- Email: [email protected]
STOCK ALLEGATIONS AGAINST INSURANCE DOCTORS.
352 the low For use
flats-all necessitate careful consideration. the reservation the water is pumped to settling tanks, where the suspended matter is first precipitated by coagulation with aluminum sulphate, after which the water is passed through sand filters. This purification is further supplemented by disinfecting the water with liquid chlorine. Mosquitoes, it is noted, have been practically exterminated by the usual methods. The reservation offers many facilities for research work, particularly in various phases of sanitary engineering. Its position is suitable for the establishment of a school for the teaching of public health administration. on
---
THE FUTURE OF RED CROSS CLINICS. SCATTERED over the country are a number of clinics founded by the Red Cross for the treatment of the wounded. Now that pensioners under treatment are happily becoming fewer, a movement is being made to retain the services of these clinics for civilian patients. Physical therapy in the treatment of injury and disease is becoming more and more widely recognised, and there are comparatively few large city hospitals where a department devoted to this treatment cannot be found. But the expense of securing this treatment in private is considerable, and a large section of the community is rightly unwilling to attend hospital for treatment, and yet cannot afford to pay for it to be administered privately or in their own homes. For these the proposed transfer of the Red Cross clinics to civilian work will be an incalculable boon, and may well be carried through provided sundry safeguards are observed. We may classify these as affecting the medical men of the district, the patient, and the Little opposition will arise practising masseur. from medical men provided that patients are admitted to the clinics only on the recommendation of a qualified medical practitioner. This would protect the clinic from the patient who casually drops in for treatment without the knowledge or consent of his doctor. Patients must be safeguarded by placing the clinic under the care of a medical man specially qualified to prescribe details of treatment, and able to supervise and control everything that is done on their behalf. The interests of the practising masseur should be safeguarded by ensuring that only patients who are unable to pay the fees for private treatment usual in the district are received as patients of the clinic. This would entail the employment of an almoner or some other person suitably skilled in social service work. Should the clinics be run in any sense as competitors with the private masseur, great hardship would be inflicted. Granted these safeguards, we welcome the proposed transfer.
briefly
TUMOURS
OF
THE
BONY
CHEST
WALL.
ACCORDING: to ]Jr. U. A. liedk)loiii,l of the
Clinic, tumours of the bony chest wall
are
Mayo
compara-
rare. He has collected 213 cases, including 48 from the Mayo Clinic, 23 of which came to operation, and 25 in which operation was not performed. In 167, or 78-7 per cent. of the 213 cases, the tumours were of the ribs, and 46, or 21-3 per cent., were of the sternum. 61.4 per cent. were sarcoma, and 18 per cent. were chondroma, the ribs being primarily involved in 78-7 per cent., the sternum in 21-3 per Of the Mayo Clinic cases,2 were examples cent. of recurrent carcinoma following amputation of the breast in the female, in 2 the primary growth was in the male breast, 1 was a hypernephroma secondary to a tumour of the kidney on the same side, and I was secondary to a cancer of the thyroid. Although there is usually no history of trauma in tumours of the chest wall, the absence of such a history is no proof that the origin of the tumour was not traumatic. Minor injuries, .as Dr. Hedblorn points out, are as a rule quickly forgotten. Moreover, chest tumours are
tively
1
Archives of Surgery. July, 1921.
in males who are more liable to injury, and the area involved is usually the more exposed anterior and lateral portion of the chest. It is probable therefore that in some cases at least trauma plays a part in the setiology both with regard to incidenc& and the malignant degeneration of the benign forms. Apart from the presence of a tumour, pain, which may be present before there is any discernible growth, is the most characteristic symptom both in benign and malignant tumours, being present in 50 per cent. of the 213 cases. Loss of weight was noted in 15, or 31-2 per cent., dyspnoea was present in only 4 cases, and effusion in 2. In typical well advanced cases the diagnosis of neoplasm is certain, but in early Cold abscess, cases a diagnosis may be impossible. exostosis, gumma, aneurysm, and dermoid cyst must be differentiated. Early radical extirpation, which was performed in 10 of the 48 Mayo Clinic cases, is the treatment of choice, while late radical or palliativeextirpation, which was performed in 13 ofthose cases, may result in a relatively long period of freedom from recurrence even in the presence of extensive involvement. The contra-indications to operation are metastases, very extensive involvement, periostitis, and advanced cachexia. Intratracheal or intracommoner
pharyngeal insufflation anaesthesia affords an effective means of preventing operative pneumothorax. Shock,
pneumonia, of death
and empyema
are
the commonest
causes
following operation.
STOCK ALLEGATIONS AGAINST INSURANCE
DOCTORS. AT the recent delegates’ meeting of the High Court of the Ancient Order of Foresters, held at Leeds, serious charges were made against panel doctors. In the words of the High Chief Ranger, as they appear in the daily press :,
Panel doctors frequently issue certificates without seeing the insured person. 2. There is a marked tendency...... to refer patients for hospital treatment as out-patients, panel doctor gets his capitation fee whether the man is well or ill. The net result is that the doctor draws the money while the hospital does the work. 3. In some cases panel doctors show a reluctance to call on patients outside surgery hours. 4. In order to retain their panel at present strength " a few " panel doctors are chary about offending possible malingerers by giving them too hasty clearing-off notices, fearing that the patients might change their panel.
1.
as the
Items 1 and 4 refer to breaches of the certification rules and the Order of Foresters has only itself to blame if the doctors guilty of such unprofessional conduct are not brought before the proper tribunal. Lax certification is dealt with very severely by the to his Minister of Health when cases are notice by medical service subcommittees, and the General Medical Council has warned the profession that such conduct will incur grave penalties. In regard to item 2 the practice of referring cases to hospital out-patient departments is necessary under the present system owing to the fact that in no other way can a second opinion be obtained for an insured That hospitals are not paid for the services person. they render to insured persons is not the fault of the insurance practitioners, who hope that the omission will be rectified in the near future. The reluctance suggested in item 3 would render doctors liable to a charge of negligence, also a matter readily dealt with by the medical service subcommittee. It seemslto us that there is little or no substance in these and similar complaints, for, as Sir A. Mond pointed out in the House of Commons last week in reply to Mr. Haydn Jones, machinery is provided under the Insurance Act regulations for investigating complaints and imposing penalties where such complaints are substantiated. But the Minister added that he was considering whether the time had not come for an inquiry into the working of the Acts as regards both cash and medical benefits.
brought
flats-all necessitate careful consideration. the reservation the water is pumped to settling tanks, where the suspended matter is first precipitated by coagulation with aluminum sulphate, after which the water is passed through sand filters. This purification is further supplemented by disinfecting the water with liquid chlorine. Mosquitoes, it is noted, have been practically exterminated by the usual methods. The reservation offers many facilities for research work, particularly in various phases of sanitary engineering. Its position is suitable for the establishment of a school for the teaching of public health administration. on
---
THE FUTURE OF RED CROSS CLINICS. SCATTERED over the country are a number of clinics founded by the Red Cross for the treatment of the wounded. Now that pensioners under treatment are happily becoming fewer, a movement is being made to retain the services of these clinics for civilian patients. Physical therapy in the treatment of injury and disease is becoming more and more widely recognised, and there are comparatively few large city hospitals where a department devoted to this treatment cannot be found. But the expense of securing this treatment in private is considerable, and a large section of the community is rightly unwilling to attend hospital for treatment, and yet cannot afford to pay for it to be administered privately or in their own homes. For these the proposed transfer of the Red Cross clinics to civilian work will be an incalculable boon, and may well be carried through provided sundry safeguards are observed. We may classify these as affecting the medical men of the district, the patient, and the Little opposition will arise practising masseur. from medical men provided that patients are admitted to the clinics only on the recommendation of a qualified medical practitioner. This would protect the clinic from the patient who casually drops in for treatment without the knowledge or consent of his doctor. Patients must be safeguarded by placing the clinic under the care of a medical man specially qualified to prescribe details of treatment, and able to supervise and control everything that is done on their behalf. The interests of the practising masseur should be safeguarded by ensuring that only patients who are unable to pay the fees for private treatment usual in the district are received as patients of the clinic. This would entail the employment of an almoner or some other person suitably skilled in social service work. Should the clinics be run in any sense as competitors with the private masseur, great hardship would be inflicted. Granted these safeguards, we welcome the proposed transfer.
briefly
TUMOURS
OF
THE
BONY
CHEST
WALL.
ACCORDING: to ]Jr. U. A. liedk)loiii,l of the
Clinic, tumours of the bony chest wall
are
Mayo
compara-
rare. He has collected 213 cases, including 48 from the Mayo Clinic, 23 of which came to operation, and 25 in which operation was not performed. In 167, or 78-7 per cent. of the 213 cases, the tumours were of the ribs, and 46, or 21-3 per cent., were of the sternum. 61.4 per cent. were sarcoma, and 18 per cent. were chondroma, the ribs being primarily involved in 78-7 per cent., the sternum in 21-3 per Of the Mayo Clinic cases,2 were examples cent. of recurrent carcinoma following amputation of the breast in the female, in 2 the primary growth was in the male breast, 1 was a hypernephroma secondary to a tumour of the kidney on the same side, and I was secondary to a cancer of the thyroid. Although there is usually no history of trauma in tumours of the chest wall, the absence of such a history is no proof that the origin of the tumour was not traumatic. Minor injuries, .as Dr. Hedblorn points out, are as a rule quickly forgotten. Moreover, chest tumours are
tively
1
Archives of Surgery. July, 1921.
in males who are more liable to injury, and the area involved is usually the more exposed anterior and lateral portion of the chest. It is probable therefore that in some cases at least trauma plays a part in the setiology both with regard to incidenc& and the malignant degeneration of the benign forms. Apart from the presence of a tumour, pain, which may be present before there is any discernible growth, is the most characteristic symptom both in benign and malignant tumours, being present in 50 per cent. of the 213 cases. Loss of weight was noted in 15, or 31-2 per cent., dyspnoea was present in only 4 cases, and effusion in 2. In typical well advanced cases the diagnosis of neoplasm is certain, but in early Cold abscess, cases a diagnosis may be impossible. exostosis, gumma, aneurysm, and dermoid cyst must be differentiated. Early radical extirpation, which was performed in 10 of the 48 Mayo Clinic cases, is the treatment of choice, while late radical or palliativeextirpation, which was performed in 13 ofthose cases, may result in a relatively long period of freedom from recurrence even in the presence of extensive involvement. The contra-indications to operation are metastases, very extensive involvement, periostitis, and advanced cachexia. Intratracheal or intracommoner
pharyngeal insufflation anaesthesia affords an effective means of preventing operative pneumothorax. Shock,
pneumonia, of death
and empyema
are
the commonest
causes
following operation.
STOCK ALLEGATIONS AGAINST INSURANCE
DOCTORS. AT the recent delegates’ meeting of the High Court of the Ancient Order of Foresters, held at Leeds, serious charges were made against panel doctors. In the words of the High Chief Ranger, as they appear in the daily press :,
Panel doctors frequently issue certificates without seeing the insured person. 2. There is a marked tendency...... to refer patients for hospital treatment as out-patients, panel doctor gets his capitation fee whether the man is well or ill. The net result is that the doctor draws the money while the hospital does the work. 3. In some cases panel doctors show a reluctance to call on patients outside surgery hours. 4. In order to retain their panel at present strength " a few " panel doctors are chary about offending possible malingerers by giving them too hasty clearing-off notices, fearing that the patients might change their panel.
1.
as the
Items 1 and 4 refer to breaches of the certification rules and the Order of Foresters has only itself to blame if the doctors guilty of such unprofessional conduct are not brought before the proper tribunal. Lax certification is dealt with very severely by the to his Minister of Health when cases are notice by medical service subcommittees, and the General Medical Council has warned the profession that such conduct will incur grave penalties. In regard to item 2 the practice of referring cases to hospital out-patient departments is necessary under the present system owing to the fact that in no other way can a second opinion be obtained for an insured That hospitals are not paid for the services person. they render to insured persons is not the fault of the insurance practitioners, who hope that the omission will be rectified in the near future. The reluctance suggested in item 3 would render doctors liable to a charge of negligence, also a matter readily dealt with by the medical service subcommittee. It seemslto us that there is little or no substance in these and similar complaints, for, as Sir A. Mond pointed out in the House of Commons last week in reply to Mr. Haydn Jones, machinery is provided under the Insurance Act regulations for investigating complaints and imposing penalties where such complaints are substantiated. But the Minister added that he was considering whether the time had not come for an inquiry into the working of the Acts as regards both cash and medical benefits.
brought