Invitations to Health-Resorts

H. N. Oglesby
1884 BMJ (Clinical Research Edition)  
U13 .BRISH MDICAZ,O. Ot' .44. 743 INVITATIONS TO HEALTH-RESORTS. SIR, -Kindly allowv me a few lines in your valuable paper to protest against the abuse of the correspondence columns by medical men residing at health-resorts. We have had (thanks to the cholera) a flood of advertisements from medical men, recommending their particular sanatorium as a fit and proper place for all the diseases under the sun. Their statements are often mnisleading to general practitioners; and, as a fair sample, I
more » ... a fair sample, I may mention the opinion emanating from Arcachon, and given in the JOURNA.L of October 4th, that there have been cases of cholera "in some towns in England this summer." This is, of course, a mistake, and calculated to keep Continental tourists from visiting England. Again, the Harrogate physician tells us that the death-rate of his particularly bleak townis only thirteen per thousand, and practically advises phthisical patients to winter there. I presume he overlooked the fact, that a death-rate of thirteen means that each person born lives to the age of seventy-seven years ; or he would, in common fair-. ness, have added that such a deathl-rate was only exceptional, and impossible to continue.-I ani, sir, yours obediently, give mie to understand that a patient has the righit to go to another doctor, and that thllat doctor has a right to instruct the family doctor as to how he should treat the case without the family doctor having ever been consulted( in the miatter. With this finding I entirely disagree. I do hol(l, hoeveer, that a patient hias a perfectright to goto any medical iian whose advice hlie wishes to have, and so obtain a "seconld opinioIi." But as this "second opinioms" can, without the kilowledge of the famiiily doctor, examinie the patient, ask all niecessary questions, asld take his two-guinea fee, surely hlie can also write a prescription and give it to the patient, and nottrouble himnself by writing to the family doctor, and telling him to Write out a prescription for him. No iman of any spirit, or with any feelings of true manhood, would take this as his part or share in a "consultation," I thinik the usual course when a patient wishes to have a consultation between his ewn family doctor and another, who resides at somse distance, is for the patient to come to his usual adviser, tell him that he is going, for instance, to London, and that while there he wishes to see such asid such a doctor. Tlhei the family doctor, at the request of the patient, writes a statement of the patient's case, which the latter takes with him aind gives to the other doctor. After examination of the patient, the doctor states that he will write to the family doctor, and that the latter will probably explain, to himi the outcome of the consultation. Thus there will be carried out a true consultation. It seems to-me that there are a few who hlave not correct ideas about the terms "consultation," second opinioii," aind "hell)." I aiim right, I think, in holding that no such a thing as a consultation can take place between a doctor of medicine and one of the noln-medical public (patients); that in such a case it would be a matter of advice only ; also, that a "second opinion" is where a patient goes to the house of another doctor-the so-called neutral ground-and obtains ar opinion. So it would be a imatter of "help" when one doctor asks that anothe' should be brought in to hlelpl) in a case of surgery or midwifery, where a line of action has been decided on, but where it is necessary to have help. In my case, I think I acted rightly in refusing to accept the advice given by the specialist, for his was a "second opinion," and not a consultation, and therefore he had Ino right to mix me up in his transaction. Since then, I have had a consultation with a Liverpool doctor concerning this same case. You must see, sir, that, if I gave my sanction to your; finding, my life would be subject to great annoyance; for, if any or all of miy patients were to go to another doctor in Liverpool without my knowledge, and if that doctor were to write to tell me of this, and at the some timie direct me how to act, a very strange state of'affairs would be brought about. This is what the specialist did to me. You say he acted rightly; I say hlie acted wrongly. May I again ask for a reconsideration of my previous letter, and an answer, to this one.-Yours obediently, ROBERT RENTOUL, M.D. Liverpool. *** ToDr. Rentoul's request (which we have willingly acceded to) for a reconsideration of the subject of his letter which appeared in the JOURNAL of the 20th ultimlo, we are unable, as the result, to return other answer than that the opinion which we then deliberately expressed is now as conscientiously adhered to. With regard to his second commiunication, in wliich hlie not only maintains the correctness of his personal ethical opinion of the case he submitted, and rejects our owI as etroneous, but also, in the initial paragraph, mis-states ouir recorded opinion, we feeI that'to reopen the question under such circumnstances wouldbe useless, conducing neither to the interest of the profession at large, nbr to the advantage of hiYmseIf individually. We would, however, Venture to suiggest to him, as a comparatively young practitioner, a careful perusal of the Code Of Medicl Ethids, from which we fain wouldcl hope that he will derive a clearer and-juster view of thetrue ethics of the case than that which he now appears to entertain. PRESCRIPTIONS FOR VENEREAL DISEASE IN LEGAL PROCEEDINGS. SIR,-If you will permit me to offer a few remarks in-the JouR&n which shall have some reference to the letter and advfee under the heading "Psbescriptions for Venereal Disease in Legal Proceedings" of 20th ultimo, l will be muth obliged. Some years ago, a gentleman and his famiily with whom I am on most intimate terms went to the seaside, and whilst there, the husband was summoned to London, by a Parliamentary Committee, for a fortnight. On his return, coitus took place, and the next day a scalding, followed by a urethral discharge, re' sulted, and the wife complained similarly. HIe wrote to me detailing. the cii. culsstances, and in a most alarmed and disturbed state, protesting and asseverating that there was not an occasion by which lhe could have acquired disease, and asking for instructions. Fortunately, I had had experience of a like case previously, which converted me from the belief that gonorrhcea requires a specific alien power for its origin anid propagation. I explained to my friend that a discharge of mucus or pus from the vagina or uterus, miixed with an unstable fluid such as urine at a ternperature of about 100°Fahr., and rubbed into or inoculated in the mucous mem, brane or skin, and kept warm and undisturbed for several hours, will set up issflammation and a discharge; and that, withi abstinence and a few injections of alum-mucilage and belladonna-extract, a cure would be accomplished in a few days. The gentleman is a good chemist and anl amiateur physiologist. There was no sueing for a divorce. Before any medical man would swear that gonorrhcea is due to a specific and semper idea poison, he should be satisfied that a drop of ordinary muco-pius, or even so-called laudable pus, mixed with a few drops of urine, and kept at a temnperature of 99' for soine hours, if rubbed into the meatus urinarius when retiriag to sleep, and left unwashed till morning, did not produce a scalding and mucopurulent discharge. I do not dispute but that "J. D." has had a confession of illicit intercourse from his patient; if so, however, he need net tell it; he can refuse to answer; conversation is not evidence. I am induced to ask you and the medical profession to give attention to an evil vwhich the ilumber of medical congresses and the universal cry for educationi do not seem to affect: it is the frivolous manner and apparent absence of a sense of the responsibility in which the cause and origin of some affections are pronounced to be due to hereditary taint, to venereal disease, transmitted or acquired, and to secret drinking. I do not write thus as a literary censor or as an abstract philosopher, nor is it that I seek the retort of being considered sardonlic by those whom my words may affect. I rather treat of what I hlave experienced. If members of the medical profession do not restrict their professional opinions, both in private and public, to what they know and to what are demionstrable facts, and reliable logical and physical inductions from facts, they will continue to be addressed in the advertisements of administrative boards a's "persons," and they will earn from the public the odium (which the late medicolegal investigations in London and Dublin aroused) of stating what they do not know, and, in the estimate of the less charitable, of swearing what they'do notbelieve.-Yours truLly, STAFF OF THE -ARMIY. . THE official announcement that the medical officers of the army have for the future, like their combatant brother officers, to submit to examination as a condition indispensable to promotion, has caused a good deal of discussion, and, if we are to judge by letters which have appeared in the press, some discontentin the service. At a time when the medical service, for good and sufficient, reasons, had become so unpopular that difficulty was-experienced ini recruiting its ranks with efficient and capable officers, a notiontook possession of the minds of the advisers of' the .War Office, that one of the causes of this unpopularity was the' examination exacted by the 'regulations as a sine qud non to promotion to the rank of surgeon-major. Unfortunately, as it appears to us, the opinion thus tendered was acted upon, and it was thought by those who gave 'it that the most attractive feature in the Warrant which did soe much to restore the' lbst prestige of the service, was the abolition of the examination-test -or promotion. We believe that the examination was a'mere bugbear; that it never kept back a single capable candidate, and that its abolition was a mistake. The proot of this is te be found in the fact that the 'Secretary for India had the good sense to maintain the competition for final places at Netley by examination, even after the War Office, following the same evil counsel, had ceased to, do so; yet this persistence on the part of the India Office never had the effect of diminishing the competition for appointments.' As 'we have seen, the War Office has had to retrace its steps, giving anthetier example of' that habit of doing and undoing, which pervades every braneh' of the military administration of this country. It is noedles to say we are entirely on the side of those who maintained'thosne itys of this. xmTaion in the interest of the service. This test is-rigorously applied, :not'only to officers of Cavalry and the Line, but,ialso' to the two scientific branches of the Army, the Artillery, and Engineers. The object il view is to insure, as far as praeticable, that military officers shall not only hold fast the knowledge of their profession. thby possessed when
doi:10.1136/bmj.2.1241.743 fatcat:2tmplfyf4zdb5pqzhibpv5tesm