1414

OBITUARY

WILLIAM STUART-LOW, F.R.C.S. Eng.CONSULTING SURGEON, CENTRAL LONDON THROAT AND EAR

HOSPITAL

WE owe the following memoir to Sir JamesDundas-Grant : "William Stuart-Low’s death fromheart failure following influenza was the end of avery remarkable career. He was born at Burntisland,in Fife, in 1857. His father was in the scholasticprofession and doubtless bequeathed to him thecapacity for teaching which displayed itself when hejoined the staff of the Central London Throat andEar Hospital. Intended for the veterinary profession,he was attracted to that of medicine and was able

to qualify in 1884as Licentiate of theRoyal College ofPhysicians of Edin-burgh. According tohis own story, hav-ing his way to make,he started practicein a working-classneighbourhood inthe south-westerndistrict of London,taking also a resi-dent patient intohis house to helptowards the neces-

sary expenses. Hethen migrated tothe more desirablesurroundings ofHerne Hill wherehe had the good

fortune to meet a lady of both personal and intel-lectual attractions, who became his wife. She added

greatly to the brightness of his life and he afterwardsspoke of her as the best friend he ever had.’ Whilein busy practice he made time for preparing for theFellowship of the Royal College of Surgeons of

England, absorbing with avidity both the academicteaching and the obiter dicta of those from whomhe sought instruction. He was particularly inspiredby the teaching of the late Wm. Anderson, surgeonto St. Thomas’s Hospital, for whose anatomicalaccuracy and surgical refinement he had the greatestadmiration.

"In 1903 he was appointed to the staff of the

hIR= STUART-LOW

Central London Throat and Ear Hospital at the

age of 46. Both there and at the Polyclinic-theMedical Graduates’ College in Chenies-street, W.C.-he made his mark as a teacher and thereby addedconsiderably to his success in consulting practice.Curiously, he was guided more by his perfervidumingenium than by the Scotch tendency to rely onstrict logical reasoning. It may be said that hismethods were inductive rather than deductive, andhe had original views which when tested in his ownpractice had a remarkable measure of success. Hisinsistence, for instance, on the value of mucin incancer of the throat may not be universally accepted,but there can be no doubt as to the relief afforded bythe use of his preparations. His use of horse serumin the irrigation and dressing of operation woundswas an original idea, but it appears to have itsequivalent in some modern methods of treatment.He devised a number of details in dressing, fixing,and dealing with operation cases, which affordedevidence of his originality.

" At the Royal Society of Medicine he was a veryregular attendant, though he did not show manycases. His remarks, however, were at times inspiredby his difference of opinion from that of some previousspeaker. He then expressed himself with deliberationand emphasis, and if he appeared to be unnecessarilydownright in his utterance it was probably becausehe had formulated in his mind what he had to saytersely and without the frills with which too manyspeakers embellish their statements.

" Stuart-Low was powerfully built and endowedwith exceptional physical vigour. An unusually earlyriser, he took a pride in performing his operationswhen others had not yet breakfasted. In spite ofhis commanding figure he tended on the whole tobe shy and reserved, and the sensitiveness of hisdisposition was known probably to only a few. Hewas not a prolific writer, but he put forward his viewswith decision and happy phraseology. His work on’Mucous Membranes, Normal and Abnormal, includ-ing Mucin and Malignancy,’ published in 1905,amply illustrates the characteristics of his vigorousmodes of thought.

" To the writer he was ever a loyal friend, whetheras pupil, assistant, or colleague, and he and manyothers with him will greatly miss Stuart-Low anddeplore his decease. He is survived by his widowand a son and daughter." J. D.-G.

PANEL AND CONTRACT PRACTICE

Study Courses at HammersmithWE have already noted that the British Post-

graduate Medical School is arranging during the

coming summer intensive "refresher" courses for

general practitioners. The first of these courses, ofwhich full details will be found in our advertisementcolumns, opens next Monday, June 17th, and as

only a limited number can be admitted to one courseearly application for the later courses is recommended.Here it is appropriate to consider the circumstancesin which certain insurance practitioners may receivefinancial assistance towards such study. Assistanceis made by way of grants from the special expensesportion of the central mileage fund, and it must beshown that the doctor (1) has been in practice otherthan hospital practice at least one year before the

date of application ; (2) practises in an isolated orsparsely populated rural area and has no reasonableaccess to a town in which hospital practice is avail-able and meetings of medical societies can be attended;and (3) is unable, without assistance, to afford thecost of a course of study. Recommendations are

made to the Ministry of Health not later than theend of February in each year jointly by the insurancecommittee and the panel committee which mustsatisfy themselves that applicants fall within theterms of eligibility. Applications for a further coursewould be entertained after an interval of five years,unless special reasons are advanced for a repeatcourse at a shorter interval. The available fund islimited, and applications from any area are consideredin relation to those from the country as a whole.Normally the grant would not exceed 120, but in

1415PARLIAMENTARY INTELLIGENCE

exceptional cases the whole cost may be met (subjectto prescribed maxima under each item) for subsistenceexpenses, travelling expenses to the nearest suitablecentre, course fees, and the engagement where

required of a whole-time locum tenens.It should be borne in mind that the scheme is

restricted to insurance practitioners in rural districts,and it is, presumably, now too late to apply forassistance for the year 1935, although in view of thenew situation created by the opening of the Hammer-smith school it might be well to test this.

Refusal to Visit: Charge RebuttedA London insurance practitioner was recently

charged with having failed to visit a patient onrequest. The complaint was that the woman havingbeen discharged from hospital became ill the same

evening and requested a home visit on the followingmorning, but the practitioner declined to come andthe services of another doctor were obtained.The practitioner pointed out that he had received

a telephone message from the house physician toone of the honorary staff of the hospital to the effectthat the patient had discharged herself voluntarily,that she had been in bed for two weeks, had beenexamined by the " honorary " personally, had hadnumerous X rays taken, and every conceivable

pathological test, all with negative result. Thehospital authorities had told her she was not illbut had advised her to remain a day longer to getused to being out of bed. The practitioner havingattended her at home or at his surgery 43 times duringthe previous 12 months without ever finding anysign of physical disease agreed with the opinionof the house physician that while there might be aneurotic element in the patient’s condition she wasnot physically ill. Next morning he received a

clinical report from the hospital and soon afterwardsa message from the patient’s mother asking for ahome visit. Being engaged with another patient he

sent a message to the mother that he had beeninformed by the hospital that her daughter was notill, but if she wished to see him she could come to thesurgery-less than two minutes’ walk. The mothersent a further message that the patient was ill andneeded attention, to which he replied that he wasengaged but would be prepared to see the motherin half an hour’s time. No further application wasmade for his services.

Unfortunately the patient was ill this time.The other doctor who was called in found her sufferingfrom a febrile attack with pain in her back, vomiting,headache and general malaise, and unfit in his

opinion to leave the house. Although (in the wordsof the subcommittee’s report) she "gave a lengthyhistory of various illnesses from which she hadsuffered in the past," it might well have been heldthat the practitioner had committed a breach ofSection 9 (5) of the terms of service in failing tovisit a patient whose condition so required, but thecommittee took the view that the previous historyof the case, coupled with the message from the

hospital and the clinical report, doubtless promptedthe practitioner to regard as unreasonable the requestfor a home visit within 24 hours after the patienthad voluntarily discharged herself from hospital.Although the practitioner had offered to interviewthe mother within half an hour another doctor wascalled in and no further attempt was made to obtainthe services of the responsible practitioner. Thecommittee found that there was no failure on the

part of the practitioner to comply with the terms ofservice and that the cost of treatment obtained fromthe second doctor was not reasonably and necessarilyincurred.The case was dealt with under 6 (1) (b) of the rules

for the administration of medical benefit; whenthe subcommittee are of opinion that the case is onewhich can be disposed of on the written statements ofthe parties, and both parties agree, there is no hearing.

PARLIAMENTARY INTELLIGENCE

NOTES ON CURRENT TOPICS

Whitsuntide AdjournmentTHE House of Lords adjourned for the Whitsuntide

recess on Thursday, June 6th, until June 17th. TheHouse of Commons adjourned on Friday, June 7th,until June 17th.

The Housing Bill in the LordsOn June 5th in the House of Lords Viscount

HALIFAX, President of the Board of Education,moved the second reading of the Housing Bill. Hesaid that the suspension of building during the war,the dislocation of labour and material supplies whichfollowed the war, the suspension of emigration, andthe steady increase of population amounting tosome 2,000,000 persons between 1921 and 1931,taken together with the need of improving thenexisting conditions had been the occasion of a wholeseries of Housing Acts and of the provision of some-thing like 2,500,000 houses between 1919 and 1934,estimated to give accommodation to some 7,000,000persons. But all that great provision of houseshad made no more than a negligible contributiontowards the solution of the worst housing evils-namely, slums and overcrowding-for the reason,he supposed, that they had failed to define theirobjects with sufficient clearness and to satisfy them-selves that they had adequate powers to achievethem. It was the recognition of that fact that had

induced the present Government for the first time,he believed, in the history of housing reform to tryto attack the problem on what they believed to bemore definite and more logical lines. In that policythe Government had accordingly sought to proceedby three quite distinct and consecutive stages. Thefirst stage was taken in 1933 when they withdrewthe subsidies for new houses at large, thus liberatingas far as possible the instrument of private enter-prise from the shackles of subsidy competition andensuring that where subsidies were still essentialthe available public money should not be dissipatedbut should be used only where the principal objectof getting houses of the right sort and in the rightplace could not be achieved without them. Thenumber of houses that were built by private enter-prise in the half-year ending in March, 1934, was over120,000 ; in the next six months it was 137,000 ; andin the six months recently ended it was just on150,000. That last figure represented a total ofabout 300,000 houses a year, which compares withan annual total of about 200,000 before the passingof the 1933 Act, and it was interesting to add thatthis figure of 300,000 houses a year was estimatedto include not less than 100,000 Class C houses.Those figures were sufficient justification of thepolicy that the 1933 Act embodied.

Generally speaking, present-day building costsand rates of interest when taken with the Exchequersubsidy under the 1930 Act made it possible tocharge an inclusive rent of not more than 10s. a

week, and many local authorities charged rents wellbelow that sum. There was a provision in this