Realm Of Medicine Research Articles

Limit AAP policy to medical practice

The American Academy of Pediatrics is a fine organization with numerous outstanding accomplishments in its history. However, it should limit its policy statements to medically related problems. The stated policy of strict gun control/ban in the Firearms and Adolescents. policy statement puts the AAP in territory outside the realm of medicine.

Hospital-Wide Program Identifies Battered Women; Offers Assistance

POLICE OFFICERS say that responding to a call involving domestic assault is one of the most dangerous aspects of their work. For physicians, it is no less a challenge. Treating the injury lies comfortably within the realm of medicine, but addressing the injury's cause can feel like trespassing in another's territory. Physicians have been criticized for not asking about the cause of a woman's injuries, even when it is clear that she was deliberately hurt by another person. But if physicians do choose to ask, and discover the patient is a victim of abuse, what can they offer her? Many physicians lack an effective way to connect these women with services that could help. Simply giving her the telephone number of a crisis center is rarely sufficient—battered women are not likely to call these numbers unless they are also receiving ongoing, personal support of some kind. Many are afraid that

Hospital-wide program identifies battered women; offers assistance

POLICE OFFICERS say that responding to a call involving domestic assault is one of the most dangerous aspects of their work. For physicians, it is no less a challenge. Treating the injury lies comfortably within the realm of medicine, but addressing the injury's cause can feel like trespassing in another's territory. Physicians have been criticized for not asking about the cause of a woman's injuries, even when it is clear that she was deliberately hurt by another person. But if physicians do choose to ask, and discover the patient is a victim of abuse, what can they offer her? Many physicians lack an effective way to connect these women with services that could help. Simply giving her the telephone number of a crisis center is rarely sufficient—battered women are not likely to call these numbers unless they are also receiving ongoing, personal support of some kind. Many are afraid that

The Myth of Mental Illness: The Feuchtersieben Version

Ernst von Feuchtersieben is an eminent nineteen century Viennese psychiatrist who is almost completely ignored both by modern psychiatrists and historians of psychiatry. Flowever, he has recently been mentioned by Thomas Szasz who views him as his predecessor and ascribes to hiin his own thesis, namely, that mental illness is a mere myth (or at best a mere metaphor) which was introduced into psychiatry by Johann Heinroth. The present essay examines the question can Feuchtersieben be viewed as Szasz's forerunner. Szasz follows the individualistic principles rigorously and argues that all goal-directed individuals are autonomous—regardless of whether they stiffer while struggling towards their goals. Hence, Szasz excludes the mentally ill from the realm of medicine and renders immoral the psychiatrists who impose on them psychiatric diagnosis and treatment. For those who endorse in one and the same time both the principles of individualistic ethics and the common opinions concerning the autonomy of the mentally ill, the paradoxicality of the common opinions, in the light of Szasz's works, seems unsolvable. Feuchtersieben endorses (the Kantian version of) the individualistic ethics yet, sensitive to the paradox, he follows Solomon Maimon's critique of Kant and rejects, at times, Kant's dogmatic view of human freedom. He thus rejects both poles of the paradox as a myth (à la Lévi-Strauss) and offers an alternative approach instead of the paradoxical one. Fie recommends we view mental health and autonomy as regulative principles in the empirical domain. The physician, the educator, the clergyman and the legislator should cooperate in diagnosing and treating defects of both mental health and human autonomy. Szasz is therefore in error when he claims Feuchtersieben as his predecessor. The views concerning the mentally ill of these two are diametrically opposed. Moreover, I think Feuchtersleben's view is superior: indeed, whereas Szasz succumbs to or, at best, explains away the myths which prevail to the present day regarding the mentally ill, Feuchtersieben offers an explanation and a proposal of treatment.

Abortion in Chinese Law

In every human society procreation is a matter of basic concern. In Confucian China, this concern was sanctified by the cult of ancestor worship into the very basis of morality; the inability to provide one's ancestors with a male heir to continue the line was the gravest failure in a man's performance of his filial duty. At the same time, traditional Chinese law gave wide power to parents over their offspring, culminating in the Qing Code grant of power, in effect, over life and death. Infanticide also was not prohibited.1 Thus the obsession to possess was coupled with an almost absolute power (and often readiness) to dispose. Both have been swept away by the social revolution over the past century. In this light it is interesting to explore the changes in Chinese law on the subject of abortion from imperial times to the present day. These changes reflect the transformations in the Chinese views of human life, social organization, and the status of women. By comparison with the treatment of the subject in Western law, the following questions are posed: What constitutes a legal offense of abortion? Is abortion considered homicide? Who is liable to be punished for the offense, and how severely? What is the legal status of the foetus? Finally, whom (or what) does the abortion law protect? Consideration of these questions will bring the discussion beyond law into the realms of medicine and Weltanschauungen.

The World Health Organization: Promotion of US and Soviet Foreign Policy Goals

International health matters have a significance that transcends the realm of medicine. This paper demonstrates how an international health organization can serve its members—in this case the US and the USSR—in promoting their foreign policy goals. This does not imply that, in the advancement of political interests through WHO, the essentially nonpolitical character of that body is compromised. Indeed, attempts to introduce political questions per se before its assemblies have met with prompt rejection. The ultimate political objectives of the democratic and totalitarian state remain disparate. In promoting their foreign policy goals, however, the US and the Soviet Union use independent but strikingly similar means to advance a variety of important national programs and objectives.

Current Therapy, 1950

In 704 pages this book covers the whole realm of medicine from one aspect only—treatment. No attempt is made at discussion of etiology, pathology, or diagnosis of the hundreds of conditions covered, but each of over 250 contributors has described in detail his present methods of therapy for a particular disease. To avoid a limited viewpoint in areas where legitimate differences may exist, frequently more than one author gives treatment procedures for the same disease.

SIGNIFICANCE OF THE pH OF NASAL SECRETIONS IN SITU

Despite the fact that scientific investigation of the p H mechanism began more than a half century ago, it is only recently that the interest of practical technologists at large—and rhinologists in particular—has been aroused. The subject of hydrogen ion concentration was poorly defined and lacked a clear, comprehensible nomenclature. With the advent, however, of comparatively new and simple methods for measuring hydrogen ion concentration, it has been possible to awaken the clinician's interest in a type of investigation that has practical application to innumerable and diversified fields. In the realm of medicine, the p H influence is intimately associated with general health. More specifically, in the case of blood it is of paramount importance. The p H influence is not restricted to blood alone, for the p H of spinal fluid, lymph—in fact all body fluids, including the nasal secretions—has definite clinical significance. It will be recalled that the p H scale, a means

The Rôle of Radiology in Medicine

THE International Radiological Congresses have made it a rule to place on their programs, in addition to the scientific questions, radiological-organization problems of general interest for medicine as a whole. The present Congress has placed on its program for discussion that most central of all radiological-organization problems: the integration of radiology into medicine as a whole. The President of this congress, Dr. Arthur Christie, and Dr. William Mayo, America's world-renowned surgeon, ruler of one of the metropolises in the realm of medicine, have displayed for us their broad view of one side of the problem: the unity of medicine. To me has been given the honorable task of opening the discussion of the problem's other side: the role of radiology as a member of the unity of medicine. For the one who can remember the birth of radiology, the story of the development of this science is a marvelous one. The new light became visible like a dazzling meteor in the evening of the nineteenth century. It surrounded the morning of our own century with the rosy light of hope and promise. Like a glittering sun it shines resplendent on the working day of the twentieth century, revealing new fairways and fresh horizons in nearly every land in the world of science. In medicine, radiology has played the role of a pioneer and a creator in the spheres of diagnostics and of therapy. Its revolutionizing work in the domain of diagnostics is that it has extended. the physician's field of vision to include the interior of the living man. Roentgen diagnostic methods have increased diagnostic skill in almost every branch of the medical science, and in this way have contributed in a high degree to the reliability of our judgment of the indications of treatment and have thereby improved the results of treatment. I will merely remind my hearers that roentgen diagnostics have contributed most essentially to the magnificent progress made during the present century in the provinces of abdominal, thoracic, and cerebral surgery, and in orthopedics. As regards internal medicine, too, roentgen diagnostics have become an indispensable guiding star. Also radiotherapy, that is, Finsen-, Roentgen-, and Curie-therapy, has created an epoch in the history of medicine. By its destructive action on malignant tumors and dermatic fungi, by its power of hastening or causing a healing process in inflammatory conditions of various kinds, and by its readjustive action on certain disturbances in the functions of the endocrine glands and the hematopoietic organs, radiotherapy has become an indispensable weapon in the service of medicine. But how is it that radiology has come to play such a röle that one is entitled to say it has set its seal most decisively on the medical science of the present century? And how, in the future, will radiology be able to continue to play this important part?

The Factor of Hypoglycemia in the ætiology of Idiopathic Epilepsy

In the whole realm of medicine there are few more easily recognizable clinical syndromes than those which have been grouped together under the generic term of “epilepsy” or “epileptiform convulsions”; nevertheless, in spite of a vast amount of research work, the causation of these conditions is still imperfectly understood.

CAUSES OF DEATH IN STATUS LYMPHATICUS

In the realm of medicine and surgery there are still a number of pathologic conditions of uncertain etiology but none that possesses more features of interest than the condition of constitutional hypersusceptibility known as status lymphaticus. Not only is the etiology of this condition uncertain, but the symptoms are vague, the diagnosis is difficult or impossible to make, the treatment is of doubtful value, and the sudden death that is occasionally seen has never been satisfactorily explained. The interest that has been attached to this subject is evident in the enormous amount of conflicting literature that has accumulated, especially on the significance of the enlarged thymus gland. With such diversity of opinion regarding status lymphaticus and the thymus gland, it is not surprising to find some physicians who seriously question the existence of such a condition and the occasional sudden death without adequate cause. In a recent contribution, 1 I

The Significance of Small Intestinal Stasis

DURING our routine examinations of the gastro-intestinal tract at the University Hospital in Philadelphia, we have frequently been impressed by the unusual and varied appearances so commonly observed in the small intestine. We have often been at a loss to adequately interpret these apparent variations from the normal, and this, we dare say, has been the experience of most roentgenologists. The marked frequency of these atypical small intestinal forms has led us to undertake a study to determine, if possible, the cause of these apparent abnormalities. This presentation is a preliminary report of the problem and serves as an outline for future study. We hope that this subject will prove of sufficient interest to induce others to make similar observations. The small intestine is regarded by some authorities as the most essential portion of the alimentary canal. With this in mind one wonders why the diagnosis of small intestinal lesions has played so little part in the evolution of gastro-intestinal roentgenology. There are two reasons for this apparent neglect on the part of roentgenologists: First, in spite of its importance, the small intestine is not often the seat of an organic lesion; second, because of its size, mobility, and irregularity, the small intestine does not lend itself to roentgenologic study as favorably as the stomach or colon. Recent observations, however, have led us to believe that much valuable information is to be obtained from a study of the small intestine. Physiologists and clinicians are becoming more and more impressed with the co-ordinated action of the various organs comprising the digestive system. Thus a disturbance of function in one organ reflects itself in a readjustment of function in the other organs of this system. No one is able to appreciate this fact better than the roentgenologist, who so frequently encounters disturbances in gastric function resulting from pathology elsewhere. The small intestine, situated as it is between the stomach and colon, must have its functions frequently altered by disturbances in either of these portions of the tract. Nature has wisely recognized this fact and has placed most of the small intestine upon a mesentery, thus permitting it to move about the abdomen with more or less freedom. Reflect for a moment on the many compromising situations that would arise were the jejunum and ileum fastened securely in place as is the duodenum. One has but to think of the great variability of the symptomatology of diseases of the gastro-intestinal tract to conjecture that possibly, within the small bowel, lies the origin of many of those atypical symptoms which so frequently tax the diagnostic acumen of the physician. There are no diseases in the whole realm of medicine which so seldom run true to clinical types as do those of the gastro-intestinal tract. Clinical medicine has made but little more progress than has roentgenology in arriving at a true appreciation of small intestinal function.

Roentgenology—the Handmaid of Diagnosis

The time has gone by when the conscientious physician can afford to take the responsibility of dismissing a patient with a clean bill of health if he has failed to utilize the precise methods of analysis which science has made available. While this may be superficially annoying to the gifted men who in times gone by have been our chief dependence in the finer points of diagnosis, the true physician will rejoice in the fact that science has made available methods of analysis that may be utilized by the average physician. This was well expressed by Sir Thomas Lewis in his classic work on “The Mechanism and Graphic Registration of the Heart Beat,” in which he says: In no science, in the true sense of the word, is there the almost open vaunting of and reliance upon personal skill; in no science is supposed manipulative dexterity so venerated, as in our realm of medicine…. A method depending for its success upon a supposedly unusual sensitiveness of touch or of hearing is one the clinical scope of which is admittedly limited, the scope of which in science is almost negligible. Some physicians have complained that medicine is becoming too much of a science and is losing its quality as an art. I fail to see why it is not possible to preserve all that is fine and helpful in the art of medicine and at the same time utilize every scientific aid that can be made available. A physician highly qualified in the art of medicine loses nothing by excluding guesswork, so far as possible, from his diagnosis. It is true that with the multiplicity of instruments of precision and definite mechanical means of checking up the functions of the organs, there may be an invitation to physicians who seek the easiest rather than the best pathways, to rely too much upon such measures. But that is a necessary risk in the development of the art and science of medicine. Right-minded teachers and right-minded students will welcome the opportunity to broaden their work. As the technical methods of checking up the functions of the body increase and improve, there will be a release of ability in the direction of solving the vast number of obscure problems that now confront us in the field of clinical medicine. There is another type of physician who needs to give his attention to the facilities of the X-ray and pathological laboratory, and that is the one who flatters himself that with his unaided senses he can fully protect his patient. It is this type of physician who, when a patient comes to him with a health examination report in which an X-ray examination of the chest, for example, is recommended, will tell his patient that this is entirely unnecessary: “I have gone over your chest and I find no indications of any pathology.” A physician who makes such a statement is either grossly ignorant of the science of medicine or unduly influenced by his emotional reaction to the suggestion that an X-ray examination would be a measure of protection in such a case.

Modern treatment of chronic urethritis

1. 1. Chronic urethritis is preventable in the majority of cases. 2. 2. Chronic urethritis is essentially a urologic entity, entirely apart anatomically and clinically from its precursor, acute anterior urethritis. 3. 3. Cure is dependent on our ability to locate infected foci, and having located them, to eliminate or destroy the gonococci, and restore tissues to their normal condition if possible. 4. 4. Cooperation of the patient must be secured and is predicated on our imparting to him the knowledge requisite to his understanding the serious nature of his disease and its treatment. 5. 5. The successful treatment depends on conditions and circumstances and the reaction of tissues to it, and nowhere in the realm of medicine or surgery is the maxim of Aristotle more appropriate than when used with reference to the treatment of chronic urethritis: “Not too much, not too little.”

THE USE AND ABUSE OF BACTERIAL THERAPY

As one of the earlier pupils of Wright at St. Mary's Hospital, London, I trust that some of the things I shall say in the discussion of this subject may not seem to be at variance with the teachings of that brilliant student of immunity. There can be no doubt of the value of his researches and their practical application in that realm of medicine with which we are so frequently concerned. But as often happens with any more or less complicated and difficult mode of procedure, the method has been misunderstoodand misapplied by many whose optimism carried them further than the facts warranted. It will not be necessary to discuss in detail the features of immunity conferred by the inoculation of bacterial cells or their products in the varied types of infection to which the method is applicable, but rather to consider the practical aspects of treatment involved. If

GENERAL AND SPECIAL TREATMENT OF TUBERCULOSIS.

It is a source of pleasure to state in the words of an authority, Solis Cohen, that tuberculosis of the lungs is a curable disease. This authority, however, believes that the statement must be considerably modified with reference to the outcome of every case. We all realize from painful experience how utterly inefficient were our past resources in the arrest of these cases. There is no disease within the realm of medicine that gives the physician more prolonged and painful anxiety, because, in the first place, it is a pathologic process, generally occupying a lengthened period of time, whether in the direction of recovery or death; and in the second place, because we can not weigh in the balance the amount of potential energy possessed by the victim and the degree of vitality of the invading bacilli. We are thus surrounded by a cloud of uncertainty. It may be well