125 us careful of being too suspicious. Genuine differences of opinion must often occur. In one such case an expert known to favour the insurance comp...

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125 us careful of being too suspicious. Genuine differences of opinion must often occur. In one such case an expert known to favour the insurance companies but appointed by the local magistrate estimated as the result of an accident that the victim’s leg was shortened by about 5 millimetres, and concluded that his wage-earning capacity had been impaired to the extent of 5 per cent. The tribunal, acting accordingly, fixed the annual pension to be paid at 63 francs. But the victim appealed against this decision. Three other experts agreed that the shortening of the leg amounted to 25 millimetres, and thereupon the court raised the pension to 382 francs. So often are such differences of opinion worked in France against the workmen, according to Dr. Diverneresse, that he advises them strongly not to present themselves before an expert unless accompanied bv a medical man to watch over their interests. The insurance companies, if on good terms with the employer, have other methods of avoiding the fulfilment of their obligations. A case is related of a workman who was injured, and the tribunal estimated that his earning capabilities had been permanently reduced in the proportion of 12 per cent. The pension allowed was based on this estimate. Thereupon the company proposed to buy up his rights by paying a sum down. This sum, of course, should have been calculated on the basis of the 12 per cent. The employer, however, threatened to discharge the workman if he did not accept a sum calculated on the basis of 8 per cent. Rather than lose his situation the workman consented thus to lose a third of the compensation to which he was entitled, but so that the President of the tribunal should authorise this reduction it was necessary to produce a medical certificate testifying that now the workman in question was suffering from incapacity equal to only 8 per cent. Before me is the photograph of the letter written on the paper of the insurance company, whose full name and address are printed on the top. The name of the doctor to whom it is addressed heads the letter. This is a literal translation of the letter :We are going to send you one of our pensioners, named V——, with whom we have to come to terms for the purchase of his pension.

insurance to make

before a certain date when this was absolutely false. Then when the independent practitioner refused to comply the manager of the works insisted that the medical fees for which his firm was responsible should be reduced by 25 per cent. This meant the trouble of legal proceedings, but the doctor won his case. After that the workmen were not only forbidden to call in this practitioner when an accident occurred but also in cases of ordinary sickness. All this was absolutely illegal, but it was done all the same.

Remedies. selected out of a great number to show the demoralising influence exercised by speculative insurance con:panies. There are more than 300,000 labour accidents in France during the course of a year. At least a quarter of these accidents necessitate the obtaining of a certificate from an expert. It will be seen at once that on the result very large sums of money are involved. The interest of the nation is not specially bound up in economising the employers’ capital. The object of legislation on the employers’ liability for accidents is to diminish the frequency of such accidents, and when they occur to prevent the pauperisation of the injured and their families. The State is interested in seeing that the injured receive the full amount to which they are entitled. The interest of the medical profession is that medical men shall not be influenced in their judgment by pressure brought to bear upon them either by the injured on one side or by the employers and the insurance companies on the other side. The best guarantee against pressure from the latter source is the free choice by the patient of his medical attendant. But in some places the medical practitioner is liable to persecution if he responds to such a call, and the workman on his side runs the risk of being discharged if he does not call in the medical practitioner pressed upon him. Thus is the law defeated and the injured workman defrauded. The honour of the medical profession is involved in this scandal. Fortunately, there are medical unions to take up the matter, force the question forward, and insist on the impartial To secure this the experts consulted fulfilment of the law. The initial reduction was 12 per cent. ; the new reduction will be must be beyond all suspicion ; they should not have any con8 per cent. which we ask you to inscribe on the certificate which you will nexion whatsoever with insurance companies or industrial be so good as to deliver so as to enable us to come to terms. enterprises, and they should be appointed beforehand and This letter is signed by the agent of the company. It is not chosen by local magistrates after an accident has neither more nor less than an order to estimate the damage occurred. Above all, any attempt at intimidation or unfair done at 8 instead of 12 per cent. without the slightest regard pressure should be severely dealt with. to the facts of the case. In another letter, of which I have also the photographed copy, the medical man is not called upon to alter an estimate of damage done, on which there THE MEETING OF THE CANADIAN might conceivably be some difference of opinion, but he is asked to state in his certificate that the patient was PUBLIC HEALTH ASSOCIATION cured on the 24th of the month instead of the 31st. It is IN MONTREAL. urged that medical certificates given under such circumstances to oblige insurance companies are not in keeping (FROM OUR SPECIAL CORRESPONDENT.) with either science or conscience, and I am glad to believe that they are not given as frequently as they are demanded.



are a

few of the


Opening Ceremony.

Pressure to Prevent the Free Choice of Medioal Attendant. The law, however, insists that the victim shall have the free choice of a medical attendant. But the companies strive by every means to prevent workmen exercising their legal right. On one side they attack and intimidate the workmen and on the other side they use much the same means against the medical practitioners. If the latter are sufficiently independent different and insidious methods of persecution may be directed against them-at least Dr. Diverneresse states that this is the case. The fact that a practitioner acquires some popularity among the working classes and is often consulted by injured workmen will It will be be considered as a suspicious circumstance. whispered around that at heart he must be an anarchist, and the more wealthy inhabitants a dangerous person, in the neighbourhood will be advised to consult someone who enjoys a better reputation in the ranks of polite society. A good case of this sort is described as occurring to a practitioner who attended most of the workmen engaged at some large works in the department of the Ardennes. The manager openly declared that he had forbidden his workpeople to call in the services of the practitioner in question when an accident occurred because he had not fulfilled expectations in supporting the interests of the works." The interests of the works were to be suppurted in one instance by declaring that a patient had been cured


THE newly-formed Canadian Public Health Association held its first annual meeting in Montreal on Dec. 13th, 14th, and 15tb, 1911. The Governor-General of Canada, His Royal Highness the DUKE of CONNAUGHT, became a Patron, and, accompanied by the Duchess of Connaught and the Princess Patricia, performed the opening ceremony in the Convocation Hall of the Royal Victoria College. The Hon. R. L BORDEN, Premier of Canada, a Vice-Patron of the association, and the Hon. MARTIN BURRELL, Minister of Agriculture and a Vice-Presideht, took part in the

proceedings. The meeting

was presided over by Dr. T. W. STARKEY, President of the association, professor of hygiene at McGill University, to whose zeal much of the success of the arrangements was due. After a brief address of welcome to Their Royal Highnesses and an expression of the gratitude of the association to Lord Strathcoma, Dr. Starkey read the postscript of a letter from the Canadian High Commissioner, enclosing a cheque for §2500 (.6500) for the use of the association. The DUKE of CONNAUGHT, in an excellent speech, emphasised the need for the general public to take an intelligent He said: "Our idea is interest in preventive medicine. that what was good enough for the past generation is not good enough for the present, and to improve conditions we teach the growing generation."


126 Mr. BORDEN laid stress on the fact that in the past the and most of the papers read were contributed by women. It public health in Canada had not received all the can be asserted with truth that from all points of view these consideration it should have received, but he intimated papers compared favourably with those read in the other that in the future the Federal Government would pursue sections, and from a purely literary standpoint they were a different policy in this respect. generally superior. The first paper read in this section, however, was by a Mr. BURRELL, Minister of Agriculture, made the announcement of the evening, to the effect that a national department man. Dr. GEORGE ADAMI, professor of pathology, McGill of health would be created. "Speaking quite unofficially," University, treated of the value of exhibitions as agents in he said, I I I would say I believe the time has come when, the public health campaign. He made out a very good case for such means of popularising public health movements, and even if it does not demand a portfolio, it should at least have a full-fledged department in the Federal Government." incidentally said : The daily press to a greater and greater Sir LOMER GOUIN, Premier of the province of Quebec, who extent is becoming one of the most effective agents in spoke in French, also announced that the Government of making known the defects in conditions relating to the public the province contemplated taking forward steps with regard health." Miss ETHEL HURLBATT, principal of the Royal He said that the Government of Victoria College, read a paper on Work for Women as to sanitary matters. Quebec had decided to extend its hygienic work by dividing Sanitary Inspectors. She said that Canada was beginning to Quebec into ten sanitary districts, an expert reporting realise that the health and well-being of the individual involved that of the community, and that the latter was directly to the Government for each district. Brief addresses were also given by Dr. GUERIN, Mayor of coming to see its duty in enforcing proper precautions for the care of individual lives. Miss Hurlbatt advised the Montreal, and by Dr. MONTIZAMBERT, of Ottawa. Dr. MONTIZAMBERT, as the oldest sanitarian in Canada employment of women sanitary inspectors in factories where (having been appointed to an official post by Sir John I, women worked, as well as in many homes. MacDonald in 1866), in moving a vote of thanks to the Dr. A. D. BLACKADER, professor of pharmacology and Governor-General for opening the meeting and to the therapeutics at McGill University, discussed the important Duchess of Connaught and Princess Patricia for being causes of high infantile mortality in large cities, and the influence exerted by milk depôts. present, recounted the history of sanitation in Canada. Before leaving Victoria College the Duke and Duchess, with (To be concluded.) other guests, partook of supper in the dining-hall. It may be said that the whole proceedings passed off without a hitch, a fact which reflects great credit upon all those BIRMINGHAM. responsible for the arrangements. A meeting inaugurated in such auspicious circumstances OUR OWN CORRESPONDENT.) (FROM had a high ideal to reach, and so far as the serious business of the meeting was concerned its members rose to The General Hospital. the occasion. The attendance was good, about 130 members AT a meeting of the board of management on Jan. 5th a being present, while the papers contributed were numerous letter was read from Professor Robert Saundby resigning and generally of a high standard. If one desired to be his post as honorary physician to the hospital. It was unanicensorious, perhaps the criticism might be made that there mously resolved :was somewhat of a plethora of papers, more than 50 being That the board, having received with great regret the resignation of contributed. This, however, certainly speaks well for the Dr. Saundby, senior honorary physician, desire to record their high in of of those interested health matters in all parts appreciation of the very able manner in which he has discharged his energy duties as honorarv physician for the past 27 years, of the skill and the Dominion. attention he has devoted to the patients under his care, and of the Read. Papers interest he has taken in the welfare of the institution ; that his resignaIn the first general session Colonel G. CARLETON JONES, tion be accepted with great regret, that the post be declared vacant, and that steps be taken to fill the vacancy on Friday, Jan. 25th. M.D., M.R.C.S., Director-General, Medical Services, was further resolved :Department of Militia and Defence, Ottawa, read a paper ItThat it be recommended at the next meeting of the governors that, on the Military Aspects of Sanitation, in which he pointed in consideration of the eminent services rendered by Dr. Robert Saundby out that although Canada was not generally regarded as a to the hospital during the past 36 years, he be appointed honorary military nation, a form of conscription was really in force, consulting physician to the hospital. and that therefore military sanitation was of more than A committee was appointed to consider what steps should academic interest. he taken to commemorate Professor Saundby’s services. Dr. J. D. PAGE, of Quebec, dealt with medical inspection Professor Saundby, who is the President of the British and the care of immigrants on shipboard. He said that the Medical Association, came to Birmingham in April, 1876, examination of immigrants on’ shipboard was largely per- when he was resident registrar and pathoappointed functory, and consequently more or less useless to the logist to the General Hospital. In November, 1877, Canadian medical inspectors of immigrants. He pointed out he was made assistant and in January, 1885, physician, that the law directed that ships’ surgeons should examine was elected honorary physician. He has thus been conimmigrants carefully, but said they did not live up to this nected with the hospital for 36 years, and for several obligation. He urged that no one had better opportunities years has been senior physician. He is also professor for judging of the physical and mental fitness of an immi- of medicine in the Birmingham University, consulting grant than the ship’s surgeon. The chief reason for this physician to the Eye Hospital, and the representative of the slackness on the part of ship’s surgeons, according to Dr. University on the General Medical Council. Page, was that these were usually young men who came for a New Year Honour. change and a cheap sea trip, and had had no training whatThe conferment of knighthood upon Professor Bertram ever in regard to the work they were supposed to perform on board ship. Of course, the fault for this state of affairs C. A. Windle has caused much satisfaction to his numerous really lay with the shipowners, who would not give sufficient friends in Birmingham, where for many years he was proremuneration to attract able medical men. Dr. Page thought fessor of anatomy and Dean of the medical school. Like that if an initial salary of$1000 (£200) a year were offered Professor Saundby, he came to Birmingham as pathologist to the General Hospital, a post which has been successively an efficient class of medical men might be secured for immigrant ships. The speaker had spoken to shipowners on the occupied by many distinguished medical men in Birmingham subject, who had replied that so long as they could procure and elsewhere. Anteriur Poliomyelitis. more men by far than they required at the present beggarly rate of wages, they saw no cause to offer superior induceThe medical officer of health, J. Robertson, has ascerments. Thus there would seem to be little hope of bettering tained that during 1911 there were 150 to 200 cases of the situation in this quarter, and some other means must be anterior poliomyelitis in the city with a few deaths. In resorted to to remedy existing conditions in this respect. several families more than one case occurred. In October last Dr. P. H. BRYCE read an exceedingly able paper on the the health committee passed a resolution ordering that the Conservation of Food by Cold, a vital subject in these days Infectious Diseases Notification Act should apply within the on this side of the Atlantic. city for a period of two years to this disease. The resolution One of the most interesting sections of the meeting was was submitted to the Local Government Board for approval that of the social workers. This might be termed the ladies’ and came into operation, on Jan. lst. Jan 9th. meeting, as the convener was Dr. GRACE RITCHIE ENGLAND,

matter of