LIFE ASSURANCE; FEES TO MEDICAL MEN
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110 3. It is a frequent cause of disordered health during preg- nancy, or of "laborious pregnancy." It is also one of the most frequent causes of abortion, both in the early and in the later months of pregnancy. It may occasion abortion, either directly, by reflex action, or indirectly, by giving rise to disease of the ovum or placenta, or to uterine haemorrhage. 4. The instrumental examination of females labouring under inflammatory ulceration of the cervix during pregnancy is unattended with any risk, either to the mother or to the foetus; and it is absolutely necessary, in order not only fully to recognise the disease, but also to treat it. 5. The treatment of these forms of uterine inflammation must be governed by nearly the same rules in the pregnant state as in the non-pregnant state. A properly conducted treatment is nearly always successful in preserving the life of the child and the integrity of the pregnancy, as well as in curing the inflammatory and ulcerative disease. It is also the only means we possess of warding off the imminent danger of abortion to which the patient is exposed. 6. This form of uterine inflammation being, generally speaking, the cause of those repeated and successive mis- carriages which prevent females giving birth to a living child, it is only by curing it that we can hope to make them bear the product of conception to its full period. 7. The serious inflammatory and hæmorrhagic symptoms which sometimes follow abortions are generally occasioned by unrecognised inflammatory ulceration of the uterine neck. On investigation, it often becomes evident that this disease existed previous to the abortion, and occasioned it. The same remark may apply to some cases in which the above-mentioned symptoms precede and follow labour at the full time, as ulcera- tive inflammation of the cervix in the pregnant state is by no means necessarily followed by abortion. 8. Although inflammatory ulceration of the cervix seems generally to be a cause of sterility, yet, as will appear from the above essay, there are frequent exceptions to the rule. In some females, the tendency to become impregnated is so great that no amount of uterine disease appears to prevent concep- tion taklna’ place.—I remain. Sir- vour obedient servant. HENRY BENNET, M.D. Cambridge-sq., Hyde-park, July, 1847. LIFE ASSURANCE; FEES TO MEDICAL MEN. To the Editor of THE LANCET. SIR,—Your correspondent, J. R., I suspect, is attached to some life assurance office as medical officer, and being well paid himself cares not about his professional brethren, but would rather they should do his work while he receives the reward. Your question, if some are paid, why not all, is a very pertinent one. The offices are still disposed to quibble on the point of their application being a mere reference, which argument has been disposed of over and over again. They apply for professional information, and for a professional opinion. The person who proposes to insure his life tells them, upon their requisition, the name of his medical attend- ant, who, they think, is the best qualified to give them such information, accompanied also by his opinion, as will enable them to decide on accepting or rejecting the assurance. They take the matter entirely out of the proposer’s hands, and apply secretly and confidentially to the medical man for his aid, in his professional capacity, to protect themselves, as against the party proposing to insure his life. If they require e services of this character, surely they should be well paid for. I think the life assurance companies should be content with the opinion of (what they call) their own medical officer, as their applying to the medical man of the party proposing an assurance, and the manner of their application, may be looked upon as a breach of trust, but for permission having been given by the latter, which they perversely call a refer- ence. I am surprised that the medical profession have so long tolerated the impositions of the assurance companies, in allowing them to suck their brains, and fatten on their unpaid labours; and I am sure they need only be unanimous and firm to put a stop to the system. The fruits of the proper resistance of the profession are daily becoming apparent, as an extract from the prospectus of another recently established company, " The Professional Life Assurance," will show. " The directors of this corporation feel that the members of the medical profession have had cause for complaint in being expected to answer a series of questions propounded to them by assurance companies, relative to the health of parties desirous of assuring, without a fee from the office requiring their opinion, (the office referring them to the parties assuring for remuneration-a claim which, in nine cases out of ten, is ot admitted;) they have therefore determined to act on a more liberal principle, and to pay to every medical man to whom they apply for such information, the usual fee of one guinea." Th3 profession will be much indebted to you, Sir, for keeping the subject alive in the columns of THE LANCET; and I hope, notwithstanding J. R.’s request, that you will not let it drop till medical men obtain full justice from these rich and overbearing companies. I remain, Sir, your obedient servant, July, 1847. _____ H. S. To the Editor of Tar LANCET. SIR,—Your determination to continue to discuss the ques. tion of fees to medical practitioners from Insurance Offices will, I am sure, meet with the support of almost every member of our ill-used profession, whose zealous and untiring advocate you have so long proved yourself. The fact assumed by ‘= J. R.," that the ten-years’ debate of this subject has been attended with " not the slightest benefit," if correct, (which I by no means admit,) would afford the strongest argument for its continued agitation. I am, how. ever, by no means sure that your labour has been so entirely in vain. That point could be soon decided by ascertaining how large a proportion of the London offices recognised our claims in 1837, and how many at the present time. Hitherto our efforts have been almost entirely limited to the exposure of such offices as refused to admit our claim. I would now suggest that we use all our influence, in private as well as in public, in support of those offices which recognise the justness of our demand. In accordance with these views I beg to inform you, that an application which I lately received from the " India and London Life Assurance Office " concluded as follows: Any communication you may favour me with will be considered strictly confidential, and the usual fee of one guinea remitted to you." Upon the receipt of my report, although unfavoiir- able to my patient, a post-office order for that amount was immediately remitted.—I am, Sir, your obedient servant, July, 1847. A COUNTRY PRACTITIONER. M. COSTE’S OPINIONS ON THE NATURE OF THE MEMBRANA DECIDUA, IN 1847, AND IN 1837. To the Editor of THE LANCET. IN THE LANCET of July 3rd, 1847, it is stated, that on the 24th of May, a note was read by M. Coste to the Institute, " On the Nature of the Decidua formed around the Ovum in the Human Subject." In this note, it is stated by M. Coste, that he " has opened a great number of the bodies of women who have com= mitted suicide," and that " he believes he has now collected such decisive observations on gestation in the human species, as to remove all doubts from any subject connected with it." The results of these researches are- 1. "That there is never produced normally in the womb of the human female, neither before nor during gestation, any false membrane or hydroperionic fluid, and consequently the deciduous membranes, as represented, are purely ideal." This very decided result is little calculated to inspire unbounded confidence in the accuracy of M. Coste’s observations, for there is not one member of the profession who does not know, and has not seen, membranes expelled from the unimpregnated uterus, which it would have been difficult or impossible to dis- tinguish from deciduous membranes, the products of concep- tion, and respecting the nature of which he would not, in a court of law, have shrunk from giving a positive opinion. That membranes having the appearance, and some of the anato- mical characters, of true deciduous membranes, are sometimes discharged from the uterus where conception was impossible, does not admit of doubt or dispute, though M. Coste affirms that they are " purely ideal." 2. The second conclusion drawn by M. Coste, from "’several years’ experience," and from having " opened a great number of the bodies of women who have committed suicide," is," that the ovum, on reaching the cavity of the uterus, after concep- tion, " is brought into immediate contact with the hypertro- phied mucous membrane, depressing it at the point where the placenta is hereafter to be developed; and the mucous mem- brane itself, influenced by the action the ovum sets up in it, swells and rises as a prominent ring around it, or as a circular fold, which at length covers over and encloses it, constituting what has been named the decidua reflexa. As this coat, ac cording to my observations, is a prolongation of the uterine mucous membrane, it has, at the first, the same structure as it. It is glandular and vascular in all its extent, like the mucous
Transcript of LIFE ASSURANCE; FEES TO MEDICAL MEN
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3. It is a frequent cause of disordered health during preg-nancy, or of "laborious pregnancy." It is also one of themost frequent causes of abortion, both in the early and in thelater months of pregnancy. It may occasion abortion, eitherdirectly, by reflex action, or indirectly, by giving rise todisease of the ovum or placenta, or to uterine haemorrhage.
4. The instrumental examination of females labouring underinflammatory ulceration of the cervix during pregnancy isunattended with any risk, either to the mother or to thefoetus; and it is absolutely necessary, in order not only fullyto recognise the disease, but also to treat it.
5. The treatment of these forms of uterine inflammationmust be governed by nearly the same rules in the pregnantstate as in the non-pregnant state. A properly conductedtreatment is nearly always successful in preserving the life ofthe child and the integrity of the pregnancy, as well as incuring the inflammatory and ulcerative disease. It is also theonly means we possess of warding off the imminent danger ofabortion to which the patient is exposed.
6. This form of uterine inflammation being, generallyspeaking, the cause of those repeated and successive mis-
carriages which prevent females giving birth to a living child,it is only by curing it that we can hope to make them bearthe product of conception to its full period.
7. The serious inflammatory and hæmorrhagic symptomswhich sometimes follow abortions are generally occasioned byunrecognised inflammatory ulceration of the uterine neck.On investigation, it often becomes evident that this diseaseexisted previous to the abortion, and occasioned it. The sameremark may apply to some cases in which the above-mentionedsymptoms precede and follow labour at the full time, as ulcera-tive inflammation of the cervix in the pregnant state is byno means necessarily followed by abortion.
8. Although inflammatory ulceration of the cervix seemsgenerally to be a cause of sterility, yet, as will appear fromthe above essay, there are frequent exceptions to the rule. Insome females, the tendency to become impregnated is so greatthat no amount of uterine disease appears to prevent concep-tion taklna’ place.—I remain. Sir- vour obedient servant.
HENRY BENNET, M.D.Cambridge-sq., Hyde-park, July, 1847.
LIFE ASSURANCE; FEES TO MEDICAL MEN.To the Editor of THE LANCET.
SIR,—Your correspondent, J. R., I suspect, is attached tosome life assurance office as medical officer, and being wellpaid himself cares not about his professional brethren, butwould rather they should do his work while he receives thereward. Your question, if some are paid, why not all, is avery pertinent one. The offices are still disposed to quibbleon the point of their application being a mere reference,which argument has been disposed of over and over again.They apply for professional information, and for a professionalopinion. The person who proposes to insure his life tells
them, upon their requisition, the name of his medical attend-ant, who, they think, is the best qualified to give them suchinformation, accompanied also by his opinion, as will enablethem to decide on accepting or rejecting the assurance.
They take the matter entirely out of the proposer’s hands,and apply secretly and confidentially to the medical man forhis aid, in his professional capacity, to protect themselves, asagainst the party proposing to insure his life. If they require eservices of this character, surely they should be well paid for.I think the life assurance companies should be content withthe opinion of (what they call) their own medical officer, astheir applying to the medical man of the party proposing anassurance, and the manner of their application, may belooked upon as a breach of trust, but for permission havingbeen given by the latter, which they perversely call a refer-ence. I am surprised that the medical profession have solong tolerated the impositions of the assurance companies, inallowing them to suck their brains, and fatten on their unpaidlabours; and I am sure they need only be unanimous andfirm to put a stop to the system. The fruits of the properresistance of the profession are daily becoming apparent, asan extract from the prospectus of another recently establishedcompany, " The Professional Life Assurance," will show." The directors of this corporation feel that the members ofthe medical profession have had cause for complaint in beingexpected to answer a series of questions propounded to themby assurance companies, relative to the health of partiesdesirous of assuring, without a fee from the office requiringtheir opinion, (the office referring them to the partiesassuring for remuneration-a claim which, in nine cases outof ten, is ot admitted;) they have therefore determined to
act on a more liberal principle, and to pay to every medicalman to whom they apply for such information, the usual feeof one guinea."Th3 profession will be much indebted to you, Sir, for
keeping the subject alive in the columns of THE LANCET; andI hope, notwithstanding J. R.’s request, that you will not letit drop till medical men obtain full justice from these richand overbearing companies.
I remain, Sir, your obedient servant,July, 1847. _____
H. S.
To the Editor of Tar LANCET.SIR,—Your determination to continue to discuss the ques.
tion of fees to medical practitioners from Insurance Officeswill, I am sure, meet with the support of almost everymember of our ill-used profession, whose zealous and untiringadvocate you have so long proved yourself.The fact assumed by ‘= J. R.," that the ten-years’ debate of
this subject has been attended with " not the slightest benefit,"if correct, (which I by no means admit,) would afford thestrongest argument for its continued agitation. I am, how.
ever, by no means sure that your labour has been so entirelyin vain. That point could be soon decided by ascertaininghow large a proportion of the London offices recognised ourclaims in 1837, and how many at the present time.Hitherto our efforts have been almost entirely limited to
the exposure of such offices as refused to admit our claim.I would now suggest that we use all our influence, in privateas well as in public, in support of those offices which recognisethe justness of our demand.In accordance with these views I beg to inform you, that
an application which I lately received from the " India andLondon Life Assurance Office " concluded as follows: Anycommunication you may favour me with will be consideredstrictly confidential, and the usual fee of one guinea remittedto you." Upon the receipt of my report, although unfavoiir-able to my patient, a post-office order for that amount wasimmediately remitted.—I am, Sir, your obedient servant,
July, 1847. A COUNTRY PRACTITIONER.
M. COSTE’S OPINIONS ON THE NATURE OF THEMEMBRANA DECIDUA, IN 1847, AND IN 1837.
To the Editor of THE LANCET.IN THE LANCET of July 3rd, 1847, it is stated, that on the 24thof May, a note was read by M. Coste to the Institute, " On theNature of the Decidua formed around the Ovum in the HumanSubject." In this note, it is stated by M. Coste, that he " hasopened a great number of the bodies of women who have com=mitted suicide," and that " he believes he has now collectedsuch decisive observations on gestation in the human species,as to remove all doubts from any subject connected with it."The results of these researches are-
1. "That there is never produced normally in the womb ofthe human female, neither before nor during gestation, anyfalse membrane or hydroperionic fluid, and consequently thedeciduous membranes, as represented, are purely ideal." Thisvery decided result is little calculated to inspire unboundedconfidence in the accuracy of M. Coste’s observations, for thereis not one member of the profession who does not know, andhas not seen, membranes expelled from the unimpregnateduterus, which it would have been difficult or impossible to dis-tinguish from deciduous membranes, the products of concep-tion, and respecting the nature of which he would not, in acourt of law, have shrunk from giving a positive opinion. Thatmembranes having the appearance, and some of the anato-mical characters, of true deciduous membranes, are sometimesdischarged from the uterus where conception was impossible,does not admit of doubt or dispute, though M. Coste affirmsthat they are " purely ideal."
2. The second conclusion drawn by M. Coste, from "’severalyears’ experience," and from having " opened a great numberof the bodies of women who have committed suicide," is," thatthe ovum, on reaching the cavity of the uterus, after concep-tion, " is brought into immediate contact with the hypertro-phied mucous membrane, depressing it at the point where theplacenta is hereafter to be developed; and the mucous mem-brane itself, influenced by the action the ovum sets up in it,swells and rises as a prominent ring around it, or as a circularfold, which at length covers over and encloses it, constitutingwhat has been named the decidua reflexa. As this coat, according to my observations, is a prolongation of the uterinemucous membrane, it has, at the first, the same structure as it.It is glandular and vascular in all its extent, like the mucous
