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THE ASSURANCE OFFICES AND THE MEDICAL PROFESSION.
651 I could say much more upon this subject, but your the flexor tendon of the index finger. I found that she was be, and my time is, exhausted. I would only fur- so entirely deficient in self-control, that without a strong phaentreat you, to aim at healing any breaches that may lanx of assistants it would be impossible to remove it, and as exist or arise in our ranks, and join cordially in attaining these it was important that this should be done without delay, I ust ends.-I remain. Sir, your obedient, faithful servant, poured about twenty drops of chloroform into an ordinary inGEORGE WEBSTER. haler, and with the aid of a non-professional friend she began to breathe it. She soon appeared partially affected, but when I made an incision, she gave some slight evidence of pain. I ON THE EMPLOYMENT OF THE FORCEPS IN very speedily succeeded in finding and removing the fragment MIDWIFERY. of needle, and immediately discontinued the inhalation, which To the Editor of THE LANCET. was certainly not kept up more than three minutes. I obSiR,-I shall feel obliged by your giving me an opportunity served, that during this time she did not close her eyes, but of replying to the laconic note of Mr. Joshua Waddington, sat quietly in the chair, apparently staring at me. When I that appeared in the last number of THE LANCET, respecting had dressed the wound, I told her she might get up and leave some observations of mine on the use of the obstetric forceps, the room, but she took no notice, and continued in precisely which were lately recorded in your valuable pages. Mr. the same position. Her appearance was now somewhat reWaddington seems to construe them in a different light from markable ; her eyes were unusually wide open, her cheeks that intended, and to have forgotten that the object of my paper were of the usual colour, the pulse was beating normally, but was, to show that the instrument, as recommended by almost there was no trace of consciousness. I shook and pinched all teachers and writers on the obstetric art, is rarely had re- her, but she gave no evidence of sensation; the body appeared in its usual vigour; the mind was gone. Never having before course to, and always as a desperate resource, and that therefore its use is much more limited than safety dictates, or seen such symptoms after the use of chloroform, I felt rather reason demands. I can assure him, that had I thought the anxious and uneasy. I threw cold water in her face, and evil confined to his practice alone, as he appears to think, I gave ammonia, but without any sensible effect. I could not would never have raised my voice against it. His communi- at this time trace the slightest movement of any voluntary cation had only the effect of calling my attention more par- fibre of the body. ’I now placed her in a recumbent ticularly to the subject, and if my strictures bore anything position, and thus she remained for about half an hour. At beyond what its general tendency,-the undervaluing of the the end of this time she gave some signs of returning conforceps-warranted, nothing was farther from my intention, for sciousness, and requested to be placed in a chair. She comit is the too general neglect of the value of the instrument of plained of intense pain in her head, and soon relapsed into which I have complained, that ought to be the very " head her former state. I laid her down again; and so she remained and front of my offending." He kindly recommends to my for nearly another half-hour, when she revived, drank a little "serious consideration," a half table of statistics, to show that warm wine-and-water, and with the aid of another person, was the practice he adopted has found countenance with others ; able to find her way home. She suffered through the night but here, in sympathy, I would beg to say, that I can furnish and during the following day from a violent headach, but she him with others of a similar kind, to the contents of which, now feels no ill effects. I am induced to lay this case before in so far as they can serve him, I make him welcome. If he your readers, because it exhibits a train of symptoms I have thinks the employment of the forceps, at an average of one in not before met with, and because I think every new or unusual every 787 cases (as he leads us to suppose he does), calculated effect of chloroform should be recorded. I am far from wishto secure the full amount of benefit from their legitimate use, ing to argue against its use, but I think we must all feel we why not give us the table complete? why "curtail it of its have to deal with a formidable power; that we should reserve fair proportions"&ic rc; If its results were " gazetted," he must it for important operations; that we should employ some one have thought they could neither benefit his cause, nor do conversant with its effects to administer it; and that we should honour to your pages. Your correspondent seems to repre- always give patients the option of taking it, or not. We thus sent the forceps as an agent of - destruction, so that where use every fair precaution against accident; and in the event they have been employed he naturally calls for a return of of any unfortunate result, are fortified, by every available rethe killed and wounded, from which I may presume to guess source, to meet the painful questionings of our own minds, of that he might have said, in reference to the subject, in the the profession, or of the public. I remain, Sir, your obedient servant, language of the Mantuan bard, with as much reverence for ’, GEORGE CRITCHETT. truth as for poetry, " quæ ipse miserrima vidi, et quorum pars It is at evident that his fui." least inquiries concern’ magna the "maimed and dead," show he neither knows the cases I THE ASSURANCE OFFICES AND THE MEDICAL nor " the in which they may -be applicable, mode of acting PROFESSION. with them;" and as this knowledge cannot be acquired by To the Editor of THE LANCET. in I i once eleven would as them advise him, years, using only a friend, to practise under the eye of a master, for by that a humble member of the medical profession, I SIR,—As means, I doubt not, he will gain confidence in their value, ’ cannot be sufficiently thankful for the strenuous efforts you and be weaned from his unnecessary fears. are making to compel insurance offices to pay for any inforI am. Sir. vour most obedient servant. mation they require from the medical attendant of parties C. STEWART, SEN., Surgeon. wishing to insure their lives. I have, and shall always, resist giving confidential information, gratis. Were the profession, as a body, to decline furnishing gratuitous confidential inforON THE EFFECTS OF CHLOROFORM. mation, I think, in a few weeks, the siege of life-assurance inTo the Editor of THE LANCET. stitutions against medical men would be razed. I would suggest, if it meets your approbation, that a list be SIR,—Notwithstanding the very natural enthusiasm with which the discovery of anaesthetic agents was hailed, both by appended to THE LANCET, or else forwarded on application, on the profession and the public, it cannot, I think, be denied payment of an equivalent, of all those institutions which pay that every month brings with it some record that must awaken the medical attendant his fee, and those which do not; and the thoughtful consideration of the one, and the well-grounded then every medical man can hang up in a convenient place fears of the other. True it is, that a vast aggregate of suffer- such list, and can see at once what offices he will recommend; ing has been thus spared, but it must be admitted that one un- and I am sure none will advise an insurance in any office which fortunate case more than counterbalances a long series of does not pay for the information required. Could we not form successful results, and every operating surgeon must await an communication to life assurance anti-gratuitousIconfidential with some painful anxiety the occurrence of some case in his offices, think it might be done. society ? own practice, proving the strange uncertainty and alarming Excuse me troubling you with these remarks; but having power of this agent. I am far from presuming to come for- had differences with offices, I am induced to do so; and I ward as any authority upon this subject; my object is rather remain, dear Sir, yours truly, to call forth matured experience, and to encourage the pubH. R. GLEADOWE, M.R.C.S. & L.A.C. lication of any new phase or symptom to which this potent fluid may give rise, and to set an example by briefly relating To the Editor of THE LANCET. a somewhat anomalous case that recently occurred in my own practice. A few weeks ago, a young healthy servant girl, SIR,—Allow me to inclose a letter received from an inabout eighteen years of age, was sent to my house by a neigh- surance office, in reply to one demanding the fee for filling up bouring practitioner, having broken a needle into the palm of a certificate. My letter, you will observe, was forwarded to her piece could be distinctly felt lying close upon the patient.
accepted.
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652 I hope the circumstances above alluded to will induce you to record the name of this office in your black-list. I
am.
Sir.
vonr
obedient servant.
G. F.
REE, M.R.C.S.E.
.
National Provident Institution, Sept. 29, 1819.
THE
Secretary presents
his
to inform him it is not the vident Institution to pay a fee
begs
compliments to Mr. Ree, and I practice of the National Pro-
Office and myself, for insertion in THE LANCET, if you can find for it. I fear you did not receive my last communication, as you did not acknowledge it in any way. I am, Sir, your most obedient servant, WM. HIGHMORE. *’ We apologize for the omission.—ED. L. room
Merchant’s &
for the certificate of a proposer’s medical attendant. The Secretary has therefore forwarded Mr. Ree’s note to Mr. B—.
Tradesmen’s Mutual Life-Assurance Office
London, November 16, 1849.
SIR,—I will be obliged by your informing me if you will un. dertake the office of local medical referee for, and have the means of promoting, the interest of this Society, which is established on the mutual principle, now universally acknowledged To elte Editor of THE LANCET. to be the only just and equitable one towards the assured. I shall have much pleasure in furnishing you with every SIR,—As another of the fruits of that stand which the profession (so ably directed by yourself) are making on the sub- information relative to the professional fee, and the advantages ject of life assurance, I beg to send you the accompanying arising from the introduction of business, on receiving a favourable reply.-I am, Sir, your obedient servant, circular, received this morning by your obedient servant, W. F. .Nov. 1, 1849. I THOMAS MUSGRAVE, Sec. East of Scotland Life-Assurance Company, Dundee, October 30, 1849. much pleasure in intimating to you, that the directors of this company have resolved in future to pay a fee of half a guinea to the private medical referees of persons proposed for assurance for each report made to the company, and that our agent in Aberdeen, Mr. Charles Grainger, advocate, has received instructions to that effect. I trust that this arrangement-by which the differences which have hitherto been felt to exist betwixt the mpdica.1 profession and the life-assurance offices will be effectually removed-may prove advantageous to both parties; and as it will involve additional expense to the company, I humbly submit that the medical profession are called upon to support this and other offices who have set the example in this matter. I am, Sir, vour obedient servant. EBEN. E. SCOTT, Manager. ° ’GVe do not at all approve of half-guinea fees in these cases.—ED. L.
SIR,—I have
___
To the Editor of THE LANCET. SIR,—If the medical profession were like the professions of the law or the church-namely, if they held together to support their common interest-it would be a very easy task to bring the refractory offices to cloth. It is perfectly self-evident who is the real and substantial gainer by the confidential (save the mark!) report of the medical referee. If he recommends the office a good, healthy life, one who will pay in the whole premium, both principal and compound interest, the office is much more the gainer than the assured; and if he confidentially prevents the office from taking a bad and hereditarily, though not at the time actually, unhealthy life, one upon which the office would, in all probability, be called upon to pay the whole sum assured before he had paid even three annual payments, the office is, in that case, the sole gainer, because he protects it from an absolute and almost total loss by the confidential information which he alone is qualified to give; and the patient is not only the loser by his life not being insured, but is even called upon to pay for the very information which has prevented the office from assuring it. Was ever anything so monstrous? Now that four or five-and-twenty offices have acknowledged the justice of this principle, it behoves the profession to support those offices, and those only, that admit it; and to mark their determination to do so,let every medical referee of those offices who do not acknowledge such principle at once throw up their appointment, and refuse to certify to them for any private patients of their own. By so doing, the assurance ,,offices can have no alternative; they must either equitably agree to pay the referees in all cases, or they must shut up their offices, and suspend business altogether. I trust the feeling is so far unanimous in the profession that the members will not hesitate to act thus; for myself, I am prepared to do I am referee for several offices, some of them—for inso. stance, the Britannia and the Westminster-that acknowledge the justness of the principle contended for, and some that do not; but I have determined, if they do not do so shortly, to write and decline continuing longer to act in that capacity for them, and I hope my medical brethren generally will follow mv example.—I remain. Sir. vours &c.. WILLIAM HIGHMORE M.R.C.S., &c.
Sherborne, Nov. 18, 1849.
SIR,—I beg to acknowledge the receipt of your favour, offering me to be the local medical referee of the Merchant’s and Tradesmen’s Assurance Society, for which I am much obliged; but before I can accept it, I must beg you to inform me if the Society agrees to pay a fee for the opinion of the medical referee named by each proposer for assurance; if not, I must take the liberty of declining it. You are of course aware that this subject is now much discussed, both by the profession and the public; and that about thirty offices, and amongst them
several mutual ones, have
come
to the deter-
mination of
doing so. It is obviously, therefore, our duty to support only those offices who conform to this act of justice; and this the profession are becoming daily more determined to do.-I am,
Sir,
obedient servant, W. HIGHMORE. answer to this letter, Dec. 4, 1849.-
your most
[I have received W. H.]
no
.
To ae Editor of THE LANCET. SIR,—A difference of opinion prevails between some of the life-assurance societies and several members of the medical profession on the payment of a fee, by the offices, to the ordinary attendant of a person proposing to insure. It is important that the question be fairly stated; and as I believe only one side of it has hitherto been exhibited in your pages, I am induced to offer a few remarks on the subject, and rely on your impartiality for their insertion. Some writers on this question not only demand payment for the information required by the insurers, but insist on naming the source of that payment, and positively refuse to give information unless they are paid by the offices, and not by the for insurance. Surely these gentlemen forget that applicants in this, as in every contract, there are two parties. The offices make known the conditions on which they effect insurances; and one of these is, that the proposer shall furnish the directors,with a full and true account of every circumstance relating to his health. This is evidently a preliminary step, the fulfilment of which devolves on the applicant. So far the treaty is analogous to a negotiation for the sale and purchase of an estate : the purchaser accedes to the terms of the vendor; but before proceeding further requires satisfactory proof that the title to the property is safe. According to the principle advocated by those who contend that the insurance societies should pay all expenses, the vendor would say to the purchaser, "refer you to my solicitor for information about the title, and as the inquiry is made by your desire, you will pay him for his trouble, whether his report be favourable or unfavourable." Were a stickler for payment by the offices in the situation of the purchaser of the estate, he would, I have no doubt, consider it very unjust to be called upon to pay the vendor’s solicitor as well as his own; yet this is precisely what he requires the insurance societies to do, as they all have their own medical referees, whom they pay for their services. A considerable number of the proposals submitted to the insurance societies is never completed. It is obvious, therefore, that if the societies paid a fee to the medical attendant of every applicant, they would open a door to fraud and loss. The medical profession, I believe, is neither higher nor lower in the scale of morality than others; there are unworthy members in all; and it would be To the Editor of THE LANCET. easv for a dishonest man to defraud insurance societies by SIR,—Ibeg to send you the inclosed correspondence, between becoming the medical referee of applicants who never intend the of the Merchant’s and Tradesmen’s Mutual Life that their proposals shall be completed. The loss, tco, in such
Secretary
653 fall instances, would in the
4. What has been the general state of his health since you on the insured, as in most offices they have known him ? profits of the establishment. This statement shows, I think, that the demand of payment 5. Do you know, or have you ever heard, that he has had from the offices, by the proposer’s attendant, is founded neither asthma,, any fit, habitual cough, or spitting of blood, or any in justice nor equity. The only argument of any apparent disorder tending to the shortening of life ? 6. Is he subject to gout, insanity, or any other constituweight in support of this claim is, the circumstance of the referee being applied to by the office; but this is merely an tional disorder ? 7. Are you acquainted with his ordinary manner of living arrangement of convenience, and dos not affect the principle of the question, as the inquiry is made by desire of the appli- and habits, and what are they ? 8. In your opinion, is he likely to live as long as any other cant, and to enable him to fulfil his part of the contract. In most of these cases the medical attendant is requested to state healthy person of his age (being 42 years) ? 9. Is there any other circumstance or information respectwhat he knows about the constitution of some friend or patient; and to require payment generally for such a certificate some- ing his past or present health, and habits of life, within your what derogates from the liberality which usually characterizes knowledge or belief, which may tend to shorten life ?" the medical profession. I do not mean, however, to say that a Tavistock-street, Coveat-garden, Oct. 6, 1849. medical man is bound always to give the required information gratuitously. If he has lost sight of the al:plicant for some time, or the investigation occasions more than usual trouble, Medical News. he is entitled to a fee; but when the proposer is a friend, who or meets the medical attendant, and frequently, perhaps daily, ROYAL COLLEGE OF SURGEONS.—EXAMINATIONS FOR THE whose state of health is undeniable, I hope, for the honour of the profession, that the certificate would be given without re- I FELLOWSHIP.—Questions on the third day’s examination, Dec. numeration. Peculiar cases may certainly occur, in which the 6,1840:— Pathology and Surgery, No. I.—1. In the two forms of directors, in their discretion, may deem it their duty and their interest to pay the applicant’s referee for minute information, erysipelas, simple and phlegmonous, what are respectively the and I believe all omces occasionally do so; but as a general principal symptoms, what the course and termination, and rule, nothing can be moreclearly just than that both parties what the treatment, constitutional and local ? 2. What is the treatment to be adopted in a case of wound should pay their own referees. I am aware that some offices, yielding to the demands of of the brachial artery occurring in venesectien ? 3. Describe the treatment of retention of urine from stricthe profession, have advertised their intention to pay the I medical referee of the proposers; but I suspect a strict inves- ture in the urethra, and the consequences which are to be when the retention is not relieved. tigation would show that these offices get all the information apprehended I 4. the progress of a carbuncle from its commenceDescribe and can from other to the atsources, they apply applicant’s tendant only in cases of doubtful health, and in places where ment to its termination, when not arrested by treatment. they have no medical referee of their own. When, indeed, we Describe also the treatment, both constitutional and local, by consider the losses which life-insurance societies might sustain which its progress may be arrested. ’from the abuse of the regulation, if carried to its fullest ex- 5. Describe the characters of dislocations of the shoulder-
participate
.
tent, the directors of these establishments will not do their joint, and the modes of reduction. duty to those whose concerns they govern, if they do not keep I 6. What is the effect of opium on the system? What which in
are
are use ? And what are this expense within the narrowest possible limits. the principal preparations I will not trouble you further, but conclude with the signa- the doses of each ? I N.B. Answers to any four of these questions will be accepted ture aa FIAT JUSTITIA. as that are accurate and ade-
sufficient, provided always
____
quate.
they
To the Editor of TiaB LANCET. Pathology and Surgery. No. 2.-1. Describe the nature and received an application from the physiological consequences of asphyxia, its causes, especially Directors of the Economic Life-Assurance Society, in New those depending upon irrespirable gases, and the more imBridge-street, Blackfriars, respecting an assurance about to portant remedial measures required. 2. State what is known with regard to the pathological be effected on the life of one of my patients, together with the enclosed list of questions, which I should be glad to see pub- changes in the blood. 3. Describe the principal varieties of the pulse, and in what lished with this letter, as they are such as the medical attendant alone of the assured can answer satisfactorily. In my respect they may be severally regarded as diagnostic of morbid of the system. reply, I declined answering the queries, unless I received a fee conditions 4. the morbid changes which take place in the for so doing, and I was promptly answered by Mr. Macdonald, the secretary, to the effect that I was not applied to as the pro- urinary organs from long-continued irritation of the bladder and explain in detail the causes of such changes. fessional, but as a private referee, and therefore the office or urethra; 5. Describe the different methods by which a calculus may could not think of paying meafee; and further, that Mr. had no medical attendant. Surprised at such a statement, as be removed from the bladder, and what the circumstances for the pre- under which they may be severally indicated. I had been in occasional attendance on Mr. 6. Describe the various circumstances of surgical interest vious three years, I lost but little time in waiting on him, and intestine. stating these facts, when he told me that he had given in my which attend a casetoof wounded N.B.-Answers name as his surgeon, and not as a private referee. My answer any four of these questions will be acto the office, of course, referred to this declaration of my cepted as sufficient, provided always that they are accurate patient, and contained a reiteration of my determination not and adequate. to reply to the official queries, unless I were paid for so doing. ROYAL COLLEGE OF SURGEONS.—The following members of Since then, I have not heard further on the subject. the College, having undergone the necessary examinations, on Comment on this proceeding is hardly necessary. It is the 4th, 5th, and 6th instant, were admitted "fellows," at the evident that the directors, aware of the determination of the meeting of the council, on the 7th instant :greater part of the profession not to furnish certificates of the BARKER, WALTER GOODYER, Worthing, diploma dated Oct. state of their patients’ health, and their fitness for life assur25,1839. without an have a new ance, adequate remuneration, adopted BUTLER, FREDERICK JOHN, Winchester, May 8, 1840. plan-that of applying to them, not as medical men, but as CnARLETON, GEORGE WASHBOURNE, Gloucester, July 3,1835. private referees, hoping thus to obtain, by a ruse, the informaDpuiTT, WILLIAM, Wimborne-Minster, Dorsetshire, July 30, tion they require, without paying for it. Such a dirty 1841. manoeuvre a respectable office ought to be ashamed of. DAMPIER, NATHANIEL JOHN, Woburn-place, Russell-square, I am, Sir, your obedient servant, May 24,1844. JOHN FOOTE, M.R.C.S.L. THARP MOUNTAIN, Lincoln’s-inn fields, Jan. 3, GIRDLESTONE, « TO THE PRIVATE REFEREE. 1845. JOHN FooTE, Esq., will oblige the Directors of the EcoHAYNES, RAYMOND LEVI, Holloway, March 5,1841. nomic Life-Assurance Society by answering the HIND, GEORGE WILLIAM, Alfred-place, Bedford-square, Nov. 3, 1827. questions respecting the health and constitution of Mr.—. 1. How many years haveyou known him’? HODGES, RICHARD, Rochford, Essex, July 31, 1843. 2. When did you last see him? HULME, EDWARD CIIARLES, Maisonette, Totness, Devon, 3. In what state of health was he at that time ? April 12,1844.
SIR,—Some time back, I
Describe
--
li
.
following
accepted.
space must
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hand; the
652 I hope the circumstances above alluded to will induce you to record the name of this office in your black-list. I
am.
Sir.
vonr
obedient servant.
G. F.
REE, M.R.C.S.E.
.
National Provident Institution, Sept. 29, 1819.
THE
Secretary presents
his
to inform him it is not the vident Institution to pay a fee
begs
compliments to Mr. Ree, and I practice of the National Pro-
Office and myself, for insertion in THE LANCET, if you can find for it. I fear you did not receive my last communication, as you did not acknowledge it in any way. I am, Sir, your most obedient servant, WM. HIGHMORE. *’ We apologize for the omission.—ED. L. room
Merchant’s &
for the certificate of a proposer’s medical attendant. The Secretary has therefore forwarded Mr. Ree’s note to Mr. B—.
Tradesmen’s Mutual Life-Assurance Office
London, November 16, 1849.
SIR,—I will be obliged by your informing me if you will un. dertake the office of local medical referee for, and have the means of promoting, the interest of this Society, which is established on the mutual principle, now universally acknowledged To elte Editor of THE LANCET. to be the only just and equitable one towards the assured. I shall have much pleasure in furnishing you with every SIR,—As another of the fruits of that stand which the profession (so ably directed by yourself) are making on the sub- information relative to the professional fee, and the advantages ject of life assurance, I beg to send you the accompanying arising from the introduction of business, on receiving a favourable reply.-I am, Sir, your obedient servant, circular, received this morning by your obedient servant, W. F. .Nov. 1, 1849. I THOMAS MUSGRAVE, Sec. East of Scotland Life-Assurance Company, Dundee, October 30, 1849. much pleasure in intimating to you, that the directors of this company have resolved in future to pay a fee of half a guinea to the private medical referees of persons proposed for assurance for each report made to the company, and that our agent in Aberdeen, Mr. Charles Grainger, advocate, has received instructions to that effect. I trust that this arrangement-by which the differences which have hitherto been felt to exist betwixt the mpdica.1 profession and the life-assurance offices will be effectually removed-may prove advantageous to both parties; and as it will involve additional expense to the company, I humbly submit that the medical profession are called upon to support this and other offices who have set the example in this matter. I am, Sir, vour obedient servant. EBEN. E. SCOTT, Manager. ° ’GVe do not at all approve of half-guinea fees in these cases.—ED. L.
SIR,—I have
___
To the Editor of THE LANCET. SIR,—If the medical profession were like the professions of the law or the church-namely, if they held together to support their common interest-it would be a very easy task to bring the refractory offices to cloth. It is perfectly self-evident who is the real and substantial gainer by the confidential (save the mark!) report of the medical referee. If he recommends the office a good, healthy life, one who will pay in the whole premium, both principal and compound interest, the office is much more the gainer than the assured; and if he confidentially prevents the office from taking a bad and hereditarily, though not at the time actually, unhealthy life, one upon which the office would, in all probability, be called upon to pay the whole sum assured before he had paid even three annual payments, the office is, in that case, the sole gainer, because he protects it from an absolute and almost total loss by the confidential information which he alone is qualified to give; and the patient is not only the loser by his life not being insured, but is even called upon to pay for the very information which has prevented the office from assuring it. Was ever anything so monstrous? Now that four or five-and-twenty offices have acknowledged the justice of this principle, it behoves the profession to support those offices, and those only, that admit it; and to mark their determination to do so,let every medical referee of those offices who do not acknowledge such principle at once throw up their appointment, and refuse to certify to them for any private patients of their own. By so doing, the assurance ,,offices can have no alternative; they must either equitably agree to pay the referees in all cases, or they must shut up their offices, and suspend business altogether. I trust the feeling is so far unanimous in the profession that the members will not hesitate to act thus; for myself, I am prepared to do I am referee for several offices, some of them—for inso. stance, the Britannia and the Westminster-that acknowledge the justness of the principle contended for, and some that do not; but I have determined, if they do not do so shortly, to write and decline continuing longer to act in that capacity for them, and I hope my medical brethren generally will follow mv example.—I remain. Sir. vours &c.. WILLIAM HIGHMORE M.R.C.S., &c.
Sherborne, Nov. 18, 1849.
SIR,—I beg to acknowledge the receipt of your favour, offering me to be the local medical referee of the Merchant’s and Tradesmen’s Assurance Society, for which I am much obliged; but before I can accept it, I must beg you to inform me if the Society agrees to pay a fee for the opinion of the medical referee named by each proposer for assurance; if not, I must take the liberty of declining it. You are of course aware that this subject is now much discussed, both by the profession and the public; and that about thirty offices, and amongst them
several mutual ones, have
come
to the deter-
mination of
doing so. It is obviously, therefore, our duty to support only those offices who conform to this act of justice; and this the profession are becoming daily more determined to do.-I am,
Sir,
obedient servant, W. HIGHMORE. answer to this letter, Dec. 4, 1849.-
your most
[I have received W. H.]
no
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To ae Editor of THE LANCET. SIR,—A difference of opinion prevails between some of the life-assurance societies and several members of the medical profession on the payment of a fee, by the offices, to the ordinary attendant of a person proposing to insure. It is important that the question be fairly stated; and as I believe only one side of it has hitherto been exhibited in your pages, I am induced to offer a few remarks on the subject, and rely on your impartiality for their insertion. Some writers on this question not only demand payment for the information required by the insurers, but insist on naming the source of that payment, and positively refuse to give information unless they are paid by the offices, and not by the for insurance. Surely these gentlemen forget that applicants in this, as in every contract, there are two parties. The offices make known the conditions on which they effect insurances; and one of these is, that the proposer shall furnish the directors,with a full and true account of every circumstance relating to his health. This is evidently a preliminary step, the fulfilment of which devolves on the applicant. So far the treaty is analogous to a negotiation for the sale and purchase of an estate : the purchaser accedes to the terms of the vendor; but before proceeding further requires satisfactory proof that the title to the property is safe. According to the principle advocated by those who contend that the insurance societies should pay all expenses, the vendor would say to the purchaser, "refer you to my solicitor for information about the title, and as the inquiry is made by your desire, you will pay him for his trouble, whether his report be favourable or unfavourable." Were a stickler for payment by the offices in the situation of the purchaser of the estate, he would, I have no doubt, consider it very unjust to be called upon to pay the vendor’s solicitor as well as his own; yet this is precisely what he requires the insurance societies to do, as they all have their own medical referees, whom they pay for their services. A considerable number of the proposals submitted to the insurance societies is never completed. It is obvious, therefore, that if the societies paid a fee to the medical attendant of every applicant, they would open a door to fraud and loss. The medical profession, I believe, is neither higher nor lower in the scale of morality than others; there are unworthy members in all; and it would be To the Editor of THE LANCET. easv for a dishonest man to defraud insurance societies by SIR,—Ibeg to send you the inclosed correspondence, between becoming the medical referee of applicants who never intend the of the Merchant’s and Tradesmen’s Mutual Life that their proposals shall be completed. The loss, tco, in such
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4. What has been the general state of his health since you on the insured, as in most offices they have known him ? profits of the establishment. This statement shows, I think, that the demand of payment 5. Do you know, or have you ever heard, that he has had from the offices, by the proposer’s attendant, is founded neither asthma,, any fit, habitual cough, or spitting of blood, or any in justice nor equity. The only argument of any apparent disorder tending to the shortening of life ? 6. Is he subject to gout, insanity, or any other constituweight in support of this claim is, the circumstance of the referee being applied to by the office; but this is merely an tional disorder ? 7. Are you acquainted with his ordinary manner of living arrangement of convenience, and dos not affect the principle of the question, as the inquiry is made by desire of the appli- and habits, and what are they ? 8. In your opinion, is he likely to live as long as any other cant, and to enable him to fulfil his part of the contract. In most of these cases the medical attendant is requested to state healthy person of his age (being 42 years) ? 9. Is there any other circumstance or information respectwhat he knows about the constitution of some friend or patient; and to require payment generally for such a certificate some- ing his past or present health, and habits of life, within your what derogates from the liberality which usually characterizes knowledge or belief, which may tend to shorten life ?" the medical profession. I do not mean, however, to say that a Tavistock-street, Coveat-garden, Oct. 6, 1849. medical man is bound always to give the required information gratuitously. If he has lost sight of the al:plicant for some time, or the investigation occasions more than usual trouble, Medical News. he is entitled to a fee; but when the proposer is a friend, who or meets the medical attendant, and frequently, perhaps daily, ROYAL COLLEGE OF SURGEONS.—EXAMINATIONS FOR THE whose state of health is undeniable, I hope, for the honour of the profession, that the certificate would be given without re- I FELLOWSHIP.—Questions on the third day’s examination, Dec. numeration. Peculiar cases may certainly occur, in which the 6,1840:— Pathology and Surgery, No. I.—1. In the two forms of directors, in their discretion, may deem it their duty and their interest to pay the applicant’s referee for minute information, erysipelas, simple and phlegmonous, what are respectively the and I believe all omces occasionally do so; but as a general principal symptoms, what the course and termination, and rule, nothing can be moreclearly just than that both parties what the treatment, constitutional and local ? 2. What is the treatment to be adopted in a case of wound should pay their own referees. I am aware that some offices, yielding to the demands of of the brachial artery occurring in venesectien ? 3. Describe the treatment of retention of urine from stricthe profession, have advertised their intention to pay the I medical referee of the proposers; but I suspect a strict inves- ture in the urethra, and the consequences which are to be when the retention is not relieved. tigation would show that these offices get all the information apprehended I 4. the progress of a carbuncle from its commenceDescribe and can from other to the atsources, they apply applicant’s tendant only in cases of doubtful health, and in places where ment to its termination, when not arrested by treatment. they have no medical referee of their own. When, indeed, we Describe also the treatment, both constitutional and local, by consider the losses which life-insurance societies might sustain which its progress may be arrested. ’from the abuse of the regulation, if carried to its fullest ex- 5. Describe the characters of dislocations of the shoulder-
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tent, the directors of these establishments will not do their joint, and the modes of reduction. duty to those whose concerns they govern, if they do not keep I 6. What is the effect of opium on the system? What which in
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are use ? And what are this expense within the narrowest possible limits. the principal preparations I will not trouble you further, but conclude with the signa- the doses of each ? I N.B. Answers to any four of these questions will be accepted ture aa FIAT JUSTITIA. as that are accurate and ade-
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To the Editor of TiaB LANCET. Pathology and Surgery. No. 2.-1. Describe the nature and received an application from the physiological consequences of asphyxia, its causes, especially Directors of the Economic Life-Assurance Society, in New those depending upon irrespirable gases, and the more imBridge-street, Blackfriars, respecting an assurance about to portant remedial measures required. 2. State what is known with regard to the pathological be effected on the life of one of my patients, together with the enclosed list of questions, which I should be glad to see pub- changes in the blood. 3. Describe the principal varieties of the pulse, and in what lished with this letter, as they are such as the medical attendant alone of the assured can answer satisfactorily. In my respect they may be severally regarded as diagnostic of morbid of the system. reply, I declined answering the queries, unless I received a fee conditions 4. the morbid changes which take place in the for so doing, and I was promptly answered by Mr. Macdonald, the secretary, to the effect that I was not applied to as the pro- urinary organs from long-continued irritation of the bladder and explain in detail the causes of such changes. fessional, but as a private referee, and therefore the office or urethra; 5. Describe the different methods by which a calculus may could not think of paying meafee; and further, that Mr. had no medical attendant. Surprised at such a statement, as be removed from the bladder, and what the circumstances for the pre- under which they may be severally indicated. I had been in occasional attendance on Mr. 6. Describe the various circumstances of surgical interest vious three years, I lost but little time in waiting on him, and intestine. stating these facts, when he told me that he had given in my which attend a casetoof wounded N.B.-Answers name as his surgeon, and not as a private referee. My answer any four of these questions will be acto the office, of course, referred to this declaration of my cepted as sufficient, provided always that they are accurate patient, and contained a reiteration of my determination not and adequate. to reply to the official queries, unless I were paid for so doing. ROYAL COLLEGE OF SURGEONS.—The following members of Since then, I have not heard further on the subject. the College, having undergone the necessary examinations, on Comment on this proceeding is hardly necessary. It is the 4th, 5th, and 6th instant, were admitted "fellows," at the evident that the directors, aware of the determination of the meeting of the council, on the 7th instant :greater part of the profession not to furnish certificates of the BARKER, WALTER GOODYER, Worthing, diploma dated Oct. state of their patients’ health, and their fitness for life assur25,1839. without an have a new ance, adequate remuneration, adopted BUTLER, FREDERICK JOHN, Winchester, May 8, 1840. plan-that of applying to them, not as medical men, but as CnARLETON, GEORGE WASHBOURNE, Gloucester, July 3,1835. private referees, hoping thus to obtain, by a ruse, the informaDpuiTT, WILLIAM, Wimborne-Minster, Dorsetshire, July 30, tion they require, without paying for it. Such a dirty 1841. manoeuvre a respectable office ought to be ashamed of. DAMPIER, NATHANIEL JOHN, Woburn-place, Russell-square, I am, Sir, your obedient servant, May 24,1844. JOHN FOOTE, M.R.C.S.L. THARP MOUNTAIN, Lincoln’s-inn fields, Jan. 3, GIRDLESTONE, « TO THE PRIVATE REFEREE. 1845. JOHN FooTE, Esq., will oblige the Directors of the EcoHAYNES, RAYMOND LEVI, Holloway, March 5,1841. nomic Life-Assurance Society by answering the HIND, GEORGE WILLIAM, Alfred-place, Bedford-square, Nov. 3, 1827. questions respecting the health and constitution of Mr.—. 1. How many years haveyou known him’? HODGES, RICHARD, Rochford, Essex, July 31, 1843. 2. When did you last see him? HULME, EDWARD CIIARLES, Maisonette, Totness, Devon, 3. In what state of health was he at that time ? April 12,1844.
SIR,—Some time back, I
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