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PENDING No chiropractic legislation was enacted in 1924. At the present time, however, bills are pending to commit the state of Michigan and the state of West Virginia to the chiropractic cause.
The Michigan definition in the pending bill (S. B. No. 164) is a "straight" chiropractic product :
Chiropractic is defined to be the science of palpating and adjusting the articulations of the human spinal column by hand only. This detinition is inclusive, and any and all other methods are hereby declared not to be chiropractic..
No licensee may under any circumstances hold himself out to the public as practicing or practice anything but straight chiropractic as hereinbefore defined.
The West Virginia definition is of the same type (S. B. 260), but is a frank avowal of the inadequacy of manual palpation for the detection of so-called chiropractic spinal lesions. It is an interesting recognition of the uselessnessone might almost infer, a recognition of some hidden danger--of Palmer's "Neurocalometer," for apparently it makes the use of that contrivance, as “a mechanical contrivance" or other agency, by chiropractors unlawful in West Virginia. The definition is as follows:
The practice of chiropractic is hereby defined as physical diagnosis, nerve tracing, palpation of the segments of the spinal column, the adjustment of misaligned segments of the spinal column to their normal position for the purpose of relieving pressure upon spinal nerves.
The use of any mechanical devices of any kind or any agency whatsoever, other than the human hands, is prohibited in the practice of chiropractic, excepting the use of adjusting tables, and the employment of the x-ray, which may be used only for the purpose of making pictures of the spine or segments of the spinal column, and only then by those who have completed the course and are in possession of a diploma in spinography, issued by a regularly chartered school of chiropractic teaching spinography. .
A chiropractor shall not be permitted to prescribe for any person any medicine or drugs now or hereafter included in materia medica, or to administer any such medicine or drugs; and no chiropractor shall perform any minor or major surgery, practice obstetrics or practice osteopathy unless duly licensed to do so by laws of this state in addition to his license to practice chiropractic.
THE EVOLUTION OF DEFINITION An examination of the various definitions of chiropractic set forth above show a process of evolution. Despite the claim that the very foundation of chiropractic was the hypothesis that all disease was the result of displacement of the vertebra, the earliest statute shows that that dogma was not recognized. In fact, it is difficult to see why the earliest statute was enacted at all, for the chiropractor as defined by them was nothing more nor less than an osteopath. One might almost hazard a guess that this palpable fact stood in the way of the growth of chiropractic as an independent trade; it made it necessary for those who were exploiting chiropractic through the development of chiropractic schools to allege some essential difference between chiropractic and osteopathy, on which to base their claim for recognition independent of osteopathy. Without such independent recognition, graduates of chiropractic schools would supposedly be outlawed everywhere. They could not be licensed as nonsectarian physicians, not only because of their lack of education and their general ignorance and unskilfulness, but because they possessed no medical education and no degree in medicine. They could not be licensed in osteopathy, because they had studied in no osteopathic school and had been graduated by no such school as the osteopathic laws require. Unless chiropractic could get its own licensing boards, the chiropractic schools must go to the wall. The supposed vital spark of a chiropractic dogma was found in the claim that the back-bone was the seat of all disease and that the hand was the sole corrective power. And around that dogma has been built up a mass of legislation that is a disgrace to the supposed intelligence of the American people.
HEALTH PROTECTION IN AMERICAN INDUSTRIAL
PLANTS * That American industry leads the world in protecting the health of its workers is evident from the great forward strides made in this field by industrial establishments in the United States, as reflected in a survey of the cost of health service in industry now being made by the National Industrial Conference Board, 247 Park Avenue, New York. According to the board's investigation, as far as completed, on the average about 16 per cent. more money per employee is now being spent by industry on medical supervision than was being spent four years ago, when a similar survey was made by the board.
Industry values the health of its workers. Talk to a man who has been in the army, and he will tell you that at no time of his life was his general health more scrupulously looked after than while in the service. Likewise, employers are concerned over the well being of their employees, to a degree where the question might well be raised whether if, in an up-to-date industrial plant, the worker's physical well being often is not better protected than it is in his home or wherever he may spend his leisure time. Care is taken in every modern establishment that ventilation and illumination are as perfect as technical science can make them, so as to enable the worker to do his best and without unnecessary strain. Shower baths and recreation grounds are provided more and more generally.
Out of 446 establishments covered by the survey of the board, 255 report that applicants for employment are being physically examined, and most of these plants use the result of the medical examination as a guide in selecting the proper work for the applicant. In many plants, employees as well as executives are reexamined at regular intervals. Much care is exercised to safeguard workers from contact with infectious diseases.
CONSERVING PRODUCTIVE POWER Much possible damage to health and the productive capacity of both, the individual worker himself as well as the productive power of the nation at large, is obviated by physical examinations. Naturally, not all applicants for work are in perfect health. Many have minor ailments that can be corrected, but are not known to them until they are examined when asking for work. This often results in making a sound, hundred per cent. worker out of one previously able only to do little or mediocre work, to the loss of both himself and productive power at large. Defective teeth, tonsils, defective vision and curable skin diseases, for instance, are cases in point. Again, physical examination will uncover some chronic defects which do not entirely bar the applicant from work, but require that he be given a specific kind of work which he can do with the least injury to himself. Arrested or cured tuberculosis, varicose veins, flatfoot, high blood pressure, kidney and heart disease are in this class. Other defects, not always known to the worker himself, such as defective eyesight, defective hearing, or heart trouble might well present danger to the safety of other workers and the plant if the worker is placed on a job apt to place strain on the organs involved.
BENEFIT Physical examinations, therefore, are an insurance and protection, both to all workers and to the industrial establishment as a whole. As a result of such examinations, many men and women suffering from one defect or other, who otherwise might not have been able to hold a job, or only a poorer job, are enabled to hold good jobs where their particular affliction does not interfere with their work. The survey of the Conference Board, as far as completed, indicates increasing
*Editor's Note.—This is a bulletin of the National Industrial Board, Inc., and as such should be of much interest to physicians generally.
employment of such "substandard" workers, which is equivalent to a fuller utilization of the available productive power of the nation, and means a livelihood for many a man or woman who otherwise would be dependent on others.
Besides the care taken of employees in accidents, many industrial plants give what aid they can in case of sickness, with a view to cutting short the period of illness and returning the worker to his job as soon as possible. In this connection visiting nurses are often used to watch over the progress of the patient, although generally medical attention during illness not contracted through his work of course is a personal matter for the employee to procure.
Objections to physical examination by employees and applicants for work are practically nil, the board's investigation indicates.
Only eleven plants had discontinued the policy of medical examination out of the 446 included in the survey.
In 501 plants replying to the board's questionnaire, the following personnel was engaged in looking after the physical welfare of the workers : 265 full-time physicians; 356 part-time physicians; 773 physicians on call; thirteen full-time dentists; seventy-eight part-time dentists; 152 male nurses; 693 female nurses, and 121 visiting nurses. The medical staff included 256 technical assistants and 361 clerical assistants.
The board's investigation, as far as completed, indicates increasing thoroughness of physical examinations of the workers, and that the general policy of the industries is to extend medical supervision into the fields of sanitation, safety, general welfare, home visitation, health education and related matters.
NEEDS AND STANDARDS OF OUTPATIENT SERVICE *
The clinic examining and treating patients while they are up and about is of great medical importance. In the clinic it is possible to make an early diagnosis and provide effective treatment for many serious diseases, while they are still in a curable stage. The clinic can alleviate suffering and inefficiency due to chronic conditions and prolong the productive life of the patient. Many distressing diseases or defects of special organs or functions require the facilities and services of a specialist which large numbers are unable to obtain except through the outpatient clinic.
THE OUTPATIENT CLINIC The association of outpatient service with hospital beds is mutually advantageous. The patient may thus be cared for at all stages of an illness, the beds providing for the most acute period or for surgical operation, the outpatient department for the early stages and for the after-care necessary to restore health completely and to ascertain end-results.
The outpatient department of the hospital generally treats at least five times as many persons as are cared for in the wards during the same period. For example, some five million visits are made by patients to all the clinics in this city annually.
The clinic is an important agent in the prevention of diseases and in the organized public health movements of today. It provides a connecting link between the hospital and the community. In the clinic there is special opportunity for the close association of social service with medical service. In certain branches, such as pediatric and cardiac clinics, this association has been shown to be an essential part of the clinic's effectiveness.
* Issued by The Associated Out-Patient Clinics of New York City and distributed by the Public Health Committee of the Medical Society of the County of Kings to its members.
In the education of the medical student and as a field for research into the causes and methods of treating disease, the clinic is of increasing importance.
OUTPATIENT CLINICS REQUIRE ADEQUATE SUPPORT Notwithstanding these facts, outpatient service has been a relatively neglected part of hospital administration, far more so than its importance to the public and to the medical profession would justify. More than twenty-five hundred physicians are serving in the clinics of this city, the large majority without any financial remuneration. These physicians generally feel that the outpatient departments do not receive from the governing boards the attention or support commensurate with their value to the public and their obligation of adequate service to the individual patient.
We, therefore, are gratified to see the effort made by the Associated Outpatient Clinics to study carefully and continuously the problems of outpatient work in New York City, particularly as associated with the hospitals. We welcome the attempt of the association to prepare standards which, while necessarily tentative, should serve as a guide to the authorities of all institutions doing outpatient work. The following standards are considered by the Associated Outpatient Clinics as among the essentials for a satisfactory outpatient service:
FIVE FUNDAMENTAL STANDARDS 1. The outpatient and the bed services should be regarded as intimately associated phases of hospital work and should be unified as fully as possible as to medical staff and as to administrative organization.
2. The number of patients accepted for care should be limited and regulated according to the facilities of staff, space and equipment.
, 3. Adequate records should be maintained of the medical work, the attendance, and the income and expenditure. All the medical records of a patient should be filed together.
4. Adequate laboratory service should be made available for the outpatient department.
5. Nursing service, social service, and clerical service should be provided. Physicians should be able to devote their time to their patients and be freed from mechanical and clerical duties.
These standards are not theoretical. A number of the fifty-four outpatient departments of hospitals which are members of the Associated Outpatient Clinics have one or more of these principles in actual operation; several have adopted all of them. ENDORSEMENT OF
STANDARDS We cordially endorse these standards. Each one carries with it practical implications with respect to the organization, staff and equipment that should be provided. Successful methods for their practical application have been worked out, but will, of course, vary in detail according to the conditions in each institution, so that the appropriate methods must be the subject of inquiry and study by the authorities of each institution for itself.
It is recognized that some, though not all, of the most needed improvements will require additional funds. It is not believed, however, that resources will be lacking once the importance of the work, its relative economy and its existing needs are thoroughly understood. We urge the governing boards to devote their attention to these standards, to compare them with existing conditions in their own outpatient services, and to consider what steps need be taken to bring the outpatient service to the level implied by these essential principles. Their adoption and their practical application would contribute greatly to improvement of service to patients, the purpose for which our medical institutions are conducted.
A COURT'S VIEW OF EXPERT TESTIMONY One familiar with the complexities of medicine and with its nomenclature who has been called on to sit through a session of a civil or criminal court can but wonder what the ordinary jury gets out of the bombardment of scientific and ultrascientific words and phrases that is Aung at them by the expert witness. It is not at all unusual for the attorneys in a given case, or even the court, to show a lack of understanding of the language of the expert. Then what must be the effect of the Greco-Latin-English-American polysyllabics on the poor jury, most of whom think and talk in one and two section words? And, especially, when the experts on the two sides, talking the same ununderstandable language, use it to try to prove two exactly opposite propositions? Well, here's what a Utah court had to say about certain phases of the subject :
There was, it seems to us, more learning displayed in trying the case than was necessary. The bill of exceptions abounds with technical terms and learned disquisitions on "embolisms, and on “thrombosis," on "acclude” and on “accludation," on "ankle clonus" and "syphilitic myelitis," on "primary, secondary, and tertiary syphilis,” and also on “latent, acquired and congenital syphilis," on "parasyphilis," "syphilitic degeneration,” and on malignant "endocarditis." There is also much said about the cervical, dorsal, lumbar, sacral, thoracic and the epitrochlear and other regions. In addition to all this we have also lectures on Wassermann's tests and on Babinski's toe sign. Indeed, the only regions that are not discussed and defined are the solar plexus, the oil, and the nether regions. Then we have the
exaggerated reflexes" and hundreds of other things. All this is followed with a most interesting discussion of the germ which, it is said, produces the disease called syphilis. But even here the doctors, as usual, differ. Some call the germ by the old familiar name of Spirochaeta; others call it Spirochaeta pallida; while still others give it the name of Treponema pallidum. Much is said about the past history of syphilis. The doctors traced it back before Abraham's time. After reading the learned discussions of the doctors and their statements respecting the numerous ways by which the ordinary mortal may become infected with the ubiquitous and never sleeping Treponema pallidum, one marvels why any of us have escaped its deadly grasp. Much of the evidence in this case, while no doubt interesting, and, perhaps, enlightening, to the medical fraternity, nevertheless merely tends to bewilder and confuse the laymen who are called to sit as jurors. It is therefore not hard to conceive that, unless the jury is carefully and fully directed in the instructions, they may easily be misled respecting what their verdict should be.
A NEW OLD SCHEME An enterprising gentleman in Chicago has established what he calls an "Ethical News Service" which, apparently, he has been industriously attempting to sell to physicians. In letters sent to physicians, he propounds a few questions and answers them, evidently to his own satisfaction, before offering his “ethical service”— exclusive rights at $15 per.
"Have you ever given thought to the disadvantages that the physician labors under in the pursuit of his profession?" he wants to know. Apparently he thinks you have not considered the matter, though you are a physician, and he is not one.
His next is, "Have you noticed in reading the metropolitan papers how consistently the same physicians are mentioned in discussions of medical matters?" Well, have you? We ask the same question, but not for the same reason.
Then comes, “Why should a select half dozen, out of possibly ten thousand equally good doctors, be kept in the spotlight?" That's another perfectly good question, but not for the reason the “ethical news service" man had in his head when he asked it.
And now we are "getting ho:" with the next two questions, because they are leading us straight to the Ethiopian concealed in the accumulation of ligneous material: "Are you interested in a like opportunity for yourself in your own community? If you may not use advertising display space, why not take advantage of the opportunity offered by the news column ?"
After presenting, with each question, what purports to be argument in favor of the point of view of the “Director" of this “ethical news service," his letter