisted in the defini t ion of the body of knowledge 5f emergency medicine. In this way those of us wh O W~illseek certification will owe dues to Jack Carey. '

Medicine is. a dynamic , f lu id profession, with ever-changing boundaries. In his way, Jack influenced those boundaries. Very few of us have an opportunity to change the face of medicine. Very few of us se ize that opportunity and make use of it. Jack did. Through his i nvo lvemen t in emergency medicine education, th rough his invo lvement with Ken tucky EMS, and through his involvement with the certification exami- nation, Jack has changed medicine.

In a more personal vein, I liked Jack Carey. He was a warm, personable individual who affected all of us who came into contact with him. Never did I visit Kentucky that Jack and his associates didn' t make me feel that I had re turned home. I liked being with and associating with him. I was proud of him and his repre- sent ing emergency medicine.

Nothing any of us can say can make things easier for his family. No one can enter into their personal grief. I missed him while he was sick; I 'll miss him more now. To emergency medicine, he was an unsung hero. We'll miss him, but we'll know he was here.

Ronald L. Krome, MD Editor

70/1 20 JACEP 7:3 (M ar) 1978