1743THE AUTUMN SESSION OF THE GENERAL MEDICAL COUNCIL.

THE LANCET.

LONDON: SATURDAY, DECEMBER 15, 1900.

THE General Medical Council sat for eight days at its t]

recent autumn session, three of which were mainly tl

occupied with penal cases. Among the other important subjects which occupied the time of the Council were t’

the new rules for obtaining diplomas in public health, t

the question in dispute between the Royal Colleges of Physicians of London and Surgeons of England and i

the General Medical Council, and the financial position i

of the Council. Besides -these there were 30 or 40 other t

questions upon which the Council had to deliberate, so that 1

even while we think that the Council occasion- i ially spends too much time over its discussions, we admit that the discussions have to cover a great deal i

i

of ground. Sir CHRISTOPHER NIXON in the debate on Ithe issues between the Royal Colleges of Physicians of tLondon and Surgeons of England and the Council displayed t

a natural dissatisfaction with the powers of the Council,

"The profession," he said, "look to this Council to secure uniformity of action among the medical authorities of the ’United Kingdom, and it should not be shown to them that after all the Council had only the power to express piousopinions." Sir CHRISTOPHER NIXON was well supportedin his view by the majority of the Council who were resolvedto adhere to their resolution on this subject. Members of

the Council who spoke in this sense must have known thatby adhering to a resolution which they have no means ofenforcing, they were not advancing by one hair’s breadth

the adjustment of this unhappy difference. We ask the

Council to be strong, but it must recognise that occasionallyagreement to a compromise is the only way out of an

npasse. It is a serious thing for the Council to demon-strate, not its power of securing uniformity, but its

helplessness-which is what may be done by overstatingits authority.

If the determination of the Council to adhere to its resolu-

tion means no more than to exclude from the Students

Register of the Medical Council all who satisfy the two

Colleges as to the efficiency of their education in the funda-mental sciences, it is difficult to understand who is to getany satisfaction out of so barren a result. It is not pre-tended that registration on the Students Register can beenforced on students, or that it is necessary as a preliminaryto medical education or to the acquisition of a medicalqualification from any of the bodies. To compel appli-cants for registration on the Students Register, whohave already satisfied the two Colleges, to encounter

trouble and delay is only likely to irritate the students

and the Colleges, to, place the Council in an unenviable

position, and to deprive the Students Register of a largenumber of students. The Council must, in our opinion, eithergo further and promote a large scheme for insuring uni-

formity of education or it will have to agree to some modusvivendi. We do not admire the unbending attitude of the

Colleges, or the tone and style in which the case between

them and the Council is stated. Their own representativesin the Council voted against the proposal to try to find

an amicable settlement of the points in dispute, though.this was the very suggestion of their legal adviser.

It is easy to see that the recognition of schools as.

medical schools may be open to abuses. But, on the

other hand, the Royal Colleges of Physicians of Londonand Surgeons of England appear to have taken much-

trouble to ascertain the equipment of the schools which

they have recognised, and to have reason to believed

that many of them are more efficiently provided withthe means of teaching chemistry, biology, and physicsthan are some of the medical schools. The General

Medical Council has not the means or the time to satisfyitself on this subject. It is difficult to understand how

it can proceed to approve or to disapprove of institu-

tions which it has no means of inspecting properly.Though counsel on both sides may agree, it is still doubtfulif the Council can compel the licensing bodies to complywith the requirements and recommendations containedin its resolutions with reference to the course of

preliminary study to be gone through by students. Under

these circumstances we can only impress on both partiesthe obligation to give and to take a little. Both sides

should attempt, and attempt quickly, to find some means

of upholding the influence of the General Medical Councilwithout detracting from the individual responsibility of

separate medical authorities.We cannot help feeling that the General Medical Council

in its individual capacities loses sight somewhat of its

responsibility as a whole, which is towards the public andthe medical profession, and not towards a group of univer-sities and corporations. We think our feeling must be

shared by Dr. PYE-SMITH. Dr. PYE-SMITH, who is alwayslistened to with much respect in the General Medical Council,expressed the opinion at the late meeting that the Councilwould never do its best until it was reduced in size to one-

half of its present number and until the reporters wereexcluded. The first part of Dr. PYE-SMITH’S forecast is

flattering to us, for we have always held that the Council istoo large ; the second part is not flattering to his colleaguesin whichever way it is regarded. There is, however, no

chance of the Council being diminished in numbers at

present, for as the direct representatives require to be

increased, and not diminished, in numbers the only waythat diminution could be effected would be by depriving

certain universities and corporations of a separate voice.. In some directions this might be a reform, but there

! is no tendency towards it. In spite of the conjunctionr of the Royal Colleges in the three divisions of the

1 Kingdom each body likes to assert distinctness and in-- dividuality at the General Medical Council. There is un-

happily no sign of conjunction of universities in anyr division of the kingdom even for examination purposes.s Each body requires its separate mouthpiece and Parliamenteis not likely to alter the privileges that are now enjoyed bye any of them. And we should oppose the exclusion of

r the reporters as a backward step. There may be members

- of the Council who speak for the sake of being reported,s but the utility of the Council should not be made to suffere for the vanity of a few. The Council is a public body. It

has the enormous power of erasure from the Register and it

1744 LIABILITY OF THE BREWER IN RECENT EPIDEMIC OF PERIPHERAL NEURI PIS. [

is of the utmost importance that proceedings attending sucherasure should take place openly, for the instruction of thepublic on the one hand and to give fair play to the accused onthe other. The Council has great duties in relation to educa-tion and must express opinions on measures of legislationhaving medical bearings, in regard to all of which publicity ofstatement may be of the greatest importance. The members

of the medical profession are entitled to know the views

and the proceedings of a Council which they support withtheir fees and which orders their education and conduct.

The public have at least an equal right to know what

measures are being taken to keep medical education upto a proper standard and to supply an accurate registerof qualified medical men.

THE epidemic of peripheral neuritis which was traced tothe consumption of beer containing arsenic is, we hope,in process of being arrested. Its causes, so far as

they may depend on the use in brewing of glucose or

" invert" sugar prepared with impure sulphuric acid, havebeen traced, and in all parts of the kingdom medical menare on the alert to detect and deal with new foci, whilethe publicity given by the press to the matter as one of

widespread interest and obvious emergency has helped toavert the danger. Fresh cases have, however, been

announced since our last issue, whilst several inquiries held

by coroners have brought into prominence a question whichmay come before any of our readers in the near future-Who,if anyone, is liable to compensate those who have lost rela-tives by death ? This is a most important point where thoseaffected are from the nature of the case largely drawnfrom the wage-earning class. It will be well that medical

men should make themselves to some extent familiar with

the law in relation to the occurrences.

Some persons have apparently lost their lives throughdrinking beer containing arsenic, and it need hardly be saidthat where a person’s death is caused by the wrongful act,neglect, or default of another, and the injured person,if he had lived, could have maintained an action, Lord

CAMPBELL’S Act enables relatives within certain limita-

tions to recover compensation for their loss. The recent

epidemic seems likely, therefore, to produce a large numberof such claims; but the alleged facts upon which they will befounded are without any close parallel, and if the liabilityis seriously disputed by those whom it is sought to make

esponsible, some time may elapse before it is fully estab-lished. Yet, if we may hazard an opinion on so debateablea topic, it seems reasonable to suppose that someone will

be found liable to pay compensation in some cases, whilethose seeking it will direct their efforts against the brewerswith the best chance of success. Possibly some difference

may arise between publicans selling in ’’ tied houses" and

those who do not, but we may assume that the public-housesfor the most part will be found to have been " tied," acircumstance which needs no definition, but which resultsin the publican being virtually the agent of the brewer, orin any case in his selling a beer the source of which is wellknown to the consumer.

The brewers have hitherto met the emergency with everyeffort to abate the evil, and it is probable that they will also

show a conciliatory spirit if threatened with litigation, butthe door to unfair or mistaken claims is a very large one, sothat the brewers must not be blamed if they take every stepto protect themselves and to sift the statements of those

who may proceed against them. It will be seen at once

that the purely medical evidence may be of enormous

value to persons making a claim upon the brewers,while the evidence of medical officers of health,public analysts, and borough chemists may be of equalimportance. The claimants will, presumably, have to showthat the person affected died from, or exhibited symptomsclearly indicating, arsenical poisoning; that such persondrank beer from a certain public-house ; and that samples ofbeer from that public house contained arsenic in quantitiessufficient to account for the symptoms complained of. It

will hardly be necessary to go through his dietary to showthat he did not get the arsenic in any other way ; that willbe a matter for the defendants to prove if they allege it.

The kind of scientific evidence that plaintiffs will requireis shown by the communications that have appeared in ourcolumns, and every medical man who finds himself con-

fronted with what he believes to be a case of arsenical

poisoning from beer-drinking must be prepared to give in acourt of law similar information concerning his patient.The report by Professor SHERIDAN DELEPINE and Mr.

C. H. TATTERSALL 1 says : " Every case we have followed up(about 100) can be traced to beer in the brewing of which

glucose or sugar from one manufactory was used." If the

arsenic can be traced as far back as the brewer it will scarcelybe necessary to follow it further, although the brewer mayultimately have a remedy against the person who suppliedhim with glucose, while the manufacturer of glucose may inhis turn some day maintain a claim against the personfrom whom he bought his sulphuric acid. Much will

presumably turn in all such cases on the amount of

knowledge on the part of the vendor of the purposes forwhich the thing sold was to be used. If anyone is sued

for damages in consequence of the epidemic which we arenow considering, whether he be publican, brewer, manufac-turer of glucose, or manufacturer of sulphuric acid, he willbe sued on one of two grounds-either because he sold some-

thing with a warranty, express or implied, that it was fit

for its purpose (in which case should it prove unfit he would

be liable whether negligent or not), or because having a dutytowards his purchaser he neglected that duty. Let us take

first the case of the publican. It appears from decided cases,the principal ones arising out of the sale of diseased

meat, that there would be no implied warranty at

common law by him that the beer was wholesome,and the 14th section of the Sale of Goods Act, sub-section 1,does not seem to affect the ordinary sale of beer to a

customer in a public-house. It apparently imports a

warranty only where the buyer relies on the skill and

judgment of the seller-a relation which does not seem toexist where a customer calls for a pot of beer in a

public-house. Nor can a publican be reasonably held

to be negligent because he does not know that

the beer which he retails, but does not make, contains a

1 THE LANCET, Dec 1st, 1900, p. 1603.2 Emmerton v. Mathews, 7, Hurlston man’s Reports, 586Ward v. Hobbs, 4, Appeal Cases, 13.

1745THE NATIONAL HOSPITAL FOR THE PARALYSED AND EPILEPTIC.

- minute but injurious quantity of arsenic. There can Bhardly be a duty incumbent upon him to make the I’ inquiry or to have the knowledge necessary for such a

discovery. With regard, however, to the brewer the case isdifferent. Like the publican, he knows that the beer is goingto be drunk by human beings. Like the publican, he maynot be held to warrant it wholesome, which would makehim civilly liable if some murderous assistant were to

poison it wholesale. But it is at least arguable that

he should know the chemistry of his trade and that

the chemist whom he employs should have his mind directedto all possible, as well as obvious, dangers. The use of

glucose and "invert" sugar is of comparatively moderndate. The employment of these substitutes has provokedmuch comment and remonstrance. The brewers who

have introduced these ingredients into beer have done

so for their own convenience, and it may well be urgedagainst them that it was their duty to see that

the chemically obtained sugars which they bought were

pure. The danger of arsenical poisoning may not havebeen pointed out to them in terms by their critics, but

it was they themselves who maintained that the new

system of brewing was wholesome, and it was their businessto see that it was so.

IT was recently decided by the board of managementof the National Hospital for the Paralysed and Epileptic,acting upon the advice of the Lord Chancellor, one of

their body, that an inquiry into the management of the

hospital should be held by the Right Hon. Sir FORD NORTH,a retired judge of the High Court. We announced this last

week. Sir FORD NORTH’S inquiry was to be directed towards

obtaining information for a report upon the allegationsmade by the medical staff concerning (to quote the termsof reference) : " (a) the diet of the patients ; (b) the con-dition, care, and treatment of the patients ; and (c) the

nursing of the hospital-brought forward, under the

headings above quoted in the statement, dated May,1900, issued by the medical staff to the governors or

or about June 16th, 1900." As soon as the terms

of reference of Sir FORD ’NORTH’S proposed inquirywere made known the medical staff of the hospitadecided that they could not recognise the court

Sir FORD NORTH, they pointed out, had been invited to

make his investigations solely by one of the parties to the

controversy-namely, the board of management ; and

secondly, the scope of the inquiry was limited to th

domestic conditions of the hospital and appeared to exclud.from consideration the all-important topic of the constitution of its management. The attitude thus taken u

by the medical staff was absolutely consistent wit

the position that they have occupied throughoulThey have asked for inquiry, but for inquiry int

all the matters at issue between themselves and tb

board of management. An investigation of certain chargewhich they considered it their duty to make many montlago will form part of such an inquiry, and not the lea:

important part. But when the board proposed, instead (

a thorough investigation of the whole situation between tltwo parties, a limited inquiry, to be conducted by a court 4

their own appointment into one side issue, the medical sta

very properly refused to have anything to do with the matter.We now learn that Sir FORD NORTH’S proposed inquiry hasbeen adjourned sine die, and we may be permitted to wonderwhat the board of management ever expected to take bysuch an inquiry. We have every desire to credit both sides

of this unfortunate controversy with good faith, therefore wemust suppose that the request to Sir FORD NORTH to obtaininf ormation for a report upon the accuracy of the statements

placed before the governors of the hospital last May by themedical staff was made with the belief that such a partialinquiry would meet the case. But while we credit the board

of management with an honest attempt at reform we cannot

compliment them upon their sagacity. They had before themthe clear and reiterated statement of the medical staff that

they would have nothing to do with a partial inquiry, so thatthe refusal of the medical staff to recognise Sir FORD

NORTH’S court was only to be expected. And if in spiteof this refusal the inquiry had been held, in what waywould the report have been conclusive ? Quite apart fromthe fact that the most important witnesses would have beenabsent, Sir FORD NORTH, a learned lawyer, is not an experton hospital feeding, on nursing, or on sanitation ; he was

provided with no medical assessor; and he was invited to

discharge his unenviable duty by one party-the accusedparty-to a controversy. No practical purpose whatever

could have been served by such an inquiry. To put it

bluntly, if the report of Sir FORD NORTH had been a, favourable one it would have been regarded as a whitewash.The only satisfactory mode of settlement is the appointment

of a perfectly independent committee with a free hand to, inquire into all the points at issue between the medical staff; and the board of management, together with the admission; of representatives of the staff to the board.

Annotations.

THE SANITATION OF BARGES.

" Ne quid nimis." "

THE last issued half-yearly report of the medical officerof health of the Port of London, a valuable if somewhat

belated document, deals in some detail with the sanitaryconditions which obtain on the" dumb craft " which do so

much of the carrying trade in the lower Thames. Thesecraft are said not to be inhabited because the men who

navigate them do not, or at any rate are not supposed to,sleep on board. The owners of the vessels plead that it isunreasonable to expect that they should be fitted up withsleeping accommodation, because they do not wish the men tosleep during a voyage, and if the crew remain on board whenthe vessel is moored it is for the purpose of keeping watchover the cargo, and therefore facilities for sleep are dis-tinctly contra-indicated. The owners state also that as the

: men who work these craft are constantly being changed it: would be practically impossible for them to exercise due

supervision over a sleeping cabin and that they would there-fore be constantly put to great expense in the cleansingand repair of the place. There is perhaps less in this con-

tention than in the former one, although Dr. W. Collingridge,the writer of the report, who is intimately acquainted with

the practical working of all river craft, considers that it isnot unreasonable that the barge owners should altogether