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THE DEBATE ON MEDICAL AID ASSOCIATIONS AT THE GENERAL MEDICAL COUNCIL REGARDED FROM A LEGAL POINT OF VIEW.
THE DEBATE ON MEDICAL AID ASSOCIATIONS.
1332
THE Cavendish Lecture will be delivered on Wednesday, June 14th, at the West London Hospital, Hammersmith, by Mr. Henry Morris, M.A., M.B., F.R.C.S., on the subject of "Some Changes in Surgical Opinion regarding the Diseases of " the Urinary Organs." The West London Medico-Chirurgical Society will afterwards hold a conversazione.
simple affection of peripheral nerves but is a toxic process, widespread affection of the nervous system, central as well as peripheral. This may be true of some cases, but there is no doubt that in others the degenerative effects are recognisable only in the nerves. with
EFFECTS OF DRY CUPPING ONE OR MORE LIMBS.
I
AT the Cochin Hospital, Paris, on Tuesday last, two new KREiNDEL, who has made some observations with an apparatus constructed on the principle of Junod’s boot, wards, fitted up with the most approved antiseptic arrangefinds that diminished atmospheric pressure applied to one or ments, were opened. They are named respectively the more limbs produces a diminution of blood pressure, increased Lister " and the "h.bStilr ward3. frequency of respiration and cardiac contraction, together with a lowering of the temperature of the body. A FRENCH HOSPITAL is about to be established in Brussels DR. T.
"
at
a
cost of
50,000 francs.
-
SUPPRESSION OF PHOSPHATES IN FEVER. DR. FREUND of Vienna, having remarked that in cases of febrile rigors the uiine ceases temporarily to contain phosphates, administered to a patient with intermittent fever phosphoric acid during the intermissions, the phosphates in the urine being thus increased. As soon, however, as the cold stage of the fever came on the phosphates disappeared from the urine and only regained their ordinary quantity after the lapse of some hours. He concludes, therefore, that the absence of phosphates is due to their retention in the system rather than to suppression of the metabolic changes to which their excretion is due.
THE EFFECT OF A HIGH TEMPERATURE ON THE WHITE BLOOD CORPUSCLES. DR. E. CHLENOFF has found that when dogs are kept for five or six hours at a temperature of 107’ F. the white corpuscles in the blood diminish to half their ordinary number, but the number of the red corpuscles and the amount of haemoglobin they contain remain unchanged. After a lapse of twenty hours, when the temperature has fallen to normal or even lower, the number of white corpuscles may be found to have increased somewhat beyond the usual limit.
FOREIGN UNIVERSITY INTELLIGENCE. - BceZo/M.—Dr.
Fargas has been selected by competition for the Professorship of Midwifery and Gynxcology. - NyM.—Dr. Eugen Fraenkel.Wt-oeeM of Gynaecology, has been promoted to an Extraordinary Professorship. Dr. Filehne, Professor of Pharmacology, having obtained eighteen months’ leave for the purpose of making scientific investigations in America, Dr. Geppert of Bonn has been appointed as his substitute.
Götti,ngen.-Dr. Beneke, Prosector of the Ducal Hospital Brunswick, has been recognised as privat-docent of Pathological Anatomy. in
I.,iizsbr,iie7,.-A students’ disturbance has occurred in consequence of some military regulation concerning their period of military service and they have all refused to attend lectures. 41-t. Potersburtt (Medico-Cliirurgi.cal Academy).-Dr. V. I. Dobrovolski, Professor of Ophthalmology, has resigned. 2/.—The new Professorship of Physics has been filled by the appointment of Dr. Wolff. Hc/MM.—Professor Alexander Kolisko has been offered the chair of Pathological Anatomy vacated by the death of Professor Kundrat. Or the 375 houses in the City of London inspected during the past fortnight Dr. Sedgwick Saunders, the medical officer of health, reports that forty-two required sanitary improvement. He also reports that during the same period fifteen tons of meat were condemned at the markets. The birth- and death-rates were 12 °13 per 1000 of the population per annum.
THE annual conversazione of the Royal Wednesday next, June 7th.
Society will be held
on
THE DEBATE ON MEDICAL AID ASSOCIATIONS AT THE GENERAL MEDICAL COUNCIL REGARDED FROM A LEGAL POINT OF VIEW. (BY
A
MEMBER
OF THE
BAR
WHO WAS
PRESENT.)
THE report of the committee on Medical Aid Associations gave rise to a most interesting and important debate. On all hands it was admitted that the committee, of which Dr. Glover was chairman and Mr. Wheelhouse, Dr. Leech, Mr. Teale, Dr. Bruce and Dr. MacAlister were members, had completed the onerous task assigned to them by the Council’s resolution of November last in a manner that called for special acknowledgment. All the material facts encountered in the course of the committee’s investigations were set out clearly and impartially in the report without any intrusion of irrelevant topics or misleading suggestions, so that the Council had the advantage of being left face to face with the evidence that told for and against the specific recommendations submitted for their acceptance. Of course, quite apart from any justification that these recommendations might derive from facts disclosed in the report, they had to ustified by reason of their own intrinsic reasonableness and fitness to effect the purposes for which they were proposed. The debate was opened by Dr. Glover, who in a lucid and judicial speech reviewed the evidence that had been taken by his committee and pointed out its bearings upon the matters submitted to the arbitrament of the Council. The adoption of the first recommendation was unanimously agreed to. It simply extends the rules already laid down by the Council as to "covering" unqualified assistants to the case of a medical officer of a Medical Aid Association who acts with an unqualified assistant. It need hardly be pointed out that the two forms of "covering are distinguishable. In the one case the qualified man stands in the relation of employer to his unqualified assiaant ; in the other both are engaged by a common employer in a common employment. The second recommendation ran thus : That the Council do record its opinion that a medical practitioner is acting in a reprehensible manner-(l) if he holds a medical aid appointment the duties of which are so onerous that he cannot do justice to the sick under his care ; (2) if he consents to give certificates where in his opinion they are not justifiable on medical grounds ; (3) if he accepts or retains employment by an association in which canvassing is used to attract members. Obviously the committee shrank from advising the Council to say that the conduct above particularised was infamous in a professional respect." The logical weakness of this was quickly made apparent when Sir John Simon rose and pointed out that the Medical Act provided no machinery for dealing with the "minor morals " of the profession or with mere commercial and economic questions affecting medical practitioners, and that they would be acting 1dtrtL t’Îns if they claimed to exercise any disciplinary supervision in such matters. It was a perfectly fair argument to accept the committee’s
be j
position
’
UNCERTIFIED CAUSES OF DEATH AND INQUESTS.
1333
c was characterised by an eminent member of the estimate of the conduct they thought "reprehensible " but (< offence in effect to say : "Since you do not Council. C That the great professional and public interests which are consider this to amount to the only conduct we are empowered t to the General Medical Council are in perfectly safe to deal with-viz., that which is ’infamous in any profes- entrusted sional respect ’-you make out no case for our intervention." Ikeeping must, I think, be the verdict of an intelligent and ( listener to this debate on Medical Aid AssociaHad the committee asked the Council to say that the prac- disinterested tices described in Recommendation II. were "infamous" theitions. Moreover, I feel satisfied that he would not fail to result might have been the same, but the discussion must from the discussion that it would be quite impossible 5 gather 1 1 induce the Council to move forward even along the path have taken a very different course. Then neither the 1dtra to t’;’;’M argument nor the question-begging "minor morals" imarked out for .it by the Medical Act except in the most view would be available to confuse the real issues of the gradual, 1 prudent and cautious manner. situation. It would not be contended that the General Medical Council had not the power to say, if they thought fit, that a That certain definable sort of conduct was "infamous." function is vested in them by the Medical Act. They are, UNCERTIFIED CAUSES OF DEATH AND in fact, constituted the sole judges by that Act of what INQUESTS. I - infanaous conduct" is. "The Legislature," as was said in one of the early decisions on the Act, "considering them IT appears from the Registrar-General’s Annual Summary the best judges in such a matter, have left the matter in their arbitrament." What, therefore, the General Medical Council, for 1892, recently issued, that 4180 deaths were registered in acting honestly within their jurisdiction, declare to be "in- thirty-three of the largest English towns during that year famous conduct" is conclusive. They were not asked to make without any legal’ certification of the cause of death. Of any such declaration in reference to the matters referred to these deaths 804 occurred in London, 594 in Liverpool, 519 in Recommendation II., and they refused to pronounce them in .1 Birmingham, 293 in Sheffield, 239 in Manchester, 168 in reprehensible" by eighteen to seven votes after a very West Ham, 160 in Hull, 152 in Salford and 100 in Preston. animated discussion. That the Council did not feel very sure of their ground in On the other hand, the cause of every death was duly rejecting the recommendation is clear from the fact that certified in Croydon and only 12 uncertified causes of death when it reappeared in a very thin disguise in Sir Walter were recorded in Burnley. The percentage of uncertified Foster’s amendment it received a good deal more support and causes of death in 1892 averaged 2-0 in these thirty-three was only defeated by the narrow majority of fourteen to large towns, and ranged from 00 in Croydon, 0’5 in Birkentwelve votes. This decision might be taken as indicating a head, 0’7 in Burnley and 0’9 in London and Leeds, to 4’0 in very real anxiety on the part of an influential minority of Hull, 4-2 in West Ham, 4-3 in Sheffield, 4-5 in Halifax, 4-7 in The cause of this wide the Council to find a remedy for the evils brought to light Liverpool and 5’3 in Birmingham. by the inquiry of the committee, and it would be very unsafe range of proportions of uncertified deaths in the large for Medical Aid Associations and their medical officers to English towns appears to be a fitting subject for the attention of the Select Committee of the House of Commons assume that the second resolution imposes no obligation on them to mend their ways. The resolution seems to us cal- which is now taking evidence on the subject of Death culated to mislead medical officers of Medical Aid Associa- Certification. These figures should, moreover, be carefully tions as to the statutory powers of the Council. The better considered in relation to the proportion of inquests course would have been to transmit the report to the Medical held in the various towns, which varies almost as widely Aid Associations, leaving it to convey its own lesson without as the proportion of uncertified causes of death. During the year 1892 the percentage of inquests to total deaths note or comment. There ought to be no doubt in the medical profession as to the in the thirty-three towns averaged 6’8, and ranged in disciplinary powers of the Council under the twenty-ninth the several towns from 2’6 in Preston, 3’4 in Burnley, section of the Medical Act, but whether the practices struck 35 in Birmingham and 3-6 in Brighton and Huddersfield, at in the second recommendation are such as call for the to 7’8 in London and Manchester, 8’3 in Sunderland exercise of those powers is a very grave question and one and Newcastle, 8’6 in Gateshead, 8’9 in Derby and 9’4 in which was not by any means disposed of by the resolution Birkenhead. The variations in the proportions of inquests appended to the report. With great deference to Sir John held are to a slight extent due to the varying proportions of Simon, such practices cannot be summarily dismissed as deaths from violence ; but this factor can only account for belonging to the "minor morals " of the profession. Surely a small part of the differences. For instance, the death-rate where the issue raised is "efficient practice," as is the case from violence in 1892 was almost identical in Birmingham in the first part of Recommendation II., a "major moral " and Birkenhead, and yet the proportion of inquests in these question of the first order comes up for judgment. The towns was 3’5 and 9’4 respectively. It would be worth while ’’morals"" too are just those that the public are entitled to inquire whether the small proportion of inquests held in Let it be Birmingham has any connexion with the high rate of unto have warranted sound by the Council. borne in mind that the object of the Medical Act is certified causes of death, or whether the high proportion of to enable "persons requiring medical aid to distinguish inquests (9-4 per cent.) held in Birkenhead has directly or qualified from unqualified practitioners." To do this indirectly any effect on the proportion of uncertified causes effectually a General Medical Council is created and armed of death in that town, which was only 0 5 per cent. in 1892. with adequate powers for ensuring that only persons It may further be pointed out that in each of the several towns possessing the "requisite knowledge and skill"for the mentioned above in which the highest proportions of inquest "efficient practice of their profession"shall be admitted cases were recorded-namely, from 7’8 to 9’4 per cent.-the to registration. The Council can go behind diplomas and percentage of uncertified deaths was low and ranged from licences to ascertain whether their face value corresponds to 05 to 2.0; whereas, on the other hand, with the single a sufficiently high real value and can invoke the aid of the exception of Burnley, excessive proportions of uncertified Privy Council to compel the bodies conferring them to bring deaths, ranging from 2 -8 to 53, were recorded in each of the up the professional training of their students to a sufficiently towns in which the proportion of inquest cases was abhigh standard. Is it to be said that, after all precautions are normally low and below 4 per cent. taken to guard the portals of the medical profession against The varying proportion of uncertified causes of death in the entrance of persons without the necessary knowledge and Birmingham appears to afford conclusive evidence of the skill for "efficient practice, " no duty devolves on the Councilreality of the relation between uncertified deaths and inquests. to see that a registered medical practitioner does not deliber- The proportion of inquests held in Birmingham was until ately put himself from year’s end to year’s end in a position in quite recently exceptionally high, even for a large town ; it which the efficient practice of his profession is impossible ?2 averaged, indeed, 8-9 per cent. during the eight years If that be a " minor moral " question, it is at any rate one 1881-88. The highest percentage was 9-6 in 1886, since which involves the health or lives of the Queen’s subjects. which the proportion has shown a remarkable and comparaNor can the granting of medical certificates on insufficienttively steady decline, and had fallen to 3-5 in 1892, a pergrounds be treated as a " minor moral " offence. The Legis- centage which was little more than a third of that which lature has attached particular importance to medical certifi- prevailed six years before, in 1886. Concurrently with this cates. The Courts recognise them as evidence of the state of marked decline in the proportion of inquests the percentage health they certify. To grant false certificates is assuredlyof uncertified deaths in Birmingham has shown an equally The proportion of uncertified deaths in more blameworthy professionally than "telling lies," as theremarkable increase.
own
not
infamous," and
,
1332
THE Cavendish Lecture will be delivered on Wednesday, June 14th, at the West London Hospital, Hammersmith, by Mr. Henry Morris, M.A., M.B., F.R.C.S., on the subject of "Some Changes in Surgical Opinion regarding the Diseases of " the Urinary Organs." The West London Medico-Chirurgical Society will afterwards hold a conversazione.
simple affection of peripheral nerves but is a toxic process, widespread affection of the nervous system, central as well as peripheral. This may be true of some cases, but there is no doubt that in others the degenerative effects are recognisable only in the nerves. with
EFFECTS OF DRY CUPPING ONE OR MORE LIMBS.
I
AT the Cochin Hospital, Paris, on Tuesday last, two new KREiNDEL, who has made some observations with an apparatus constructed on the principle of Junod’s boot, wards, fitted up with the most approved antiseptic arrangefinds that diminished atmospheric pressure applied to one or ments, were opened. They are named respectively the more limbs produces a diminution of blood pressure, increased Lister " and the "h.bStilr ward3. frequency of respiration and cardiac contraction, together with a lowering of the temperature of the body. A FRENCH HOSPITAL is about to be established in Brussels DR. T.
"
at
a
cost of
50,000 francs.
-
SUPPRESSION OF PHOSPHATES IN FEVER. DR. FREUND of Vienna, having remarked that in cases of febrile rigors the uiine ceases temporarily to contain phosphates, administered to a patient with intermittent fever phosphoric acid during the intermissions, the phosphates in the urine being thus increased. As soon, however, as the cold stage of the fever came on the phosphates disappeared from the urine and only regained their ordinary quantity after the lapse of some hours. He concludes, therefore, that the absence of phosphates is due to their retention in the system rather than to suppression of the metabolic changes to which their excretion is due.
THE EFFECT OF A HIGH TEMPERATURE ON THE WHITE BLOOD CORPUSCLES. DR. E. CHLENOFF has found that when dogs are kept for five or six hours at a temperature of 107’ F. the white corpuscles in the blood diminish to half their ordinary number, but the number of the red corpuscles and the amount of haemoglobin they contain remain unchanged. After a lapse of twenty hours, when the temperature has fallen to normal or even lower, the number of white corpuscles may be found to have increased somewhat beyond the usual limit.
FOREIGN UNIVERSITY INTELLIGENCE. - BceZo/M.—Dr.
Fargas has been selected by competition for the Professorship of Midwifery and Gynxcology. - NyM.—Dr. Eugen Fraenkel.Wt-oeeM of Gynaecology, has been promoted to an Extraordinary Professorship. Dr. Filehne, Professor of Pharmacology, having obtained eighteen months’ leave for the purpose of making scientific investigations in America, Dr. Geppert of Bonn has been appointed as his substitute.
Götti,ngen.-Dr. Beneke, Prosector of the Ducal Hospital Brunswick, has been recognised as privat-docent of Pathological Anatomy. in
I.,iizsbr,iie7,.-A students’ disturbance has occurred in consequence of some military regulation concerning their period of military service and they have all refused to attend lectures. 41-t. Potersburtt (Medico-Cliirurgi.cal Academy).-Dr. V. I. Dobrovolski, Professor of Ophthalmology, has resigned. 2/.—The new Professorship of Physics has been filled by the appointment of Dr. Wolff. Hc/MM.—Professor Alexander Kolisko has been offered the chair of Pathological Anatomy vacated by the death of Professor Kundrat. Or the 375 houses in the City of London inspected during the past fortnight Dr. Sedgwick Saunders, the medical officer of health, reports that forty-two required sanitary improvement. He also reports that during the same period fifteen tons of meat were condemned at the markets. The birth- and death-rates were 12 °13 per 1000 of the population per annum.
THE annual conversazione of the Royal Wednesday next, June 7th.
Society will be held
on
THE DEBATE ON MEDICAL AID ASSOCIATIONS AT THE GENERAL MEDICAL COUNCIL REGARDED FROM A LEGAL POINT OF VIEW. (BY
A
MEMBER
OF THE
BAR
WHO WAS
PRESENT.)
THE report of the committee on Medical Aid Associations gave rise to a most interesting and important debate. On all hands it was admitted that the committee, of which Dr. Glover was chairman and Mr. Wheelhouse, Dr. Leech, Mr. Teale, Dr. Bruce and Dr. MacAlister were members, had completed the onerous task assigned to them by the Council’s resolution of November last in a manner that called for special acknowledgment. All the material facts encountered in the course of the committee’s investigations were set out clearly and impartially in the report without any intrusion of irrelevant topics or misleading suggestions, so that the Council had the advantage of being left face to face with the evidence that told for and against the specific recommendations submitted for their acceptance. Of course, quite apart from any justification that these recommendations might derive from facts disclosed in the report, they had to ustified by reason of their own intrinsic reasonableness and fitness to effect the purposes for which they were proposed. The debate was opened by Dr. Glover, who in a lucid and judicial speech reviewed the evidence that had been taken by his committee and pointed out its bearings upon the matters submitted to the arbitrament of the Council. The adoption of the first recommendation was unanimously agreed to. It simply extends the rules already laid down by the Council as to "covering" unqualified assistants to the case of a medical officer of a Medical Aid Association who acts with an unqualified assistant. It need hardly be pointed out that the two forms of "covering are distinguishable. In the one case the qualified man stands in the relation of employer to his unqualified assiaant ; in the other both are engaged by a common employer in a common employment. The second recommendation ran thus : That the Council do record its opinion that a medical practitioner is acting in a reprehensible manner-(l) if he holds a medical aid appointment the duties of which are so onerous that he cannot do justice to the sick under his care ; (2) if he consents to give certificates where in his opinion they are not justifiable on medical grounds ; (3) if he accepts or retains employment by an association in which canvassing is used to attract members. Obviously the committee shrank from advising the Council to say that the conduct above particularised was infamous in a professional respect." The logical weakness of this was quickly made apparent when Sir John Simon rose and pointed out that the Medical Act provided no machinery for dealing with the "minor morals " of the profession or with mere commercial and economic questions affecting medical practitioners, and that they would be acting 1dtrtL t’Îns if they claimed to exercise any disciplinary supervision in such matters. It was a perfectly fair argument to accept the committee’s
be j
position
’
UNCERTIFIED CAUSES OF DEATH AND INQUESTS.
1333
c was characterised by an eminent member of the estimate of the conduct they thought "reprehensible " but (< offence in effect to say : "Since you do not Council. C That the great professional and public interests which are consider this to amount to the only conduct we are empowered t to the General Medical Council are in perfectly safe to deal with-viz., that which is ’infamous in any profes- entrusted sional respect ’-you make out no case for our intervention." Ikeeping must, I think, be the verdict of an intelligent and ( listener to this debate on Medical Aid AssociaHad the committee asked the Council to say that the prac- disinterested tices described in Recommendation II. were "infamous" theitions. Moreover, I feel satisfied that he would not fail to result might have been the same, but the discussion must from the discussion that it would be quite impossible 5 gather 1 1 induce the Council to move forward even along the path have taken a very different course. Then neither the 1dtra to t’;’;’M argument nor the question-begging "minor morals" imarked out for .it by the Medical Act except in the most view would be available to confuse the real issues of the gradual, 1 prudent and cautious manner. situation. It would not be contended that the General Medical Council had not the power to say, if they thought fit, that a That certain definable sort of conduct was "infamous." function is vested in them by the Medical Act. They are, UNCERTIFIED CAUSES OF DEATH AND in fact, constituted the sole judges by that Act of what INQUESTS. I - infanaous conduct" is. "The Legislature," as was said in one of the early decisions on the Act, "considering them IT appears from the Registrar-General’s Annual Summary the best judges in such a matter, have left the matter in their arbitrament." What, therefore, the General Medical Council, for 1892, recently issued, that 4180 deaths were registered in acting honestly within their jurisdiction, declare to be "in- thirty-three of the largest English towns during that year famous conduct" is conclusive. They were not asked to make without any legal’ certification of the cause of death. Of any such declaration in reference to the matters referred to these deaths 804 occurred in London, 594 in Liverpool, 519 in Recommendation II., and they refused to pronounce them in .1 Birmingham, 293 in Sheffield, 239 in Manchester, 168 in reprehensible" by eighteen to seven votes after a very West Ham, 160 in Hull, 152 in Salford and 100 in Preston. animated discussion. That the Council did not feel very sure of their ground in On the other hand, the cause of every death was duly rejecting the recommendation is clear from the fact that certified in Croydon and only 12 uncertified causes of death when it reappeared in a very thin disguise in Sir Walter were recorded in Burnley. The percentage of uncertified Foster’s amendment it received a good deal more support and causes of death in 1892 averaged 2-0 in these thirty-three was only defeated by the narrow majority of fourteen to large towns, and ranged from 00 in Croydon, 0’5 in Birkentwelve votes. This decision might be taken as indicating a head, 0’7 in Burnley and 0’9 in London and Leeds, to 4’0 in very real anxiety on the part of an influential minority of Hull, 4-2 in West Ham, 4-3 in Sheffield, 4-5 in Halifax, 4-7 in The cause of this wide the Council to find a remedy for the evils brought to light Liverpool and 5’3 in Birmingham. by the inquiry of the committee, and it would be very unsafe range of proportions of uncertified deaths in the large for Medical Aid Associations and their medical officers to English towns appears to be a fitting subject for the attention of the Select Committee of the House of Commons assume that the second resolution imposes no obligation on them to mend their ways. The resolution seems to us cal- which is now taking evidence on the subject of Death culated to mislead medical officers of Medical Aid Associa- Certification. These figures should, moreover, be carefully tions as to the statutory powers of the Council. The better considered in relation to the proportion of inquests course would have been to transmit the report to the Medical held in the various towns, which varies almost as widely Aid Associations, leaving it to convey its own lesson without as the proportion of uncertified causes of death. During the year 1892 the percentage of inquests to total deaths note or comment. There ought to be no doubt in the medical profession as to the in the thirty-three towns averaged 6’8, and ranged in disciplinary powers of the Council under the twenty-ninth the several towns from 2’6 in Preston, 3’4 in Burnley, section of the Medical Act, but whether the practices struck 35 in Birmingham and 3-6 in Brighton and Huddersfield, at in the second recommendation are such as call for the to 7’8 in London and Manchester, 8’3 in Sunderland exercise of those powers is a very grave question and one and Newcastle, 8’6 in Gateshead, 8’9 in Derby and 9’4 in which was not by any means disposed of by the resolution Birkenhead. The variations in the proportions of inquests appended to the report. With great deference to Sir John held are to a slight extent due to the varying proportions of Simon, such practices cannot be summarily dismissed as deaths from violence ; but this factor can only account for belonging to the "minor morals " of the profession. Surely a small part of the differences. For instance, the death-rate where the issue raised is "efficient practice," as is the case from violence in 1892 was almost identical in Birmingham in the first part of Recommendation II., a "major moral " and Birkenhead, and yet the proportion of inquests in these question of the first order comes up for judgment. The towns was 3’5 and 9’4 respectively. It would be worth while ’’morals"" too are just those that the public are entitled to inquire whether the small proportion of inquests held in Let it be Birmingham has any connexion with the high rate of unto have warranted sound by the Council. borne in mind that the object of the Medical Act is certified causes of death, or whether the high proportion of to enable "persons requiring medical aid to distinguish inquests (9-4 per cent.) held in Birkenhead has directly or qualified from unqualified practitioners." To do this indirectly any effect on the proportion of uncertified causes effectually a General Medical Council is created and armed of death in that town, which was only 0 5 per cent. in 1892. with adequate powers for ensuring that only persons It may further be pointed out that in each of the several towns possessing the "requisite knowledge and skill"for the mentioned above in which the highest proportions of inquest "efficient practice of their profession"shall be admitted cases were recorded-namely, from 7’8 to 9’4 per cent.-the to registration. The Council can go behind diplomas and percentage of uncertified deaths was low and ranged from licences to ascertain whether their face value corresponds to 05 to 2.0; whereas, on the other hand, with the single a sufficiently high real value and can invoke the aid of the exception of Burnley, excessive proportions of uncertified Privy Council to compel the bodies conferring them to bring deaths, ranging from 2 -8 to 53, were recorded in each of the up the professional training of their students to a sufficiently towns in which the proportion of inquest cases was abhigh standard. Is it to be said that, after all precautions are normally low and below 4 per cent. taken to guard the portals of the medical profession against The varying proportion of uncertified causes of death in the entrance of persons without the necessary knowledge and Birmingham appears to afford conclusive evidence of the skill for "efficient practice, " no duty devolves on the Councilreality of the relation between uncertified deaths and inquests. to see that a registered medical practitioner does not deliber- The proportion of inquests held in Birmingham was until ately put himself from year’s end to year’s end in a position in quite recently exceptionally high, even for a large town ; it which the efficient practice of his profession is impossible ?2 averaged, indeed, 8-9 per cent. during the eight years If that be a " minor moral " question, it is at any rate one 1881-88. The highest percentage was 9-6 in 1886, since which involves the health or lives of the Queen’s subjects. which the proportion has shown a remarkable and comparaNor can the granting of medical certificates on insufficienttively steady decline, and had fallen to 3-5 in 1892, a pergrounds be treated as a " minor moral " offence. The Legis- centage which was little more than a third of that which lature has attached particular importance to medical certifi- prevailed six years before, in 1886. Concurrently with this cates. The Courts recognise them as evidence of the state of marked decline in the proportion of inquests the percentage health they certify. To grant false certificates is assuredlyof uncertified deaths in Birmingham has shown an equally The proportion of uncertified deaths in more blameworthy professionally than "telling lies," as theremarkable increase.
own
not
infamous," and
,