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1742 MEDICINE AND THE LAW.-THE SERVICES.
lecture being Cancer and its Treatment. The best thanks ofthe Council were given to Mr. Mayo Robson for his lecture
. and he was requested to publish it.The PRESIDENT reported that he had unveiled a window
un Norwich Cathedral erected in memory of the late Mr.William Cadge, F.R.C.S.
MEDICINE AND THE LAW.
uledical Men and the Police Call." "
A CORRESPONDENT asks " whose duty it is to see that the
medical practitioner is paid in the case of a police call," andfurther inquires " whether the police are justified in referringthe medical man to the patient’s friends or relatives for pay-ment." " He suggests that it is the duty of the police "toforward a certificate for the payment of the fee to themedical practitioner called " and that even if the relativesundertake the payment of the fee it is not for the medicalman to undertake the collection of it. The question ofwho is to pay the medical practitioner who at theinstance of the police attends to a person in needof his aid is one which often arises and from the
point of view of the medical man it is unjust that’he should be summoned, perhaps from his hardly earnedMst, to attend upon a patient who either will not be ableto pay him or who will deny his liability to do so and at thesame time to find that the police authorities also refuse toacknowledge the debt as theirs. It is a hardship and it isone for which it is not easy to suggest a remedy unlessmedical men sitting upon the local bodies which controlthe funds placed at the disposal of chief constables seetheir way to devise one and to carry it into practice.The legal position can be best appreciated by imagin-ing a concrete case. A policeman on his beat finds a
tramp apparently dying from disease or from a serious woundin the road 100 yards from the house of a medical man anda mile or two from the nearest hospital or workhouse
infirmary. If the policeman leaves the man to die withoutsummoning medical aid he will be censured, perhaps bymedical men, for his inhumanity. He, however, goes to thehouse of the practitioner who lives close by and askshim to come. The medical man may either go at oncewithout question or he may consider these points.The tramp will not be able to pay him and his rela-
tives, if they can be found, will probably refuse to do’so and cannot be compelled to accept the liability. Theycertainly do not summon him or enter into any under-
taking to remunerate him. The policeman calls on him toattend but the policeman is not authorised to pledge thecredit of his superior officers or of the fund out of which he.draws his pay for the supply of medical aid to persons,tramps or otherwise, found in need of it upon the highway.The policeman is not offering to make himself personallyliable and if asked definitely to do so would naturally decline.It is doubtful also whether the persons intrusted with thefinance of the police force would legally be justified inspending money with such an object. The police, inci-dentally to their duties in preventing or detecting crime,summon the medical man in order to save a life apparentlyin danger or to allay suffering. The medical man, in-
cidentally to his profession, from which he earns, or
.endeavours to earn, a living, is called upon to exercise hisprofessional skill without hope of reward or with butficanty expectation of any adequate remuneration. If heTefuses to go his neighbours, should they hear of it, will
say hard things of him, as they would have done of the,constable if he had failed "to call a doctor." If he
goes they probably will hear nothing of the matter andbe will, almost certainly, have perforrred a charitable actwithout thanks from anyone, for even the person relievedmay be expected to evince no gratitude towards him.’The situation is an extremely unpleasant one, for thosewho do charitable acts in other spheres of life at least- can choose the objects of their benevolence. Thereis, however, as a matter of fact, great difficulty in sug-gesting a remedy which local authorities are likely to
.put into practice, and the response, made gratis, to the" police call" seems likely to remain among the deeds.of kindness done by the medical profession, to their,own cost in time and labour, not only without any rewa] dor compensation but without praise or congratulation.
The average member of the public would say of the medicalman in the circumstances imaginel, " Of course he goes ;he would be a callous brute if he did not." He does notreflect, however, on what his own feelings would be if hewere expected suddenly to exercise his own profession orbusiness at any hour of day or night on behalf of a needystranger who would probably be found ungrateful and un-deserving. Whatever remedy, however, anyone may be ableto suggest for the existing state of things, it is certain thatat present it is not anyone’s "duty to see thnt the medicalpractitioner is paid." We would that it were so.
THE SERVICES.
ROYAL NAVY MEDICAL SERVICE.THE following appointments are notified :-Fleet Sur-
geons : E. H. Meaden to the Fire Queen, additional, to belent to the .Apollo and then to the Brilliant; and J. C. F.Whicher to the Brillimnt on recommissioning.
ROYAL ARMY MEDICAL CORPS.Lieutenant-Colonel J. R. Mallins, retires on retired pay
(dated Dec. 14th, 1904). Lieutenant F. H. Noke is con-firmed in his rank.
INDIAN MEDICAL SERVICE.The King has approved of the retirement from the
service of the undermentioned officers :-Lieutenant-ColonelFrederick Robert Swaine (dated Nov. 1st, 1904) and Lieu-tenant-Colonel Shibram Borah (dated Sept. 10th, 1904).
IMPERIAL YEOMANRY.Middlesex (Duke of Cambridge’s Hussars) : Herbert
Meggitt to be extra Surgeon-Lieutenant under paragraph 30Yeomanry Regulations (dated Nov. 26th, 1904).
ARMY MEDICAL RESERVE OF OFFICERS.
Surgeon-Captain W. B. Cockill to be Surgeon-Major(dated Nov. 26th, 1904) ; Surgeon-Captain T. E. Stuart tobe Surgeon-Major (dated Nov. 26th, 1904).
VOLUNTEER CORPS.
Royal Garrison Artillery (Vol1tnteers): : Ist Cornwall
(Duke of Cornwall’s) : Surgeon-Captain R. G. Nesbitt tobe Surgeon-Major (dated Dec. 10th, 1904). lst Lanark-shire : Surgeon-Lieutenant-Colonel J. Provan retires under
paragraph 103. Volunteer Regulations, and is granted the
honorary rank of Surgeon-Colonel, with permission to wearthe prescribed uniform (dated Dec. 10th, 1904). Rifle:3rd Volunteer Battalion the Royal Fusiliers (City of LondonRegiment): Surgeon-Lieutenant J. A. Angus to be Surgeon-Captain (dated Dec. 10th, 1904). 4th Volunteer Battalionthe Royal Fusiliers (City of London Regiment) : Super-numerary Surgeon-Major (Brigade-Surgeon-Lieutenant-Colonel) W. D. Waterhouse (Senior Medical Officer,2nd London Volunteer Infantry Brigade) to be Surgeon-Lieutenant-Colonel (dated Dec. 10th, 1904). 2nd VolunteerBattalion the Loyal North Lancashire Regiment: Surgeon-Lieutenant F. Robinson resigns his commission and is
appointed Second Lieutenant (dated Dec. 10th, 1904).13th Middlesex (Queen’s Westminster) : The undermentionedofficers resign their commissions :-Surgeon-Captain B. L.Stivens (dated Dec. 10th, 1904) and Surgeon-Captain J. S.Hudson (dated Dec. 10th, 1904). 18th Middlesex : Surgeon-Major C. Godson to be Surgeon-Lieutenant-Colonel (datedDec. 10th, 1904).
ROYAL ARMY MEDICAL CORPS (VOLUNTEERS).The Glasgow Companies: Lieutenant J. Bruce to be Captain
(dated Dec. 10th, 1904). Lancashire Fusilier Bearer Com-pany : Surgeon-Captain R. Mitchell to be Surgeon-Major(dated Dec. 10th, 1904).
THE TIBET MISSION.Tentioned in Despatches.
Major A. R. Aldridge, R.A.M.C., Lieutenant-ColonelL. A. Waddell, C.LE., I.M.S., Major C. N. C. Wimberley,LM.S., and Captain T. B. Kelly, I.M.S., are mentioned in alespatch relating to the Tibet expedition published in theLondon Gazette of Dec. 13th. The document contains thefollowing paragraphs : I I The peculiar climatic and physicalconditions threw an additional strain on the medical de-
partment. But all requirements were met and the forcenaintained in good health throughout the operations.
1743THE SERVICES.-VITAL STATISTICS.
’The total number of deaths and men invalided, ex-
cluding war casualties, was 411 and 671 respectively, andof these numbers 202 and 405 were more or less due to<the special climatic conditions. In addition to the above160 wounded from among our forces had to be cared for,.exclusive of a large number of Tibetan wounded who alsoreceived medical attendance. That everything worked so-well reflects great credit on this department." ...... "Thework which fell to the troops had to be carried out in theface of physical difficulties which subjected them to theseverest hardships and privations, and these became in-
creasingly acute as they neared their destination. Notwith-
standing these difficulties, supplemented as they were by;armed opposition, the undertaking was carried through inso successful a manner as to constitute it a highly creditableachievement. "
DRINKING WATER FOR SAILORS.
During the last few years, says Dr. Le Mehaute in theArchives de Médecine Navale for September, naval hygiene!has made great progress and considerable amelioration hastaken place in everything that concerns the well-being aswell as the health of the men who have to pass the greaterpart of their time afloat. Among the questions which chiefly- occupy the attention of sanitarians that of potable water.stands in the front rank. The purity of drinking water is
important on land but it is still more so at sea where nothingis more intimately connected with the efficiency and freedomfrom disease of a ship’s company than the water-supply.When an epidemic due to impure water breaks out in a townor village the inhabitants can adopt those measures whichseem good to them individually for the protection of them-selves and their families. There are many courses open tothem, including the radical one of flight, but afloat thosewho are exposed to the infection can do but little. If the
water-supply on board a ship should unfortunately become- contaminated the health of the entire crew is endangered.The men have no means of safeguarding themselves. Forthis reason it is of the first necessity that the water providedfor drinking purposes at sea should be fresh and limpid,pleasant to the taste, and perfectly free from noxious germs.In this brief formula all the essential points are comprised,but unfortunately it cannot be said to be universally applic-able throughout the French navy. Notwithstanding all theattention that has been devoted to the subject and in spite ofthe numerous remedial measures proposed by naval medicalofficers, many of which have been adopted, the appliancesfor the storage and distribution of potable water still leavesomething to be desired in some French war vessels. Dr.Le Méhauté proposes to substitute water that has been steri-lised by heat for the distilled water at present used, thelatter, in his opinion, being open to many grave objections,including excessive costliness. To install the system which heproposes would cost very little, as the existing pipes and re-servoirs could be utilised. The only innovation would be thesteriliser which should be placed between the storage tanksand the distributing fountains. Towards the end of hisarticle (first part) Dr. Le Mehaute describes and illustrates.a fountain which he has invented in order to enable each individual to have a separate drinking utensil. This fountainconsists of a semi-cylindrical receptacle of copper fixed at a Jconvenient height and fitted with five tubes which close by means of taps. When a sailor wants to drink all he has to !’do is to affix a sterilised mouthpiece, which he finds in a tsuitable dish, to the end of one of the tubes and to apply his i
lips to it precisely like a baby with a bottle. He then turns i
the tap and sucks until his thirst is assuaged. As soon as 1this object is achieved he has to close the tap and throw his t
mouthpiece into another dish to await sterilisation. It ispart of the chief sick-bay attendant’s duty to look after thefountains and to see that the mouthpieces are duly disinfected,and also to make sure that a supply of these is forthcomingwhen required.
THE ARMY MEDICAL RESERVE.Mr. George Stoker, C.M.G., in a letter to the Times of c
Dec. 8th pleads for " an efficient and adequate reserve for the Army Medical Service. The Army Medical Service 1has been greatly improved in many ways and no doubt B
much that still remains to be done in this direction twill eventually be accomplished, but, be it ever so
perfect, an Army Medical Service sufficient for peace re- t
quirements can never meet the exigencies of a great war." The scheme for an Army Medical Reserve of which he gives - an outline " consists in the organisation of a system which i
shall embrace a number of units called civilian auxiliaryhospitals, to be set on foot in times of peace and called outfor service in times of war and stress. These hospitals wouldbe organised in connexion with, and affiliated to, the generalhospitals throughout the empire. Such institutions wouldafford an ample and continuous supply of efficient physicians,surgeons, and nurses."
THE AMIR OF AFGHANISTAN AND HIS ARMY.
Our readers may be glad to have their attention directedto an article in the Fortnightly -Revie7v for this month on"The Awakening of Afghanistan," in which there is an
interesting reference to the beneficial medico-politicalinfluence of such services as that rendered by Major Bird,I.M.S., by his journey to Cabul and his successful treatmentof the Amir. The paper is well worth reading as a whole,for it gives a good picture of the relations existing betweenthe Amir and the Indian Government and how these maybe best strengthened and developed for the mutual benefit ofboth.
THE WAR IN THE FAR EAST.
The only important war news to be recorded concerns PortArthur and what practically amounts to the total destructionof the Russian fleet there. The capture of 203 Metre Hillby the Japanese, which gave rise to heavy losses on bothsides, has been followed by the evacuation of several adjoin-ing positions on the part of the Russians and it is to be
hoped that there will soon be an end to further futile
fighting and carnage in this direction. When the BalticFleet arrives at Port Arthur, if it ever does, it seemscertain that it will get no aid from the once splendidfleet in the Pacific and cannot count upon the harbour andfortress as a shelter and naval base of operations. FromManchuria there is no news of importance. The tempera-tnre on the Shaho is 200 below zero but according toofficial accounts from Tokio the Japanese forces being amplysupplied with warm clothing are standing the cold very welland are in a satisfactory state of health. With regard tothe Russians, the reports about their health and hospital andmedical arrangements generally are conflicting. Accordingto the description given by Major Seaman, medical officer ofthe United States army, he found a striking differencebetween the health conditions and medical arrangements ofthe two armies, those on the Russian side contrasting veryunfavourably in those respects with those obtaining in theJapanese armies. Nor does Major Seaman stand alone inthis view, for Dr. Dvoretzky of Moscow has recently describedthe shortcomings and limited authority of the Russian armymedical service. There is evidently a strong feeling inMoscow that the very favourable health reports which havebeen published by the Russian Government do not representthe real state of affairs at the seat of war.The Russian hospital ship Orel, the equipment of which has
been conjointly carried out by the Russian and French RedCross Societies, has arrived at the Cape. The hospital staffincludes 80 nurses and the vessel is provided with a numberof boats and launches intended for the removal and succourof the wounded in case of a naval action.The advices of the Russian Red Cross Society mention a
large number of cases of mental trouble in the army, saysthe Novoe Vrernya. These cases are sent to Moscow or toSt. Petersburg where they might be properly attended to ifthese towns would not delay in the construction of suitableinfirmaries. For this purpose there have been 2,500,000roubles available for several years, but although this sumhas been gathering interest no hospitals have been built forthe insane.
VITAL STATISTICS.
HEALTH OF ENGLISH TOWNS.
IN 76 of the largest English towns 7718 births and 5426deaths were registered during the week ending Dec. 10th.The annual rate of mortality in these towns, which hadbeen 16 6, 17’ 3, and 21’ 6 per 1000 in the three precedingweeks, declined again last week to 18’ 5 per 1000. In Londonthe death-rate was 18’1 1 per 1000, while it averaged18 - 7 in the 75 other large towns. The lowest death-rates in these towns were 8’ 9 in Bournemouth, 9’ 5 inSmethwick, 10’ 4 in Aston Manor, 10’ 9 in Hornsey,11’7 in King’s Norton and in Newport (Mon.), 11’8in Devonport, and 12’ 0 in Northampton and in West
