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INFECTIOUS DISEASE
1300
PANEL AND CONTRACT PRACTICE.-VITAL STATISTICS
number as in the county of London proportion of two-thirds males to one-third females, or about 54 per cent. of the total male and 26 per cent. of the total female population. Medical benefit for insured persons cost about 1,000,000, of which 170,000 was spent on drugs and appliances. There has been a decline in the extent to which approved societies have utilised the services of regional medical officers for examining insured persons whose continued incapacity for work is considered doubtful. The peak year was 1932; in 1933 there was a reduction of over 8000, and a further similar reduction brings the figure down to 44,870. Recently, except in 1933, the references in respect of men have been fewer than in respect of women, and the return to the normal in 1934 is accounted for by the reduction in the number of references being greater for men than for women. The proportion of cases in which the R.M.O. agreed with the medical practitioner that the insured person was incapable of work was higher-by fully 2 per cent.-in 1934 than in the previous year. Some of the part-time practitioners who examine insured persons are specialists in various branches of medicine. Special blood examinations, fractional test-meals, and urea-concentration tests are available for the R.M.O. in making his decision in difficult cases. An important part of his work, which deserves not to be overlooked, is to give advice in carrying out national health insurance duties. The year 1934 has seen a general improvement in the relationship of the regional medical staff with the insurance practitioner.
roughly
the
same
-in the
The Cost of
his doctor, but that someone else had engineered the transaction without his knowledge. For your own sake then, will you please, in future, insist that if a person wants to transfer to your list he shall himself sign the Part Al. For my part, it will be my unpleasant duty to reject any transfer acceptances of this kind which are not properly completed by the applicant as well as by the doctor. No one dislikes red tape more than I do, but this particular piece has been forced upon me, and any inconvenience which would arise as a result of it can be prevented if you and your medical colleagues will cooperate by insisting that Part Al (the red printed slip) and, if possible, medical cards as well, are properly completed before you send them here.
INFECTIOUS DISEASE
Drugs
An insurance committee in Lancashire
IN ENGLAND AND WALES DURING THE WEEK ENDED
recently
had under consideration a report on the cost of drugs per head of the insured population for nine county boroughs. It appeared that the cost last year in pence was : Oldham, 45-9; Blackburn,
Barrow, 43-6 ; Preston, 43-3 ; Bury, 394 ; Burnley, 38-4; Blackpool, 35-0; Rochdale, 34-34; and Bolton, 34-0. The cost per head in London for 1934 448 ;
The curious fact that in Oldham the 37-01. cost is a third more than in Bolton doubtless has some good cause which it would be profitable to discover. It may be recalled that Manchester recently looked into the causes of the high cost of supplying drugs and appliances in that area.
was
MAY
18TH, 1935
Notifications.-The following cases of infectious disease were notified during the week : Small-pox, 0 ; scarlet fever, 1990 ; diphtheria, 1057 ; enteric fever. 17 ; acute pneumonia (primary or influenzal), 949; puerperal fever, 53 ; puerperal pyrexia, 96 ; cerebrospinal fever, 19 ; acute poliomyelitis, 9; acute polio-encephalitis, 1 ; encephalitis lethargica, 5; dysentery, 14: ; ophthalmia neonatorum, 84. No case of cholera, plague, or typhus fever was notified during the week. The number of
cases
in the Infectious
Hospitals of the London
County Council on May 24th was 3161, which included : Scarlet fever, 957 ; diphtheria, 1274 ; measles, 30 ; whoopingcougb, 388 ; puerperal fever, 27 mothers (plus 9 babies); encephalitis lethargica, 269 ; poliomyelitis, 3. At St. Margaret’s Hospital there were 19 babies (plus 9 mothers) with ophthalmia neonatorum.
Friendly Guidance The clerk of the London Insurance Committee has issued another of what he calls his " written chats." He opens with an apology that on this occasion the letter is not accompanied by a cheque, expresses his not entirely unselfish " pleasure at the prospect of the early withdrawal of the economy cuts, and then proceeds as follows :"
is, however, another very real reason for my writing to you now. As you know, if an insured person There
the list of another local practitioner wants to transfer must, if he is unable to obtain the consent of his own practitioner, write to me for the consent of the Committee to his transferring at the end of the quarter. This consent is given in the form of a red printed slip (Al) attached to the medical card. I know that many insured persons have a disinclination to signing their names, but Part Al definitely provides for and therefore requires the signature of the insured person himself, although in the past we have not insisted upon it any more than we insist upon a signature in Parts A,"" B," C " or " D " of the medical card. A number of cases have occurred recently, however, in which it has been alleged that the insured person had no desire to change
on
to you, he
"
"
A reference to information attached to medical regarding the allocation of insured persons who fail to select an insurance practitioner is followed by a concise statement of what may and should be prescribed by insurance doctors, written from the positive point of view. This should once and for all prevent such inquiries as " Am I permitted to prescribe cod-liver oil for patients other than those suffering from tuberculosis ?"or " May I order vaccines for insured persons" which we understand have actually been received recently. The clerk gives a gentle reminder to any practitioners who may have been remiss in returning medical records, and in a postscript he relents to the extent of indicating that if the recipient is entitled to receive a cheque in connexion with the final settlement for 1934 he will find it enclosed with the letter.
cards
Deaths.-In 121 great towns, including London, there was no death from small-pox, 1 (0) from enteric fever, 21 (0) from measles, 6 (0) from scarlet fever, 21 (4) from whooping-cough, 37 (3) from diphtheria, 30 (9) from diarrhoea and enteritis under two years, and 73 (5) from influenza. The figures in parentheses are those for London itself. Diphtheria occasioned 5 deaths at Liverpool, 3 at Hull, 2 each at Leeds, Manchester, and Oldham. Six fatal cases of measles were reported from Wigan, 3 from Sunderland. Deaths from whooping-cough numbered 3 at Middlesbrough and at Stoke-onTrent. Of the much diminished deaths attributed to influenza 6 were reported from Manchester, 5 from Middlesbrough, 4 from Leeds, 3 each from Acton, Blackburn, Bradford, Sheffield, and
Birmingham.
The number of stillbirths notified during the week was 289 (corresponding to a rate of 40 per 1000 total births), including 51 in London. WEST
LONDON
HOSPITAL.-The
Silver Jubilee
extensions to this hospital will be finished in a few months’ time, when the institution will be equipped with up-to-date casualty, X ray (diagnostic), and pathological departments. About 20,000 is still required to cover the cost.
PANEL AND CONTRACT PRACTICE.-VITAL STATISTICS
number as in the county of London proportion of two-thirds males to one-third females, or about 54 per cent. of the total male and 26 per cent. of the total female population. Medical benefit for insured persons cost about 1,000,000, of which 170,000 was spent on drugs and appliances. There has been a decline in the extent to which approved societies have utilised the services of regional medical officers for examining insured persons whose continued incapacity for work is considered doubtful. The peak year was 1932; in 1933 there was a reduction of over 8000, and a further similar reduction brings the figure down to 44,870. Recently, except in 1933, the references in respect of men have been fewer than in respect of women, and the return to the normal in 1934 is accounted for by the reduction in the number of references being greater for men than for women. The proportion of cases in which the R.M.O. agreed with the medical practitioner that the insured person was incapable of work was higher-by fully 2 per cent.-in 1934 than in the previous year. Some of the part-time practitioners who examine insured persons are specialists in various branches of medicine. Special blood examinations, fractional test-meals, and urea-concentration tests are available for the R.M.O. in making his decision in difficult cases. An important part of his work, which deserves not to be overlooked, is to give advice in carrying out national health insurance duties. The year 1934 has seen a general improvement in the relationship of the regional medical staff with the insurance practitioner.
roughly
the
same
-in the
The Cost of
his doctor, but that someone else had engineered the transaction without his knowledge. For your own sake then, will you please, in future, insist that if a person wants to transfer to your list he shall himself sign the Part Al. For my part, it will be my unpleasant duty to reject any transfer acceptances of this kind which are not properly completed by the applicant as well as by the doctor. No one dislikes red tape more than I do, but this particular piece has been forced upon me, and any inconvenience which would arise as a result of it can be prevented if you and your medical colleagues will cooperate by insisting that Part Al (the red printed slip) and, if possible, medical cards as well, are properly completed before you send them here.
INFECTIOUS DISEASE
Drugs
An insurance committee in Lancashire
IN ENGLAND AND WALES DURING THE WEEK ENDED
recently
had under consideration a report on the cost of drugs per head of the insured population for nine county boroughs. It appeared that the cost last year in pence was : Oldham, 45-9; Blackburn,
Barrow, 43-6 ; Preston, 43-3 ; Bury, 394 ; Burnley, 38-4; Blackpool, 35-0; Rochdale, 34-34; and Bolton, 34-0. The cost per head in London for 1934 448 ;
The curious fact that in Oldham the 37-01. cost is a third more than in Bolton doubtless has some good cause which it would be profitable to discover. It may be recalled that Manchester recently looked into the causes of the high cost of supplying drugs and appliances in that area.
was
MAY
18TH, 1935
Notifications.-The following cases of infectious disease were notified during the week : Small-pox, 0 ; scarlet fever, 1990 ; diphtheria, 1057 ; enteric fever. 17 ; acute pneumonia (primary or influenzal), 949; puerperal fever, 53 ; puerperal pyrexia, 96 ; cerebrospinal fever, 19 ; acute poliomyelitis, 9; acute polio-encephalitis, 1 ; encephalitis lethargica, 5; dysentery, 14: ; ophthalmia neonatorum, 84. No case of cholera, plague, or typhus fever was notified during the week. The number of
cases
in the Infectious
Hospitals of the London
County Council on May 24th was 3161, which included : Scarlet fever, 957 ; diphtheria, 1274 ; measles, 30 ; whoopingcougb, 388 ; puerperal fever, 27 mothers (plus 9 babies); encephalitis lethargica, 269 ; poliomyelitis, 3. At St. Margaret’s Hospital there were 19 babies (plus 9 mothers) with ophthalmia neonatorum.
Friendly Guidance The clerk of the London Insurance Committee has issued another of what he calls his " written chats." He opens with an apology that on this occasion the letter is not accompanied by a cheque, expresses his not entirely unselfish " pleasure at the prospect of the early withdrawal of the economy cuts, and then proceeds as follows :"
is, however, another very real reason for my writing to you now. As you know, if an insured person There
the list of another local practitioner wants to transfer must, if he is unable to obtain the consent of his own practitioner, write to me for the consent of the Committee to his transferring at the end of the quarter. This consent is given in the form of a red printed slip (Al) attached to the medical card. I know that many insured persons have a disinclination to signing their names, but Part Al definitely provides for and therefore requires the signature of the insured person himself, although in the past we have not insisted upon it any more than we insist upon a signature in Parts A,"" B," C " or " D " of the medical card. A number of cases have occurred recently, however, in which it has been alleged that the insured person had no desire to change
on
to you, he
"
"
A reference to information attached to medical regarding the allocation of insured persons who fail to select an insurance practitioner is followed by a concise statement of what may and should be prescribed by insurance doctors, written from the positive point of view. This should once and for all prevent such inquiries as " Am I permitted to prescribe cod-liver oil for patients other than those suffering from tuberculosis ?"or " May I order vaccines for insured persons" which we understand have actually been received recently. The clerk gives a gentle reminder to any practitioners who may have been remiss in returning medical records, and in a postscript he relents to the extent of indicating that if the recipient is entitled to receive a cheque in connexion with the final settlement for 1934 he will find it enclosed with the letter.
cards
Deaths.-In 121 great towns, including London, there was no death from small-pox, 1 (0) from enteric fever, 21 (0) from measles, 6 (0) from scarlet fever, 21 (4) from whooping-cough, 37 (3) from diphtheria, 30 (9) from diarrhoea and enteritis under two years, and 73 (5) from influenza. The figures in parentheses are those for London itself. Diphtheria occasioned 5 deaths at Liverpool, 3 at Hull, 2 each at Leeds, Manchester, and Oldham. Six fatal cases of measles were reported from Wigan, 3 from Sunderland. Deaths from whooping-cough numbered 3 at Middlesbrough and at Stoke-onTrent. Of the much diminished deaths attributed to influenza 6 were reported from Manchester, 5 from Middlesbrough, 4 from Leeds, 3 each from Acton, Blackburn, Bradford, Sheffield, and
Birmingham.
The number of stillbirths notified during the week was 289 (corresponding to a rate of 40 per 1000 total births), including 51 in London. WEST
LONDON
HOSPITAL.-The
Silver Jubilee
extensions to this hospital will be finished in a few months’ time, when the institution will be equipped with up-to-date casualty, X ray (diagnostic), and pathological departments. About 20,000 is still required to cover the cost.