the royal medical benevolent college, epsom

1
723 of my late husband, I think it only right to state that the real complainant was another medical man, as can easily be proved. Beyond trying to get an honest living in that man’s neighbourhood my poor husband never did him any harm, but the action which resulted from his complaint caused my husband’s death at the early age of 31 years, leaving me completely unprovided for. Mr. Bredin was a true and loyal friend to us both. I am, Sirs, yours faithfully, CAROLINE KINGSLEY HUNTER. Warwick-street, S.W., March 7th, 1899. "SYMPTOMS OF POISONING FROM A SMALL DOSE OF TINCTURE OF CANNABIS INDICA." To the Editors of THE LANCET. SIRS,-I have been interested by reading in THE LANCET of Dec. 24th, 1898, the valuable observation on cannabis Indica by Mr. Antony Roche. I had a similar experience not long ago which might interest your readers. The patient, a young woman, aged 19 years, strong and robust in health, consulted me for dysmenorrhoea. I ordered her three- quarters of a grain of extract of cannabis Indica and added some camphor to it to be made into a pill. The next day her friends were alarmed by her condition and sent for me. I found that after taking one pill she was noticed to be different from her usual manner and the pleasurable intoxi- cation of Indian hemp was present in a feeling of happiness and excitement. Soon, however, she complained of dizziness and went to sleep. On awaking the next morning she was herself. The druggist assured me that no mistake had been made and that a similar preparation was sent to another person who took it without the least symptom of intoxica- tion. I quite agree with Mr. Roche that some people are more susceptible to the action of the drug than others, in spite of the variation in strength of the official extract or tincture, and it would be better to begin with very small doses to test the patient’s tolerance of it. I am, Sirs, yours faithfully, ANTONIUS J. MANASSEH. Brumana, Beyrout, Jan. 10th, 1899. "REGINA v. REICHARDT." To the Editors of THE LANCET. SIRS,-Referring to Dr. Goodhart’s remark, " I will not take up your space by discussing with Mr. Sers what con- stitutes insanity,’ " I can assure this gentleman that I am better engaged on this occasion and have nothing whatever to do with the subject beyond what is involved in the legal aspects of the case. As I gather from Dr. Goodhart’s letter he claims for certain privileged persons a kind of moral right to break the law-at least, he appears to see no reason why cases of temporary insanity should not be treated in un- certified houses ; but if so, what is the use of legislation on the subject ? The point I intended to bring before you is one of extreme simplicity. Dr. Reichardt, as I under- stand, received a patient suffering from some indefinite form of nervous disease which resulted in suicide. I submit therefore a primâ-facie case presented itself that the law was being tampered with. I say a primâ-facíe case was created to this effect and how could the case be decided on its merits without resorting to a court of law ? The fact that the case had been seen by Dr. Savage, Dr. Goodhart, and Mr. E. C. Kingsford who pro- nounced it unripe for an asylum I further submit was not sufficient reason for deterring the Commissioners from taking legal proceedings, otherwise the administration of the law with regard to the control of insane persons would practically be at the caprice and mercy of private individuals; and although, of course, the bona fides of these gentlemen is un- questionable-and I say this with perfect sincerity-the fact of the case having been seen by the aforesaid gentlemen and considered unfit for an asylum is not sufficient reason for keeping the law in a state of inertia, otherwise there is no guarantee that on any future occasion men of equal integrity might be concerned and as an ultimate consequence of establishing such a precedent a refined system of covering or evading the law might be thereby created. I am, Sirs, yours faithfully, ,,--- CLEMENT H. SERS. Queen’s-road, Peckham, S.E., Feb. 18th, 1899. THE ROYAL MEDICAL BENEVOLENT COLLEGE, EPSOM. To the Editors of THE LANCET. SIRS,-The appeal to the general public made by the- treasurer of the Royal Medical Benevolent College at the end of last year appears to me to be well founded. How many practitioners sacrifice their lives in the ser- vice of the public before they have had time to saveo- Dr. Holman asks for no help for the school, but urgently asks for aid in getting together the .E6000 he has to find each year for the Council to spend on the aged pensioners and young foundation scholars. The appeal although addressed to the public in no way does away with the claims of this institution to the support of the profession. A perusal of the annual report tells a miserable tale of the scant support the College receives from medical men. Who. can tell how soon misfortune may overtake a practi tioner ? ? Would it not be well even as a small insurance to subscribe to the College and thus to constitute a claim if necessity should arise to reap some of the benefits now offered but which might be so largely extended if money was forthcoming ? I am, Sirs, yours faithfully, "’’’’’’’’’’’’’’J’ f M.D. M.D. "DIFFICULTIES UNDER THE NEW VACCINATION ACT." To the Editors of THE LANCET. SIRS,-In THE LANCET of March 4th two gentlemen write on the above subject. One says: "Private practitioners have the game in their own hands. They have simply to take care that all their cases are vaccinated or accounted for to the vaccination officers before they are four months old."’ The second says: "Because your correspondent’s patients and themselves [the italics are mine] do not comply with the law they try to make the public vaccinators answerable." May I ask what these gentlemen mean ? It is, I think, the usual practice with private practi- tioners to vaccinate or sign postponement certificates only when the children are submitted to them. Both these gentlemen seem to imply that it is part of private practi- tioners’ duty to either call upon the parents of such children as they have brought into the world without being sent for or to send them a reminder before the child is four months old as to the law on the matter. To take either of these steps would be offensive to most medical men, I think, and might lay them open to the charge of touting. Besides, it is no part of their duty and however the public vaccinator may be bound by the law the omission of these steps in no way justifies your second correspondent in saying that the medical attendant" has not complied with the law" ; 9 the parent may not have complied, but the new Act imposes no obligation whatever upon the medical attendant. General practitioners have considerable justification for feeling sore on the point. Etiquette towards a professional brother is violated by visiting and offering to vaccinate" his patient. It may be the law, but I should not care to carry it out and visit another man’s patient in defiance of the ethics of the profession. I am, Sirs. yours faithfully, March 4th, 1899. GENERAL PRACTITIONER. To the Editors of THE LANCET. SIRS,-Mr. T. F. I. Blaker must pardon me when I suggest that he has not quite grasped my argument and that that is why he finds my letter " silly." He simply begs the question when he justifies the public vaccinator as one "doing his duty." I say that to call on strangers and offer professional services is work that no professional man ought to under- take. It is only his "duty" inasmuch as he has volun- tarily undertaken it. The medical officer of a canvassing medical aid society might as well plead that it was his I I duty "’ to countenance canvassing and he might even say that the society was recognised by Act of Parliament. Parliament is no supporter of, but rather opposed to, our ethical laws. He must also pardon me for objecting to his suggestion that we must play the game by paying unasked visits ourselves and so defeat the public vaccinator. It is this very calling on people who have not requested our services that I think so undignified and unprofessional. Such visits would be very

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of my late husband, I think it only right to state that thereal complainant was another medical man, as can easily beproved. Beyond trying to get an honest living in that man’sneighbourhood my poor husband never did him any harm,but the action which resulted from his complaint causedmy husband’s death at the early age of 31 years, leaving mecompletely unprovided for.Mr. Bredin was a true and loyal friend to us both.

I am, Sirs, yours faithfully,CAROLINE KINGSLEY HUNTER.

Warwick-street, S.W., March 7th, 1899.

"SYMPTOMS OF POISONING FROM A SMALLDOSE OF TINCTURE OF CANNABIS

INDICA."To the Editors of THE LANCET.

SIRS,-I have been interested by reading in THE LANCETof Dec. 24th, 1898, the valuable observation on cannabisIndica by Mr. Antony Roche. I had a similar experience notlong ago which might interest your readers. The patient, ayoung woman, aged 19 years, strong and robust in health,consulted me for dysmenorrhoea. I ordered her three-

quarters of a grain of extract of cannabis Indica and addedsome camphor to it to be made into a pill. The next day herfriends were alarmed by her condition and sent for me. Ifound that after taking one pill she was noticed to bedifferent from her usual manner and the pleasurable intoxi-cation of Indian hemp was present in a feeling of happinessand excitement. Soon, however, she complained of dizzinessand went to sleep. On awaking the next morning she washerself. The druggist assured me that no mistake had beenmade and that a similar preparation was sent to anotherperson who took it without the least symptom of intoxica-tion. I quite agree with Mr. Roche that some people aremore susceptible to the action of the drug than others, inspite of the variation in strength of the official extract ortincture, and it would be better to begin with very smalldoses to test the patient’s tolerance of it.

I am, Sirs, yours faithfully,ANTONIUS J. MANASSEH.

Brumana, Beyrout, Jan. 10th, 1899.

"REGINA v. REICHARDT."To the Editors of THE LANCET.

SIRS,-Referring to Dr. Goodhart’s remark, " I will nottake up your space by discussing with Mr. Sers what con-stitutes insanity,’ " I can assure this gentleman that I ambetter engaged on this occasion and have nothing whateverto do with the subject beyond what is involved in the legalaspects of the case. As I gather from Dr. Goodhart’s letterhe claims for certain privileged persons a kind of moral rightto break the law-at least, he appears to see no reason whycases of temporary insanity should not be treated in un-

certified houses ; but if so, what is the use of legislation onthe subject ? The point I intended to bring before you isone of extreme simplicity. Dr. Reichardt, as I under-stand, received a patient suffering from some indefiniteform of nervous disease which resulted in suicide. Isubmit therefore a primâ-facie case presented itselfthat the law was being tampered with. I say a

primâ-facíe case was created to this effect and howcould the case be decided on its merits without resorting toa court of law ? The fact that the case had been seen byDr. Savage, Dr. Goodhart, and Mr. E. C. Kingsford who pro-nounced it unripe for an asylum I further submit was notsufficient reason for deterring the Commissioners from takinglegal proceedings, otherwise the administration of the lawwith regard to the control of insane persons would practicallybe at the caprice and mercy of private individuals; andalthough, of course, the bona fides of these gentlemen is un-questionable-and I say this with perfect sincerity-the factof the case having been seen by the aforesaid gentlemen andconsidered unfit for an asylum is not sufficient reason forkeeping the law in a state of inertia, otherwise there is noguarantee that on any future occasion men of equal integritymight be concerned and as an ultimate consequence ofestablishing such a precedent a refined system of covering orevading the law might be thereby created.

I am, Sirs, yours faithfully, ,,---

CLEMENT H. SERS.Queen’s-road, Peckham, S.E., Feb. 18th, 1899.

THE ROYAL MEDICAL BENEVOLENTCOLLEGE, EPSOM.

To the Editors of THE LANCET.

SIRS,-The appeal to the general public made by the-treasurer of the Royal Medical Benevolent College at theend of last year appears to me to be well founded.How many practitioners sacrifice their lives in the ser-

vice of the public before they have had time to saveo-

Dr. Holman asks for no help for the school, but urgentlyasks for aid in getting together the .E6000 he has to findeach year for the Council to spend on the aged pensionersand young foundation scholars. The appeal althoughaddressed to the public in no way does away with theclaims of this institution to the support of the profession.A perusal of the annual report tells a miserable tale of thescant support the College receives from medical men. Who.can tell how soon misfortune may overtake a practitioner ? ? Would it not be well even as a small insurance tosubscribe to the College and thus to constitute a claim ifnecessity should arise to reap some of the benefits nowoffered but which might be so largely extended if moneywas forthcoming ? I am, Sirs, yours faithfully,"’’’’’’’’’’’’’’J’ f

M.D.M.D.

"DIFFICULTIES UNDER THE NEWVACCINATION ACT."

To the Editors of THE LANCET.

SIRS,-In THE LANCET of March 4th two gentlemen writeon the above subject. One says: "Private practitioners havethe game in their own hands. They have simply to takecare that all their cases are vaccinated or accounted for tothe vaccination officers before they are four months old."’The second says: "Because your correspondent’s patientsand themselves [the italics are mine] do not complywith the law they try to make the public vaccinatorsanswerable." May I ask what these gentlemen mean ?It is, I think, the usual practice with private practi-tioners to vaccinate or sign postponement certificates onlywhen the children are submitted to them. Both these

gentlemen seem to imply that it is part of private practi-tioners’ duty to either call upon the parents of such childrenas they have brought into the world without being sent foror to send them a reminder before the child is four monthsold as to the law on the matter. To take either of these

steps would be offensive to most medical men, I think, andmight lay them open to the charge of touting. Besides, itis no part of their duty and however the public vaccinatormay be bound by the law the omission of these steps inno way justifies your second correspondent in saying thatthe medical attendant" has not complied with the law" ; 9the parent may not have complied, but the new Act imposesno obligation whatever upon the medical attendant.

General practitioners have considerable justification forfeeling sore on the point. Etiquette towards a professionalbrother is violated by visiting and offering to vaccinate"his patient. It may be the law, but I should not care tocarry it out and visit another man’s patient in defiance ofthe ethics of the profession.

I am, Sirs. yours faithfully,March 4th, 1899. GENERAL PRACTITIONER.

To the Editors of THE LANCET.

SIRS,-Mr. T. F. I. Blaker must pardon me when I suggestthat he has not quite grasped my argument and that that iswhy he finds my letter " silly." He simply begs the questionwhen he justifies the public vaccinator as one "doing hisduty." I say that to call on strangers and offer professionalservices is work that no professional man ought to under-take. It is only his "duty" inasmuch as he has volun-tarily undertaken it. The medical officer of a canvassingmedical aid society might as well plead that it was his I I duty "’

to countenance canvassing and he might even say that thesociety was recognised by Act of Parliament. Parliament isno supporter of, but rather opposed to, our ethical laws. Hemust also pardon me for objecting to his suggestion that wemust play the game by paying unasked visits ourselves andso defeat the public vaccinator. It is this very calling onpeople who have not requested our services that I think soundignified and unprofessional. Such visits would be very