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1197 MEDICAL MEN AS WITNESSES.-PLACENTA PRÆVIA. duty cast upon him to express himself with a certainty that he does not feel. When conviction follows a prosecution of the kind referred to, whether it be for manslaughter or for the lighter offence, trifling penalties only are, as a rule, imposed. In the case immediately under con- sideration, that of a couple named Clark, tried at the recent sessions at the Old Bailey, Mr. Justice Grantham sentenced the man to four months’ and the woman to two months’ imprisonment in the second division. Such a penalty cannot be expected to act as a deterrent, but it is doubtful whether a heavier one would not merely exalt those receiving it into the position of martyrs and possibly win adherents to their faith by the publicity that would inevitably ensue. There would posssibly be some hope of the gradual conversion of the Peculiar People to reasonable views were it not that in the newspapers read by the humbler classes from which the Peculiar People are recruited there is a general tendency to belittle and to ridicule the work of the medical man, while the advertisements of the quack medicine vendor fill whole columns with promises of cheap and speedy restoration to health for those who avoid the qualified practitioner and buy the vaunted pill or potion. Those who are brought into contact with the Peculiar People may be able to some extent to urge upon them in time of health the consideration of a ques- tion which in time of illness they have no leisure to discuss, and to persuade them not to carry their religion to the point’ of breaking the law of the land they live in, but we have little hope that argument will effect much. The person who has convinced himself as the Peculiar People have done, if once satisfied that he is right, is not likely to allow his children to wait until they can choose for themselves, and the law can do but little to save the children’s lives because punishment as a deterrent seems to be out of the question and the law, as a rule, is only set in motion when death has ensued and the absence of a certificate has caused a coroner to hold an inquiry. - MEDICAL MEN AS WITNESSES. AN action which was recently brought with success at the New Mills County-court by a medical man deserves a few words of comment from us. The plaintiff, Dr. George Lorimer of Buxton, went to London some’ time in 1898 upon a summons in order to give evidence in the High Court of Justice as to the capacity of a former patient to make a will, the deceased having been attended by him with regard to her mental condition. Dr. Lorimer charged five guineas for preparing his case and five guineas a day while in London, exclusive of railway fares and expenses. His account for £25 12s. was not, however, settled and after repeated efforts to obtain payment he sued to recover that amount. Evidence was given as to the scale of charges laid down by the Manchester Medico-Ethical Association, showing that Dr. Lorimer’s account was in accordance with pro- fessional custom. For the defence it was contended that Dr. Lorimer was not entitled to charge as an expert witness, because his evidence related to the question of fact whether he did or did not believe the testatrix to have been in her right mind. We are not sur- prised to find that this novel contention did not commend itself to his Honour Judge Smyly who gave judgment for the amount claimed with costs. A medical man is called in to see a patient because he is an expert in the treatment of disease and for no other reason. If his attendance leads to his being subpoenaed as a witness to depose to matters coming within the scope of his observa- tion as a medical man it would be contrary to common sense to say that his evidence was other than that of an expert. Apart from his being an expert he would never have been called as a witness at all. That a medical* man can be taken from his practice for several days without. compensation in order to assist a litigant is a very grave hardship, and that those in charge of the conduct of cases where medical evidence is required should often try to obtain such evidence at the medical man’s expense is not a little scandalous. We are always glad to chronicle the defeat of such manoeuvres. The compensation claimed by Dr. Lorimer was certainly not excessive in the circumstances ; - moreover, the estate of the testatrix could well afford to pay it. Where a party in a lawsuit requires medical evidence it should be possible for the medical man to arrange with the solicitor who is entrusted with the case sufficiently clear terms to avoid the inconvenience and the annoyance of a subsequent dispute as to remuneration. To give medical evidence is a disagreeable necessity incidental to our profes- sion and every attempt should be made to insure the proper payment of medical witnesses. We trust that the public have noted Judge Smyly’s words in giving judgment for Dr. Lorimer for the amount claimed with costs. He said that the time given to the case by Dr. Lorimer, who had been called as an expert witness, was worth more than the fee charged. As a rule there is no sort of relation between the value of the work and the scale of the remuneration of medical witnesses. PLACENTA PRÆVIA. THE treatment of placenta prævia must always be a subject of much interest to those engaged in obstetric practice. The performance of internal or bipolar version is still the most successful and the simplest method of treating this compli- cation. That cases of central placenta prævia which do not require any treatment at all do occur, however, is shown by the case recorded by Mr. A. W. Lemarchand in the current number of THE LANCET. At the present day when the obstetrician is usually also a gynaecologist it is not sur-- prising to find that abdominal section has been proposed as a method of , treating placenta prasvia. There is na doubt a great fascination about the ease and rapidity with which a Cassarean section can be performed. under suitable surroundings and the death-rate of such. an operation should be very small indeed. It does not require any prophetic vision to see that the scope of this operation will become larger and larger in the future and that it will to a considerable extent replace the operation of the induction of premature labour, at any rate in those cases of pelvic contraction in which the question of obtaining a living child with certainty is a matter - of some doubt. When we contrast the difficulty of a bipolar or internal version performed through the vagina with the ease and security of a Cæsarean section it is little wonder that men often better trained in gynaecology than in obstetric medicine should prefer the latter operation to the- former. Unless, however, the operation of Cæsarean section is to be performed upon all cases of placenta prævia, a suggestion which even its most staunch supporters. would hardly put forward, it must be reserved for those cases in which the haemorrhage is severe-that is to say, precisely the cases that are most likely to give bad results and that are least able to stand the shock of an abdominal section. The present methods of treating placenta prævia—viz., by rupture of the membranes, bipolar or internal version, or the introduction of Champetier de Ribes’s bag after rupture of the membranes, are undoubtedly attended with a high foetal mortality, but the maternal death-rate of cases so treated should not, and does not, exceed 5 per cent. It may be that we do not in this country consider the life of the child as much as we ought to, but no method of treat- ment can be considered justifiable which increases the risk to the life of the mother for the sake of a child, the-

MEDICAL MEN AS WITNESSES

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1197MEDICAL MEN AS WITNESSES.-PLACENTA PRÆVIA.

duty cast upon him to express himself with a certainty thathe does not feel. When conviction follows a prosecution ofthe kind referred to, whether it be for manslaughter or

for the lighter offence, trifling penalties only are, as

a rule, imposed. In the case immediately under con-

sideration, that of a couple named Clark, tried at the

recent sessions at the Old Bailey, Mr. Justice Grantham

sentenced the man to four months’ and the woman

to two months’ imprisonment in the second division. Such

a penalty cannot be expected to act as a deterrent, butit is doubtful whether a heavier one would not merely exaltthose receiving it into the position of martyrs and possiblywin adherents to their faith by the publicity that wouldinevitably ensue. There would posssibly be some hopeof the gradual conversion of the Peculiar People to

reasonable views were it not that in the newspapers read bythe humbler classes from which the Peculiar People are

recruited there is a general tendency to belittle and to ridiculethe work of the medical man, while the advertisementsof the quack medicine vendor fill whole columns with

promises of cheap and speedy restoration to health for thosewho avoid the qualified practitioner and buy the vauntedpill or potion. Those who are brought into contact withthe Peculiar People may be able to some extent to urgeupon them in time of health the consideration of a ques-tion which in time of illness they have no leisure to

discuss, and to persuade them not to carry their religionto the point’ of breaking the law of the land they livein, but we have little hope that argument will effectmuch. The person who has convinced himself as thePeculiar People have done, if once satisfied that he is

right, is not likely to allow his children to wait until theycan choose for themselves, and the law can do butlittle to save the children’s lives because punishment as adeterrent seems to be out of the question and the law, as arule, is only set in motion when death has ensued and theabsence of a certificate has caused a coroner to hold an

inquiry. -

MEDICAL MEN AS WITNESSES.

AN action which was recently brought with success at

the New Mills County-court by a medical man deserves afew words of comment from us. The plaintiff, Dr. GeorgeLorimer of Buxton, went to London some’ time in 1898

upon a summons in order to give evidence in the HighCourt of Justice as to the capacity of a former patient tomake a will, the deceased having been attended by him withregard to her mental condition. Dr. Lorimer charged fiveguineas for preparing his case and five guineas a daywhile in London, exclusive of railway fares and expenses.His account for £25 12s. was not, however, settled and afterrepeated efforts to obtain payment he sued to recover thatamount. Evidence was given as to the scale of charges laiddown by the Manchester Medico-Ethical Association, showingthat Dr. Lorimer’s account was in accordance with pro-fessional custom. For the defence it was contended thatDr. Lorimer was not entitled to charge as an expertwitness, because his evidence related to the questionof fact whether he did or did not believe the testatrixto have been in her right mind. We are not sur-

prised to find that this novel contention did not commenditself to his Honour Judge Smyly who gave judgment forthe amount claimed with costs. A medical man is calledin to see a patient because he is an expert in thetreatment of disease and for no other reason. If hisattendance leads to his being subpoenaed as a witness to

depose to matters coming within the scope of his observa-tion as a medical man it would be contrary to commonsense to say that his evidence was other than thatof an expert. Apart from his being an expert he would

never have been called as a witness at all. That a medical*man can be taken from his practice for several days without.compensation in order to assist a litigant is a very grave

hardship, and that those in charge of the conduct of caseswhere medical evidence is required should often try to obtainsuch evidence at the medical man’s expense is not a little

scandalous. We are always glad to chronicle the defeatof such manoeuvres. The compensation claimed by Dr.

Lorimer was certainly not excessive in the circumstances ; -moreover, the estate of the testatrix could well afford to payit. Where a party in a lawsuit requires medical evidence itshould be possible for the medical man to arrange with thesolicitor who is entrusted with the case sufficiently clearterms to avoid the inconvenience and the annoyance of a

subsequent dispute as to remuneration. To give medicalevidence is a disagreeable necessity incidental to our profes-sion and every attempt should be made to insure the properpayment of medical witnesses. We trust that the publichave noted Judge Smyly’s words in giving judgment forDr. Lorimer for the amount claimed with costs. He said

that the time given to the case by Dr. Lorimer, who hadbeen called as an expert witness, was worth more than thefee charged. As a rule there is no sort of relation betweenthe value of the work and the scale of the remuneration ofmedical witnesses.

___

PLACENTA PRÆVIA.

THE treatment of placenta prævia must always be a subjectof much interest to those engaged in obstetric practice. The

performance of internal or bipolar version is still the most

successful and the simplest method of treating this compli-cation. That cases of central placenta prævia which do notrequire any treatment at all do occur, however, is shown

by the case recorded by Mr. A. W. Lemarchand in the currentnumber of THE LANCET. At the present day when theobstetrician is usually also a gynaecologist it is not sur--

prising to find that abdominal section has been proposedas a method of , treating placenta prasvia. There is nadoubt a great fascination about the ease and rapiditywith which a Cassarean section can be performed.under suitable surroundings and the death-rate of such.an operation should be very small indeed. It doesnot require any prophetic vision to see that the scopeof this operation will become larger and larger in thefuture and that it will to a considerable extent replacethe operation of the induction of premature labour, at

any rate in those cases of pelvic contraction in which the

question of obtaining a living child with certainty is a matter -of some doubt. When we contrast the difficulty of a bipolaror internal version performed through the vagina with theease and security of a Cæsarean section it is little wonderthat men often better trained in gynaecology than in

obstetric medicine should prefer the latter operation to the-former. Unless, however, the operation of Cæsareansection is to be performed upon all cases of placentaprævia, a suggestion which even its most staunch supporters.would hardly put forward, it must be reserved for those casesin which the haemorrhage is severe-that is to say, preciselythe cases that are most likely to give bad results and thatare least able to stand the shock of an abdominal section.The present methods of treating placenta prævia—viz., byrupture of the membranes, bipolar or internal version, orthe introduction of Champetier de Ribes’s bag after ruptureof the membranes, are undoubtedly attended with a highfoetal mortality, but the maternal death-rate of cases

so treated should not, and does not, exceed 5 per cent.It may be that we do not in this country consider the lifeof the child as much as we ought to, but no method of treat-ment can be considered justifiable which increases the riskto the life of the mother for the sake of a child, the-