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BRITISH HEALTH RESORTS ASSOCIATION
50
(F) This patient
was told the doctor he wanted to Dr. A. In view of this report the sub. committee decided not to try to get Dr. B. removed from the panel ; but as in the course of the investigations it had been discovered that he gave some of these insured persons who are not on his list medicine by prescription on the official form and on one occasion a certificate without seeing the patient, it asked the panel committee to refer the case to the medical service subcommittee for investigation. This will require the consent of the Minister of Health, for it is technically out of time owing to the delay involved in the investigation by the panel committee. The panel committee passed the reference, so that, subject to the Minister’s consent, it now goes to the insurance committee. If the Minister does give consent then three of the seven men who will have to hear this case will have been familiar with the details of the complaint from its commencement, and if they are the normal medical members of that sub. committee one of them was actually present at the original inquiry whilst another in his capacity of chairman of the main committee cannot fail to have all the details of the case at his fingers’ ends. There is obviously something wrong in the administration of justice to insurance practitioners as instanced in this case. The decision of the ethical subcommittee that this man was guilty of canvassing, for which the panel committee must accept full responsibility, was based on evidence which was proved insufficient. The panel committee’s decision to make representations to the Minister with a view to the withdrawal of the practitioner’s name from the medical list, had therefore to be rescinded. Instead of then letting the matter drop, the panel committee decided to put this doctor on trial again see
was
minor charge before a tribunal in which its own members have to adjudicate and decide the penalty, on a
if any. The function of the
panel committee (through its subcommittee) should be to try and effect a friendly settlement between two doctors who are in dispute. When evidence is given that something quite serious has occurred the matter should be referred, without details being published, to the proper tribunal for the hearing of such cases, either the General Medical Council or the Ministry of Health
ethical
the medical service subcommittee. No officers of the committee (since they are ex-officio members of all subcommittees), and no members of the ethical committee should be eligible to sit as medical members of the medical service subcommittee. The ethical subcommittee has no statutory power to call evidence, it cannot pay the out-of-pocket expenses of witnesses, and by its size also it is quite unsuitable to deal with this sort of case. It appears to have been overlooked in the regulations under which the panel committee can refer cases to the medical service subcommittee for trial that its own members sit upon that sub. committee and may have taken part (as in the present case) in adjudicating upon the case previously. This seems to be a more glaring anomaly than the former method of reference by the insurance committee to its own subcommittee. One way of getting over the reference difficulty would be to send the case to another medical service subcommittee, where, of course, no one would have had any previous details that might possibly prejudice their minds. It is clear that under the present procedure the administration of justice to an insurance practitioner may not be conducted in the proper atmosphere of impartiality.
or
CORRESPONDENCE BRITISH
HEALTH RESORTS ASSOCIATION To the Editor
of
THE LANCET
SiR,-We have been much encouraged of late by the increasing interest shown in the work of the British Health Resorts Association by the medical profession. Our association is largely medical, not only in personnel but in its objects, which are to awaken and sustain interest in the health side of our British resorts. At our recent conferences at and Cromer we were supported by leaders Harrogate of the profession, and I venture to think that the quality of the discussions was something of which we may be proud. Though we look in the main for financial support to the local authorities of the places we are trying to help, we are very anxious to secure more of it from the medical profession, particularly from those members practising in the health resorts or who take a special interest in climatology, balneology, and physical medicine. The recent action of the Harrogate Medical Society and the Torquay division of the B.M.A. has therefore given our council great pleasure. These bodies have circularised their members with a view to enlisting their interest in our work, and by this means we have secured a considerable number of new members. Our medical advisory committee would be glad to have an opportunity in your columns of bringing these examples to the notice of similar bodies, in the hope that they may do likewise. Our subscription is nIs. a year, though we would welcome any donations, small or large. We cannot offer any direct material advantage to subscribers,
believe there are many who would be willing a practical interest in a movement which has a distinctly medical as well as a patriotic aim. I shall be glad to answer any inquiries. I am, Sir, yours faithfully, ALFRED Cox, but
we
to show
199, Piccadilly, W., July 2nd.
General Secretary.
JOINT LUBRICATION To the Editor
of
THE LANCET
SiR,—In your last issue Dr. Shirley Jones has called attention to the importance of the viscosity of synovial fluid in relation to joint lubrication, and has inferred that certain forms of arthritis may be due to alterations in the mucin content of this fluid. Very little is known about the physiology of the mucoproteins, but it does seem fairly clear that the thyroid gland is concerned. Thus in myxoedema there is a generalised accumulation in the tissues of a colloid which is, or closely resembles, a mucoprotein, and it is also known that the secretion of the parotid gland in this disease assumes an abnormally mucoid character. Since this plethora of mucoprotein is readily corrected by thyroxine it might be anticipated that the opposite condition of hyperthyroidism would be accompanied by a paucity of mucin in the tissues, and if the synovial fluids share in these general changes, then arthritis, from defective lubrication, should be commonly encountered in Graves’s disease. It is rather that Duncan Amer. S. Med. Assoc., (Jour. suggestive 1932, xcix, 1239) and others regard polyarthritis
(F) This patient
was told the doctor he wanted to Dr. A. In view of this report the sub. committee decided not to try to get Dr. B. removed from the panel ; but as in the course of the investigations it had been discovered that he gave some of these insured persons who are not on his list medicine by prescription on the official form and on one occasion a certificate without seeing the patient, it asked the panel committee to refer the case to the medical service subcommittee for investigation. This will require the consent of the Minister of Health, for it is technically out of time owing to the delay involved in the investigation by the panel committee. The panel committee passed the reference, so that, subject to the Minister’s consent, it now goes to the insurance committee. If the Minister does give consent then three of the seven men who will have to hear this case will have been familiar with the details of the complaint from its commencement, and if they are the normal medical members of that sub. committee one of them was actually present at the original inquiry whilst another in his capacity of chairman of the main committee cannot fail to have all the details of the case at his fingers’ ends. There is obviously something wrong in the administration of justice to insurance practitioners as instanced in this case. The decision of the ethical subcommittee that this man was guilty of canvassing, for which the panel committee must accept full responsibility, was based on evidence which was proved insufficient. The panel committee’s decision to make representations to the Minister with a view to the withdrawal of the practitioner’s name from the medical list, had therefore to be rescinded. Instead of then letting the matter drop, the panel committee decided to put this doctor on trial again see
was
minor charge before a tribunal in which its own members have to adjudicate and decide the penalty, on a
if any. The function of the
panel committee (through its subcommittee) should be to try and effect a friendly settlement between two doctors who are in dispute. When evidence is given that something quite serious has occurred the matter should be referred, without details being published, to the proper tribunal for the hearing of such cases, either the General Medical Council or the Ministry of Health
ethical
the medical service subcommittee. No officers of the committee (since they are ex-officio members of all subcommittees), and no members of the ethical committee should be eligible to sit as medical members of the medical service subcommittee. The ethical subcommittee has no statutory power to call evidence, it cannot pay the out-of-pocket expenses of witnesses, and by its size also it is quite unsuitable to deal with this sort of case. It appears to have been overlooked in the regulations under which the panel committee can refer cases to the medical service subcommittee for trial that its own members sit upon that sub. committee and may have taken part (as in the present case) in adjudicating upon the case previously. This seems to be a more glaring anomaly than the former method of reference by the insurance committee to its own subcommittee. One way of getting over the reference difficulty would be to send the case to another medical service subcommittee, where, of course, no one would have had any previous details that might possibly prejudice their minds. It is clear that under the present procedure the administration of justice to an insurance practitioner may not be conducted in the proper atmosphere of impartiality.
or
CORRESPONDENCE BRITISH
HEALTH RESORTS ASSOCIATION To the Editor
of
THE LANCET
SiR,-We have been much encouraged of late by the increasing interest shown in the work of the British Health Resorts Association by the medical profession. Our association is largely medical, not only in personnel but in its objects, which are to awaken and sustain interest in the health side of our British resorts. At our recent conferences at and Cromer we were supported by leaders Harrogate of the profession, and I venture to think that the quality of the discussions was something of which we may be proud. Though we look in the main for financial support to the local authorities of the places we are trying to help, we are very anxious to secure more of it from the medical profession, particularly from those members practising in the health resorts or who take a special interest in climatology, balneology, and physical medicine. The recent action of the Harrogate Medical Society and the Torquay division of the B.M.A. has therefore given our council great pleasure. These bodies have circularised their members with a view to enlisting their interest in our work, and by this means we have secured a considerable number of new members. Our medical advisory committee would be glad to have an opportunity in your columns of bringing these examples to the notice of similar bodies, in the hope that they may do likewise. Our subscription is nIs. a year, though we would welcome any donations, small or large. We cannot offer any direct material advantage to subscribers,
believe there are many who would be willing a practical interest in a movement which has a distinctly medical as well as a patriotic aim. I shall be glad to answer any inquiries. I am, Sir, yours faithfully, ALFRED Cox, but
we
to show
199, Piccadilly, W., July 2nd.
General Secretary.
JOINT LUBRICATION To the Editor
of
THE LANCET
SiR,—In your last issue Dr. Shirley Jones has called attention to the importance of the viscosity of synovial fluid in relation to joint lubrication, and has inferred that certain forms of arthritis may be due to alterations in the mucin content of this fluid. Very little is known about the physiology of the mucoproteins, but it does seem fairly clear that the thyroid gland is concerned. Thus in myxoedema there is a generalised accumulation in the tissues of a colloid which is, or closely resembles, a mucoprotein, and it is also known that the secretion of the parotid gland in this disease assumes an abnormally mucoid character. Since this plethora of mucoprotein is readily corrected by thyroxine it might be anticipated that the opposite condition of hyperthyroidism would be accompanied by a paucity of mucin in the tissues, and if the synovial fluids share in these general changes, then arthritis, from defective lubrication, should be commonly encountered in Graves’s disease. It is rather that Duncan Amer. S. Med. Assoc., (Jour. suggestive 1932, xcix, 1239) and others regard polyarthritis