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simply with an idea of getting into heaven. Just a few words about sexual morality. According to the very best authorities, a Without regard to abstract right or wrong, great many very disagreeable, mean and nar. human experience has shown that anything row-minded individuals are sure to go to approaching free love is incompatible with heaven, and you don't want to spend your either advanced savagery or civilization, alearthly existence with such a one, even if he though in a very low state of savagery or in will finally be renovated.
a state of barbarism with virtual or actual First of all, let us consider out and out slavery for part of the people, various phases quackery. There is nothing essentially sin- of free love or, at least, polygamy, may exist. ful in having a large sign or in mailing But it is a crude, hard fact, that in any large cards, dodgers and almanacs to persons community, there is very nearly one woman whom you do not know, nor in paying for to each man, and that whenever the stress of newspaper advertisements, nor in bragging living is great enough to make the life worth about yourself as wonderfully gifted, nor in while, the necessary effort of taking care of making a partnership with some fanoy name. the weaker and dependent part of the race, All of these methods are used in other busi. will not be made unless the average man is nesses. Some are, in and of tbemselves, per- sure of his own wife and his own offspring. fectly straightforward, others are merely the It is true that a great many persons harmless exaggeration and distortion of the too weak to resist temptation, and that peliteral truth, that people expect and discount culiur circumstances and, especially, the apin advertisements. Why are they unethical?
Why are they unethical? plication of excellent general laws to excepLet us answer this question with another: tional cases, do occasionally almost seem to Why are you tempted to resort to them? Be- justify the violation of the general princi. cause you expect they will increase your ples of sexual morality. But society oan trade. But why will they increase your trade? exist only as these principles, are generally Because most physicians are too gentlemanly adhered to. However, as a man, you must to employ them. There you have the gist of observe or break these rules according to the whole matter of etbical objection to your own understanding of right and wrong. quackery. It is not that any one means of As a physician something more is expected advertising is, of itself, sinful or dishonora
The Hippocratio oath fully covers ble but merely that the man who resorts to the ground It is one thing to be morally these means is competing unfairly and is re- bad, as a man; quite a different matter to lying on the fact that the majority of bis op- take advantage of the peculiar trust imposed ponents are too honorable to resort to his own in you as a physician. If you are going to tactics. The quack is like the man who play this game, at least play it fairly, against looks at his opponents hand in a game of a woman fairly armed to resist you, mature cards, like the pugilist who strikes a blow enough to judge for herself, and with no when his opponent is giving him a gener- sense of obligation to you for favors of enious chance to recover himself, like the man ployment as your assistant in any capacity, who slips into a seat in a crowded car that and not disposed to yield to you by reason the man abead of bim is offering to a wo
of a confidence or affection due to your proman. Don't tie yourself for life to this fessional ministrations. kind of a companion, rather pick out an The gross violations of morals have no honest thief or square burglar.
speoial relation to medical practice, but However, if you are going to be a quack there are many little ways in which this life at all, at least be honest enough to proclaim companion ought
companion ought to be trained.
be trained. Don't live yourself as playing an unfair game. Don't with a man that has a petty, jealous disposi. compound your dishonesty by pretending to tion. If you find that it hurts your feelings be ethical. If you want newspaper advertis- to learn that a friend is sick and bas employed ing, pay for it like a man, don't pull the legs some other physician; if some one praises a of editors and reporters for puffs. Or, at rival and you have to pull bard to get up kind least, don't be a hypocrite of the third degree words from your throat; if the news of anwho gets his assistant to look after the press other physician's downfall comforts you, go notices and then proclaims to his students and kick yourself until you are cured, other. and colleagues that he hates newspaper no- wise, erentually, others will kick you. toriety, who indirectly sends word to the Don't be narrow. There is something serpapers that he will operate on a rare case at iously wrong with a physician who is simply clinic, and then makes a sensation that will an appendage to a sign and an obstetric bag. certainly invite public comment, by ejecting You should always be advancing in your a reporter. It is unpleasant to live with an chosen art and science and, unless you are openly unfair man, it is worse yet to live so unfortunate as to justify the most modest with a second or third degree sneak.
estimate of yourself, you should be a producer, as well as
à consumer of medical the pelvic section less disturbing by requir. knowledge. Be both a user and a maker of ing less separation of the divided bone. medical societies and medical journals.
However broad a physician, a man maybe, he is narrow if he remains only a physician. A thoroughly well rounded man must be medioore in everything but every man should have at least one hobby, intellectual or social, selfish or philanthropic, outside his life work. We cannot all be a poet like Holmes, or a genealogist like Stiles, or a muscial com poser like Hemmeter, or a novelist like Doyle, or an executive or politician like Wood.
But be something or do something, however humble and useless, so that you will know somebody besides those who are sick.
In short, spend your life with a man who is not only a fairly good and conscientious doctor, but a decent man, a gentleman and, not necessarily a scholar but an active, interesting fellow.
PUBIOTOMY AND ITS RELATIVE INDI.
DR. E. B. MONTGOMERY.
E. B. MONTGOMERY, M. D.
The various modifications of Gigli's tech.
nique of this operation are discussed in deAFTER a brief sketoh of the history of tail, and a full bibliography of the subject is symphysiotomy from which pubiotomy is an
appended. outgrowth, both accomplishing the same object of equally enlarging the pelvic diameters, the author gives an extended review of the literature of the subject giving all cases
“WHEN your position demands that you
use your own judgment, no other person's orted in medical journals and transac- judgment will be as good.” tions, as well as verbally and by letter. The number has now reached about 300, with a
THE CONDITIONS OF FEMALE AND CHILD total mortality of 2-3 per cent, and a mortal. LABOR. – Mrs. J. Ellen Foster has been de. ity in cases aspetic before operation of O per tailed by the President from the Department cent. There has been no morbidity or im- of Justice, to investigate the conditions of pairment of gait. Comparing these figures female and child labor throughout the United with those given in Rubinrot's exhaustive States. study of symphysiotomy, tbe author con.
“ETHER DAY" was celebrated at the oludes that pubiotomy should absolutely replace the former in all cases in wbich it
Massachusetts General Hospital on October would otherwise bave been done.
16th, thus celebrating the sixtieth anniverOn account of smaller mortality it should
sary of the performance of the first operation replace Cesarean section where that would
under ether at that hospital.
The event is otherwise be chosen, in all cases buving a con
commemorated each year, the custom bav. jugata vera of 7 cm. or over in rachitic or
ing been instituted ten years ago. contracted pelves.
It should absolutely re- At the annual meeting of the Denver Clinplace embryotomy in the living child, pre- ical and Pathological Society, October 20, senting practically no greater risk to the Dr. C. B. Van Zant was chosen president; mother and saving the life of the child. It Dr. George B. Packard, first vice-president; should largely replace induction of premature Dr. George H. Stover, second vice-president. labor, or by combining pubiotomy labor may Re-elected were the secretary, Dr. Frank W. be induced at eight months, or later, increas- Kenney; the treasurer, Dr. J. A. Wilder; the ing the chances of the living child and making committee on admission, Drs. Jayne and
Bergtold; and the executive commitiee, Drs. Abstract of a paper read before the Mississippi Valley Medical Association, Hot Springs, Ark., November 7, 1906. Lyman and Hickey.
The Medical Society of City Hospital Alumni
President, LOUIS H. BEHRENS, 3742 Olive Street
Secretary, FRED. J. TAUSSIG, 2318 Lafayette Ave.
CHAIRMEN OF STANDING COMMITTEES :
Scientific Communication, Wm. S. Deutsch, 3135 Washington Ave. Executive, A. Ravold, Century Building
Publication, W. E. Sauer, Humboldt Building Entertainment, Frank Hinchey, 4041 Delmar Ave.
Public Health, R. B. H. Gradwohl, 522 Washington Ave
ST. LOUIS, MO.
A CASE OF CANCER OF THE CERVIX AS- On May 3 I performed a radical abdom. SOCIATED WITH FIBROIDS AND OPER- inal pan-bysterectomy.
The uterus was ATED ON BY THE RADICAL ABDOM- found adberent to the rectum with several INAL METHOD.*
myomatous nodules upon its surface. In
freeing the tissues about the right ureter, acFRED. J. TAUSSIG, M. D.
cording to the method of Wertheim, a liga
ture was accidentally' slipped around this The patient, Mrs. W., aged 71 years, came
structure. The mistake was shortly after
wards recognized and the ligature cut, but in into my charge at the St. Louis Skin and Cancer Hospital on April 21, 1906. There
so doing the ureter was necessarily exposed
for some distance. About one inch of the was no history of cancer in her family. Men
vagina with its connective tissue was removed struation began at the age of lő, and was in
with the uterus and adnexa. The operation every way normal until she was 35 years old.
lasted one hour and fifty minutes. At this time she began to notice a decided in. crease in the menstrual flow and the growth
Outside of post-operative urine retention of some tumor in the pelvic region. This her
with a resultant cystitis the patient for the
first twelre days made a good recovery. On dootor declared to be a uterine fibroid. Treatment consisted of ergot given internally.
this day there was noticed the escape of some The tumor remained stationary in size until
urine through the vagina. It soon became
evident that a partial necrosis of the right the menopause, which set in between the forty-fifth and fiftieth year. The tumor
ureter had taken place and the fistula result. rapidly diminished in size after this.
Note. ing in spite of all endeavors, refused to close.
When the patient left the hospital, on June worthy is the fact that although the patient bad been married since her twenty-first year,
23, her general condition was excellent.
A there had resulted no pregnancy.
Every: secondary operation for the relief of the fisthing went well until July, 1901, when she
tula was advised, but the patient refused to
have this done. The last examination, made began to notice a slight blood-tinged discharge. Soon thereafter she observed upon
two and one-half months ago, showed no re
turn of the cancer. taking a douche a moderate hemorrhage. From this time she grew steadily worse, but
The further microscopio examination of it was not until October, 1905, a year and a
the specimen removed showed that apparently quarter after the first onset of her trouble that
the excision had taken place in healthy tis. she consulted a physician. He did not advise operation, but prescribed a wash. The dis
The special points of interest in the case charge now became odorons and the bleeding city has been done only three or four times,
outside of the type of operation, which in this was hemorrbagio whenever the growth now felt protruding into the vagina was touched.
are: (1) The unusually slow growth of the In general appearance the patient was
cancer, being operable two years after the on. rather emaciated, appetite, poor but not very
set of bleeding; (2) its occurrence in a nullianemic, considering the duration of her bleed.
parous woman associated with fibroids of the ing. A cauliflower mass, the size of a man's fundus; (3) the necrosis fistula resulting from fist was found obliterating the vagina. Much
undue exposure of the ureter. to my surprise I found that the uterus was
REPORT OF CASE OF ENCEPHALO-CYSTO-MEN. still freely movable, and that by recto-vaginal
INGOCELE, OPERATION, PRESENTA. examination there was seen to be no infiltra
SPECIMEN. tion of the pelvio connective tissue. The pathologio examination made by Dr. McCon- Two days ago I was called to a confinenell of a piece of the tumor showed a me. ment case.
Before delivery nothing abnordullary carcinoma of the cervix.
mal was noted, but the indistinct fetal heart *Read at the meeting of Oct. 4th, 1906.
beat, which was about 115 or 120 per minute.
As the head dilated the perineum I noticed a swelling in the region of the posterior fon
Dr. Henry Jacobson.- Where it is nec. tanel. It was readily recognized as a menin. essary to dissect the tissues outside of the gocele. The child breathed normally. The uterine proper it would be much safer to inopening in the cranium was hardly larger troduce catheters into the ureters before the than the end of one's thumb. For the next operation and leave them there throughout six hours there was no seepage of the menin. the operation. Then if the growth extends geal fluid, but after that it soaked the gauze, around the ureter it can be more readily reand as there was beginning necrosis at the moved, and there would be no danger of ty. top of the mass I decided after consultation ing the ureter. with Dr. Fry, to do an operation, as leaving Dr. Taussig, in closing.--In reply to Dr. it meant certain death. Yesterday at noon
Dorsett, I found no enlarged glands in this when the child was thirty hours old I cut
case. I made, a search for them. I have away this meningeal sac. The specimen is given up trying to take out normal glands, in three pieces. You can see how thin the In an old woman (over 70 years of age) I did skin is at the point of beginning vecrosis. not feel like trying to remove the normal Within the meningeal sac was found a sinall lymphatic glands. As to the use of the piece of brain tissue. This was ligated, a cat. catheter in the ureters, it is very dangerous gut purse-string suture put at the base of the for the reason that we often have to use sac and the skin was closed with interrupted clamps, and if we catch the greter in the silk-worm gut sutures. The child showed clamp the catheter may be broken. I know but little immediate shock. It passed a good Dr. Sampson spoke to me about such an acnight, taking one or two ounces of milk di.
cident at Johns Hopkins. luted with water every two hours as well as Dr. Jacobson. I believe he would be rectal saline enemas. This afternoon there
a careless surgeon to say the least, to clamp is a temperature of 102 deg. but it nurses, a ureter, when his fingers would so easily retains its food, and there is a possibility feel the ureter with the catheter inside. that the child will pull through.
If he would clamp the ureter, the orushing Dr. Allison, who kindly assisted me in
of the delicate tissues would cause a necrosis, this operation, has assisted Dr. Lovett, of Bos, and as a result almost surely a fistula, and ton, in two or three similar operations, and
later if the fistula closes a stricture of the I understand the results are not discouraging,
ureter. though none of Dr. Lovett's cases large as this one, or done so soon after birth.
PRESENTATION OF SPECIMEN OF
Dr. Walter B. Dorsett.-I have bad no
HENRY JACOBSON, M. D. experience in meningocele in the new-born. As far as the other specimen is concerned he spoke of a necrosis of the ureter. Were the This was removed last month. glands that were taken out along the ureter tient, age 39, never had children, a poor enlarged or attached to it? The question is, woman, bad had severe pressure symptoms, was the ureter involved in the malignant dis- which made an invalid of her and had been ease? Not long ago 1 had a case something treated for sciatica and lumbago. I found like this.
The growth seemed to be on the upon examination an enlarged nodular uterus posterior wall of the uterus, and it had as- pressing against sacrum and diagnosed fibrosumed the shape of the pelvis. It went around myoma, and I operated on the 16th of last the ureters like a horseshoe, but I was en- month. She made an uninterrupted recor. abled to remove it. Had it enclosed the ery, and is entirely free from pain. You will ureter entirely I doubt if I could have re- see that the specimen is intermural would moved it. This case was of particular in- soon have become subperitoneal. There was terest to me on account of the absence of no hemorrhage in this case, because it was pain while there was great destruction of not growing towards the endometrium. This tissue. While it looked like a fibroid, micro- tumor was situated in the inferior posterior scopically it was found almost entirely car. wall of the fundus of the uterus; in this cinomatous in character, with very few fibroid situation the growths always call for early re. elements. The question bas long been dis. moval on account of the distressing pains in cussed whether fibroid tumors become malig. back, and radiating reflex pains down the nant, or whether they facilitate the growth of thighs. It also illustrates that too much malignancy. This case may throw some light stress must not be laid on uterine hemorrhage on the subject.
in suspected growths of the uterus.
SELECTED ARTICLE could in any way be modified to impart suffi.
oient knowledge without impairing the
health of the child, and with less liability THE PHYSICAL CARE OF SCHOOL of exposing the child to contagious diseases. CHILDREN.
Let us first consider what are the essen.
tials of the preservation of good health in ROWLAND GODFREY FREEMAN, M, D.
First, they need ample rest. They should
have ten or twelve hours in bed at night, Lecturer on Pediatrics, University and Bellevue Hospital Medical School; Attending Physician Foundling Hospi
and often with advantage a nap after the tal and Nursery and Child's Hospital, The Seaside midday meal. Hospital of St. John's Guild, New York.
Second. A proper diet: A moderate breakIt is probably the opinion of most physi. fast, a substantial but digestible dinner, and cians of this city who have the care of child- a simple supper. All these meals to be eaten ren that almost all school children are over- slowly and well masticated. worked, and that this is true in all grades of Third. Fresh air. A child should be out. school life, in the kindergarten, the primary of-doors several hours a day, and when in school, the secondary school; and the same the house should be in rooms well ventilated is true of young men in the professional and provided with at least 1,500 cubic feet of schools. This overworking is a natural tend- air space per person. ency, because children are sent to school to Fourth. Freedom from dust and exposure learn certain facts and to receive mental to disease. Infections due to dust and the training, and each institution is striving for direct exposure to contagious diseases cause a high standard of scholarship. Such a prac- a large part of the siokness of sohool children. tice is apt to cause some physical wrecks, as Fifth. Freedom from worry and fatigue. we know is the case in New York, through a Neurasthenia exists in earliest infancy and is straining of the nervous system or on account common in school children. It is induced of the lack of physical exercise caused by by anxiety, and particularly in children by continuous application to studies, while in- prolonged application. The child can exert directly by overworking the teachers who are itself intensely for short periods without apt to become neurasthenic, there is set up a harm, but prolonged application produces reflected nervous irritabiilty in their pupils. marked fatigue.
Under good surroundings that can be regu- Our experience tells us that when these five lated, the care of children, both by parents essentials of good health can be maintained and physician, is a source of considerable ample rest, proper diet, fresh air, freedom satisfaction and pleasure until they enter the from infection and freedom from worry, there kindergarten or school. Until that time they is usually little difficulty in securing promay be troubled occasionally with slight longed good health. Our problem, then, is colds, with oonstipation, or with adenoid hy. to ascertain whether such conditions are pracpertrophy, but as a rule they may be kept in ticable for our school children. They are good health. As soon as the child is en- certainly not offered now to any school child. tered in the kindergarten infections are more ren. Can private or public schools be organapt to occur. Colds recur more frequently, ized that would afford them? and the ordinary acute infectious diseases of The first condition, ample rest, may be ob. children are apt to break out. Whooping. tained with our present sobool arrangements, cough, mumps, chicken-pox, and measles usu. except that with most classes no opportunity ally occur within a few years after the en- is allowed for a nap after dinner. This is not trance at the kindergarten. As the child necessary in all cases, but is always desirable. leaves the kindergarten and enters the prim. The diet is also a matter for home regulation, ary school this liability to contract conta- except in publio school children, but this opgious diseases persists, wbile the prolonged portunity for the children to take their hearty concentration required in the school regime midday meal at leisure is often prevented by produces frequently, toward the end of the too small an allowance of time for the noonschool year, certain nervous disorders, of day recess. In some of our best schools but which chorea and hysteria are the more com- forty-five minutes are allowed for the ohild mon varieties.
to go to his home, eat the most substantial The question naturally arises whether these meal of the day with meat, and return to disadvantages of our present school system school. One hour would seem to be too litare due to any defect in school methods, or tle for such a recess. The question whether whether they are only an accompaniment of our public school system should not provide a system of education that is necessary for one nourishing meal a day, at least to those each generation, and whether school life children who are poorly fed at home, is a