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to spare time even to apply field dressings to theirwounded comrades. In considering these factors MajorMurray 3 concludes that stretcher-bearers must bedisposed so as to provide immediate and essential first-aid, and he has devised a battle-drill for them whichreduces searching to a fine art. The squads are trainedto make systematic hunts in fields, scrub, woods andhouses. During the search each bearer works singly,and when he finds a casualty his duty is merely to stophaemorrhage and mark the man’s position so that thiscan readily be found again. The squad then re-forms,and, where necessary, removes the wounded in turn tothe most accessible place at which they can be trans-ferred to motor transport. As became customary inCivil Defence work during air-raids, first aid on the spotis reduced to a minimum, being mostly left until thepatient is in a vehicle. When accompanying troops inaction, the bearers must practise fieldcraft and personalcamouflage ; for they must never be responsible forgiving the unit’s position away to the enemy. And skillis also called for in " medical fielderaft "-the approachto, and removal of, the wounded man under fire bothby day and by night. In urging the importance of thisside of medical work in the field, Murray demonstratesthat it often needs a trained mind in a trained body ;but undoubtedly motor transport has lightened the

physical burden on the stretcher-bearer, and very oftenit can take his place.

ETHICS FOR THE YOUNG PRACTITIONER

IN an address to Guy’s students, Sir Herbert Eason 4has summarised the standards of professional ethics withthe authority of the president of the tribunal responsiblefor their enforcement. Mention of the Warning Noticeissued by the GMC naturally led him to an early referenceto the risks of lax certification. He had been appalled, 0-he said, in his hospital experience, to see house-officerssigning certificates in blank for sisters or nurses or

dressers to fill up afterwards-statements that the patientwas suffering from some disability or disease and wasunfit to follow his or her employment. He advisedstudents never to sign a blank certificate or any docu-ment for the entire accuracy of which they were unableto vouch. "It is no good saying’ I have today examinedSo-and-so’ when in fact you examined him yesterday."Next he expounded the warning against assistingunqualified practitioners. This was " infamous con-

duct " because it traversed the whole aim of the MedicalActs by obscuring the statutory distinction between thequalified and the unqualified. Administering an anaes-thetic to help an osteopath’s treatment of patients wascovering an unqualified practitioner. But this did notmean that the qualified man cannot ask a masseuse tomassage a patient. " You can even ask an osteopathor a chiropractor to assist you in treating a patient solong as the patient is under your own care." Of fourother classes of conduct often brought to the notice of theGMC the commonest was that of the practitioner founddrunk. The council, explained Sir Herbert, seldom takesa man off the Register for a single conviction of drunken-ness ; it will give him a warning. A second convictionfor drunkenness probably means a stiffer warning. Athird is likely to involve action. If a doctor habituallygets drunk, can he be fit to be in charge of patients ‘1 It is,of course, a grave matter to remove a man from the

Register for three cases of drunkenness. The councilmay perhaps suspend judgment and put the respondenton probation for a year or so, requiring certificates as tohis behaviour in the interval and insisting on an under-taking for good behaviour in future. Drunkenness in

charge of a motor-car is more seriously regarded. Itshows not only over-indulgence in alcohol but also areprehensible absence of responsibility. A man who,

3. Murray, R. O., J.R. Army med. Cps, June, 1943, p. 291.4. Guy’s Hosp. Gaz. July 10, 1943, p. 147.

when under the influence of alcohol, thinks himself fitto drive a dangerous machine like a car is a menace bothto his patients and to the public. The other threeclasses of professional misconduct were described as thethree As-advertising, abortion and adultery. Thefirst includes those flattering little paragraphs about thedistinguished surgeon or. eminent physician and hiswell-known patients-laudation which a few practi-tioners signally fail to avoid, to the detriment of theirmore honourable and reticent brethren. The second,abortion, is, as the law stands, a felony punishable withpenal servitude. Whatever views practitioners may holdabout birth control, whatever appeals may be made tothem to save an innocent’s girl’s reputation and herfamily’s credit and social standing, they must realise thatthe GMC cannot ignore what the state regards as a

serious crime. Lastly, a charge of adultery means thatthe council, without pretending to be a court of morals,must protect the public. Adultery per se is not infamousconduct in a professional respect, but, if committed witha patient or a member of a patient’s household, it is abreach of trust and an abuse of confidence. To hisadmirable exposition of the professional code, and hisvirile statement of the things which are " not done,"Sir Herbert Eason added two precepts of worldly wisdom.The practitioner who is charged in the police-court withdrunkenness or other offences should never allow himselfto be persuaded to plead guilty by the argument that hewill thus escape publicity. Secondly, as soon as he isqualified, he should join one of the well-establishedmedical defence societies. This will protect him fromthe formidable risks of practice, whether they arisefrom the accusations of female patients or from any othersource. It will ensure for him legal advice and assistancefrom the day of his registration to the day of his retire-

ment, amid unforeseen dangers which even the greatestcare can hardly avoid.

CONTINUOUS SPINAL ANÆSTHESIATHE continuous technique frees spinal anesthesia from

the disadvantages of single-dose administration ; and

though the minimum dose which must be given forabdominal anaesthesia will allow sufficient operating timefor most cases there are occasions when a chance to

lengthen anaesthesia is welcome. The method willtherefore apply chiefly to operations lasting longer than1-2 hours. In the last few years, though simpler andsafer methods have been developing, spinal anaesthesiahas once again suffered from the enthusiasm of its newrecruits, and those contemplating using the continuousmethod should take to heart Nosworthy’s advice, quotedby Lee (p. 156), to learn the old technique first and thenthe new one developed from it. Lemmon and Pascha1,1who first described the method, found it difficult tomaintain a good puncture with the patient lying, on hisback. The divided mattress and the malleable needleovercame this trouble. The malleable needle may in thelong run prove the best safeguard against breakage of thespinal needle, an accident sufficiently serious to make theuse of a hard steel needle a real danger. Reports so farindicate that spinal anaesthesia maintained over severalhours does not produce any detectable damage to thecentral nervous system ; but the use of 5% procaine inglucose may be compared (not without apprehension)with the 0-5-1% used for nerve blocking elsewhere.Fraser 2 obtained satisfactory results with 1 % procaine,and it should be borne in mind that lesions of the caudaequina have followed the use of strong procaine solutions.$Except perhaps in the hands of experts, the use of thistechnique for operations like appendicectomy, hernio-tomy and colostomy, seems unjustified, for the chance ofanaesthesia wearing off before the operation is finished1. Lemmon, W. T. and Paschal, G. W, jun. Ann. Surg. 1940, 111, 141.2. Fraser, R. J. Anœsth. & Analges. 1943, 22, 38.3. Ferguson, F. R. and Watkins, K. H. Brit. J. Surg. 1937-38,

25, 735.