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NOTIFICATION AND PROFESSIONAL COURTESY.
599 on the patient. There are circumstances in which it may be reasonable not to press this course ; but it is the normal one, and should always be proposed by the con-
attendance
sultant.-ED. L.
"THE
-
MEDICAL PROFESSION AND ’STORES’ SYSTEM." To the Editors of THE LANCET.
THE
SIRs,-I feel called upon to make some remarks on the article which appeared in THE LANCET of Aug. 25th under the above heading, because if I am not the individual actually referred to as "Oculist" I bear a very striking resemblance to him. My observations would apply solely to that part of your article that deals with "oculists," and I wish it to be understood that I neither express nor imply any opinion upon the other matters dealt with. and which, I understand, apply to another association. You say that such an "arrangement" as you believe to exist is both objectionable and unnecessary. Two objections are pointed out :-(a) That it involves advertisement of the names of practitioners and their being sent promiscuously to the patients of other practitioners. As neither the name nor the fee can be ascertained except upon inquiry this objection falls to the ground. (b) " The tendency of such arrangements is to attract shabby or ungenerous persons who wish to pay less than they can afEord." It is apparently your opinion that it is the duty of patients to pay as much as they can aSord; but let that pass. I am no advocate for "arrangements" by which a medical man pays a visit for about the same fee as the dustman, but I do not see how the objection applies when the fee is one which will nearly always be accepted if "circumstances" are pleaded-one which is universal except at a firat visit, and one which till a few years ago was usual even for a first visit, and is still believed to be so by some patients. It is said that such an arrangement is unnecessary. In exact proportion as it is unnecessary it will be inoperative. The necessity has, however, arisen, and will arise again. Members go to the "Stores" for glasses, not, as a rule, because they are "shabby or ungenerous," but because they honestly believe that testing for glasses is a mechanical process which can be carried out by an optician ; and it must be admitted that in the majority of adult patients the optician obtains results which are alarmingly accurate. If the business is to be conducted honestly, patients must frequently be told that they must get a prescription. The Association wishes to have one or more names of surgeons whom they believe to be reliable, to whom they may refer such patients as desire it. The wish seems to me to be a perfectly legitimate one on the part of the Association, and one which on the part of the surgeon. can be honourably met Such patients have too frequently in the past gone to the nearest hospital. There are two more points on which I must touch. A prescription form is referred to as if it were the property of the "oculist." This is misleading ; it is merely a blank form for prescribing glasses, and the name and address of the surgeon are detachable ; it forms no part of the prescription, and is only to be given when asked for. Lastly, the paragraph in the "programme" which is quoted in full. Some announcement to members of a new arrangement was thought necessary. The paragraph was not meant to attract the "shabby and ungenerous" public. It is intended to apply only to refraction cases, and not to "professional advice" in any wider sense, hence the use of the term "oculist." But it evidently might be taken to mean more than it does, and it might encourage patients to go to the "Stores"for their glasses in the first instance. For these reasons neither this nor any similar paragraph will appear in future editions, as long as the present writer has any connexion with the "Association."—I am, Sirs, yours truly, " OCULIST." Aug. 28th, 1894.
and has continued his visits, so that I have not since. my patient. I wrote to the lady of the house for an explanation, and she informed me that the medical officer of health told her as he was leaving that he would come again on the morrow. She expressed her astonishment at thenecessity of a second visit from him, but thought it was part. of his duties as medical oflicer of health ; consequently he. had made one or two visits before she discovered how matters stood. She states in a letter to me that she did not send for or ask this medical officer of health to attend her daughter, and that the only intimation of illness at her house which he. had received was the notice I had sent to him myself. The questions I wish to put may be of interest and importance to. many practitioners who are in districts where the Infectious. Diseases’ Notification Act is made law. Is a man bound to. report to the sanitary authorities an infectious case when he ruus such a risk of having his case taken from him by one of their officers ? Is it not generally understood that the medical practitioner who reports a case is in attendance on that case ? Is a medical officer of health overstepping hisduties when he examines and prescribes for a patient after receiving a notice from the practitioner in attendance and without the latter’a presence ? What redress can a medical practitioner claim for the loss of a patient under such circumstances, and before whom should he place his. I am of opinion that such affairs are a perfect nuisance to medical practitioners, and it comes very hard on them because a certain law compels them to make a report to another man of an illness at a certain house, which induces that man to take the case out of their hands. Is the sanitary board responsible for such behaviour of their medical officer of health ? I would suggest that the Local Government Board regulations might be reformed with. advantage, for I do not think that in this age of sanitary science men in general practice are the proper persons to be appointed medical officers of health ; and, again, familiesnot infrequently change their medical attendant, and it must become very irksome to medical officers of health when. they have to visit, on the report of another man, a house they were in the habit of attending formerly, and just as disagreeable for the man who has to make the report. I am sure that if some alterations in the rules were instituted it. would prevent many such unpleasant circumstances as I have. I am, Sirs, yours faithfully, related. case
seen
grievances ?
GENERAL PRACTITIONER.
DEATHS UNDER CHLOROFORM. To the Editors of THE LANCET. of death under chloroform which haveSIRS,-The been recently recorded, and others which have recently occurred but have not been recorded suggest the questioncases
was chloroform given ? They were all patients who could have taken ether quite readily,yet chloroform was preferred with fatal result. Chloroform is the anaesthetic liked by the patient, and it is easier for the surgeon to give, but the fact remains that it is very fatal and that no amount of auscultation of the chest or other investigation will give information which will enable anyone to say whether the patient will take it safely or not. There are fome cases for which chloroform is the only anaesthetic that can be used, but for all ordinary cases ether should be given. The surgeon who deliberately gives chloroform instead of ether and loses his patient exposes himself, in my mind, to the charge of manslaughter, unless able togive very good reason for his choice of the anaesthetic. TheNo one can gainsay this. A one is safe, the other is not. common sense rule to make in all our hospitals would be one to compel the anaesthetist to give ether only without the express permission of the surgeon in charge of the patient. There would be fewer deaths. I am, Sirs, yours faithfully, A HOSPITAL SURGEON. Sept. 5th, 1894.
Why
-
.
_._
NOTIFICATION AND PROFESSIONAL COURTESY. To the Editors af- THE LANCET.
SIRS,-I would like
to trouble you for advice on the followmatter. I was attending a case of scarlet fever. The Infectious Disease Notification Act being in force in this district, I reported the case in proper manner to the medical officer of health, who, from the time of his first visit, attended the
ing
.
_,.__
(FROM
TT"".....
-
n___-
LIVERPOOL. CORRESPONDENT.)
OUR OWN
The Proposed Crematoium. WHATEVER diversities of opinion may exist as to the propriety of cremation as a mode of disposal of the dead, there can be no doubt that it is faeourably regarded by a
attendance
sultant.-ED. L.
"THE
-
MEDICAL PROFESSION AND ’STORES’ SYSTEM." To the Editors of THE LANCET.
THE
SIRs,-I feel called upon to make some remarks on the article which appeared in THE LANCET of Aug. 25th under the above heading, because if I am not the individual actually referred to as "Oculist" I bear a very striking resemblance to him. My observations would apply solely to that part of your article that deals with "oculists," and I wish it to be understood that I neither express nor imply any opinion upon the other matters dealt with. and which, I understand, apply to another association. You say that such an "arrangement" as you believe to exist is both objectionable and unnecessary. Two objections are pointed out :-(a) That it involves advertisement of the names of practitioners and their being sent promiscuously to the patients of other practitioners. As neither the name nor the fee can be ascertained except upon inquiry this objection falls to the ground. (b) " The tendency of such arrangements is to attract shabby or ungenerous persons who wish to pay less than they can afEord." It is apparently your opinion that it is the duty of patients to pay as much as they can aSord; but let that pass. I am no advocate for "arrangements" by which a medical man pays a visit for about the same fee as the dustman, but I do not see how the objection applies when the fee is one which will nearly always be accepted if "circumstances" are pleaded-one which is universal except at a firat visit, and one which till a few years ago was usual even for a first visit, and is still believed to be so by some patients. It is said that such an arrangement is unnecessary. In exact proportion as it is unnecessary it will be inoperative. The necessity has, however, arisen, and will arise again. Members go to the "Stores" for glasses, not, as a rule, because they are "shabby or ungenerous," but because they honestly believe that testing for glasses is a mechanical process which can be carried out by an optician ; and it must be admitted that in the majority of adult patients the optician obtains results which are alarmingly accurate. If the business is to be conducted honestly, patients must frequently be told that they must get a prescription. The Association wishes to have one or more names of surgeons whom they believe to be reliable, to whom they may refer such patients as desire it. The wish seems to me to be a perfectly legitimate one on the part of the Association, and one which on the part of the surgeon. can be honourably met Such patients have too frequently in the past gone to the nearest hospital. There are two more points on which I must touch. A prescription form is referred to as if it were the property of the "oculist." This is misleading ; it is merely a blank form for prescribing glasses, and the name and address of the surgeon are detachable ; it forms no part of the prescription, and is only to be given when asked for. Lastly, the paragraph in the "programme" which is quoted in full. Some announcement to members of a new arrangement was thought necessary. The paragraph was not meant to attract the "shabby and ungenerous" public. It is intended to apply only to refraction cases, and not to "professional advice" in any wider sense, hence the use of the term "oculist." But it evidently might be taken to mean more than it does, and it might encourage patients to go to the "Stores"for their glasses in the first instance. For these reasons neither this nor any similar paragraph will appear in future editions, as long as the present writer has any connexion with the "Association."—I am, Sirs, yours truly, " OCULIST." Aug. 28th, 1894.
and has continued his visits, so that I have not since. my patient. I wrote to the lady of the house for an explanation, and she informed me that the medical officer of health told her as he was leaving that he would come again on the morrow. She expressed her astonishment at thenecessity of a second visit from him, but thought it was part. of his duties as medical oflicer of health ; consequently he. had made one or two visits before she discovered how matters stood. She states in a letter to me that she did not send for or ask this medical officer of health to attend her daughter, and that the only intimation of illness at her house which he. had received was the notice I had sent to him myself. The questions I wish to put may be of interest and importance to. many practitioners who are in districts where the Infectious. Diseases’ Notification Act is made law. Is a man bound to. report to the sanitary authorities an infectious case when he ruus such a risk of having his case taken from him by one of their officers ? Is it not generally understood that the medical practitioner who reports a case is in attendance on that case ? Is a medical officer of health overstepping hisduties when he examines and prescribes for a patient after receiving a notice from the practitioner in attendance and without the latter’a presence ? What redress can a medical practitioner claim for the loss of a patient under such circumstances, and before whom should he place his. I am of opinion that such affairs are a perfect nuisance to medical practitioners, and it comes very hard on them because a certain law compels them to make a report to another man of an illness at a certain house, which induces that man to take the case out of their hands. Is the sanitary board responsible for such behaviour of their medical officer of health ? I would suggest that the Local Government Board regulations might be reformed with. advantage, for I do not think that in this age of sanitary science men in general practice are the proper persons to be appointed medical officers of health ; and, again, familiesnot infrequently change their medical attendant, and it must become very irksome to medical officers of health when. they have to visit, on the report of another man, a house they were in the habit of attending formerly, and just as disagreeable for the man who has to make the report. I am sure that if some alterations in the rules were instituted it. would prevent many such unpleasant circumstances as I have. I am, Sirs, yours faithfully, related. case
seen
grievances ?
GENERAL PRACTITIONER.
DEATHS UNDER CHLOROFORM. To the Editors of THE LANCET. of death under chloroform which haveSIRS,-The been recently recorded, and others which have recently occurred but have not been recorded suggest the questioncases
was chloroform given ? They were all patients who could have taken ether quite readily,yet chloroform was preferred with fatal result. Chloroform is the anaesthetic liked by the patient, and it is easier for the surgeon to give, but the fact remains that it is very fatal and that no amount of auscultation of the chest or other investigation will give information which will enable anyone to say whether the patient will take it safely or not. There are fome cases for which chloroform is the only anaesthetic that can be used, but for all ordinary cases ether should be given. The surgeon who deliberately gives chloroform instead of ether and loses his patient exposes himself, in my mind, to the charge of manslaughter, unless able togive very good reason for his choice of the anaesthetic. TheNo one can gainsay this. A one is safe, the other is not. common sense rule to make in all our hospitals would be one to compel the anaesthetist to give ether only without the express permission of the surgeon in charge of the patient. There would be fewer deaths. I am, Sirs, yours faithfully, A HOSPITAL SURGEON. Sept. 5th, 1894.
Why
-
.
_._
NOTIFICATION AND PROFESSIONAL COURTESY. To the Editors af- THE LANCET.
SIRS,-I would like
to trouble you for advice on the followmatter. I was attending a case of scarlet fever. The Infectious Disease Notification Act being in force in this district, I reported the case in proper manner to the medical officer of health, who, from the time of his first visit, attended the
ing
.
_,.__
(FROM
TT"".....
-
n___-
LIVERPOOL. CORRESPONDENT.)
OUR OWN
The Proposed Crematoium. WHATEVER diversities of opinion may exist as to the propriety of cremation as a mode of disposal of the dead, there can be no doubt that it is faeourably regarded by a