PANEL AND CONTRACT PRACTICE

PANEL AND CONTRACT PRACTICE

965

20 grains of pure chloral hydrate and half an by no means least, Vivian Poore, a master both of of the fresh infusion of digitalis at 9 P.M. on clinical medicine and of epigram. the first day of the illness, giving another grs. 10 an References have been made to Bradford’s remarkhour later if the patient were awake. able memory. I have often heard Bradford himself The next and following days the patient had chloral speak of this gift as a striking quality of Poore’s grs. 20, with the digitalis night and morning if genius, who, years after the event, would remind his necessary, and no other medicine ; for nourishment listeners of the clinical features of a particular case in a particular bed in Ward IX of the old U.C.H. 8 oz. of milk and half an ounce of brandy every two hours if he were awake. As a matter of fact, these Of Bradford’s early triumphs in physiology, patients seldom sleep more than two hours on a and his almost precocious capture of the F.R.S., stretch, but the sum total during 24 hours is often others better qualified have spoken. We remember 10 to 12 hours, with comfortable drowsiness between. him as the quiet helper and steadfast friend, and a If sleep should be prolonged beyond four hours they personal instance will serve as an illustration. I had should be roused for nourishment, but never to take not seen him for nearly ten years when I unexpectedly the temperature. On no consideration whatever met him in France in 1918. In the uniform of a should an alkali be given with chloral hydrate. major-general, and wearing the ribbons of the I am, Sir, yours faithfully, K.C.M.G. and C.B., his spare, slightly stooping figure T. PAGAN LOWE. contrasted somewhat strangely with those to which April llth. one had become accustomed during four years of war. SIR JOHN ROSE BRADFORD And, in a moment it was Bradford and no other. In To the Editor of THE LANCET the same quiet voice he expressed the same measured an when are SiR,-In age octogenarians plentiful, concern for what I was doing, and asked how things and even nonagenarians by no means rare, the were going with me. It was as if we had parted but passing of Rose Bradford will, to his many pupils the week before-so unfailing was his memory, and friends-the terms are synonymous-seem so unswerving his sympathy. And U.C.S., U.C.L., and U.C.H. will for many grievously premature. Memory takes one back to 1889 when he won the Gold Medal at the London generations bear the imprint of the character and M.D. Exam., an honour which, for several years example of the most distinguished and lovable thereabouts, was " farmed " by U.C.H. Bradford personality who has ever crossed the threshold of all I am, Sir, yours faithfully, inherited the teaching of a gifted band-Jenner, three. ERNEST STORK. Quain, Bastian, Ringer, Freddy " Roberts, and, Bury St. Edmundss April 13th.

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PANEL AND CONTRACT PRACTICE and the requirement to furnish is equally insistent. A Large Industrial Group practitioner in the North of England is likely to have AT the annual meeting of the National Federation this fact brought rather sharply to his notice if the of Employees’ Approved Societies a claim was made recommendation of the local insurance committee is by the president, Mr. Henry Lesser, that the sickness adopted by the Minister of Health. On two previous statistics compiled each year by the Federation are occasions this practitioner had been fined owing to unique in this country for the picture they give of his failure to transmit forms of medical record on occupational sickness. Details for 1934 are not yet demand. Between June 22nd and Dec. 10th, 1934, available, but he was able to give the benefit per repeated applications were made to him without avail member as 11-21 days for men and 10-35 days for for the return to the committee of the medical records women, being a slight improvement in the one case of 42 insured persons lemoved from his list, and and a slight setback in the other. The number of between Dec. 10th, when the matter was referred to claims paid in 1934 was, however, lower than in 1933, the medical service subcommittee for investigation, both for men and women. Expenditure on influenza and Jan. 24th, 1935, further application had been made was notably less in 1934 than in 1933, but in almost without avail for the return of 49 more records. The every other group of diseases there were small practitioner admitted his omission to return them, increases. Incapacity among men from nervous giving as the reason for his failure to do so that he had diseases had, he said, increased steadily from 0-99 been ill and had from time to time employed a locum days per member in 1929 to 1-59 days per member tenens to help him in his practice, but preferred to Sickness in

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in 1934 ; in women, on the other hand, the amount of illness from this cause had remained stationary. Reviewing the sickness experience of the last six years he found no indication of any lowering of the general standard of health among the members ; the rate of sickness remained slightly below that of 1929. This encouraging result might, Mr. Lesser remarked, be attributed " to some extent at least " to improved medical service provided under the National Health Insurance Acts. A Costly Omission 9 Clause (12) of the terms of service requires an insurance practitioner to keep and furnish records of the diseases of his patients and of his treatment of them in such form as the Minister may determine. Some practitioners appear still to be under a misapprehension as to the meaning of the words " to keep." Reference to the context will show that the requirement is to keep the record in the sense of compiling it,

attend to the clerical side of his work himself. Notwithstanding his undertaking to return the records within a week or so, and his statement that he realised the serious nature of his omission, the insurance committee decided to make representations to the Minister that, owing to his repeated failure to comply with the terms of service, the conditions on which the money for defraying the cost of medical benefit is payable to the committee had not been fulfilled and that the sum of n5 should be withheld, such sum to be recovered by deduction from his own remuneration. This appears to be a case where it would have been cheaper for the practitioner to have obtained clerical assistance. Personal Attendance Overdone ? A London practitioner has incurred trouble for himself by an endeavour to do his best for the patient instead of handing over his responsibility to a hospital.

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MEDICINE AND THE LAW

patient was seen by this practitioner and his partner alternately twice in October and twice early

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in November. On the occasion of the first consultation he complained of sore-throat and cough ; his chest was examined and his heart was found to be in a weak state ; the cough was considered to be due to pharyngitis. On Nov. 6th the man attended the was and seen surgery by the partner who, on examination, found him suffering from palpitation and shortness of breath on exertion, bruit of mitral disease with dilatation of the right side of the heart, moist rales all over the chest, temperature normal, sputum greyish, and oedema of feet. The partner diagnosed heart failure and advised bed, pointing out the vital importance of rest. Visits were made to the patient four times up to Nov. 27th, and on the 29th idem he attended at the surgery and was instructed to return to bed. Further visits were paid on Dec. 3rd, 6th, and 10th, on the last of which dates, after an interview with the patient’s brother, the partner arranged for the removal of the patient to a local hospital. After admission raised evening temperatures suggested the desirability of X ray and sputum tests ; the former indicated a tuberculous condition of the lung and the latter the scanty presence of tubercle bacilli. The patient died in hospital on Jan. 13th. His brother, who made a complaint to the insurance committee, did not allege neglect against either the practitioner or his partner in so far as their treatment of the patient was concerned ; but he thought that if the existence of tuberculosis had been diagnosed earlier life might have been prolonged. He suggested that the partner was negligent in not having arranged earlier for admission to hospital, and referred to the fact that other residents in the house where his brother lodged were not aware of the necessity for precautionary measures against infection. In his evidence to the medical service subcommittee the practitioner stated that symptoms associated with mitral stenosis, from which the insured person was suffering, would produce exactly the symptoms found. There were no symptoms, such as night sweats, indicative of the existence of tuberculosis, and having regard to the diseased condition of his heart the cough was regarded as due to that condition. The insured person seems to a large extent to have disregarded the advice to have complete rest in bed, inasmuch as on every occasion on which he was visited he was found out of bed. The committee expressed themselves satisfied that both the practitioner and his partner gave proper and sufficient attention to the case and that they were in no way negligent in not arranging earlier for the admission of the patient to hospital. On the contrary, the fact that the partner continued to treat the insured person in respect of his very serious heart condition, rather than absolve himself of responsibility by sending the patient to hospital, suggested that he was taking a genuine interest in the case.

SOCIETY FOR PROVISION OF BIRTH CONTROL CLINICS. A lecture on the theory and practice of contraception will be given to medical practitioners and students by Dr. Gladys Cox on Friday, May 3rd, at the Walworth Women’s Welfare Centre, at 6 P.M. At the centre demonstrations will be given at 6 P.M. and at 7 P.M. on Friday, May 10th, and at the same hours on Friday, May 17th. The fee for the lectures and demonstrations at the centre is 5s. ;they are open to medical practitioners and students who have completed their gynaecological course, and those wishing to be present are asked to signify at which of the alternative hours they wish to attend.

MEDICINE AND THE LAW

Damages for Dead Person’s Sufferings UNACCUSTOMED consequences are flowing from the new legal rule that a living person may obtain damages for pain and suffering negligently inflicted It remains to be seen how far on a dead person. the rule will go in the field of professional negligence. Meanwhile, it is having its natural application in connexion with traffic injuries, as is illustrated by the case of Rose v. Ford recently decided at Birmingham assizes. A woman was injured by a careless motorist; her leg had to be amputated and, four days after the accident, she died. Her father sued the motorist for damages. Before 1934 there was a legal maxim that personal actions died with the person concerned ; the judges had evolved the rule that in a civil court the death of a human being could not be complained of as an injury. To this rule an exception was made by the Fatal Accidents Act, sometimes called Lord Campbell’s Act, in 1846. Under this statute it became possible for a wife, husband, parent, or child to bring an action for damages where death had been caused by wrongful act, neglect, or default. In the Birmingham case the father obtained 300 damages under this Act as he could have done before 1934. But he also obtained E500 damages under the new law. Had his daughter lived, she would have been entitled to damages for the pain and suffering caused by the motorist’s negligence and for the loss of her leg. The Law Reform (Miscellaneous Provisions) Act of last year introduced the general principle (subject to certain exceptions and limitations) that on death all causes of action on which the dead person might have sued are henceforth to survive for the benefit ofthe dead person’s estate. Thus the father could obtain the E500 for the four days of pain and suffering endured by his dead daughter and for the loss of her leg. Counsel for the defendant motorist sought to resist the claim or to diminish the damages by an argument which was really an attack upon the new law. Suppose, he said, a man has left all his to the British Museum and is run over and property a injured by motorist and dies of his injuries a week later ; would it not be absurd that an institution like the British Museum should be entitled to stand in the dead man’s shoes and to recover damages for personal injuries and suffering which an impersonal body cannot feel ? The argument, however, met with no success. In one respect the plaintiff failed in the Birmingham case. The father had claimed damages ’not only for his daughter’s sufferings and the amputation, but also for the shortening of her expectation of life. Under this last heading Mr. Justice Humphreys declined to allow the father any damages because there was, he said, no evidence that she suffered mentally on account of that shortened expectation. Not long ago the Court of Appeal confirmed a judgment by Mr. Justice Acton (Flint v. Lovell) awarding 4000 for shortened expectation of life to a man of 70 who, by injury in a motoring accident, had lost the prospect of an " enjoyable, vigorous, and happy old age," and was now, according to the medical evidence, not likely to live for another year. If a living person can thus obtain damages for shortened expectation of life, will not a similar course of action survive to the estate of a dead person ?It is worth noting that Sir Frederick Pollock, a high authority, has lately criticised the Court of Appeal for its attitude in Flint v. Lovell. The veteran jurist has no objection to the calculation of shortened expectation by