the lancet 100 years ago

1
708 of Intellectual Workers, the University Bureau of Statistics, the Confederation of French Medical Syndicates, the Confederation of Dental Syndicates, the National Veterinary Syndicate, the National Student Union, and representatives of the French lawyers and architects. After a prolonged and friendly discussion, all concerned agreed on the desirability of preparing a scheme according to which the members of the liberal professions would be obliged under State control to contribute towards their own pensions, which could be claimed at 65, but the receipt of which could be deferred at the wish of their beneficiaries. This pension scheme would also be applicable to widows and children. M. Pomaret, the University Bureau of Statistics, and certain actuaries have been requested to work out the details of this scheme as quickly as possible, in order that it may be thoroughly examined and discussed with a view to its adoption by Parliament at an early date. A DOCTOR’S BUDGET Recent correspondence in Ooncours Medical throws some light on the financial problems of the general practitioner in France. One writer, who professes to give not his own budget but a synthetic substitute which he says is representative of several general practitioners in the suburbs of Paris, puts the annual professional outgoings per doctor at 70,000 francs. If some 30,000 francs be added to this sum for the luxury of a wife and family, a Parisian doctor must earn some 100,000 francs a year-E750 at current rates of exchange-if he is to hold his head above water and his family in its proper social place. With regard to the 70,000 for professional expenses, 20,000 are allowed for the running of a car and 11,000 for paying and feeding a maid. Taxes run away with 8000, the rent of a consulting-room with 4000, the telephone with 2000, medical publications and post- graduate courses with 1700, and a locum tenens with 4500. The other items in this 70,000 budget are individually small and of importance only collec- tively. The same writer calculates that the average cost to a doctor of a consultation is 13 francs so that he is only 7 francs in pocket after a 20-franc consultation, or 12 francs in pocket after a 25-franc visit. These fees for a consultation and a visit respec- tively are probably above rather than below the average even if no account be taken of those patients who act on the principle that it is better (for the doctor) to give than to receive. DEATH CERTIFICATE PROBLEMS The Ministry of Public Health’s new regulations for death certificates have caused much heart-burning. Not a few mourn those happy days when, without having to inspect a dead body or make awkward inquiries of the relatives, one airily stated that Monsieur X was dead from natural causes. Now we must hie, ourselves to the house of death, and not only view the corpse, but also discover and state why the patient died. Should our honesty be more in evidence than our tact, there is nothing to prevent an outraged widow from prosecuting us for the viola- tion of the professional secrecy imposed on us not only by the best traditions of our profession, but also and very explicitly by the law. Dr. Paul Boudin, legal adviser to Concours Médical has some words of forensic wisdom to say on this subject. He warns doctors against the making of incomplete or misleading statements on a death certificate, for once they are made there is no knowing where they may lead. A flat refusal to issue any death certificate is much safer for the doctor, though what the other parties concerned with the death and burial of Monsieur X are to do in this event Dr. Boudin does not say ; presumably it is to be their funeral, not the doctor’s, and it is in him alone Dr. Boudin is for the moment interested. It comes to this, that the interests and feelings of individuals, from the dead and his family to the doctor, have to be weighed against those of the public health authorities anxious to publish instructive vital statistics. Another problem arising out of the new regulations concerns the remuneration the doctor earns but may not receive for the execution of his new duties. It is to be hoped that the civil authority-i.e., the municipal officials-will collect these dues on behalf of the doctor as if they were so many rates and taxes, so that he does not have to send in a bill as for personal and private service to an individual. For after all these new regulations are not so much for the immediate benefit of the defunct, his relatives and heirs, as for that of the State. DEATH OF DR. ANTOINE BECLEEE gnly a few weeks ago Dr. Antoine Béclère pub. lished a most interesting paper in La Presse Médicale on influenza and on the comparative importance of its specific virus and Pfeiffer’s bacillus. Now he is dead, and the press is unanimous in honouring his memory as that of one of the greatest radiologists in France. It was only last year that the radiological world celebrated his scientific jubilee, when the high honour of commander of the Legion of Honour was conferred on him. A member of the Academy of Medicine, he was its president a few years ago, and he has also been president of the Medical Radiological Society of France. One of his biographers has written : " To analyse the radiological work of Antoine Béclère would be to pass in review all the medical applications of the X rays." He was, however, by no means shut up in the water-tight compartment of his own specialty, and his interest in bacteriology was much more than that of the dabbling dilettante. THE LANCET 100 YEARS AGO September 16th, 1837, p. 889. From a lecture on Materia Medica and Therapeutics delivered at the Windmill-street School of Medicine by Dr. GEORGE G. SIGMOND. , The nettle has been employed as a rubefacient, and urtication, or the application of the urtica dioica to paralytic limbs, or in torpid and lethargic affections, has been found very successful; the young shoots, or tops, are gathered by the rustic classes to boil in broth or gruel; the juice of the leaves has been employed in hemoptysis ; a conserve of the flowers and of the seed allays irritation in the kidneys, and, where stone exists, has been given, as an anodyne, with very good effect ; a leaf of the nettle placed upon the tongue, and pressed hardly against the palate, has a very instantaneous effect in bleeding at the nose. Even some of the species of the fig are narcotic and poisonous ; thus, the ficus toxicaria is highly poisonous; most of them have, however, the reputation of being generally demulcent, and slightly laxative ; they have long been employed in domestic medicine as poultices, and our older writers on " Materia Medica," ascribe their introduction into use, in this way, to their being mentioned in Isaiah for the cure of Hezekiah, when " sick unto death." For Isaiah had said, " Let them take a lump of figs, and lay it for a plaster upon the boil, and he shall recover." " This," as Professor Burnet observes, " was two hundred and sixty years before the time of Hippocrates, and is the most ancient cataplasm of which history makes mention." From a leading article. Let us not be misunderstood,-though by this time parentheses of explanation are hardly necessary to ensure a comprehension of the views and language of THE LANCET.

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Page 1: THE LANCET 100 YEARS AGO

708

of Intellectual Workers, the University Bureau ofStatistics, the Confederation of French MedicalSyndicates, the Confederation of Dental Syndicates,the National Veterinary Syndicate, the NationalStudent Union, and representatives of the Frenchlawyers and architects. After a prolonged and friendlydiscussion, all concerned agreed on the desirabilityof preparing a scheme according to which the membersof the liberal professions would be obliged under Statecontrol to contribute towards their own pensions,which could be claimed at 65, but the receipt of whichcould be deferred at the wish of their beneficiaries.This pension scheme would also be applicable towidows and children. M. Pomaret, the UniversityBureau of Statistics, and certain actuaries have beenrequested to work out the details of this scheme asquickly as possible, in order that it may be thoroughlyexamined and discussed with a view to its adoptionby Parliament at an early date.

A DOCTOR’S BUDGETRecent correspondence in Ooncours Medical throws

some light on the financial problems of the generalpractitioner in France. One writer, who professes togive not his own budget but a synthetic substitutewhich he says is representative of several generalpractitioners in the suburbs of Paris, puts the annualprofessional outgoings per doctor at 70,000 francs.If some 30,000 francs be added to this sum for theluxury of a wife and family, a Parisian doctor mustearn some 100,000 francs a year-E750 at currentrates of exchange-if he is to hold his head abovewater and his family in its proper social place. Withregard to the 70,000 for professional expenses, 20,000are allowed for the running of a car and 11,000 forpaying and feeding a maid. Taxes run away with8000, the rent of a consulting-room with 4000, thetelephone with 2000, medical publications and post-graduate courses with 1700, and a locum tenenswith 4500. The other items in this 70,000 budgetare individually small and of importance only collec-tively. The same writer calculates that the averagecost to a doctor of a consultation is 13 francsso that he is only 7 francs in pocket after a 20-francconsultation, or 12 francs in pocket after a 25-francvisit. These fees for a consultation and a visit respec-tively are probably above rather than below theaverage even if no account be taken of those patientswho act on the principle that it is better (for thedoctor) to give than to receive.

DEATH CERTIFICATE PROBLEMS

The Ministry of Public Health’s new regulationsfor death certificates have caused much heart-burning.Not a few mourn those happy days when, withouthaving to inspect a dead body or make awkwardinquiries of the relatives, one airily stated thatMonsieur X was dead from natural causes. Now wemust hie, ourselves to the house of death, and notonly view the corpse, but also discover and state

why the patient died. Should our honesty be more inevidence than our tact, there is nothing to preventan outraged widow from prosecuting us for the viola-tion of the professional secrecy imposed on us notonly by the best traditions of our profession, but alsoand very explicitly by the law. Dr. Paul Boudin,legal adviser to Concours Médical has some words offorensic wisdom to say on this subject. He warnsdoctors against the making of incomplete or misleadingstatements on a death certificate, for once they aremade there is no knowing where they may lead. Aflat refusal to issue any death certificate is much saferfor the doctor, though what the other parties concernedwith the death and burial of Monsieur X are to do

in this event Dr. Boudin does not say ; presumablyit is to be their funeral, not the doctor’s, and it isin him alone Dr. Boudin is for the moment interested.It comes to this, that the interests and feelings ofindividuals, from the dead and his family to the doctor,have to be weighed against those of the public healthauthorities anxious to publish instructive vitalstatistics.Another problem arising out of the new regulations

concerns the remuneration the doctor earns but maynot receive for the execution of his new duties. It isto be hoped that the civil authority-i.e., the municipalofficials-will collect these dues on behalf of thedoctor as if they were so many rates and taxes, sothat he does not have to send in a bill as for personaland private service to an individual. For after allthese new regulations are not so much for theimmediate benefit of the defunct, his relatives andheirs, as for that of the State.

DEATH OF DR. ANTOINE BECLEEE

gnly a few weeks ago Dr. Antoine Béclère pub.lished a most interesting paper in La Presse Médicaleon influenza and on the comparative importance ofits specific virus and Pfeiffer’s bacillus. Now he isdead, and the press is unanimous in honouring hismemory as that of one of the greatest radiologists inFrance. It was only last year that the radiologicalworld celebrated his scientific jubilee, when the

high honour of commander of the Legion of Honourwas conferred on him. A member of the Academy ofMedicine, he was its president a few years ago, and hehas also been president of the Medical RadiologicalSociety of France. One of his biographers has written :" To analyse the radiological work of Antoine Béclèrewould be to pass in review all the medical applicationsof the X rays." He was, however, by no means shutup in the water-tight compartment of his own

specialty, and his interest in bacteriology was muchmore than that of the dabbling dilettante.

THE LANCET 100 YEARS AGOSeptember 16th, 1837, p. 889.From a lecture on Materia Medica and Therapeutics

delivered at the Windmill-street School of Medicine

by Dr. GEORGE G. SIGMOND. ,

The nettle has been employed as a rubefacient, andurtication, or the application of the urtica dioica to

paralytic limbs, or in torpid and lethargic affections, hasbeen found very successful; the young shoots, or tops, aregathered by the rustic classes to boil in broth or gruel;the juice of the leaves has been employed in hemoptysis ;a conserve of the flowers and of the seed allays irritationin the kidneys, and, where stone exists, has been given,as an anodyne, with very good effect ; a leaf of the nettleplaced upon the tongue, and pressed hardly against thepalate, has a very instantaneous effect in bleeding at thenose. Even some of the species of the fig are narcoticand poisonous ; thus, the ficus toxicaria is highly poisonous;most of them have, however, the reputation of beinggenerally demulcent, and slightly laxative ; they havelong been employed in domestic medicine as poultices, andour older writers on " Materia Medica," ascribe theirintroduction into use, in this way, to their being mentionedin Isaiah for the cure of Hezekiah, when " sick unto death."For Isaiah had said, " Let them take a lump of figs, andlay it for a plaster upon the boil, and he shall recover."" This," as Professor Burnet observes, " was two hundredand sixty years before the time of Hippocrates, and is themost ancient cataplasm of which history makes mention."

From a leading article.Let us not be misunderstood,-though by this time

parentheses of explanation are hardly necessary to ensurea comprehension of the views and language of THE LANCET.