- Email: [email protected]
THE DEATH OF A CORONER LEAVING AN INQUEST UNFINISHED.
THE DEATH OF A CORONER LEAVING AN
924
On the above I wrote as follows: "Now, what does the sentence of this extract amount to ? To my mind, and probably to the minds of other medical officers, it amounts to this, that, in fact, varicocele scarcely at all affects the ability of a soldier to perform all his duties. I may ask, Have army medical officers ever had officers or soldiers under treatment for varicocele or been obliged to In an exexcuse them from any duty on that account ? perience of 30 years’ service I never treated an officer or soldier for varicocele and it would be futile to contend that during this period there did not exist many hundreds who must have had the disability."2 After my article appeared other army surgeons recorded experience different from mine. Of course, the foregoing transcriptions refer to recruits. I am, however, now concerned only with candidates for commissions in the army. It will be interesting to your readers in the civil profession if I quote the phrasing of the army medical regulations for the guidance of medical officers serving on medical boards for the examination of candidates and also for recruits. The former reads thus: " That he varicocele, varicose [the candidate] does not suffer from veins in a severe degree ....... a slight defect if successfully cured by operation is not a disqualification " ; in the latter "varicocele beyond a limited extent." That is, the conditions above are considered disabilities within the limits laid
closing
......
down. Now in support I
less of the views I have expressed senior surgeon of one of the leading in London who writes to me as follows :more or
quote the opinion of
hospitals
a
I have been lecturing at hospital for the last 20 years on the of calling or treating varicoeele as in any sense a disease. I have as surgeon to never seen a single instance of dilated veins in the cord producing any real trouble. I have on this account always to think of inter refused to operate or allow my house surgeons at fering with the cases. The condition is a physiological one and can be seen in all the sheep race of animals (ovis) at the season when they are not rutting. The dilatation retards the flow of blood through the testicle and prevents the testicles being active when not required. -
absurdity
INQUEST UNFINISHED.
of varicocele offhand and have nothing whatever and provisional entry thereafter? I am informed that naval surgeons are emphatic and relentless in excluding candidates or recruits the subjects of varicocele in any form-I assume there must be somestrong grounds for this. If so, I trust that naval medical officers will take part in any discussion which may follow publication of this letter. We in the army have of latecopied the Admiralty in our highest institutions ; let us, then, copy their medical system, for presumably the military officer is required to be as efficient as the naval officer. The former certainly serves abroad a great deal and undergoes the same risks of service in all climates. In conclusion, as I have stated that during my experience I have seen deplorable results of operations recommended, I shall ask the forbearance of your readers while I quote two examples. A B was operated on for varicocele of the left testicle, which atrophied ; subsequently varicocele developed in the right. C D, a successful competitor, was rejected for undescended testicles; he was subsequently operated on by an eminent London surgeon. The lad competed a second time3 after this and was again successful. On being reexamined by the Army Medical Board the scrotum was found to contain two pea-sized bodies on each side supposed tobe testicles. We army medical officers must apply theWar Office regulations no matter what our private opinions may be.-I am, Sirs, yours faithfully, FRANK HOWARD, M.D. St. And., Colonel, Army Medical Staff (R.P.); Senior Medical Officer, Recruiting ... London Area. Sussex Mansions, S.W., Sept. 15th, 1905.
reject
cases
to do with
recommending operations
-
-
-
-
-
-
THE
DEATH OF A CORONER LEAVING AN INQUEST UNFINISHED.
To the Editors of THE LANCET. a short article under the heading of "Medicine the of varicocele SIRs,-In discussing subject days with a officer of the Indian Medical Service and the Law"contained in THE LANCET of Sept. 16th you, who recently held not only a high position at the India Office refer to a case of exhumation of a dead person in South but also previously one in a teaching university hospital in Staffordshire which arose through the adjournment of the India and he has kindly permitted me to record his opinion. inquiry and the sudden death of the coroner. As I am It is this : that in the course of 26 years of an extensive the deputy coroner referred to, perhaps you will excuseand varied practice he recollects advising an operation for me if I point out that your writer laboured under some of the reason of the exhumation and varicocele but once, he now forgets why. He does not con- mlsapprehen&ion I did not consider it sider varicocele a disability, and if he were to recommend the requirements of the law. an operation it would merely be to get over an official necessary that the jury should again view the body, regulation which debars admission to the public service on nor did I even suggest the possibility of the law reaccount of varicocele. quiring it. I merely conformed to the law in viewing It is not necessary, Sirs, for me to point out that the the body myself. The jury having once viewed, the law, so results of operations for varicocele are far from being far as they were concerned, was sati-fied, but a coroner uniformly satisfactory and that occasionally disastrous cannot hold an inquiry without viewing and the coroner who consequences have ensued-to wit, atrophy of the testicle. had previously viewed was dead. I may add that my own In a very large number of the cases put back by army opinion as to the viewing of bodies is that it should bemedical boards for operations, apart from the chronically left entirely with the coroner to decide whether the jury view or not view. enlarged testicle which follows, the parents or guardians ot tne iarts can III altord tne expenses attending an operaI am, Sirs, yours faithfully, ALBERT A. BETHAM, tion and detention in a home, and I have heard bitter Sept. 19th, 1905. Acting Coroner for Staffs. complaints on this subject. It is, indeed, possible that in a highly neurotic or neurasthenic lad or young man 3 Successful candidates if medically rejected are obliged to compete varicocele may give rise to trouble ; but I contend that again. because such a state may exist in an exceptional case it is unnecessary, if not unfair, to subject candidates to the FAKIRS AND ANÆSTHESIA.-The Medical Council expense and risk of operations as we so frequently do. Not long ago a young officer in the militia who had a large of the Russian Ministry of the Interior has forhidden, says varicocele asked me about competing for the regulars; I the Stovo, that Indian fakirs should hold séances for the advised him not to do so as he would surely be rejected purpose of inducing hypnotism or anaesthesia. for the varicocele and be put back for operation which THE METROPOLITAN ASYLUMS BOARD AND THE i certainly should not advise him to undergo. This young officer subsequently went to Nigeria and did some stiff TREATMENT OF ITS ASSISTANT MEDICAL OFFICERS.-At a of the Metropolitan Asylums Board held on marching and hard work in that trying climate and has meeting the asylums committee reported that it had 16th, Sept. returned after more than a year without a day’s sickness or received the resignations of three assistant medical officers any inconvenience from a very large varicocele. The proposition I offer is this : if we honestly believe employed at Ddrenth Asylum as a protest against the varicocele to be a disqualification for the army let us reject general conditions appertaining to their position and the case at once and let us not commit ourselves to recom- asking that an inquiry should be made into the grounds of their protest. The committee further stated that all the mending any operation and provisional entry into the army correspondence in connexion with the resignations, together after it if only it be seccessful (see extract of regulation with communications from the officers had appeared quoted above), for the military authorities have numbers of in recent issues of THE LANCET, had which been read and concandidates on the qualified list ready to replace rejections on medical grounds. Why cannot we in the army follow the sidered and it had appointed a special subcommittee of rule laid down in the Admiralty medical regulations-viz., nine members to inquire into the whole of the circumstances which have led to the resignations. The action of the committee was approved and the report was adopted without 2 Many medical officers of long service have borne me out in this discussion. experience. A few
ago I
was
distinguished
should
THE ORGANISATION OF THE MEDICAL PROFESSION.
925
and the cost of medical attendance in case of accident. Such payments are to continue, if necessary, for six months. After that the patient becomes an ordinary or chronic patient and is no longer treated as a case of accident. Though theoretically every Belgian is entitled to (FROM OUR SPECIAL COMMISSIONER.) gratuitous medical assistance if he has no means of his own this medical service is so badly paid and organised that it is 1905. Liege, August, ineffective. Therefore the new law which provides medical CONGRESS OF THE BELGIAN MEDICAL UNIONS. treatment and sick allowance in case of accidents will A SMALL but interesting Congress has been held at Liége probably be supplemented by another similar law to meet ’during the month of August under the name of the National cases of ordinary sickness. If the insurance companies or Congress of Professional Medicine. Practically this meant the employers are also to have the choice of the medical medical ethics and economics. The editor of Le Scalpel, attendant for ordinary ca, es of illness then what will there Dr. L. DEJACE, presided. The Government patronised the be remaining for the independent practitionerI Nearly the whole of the working classes will be withdrawn from the "Congress and was represented by Dr. El. Voituron from the domain of general medical practice. They will all be Ministry of Agriculture, which has among its duties super- attended by the salaried servants of the employers or of the intendence of the sanitary service of Belgium. Though insurance companies. In view of such a contingency the many influential medical men and medical societies sup- Liege Congress insisted that whoever pays, still it shall be ported this Congress it must be confessed that the number the patient himself who must be allowed to select his medical of the " adherents " and subscribers who actually attended attendant. In raising this question the Congress at Liege has rendered was not large. The Congress met in the hall of the Academies at the University of Liege and the first question good service It is a problem that interests not only the Belgian -discussed was introduced by Dr. J. P. NuEL, professor of practitioners : in all countries there is a strong tendency in ophthalmology. It dealt with the new Belgian law of favour of legislative interference in such matters. The great Dec. 24th, 1903, by which employers are compelled to example set by Germany with its compulsory insurance laws provide medical treatment for their workers when accidents is being followed by other nations. Each country will intro- occur. Dr. Nuel urged that the injured workers ought to duce modifications to suit local conditions, but something be allowed to select their medical attendant. In France this more or less complete or incomplete is likely to be attempted was permitted. In Germany, for some 12 years, the medical by nearly all the legislatures of civilised countries. In this had .:profession struggled in vain to establish this principle. the interests of the medical profession are sure to be sacriThe last congress where the matter was discussed is said. to ficed unless the profession is able to organise and to make have been attended by 4000 German medical practitioners its voice heard. After hearing Dr. Nuel’s report a brief - and the great majority voted in this sense. But in the discussion ensued and the Congress eventually unanimously that the law should be so Belgian Parliament it was argued that the workman should adopted a asproposition demanding to enable the victims in cases of accidents to not choose his medical attendant because his employer amended would know better whom to select and, because, if the select the practitioner by whom they desire to be attended. The next question related to the choice of medical experts -workmen selected their medical attendant, the expense would be much greater. Also it was said that as the employer had when a contest arose in the law courts as to the injury done - to pay he ought to be able to choose which surgeon by an accident in a mine, factory, or workshop. At first it should be engaged, just as he chose his own engineers was proposed that the Belgian law should be similar to the .:and others whom he employed. In reply, it is pointed French law and declare that the medical man attending out that the engineers watch over the employer’s the patient, whether chosen by the employer or by property but the medical man is called upon to attend the patient himself, could not be appointed as expert. to the health, to the very existence, of the workman. Nor should the medical practitioner appointed by the The employer might as well impose a tailor, a baker, a employer to report on the condition and the treatment grocer on his workmen on the ground that indirectly he pays of the patient be admitted as expert in the matter To this rule the Belgian Government them all. Again, it is essential that all patients should be under judgment. created by medical attendants in whom they have confidence, had assented and then it altered its mind, leaving the .and this is most likely to be the case if they themselves judge free to act as he thought best. But then if the judge choose their medical attendant. It appears, however, that calls upon the medical attendant to act as witness the latter figures were quoted in the French Chamber of Deputies and exposes himself to be prosecuted for revealing professional Teproduced before the Belgian Chamber of Representatives secrets. To be safe the medical attendant must obtain a which caused much alarm. These related to five insurance written permission from his patient and if such medical companies that covered the employers’ liabilities and showed testimony is not favourable to the patient’s claims then the that a fifth, sometimes a fourth, of the total sum allotted for latter may refuse to give the authorisation. Evidently the accidents was spent in paying fees to the medical attendants. intervention of an impartial outsider is needed ; but this Instead of considering this a proof of the great services may entail extra expense and on all sides the greatest fear rendered by the profession it was interpreted as signif3 ing was manifested of spending more than can possibly be that the medical fees paid were very high. As a matter of helped. No motion, however, was submitted on this subject. Then a nice point was raised which applies to all countries. fact, they only amounted to from 5d. to 6d. per day per paiient, medicine included. Then it must be borne in mind A workman is injured. His employer must pay the medithat in France during the first four days, and in Belgium cal attendant ; but the injured man may be taken to a -during the first seven da3 s, no payment whatever is made, hospital where no charge is made. The Congress adopted .either to the workman or his medical attendant. It is only a proposition to the effect that the medical attendant when the accident is sufficiently severe to require treatment should, in all cases, be paid, whether he be the house lasting longer than this period that compensation is given. surgeon at a hospital or in private practice. The money As slight injuries are of frequent occurrence it has been is there, it has been provided for by law, and why should it reckoned in Germany that they represent nearly half the not be paid because it so liappened that it was more conamount of medical attendance given. Other statistics, venient to carry the injured man to a hospital instead of from a benefit all at Mons, notably society go to show that taking him to his home ! The question of organising medical unions or syndicates there is very little danger that the medical men who attend in cases of accidents will be over-paid. On the contrary, was then discussed and it was felt that medical men should avail themselves of all laws facilitating the organi-ation of they are usually and scandalously under-paid. At the Liege Congress it was stated that the colliery crafts, trades, and professions. By the Belgian law such surgeons in the surrounding coalfields only earned from £80 unions are given facilities for insurance, within certain limits, to £120 a year all told and that on an average they did not on very advantageous terms and with a State guarantee. receive more than 2d. per consultation. In such circum- There is no reason why medical men should not profit by stances the necessity of organisation is very evident. The this law ; it would be a great boon to the poorer practiworking classes have so far organised that they have com- tioners. The Congress, after hearing a report on the subject pelled the Government to enact laws in their favour, but read by Dr. LOONTJENS, unanimously adopted the following while thei-e laws were being discussed the medical profession motion :This Congress of Professional Medicine recommends medical clubs had no organisation capable of protecting its interests or societies to study the law of March 31st, 1898, on professional or these were And at stake. the will matter though equally trades unions. The medical societies would be well advised if they not end here. The new law compels the employer to pay followed the example of the professional or trades unions and inserted
compensation
THE ORGANISATION OF THE MEDICAL PROFESSION.
an
924
On the above I wrote as follows: "Now, what does the sentence of this extract amount to ? To my mind, and probably to the minds of other medical officers, it amounts to this, that, in fact, varicocele scarcely at all affects the ability of a soldier to perform all his duties. I may ask, Have army medical officers ever had officers or soldiers under treatment for varicocele or been obliged to In an exexcuse them from any duty on that account ? perience of 30 years’ service I never treated an officer or soldier for varicocele and it would be futile to contend that during this period there did not exist many hundreds who must have had the disability."2 After my article appeared other army surgeons recorded experience different from mine. Of course, the foregoing transcriptions refer to recruits. I am, however, now concerned only with candidates for commissions in the army. It will be interesting to your readers in the civil profession if I quote the phrasing of the army medical regulations for the guidance of medical officers serving on medical boards for the examination of candidates and also for recruits. The former reads thus: " That he varicocele, varicose [the candidate] does not suffer from veins in a severe degree ....... a slight defect if successfully cured by operation is not a disqualification " ; in the latter "varicocele beyond a limited extent." That is, the conditions above are considered disabilities within the limits laid
closing
......
down. Now in support I
less of the views I have expressed senior surgeon of one of the leading in London who writes to me as follows :more or
quote the opinion of
hospitals
a
I have been lecturing at hospital for the last 20 years on the of calling or treating varicoeele as in any sense a disease. I have as surgeon to never seen a single instance of dilated veins in the cord producing any real trouble. I have on this account always to think of inter refused to operate or allow my house surgeons at fering with the cases. The condition is a physiological one and can be seen in all the sheep race of animals (ovis) at the season when they are not rutting. The dilatation retards the flow of blood through the testicle and prevents the testicles being active when not required. -
absurdity
INQUEST UNFINISHED.
of varicocele offhand and have nothing whatever and provisional entry thereafter? I am informed that naval surgeons are emphatic and relentless in excluding candidates or recruits the subjects of varicocele in any form-I assume there must be somestrong grounds for this. If so, I trust that naval medical officers will take part in any discussion which may follow publication of this letter. We in the army have of latecopied the Admiralty in our highest institutions ; let us, then, copy their medical system, for presumably the military officer is required to be as efficient as the naval officer. The former certainly serves abroad a great deal and undergoes the same risks of service in all climates. In conclusion, as I have stated that during my experience I have seen deplorable results of operations recommended, I shall ask the forbearance of your readers while I quote two examples. A B was operated on for varicocele of the left testicle, which atrophied ; subsequently varicocele developed in the right. C D, a successful competitor, was rejected for undescended testicles; he was subsequently operated on by an eminent London surgeon. The lad competed a second time3 after this and was again successful. On being reexamined by the Army Medical Board the scrotum was found to contain two pea-sized bodies on each side supposed tobe testicles. We army medical officers must apply theWar Office regulations no matter what our private opinions may be.-I am, Sirs, yours faithfully, FRANK HOWARD, M.D. St. And., Colonel, Army Medical Staff (R.P.); Senior Medical Officer, Recruiting ... London Area. Sussex Mansions, S.W., Sept. 15th, 1905.
reject
cases
to do with
recommending operations
-
-
-
-
-
-
THE
DEATH OF A CORONER LEAVING AN INQUEST UNFINISHED.
To the Editors of THE LANCET. a short article under the heading of "Medicine the of varicocele SIRs,-In discussing subject days with a officer of the Indian Medical Service and the Law"contained in THE LANCET of Sept. 16th you, who recently held not only a high position at the India Office refer to a case of exhumation of a dead person in South but also previously one in a teaching university hospital in Staffordshire which arose through the adjournment of the India and he has kindly permitted me to record his opinion. inquiry and the sudden death of the coroner. As I am It is this : that in the course of 26 years of an extensive the deputy coroner referred to, perhaps you will excuseand varied practice he recollects advising an operation for me if I point out that your writer laboured under some of the reason of the exhumation and varicocele but once, he now forgets why. He does not con- mlsapprehen&ion I did not consider it sider varicocele a disability, and if he were to recommend the requirements of the law. an operation it would merely be to get over an official necessary that the jury should again view the body, regulation which debars admission to the public service on nor did I even suggest the possibility of the law reaccount of varicocele. quiring it. I merely conformed to the law in viewing It is not necessary, Sirs, for me to point out that the the body myself. The jury having once viewed, the law, so results of operations for varicocele are far from being far as they were concerned, was sati-fied, but a coroner uniformly satisfactory and that occasionally disastrous cannot hold an inquiry without viewing and the coroner who consequences have ensued-to wit, atrophy of the testicle. had previously viewed was dead. I may add that my own In a very large number of the cases put back by army opinion as to the viewing of bodies is that it should bemedical boards for operations, apart from the chronically left entirely with the coroner to decide whether the jury view or not view. enlarged testicle which follows, the parents or guardians ot tne iarts can III altord tne expenses attending an operaI am, Sirs, yours faithfully, ALBERT A. BETHAM, tion and detention in a home, and I have heard bitter Sept. 19th, 1905. Acting Coroner for Staffs. complaints on this subject. It is, indeed, possible that in a highly neurotic or neurasthenic lad or young man 3 Successful candidates if medically rejected are obliged to compete varicocele may give rise to trouble ; but I contend that again. because such a state may exist in an exceptional case it is unnecessary, if not unfair, to subject candidates to the FAKIRS AND ANÆSTHESIA.-The Medical Council expense and risk of operations as we so frequently do. Not long ago a young officer in the militia who had a large of the Russian Ministry of the Interior has forhidden, says varicocele asked me about competing for the regulars; I the Stovo, that Indian fakirs should hold séances for the advised him not to do so as he would surely be rejected purpose of inducing hypnotism or anaesthesia. for the varicocele and be put back for operation which THE METROPOLITAN ASYLUMS BOARD AND THE i certainly should not advise him to undergo. This young officer subsequently went to Nigeria and did some stiff TREATMENT OF ITS ASSISTANT MEDICAL OFFICERS.-At a of the Metropolitan Asylums Board held on marching and hard work in that trying climate and has meeting the asylums committee reported that it had 16th, Sept. returned after more than a year without a day’s sickness or received the resignations of three assistant medical officers any inconvenience from a very large varicocele. The proposition I offer is this : if we honestly believe employed at Ddrenth Asylum as a protest against the varicocele to be a disqualification for the army let us reject general conditions appertaining to their position and the case at once and let us not commit ourselves to recom- asking that an inquiry should be made into the grounds of their protest. The committee further stated that all the mending any operation and provisional entry into the army correspondence in connexion with the resignations, together after it if only it be seccessful (see extract of regulation with communications from the officers had appeared quoted above), for the military authorities have numbers of in recent issues of THE LANCET, had which been read and concandidates on the qualified list ready to replace rejections on medical grounds. Why cannot we in the army follow the sidered and it had appointed a special subcommittee of rule laid down in the Admiralty medical regulations-viz., nine members to inquire into the whole of the circumstances which have led to the resignations. The action of the committee was approved and the report was adopted without 2 Many medical officers of long service have borne me out in this discussion. experience. A few
ago I
was
distinguished
should
THE ORGANISATION OF THE MEDICAL PROFESSION.
925
and the cost of medical attendance in case of accident. Such payments are to continue, if necessary, for six months. After that the patient becomes an ordinary or chronic patient and is no longer treated as a case of accident. Though theoretically every Belgian is entitled to (FROM OUR SPECIAL COMMISSIONER.) gratuitous medical assistance if he has no means of his own this medical service is so badly paid and organised that it is 1905. Liege, August, ineffective. Therefore the new law which provides medical CONGRESS OF THE BELGIAN MEDICAL UNIONS. treatment and sick allowance in case of accidents will A SMALL but interesting Congress has been held at Liége probably be supplemented by another similar law to meet ’during the month of August under the name of the National cases of ordinary sickness. If the insurance companies or Congress of Professional Medicine. Practically this meant the employers are also to have the choice of the medical medical ethics and economics. The editor of Le Scalpel, attendant for ordinary ca, es of illness then what will there Dr. L. DEJACE, presided. The Government patronised the be remaining for the independent practitionerI Nearly the whole of the working classes will be withdrawn from the "Congress and was represented by Dr. El. Voituron from the domain of general medical practice. They will all be Ministry of Agriculture, which has among its duties super- attended by the salaried servants of the employers or of the intendence of the sanitary service of Belgium. Though insurance companies. In view of such a contingency the many influential medical men and medical societies sup- Liege Congress insisted that whoever pays, still it shall be ported this Congress it must be confessed that the number the patient himself who must be allowed to select his medical of the " adherents " and subscribers who actually attended attendant. In raising this question the Congress at Liege has rendered was not large. The Congress met in the hall of the Academies at the University of Liege and the first question good service It is a problem that interests not only the Belgian -discussed was introduced by Dr. J. P. NuEL, professor of practitioners : in all countries there is a strong tendency in ophthalmology. It dealt with the new Belgian law of favour of legislative interference in such matters. The great Dec. 24th, 1903, by which employers are compelled to example set by Germany with its compulsory insurance laws provide medical treatment for their workers when accidents is being followed by other nations. Each country will intro- occur. Dr. Nuel urged that the injured workers ought to duce modifications to suit local conditions, but something be allowed to select their medical attendant. In France this more or less complete or incomplete is likely to be attempted was permitted. In Germany, for some 12 years, the medical by nearly all the legislatures of civilised countries. In this had .:profession struggled in vain to establish this principle. the interests of the medical profession are sure to be sacriThe last congress where the matter was discussed is said. to ficed unless the profession is able to organise and to make have been attended by 4000 German medical practitioners its voice heard. After hearing Dr. Nuel’s report a brief - and the great majority voted in this sense. But in the discussion ensued and the Congress eventually unanimously that the law should be so Belgian Parliament it was argued that the workman should adopted a asproposition demanding to enable the victims in cases of accidents to not choose his medical attendant because his employer amended would know better whom to select and, because, if the select the practitioner by whom they desire to be attended. The next question related to the choice of medical experts -workmen selected their medical attendant, the expense would be much greater. Also it was said that as the employer had when a contest arose in the law courts as to the injury done - to pay he ought to be able to choose which surgeon by an accident in a mine, factory, or workshop. At first it should be engaged, just as he chose his own engineers was proposed that the Belgian law should be similar to the .:and others whom he employed. In reply, it is pointed French law and declare that the medical man attending out that the engineers watch over the employer’s the patient, whether chosen by the employer or by property but the medical man is called upon to attend the patient himself, could not be appointed as expert. to the health, to the very existence, of the workman. Nor should the medical practitioner appointed by the The employer might as well impose a tailor, a baker, a employer to report on the condition and the treatment grocer on his workmen on the ground that indirectly he pays of the patient be admitted as expert in the matter To this rule the Belgian Government them all. Again, it is essential that all patients should be under judgment. created by medical attendants in whom they have confidence, had assented and then it altered its mind, leaving the .and this is most likely to be the case if they themselves judge free to act as he thought best. But then if the judge choose their medical attendant. It appears, however, that calls upon the medical attendant to act as witness the latter figures were quoted in the French Chamber of Deputies and exposes himself to be prosecuted for revealing professional Teproduced before the Belgian Chamber of Representatives secrets. To be safe the medical attendant must obtain a which caused much alarm. These related to five insurance written permission from his patient and if such medical companies that covered the employers’ liabilities and showed testimony is not favourable to the patient’s claims then the that a fifth, sometimes a fourth, of the total sum allotted for latter may refuse to give the authorisation. Evidently the accidents was spent in paying fees to the medical attendants. intervention of an impartial outsider is needed ; but this Instead of considering this a proof of the great services may entail extra expense and on all sides the greatest fear rendered by the profession it was interpreted as signif3 ing was manifested of spending more than can possibly be that the medical fees paid were very high. As a matter of helped. No motion, however, was submitted on this subject. Then a nice point was raised which applies to all countries. fact, they only amounted to from 5d. to 6d. per day per paiient, medicine included. Then it must be borne in mind A workman is injured. His employer must pay the medithat in France during the first four days, and in Belgium cal attendant ; but the injured man may be taken to a -during the first seven da3 s, no payment whatever is made, hospital where no charge is made. The Congress adopted .either to the workman or his medical attendant. It is only a proposition to the effect that the medical attendant when the accident is sufficiently severe to require treatment should, in all cases, be paid, whether he be the house lasting longer than this period that compensation is given. surgeon at a hospital or in private practice. The money As slight injuries are of frequent occurrence it has been is there, it has been provided for by law, and why should it reckoned in Germany that they represent nearly half the not be paid because it so liappened that it was more conamount of medical attendance given. Other statistics, venient to carry the injured man to a hospital instead of from a benefit all at Mons, notably society go to show that taking him to his home ! The question of organising medical unions or syndicates there is very little danger that the medical men who attend in cases of accidents will be over-paid. On the contrary, was then discussed and it was felt that medical men should avail themselves of all laws facilitating the organi-ation of they are usually and scandalously under-paid. At the Liege Congress it was stated that the colliery crafts, trades, and professions. By the Belgian law such surgeons in the surrounding coalfields only earned from £80 unions are given facilities for insurance, within certain limits, to £120 a year all told and that on an average they did not on very advantageous terms and with a State guarantee. receive more than 2d. per consultation. In such circum- There is no reason why medical men should not profit by stances the necessity of organisation is very evident. The this law ; it would be a great boon to the poorer practiworking classes have so far organised that they have com- tioners. The Congress, after hearing a report on the subject pelled the Government to enact laws in their favour, but read by Dr. LOONTJENS, unanimously adopted the following while thei-e laws were being discussed the medical profession motion :This Congress of Professional Medicine recommends medical clubs had no organisation capable of protecting its interests or societies to study the law of March 31st, 1898, on professional or these were And at stake. the will matter though equally trades unions. The medical societies would be well advised if they not end here. The new law compels the employer to pay followed the example of the professional or trades unions and inserted
compensation
THE ORGANISATION OF THE MEDICAL PROFESSION.
an