108

similar hospitals. Up to the present there have been a few .1consultant members of professional eminence on the Hamp-stead staff, but their office has been just as much of a sine-cure as that of a consultant member of the staff of anyLondon general hospital. The King Edward’s HospitalFund for London had intimated to the council of the

hospital when it attained its present importance that itwould be well advised to change the constitution of itsstaff from local practitioners to "consultants," althoughit is noteworthy that the Fund has never committeditself to the definition of a consultant. During 1906 thecouncil considered the matter and it was this event that

brought about the meeting and resolutions to which wehave referred above. The council appointed a special com-mittee to consider the subject, which reported on Februarylast " that this committee is of opinion that it is desirableto appoint a staff of four consultants of high standing (twosurgeons and two physicians), but that under the specialcircumstances of the Hampstead General Hospital it is

important to retain the cooperation on the medical staff ofmedical men residing in the neighbourhood of the hospital."At the end of last year matters were hurried on by anew factor. The North-West London Hospital was insuch severe financial difficulties that it was suggested toclose it. The King’s Fund, however, took the matter in handand proposed to the Hampstead Hospital that they shouldamalgamate and carry on their out-patients department atthe North-West London Hospital, where there had beenan out-patient practice of about 123,000 a year, whilst theHampstead attendances of out-patients did not much exceed21,300. The Fund promised the Hampstead Hospital 1500a year and other benefits resulting from the amalgamation,but the offer was absolutely conditional on the replacementof the staff by the undefined "consultants" and the inclusionof certain members of the North-West London Hospitalstaff. After much negotiation the Fund agreed to retain thepresent medical officers for a period of 18 years from the timeof their original election, giving them terms of from five toseven years to run, but it would not agree to the subsequentpromotion of the assistant medical officers, although one ofthese gentlemen holds the Fellowship of the Royal College ofSurgeons of England. In fact, it laid down the absoluterule that in future the staff must be " consultants " and notlocal practitioners, however capable these may be. The

hospital council, without referring the matter of amalgama-tion or staff constitution to the general body of governors,has accepted the terms, including the appointment ofthree members of the North-West London Hospital staff.The condition precluding the present assistant officers frompromotion was the last concession made to the King’sFund and was only carried by one vote, and subsequentevents have proved that the council was divided on

many points. Meanwhile the local profession as repre-sented by the British Medical Association had been active ;a conference was held between its 1906 committee andmembers of the staffs of the two hospitals concerned, whereit was agreed that there was no objection to amalgama-tion under certain very clear conditions regulating the out-patients and insuring a good local professional representa-tion on the staff and the committee. A meeting of the pro-fession was convened on May 24th to consider these recom-mendations and so far from supporting them unanimously amotion that the amalgamation was undesirable was onlylost by the casting vote of the chairman. At this time thestaff of the hospital were trying to support their council asfar as they reasonably could in a most trying and delicateposition and the local profession were handicapped in theirendeavours by not having the staff with them. When,however, the council made its final surrender to theKing’s Fund the staff decided to make common cause withtheir outside brethren and at a well-attended professionalmeeting on July 3rd, under the auspices of the local branchof the British Medical Association, Dr. E. CollingwoodAndrews on behalf of the staff rehearsed the position andannounced that his colleagues and he had decided to supportthe motion before the meeting :-That this meeting considers the Hampstead General Hospital should

always have a staff of local practitioners, and in consideration of thisopinion calls upon the members of the medical profession to refuse toaccept any office on the staff on terms which are net consideredsatisfactory by the local profession.

He, moreover, announced that a special meeting of governorsand subscribers of the hospital had been convened forJuly 16th who would be asked to rescind the council’s

decision and to vote for the continuance of an acting staff oflocal men with an increased consulting staff. Dr. Andrews,it is suggested, minimised the financial support broughtby the North-West London Hospital to the amalgamationscheme, but though an important matter it does not affectthe position brought about by the proposals. If these are-not carried the staff will resign in a body ; if they arecarried it appears that the amalgamation scheme will fallto the ground, but we understand that the hospital will notthereby lose the support of the King’s Fund. The meetingreceived the attitude of the staff very favourably, althoughone or two gentlemen tried to confuse the issue with the out-patient controversy. The resolution was carried nemine con-tradicente and there the matter rests until the meeting ofhospital governors has been held. We have only had spaceto indicate the outline of the matter and shall acquaint ourreaders with the issue in due course. It is impossible toforetell what this may be as the situation is one of ex-

treme difficulty. There is no doubt, however, that the localprofession has had its influence greatly strengthened by thesupport of the hospital staff. We trust that the governors atthe approaching meeting will not be swayed by personalconsiderations but will record their decision in what theyconceive to be the true interests of the hospital’s welfare.

MEDICINE AND THE LAW.

attempted Suicide and the Policeat Chelmsford.A CURIOUS and unaccountable attitude appears to have

been adopted by the police authorities at Chelmsford, accord-ing to the evidence given at an inquest held there recently.The deceased, a carpenter, had become insane and had cuthis throat in the street. He was taken by the policewhile still alive to the Chelmsford Infirmary and waathere attended to, but was not allowed to remainas an in-patient because the police authorities atChelmsford refuse to permit a constable to remain inthe infirmary in charge of a person who has attemptedsuicide and the authorities of the Chelmsford Infirmarynaturally and rightly decline to entertain such patientswithout police assistance. On the occasion in question thedeceased, after receiving surgical aid at the infirmary, wastaken by the police to the workhouse infirmary, but there hewas refused admission, equally rightly, because he was not aproper subject for poor relief. A medical man who appearsto have been summoned to attend him at his homefound that his condition required that he should betreated in a hospital, and interesting himself vigorouslyin the matter persuaded the guardians to stretch a.

point and to allow him to be admitted to the workhouseinfirmary. The guardians passed a special resolution thathe should be taken in, but an hour after his arrival he died.The jury at the inquest had before them correspondencebetween the infirmary board and the police which passed in1904, in which the board intimated that it could notundertake the care of those who had attempted to commitsuicide without the assistance of the police, to which thechief constable had replied that he could not instruct thepolice not to take a patient whose life was in dangerto the infirmary if that was the nearest availableplace, but that it would be detrimental to the public

service to allow his men to remain there. They hadalso evidence to the effect that the institution hadno male attendants to take care of such cases as that, described and that would-be suicides were admitted toI London hospitals only because the police always remainedL in charge of persons for whose safety they were directlyL responsible. In reply to this the deputy chief constable isL reported to have made the statement that " there is no powerl to put the police in charge." The jury at the conclusionL of the inquest returned a verdict of suicide during; temporary insanity, with a rider that the guardians

should have been notified of the correspondence betweenthe police and the infirmary, that the guardians were greatlyto blame, and that the relieving officer was not to blame ashe had only done his duty. Such censure seems to be unl deserved and misplaced. The guardians of the union appear

to have acted with humanity and to have done their best fors the deceased when they were fully informed that his life wasr in danger, although, strictly speaking, he would not in other circumstances have constituted a case for treatment under

109

the Poor-law. The cause of the delay in placing this un-fortunate man where he could best be taken care of seems tohave been due to the attitude of the police, which mustsurely be unusual. It is their duty to remain in charge of aperson who is in their custody in consequence of the crimehe has committed in attempting to take his own life andit is equally their duty to afford him the best chance possibleof having his life saved. A visit to a few of the Londonhospitals would soon convince the police of Chelmsford thatthere is " power to put the police in charge," and that it isvery frequently done in the metropolis, where the Home<office would quickly interfere if such a course were a wrongone to adopt and detrimental to the public service. Evenwith a constable remaining present to render assistance ifneeded the desirability of admitting an insane patient mustbe one for the consideration of the hospital committee, tobe determined according to the patient’s condition. Withontsuch assistance it would be wrong for the hospital to under-take a responsibility to a large extent outside its province.

’ Parental Liability.The Journal of the American Medical Association records

an interesting case in regard to the liability for fees incurredby a parent who had requisitioned the extraordinary servicesof a medical man on behalf of his adult son. The plaintiffsued for 816,000 as a reasonable remuneration for havingbeen in constant and exclusive attendance on the de-fendant’s son for 40 days before his death. He had beensummoned for this purpose by an urgent telegram from thefather, which the plaintiff contended constituted an impliedcontract of liability for reasonable fees. The defence wasthat from$4000 to$6000 was an ample fee for the servicesrendered. The plaintiff secured a verdict for$12,666. Thedefendant, however, moved for a new trial on the ground oferror in the instructions and that the verdict was excessive,and this was sustained by the trial court. The SupremeCourt has affirmed this order. The decision was embodiedin a lengthy judgment which affirmed, inter alia, that thejury had been wrongly instructed when told to take intoconsideration the defendant’s wealth and the plaintiff’sgeneral professional reputation when assessing the award.

Looking Back.FROM

THE LANCET, SATURDAY, July 11th, 1829;REMUNERATION TO MEDICAL WITNESSES.

To the EditfJ’1’ of THE LANCET. ISIR,-Can you or any of your numerous readers inform me,whether a regularly educated medical man, a member of the 1College, &c., who is called to the case of a drowned person, Iuses every means to restore to life the said drowned person, i

and afterwards is obliged to attend the inquest upon thebody; whether this medical man is not entitled by law tosome remuneration ? In asking the question, I speak feelingly,having been called to several cases of this kind, and, indeed,I was called up in the middle of the night to one, only theearly part of this week.

I remain, Sir,Your obedient servant,

6. London Terrace, Hackney Road,June 27th, 1829.

HORATIO COLLMAN.

Such is the disgraceful state of the law regarding themedical profession, that a medical man, thus circumstanced,cannot legally recover compensation for his time andtrouble!-ED. L.

VITAL STATISTICS.

HEALTH OF ENGLISH TOWNS.

IN 76 of the largest English towns 8255 births and 3853deaths were registered during the week ending July 6th.The annual rate of mortality, which in the successive weeksof last quarter had declined uninterruptedly from 17’ 9 to12’5 per 1000, was again 12’ 5 in the week under notice.During the 13 weeks ending June 29th the death-rate in thesetowns averaged 15 1, the rate in London during the sameperiod being 14’6. The lowest rates last week in the 76

towns were 4’1 in Walthamstow, 5’2 in Hornsey, 6’0 inNorthampton, and 6’ 2 in King’s Norton ; the highest rateswere 18’ 4 in Sunderland, 18’ 5 in Bolton, 18’ 6 in Bury,18 . 9 in Blackburn, 19’ 6 in Burnley, and 20 0 in Middles-brough. The 3853 deaths in the 76 towns were sevenin excess of the number in the preceding week andincluded 366 which were referred to the principal epi-demic diseases, against 430, 365, and 427 in the three

preceding weeks; of these, 130 resulted from measles,109 from whooping-cough, 47 from diarrhoea, 41 from

diphtheria, 32 from scarlet fever, and seven from "fever"(principally enteric), but not any from small-pox. Nodeath from any of these epidemic diseases was registeredin Willesden, Southampton, Plymouth, Northampton,Devonport, or in ten other of the 76 towns ; the annualrates from these diseases, however, ranged upwards to 3’1 1in Blackburn, 3’ 3 in Derby, 3’ in Bolton, 5’3 3 in Wigan,and 5’ 4 in Walsall The 130 fatal cases of measles showeda decline of 28 from the number in the previous week, thehighest annual rates therefrom being 1’ 8 in Hull, 2’ 3 inBolton, 2’ 5 in Derby, 3 - 5 in Wigan, and 4’ 9 in Walsall.The 109 deaths from whooping-cough were 27 fewer thanthe number in the preceding week, the death-rates from thisdisease ranging upwards to 1.0 in Leeds, 1 - 1 in Bolton,1 - 4 in Merthyr Tydfil, 1 - 8 in Wigan and in Bury, and 1 - 9 inTynemouth. The fatal cases of diarrhoea, which had been 50,53, and 51 in the three preceding weeks, declined to 47 in theweek under notice. The 41 deaths from diphtheria exceededby 11 the number in the preceding week, the greatest propor-tional mortality from this disease being recorded inHuddersfield. The deaths from scarlet fever, which hadbeen 32 and 40 in the two preceding weeks, declined againlast week to 32. The seven fatal cases of "fever " includedtwo in Liverpool and two in Burnley. The number ofscarlet fever patients under treatment in the MetropolitanAsylums Hospitals and the London Fever Hospital, which hadbeen 2936, 2985, and 3022 at the end of the threepreceding weeks, had further risen to 3193 at the endof last week; 504 new cases were admitted during theweek, against 389, 414, and 422 in the three precedingweeks. The deaths in London referred to pneumonia andother diseases of the respiratory organs, which had been156 in each of the two preceding weeks, declined lastweek to 148, but were 18 in excess of the correctedaverage number in the corresponding week of the pre-vious five years. The causes of 31, or 0 - 8 per cent., ofthe deaths registered in the 76 towns during the week werenot certified, either by a registered medical practitioner orby a coroner. All the causes of death.were duly certified inLeeds, Bristol, West Ham, Newcastle-on-Tyne, Hull, and in56 other of the 76 towns ; the proportion of uncertifieddeaths, however, showed a marked excess in Liverpool,Birmingham, Sheffield, Gateshead, and St. Helens.

HEALTH OF SCOTCH TOWNS.

The annual rate of mortality in eight of the principalScotch towns, which had been equal to 17’ 3 and 15’ 0per 1000 in the two preceding weeks, further declined to 14’ 5in the week ending July 6th, but was 2’ 0 per 1000 inexcess of the mean rate during the same period inthe 76 large English towns. The rates in the eight Scotchtowns ranged from 10 - 2 in Greenock and 11’ 7 in Aber-deen to 15-3 3 in Glasgow and 19’ 3 in Leith. The 504deaths in the eight towns showed a decline of 18 fromthe number in the preceding week, and included 59 whichwere referred to the principal epidemic diseases, against84 and 76 in the two preceding weeks. These 59 deathswere equal to an annual rate of 1. 7 per 1000, whichexceeded by 0.5 per 1000 the rate from the principalepidemic diseases in the 76 English towns ; they included18 which were referred to whooping-cough, 18 to "fever,"10 to diarrhoea, six to diphtheria, five to measles, and twoto scarlet fever, but not any to small-pox. The deathsfrom whooping-cough, which had declined from 57 to 34in the four preceding weeks, further fell last week to 18,of which ten occurred in Glasgow, three in Edinburgh,three in Dundee, and two in Aberdeen. The fatal cases

of " fever," which had been 14 and 21 in the two previousweeks, declined again to 18 last week, and included ten ofcerebro-spinal meningitis in Glasgow, three in Edinburgh, andthree in Leith. The deaths from diarrhoea, which had been23 and 13 in the two preceding weeks, further fell last weekto ten, of which six were registered in Glasgow and two in