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Don't forget, brother, don't forget your skill,
Don't forget to render your well earned bill.

Doctor, when called on to fix your fee,
Be not deterred by modesty;

Proportion your charge on what is said,
How much the income, what rent is paid;
Be well prepared, use asceptic care,
From infectious germs the patient spare,
Thus honestly earn a liberal fee,

"For of his hire the laborer's worthy";

Charge, brother, charge, charge a sum that's fair,

Charge, when you deliver the passengare.

—A. Ernest Gallant, M. D., Annals of Gynecology and Pediatrics.

The Ethics and Laws Regarding the Interruption of Pregnancy.

BY FRED J. TAUSSIG, M. D., ST. LOUIS.

Many, particularly among the laity, claim that by giving our sanction to the interruption of pregnancy under certain special circumstances, we are offering a loophole of escape to all those who desire to interrupt pregnancy for their own personal gain. On the one hand, they say, we condemn it as a criminal procedure, and on the other recommend it as a means of saving the mother's life. Are we consistent? As much so, surely, as when we condemn the killing of a man in one case as murder, and in another case praise it as the highest type of patriotism. If it is justifiable for a man to kill another for the defense of his country and his home, surely it can not be wrong for the doctor to take a life for the defense of his patient.

But just as the law has sharply defined the line between murder and self-defense or defense of one's home, so, too, we must in our laws and code of ethics set down certain rules for the protection of society so that this privilege accorded the physician is not abused.

I recall at the Portland meeting of the American Medical Association, when the subject of the interruption of pregnancy in tuberculosis came up for discussion, that several members declaimed against the abuse this doctrine might give rise to. Occasionally I have heard obstetricians say that it was all right for us to know about these special indications for interrupting pregnancy, but that we should not be spreading the information among general prac

titioners for fear that it would lead to the interruption of pregnancy on the slightest provocation.

I don't believe the science of medicine is anything to keep quiet about. The more the practitioners know the facts, the greater the ultimate benefit for mankind. Practitioners have heard of the advisability of interrupting pregnancy in tuberculosis, heart disease, etc., and it is our duty to instruct them not merely when to resort to this procedure, but also, and above all, when not to resort to it. It should be emphasized that the life of the child must not be taken merely for reasons of inconvenience or even actual suffering on the part of the patient but only when the mother's life is actually endangered.

For the protection of the good name of the medical profession, I should advise that the following rules be conformed with:

(1) In the first place, we should define as accurately as possible the special conditions under which the interruption of pregnancy is permissible and require that in every instance these special conditions really exist.

(2) Pregnancy should be interrupted only after the physician in charge has consulted with one or more physicians and obtained their approval.

(3) We should demand that the consultant be not merely any other physician, but some person of note in the community. The danger lies, of course, in the fact that the unscrupulous doctor will call in some equally unscrupulous medical friend and, after consultation, proceed to do that legally which he would otherwise hesitate to perform. Of course, the municipality is the loser by this taking of human life, and it seems to me fair and expedient that it protect its rights by the appointment of a board of consultants without whose consent it should be considered criminal to induce an abortion. The success of the advisory board of three physicians on questions of insanity, recently appointed in this city, leads me to believe that a board of three persons similarly appointed from a list of those specially qualified to serve in this capacity would be a means of protecting the community in a matter vital to its interests.

I offer this merely as a suggestion for the consideration of the committee appointed to revise the laws relating to criminal abortion. The present wording of the State statutes is certainly extremely vague and unsatisfactory and gives the State absolutely no protection. Interstate Medical Journal.

Neurasthenia,

Hubert Richardson classifies the etiological factors of neurasthenia under four heads: (1) Mental strain; (2) disturbances of digestion, malnutrition, and auto-intoxication; (3) toxemia from infectious diseases: (4) traumatism and shock. It is apparently the vasomotor system which is principally affected. All emotions act upon this system of nerves. An important etiological factor from a therapeutic standpoint is a gouty constitution. In a case of this kind the urine is intensely acid and the carbon nitrogen factor is very low. The most marked system is irritability of temper. Among the various symptoms of neurasthenia are headache, insomnia, pains in the spinal column, disordered digestion, disturbance of the blood pressure, angina, depression of the functions of the genital organs, and disorders of the mental faculties. There is no specific treatment for neurasthenia. The whole system should be built up in every possible way. The physician must first gain the patient's confidence and then hold him to his treatment by tact and patience.-Medical Record, November 10, 1906.

Results in Roentgen Therapy.

Charles Lester Leonard believes that the Roentgen ray is one of the most powerful of therapeutic agents. It should be administered with caution and only by those who are educated and competent to observe its physiological action. Experimental studies have been confirmed by clinical experience. It has been demonstrated that this agent acts primarily upon the lymphatics, destroying them, and localizing the disease, thus preventing any spread or metastasis. The rays have been shown to produce a marked increase in metabolic activity. They render a very valuable service as a palliative agent, lengthening life and alleviating suffering in cases of malignant diseases.-Medical Record, November 17, 1906.

THE backwardness of health departments in protecting city milk supplies from infection by typhoid fever is illustrated by the fact that the city of Denver, Colo., has only within a few weeks passed an ordinance designed to compel dairymen to sterilize their utensils before using them. What other health protective features the ordinance contains, if any, we can not state, but it should strike at the root of the matter by prohibiting the use of impure water for washing milk pails, cans or bottles. In fact, every city should exclude from delivery or sale within its limits any milk

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from a dairy farm whose water supply is not above suspicion. Denver the water company has been bitterly attacked, of late, on account of the prevalence of typhoid in the city, it being alleged that the responsibility for the disease rested on the company. Without presuming to pass on this contention we do emphatically assert that the time has come for health departments and the public generally to look well to other causes than water for the spread of typhoid. To this end, water departments must, in many cities, insist on the reorganization of health departments and on emple appropriations for health board work. The readers of Engineering News could aid greatly in these reforms in their respective localities by lending their influence and intelligence to all movements that will increase the efficiency of general health protective work. One of the most important means to this end is the appointment of well-trained, well-paid, permanent health officers, who give their whole time and energy to their work.-Engineering News, November 22, 1906.

Concerning the History and Value of Massage and Exercise.

BY BERNHARD ANDERSON, MASSEUR AND PHYSICAL DIRECTOR.

In the struggle against disease, science has furnished many different forms of treatment, and, though a physician may specialize, it will greatly increase confidence in him if he is acquainted with all available therapeutic agents.

If we go back to early times we find that the history and literature of massage and exercise is as old as that of any curative agent. The excuse for its being left somewhat behind is, that it is rather laborious and some men have thought themselves beyond and above such a task, with the result that many doctors hardly know what massage really is, and thus furnish a reason for the existence of osteopathy and other forms of treatment similar to massage.

If the medical profession in general would more fully appreciate massage treatment and exercises, and prescribe them when needed, employing people who are properly educated to give treatment, then the osteopathic cult would gradually vanish. A reason why the medical men do not more frequently prescribe massage is, no doubt, the poor results obtained by many operators, and much harm has been done to patients as well as to the reputation of massage treatment, because the physician has not been careful enough in the

selection of the person to apply the treatment, but simply told the patients to have massage from somebody and anybody.

When a physician decides to have this treatment applied to a patient, a detailed statement of the conditions should be made to the masseur and a complete understanding as to what is to be accomplished. This reminds me of an incident. A gentleman came into my office and said: "I am a doctor and I wish to have massage to my shoulder." I told him I would be very glad to do what I could for him if he would please explain what the ailment was and what he expected to have done. "You can not cure me, as my trouble is there to stay, and I don't see any reason to waste time explaining things to you," was the reply. "In that case," I said, "I can do nothing for you." However, the gentleman in question came back in a few days and I had the satisfaction of eliminating his trouble to a great extent. Since then I have, to our mutual satisfaction, given treatment to several of his patients.

It is impossible to anyone to gain a thorough knowledge of the system, and learn to give treatment understandingly from a few lectures or a brief manual. There are, however, many conditions in which massage, together with a few passive and resistive movements, not only give relief, but effect a cure, when applied according to physiologic laws.

A short review of the literature of this curative agent may be interesting. Nature early taught man to knead his flesh or bend his body to relieve him of certain ills, and the practice of these maneuvers is as old as mankind. Books were written about gymnastics as early as 3000 years B. C., among them the Kong-Fu in Chinese. We also know that the Persians, Phoenicians and Egyptians knew about massage as well as gymnastics. The Greeks, however, were the first to make genuine progress in this branch, as in so many others. Esculapius, Apollo's descendant, is said to have been the inventor of the art of gymnastics.

Mercurialis in the sixteenth century wrote a book, "De Arte Gymnastica," or the science of bodily exercises, which he has divided into Gymnastics for Athletes, for the Military and for the cure of disease. To this latter branch, as used by the Greeks and Romans, he gave special attention, and pointed out the use of the different movements in different diseases and also gave rules for their application in special cases.

It is interesting to read about Thomas Lydenham, 1624-1689, a noted English physician, called "the English Hippocrates." He left the routine practice of his time and based his own upon the

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