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MURDER BY POISON.
1020 on
one
physiology,
I did not meet with
a
single
man
who advocated the wool test. Mr. Parsons must be aware from the numerous papers which have been published in all parts of the world of the universal condemnation of this test. Though those in authority who have recommended the methods which have been so severely condemned may be very grateful to him for his advocacy, the writer of a text-book is
hardly dealing fairly with a subject when he entirely ignores and opinions of the vast majority. I am, Sir, yours faithfully,
the work
Willesden
F. W. EDRIDGE-GREEN. Green, N.W., April 5th, 1912.
DYSENTERY AND LIVER ABSCESS IN BOMBAY. To the Editor of THE LANCET. SiR,--On p. 1630 of THE LANCET of Dec. 9th, 1911, reference
was
made to myself
as
joint
Memoir, Government of India, No. 47,
author of Scientific on "Dysentery and
Liver Abscess in Bombay." I should like to point out that, as indicated in the introduction to that memoir, the responsibility for the form in which the report is presented was not shared by me. The only contribution made by me to the memoir was in the form of an independent note on the report. By some error this note was printed in the text of the memoir among the I I General Conclusions"(No. 15, p. 53). I should be glad if you would kindly publish this explanation. I am, Sir, yours faithfally, R. T. WELLS. Jullundur, Punjab, March 21st, 1912.
OSMOTIC
PRESSURE AND ITS LOGICAL BEARING. To the EditO’l’ of THE
PHYSIO-
LANCET.
SIR,-The interesting annotation under the above heading in your last issue adds another proof of the great importance of physical chemistry in medicine Your columns have long recognised this, but there are still some to whom such statements as "pure water is a poison " or pure water is very caustic"are startling. The celebrated "prison spring " at Gastein in the Tyrol has been known for years as one of the purest natural waters existing, and this extreme purity or poorness in ions leads to the swelling and destruction of the epithelial cells of the digestive tract, just as distilled water, owing to the difference of osmotic pressure, may cause catarrh of the stomach by rapidly entering the cella, the cells dryi’g and being cast off. the osmotic force of fluids has to be reckoned with not only when they are used for injection but when also they are used for application to wounds both superficial and deep. Professor Leduc refers to this in his admirable book on "Electric Ions and their Use in Medicine," for he says: ’’ Whenever one makes a wound one should take into consideration the osmotic pressure of the liquids brought into contact with it, in order to avoid damaging the vitality of the living surfaces. This precaution is still more necessary when foreign liquids are put in contact with the delicate cells of surfaces covered with serous membranes. Moist applications to remove dry crusts, such as those of eczema and impetigo, are more successful the lower the osmotic pressure of the liquid employed. The most useful applications for this purpose are composed of absorbent lint impregnated with boiled distilled water, under the influence of which the morbid cells rapidly swell up. burst, and are dissolved." If I am not mistaken, "the new physics" and the new chemistry," ions, electrons, gels, and sols, are going to remove much empiricism from medicine, and "the new medicine " will necessarily involve a new preliminary training of its workers.-I am, Sir, yours faithfully. COLLOID. April 9th, 1912.
salts As
passing out,
pointed out in your note,
__________________
MURDER BY POISON. To
the
Editor of THE LANCET. SiR,-In your very interesting annotation, Murder by Prison, in THE LANCET of March 30th. you mention the trials for murder by poison of Lamson, Pritcbard, and Palmer as being the most notable trials of medical men for murder in the last century. One equallv notable was that of Dr. Cross, Shandy Hall, Dripsey. A point of interest in this case was
that the Crown analyst, in giving evidence, admitted that in his first calculation of the amount of arsenic found he had made an error ; nevertheless, a conviction was obtained. With reference to the trial of Palmer, I read, some years ago, a pamphlet published shortly after the trial, giving a full account of the trial, a history of Palmer’s life, and if my memory serves me rightly it mentions the effort made to change the name of the town. I think this pamphlet is not the same as the one mentioned as forming Appendix I. of Mr. Knott’s book. The Palmerston incident is in all probability based on fact, as the inhabitants of Rugeley did not make a second attempt to change the name. I am, Sir, yours faithfully, CIVIL SURGEON. CIVIL SURGEON. April 4th, 1912.
THE MEDICAL PROFESSION AND THE NATIONAL INSURANCE ACT. Tø the Editor of THE LANCET. SiR.—Your correspondent, Dr. O. F. Seville, in THE LANCET of March 30th, p. 898, asks, "Why do not the advocates
of payment for work done tell us how they would deal with the two great obstacles to the system they propose"—viz., "overcharge by doctors and bookkeeping." It is quite evident that Dr. Seville has not read much of the corre. spondence on this subject, either in THE LANCET or the British Medical Journal, for he remarks with regard to the latter obstacle-i.e., bookkeeping-that it "has not, so far as I know, been suggested hitherto." As a matter of fact, both these points have been repeatedly dealt with by the advocates of payment for work done, but as others besides Dr. Seville have probably not heard or seen the answers to these questions perhaps you will allow me to reiterate them. (a) Over-charging by doctors.-I presume by this Dr. Seville really means over- visitation, as upon an agreed scale of fees, with a proper record of visits paid, overcharging for work actually done would be impossible. I have dealt with this specific charge of over-visitation in the British Medical Journal supplement, March 9th, 1912, p 302, to which I would refer In the first place I Dr. Seville and others interested. challenge Dr. Seville and those who think similarly to prove their charge-viz , that doctors generally are adiieted to over-visiting, also to state the grounds of this belief in the wholesale dishonesty of their fellow practitioners, for this is what the charge really amounts to. Instead of evidence we are almost invariably met with the human nature" argument, which is certainly not evidence but a most gratuitous assumption. It should not be necessary, at least before an audience of medical men, to insist that we are not a set of ravenous sharks ready to devour all that comes within our reach. The whole history of our profession shows that it is we who allow ourselves to be fed upon by, and not we who feed upon, the community. No class or profession, taken in the bulk, have given more of their time and self-sacrificing energy for their fellows and received for their services than less in monetary equivalent ours. No body of men have been more exploited by individuals, societies, pseudo-philanthropists, and politicians. Few, if any, of us have ever neglected the call of suffering humanity even when we knew tull well that virtue would have to be its own (and only) reward. Finally, are we not trusted daily with the lives, happiness. and inmost personal secrets of large numbers of our fellow countrymen and countrywomen ? Yet it is calmly suggested nay, more than merely suggested, definitely alleged, that if we agree to work the Insurance Act under a system of payment for attendance we shall immediately lose our accustomed probity, selfrespect. and patriotism, and forthwith pile up huge bills for unnecessary visits which will swamp the national exchequer. This is Dr. Seville’s reasoning developed to its logical conclusion, which is in my opinion to reduce it to an If the medical profession is not to be absurdity. trusted in regard to frequency of visitation upon sick people, it is a fortiori unfit to have the medical care and treatment of these people, and t be trusted with their reputations and concerns. No doubt some men are inclined to attend oftener than others ; they are naturally more anxious and fussy, and these may possibly put in some strictly unnecessary visits. On the other hand, other men from over-scrupulousness in the opposite direction, or because they have more to do than they can manage, may visit too
one
physiology,
I did not meet with
a
single
man
who advocated the wool test. Mr. Parsons must be aware from the numerous papers which have been published in all parts of the world of the universal condemnation of this test. Though those in authority who have recommended the methods which have been so severely condemned may be very grateful to him for his advocacy, the writer of a text-book is
hardly dealing fairly with a subject when he entirely ignores and opinions of the vast majority. I am, Sir, yours faithfully,
the work
Willesden
F. W. EDRIDGE-GREEN. Green, N.W., April 5th, 1912.
DYSENTERY AND LIVER ABSCESS IN BOMBAY. To the Editor of THE LANCET. SiR,--On p. 1630 of THE LANCET of Dec. 9th, 1911, reference
was
made to myself
as
joint
Memoir, Government of India, No. 47,
author of Scientific on "Dysentery and
Liver Abscess in Bombay." I should like to point out that, as indicated in the introduction to that memoir, the responsibility for the form in which the report is presented was not shared by me. The only contribution made by me to the memoir was in the form of an independent note on the report. By some error this note was printed in the text of the memoir among the I I General Conclusions"(No. 15, p. 53). I should be glad if you would kindly publish this explanation. I am, Sir, yours faithfally, R. T. WELLS. Jullundur, Punjab, March 21st, 1912.
OSMOTIC
PRESSURE AND ITS LOGICAL BEARING. To the EditO’l’ of THE
PHYSIO-
LANCET.
SIR,-The interesting annotation under the above heading in your last issue adds another proof of the great importance of physical chemistry in medicine Your columns have long recognised this, but there are still some to whom such statements as "pure water is a poison " or pure water is very caustic"are startling. The celebrated "prison spring " at Gastein in the Tyrol has been known for years as one of the purest natural waters existing, and this extreme purity or poorness in ions leads to the swelling and destruction of the epithelial cells of the digestive tract, just as distilled water, owing to the difference of osmotic pressure, may cause catarrh of the stomach by rapidly entering the cella, the cells dryi’g and being cast off. the osmotic force of fluids has to be reckoned with not only when they are used for injection but when also they are used for application to wounds both superficial and deep. Professor Leduc refers to this in his admirable book on "Electric Ions and their Use in Medicine," for he says: ’’ Whenever one makes a wound one should take into consideration the osmotic pressure of the liquids brought into contact with it, in order to avoid damaging the vitality of the living surfaces. This precaution is still more necessary when foreign liquids are put in contact with the delicate cells of surfaces covered with serous membranes. Moist applications to remove dry crusts, such as those of eczema and impetigo, are more successful the lower the osmotic pressure of the liquid employed. The most useful applications for this purpose are composed of absorbent lint impregnated with boiled distilled water, under the influence of which the morbid cells rapidly swell up. burst, and are dissolved." If I am not mistaken, "the new physics" and the new chemistry," ions, electrons, gels, and sols, are going to remove much empiricism from medicine, and "the new medicine " will necessarily involve a new preliminary training of its workers.-I am, Sir, yours faithfully. COLLOID. April 9th, 1912.
salts As
passing out,
pointed out in your note,
__________________
MURDER BY POISON. To
the
Editor of THE LANCET. SiR,-In your very interesting annotation, Murder by Prison, in THE LANCET of March 30th. you mention the trials for murder by poison of Lamson, Pritcbard, and Palmer as being the most notable trials of medical men for murder in the last century. One equallv notable was that of Dr. Cross, Shandy Hall, Dripsey. A point of interest in this case was
that the Crown analyst, in giving evidence, admitted that in his first calculation of the amount of arsenic found he had made an error ; nevertheless, a conviction was obtained. With reference to the trial of Palmer, I read, some years ago, a pamphlet published shortly after the trial, giving a full account of the trial, a history of Palmer’s life, and if my memory serves me rightly it mentions the effort made to change the name of the town. I think this pamphlet is not the same as the one mentioned as forming Appendix I. of Mr. Knott’s book. The Palmerston incident is in all probability based on fact, as the inhabitants of Rugeley did not make a second attempt to change the name. I am, Sir, yours faithfully, CIVIL SURGEON. CIVIL SURGEON. April 4th, 1912.
THE MEDICAL PROFESSION AND THE NATIONAL INSURANCE ACT. Tø the Editor of THE LANCET. SiR.—Your correspondent, Dr. O. F. Seville, in THE LANCET of March 30th, p. 898, asks, "Why do not the advocates
of payment for work done tell us how they would deal with the two great obstacles to the system they propose"—viz., "overcharge by doctors and bookkeeping." It is quite evident that Dr. Seville has not read much of the corre. spondence on this subject, either in THE LANCET or the British Medical Journal, for he remarks with regard to the latter obstacle-i.e., bookkeeping-that it "has not, so far as I know, been suggested hitherto." As a matter of fact, both these points have been repeatedly dealt with by the advocates of payment for work done, but as others besides Dr. Seville have probably not heard or seen the answers to these questions perhaps you will allow me to reiterate them. (a) Over-charging by doctors.-I presume by this Dr. Seville really means over- visitation, as upon an agreed scale of fees, with a proper record of visits paid, overcharging for work actually done would be impossible. I have dealt with this specific charge of over-visitation in the British Medical Journal supplement, March 9th, 1912, p 302, to which I would refer In the first place I Dr. Seville and others interested. challenge Dr. Seville and those who think similarly to prove their charge-viz , that doctors generally are adiieted to over-visiting, also to state the grounds of this belief in the wholesale dishonesty of their fellow practitioners, for this is what the charge really amounts to. Instead of evidence we are almost invariably met with the human nature" argument, which is certainly not evidence but a most gratuitous assumption. It should not be necessary, at least before an audience of medical men, to insist that we are not a set of ravenous sharks ready to devour all that comes within our reach. The whole history of our profession shows that it is we who allow ourselves to be fed upon by, and not we who feed upon, the community. No class or profession, taken in the bulk, have given more of their time and self-sacrificing energy for their fellows and received for their services than less in monetary equivalent ours. No body of men have been more exploited by individuals, societies, pseudo-philanthropists, and politicians. Few, if any, of us have ever neglected the call of suffering humanity even when we knew tull well that virtue would have to be its own (and only) reward. Finally, are we not trusted daily with the lives, happiness. and inmost personal secrets of large numbers of our fellow countrymen and countrywomen ? Yet it is calmly suggested nay, more than merely suggested, definitely alleged, that if we agree to work the Insurance Act under a system of payment for attendance we shall immediately lose our accustomed probity, selfrespect. and patriotism, and forthwith pile up huge bills for unnecessary visits which will swamp the national exchequer. This is Dr. Seville’s reasoning developed to its logical conclusion, which is in my opinion to reduce it to an If the medical profession is not to be absurdity. trusted in regard to frequency of visitation upon sick people, it is a fortiori unfit to have the medical care and treatment of these people, and t be trusted with their reputations and concerns. No doubt some men are inclined to attend oftener than others ; they are naturally more anxious and fussy, and these may possibly put in some strictly unnecessary visits. On the other hand, other men from over-scrupulousness in the opposite direction, or because they have more to do than they can manage, may visit too