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DISLOCATION OF THE PROXIMAL PHALANX OF THE GREAT TOE.
213 disease too little attention has been paid to the soil, especially to the soil of the adult, modified as it necessarily is by the habits and environment of years. .hope Dr. Latham will be able to publish at an early date his promised further contribution on this T
subject
Q.1YI
Oir
A7niirc
faithfully
R. ACKERLEY.
Llandrindod Wells, Jan. 13th, 1914.
DISLOCATION OF THE PROXIMAL PHALANX OF THE GREAT TOE. To the Editor of THE LANCET.
SIR,—I was called a few days ago to a miner who caught by the trouser pocket by a revolving wheel and swung violently round the room. His injuries consisted of skin scratches in various parts and a dorsal dislocation (easily reduced) of the proximal phalanx of the great toe
had been
foot. At the time of the accident he waa wearing the heavy boots common to miners. The case is interesting in connexion with that mentioned by Dr. Henry Robinson in his letter in your columns last week and your previous I am, Sir, yours faithfully, annotation. GEORGE F. RIGDEN, M.B., B.S. Lond., M.R.C.S., L.R.C.P. on one
Cinderford, Glos., Jan. 10th, 1914.
IMPROVEMENTS IN THE NAVAL MEDICAL SERVICE. To the Fditor of THE
LANCET.
SIR,-The recent alterations and improvements in the Naval Medical Service announced in your Service news have been long asked for.1 I think it would have done more good to recruiting had’better pay been given, particularly increased pay for higher qualifications-1s. a day for each extra qualification obtained within the first ten years of service, 2s. for each obtained in the next ten (to encourage officers to go through courses when they are becoming rusty), and 2s. 6d. for any obtained after 20 years. Executive officers who get higher qualifications are paid better-from Is. 6d. to 4s.-as gunnery, torpedo, or navigating officers, although they get their education at the public expense. I am, Sir, yours faithfully, Jan.
10th, 1914.
FLEET-SURGEON, R.N.
THE NATIONAL INSURANCE ACT: THE SURPLUS FUNDS.
The recent
case
of
a
patient’s
death after
a
midwife had sent for several doctors, and the coroner’s remarks at the inquest, is still fresh in our memories, but no one, least of all the midwife,, expects a doctor to do arduous work for nothing. Things have made strides since the days of my training, but it may not be out of place to remark here that on one occasion I sent for ten doctors in succession, with refusals from each one, to come to my assistance for a transverse presentation. Happily I had wisely done this early enough in labour that there was no immediate danger to my patient, and ultimately two women doctors arrived with chloroform. I did not blame the doctors then, nor do I do so now; it was midnight, a blizzard,. and I, a stranger, calling them to the poorest of tenement houses. Only one or two touched upon the fee question; besides which, each one who refused did not know that nine others would do the same ; and I have since known many who rise from their beds to do arduous work without much hope of monetary reward. Reports of the Central Midwives Board penal cases show how many midwives are removed from the roll for failure to send for medical aid. But,. whatever happens afterwards, the Board holds a midwife to be free of blame if, in obedience tothe rules, she has called in a doctor on the first recognition of symptoms for which she is forced to send for medical assistance. A reserve fund for adequate payment of doctors when attending very poor cases would benefit both doctors on the panel and those who are not. It would benefit the midwife,. who would not hesitate to get help early in labour, resulting in easier work for the doctor who comes to her assistance. It would benefit the poorest of patients by relieving them of the anxious worry of another fee to pay, leaving more for nourishment, which, with freedom from worry, might prevent loss of milk, to the benefit of the child. Lastly, it would benefit the State by preserving (who knows) a Prime Minister or a Poet, Laureate, and thereby decreasing the infant. mortality.-I am, Sir, yours faithfully, JANET EWART STCLAIR,
insured
Honorary Secretary, Fulham Association of Midwives.
Irene-road, S.W., Jan. 10th, 1914.
CENTENARIANS.-The death is announced at the village of Newcastleton, Roxburghshire, of Mrs. Helen Kerr in her 104th year.-Mrs. Lambert has recently celebrated her 100th birthday at Edmonton.
ROYAL LONDON OPHTHALMIC HOSPITAL.-The, annual dinner of past and present students will take eighth To the Editor ot THE LANCET. place at the Imperial Restaurant, Regent-street, W., on, Feb. 3rd, at 7.45 for 8 o’clock, Mr. G. A. Berry, SIR,-Reading in THE LANCET of Jan. 10th Mr. E. Tuesday, F. R. C. S. in the chair. Each student is entitled LL.D., Nundy’s letter, and your further comments, on the to introduce twoEdin., Tickets (price 10s. 6d. each,. guests. of distribution unallotted National Insurance funds, exclusive of be had on application to either of wine) may I venture to invite your readers to consider a the honorary secretaries-Mr. Arnold Lawson, 12, Harleysuggestion which I have embodied in a letter to street, W., or Mr. J. Herbert Parsons, 54, Queen Anne--
the Insurance Commissioners. It has struck me street, W. that part, at any rate, of the unallotted fund, after THE SOCIETY OF MEDICAL OFFICERS OF HEALTH: all doctors have been paid what is due to them, SCHOOL MEDICAL SERVICE GROUP.-A general meeting of be well retained as a reserve fund for doctors might the North-Western Branch of this body will be held in the who have promptly gone to a midwife’s assistance, Milton Hall, Manchester, on Saturday, Jan. 24th, when, owing to the poverty of the patient, there is at 2.30 P.M. Deansgate, matters will be considered, such as Important a difficulty about the fee. The weekly wage of the the improvement of the status and remuneration of the. insured person might be taken into consideration, service, consideration of security of tenure in relation to, for those who can afford it are generally found increase of salary, necessity of including public health work to relieve the monotony of medical inspection, and the quite willing to pay. advisability of forming a north-western branch group of the1 main group of the society. THE LANCET, Dec. 6th, 1913, p. 1649.
subject
Q.1YI
Oir
A7niirc
faithfully
R. ACKERLEY.
Llandrindod Wells, Jan. 13th, 1914.
DISLOCATION OF THE PROXIMAL PHALANX OF THE GREAT TOE. To the Editor of THE LANCET.
SIR,—I was called a few days ago to a miner who caught by the trouser pocket by a revolving wheel and swung violently round the room. His injuries consisted of skin scratches in various parts and a dorsal dislocation (easily reduced) of the proximal phalanx of the great toe
had been
foot. At the time of the accident he waa wearing the heavy boots common to miners. The case is interesting in connexion with that mentioned by Dr. Henry Robinson in his letter in your columns last week and your previous I am, Sir, yours faithfully, annotation. GEORGE F. RIGDEN, M.B., B.S. Lond., M.R.C.S., L.R.C.P. on one
Cinderford, Glos., Jan. 10th, 1914.
IMPROVEMENTS IN THE NAVAL MEDICAL SERVICE. To the Fditor of THE
LANCET.
SIR,-The recent alterations and improvements in the Naval Medical Service announced in your Service news have been long asked for.1 I think it would have done more good to recruiting had’better pay been given, particularly increased pay for higher qualifications-1s. a day for each extra qualification obtained within the first ten years of service, 2s. for each obtained in the next ten (to encourage officers to go through courses when they are becoming rusty), and 2s. 6d. for any obtained after 20 years. Executive officers who get higher qualifications are paid better-from Is. 6d. to 4s.-as gunnery, torpedo, or navigating officers, although they get their education at the public expense. I am, Sir, yours faithfully, Jan.
10th, 1914.
FLEET-SURGEON, R.N.
THE NATIONAL INSURANCE ACT: THE SURPLUS FUNDS.
The recent
case
of
a
patient’s
death after
a
midwife had sent for several doctors, and the coroner’s remarks at the inquest, is still fresh in our memories, but no one, least of all the midwife,, expects a doctor to do arduous work for nothing. Things have made strides since the days of my training, but it may not be out of place to remark here that on one occasion I sent for ten doctors in succession, with refusals from each one, to come to my assistance for a transverse presentation. Happily I had wisely done this early enough in labour that there was no immediate danger to my patient, and ultimately two women doctors arrived with chloroform. I did not blame the doctors then, nor do I do so now; it was midnight, a blizzard,. and I, a stranger, calling them to the poorest of tenement houses. Only one or two touched upon the fee question; besides which, each one who refused did not know that nine others would do the same ; and I have since known many who rise from their beds to do arduous work without much hope of monetary reward. Reports of the Central Midwives Board penal cases show how many midwives are removed from the roll for failure to send for medical aid. But,. whatever happens afterwards, the Board holds a midwife to be free of blame if, in obedience tothe rules, she has called in a doctor on the first recognition of symptoms for which she is forced to send for medical assistance. A reserve fund for adequate payment of doctors when attending very poor cases would benefit both doctors on the panel and those who are not. It would benefit the midwife,. who would not hesitate to get help early in labour, resulting in easier work for the doctor who comes to her assistance. It would benefit the poorest of patients by relieving them of the anxious worry of another fee to pay, leaving more for nourishment, which, with freedom from worry, might prevent loss of milk, to the benefit of the child. Lastly, it would benefit the State by preserving (who knows) a Prime Minister or a Poet, Laureate, and thereby decreasing the infant. mortality.-I am, Sir, yours faithfully, JANET EWART STCLAIR,
insured
Honorary Secretary, Fulham Association of Midwives.
Irene-road, S.W., Jan. 10th, 1914.
CENTENARIANS.-The death is announced at the village of Newcastleton, Roxburghshire, of Mrs. Helen Kerr in her 104th year.-Mrs. Lambert has recently celebrated her 100th birthday at Edmonton.
ROYAL LONDON OPHTHALMIC HOSPITAL.-The, annual dinner of past and present students will take eighth To the Editor ot THE LANCET. place at the Imperial Restaurant, Regent-street, W., on, Feb. 3rd, at 7.45 for 8 o’clock, Mr. G. A. Berry, SIR,-Reading in THE LANCET of Jan. 10th Mr. E. Tuesday, F. R. C. S. in the chair. Each student is entitled LL.D., Nundy’s letter, and your further comments, on the to introduce twoEdin., Tickets (price 10s. 6d. each,. guests. of distribution unallotted National Insurance funds, exclusive of be had on application to either of wine) may I venture to invite your readers to consider a the honorary secretaries-Mr. Arnold Lawson, 12, Harleysuggestion which I have embodied in a letter to street, W., or Mr. J. Herbert Parsons, 54, Queen Anne--
the Insurance Commissioners. It has struck me street, W. that part, at any rate, of the unallotted fund, after THE SOCIETY OF MEDICAL OFFICERS OF HEALTH: all doctors have been paid what is due to them, SCHOOL MEDICAL SERVICE GROUP.-A general meeting of be well retained as a reserve fund for doctors might the North-Western Branch of this body will be held in the who have promptly gone to a midwife’s assistance, Milton Hall, Manchester, on Saturday, Jan. 24th, when, owing to the poverty of the patient, there is at 2.30 P.M. Deansgate, matters will be considered, such as Important a difficulty about the fee. The weekly wage of the the improvement of the status and remuneration of the. insured person might be taken into consideration, service, consideration of security of tenure in relation to, for those who can afford it are generally found increase of salary, necessity of including public health work to relieve the monotony of medical inspection, and the quite willing to pay. advisability of forming a north-western branch group of the1 main group of the society. THE LANCET, Dec. 6th, 1913, p. 1649.