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Medical Men and Workmen's Compensation.
1305 monoxide, the result of chloroform cquantity which enters the tissues of the central nervous decomposition, may appear in 1000 grammes of blood duringIsystem. Obviously, therefore, to any two individuals A I B the same amount of the drug might be offered profound chloroform narcosis. Certainly, the experiments ofand i the more recent observers seem to prove that none of thefor inhalation, the same amount might be inhaled, the I amount might be present in the blood, and yet the haemoglobin of a chloroformed animal is in the state of CO-same a 4 Yet the of the itself is colour blood central nervous system of A might have enough chloroform good haemoglobin. 1 guide to the degree of anaesthesia in a chloroformed animal.to produce anaesthesia, while that of B might be only i to the degree of arousing some slight excitement. It appears that in the case of dogs chloroform enters theaffected
centimetres of carbon
is the case with cats. TheAnother highly important conclusion which tallies with latter were chosen for the present investigation because their clinical experience is the statement that the amount of behaviour towards anaesthetics is more comparable with that chloroform in the blood which produces anaesthesia varies of the human subject. Whatever be the exact character of with the rate of induction of anaesthesia. This is to say, the association between the chloroform in an anaesthetised that roughly speaking the more gradually the patient is animal and the corpuscles of the animal’s blood one fact anaesthetised with chloroform the less of the drug will he about it is certain-namely, the firmness of the association. have to inhale from first to last. This fact is one of the There is no smell of chloroform to be detected in samples chief arguments in support of those chloroform-regulating of such blood, and if samples are allowed to stand forms of apparatus by which it is possible to give exfor a night they suffer no diminution in chlorine, show- tremely low percentages of chloroform vapour and to control ing presumably no diminution in the chloroform which the the percentage inhaled throughout the whole course of the blood holds. Another feature of the relation of chloroform narcosis. Yet it is important that the administrator should to the blood of an animal which is killed by the anaesthetic bear in mind the conclusions which show with what minute is its bearing upon medico-legal inquiries. This is the great quantities of chloroform anassthesia may be maintained, and diminution of chloroform in the blood that is observed for this reason we have drawn attention to the point. The shortly before death. The explanation preferred for this methods described in these researches for the estimation of phenomenon is that an abnormal quantity is at this time to chloroform in the blood are novel and practically free from be found in the tissues themselves, particularly the tissues error. They would appear to be capable of giving more of the nervous system. In animals which are anaesthetised trustworthy results than those employed previously by but not killed by chloroform the amount of the drug which SCHMIEDEBERG and POHL and to supply figures more enters the central nervous system may equal, but never accurate than those recently obtained by French observers. exceeds, and is generally much less than, the amount in the Dr. BUCKMASTER and Mr. GARDNER refer to experiments to be described in the future bearing upon the production of blood. From the clinical point of view we may notice in these anaesthesia under varying conditions, and we hope to revert physiological observations one or two points which are later to their valuable and suggestive investigations.
plasma rather more readily than
,
harmony with our preconceived notions. There are necessarily differences between the conditions which obtain in the physiological laboratory and the operating theatre, and a recognition of this fact explains apparent discrepancies between physiological experiments and clinical observation.
in
In the
one case
the
Medical
this is
impossible-at least,
Compensation.
in
manner in which the Workmen’s affect medical practitioners. would Compensation Act, 1906, As all our readers know, the Act at present in force, a piece of legislation dating from but nine years ago, contains a number of conditions which have proved fruitful sources of litigation. The " workman " to be assisted by the moribund Act is limited by definition and the circumstances in which he can claim compensation are detailed and particular, but by the Act which will come into force on July lst next all these conditions and limitations will be swept away. Under Clause 13 of this Act the " workman " is defined in the following words :-
columns to the
That the conclusions arrived at by experiwholly true when applied to clinical ends there
cases.
ment are
be no doubt, and they further lead the clinician modify his methods in such ways as will enable him to produce results parallel with those obtained in the laboratory. It is from this point of view that the work of such investigators as Dr. BUCKMASTER and Mr. GARDNER stands out as of conspicuous value to the practitioner of medicine. To take an example. In the ordinary methods can
to
of inhalation as conducted in the clinical theatre there is a much greater chance of mechanical obstruction to breath-
ing
than when the chloroform is aspirated directly through tracheal tube, as in the case of the physiological experiment. Again, the so-called 6°idiosyncrasy"which has been assumed to exist in certain persons with regard to anaesthetics becomes intelligible if the physiologist’s conclusion is correct that there is no absolute relation between the proportion of chloroform in the blood and the effects of the drug upon the entire organism, for these are determined not by the amount of chloroform present in the circulation but by the
Men and Workmen’s
SOME six months ago Mr. ALBERT BENTHALL, who has given much attention to the medical questions connected with the various forms of insurance, called attention in our
almost absolute control can be obtained over circumstances of the administration of the
environing anaesthetic; in the other many
.
a
I
pronounced
" Workman’does not include any person employed otherwise than by way of manual labour whose remuneration exceeds E250 a year, or a person whose employment is of a casual nature and who is employed otherwise than for the purposes of the employer’s trade or business, or a member of a police force, or an outworker, or a member of the employer’s family dwelling in his house, but, save as aforesaid, means any person who has entered into or works under a contract of service or apprenticeship with an employer, whether by way of manual labour, clerical work, or otherwise, and whether the contract is expressed or implied, is oral or in writing."
1306
pensation, the legal liability being for a sum equal to threee years’ wages, or .f.150, whichever of these sums is larger,, providing that the payment does not exceed 300. But thee death of an employee is not_so much to be feared as his orr her disablement from accident, for here a weekly paymentt during the continuance of the disablement will have to bee paid, which might conceivably mean an annuity by the sidee of which any lump sum payable in case of death might bee a comparatively small amount. From these circumstances,:, all of which have been brought prominently before ourr readers in our editorial columns during the past six months,i, it will be seen that a very large number of medical menn will have to insure against their new risks unless they aree willing to take the chance of being heavily mulcted byy
detached and forwarded to the Medical Insurance Committee, care of the British Medical Association, 6, Catherine-street, Strand, London, it will receive prompt attention, while any further information that may be required will be supplied by the committee. Our advice is that, in cases where there seems doubt whether an employee comes within the scope of the Act, the small premium to cover insurance should be paid willingly, at any rate until legal proceedings under the Act have led to certainty as to the interpretation of its provisions. It will be open to any employee who can find a solicitor to assist him to bring an action against his employer for compensation under the Act. Although the employer may win the case he will have to meet his legal expenses unless he is Insurance carries such expenses. insured. The scheme is simple in its nature and should be comprehensible, we think, without any trouble. The Medical Insurance Committee has established an agency for insurance against risks arising under the new Workmen’s Compensation Act, the scheme also taking cognisance of all risks of the employer for compensation to his employees at common law, as well as the risks of fire, burglary, and accident to the insurer. The agency will allow a discount of 10 per cent. to the insurer upon his premiums save in the case of fire, and here the rebate is not offered by the Guardian Insurance Company ; but we understand that the principal
fortune.
insurance offices
From this definition of "workman"it will be seen thatLt medical men are especially concerned in the working 01)f
the
new
Act, for many medical practitioners necessarilyy in
addition
general domestic servants ann locum-tenent, a coachman orr dispenser, chauffeur or both, and may also have to employ a surgeryy boy and other dependents whose occupation may or mayy
employ
assistant
or
to
a
not come under the head of casual work.
In the eventLt
fatal accident happening to any of these " workmen " in the course of their duties the employers will bee liable, if the employees have any dependents, to payy to these dependents perhaps as much as z2300 in com-Lof
a
form
being
unanimous irL deciding that no discount for premiums can be allowed to an insurer in respect of fire, a solidity of opinion that is probably dictated by the relations of the various offices to their regular agents. In proportion to the extent to which this scheme meets with the general support of the medical profession there will be left, after allowing the discount and paying expenses, a large or a small annual sum in the are
As an outcome of this feeling a Medical Insurance Committee was formed early this year to consider whether itt would not be possible to devise a scheme for combinationa in insurance whereby medical men, who must in the futuree become the payers of increased annual sums in premiums,, could benefit from some cooperative scheme ensuring to themi The Medical Insurance Committee ass a substantial rebate. originally constituted consisted of representatives of thee hands of the Medical Insurance Committee to be disposed British Medical Journal,-THE LANCET, Dr. H. RADCLIFFEE of for the benefit of the insured. The scheme provides that CROCKER (who accepted the invitation to become chair- this sum shall be devoted to benevolent purposes, and man), Dr. J. A. MACDONALD, Mr. GEORGE EASTES,, it will presumably be expended for the benefit of any Mr. ALBERT BENTHALL, Dr. T. H. ARNOLD CHAPLIN, Mr. J. persons insuring through the Medical Insurance Committee SMITH WHITAKER, and Mr. Guy ELLISTON, secretaryr who are incapacitated from work by age or disease or who of the British Medical Association, and after consider- are in poverty. Those widows or orphans of the insured able deliberation, in which the exact position of thee whose pecuniary resources are particularly slender will Association towards the scheme was arrived at, it wass probably receive the earliest attention of the committee. settled that the committee should arrange to conduct an agency for insurance against accident and other -
-
.
-
risks
on behalf of medical men, the usual agency commission being used for defraying clerical labour and for benevolent purposes for the benefit of the insurers. The committee sat frequently and received particulars of agency commission and rates of premium from a number of insurance companies and is now in the position to recommend the proposals made to it by the Guardian Assurance Company, Limited, against risks arising under the Workmen’s Compensation Acts, as well as in respect to fire, burglary, and accident to the insurer. An advertisement giving full particulars with regard to the arrangements of the Medical Insurance Committee with the Guardian Insurance Company, as well as the rates of premium and form of proposal to be addressed to the committee, will be found on page 19 of On the lower part of the our advertisements this week.
Annotations. "
Ne quid nimis."
THE CONTROL OF MALARIA IN INDIA BY THE ITALIAN METHOD OF LAND IRRIGATION AND SILT-BUILDING. AN interesting paper on the Applicability to India of the Italian Method of Utilising Silt"" ways read before the Indian section of the Society of Arts on May 2nd by Sir Edward Buck, K.C.S.I., who has already made a report on the subject to the Governor-General of India in Council. Since the twelfth century the Italian agriculturists have been accustomed to carry on engineering works for the control of their natural water-supplies as well as for agricultural purposes, and these Professor Niccoli of Pisa (quoted by Sir Edward Buck) has summarised as follows: (1)
centimetres of carbon
is the case with cats. TheAnother highly important conclusion which tallies with latter were chosen for the present investigation because their clinical experience is the statement that the amount of behaviour towards anaesthetics is more comparable with that chloroform in the blood which produces anaesthesia varies of the human subject. Whatever be the exact character of with the rate of induction of anaesthesia. This is to say, the association between the chloroform in an anaesthetised that roughly speaking the more gradually the patient is animal and the corpuscles of the animal’s blood one fact anaesthetised with chloroform the less of the drug will he about it is certain-namely, the firmness of the association. have to inhale from first to last. This fact is one of the There is no smell of chloroform to be detected in samples chief arguments in support of those chloroform-regulating of such blood, and if samples are allowed to stand forms of apparatus by which it is possible to give exfor a night they suffer no diminution in chlorine, show- tremely low percentages of chloroform vapour and to control ing presumably no diminution in the chloroform which the the percentage inhaled throughout the whole course of the blood holds. Another feature of the relation of chloroform narcosis. Yet it is important that the administrator should to the blood of an animal which is killed by the anaesthetic bear in mind the conclusions which show with what minute is its bearing upon medico-legal inquiries. This is the great quantities of chloroform anassthesia may be maintained, and diminution of chloroform in the blood that is observed for this reason we have drawn attention to the point. The shortly before death. The explanation preferred for this methods described in these researches for the estimation of phenomenon is that an abnormal quantity is at this time to chloroform in the blood are novel and practically free from be found in the tissues themselves, particularly the tissues error. They would appear to be capable of giving more of the nervous system. In animals which are anaesthetised trustworthy results than those employed previously by but not killed by chloroform the amount of the drug which SCHMIEDEBERG and POHL and to supply figures more enters the central nervous system may equal, but never accurate than those recently obtained by French observers. exceeds, and is generally much less than, the amount in the Dr. BUCKMASTER and Mr. GARDNER refer to experiments to be described in the future bearing upon the production of blood. From the clinical point of view we may notice in these anaesthesia under varying conditions, and we hope to revert physiological observations one or two points which are later to their valuable and suggestive investigations.
plasma rather more readily than
,
harmony with our preconceived notions. There are necessarily differences between the conditions which obtain in the physiological laboratory and the operating theatre, and a recognition of this fact explains apparent discrepancies between physiological experiments and clinical observation.
in
In the
one case
the
Medical
this is
impossible-at least,
Compensation.
in
manner in which the Workmen’s affect medical practitioners. would Compensation Act, 1906, As all our readers know, the Act at present in force, a piece of legislation dating from but nine years ago, contains a number of conditions which have proved fruitful sources of litigation. The " workman " to be assisted by the moribund Act is limited by definition and the circumstances in which he can claim compensation are detailed and particular, but by the Act which will come into force on July lst next all these conditions and limitations will be swept away. Under Clause 13 of this Act the " workman " is defined in the following words :-
columns to the
That the conclusions arrived at by experiwholly true when applied to clinical ends there
cases.
ment are
be no doubt, and they further lead the clinician modify his methods in such ways as will enable him to produce results parallel with those obtained in the laboratory. It is from this point of view that the work of such investigators as Dr. BUCKMASTER and Mr. GARDNER stands out as of conspicuous value to the practitioner of medicine. To take an example. In the ordinary methods can
to
of inhalation as conducted in the clinical theatre there is a much greater chance of mechanical obstruction to breath-
ing
than when the chloroform is aspirated directly through tracheal tube, as in the case of the physiological experiment. Again, the so-called 6°idiosyncrasy"which has been assumed to exist in certain persons with regard to anaesthetics becomes intelligible if the physiologist’s conclusion is correct that there is no absolute relation between the proportion of chloroform in the blood and the effects of the drug upon the entire organism, for these are determined not by the amount of chloroform present in the circulation but by the
Men and Workmen’s
SOME six months ago Mr. ALBERT BENTHALL, who has given much attention to the medical questions connected with the various forms of insurance, called attention in our
almost absolute control can be obtained over circumstances of the administration of the
environing anaesthetic; in the other many
.
a
I
pronounced
" Workman’does not include any person employed otherwise than by way of manual labour whose remuneration exceeds E250 a year, or a person whose employment is of a casual nature and who is employed otherwise than for the purposes of the employer’s trade or business, or a member of a police force, or an outworker, or a member of the employer’s family dwelling in his house, but, save as aforesaid, means any person who has entered into or works under a contract of service or apprenticeship with an employer, whether by way of manual labour, clerical work, or otherwise, and whether the contract is expressed or implied, is oral or in writing."
1306
pensation, the legal liability being for a sum equal to threee years’ wages, or .f.150, whichever of these sums is larger,, providing that the payment does not exceed 300. But thee death of an employee is not_so much to be feared as his orr her disablement from accident, for here a weekly paymentt during the continuance of the disablement will have to bee paid, which might conceivably mean an annuity by the sidee of which any lump sum payable in case of death might bee a comparatively small amount. From these circumstances,:, all of which have been brought prominently before ourr readers in our editorial columns during the past six months,i, it will be seen that a very large number of medical menn will have to insure against their new risks unless they aree willing to take the chance of being heavily mulcted byy
detached and forwarded to the Medical Insurance Committee, care of the British Medical Association, 6, Catherine-street, Strand, London, it will receive prompt attention, while any further information that may be required will be supplied by the committee. Our advice is that, in cases where there seems doubt whether an employee comes within the scope of the Act, the small premium to cover insurance should be paid willingly, at any rate until legal proceedings under the Act have led to certainty as to the interpretation of its provisions. It will be open to any employee who can find a solicitor to assist him to bring an action against his employer for compensation under the Act. Although the employer may win the case he will have to meet his legal expenses unless he is Insurance carries such expenses. insured. The scheme is simple in its nature and should be comprehensible, we think, without any trouble. The Medical Insurance Committee has established an agency for insurance against risks arising under the new Workmen’s Compensation Act, the scheme also taking cognisance of all risks of the employer for compensation to his employees at common law, as well as the risks of fire, burglary, and accident to the insurer. The agency will allow a discount of 10 per cent. to the insurer upon his premiums save in the case of fire, and here the rebate is not offered by the Guardian Insurance Company ; but we understand that the principal
fortune.
insurance offices
From this definition of "workman"it will be seen thatLt medical men are especially concerned in the working 01)f
the
new
Act, for many medical practitioners necessarilyy in
addition
general domestic servants ann locum-tenent, a coachman orr dispenser, chauffeur or both, and may also have to employ a surgeryy boy and other dependents whose occupation may or mayy
employ
assistant
or
to
a
not come under the head of casual work.
In the eventLt
fatal accident happening to any of these " workmen " in the course of their duties the employers will bee liable, if the employees have any dependents, to payy to these dependents perhaps as much as z2300 in com-Lof
a
form
being
unanimous irL deciding that no discount for premiums can be allowed to an insurer in respect of fire, a solidity of opinion that is probably dictated by the relations of the various offices to their regular agents. In proportion to the extent to which this scheme meets with the general support of the medical profession there will be left, after allowing the discount and paying expenses, a large or a small annual sum in the are
As an outcome of this feeling a Medical Insurance Committee was formed early this year to consider whether itt would not be possible to devise a scheme for combinationa in insurance whereby medical men, who must in the futuree become the payers of increased annual sums in premiums,, could benefit from some cooperative scheme ensuring to themi The Medical Insurance Committee ass a substantial rebate. originally constituted consisted of representatives of thee hands of the Medical Insurance Committee to be disposed British Medical Journal,-THE LANCET, Dr. H. RADCLIFFEE of for the benefit of the insured. The scheme provides that CROCKER (who accepted the invitation to become chair- this sum shall be devoted to benevolent purposes, and man), Dr. J. A. MACDONALD, Mr. GEORGE EASTES,, it will presumably be expended for the benefit of any Mr. ALBERT BENTHALL, Dr. T. H. ARNOLD CHAPLIN, Mr. J. persons insuring through the Medical Insurance Committee SMITH WHITAKER, and Mr. Guy ELLISTON, secretaryr who are incapacitated from work by age or disease or who of the British Medical Association, and after consider- are in poverty. Those widows or orphans of the insured able deliberation, in which the exact position of thee whose pecuniary resources are particularly slender will Association towards the scheme was arrived at, it wass probably receive the earliest attention of the committee. settled that the committee should arrange to conduct an agency for insurance against accident and other -
-
.
-
risks
on behalf of medical men, the usual agency commission being used for defraying clerical labour and for benevolent purposes for the benefit of the insurers. The committee sat frequently and received particulars of agency commission and rates of premium from a number of insurance companies and is now in the position to recommend the proposals made to it by the Guardian Assurance Company, Limited, against risks arising under the Workmen’s Compensation Acts, as well as in respect to fire, burglary, and accident to the insurer. An advertisement giving full particulars with regard to the arrangements of the Medical Insurance Committee with the Guardian Insurance Company, as well as the rates of premium and form of proposal to be addressed to the committee, will be found on page 19 of On the lower part of the our advertisements this week.
Annotations. "
Ne quid nimis."
THE CONTROL OF MALARIA IN INDIA BY THE ITALIAN METHOD OF LAND IRRIGATION AND SILT-BUILDING. AN interesting paper on the Applicability to India of the Italian Method of Utilising Silt"" ways read before the Indian section of the Society of Arts on May 2nd by Sir Edward Buck, K.C.S.I., who has already made a report on the subject to the Governor-General of India in Council. Since the twelfth century the Italian agriculturists have been accustomed to carry on engineering works for the control of their natural water-supplies as well as for agricultural purposes, and these Professor Niccoli of Pisa (quoted by Sir Edward Buck) has summarised as follows: (1)