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MEDICAL CERTIFICATES IN RESPECT OF SCHOOL ATTENDANCE.
50
CERTIFICATION UNDER THE LUNACY ACTS. To the Editors of THE LANCET. SIRS,-I should be much obliged if you would kindly inform me whether, in the event of a club patient having to be sent as a pauper to an asylum, it is usual for the relieving officer to obtain the lunacy certificate from (a) the Poor-law medical officer or from (b) the medical man in I am, Sirs, yours faithfully, attendance. A. B. C. June 15th, 1905. To determine the exact procedure required in order to insane person who, by reason of his mental infirmity, get has become chargeable to his parish or union into an asylum is a perennial source of trouble to medical men. This is a natural consequence of that difficulty in interpreting the provisions of the Lunacy Acts which results from the ambiguity of the language of those statutes. We have frequently had occasion to deal with this topic, but the above letter shows that there are still rough places Our correspondent asks whether, to be made smooth. in the event of a club patient having to be sent as a pauper to an asylum, it is usual for the relieving officer to obtain the necessary medical certificate from the Poor-law medical officer or from the medical man in attendance. The question indicates some misapprehension of the relieving officer’s position. It is not the business of this officer to obtain a certificate at all. His duty under the Act of 1890, as lai 1 down in Section 14, subsection (2), consists in giving notice to a justice having jurisdiction that there is an alleged lunatic to be dealt with. Section 16 directs the justice to call in a medical practitioner and no restriction is placed upon the choice which the justice may make except that Section 32 prohibits the employment of an interested person. It is, however, quite a common thing for boards of guardians to arrogate to themselves the selection of a medical man. Acting through their relieving officer they require their own medical officer to certify and make the fees which they have to pay for the certificates a part, and sometimes a considerable part, of his salary. Justices often, it would appear, through of the extent of their own powers, acquiesce in ignorance the arrangement. There is no doubt that this course is productive of much annoyance to the general practitioner, especially in the case of club patients, who are not ordinarily sources of much profit to their medical attendants, but it must be remembered that the Poor-law medical officer has also some right to be considered and that any departure from the customary routine which a justice might see fit to make would involve an already badly paid official in pecuniary loss for which the Lunacy Acts provide no compensation. - end. L.
**
an
MEDICAL CERTIFICATES IN RESPECT OF SCHOOL ATTENDANCE. 2b
the Editors of THE LANCET. education committee of the Surrey county SIRS,-The council last year introduced tentatively a scheme for the certification of absentee school children by the medical officers of health of a few of the Surrey districts. A fee of 5s. was paid for a visit to the home of the child. Although in some of the districts this might involve a journey of eight miles some of the members of the committee considered the fee excessive and the scheme was abandoned. The school attendance committee of the petty sessional division of Guildford then approached some of the medical men practising in one part of its district with a view to their examining children at their surgeries and giving the necessary certificate for a fee of ls., or visiting the children at their homes for a fee of 2s. The offer was accepted by two practitioners, although the district in question comprises some 21 square miles !The commendable action of the Sevenoaks division of the British Medical
Association mentioned by Dr. 0. D. Marriott in THE LAKCET of June 24th might with advantage be extended to this district. I am, Sirs, yours faithfully, X.
THE HOUSE OF LORDS COMMITTEE ON THE SANDGATE "SANATORIUMS" NUISANCE. (BY
OUR
SPECIAL SANITARY
COMMISSIONER,
THE minutes of proceedings taken before the Select Committee of the House of Lords on the Sandgate Urban District Council (Sanitary Powers) Bill go far to confirm what has been said in these columns concerning the pretended out-door treatment of patients suffering from tuberculosis at the homes of the late Mr. J. J. Jones of Sandgate. The more sensational features of the case were, it is true, somewhat toned down. The fact that the author of the whole grievance is dead and that his successors seem to have endeavoured to effect improvements suffices to explain the There was a very natural more considerate attitude adopted. desire to avoid as far as possible hurting the feelings of the youthful and comparatively irresponsible successor to the management. Much trouble has recently befallen the family. The late Mr. J. J. Jones had somehow succeeded in gaining possession of 19 properties at Sandgate and some 30 houses. The son who helped him to manage this property died suddenly and in dramatic circumstances. Shortly afterwards Mr. J. J. Jones fell ill and died in March, 1904. Another son, Mr. P. H. Jones, had been sent directly from school to Paris and had been in business there for seven years. Suddenly he was called upon to give up his Paris business and to take in hand the management of the homes and properties at Sandgate. This Mr. Jones, though only 26 years old, seems to have acquired some business capacity as an administrator, but he could not have any technical knowledge as to sanatoriums or any personal knowledge of the Sandgate business. He does seem, however, to have realised that this business was not carried on in a very correct manner. Notably, he felt that the medical control was not sufficient and also that it was folly to pretend that the treatment was similar to that given at Nordrach, Davos, and Leysin. He consequently destroyed 10,000 circulars which made this assertion and which his father had printed. In these circumstances there was a general desire to deal gently with Mr. Jones, jun. Nevertheless, the main principles at issue remain- unaltered and attempted reforms made to-day are no guarantee for the future. Such reforms may be due to an honourable desire to remove grievances or merely to fear engendered by the actual and very general outcry. In either case a change of management or a change of disposition may produce other alterations and there is nothing to prevent matters from becoming as bad as, or worse than, they were in the
past. As
example of such instability the late Mr. J. J. Jones me on July 21st, 1903, giving a list of five houses containing 126 beds which, he stated, were "used strictly and exclusively for phthisical patients." He also mentioned an
wrote to
three other houses with 80 beds for children and convalescents from infirmaries. That these figures might be altered and probably increased is shown by the fact that Mr. Jones further remarks in this letter that " the numbers stated are as accurate as we can give you at the present time," and adds : " We calculate we can receive after the end of this week when the transfers have been made and the enlarged accommodation in use, about 23 more patients." Thus it seems as if the late Mr. Jones contemplated receiving 149 tuberculous patients. At that time apparently it was the policy to exaggerate rather than to minimise the number of cases of tuberculosis taken into the homes at Sandgate. The late Mr. Jones even succeeded in convincing the medical officer of health, Dr. C. E. Perry, that he had received in his homes during the year 1903 no less than 880 tuberculous patients. Now Mr. Jones, jun., appears before the House of Lords Committee and states that there are only 116 beds available for tuberculous cases and that he has looked through his father’s books and can only find trace of 518 tuberculous patients as having been received in the homes
CERTIFICATION UNDER THE LUNACY ACTS. To the Editors of THE LANCET. SIRS,-I should be much obliged if you would kindly inform me whether, in the event of a club patient having to be sent as a pauper to an asylum, it is usual for the relieving officer to obtain the lunacy certificate from (a) the Poor-law medical officer or from (b) the medical man in I am, Sirs, yours faithfully, attendance. A. B. C. June 15th, 1905. To determine the exact procedure required in order to insane person who, by reason of his mental infirmity, get has become chargeable to his parish or union into an asylum is a perennial source of trouble to medical men. This is a natural consequence of that difficulty in interpreting the provisions of the Lunacy Acts which results from the ambiguity of the language of those statutes. We have frequently had occasion to deal with this topic, but the above letter shows that there are still rough places Our correspondent asks whether, to be made smooth. in the event of a club patient having to be sent as a pauper to an asylum, it is usual for the relieving officer to obtain the necessary medical certificate from the Poor-law medical officer or from the medical man in attendance. The question indicates some misapprehension of the relieving officer’s position. It is not the business of this officer to obtain a certificate at all. His duty under the Act of 1890, as lai 1 down in Section 14, subsection (2), consists in giving notice to a justice having jurisdiction that there is an alleged lunatic to be dealt with. Section 16 directs the justice to call in a medical practitioner and no restriction is placed upon the choice which the justice may make except that Section 32 prohibits the employment of an interested person. It is, however, quite a common thing for boards of guardians to arrogate to themselves the selection of a medical man. Acting through their relieving officer they require their own medical officer to certify and make the fees which they have to pay for the certificates a part, and sometimes a considerable part, of his salary. Justices often, it would appear, through of the extent of their own powers, acquiesce in ignorance the arrangement. There is no doubt that this course is productive of much annoyance to the general practitioner, especially in the case of club patients, who are not ordinarily sources of much profit to their medical attendants, but it must be remembered that the Poor-law medical officer has also some right to be considered and that any departure from the customary routine which a justice might see fit to make would involve an already badly paid official in pecuniary loss for which the Lunacy Acts provide no compensation. - end. L.
**
an
MEDICAL CERTIFICATES IN RESPECT OF SCHOOL ATTENDANCE. 2b
the Editors of THE LANCET. education committee of the Surrey county SIRS,-The council last year introduced tentatively a scheme for the certification of absentee school children by the medical officers of health of a few of the Surrey districts. A fee of 5s. was paid for a visit to the home of the child. Although in some of the districts this might involve a journey of eight miles some of the members of the committee considered the fee excessive and the scheme was abandoned. The school attendance committee of the petty sessional division of Guildford then approached some of the medical men practising in one part of its district with a view to their examining children at their surgeries and giving the necessary certificate for a fee of ls., or visiting the children at their homes for a fee of 2s. The offer was accepted by two practitioners, although the district in question comprises some 21 square miles !The commendable action of the Sevenoaks division of the British Medical
Association mentioned by Dr. 0. D. Marriott in THE LAKCET of June 24th might with advantage be extended to this district. I am, Sirs, yours faithfully, X.
THE HOUSE OF LORDS COMMITTEE ON THE SANDGATE "SANATORIUMS" NUISANCE. (BY
OUR
SPECIAL SANITARY
COMMISSIONER,
THE minutes of proceedings taken before the Select Committee of the House of Lords on the Sandgate Urban District Council (Sanitary Powers) Bill go far to confirm what has been said in these columns concerning the pretended out-door treatment of patients suffering from tuberculosis at the homes of the late Mr. J. J. Jones of Sandgate. The more sensational features of the case were, it is true, somewhat toned down. The fact that the author of the whole grievance is dead and that his successors seem to have endeavoured to effect improvements suffices to explain the There was a very natural more considerate attitude adopted. desire to avoid as far as possible hurting the feelings of the youthful and comparatively irresponsible successor to the management. Much trouble has recently befallen the family. The late Mr. J. J. Jones had somehow succeeded in gaining possession of 19 properties at Sandgate and some 30 houses. The son who helped him to manage this property died suddenly and in dramatic circumstances. Shortly afterwards Mr. J. J. Jones fell ill and died in March, 1904. Another son, Mr. P. H. Jones, had been sent directly from school to Paris and had been in business there for seven years. Suddenly he was called upon to give up his Paris business and to take in hand the management of the homes and properties at Sandgate. This Mr. Jones, though only 26 years old, seems to have acquired some business capacity as an administrator, but he could not have any technical knowledge as to sanatoriums or any personal knowledge of the Sandgate business. He does seem, however, to have realised that this business was not carried on in a very correct manner. Notably, he felt that the medical control was not sufficient and also that it was folly to pretend that the treatment was similar to that given at Nordrach, Davos, and Leysin. He consequently destroyed 10,000 circulars which made this assertion and which his father had printed. In these circumstances there was a general desire to deal gently with Mr. Jones, jun. Nevertheless, the main principles at issue remain- unaltered and attempted reforms made to-day are no guarantee for the future. Such reforms may be due to an honourable desire to remove grievances or merely to fear engendered by the actual and very general outcry. In either case a change of management or a change of disposition may produce other alterations and there is nothing to prevent matters from becoming as bad as, or worse than, they were in the
past. As
example of such instability the late Mr. J. J. Jones me on July 21st, 1903, giving a list of five houses containing 126 beds which, he stated, were "used strictly and exclusively for phthisical patients." He also mentioned an
wrote to
three other houses with 80 beds for children and convalescents from infirmaries. That these figures might be altered and probably increased is shown by the fact that Mr. Jones further remarks in this letter that " the numbers stated are as accurate as we can give you at the present time," and adds : " We calculate we can receive after the end of this week when the transfers have been made and the enlarged accommodation in use, about 23 more patients." Thus it seems as if the late Mr. Jones contemplated receiving 149 tuberculous patients. At that time apparently it was the policy to exaggerate rather than to minimise the number of cases of tuberculosis taken into the homes at Sandgate. The late Mr. Jones even succeeded in convincing the medical officer of health, Dr. C. E. Perry, that he had received in his homes during the year 1903 no less than 880 tuberculous patients. Now Mr. Jones, jun., appears before the House of Lords Committee and states that there are only 116 beds available for tuberculous cases and that he has looked through his father’s books and can only find trace of 518 tuberculous patients as having been received in the homes