seventeen children, nearly all of them lived to be grown. As prolific as Mrs. F., was her neighbor Mrs. H., was ahead of her and so far as I know, Mrs. H., still holds the record of Montgomery county, though she has been dead fifty years. I have not heard of any one taking the record from her. In her day she seemed to be very proud of it as she would say "I am the mother of twenty-six children." If these four women had lived in France, their names would have been on the honor roll of the pension department, for they certainly earned and deserved a pension, which none of them received. THE DUTY OF PHYSICIANS TO THEM- AND TO THE LAITY.* By W. G. KINGSOLVING, Eddyville. The physician should be competent, should be moral, should be a gentleman in the truest sense of the word, and he should have his whole soul in his work. The responsibility resting upon him is wonderfully and fearfully great; unsurpassed by any other avocation; and I am afraid a great many do not feel and realize the fearful responsibility placed upon them. Every physician should take care of himself and family. Surely every every laborer is worthy of his hire. Surely the great require ments and importance of a physician's work demand that he should be properly rewarded for his services. Surely every doctor should try to collect his bills, and the people should be willing to pay him well, so he could more. efficiently serve them. But instead of that, the doctor is generally very poorly paid and has a hard time to get the meagre sum he does get. This should not be, and the doctors are mostly to blame for it, because they will not work together and for each other. It is said that $750.00 is the average wages of doctors. This is less than the brick layer, less than the guards receive at the penitentiaries. They receive $75.00 per month and do not have to spend any money to educate themselves; no money spent in college as a preparation--just so they can handle a gun, they are well paid for their work considering the requirements of qualification. The daily laborer receives a dollar or a dollar and a half a day, and considering his expenses, he is better paid than the average doctor; and yet you often hear people say the doctors extortion upon them, rob them. This shows that the people are ignorant about the real conditions *Read before the Southwestern Kentucky Medical Association. existing and that physicians fail to properly teach and train them, and physicians, instead of working together like brothers ought to do, work against each other, cut prices and undermine their brother doctor in many ways. This should not be. We should all strive together to eliminate this terrible curse to our profession. A short time ago I knew a doctor who did a large practice. He was a jolly good fellow, a good physician. He went night and day, cold or hot, and wore himself out, but when he died he left nothing for his family to live upon, and those who never paid him their bills did not honor him as much as if he had forced them to pay their just debts. By these careless business methods he brought want and distress upon his family and an untold injury to the profession by training his patrons to be criminally negligent about paying their doctor bills. Another good physician 85 years old, died a few years ago. practiced 55 or 60 years. He was a good man. He had The people owed him perhaps $50,000. He never tried to collect any money. He said he did not expect his reward here. his reward here. He expected it in heaven. By this foolishness he ruined the people and when he died he did not have enough to bury him decently. I had some experience with this good old careless doctor. I was in an adjoining community to him and when I would get in earntheir bills they would quit me and go to this est about some of my tardy patrons paying peculiar old doctor and get him to do their practice and I would lose my bill. But finally this good old man died and went to heaven and then, thank the Lord, I had the advantage of some of these dead beats and forced them to pay and they were ever afterwards as good as a national bank. These two doctors serve to illustrate a condition that is very prevalent in our ranks So many doctors will not collect their bills, becompetitor, money or no money. The people cause they want to be popular and beat their learn this and go from one to another and in this way many people never pay a doctor bill. I have had patrons quit me and employ other doctors because I insisted that I be paid, and these doctors gloated over receiving these patrons when they were bound to know that these patrns were infernal dead beats. So many doctors are proud of an extensive practice whether there is any pay or not. In this way they uphold dead beats, bring poverty and want upon themselves and families, injure every other physician and degrade a noble profession. Again so many doctors will cut on prices and jockey on fees, like a low down horse jockey will jockey in trading his plug horses. I have known doctors to agree on certain prices, charge these prices, then on settlement cut the bill one-third and swear the patron to secrecy and say confidentially, This is the regular prices we physicians charge but being it's you, I will knock off one-third; but don't you say anything about it." The low down political demagogue is one of the lowest wretches in existence. He drinks with the drunkard, he gambles with the gambler, he will bribe and be bribed, among sinners he is a ring leader; when among Christians he is very righteous. He pre tends to have extreme love for everybody, kisses all the babies, gives nickels and dimes to nearly every child he meets, compliments all the women and pats every man on the back-a pretended friend to everybody, but at last you find him to be a selfish, deceitful wretch, a friend to nobody and a curse to the people. I have heard of doctors having "lick-logs". They would practice every fiendish trick of the demagogue. They would keep whiskey to treat the drinking classes, pet and kiss and fondle every child, compliment and flatter the women and almost hug every man in their solicitation for practice. Then they are always on the alert. If any doctor has a settlement with any of his patrons and if there is the slightest dissatisfaction about the charges, this medical demagogue is "Johnnie on the Spot" ready to do claims the practice much cheaper and he claims much better. He enters into the confidence of the patron and gains the practice through deceit and duplicity. In this way our profession is degraded and we are dragged down by the slime and corruption of the traitorous demagogue. You may denounce the advertising quack and pass laws to check him in his dubious ways, but he is nothing to compare with the snide that is in the regular ranks and claims to be an honest physician, but is a hidden devil and works under cover to despoil his professional brother and deceive the people. The advertising quack stands upon earth and you have some chance at him, but this demagogue that gets into our ranks, "a wolf in sheep's clothing," is like a mole that burrows in the earth and undermines everything that is good and true and noble in our profession; and like the mole, he is hard to catch, because he has so many low underground caverns by which to escape when pushed by justice, and, therefore it is difficult to inflict upon him his just punishment. punishment. After he had preached for some time he passed the hat around and took up a collection for his preaching. When his hat returned some devilish fellow had put in a button. This made the preacher mad and he at once changed his notion about future punishment. I have been preaching there is no hell," said he, "but if there is no hell there ought to be a hell to put that fellow in that put that button in my hat." If there is no hell there ought to be one to put the suide and traitorous demagogue in because it is impossible to bring him to justice here on earth. CRIMINAL ABORTION. into the minds of the people. It is a fad that There is a peculiar, strange notion getting is growing upon the minds of a great many that profess to be moral and even religious people. They would be horror stricken at the idea of murdering a man or woman, a small child or a babe at its mother's breast, but they have not the least remorse of conscience when they murder the foetus in utero. It seems that some are ignorant and do not realize that it is dangerous and a great crime, but others are well informed upon the subject and although they may profess respectability and piety they are hypocrites, and so infernally mean they don't care to murder their offspring and even solicit the doctor to perform the hellish deed. a Not long ago I was called to see a woman, pregnant for the third time. She claimed she had as many children as she wanted and was not able to take care of any more, and she wanted me to produce abortion on her like physician over in Tennessee had done the year before. I told her no doctor was justifiable in performing abortion only to save the life of the mother and as she was in good health, we would commit a great crime and endanger her health and life to perform abortion. She was not satisfied with the advice but the husband agreed with me and thanked me for not doing as the Tennessee physician had done the year before, which caused him a great deal of expense and his wife a long term of sickness. So she became satisfied to go on with her pregnancy and left the State in two or three months after that in good health and good spirits. Another case I remember. A young couple with one child, the wife became pregnant the second time. An abortion occurred accidentally or on purpose-I think on purpose. A severe septicemia intervened. I was called to clean up and clear away the debris. I worked hard to save the woman and finally sueceeded. They were greatly pleased with my services in that time of great need, and seemHe preached that there was no hell, no future ed to think me a great dotcor, and they were This brings to my mind the Universalist preacher who preached at Scottsburgh in Caldwell county a good years ago. many warm and ardent friends. In about a year afterwards she again became pregnant, they became very much alarmed and said nothing would bring on the desired menstruation and that I must do something to terminate this pregnancy, that they were not able to raise any more children and if this pregnancy was not terminated they would not pay me the balance of my doctor bill. I told them that I could not produce abortion, that it was a crime, a penitentiary offense, besides being dangerous to the mother's health and life. They got mad at me and quit me and employed another doctor to wait on her in her confinement. Now, fellow physicians, the history of such cases represents a serious condition that is taking hold upon the minds of a great many people, and it behooves all good, honorable physicians to raise their voices in condemnation of such crimes, and do all in their power to teach the people better, and do all they can to purge the profession of sneaking, hidden, abortionists and bring to justice all who commit such crimes. Formerly it was regarded as a violation of medical ethics for physicians to lecture and instruct the people upon medical subjects. This was a serious mistake; because the more other diseases. Every good physician should cooperate with this health officer, be a teacher of sanitation and give the people wholesome instruction upon the healing art, and try to banish ignorance and superstition out of the minds of the people, and elevate the science of medicine to the pinnacle of efficiency and honor; annul the vagaries of so-called Christian Science, eliminate the curse of quackery in the profession, and expose the medical demagogue wherever he may be found. I love the profession of medicine and would like to see it blossom as the rose. I would like to see it held upon a high plane of universal honor and respect. I would like to see physicians work together in unity, shoulder to shoulder, head to head and heart to heart. I would like to see every good doctor well paid for his arduous work, and when he dies leave something for his family to live upon, and keep the wolf from the door. I love my country, and would like to see the people so educated that they would not be duped by quacks and demagogues, but would come up to the help of the honest doctors in the prevention and cure of diseases. Scoliosis.-H. B. Thomas, Chicago (Journal A. M. A., Jan. 23, 1915), calls attention to certain intelligent the people are upon these subjects points in the etiology of congenital scoliosis. He the more easy and pleasant is our practice: and we are now giving public lectures upon sanitation, the cause of disease, its prevention and the rational cure. It seems that the laity in general are more ignorant and superstitious upon the subject of medicine than any other. The most they have ever learned has been from almanacs. patent humbug advertisements, and the teachings of traveling charlatans. No wonder they are humbugged by every patent medicine that comes along. Hence many preachers. judges and persons in high places are often duped into giving testimonials to quack nostrums; and they often make use of silly remedies and adopt superstitious ways for the eure of dis ease. I knew a learned lawyer and statesman to listen to the crazy whims of his wife and depend upon the superstitions orgieries of Christian Science (so-called), to cure a fever. Many people that in a general way are educated and intelligent, are foolish enough to believe in the faith doctor and practice many silly things to their great detriment. This condition of affairs calls for intelligent, scientific instruction to the laity upon the prevention and cure of disease. Every Every county should have an all-time health officer to protect the health of the people, to urge vaccination for the prevention of small-pox, to teach the people how to prevent typhoid fever, dysentery, tuberculosis and a host of excludes those cases that are the direct result of bony congenital defects and includes under this head only those that have another origin than arrested bony development, hence we have left for consideration, he says, the following theories of the cause: heredity; intraurterine pressure or injury; intra-uterine paralysis; intra-uterine rickets and intra-uterine anomalies of muscles. We should distinguish between congenital and acquir ed characters. Histories of cases of scoliosis frequently how that other members of the family on the father's or mother's side also had similar deformity. The other causes, except the last, will be evident to anyone considering the subject. As regards the anomalies of muscles, they may give a key to the etiology and he quotes from the notes of Prof. B. C. H. Harvey as to the finding of such in the cadaver in different instances; especially anomalies must be considered as a cause for beginning asymmetry, the exaggeration of which by abnormal insertion of the trapesius muscle. Such position would give rise to scoliosis. It cannot be contended, however, that all subjects with anomalies of muscle length or attachment will necessarily have scoliosis. So far as Thomas knows this theory that scoliosis may be caused by an asymmetrical attachment of muscles has not been hitherto advanced. He offers it however, because he thinks it ought to have a place in the general consideration of the etiology of these cases. The case reported was not of this kind but was one due to bony defects. The article is illustrated. CEREBRAL CONCUSSION AND COMPRESSION.* By J. F. DAUGHERTY, Demossville. In the field of surgery there is nothing that gives the surgeon more worry or more alarm than injuries of the head which may be classed as cerebral concussion or compression. For some of the worst injuries may recover while on the other hand what may at first seem only a trivial injury prove fatal in the end. Therefore, as cases have recovered after missiles have passed entirely through the brain taking bone and brain matter on the way no case should be regarded as hopeless. Again, since cases have proven fatal from what seemed only a slight injury, all cases must be regarded as suspicious. When called to an unconscious case we must first consider whether we have a case of cerebral concussion or compression, cerebral hemorrhage, uraemia, alcoholic or drug poison, ptomain poison or hysteria. We may have the symptoms of compression and concussion so merged one into the other at first we are not able to tell what are the conditions with which we are to deal. By the term cerebral concussion we mean a severe shaking up or contusion of the brain caused by violence. By compression we mean undue pressure on the brain by some foreign body, it may be abscess, blood clot, tumor, piece of bone, lead or some other foreign substance. Symptoms of compression in general are those of paralysis, usually unilateral, breathing is puffy. vomiting absent. In concussion the nervous system and circulatory system are mostly involved. The anatomical condition of the brain after death from concussion is often insufficient to "omprehend the fatal result. The symptoms of concussion range from a mere daze, to those of deep unconsciousness. In pure cases there are no paralysis often the patient is very restless, and throws his limbs about in all directions, loud speaking to him may elicit attention but his answers are mostly incoherent, there is palor, coldness of surface, sweating; vomiting is usual, which may come early or late. In favorable cases, vomiting ceases as patient slowly returns to consciousness which which may be preceded by delirium. Pulse is usually feeble and fast. There may be retention of urine, sluggishness of bowels. Respiration is ir regular and sometimes almost ceasing, pupils are not of much diagnostic value as to whether it is compression or concussion. The reaction from pure concussion is usually slow. the patient is apt to be dazed for some time, although the pulse and temperature may be normal. When these rebound with fever and *Read before the Pendleton County Medical Society. florid complexion, and suddenly or gradually another, but deeper, unconsciousness supervenes, it is almost certain that positive lesion took place at time of injury. Now, really compression followed by inflammation is the condition with which we have to deal. DIAGNOSIS. The history of the case and symptoms as detailed will enable us in most cases to reach a conclusion as to how much injury has been done to the brain. There are some conditions from which concussion is to be carefully distinguished. These are simple fracture with or without depression, compression from any cause, drunkeness and epilepsy. There may be such profound shock with fracture that at first concussion symptoms mask those of the lesion, or even keep them for a time completely hidden. There is a marked distinction between the ordinary symptoms of compression and those of concussion whether from deand those of concussion pressed fracture or effusion as of blood in apoplexy. Here there are flushed, and often swollen countenance, stertorious breathing, slow, and it may be strong, pulse; deep or absolute insensibility and fixed pupils. The injury, if there is one, is mostly palpable and explanatory. If it is concealed the other symptoms point to the true nature of the The diagnosis from drunkenness is not always easy. Deep intoxication is more apt to be accompanied with compression than with concussion signs. Drunkards often have bruises on their heads, but if they have suspicious symptoms accompanying, then the patient should be kept under observation for several hours. case. Prognosis in concussion is usually favorable, but if complete unconsciousness is present it is doubtful as to the individual as long as this lasts, for as before intimated, the cases that recover may present as marked symptoms as those that prove fatal. Recovery is mostly complete but not suddenly so. The af ter effects in any case may prove serious. There is, however, an unwarranted tendency to attribute any defect in character and even criminal deeds to a blow upon the head. The blow may be the cause of subsequent epilepsy, chronic inflammation and insanity, or imbecility. These cases have an almost continuous history of trouble from the date of injury, the manifestations varying in severity from time to time, as pathologic changes develop them. TREATMENT. In mild cases of concussion rest is all that is required. The symptoms should be well watched for several days to see whether any serious complication follows the injury. Again, serious symptoms may be present without indicating any great gravity in the case. Children, for example, often have convulsions from the slightest cause. After injury of head they will have convulsions for two or three days and then go on to recovery. The more serious cases also require rest, hot applications to extremities. nape of the neck and over the stomach, also along the sides of the body. Stimulants should be used continuously as some unpleasant consequences of the brain may follow. If the reaction is regular with gradual restoration to consciousness and no noticeable rise in temperature, nothing more is required than rest, cool drinks mild diet, bowels and bladder must be attended to; catheter may have to be used. Restlessness can be controlled with bromides, chloral, etc. When reaction is followed by fever and especially if accompanied with secondary unconsciousness, give salines, ice cap to head, or blood letting may be preferred by some. Hot water in some cases 120 degrees to 130 degrees, acts well. Treatment of compression is mostly expectant. If symptoms warrant it, trephine. THE RELATION OF THE HOSPITAL By SARA E. Dосk, Paducah. Woman Some one has said a nurse is born and not made, I would like to amend that by saying, a nurse is born and then trained. possesses qualities which naturally make her superior to the average man for this important work, which stands second to the medical profession itself. The nursing profession is monopolized almost entirely by women. It's about the only thing we are allowed to do without the blame of trying to take away the work from the poor men. In spite of the fact that women are naturally adapted to the art of nursing, superintendents of hospitals often find it difficult to obtain desirable applicants for training. The possible reason for this is, the lack of home training, and that children are rarely taught the importance of obedience. In my estimation, obedience is the first law and the very cornerstone of good nursing, and here is the first stumbling block for the beginner. No matter how gifted she may be she will never become a reliable nurse until she can obey without question. The first and most helpful criticism I ever received from a doctor was when he told me that I was simply supposed to be an intelli *Read before the Southwestern Medical Association at Paducah,, May 12, 1915. gent machine for the purpose of carrying out his orders. As to the relation of a nurse to the doctor, there can be no relation of the nurse to the doctor other than a strictly professional one. Any other relation will mean disaster to the nurse. By disaster, I mean that any relation not professional will lead professional will lead to misunderstandings, quarrels or perhaps marriage, and in either case the nurse's usefulness as a professional nurse will be at an end. This to me is a pretty good argument why a nurse should maintain strictly formal relations toward the doctor, never forgetting that her success in the future depends mainly on the doctor's recommendation and influence. It is true that after several years of doing private duty a good nurse receives many calls through the friends of patients, but suppose she steps beyond the bounds of professional etiquette and commits that unpardonable sin of suggesting to the family that another doctor be called in, perhaps the one she prefers and, in other ways, conducts herself unbecoming as a nurse. Her opportunities will be limited to nursing for that one particular doctor, no matter how qualified and accomplished she may be. Instances have occurred where the physician has been dismissed and the unprofessional nurse retained (but this is very unusual). The professional career of such a nurse is bound to be short. My advice to nurses doing hospital work or private duty would be to maintain a strictly formal attitude toward the doctor. You may not care for the personality of the doctor who is in attendance but you are bound to respect his profession and obey his orders. If his conduct is such as to offend and make it impossible for you to do conscientious work, make some excuse and give up the case. It is always well on taking charge of a case to inquire from the doctor what he would allow the nurse to do if any emergencies arose. This is not only for the patient's safety but for the nurse's protection. As you know, there are occasions where a nurse's prompt action may save the life of her patient, but at at the same time she would like to know that attending physician. the means are entirely approved of by the After all, no matter how professional or clever a nurse may be, she will never be successful if she lacks common sense, tact, and the ability to grasp the fact that her real success depends on the little things in nursing and not on the fact that she may be able to diagnose the case. As to the relation of the doctor to the nurse, I believe the doctors are mainly responsible for the many inefficient nurses that |