The writings of Sir Bernard Spilsbury: Part I

This is a two-part historical feature, highlighting the rare writings of Sir Bernard Spilsbury, the recognized leader of British forensic medicine in the first half of the 20th century. Parts I and II were compiled from the publications of the Medicolegal Society of Great Britain, where Sir Bernard Spilsbury served as President in 1933. Although his profile was presented previously in this Journal (vol. 2, no. 2, 179-182, 1981), it is felt that much of Sir Bernard Spilsbury's personality comes out in his writings and recordings of his speeches in the Medicolegal Society publications. Part I includes his lecture on "The Medico-Legal Significance of Bruises," presented before the Medicolegal Society in 1938; and a short case report read before the Medicolegal Society in 1924. The subject of the case report was sudden death from inhibition. Part II will contain two papers from the Medicolegal Society publications.     

Practitioner fraud and abuse in medical benefit programs: government regulation and professional white-collar crime

Physicians who defraud and abuse medical benefit programs provide a unique group of lawbreakers for scientific study. They could be considered to epitomize white collar criminals given their exceedingly high socioeconomic status and power as a professional group. Using official reports and documents, as well as interviews with enforcement and program personnel at both state and federal levels, this study examines the problem of physician fraud and abuse in Medicare and Medicaid. Major areas relevant to understanding this phenomenon and its control are presented and policy implications of present knowledge in the area are discussed.     

Spleen and portal lymphnode pathology in fatal drug addiction

Spleen and portal lymphnode sections from 86 drug addicts submitted for medico-legal autopsy at the Institute of Forensic Medicine in Copenhagen in the year 1979 were studied together with tissue sections from 24 "normal" persons. In 70% of the drug addicts the spleen weight was more than 200 g, and in 71% portal lymphnode hyperplasia was found. Birefringent foreign material was found in spleen tissue of drug addicts in 72% and in portal lymphnode tissue in 44%. Signs of antigen stimulation in both spleen and portal lymphnode tissue evaluated by the number of germinal centre and plasma cells were found in more than 80% of the drug addicts compared with about 20% of the "normal" persons. The results were related to anamnestic information of duration of drug abuse, to the spleen weight, to the occurrence of birefringent material and to the liver changes. Examination of lysozyme and immunoglobulin containing cells using the indirect preoxidase technique was performed in a total of 72 cases of spleen tissue, 59 cases of portal lymphnode tissue from drug addicts, 24 cases of spleen tissue and 18 of portal lymphnode tissue from "normal" persons. Lysozyme, IgM and IgG containing cells were found significantly more often among drug addicts than "normal" persons. The results indicate that the splenomegalia and the portal lymphnode hyperplasia often found in drug addicts are caused by continuous antigen stimulation due to repeated injections of various antigens.     

Enforcing ethics in social work

The attention paid by the social work profession to ethical issues has waxed and waned since the formal inauguration of the profession in the late 19th century. For the first half century of the profession's life, relatively little attention was devoted to problems of professional ethics, though social work's literature was filled with discussions of value-laden issues that arise in practice. In recent years, interest in professional ethics has increased substantially. This article discusses the growth of interest in professional ethics, the formulation of the social work code of ethics, the adjudication of grievances in social work, and the strengths and limitations of the profession's code.     

Consumer-sponsored prepaid group practice: restructuring the health care system

The traditional separation of health care delivery and financing systems is breaking down as various new types of health care facilities are established and as payment continues to be a major concern. Group Health Cooperative of Puget Sound (GHC) was organized as a prepaid group practice system responsive to consumers. Costs, methods of payment and delivery of care are interrelated and are all influenced by consumer ownership. GHC has been refining its benefit programs since 1945. Strategies for controlling use and costs focus on improved provider management and on flexibility. This article explains how the structure of GHC benefits the consumer.