BERLIN.

1165 of 360,000, and in the collection of joe200,000, all the work having been done by voluntary effort. BERLIN. Great changes affecting the profession of medicine (FROM OUR OWN CORRESPONDENT.) in its relation to the public were everywhere being discussed, and were mostly acknowledged to be inevitable. It would be idle to deny that certain Critical Condition of the Medical Profession. tendencies had given cause for uneasiness, even alarm. Prof. Schlossmann, of Dusseldorf, lately read a It had been said that the day was approaching when the State would control all the medical services in this paper before the German Society for Social Hygiene country, and that the first great step to this end on the crisis in our profession. The liberty of the would be taken with the fall of the voluntary hospitals. medical man, he said, is a dream of days gone by Mr. Arthur Greenwood (Minister of Health), in and the profession cannot longer resist a progressive responding, said that the view that the Ministry of nationalisation. Apart from some specialists with a Health had no regard for the voluntary hospital large income the majority of doctors earn their system of this country was utterly mistaken. FromI livelihood from the fees paid them from institutions two points of view, the voluntary hospital system in under the State Insurance Act. This Act provides this country was vital to the progress of public health. them with 250,000,000 marks every year. Moreover, First, it was interwoven with the growth of knowledge the individual practitioner has to observe so many on problems affecting the lives of our people ; secondly, rules and regulations issued by the government and there was need of every hospital bed existing in this by insurance authorities that he cannot be described country. His only object was to form a great as a free worker. Prof. Schlossmann does not at all agree brotherhood of people who would serve the common with the leaders of the profession in their fight against ends of humanity. In the effort to understand the sick clubs and other institutions of State insurance, problems which doctors felt were fundamental in the for he holds that it only embitters their mutual public interest, he had gathered to himself the heads relations. It would be better, he thinks, to cooperate of the profession, in a spirit of friendship, and the with them so as to get over certain abuses. response had been whole-hearted. He was appalled, According to Prof. Schlossmann, the profession as he dug deeper and deeper into the problems of is suffering from an economic crisis, an ethical crisis, public health, by our lack of knowledge, which only and a crisis of confidence. The position of the younger the medical profession could remedy. There re- generation who have to wait several years before mained much to be learned, and, when it had been admission to club practice is desperate financially, learned, much to be applied. He welcomed, without but still worse is the fact that they are obliged to be reservation, the fullest cooperation of the medical without work at a time when it is most desirable profession, and would do all in his power to help that that they should be gaining experience and consolidaprofession in its work. He asked-was entitled to ting what they have learnt. The present method of ask-the members of the profession that they in their study does not create medical practitioners ; two turn would assist His Majesty’s Government, and years are spent in learning chemistry, physics, botany, would believe that the Government was as much zoology, physiology, and anatomy, and during this concerned with the problems at issue as medical men time the medical student does not see a single patient. were themselves, because they had got to face the Furthermore, clinical teaching is much too theoretical. results of lack of knowledge. He hoped that, as this What is worst of all is the public lack of confidence Government grew from strength to strength, and as in doctors. The Insurance Act leads the patient to it was succeeded by others of similar intensity of look upon the practitioner as more of a sick club purpose, the bond between this great profession officer than a medical adviser. Medicine has changed and the Government would also grow from strength from an empirical to a technical science. The to strength. He claimed the assistance of the pro- individual practitioner is not in a position to know all fession that there might issue a magnificent people, the technical methods of treatment and still less to people of fine calibre and tremendous spirit, a body provide for himself all the technical apparatus ; this of citizens which would lead the world. is the reason why patients are often sent to Mr. H. P. Macmillan, K.C., expressed his conviction dispensaries, hospitals, and clinics,which have modern of. the great mutual benefit which results from equipment. The increasing number of unqualified association with members of other professions. persons and the afflux of patients towards them Professional men were apt to get into ruts-and a rut, bear further witness to the critical state of the as had been happily said, only differed from a grave profession. in being narrower. Sir Alfred Ewing had once Prof. Schlossmann suggests not that social insurance suggested that we all needed " re-potting " at in- should be limited but rather that it should be tervals. We got pot-bound in our professional extended. The object of sick clubs should be not routine, and an occasional transplantation into fresh only to cure their members but also to keep them in soil was wonderfully reviving. It was only within the good health. If this were done, and if those classes last hundred years that medicine, like law, had of the population who are still outside national finally emerged from the fogs of mediaeval mysticism. insurance were admitted to its benefits, a great number The earlier London pharmacopoeias read like inven- of the profession would find employment. His tories of an alchemist’s spells and potions. Even in address has created a sensation, for he is a man who is 1824, neither morphia, iodine, nor quinine was to be well known in his specialty and also as president of found in the official Pharmacopoeia. The great the successful exhibition of hygiene held in Düsseldorf strides recently made in the direction of preventive in 1926. The Ärztliche Vereinsblatt, the official medicine in the department of public health empha- organ of the Vereinsbund, says that his opinion sised the fact that in the treatment of mental that the representatives of the profession are hostile disorder alone the public was still excluded by an to State insurance is absolutely erroneous. But antiquated system from the benefit of preventive the medical profession, it continues, wishes to remain treatment. Mr. Macmillan hoped that this restriction a free profession whose rights and duties as to insurance would soon be removed. To the need for preserving practice are limited by free agreement, and it is not the voluntary hospitals system, the Minister of inclined to become a mere collection of insurance Health had referred with a fitting emotion. All employees. would rejoice that the Minister recognised the value of these institutions, and that apprehension of peril Treatment of Congenital Dislocation of Hip-joint. to them was not likely to be realised under his The German Congress of Orthopaedics discussed guidance. the results of the treatment of congenital dislocation of the hip-joint. Prof. Lange, of Munich, reported SOUTHPORT HOMOPATHIC HOSPITAL.-This hospital the results obtained by the bloodless method of has been purchased for C3500 by the Southport Town been generally adopted for Council. It is in future to be used for the treatment of Lorenz which has 30 At Munich and years. elsewhere, he said, he had and infirm aged patients.

ship

.

1166 cases in which the reduction between 3 and 25 years ago. Only in 5 per cent. had reduction proved impossible, but the difficulty was to retain the reduced joint in position, especially after the dressing had been removed. Redislocation may take place and sometimes a deforming arthritis or coxa vara may develop in the course of years. In 50 per cent. a full anatomical and functional cure was obtained, but to get this result the children had to remain under care for several years. Functional troubles rarely developed in cases where the deformity was reduced within the first two years, and the moral was that this should be done as early as possible. Dr. Spitzy, of Vienna, described a method of producing an acetabulum in cases where the reduction had been only temporarily effective. He makes the joint accessible without opening it and drives a splint, taken from the tibia, into the region above the head of femur. In this way an impediment to dislocation is provided. He has operated on 15 cases with good results.

studied the results of 2200 was

performed

great interest in the exhibition and several governments have already declared their readiness to contribute. In the past year 100,000 former combatants have made claims for the first time for damage done to their health by the war. In the past nine years 2 million certificates have been given under the law for the care of the victims ; 900,000 combatants receive pensions ; and there are 100 offices for the the injured, with 500 full-time medical care of officers. _______________

PARIS. (FROM

OUR OWN

CORRESPONDENT.)

Clemenceau. in Paris claims the great patriot as one of themselves. Georges Eugene Benjamin Clemenceau was born in 1841 at Mouilleronen-Pareds in the Vendee, was educated at the Lycee THE medical

profession

Abandonment of a Medical Qualification. The question whether a medical man may renounce of Nantes, and became a docteur-en-medecine. his qualification has lately been decided by the Migrating to the United States in 1865 he returned Bavarian High Court. A doctor was being prosecuted to Paris in 1870 and practised as a physician in for a crime, and, expecting to be sentenced to Montmartre before he was elected mayor of the imprisonment and loss of civil rights, which includes eighteenth arrondissement and a member of the the loss of the qualification, he informed the Govern- National Assembly. ment that he wished to renounce his qualification. X Rays and Neighbourliness. Nevertheless, after being discharged from prison, he Some time back one of the great Paris dailies continued to describe himself in his prescriptions and foreboded all sorts of troubles for the unhappy people on his door-plate as a qualified medical man, and was therefore prosecuted’ for wrongfully assuming that who live in the neighbourhood of X ray installations. title and making the public believe that he was duly It was not the first time that Mr. Coutremoulins, the qualified. In the trial he pleaded that his letter to distinguished physicist, obtained a hearing for some the Government had been voluntary, that he had not of his ideas in the lay press and in official circles. been deprived of the right to revoke it, and that Mr. Coutremoulins was one of the X ray pioneers in he thus had the right of describing himself as qualified. this country, and though he is no physician he is still The supreme court, however, found him guilty. It at the head of the Rontgen service at the Necker. held that a medical man has the right to renounce Much sensation was caused by his discovery that a his qualification, but only on condition that he does photographic film is affected by the rays from a tube In his experiments it was, of not intend to use it again. The defendant had been 100 yards away. a naked tube. Mr. Coutremoulins draws the punished for his crime with the loss of civil rights course, which include the qualification; if he wished to deduction that X ray installations are dangerous for regain it he would have to petition the Government the neighbourhood. Most of his medical friends would say : No, not if the tubes are protected. for an act of grace. But their evidence is held to be biased because it is Leaf Silver as a Dressing for Wounds. in their own interest to minimise the risk. Some Dr. Moritsch recommends leaf silver as a covering years ago the Académie des Sciences of Paris appointed for fresh injuries, wounds, excoriations, and bruises. a special committee to study the question, and its This material has been used by Prof. Lexer, of Munich, answer was that in actual X ray work no danger Now a committee has been to cover sutures in plastic and cosmetic operations. exists for neighbours. Moritsch has noticed that under the silver leaf the appointed by the prefet of police, of which Mr. wounds become cleaner and the discharge is less than Coutremoulins is a member. It is somewhat remarkunder the usual ointment dressing, also the change able that with the exception of Dr. Zimmern and of dressing is less painful. Owing to the bactericidal Dr. Lobligeois no other member of the committee has So everyone wonders action of leaf silver the sutures may be left longer in special knowledge of X rays. the wound, which is of special importance with what authority its decisions will have. wounds under a plaster-of-Paris dressing. The Confederation des Syndicats Medicaux has sent to every member of both Chambers, senators and Gonococcal Meningitis. Dr. Lorentz has recently observed in the Berlin deputies, a formal letter containing the solemn Westend Hospital a case of gonococcal meningitis. decision of the medical profession to refuse collaboraSuch cases are very rare and it has seldom been tion if the social insurance law is not modified. demonstrable that meningitis occurring during Amendment is indeed probable, but when ? The law is due to into force on Feb. 5th. The budget gonorrhoea was due to the infection. In the case under discussion come is only just started and will scarcely be his care the gonorrhcea was complicated by arthritis. The organism cultivated from the cerebro-spinal fluid finished by the New Year. Then come the holidays, which are sacrosanct, and January will be over. was shown to be Neisser’s gonococcus by microProf. Netter, of the Institut Pasteur, has given the scopical, biological, and serological examination. de Medecine his views on the aetiology of Académie An international exhibition of hygiene is to be held in Dresden. It is the purpose of the exhibition to post-vaccinal encephalitis as a result of his study of instruct the public in health matters and to give a a campaign of vaccination at Rotterdam. He lays the full picture of what has been done in this direction. responsibility on the preparation of vaccine lymph Whereas the exhibition of Diisseldorf was universal by passage through the rabbit. and included every branch of hygiene, social medicine, Cesar Roux, professor of surgery in the University and gymnastics, the Dresden exhibition will be limited of Lausanne, has been awarded the diploma of to personal hygiene. It is expected that the German doctor hon. caus. of the University of Paris. The

States and Provinces, and all the bodies concerned in same distinction has been granted to Dr. Egas health, will take part, as they did in the last Dresden Moniz, of Lisbon, the originator of arteriography by exhibition in 1911. Foreign countries have shown injection of sodium iodide, by the University of Lyon.