- Email: [email protected]
A CASE OF COLOUR BLINDNESS.
THE MEDICAL PROFESSION AND THE NATIONAL INSURANCE ACT.
970
granted. If the list of the Manchester and Salford Committee, published in the Daily Mail of Sept. 25th, can be taken as a specimen of those all over the country, it is very evident that the demand for adequate representation is fully justified. It will be of interest to medical men, and possibly also to the public, to know that copies of these lists may be obtained from Messrs. Wyman, Fetter-lane, London, E.C., at the price of ld. each, and the Executive Committee of the
Up to this age the penalty might be an indeterminate sentence in a Borstal institution. The present law of fining or sending a girl to Holloway for a fortnight is a pathetic farce-’women learn to evade the police : girls, as is shown by the collection of cases in the Vigilance Record for August (1912), are, owing to our administration, placed at the mercy of the souteneur at an age when their protected sisters are still at their lessons in the schoolroom. I am, Sir, yours faithfully, ETTIE SAYER. ’ Upper Brook-street, W., Sept. 25th, 1912.
National Medical Union urges everyone to obtain a copy and study the composition of these committees which are given so much power over the health and lives of their fellow men. It is imperative that the public should be reminded of the fact that the medical profession is fighting, not only for its own rights, but also for the good of the national health, and that the question of remuneration is only one of many points of difference between the Chancellor of the Exchequer and I am. Sir. vours faithfullv. itself. J. WEBSTER WATTS, Manchester, Sept. 30th, 1912. Secretary, National Medical Union. to
A CASE OF COLOUR BLINDNESS. To the Editor of THE LANCET. was present, along with Professor Trouton, at the test of the case made by Dr. F. W. Edridge-Green, which is described in THE LANCET of June 22nd, 1912. The examinee passed, successfully the official wool test of the Board of Trade, but failed completely when tested with There is no doubt whatever Dr. Edridge-Green’s lantern. that the examinee was a very dangerous case in spite of passing the wool test. This case alone would make it clear that a lantern test is necessary. But there are lanterns and lanterns, and in my opinion it is exceedingly doubtful whether the new lantern suggested by the recent Departmental Committee has the requisites for effecting a correct discrimination between candidates. To mention one point only, it lacks any possibility of adjusting the luminosity so as to imitate the effects of atmospheric changes. This is the requisite which every lantern must have if it is to discriminate between the safe and the unsafe colour defective. It is possible to imitate service conditions in this respect with Dr. Edridge-Green’s lantern. A lantern that lacks this provision is as useless as the fine weather tests which were made in the open by the Departmental Committee. With regard to the proposed flicker method of discriminating the colour-blind, it should be noted that it has no theoretical basis ; the recent report itself shows that in several cases its indications are erroneous. The best that can be said for it is that it is on its trial, and in any case it will be an extremely indirect and recondite method for ascertaining a very simple fact. I am. Sir. vours faithfullv. University College, W.C., Sept. 27th, 1912. ALFRED W. PORTER.
SIR,-I
.
A CORRECTION. To the -Editor of THE LANCET.
SiR,—In my paper entitled " The Technique of the More Extensive Abdominal Operations for Cancer of the Womb," which appeared in THE LANCET of Sept. 21st, p. 825, first column, last paragraph, I have stated, "My own series This should read, "52 of 41 cases with two deaths,"&c. cases with three deaths." I should have made the correction had not absence from home prevented me from revising the I am, Sir, yours faithfully, proof. F. J. MCCANN. W., Sept. 30th, 1912. V
Wimpole-street,
THE MEDICAL PROFESSION AND THE NATIONAL INSURANCE ACT.
I
To the Editor of THE LANCET. understand that a vigorous effort is being made to SIR,—I make a system of payment by fees appear unanimous on the part of the medical profession. This is far from the case, though in the present state of feeling the opposition to it may not be so articulate as it would otherwise prove. In a former issue you were good enough to print a letter from me showing the extravagance of this demand on the public revenue, but a consideration probably more likely to operate on the minds of those who are supporting it has so far been strangely forgotten. At first the burden on the ratepayers would be very heavy, and in the over-taxation with which the country is now afflicted this would prove intolerable; but in course of time, if the present signs prove to be correct, a great change will be effected in the amount of disease and in the cost of attendance thereupon. The whole trend of medical science is in the direction of prophylaxis by the elimination of the causes of disease, and one by one whole groups of ailments, and these, perhaps, the most common and fatal, are being added to the list of specific infections. By the use of sera it is fully expected that many of these diseases will be brought into subjection to the preventive power of medicine, and it is needless to point out that this will effect a gradual, or even rapid, diminution in their incidence and the income derivable from attendance upon them. If this happy consummation is attained, many medical men now in busy practice will find much of their occupation gone, and the profession will suffer heavy financial loss if the payment is on the basis of work done. On the capitation system, on the other hand, the payment would still continue whilst the work is diminished. Perhaps the advocates of this system have hardly viewed the question from this standpoint, and should pause before they go further in their demand. On the other hand, while the national funds would suffer temporarily, they may benefit ultimately by an improved health standard of the population, I am, Sir, yours faithfully, M.D. 1912. Sept. 26th,
THE POST OF MEDICAL REFEREE.
To the Editor of THE LANCET. To the Editor of THE LANCET. the end of an annotation on p. 897 of SIR,-At THE LANCET of on his in at Victor Sept. 28th, under the heading "An SIR,—Sir speech Appleby Horsley, of Unusual Case under the Workmen’s Compensation Act," you Sept. 26th, refers to the difficulty between the Chancellor the Exchequer and the medical profession as being " merely say: "It seems to us unfortunate that an official medical a question of remuneration for work done." referee attached to a particular court should be allowed in is ima the of remuneration very any circumstances to give expert evidence in the court of Undoubtedly question portant one, but it is by no means so all-engrossing to the which he is in some sense part of the judiciary, since it is to medical profession as has been represented. The chief him that the judge ordinarily looks for guidance." How far are the last clause and the inference drawn from opposition of the profession to the Act is on account of its inadequacy as a measure for improving the public health, it justified ? According to the annual report on the Workbut there are many other important points in its medical men’s Compensation Act for 1909 (the latest I have to refer clauses to which medical men object. The financial side of to) the number of claims for compensation settled in the the question, although bound up with these, has been given a county courts that year was in England 3087, in Scotland 450, in Ireland 568, whilst the number of references made to publicity which is totally out of proportion to its merits. One of the most important of the demands of the pro- the medical referees was in England 225, in Scotland 62, in fession is for adequate representation on the Local Health Ireland 10, and the number of times the medical referees sat Committees. A perusal of the lists which have been pub- with the judges as assessors was in England 240, in Scotland lished, giving the names of the members of these com- 79, in Ireland 57 ; so that, on an average, a medical referee mittees, is ample evidence that this demand has not been,was concerned with only one in every five or six cases. .,
970
granted. If the list of the Manchester and Salford Committee, published in the Daily Mail of Sept. 25th, can be taken as a specimen of those all over the country, it is very evident that the demand for adequate representation is fully justified. It will be of interest to medical men, and possibly also to the public, to know that copies of these lists may be obtained from Messrs. Wyman, Fetter-lane, London, E.C., at the price of ld. each, and the Executive Committee of the
Up to this age the penalty might be an indeterminate sentence in a Borstal institution. The present law of fining or sending a girl to Holloway for a fortnight is a pathetic farce-’women learn to evade the police : girls, as is shown by the collection of cases in the Vigilance Record for August (1912), are, owing to our administration, placed at the mercy of the souteneur at an age when their protected sisters are still at their lessons in the schoolroom. I am, Sir, yours faithfully, ETTIE SAYER. ’ Upper Brook-street, W., Sept. 25th, 1912.
National Medical Union urges everyone to obtain a copy and study the composition of these committees which are given so much power over the health and lives of their fellow men. It is imperative that the public should be reminded of the fact that the medical profession is fighting, not only for its own rights, but also for the good of the national health, and that the question of remuneration is only one of many points of difference between the Chancellor of the Exchequer and I am. Sir. vours faithfullv. itself. J. WEBSTER WATTS, Manchester, Sept. 30th, 1912. Secretary, National Medical Union. to
A CASE OF COLOUR BLINDNESS. To the Editor of THE LANCET. was present, along with Professor Trouton, at the test of the case made by Dr. F. W. Edridge-Green, which is described in THE LANCET of June 22nd, 1912. The examinee passed, successfully the official wool test of the Board of Trade, but failed completely when tested with There is no doubt whatever Dr. Edridge-Green’s lantern. that the examinee was a very dangerous case in spite of passing the wool test. This case alone would make it clear that a lantern test is necessary. But there are lanterns and lanterns, and in my opinion it is exceedingly doubtful whether the new lantern suggested by the recent Departmental Committee has the requisites for effecting a correct discrimination between candidates. To mention one point only, it lacks any possibility of adjusting the luminosity so as to imitate the effects of atmospheric changes. This is the requisite which every lantern must have if it is to discriminate between the safe and the unsafe colour defective. It is possible to imitate service conditions in this respect with Dr. Edridge-Green’s lantern. A lantern that lacks this provision is as useless as the fine weather tests which were made in the open by the Departmental Committee. With regard to the proposed flicker method of discriminating the colour-blind, it should be noted that it has no theoretical basis ; the recent report itself shows that in several cases its indications are erroneous. The best that can be said for it is that it is on its trial, and in any case it will be an extremely indirect and recondite method for ascertaining a very simple fact. I am. Sir. vours faithfullv. University College, W.C., Sept. 27th, 1912. ALFRED W. PORTER.
SIR,-I
.
A CORRECTION. To the -Editor of THE LANCET.
SiR,—In my paper entitled " The Technique of the More Extensive Abdominal Operations for Cancer of the Womb," which appeared in THE LANCET of Sept. 21st, p. 825, first column, last paragraph, I have stated, "My own series This should read, "52 of 41 cases with two deaths,"&c. cases with three deaths." I should have made the correction had not absence from home prevented me from revising the I am, Sir, yours faithfully, proof. F. J. MCCANN. W., Sept. 30th, 1912. V
Wimpole-street,
THE MEDICAL PROFESSION AND THE NATIONAL INSURANCE ACT.
I
To the Editor of THE LANCET. understand that a vigorous effort is being made to SIR,—I make a system of payment by fees appear unanimous on the part of the medical profession. This is far from the case, though in the present state of feeling the opposition to it may not be so articulate as it would otherwise prove. In a former issue you were good enough to print a letter from me showing the extravagance of this demand on the public revenue, but a consideration probably more likely to operate on the minds of those who are supporting it has so far been strangely forgotten. At first the burden on the ratepayers would be very heavy, and in the over-taxation with which the country is now afflicted this would prove intolerable; but in course of time, if the present signs prove to be correct, a great change will be effected in the amount of disease and in the cost of attendance thereupon. The whole trend of medical science is in the direction of prophylaxis by the elimination of the causes of disease, and one by one whole groups of ailments, and these, perhaps, the most common and fatal, are being added to the list of specific infections. By the use of sera it is fully expected that many of these diseases will be brought into subjection to the preventive power of medicine, and it is needless to point out that this will effect a gradual, or even rapid, diminution in their incidence and the income derivable from attendance upon them. If this happy consummation is attained, many medical men now in busy practice will find much of their occupation gone, and the profession will suffer heavy financial loss if the payment is on the basis of work done. On the capitation system, on the other hand, the payment would still continue whilst the work is diminished. Perhaps the advocates of this system have hardly viewed the question from this standpoint, and should pause before they go further in their demand. On the other hand, while the national funds would suffer temporarily, they may benefit ultimately by an improved health standard of the population, I am, Sir, yours faithfully, M.D. 1912. Sept. 26th,
THE POST OF MEDICAL REFEREE.
To the Editor of THE LANCET. To the Editor of THE LANCET. the end of an annotation on p. 897 of SIR,-At THE LANCET of on his in at Victor Sept. 28th, under the heading "An SIR,—Sir speech Appleby Horsley, of Unusual Case under the Workmen’s Compensation Act," you Sept. 26th, refers to the difficulty between the Chancellor the Exchequer and the medical profession as being " merely say: "It seems to us unfortunate that an official medical a question of remuneration for work done." referee attached to a particular court should be allowed in is ima the of remuneration very any circumstances to give expert evidence in the court of Undoubtedly question portant one, but it is by no means so all-engrossing to the which he is in some sense part of the judiciary, since it is to medical profession as has been represented. The chief him that the judge ordinarily looks for guidance." How far are the last clause and the inference drawn from opposition of the profession to the Act is on account of its inadequacy as a measure for improving the public health, it justified ? According to the annual report on the Workbut there are many other important points in its medical men’s Compensation Act for 1909 (the latest I have to refer clauses to which medical men object. The financial side of to) the number of claims for compensation settled in the the question, although bound up with these, has been given a county courts that year was in England 3087, in Scotland 450, in Ireland 568, whilst the number of references made to publicity which is totally out of proportion to its merits. One of the most important of the demands of the pro- the medical referees was in England 225, in Scotland 62, in fession is for adequate representation on the Local Health Ireland 10, and the number of times the medical referees sat Committees. A perusal of the lists which have been pub- with the judges as assessors was in England 240, in Scotland lished, giving the names of the members of these com- 79, in Ireland 57 ; so that, on an average, a medical referee mittees, is ample evidence that this demand has not been,was concerned with only one in every five or six cases. .,