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referendum, and Dr. CHARLES HILL was called on toconsult a dictionary. This he did with resoundingeffect, but the meeting’s doubt remained. Dr. DAIN
thereupon stated that a plebiscite would be taken
by the council to find out whether doctors were preparedto serve, but this was not the appropriate moment for it.
A motion from Buxton and Dorset urged that theremust be a right of appeal from the decision of theMinister to the courts ; this was generally agreed, andDr. DAIN promised to bear it in mind. Dr. DE SWIET
(Paddington) wanted legal representation for anyoneappearing before a tribunal. The present arrangement,he -said, was unsatisfactory ; there was no legal repre-sentation, for example, before insurance committees.It was a pity that the new Bill said nothing aboutreferm of the G.M.C., but it was a greater pity that itintroduced a new disciplinary body, the tribunal, fromwhich there was no appeal, and before which legal repre-sentation was forbidden. Dr. R. W. MCCONNEL (Bucks)thought a doctor would get more justice from a medicalservice subcommittee, on which there were no lawyers,than by dragging in law-courts. Dr. ARTHUR (Gates-head) asked that new machinery should be set up todecide on all matters of arbitration without reference tothe Minister.
East Yorkshire feared that general practitioners wouldbe excluded from being called in by midwives in emer-gencies. While midwifery was still included in themedical curriculum, practitioners should be permitted tocarry out domiciliary midwifery. Mr. J. D. R. MURRAY(Exeter) urged that the patient should be the one tochoose the doctor rather than the midwife. Mr.hTICFIOLSON-LAILEY thought that every woman underthe new service should be free to engage a private doctorfor her confinement, who should obtain the fees underthe service. There was no mechanism in the scheme fora family doctor to attend a normal case. Dr. PRIEST-MAN (Bradford) emphasised that midwifery was essen-tially the job of a general practitioner provided he couldcall in a consultant if necessary. These suggestionswere all carried.
At this stage the meeting, with an eye to the 60motions still outstanding, began to be a little hustled.This was a pity because Dr. R. COVE-SMITH now producedsomething of a bombshell in the form of counsel’s opinionon section 35 of the Bill, which lays down the penaltiesfor infringement of the regulations. He told the meetingenough of the legal opinion to make their hair stand onend in the few minutes allowed him. It appeared, forexample, that a doctor might find himself involved incriminal proceedings if he sold a second-hand stethoscopeto his successor. He made it clear that this sectiondeserved careful investigation. Mr. A. DICKSON WRIGHT(Marylebone) described the penalties in section 35 as
"savage,’’ and Dr. HELME called the Minister’s powersfantastic. He could withhold grants at any stage if hedid not like the action of a doctor, and could even setup .a new service by regulations. Dr. J. A. GORSKY(Westminster) agreed that the Minister could repeal anysection of the Act or the Act itself on his own responsi-bility. Dr. COVE-SMITH, remarking that the price offreedom is eternal vigilance, advised the meeting not tobe let in for the penal clauses.
Dr. 0. C. CARTER (Bournemouth) moved that underthe Bill any private practitioner or specialist should havethe same rights and privileges for treating patients asdoctors have at present, and this was carried. Dr.S. WAND (Birmingham), speaking for the general-practice
I committee, said he could see no chance of the Govern-: ment encouraging private practice. Dr. J. R. BAKER
(Scunthorpe) would like to see a permanent privatel practice service, with equal facilities, set up as a yard-L stick for the public service. It would be to the detri-, ment of the public service if no alternative was provided.
Dr. R. P. LISTON (Tunbridge Wells) urged that G.P.sshould have a right of access to any pay-beds available
) in hospital, and his motion was carried unanimously.! Dr. J. B.W. RowE (Harrow) wanted a grant-in-aid system
to enable patients to obtain private attention if theywished, but Dr. WAND was afraid that if the Bill allowedgrants-in-aid these might defeat the whole interests ofprivate practice. Dr. ARTHUR, on the other hand,recalled that such grants had been worked by providentsocieties for years. In his view, they would save privatepractice in many areas. The meeting agreed to supporta grant-in-aid plan.
Dr. A. A. MCINTOSH NICOL (Sunderland) asked forurgent attention to be given to the interest of ex-Servicedoctors, and suggested that such attention would helpto enlist their cooperation in the opposition to the Bill.He urged that part of the, B.M.A. fighting fund shouldbe allocated to Service doctors who could not find asuitable job because of uncertainty as to the future.
They would be driven into a State service by,lack ofmoney. Dr. W. B. A. LEWIS (Shropshire) said theex-Service doctor was a very real weakness in the
position of the profession. The B.M.A. scheme forhelping him to buy a practice offered terms little betterthan that of insurance companies. Mr. C. E. BEARE(Reigate) hoped that doctors selling. practices or takingin assistants would offer the new man better terms thanbefore--e.g., one year’s purchase without interest. Themeeting agreed unanimously to recommend a share ofthe fighting fund for ex-Service doctors.
Perhaps because it was hurried, the meeting was hastyin supporting a motion regretting the abolition of com-pulsory vaccination in the Bill. Dr. COCKSHUT explainedto them that abolition was proposed on the advice ofexperts, who were unanimously of the opinion that, farfrom reducing the amount of vaccination done, abolitionof compulsion would considerably increase it. This wasone occasion on which the Minister had acted on expertadvice, and it would be a pity if the meeting opposedthe experts. The meeting thereupon reversed its opinion.
Medicine and the Law
Overdose of MorylFOR the third year in succession we have to record a
death due to an overdose of carbachol. At a recent inquestat Croydon upon the death of Margaret Bullock, a marriedwoman, the doctors were alleged to have been misled bythe printed instructions issued by the manufacturers.The evidence, as recorded in last week’s issue of the
Croydon Advertiser, was as follows. The deceased wasadmitted to the Croydon General Hospital at about10.30 A.M. on April 19 ; she had been warned on theprevious day by a member of the medical staff when shevisited the hospital for examination that she ought toenter the hospital at once ; J he had found that herpulse-rate was over 160. When she entered the ward onthe 19th, he found that the pulse-rate had not fallen.He discussed the case with the house-physician, askedat the dispensary for Mecholyl,’ was told that therewas none in stock, and being shown a box of Moryl,’ordered the injection of one ampoule of moryl. Thedrug was sent to the ward from the dispensary. Thehouse-physician read the instructions in the box ; thedosage printed agreed with the dose which had beenordered, and the ward sister was directed to carryon with the injection. The house-physician had not
used moryl before and was unaware of its history or ofthe dosage but followed what were understood to bethe printed instructions issued.At 1.15, in response to an urgent call, the house-
physician visited the ward and found the patient veryblue and gasping for breath ; her pulse was not palpableat the wrist. The patient collapsed and died very quickly.Informed of the fatality, the doctor who had ordered themoryl to be administered inquired what amount hadbeen injected and was told that the dose was 0-1 gramme.He immediately realised that there had been an over-dose, since the correct dose should have been 0-00025 g.After seeing the house-physician and ward sister, hetelepfioned to Messrs. Savory and Moore, the manu-facturers, and asked them how it was that one grammeof moryl was in a box containing printed instructionsthat the dose of moryl should be a half to one grammerepeated three or four times during the day. It wasGood Friday and he could not get in touch with themanaging director till next day. The latter telephonedto him on the Saturday and, in the course of discussion,referred to the previous case at Oxford about 18 monthsearlier ; after the Oxford incident, he said, he hadtwice caused notices to be published in THE LANCETasking for the ampoules to be returned.
Mr. Samuel Stevenson, chief chemist to the manu-facturers, mentioned the Oxford case in his evidencebefore the coroner. After the’ inquest at Oxford, he said,Savory and Moore had been asked to withdraw all thepackets then in use ; a telephone message had been senton behalf of the manufacturers to the Croydon Hospital,asking for the return of any packets they possessed.The firm’s records showed that the hospital receivedmoryl in December, 1940, to be used for ionisation.The hospital disputed the statement that it had receiveda telephone message from the manufacturers.The pathologist who conducted the postmortem
examination said that Mrs. Bullock had been in a seriouscondition. She had a cancer in the left breast and alump on the thyroid gland. Death was caused bypoisoning due to an overdose of moryl. The deputycoroner, in summing up, said that the hospital doctorshad admitted an error. The jurv might find that thehospital had, or had not, received word to send backthe drug ; it was possible that the firm’s instructionshad been misleading. The jurv returned an open verdict.
Besides the Oxford fatality already mentioned (Lancet,1944, ii, - 609, 669) there was a similar death in theCoventry and Warwickshire Hospital (1945, i, 504).In the Oxford case the widow of the deceased wasawarded damages against Savory and Moore Ltd.in an action alleging that the firm had been negligent.The negligence which the judge found to be establishedby the evidence consisted of the packing of moryl crystalsin an ampoule and putting into a box containingampoules of crystal moryl a pamphlet of printed instruc-tions similar to the instructions put into boxes con-taining ampoules of the liquid form of the drug. Inthe light of the three cases which have now occurred,it is obvious that dispensaries should overhaul theirstores and see that no further risk is run.
INFECTIOUS DISEASE IN ENGLAND AND WALESWEEK ENDED APRIL 27
- VoMtcco’M.s.—Infectious disease : smallpox, 0 : scarletfever, 1054 ; whooping-cough, 1669 ; diphtheria, 389 ;paratyphoid, 5 ; typhoid, 4 ; measles (excluding rubella),2793 ; pneumonia (primary or influenzal), 654 ; cerebro-spinal fever, 48 ; poliomyelitis, 5 ; polio-encephalitis, 0 ;encephalitis lethargica, 0 ; dysentery, 163 ; puerperalpyrexia, 148 ; ophthalmia neonatorum, 50. No case ofcholera or typhus was notified during the week.The number of service and civilian sick in the Infectious Hospitals
of the London County Council on April 24 was 1161. During theprevious week the following cases were admitted: scarlet fever, 45 ;diphtheria, 30 : measles, 87 ; whooping-cough, 26.Deaths.-In 126 great towns there were no deaths from
enteric fever, 3 (0) from scarlet fever, 6 (1) from measles,7 (3) from whooping-cough, 1 (0) from diphtheria, 56 (6)from diarrhcea and enteritis under two years, and 18 (2)from influenza.The number of stillbirths notified during the week was
235 (corresponding to a rate of 27 per thousand totalbirths), including 32 in London.
In England NowA Running Commentary by Peripatetic CorrespondentsTHIS year the summer exhibition of the Royal Academy
begins in the courtyard of Burlington House whereKing George V sits ready mounted for his journey toAdelaide, while a rather dwarfed Sir Joshua seems to bedashing off a farewell sketch of the departing monarch.Inside, the academicians have decided to put the warbehind them as quickly as possible, and there are veryfew uniformed portraits-a dubious gain, modernmasculine dress being what it is. But Mr. RodrigoMoynihan has contributed an effective study of Mr.Somerville Hastings wearing his badge of office as
chairman of the L.C.C. for 1944-45. Mr. Henry Lamb,a contemporary truant from medicine, shows portraitsof children and adults, including a notable head of
Benjamin Britten. Among the sculpture is Mr. EscourtClack’s bronze bust of Sir Alexander Fleming, F.R.S.,and Mr. Benno Schotz’s bronze of Sir Donald Pollock,lord rector of Edinburgh University from 1939 to 1945,in academic hood. Mr. Huxley Jones’s head of Dr.Douglas MacCalman is in the central hall. The archi.tectural drawings include Mr. Herbert Clark’s plans fora special hospital on a town site ; W. and T. R. Milburn’ssanatorium at Middlesbrough Stanley Hall andEaston and Robertson’s rebuilding scheme for theLondon Chest Hospital ; and Henry Braddock’s oldpeople’s dwellings at Ashford, Kent.
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There were only two F.B.s in eye, a dogbite, and ano-doctor’s-letter waiting in the receiving-room untilhe arrived to disturb us. His inanimate bloody bodywas escorted in by a policeman, two ambulance men, anUnderground inspector, and a witness. The history wasconfused, but the odds seemed on the razor-slash storyof the witness rather than the fit story of the inspector.When all the blood had been cleared up, the only woundsto .be found were two parallel scratches on each cheekand across his forehead. Sister looked over the screen,said " Fake," and started to talk to a detective who.hadarrived by then. Encouraged by Sister’s diagnosis and a,completely normal c.N.s. we tried the routine inch of hatpinwithout much success; face-slapping and corneal traumawere also non-productive, and more medieval methodsof revival were being planned when Sister looked overagain and hissed " Talk about jail." The sentence" Well, if he doesn’t behave himself he’ll have to goto jail " produced complete recovery, the patient sittingup and saying, " Sure and that’s where I want to go."Rather shattered by this, we appealed to the detective,who thereupon recognised the patient as an old andvalued customer. A short conference, in which thepatient took an active part, decided it would be bestto be arrested as drunk and disorderly, a plea of destitutenot being allowed in view of his considerable financialmeans and a Salvation Army hostel season ticket.As he was leaving he told us he wanted to go to jail
because he had found that the regular meals and sleepprovided by His Majesty -did his ‘‘ gastric " the worldof good. * * I ,
It was impossible for one whose last visit to theContinent was in the spring of 1939 to conceal hisexcitement as the Belgian coast and Flanders cameinto view through the windows of the Sabena Company’Stwenty-seater plane. I turned to my neighbour, a
young Belgian civil servant returning from an economicconference in London, and said : " This is D-day for me."" It will be rather different on this occasion," was* hisreply ; " there will be no resistance."The Brussels airport looked dreary and empty in
the darkening afternoon of a hard winter day. I wassurprised to find the R.A.F. still in’titular control andthat all travellers went through the bottle-neck of Britishmilitary security. At the Sabena office the wife of myBrussels friend and colleague-my hostess on manyprevious visits-was waiting with a car to conveyme to the club of the Fondation Universitaire (F.U.)where I had been a temporary member on similarmissions before the war. Behind its simple facade in thequiet Rue d’Egmont the interior of the F.U. lookedas dignified and elegant as ever. Le taríf, allowing forthe increased cost of living, was still moderate-English