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MEDICAL POLITICS IN AUSTRIA.
608
it
with reserve, seems to have been established that when intercourse has taken place under such circumstances the occurrence of pregnancy appears to the woman to be impossible and she may naturally and in good faith attribute her symptoms to disease rather than to pregnancy. Coming now to the case of a married woman, the probability of her remaining unconscious of her condition in advanced pregnancy is much less, but there is also generally more That a married reason for accepting her statement as true. woman may remain ignorant of her condition up to the time of full term labour is established by Dr. Tanner’s case, quoted by Guy and Ferrier, of a woman, aged forty-two years, and three years married, who menstruated scantily for five or six months, and then menstruation ceased for nine months. She was taken in labour and delivered of a mature female child by instruments. Both parents are said to have been anxious to have children, but the woman had no idea she was pregnant and could scarcely believe not only the fact of the pregnancy, but that she had been in labour for ten hours. Another case, the Hawkins divorce case, also quoted by Guy and Ferrier, shows that those about the patient, even her husband sleeping with her till within five minutes of her delivery, may remain ignorant of the pregnancy. In that case the Lord Chancellor was convinced that the petitioner (the husband) had remained ignorant of his wife’s condition even in the circumstances above stated. Presumably, in the case on which an inquest has just been held, the husband had been sleeping with his wife till within an hour or so of her confinement, yet he said he had no idea of her condition, and there seems no reason, such as might have been present in the Hawkins case, for doubting the truth of his statement. The present case is, therefore, extremely interesting ; it establishes still more clearly than before the possibility of ignorance of pregnancy existing on the part both of the woman and of her husband up till the very last moment.
MEDICAL POLITICS IN AUSTRIA. OUR readers will have noticed in the letters of
our
Vienna
correspondent how many of the questions which agitate the profession in England do so as much or more in countries where it is more severely regulated by law than is the case here. Not the least interesting part of his communication in THE LANCET of Feb. 20th is the account of the Austrian medical chambers, which are nineteen in number and scattered through all parts of that country. They cannot be called medical councils. At least, they do not discharge the functions in regard to medical education and registration which our General Medical Council discharges. But they have considerable powers of an ethical kind. Each medical man is required to report himself, with various particulars, to the chamber of the particular district in which he resides. The chambers are not bound too closely or hampered, as our General Medical Council sometimes seems to be, by the hard terms of an Act of Parliament, but can discuss matters relating to the general interests of the profession. They are expected to uphold its privileges, and the courts of law are entitled to ask them for the expression of opinion. Questions of honour and ethics are not decided by the chamber, but by a council of honour composed of from three to seven members. To crown all, the principle of Direct Representation is in full force. The chambers are elected by the medical men of the province or district. It is complained that the powers of the chambers are limited. But there is a power of imposing fines not exceeding f,20 on medical men for professional misbehaviour which might well be a very valuable m.eans of bringing erring brethren to better ways, and more merciful than the system of erasure. We have remarked in a previous number on the grave evils in Austria
connected with a wholesale State system of insurance against sickness. Such a system means inevitably a cheap system of medical attendance. Hitherto in Germany and in Austria the system has been confined to the working-class ; but it is proposed to extend it to employers and tradesmen. So strong is the feeling against such action by the Government that an unprecedentedly large meeting of medical men from all parts of Vienna, numbering a thousand, has been held to protest against it. It is pitiable when a strong Government, which is exacting in its educational demands, interferes in the domain of private practice and caters for those who are quite capable of taking care of themselves. The system threatens to ruin private practice altogether, and we sincerely urge our brethren in Austria to resist it in every possible way. But it is not the State alone that injures the profession. Its own members are scarcely less to blame for joining medical associations which confound the poor and the well-to-do and use methods of low competition which are as inconsistent with the welfare of the patient as with the dignity of the medical practitioner. Dr. Scholz referred to cases in which the practitioner received a penny a visit. Surely the end of such methods must be the rapid degradation of the profession. When Dr. Scholz recommends as a remedy the employment of every man by the State he probably means that the poor for whom the State provides attendance should have a choice of the medical men. Apart from the poor, the more free medical practice is from State control, and the more private and personal the relation between the medical man and his patient the better. The evils so vividly described are to be met by strong organisation in the profession and by a powerful and united protest from all the organisations of the profession to the Government.
THE ENDEMIC FEVER OF THE MEDITERRANEAN. WE have received a copy of a paper by Surgeon-Captain M. L. Hughes, of the Army Medical Staff, which was read before the Royal Medical and Chirurgical Society in April last and reprinted from the volume of the society’s Transactions. As the subject is one of considerable interest, about which a good deal has been written from time to time, we may very briefly call attention to it. The first accurate description of the fever of the Mediterranean, says the writer, was published by Dr. Marston while serving as an army surgeon in Malta in 1861, and since that time it has been written upon by numerous medical officers and others, ending with the discovery in 1887 by Surgeon-Major Bruce of a causal The disease has a wider geography micro-organism. than that implied in its name, for there is reason to believe that the same fever exists on the borders of the Red Sea and probably elsewhere. Surgeon-Captain Hughes describes its symptomatology under three separategroups, the malignant or fatal type, the undulatory, and the intermittent type. He points out its special its differential diagnosis from typhoid and symptoms, other forms of fever, its pathological anatomy, founded on the reports of sixty post-mortem examinations at thirteen of which he was present, and its bacteriology, based upon thirteen cases in which a micro-organism was found by him similar to that described by Surgeon-Major Bruce. The fever commonly runs a very variable but protracted course, and is often complicated with, or followed by, various nervous, rheumatic, or glandular affections, and does not respond to any specific treatment. In fatal cases there is no lesion It is often curiously of Peyer’s glands to be discovered. localised to certain rooms in buildings or to certain households and seems greatly to depend upon causes of insanitation-fæcal contamination of soil and air, with warmth and moisture and a drying soil, and insufficient superficial space-
it
with reserve, seems to have been established that when intercourse has taken place under such circumstances the occurrence of pregnancy appears to the woman to be impossible and she may naturally and in good faith attribute her symptoms to disease rather than to pregnancy. Coming now to the case of a married woman, the probability of her remaining unconscious of her condition in advanced pregnancy is much less, but there is also generally more That a married reason for accepting her statement as true. woman may remain ignorant of her condition up to the time of full term labour is established by Dr. Tanner’s case, quoted by Guy and Ferrier, of a woman, aged forty-two years, and three years married, who menstruated scantily for five or six months, and then menstruation ceased for nine months. She was taken in labour and delivered of a mature female child by instruments. Both parents are said to have been anxious to have children, but the woman had no idea she was pregnant and could scarcely believe not only the fact of the pregnancy, but that she had been in labour for ten hours. Another case, the Hawkins divorce case, also quoted by Guy and Ferrier, shows that those about the patient, even her husband sleeping with her till within five minutes of her delivery, may remain ignorant of the pregnancy. In that case the Lord Chancellor was convinced that the petitioner (the husband) had remained ignorant of his wife’s condition even in the circumstances above stated. Presumably, in the case on which an inquest has just been held, the husband had been sleeping with his wife till within an hour or so of her confinement, yet he said he had no idea of her condition, and there seems no reason, such as might have been present in the Hawkins case, for doubting the truth of his statement. The present case is, therefore, extremely interesting ; it establishes still more clearly than before the possibility of ignorance of pregnancy existing on the part both of the woman and of her husband up till the very last moment.
MEDICAL POLITICS IN AUSTRIA. OUR readers will have noticed in the letters of
our
Vienna
correspondent how many of the questions which agitate the profession in England do so as much or more in countries where it is more severely regulated by law than is the case here. Not the least interesting part of his communication in THE LANCET of Feb. 20th is the account of the Austrian medical chambers, which are nineteen in number and scattered through all parts of that country. They cannot be called medical councils. At least, they do not discharge the functions in regard to medical education and registration which our General Medical Council discharges. But they have considerable powers of an ethical kind. Each medical man is required to report himself, with various particulars, to the chamber of the particular district in which he resides. The chambers are not bound too closely or hampered, as our General Medical Council sometimes seems to be, by the hard terms of an Act of Parliament, but can discuss matters relating to the general interests of the profession. They are expected to uphold its privileges, and the courts of law are entitled to ask them for the expression of opinion. Questions of honour and ethics are not decided by the chamber, but by a council of honour composed of from three to seven members. To crown all, the principle of Direct Representation is in full force. The chambers are elected by the medical men of the province or district. It is complained that the powers of the chambers are limited. But there is a power of imposing fines not exceeding f,20 on medical men for professional misbehaviour which might well be a very valuable m.eans of bringing erring brethren to better ways, and more merciful than the system of erasure. We have remarked in a previous number on the grave evils in Austria
connected with a wholesale State system of insurance against sickness. Such a system means inevitably a cheap system of medical attendance. Hitherto in Germany and in Austria the system has been confined to the working-class ; but it is proposed to extend it to employers and tradesmen. So strong is the feeling against such action by the Government that an unprecedentedly large meeting of medical men from all parts of Vienna, numbering a thousand, has been held to protest against it. It is pitiable when a strong Government, which is exacting in its educational demands, interferes in the domain of private practice and caters for those who are quite capable of taking care of themselves. The system threatens to ruin private practice altogether, and we sincerely urge our brethren in Austria to resist it in every possible way. But it is not the State alone that injures the profession. Its own members are scarcely less to blame for joining medical associations which confound the poor and the well-to-do and use methods of low competition which are as inconsistent with the welfare of the patient as with the dignity of the medical practitioner. Dr. Scholz referred to cases in which the practitioner received a penny a visit. Surely the end of such methods must be the rapid degradation of the profession. When Dr. Scholz recommends as a remedy the employment of every man by the State he probably means that the poor for whom the State provides attendance should have a choice of the medical men. Apart from the poor, the more free medical practice is from State control, and the more private and personal the relation between the medical man and his patient the better. The evils so vividly described are to be met by strong organisation in the profession and by a powerful and united protest from all the organisations of the profession to the Government.
THE ENDEMIC FEVER OF THE MEDITERRANEAN. WE have received a copy of a paper by Surgeon-Captain M. L. Hughes, of the Army Medical Staff, which was read before the Royal Medical and Chirurgical Society in April last and reprinted from the volume of the society’s Transactions. As the subject is one of considerable interest, about which a good deal has been written from time to time, we may very briefly call attention to it. The first accurate description of the fever of the Mediterranean, says the writer, was published by Dr. Marston while serving as an army surgeon in Malta in 1861, and since that time it has been written upon by numerous medical officers and others, ending with the discovery in 1887 by Surgeon-Major Bruce of a causal The disease has a wider geography micro-organism. than that implied in its name, for there is reason to believe that the same fever exists on the borders of the Red Sea and probably elsewhere. Surgeon-Captain Hughes describes its symptomatology under three separategroups, the malignant or fatal type, the undulatory, and the intermittent type. He points out its special its differential diagnosis from typhoid and symptoms, other forms of fever, its pathological anatomy, founded on the reports of sixty post-mortem examinations at thirteen of which he was present, and its bacteriology, based upon thirteen cases in which a micro-organism was found by him similar to that described by Surgeon-Major Bruce. The fever commonly runs a very variable but protracted course, and is often complicated with, or followed by, various nervous, rheumatic, or glandular affections, and does not respond to any specific treatment. In fatal cases there is no lesion It is often curiously of Peyer’s glands to be discovered. localised to certain rooms in buildings or to certain households and seems greatly to depend upon causes of insanitation-fæcal contamination of soil and air, with warmth and moisture and a drying soil, and insufficient superficial space-