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THE U.S. ARMY MEDICAL SERVICE.

PROBLEMS of reconstruction have had much attentionin the United States during this year, perhaps in partbecause she has had fewer immediate anxieties thanother nations; certainly they have been approachedwith great breadth of view. The latest evidence tocome before us concerns the Army Medical Service,dealt with in a paper by Major F. Kramer, MedicalCorps, U.S. Army, in the Military Surgeon forDecember. It has been decided that there shall beestablished at Washington, D.C., the Army MedicalCentre. For it there has been reserved a site of greatnatural beauty, a well-situated large natural amphi-theatre. Here will be built the large single building ofthe Army Medical School, where will be centred post-graduate instruction for all divisions of the Medical

Department, including, be it observed, the Dentaland Veterinary Corps, with complete laboratoriesfor research work. Associated with this will bebuilt a new hospital, the Walter Reed General Hospitalof 750 beds. There will be houses for officers andmen, and recreation grounds. The Surgeon-General’slibrary and museum will be here, and the whole is

expected to become an important unit in the post-graduate instruction of the country generally, and acommon meeting place for all in the medical professionwithin and without the service. Meanwhile the educationof officers is not being neglected, and 20 medical officersare at present seconded and undergoing special courses incivil medical schools. A new portal of entry has beenopened to the service from the civil profession, for thebest schools may recommend honour students, who arephysically fit, to be house surgeons or house physiciansin military hospitals for a year, after which, if approved,they are commissioned as first lieutenants. Orderlies,too, are being better trained, especially in work inlaboratories and operating theatres, extra pay beinggiven when qualification is shown. The pay of theNurses has been raised 20 per cent., and they havebeen given relative rank. A new Army Medical NursingSchool and Nurses Home will be part of the centre.Here army nurses will get a three years’ training. Thisaims to be an ideal nursing school, to turn out a

better trained body of nurses, and to maintain full andcordial relations with the profession at large.

PROFESSIONAL CONDUCT AND ERASURE FROM

THE REGISTER.

THE periodical statement from the General MedicalCouncil summarising the resolutions and decisions ofthe Council upon forms of professional misconductwhich have from time to time been brought beforethem, in the exercise of their disciplinary jurisdictionover the members of the medical and dental professions,has just been issued. This jurisdiction was conferredupon the Council by the 29th Section of the MedicalAct, 1858, and by the 13th Section of the Dentists Act,1878. A few instances of professional misconduct areset forth, not as constituting a complete list of offenceswhich may be punished by erasure from the Register,but as broad examples. The instances thus brought tothe notice of registered medical and dental practitionersmay briefly be described as follows :-

(1) Certificates, notices, reports, aec.-The signing and givingin a professional capacity of any certificate or document ofa kindred character, for subsequent use in courts of justiceor for administrative purposes, which is untrue, mis-leading, or improper. Such documents include certificates,notifications, reports, &c., under the statutes and Actsrelating to births, deaths, and disposal of the dead; lunacyand mental deficiency ; vaccination; factories ; education ;public health; workmen’s compensation; notification ofinfectious diseases; national insurance; old-age pensions;merchant shipping; sick benefit, insurance, and FriendlySocieties; the procuring of Foreign Office passports; theexcusing of attendance in courts of law, in the publicservices, in public offices, or in ordinary employment; andin connexion with naval and military matters.

in connexion with professional covering.-The employmentin connexion with professional practice of an assistant who

is not duly qualified and registered, or the enabling of anyperson, known to be unqualified and unregistered, to attendor treat a patient in respect of a matter requiring pro-fessional discretion or skill. (These rulings do not apply soas to restrict the proper training and instruction of bona fidestudents, or the legitimate employment of dressers, mid-wives, dispensers, surgery attendants, and skilled mechanicsunder the immediate personal supervision of a registeredpractitioner.)

(3) Sale of poisons.-The employment for his own profitand under cover of his own qualifications, by any registeredpractitioner who keeps a shop or other place in whichscheduled poisons or preparations containing scheduledpoisons are sold to the public, of assistants who are leftin charge, but are not legally qualified to sell scheduledpoisons.

(4) Association with unqualified persons.-Any assistancegiven, either by administration of anaesthetics or otherwise,to an unqualified person attending or treating any otherperson in respect of matters requiring professional discretionor skill.

(5) Advertising and canvassing.-The practices of (a)advertising by a registered medical practitioner with a

view to his own gain, particularly if depreciatory of otherpractitioners, or of sanctioning such advertising; (b) employ-ing or sanctioning employment of agents or canvassers forthe purpose of procuring patients ; and (c) associating withor accepting employment under any association whichpractises canvassing or advertising for the purpose ofprocuring patients.

(6) Association with uncertified itomeitpractising as midwives.-Knowingly enabling uncertified women, on pretence thatsuch women are acting under direction, to attend women inchildbirth, contrary to law. It is provided in the MidwivesAct, 1902, and in the Midwives (Scotland) Act, 1915, that " nowoman shall habitually and for gain attend women in child-birth otherwise than under the direction of a qualifiedmedical practitioner, unless she be certified under this Act."

A registered practitioner who is proved to have com-mitted any of the offences detailed above is liable tohave his name erased from the Medical Register,and it is well that categorical warning should comeperiodically from the Council. It is clear that underseveral of the headings a practitioner through ignorance,coupled with carelessness, may be placed in a seriouslyunethical position. -

THE REPORTING OF FOOD POISONING.

UNDER existing regulations neither medical practi-tioners nor the general public are obliged to report cases offood poisoning to the medical officer of health, but thereis every hygienic and social obligation for doing so. A

statutory duty rests upon medical officers of health to

report to the Ministry of Health any outbreak of seriousepidemic disease, and in a recent circular (Memo. 39,Foods) the Ministry requests medical officers, when-ever they have reason to suspect that any deathor outbreak of illness in their districts is due to foodpoisoning, promptly to notify the Ministry, which maybe in a position to offer useful assistance in regard tothe immediate measures to be taken, and to elucidatepoints at present obscure in the causation of foodpoisoning. Early notification may show that othercases are occurring elsewhere from similar causes-e.g.,where one or two members of a household are sufferingin consequence of the consumption of canned food froma particular tin other canned foods of similar originmay be causing illness elsewhere. In any outbreakwhere the implicated food has been prepared in thedistrict the medical officer is advised to proceed at oncewith detailed investigations into the conditions of itspreparation, and to obtain material for bacteriologicalor chemical examination, steps being taken the whileto prevent further consumption of the suspected f )od bystopping its sale and recovering unconsumed portionsof what has already been sold. Suggestions are madein the circular for the collection and examination ofmaterial for chemical and bacteriological examination,and the reminder is added that the serological reactionof the blood of persons attacked should always bebacteriologically investigated. An appendix to thememorandum contains the headings of inquiries appro-priate for outbreaks of poisoning by meat foods andwhen contamination with inorganic poison is suspected.