MEDICAL FEES IN CORONERS' COURTS.

204 and First

Physician of the Jamsetjee Jeejeebhoy Hospital,Jan. 22nd, and terminate on Thursday, Jan. 28th. The I will be promulgated on Saturday, Jan. 30th, when The European nurse who attended the late results t Director-General of the Army Medical Department will Surgeon-Major Manser during his fatal illness has since died the -from plague, having, in all probability, also contracted thepreside. I disease in the execution of her duty. THE NIGER COMPANY CAMPAIGN. Dr. Thomas Jameson, eldest brother of Dr. Leander Starr The force proceeding on this expedition consists of Hausa Jameson, died on New Year’s Day at his residence in Knollys- t with Maxim guns and twenty-six officers, under Major road, Streatham, where he was in practice. He was fifty-nine troops, two and 900 carriers, to march against the Arnold, surgeons, years old. He graduated M.D. at Edinburgh University inFoulah 1 at Kabbar, south-west of the Niger. forces 1858, in which year he also obtained the Licence of the Royal College of Surgeons of Edinburgh. He became a Surgeon in ROYAL VICTORIA HOSPITAL, NETLEY. the Royal Navy on Aug. 20th, 1858, was promoted to be Staff has been received that Surgeon-Captain I. Notification Surgeon on Nov. 29th, 1869, and retired on April 10th, 1872. Paterson. M.B. Edin., A.M.S., will arrive at Netley for duty Dr. Jameson was in receipt of a pension for wounds. ( on the 5th proximo. Bombay.

CIVIL SURGEONS IN BENGAL. The Director-General of the Army Medical Staff and Mrs. A notification appears in the Caleutta Gazette of Dec. 16th, Jameson, Major-General and Mrs. Maurice, Surgeon-Colonel 1896, announcing that, in accordance with the orders ofand [ Mrs. Ferguson, Surgeon-Colonel and Mrs. Fawcett, and the Government of India in the Home Department, No. 910, imany other officers were present during one of the series of dated Oct. 19th, 1896, sanctioning the abolition in Bengal of Christmas ( and New Year entertainments held at the Herbert the present classification of civil surgeons by stations and Hospital, Woolwich. the substitution in its place of a personal classification under ’ which the higher emoluments now given for the charge of It has been decided that officers of the Army Medical first-class stations will be granted to commissioned medicalStaff will be viewed as on separate lists for each of the four ( officers according to seniority and merit without regard to Commands in India. Officers of the Indian Medical Service the stations at which they may be employed, the Lieutenant- will be viewed as on separate lists for the Madras and Governor is pleased to order that the following medical cfficersBombay Commands, but collectively as on one list for the and Punjab Commands. shall, with effect from Dec. lst, 1896, draw the higher emolu-- Bengal At the quarterly meeting of the directors of the Naval ments hitherto attached to the six first-class civil stations, Bengal: Brigade-Surgeon-Lieutenant-Colonel W. H. Gregg,Medical Supplemental Fund, held on Jan. 12th, Dr. W. H. Brigade-Surgeon-Lieutenant-Colonel C. J. W. Meadows,Lloyd, Inspector-General, in the chair, the sum of Z85 was Surgeon-Lieutenant-Colonel J. M. Zorab, Surgeon-Lieutenant-distributed among the several applicants. Colonel Russik Lal Dutt, Surgeon-Lieutenant-Colonel G. An examination of candidates for thirty-five commissions Price, Surgeon-Major A. W. D. Leahy. Officers drawing thein the Army Medical Staff will be held at the Examinahigher allowance will in future be styled civil surgeons oftion Hall, Victoria Embankment, W.C., on Feb. 5th and the first class, all others being styled civil surgeons of the following days. second class. THE NEWS FROM WEST AFRICA. There seems unhappily to be little doubt that the disastrous news from Benin of the massacre of a British expedition is true. The expedition started on a perfectly peaceful mission and unarmed from the coast by way of "Audi alteram partem." Sapele to Benin city. According to a Reuter’s telegram the Consul-General’s yacht Ivy brought the intelligence to Bonny that the expedition, with the native followers, had been surMEDICAL FEES IN CORONERS’ COURTS. prised and massacred by the King’s people. Among the names To the Editors of THE LANCET. -of those who are supposed to have perished we sincerely of officer of the to notice the medical that regret expedition, SIRS,-In an annotation in THE LANCET of Jan. 9th you Dr. R. H. Eiliott. The mission to the King of Benin was to an inquest held by me on Jan. 3rd at Croydon refer apparently an important one, as the acting Consul-General, Hospital, when the acting house surgeon declined to reveal his Deputy-Commissioner, the Commandant of the Niger the results of his post-mortem examination unless I paid him Coast Protectorate Force, and others accompanied it. Benin the fee and until (in answer to his query) I informed him city lies about sixty miles inland from the mouth of the that the consequence of his refusal would be his committal River Niger. This treacherous conduct of the King of for contempt of Court. I do not wish to deal with this Benin will no doubt lead to a punitive expedition against individual case, though acquiescing in your opinion that it him and his people. was an "incident to be regretted," for the gentleman AMBULANCE SHIPS IN THE UNITED STATES NAVY. subsequently apologized for his ignorance of the Law. Such occur from time to time, and it is matter of incidents It is proposed to add ambulance ships to the navy of the United States. The new ships will be fast unarmoured regret and surprise to me that in most of our text-books on steamers of three decks, fitted with large wards and operating Forensic Medicine no mention is made of the rights and rooms. Each squadron of men-of-war going into action duties of medical men in coroners’ courts. You observe that would be accompanied by one ambulance ship, which would "it is strange that it is not universally known by this time a medical man who has attended a patient at a hospital, .gather and collect the wounded during, and after, the con- that workhouse infirmary, or other public institution-the death flict and convey them to a distance, where, in comparative in such place-cannot recover fees for occurred having safety and quietness, they would receive treatment. Such making a post-mortem examination or for evidence at ships will doubtless be rendered easily distinguishable by an inquest." But even your description isgiving in accordhardly and means of shape, colour, flags, and it may confidently with the present practice of some coroners-myself be trusted will be respected as far as possible by the ance among them-who have taken advantage of an exposition of combatants. the law a little more favourable to our profession. As the THE INDIAN TROOPS FROM SUAKIN. matter is frequently referred to in your correspondence The Indian contingent to Suakin has returned, of course, columns, perhaps you will allow me to state the law and to India after having had a monotonous and trying time practice as at present existing. The law as to "fees to .of it in that very hot and uninteresting station. The medical witnesses " in a coroner’s court is laid down in the accounts of the outbreak of scurvy among the troops at 22nd section of the Coroners’ Act, 1887, wherein a guinea is Suakin seem to have been somewhat exaggerated, for the awarded for " attending to give evidence at any inquest," " number of severe cases was relatively small, although a and also a guinea for making a post-mortem examination; mild form of the disease was very prevalent among the sepoys but, " provided that where an inquest is held on the body of .and native followers. died in a county or other lunatic a person who has or in a public hospital, infirmary, or other medical asylum, ARMY MEDICAL SCHOOL. institution, or in a building or place belonging thereto, The Netley examination for surgeons on probation passing or used for the reception of the patients’ thereof, whether out of the Army Medical School will commence on Friday, the same be supported by endowments or by voluntary

Correspondence.

205 right hand into the womb

subscriptions, the medical officer whose duty it may have been to attend the deceased person as a medical officer of such institution as aforesaid shall not be entitled to such fee or remuneration." Amongst coroners there is but one interpretation of these words-viz , that house surgeons are not entitled to such fee. Such "medical officersare explicitly excluded from the privilege of claiming a fee by the words, " a public hospital," and again by the phrase, " a medical institution-

endowments or by voluntary subscriptions." Bat coroners differ in their practice as to medical officers of workhouse infirmaries. These infirmaries are not supported "by endowments" or "by voluntary subscriptions," but by the rates, and of these there is no mention. Hence, a year or two ago, Mr. Poland, Q.C., gave it as his opinion that medical superintendents of workhouse infirmaries and their assistants were entitled to fees. As soon as I became aware that this was the judgment of so eminent a lawyer, I at once wrote to our town clerk, himself a solicitor, and asked him to consider the matter with the Recorder and to authoriee me, if they could accept Mr. Poland’s interpretation of the Act, to pay the usual fees to Mr. Wilson, the medical superintendent of our infirmary, who had wisely brought the matter to my notice. And I am glad to say that with their approval from that time I have paid the medical officers of our workhouse infirmary the fees which other medical practitioners receive. All such medical officers elsewhere may well try to persuade their coroners that it has been held by a high authority that they are entitled to fees ; but it is surely time that students, ere they leave their hospitals, should be informed that if they seek house-surgeoncies they must be prepared to undertake all the duties of the position and that it is unwise to make demands that coroners, however friendly to them, must firmly refuse. I am, Sirs, yours sincerely, THOMAS JACKSON, J.P., Thornton Heath, Jan. 11th, 1897. Coroner for Croydon.

supported by

"POST-PARTUM HÆMORRHAGE AND ITS TREATMENT." To the Editors of THE LANCET. SIRS,-I am glad to see, both from an article by Dr. Laird in THE LANCET of Sept. 19th, 1896, and from several letters I have received, that the question of post-partum haemorrhage

and its treatment has excited some interest. Most of the letters I have received speak of the method I have advocated with approbation and confidence ; one writer, however, agrees as to its value, but considers it a secondary measure, manual

compression, injections, &c., apparently holding a primary place in importance. I cannot help thinking that if he discovered a leak in a water pipe in his house from which water was pouring he would have no great opinion of the plumber who on being called in should say: "As a primary

,

to close it, and with the leftft hand compress the uterine and ovarian arteries against it on either side, the fingers grasping the left side and the thumb the right side." I presume that Dr. Laird seriously means what he says, but it is difficult to understand how the thumb can control two distinct arteries, the one entering at the top and the other at the neck of the uterus. Even if we grant this to be possible when the uterus is small and contracted, how is it to be done in these cases, the essential characteristic of which is that there is little or no. contraction, but the uterus is a widely dilated flabby mass filling, in some cases, more than half the abdomen ? The power of knowing what is going on, which Dr. Laird claims "as one of the great advantages of this plan," I fully recognise, but it is not necessary, I conceive, that we should feel the gushing blood to recognise its presence. Blood is being poured out either into the dilating uterus or through the vagina into the open. If the latter, we can see it ; if theformer, the hand pressed down upon the aorta above it would be equally conscious of the increasing bulk below. I say would be, because I have never found bleeding to go on when once the aorta was controlled, and therefore can only speak of the sensation given to the hand frequently of a big sloppy mass when compression is commenced. One need not speakof the quick, running pulse, the white, sweating face, the deep, gasping respirations, because these will occur to eveiyone. Dr. Laird is very anxious about the effect ofI I practically stopping the blood supply to half the human frame," which I admit is done by the method of aortic compression. From personal experience I can assure him he need not be ; but even theoretically there is nothing in the objection. Pressure by far rougher means has been kept up for far longer periods than is here required for aneurysm of the common iliac, the external iliac, and the femoral arteries, and the blood has been shut off an extremely long time by Martin’s bandage and a tourniquet in osteoplastic and other operations. It is. of the utmost importance to remember which half of the human frame is kept empty and which half is thereby kept full by this manceuvre. The full half contains the essentially vital organs and the empty half contains nothing absolutely essential to life. Were the upper half to lose a sufficient supply the nervous centres of respiration and of circulation cease to act. It is not sufficient that they should have If they cease some blood; they must have enough. it will not matter much whether the patient has legs or not. But practically I have never seen anything worse follow than some coldness, numbness, and paresis of the muscles, which is never more than temporary, except the usual tingling, which may even be painful when the current returns. Is this a heavy price to pay for life ? I confess I cannot follow Dr. Laird or the authorities he refers to in their dread of regurgitation from the vena cava. On what observations or even constituent theory does it rest ? Why should it regurgitate ? If the patient were erect and walking about it might be possible, but if the foot of the bed is properly lifted the patient is in the directly opposite position. Why should the blood in the vena cava which up to now has always flowed in the direction nature originally marked out for it now all at once turn round and walk the other way ? If there were compression of the cava above it would be conceivable, but no veins bleed to any extent if there is free passage for their contents towards the heart and gravity assists, and here there is no obstacle ; indeed, the laboured efforts of the heart to fill itself sufficiently tend toempty the cava away from the uterus rather than to overfill it. The whole idea is to me incomprehensible. Moreover, experience, the final test, proves that there is nothing in it. I am glad that Dr. Laird is directing his attention to this subject, but I am sure that the further he follows it up and the more cases he sees the more he will agree with me that we ought all to have one plain, positive dictum based on common consent and common sense, upon which we can all act at once without any doubt or vacillation. I am, Sirs, yours faithfully, ......

will dab some putty on this hole and as a will turn off the main tap." secondary Some weeks ago a correspondent, signing himself "Rinaldo," wished to know if Davy’s lever was used in these cases. May I point out to him that it is of the utmost importance in a matter of this kind, when every moment is of importance, that we should not be dependent upon any instrument which may or may not be there, but that each man should be able at once to control the haemorrhage, as Hans Breitmann would say, ’’ mit dose dings dat God has gave him." But the most serious contributor to the subject is Dr. Laird and I ask for a little of your valuable space in which to reply to him. In the first place, he will, I am sure, admit that all analogies break down if you push them too far. If he will read my paper again he will see that I never intended the illustration I gave to stand as a parallel in all points; and, indeed, he admits that it stands good "in the sense in which I applied it." However, this is not the main point. If I understand Dr. Laird rightly he advocates pressure near the entrance of the arteries G. STANMORE BISHOP. into the uterus. I notice that he does not say how St. Ann’s-square, Manchester, Jan. 9th, 1897. often he has carried out this plan or what were the results. Indeed, he speaks in the old doubtful way about it"Should bleeding not then be fully controlled " ; "the " TRADES UNIONISM AND THE MEDICAL pressure on the arteries may be applied probably with better PROFESSION." effect," &c. (the italics are mine) ; and it is this very doubtTo the -Editors of THE LANCET. ful tentative condition of mind that, I submit, should be I absolutely eliminated when face to face with so serious a SIRS,-A "blackleg"may be described as one who may not only refuse to join with his fellows in a demand for condition, so immediate a danger. Let us consider the method itself. You are to pass the wages or in resisting additional burdens to his labour, measure we

one we

higher