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Medical officers and coroners
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PUBLIC
nurses h a s little o r no c o n n e c t i o n w i t h general public h e a l t h w o r k in the area. Such s e p a r a t e organizations a n d officers, as we p o i n t e d out in o u r J u n e issue, in c o n n e c t i o n w i t h measles, are to be r e g a r d e d as u n d e s i r a b l e a n d m u s t inevitably" lead to w a s t e a n d o v e r l a p p i n g , a n d it is to be h o p e d t h a t th~ Local G o v e r n l n e n t B o a r d will ~n f u t u r e m a k e a decided s t a n d on this subject, and will insist Oil all public medical w o r k being c o m b i n e d in one d e p a r t m e n t a n d u n d e r one head. U n t i l this is done it is difficult to regard t h e L o c a l G o v e r n m e n t B o a r d as an ideal nucleus of a Ministry of H e a l t h . T h e a t t i t u d e and a p p a r e n t policy of t h e Local G o v e r n m e n t B o a r d o n t h e s u b j e c t of, unification of local control of all public medicat services is u n f o r t u n a t e l y a n d r e g r e t a b l y v a g u e a t present, a n d c a n o n l y be e x p l a i n e d either b y t h e f a c t t h a t the medical d e p a r t m e n t of the B o a r d h a s got o u t of t o u c h w i t h the actual practice of p r e v e n t i v e medicine in the country, or t h a t t h e m e d i c a l d e p a r t m e n t is n o t allowed to h a v e t h a t influence u p o n the policy of the B o a r d which the Public H e a l t h Service of the c o u n t r y , as well as the general public, intend it to h a v e . T o this a s p e c t of t h e s u b j e c t we p r o p o s e to r e t u r n in a f u t u r e issue. I t is e a r l y in t h e d a y to ask for results f r o m t h e e x p e n d i t u r e u p o n tuberculosis, b u t there are indications t h a t m e m b e r s of the public are asking for i n f o r m a t i o n as to w h e t h e r the large e x p e n d i t u r e o n this w o r k d u r i n g the p a s t few y e a r s h a s p r o d u c e d a n y a p p r e c i a b l e results. Of course, n o t h i n g is easier t h a n to show t h a t t h e incidence or m o r t a l i t y of tuberculosis during a recent year, such as I 9 I 7, shows a considerable i m p r o v e m e n t on t h e figures for some selected y e a r of a b o u t t e n y e a r s ago, b u t it is h o p e d t h a t t h e r e will be no a t t e m p t s to mislead the public b y p r o d u c i n g s t a t i s t i c s of this kind. M a n y of our readers will p r o b a b l y r e m e m b e r h o w a s h o r t t i m e ago it was claimed t h a t the i n a u g u r a t i o n of dispensaries in a c e r t a i n t o w n h a d p r o d u c e d a m a r k e d effect u p o n t u b e r eulosis in t h a t town, a n d t h e ease was alleged to b e " p r o v e d " b y figures r e p r e s e n t i n g two selected y e a r s such as the above. Such m e t h o d s of " p r o o f " are m o r e likely to be a d o p t e d b y clinicians a n x i o u s to p r o v e the success of some special d i s p e n s a r y or hospital or t r e a t m e n t , t h a n t h e y are b y medical officers of health, who h a v e b e e n a c c u s t o m e d for y e a r s to a n a l y s e statistical w o r k a n d to t e s t its
HEALTH.
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reliability a n d usefulness. V~hatever the results of the p a s t e x p e n d i t u r e u p o n tuberculosis m a y p r o v e to be, one m a y confidently c l a i m t h a t a n i m p r o v e m e n t c a n be o b t a i n e d b y linking u p all tuberculosis w o r k m o r e closely w i t h t h e general public h e a l t h o r g a n i z a t i o n t h r o u g h o u t the c o u n t r y . MEDICAL O F F I C E R S AND CORONERS. Council of Medical Defence Union is T H Edesirous of raising a test action in the Courts as to the legal rights of Naval and Military Medical Officers attached to Naval or Military Hospitals to fees under the Coroners Act for making postmortem examinations and for giving evidence at an inquest by direction of a coroner. I t is contended on the part of the Council that a Naval or Military hospital or the sick bay of any N a v a l or Military institution is not a " place " within the meaning of the exemption to payment clause of the Coroners Act of 1887--sub-section 2 of the 22 Sect. such a " place " being neither a county or other asylum, or a public hospital or infirmary nor other medical institution, as it is not for the public, nor is it supported b y emoluments or by voluntary subscriptions. The Council hoped to have commenced action upon evidence which was placed before them in the County of Kent ; but it was found impossible to do so, as the Naval Medical Officer concerned had not received the statutory summons to make the examination and to attend the inquest, but had carried out these acts after courteously accepting the verbal authority of the coroner to do so. I n the absence of an official summons there was created a loophole for the County Council to raise legally a defence which would have obscured the issues, and with great reluctance the proposed test action had to be dropped. The medical officers concerned in all such establishments are now advised not to attend in future to any direction of a coroner which is not supported b y an actual summons, and to decline to make an examination or to attend to give evidence as a medical witness until the legal procedure is adopted and carried out in accordance with the Act. Upon this procedure being carried out, and a refusal by the coroner to p a y the statutory fees following on, proceedings will at once be instituted, and the decision of the High Court taken as to the legality, or otherwise, of the refusal. I t is difficult to imagine why medical officers, either of naval, military, or civil medical institutions, should be called upon to perform important scientific duties gratuitously, and apparently there is neither law nor equity to support the corv6e. Medical officers who can offer evidence should communicate with the Secretary, Medical Defence Union, 4, Trafalgar Square, W.C.2.
PUBLIC
nurses h a s little o r no c o n n e c t i o n w i t h general public h e a l t h w o r k in the area. Such s e p a r a t e organizations a n d officers, as we p o i n t e d out in o u r J u n e issue, in c o n n e c t i o n w i t h measles, are to be r e g a r d e d as u n d e s i r a b l e a n d m u s t inevitably" lead to w a s t e a n d o v e r l a p p i n g , a n d it is to be h o p e d t h a t th~ Local G o v e r n l n e n t B o a r d will ~n f u t u r e m a k e a decided s t a n d on this subject, and will insist Oil all public medical w o r k being c o m b i n e d in one d e p a r t m e n t a n d u n d e r one head. U n t i l this is done it is difficult to regard t h e L o c a l G o v e r n m e n t B o a r d as an ideal nucleus of a Ministry of H e a l t h . T h e a t t i t u d e and a p p a r e n t policy of t h e Local G o v e r n m e n t B o a r d o n t h e s u b j e c t of, unification of local control of all public medicat services is u n f o r t u n a t e l y a n d r e g r e t a b l y v a g u e a t present, a n d c a n o n l y be e x p l a i n e d either b y t h e f a c t t h a t the medical d e p a r t m e n t of the B o a r d h a s got o u t of t o u c h w i t h the actual practice of p r e v e n t i v e medicine in the country, or t h a t t h e m e d i c a l d e p a r t m e n t is n o t allowed to h a v e t h a t influence u p o n the policy of the B o a r d which the Public H e a l t h Service of the c o u n t r y , as well as the general public, intend it to h a v e . T o this a s p e c t of t h e s u b j e c t we p r o p o s e to r e t u r n in a f u t u r e issue. I t is e a r l y in t h e d a y to ask for results f r o m t h e e x p e n d i t u r e u p o n tuberculosis, b u t there are indications t h a t m e m b e r s of the public are asking for i n f o r m a t i o n as to w h e t h e r the large e x p e n d i t u r e o n this w o r k d u r i n g the p a s t few y e a r s h a s p r o d u c e d a n y a p p r e c i a b l e results. Of course, n o t h i n g is easier t h a n to show t h a t t h e incidence or m o r t a l i t y of tuberculosis during a recent year, such as I 9 I 7, shows a considerable i m p r o v e m e n t on t h e figures for some selected y e a r of a b o u t t e n y e a r s ago, b u t it is h o p e d t h a t t h e r e will be no a t t e m p t s to mislead the public b y p r o d u c i n g s t a t i s t i c s of this kind. M a n y of our readers will p r o b a b l y r e m e m b e r h o w a s h o r t t i m e ago it was claimed t h a t the i n a u g u r a t i o n of dispensaries in a c e r t a i n t o w n h a d p r o d u c e d a m a r k e d effect u p o n t u b e r eulosis in t h a t town, a n d t h e ease was alleged to b e " p r o v e d " b y figures r e p r e s e n t i n g two selected y e a r s such as the above. Such m e t h o d s of " p r o o f " are m o r e likely to be a d o p t e d b y clinicians a n x i o u s to p r o v e the success of some special d i s p e n s a r y or hospital or t r e a t m e n t , t h a n t h e y are b y medical officers of health, who h a v e b e e n a c c u s t o m e d for y e a r s to a n a l y s e statistical w o r k a n d to t e s t its
HEALTH.
jvLx2,
reliability a n d usefulness. V~hatever the results of the p a s t e x p e n d i t u r e u p o n tuberculosis m a y p r o v e to be, one m a y confidently c l a i m t h a t a n i m p r o v e m e n t c a n be o b t a i n e d b y linking u p all tuberculosis w o r k m o r e closely w i t h t h e general public h e a l t h o r g a n i z a t i o n t h r o u g h o u t the c o u n t r y . MEDICAL O F F I C E R S AND CORONERS. Council of Medical Defence Union is T H Edesirous of raising a test action in the Courts as to the legal rights of Naval and Military Medical Officers attached to Naval or Military Hospitals to fees under the Coroners Act for making postmortem examinations and for giving evidence at an inquest by direction of a coroner. I t is contended on the part of the Council that a Naval or Military hospital or the sick bay of any N a v a l or Military institution is not a " place " within the meaning of the exemption to payment clause of the Coroners Act of 1887--sub-section 2 of the 22 Sect. such a " place " being neither a county or other asylum, or a public hospital or infirmary nor other medical institution, as it is not for the public, nor is it supported b y emoluments or by voluntary subscriptions. The Council hoped to have commenced action upon evidence which was placed before them in the County of Kent ; but it was found impossible to do so, as the Naval Medical Officer concerned had not received the statutory summons to make the examination and to attend the inquest, but had carried out these acts after courteously accepting the verbal authority of the coroner to do so. I n the absence of an official summons there was created a loophole for the County Council to raise legally a defence which would have obscured the issues, and with great reluctance the proposed test action had to be dropped. The medical officers concerned in all such establishments are now advised not to attend in future to any direction of a coroner which is not supported b y an actual summons, and to decline to make an examination or to attend to give evidence as a medical witness until the legal procedure is adopted and carried out in accordance with the Act. Upon this procedure being carried out, and a refusal by the coroner to p a y the statutory fees following on, proceedings will at once be instituted, and the decision of the High Court taken as to the legality, or otherwise, of the refusal. I t is difficult to imagine why medical officers, either of naval, military, or civil medical institutions, should be called upon to perform important scientific duties gratuitously, and apparently there is neither law nor equity to support the corv6e. Medical officers who can offer evidence should communicate with the Secretary, Medical Defence Union, 4, Trafalgar Square, W.C.2.