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THE COUNCIL OF THE ROYAL COLLEGE OF SURGEONS OF ENGLAND AND THE FELLOWS AND MEMBERS.
LIFE ASSURANCE AND THE MEDICAL PIIOFESSION.
1110
Council, the Members of the College have only united front to
ensure
to their
champions
the
to show athe mercy
victory in
Much might be done the directors. of way securing uniformity of conditions and reducing the Life Assurance Contract to a simple and easily intelligible form if the Companies were approached by a strong and representative Committee. We trust then that some amongst the influential members of the profession will see the importance of making use of the present opportunity and combining for the purpose of carrying on to its completion the task which we have put in hand.
thein
struggle. Tnr Supplement which we published last week on the subject of Life Assurance and the Medical Profession represents9 as much as it is possible for us, in the capacity of medical 1 journalists, to accomplish towards the desirable end off diffusing the knowledge and popularising the practice of this! most useful and even necessary form of thrift. And we are2 even disposed to hope that our labours will prove to have been in no small measure helpful to our readers. The information conveyed through our pages should certainly make it easier now than it was before for a medical practitioner to assure his life to good advantage, since he may easily discover which are the companies that are addressing themselves to adapt their business arrangements to his particular needs, and how he may secure the important advantage of escaping the burden of the agent’s commission, which, as a rule, has to be borne by the holders of a Life Assurance Company’s policies. In order that this important information may be as widely distributed as possible, we have reprinted the Supplement in a separate form, and circulated it gratuitously to every member of the medical profession upon the Register. In this way we hope to have effectively accomplished the task which we have undertaken. But, although our share of the work is, for the moment, done, we cannot but perceive that it has created an opportunity of which we have been able to take only partial advantage. More than one of the Life Offices, replying to our inquiries, have intimated their readiness to communicate with a Medical Committee, if formed, with a view to the adjustment of life assurance facilities to the professional requirements of medical men, and it would, in our judgment, be a matter for great regret if this suggestion were to be allowed to fall flat. The great scope for such adjustment which existing arrangement affords is strikingly illustrated by the fact that on receipt of our circular communicating the results of the preliminary inquiry which we had made throughout the profession, one of the leading Offices immediately produced a new table, unpublished before either by itself or by any other Company, which undoubtedly has the merit of meeting in a very striking way the peculiar exigencies of a professional career. Much more remains to be done in the same direction. The past few years have seen great improvements introduced into the practice of Life Assurance in the way of liberalising its conditions, abolishing needless restrictions, and protecting the benefits of the contract against forfeiture. But these improvehave been in ments various degrees and under adopted various forms by the different Offices, and the consequence is a most bewildering variety of contracts, differing from one another in important details, while all conforming to certain broad outlines. A proposer cannot tell without the most painstaking and skilful preliminary examination what sort of a policy lie is in reality going to get. It may be almost as negotiable as a bank-note, or it may be hedged about with so many limitations, restrictions, and conditions that the most innocent mistake or the most trivial oversight may place him at any moment at .
of
the
_____________
Annotations. "
Ne
quid nimis."
THE COUNCIL OF THE ROYAL COLLEGE OF SURGEONS OF ENGLAND AND THE FELLOWS AND MEMBERS.
OUR readers may have observed that the Council of the of Surgeons of England had under their consideration on the 13th inst. the resolution passed at the annual meeting of the Fellows and Members, and the points raised by the deputation from the Fellows’ Association. To the resolution of the Fellows and Members in favour of the introduction of a Bill into Parliament to amend the constitution of the College, and expressing regret that the Council has shown no disposition to meet the wishes of Fellows and Members in spite of repeated protests, the Council replies by referring to the resolution of the Council of November, 1888, in which they considered that with the grant of the Supplemental Charter the matters in conten. tion should be allowed to rest. The answer destroys any hopes of an early settlement of the questions at issue between the Council and the Members of the College which may have been engendered by the attitude of Sir Spencer Wells at the annual meeting, and means a continuance of an internecine struggle. For can the Council seriously believe that they can sit like Canute before the rising tide, and, with a resolution of this kind, arrest its course ? The determination of the Privy Council to introduce into the Supplemental Charter only such points as were not the subject of contention did not mean a victory for the Council and a defeat of the Fellows and Members. It was simply a postponement of judgment, a reference of the controverted questions back to the contending parties, an exhortation to them to settle these questions by a mutual understanding and agreement. The Council therefore assumes a very serious responsibility in turning a deaf ear to the resolution of the general meeting, in determining to maintain its attitude of passive resistance, and sitting with folded arms continuing to repeat its everlasting What course is now open to the Members MOM possumus. but to proceed as they are proceeding in the Court of Chancery, and by the introduction of a Bill into Parlia. ment ?’? Those among the Members who dislike this action must see that the Council of the College prevents any intra-mural settlement. They might have invited a con. ference, as suggested by Sir Spencer Wells, but they have followed other counsel, and all hope of a settlement which would have done honour to both the Council and the Members must be regarded as at an end. In respect of the three points raised by the deputation from the Association of Fellows, and embodied in a memorandum which we publishe.d last week, the Council has decided (1) to take the opinion of counsel on the question of the power of the Council to call separate meetings of Fellows, (2) to refer the question of voting-papers to a committee, and (3) that it is out of their power to grant the request of the Fellows’
Royal College
1111 Association to consult the Fellows before concluding any (jates examined 36 were rejected. The mode of conducting arrangement with the University of London. It is a stepthe colour test examination was the same as that described gained by the Fellows’ Association that they have at least iln the report for the year 1887--viz., by slips of coloured succeeded in inducing the Council to take their first two paper and by coloured glasses in a bull’s-eye lantern at points seriously into consideration, and we trust that this 1bwenty feet ; but the whole subject of colour vision and the may lead to improved relations between the Council and a 1best mode of conducting the examination are now under imvestigation by a committee appointed by the Royal large section of the Fellows of the College.
Society. TREATMENT OF ENURESIS. DR. KUPKE of Posen, in a paper published in the Allgemeine Medicinische Central-Zeitung, gives his views on the treatment of incontinence of urine. He considers the cause to be either diminished activity of the vesico-spinal centre in the lumbar part of the cord, or partial anaesthesia of the sensory nerves of the bladder, both of these conditions preventing prompt information being conveyed to the cortex of the cerebrum when the bladder is becoming full. In cases where deep sleep occasions the brain to lose control over the bladder, it is well to keep a light burning in the room so as to lessen the depth of the sleep. After calling attention to a number of well-recognised causes of enuresis, such as phimosis, intestinal worms, &c., Dr. Kupke mentions Guyon’s and Unverricht’s methods of galvanising the parts, the former by means of a urethral electrode, the latter by means of a large stationary positive electrode applied to the lumbar region and a small negative electrode moved from place to place over the pubes. He himself, however, prefers faradisation, combined with medicinal treatment. The former is applied by means of a large, flat, stationary, positive electrode over the last dorsal and first lumbar vertebrae, while a small positive electrode is applied with stroking movements over the region of the bladder. The most valuable drug is one which is but little known in this country-the sweet sumach (Rhus aromatica). The preparation he employs is the Extractum fluidum rhois aromaticæ, of which from five to fifteen drops are given night and morning in a little milk, according to the age of the child. Treatment must in many cases be persevered in for three or four months in order to obtain a lasting cure. The well-known regimen as to fluids at night, a hard mattress, baths, &c., must of course be attended to. Strychnine, which used to be given before rhus aromatica was adopted, is best administered hypodermically-one milligramme of the nitrate daily. Tincture of nux vomica is unsuitable.
COLOUR-BLINDNESS AMONG SEAMEN.
WE learn from a contemporary that Mr. G. L. Swanston, Assistant Secretary to the Board of Trade, has forwarded a report to the Marine Department for the year ending May 31st, 1890, in which he gives the results of the examination in colours for masters’ and mates’ certificates of competency, as well as for other persons belonging to the mercantile marine. From this report it appears that the number of those who presented themselves for examination for the master’s and mate’s certificate of competency under Form Examination 2 amounted to 4662, being an increase of 219 over the previous year, when 4443 were examined. The number of those who were rejected for inability to distinguish colours was 23, which is only 1 in 200, a much smaller proportion than might have been anticipated from the percentage numbers usually given, which amount to about 3 or 4 per cent. In the previous year 18 were rejected out of 4443 for this cause, or 1 in 244-a still smaller percentage. The number of persons examined in colours only under Form Examination 2A amounted to 839, of whom 29 were rejected, or 1 in 29, which is about 3’3 per cent., being a reduction of about 1 per cent. as compared with the previous year, when out of 789 candi-
-
THE LATE INFLUENZA EPIDEMIC. AT the meeting of the Berlin Medical Society on the 3rd inst. Dr. S. Guttmann presented a preliminary report upon the collective investigation initiated by that society during the iniluenza epidemic of last winter. He stated that 18,000 cards containing questions had been distributed. Of those that had been returned filled up there had been selected 4000, which referred to as many as 100,000 cases. The committee is now engaged in analysing the information thus obtained. Nor has the investigation been confined to Germany. Many particulars have been furnished from Belgium, Italy, and Russia, whilst through ’the assistance of Professor Adamkiewicz a large amount of information has been collected in Galicia. A certain amount of information respecting outbreaks on shipboard has also been obtained through the ocean steamships companies. As soon as possible it is intended to publish in full detail the results of the inquiry, which cannot fail to prove of great interest from every point of view. It is, perhaps, to be regrettedthat in England, where the system of collective investigation of disease first arose, owing, it may be remembered, largely to the enthusiastic advocacy of the late Dr. Mahomed, there should not have been instituted an inquiry into influenza on the same lines as this German investigation, which seems to have been so successful. PHYSICAL AND CHEMICAL CHANGES BLOOD IN DISEASE.
IN THE
DR. SCIOLLA of Genoa, at the recent Congress of the Italian Society of Internal Medicine, reported some interesting experimental researches on physico-chemical changes of the blood in different morbid conditions. He stated that the density of the blood diminishes during acute febrile states and the first stage of convalescence, increasing afterwards with greater or less rapidity according to the nature of the disease. The same thing is always observable in the density of blood serum, with this difference, that it begins to increase as soon as there is any improvement in the condition of the patient, sometimes, indeed, a short time previously. The density of the serum is increased in malaria, whilst that of the blood is diminished. Tuberculous affections, unaccompanied by serious alterations of the blood, only slightly modify the density of blood serum and blood. The densities of blood serum and blood are both diminished in catarrhal jaundice, probably owingto defective assimilation of food. The density of the blood is almost normal, whilst that of the serum is increased, in cirrhosis of the liver and in cancer of the gall-bladder. The densities of blood and serum are not sensibly diminished in benign forms of diabetes. The greatest diminution in the density of the blood is observable in diseases accompanied by grave morbid changes of the blood. The most striking examples were those seen in three fatal cases of pneumonia. Dr. Sciolla also observed the chemical modifications of the blood in pneumonia, typhoid fever, malaria, anæmia, and in leukæmia. About the fourth or fifth day of croupous pneumonia there is a marked diminution in the albuminoid substances of the blood, especially the globulin. The extractive matters increase during the febrile period. In convalescence the quantity of albuminoids, especially of the globulins, and
1110
Council, the Members of the College have only united front to
ensure
to their
champions
the
to show athe mercy
victory in
Much might be done the directors. of way securing uniformity of conditions and reducing the Life Assurance Contract to a simple and easily intelligible form if the Companies were approached by a strong and representative Committee. We trust then that some amongst the influential members of the profession will see the importance of making use of the present opportunity and combining for the purpose of carrying on to its completion the task which we have put in hand.
thein
struggle. Tnr Supplement which we published last week on the subject of Life Assurance and the Medical Profession represents9 as much as it is possible for us, in the capacity of medical 1 journalists, to accomplish towards the desirable end off diffusing the knowledge and popularising the practice of this! most useful and even necessary form of thrift. And we are2 even disposed to hope that our labours will prove to have been in no small measure helpful to our readers. The information conveyed through our pages should certainly make it easier now than it was before for a medical practitioner to assure his life to good advantage, since he may easily discover which are the companies that are addressing themselves to adapt their business arrangements to his particular needs, and how he may secure the important advantage of escaping the burden of the agent’s commission, which, as a rule, has to be borne by the holders of a Life Assurance Company’s policies. In order that this important information may be as widely distributed as possible, we have reprinted the Supplement in a separate form, and circulated it gratuitously to every member of the medical profession upon the Register. In this way we hope to have effectively accomplished the task which we have undertaken. But, although our share of the work is, for the moment, done, we cannot but perceive that it has created an opportunity of which we have been able to take only partial advantage. More than one of the Life Offices, replying to our inquiries, have intimated their readiness to communicate with a Medical Committee, if formed, with a view to the adjustment of life assurance facilities to the professional requirements of medical men, and it would, in our judgment, be a matter for great regret if this suggestion were to be allowed to fall flat. The great scope for such adjustment which existing arrangement affords is strikingly illustrated by the fact that on receipt of our circular communicating the results of the preliminary inquiry which we had made throughout the profession, one of the leading Offices immediately produced a new table, unpublished before either by itself or by any other Company, which undoubtedly has the merit of meeting in a very striking way the peculiar exigencies of a professional career. Much more remains to be done in the same direction. The past few years have seen great improvements introduced into the practice of Life Assurance in the way of liberalising its conditions, abolishing needless restrictions, and protecting the benefits of the contract against forfeiture. But these improvehave been in ments various degrees and under adopted various forms by the different Offices, and the consequence is a most bewildering variety of contracts, differing from one another in important details, while all conforming to certain broad outlines. A proposer cannot tell without the most painstaking and skilful preliminary examination what sort of a policy lie is in reality going to get. It may be almost as negotiable as a bank-note, or it may be hedged about with so many limitations, restrictions, and conditions that the most innocent mistake or the most trivial oversight may place him at any moment at .
of
the
_____________
Annotations. "
Ne
quid nimis."
THE COUNCIL OF THE ROYAL COLLEGE OF SURGEONS OF ENGLAND AND THE FELLOWS AND MEMBERS.
OUR readers may have observed that the Council of the of Surgeons of England had under their consideration on the 13th inst. the resolution passed at the annual meeting of the Fellows and Members, and the points raised by the deputation from the Fellows’ Association. To the resolution of the Fellows and Members in favour of the introduction of a Bill into Parliament to amend the constitution of the College, and expressing regret that the Council has shown no disposition to meet the wishes of Fellows and Members in spite of repeated protests, the Council replies by referring to the resolution of the Council of November, 1888, in which they considered that with the grant of the Supplemental Charter the matters in conten. tion should be allowed to rest. The answer destroys any hopes of an early settlement of the questions at issue between the Council and the Members of the College which may have been engendered by the attitude of Sir Spencer Wells at the annual meeting, and means a continuance of an internecine struggle. For can the Council seriously believe that they can sit like Canute before the rising tide, and, with a resolution of this kind, arrest its course ? The determination of the Privy Council to introduce into the Supplemental Charter only such points as were not the subject of contention did not mean a victory for the Council and a defeat of the Fellows and Members. It was simply a postponement of judgment, a reference of the controverted questions back to the contending parties, an exhortation to them to settle these questions by a mutual understanding and agreement. The Council therefore assumes a very serious responsibility in turning a deaf ear to the resolution of the general meeting, in determining to maintain its attitude of passive resistance, and sitting with folded arms continuing to repeat its everlasting What course is now open to the Members MOM possumus. but to proceed as they are proceeding in the Court of Chancery, and by the introduction of a Bill into Parlia. ment ?’? Those among the Members who dislike this action must see that the Council of the College prevents any intra-mural settlement. They might have invited a con. ference, as suggested by Sir Spencer Wells, but they have followed other counsel, and all hope of a settlement which would have done honour to both the Council and the Members must be regarded as at an end. In respect of the three points raised by the deputation from the Association of Fellows, and embodied in a memorandum which we publishe.d last week, the Council has decided (1) to take the opinion of counsel on the question of the power of the Council to call separate meetings of Fellows, (2) to refer the question of voting-papers to a committee, and (3) that it is out of their power to grant the request of the Fellows’
Royal College
1111 Association to consult the Fellows before concluding any (jates examined 36 were rejected. The mode of conducting arrangement with the University of London. It is a stepthe colour test examination was the same as that described gained by the Fellows’ Association that they have at least iln the report for the year 1887--viz., by slips of coloured succeeded in inducing the Council to take their first two paper and by coloured glasses in a bull’s-eye lantern at points seriously into consideration, and we trust that this 1bwenty feet ; but the whole subject of colour vision and the may lead to improved relations between the Council and a 1best mode of conducting the examination are now under imvestigation by a committee appointed by the Royal large section of the Fellows of the College.
Society. TREATMENT OF ENURESIS. DR. KUPKE of Posen, in a paper published in the Allgemeine Medicinische Central-Zeitung, gives his views on the treatment of incontinence of urine. He considers the cause to be either diminished activity of the vesico-spinal centre in the lumbar part of the cord, or partial anaesthesia of the sensory nerves of the bladder, both of these conditions preventing prompt information being conveyed to the cortex of the cerebrum when the bladder is becoming full. In cases where deep sleep occasions the brain to lose control over the bladder, it is well to keep a light burning in the room so as to lessen the depth of the sleep. After calling attention to a number of well-recognised causes of enuresis, such as phimosis, intestinal worms, &c., Dr. Kupke mentions Guyon’s and Unverricht’s methods of galvanising the parts, the former by means of a urethral electrode, the latter by means of a large stationary positive electrode applied to the lumbar region and a small negative electrode moved from place to place over the pubes. He himself, however, prefers faradisation, combined with medicinal treatment. The former is applied by means of a large, flat, stationary, positive electrode over the last dorsal and first lumbar vertebrae, while a small positive electrode is applied with stroking movements over the region of the bladder. The most valuable drug is one which is but little known in this country-the sweet sumach (Rhus aromatica). The preparation he employs is the Extractum fluidum rhois aromaticæ, of which from five to fifteen drops are given night and morning in a little milk, according to the age of the child. Treatment must in many cases be persevered in for three or four months in order to obtain a lasting cure. The well-known regimen as to fluids at night, a hard mattress, baths, &c., must of course be attended to. Strychnine, which used to be given before rhus aromatica was adopted, is best administered hypodermically-one milligramme of the nitrate daily. Tincture of nux vomica is unsuitable.
COLOUR-BLINDNESS AMONG SEAMEN.
WE learn from a contemporary that Mr. G. L. Swanston, Assistant Secretary to the Board of Trade, has forwarded a report to the Marine Department for the year ending May 31st, 1890, in which he gives the results of the examination in colours for masters’ and mates’ certificates of competency, as well as for other persons belonging to the mercantile marine. From this report it appears that the number of those who presented themselves for examination for the master’s and mate’s certificate of competency under Form Examination 2 amounted to 4662, being an increase of 219 over the previous year, when 4443 were examined. The number of those who were rejected for inability to distinguish colours was 23, which is only 1 in 200, a much smaller proportion than might have been anticipated from the percentage numbers usually given, which amount to about 3 or 4 per cent. In the previous year 18 were rejected out of 4443 for this cause, or 1 in 244-a still smaller percentage. The number of persons examined in colours only under Form Examination 2A amounted to 839, of whom 29 were rejected, or 1 in 29, which is about 3’3 per cent., being a reduction of about 1 per cent. as compared with the previous year, when out of 789 candi-
-
THE LATE INFLUENZA EPIDEMIC. AT the meeting of the Berlin Medical Society on the 3rd inst. Dr. S. Guttmann presented a preliminary report upon the collective investigation initiated by that society during the iniluenza epidemic of last winter. He stated that 18,000 cards containing questions had been distributed. Of those that had been returned filled up there had been selected 4000, which referred to as many as 100,000 cases. The committee is now engaged in analysing the information thus obtained. Nor has the investigation been confined to Germany. Many particulars have been furnished from Belgium, Italy, and Russia, whilst through ’the assistance of Professor Adamkiewicz a large amount of information has been collected in Galicia. A certain amount of information respecting outbreaks on shipboard has also been obtained through the ocean steamships companies. As soon as possible it is intended to publish in full detail the results of the inquiry, which cannot fail to prove of great interest from every point of view. It is, perhaps, to be regrettedthat in England, where the system of collective investigation of disease first arose, owing, it may be remembered, largely to the enthusiastic advocacy of the late Dr. Mahomed, there should not have been instituted an inquiry into influenza on the same lines as this German investigation, which seems to have been so successful. PHYSICAL AND CHEMICAL CHANGES BLOOD IN DISEASE.
IN THE
DR. SCIOLLA of Genoa, at the recent Congress of the Italian Society of Internal Medicine, reported some interesting experimental researches on physico-chemical changes of the blood in different morbid conditions. He stated that the density of the blood diminishes during acute febrile states and the first stage of convalescence, increasing afterwards with greater or less rapidity according to the nature of the disease. The same thing is always observable in the density of blood serum, with this difference, that it begins to increase as soon as there is any improvement in the condition of the patient, sometimes, indeed, a short time previously. The density of the serum is increased in malaria, whilst that of the blood is diminished. Tuberculous affections, unaccompanied by serious alterations of the blood, only slightly modify the density of blood serum and blood. The densities of blood serum and blood are both diminished in catarrhal jaundice, probably owingto defective assimilation of food. The density of the blood is almost normal, whilst that of the serum is increased, in cirrhosis of the liver and in cancer of the gall-bladder. The densities of blood and serum are not sensibly diminished in benign forms of diabetes. The greatest diminution in the density of the blood is observable in diseases accompanied by grave morbid changes of the blood. The most striking examples were those seen in three fatal cases of pneumonia. Dr. Sciolla also observed the chemical modifications of the blood in pneumonia, typhoid fever, malaria, anæmia, and in leukæmia. About the fourth or fifth day of croupous pneumonia there is a marked diminution in the albuminoid substances of the blood, especially the globulin. The extractive matters increase during the febrile period. In convalescence the quantity of albuminoids, especially of the globulins, and