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MEDICAL PROTECTION.
842 substance present which is essential to the assimilability of food. If we accepted the position laid down we should have to conclude that there is something radically wrong with our methods of preparing food which seemingly ought to have favoured a general distribution of " deficiency diseases." A letter in another column has prompted these remarks. ____
THE COMPLIMENTARY DINNER TO SURGEONGENERAL GORGAS.
AT this dinner, which will be held on Monday next, March 23rd, at 7.45 P.M., at the Savoy Hotel, we
understand that the Archbishop of Canterbury and the Lord Chancellor, Lord Haldane, will be present, as well as the Colonial Secretary, Mr. Lewis Harcourt, and Viscount Bryce. The dinner is supported by Sir Rickman Godlee, President of the Royal College of Surgeons of England ; Sir Francis H. Champneys, President of the Royal Society of Medicine; Sir David Ferrier, President of the Medical Society; Dr. W. A. Hollis, President of the British Medical Association ; Sir Havelock Charles, President of the Society of Tropical Medicine and Hygiene; Sir William Osler, Regius Professor of Medicine, Oxford; Sir Clifford Allbutt, Regius Professor of Medicine, Cambridge ; Surgeon-General Arthur W. May, Director-General of the Naval Medical Service; Sir W. Launcelot Gubbins, Director-General of the Army Medical Service; Professor W. J. R. Simpson and Dr. F. M. Sandwith, of the London School of Tropical Medicine; Sir Ronald Ross, Sir James Reid, and Sir Frederick Treves. The chair will be taken by Sir Thomas Barlow, President of the Royal College of Physicians of London, and the organisers of the dinner are particularly anxious that representative medical men should be present to do honour to their distinguished American guest. All communications should be addressed to Mr. J. Y. W. MacAlister at the house of the Royal Society of Medicine, 1, Wimpole-street, London, W. The dinner tickets are 25s., and cheques should accompany applica-
tions. ____
"DICHOTOMY" IN THE UNITED STATES AND IN
CANADA.
THE dodge of dividing fees secretly between the general practitioner and the operating surgeon was stated publicly not long ago to be rife in the United States and Canada. The question was discussed at the time with an acrimony that, despite some weak evidence, went far to prove the custom to be in vogue ; and now the matter is again on the tapis. At the twenty-third annual meeting of the Western Surgical Association held in St. Louis on Dec. 19th and 20th, 1913, Dr. Jabez N. Jackson, of Kansas City, Mo., the President, in his presidential address, took " dichotomy," as the reprehensible practice is called, for his main subject. His objections to the practice were the obvious ones, and were formulated in the obvious manner. He said that dichotomy induced family practitioners to betray the confidence of their patients who were referred to surgeons, not necessarily the most competent, not those who offered the greatest possibility of the saving of life or the preservation of health, but to men who paid coin to get hold of their victims. By this practice the patients were robbed, while it penalised honesty in those who sat idly by rather than make shameful bargains, allowing less competent competitors to buy their practices.
worst of all, it led to many unnecessary operations with their attendant risk and expense. "In all it was a betrayal of trust, encouraged dishonesty, bred incompetency, and should, in short, be regarded as a crime." The indictment is not too severe for the offence-in fact, the professional degradation of "dichotomy" can hardly have required pointing out. What is needed is a remedy-viz., the public exposure of known offenders, and this is the course that is now being widely discussed and forcibly advocated. In Canada the practice of secret division of fees was stigmatised no less harshly some two years ago at the annual meeting of the Ontario Medical Association by Dr. Herbert A. Bruce, of Dr. Bruce appeared to admit that the Toronto. custom existed by the terms of reprobation which he considered it his duty to use. Enough words have been wasted in describing the professional enormity of the offence ; we should now like to see some of the offenders named and shamed. Surely if the sin is so common many of the sinners must be known.
Finally, and perhaps
____
MEDICAL PROTECTION.
THE annual report of the London and Counties Protection Society, which will be presented to the annual meeting of the members on March 25th, discloses once more a record of steady growth and of increasing usefulness. Since the last annual meeting the society has lost its President, Sir Jonathan Hutchinson, who had filled that office during the whole 22 years of the society’s existence. In his place Dr. G. A. Heron has been elected, and has resigned the treasurership in consequence, to which Mr. C. M. Fegen has been elected in his stead. The report contains cases illustrative of the defence work done on behalf of the members. Interesting as many of these cases are, there is a strong similarity between the events of one year and another ; and they point very strongly once more the moral which impresses itself instantaneously on all who read them-namely, the imperative necessity of an organised and cooperative system of legal defence for the medical profession. With increasing experience of the new system inaugurated in 1911 the financial position of this society is growing rapidly stronger and more assured. It will be remembered that in that year the constitution of the society was altered in such a way as to give the council power to insure members up to an amount of .:B2000 in any one case and up to an aggregate of .:B22,000 for the whole society against costs and damages given against them. Previously the society had insured members only against the actual costs of their defence. It is evident from the financial statement that the increase of the subscription from 10s. to 11per annum has so far been more than adequate to cover the extra risk insured; and the consequence is that the reserve funds of the society are accumulating rapidly. This is, of course, a source of great strength, and if the favourable experience of the society in respect of this part of its work continues it will be possible either to reduce the subscription which the members pay or to terminate the arrangement whereby the society reinsures with Lloyd’s the whole of its annual risk of adverse verdicts beyond the first .:B2000, thus saving the annual premiums paid to cover this contingency. As previously, the society was able to recover a substantial proportion (nearly JB900 out of £2300) of its
843 law costs from defeated adversaries. The whole of the accounts and balance-sheets reveal a promising
condition.
____
OPHTHALMOLOGICAL SOCIETY KINGDOM.
OF
THE
UNITED
THE annual Congress of the Ophthalmological Society of the United Kingdom will be held, under the presidency of Mr. F. Richardson Cross, on Thursday, Friday, and Saturday, April 23rd, 24th, The meetings will take place at the and 25th. rooms of the Royal Society of Medicine, 1, Wimpolestreet. On Thursday and Saturday mornings papers will be read from 10 A.M. till 1 P.M.; on Friday morning there will be a discussion, to be opened by Mr. E. Treacher Collins and Lieutenant-Colonel H. Herbert, on Post-operative Complications of Cataract Extraction. The annual business meeting will be held at 4 P.M. on Thursday, and at 5 P.M. on the same day Professor Uhthoff, of Breslau, will deliver the Bowman lecture on Experiences and Considerations on the Importance of Ophthalmology in Brain Surgery. Members of the society and their friends will dine together on Thursday evening. It has been arranged to hold a clinical meeting on Friday afternoon at the Central London Ophthalmic Hospital, Judd-street, W.C. During the congress a museum of objects of ophthalmic interest will be exhibited in the Bowman library at the Royal Society of Medicine. Communications respecting the scientific meetings should be addressed to Mr. G. Coats, 50, Queen Anne-street, W., respecting. the museum to Mr. M. S. Mayou, 30, Cavendish-square, W., and respecting the dinner to Mr. Elmore Brewerton, 84, Wimpole-street, W.
always be obtained in large numbers, but [for the administrative duties of the medical service long and varied training is necessary. Everyone knows and acknowledges the importance and the difficulties of the supply department in war; but it has only recently been realised that it is as difficult a problem to get a wounded man down to the base as to get a dead bullock up to the front. In war time it is not the performance of brilliant surgical operations, nor the successful treatment of serious diseases, that constitutes the chief value of the medical department; this depends on the prevention of disease, the rapid evacuation of sick and wounded, and the immediate treatment of minor ailments and injuries, so as to get the men back to the fighting line as quickly as possible. All this requires careful organisation, and Colonel Purdy mentions that New South Wales was the first country in the world to possess a properly organised,. properly equipped medical force that was the admiration of all who saw it working in South Africa. In another paper Colonel Purdy, speaking from his experience in the South African war as to water supply in the field, states his firm opinion that the best and most rational system is to encourage every man to boil water for himself. If made into tea, as was done by the Australians in the war, the practice is both effectual and popular. OCEANOGRAPHY AND
DURING
some
extensive
PUBLIC
HEALTH.
oceanographic investiga-
tions, conducted mainly with the object of localising distant icebergs by observations upon the electroconductivity of sea water, Dr. Myer Coplans, of£
Leeds University, happened by chance upon certain facts which may have an important bearing on the health of passengers on Atlantic liners. By means NAVAL AND MILITARY MEDICINE AT THE of a compensated conductivity salinometer of his ANTIPODES. own invention Dr. Coplans estimates the electric THE British public are not likely to forget the conductivity of the water 18 feet below the surface, patriotism so vigorously demonstrated by our and is thus enabled to deduce the degree of its Whether this method will provide an Colonial kinsmen during the war in South Africa, salinity. and it is not too much to say that our home infallible indication of the neighbourhood of icemilitary authorities found a good deal to learn from bergs is not yet proved;if it does, the travelling. the capable and energetic methods of administra- public will have much to thank Dr. Coplans While measuring the electro-conductivity In Australasia for. tion of the daughter States. military training is now compulsory on all male of the water in the Gulf of St. Lawrence citizens; from the age of 12 to 18 in cadet corps, he found that near the mouth of each tributary and from 20 to 26 as citizen soldiers; in New river there is a rise in the salinity of the water. Zealand the liability ceases at 25. Colonel James R. The water of Lake St. Peter and above was much Purdy, Director of Medical Services, New Zealand, more pregnant with saline products than that of makes some very pertinent observations in a book the tributaries below Three Rivers and Quebec. which he has just published and in which an This result he ascribes to the fact that the sewage address delivered by him at the Australasian from Ottawa and Montreal is largely deposited in Medical Congress of 1911 is reproduced. Colonel the broad expanse of Lake St. Peter. The importPurdy urges that only the very best youth of ance of this resides in the fact that the ocean-going the country should be taken for the army. steamships plying to and from Montreal take their There is no sense in training up a soldier fresh water from this place. If Dr. Coplans’s conto fight, and when the day of battle comes tention that this water is in reality heavily confinding he is unable for physical reasons to taminated with sewage is correct it is obviously a. do so. He has satisfied himself that only men of matter of the greatest importance that ship-owners. the very highest stamp of physical development should know this and act upon it. It is to be hoped can possibly stand the stress of modern methods of that the authorities will take steps to ascertain he 40 considers of that cent. the warfare; youth whether this water is or is not bacterially per of Australasia are for some cause or other unfit for infected, and that meanwhile it will be treated efficient military service, but believes that in a few as under some suspicion. That this question years, owing to the great improvement in physique of public health should arise out of researches effected by physical training, this percentage of undertaken for the detection of invisible iceunfitness will be very greatly reduced. He insists bergs at sea is only another instance of the on the need for all-round military training for the unexpected gifts with which science proverbially medical officer. For the actual treatment of ! rewards now and then her patient followers. The army sick and wounded in war civilian practitioners cansignificance of these observations in the St.Lawrence
THE COMPLIMENTARY DINNER TO SURGEONGENERAL GORGAS.
AT this dinner, which will be held on Monday next, March 23rd, at 7.45 P.M., at the Savoy Hotel, we
understand that the Archbishop of Canterbury and the Lord Chancellor, Lord Haldane, will be present, as well as the Colonial Secretary, Mr. Lewis Harcourt, and Viscount Bryce. The dinner is supported by Sir Rickman Godlee, President of the Royal College of Surgeons of England ; Sir Francis H. Champneys, President of the Royal Society of Medicine; Sir David Ferrier, President of the Medical Society; Dr. W. A. Hollis, President of the British Medical Association ; Sir Havelock Charles, President of the Society of Tropical Medicine and Hygiene; Sir William Osler, Regius Professor of Medicine, Oxford; Sir Clifford Allbutt, Regius Professor of Medicine, Cambridge ; Surgeon-General Arthur W. May, Director-General of the Naval Medical Service; Sir W. Launcelot Gubbins, Director-General of the Army Medical Service; Professor W. J. R. Simpson and Dr. F. M. Sandwith, of the London School of Tropical Medicine; Sir Ronald Ross, Sir James Reid, and Sir Frederick Treves. The chair will be taken by Sir Thomas Barlow, President of the Royal College of Physicians of London, and the organisers of the dinner are particularly anxious that representative medical men should be present to do honour to their distinguished American guest. All communications should be addressed to Mr. J. Y. W. MacAlister at the house of the Royal Society of Medicine, 1, Wimpole-street, London, W. The dinner tickets are 25s., and cheques should accompany applica-
tions. ____
"DICHOTOMY" IN THE UNITED STATES AND IN
CANADA.
THE dodge of dividing fees secretly between the general practitioner and the operating surgeon was stated publicly not long ago to be rife in the United States and Canada. The question was discussed at the time with an acrimony that, despite some weak evidence, went far to prove the custom to be in vogue ; and now the matter is again on the tapis. At the twenty-third annual meeting of the Western Surgical Association held in St. Louis on Dec. 19th and 20th, 1913, Dr. Jabez N. Jackson, of Kansas City, Mo., the President, in his presidential address, took " dichotomy," as the reprehensible practice is called, for his main subject. His objections to the practice were the obvious ones, and were formulated in the obvious manner. He said that dichotomy induced family practitioners to betray the confidence of their patients who were referred to surgeons, not necessarily the most competent, not those who offered the greatest possibility of the saving of life or the preservation of health, but to men who paid coin to get hold of their victims. By this practice the patients were robbed, while it penalised honesty in those who sat idly by rather than make shameful bargains, allowing less competent competitors to buy their practices.
worst of all, it led to many unnecessary operations with their attendant risk and expense. "In all it was a betrayal of trust, encouraged dishonesty, bred incompetency, and should, in short, be regarded as a crime." The indictment is not too severe for the offence-in fact, the professional degradation of "dichotomy" can hardly have required pointing out. What is needed is a remedy-viz., the public exposure of known offenders, and this is the course that is now being widely discussed and forcibly advocated. In Canada the practice of secret division of fees was stigmatised no less harshly some two years ago at the annual meeting of the Ontario Medical Association by Dr. Herbert A. Bruce, of Dr. Bruce appeared to admit that the Toronto. custom existed by the terms of reprobation which he considered it his duty to use. Enough words have been wasted in describing the professional enormity of the offence ; we should now like to see some of the offenders named and shamed. Surely if the sin is so common many of the sinners must be known.
Finally, and perhaps
____
MEDICAL PROTECTION.
THE annual report of the London and Counties Protection Society, which will be presented to the annual meeting of the members on March 25th, discloses once more a record of steady growth and of increasing usefulness. Since the last annual meeting the society has lost its President, Sir Jonathan Hutchinson, who had filled that office during the whole 22 years of the society’s existence. In his place Dr. G. A. Heron has been elected, and has resigned the treasurership in consequence, to which Mr. C. M. Fegen has been elected in his stead. The report contains cases illustrative of the defence work done on behalf of the members. Interesting as many of these cases are, there is a strong similarity between the events of one year and another ; and they point very strongly once more the moral which impresses itself instantaneously on all who read them-namely, the imperative necessity of an organised and cooperative system of legal defence for the medical profession. With increasing experience of the new system inaugurated in 1911 the financial position of this society is growing rapidly stronger and more assured. It will be remembered that in that year the constitution of the society was altered in such a way as to give the council power to insure members up to an amount of .:B2000 in any one case and up to an aggregate of .:B22,000 for the whole society against costs and damages given against them. Previously the society had insured members only against the actual costs of their defence. It is evident from the financial statement that the increase of the subscription from 10s. to 11per annum has so far been more than adequate to cover the extra risk insured; and the consequence is that the reserve funds of the society are accumulating rapidly. This is, of course, a source of great strength, and if the favourable experience of the society in respect of this part of its work continues it will be possible either to reduce the subscription which the members pay or to terminate the arrangement whereby the society reinsures with Lloyd’s the whole of its annual risk of adverse verdicts beyond the first .:B2000, thus saving the annual premiums paid to cover this contingency. As previously, the society was able to recover a substantial proportion (nearly JB900 out of £2300) of its
843 law costs from defeated adversaries. The whole of the accounts and balance-sheets reveal a promising
condition.
____
OPHTHALMOLOGICAL SOCIETY KINGDOM.
OF
THE
UNITED
THE annual Congress of the Ophthalmological Society of the United Kingdom will be held, under the presidency of Mr. F. Richardson Cross, on Thursday, Friday, and Saturday, April 23rd, 24th, The meetings will take place at the and 25th. rooms of the Royal Society of Medicine, 1, Wimpolestreet. On Thursday and Saturday mornings papers will be read from 10 A.M. till 1 P.M.; on Friday morning there will be a discussion, to be opened by Mr. E. Treacher Collins and Lieutenant-Colonel H. Herbert, on Post-operative Complications of Cataract Extraction. The annual business meeting will be held at 4 P.M. on Thursday, and at 5 P.M. on the same day Professor Uhthoff, of Breslau, will deliver the Bowman lecture on Experiences and Considerations on the Importance of Ophthalmology in Brain Surgery. Members of the society and their friends will dine together on Thursday evening. It has been arranged to hold a clinical meeting on Friday afternoon at the Central London Ophthalmic Hospital, Judd-street, W.C. During the congress a museum of objects of ophthalmic interest will be exhibited in the Bowman library at the Royal Society of Medicine. Communications respecting the scientific meetings should be addressed to Mr. G. Coats, 50, Queen Anne-street, W., respecting. the museum to Mr. M. S. Mayou, 30, Cavendish-square, W., and respecting the dinner to Mr. Elmore Brewerton, 84, Wimpole-street, W.
always be obtained in large numbers, but [for the administrative duties of the medical service long and varied training is necessary. Everyone knows and acknowledges the importance and the difficulties of the supply department in war; but it has only recently been realised that it is as difficult a problem to get a wounded man down to the base as to get a dead bullock up to the front. In war time it is not the performance of brilliant surgical operations, nor the successful treatment of serious diseases, that constitutes the chief value of the medical department; this depends on the prevention of disease, the rapid evacuation of sick and wounded, and the immediate treatment of minor ailments and injuries, so as to get the men back to the fighting line as quickly as possible. All this requires careful organisation, and Colonel Purdy mentions that New South Wales was the first country in the world to possess a properly organised,. properly equipped medical force that was the admiration of all who saw it working in South Africa. In another paper Colonel Purdy, speaking from his experience in the South African war as to water supply in the field, states his firm opinion that the best and most rational system is to encourage every man to boil water for himself. If made into tea, as was done by the Australians in the war, the practice is both effectual and popular. OCEANOGRAPHY AND
DURING
some
extensive
PUBLIC
HEALTH.
oceanographic investiga-
tions, conducted mainly with the object of localising distant icebergs by observations upon the electroconductivity of sea water, Dr. Myer Coplans, of£
Leeds University, happened by chance upon certain facts which may have an important bearing on the health of passengers on Atlantic liners. By means NAVAL AND MILITARY MEDICINE AT THE of a compensated conductivity salinometer of his ANTIPODES. own invention Dr. Coplans estimates the electric THE British public are not likely to forget the conductivity of the water 18 feet below the surface, patriotism so vigorously demonstrated by our and is thus enabled to deduce the degree of its Whether this method will provide an Colonial kinsmen during the war in South Africa, salinity. and it is not too much to say that our home infallible indication of the neighbourhood of icemilitary authorities found a good deal to learn from bergs is not yet proved;if it does, the travelling. the capable and energetic methods of administra- public will have much to thank Dr. Coplans While measuring the electro-conductivity In Australasia for. tion of the daughter States. military training is now compulsory on all male of the water in the Gulf of St. Lawrence citizens; from the age of 12 to 18 in cadet corps, he found that near the mouth of each tributary and from 20 to 26 as citizen soldiers; in New river there is a rise in the salinity of the water. Zealand the liability ceases at 25. Colonel James R. The water of Lake St. Peter and above was much Purdy, Director of Medical Services, New Zealand, more pregnant with saline products than that of makes some very pertinent observations in a book the tributaries below Three Rivers and Quebec. which he has just published and in which an This result he ascribes to the fact that the sewage address delivered by him at the Australasian from Ottawa and Montreal is largely deposited in Medical Congress of 1911 is reproduced. Colonel the broad expanse of Lake St. Peter. The importPurdy urges that only the very best youth of ance of this resides in the fact that the ocean-going the country should be taken for the army. steamships plying to and from Montreal take their There is no sense in training up a soldier fresh water from this place. If Dr. Coplans’s conto fight, and when the day of battle comes tention that this water is in reality heavily confinding he is unable for physical reasons to taminated with sewage is correct it is obviously a. do so. He has satisfied himself that only men of matter of the greatest importance that ship-owners. the very highest stamp of physical development should know this and act upon it. It is to be hoped can possibly stand the stress of modern methods of that the authorities will take steps to ascertain he 40 considers of that cent. the warfare; youth whether this water is or is not bacterially per of Australasia are for some cause or other unfit for infected, and that meanwhile it will be treated efficient military service, but believes that in a few as under some suspicion. That this question years, owing to the great improvement in physique of public health should arise out of researches effected by physical training, this percentage of undertaken for the detection of invisible iceunfitness will be very greatly reduced. He insists bergs at sea is only another instance of the on the need for all-round military training for the unexpected gifts with which science proverbially medical officer. For the actual treatment of ! rewards now and then her patient followers. The army sick and wounded in war civilian practitioners cansignificance of these observations in the St.Lawrence