2
322 Notes, Short Comments, and Answers to Correspondents. MEDICAL MEN AND THE RIGHT TO REFUSE ’ ATTENDANCE. THE old question of the common-law medical rights of a medical practitioner to refuse to attend when summoned to visit a sick person without receiving a fee was raised at an inquest recently at York, when Dr. P. Schmidt was unjustly held by the jury to be ’deserving of the severest censure in not carrying the case through." The medical man had received a fee for a previous attend- ance upon the deceased, a child of 6 months, but when sent for on the following day delayed going until the evening. He then recommended that the child should be taken to the county hospital, where the death took place a few minutes after the patient’s admission. The fact that a second fee was not forthcoming was frankly admitted by the medical man to have been his reason for not attending when he was summoned. The report of the evidence given at the inquest by Dr. Schmidt justifies the surmise that a somewhat outspoken manner of asserting his right to ask for a fee and to refuse attendance in the absence of one may have prejudiced the medical man before the jury and may have been largely responsible for the censure passed upon him. The justice of such censure is not apparent. ln refusing to attend in the absence of any prospect of remuneration a medical man exercises an undoubted right, which the public at large has recognised by instituting voluntary hospitals and dispensaries and Poor-law infirmaries for the benefit of those unable to pay for medical attendance. A medical man may, and very often does, attend poor patients without hope of reward, but the extent to which he does this is a matter which must be left to him to decide. One man having private means, or a remunerative practice, can afford to be generous in such matters where another cannot. A medical practitioner living in a poor neighbour- hood would find a very large number of patients anxious to employ him and unable to pay him, if he once let it be known that his services were at the disposal of those so situated. In the same way a provision merchant in such a district who was ready to hand over his goods to those unable to pay for their purchases would soon have many customers. But neither the medical man nor the pro- vision merchant would make a livelihood, and each has an equal right to endeavour to do so. Probably if medical men asked the editors of their local daily and weekly papers to insert the above remarks, we would have a marked falling off in these very questionable censures by coroners and Poor-law juries, VITAL STATISTICS OF THE FEDERATED MALAY STATES AND THE STRAITS SETTLEMENTS. Sir Edward Lewis Brockman, K.C.M.G., Chief Secretary to the Government of the Federated Malay States (Perak, Selangor, Negri Sembilan, and Pahang), in his report for the year 1915, just presented to Parliament, states that as the conditions relating to immigration and emigration have recently been abnormal the present population is probably considerably less than that shown by the census of 1911, viz., 1,172,336. The number of births in 1915 was 29,699 and of deaths 33,899. There were 5778 deaths of infants under one year of age and the infantile mortality rate was 194 per 1000. It is suggested by the Principal Medical Officer that without malaria the infantile death-rate would not be of great importance. The death-rate in the principal towns in 1915 was: Kuala Lumpur, 27-83 per 1000; Ipoh, 27-8 per 1000; Taiping, 33-99; and Seremban, 47-15. Malaria accounted for 44 per cent. of the total deaths. Dysentery and diarrhoea caused 3148 deaths, beri-beri 871, and pulmonary tuberculosis 1995. There was a severe outbreak of small-pox in the district of Lower Perak. Several cases also occurred in Selangor and Negri Sembilan, but only one case was reported in Pahang. Two cases of plague occurred in Perak, Venereal diseases show a distinct falling-off. The medical institutions maintained by the Government comprise 42 hospitals, 9 jail hospitals, 2 lunatic asylums, 3 leper asylums, and 15 out-door dispensaries. The number of in-patients treated during the year was 72,792 and of out-patients 204,997, both totals showing a remarkable decrease as compared with the previous year. The reports of the lady medical officers at Kuala Kangsar and Kuala Pilah show that they are doing much good work. Their services are greatly appreciated. Attempts have been made to get into touch with native midwives, but without much success. One of the lady medical officers observes that the large percentage of normal maternity cases among Malay women gives the midwives the appearance of skill which they do not possess; and on the subject of infantile mortality she expresses the opinion that it is fever that more likely causes the high mortality than any errors in feeding. On an estimated total population of 776,444 in the Straits Settlements, the birth-rate in 1915 was 29-25, and the death-rate 29-15 per 1000 ; for the European inhabitants, estimated at 8086, these ratios were 24-24 and 14-96 per 1000 respectively. The Principal Medical Officer, Dr. W. Gilmore Ellis, considers that on a different and more exact estimate of the population, according to the method of the medical officer of health of Singapore, the death-rate should be really 31’13 per 1000. The infantile mortality was 236’68 per 1000, being highest among Malays, who habitually feed their infants a few days old on boiled rice, which leads to indigestion and convulsions. Lectures on the subject are being given in the vernacular by Dr. Keun, which, it is hoped, may lead to improvement. There were 37 cases of plague (with 33 deaths) and 17 cases of cholera (with 10 deaths). Deaths from beri beri have decreased steadily from 2056 in 1911 to 1079 in 1915. At the Beri-beri Hospital, Pasir Panjang, all of the cases admitted had habitually eaten uncured Siam rice; of the 135 discharged 9 were recovered and 113 considerably improved. At the Leper Asylum, Penang, with 411 inmates, more than 70 cases have been treated with injections of nastin and Dr. Heiser’s preparation of chaulmoogra oil; the results are being carefully watched, and in many instances consider- able improvement (return of sensation, shrivelling up of nodules, disappearance of dermatitis) has been observed. There have been fewer admissions for ankylostomiasis (932) during 1915 than in either of the two years preceding, but owing to the paucity of health officers it has not been possible to make much progress in the eradication of the disease. Mr. Gilbert Brooke, chief health omcer of Singapore, reports that the practical absence of infectious disease from all the great ports of the East is without parallel for several decades past; for five weeks from the beginning of September not a single port was in quarantine. No immigration was allowed during the first three months of the year, and for the next three months only limited immigration. Owing to the war the return pilgrimage season for Mecca had been accelerated into 1914, and no pilgrim sailings left the Straits at all for the 1915 season. A new quarantine and prevention of disease ordinance has been passed, including, among other im- provements, the insistence on vaccination of unprotected immigrants from China and India, and discretionary powers for the detection and treatment of cases of infectious disease, and for their repatriation if necessary. KITCHENER CLUB FOR WOUNDED SOLDIERS. THIS club for wounded soldiers has been started under the ’ aegis of the Red Cross at 8, Cambridge-gate, Regent’s Park, London, N.W., and is open daily from 10 to 6. Reading and writing rooms are provided, and lunch and tea will be served free of charge. WOMEN SANITARY INSPECTORS AND HEALTH VISITORS’ ASSOCIATION. THE 1916-1917 handbook of the association, just issued, contains the names of the executive officers and members of committees, the rules of the association, an alphabetical list of members and associates, and the report for the session 1915-16. Several members are engaged on war service. The honorary secretary of the association is Miss O’Kell, 12, Buckingham-street, Strand, London, W.C. FOOD SUBSTITUTES IN GERMANY. IT is probable that some difficulty is being experienced in those countries suffering from a shortage of food in administering the adulteration laws, inasmuch as mixtures are now allowed which were not allowed before. We have as examples in our own country the watering of spirits, the addition to wheat flour of other flours, and so forth. The opportunity, however, was sure to be one seized upon by the unscrupulous, and examples appear to have occurred in Germany of selling substitutes for the genuine article which can in no sense be regarded as supplying the necessary qualities of the comestibles so imitated. In connexion with an exhibition of food substitutes a report has been issued by the Berlin Municipal Laboratory on the food adulterations which are at present so plentiful in Germany. It is stated that a large number of enter- prising persons are devoting their time to the manufacture of food substitutes. Among these are the "bouillon cubes," which by law must contain at least 7 per cent. of meat extract, but which actually consist of common salt together with a little colouring matter. "Powdered beef-tea," which is sold in attractive-looking small boxes, is composed of wheat-flour, common sq.lt, a little clay, with a mere trace of meat extract. A "cheese substitute" in the form of a red powder contains 70 parts of common salt, 20 parts of powdered Hungarian pepper, a few grains of
