LIFE ASSURANCE.—FEES TO MEDICAL PRACTITIONERS.

81 ether, and was for some time greatly embarrassed in procuring suitable apparatus. My first attempts were made with a sponge; next, I used a simple conical glass tube, with a sponge in the larger end; and after that, other instruments, none of which, however, affording but partial success. Up to this time, I had given the ether but once at the Massachusetts General Hospital, which was on the 16th of October, and having another engagement there for the next day, (the 17th,) and my first application being but partially successful, I found that, in the meantime, I must procure some more perfect apparatus. Accordingly, I conversed with Dr. A. A. Gould, a distinguished physician of Boston, (late on the night of the 16th,) as to the best means of rendering my newly discovered agent available, when he rendered me important service in arriving at the valvular system now in use in this country. I had these valves introduced into a glass globe the next morning, before the hour of my engagement at the hospital,-at eleven o’clock,-when the fate of my discovery, for the time being, at least, was to be settled. I had passed a sleepless night. In the morning, before light, I aroused an instrument-maker, and superintended the work; and when a

the hour came, I went almost with a feverish excitement to the hospital. Heretofore, with two or three exceptions, surgeons, physicians, and all, were incredulous; so that, as may be easily seen, my position was a most trying one. But, with my new apparatus, I went before the doctors-gave the ether - when the second capital operation was performed, this time with perfect success. But the result of the experiment of the 17th of October is before the world. And the apparatus thus constructed is still generally in use in this country, although I have since discovered a far more simple and perfect means of administering the vapour; hence the object of this communication. I was never satisfied with any apparatus at all for the purpose of inhalation, there being so much repugnance to it. I was led, therefore, to make further experiments on this subhave resulted in an entire abandonment of my old ject, which inhaler, and the substitution of the sponge. This should be about the size of the open hand, or a little larger, and concave, to suit over the nose and mouth. The sponge is then thoroughly saturated with ether, applied to the nose and mouth, and, with the latter open, the patient directed to inhale as fully and freely as possible. In this way, I have found the result more sure and satisfactory, and the difficulty of inhalation very much reduced, or entirely removed. The most delicate or nervous females, or aged persons, as well as young children, are thus rapidly and almost imperceptibly narcotized, even before they are aware, as in some cases, that the administration has commenced. The beauty and importance of this means is its perfect simplicity. Formerly, many persons could not be induced to persevere ; now I do not find any who cannot inhale the vapour without serious diffi-

Assurance Society, respecting the health, present and past, &c., of Mr. -. In answer, I beg to state, that I never reply to any such questions, unless I receive the usual fee, and I feel surprised that the directors should request me to furnish them with my opinion on a professional subject without offering to make me any remuneration for the same, especially as such nnininn is for their

own

peculiar benefit

T remain Xrf

J. W. TRIPE." In reply to the above, I received a printed answer, which I have enclosed to you. Metropolitan Life Assurance Society, No. 3, Princes-street, Bank, June Sth, 1847. " SIR,—On my return here, after a few days’ absence, I re ceived your letter of the fourth inst., which had remained unopened, and with reference thereto have to request the favour of your attention to the accompanying paper, explanatory of the reasons why this Society declines the payment of fees to the professional referees of parties proposing their "

lives for assurance—I

am

John W. Tripe, Esq., M.D., Commercial-road.

Sir

vrmf

nherlinnt. servant

HENRY

MARSHAL,

Chief Clerk.

"

’Metropolitan Life Assurance Society. ‘° ‘ As some gentlemen of the medical profession have hesi» tated to answer the customary inquiries respecting parties who wish to assure their lives, unless they receive a fee from the office, the directors apprehend there is some misconception as to the nature of the application; they therefore submit to them the following observations. " , This Society has its own medical officers, both in town and country, before one of whom every person desirous of effecting an assurance on his life must personally appear and be examined, and to whom (if in the country) a fee is regu larly paid and charged to the assured; but, in addition to this, a reference is required to the party’s own professional attendant, that a knowledge may be gained of his general state of health, &c.; it will therefore be seen, that it is not so much the office, as the party wishing to assure, that the medical gentleman is, in these cases, requested to oblige; and as such information is commonly required but once in a person’s life, can it be thought an unreasonable demand to make upon the attendant of the family ? professional " , Where, however, a contrary opinion is entertained, it is submitted that the charge should be made, not through the office, but in a direct way; and while the directors do not presume to dictate in the matter, it is their duty to state, that if such information is refused, an obstacle is thrown in the way of effecting the assurance. " By the enclosed prospectus it will be seen that this Society is established upon the mutual principle, which may explain the difference between the practice of this and some other offices, as respects the payment of these medical fees. 1 No. 3, Princes-street, Bank.’ I culty. Believing that this is an important improvement-at least " SIR,—In answer to yours of yesterday, I beg to state, on the means employed in this country-to produce insensithat having carefully perused your printed answer, my opinion to and even without that the bility pain, knowing sponge may not have been long since generally used elsewhere, I venture still remains unchanged, indeed, if anything, is rather to throw out the hint, trusting that it may be of some service strengthened, by the consideration which I have bestowed on subject. to those who cannot readily get an inhaler, should one be the " You state, thata reference is required to the party’s preferred.-I am, respectfully, your obedient servant, professional attendant, that a knowledge may be gained of his W. T. G. G. MORTON. Boston, June 30th, 1847. In regard to this point, I do not general state of health,’ &c. #* It is just to say, that the inhalation, by means of a consider that the assurer is in justice bound to furnish an sponge, had been recommended and practised for some time, opinion which may be adverse to his interests; but I think that the utmost information which he can be expected to in this country, by Dr. Smith, of Cheltenham.-ED. L. afford is an enumeration of the diseases with which he has been afflicted. If, therefore, my patient wrote to me, requestLIFE ASSURANCE.—FEES TO MEDICAL ing to be furnished with a written communication, stating the diseases for which I had attended him, I would most readily PRACTITIONERS. furnish laim with it; but when I receive a document from an To the Editor of THE LANCET. assurance office, in the name of the directors thereof, requestSIR,—In accordance with your request, in THE LANCET of ing my professional opinion on several given points, and this June 26th, I beg to forward a copy of a correspondence opinion to be furnished by me for the especial benefit of the which I have had with the Metropolitan Life Assurance office, I do not think that I should act fairly towards my pawith the hope that your endeavours to remove this, of the many evils with which we are oppressed, will be successful. I remain, obediently yours, Commercial-road, London, July 3, 1847. JOHN W. TRIPE, 1VI.D. During the early part of last June I received a communication from the aforesaid Society, requesting me to furnish the directors with answers to a long list of queries. The following was addressed by me in reply to their secretary :" SIR,—I beg to acknowledge the receipt of a list of inquiries from you, on behalf of the directors of the Metropolitan Life

Society, one

"

tient if I furnished such particulars and charged him for the I must therefore decline answering any queries that same. may be put to me by the office, unless I am paid for such answers by the directors. You also say,’Can it (giving the opinion in question) be thought an unreasonable demand to make upon the professional attendant of the family’?’ What the precise meaning of this paragraph may be, I do not understand; but if it is intended to assert that a medical practitioner shall be called on to give an opinion gratuitously, on points which require a good knowledge of his profession, and that such a demand is

82

unreasonable, I must beg, on behalf- of the medical profession, to repudiate such a supposition, and to state that we are as fully entitled to be paid for an opinion as an attorney; and who, I ask, would apply to him with the expectation of receiving it gratuitously ? I have always been told, that the value of a thing is the amount which it will produce, and I must therefore protest against an insinuation, that a medical practitioner’s opinion is worth nothing. " In conclusion, I beg of you most distinctly to understand, that I do not consider that my patient ought to supply answerss to queries such as those which you have sent to me, and therefore if he offered to pay me the sum which I require, I would not answer them, and will do so only on receiving payment from the Company, inasmuch as the opinion is required not

for the especial benefit of such Comnanv.-I remain. &c.

J. W.

TRIPE, M.D.

my

After this correspondence patient made me an offer of the fee, requesting that I would fill up the certificate. This, from conscientious motives, I declined, but gave him a statement of the diseases for which I had attended him, and which I believe was sufficient to satisfy the directors.

Sutherland, and Shearman, if they will continue to insult the understanding and the sense of justice of their medical brethren, by such an N.B. as the above, which I can only designate as a dishonest evasion. Let me thank you for opening the columns of THE LANCET for the discussion of this question, and also express a hope that medical men will supply you from week to week with their experiences and opinions upon this topic. I am, Sir, your obedient servant,

R.

P.S.-Let medical men observe the covert and foolish attempt of this office to array practitioners of the country against those of London. The" N.B." is written as though only a few of those " in the country" claimed their just dues, and would imply that in town, medical men were quite easy and dupeable by the life offices, than which nothing can be more untrue.

ASSISTANT-SURGEONS IN THE ROYAL NAVY. 3’0 the Editor of THE LANCET.

SIR,—Ilately returned from Canada, on leave of absence, one of her Majesty’s ships. I messed, of course, with the lieutenants, surgeon, paymaster, &c., in what is called the ward-room. Having remarked the absence of the assistantsurgeon at the mess-table, I was not a little surprised to learn in

THE

CLERICAL, MEDICAL, AND GENERAL

LIFE

ASSURANCE SOCIETY.

SIR,—It might have been expected that the payment of medical men, for the answers necessary to life insurance, - would have commenced, not with such offices as the Professional, the Legal and General, and others, where many of the directors are lawyers, but with such offices as the Clerical, Medical, and General, where many medical men are on the board of directors. Surely if such men as Mr. C. Buller, Q.C., Mr. Samuel Martin, Q.C., Mr. Montague Chambers, Q.C., Mr. Anderdon, Q.C., and Mr. Cockburn, Q.C., think medical men ought to be paid for the information they give to life offices, we might have expected the same liberality from Dr. Blackall, Dr. Moore, Dr. Dunlap, Dr. Hue, Dr. Merriman, Dr. Sutherland, and Dr. Shearman; and Mr. Babington, Sir Benjamin Brodie, and Mr. Samuel Cooper; all of whom are office-bearers in the Clerical, Medical, and General Life Assurance Society. I observe, indeed, that a majority of the directors in this office are medical men. We lately saw a

that assistant-surgeons in the navy are not allowed to sit with the other commissioned officers, but are. in every instance, compelled to mess and associate with the non-commissioned

officers, paymasters, clerks, &c. I then inquired, Were they properly-qualified medical men ? and was told that they all have obtained, before entering the service, as high qualifications as any class of practitioners in the empire. Such being the case, I am astonished that any gentleman should demean himself so much as to enter or remain in a service where he is treated in such a degrading and heartless manner; and I do think, that naval assistant-

surgeons may thank themselves for their present very humiliating position; their slavish submission to such heartless tyranny is the sole cause of its continuance. Let them shake offtheir criminal apathy: let them assert their rights; let them demand justice; and their military brethren will make a common cause with them. Nor will the civil prac titioners of the empire be wanting in their duty. A unanimous very flourishing account of the affairs of this Society in an appeal of this kind to the legislature, will be irresistible; advertisement in THE LANCET, so that there can be no plea of the effort has only to be made, and success will inevitably poverty. The shares in this office, upon which 2l. 10s. have crown it. Naval assistant-surgeons ! just look at your humiliating been paid, are quoted as high as 22l.; yet they never pay a medical man for his opinion. Surely an office so prosperous, position. You are denied cabins, servants, and all the common and whose directors must know how much depends on the comforts allowed to the other commissioned officers; you are those who are answers of medical men, might be more just. They escape expelled fromintheir society, and thrustamong come forward maninferiors then, Do, to the hand every respect. the to your payment by adding following paper they the proposer :fully ; be temperate, but firm; no compromise. Remember, " N.B.—In every proposal that is made to the omce, it is the eyes of the profession are upon you, and it " expects that man will do his duty." required that the proposer do furnish the directors, at his every Insertion of these remarks will much oblige own expense, with evidence of the life proposed being eligible A MILITARY SURGEON. July, 1847. for assurance. This notification becomes necessary, since several medical practitioners in the country have declined answering the queries sent to them by the office until a fee DR. RAMADGE AND THE COLLEGE OF has been paid to them; and in order to prevent delay and disPHYSICIANS. appointment to the proposer, it is recommended that he do in the first instance arrange this matter of charge withthe To the Editor of THE LANCET. " medical referee.’ This is equivalent to a refusal of all payment whatever; SIR, —In your summary of "Medical News" of the past for as the directors require the medical report to be sent to week, an announcement appears that, in the election of a them privately through the post, and refuse the assurance, or Fellow of the College of Physicians to deliver this year’s require an additional premium if the proposer be not in per- Harveian Oration, " Dr. Ramadge, of Ely-place, was passed fect health, the information is so clearly for the safety and over, under the plea that he had infringed the by-laws of the profit of the office, that few assurers would think it just to* College;" with which statement is coupled an insinuation, pay the medical man for an opinion which might have been that that physician has, in some manner, qualified himself to adverse to his own interests. I hold that so is the march, en pair, with the "mesmeric orator" of last year. I office the party benefited, that a medical man cannot honestly believe, from your known sense of justice and love of fair take a fee from his patient for privately answering the queries play, that you will allow me, as a friend of Dr. Ramadge, of a life office-it may be, to his great detriment and to their a small share of your space, to explain in what way he is supposed to have infringed a by-law; and to protest gain. I have seen it argued, that it is not the office, but the against the ill-natured insinuation thrown out. It would be assured, who benefits by the life insurance; and that therefore easy for me to show to what extent Dr. Ramadge has been a the office ought not to pay medical fees. How comes it, then, fellow-labourer with yourself in the cause of medical reform, I would ask, that the offices are glad to pay legal men five and that, too, at a period when reform of every kind was someper cent. per annum upon all premiums they bring to these what more unfashionable than it is at this time. offices ? The services are as important in the one case as the I could point out that Dr. Ramadge was the first to advocate the necessity of throwing open theHunterian Museum, on other; but the paid are lawyers, the unpaid, medical men! I would, in conclusion, ask Messrs. Moore, Babington, a more liberal scale, to all ranks of the profession ; that he Blackall, Brodie, Cooper, Dunlap, Green, Hue, Merriman, was indirectly instrumental in the detection of murders, for

obviously