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THE FACTORIES BILL AND MEDICAL PRACTICE
644 months. The presence of numerous leucocytes in the prostatovesicular fluid is taken as evidence of probable infectiousness, but he believes that the most efficient single test is the examination for gonococci of the semen, or prostatovesicular fluid obtained by digital massage, by microscopic and cultural methods. He doubts the value of the complement-fixation test for gonorrhoea in the bloodserum as a test of cure. While many will not accept these views in their entirety they give a fair indication of the doubts and the hazards that arise. It seems that the most rigid precautions will sometimes result in disastrous transference of infection to innocent persons with resulting loss of health and happiness and possible transmission of infection to the next generation. It is certain that these responsibilities are sometimes too lightly undertaken, and that even the most elementary precautions are often omitted. THE FACTORIES BILL AND MEDICAL PRACTICE
THE Factories Bill which was introduced by the Home Secretary in the House of Commons on Jan. 29th, and read a second time without a division on Feb. 15th, is still being considered in Standing Committee. We have already dealt in a leading article (Feb. 20th, p. 451) with the vital question of the adolescent in industry. It may now be useful to summarise the changes which the Bill, if it is passed into law in its present form, will make in the work of doctors who are wholly or partially engaged in industry. The position of the whole-time industrial medical officer remains substantially unaltered except that under Section 11 the Secretary of State may make special regulations for the medical supervision (not treatment) of persons employed at a factory in certain circumstances which have caused or appear likely to cause ill health. Temporary arrangements for such supervision may be made without waiting for the inquiry which must precede the issuing of a special order. It is possible that this section will provide the foundation upon which a more efficient medical service for industry may be built. Again under Section 119 (3) the Secretary of State may authorise a medical practitioner who is employed by the occupier... in connexion with the medical supervision of the factory to act as an " examining surgeon." The appointment and conditions of work of this officer are set out. He is to be appointed by the chief inspector (or his district deputy) who also has power to revoke the appointment. Appeal against the appointment or against the revocation of an appointment may be made to the Secretary of State. No practitioner directly or indirectly interested in any firm can act as an examining surgeon for that firm, except that a medical man employed by a firm may be employed as an examining surgeon if he is authorised by the Secretary of State to do so. This proviso raises a point of more than academic interest. The examining surgeon from the terms of his appointment is a subordinate official of the Home Office medical staff. A medical man employed by a firm might lack (in certain circumstances) that measure of independence and freedom which is essential for the proper discharge of judicial or semijudicial duties. The other duties of the examining surgeon are to make such examinations and reports as the Secretary of State may direct, to make an annual report, and to carry out certain duties under the Compensation Acts. Upon the question of fees the Bill is silent, except that it provides that they shall be paid by the employer and be determined by
the Secretary of State (or by agroement between the surgeon and the employer). Most of the criticisms, just and unjust, which have in the past been levelled
against
the
existing certifying factory surgeon’s
work have been due to his inadequate remuneration. Unless there is improvement in the rate of fees paid for these examinations the other alterations in medical work proposed in the Bill will lose much of their Under Section 69 the examining surgeon value. may be called upon to report on accidents and poisonings in industry. If full use is made of these powers the surgeons will gain an insight into working conditions which otherwise may be denied them. Special examinations of this kind should provide a new source of information about industrial disease and accident. Section 92 governs procedure for the examination of young persons. Power is to be granted to the surgeon to issue provisional certificates of fitness (up to 21 days); to call for the re-examination of young persons (when necessary) ; and to request the medical officers of the local education authority to provide confidential reports on the past medical history of young persons in doubtful cases. Inspectors are to have power to order the suspension (subject to re-examination) of any young person who appears to them to be unfit for the particular work which he or she is doing. Moreover power is given to the Secretary of State to prescribe the facilities which must be provided for the carrying out of these examinations. It will be seen that in these respects the Bill marks a real advance upon existing conditions of medical work in industry. It is essential that the provisions designed to protect the examining surgeon both in his appointment and dismissal should be strong enough to preserve that measure of independence which is necessary to his efficiency. HERMANN
KÜMMELL
GERMAN surgery is the poorer for the death on Feb. 21st of Prof. gummell, who occupied for many years the chair of surgery at Hamburg. Born in 1852 at Corbach, he qualified in 1875 and in 1883 became associated with the Hamburg-Eppendorf Hospital. After 36 years of service there the Hanseatic city at last made up its mind to have its own university and Kummell was chosen as the first professor of surgery. His writings cover almost the whole field of surgery and make an impressive list. Although in this country his name is associated mainly with the spinal disease that bears his name, In abdominal surgery claimed much of his interest. 1890, when appendicitis was still known as perityphlitis, he was writing about its radical cure. Eight years later he was counting 104 recoveries after appendicectomy, and in 1905 he had an experience of 1000 operations. He wrote largely on genito-urinary surgery, particularly in relation to prostatic enlargement ; other subjects he touched ranged from Volkmann’s ischaemic contracture to injuries of the thorax and resection of the colon. " Kummell’s disease " is a late sequel of spinal injury characterised by increasing kyphosis and pain referred along the distribution of the spinal nerves. In his original description he attributed these symptoms to disturbance of the local circulation as the result of a rarefying osteitis followed by collapse of the vertebral body. Nowadays most of such cases are regarded as compression fractures of the vertebral bodies, which, in the absence of radiological examination, have remained unsuspected, until pressure has caused a slow collapse of the cancellous bone with compression of the emerging spinal nerves.
,
THE Factories Bill which was introduced by the Home Secretary in the House of Commons on Jan. 29th, and read a second time without a division on Feb. 15th, is still being considered in Standing Committee. We have already dealt in a leading article (Feb. 20th, p. 451) with the vital question of the adolescent in industry. It may now be useful to summarise the changes which the Bill, if it is passed into law in its present form, will make in the work of doctors who are wholly or partially engaged in industry. The position of the whole-time industrial medical officer remains substantially unaltered except that under Section 11 the Secretary of State may make special regulations for the medical supervision (not treatment) of persons employed at a factory in certain circumstances which have caused or appear likely to cause ill health. Temporary arrangements for such supervision may be made without waiting for the inquiry which must precede the issuing of a special order. It is possible that this section will provide the foundation upon which a more efficient medical service for industry may be built. Again under Section 119 (3) the Secretary of State may authorise a medical practitioner who is employed by the occupier... in connexion with the medical supervision of the factory to act as an " examining surgeon." The appointment and conditions of work of this officer are set out. He is to be appointed by the chief inspector (or his district deputy) who also has power to revoke the appointment. Appeal against the appointment or against the revocation of an appointment may be made to the Secretary of State. No practitioner directly or indirectly interested in any firm can act as an examining surgeon for that firm, except that a medical man employed by a firm may be employed as an examining surgeon if he is authorised by the Secretary of State to do so. This proviso raises a point of more than academic interest. The examining surgeon from the terms of his appointment is a subordinate official of the Home Office medical staff. A medical man employed by a firm might lack (in certain circumstances) that measure of independence and freedom which is essential for the proper discharge of judicial or semijudicial duties. The other duties of the examining surgeon are to make such examinations and reports as the Secretary of State may direct, to make an annual report, and to carry out certain duties under the Compensation Acts. Upon the question of fees the Bill is silent, except that it provides that they shall be paid by the employer and be determined by
the Secretary of State (or by agroement between the surgeon and the employer). Most of the criticisms, just and unjust, which have in the past been levelled
against
the
existing certifying factory surgeon’s
work have been due to his inadequate remuneration. Unless there is improvement in the rate of fees paid for these examinations the other alterations in medical work proposed in the Bill will lose much of their Under Section 69 the examining surgeon value. may be called upon to report on accidents and poisonings in industry. If full use is made of these powers the surgeons will gain an insight into working conditions which otherwise may be denied them. Special examinations of this kind should provide a new source of information about industrial disease and accident. Section 92 governs procedure for the examination of young persons. Power is to be granted to the surgeon to issue provisional certificates of fitness (up to 21 days); to call for the re-examination of young persons (when necessary) ; and to request the medical officers of the local education authority to provide confidential reports on the past medical history of young persons in doubtful cases. Inspectors are to have power to order the suspension (subject to re-examination) of any young person who appears to them to be unfit for the particular work which he or she is doing. Moreover power is given to the Secretary of State to prescribe the facilities which must be provided for the carrying out of these examinations. It will be seen that in these respects the Bill marks a real advance upon existing conditions of medical work in industry. It is essential that the provisions designed to protect the examining surgeon both in his appointment and dismissal should be strong enough to preserve that measure of independence which is necessary to his efficiency. HERMANN
KÜMMELL
GERMAN surgery is the poorer for the death on Feb. 21st of Prof. gummell, who occupied for many years the chair of surgery at Hamburg. Born in 1852 at Corbach, he qualified in 1875 and in 1883 became associated with the Hamburg-Eppendorf Hospital. After 36 years of service there the Hanseatic city at last made up its mind to have its own university and Kummell was chosen as the first professor of surgery. His writings cover almost the whole field of surgery and make an impressive list. Although in this country his name is associated mainly with the spinal disease that bears his name, In abdominal surgery claimed much of his interest. 1890, when appendicitis was still known as perityphlitis, he was writing about its radical cure. Eight years later he was counting 104 recoveries after appendicectomy, and in 1905 he had an experience of 1000 operations. He wrote largely on genito-urinary surgery, particularly in relation to prostatic enlargement ; other subjects he touched ranged from Volkmann’s ischaemic contracture to injuries of the thorax and resection of the colon. " Kummell’s disease " is a late sequel of spinal injury characterised by increasing kyphosis and pain referred along the distribution of the spinal nerves. In his original description he attributed these symptoms to disturbance of the local circulation as the result of a rarefying osteitis followed by collapse of the vertebral body. Nowadays most of such cases are regarded as compression fractures of the vertebral bodies, which, in the absence of radiological examination, have remained unsuspected, until pressure has caused a slow collapse of the cancellous bone with compression of the emerging spinal nerves.
,