1069 ctfect of nitrite of amyl upon the pulmonary arteriolcs. This clear demonstration of the action of nitrite of amyl shows the value of that agent ...

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1069 ctfect of nitrite of amyl upon the pulmonary arteriolcs. This clear demonstration of the action of nitrite of amyl shows the value of that agent as an aid to artificial resPim-1 tion in all cases of suspended animation from apnoea. What-

cause of the apnoea,, whether hanging or the inhalation of an azotic gas such as nitrous oxide or nitrogen, a blow on the head or mechanical injury of the brain, the shock of lightning or electricityin each and all of these cases the relaxation of the pulmonary arterioles by the vapour of amyl nitrite has a double effect, (1) it immediately lessens the weakening over-distension of the right cavities of the heart ; (2) by allowing the blood to pass on to the left side of the heart and so to the coronary arteries, the contractile power of the heart’s walls, which had been impaired by anaemia resulting from the arrested pulmonary circulation, is in-





I nm. Sirs.





Savile-row, Oct. 14th, 1895.

"THE BATTLE OF THE CLUBS." To the Editors of Tiiii LAKCET. SlES,—After many days it seems that the seed which of


been winked at can be easily proved, for within a very short space of time I have examined for a society either nineor ten members certified to be suffering from various complaints ; in only one instance was there the least evidence of disease or infirmity, and my decision-that with this. single exception they were able to work-was disputed by only one member, who was afterwards examined by an independent medical man and expelled from the society. Now, Sirs, I do not wish to justify the action of those’ medical associations that treat their surgeons as mere moneymaking machines but 1 do say that friendly societies havea right to provide themselves with the best medical attendance for the money they can afford to spend ; and, furthermore, I would add that in my opinion the dignity of’ the profession is as gate in the keeping of medical aid surgeons as it is in the hands of those whose only right to. dictate is that the practice they purchased has been reduced in value by the action of the clubs. I have been medical officer to an association for over three years, and I challenge any medical man in the district to prove me guilty of’ the slightest breach of medical etiquette. Before medical’ aid associations were brought under the notice of the General Medical Council I wrote to Dr. Leslie Phillips offering to resign my position if lie thought by doing so I would benefit. the profession. I am still prepared to act in the same. manner under a like condition. I am. Sirs. vours faithfullv. N. L. USHER SOMERS. High-street, West Bromwich, Oct. 20th, 1895.

I has

have been persistently, if somewhat feebly, sowing is taking root, and here and there springing up. We have to ,how that we are not acting selfishly, but as much in the interest of the sick poor as our own. Provident arrangements made in accordance with the just demands of the profession tend to encourage independence in the working class and to obviate pauperism. Provident arrangements forced To the Editors of THE LANCET. upon the profession by syndicates and insurance societies on have no wish to prolong this correspondence, but. Sms,-I their own terms, and chieiiy in their own supposed interests, must again assert that our balance on the year’s (1894) the class and the pauperise working degrade profession. Our was £40, and not £200 as stated by you. have become working Eastbourne, Portsmouth, Lincoln, &c., for 1894 was E989 10.’!. 2d. and payments £949 1s. ld., centres of revolt against impositions which have become receipts as per my previous. unbearable. It is necessary now that the movement leaving balance on year of £40 9s. ld., letter. I am, Sirs, vours faithfully, become national and should cease to be merely local. WM. COULSON, Secretary. 1 would suggest that in each town and district throughout Lincoln Oddfellows’ Medical Institute, the country medical unions should be formed, and that each Lincoln, Oct. 22nd, 1895. us

union should regulate the provident question in its own district on the lines of the Eastbourne arrangement, modified according to the needs of each locality. Existing friendly societies and medical aid associations can easily make arrangements with the practitioners of their district, and those of their medical officers who have earnecl the respect and esteem of their clients will at once step into a position of comparative independence with a chance of private practice. All that these societies have to do is to accept the "wage limit," to consent to a reasonable provident payment, and the principle that each head of a household shall choose his own medical attendant without the presence of can-

vassing or touting. To accomplish this in the profession Loughborough,


We refer *** institute for the

"HOSPITAL ABUSE AT BRIGHTON." To the Editors of THE LANCET. SIRS,—In the interest of accuracy I beg your insertion of a quotation in my letter of Sept. 24th side by side with Dr.



18th, 1895.




J. B.


deduction therefrom in your issue of Oct. 12th :searching scrutiny...... "According to Dr. A. J. Richard-

VTaring’s "A

showed that 96 per cent. of the cases

all that is necessary i., united action

Mr. Coulson to the balance-sheet of the. year in question and our words.-ED. L.



son 4 per cent. of the caseswhich were treated were not enfor gra- titled to charity." ......


fit and proper subjects tuitous treatment, and though in the remaining 4 per cent. sufficient information could not be obtained, it was thought that even in these cases, were closer scrutiny possible, it might be shown that several could be received without any abuse of the cliarity."

To the Editors of THE LANCET. to a medical aid association I beg to take exception to the ab uno disce omnes strain of Mr. Lionel Stretton’s letter published in THE LANCET of the In my above-quoted extract from the hospital report it is 19th inst. That certain abuses do exist in the management evident that, when the Iseveralwho could be received’ of several medical aid associations and that these abuses are without abuse are subtracted from the 4 per cent., 4. countenanced by the medical officers I admit; but I am I cannot remain. Having been a member of the sub-committee unwilling to acknowledge that this is the rule, not the which drew up this very clause, I may explain that this exception. In order to justify the existence of these institu- 4 per cent. was made up of three groups: (1) the unfit for tions we must consider the causes which led to their forma- charity; (2) the cases which it was impossible to duly tion. In the first instance, medical men confided the care investigate ; and (3) the cases it was inadvisable to further Now neither I nor the of their club patients to the tender mercies of unqualified investigate for various reasons. the proportions of these have of the club notes were to given hospital assistants; secondly, secretary frequently given I a.m. Sirs. vours faithfullv. malingerers in order to secure their votes ; and, lastly, three groups. A. J. RICHARDSON. cases of gross imposition were often winked at. To procure the services of a medical attendant whose qualifications St. John’s-terrace, West Brighton, Vet. ittn, 1HHO. would be guaranteed friendly societies were obliged to cooperate, and in order to make their medical officers inde"OVER-OPERATING IN GYNÆCOLOGY." pendent of individual members, as a precaution against fraud, it was found necessary to pay a fixed salary. To prove that To t7te Editors of THE LANCET. this state of affairs did exist I should not have to go a SIRS,-I shall be glad if you will kindly allow me space tothousand miles from home, but could instance several cases not far away where the wives of club patients have been state that I was careful not to fall into the error suggested attended by unqualified assistants,and at present there is prac- by Mr. Tait in his letter of Oct. 12th, and that I did not refer to undertaken for the relief of uterinetising in the district an individual whose only pretention to mvoma. operationsI am. Sirs. vnnrs faithfully. qualification is that he was assistant to a local practitioner JOHN F. BULLAR. Southampton, Oct. 22nd, 1895. the greater part of whose club practice he managed for some time. That imposition by certain friendly society members *** This correspondence must now cease.-Eu. L.

SIRS,—As medical officer