1642 THE NATIONAL INSURANCE BILL.

THE LANCET.

LONDON: SATURDAY, DECEMBER 9, 1911.

The National Insurance Bill.DURING the past week the general opposition to the

National Insurance Bill has not grown less in the medical

profession. Numerous correspondents of our own, as well

as published statements elsewhere, show that this hostility,although of the most varied kind, has one common origin-the feeling that the principles rather than the details of

medical practice have received no proper respect. It

is true that throughout the Committee stage of the

Bill many other of the interests affected were found

not to have been consulted or considered, and in con-

sequence the Chancellor of the Exchequer showed him-

self willing to amend clause after clause in various

directions. But in dealing with a highly organised pro-fession like that of medicine, where the organisation consists

largely in a differentiation of duties among men with

common ideals, it must be a highly dangerous proceedingto try to force upon a substantial proportion of them a

scheme which may profoundly modify their lives and liveli-hoods without an anxious and well-informed examination

of all the facts drawn from unassailable sources. We

have protested against the passage of the Bill, as it stood andas it stands, because it will turn the medical professionupside down without in any way securing a proportionatebenefit to medicine or to the public. It is not beyond human

ingenuity to devise a scheme to which, while the nation was

enjoying the advantages of a National Insurance measure,the medical profession could heartily subscribe. But such a

scheme should be inspired in its origin with real knowledge.The multiplicity of amendments in the section of the Bill

dealing with medical benefits shows sufficiently that the

National Insurance Bill was faulty in its inception,though it also testifies to the willingness of the Chancellorof the Exchequer to meet his critics in amity if not insubstance.

The acceptance by Mr. J. SMITH WHITAKER, with the

approval of the Council of the British Medical Association,of the post of Deputy Chairman of the Board of Commis-sioners to be constituted under the Act, must be regarded ass, policy of compromise on the part of the Association, whose

position will be puzzling to all of its ordinary members, and

mortifying in the extreme to some of them. The governingbody of the Association has throughout advocated makingthe best of the Bill, and has resisted the proposal that themedical profession, finding the scheme unworkable, shouldhave nothing further to do with it. The line of compromisetaken has not been in response to any general mandate of the

members, but rather to the feeling of the Council that a policyof making good terms under the Bill was supported by a

majority, either in number or weight, among the constitu-

encies. Throughout the summer, therefore, negotiations havebeen taking place between the Association and the Chancellorof the Exchequer, the field of debate being presumably the

. six cardinal points on the granting of which dependedthe adherence of the Association to the Bill. At the

meeting of the Representative Body of the Associa-

tion held on Nov. 23rd and 24th in London, not

without many dissentients however, the Representativesdecided to take the advice of a report to them from the

:

Council, and to continue through the Association a conditional

support of the Bill, although the six cardinal points had notbeen granted. At the same time the determination to

insist upon these points was re-affirmed by what wastermed a "Declaration with regard to Future Action

as to the Cardinal Principles," the resolution in ques-tion being to the effect that the British Medical Associationwould use every possible means to ensure that no medical

practitioner should undertake the attendance and treat-

ment of persons insured under the Bill save in accordance

with the six cardinal principles. The situation, therefore,does not differ now much from what it was six months ago,save in the important fact that the medical secretary of theAssociation, with the approval of the Council, has beenplaced in a high position on the small and supreme body ofCommissioners to whom will fall the administration of the

Bill.

Mr. SMITH WHITAKER has proved himself to be an

indefatigable worker and an accomplished advocate of the

policy of the Association, and his knowledge of the medicalside of the Insurance Bill in all its permutations andcombinations is probably unrivalled. To a large ex-

tent he has been the mouthpiece of the Association

during the past six or seven eventful months. His

transference, therefore, from the position of chief advocateof a policy of resistance to the Bill until certain con-

cessions are made, to the position of Deputy Chairmanof the Commissioners is startling. In his new positionhis freedom of speech and of action are necessarilycurtailed. Hitherto he has spoken for the large section ofthe Association whose opinions have coincided with those

of their leaders ; henceforward he will be one of a small

group of judicial officers whose business it will be to

secure the smooth working of the Act and to dispense evenjustice between the most conflicting interests. That he will

do his utmost to uphold the policy which he has alreadyexpounded with such zeal and ability may be taken for

granted. He knows the arguments for that particularcourse and the general justice of the medical protests ;but will he have power to enforce his views ? The motives

of the Council in approving his appointment have beenexcellent ; but while reflections upon the integrity of the

Council are ridiculous those upon their judgment have force.They have endorsed, by sanctioning Mr. SMITH WHITKER’Snew position, the working, not the principles, of a measuredangerous to the medical profession, one whose influence

, has not been gauged and whose promise is fall of ill

omen.

1643THE GENERAL MEDICAL COUNCIL & SANDOW CURATIVE INSTITUTE. [DEC. P, 1911.

The General Medical Council andthe Sandow Curative Institute. i

THE proceedings taken by the British Medical Association before the General Medical Council with regard to the con-dnct of three medical practitioners in associating themselvesin their professional capacity with the " Sandow CurativeInstitute" have reached a further, but not a final, stage atthe recent session of the Council. The name of one of the

three gentlemen referred to, Mr. M. E. A. WALLIS, was at thesession of last May removed from the Medical Register.Another, Mr. C. E. TRIMBLE, in whose case judgment was

postponed in May to allow him to reconsider his position, hasnow produced evidence to show that he is practisinghis profession in Wales, having entirely severed his

connexion with the Sandow Institute, and with regard to himall proceedings are consequently at an end. The third

practitioner affected, Mr. J. R. WALLACE, had the same

opportunity afforded to him as Mr. TRIMBLE, but took adifferent course. He remained associated with the Sandow

Institute, and before the Council at its recent session thiswas frankly admitted on his behalf by Lord ROBERT CECIL,X.C., who stated that the institute had discontinued adver-

tising for the purpose of procuring patients or with the

promise to cure disease, that Mr. WALLACE had now abso-lute control and direction of the institute, and that he

accepted full responsibility for everything done in it. This

was borne out by the personal evidence of Mr. WALLACE,who stated that he saw all patients and prescribedthe treatment to be pursued, being entirely responsiblefor that treatment. He also said that Mr. SANDOW still

saw cases occasionally but undertook no responsibility with

regard to their treatment, and that the new arrangementthus described constituted a complete change from that

which had prevailed before. This being clearly an efCOrtmade by Mr. WALLACE and the Sandow Institute to bringthe practice of the former within lines consistent with thewell-known principles of medical ethics the Council acceptedit as such, so far as the information made that possible.That is to say, the Council again adjourned the case of

Mr. WALLACE until the next session in order that he

might then produce more satisfactory evidence regardinghis professional conduct, such evidence, as was suggested,to be that of medical practitioners. This we interpret tomean that in the opinion of the Council the association

of Mr. WALLACE with the Sandow Institute might in the

working prove blameless, but that only from observation ofthe actual practice that might follow professions of amend-ment could it be ascertained whether the features which

rendered the Sandow Curative Institute objectionable hadfinally disappeared. IAt this stage the matter might have rested for another I

six months, and, strictly speaking, it does so rest, so faras the consideration to be afforded to it by the General

Medical Council is concerned. From announcements made

through the medium of the daily press by Mr. EuGSEN

SANDOW, however, and from a letter addressed by Mr.

WALLACE to the Registrar of the General Medical Council,we gather that the more recent conditions described byMr. WALLACE in his evidence-upon which Lord ROBERT

CECIL relied in addressing the Council as consti-

tuting, according to his case, a course of conduct

beyond reproach-are not to be maintained. The state-

ment referred to as made by Mr. SANDOW was publishedin the newspapers of Dec. lst, where it may be read. It

describes the decision of the Council as a refusal of " plainjustice," and as suspending the sword of the Council’s

displeasure above Mr. WALLACE’S head for a further periodof six months, and it concludes as follows : "As apparentlythere is no means of satisfying that autocratic body, theGeneral Medical Council, and I fail to see any reason

whatsoever why the British public should be deprived of thebenefit of my medicineless treatment, to which so manythousands have testified, I intend to leave the final

judgment of the rights and wrongs of this mysteriousoffence against an obscure and unreasonable tradition to bedecided by the British sense of justice and fair-play, andfrom now onwards shall place my Curative Institute at

St. James’s-street at the disposal of every sufferer by makingknown, through the medium of the Press, that such an

institute exists." Mr. WALLACE, in his letter to the GeneralMedical Council, protests generally against the course adoptedby the authoritative body of the profession, and in particularagainst what he alleges to be an ignoring of evidence ofsimilar practices in connexion with other institutions

employing medical men. He writes : " I I desire to state now,

rather than wait until the expiration of six months hence,that I intend to continue my work. If the General MedicalCouncil consider that they are entitled to resolve that

this constitutes infamous conduct in a professional re-

spect’ on my part, then I leave them to direct the

removal of my name from the Medical Register ; but I

reserve my right to question their decision, and I trust theywill take an early opportunity of passing some resolution, soas to enable me to do this without unnecessary delay." We

gather from this that when the case of Mr. WALLACE comes

again before the General Medical Council there will neces-

sarily be evidence of a fresh course of conduct differingfrom that described at the session recently concluded, and

again from that which prevailed before last May, and that

any decision come to which is adverse to Mr. WALLACE will

be called in question, so far as this may be possible, in the

High Court of Justice. In these circumstances we have

referred above to the present stage of the proceedings asnot being final, and we almost necessarily refrain from

commenting upon the position taken up by Mr. WALLACEand Mr. SANDOW.

We may, however, remind our readers of a few of the

facts not in dispute which were before the General

Medical Council last May, and upon which its deci-

sions were then passed with regard equally to all the

three medical men implicated. With the side of the

business of Sandow, Limited, which is connected with the

promotion of muscular development and the increase of

physical efficiency in those who present themselves as

clients of a noted "strong man," the medical pro-

fession is not immediately concerned. Mr. SANDOW

has cultivated an extraordinary muscular developmentin himself, and if others try to emulate him by seek-

ing instruction from him, his position with regard to

1644 DREAMS.

his clients and pupils is not greatly different from that ofthe professional athlete who trains amateurs for rowing,boxing, running, or other branches of athletics. The case

which was brought before the General Medical Council asto. the connexion with the institute of three registeredmedical men had nothing to do with such an aspect of Mr.SANDOW’S business. In addition to giving instruction in

dumb-bell exercises and other methods of increasing muscular

power, and as a later development, Sandow, Limited, has

sought to derive profits from a branch of its business

described as the "Sandow Curative Institute," and fromwhat it has described in advertisements as "curative

physical culture." As evidence of this claim to be

curative—that is to say, to treat and to heal disease-

one of the pamphlets or advertising leaflets issued bythe institute and laid before the General Medical Council

recommended all sufferers from the complaints mentioned init to place themselves uureservedly in the advertisers’ hands,the complaints mentioned including "acute bronchitis."

1t was stated as a matter of history, and was not disputed,that the practice of the institute had been at one time tosend prospective subjects to private medical practitioners forexamination in order to ascertain whether any physicalweakness rendered the treatment proposed for them inadvis-

able, but that as a matter of greater convenience the medicalmen before the Council had been engaged as officers of theinstitute to make such examinations as indicated above uponits premises, but that their employment was not for the

purpose of prescribing physical exercises or any other formof treatment for those consulting them. It was not disputedby the three gentlemen whose conduct was under review that

sundry advertisements issued by the institute had appearedto them to be objectionable. On the other hand, it was not

suggested by those who laid the facts before the General

Medical Council that the position and conduct of the threemedical men complained of had not been frankly and

accurately described by them at the inquiry and before it, orthat they had originally intended to transgress the rules ofconduct which should be observed by members of their pro-fession, or that the statement made by Mr. WALLis was

untrue when he said that during his service as medical

officer of the institute a great many medical practitionersbad visited it and had brought their patients there to

undergo treatment. Upon the facts which we have brieflysummarised above were based the propositions advanced

before the Council by Mr. SMITH WHITAKER on behalf ofthe British Medical Association that (1) the Sandow

Institute undertook the treatment of disease ; (2) that thegentlemen proceeded against were employed by the institutein their professional capacity and were aiding and abettingin the carrying out of the treatment of disease by the

institute ; (3) that the institute had recourse to an extensive

system of advertising for the purpose of attracting patients ;nd (4) that the treatment of those patients at the institutewas entirely prescribed by Mr. SANDOW, an unqualifiedperson.

We believe that we have correctly stated above enoughto show exactly what the issues have been which the GeneralMedical Council up to now has had to consider and decide,&n4 as to which members of the medical profession will form

their own opinions. Mr. SANDOW and Mr. WALLACE have

submitted them to the public, a tribunal not always un-

prejudiced and not entirely competent to appreciate the

principles upon which decisions of the General Medical

Council upon matters of professional conduct are based.

Both have also intimated that before the case of Mr. WALLACE

comes again before the General Medical Council a different

practice will have been in use, as to which, presumably, therewill be no secret, and as to which evidence will, if desired, be

forthcoming. Mr. WALLACE has added to this the informationthat he desires without delay to test the legality of the Council’sattitude towards the Sandow Curative Institute and himself.

If by an appeal to judicial authority upon a point or points oflaw a question directly affecting the ethical standards of themedical profession, and of no small importance to the public,can be finally determined, we feel sure that none will

welcome the occasion more than the profession at large orthe Council, which Mr. SAKDOBv denounces as autocratic,and which Mr. WALLACE accuses of ignoring evidence

tendered on his behalf.

Annotations.

DREAMS.1

11 Ne quid nimis."

SOMEONE has said that a Philistine family can be definedas one of which all the members tell each other their dreams

when they meet at the breakfast table. Yet the subject ofdreams has from time immemorial exercised a fascination

over the intellectual and the illiterate alike, although theattitude of mind in which it is approached may vary

enormously. Some will see in the tragic poignancy of adream a revelation, from an ultra-mundane source, of thingsto come, while others will attribute similar phenomena tounusual visceral activity consequent on an injudicious meal.The late Sir Samuel Wilks, Mr. Ellis reminds us, once madethe acute remark that 1, the dreamer merely forms a mentalpicture, and the description of it he calls his dream." It is

in the process of describing dreams that expansions are

liable to occur, that dream incidents are prone to be alteredin accordance with conscious memories, that coloured

interpretations of the dream reality are apt to vitiate its

simplicity. For years Mr. Ellis has made it a practice towrite down in the morning the plain unvarnished data of hisdreams and to adopt the introspective method of dealingwith these data. He has therefore been able to satisfyhimself that the facts as given in the volume before us arereasonably accurate, and has confined his discussion to whatmay be called the problems of normal dreaming. The readerwill find that Mr. Ellis’s dream experiences are very like hisown, though curiously enough there appears to be no refer-ence to the " inadequately clothed " dream with which mostare familiar. Many of the phenomena receive at Mr. Ellis’shands ample explanation on perfectly simple grounds, to

the achievement of which his psychological knowledge andscientific spirit alike contribute. The symbolism of dreamsis duly exemplified, and although the author is ready toadmire the profound and daring interpretations of dream

symbolism furnished by Professor Freud, he is unable to followhim into the devious and puzzling maze of wish-fulfilment.

1 The World of Dreams. By H. Havelock Ellis. London: Constabland Co. 1911. Pp. 288. Price 7s. 6d. net.