416

THE LANCET.

LONDON: SATURDAY, AUGUST 12, 1899.

MEDICAL MEN AND HOLIDAYS.

THE holidays of 1899 are upon us in an acute form.

Whatever the profession may think of holidays there is noreason to be in any doubt as to the opinion of the public onthe subject. Every stratum of society is permeated withthe notion of getting away from the duties and responsi-bilities of life and that for an ever-increasing length oftime and at an ever-increasing distance from the field

of ordinary work. There are certain people who dividetheir time almost equally between work and change.As soon as they return from one holiday they begin to

arrange the time and place of the next. They seem neverto be at home except when they are from home. Their

holiday is a moving one ; they do not abide in one place andscarcely in one country ; they are mostly "on the road."

Egypt, India, China, Japan, Australia are their landmarks andthe restless ocean is their highway pending the time whenthe Siberian railway and other schemes will enable themto get round the world in three weeks. Travelling on sucha scale, of course, is beyond the means of the great majorityof people and it is not to be regretted that it should be

so. Such constant locomotion is an evil. It is not a

holiday ; it is not rest-it is restlessness. But short of

this an amount of time and a proportion of income neverdreamt of by our forefathers are devoted to the purposes of

holidays. Even the poor nowadays contrive to obtain a peepat the sea or at the country, and, thanks to the ever-growingsympathy of society, the children of the poor in our

large towns, through the country holiday funds, get thatacquaintance with nature which was impossible to the

children of towns of the last generation. The richer

classes find more and more that the pleasure of their

own holiday is increased when they have contributed

to a similar enjoyment on the part of their poorer

neighbours.The least holiday-making profession is the medical profes-

sion. With the sister professions the case is quite different.The clergy of all denominations, whatever their sharptheological differences, all agree on the necessity for a goodmonth’s or six weeks’ holiday. In law the whole machineryof the High Courts is suspended for a long vacation and thelaw’s delay takes almost an absolute form for two or threemonths. But with the medical profession it is altogetherdifferent. Not a few medical men never sleep away fromhome, and when at home they lie with the ear open for the

night bell all the year round. A very large number of

practitioners content themselves with a week, or at most

two weeks, of holiday in the year, and are only forced tothat by indications of breakdown which they dare not

disregard. The habit of labour is formed by the verynature of the medical profession and by the practice

of the medical art. A pressure is put on a medical man to

forego his holiday which scarcely resembles that put on other

professional men. This is especially true of the general practi-tioner. His relation to his patients becomes almost a socialand a personal one, and as the time for a holiday comes roundand those whom he has known for years are in a plight ofsickness or even danger he leaves them with a reluctance

only less than that with which he would leave a memberof his own family in similar circumstances. Added to this

is the difficulty of providing a substitute or a locum-tenent.In remote country districts where the monotony of

life much needs to be broken this difficulty is

felt very acutely and the good doctor almost despairsof his needed change. The difficulty is said to

have been much increased by the recent action of the

General Medical Council in forbidding the employment ofunqualified assistants. We have no doubt that this is so

and will continue to be so for a time. Qualified assistantsand locum-tenents are so much more in demand that their

price has gone up to the great inconvenience of the

medical practitioner whose patients are poor and whose feesare small. But such facts, though powerful, are not final.They have to be adjusted and they are capable of adjust-ment. The ultimate effect of the abolition of the

unqualified assistant must be to increase the apprecia-tion of medical service and with it the means of

the medical man to take a regular and a longer holiday.One other effect of this abolition should be to make

members of the profession practising in the same placemore neighbourly, more helpful to each other, and moretrustful. It is in this direction that the true strength ofthe profession lies and every change in it which tends tomake medical men realise how much they can help oneanother and how helpless they are without a mutual dis-

position of this sort will enhance the ease of medical

life and facilitate the holiday which every practitionerneeds.

Whatever the difficulties of arranging a holiday it is clear

that it must be considered more and more as a necessity oflife, only less so than food and clothing. The pressure and

pace of life are unprecedented. We live through as muchin a month as our forefathers did in a year and the veryhabit of society in making so much of holiday makes itimperative that we should do the same. A holiday is aneducation in itself and it takes the mind out of parochialismand provincialism more successfully than any other method.Without this education we lose influence with an importantsection of our patients and actually fail to acquire some

very useful knowledge. The reluctance to leave patients isto be overcome in their interest as well as in that of the

practitioner. Intelligent patients quite realise this and often

say so. These arguments, which are of perpetual force, are ,

especially so in a season like the present. The prosperityof the country is admitted on all hands and must enableeven medical men who have too little share in such generalprosperity to take a holiday with a little more ease than

usual. The very beauty of the summer invites us forth

to "fresh woods and pastures new." The heat has been

unusual and withal somewhat exhausting. So we counsel

all our readers to seek freedom from the toil and worry of

their professional duties for a space of at least a month, and

417THE CASE OF KIDD v. CRANE.

let them not forget after arranging such respite for thom-selves to be willing to do as much as lies in their power tofacilitate a holiday for any weary neighbour.

MEMBERS of the medical profession are unfortunately very 1

liable to have charges made against them by those who areeither entirely ignorant of the matters concerned or are mis-led by false statements, the object frequently being either toobtain cheap notoriety in the locality in which the traducersdwell or to obtain revenge for some imaginary slight cast

upon them by the practitioner. Whatever may be the

circumstances or the object of the libel it is extremely try-ing for the practitioner and may entail a state of affairs

amounting to ruin. A case in point was tried at the assizesheld at Birmingham on August 4th and the followingday before Mr. Commissioner ENGLISH HARRISON, Q.C. This

was an action for libel brought by Mr. HUGH CAMERONKIDD, M.B. Lond., F.R.C.S. Eng., a medical man in prac-tice at Bromsgrove, against Mr. A. J. CRANE, a baker, anda member of the Bromsgrove Urban District Council. Dr.

KIDD is the medical officer of health of the town of Broms-

grove and of the North Bromsgrove Urban District, and alsoof the Bromsgrove, Redditch, and Droitwich Joint Isolation

Hospital, and it was in reference to his conduct at this

hospital that the allegations were made. Fortunately forDr. KIDD he is a member of the Medical Defence Union

and the case is one typical of the value of this excellent

society to members of our profession. The council of the

Defence Union undertook all the responsibilities of the

conduct of the case, instructed solicitor and counsel, andthus saved Dr. KIDD an immense amount of worry and

anxiety besides relieving him of costs.The charges which the defendant brought against the

plaintiff, and which were published in a local paper on

Sept. 17t.h, 1898, were mainly and briefly as follows:

they amounted to neglect, malpraxis, and mismanagementof the hospital generally. It was alleged that a "patientwas in the hospital one week and three days and never sawthe doctor once, and -all the six weeks and three days shewas there she never had one drop of medicine." With

reference to a death which took place in the institution thedefendant alleged that although the patient (a little girl)was in great agony for two days the medical officer

did not see her, and that she was frightened by a

threat of being put into "boiling blankets" to make

her keep quiet in bed, that the medical officer actuallyordered this treatment, and that the girl died whilst under-going it. Further, that" men, women, youths, and boysand girls had to eat, drink, lie and sleep all in one room" ;also that the hospital was so badly constructed that raincame into the building, and that the wind could be feltby the patients as they lay in bed. These charges,together with others, were first made at a meeting of theBromsgrove Urban District Council; Mr. CRANE was

offered an opportunity of formulating his charges but didnot take advantage of it, and as they were not withdrawnthe action for libel was brought against him. Dr. KIDD

had no difficulty in entirely rebutting all the charges. It

was shown by the evidence that the patient who was

in the hospital without seeing the medical man for

10 days and received no medicine was admitted at a late

stage of the disease, that convalescence was not inter-

rupted, that she required no medicine, that it was not truethat Dr. KIDD did not see her for 10 days after her

admission, and, further, it was shown that she was

41....i.,.C.......7,...4 ..___._L The ,_m,_ ___, --- -.........L......’L-the defendant’s aunt. The little girl was niece to the

woman already mentioned. Nephritis set in as a complica-tion of scarlet fever and she died from ursemia. A hot-

pack was ordered as a means of treatment-hence the state-ment about "boiling blankets "-but the disease was too faradvanced for it to be of any avail. It was also proved thatDr. KIDD was indefatigable in his attendance on the patients.The hospital was only a temporary one-a hospital marqueetent with double canvas walls. It was well ventilated,but when there was heavy rain the water trickled down inone or two places, the beds, however, being carefully removedfrom the damp. The patients were mostly young children,but whilst the woman already referred to was an inmate

there were two boys as patients, about 15 or 16 years old.

They occupied the same large tent, but their beds were

thoroughly screened off from the other beds and Dr. KIDDhad heard no complaints. There had been over 60 patientsin the hospital in the year and only four had died. Other

charges were similarly disproved and the jury had no; hesitation in returning a verdict in Dr. KIDD’S favour with- damages of £ 150, the foreman adding that had it not beeni for the position of the defendant they would have givent much heavier damages.

Dr. KIDD will receive the congratulations of all

members of the medical profession on having so completelyvindicated his character. It is very trying, but it can-

not, unhappily, be prevented, that charges of this kind

should be so frequently made. The medical man is

placed in a most difficult position and very often for

many reasons he has not the power to take such decided

steps as did Dr. KIDD. The result shows the value of the

work of associations founded for medical defence. Althoughan evil-disposed person is willing to enter the law-courts

against a single individual who, he thinks, will be unableto adequately defend himself, he will hesitate if he knowsthat his victim is backed up by a powerful society whose aimit is not only to support its members, when they are attacked,by the potent means at its disposal and to take action insuch cases as the one to which we have referred, but also to

prosecute quacks, to aid the Government in suppressing suchcrimes as abortion, and generally to take every opportunityto support the honour and prestige of the medical profession.

THE providing of the working-classes in our great townswith wholesome sanitary homes and the encouragement ofall those who are willing to assist in the enterprise arematters of so great importance that it is not easy to

understand by what process of reasoning the London

County Council can have arrived at the conclusion that

it was desirable to prosecute Lord ROWTON, Sir RICHARD

FARRANT, and all who are responsible for the admirable

institutions known as Rowton Houses on the groundthat they were keeping them as common lodging-houseswithout registering them under the Lodging-Houses Acts.

Mr. E. W. GARBETT, the latest addition to the ranksG 3

418 THE POOR MAN’S HOTEL.

of London magistrates, in a clear and well-reasoned

judgment has now pointed out that the question whetherRowton Houses are common lodging-houses is one of

fact rather than of law ; he has found that in fact theyare not common lodging-houses and has dismissed the

summons, while many of the points which he reviewed in

giving his decision, when looked at by the light of common-sense, seem to condemn the action of the London CountyCouncil as unnecessary and mischievous. On the one

hand, there was no defect of sanitation, no abuse or

mismanagement which it was desired to put an end to andwhich might have been set right had they been declared ,,

common lodging-houses, but not otherwise. On the other

hand, it was established by the evidence of Lord ROWTONthat the stigma attaching to common lodging-houses amongthe working-classes and their employers would very seriouslyaffect the utility of Rowton Houses and similar institutionswere they compelled to stand on the same footing. This

opinion of his Lordship, which bears the weight of experi-ence, must have been well known to the London CountyCouncil or could and should have been ascertained by it if

its own knowledge gained in following the movement ofwhich Lord Row2oN has been the pioneer was insufficientfor its guidance.

It may not have been material that Rowton Houses

are philanthropic rather than charitable institutions

giving to working men desirable and desired homes whilereturning to the promoters an average dividend of 4½ percent. (a matter which should serve to encourage future

enterprise of a similar character), but it certainly was ofvital importance in considering their position in relation

to that of "common" lodging-houses that their organisersexercise a discretionary power to select persons to be

admitted to them, excluding the dirty and disreputable and

maintaining the buildings as comfortable and cheap hotels orboarding-houses for deserving but poor men. The Lodging-Houses Acts of 1851 and 1853 were not framed with the

definite intention that they should include Rowton Houses, for

they were passed 40 years before Lord BEACONSFIELD’S former

secretary and friend brought his scheme to a practical head.

They could not be thought to include them propheticallyunder any definition of a common lodging-house, for by a

happy-go-lucky practice not rare in Acts of Parliament theycontain no definition of their own subject-matter. They alsocontain provisions inapplicable to Rowton Houses, ordering,for instance, periodical whitewashing of portions of the

edifice which in the case of Rowton Houses are tiled. In these

circumstances we can hardly believe that the prosecutorswere advised by their learned counsel that they were sureof success ; and if the result was doubtful and no abuse

existed that needed remedy there can hardly have been

any good reason for incurring and causing the expense of

legal proceedings. It must further be remembered that

these proceedings if successful would have tended to

cripple and check the growth of an enterprise worthy ofall encouragement; while even the existence of an abuse suchas a defect of sanitation would not have converted Rowton

Houses into "doss-houses," any more than the discoverythat the servants in certain West-end residences were not

provided with accommodation sufficient to satisfy enlightenedideas of sanitation would bring those residences within

the provisions of the Factory Acts. It is a matter of

regret that the London County Council, which has done somuch good work for the great metropolis which it represents,should have been defeated in a contest which it entered

of its own accord and in which the bulk of sympathymust be with the victors; but a finding of fact by a

magistrate in such a case as the above constitutes a decisionwhich is not likely to be appealed against and still less

likely to be appealed against with success.

Annotations.

THE POLICE SURGEONS’ ASSOCIATION: THEFEES OF MEDICAL WITNESSES.

"Ne quid nimis."

AT a meeting of the Police Surgeons’ Association, heldon August 3rd, at the Town Hall, Portsmouth, Mr. NelsonHardy, in moving the adoption of the report of the Council,said that by far the most important subject dealt with wasthat of medical witnesses’ fees which had already beenbefore their society for several years. In 1895, when Mr.Asquith was Home Secretary, a deputation from theassociation waited on him at the Home Office, when headmitted the justice of the claim for a revision of the scaleof fees but said that as that scale bad been fixed on 40

years previously by Sir George Grey, and successive HomeSecretaiies since his time had been afraid of burningtheir fingers by touching it, he should follow their

prudent example. This year the British Medical Association

had taken the matter up and prepared a memorial for

presentation to the Home Office, the authorities of which,however, refused to receive a deputation. Now that a

joint committee of the British Medical Association and

Police Surgeons’ Association was about to be appointedanother endeavour would be made to secure a hearingfrom those in authority to which as Englishmen theywere fairly entitled, and the members of both the Police

Surgeons’ Association and the British Medical Associationwould be urged to get the Parliamentary representatives oftheir several districts to use their influence in the matter.The report was carried. Dr. Maybury of Portsmouth, Mr.H. W. Roberts of London, and Mr. Nelson Hardy of Londonwere elected members of the proposed joint committee.The following officers and council were elected for the en.

suing year. President: Dr. Lysander Maybury (Portsmouth).Vice-Presidents: Mr. Timothy Holmes (London), Mr. ThomasBond (London), Sir H. D. Littlejohn (Edinburgh), andMr. Houchin (London). Treasurer: Mr. H. Nelson Hardy(129. Dulwich-grove, London). Honorary secretaries: Mr.F. W. Lowndes (Liverpool) and Mr. H. C. Hopkins (Bath).Council: Dr. Barnes (Carlisle), Mr. J. R. Baumgartner(Newcastle-on-Tyne), Dr. J. F. Craig (Birmingham), Dr.C. Eastwick-Field (Midhurst). Mr. G. H. Heald (Leeds),Mr. W. J. Heslop (Manchester), Dr. D. McDonnell (Belfast),Mr. H. W. Roberts (London), Mr. W. M. Roocroft (Wigan),Dr. Charles Templeman (Dundee), Mr. W. Washbourn (Glou-cester), and Dr. S. Wyborn (Windsor).

PURSER TESTIMONIAL FUND.

SOME of the former pupils of Professor Purser of TrinityCollege, Dublin, have been taking measures for thecommemoration of the completion of his 25 yearsof activity as a teacher of physiology. The fund

organised for the purpose has met with ready support,but the committee are conscious that it has not been possiblefor them to make the objects of the fund known to all who