623

age, illness, and other causes resulting in inabilityto work formed the main reason for these grants.In addition, 54 applicants received special gifts ofmoney during the year amounting to £312 in all,for sudden emergencies, such as sanatorium fees,special medical treatment, maintenance while waitingfor a post, removal expenses, remedial exercises, fares,outfits, arrears of rent, and so forth. Spectacles hadbeen supplied to three beneficiaries, and eight hadhad dental costs paid for them. £65 had been distri-buted in coal grants amongst 63 applicants. Holidayshad been secured for 18 persons, and this was recog-nised increasingly as an extremely valuable part ofthe Guild’s work. The Committee thanked thosewho had sent Surgical Aid letters and appealedearnestly for more of these, also for Royal UnitedKingdom Beneficent Association votes. The educa-tional branch was a source both of anxiety and pride. IThe responsibilities of this work were shoulderedalmost entirely by the Guild, since all appeals made Ito the Royal Medical Benevolent Fund are referredto the Guild. The anxiety arose from the increasingnumber of applications for assistance as this enter-prise of the Guild became more generally known..e872 had been spent on education and training during1923, against about £700 in the previous year.Training had been given for most varied careers, forexample, secretarial work, partial fees for a ladydentist, fashion artist, teacher of physical exercises,cookery, &c., and maintenance was paid in several caseswhere no money was available for food and housingduring training. Mrs. Ormond described in detailthe pitiable condition of various recipients of helpfrom the Guild, and made it clear that the con-

structive policy of the Guild was to assist to earn, toeducate to earn, and to induce self-reliance. Hereinlay the explanation of the widening of its self-imposed responsibilities in undertaking educationaland training schemes. It was satisfactory to notethat there had been no instances during the past yearof any beneficiary losing through his own fault aberth obtained for him. School reports and reportsof careers subsequent to school life had been grati-fying. It must not, however, be forgotten that the workcould only be carried on if the medical professionmaintained the inflow of money.

In the absence of Miss Swinford Edwards, the reportof the Father Christmas branch was read by LadyFripp, who also read a report of the Clothes Committee.Lady Lewis moved, and Mrs. Laming Evans

seconded, the re-election of Lady Bradford as president,Lady Fripp as chairman of the Council, and Mrs.Scharlieb as hon. treasurer. Mrs. Woodwark moved,and Miss Jenkyn Brown seconded, the resolution thatMrs. Barrett, Lady Lewis, and Mrs. Liveing be electedmembers of the General Purposes Committee. Thesemotions were agreed to, and a vote of thanks to thePresident and Council, proposed by Mrs. WTilfredHarris, was carried with acclamation.

The Services.ROYAL ARMY MEDICAL CORPS.

Maj. and Bt. Lt.-Col. R. B. Ainsworth to be Lt.-Col.(’rapt. 3-. H. C. Walker to be temp. Maj. whilst empld. as

a Dep. Asst. Dir. of Pathology.MILITIA.

Capt. W. A. Miller to be Maj.TERRITORIAL ARMY.

Lt. R. Morris (late Lan. Fus.) to be LLlfol’ service withLeys School Contingent, Jun. Div. O.T.C.

Lt. P. Mumford to be Lt.General Hospitals : Lt.-Col. A. L. Flemming, having

attained the age limit, is ret., and retains the rank of Lt.Col.

Capt. A. C. Court to be Maj. (Prov.).Capt. C. B. Moss-Blundell having attained the age limit

is retd. and retains the rank of Capt.Capt. A. N. Smith (late R.A.M.C.,’S.R.) to be Capt.

Correspondence.

THE RISKS OF CERTIFYING IN LUNACY:INDEMNITY INSURANCE.

" Audi alteram partem."

To the Editor of THE LANCET.

SIR,- With reference to the leading article on thecase of Harnett v. Bond and Adam, published inyour issue of March 8th, there can be no doubt as tothe serious effect the decision of the courts in thiscase will have on the minds of all members of themedical profession-not only on those members ofthat profession who specialise in mental cases. Thedecision, however, only serves to emphasise the verygrave risks to which all persons who are engaged ina professional capacity are daily subjected in carryingout their duties towards their patients or clients,notwithstanding how skilfully or carefully such dutiesmay be exercised. The decision also serves toemphasise very strongly the fact that doctors,surgeons, and other medical practitioners shouldseriously consider the advisability of protectingthemselves individually, by means of insurance,against possible claims for damages, in the same wayas other classes of professional men have deemed itessential to do for a considerable time past.

Accountants, solicitors, directors of public com-panies, and other classes of professional men considerit money well spent to arrange insurance indemnitiesso that they may carry on their profession untram-melled by the ever-present risk of finding themselvesruined financially from the action of some ungratefulor spiteful client; for it must not be forgotten that,even though an action for damages may fail, the costof defending such an action is heavy and often beyondthe means of the unfortunate vict-im, the professionalman.

This subject of professional indemnity insurance isone which has not received, hitherto, the publicityand attention which it deserves. The facilities whichare available to accountants, solicitors, and othersare equally available to members of the medicalprofession-at a very low cost-and with the remedyin their own hands, it would seem that the medicalprofession have not much need to fear the effect ofthe decision in the Harnett case.

We are, Sir, yours faithfully,SANDERSON AND CO.,

Insurance Brokers.

91-93, Bishopsgate, London, E.C.,i’vfarch 7th, 1924.

* * The measure of the protection offered to medicalmen by their own admirable defence societies isindicated in their annual reports. The extent of thecover afforded to members of the Medical DefenceUnion against damages and costs of the other side inthe event of an adverse verdict is now £3000, in anycase which is undertaken on behalf of the member bythe Council of the Union, and it must not be forgottenthat a member of the Union is provided with his legaldefence entirely free of cost to himself in addition tothe indemnity insurance. The London and CountiesMedical Protection Society undertakes to grant asimilar indemnity to its members. In view of recentevents it is probable that the Councils of the twoSocieties will consider carefully the question ofextending the benefits of their present indemnityinsurance. No doubt it is possible to insure againstany risk by paying the necessary premium, but itseems unlikely that any insurance brokers couldafford to insure individual members of the professionto the same extent as the cover provided by thedefence unions, except upon a greatly enhancedpremium. In giving protection at the rate of £1 tocover an insurance of £3000, the defence societiesretain the power to refuse to indemnify at the discretionof the Council. Without this power of refusal the! insuring society or company might be ruined by

624

insuring some disreputable individual. On the otherhand, the Council of a medical protection society,if it did not do justice to a member, could be turnedout forthwith. Since an insurance company is notsubject to any such discretion the precise conditionshave to be set forth minutely when the insurancemight fail at a critical point.—ED. L.

CERTIFICATES OF INSANITY.

To the Editor of THE LANCET.

SIR,-It is not quite clear what Dr. H. Rayner 1desires ; he appears to object to the responsibilityattaching to certification, but could this be diminishedor could the duty be performed by non-medicalcitizens ? The risk indeed is small to a man whoa,ppreciat,es what he is doing, and who acts withcommensurate care, while the responsibility forordering detention actually does rest with the legalauthorities. All that is required of the medical" witness " is definite, verified, or referenced evidence sufficient to enable this authority to form his ownopinion. If only vague, " scrappy," technical eividenceis offered, this will throw a greater moral onus uponthe medical -,opinion " that the patient should bedetained." .

The very gravity of the charges that have to be made against a medical man for wrongly certifying I(in order to constitute an actionable complaint) showshow well the profession is protected from frivolousrecriminations. If the practitioner desires furthersecurity, he need not certify ; or he could safeguardhimself to some extent by refusing to accept a fee.Further legal immunity-security for the profession-could probably only be obtained at the expense ofpublic security (from unconscientious certification),and even if we desired and could obtain this it wouldonly aggravate the public suspicion, which is our realgrievance.

It is quite true that the community demands fullprotection from insane conduct and then " salves itsconscience " by reviling and penalising its obedientprotectors, but psychiatry is not the only suffererfrom this. The most it justifies us in demanding isa more definite and explicit statement of the principlesupon which the community sanctions interferencewith personal liberty. It cannot be denied, moreover,that our own advocacy of compulsory detention forcurative purposes as distinct from security has added

to the prevailing uncertainty as to the grounds uponwhich detention is recommended and sanctioned.

Dr. Rayner’s contention that " a non-officialgeneral practitioner is not the servant of the legislature,and should therefore not be required to take anyresponsible part in carrying out its objects," appearsto me inadmissible and dangerous doctrine, as alsodoes his demand that medical certificates of insanityshould be secret and " privileged " documents. Theseform an essential part of the procedure for restrictingthe liberty of a fellow-citizen, and must stand publicscrutiny. British law does not act on secret andnon-responsible evidence.

Corporate action by the profession on the lines headvocates, and at the present moment (with a Govern-ment inquiry pending) appears to me very undesirable,especially action that appears designed to " forcethe hand" of the legislature. The only real andsatisfactory security we can have is the confidence ofthe public. Vindictive and unreasonable action ontheir part is symptomatic of suspicion and a feelingthat safeguards and supervision are insufficient.We have nothing to lose by any measures of securityit may please to take : we have everything to gainby an overhauling of the Lunacy Law with which theprofession has never been content. This overhaulhas been promised, and surely our business is ratherto prepare our case than to prejudice it by partisanaction. I am, Sir, yours faithfully,

Perth, March 15th, 1924. 1. D. SUTTIE, M.B.I. D. SUTTIE, M.B.1 THE LANCET, March 15th, p. 570.

To the Editor of THE LANCET.SIR,-Dr. Rayner’s suggestion for the protection of

medical practitioners through the wiping out of everytrace of the evidence given by them for committal toan asylum would, I fear, be likely to lead to a reactionin the direction of providing more safeguards for theindividual concerned. It would also incidentallyabolish Section 82 of the Lunacy Act.The question of a doctor’s liability in the matter of

signing a certificate did not arise in the recentaction of Harnett v. Bond and Adam. Certifyingdoctors are at the present moment amply protectedby reason of the fact that in the eye of the law it isthe reception order signed by the judicial authority,and not the medical certificate, which is the cause ofthe alleged lunatic’s committal. The certifying doctorescapes liability on the ground that he is only awitness tendering evidence. In common with allother witnesses, the reliability of the doctor’s evidenceought in fairness to be tested through cross-examina-tion by the solicitor or friend of the alleged lunaticin the presence of the magistrate and of the individualhimself. Should the latter desire it, the wholeproceedings could be conducted in privacy. Doctorsneed not consequently be in any dread as to liabilityfor damages arising out of bona fide certification,while their sworn evidence from the witness-box willbe regarded as strictly privileged.

I am, Sir, yours faithfully,S. E. WHITE, M.B., B.Sc.

1’ower Hill, E., March 16th, 1924.S. E. WHITE, M.B., R.Sc.

, To the Editor of THE LANCET., SIR,-I have read Dr. H. Rayner’s letter in your, issue of March 15th, in reply to which I think the

point he raises is covered by the last paragraph ofSection 330, Subsection 1, of the Lunacy Act, 1890.which reads as follows : " He (the doctor signing themedical certificate) shall not be liable to any civil

, or criminal proceedings whether on the ground of’ want of jurisdiction or any other ground if such

person has acted in good faith and with reasonablecare." I am, Sir, yours faithfully,

’

STANLEY A. GILL, M.D., &C.Formby, Lancs, March 17th, 192.

HARNETT v. BOND AND ADAM.

To the Editor of THE LANCET.

SIR,-In your leading article with reference to thiscase in your issue of March 8th, 1924, I note withsatisfaction that you express yourself as " amazed andhorrified " that the jury should have found that Dr.Bond was aware of the plaintiff’s sanity at the timewhen he was taking measures to return him to MallingHouse, and in addition to which I believe he statedin his evidence that he considered him to be ofunsound mind. You also draw attention to the factthat Justice Lush expressed himself surprised on

learning that the patient is not personally made awareof the grounds of his detention, and, if I rememberrightly, conveyed the impression that he consideredthe patient should be presented with a copy of hiscertificate. Personally, I have always treated thesecertificates as confidential documents, and I should beinterested to know whether this is not the way thatthey are looked upon by every Medical Superintendent.and also whether this is not the attitude the MedicalProfession would expect us to adopt? P

I am, Sir, yours faithfully,RICHARD EAGER, O.B.E., M.D.,

Medical Superintendent, Devon MentalMarch 12th, 1924. Hospital, Exminster.

RICHARD EAGER, O.B.E., M.D.,Medical Superintendent, Devon Mental

Hospital, Exminster.

** * To a question asked in the House of Commonslast week " Whether, in view of the verdict inHarnett v. Bond and Adam, the Minister of Healthproposed to suspend Dr. Bond from acting as a LunacyCommissioner pending the decision of the Court ofAppeal," Mr. Wheatley replied in the negative.Mr. Wheatley called attention to the fact that a