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Were he to retire before this without due cause, he would be guilty of a breach of contract, and even though the woman received no material damage, yet he is blameworthy; while on the other hand, if she received harm as the result of his want of attention, he might be charged with negligence.
In conducting cases of parturition, the practitioner must not only exhibit reasonable skill during the birth, but must also give proper attention to the woman afterwards. A doctor would be culpably incompetent and negligent if he could not recognise a hydrocephalic head or a cross-presentation, with the result that labour was prolonged until the uterus ruptured, or leaving a perineum torn back into the rectum unsutured, so that the patient had permanent incontinence of fæces.
Administration of Anæsthetics.—The coroner in England and Wales and Ireland has to inquire into every case of death which takes place while under the influence of an anæsthetic. The anästhetist has to appear before him, and must answer a long list of questions relative to the administration of the anästhetic.
Before, therefore, administering an anæsthetic (as you can never tell what the result may be, and so as to furnish yourself with a proper defence in the case of death ensuing) it is advisable, nay, only right and proper in the interests of the patient, to determine whether the heart, lungs and kidneys are in a healthy state. Should a fatal result follow, the anæsthetist will require to prove that it was necessary to give an anæsthetic, that the one employed was the most suitable, that the patient was in a fit state of health to have it administered, that it was given skilfully and in moderate amount, that he had the usual remedies at hand in case of failure of the heart and lungs, and that he employed every means in his power to resuscitate the patient.
Duties of the Medical or Surgical Referee.--You, as a medical practitioner, may be asked to see, either on behalf of an insurance company or as referee under the Workmen's Compensation Act, persons who have suffered injury. In such cases you ought always to see that the ordinary medical attendant has received notice of your intended visit in order that he may be present if he desires to do so. You ought not to ask him, however, any questions either in relation to his diagnosis or treatment. Your examination is merely to estimate the degree of the person's disablement and its probable duration. Only in so far as the accident has a relation to his present condition do you need to inquire into it. Satisfy yourself thoroughly, but make no statement as to what you think of his condition either to the patient himself or to his medical attendant. Take notes of the case as you make your examination, and that same evening draw up your report and send it to your employer. Be careful to keep a copy, as you may be summoned to attend court on a certain day to give evidence in support of your opinion.
Factory or Certifying Surgeons.--These surgeons are appointed by the inspector under the Factory Acts. The duties are laid down, but the principal ones are to examine young persons and children and to furnish an annual report.
The fees payable (failing any definite agreement) are 25. 6d. for each visit to the factory or workshop and 6d. for each person after the first five have been examined at that visit.
If the factory or workshop is over one mile from the surgery, then 6d. is paid for each complete half mile over and above the mile.
When the examination is conducted at the doctor's own surgery or any other place than the factory or workshop, 6d. is paid for each person so examined.
If an accident occurs in any factory or workshop, the surgeon must go at once and make an inquiry and send a report to the inspector within twenty-four hours.
EXAMINATION FOR LIFE INSURANCE
A very frequent duty which the private practitioner has to perform is to examine an individual who proposes to insure his life. The family medical attendant is often requested to do so. If he knows of nothing either in the past medical history of the proposer himself or in his family history which would tell against his being accepted as a first-class life, then he is likely to examine him willingly. If, however, he knows of any circumstance which would either debar him from being accepted altogether by the insurance company, or which would cause the company to "load" his life, then he ought at once to tell the person that he must decline to examine him. One of the questions put in the medical examination form asks if the examiner knows of anything which in his opinion would militate against the proposer's life. If the medical attendant answers this truthfully, as he is bound to do, and states some fact which will tell against the proposer, then the patient will be the first to blame his doctor for causing his proposal to be rejected entirely, or, if accepted, at an increased premium. In such a case you ought to recommend your patient to be examined by the company's chief medical officer, because we cannot escape telling what we know of the previous life history of the insurer, and if we voluntarily make a false statement we may be charged with this offence.
In making your examination, strive to be absolutely fair both to the proposer and to the insuring company. Though you will receive your fee from the company, you must not act as an agent for it, but be scrupulously just.
One's duty in this examination is not to be lightly undertaken. The proposer here acts exactly in the contrary manner to that in which an ordinary patient would do. He either denies entirely that he suffers from any disease or, at least, he minimises it greatly. The examiner has, therefore, to act the part of a detective and to try and find if there is any disease present at all. He must, therefore, perform a very complete and detailed examination in order to determine in how far the proposer differs from a healthy individual of his own age, if, indeed, he differs at all, and if there is any indication of present or past disease.
The object of the investigation is to determine whether the applicant has an average healthy life or the reverse.
Let no one be present at the investigation, not even a man's wife if he is married. You have to make inquiries regarding his past life, and it is hardly likely he will answer truthfully if she is present, or he might respond with statements which might not conduce to matrimonial felicity. Questions are asked under the following heads :
(1) The family history of the applicant.