Babies & Hospitals

To get a taste of everything new in the field of U. S. medicine this spring, a doctor would have to shuttle between Manhattan, Chicago, Kansas City, Philadelphia, Rochester (Minn.), Boston, St. Louis, Detroit, Atlantic City. He would have to attend conventions of specialists as varied as the American Academy of Pediatrics and the American Urological Association, would have to visit state medical association meetings from Alabama to Wyoming. Practically all those meetings occur in the five-week period which began last week.

Last week met the state medical societies of Arkansas. Florida. Louisiana and New York. The New York convention in Manhattan was the most notable of all except that of the American Medical Association in Kansas City next week.' By the display of 17 colored cinemas of operations, it even surpassed the A.M.A.'s program, where only ten medical movies will be presented. From manufacturer's of medical products, machines and books, who rented display space at their show, the New York society collected almost $15,000.

Babies and hospitals made the headlines in Manhattan. When Dr. Robert Arthur Wilson of Brooklyn reported that he got 400 stillborn babies to breathe by injecting a drug called alpha-lobeline hydrochloride into the vein of their umbilical cords while they were held upside down, fellow obstetricians pounced upon him. Objection No. 1: Dr. Wilson used a drug which the A.M.A. has not approved. His retort: "We must not let babies die just because the A.M.A. has not approved the drug." Objection No. 2: He did not first try such standard methods of stimulating breath in the newborn as blowing into their mouths, slapping their rumps with a wet towel, tossing them, artificial respiration. Dr. Wilson: "The lapse of one minute may be enough, through the absence of oxygen, to damage permanently the cells of the respiratory centre. Once the drug reaches the new born infant's general circulation, the respiratory gasp takes place in less than twelve seconds. Three constant reactions occur within one to four seconds before the respiratory gasp--an increase in muscle tonus, a stiffening of the arms, and a slight opisthotonos [arching of the back]." Commented Dr. George William Kosmak, conscientious editor of the American Journal of Obstetrics & Gynecology: "I have no desire to belittle the effect of the report which we have just heard.

I think, however, we should be careful in accepting this particular step as the sine qua non of resuscitation. The thing that strikes me most forcibly was that there were 400 cases of childbirth in which there was sufficient asphyxia to warrant the use of such emergency methods. This would seem to me to point to a need for reform in other directions. I think steps should be taken to reduce that need." The other major rumpus was over the relationship between doctors who practice in a hospital and the non-doctors who run that hospital. The board of directors is legally responsible for a hospital's finances and for any damages which may be inflicted on a patient "through the fault of any hospital servant, including members of the medical staff," according to Hospital Organization & Management, professional bible compiled by Dr. Malcolm Thomas MacEachern, associate director of the American College of Surgeons. Therefore the directors "not only choose the nucleus of the medical staff in a newly organized hospital," but through their chief agent, the superintendent of the hospital, also have "the right and obligation to make subsequent [medical] appointments and to remove any [ medical] member whose conduct is inimical to the welfare of the patient and of the hospital." The superintendent of a hospital is rarely a doctor. Likewise a doctor is rarely found on a hospital's board of directors. Medical matters are handled by a medical board which can advise the board of directors but is powerless to control the hospital's policy.

As a result of Depression many hospitals have lately been giving cheap diagnostic services to put their expensive xray, basal metabolism and other machines to some profitable use. This practice hits the individual doctor in the pocketbook, but he can do nothing about it because his hospital is managed entirely by laymen.

This inherent conflict between doctors and hospitals prevails in every large U. S. community. In New York it is acute enough for the State Medical Society to resolve during its convention last week "that hereafter only those institutions which realize, acknowledge and observe in practice no change in medical_ staff or professional organization without recommendation or approval of its medi-cal board shall be regarded as [ethical]." Further, the New York Society threatened to boycott hospitals whose boards of directors do not cooperate with their medical boards. The resolution: "It shall be considered unethical for any physician to accept appointment to fill a vacancy in any hospital staff or professional organization which has been created by the lay administration in disregard of the principles of equity and justice herewith declared."

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