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same ratio as to time expended as they would pay for any other professional attendance. The charge to the poor man or one of only moderate means should be commensurate with his ability to pay, no matter what the kind or the amount of the attention may be.
The primary cause for the low obstetrical fee rests with the patient. By this I mean that patients are unwilling to pay more because they do not appreciate the importance of proper obstetrical attendance. Few mothers even among the most intelligent and well-to-do have an adequate conception of what the physician should do in his attendance upon them. The average mother is satisfied with a cursory examination before confinement and two or three visits during the lying-in. She thinks that her physician is very careful and up-to-date if he satisfies his aseptic conscience with a dip of his hands in an antiseptic solution. She expects him to repair lacerations of the perineum immediately after labor, but this is the extent of her knowledge. If she suffers from sepsis during the lying-in, the physician has no trouble in attributing the fever to the milk secretion, the grip or some other commonly accepted cause of rise of temperature. If she finally makes a good or a fair recovery she is pleased with her doctor and recommends him to her friends.
The secondary cause for the low obstetrical fee rests with the physician. He gracefully submits to the fee which is current in his community and gives no more time and attention to his patient than is absolutely necessary to save himself from censure. He knows that he is poorly paid at best for his services and it is human nature for him to do as little as possible. In doing this, however, he adopts a shortsighted policy, because he misses an opportunity to demonstrate that there are some things which he does better than any of his colleagues. There is not a physician in this room who laments his fate when he is engaged for a confinement but that fails in his duty to himself when he does not explain to his patient that he cannot afford to give her the attention which her case requires unless he is adequately recompensed for his time. He should explain to her the importance of the details of proper management of pregnancy, labor, the lying-in and the nutrition of the child. If the patient is a woman of intelligence, she will realize the importance of these facts and if the physician gives her this superior attendance, she will gladly pay him for his extra care and attention.
I fully realize that most physicians who are victims of low obstetrical fees will not accept this statement but its truth is easily demonstrated. Try it! I have frequently followed other physicians in subsequent obstetrical attendance and have doubled and quadrupled their fees with the most cordial acquiescence of the patient and the consequent disrepute of the previous attendant.
I am fully convinced that if a physician will do his obstetrical work in as thorough a manner as it can be done and will let his patients know why he insists upon doing it in this way, he will have no trouble at all in securing fees which are proportionate with the work done. I know of several physicians who at my suggestion have adopted this policy and they tell me that my advice was good. One physician whose fee was the regular one of $5.00 now averages $30.00, and he says that he is doing most of the good work in his place. Not only is he better paid but he says that he is giving more study to the subject of obstetrics and consequently is doing better work.
In order to be more specific in my answer to the question embodied in the title of this paper, let me state just what I think the physician should do in every case of confinement.
(1) During gestation. He should impress upon his patient the importance of the physician's attention just as soon as pregnancy is suspected, in order that positive diagnosis may be made and the proper hygiene of pregnancy instituted. If diagnosis of pregnancy is made he should secure a full history of the patient and ascertain her present physical condition.
He should examine the urine every month from the third to the seventh month and every second week thereafter.
About the seventh month he should make a careful physical examination of his patient, examining the breasts and taking the measurements of the pelvis.
He should ascertain the qualifications of the nurse and if she happens to be one with whose work he is not familiar, investigation should be made as to her ability to comply with the requirements of aseptic work.
The nurse being secured and passed upon he should give the patient and nurse a detailed description of the preparations to be made for labor, including the arrangement of the room, the preparation of the patient, the preparation and sterilization of dressings and solutions, the drugs and everything which will be needed in the conduct of an aseptic labor.
(2) During labor. The labor should be conducted with the same details as to aseptic technique as a surgical operation. Both physician and nurse should be gowned, hand sterilization of the nurse should be insisted upon and the physician himself should wear rubber gloves, at least upon the working hand.
(3) After labor. All injuries to the birth canal should be sought out and repaired during the lying-in. Injuries to the perineum and vaginal mucous and cellular tissues should be repaired immediately after labor. Examination of the cervix should be made forty-eight hours after labor and lacerations repaired. Before the lying-in period is completed, all injuries of the genital tract resulting from previous labors should be repaired.
A visit should be made within twelve hours after labor and daily thereafter until the fifth day. After the fifth day the frequency of visits should depend upon the condition of the mother and the nutrition of the child.
(4) The nutrition of the child. The nutrition of the child should be under the direct supervision of the physician throughout the first year of its life. The mother should be instructed to make weekly reports of its weight for three months and monthly reports thereafter. I believe that physicians err in this regard more than in any other thing connected with obstetrical work. As soon as the child is born it passes entirely beyond their notice and their attention is not again called to it until some grave nutritional disturbance has carried it beyond the skill of the mother or nurse. The physician is then called and he has a far different problem confronting him than if he had seen the case in its beginning.
These, in brief, are the essentials of a physician's duty in the care of an obstetrical case. They will not be found irksome if reduced to a system and patients are instructed as to their importance so that they will give their hearty co-operation. I have found that the best way to instruct patients and secure their co-operation in these matters is to give them a book in which all the details of the management of pregnancy, labor and the lying-in are set forth in detail with the reasons why such procedures are necessary. Every physician doing obstetrical work in a thorough manner should be the author of such a book or pamphlet. It will save him a great deal of attention to details and will help him in many ways.
By Emma Butman, M. D., Toledo, Ohio. The student of the history of man will find in the legends, folk lore and history of all people, evidences of the fact that healing by some form of occult practice has been followed by all races and all people. That religion has some relation to health, is clear from almost every page of its history. The various forms of occult therapeutics have varied from the grossest form of barbaric superstition to the most refined form of the fashionable metaphysical cults of to-day. We need not go back very far to the time when the medicine man was at once healer, miracle worker, wise man and revealer of the will of the Divinities.
Within the two great branches of historical Christianity, the Protestant and the Catholic, there lives and flourishes a belief in the efficacy of faith, of relics and of the intercession of saints. All sorts of theories have been advanced to account for the cures which have been made. Priests, teachers and healers have claimed Divine power and their cures were proof positive of the school of religious thought which they favored. Every one of these groups, Christian Science, Faith Healers, Adorers of relics, Magnetic Healing, Mental Healing, Spiritual Healing, and Suggestion is ready to have its belief judged by the fruits of it in the actual restoration of the sick to health. If there ever was a time when the evidence thus offered could properly be put aside with a sneer at human credulity that day has gone, as it must have become evident to the student that there must be some great principle underlying all these forms of occult healing because they all make cures in spite of the fact that each claim to have the only correct theory. On every hand we are invited to come and see. We cannot ignore the facts thus open to observation. There must be some great force which they are all using, blindly in many cases, and their differing theories and creeds which they have built up around their cures must be regarded as incidents of this great healing force. In spite of much good evidence it was not until the present generation that this force was made an object of anything like scientific study.
The influence that caused the scientific study of matter to precede the scientific study of mind was the horror of defilement by contact with superstition. Paracelsus in 1530 advanced the theory that the heavenly bodies exerted an influence over the health of man and the thinkers of that time evolved the theory that man could and did exercise an influence over mankind. Mesmer, of Vienna, gave the initial impulse to such studies and was the first to gain anything like recognition from the scientific world. The next important step was in 1841, when the research of Dr. Braid, of Manchester, England, led to the introduction of hypnosis as an anæsthetic agent in surgery, when his really great discovery was overshadowed and forgotten through the apparently still greater discovery of the surgical uses of ether and chloroform. Thus it came about that mental healing did not attain standing as a scientific fact until the present generation. The new movement may be dated from the publication of Tuke's “Influence of the Mind Over the Body” and Bernheim's “Suggestive Therapeutics." Humanity is hemmed in by so many influences that from time immemorial no real effort has been made to gain control of impulses that run loose in the world. All are creatures of emotions, passions, circumstances and accident. What the mind will be, what the heart will be, what the body will be, are problems which are shaped to the drift of life. Look at any created life and see the effort to express itself. The tree sends its branches toward the sunlight and under ground sends forth its roots in search of water. This we call inanimate life, but it represents a force in the tree itself. The manifestation of this intelligence has been named by various investigators as Nature, the Life Principle, Vital Force and Energy. There is no place where it is not found. The air is loaded with it. Water is but a liquid union of gases and is charged with electrical, mechanical and chemical energies. This energy about us we are drinking in water, eating in food and breathing in the air. The air, sunlight, food and water are the agents of this force, which we call Electricity, and it has been clearly demonstrated that all substance contains it and the most advanced view of the scientist is that electricity is a vibration, like light, sound and heat, and that every bone, muscle, fibre, and liquid, in the human body contains that subtile agent which Franklin so deftly lured into his battery by the string of a kite. Chemical action can produce galvanic currents and when we remember that almost every portion of the body is bathed on one side with an alkaline and on the other side with an acidulous fluid, we may consider the human being an electric battery of no inconsiderable dimensions. Some authorities make the claim that this counter influence of directly opposing conditions is for no other purpose than to generate electricity. Thales, chief of the seven wise men of Greece, 2500 years ago said “Electricity is Life.” This shows a wonderful latent force in the body under control of the will. Experimenters show that it exerts an instant and powerful effect by induction on surrounding objects just as heat does by radiation. There is another force which manifests on external objects when the mind so intends. It was a French scientist who first succeeded in making the compass needle deviate by the will of man, that is, by that electrical current which produces muscular tension. The deviation was effected at great distances and ceased when the muscle was not kept tense. It was undoubtedly this electrical force as exerted upon people and objects that Shakespeare meant when he makes the witch say, “By the pricking of my thumbs, something wicked this way comes.'' There is some force, means or agent by which mind is enabled to act on matter and yet which is distinct from mind or matter. The changing hues of the Chameleon are now discovered to be accompanied by the electro-nervous symptoms that betokens a great development of this