Sperms

My recent mail swims with sperms. I send you these items to keep you informed.

Dr Paul Jarrett writes from Arizona:

I don’t know why spermatogenesis, the production of sperm, must take place at a temperature about 2 degrees below body temperature, but it does.

In order to insure propagation of the species – and this includes many other mammals – some means had to be employed so that a cooler environment than that within the peritoneal cavity, (where ovaries are completely comfortable), could be maintained.  The solution is to initiate the testicle at body temperature, an early necessity during organogenesis, and later in pregnancy move it outside where temperatures will be more easily regulated.  

Nerves provide temperature sensing while the cremaster muscles provide raising and lowering of the testes and further feed-back. Responding nerves provide for perspiration glands to produce sweat for evaporation and further cooling.  There are also mechanisms in place to minimize injury which I will not describe at this time.

Moving the testicle outside took a bit of doing.  During development of the embryo, (sometimes later-“Undescended Testicle) the testicle migrates out of the retroperitonal space through the Inguinal Canal to the Scrotum.  The process of peritoneum which forms the lining of the inguinal canal during this passage is pinched off at the Internal Ring if all goes well.  If not, a potential Inguinal Hernia exists with a pre-formed sac waiting for peritoneal contents to also migrate downward into the Inguinal Canal or Scrotal Sac.  This is known as an “Indirect Hernia”.  It happens with sufficient regularity to provide tuition for a Surgeon’s kids. I have repaired these from a few days old to well into old age.  They can occur in animals but are more common in bipeds. Continue reading

Doctor and Suer

I ate breakfast with a sixty-year old doctor who told me he’d retired from doctoring. He is a paediatrician, a member of that special tribe of doctors whose hallmark is kindness.

I congratulated him on his courage. It takes courage to walk away from a mistress as beautiful – or as possessive – as Medicine.

‘Oh no, I wasn’t brave; the opposite. I was sued.’

‘Really?’

Why was I surprised? Even in his quiet state of Tasmania we Aussies follow America in so much.

I wondered what he’d done.

‘Nothing. I wasn’t accused of doing anything wrong. That was the problem: rather I was accused of not doing something right; I didn’t detect a cancer that was diagnosed years later. By the time the cancer was found it had spread and could not be cured.’

My friend told me the story: how the woman consulted him for breastfeeding advice when her new baby was four days old for breast pain that went away over the following week. Two years later an aggressive breast cancer was discovered.

The woman visited my friend only once. By the time the case came to court the unfortunate patient had no memory of my friend.

America’s doyenne of breast feeding, a distinguished doctor, still acute in her nineties, travelled to testify what any doctor – or any mother – would know: breast pain is universal in the early days of lactation; that transient soreness of that sort is not caused by cancer but by engorgement; and when engorgement settles the pain disappeared. That is what happened in this case too; the eventual cancer was permanent but its supposed symptom was temporary.

This did not deter the counsel for the plaintiff from bullying my friend and decrying his knowledge and skill. In open court, on the public record.

The jury found for the doctor. He was exonerated. And, following two years of legal proceedings in which he lost sleep, lost weight and felt shame, he decided to stop seeing patients. ‘If I can be sued for practising properly, then I can never feel safe. I could be humiliated and publicly insulted in that way at any turn.’

A family with two small children will lose a mother. That mother will suffer and die. My friend loses his good name. A community loses the service of a person who turned his back on Medicine’s monied paths to work humbly for children. How many children of the future will never know his wisdom and skill? How many mothers might have found comfort in his counsel?

I marvelled that this person of exemplary quietude could be shamed publicly. I marvelled at the shamelessness of that lawyer, operating for a contingency fee. In pursuit of mere money that lawyer sought to take from my friend his good name. Now the lawyer has lodged notice of appeal. More grief, more tension for the accidental doctor, the human who helped another human in the elemental enterprise of physical mothering.

More tension and uncertainty, more grief for the mother who will die.

I attended a tribunal hearing once of a different type. Here there was no suit for damages. Instead the licensing authority heard an accusation against an older doctor by a patient that he’d carried out an improper examination of her chest.

The tribunal – consisting of two doctors (one female), a former police detective and a social worker – heard the patient’s evidence in a closed room. The woman was allowed the presence of a support person. The doctor and his support person were excluded. As a result the complainant was given an opportunity to present intimate evidence before a small number of persons who questioned her with respect and tact.

The lady and her supporter were then excused and shown to a private room to await the outcome.

Subsequently the doctor was called on to explain himself before that same nuclear group. He detailed a systematic mode of examination which was thorough, an examination he was taught at his medical school in the days when doctoring was painstaking and x-rays were a late resort. It transpired the patient had never before been examined with such thoroughness. She felt it improper.

The older doctor had practised in this manner for sixty-five years without any complaint against him. He took quiet pride in his meticulous methods. He knew no other way. And now those virtues had found him out.

I imagined the woman had to summon her courage and her resolve to make her complaint. But in the course of these proceedings she was not made to feel that she was on trial for her own truthfulness.

The panel – comprised of doctors and non-doctors – exonerated the doctor. The female chair said the panel found his work exemplary. She added, ‘This tribunal wishes you many more years of such careful practice.’ She then excused the doctor.

After the doctor’s departure from the premises the complainant was recalled. The tribunal explained that no finding was made against the doctor’s practice nor against the patient’s truthfulness.

Here again two innocent persons endured painful proceedings, but neither was humiliated in open court. A careful enquiry was conducted, uncontaminated by lure of money; here there was no blood sport.