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FEES FOR THE CERTIFICATION OF LUNATICS.
FEES FOR THE CERTIFICATION OF LUNATICS.
865
questions of medical interest; but it is difficult with These are some of the circumstances under which we think And the fee of one guinea to be thoroughly well earned. There a politician without being a party politician. do not enter an arena this where men medical feeling they is, however, another aspect of the question before us. The serve their while often generation well, upholding the guardians, knowing from past experience the average number might of lunacy fees to be paid in the year, have in many of their order. prestige instances fixed the salary of the medical officers at a,
many us
to be
-
SIR JAMES PAGET’S MEMOIRS. A GLANCE at the " Memoirs and Letters of Sir James Paget," published this week by Messrs. Longmans, Green, and Co., has enabled us to see how fascinating a book Mr. Stephen Paget has compiled in his father’s memory. Though dealing with a long life and one of more importance than some to which greater volumes are dedicated, the book is not a massive one. It contains some charming portraits and other illustrations, and is divided into two portions, the first containing the whole of the memoirs left by Sir James Paget and the second giving an account of his later life. The volume is one that many medical men will be eager to possess, the reasons for which opinion we shall give
after further
perusal.
--
FEES FOR THE CERTIFICATION OF LUNATICS. AT a recent meeting of the Southwark Guardians, held at the offices, John-street West, Blackfriars-road, the Finance and General Purposes Committee reported that they had had under their consideration the question of the amount of the fees paid to their medical officers for the certification of lunatics. They recommended the board to approach the various justices of the peace who were in the habit of dealing with the lunatics of the union with a request that they should direct a fee of 10s. 6d. instead of 21s. to be paid to the medical officers of the union in future, as that sum seemed, in the opinion of the committee, to be a reasonable amount for the services rendered, having regard to the fact that the medical officers were paid officials of the Mr. T. Cooksey, the chairman, congratulated union. the committee upon endeavouring to cut down expenses in view of the great increase in the board’s expenditure-and the recommendation was adopted. Guardians have looked upon the fees paid to their medical officers for the certification of lunatics with much disfavour. They have an objection to the system under which the payments are made, for they have no legal control over the amounts paid. By Section 285 of the Lunacy Act, 1890, the justice orders the payment by the guardians of what he considers to be areasonable remuneration " for the examination and certification of a lunatic. Many guardians have expressed their opinion that a guinea is a large fee for merely, as they think, writing a statement that A. B. is a lunatic. They have no idea of the mental and physical labour involved in the daily record of the patient’s symptoms ; in the accurate descriptions in the case-book of every little bruise, scar, and abrasion which the patient had on his body when admitted; and in the careful examination of the whole person and notification of every abnormal appearance which are required on the day the patient is removed to asylum. The guardians have little regard for the mental strain which is undergone by the medical officer when he is dealing with the numerous ’’border-line"" cases sent into the wards. In these he writes his certificate with a sword of Damocles over his head. The least error or mis-statement may make his certificate quite invalid, may bring him into difficulty with the Commissioners in Lunacy, may make him guilty of a misdemeanour, or may render him liable to heavy pecuniary damages. If, on the othei hand, he refuses to certify on the ground of insufficient evidence, and the patient is discharged, there is the not by any means uncommon result of a suicide o] a homicide, with more trouble for the medical officer.
nominal sum for the work to be done. They have stated that they considered the fees would bring the remuneration to an adequate amount. It would not be difficult to name a large metropolitan workhouse containing about 1600 people where the medical officer receives a salary of only ;&50 a year. The guardians are quite aware that the are the real salary and that without them fees lunacy no medical officer would hold the post for the sum they have fixed. Bearing the fact in mind that a similar method of utilising the lunacy fees obtains. at many large workhouses, let us ask the question whether the action of the guardians in requesting thejustices to award diminished fees is not a departure from. fair and straightforward dealing ? It is not likely, however, that the justices will be influenced. They will not readily surrender any of the power they hold under the provisions of the Lunacy Act. mere
-
THE
DIAGNOSIS
OF ADDISON’S
DISEASE WHEN
PIGMENTATION IS ABSENT. IN exceptional cases of Addison’s disease the characteristia. pigmentation is absent. In ordinary cases the pigmentation can be locally intensified by irritation, such as the application of a blister. This fact might have suggested thepossibility of producing pigmentation by irritation in cases in which it is entirely absent, but such an experiment does not appear to have occurred to anyone. At the meeting of the Societe Medicale des H6pitaux of Paris on July 19th M. L. Jacquet and M. Tremolieres related two cases in which pigmentation was thus produced accidentally. In the first, a case of spinal caries, the application of poultices produced pigmentation of the abdomen and the necropsy revealed tuberculosis of the suprarenal capsules. In the second case thepatient was a man, aged 31 years, who was admitted to the Saint Louis Hospital on Feb. 28th, 1901. He was very He suffered from feeble and "wasted to a skeleton." acute and incessant abdominal pains, especially in the right iliac fossa. They were increased by movements and by light pressure, relieved by deep pressure, and became recrudescent about two hours after meals. After paroxysms of pain vomiting supervened. Slight pigmentation had recently appeared in the fronto-temporal regions and there were one pigmented spot on the upper lip. and another on the lower lip. At the apex of the left lung was a cavity and at the base friction sounds were heard. Fulness was felt in the epigastrium. To relieve the pains. linseed-meal poultices with a little mustard and compresses of camphorated alcohol were alternately applied to the About a fortnight afterwards marked brown abdomen. pigmentation of the abdomen was noticed. The pigmentation extended beyond the limits of application of the poultices. The hairs were not hyper-pigmented. On July 18th the pigmentation was still present and of the same intensity, though no applications had been made to the abdomen since April. The poultices and compresses were applied to the anterior surface of the right thigh. A rosy and transitory discolouration was first produced. In some days it became red and permanent. In less than three weeks pigmentation similar to that of the abdomen was produced. Linseed-meal poultices (without mustard) were applied daily for two hours to the left shoulder, beginning on June 12th. After the removal of the poultice a rosy tint remained which progressively became more and more intense and persisted
865
questions of medical interest; but it is difficult with These are some of the circumstances under which we think And the fee of one guinea to be thoroughly well earned. There a politician without being a party politician. do not enter an arena this where men medical feeling they is, however, another aspect of the question before us. The serve their while often generation well, upholding the guardians, knowing from past experience the average number might of lunacy fees to be paid in the year, have in many of their order. prestige instances fixed the salary of the medical officers at a,
many us
to be
-
SIR JAMES PAGET’S MEMOIRS. A GLANCE at the " Memoirs and Letters of Sir James Paget," published this week by Messrs. Longmans, Green, and Co., has enabled us to see how fascinating a book Mr. Stephen Paget has compiled in his father’s memory. Though dealing with a long life and one of more importance than some to which greater volumes are dedicated, the book is not a massive one. It contains some charming portraits and other illustrations, and is divided into two portions, the first containing the whole of the memoirs left by Sir James Paget and the second giving an account of his later life. The volume is one that many medical men will be eager to possess, the reasons for which opinion we shall give
after further
perusal.
--
FEES FOR THE CERTIFICATION OF LUNATICS. AT a recent meeting of the Southwark Guardians, held at the offices, John-street West, Blackfriars-road, the Finance and General Purposes Committee reported that they had had under their consideration the question of the amount of the fees paid to their medical officers for the certification of lunatics. They recommended the board to approach the various justices of the peace who were in the habit of dealing with the lunatics of the union with a request that they should direct a fee of 10s. 6d. instead of 21s. to be paid to the medical officers of the union in future, as that sum seemed, in the opinion of the committee, to be a reasonable amount for the services rendered, having regard to the fact that the medical officers were paid officials of the Mr. T. Cooksey, the chairman, congratulated union. the committee upon endeavouring to cut down expenses in view of the great increase in the board’s expenditure-and the recommendation was adopted. Guardians have looked upon the fees paid to their medical officers for the certification of lunatics with much disfavour. They have an objection to the system under which the payments are made, for they have no legal control over the amounts paid. By Section 285 of the Lunacy Act, 1890, the justice orders the payment by the guardians of what he considers to be areasonable remuneration " for the examination and certification of a lunatic. Many guardians have expressed their opinion that a guinea is a large fee for merely, as they think, writing a statement that A. B. is a lunatic. They have no idea of the mental and physical labour involved in the daily record of the patient’s symptoms ; in the accurate descriptions in the case-book of every little bruise, scar, and abrasion which the patient had on his body when admitted; and in the careful examination of the whole person and notification of every abnormal appearance which are required on the day the patient is removed to asylum. The guardians have little regard for the mental strain which is undergone by the medical officer when he is dealing with the numerous ’’border-line"" cases sent into the wards. In these he writes his certificate with a sword of Damocles over his head. The least error or mis-statement may make his certificate quite invalid, may bring him into difficulty with the Commissioners in Lunacy, may make him guilty of a misdemeanour, or may render him liable to heavy pecuniary damages. If, on the othei hand, he refuses to certify on the ground of insufficient evidence, and the patient is discharged, there is the not by any means uncommon result of a suicide o] a homicide, with more trouble for the medical officer.
nominal sum for the work to be done. They have stated that they considered the fees would bring the remuneration to an adequate amount. It would not be difficult to name a large metropolitan workhouse containing about 1600 people where the medical officer receives a salary of only ;&50 a year. The guardians are quite aware that the are the real salary and that without them fees lunacy no medical officer would hold the post for the sum they have fixed. Bearing the fact in mind that a similar method of utilising the lunacy fees obtains. at many large workhouses, let us ask the question whether the action of the guardians in requesting thejustices to award diminished fees is not a departure from. fair and straightforward dealing ? It is not likely, however, that the justices will be influenced. They will not readily surrender any of the power they hold under the provisions of the Lunacy Act. mere
-
THE
DIAGNOSIS
OF ADDISON’S
DISEASE WHEN
PIGMENTATION IS ABSENT. IN exceptional cases of Addison’s disease the characteristia. pigmentation is absent. In ordinary cases the pigmentation can be locally intensified by irritation, such as the application of a blister. This fact might have suggested thepossibility of producing pigmentation by irritation in cases in which it is entirely absent, but such an experiment does not appear to have occurred to anyone. At the meeting of the Societe Medicale des H6pitaux of Paris on July 19th M. L. Jacquet and M. Tremolieres related two cases in which pigmentation was thus produced accidentally. In the first, a case of spinal caries, the application of poultices produced pigmentation of the abdomen and the necropsy revealed tuberculosis of the suprarenal capsules. In the second case thepatient was a man, aged 31 years, who was admitted to the Saint Louis Hospital on Feb. 28th, 1901. He was very He suffered from feeble and "wasted to a skeleton." acute and incessant abdominal pains, especially in the right iliac fossa. They were increased by movements and by light pressure, relieved by deep pressure, and became recrudescent about two hours after meals. After paroxysms of pain vomiting supervened. Slight pigmentation had recently appeared in the fronto-temporal regions and there were one pigmented spot on the upper lip. and another on the lower lip. At the apex of the left lung was a cavity and at the base friction sounds were heard. Fulness was felt in the epigastrium. To relieve the pains. linseed-meal poultices with a little mustard and compresses of camphorated alcohol were alternately applied to the About a fortnight afterwards marked brown abdomen. pigmentation of the abdomen was noticed. The pigmentation extended beyond the limits of application of the poultices. The hairs were not hyper-pigmented. On July 18th the pigmentation was still present and of the same intensity, though no applications had been made to the abdomen since April. The poultices and compresses were applied to the anterior surface of the right thigh. A rosy and transitory discolouration was first produced. In some days it became red and permanent. In less than three weeks pigmentation similar to that of the abdomen was produced. Linseed-meal poultices (without mustard) were applied daily for two hours to the left shoulder, beginning on June 12th. After the removal of the poultice a rosy tint remained which progressively became more and more intense and persisted