1495PANEL AND CONTRACT PRACTICE

Lts. K. G. W. Saunders and G. 0. Gauld to be Capts.Capt. J. E. Snow to be Divl. Adjt. 49th (W. Riding)

Div.The Efficiency Decoration has been conferred upon

Lt.-Col. H. V. Walsh.

ROYAL AIR FORCE

Squadron Leader F. B. C. L. B. Crawford to HomeAircraft Dep6t, Henlow.

Flight Lt. C. Crowley to R.A.F. Dep6t, Uxbridge.E. W. R. Fairley and R. C. O’Grady are granted short

service commissions as Flying Offrs.Flying Offr. E. H. E. Cross to R.A.F. Station, Upper

Heyford, on appointment to a short service commission.Dental Branch.-Flying Offrs. A. P. Britton to No. 1

School of Technical Training (Apprentices), Halton;and A. J. S. Wilson to Home Aircraft Dep6t, Henlow.

DEATHS IN THE SERVICESLt.-Col. BELL WILMOTT LONGHURST, R.A.M.C. retd.,

who died on June 15th in his 70th year, was the eldestson of the late Sir (Henry) Bell Longhurst, surgeon dentistto King Edward VII. Educated at King’s College,London, he qualified M.R.C.S. in 1891 and after holding ahouse appointment at King’s College Hospital joinedthe R.A.M.C., becoming It.-col. in 1915. He was in SouthAfrica from 1899-1902. In the European war he was incharge of the Lahore British General Hospital, France,and in 1919-1920 of the 21st General Hospital atAlexandria. In 1921 he took the D.T.M. Liverp. andspecialised in tropical medicine. He found recreationin rowing and swimming, being the winner of variousprizes. He married Eleanor, daughter of Mr. W. 0.Jarratt, and after his retirement went to live at Bath.

PANEL AND CONTRACT PRACTICE

_ Irregular Certification : A Contrast

AN insurance committee in the south has justdealt with three cases in which insurance practi-tioners have issued certificates irregularly; in onecase the doctor was censured-possibly because fourattempts had been made to secure his services with-out success, and he did not attend before the medicalservice subcommittee, contenting himself with writinga letter a few hours only before the meeting-andin the others the practitioners were merely warnedthat they must comply with the Medical CertificationRules. The circumstances in one of these cases areworthy of examination; the insured person hadbeen on the funds, of the society since 1932 withheart trouble. In May, 1933, she went to hospitaluntil the following December, and then was under treat’ment by Dr. A throughout 1934 and until March 7th,1935, and fortnightly thence until May 1st, 1935.Dr. A did not see her again until March 23rd, 1936,but continued to provide prescriptions and certi-ficates, which were collected by a child. The practi.tioner’s evidence was that every time he went tosee the insured person she collapsed owing to herheart condition; that she was very nervous andexcitable; that he used to pull up his car furtherdown the road so that the insured person would not’ka6w that he was coming to see her ; that everytime he left her in a state of collapse ; that he

explained to the patient’s mother why he would notcall too frequently ; that he knew exactly how thepatient was getting on ; that he told the motherthat if any change in her condition made it necessaryfor him to see her he would come at once if sentfor; that the insured person lives only 100 yardsfrom his surgery that he admitted issuing thecertificates without actually seeing the insured person.At the meeting of the subcommittee it was sug-gested to Dr. A that it would have been better to-have written to the society stating that he thoughtit inadvisable to visit the patient-for societies areempowered in suitable cases to waive the necessityfor regular medical certificates. The subcommittee,found that the doctor had committed a breach ofthe rules but they were of opinion that in not visitingthe insured person-the practitioner acted in the bestinterests of the patient, and recommended that heshould be informed that he must -in future complystrictly with the Medical Certification Rules. It is

noteworthy that the period during which the patientwas not seen by her doctor extended from May, 1935,to March, 1936.As a contrast a neighbouring committee some

time ago dealt with a similar case-of cardiac trouble

and cataleptic fits and a lengthy period duringwhich certificates were issued without examination,The doctor told the subcommittee that the patientwas suffering from major hysteria and mental trouble.and that the excitement caused by his visits did hermore harm than good. The subcommittee quoted No. 9of the Certification Rules, and found it " abundantlyclear " that the doctor, in contravention of thatrule, issued certificates on dates when he did notsee the patient. The practitioner must have knownthat he appended his signature to statements whichwere not true, and he seemed to have failed properlyto appreciate that the form of certificate suppliedfor the use of practitioners contains a statementof fact. The committee pointed out that it wasopen to the practitioner to have informed the approvedsociety that the condition of the patient had reachedthe stage where no further medical treatment waspossible for the patient’s disability, and of his viewthat his visits, by exciting her, would do more harmthan good. The society would then have been in aposition to make other inquiries if they thought fit.A fine of 1:5 was recommended with the rider thathad he not explained his omission to visit the patientas dictated by medical considerations they wouldhave suggested a larger amount. The fact thatthe 15 was actually withheld may be taken as

indicating the Minister’s view of the matter.

Intravenous InjectionsThe Kent insurance committee have recently

concurred in the decision of the local medical andpanel committee that intravenous injections of neo-salvarsan are not beyond the range of service of ageneral practitioner. In the case under review,however, the service did not fall within the scope ofthe practitioner’s obligations under the terms ofservice as it was given in a general hospital with alimited staff. The Minister has indicated that hedoes not propose to refer the case to referees.

" No Smoking" I

Mr. X, an insured person, complained to the

Birmingham insurance committee that Dr. A,assistant to Dr. B, had failed to provide him withtreatment. The story as told to the medical servicesubcommittee was as follows :-

Mr. X said he suffered from bronchitis and on

March 27th last he developed an affection of the throat.Having passed a very bad night he attended next morningat the surgery where, although a notice that smokingwas strictly prohibited was exhibited in the waiting-room,Dr. A’s clerk was smoking a cigarette. As the smokeaffected his chest Mr. X asked the clerk to be kind enough

1496 THE BIRTHDAY HONOURS

to stop smoking. After waiting some time he wassummoned to the consulting-room where Dr. A also wassmoking. He asked the doctor if he would be kind enoughto put the cigarette on one side, to which he replied witha paraphrase of " An Englishman’s home is his castle "and continued smoking. Mr. X then told Dr. A that histhroat and chest were very bad and asked for a prescrip-tion for medicine similar to that prescribed by Dr. Band also a strong gargle for the throat. He explainedthat what he wanted was a yellow medicine and allegedthat Dr. A referred to a book, wrote out a prescription,tore it up, and refused to give him treatment. Mr. Xlost his temper and left the consulting-room withouttreatment. Next day he saw Dr. B who prescribedmedicine and gargle, and after a few days in bed thecondition of the throat improved.In his own account Dr. A said that Mr. X entered

the consulting-room and in an abusive manner com-

plained that the clerk and he were smoking. He askedMr. X to be civil but he became more abusive anddemanded a prescription for medicine and gargle. Ashe had not seen Mr. X before when suffering from a badthroat he told him he wished to examine his throat,adding that he would not smoke during the examination.Mr. X refused to submit to examination and Dr. A there-

upon declined to issue a prescription and advised himto see Dr. B if he did not wish to be examined by Dr. A.Dr. A denied having torn up the prescription ; he had noteven written it. He added that he remained quiet whilethe insured person was abusing him and that Mr. Xhad previously attended for treatment while he wassmoking without raising any objection.Mr. X denied using certain bad language attributed to

him and stated that the doctor did not ask to examinehis throat, and consequently he did not refuse to beexamined.

The subcommittee pointed out that the evidencewas contradictory. They were, however, satisfiedthat Mr. X and Dr. A irritated each other, that theybecame excited and consequently neither of themwas able to give a concise statement of what actuallyhad taken place. They were satisfied that Mr. Xapplied for treatment on March 27th, that he was inneed of treatment and that treatment was not

provided, and that in failing to provide treatmentDr. A had not complied with the terms of service.As, however, the evidence as to the cause of failurewas so conflicting, they recommended the insurancecommittee to take no action.

IRELAND

(FROM OUR OWN CORRESPONDENT)

PAYMENT FOR ANTI-DIPHTHERIA IMMUNISATION

IT is unfortunate that a difference of opinionshould have arisen between the medical professionof the Irish Free State and the Department of LocalGovernment and Public Health on the question ofthe remuneration to be paid to medical men forcarrying out schemes of immunisation against diph-theria under the direction of the county medicalofficers of health. The profession is willing to co-operate in what it believes to be a beneficent measureof public health, but it demands that its servicesshould be adequately remunerated. No differencearose between the professional organisations and thelocal authorities on the question of payment, butthe Department refused its sanction to the fees thelocal authorities were willing to pay. The sums atissue are small, and it is unfortunate if a servicebeneficial to the health of the community is hinderedor hampered by so small a matter. In some quartersblame is put on the profession for not accepting thefees approved by the Department, and it is being

suggested that it is the duty of medical men toserve the public good regardless of remuneration.Nothing is more likely to prevent a friendly arrange-ment than imprudent demands of this kind. Theresponsibility for carrying out the immunisationschemes rests on the Department of Local Govern-ment and Public Health and on the local authorities.The latter make no complaint of the fees asked forby medical practitioners, and the block comes fromthe Department.

THE BIRTHDAY HONOURS

THE list of honours conferred by the King on his42nd birthday contains the following names ofmembers of the medical profession :—

, Viscount

Lord Dawson of Penn, P.C., G.C.V.O., K.C.B.,K.C.M.G., M.D., P.R.C.P.

Physician in Ordinary to H.M. The King.

G.C.V.O.

Sir Richard Robert Cruise, K.C.V.O., F.R.C.S.Surgeon oculist to H.M. The King; surgeon, RoyalWestminster Ophthalmic Hospital.

K.C.B. (Military)Surgeon Vice-Admiral Robert William Basil Hall,

C.B., O.B.E., M.R.C.S.Honorary physician to H.M. The King; medicaldirector-general of the Navy.

K.C.B. (Civil)Arthur Salusbury MacNalty, M.D., F.R.C.P.

Chief medical officer, Ministry of Health and Boardof Education.

Knights BachelorLieut.-Colonel Charles Bickerton Blackburn, O.B.E.,

M.D., Ch.M.Member of the council of the New South Walesbranch of the British Medical Association.

James Sands Elliott, M.B., F.R.A.C.S.Honorary consulting surgeon, Wellington Hospital.For public services in the Dominion of New Zealand.

Cedric Stanton Hicks, M.Sc., M.B., Ph.D.Professor of human physiology and pharmacology atthe University of Adelaide.For services to medical education.

Captain Hibbert Alan Stephen Newton, M.B., M.S.,F.R.C.S.

Member of the council and censor-in-chief, RoyalAustralasian College of Surgeons.

Major-General Cuthbert Allan Sprawson, C.LE., M.D.,F.R.C.P., D.Litt.

Honorary surgeon to H.M. The King; director-general, Indian Medical Service.

Lieut.-Colonel John Calderwood Strathearn, C.B.E.,M.D., F.R.C.S.

Warden, St. John of Jerusalem Ophthalmic Hospital,Jerusalem ; honorary consulting ophthalmic surgeonto the Government of Palestine.

Colonel Alfred Edward Webb-Johnson, C.B.E.,D.S.O.,M.B., F.R.C.S.

Surgeon to the Middlesex Hospital.C.B. (Military)

Air Vice-Marshal Alfred William Iredell, M.R.C.S.Honorary physician to H.M. The King ; director ofmedical services, Air Ministry.