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UNQUALIFIED ASSISTANTS AND THE GENERAL MEDICAL COUNCIL.
"
QROUND-t’ATER AND MALARIA."-HOSPITAL ABUSE.
G. A Sutherland and I recentlyclaimed to prove that an affection commonly known as congenital laryngeal stridor depended upon a congenital deformity of the superior laryngeal aperture aided by the flaccidity of the parts in infancy, (not on the latter factor alone as Dr. Smith erroneously interprets our views). If adenoids are the exciting cause of the affection, as Dr. Smith asserts, it is a little surprising that Dr. P. McBride, who examined six cases for Dr. Thomson of Edinburgh, and myself in some twelve consecutive cases have been unable to find them in a single instance. Dr. Smith’s contention is weakened and his bias shown by his statement that he always believed these cases were due to adenoids but that until this one case came under observation he had no substantial evidence of it. The typical class of cases described by Dr. Thomson, Dr. Sutherland, and myself form a group per se and must be carefully distinguished, as we pointed out, from cases of laryngeal spasm due to adenoids or other form of nasal obstruction. Many details of Dr. Smith’s case, apart from the result of treatment, point to its belonging to the latter class. Thus the stridor ceased under chloroform, was much increased in sleep or by closing the mouth as in feeding, and the patient was subject to severe suffocative attacks, these symptoms being characteristic of the adenoid cases and very rare in the affection we have called congenital laryngeal obstruction. Thus Dr. Smith’s case in no way controverts our views as to the pathology of the latter affection. Finally, when Dr. Smith states that he believes the affection to be due to spasmodic contraction of the ary-epiglottic folds, and that this is due to irritation set up by the adenoids in the naso-pharynx, I venture with all deference to reply that the spasm in his patient was possibly due to irritation set up by the examiner’s finger and laryngeal mirror in the infant’s pharynx-a not uncommon reflex.
I
am.
Sirs.
vours
elbeck-street, W., March 22nd, 1898.
faithfullv.
H. LAMBERT
LACK.
"GROUND-WATER AND MALARIA." To the Editors of THE LANOET.
UNQUALIFIED ASSISTANTS
895 AND THE
GENERAL MEDICAL COUNCIL. To the Editors of THE LANCET.
SIRS,-I am an unqualified medical assistant, have been in the profession forty-five years, and was apprenticed to a firm of surgeons at Nuneaton. Warwickshire, for five years, for which my father paid .f:500. I then went to Guy’s Hospital and completed my hospital curriculum, and went for ezamination, but unfortunately was rejected. I then was appointed surgeon on a ship, the Wtld Puck, sailing from London to New Zealand. I had seven voyages in the capacity of surgeon ; at the end of my seven years on board I gave up the appointment and obtained an assistancy at Great Bridge, Staffordshire. I attended 2500 cases of midwifery in seven years. I have left Great Bridge twenty-seven years and since that time have been engaged as assistant in very large practices, where I have attended a very large number of midwifery cases. I can say without exaggeration that I have attended personally 5000 cases of midwifery and never had a woman die under my treatment. I am now sixty-five years of age, in very good health, and able to do any amount of day and night work, not having had an hour’s illness in my life. On reading the important notice as to the employment of unqualified persons as assistants or otherwise directed to be issued by resolution adopted by the General Medical Council on Nov. 24th, 1897, where it says the foregoing notices do not apply to the legitimate employment of dressers, midwives, dispensers, and surgery attendants under the immediate personal supervision of a registered medical practitioner, will you kindly inform me if I can attend cases (;1 midwifery, of course under the supervision of my principals ?7 An early answer will very Yours faithfully, greatly oblige J. T. L. March 16th, 1898. *In our opinion our correspondent’s attendance on "cases of midwifery" would subject his principal to the risk of being called to account by the Council. Why should our correspondent not submit his question to the General Medical Council —Eo. L.
to point out that in Chart 2 of my paper Ground Water and Malaria on page 708 of THE LANCET of March 12th the words "fever rate"and "rainfall in inchesshould be transposed, as the first and third lines represent the fever rate, and the second and fourth the rainfall. I shall be much obliged if you will mention this in your next number, as the point is an important one. I am, Sirs, yours faithfully, LEONARD ROGERS. London, March 22nd. 1898. Abuse
SiRs,-I write
on
To th-o Editors of THE LANCET. an
(BY
OUR
SPECIAL COMMISSIONER.)
XV.-BRADFORD.1 the Hospital Medical Sta’s.-&rrzall
affecting Payments Imposed on Poor PatMnts.-A Paying Olinique for Diseases of the Eye.-The Question of the Municipalisatilm ot the Hospitals.-Charity Patients and their Christmas Dinners.-Patients attended at their Homes by Hospital SU’l’geons.-Disast’J’ous Competition against Private P’I’ac-
" THE BATTLE OF THE CLUBS."
SiRs,-I beg to enclose you a copy of
HOSPITAL ABUSE.
.
titioners.
agreement signed
BRADFORD boasts of being the seventh largest town in by all the medical men in this town. Hitherto no clubs England. In 1882 its population was estimated at 197,103, have been taken on here at less than 58. per annum, but the "Cirencester Working-men’s Conservative Benefit Society" is the birth-rate being 13-59 and the death-rate 21-01 per 1000. establishing branches here and in the neighbouring villages In 1892 the population was 219,262, the birth-rate 28 64, and will not pay more than 4s. 4d. per member per annum- and the death-rate 17 91 per 1000. In 1896 the population if they can help it-and it is to check this that we have was set down at 228,809. the birth-rate at 25-94, and the combined. death-rate at 16 77 per 1000. From these figures it will be The society went so far as to introduce a medical man seen that the attendance at the hospitals should have fallen into one of the villages, but after a stay of two or three off considerably, but these institutions, on the contrary, months he left.-I am, Sirs, yours faithfully, continually boast of their increased usefulness and appeal for more funds so as to extend the scope of their action. It HORACE E. HAYNES. Evesham, March 23rd, 1898. EBCLOSURE. Evesham, March 16th, 1898. We, the undersigned, having regard to the "sweating" rates of pavment made to medical men by medical aid associations and friendly societies, hereby agree not to undertake after this date to attend any members of such societies in the borough of Evesham at a less rate than
1
The previous articles on this subject were published in THB LANCET the following dates: (1) Sept. 26th, 1896. Plvmouth and Devonport ; (2) Oct. 10th, 1896, Exeter; (2 concluded) Oct. 17th, 1896, Exeter ; (3) Oct. 31st, 1896, St. Thomas’s Hospital, London; (4) Nov. 14th, 1896, Liverpool; (4 continued) Nov. 21st, 1896, Liverpool; (4 concluded) Dec. 12th, 1896, Liverpool; (5) Jan. 2nd, 1897, Manchester ; (5 continued) 68. per head per annum with Is. fee for examination on entrance, and Jan. 9th, 1897, Manchester; (5 concluded) Jan. 23rd, 1897, Manchester; Feb. 6th. 1897, Leeds; (6 concluded) Feb. 13th, 1897, Leeds; members of such societies having their headquarters outside the (6) (7) April 17th, 1897, Coventry; (8) May 1st, 1897, The Royal London borough at not less than Ra. npr Anniim with 1A. entrance fee. Ophthalmic Hospital; (9) May 8th, 1897, France, United Action and JOHN S. SLATER. ALLEN L. HAYNES. Legislative Action; (10) May 15th. 1897, Leicester; (11) June 5th, 1897, R. HARRISON GILPIN. A. H. MARTIN. Nottingham; (12) July 31st, 1897, Birmingham; (12 continued) F. LEONARD SESSIONS. HORACE E. HAYNES. Aug. 14th, 1897. Birmingham ; (12 continued) Sept. 4th. 1897, 2
THE LANCET, Sept. 11th, 1897, p. 653.
on
Birmingham; (12 concluded) Sept. 18th. 1897, Birmingham; (13) Oct. 30th. 1897, Southampton; (14) March 5th, 1898, Glasgow ; (14 conclztded) March 19th. 1898, Glasgow.
QROUND-t’ATER AND MALARIA."-HOSPITAL ABUSE.
G. A Sutherland and I recentlyclaimed to prove that an affection commonly known as congenital laryngeal stridor depended upon a congenital deformity of the superior laryngeal aperture aided by the flaccidity of the parts in infancy, (not on the latter factor alone as Dr. Smith erroneously interprets our views). If adenoids are the exciting cause of the affection, as Dr. Smith asserts, it is a little surprising that Dr. P. McBride, who examined six cases for Dr. Thomson of Edinburgh, and myself in some twelve consecutive cases have been unable to find them in a single instance. Dr. Smith’s contention is weakened and his bias shown by his statement that he always believed these cases were due to adenoids but that until this one case came under observation he had no substantial evidence of it. The typical class of cases described by Dr. Thomson, Dr. Sutherland, and myself form a group per se and must be carefully distinguished, as we pointed out, from cases of laryngeal spasm due to adenoids or other form of nasal obstruction. Many details of Dr. Smith’s case, apart from the result of treatment, point to its belonging to the latter class. Thus the stridor ceased under chloroform, was much increased in sleep or by closing the mouth as in feeding, and the patient was subject to severe suffocative attacks, these symptoms being characteristic of the adenoid cases and very rare in the affection we have called congenital laryngeal obstruction. Thus Dr. Smith’s case in no way controverts our views as to the pathology of the latter affection. Finally, when Dr. Smith states that he believes the affection to be due to spasmodic contraction of the ary-epiglottic folds, and that this is due to irritation set up by the adenoids in the naso-pharynx, I venture with all deference to reply that the spasm in his patient was possibly due to irritation set up by the examiner’s finger and laryngeal mirror in the infant’s pharynx-a not uncommon reflex.
I
am.
Sirs.
vours
elbeck-street, W., March 22nd, 1898.
faithfullv.
H. LAMBERT
LACK.
"GROUND-WATER AND MALARIA." To the Editors of THE LANOET.
UNQUALIFIED ASSISTANTS
895 AND THE
GENERAL MEDICAL COUNCIL. To the Editors of THE LANCET.
SIRS,-I am an unqualified medical assistant, have been in the profession forty-five years, and was apprenticed to a firm of surgeons at Nuneaton. Warwickshire, for five years, for which my father paid .f:500. I then went to Guy’s Hospital and completed my hospital curriculum, and went for ezamination, but unfortunately was rejected. I then was appointed surgeon on a ship, the Wtld Puck, sailing from London to New Zealand. I had seven voyages in the capacity of surgeon ; at the end of my seven years on board I gave up the appointment and obtained an assistancy at Great Bridge, Staffordshire. I attended 2500 cases of midwifery in seven years. I have left Great Bridge twenty-seven years and since that time have been engaged as assistant in very large practices, where I have attended a very large number of midwifery cases. I can say without exaggeration that I have attended personally 5000 cases of midwifery and never had a woman die under my treatment. I am now sixty-five years of age, in very good health, and able to do any amount of day and night work, not having had an hour’s illness in my life. On reading the important notice as to the employment of unqualified persons as assistants or otherwise directed to be issued by resolution adopted by the General Medical Council on Nov. 24th, 1897, where it says the foregoing notices do not apply to the legitimate employment of dressers, midwives, dispensers, and surgery attendants under the immediate personal supervision of a registered medical practitioner, will you kindly inform me if I can attend cases (;1 midwifery, of course under the supervision of my principals ?7 An early answer will very Yours faithfully, greatly oblige J. T. L. March 16th, 1898. *In our opinion our correspondent’s attendance on "cases of midwifery" would subject his principal to the risk of being called to account by the Council. Why should our correspondent not submit his question to the General Medical Council —Eo. L.
to point out that in Chart 2 of my paper Ground Water and Malaria on page 708 of THE LANCET of March 12th the words "fever rate"and "rainfall in inchesshould be transposed, as the first and third lines represent the fever rate, and the second and fourth the rainfall. I shall be much obliged if you will mention this in your next number, as the point is an important one. I am, Sirs, yours faithfully, LEONARD ROGERS. London, March 22nd. 1898. Abuse
SiRs,-I write
on
To th-o Editors of THE LANCET. an
(BY
OUR
SPECIAL COMMISSIONER.)
XV.-BRADFORD.1 the Hospital Medical Sta’s.-&rrzall
affecting Payments Imposed on Poor PatMnts.-A Paying Olinique for Diseases of the Eye.-The Question of the Municipalisatilm ot the Hospitals.-Charity Patients and their Christmas Dinners.-Patients attended at their Homes by Hospital SU’l’geons.-Disast’J’ous Competition against Private P’I’ac-
" THE BATTLE OF THE CLUBS."
SiRs,-I beg to enclose you a copy of
HOSPITAL ABUSE.
.
titioners.
agreement signed
BRADFORD boasts of being the seventh largest town in by all the medical men in this town. Hitherto no clubs England. In 1882 its population was estimated at 197,103, have been taken on here at less than 58. per annum, but the "Cirencester Working-men’s Conservative Benefit Society" is the birth-rate being 13-59 and the death-rate 21-01 per 1000. establishing branches here and in the neighbouring villages In 1892 the population was 219,262, the birth-rate 28 64, and will not pay more than 4s. 4d. per member per annum- and the death-rate 17 91 per 1000. In 1896 the population if they can help it-and it is to check this that we have was set down at 228,809. the birth-rate at 25-94, and the combined. death-rate at 16 77 per 1000. From these figures it will be The society went so far as to introduce a medical man seen that the attendance at the hospitals should have fallen into one of the villages, but after a stay of two or three off considerably, but these institutions, on the contrary, months he left.-I am, Sirs, yours faithfully, continually boast of their increased usefulness and appeal for more funds so as to extend the scope of their action. It HORACE E. HAYNES. Evesham, March 23rd, 1898. EBCLOSURE. Evesham, March 16th, 1898. We, the undersigned, having regard to the "sweating" rates of pavment made to medical men by medical aid associations and friendly societies, hereby agree not to undertake after this date to attend any members of such societies in the borough of Evesham at a less rate than
1
The previous articles on this subject were published in THB LANCET the following dates: (1) Sept. 26th, 1896. Plvmouth and Devonport ; (2) Oct. 10th, 1896, Exeter; (2 concluded) Oct. 17th, 1896, Exeter ; (3) Oct. 31st, 1896, St. Thomas’s Hospital, London; (4) Nov. 14th, 1896, Liverpool; (4 continued) Nov. 21st, 1896, Liverpool; (4 concluded) Dec. 12th, 1896, Liverpool; (5) Jan. 2nd, 1897, Manchester ; (5 continued) 68. per head per annum with Is. fee for examination on entrance, and Jan. 9th, 1897, Manchester; (5 concluded) Jan. 23rd, 1897, Manchester; Feb. 6th. 1897, Leeds; (6 concluded) Feb. 13th, 1897, Leeds; members of such societies having their headquarters outside the (6) (7) April 17th, 1897, Coventry; (8) May 1st, 1897, The Royal London borough at not less than Ra. npr Anniim with 1A. entrance fee. Ophthalmic Hospital; (9) May 8th, 1897, France, United Action and JOHN S. SLATER. ALLEN L. HAYNES. Legislative Action; (10) May 15th. 1897, Leicester; (11) June 5th, 1897, R. HARRISON GILPIN. A. H. MARTIN. Nottingham; (12) July 31st, 1897, Birmingham; (12 continued) F. LEONARD SESSIONS. HORACE E. HAYNES. Aug. 14th, 1897. Birmingham ; (12 continued) Sept. 4th. 1897, 2
THE LANCET, Sept. 11th, 1897, p. 653.
on
Birmingham; (12 concluded) Sept. 18th. 1897, Birmingham; (13) Oct. 30th. 1897, Southampton; (14) March 5th, 1898, Glasgow ; (14 conclztded) March 19th. 1898, Glasgow.