1457THE ROYAL MILITARY TOURNAMENT.

required but also in the examination. The latter schemeseems to us to be retrograde, for day by day it becomes 1

clearer that a thorough knowledge of the surgical branchcannot be acquired without a comprehension of the prin-ciples and practice of medicine as a whole. If the prac-tice of surgery were confined to operations then perhaps the

position assumed by the constructors of the minority schemefor the granting of dental degrees in the University of

London might be intelligible, but surgery is not a highergrade of cabinet-making. Surgery entails for its scientific

practice a thorough knowledge of the principles underlyingmedicine as a whole. Dental surgery may be regarded from

exactly the same standpoint. In some quarters it has been,and still is, the tendency to estimate the practice of

dentistry as something requiring simply manipulativedexterity, but this view has arisen partly from a want of

knowledge of the processes underlying dental disease

and not a little from that narrowed vision which the

training of the dental surgeon produces and which canonly be made broader by raising the standard of generaland scientific education. With the increased number

of medical men specially qualified as dental surgeonsa marked advance in dental pathology has taken

place and the inter-dependence of dental lesions, more

especially of the gums and periodontal membrane, and

general systemic conditions has been shown. The dental

surgeon in his practice is constantly dealing with cases

which require for their rational treatment a knowledge ofmedicine, a fact which the authors of the minority reportdo not appreciate, in our opinion, in its right significance.They would not, we are sure, consider that such well-definedbranches of medical practice as, say, ophthalmic surgeryor gynascology, should be practised by men with only a scantknowledge of general medicine and surgery. To our think-

ing, dental surgery should rank with the other specialbranches ; at any rate, all who practise dental surgeryshould be found wishing this, for only in this way can thescientific status of dentistry be maintained.

Annotations.

THE ROYAL MILITARY TOURNAMENT.

.. Ne quid nimis." "

FROM a practical point of view one of the most interestingitems in the programme of the Royal Military Tournamentnow being held at the Agricultural Hall, Islington, is the

display by the recruits from the Marine depot at Deal whohave been in the service for six months only and whoseaverage age is 18 years. These lads have had but 45 days’gymnastic training, yet their muscular development, agility,and smartness in response to the word of commandare wonderful considering the brief period of in-

struction. The exercises which they go through bringinto play all the important muscles of the body andeducate at the same time the intellectual faculties.In previous years at the Tournament similar exercises havebeen practised by non-commissioned officers under trainingat the headquarters gymnasium, Aldershot, who if we mis-take not underwent a six months’ course and not a 45

days’ course. Undoubtedly the non-commissioned officersfrom Aldershot showed remarkable muscular power com-

bined with intellectual activity both while acting individually

and collectively. So do the Marine recruits, but it is dis-

tinctly noticeable that some of them are working at thehighest possible strain. It speaks well both for officersand for men that such remarkable results should havebeen accomplished in so short a period as 45 days,but there must be always some risk in a too strenuousand hasty endeavour to bnild up muscle. It remains to

be seen what the effect will be when, after completingtheir course, the men relax their training, for it must

be remembered that over-taxation of the vascular systemmay produce untoward results at a subsequent time. A

curtailment of the period of training may, therefore,in the end be a means of loss instead of gain to the

service. Another noteworthy example of strength and

ability is the display by the Royal Marine Artillery.The general idea of this display is to show how a gun withits mountings landed from a man-of-war can be transportedand mounted in an extemporised manner on shore. The gun,

mounting, and stores, together with the wagon on which theyare placed, weigh six tons and are drawn into the arena by38 men. The slinging and unslinging of the gun on the ex-temporised gin require some skill and precision in placingthe gun centrally. When the men begin this kind of train-ing the weights with which they have to deal tax their

strength to the utmost. At the Tournament, however, thegun is manipulated with as much ease as if it were a toy.Altogether this is a truly remarkable performance. In this

connexion it would not be fair to leave unnoticed the displayby seamen of His Majesty’s ship Excellent with 12-pounderguns. The way in which these guns are manoeuvred,mounted and dismounted, and lifted with ease over an

obstacle representing a wall must be seen to be appreciated.These three items in the programme alone form an object-lesson which it would be well for everyone to see.

INSURANCE AGAINST APPENDICITIS.

THE sudden increase in the popular knowledge of

appendicitis has given rise to the idea that the maladyoccurs more frequently than is really the case, with theresult that it is dreaded more than it need be. So ithas even happened that it has been thought advisable toinsure against the loss of time and of money entailed byan attack. The Royal Exchange Assurance Company is

willing to issue policies of insurance at the rate of 5s. perannum for every .6100 and a policy may be effected up to;&500. By such a policy the holder is guaranteed all the

medical, surgical, and nursing expenses, up to the amountinsured, incurred by an attack of appendicitis. The com-

pany points out that this premium may be largely increasedin the near future, for it is obvious that at present the"risk" " of such a policy can be only very indefinitelyestimated. The only data supplied by the leaflet which wehave seen are that during 1900 15,000 operations for appendi-citis were performed in the United Kingdom and that themortality of these operations was 10 per cent. We are not

aware whence these statistics have been obtained and, in

fact, we cannot see how it is possible to discover the numberof operations because the vast majority are never recorded.Be this, however, as it may, it must be borne in mind

that many cases diagnosed as appendicitis recover without

operation and therefore the total number of cases should bemuch greater. In the proposal for insurance there is oneimportant question to be answered. It is this : Have youor has any member of your family ever suffered from appendi-citis or from any of the symptoms pertaining to it ? This is a

very wide question, for apparently a negative answer wouldmean that neither the would-be insurer nor any memberof his family had ever had a pain in the right iliac fossa.Another difficulty is that it is not clear what the word

"family" includes. It is possible that this question is

1458 THE GENERAL COUNCIL OF MEDICAL EDUCATION AND REGISTRATION.

inscribed only to obtain statistical information as to the

family liability to appendicitis, for at present it cannot be

laid down that the disease is specially prone to attack

certain families. In the " declaration " also the insurer has

to state that he has no reason to believe that he is speci-ally liable to the disease. There is one important conditionattached to these policies : the liability of the company doesnot commence until one month after the proposal has beenaccepted and the premium has been paid, so that it will notbe possible for anyone who experiences symptoms which hethinks may be due to appendicitis to rush off and to insure.The utility of the scheme depends entirely on the liabilitythere is to an attack of appendicitis. Should the diseasearise the loss of money incurred by medical, surgical, andnursing expenses would certainly be very troublesome to

many and anyone attacked would be very glad to haveinsured against this sudden expense by the payment of sucha small premium and if anyone feels inclined to insure therecannot be any harm in doing so. From the amount of the

premium we see that the company estimates the probabilitythat any individual will be attacked by appendicitis in anyone year as at most less than 1 in 400 and we should feelinclined to think that the risk is very much less than this,but no statistics exist to show the percentage of attacks inthe general population though they may be obtainable forsuch bodies of men as the army and the navy. As manycases, in this country at least, are not submitted to operationdisputes might easily arise as to the accuracy of the dia-

gnosis. Moreover, it has not rarely happened that appendi-citis has been diagnosed, the abdomen has been opened, andsome other lesion has been found. If the patient had beeninsured we can imagine his disappointment when he foundthat the fees and other expenses were payable out of hisown pocket. We would not in the least dissuade anyone

against insuring, but we must confess that in our opiniona wider policy to ’include any similar severe illness would

prove much more useful in practice. At present it is possibleto insure against sickness and accident, but the sum paid isso much per week and does not necessarily cover the expenses Iincurred.

____

NOTIFICATION FEES.

NOTWITHSTANDING the fact that the Notification Act hasnow been in operation for many years the subject of thefees payable under its provisions seems to be a never-

ceasing topic for discussion and dispute. This is, we

I!expect, partly due to the fact that a copy of the Act

itself is possessed by few medical men and partly to

the absurd fee of Is. which is paid to those who Inotify cases of notifiable diseases in their capacity as Iofficers of public institutions or bodies. We can quite (understand that district medical officers under the Poor-law and others who are not quite familiar with

the statutes are unwilling to believe that the legisla-ture has provided no further fee than Is. for the troubleof notifying the cases of infectious disease with which suchofficers are brought into contact during the performanceof their official duties. We have recently had a case broughtto our notice of a district medical officer who is content withthe customary Is. for cases concerning which he has receiveda relieving officer’s order but who claims 2s. 6d. in respect ofsubsequent cases occurring in the same house but as to

which no order has been given. We are afraid, however,that, assuming that the cases were treated by the districtmedical officer in his official capacity, the smaller feeis the only one that can be legally paid. The wordsof the Infectious Disease (Notification) Act, 1889, whichgovern the situation, are: ’’ and of one shilling if the caseoccurs in his practice as medical officer of any public bodyor institution." Unless, therefore, the cases to which refer-ence has been made were attended by the district medical

officer in his capacity of a private practitioner he is not

entitled to the larger fee of 2s. 6d. It would seem improb-able, seeing that an order had been procured for one member

; of the family, that any other member thereof could be- regarded as employing a medical man as a private practi-i tioner, and it would seem more probable that there has been; some omission on the part of the relieving officer or the

L district medical officer, in the one case in supplying an order, or in the other of notifying the fact of attendance without an

! order. So far as we are in possession of the facts we do notthink that the case to which we refer is one in which a fee

of 2s. 6d. could be reasonably claimed.

THE GENERAL COUNCIL OF MEDICAL EDUCA-TION AND REGISTRATION.

I THE Council opened its summer session on Thursday,May 21st, at 2 P.M , Sir William Turner, E.C.B., the

President, being in the chair. The session this year is

being held somewhat earlier than usual in order that

Whitsun-week may be avoided. After hearing the President’saddress the Council proceeded to the consideration of variousmatters of medical education. Our usual report of the pro-ceedings will be commenced in our next issue.

THE PHARMACEUTICAL SOCIETY.

THE annual dinner of the members of the Pharmaceutical

Society of Great Britain and their friends was held under thechairmanship of the President, Mr. G. T. W. Newsholme, inthe Whitehall Rooms of the Hôtel Metropole, London, onMay 19th. After the usual loyal toasts had been dulyhonoured Mr. Newsholme from the chair proposed the toast of"The Houses of Parliament," which was replied to by Mr.J. F. Remnant, M P., who, referring to the new Pharmacy Bill,said that he had heard some criticism in the House in regardto that clause which says that a director of a company mustbe a qualified druggist before he can deal with the ordinarybusiness of a druggist. Concerning that matter there wasan opinion given in the House of Lords that the Act couldnot apply to directors of limited liability companies. This

toast was also acknowledged by Mr. E. Marshall Hall,M.P., who declared that the new Pharmacy Bill couldnot pass into law in anything like its present form

and he advised the society to accept half a loaf as

better than nothing at all. He suggested that the

Pharmaceutical Society should obtain powers over its

members in the same manner as the General Medical Councilhas over medical men. If it could bring the power, in.

fluence, and prestige of the society thus to bear on its

members then it would have a remedy against the evilswhich it was anxious to eradicate. Mr. Marshall Hall bluntlytold his audience that a large portion of the business of adruggist as now carried on could be intrusted to unqualifiedassistants and even to shop lads. So long as the public madeno discrimination between a qualified druggist and a salesmanof sundries so long would it be difficult for Parliament to dealwith the evil. But the Pharmaceutical Society armed withthe powers which he had suggested could undertake thematter. In regard to the companies trading as druggists thedepartment particularly concerned with the business of thedruggist should be managed by a properly qualified druggist.The toast of ’’ The Medical Profession " was proposed by thechairman and responded to by Sir William S. Church whodrew attention to the embarrassing multiplicity of the

compounds turned out for the use of medical men by thesynthetical chemist. If physicians needed to be carefulin the use of drugs the public ought to be carefulin the use of the so-called chemical foods, though ifone half of the advertisements about these foods could bebelieved not only would they ward off disease but they