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ANÆSTHETISTS' FEES UNDER THE POOR-LAW.
263
percussion. There was apparently nothing to account for this condition. The necropsy revealed the fact that the left lung was simply a small mass in a semi-atelectatic condition, whilst the right lung (upper lobe) had expanded in a compensatory manner and filled the greater part of the left chest, thus obliterating the normal area of cardiac dulness. There The organs were was no external deformity of the chest. shown by Dr. Norman Dalton at a meeting of the Pathological Society of London and a discussion followed as to whether the condition was congenital or acquired. Dr. Curnow considered that the left lung had been pathologically destroyed early in life, probably during foetal life. I am, Sirs, yours faithfully, THOS. H. GARDNER, Resident Medical Officer, The Royal Hospital for Diseases of the Chest, City-road, E.C. Jan. 19th, 1899. ANÆSTHETISTS’ FEES UNDER THE
POOR-LAW. To the Editors of THE LANOET.
SIRS,--Will you kindly reply in your next issue whether the Local Government Board have ever issued an order sanctioning a fee for the administration of chloroform in operations done in the workhouse or district to medical officers under contract ? I have some recollection of having een some such announcement. I am, Sirs, yours faithfully, M.D. Jan. 22nd, 1899. *** The Local Government Board have issued no order on the subject of fees for the administration of chloroform in operations performed in the workhouse or the parish, but it s not the practice of the Board to raise any objection to the payment of a reasonable fee for assistance "at an operation" (which is the official term for the administration of an anaesthetic), rendered by an outside practitioner to the medical officer of a district or workhouse in the performance of operations of difficulty or danger. It is their rule, however, to call for a short report upon the case from the medical officer before sanctioning the fee. This procedure is of fairly frequent occurrence in large parishes and institutions, and no difficulty is ever raised. Indeed, the Board would probably hold the medical officer responsible, and blameworthy if anything went wrong, if he were to attempt to perform an operation of any importance without adequate assistance of this kind. In institutions where there is an assistant medical officer he is supposed to render such aid, but even in these circumstances, where the operation is one of much difficulty and an assistant is required in addition to the chloroformist, a fee has been sanctioned. The sum approved varies from 1 to 3 guineas, according to the magnitude and duration of the operation.-ED. L.
NOTES FROM INDIA. (FROM OUR SPECIAL CORRESPONDENT.)
provinces has also improved. On the other hand, plague seems increasing slightly in Broach and in the villages surrounding Poona. No fresh cases have occurred at Rahon in the Punjab, but heavy rain has caused great discomfort to the unfortunate people who have been turned out of their houses, and the huts in the plague camp have been swamped. The greater part of the town has been evacuated, and the remaining inhabitants will soon be cleared out. Karachi records one case and two deaths, Poona three cases and two deaths. The Plague Commission has been sitting in Calcutta, as I said in my last letter. Dr. Justice referred to the 3 cases of plague occurring among the peons of the High Court, in which he attributed the infection to dead rats, many being seen in the neighbourhood, as there was no connexion between the peons and other infected persons. Dr. Bose (native practitioner) thought that the plague was brought from Bombay, but there was no specific instance of men coming from Bombay with plague; it was simply suspicion. A heavy mortality amongst rats was noticed in March and April and the plague first appeared in Calcutta in April. He thought bubonic cases were infectious. The mortality returns were not satisfactory and plague deaths were registered under other names. Friends registered deaths and there was no system of death certificates. Dr. Hossack thought that there was a factor in the environment of Calcutta inimical to the spread of plague in epidemic form, but what it was he did not know. He said the bustis of Calcutta were in a very insanitary condition. The disinfecting measures adopted were greatly insufficient. He said that the native doctors with Indian degrees rendered no assistance, but resisted the efforts of the officials and helped to conceal cases. Mr. J. N. Banerjee had seen cases of fever with glandular enlargement, but the symptoms were little like the cases of plague which he had attended. There was great difficulty in getting information of cases. On Jan. 3rd Surgeon-General Harvey, Director-General of the Indian Medical Department, was examined. So far as he could see the case for inoculation seemed absolutely clear. Though not absolutely preventative it was so to a very considerable degree. Experiments of which he had knowledge were such as to exclude the possibility of error. He did not think people would consent to be inoculated on a large scale before an outbreak. They could not rely entirely on inoculation for coping with an outbreak. It was very valuable but could never be any but an auxiliary to sanitary measures. Looking at the importance of sanitation he thought it would be a good thing if they had in India a sufficient number of health officers with good qualifications whose time was actually given entirely to sanitary work. He had already recommended this and he expressed the hope that the time would come when every district had its sanitary medical officer. The chief obstacle was the expense involved. Calculation would show that if India spent on sanitation as much as England was supposed to do we should have to spend in proportion to the population £53,000,000 sterling, whereas the actual revenue was only f.36,000,000. On Jan. 4th the Plague Commission continued its sittings. Mr. Ferris had no doubt of the existence of plague in the city. Dr. Wallace had seen cases diagnosed as plague by others. He disagreed with the diagnoses. He was of opinion that the cases recorded as plague were those of malarial fever of a malignant type. Mr. Greesbach, Director of the Geological Survey, pointed out that the largest number of plague cases had occurred on the soil covering the Deccan trap and crystalline rocks and only a very small number on the great alluvial belt ’i stretching from the Indian Ocean to the Bay of Bengal. The former formation roughly coincided with the distribution of laterite deposits. On the trap and crystalline rocks 150,929 deaths had been recorded, while on the IndusGanges alluvium only 12,936 deaths had occurred, or only 7’88 per cent. His explanation of this apparently striking fact was that the exodus of scared population spread themselves fan-like over the Deccan trap from Bombay. On the conclusion of their work in Calcutta the Plague Commission will proceed to Agra. They will then go on to Lahore and are timed to arrive in Karachi by Jan. 23rd. Afterwards they will proceed to Cutch Maudvie, Ahmedabad, Baroda, Broach, Surat, and Damaun, reaching Bombay on Feb. 12th, where they will take evidence again until Feb. 20th. The Commission will subsequently go to Poona,
The Progress of the Plague.--The Plague Commission. THE progress of the plague in India during the past week was on the whole satisfactory. The new cases reported for the Bombay Presidency are only 2636, as against 3196 the week previously. The deaths have been 2106 against 2576. In Bombay city, however, the returns are unfavourable. There was a considerable rise both in the reported plague attacks and mortality. The disease seems to be increasing in virulency, for with 151 cases reported there were 146 deaths, while the previous week recorded 147 cases and 113 deaths. The total mortality was 894, against ’742 in the previous week, a rise of 152. The quinquennial weekly average is about 500. The rise in the Dharwar and Bijapur districts was more than counterbalanced by a fall - elsewhere. In the Madras Presidency the situation remained unchanged, but a great improvement took place both in the military and civil stations of Bangalore. There was Satara, Belgaum, Sholapur, and Ahmednugar. They will a fall in the number of deaths in the Mysore territory from embark for Europe on March 24th. 416 to 241. The position in the Wardha district central Mr. Jamsetjee N. Tata, a rich Parsee, is about to found an
percussion. There was apparently nothing to account for this condition. The necropsy revealed the fact that the left lung was simply a small mass in a semi-atelectatic condition, whilst the right lung (upper lobe) had expanded in a compensatory manner and filled the greater part of the left chest, thus obliterating the normal area of cardiac dulness. There The organs were was no external deformity of the chest. shown by Dr. Norman Dalton at a meeting of the Pathological Society of London and a discussion followed as to whether the condition was congenital or acquired. Dr. Curnow considered that the left lung had been pathologically destroyed early in life, probably during foetal life. I am, Sirs, yours faithfully, THOS. H. GARDNER, Resident Medical Officer, The Royal Hospital for Diseases of the Chest, City-road, E.C. Jan. 19th, 1899. ANÆSTHETISTS’ FEES UNDER THE
POOR-LAW. To the Editors of THE LANOET.
SIRS,--Will you kindly reply in your next issue whether the Local Government Board have ever issued an order sanctioning a fee for the administration of chloroform in operations done in the workhouse or district to medical officers under contract ? I have some recollection of having een some such announcement. I am, Sirs, yours faithfully, M.D. Jan. 22nd, 1899. *** The Local Government Board have issued no order on the subject of fees for the administration of chloroform in operations performed in the workhouse or the parish, but it s not the practice of the Board to raise any objection to the payment of a reasonable fee for assistance "at an operation" (which is the official term for the administration of an anaesthetic), rendered by an outside practitioner to the medical officer of a district or workhouse in the performance of operations of difficulty or danger. It is their rule, however, to call for a short report upon the case from the medical officer before sanctioning the fee. This procedure is of fairly frequent occurrence in large parishes and institutions, and no difficulty is ever raised. Indeed, the Board would probably hold the medical officer responsible, and blameworthy if anything went wrong, if he were to attempt to perform an operation of any importance without adequate assistance of this kind. In institutions where there is an assistant medical officer he is supposed to render such aid, but even in these circumstances, where the operation is one of much difficulty and an assistant is required in addition to the chloroformist, a fee has been sanctioned. The sum approved varies from 1 to 3 guineas, according to the magnitude and duration of the operation.-ED. L.
NOTES FROM INDIA. (FROM OUR SPECIAL CORRESPONDENT.)
provinces has also improved. On the other hand, plague seems increasing slightly in Broach and in the villages surrounding Poona. No fresh cases have occurred at Rahon in the Punjab, but heavy rain has caused great discomfort to the unfortunate people who have been turned out of their houses, and the huts in the plague camp have been swamped. The greater part of the town has been evacuated, and the remaining inhabitants will soon be cleared out. Karachi records one case and two deaths, Poona three cases and two deaths. The Plague Commission has been sitting in Calcutta, as I said in my last letter. Dr. Justice referred to the 3 cases of plague occurring among the peons of the High Court, in which he attributed the infection to dead rats, many being seen in the neighbourhood, as there was no connexion between the peons and other infected persons. Dr. Bose (native practitioner) thought that the plague was brought from Bombay, but there was no specific instance of men coming from Bombay with plague; it was simply suspicion. A heavy mortality amongst rats was noticed in March and April and the plague first appeared in Calcutta in April. He thought bubonic cases were infectious. The mortality returns were not satisfactory and plague deaths were registered under other names. Friends registered deaths and there was no system of death certificates. Dr. Hossack thought that there was a factor in the environment of Calcutta inimical to the spread of plague in epidemic form, but what it was he did not know. He said the bustis of Calcutta were in a very insanitary condition. The disinfecting measures adopted were greatly insufficient. He said that the native doctors with Indian degrees rendered no assistance, but resisted the efforts of the officials and helped to conceal cases. Mr. J. N. Banerjee had seen cases of fever with glandular enlargement, but the symptoms were little like the cases of plague which he had attended. There was great difficulty in getting information of cases. On Jan. 3rd Surgeon-General Harvey, Director-General of the Indian Medical Department, was examined. So far as he could see the case for inoculation seemed absolutely clear. Though not absolutely preventative it was so to a very considerable degree. Experiments of which he had knowledge were such as to exclude the possibility of error. He did not think people would consent to be inoculated on a large scale before an outbreak. They could not rely entirely on inoculation for coping with an outbreak. It was very valuable but could never be any but an auxiliary to sanitary measures. Looking at the importance of sanitation he thought it would be a good thing if they had in India a sufficient number of health officers with good qualifications whose time was actually given entirely to sanitary work. He had already recommended this and he expressed the hope that the time would come when every district had its sanitary medical officer. The chief obstacle was the expense involved. Calculation would show that if India spent on sanitation as much as England was supposed to do we should have to spend in proportion to the population £53,000,000 sterling, whereas the actual revenue was only f.36,000,000. On Jan. 4th the Plague Commission continued its sittings. Mr. Ferris had no doubt of the existence of plague in the city. Dr. Wallace had seen cases diagnosed as plague by others. He disagreed with the diagnoses. He was of opinion that the cases recorded as plague were those of malarial fever of a malignant type. Mr. Greesbach, Director of the Geological Survey, pointed out that the largest number of plague cases had occurred on the soil covering the Deccan trap and crystalline rocks and only a very small number on the great alluvial belt ’i stretching from the Indian Ocean to the Bay of Bengal. The former formation roughly coincided with the distribution of laterite deposits. On the trap and crystalline rocks 150,929 deaths had been recorded, while on the IndusGanges alluvium only 12,936 deaths had occurred, or only 7’88 per cent. His explanation of this apparently striking fact was that the exodus of scared population spread themselves fan-like over the Deccan trap from Bombay. On the conclusion of their work in Calcutta the Plague Commission will proceed to Agra. They will then go on to Lahore and are timed to arrive in Karachi by Jan. 23rd. Afterwards they will proceed to Cutch Maudvie, Ahmedabad, Baroda, Broach, Surat, and Damaun, reaching Bombay on Feb. 12th, where they will take evidence again until Feb. 20th. The Commission will subsequently go to Poona,
The Progress of the Plague.--The Plague Commission. THE progress of the plague in India during the past week was on the whole satisfactory. The new cases reported for the Bombay Presidency are only 2636, as against 3196 the week previously. The deaths have been 2106 against 2576. In Bombay city, however, the returns are unfavourable. There was a considerable rise both in the reported plague attacks and mortality. The disease seems to be increasing in virulency, for with 151 cases reported there were 146 deaths, while the previous week recorded 147 cases and 113 deaths. The total mortality was 894, against ’742 in the previous week, a rise of 152. The quinquennial weekly average is about 500. The rise in the Dharwar and Bijapur districts was more than counterbalanced by a fall - elsewhere. In the Madras Presidency the situation remained unchanged, but a great improvement took place both in the military and civil stations of Bangalore. There was Satara, Belgaum, Sholapur, and Ahmednugar. They will a fall in the number of deaths in the Mysore territory from embark for Europe on March 24th. 416 to 241. The position in the Wardha district central Mr. Jamsetjee N. Tata, a rich Parsee, is about to found an