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The decision referred to above to the ethical physicians of the country. There effect that since the patient died the at- is nothing in the reports of the case to tending physician could not recover for point to the fact that the suing physician services rendered, is little less than took the case on a contingent basis. The startling. It does not seem possible in holding of the court that the death of the the event of the conditions being exactly patient invalidated the claim of the physias described, that the higher courts will cian for services actually rendered, is, fail to reverse the verdict.
therefore, apparently a grave miscarriage there are several things to be considered of both law and justice. The error is so and without full and complete data it palpable that it must be corrected by the would be ridiculous to express any hard next court. The whole practice of mediand fast criticism concerning this Georgia cine as it stands to-day is jeopardized. To decision.
force physicians to take up contingent
practice would strike at the very foundaThe contingent fee in the United tion of honorable medicine. No physiStates is almost unheard of among ethical cian can conscientiously predicate his reand reputable physicians. The quack sults in any case. Every physician, in asphysician makes much of “no cure, no pay” suming charge of a patient, contracts to but since he takes the stand of no pay, no use diligent care as defined by the retreatment, and usually exacts a good big quirements of each case, and to use ordifee in advance, it is a rather empty claim. nary skill as defined by the standards of The honorable physician bases his charges other practitioners of the same school, in on the services rendered. There is but the given locality. Each physician may one object in view, to secure the best pos- exercise as much more care or use as much sible result, in the best possible way and in greater skill as lies within his power. Unthe shortest possible time. It is possible der our present fee system of charging for that the physician suing in the case services rendered, every physician assumes under discussion made some contingency the moral obligation of doing his utmost. concerning his pay in the event of the non- It is the most honorable, fair and sensible success of his treatment. It is possible system and insures the highest type of that the physicians of his locality, for local service. It recognizes the limitations of the reasons, treat all or part of their cases on medical attendant, the possible developa contingent basis. If it could be shown ment of new and unavoidable complicathat this was the custom of the locality, tions, and makes the patient assume his we can understand how the court might own share of responsibility. From every hold, in the event of absence of a definite standpoint it is best for the patient, fairunderstanding between the physician and est to both patient and physician, and the father of the child, that death of maintains the dignity, honor and ideals of the patient abrogated all claims of the at- the conscientious practitioner. It creates tending physician.
no false hopes and promises nothing but To the best of our knowledge and belief the best possible service. Georgia physicians are practicing on The contingent fee, however, is open to other basis than that followed by the other all manner of abuse. It creates false
hopes, puts a price on dishonesty, and low- but that there is an actual demand for ers the whole practice of medicine. It them. So we are not at all surprised at makes a practitioner a tradesman, a bick- seeing in family-circle magazines, articles erer, and often a gambler who takes a long formerly confined to medical literature. It chance. It fits in with quackery and is a good sign of an awakened conscience charlatanism, but it has no place in connec- whose lethargy has hitherto allowed the tion with scientific medicine.
destruction of the best of our women or The ruling of the Georgia court should, invalided them or sterilized them. Our and certainly will arouse widespread in- young folks are not defiled by knowing dignation among honorable physicians if what might defile them, but they are foreon closer examination it proves to be as warned and forearmed and able to avoid unjust and ill founded as it now appears defilement. They who know all about to be.
gonorrhea and live healthy lives, are far better off that the old-fashioned "pure in
heart," who died of gonorrheal compliThe discussion of the venereal peril in
cations in utter ignorance that there was
such a thing. So let the good work go lay literature is a desirable outcome of ef
on, even if it drives three-fourths of our forts made in that direction for a number
gynecologists out of business for lack of years. It has long been known by all
of cases. physicians that no headway was possible in the crusade against this plague, until it became a popular movement. The stumb- The cooling of hospital wards in hot ling block was the very natural repugnance weather has been neglected in a manner to discussing such affairs in any periodicals amazingly stupid. Although it is an easy, which reach the family circle. The cheap and perfectly practicable thing to smug middle-class man has always as- do, we yet allow the dreadful summer morsumed that his daughters were feeble- tality to continue year after year. When minded things who could not understand a sweltering hot wave comes and the sick their own organization or the world in begin to drop off and we can actually calwhich they live, but happily the girls are culate in advance the daily number of exresenting the reflection on their intelli- tra deaths for each degree the thermomegence. They rightly insist upon know- ter rises, we throw up our hands helplessing what is to their interest. Now that ly and beseech Heaven to send a cool they know that 80 or 90 per cent. of their wave, utterly oblivious of the fact that surgical troubles in married life and many the Lord helps those who help themselves of the deaths are the results of immoral -and helps precious few others. We conduct of boys, they are most laudably know to a certainty that cold air will save declining to be murdered any further. In the lives of the sick, and yet we won't give other words, our ideas as to what is proper it to them until after they die. The dead for "the young person” to know, have un- rooms are kept cool and why not the living dergone a remarkable change in the last rooms when engineers have already defew years. Editors are suddenly realizing vised methods of doing it? Medical literthat these matters are not only fit to print, ature is full of learned papers showing
how certain diseases are cured in the cold of infant mortality. Recent observations air of winter, and not in summer; hos- have shown that every degree over 80° pitals now use the roof, verandahs or any adds to the difficulty of recovery from any old thing to get the patients out where disease, and the higher the temperature they can breathe cold air; we are regaled the higher the mortality. So insist upon by doleful tales of the awful results of hot having some rooms which can be kept beweather; and yet it does not seem to have low 70°, then in hot weather rush in occurred to a soul among us to install an the gasping babies, rich or poor, and air cooling apparatus which will keep watch them get well without any other down the ward temperature in summer so treatment worth mentioning. Then you that the patients will get well.
will be doing something practical and the It is possible to keep a ward at any
Lord will help you without the asking. If, temperature we desire, and well
as many of our best men believe, the intilated too, at a cost so trifling that in
fantile pneumonias must have very cold comparison to the life saving, the expense
air in winter, why in the name of comis nothing. Why are we so slow? Hos- mon sense, don't we give it to them in pital trustees, wake up! Find the money
summer too? and use it, so that the little tots saved in summer will rise up and call you blessed. Post dysenteric conditions were deLadies of the ice charities! Why don't you scribed by Mr. James Cantlie of London get busy too? You know only too well in an article recently published in the what a world of good you are doing by Journal of Tropical Medicine, and though furnishing ice to the sick, so why not ex- he was not entirely supported by those tend your influence further and see that present at the reading of the paper, he they get the only thing which will save called attention to some matters which are them in our hot weather-fresh cold air of importance to physicians of all climates. to breathe and plenty of it. Any cold In the first place, he shows what the storage engineer will tell you how it's done American physicians in Manila have long and any doctor will explain its value. Of- known; namely, that the lesions of amefice buildings are cooled in summer to bic dysentery are not infrequently confined keep a man well, but if he sickens, he to the lower end of the descending colon must swelter to death in a hot ward, when and sigmoid or to the latter or even to for a few dollars spent on air cooling ap- the rectum. What he now emphasizes is paratus he could recover. We are in a the frequency with which stricture or canvery unnatural climate, much colder in cer is later found in these situations in winter and hotter in summer than our
He thinks there is a natural northern physique can stand, yet we seem tendency for such conditions to occur at to think that heating the house air in win- the end of the sigmoid from the anatomter is all that is necessary, whereas it must ical shape of the parts and though this also be cooled in summer. So let us do may not be the cause, it is well to know it at once. In particular we desire to call the fact of this localization. There is a this matter to the attention of that new well grounded suspicion that amebic inand estimable society for the prevention fection is much more common in America
than the general profession has hitherto (February 12th, 1910) Drs. Flexner and believed. Even in the tropics, quite an Lewis, following up their preliminary reextensive infection can exist without symp- port on epidemic poliomyelitis in monkeys, toms, and it would not be at all surprising describe what they believe to be a mode of if many cases in cooler climates go on to spontaneous infection. The groundwork ulcer formation unrecognized. If it is for this investigation was laid some three true that in such cases the trouble is local- years ago when it was discovered that upon ized in the sigmoid or rectum and later infecting a monkey with diplococcus intrabecomes the seat of dangerous cicatrices cellularis by injecting cultures of this oror malignant growths, its importance is ganism into the spinal canal, migration of quite evident. Luckily the ordinary case
the diplococcus into the nasopharynx does not form ulcers, but leaves a mucous readily took place. Organisms contained colitis which, though quite persistent, is within leucocytes and lying free outside of amenable to treatment and eventually dis- them were found upon microscopical exappears unless there has been much thick- amination. Hence the authors cited conening of the submucous connective tissue. cluded that the nasopharynx is probably Perhaps we are on the track of clearing both the site of origin and of elimination up the etiology of a large group of intes- of the meningitis germ in man. tinal cases which have hitherto been looked Following the same method in their unupon as not due to any infection at all. tiring efforts to determine the nature of The ameba may have these far-reaching poliomyelitis, Flexner and Lewis have effects and deserve more investigation in been able to produce paralysis and to America.
prove that the nasal mucous membrane contains the virus of this disease. When
a properly prepared solution of an excised The Mode of Infection in Poliomyelitis. portion of nasal mucous membrane sus-In a previous editorial communication pected of containing the virus was injected occasion was taken to mention the import- into the brain of a monkey, it set up charance of recognizing diphtheria when pres- acteristic symptoms including the coment in the nose.
plicating paralysis of poliomyelitic infecIt is well known that the mucous mem- tion. Paralysis also followed the inoculabrane of the upper respiratory passages tion of the fluid removed from the spinal permits free osmosis of fluids, a fact which canal when injected into the brain. is manifest in the one direction when any The value of this experimental result is irritant is applied to them and is followed very great in showing that the same path by a copious outflow of secretion, and in
by which infection is introduced into the the opposite direction by the great rapidity system through the nasopharyngeal muwith which such toxic substances as co- cosa is followed when the virus is elimcaine are absorbed into the general circula- inated in reverse order. tion when applied directly to the nasal or As a corollary to this demonstration it pharyngeal tissue.
would seem desirable to attempt prevenIn a recent communication to the Jour- tion of epidemic infantile paralysis and nal of the American Medical Association also of cerebrospinal meningitis by disinfecting both the nose and mouth in an hill with bullets until they locate the effort to destroy the secretions in which trenches of the enemy and then every shell the infectious excitant of either of these is exploded where it kills. Similarly we diseases may possibly exist.
wasted millions of dollars in yellow fever The authors state that studies are now disinfection until we located the enemy enbeing carried on relative to the resistance trenched in mosquitoes, and now we ignore of this poliomyelitic virus to the disinfect- everything but these insects. The ining agents most commonly employed. It creasing evidence that infected persons is to be hoped that some drug will be found are the main, if not the only ones, who which will kill the micro-organisms harbor living pathogenic organisms, is the without at the same time injuring or cause of the present discussion. Of destroying the delicate structures upon course there are some parasites which can which they live and grow. To this end retain vitality quite a time after leaving the much-discussed lactic acid bacilli may our bodies, but it is undoubted that most yet prove helpful, but of course little or kinds perish more or less promptly. The nothing can be said upon this subject un- discovery of more and more “carriers" til the investigations now under way are formerly unsuspected, explains those recompleted.
markable instances in which "fomites” It is likely, however, that not only men were formerly believed to live a long time ingitis and epidemic infantile paralysis are adherent to dead materials, such as clothes thus conveyed into the system, but that and houses. It has been positively proved many other infectious diseases also here that certain recurrences of small pox were find a portal of entry, which has hitherto due to the importation of a new mild unbeen very generally overlooked. For when recognized case and not to infected clothone recalls the anatomy of the upper re- ing left over from the previous epidemic. spiratory passages, their great vascularity Hence we see an increasing desire to disinand the large content of lymphoid and fect or isolate persons and not things. glandular tissue, it can be readily conceived
The ineffectiveness of much disinfecthat such a soil is very rich in the es
tion is the point made by M. Comby, sentials for the propagation of disease ex
physician to the Paris Children's Hospital, citants.
and the foremost European apostle of the We shall await further reports on this
new crusade. He shows that the means subject with much interest.
used would not necessarily kill the organ
isms even if they were alive, and that Attacks on house disinfection are be- measles and scarlet fever are really transcoming so frequent that it would not be mitted by convalescents or apparently at all surprising if the medical profession healthy “carriers.” He even presents were to reverse present beliefs. Before we facts which show to his satisfaction that knew what were the infecting agents and the desquamated scarlatinal skin is not how they reached us we were like men nearly so often the carrier as we now fighting enemies in the dark. We fired think-indeed there are doubts as to its our ammunition haphazard and naturally virulence at all—but even if it were wasted most of it. Soldiers always riddle a dangerous the ordinary fumigations and