146

At any rate, it should be imperative that every officerassuming charge of the bridge must possess a recent cer-tificate of competence from a recognised ophthalmic surgeon.Your pages have borne frequent testimony to the necessityof having properly equipped men in charge of engines onshore and at sea, and to many non-medical papers-notablythe Nautical Magazine as long ago as 1876-a plea has beenurged on the same behalf. I do not presume to know thecause of the last terrible disaster, but it would not be amissto accentuate the lesson and inquire what precautions, if

any, were adopted to ascertain the visual condition of themen on whom the safe navigation of the steamer depended.

I am, Sirs, yours faithfully,R. A. CALDWELL.J.-rt-.

Henrietta-street, Cavendish-square. July 6th, 1896.

MEDICAL MEN, PATIENTS, AND THEPOLICE.

To the Editors of THE LANCET.

SIRS,-The relation of medical men and their patients hasrecently been much discussed in the medical and other

papers, and I should be glad to have an expression of opinionon the following facts. To-day I was called upon by adetective of our local police, who informed me that a person- of some position in his own county was wanted by the policeand that a warrant was out for his apprehension ; that thesaid person was supposed to be in this city ill and under thecare of some medical man. He supposed it possible that thisperson might be under my care and showed me a photographof the person wanted. Now, Sirs. supposing the personwanted was at the time a patient of mine, and I had reco-gnised him by the photograph, what position was I in ? 2 Wasit my duty to respect the confidence of the patient or was itmy legal duty to at once give information to the police ? Asa matter of fact the person wanted has never been a patientof mine (but he might have been), and the charge withregard to which he is wanted is not a capital one.

I am, Sirs, yours very truly,... ---- r - --- -

July 7th, 1896.ARTHUR G. BLOMFIELD,

Physician, Devon and Exeter Hospital.

’" * The medical man should hold his tongue, notwith

standing the force of the social arguments that can bebrought to bear upon such reticence.-ED. L.

"TRANSFUSION OF SALINE FLUID INTOTHE AXILLARY CELLULAR TISSUE INCASES OF SEVERE HÆMORRHAGE."

To the Editors of THE LANCET.SIRS,—The solution, I believe, generally employed is one

drachm of salt to twenty ounces of boiled water. The

- ordinary table-salt was used in this case, as being that whichwas most ready to hand, and the amount roughly guessed at.

I am, Sirs, yours faithfully,West Brighton, June 30th, 1896. ARTHUR H. DODD.

CHURCH SANITARY ASSOCIATION.To the Editors of THE LANCET.

SIRS,—May I make known to your readers that Sunday,July 19th, the seventh Sunday after Trinity, is suggested bythe Church Sanitary Association as a suitable day for

stimulating from the pulpit the efforts now being made bysanitary authorities and others in the direction of providingwholesome surroundings for all ? The Gospel for the seventhSunday after Trinity is of particular application to this

subject because it contains the story of the disciples dis-tributing food to people who were already in the enjoymentof fresh air, pure water, and abundant light, as if to indicatethe Divine will that men should enjoy fulness " as well forthe body as the soul.’’ —I am, Sirs, yours obediently,

F. LAWRENCE,Hon. Sec., Church Sanitary Association.

Westow Vicarage, York, July 6th, 1896.

MEDICAL MAGISTRATES,-Mr. J. C. R. Husband,L.R.C.P. Edin., M.R.C.S. Eng., has been placed on the Com-mission of the Peace for the city of Ripon.

THE BATTLE OF THE CLUBS.—XXXVI.(Continued from p. 57.) .)

LINCOLN MEDICAL PROTECTION FUND.WE have received the following list of additional sub-

scriptions :-E. J. Leapingwell, Geo. Adkins, Paignton... £0 10 0

Che7tdle ......... jB 1 1 0 M. C, Mosham, Stick-W.L.Hubbard. Rugeley 010 6 ney, Lincs......... 0 5 0A. E. Larking, Ches- T. V. de Denne, Cradleyham ............ 0 10 6 Heath, Staffs.... 0 5 0

A. D. Chapple, Wey- G. J. Hinnell, Burybridge ............ 2 2 0 St. Edmunds ...... 0 5 0

A. L. Bentham, South- Sir Edwin Saunders,sea ............... 0 10 0 I Wimbledon Common.. 33 0

Cork and South of Ire- T. H. Dickson, H.M.’sland Branch, British Customs, B.C....... 1 1 0Medical Association ... 3 3 0A. Cohen, Warrington-

Philip G. Lee, Cork ... 1 1 0 crescent, W.......... 0 5 0L. Vlaybury, Southsea ... 1 1 0 i C. H. Wise, Waltham-W. F. Brook, Fareham, stow ............... 0 10 6Hants ............ 0 10 6 Robert A. St. Ledger,

John Mason, Winder- Watford ............ 0 10 6mere ............ 1 1 0 John Fraser, Kilsyth,

Alfred Perkins, Exeter 1 1 0 Glasgow............ 0 5 0A. P. Kingcombe, Tow- E. Hurry Fenwick,

cester ............ 0 10 0 Savile-row, W....... 5 5 0C. M. Powell, Exmouth 2 2 0H. Griffiths, Kensington-H. T. Sylvester, Pimlico, square, W.......... 1 1 0S.W............. 1 2 0E. Bartlett. Connaught-Wm. Moxon, Matlock ... 1 1 0 square, W.......... 1 1 0J. A. Armitage, Wolver- W. M. Harman, Win-hampton ......... 1 1 0 chester ............ 0 10 R

Sir Hugh R. Beevor, R. Hingston Fox, Fins-Sergeant’s-inn, E.C.... 1 1 0 bury-square, F.C.... 0 10 0

W. Hamilton Allen, A. Campbell, Navenby,Stanmore, Middlesex 1 1 0 Lines............. 1 1 0

G. C. Wilkin, Wey- F. M. Blumer, Stafford.. 0 10 6mouth-street. W.... 1 1 0J. G. Barnes, Wheatley,

J. W. Walker, Spilsby ... 1 0 0 Oxfordshire ......... 0 10 6J. R. Milsome, Addle- 1A. H. W. Clemow, Ken-

stone, Surrey ...... 0 10 6

I sington, S.W....... 0 5 0H. M. Morgan and F. M. Previous lists ......... 266 11 0Rowland, Lichl1eld... 0 10 6

NOTTINGHAM AND DISTRICT MEDICAL UNION.

We nave received from the honorary secretaries of thisassociation, Mr. W. G. Laws and Mr. G. W. Paul, the follow-ing announcements with reference to the Union :—

Objects.1. To encourage cordial relations between medical men practising in

the district.2. To give opportunities for discussion and interchange of views on

the business side of medical practice.3. To obtain the combined action and consolidated influence of

members of the Union upon points of difficulty which may arise inMedical Aid, Contract and Hospital practice.

4. Generally to safeguard and support the interests of the medicalprofession in the town and district,

Rules.

1. This society shall be called the Nottingham and District MedicalUnion, having for its object to safeguard and support the interests ofthe medical practitioners in the town and district.

2. Every registered medical practitioner shall be eligible for member-ship if approved of by the council.

3. Each member shall pay an annual subscription of 5s., due onMay 1st in each year.

4. The affairs of the union shall be managed by a president, twosecretaries and treasurer, and a council of fifteen members for the town and ten for the district. Nine shall form a quorum.

5. The officers shall be elected at the annual meeting in May of eachyear, except that three of the town and two of the district members ofcouncil shall be coopted by the council.

6. The council shall have power to fill up vacancies in their own body.’

7. The council shall meet once a quarter and when convened by the’ honorary secretaries to consider applications for advice or assistance.. and generally to carry out the policy of the union, and may call a

general meeting of the union at any time if considered necessary. ’

’

8. A special general meeting shall be called by the president at anytime upon a requisition signed by six members, such special meetingto consider no other topic than that for which the meeting was called.

9. No member of the union shall oppose any practitioner in any’

course of action which he may take with the previously expressedi sanction of the council for the general good of the profession.; 10. Any member acting, in the opinion of a special meeting called

for the purpose, contrary to the laws and regulations of the union shallupon a majority of at least three-fourths of the members present besuspended or expelled, and without appeal, from the union.

11. A special meeeing, called for the purpose of considering the con-duct of any member of the union shall only be convened after fourteendays’ written notice has been sent to the last-known address of eachmember, and such notice shall state clearly the purpose for which

: such meeting is convened.12. No new law shall be adopted and no existing law be altered or

rescinded except at the annual general meeting or at a special meetingcalled for the purpose, and fourteen days’ notice of such proposed’

alterations, signed by at least three members, shall be sent to everymember of the union in the circular convening the meeting. -

147

A list of the members of the union shows tnat all but afew of the medical men in the town have joined and a large number of gentlemen practising in the district, while we are assured that the majority of those who have stood outhave expressed their sympathy with the project. :

A copy of a letter which had been received from theLondon and Manchester Industrial Assurance Company,Limited, has also been sent to us. It has been made thesubject of amiable treatment by the new Medical Union.London and Manchester Industrial Assurance Company, Limited.

Chief Office, Southwark Exchange, London, S.E.W. Hunter, Esq., M.B., C.M., 2, Crocus-street, June 4th, 1896.

The Meadows, Nottingham.DEAR SIR,-First we would thank you for your courteous communi-

cation of the 1st inst. Gladly do we embrace the opportunity it affordsus of replying to the various points upon which your union desiresinformation.

1. The prospectuses containing names, &c. of medical gentlemen do not-constitute "advertising," but for other reasons we decided some timeago to gradually discontinue them, and Nottingham is one of thedistricts for which we have already stopped printing them.

2. Our representatives are not permitted to " act as ‘ tnuts’ for certaindoctors," and anyone proved to be so acting, after having beencautioned a first time, would be dismissed.

3. In no wise does this company "sweat" the medical profession.Our shareholders have never received a penny out of the medical aidbranch of the company’s business, for the simple reason that we havenever made any profit thereby and never expected or intended to.The apparent difference between the premium charged and the amountpaid to medical gentlemen, less expenses, is more than explained bythe fact which Mr. Plattoot pointed out to you, that we pay thedoctors in respect of lapses during a quarter just the same as ifwe received the full quarter’s premium. Our representatives are notencouraged to work the medical aid.

4. The difficulty of getting persons to submit themselves for a

medical examination preliminary to joining is too great to be overcomein the matter of small assurances under JB20. but all are required tosign a declaration of good health and freedom from chronic ailments.at time of entry. If occasionally persons do get admitted who are notin a proper state of health at the time, the premiums they have paid arereturned to them and their assurances cancelled on our hearing fromthe medical gentleman (who is paid for the quarter all the same) theil5.rst time the member applies for attendance that he or she was notafitsubject for assurance when accepted. The remedy is certainly in thedoctor’s own hands by following this simple course. No one, by theway, can receive medical aid through the company without assuringfor a sum at death, therefore it will be apparent that our representativesare urged to adopt every possible precaution in the acceptance of lives.

5. People who are really in a position to pay ordinary medical bills are’not desired by the company as members of our medical aid branch, andwe like to be informed of such cases, that they may be inquired into with a view to the plan mentioned by Mr. Platfoot being adopted. ,A medical gentleman intimately acquainted by long experience with

the way this company’s medical aid branch is conducted recentlyexplained it to a sub-committee of the General Medical Council, who,he informed us, were satisfied with his explanations.

Yours trulv,W. WOODWARD, Managing Director.

On the strength of this letter the Nottinqham and DistrictMedical Union have considered it inexpedient to call uponthe medical men attached to the society to resign at present.We have to say with regard to this letter : (1) If suchprospectuses are not advertisements, what other nameshould be employed? The names of the medical refereesare brought before the public in a manner that is’unfairly prominent. 2. It ought to be easy to ensure the- dismissal of some of the representatives. 3. The circular ofthe company announces that " the distinguishing feature ofthis company is that it not only enables persons to assure fora sum payable at death, but also to secure in case of illnessthe best medical attendance (at their own homes whenevernecessary), medicine, and advice, the two benefits beingcombined for the small sum of 22d. weekly." Will Mr. Wood-ward give a definition of the word " sweating" ? 4. No personshould be made the subject of medical aid until his physical- condition, as much as his pecuniary condition, has been

inquired into by the person from whom he is to receive-charitable treatment-i.e., the medical man. 5. What pre-cautions does the company take to prevent well-to-do personsfrom sponging upon the medical profession ?

Lastly, let it be understood clearly that the General MedicalCouncil has expressed no approval whatever of this society.

The London and Manchester Industrial Assurance Company,Limited, is not so unfair in its dealings with the medicalprofession as some of the Medical Aid Associations. Itis more courteous and more businesslike. But we begthe Nottingham and District Medical ITnion to read ourarticle published on April 4th of this year before theyconfide too much in amiable expressions. Oar SpecialCommissioner chere gave very detailed accounts of transac.tions which show the Assurance Company to be actuatedby no benevolent feelings towards medical practitioners,This company desires people to insure their lives throughits medium, and it certainly has no objection to enrol

well-to-do people for that purpose. The thing which per-suades the public, well-to-do as much as very poor, to paythe trifle each week to insure their own lives or those of theirrelatives is not the cash to be received at death but themedical treatment to be obtained for a pittance while alive,and this is offered to all alike, irrespectively of their means.The medical servant of the London and Manchester IndustrialAssurance Company, Limited, dispenses charity. He getsno credit for this and does not choose the objects of hischarity for himself. He is expected to be almost thankfulfor employment, while he has the unpleasant knowledgethat many of the people whom he attends in return for aweekly copper are in better circumstances than himself.

LIVERPOOL.(FROM OUR OWN CORRESPONDENT.)

Liverpool Students and Practical Midwifery.THANKS to the enterprise of the Dean of the Medical

Faculty of University College, Liverpool, medical students willin future be afforded better opportunities of acquiring aknowledge of practical midwifery than have hitherto beenavailable. A house has been rented in Brownlow Hill

adjoining University College, in which will reside a housesurgeon and two students desirous of attending outdoorcases. Arrangements are in progress by means of whichnotice may be given at this house of any cases of labouroccurring amongst the poor, which will be promptly attendedby the students in residence, or by the house surgeon in theirunavoidable absence. The house surgeon is to be apprised ofany abnormal case where his assistance will be required.He is also to give five clinical demonstrations out of everytwenty cases attended by students. Liverpool medicalstudents have hitherto been severely handicapped by thewant of proper instruction in practical midwifery, and haveconsequently been compelled to proceed to Dublin in orderto acquire it-a fact which has long been deplored by studentsand teachers here alike. Better things are now in store, andin course of time it is hoped that, when the fact of the newdeparture has become widely known throughout the city, thecases will be sufficiently numerous to supply the desiredmeans of instruction. Dr. Arthur Wallace has kindly con-sented to go in residence for the first month or so.

Muzzling of Dogs.The Ladies’ Committee of the Royal Society for the Pre-

vention of Cruelty to Animals have addressed a communica-tion to the City Council alleging, among other things,that, though muzzling does not amount to cruelty, the

closing of dogs’ mouths retards perspiration, which takesplace by the mouth and not by the skin, and that, owing tosuch unnatural restrictions, dogs are rendered ferocious anddangerous. They drew attention to an order of the Lanca-shire County Council of May llth exempting from themuzzling order dogs wearing a collar with the name andaddress of the owner legibly engraved thereon. Thiswas all that was asked for. The City Council couldnot see their way to interfere with the presentarrangements, as Dr. Hope had recently presented a

report to the Watch Committee on the subject. In it hementioned that three cases of rabies from dog bites hadoccurred in Liverpool since June 13th, and consequently hewas unable to advise the committee to relax the order.Dr. Hope had also expressed regret that districts adjoiningone another did not act in unison in the matter of dogmuzzling.

Worklaouses and City Hospital Nurses.The select vestry are engaged in complying with the

formalities required by the Local Government Board asessential to their approval of the plans submitted for theerection of a new home for the workhouse nurses at a cost of

£7500. The patients under treatment in the sick and infirm, wards, from the last report, numbered 1297. The mortality, for the week was 22, being the same number as in the corre-. sponding week of last year. Mr. Jenner Fust, Local Govern-. ment inspector, in his recent visit to the Toxteth Workhouse,. complimented the board of guardians upon the great improve-Lment he had noticed in nursing as compared with what had. existed some time back-a matter which it would afford him

pleasure to favourably report upon. Mr. George Griersonhas applied to the House Committee of the Corporation