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DEFINITION OF DRUGS FOR THE PURPOSES OF MEDICAL BENEFIT.
467 There are some good examples of pseudocavity shadows among the illustrations, all of which are extremely well reproduced and are accompanied by excellent descriptions which amplify the text. This is an important monograph, and throws new light on the interpretation of these difficult shadows.
Class B2 contains substances and preparations which are always drugs, but an insurance practitioner might reasonably be called upon to justify the prescribing of the substances and preparations in this class in the event of an investigation of his
appear.
prescribing.
It should be in the hands of all those interested in the radiological investigation of the lungs, and particularly those who are doing sanatorium and tuberculosis work. It is very well produced and reasonable in
price.
Examples are
:-
Agar-agar, Angier’s emulsion, antiphlogistine, boroglyceride, californian syrup of figs, ergo apiol, Fellow’s syrup, formamint tablets, glycothymoline, Heath and Heather’s herbs, liver extracts, metatone.
3 contains proprietary substances and Class B3 preparations which are alleged to be drugs or medicines but of which the composition is undisclosed. The DEFINITION OF DRUGS FOR THE Committee consider that the prescribing of such substances and preparations is most undesirable, PURPOSES OF MEDICAL BENEFIT. and hold that only the most exceptional circumstances REPORT OF THE ADVISORY COMMITTEE. could justify a practitioner in prescribing them. Examples are :-
.
——.....——.—————.——.
I (liquid),
Alkia saltrates, Andrew’s liver salt, antigermis, antigermis Beecham’s pills, bisurated magnesia, Cassell’s tablets, cicfa tablets, cuticura ointment, dermisol ointment, Eno’s fruit salt, feen-a-mint, felsol powders, germolene week, was appointed by the then Minister of ointment, Gibb’s insectol cream, guycose, Hair’s asthma asthma cure, intubine, irocose, kruschen in February, 1929, and consisted of Dr. Dudley G. cure, Himrod’s " " Greenfield (Chairman), Mr. T. Allsop, Dr. J. J. Day, salts, miol, Odds on liniment, pepsencia, phosferine and reudel bath saltrates, salvitse, tablets, phyllosan, phosferine Sir Walter M. Fletcher, F.R.S., Mr. J. E. French, bath charges, tamar indien laxative lozenges, M.P.S., Dr. A. F. Heald, Mr. W. Gill Hodgson, sulphaqua taxol tablets, Tidman’s sea salt, vinculin.
THE Advisory Committee on the Definition of Drugs the Purposes of Medical Benefit, whose second report was briefly summarised in our columns last
for
Health,I
Dr. E. Lewis Lilley, Mr. F. Llewellyn-Jones (who resigned and was -replaced by -Mr. J. E. Tomley, in November, 1929), Mr. G. A. Mallinson, Mr. Edwin Potts, Mr. Philip F. Rowsell, F.C.S., Mr. Thomas
Tickle, F.I.C., with Miss E. M. R. Russell-Smith, of
Ministry of Health, as Secretary. Their terms of reference included the distribution of 165 substances and preparations submitted to them into certain categories, depending on whether particular substance of preparation was, in their the view (a) never a drug, (b) always a drug, (c) sometimes a drug. They concluded that this classification was too simple, since certain preparations, though admittedly drugs or medicines which in appropriate circumstances should be supplied to insured persons at the cost of the Chemists’ Fund, yet, from their nature and cost should only in exceptional circumstances be prescribed in preference to other substances and preparations of reputed analogous therapeutic effect. They found it convenient, therefore, to allocate the substances and preparations referred to them among six different categories-namely, Classes A, Bl, B2, B3, Cl, and C2. the
Never a Drug. Class A contains substances and preparations which, in the opinion of the Committee, are never drugs. In this category are placed :-
Acidophilus milk, albulactin, Allenbury’s food, ambrosia, Benger’s food, bovinine meat juice, arrowroot, charcoal biscuits. Brand’s essences,
bovril, brandy, bulgarlac, calves’ foot jelly, cane sugar, Carnrick’s peptonoids, casein food, casumen, ceregen, cerolia cream, champagne, chymol, coffee, diabetic bread and biscuits, energen bread and biscuits, glaxo, glaxovo, gluten bread, glyco-lactophos, herogen, Horlick’s milk, hi-g-ah tea, ice, instant postum, iodised salt, lactic milk, lacto-dextrin, lactogen, lactose, lemco, mabela, marmite, meat extracts (other than liver extracts), meat juices, Mellin’s food, melovol, midolia biscuits, ialuiler’s nutrient, new-promonta, numol, nutrient suppositories, oatmeal, ovaltine, oxo, panopepton, pearl barley, peptonising powders, plasmon, plasmon oats, Robinson’s barley and groats, roboleine, saccharin tablets, sanaphos, sanatogen, Savory and Moore’s foods, sherry, somatose, tonagen, Torbet’s lactic oats, Valentine’s meat juice, valkasa, vibrona, vigoral, virol, virol and milk, vitafer, vitagen, vitalia meat juice, zomogen tonic food.
Bragg’s
Always
a
Drug.
Sometimes a Drug. Class Cl and Class C2 contain substances and preparations which may be, but are not always, drugs or medicines for the purposes of medical benefit. (a) Class Cl contains substances such as cod-liver oil, extract of malt and non-proprietary preparations, and combinations of these substances. While it may be argued that such substances should technically be classified as foods, and not as drugs, yet the common acceptance and usage at the present time necessitate their being recognised as drugs in many of the cases in which they are prescribed. The Committee consider, however, that these substances and preparations are occasionally prescribed in circumstances which would render it difficult to establish that their use was therapeutic rather than alimentary. (b) Class C2 contains substances and preparations, the prescribing of which by insurance practitioners is, in the opinion of the Committee, justifiable only in special circumstances. Among other substances and preparations included in Class C2 are proprietary preparations of cod-liver oil, or of malt extract, or of both combined. Examples are :Allen and Hanbury’s malt and oil, antiseptic soaps, bemax, bynin, bynogen, byno preparations, bynol, byno and oil, bynotone, Cheltenham spa water, cod-liver oil tablets, cream of malt, cuticura soap, glovo cod-liver oil tablets, hsematogen, hazeline cream, jecomalt, Jeyes’ fluid, Kepler’s maltand oil, lactagol, lactomaltine, maltine, maltine and oil, metagen, omnevit, ostelin, ostelin preparations, radio malt, radiostol, radiostoleum, resinol soap, Scott’s emulsion, virolax, vitamalt, vitamine malt, vitamogen, vitmar, Wander’s malt and oil, Wander’s malt extract c. haemoglobin, yeast-vite tablets.
The Committee note the possibility that information may become available at some future date which might cause them to revise their opinion of some or all of the preparations included in Class C2, but’consider that for the present this classification is appropriate. Some
Special Cases.
They think it desirable to amplify their in
a
the
following substances particular category.
including
or
reasons
for
preparations
Peptonising Powders. (Class A).-They consider that the would contain those substances and ordering of peptonising powders as such definitely assigns preparations which were. in the opinion of the Com- them to the position of adjuncts in the preparation, external mittee. always drugs, and could unquestionably to the body, of foods of a particular character, and consequently precludes them from being regarded as drugs or properly be supplied to insured persons at the cost medicines for the purposes of medical benefit. They would, of the Chemists’ Fund. It will, however, be observed however, regard as drugs the components of peptonising that none of the substances and preparations so far powders, e.g., pepsin, &c., when ordered by name in definite referred for consideration are placed in this class. quantities to be taken internally in prescribed doses. Class
Bl
468 Liver Extracts. to exert definite
(Class B2.)-These substances are known Procedure. therapeutic effects in certain pathogenic The position relating to the prescribing of substances conditions, notably pernicious ansemia, and have therefore been included in the category of drugs or medicines. Though which the Insurance Committee had decided never to these effects can be obtained by the consumption of animal be drugs would be as follows : (1) The insurance liver, the human digestive system may be unable to deal practitioner would be surcharged the cost of the of liver with the quantity necessary to produce the required substance so prescribed, but would have a right of therapeutic effects ; where this is the case, the exhibition of to referees. (2) The insurance chemist would concentrated extracts of liver substance is essential for appeal satisfactory treatment. The Committee consider that a be required to dispense the prescription, and would
receive payment. (3) The Insurance Committee standard should be fixed for these extracts. Medicinal Herbs. (Class B2.)-The Committee consider would take action under the proposed regulation. that the prescribing of these crude substances rather than (4) The insured person would have a right of complaint medicinal preparations thereof would only be justifiable against the insurance practitioner under Article 32 in exceptional circumstances. of the Medical Benefit Regulations, 1928, for refusing Antiseptic and Medicated Soaps. (Class C2.)-Though to prescribe an alleged drug. these substances are occasionally prescribed by practitioners As regards substances which the Insurance Comof repute, the Committee have considerable hesitation in mittee had decided to be sometimes drugs and someregarding them as substances which might be drugs ; these times not drugs, the prescribing of such substances in cosmetics save must be as exceptional soaps regarded should, in the first instance, be investigated by the circumstances. Spa and Mineral Waters.-The Committee have experi- Panel Committee under Article 42 of the Medical enced some difficulty in the classification of these substances, Benefit Regulations, 1928. If it was decided that the as they vary in composition from a weak saline solution suitable whole or any proportion of the substances prescribed for the dinner table to a strong saline solution only suitable for were not drugs in the case in question, the Insurance administration as a drug. Each case must therefore be Committee could recover the cost thereof from the considered on its merits. Where an alleged spa water is of the position of the chemist unknown composition, however, they would unhesitatingly practitioner concerned, and the insured person being the same as in connexion place it in Class B3. with substances which the Insurance Committee had Disinfectants.-When ordered as such clearly cannot be regarded as drugs for the purposes of medical benefit, but decided never to be drugs. disinfectants ordered by name in definite quantities with directions for therapeutic use internally or externally would be regarded as drugs.
MEDICINE AND THE LAW.
Suggested Regulation. The Committee conclude that it would be undesirable to attempt to regulate the present position by amendment to the existing regulations, and therefore recommend that a new regulation shall be made in the general form of the following draft.
Heavy Sentences for Criminal Abortion. police authorities notoriously find it difficult to bring cases of criminal abortion to justice : when, however, the criminals are caught and convicted, THE
inflict stern sentences. Recently, at the Central Criminal Court, Mr. Justice Talbot sentenced to five years’ penal servitude a man of 43, described as a herbalist, who pleaded guilty to a charge of supplying noxious things to a number of women knowing they were to be used for the purpose of procuring miscarriage. Prosecuting counsel said that the accused had no medical knowledge : he had been a stoker in the Navy. His shop in Notting Hill Gate was in such an appalling state of dirt that it was a danger to the community for that reason alone. The judge observed that the prisoner’s conduct was not only illegal in the highest degree but also dangerous to health. In another case a few days later Mr. Justice Avory inflicted a sentence of seven years’ penal servitude at Bristol Assizes in respect of illegal operations and other illegal acts charged as having been committed at Bath, Bristol, Bridgwater, Cardiff, and London. The prisoner made the somewhat impudent defence that what he did was merely a pretence intended to satisfy the women that they There were allegations also were having treatment. of conversion of money and of indecent assault; the judge stated he had never met a case containing so many circumstances of aggravation. In the Central Criminal Court case (first mentioned above) it was suggested on the prisoner’s behalf, in mitigation of sentence, that he had acted in ignorance of the law. The severity of these sentences may serve to remove such ignorance, if it exists.
judges
1. An Insurance Committee shall have power to recover from a practitioner by deduction from his remuneration or otherwise the cost of any substance or article prescribed by the practitioner on the official form which is not a drug or medicine, or an appliance included in the Second Schedule to the principal Regulations, and shall pay the amount so recovered into the Chemists’ Fund. 2. If any question arises as to the recovery of any sums under the preceding Article, or if any question arises in the course of an investigation, or otherwise, for determination whether a substance or preparation is one which should be ordered for or supplied to an insured person, the Committee shall refer the matter to the Panel Committee. If the Panel Committee and the Committee disagree, the matter shall be submitted to Referees appointed under this Article for decision in such summary manner as, subject to any rules made by the Minister in that behalf, may be directed by the Minister ; and the decision of those Referees, given after hearing such parties and taking such evidence, if any, as they think just, shall be final. For the purpose of giving effect to this Article the Minister shall, upon any such question arising, nominate as Referees two practitioners (who shall be selected from any panel of practitioners set up by the Minister for the purpose, or if no such panel exists, from among practitioners in actual practice) and one barrister-at-law or solicitor in actual
practice.
The Referees may decide any question coming before them a majority, but subject as aforesaid, their procedure shall be such as they may from time to time determine. If on any question referred to the Panel Committee under this Article the Committee and the Panel Committee are agreed, the Committee shall report the matter to the Minister, and the Minister may, if he thinks fit, refer the question for decision to Referees in the manner provided in this Article, and the foregoing provisions of this Article shall apply
by
accordingly.
OCCUPATION IN HOSPITAL.-The New York City The Committee hold that the Insurance Committee Committee, a voluntary body, have formed a Visiting take action 1 should under paragraph of the suggested Hospital Occupation Committee which devotes itself to the regulation when the substance prescribed (a) is included promotion of occupational therapy. In the Bellevue in a list, issued by the Insurance Committee to the Hospital children carve wooden rabbits in order to maniinsurance practitioner, of substances considered by pulate fractured wrist-bones which are mending; other the Insurance Committee never to be drugs, or (b) is patients work objects resembling spinning wheels which are really treadles for restoring strength to injured ankles. adjudged by the Panel Committee in the course of an Wool, raffia, leather, and beads are distributed with instrucof a or not to be otherwise prescribing investigation tions how to make pretty things of them. The members drug in the circumstances in which it has been of the Occupation Committee act as voluntary helpers to prescribed, or (c) is of such a nature that obviously it regular staff of occupational therapy officers, giving to the work such time as they can spare. cannot reasonably be considered to be a drug.
I
I
the
*
Class B2 contains substances and preparations which are always drugs, but an insurance practitioner might reasonably be called upon to justify the prescribing of the substances and preparations in this class in the event of an investigation of his
appear.
prescribing.
It should be in the hands of all those interested in the radiological investigation of the lungs, and particularly those who are doing sanatorium and tuberculosis work. It is very well produced and reasonable in
price.
Examples are
:-
Agar-agar, Angier’s emulsion, antiphlogistine, boroglyceride, californian syrup of figs, ergo apiol, Fellow’s syrup, formamint tablets, glycothymoline, Heath and Heather’s herbs, liver extracts, metatone.
3 contains proprietary substances and Class B3 preparations which are alleged to be drugs or medicines but of which the composition is undisclosed. The DEFINITION OF DRUGS FOR THE Committee consider that the prescribing of such substances and preparations is most undesirable, PURPOSES OF MEDICAL BENEFIT. and hold that only the most exceptional circumstances REPORT OF THE ADVISORY COMMITTEE. could justify a practitioner in prescribing them. Examples are :-
.
——.....——.—————.——.
I (liquid),
Alkia saltrates, Andrew’s liver salt, antigermis, antigermis Beecham’s pills, bisurated magnesia, Cassell’s tablets, cicfa tablets, cuticura ointment, dermisol ointment, Eno’s fruit salt, feen-a-mint, felsol powders, germolene week, was appointed by the then Minister of ointment, Gibb’s insectol cream, guycose, Hair’s asthma asthma cure, intubine, irocose, kruschen in February, 1929, and consisted of Dr. Dudley G. cure, Himrod’s " " Greenfield (Chairman), Mr. T. Allsop, Dr. J. J. Day, salts, miol, Odds on liniment, pepsencia, phosferine and reudel bath saltrates, salvitse, tablets, phyllosan, phosferine Sir Walter M. Fletcher, F.R.S., Mr. J. E. French, bath charges, tamar indien laxative lozenges, M.P.S., Dr. A. F. Heald, Mr. W. Gill Hodgson, sulphaqua taxol tablets, Tidman’s sea salt, vinculin.
THE Advisory Committee on the Definition of Drugs the Purposes of Medical Benefit, whose second report was briefly summarised in our columns last
for
Health,I
Dr. E. Lewis Lilley, Mr. F. Llewellyn-Jones (who resigned and was -replaced by -Mr. J. E. Tomley, in November, 1929), Mr. G. A. Mallinson, Mr. Edwin Potts, Mr. Philip F. Rowsell, F.C.S., Mr. Thomas
Tickle, F.I.C., with Miss E. M. R. Russell-Smith, of
Ministry of Health, as Secretary. Their terms of reference included the distribution of 165 substances and preparations submitted to them into certain categories, depending on whether particular substance of preparation was, in their the view (a) never a drug, (b) always a drug, (c) sometimes a drug. They concluded that this classification was too simple, since certain preparations, though admittedly drugs or medicines which in appropriate circumstances should be supplied to insured persons at the cost of the Chemists’ Fund, yet, from their nature and cost should only in exceptional circumstances be prescribed in preference to other substances and preparations of reputed analogous therapeutic effect. They found it convenient, therefore, to allocate the substances and preparations referred to them among six different categories-namely, Classes A, Bl, B2, B3, Cl, and C2. the
Never a Drug. Class A contains substances and preparations which, in the opinion of the Committee, are never drugs. In this category are placed :-
Acidophilus milk, albulactin, Allenbury’s food, ambrosia, Benger’s food, bovinine meat juice, arrowroot, charcoal biscuits. Brand’s essences,
bovril, brandy, bulgarlac, calves’ foot jelly, cane sugar, Carnrick’s peptonoids, casein food, casumen, ceregen, cerolia cream, champagne, chymol, coffee, diabetic bread and biscuits, energen bread and biscuits, glaxo, glaxovo, gluten bread, glyco-lactophos, herogen, Horlick’s milk, hi-g-ah tea, ice, instant postum, iodised salt, lactic milk, lacto-dextrin, lactogen, lactose, lemco, mabela, marmite, meat extracts (other than liver extracts), meat juices, Mellin’s food, melovol, midolia biscuits, ialuiler’s nutrient, new-promonta, numol, nutrient suppositories, oatmeal, ovaltine, oxo, panopepton, pearl barley, peptonising powders, plasmon, plasmon oats, Robinson’s barley and groats, roboleine, saccharin tablets, sanaphos, sanatogen, Savory and Moore’s foods, sherry, somatose, tonagen, Torbet’s lactic oats, Valentine’s meat juice, valkasa, vibrona, vigoral, virol, virol and milk, vitafer, vitagen, vitalia meat juice, zomogen tonic food.
Bragg’s
Always
a
Drug.
Sometimes a Drug. Class Cl and Class C2 contain substances and preparations which may be, but are not always, drugs or medicines for the purposes of medical benefit. (a) Class Cl contains substances such as cod-liver oil, extract of malt and non-proprietary preparations, and combinations of these substances. While it may be argued that such substances should technically be classified as foods, and not as drugs, yet the common acceptance and usage at the present time necessitate their being recognised as drugs in many of the cases in which they are prescribed. The Committee consider, however, that these substances and preparations are occasionally prescribed in circumstances which would render it difficult to establish that their use was therapeutic rather than alimentary. (b) Class C2 contains substances and preparations, the prescribing of which by insurance practitioners is, in the opinion of the Committee, justifiable only in special circumstances. Among other substances and preparations included in Class C2 are proprietary preparations of cod-liver oil, or of malt extract, or of both combined. Examples are :Allen and Hanbury’s malt and oil, antiseptic soaps, bemax, bynin, bynogen, byno preparations, bynol, byno and oil, bynotone, Cheltenham spa water, cod-liver oil tablets, cream of malt, cuticura soap, glovo cod-liver oil tablets, hsematogen, hazeline cream, jecomalt, Jeyes’ fluid, Kepler’s maltand oil, lactagol, lactomaltine, maltine, maltine and oil, metagen, omnevit, ostelin, ostelin preparations, radio malt, radiostol, radiostoleum, resinol soap, Scott’s emulsion, virolax, vitamalt, vitamine malt, vitamogen, vitmar, Wander’s malt and oil, Wander’s malt extract c. haemoglobin, yeast-vite tablets.
The Committee note the possibility that information may become available at some future date which might cause them to revise their opinion of some or all of the preparations included in Class C2, but’consider that for the present this classification is appropriate. Some
Special Cases.
They think it desirable to amplify their in
a
the
following substances particular category.
including
or
reasons
for
preparations
Peptonising Powders. (Class A).-They consider that the would contain those substances and ordering of peptonising powders as such definitely assigns preparations which were. in the opinion of the Com- them to the position of adjuncts in the preparation, external mittee. always drugs, and could unquestionably to the body, of foods of a particular character, and consequently precludes them from being regarded as drugs or properly be supplied to insured persons at the cost medicines for the purposes of medical benefit. They would, of the Chemists’ Fund. It will, however, be observed however, regard as drugs the components of peptonising that none of the substances and preparations so far powders, e.g., pepsin, &c., when ordered by name in definite referred for consideration are placed in this class. quantities to be taken internally in prescribed doses. Class
Bl
468 Liver Extracts. to exert definite
(Class B2.)-These substances are known Procedure. therapeutic effects in certain pathogenic The position relating to the prescribing of substances conditions, notably pernicious ansemia, and have therefore been included in the category of drugs or medicines. Though which the Insurance Committee had decided never to these effects can be obtained by the consumption of animal be drugs would be as follows : (1) The insurance liver, the human digestive system may be unable to deal practitioner would be surcharged the cost of the of liver with the quantity necessary to produce the required substance so prescribed, but would have a right of therapeutic effects ; where this is the case, the exhibition of to referees. (2) The insurance chemist would concentrated extracts of liver substance is essential for appeal satisfactory treatment. The Committee consider that a be required to dispense the prescription, and would
receive payment. (3) The Insurance Committee standard should be fixed for these extracts. Medicinal Herbs. (Class B2.)-The Committee consider would take action under the proposed regulation. that the prescribing of these crude substances rather than (4) The insured person would have a right of complaint medicinal preparations thereof would only be justifiable against the insurance practitioner under Article 32 in exceptional circumstances. of the Medical Benefit Regulations, 1928, for refusing Antiseptic and Medicated Soaps. (Class C2.)-Though to prescribe an alleged drug. these substances are occasionally prescribed by practitioners As regards substances which the Insurance Comof repute, the Committee have considerable hesitation in mittee had decided to be sometimes drugs and someregarding them as substances which might be drugs ; these times not drugs, the prescribing of such substances in cosmetics save must be as exceptional soaps regarded should, in the first instance, be investigated by the circumstances. Spa and Mineral Waters.-The Committee have experi- Panel Committee under Article 42 of the Medical enced some difficulty in the classification of these substances, Benefit Regulations, 1928. If it was decided that the as they vary in composition from a weak saline solution suitable whole or any proportion of the substances prescribed for the dinner table to a strong saline solution only suitable for were not drugs in the case in question, the Insurance administration as a drug. Each case must therefore be Committee could recover the cost thereof from the considered on its merits. Where an alleged spa water is of the position of the chemist unknown composition, however, they would unhesitatingly practitioner concerned, and the insured person being the same as in connexion place it in Class B3. with substances which the Insurance Committee had Disinfectants.-When ordered as such clearly cannot be regarded as drugs for the purposes of medical benefit, but decided never to be drugs. disinfectants ordered by name in definite quantities with directions for therapeutic use internally or externally would be regarded as drugs.
MEDICINE AND THE LAW.
Suggested Regulation. The Committee conclude that it would be undesirable to attempt to regulate the present position by amendment to the existing regulations, and therefore recommend that a new regulation shall be made in the general form of the following draft.
Heavy Sentences for Criminal Abortion. police authorities notoriously find it difficult to bring cases of criminal abortion to justice : when, however, the criminals are caught and convicted, THE
inflict stern sentences. Recently, at the Central Criminal Court, Mr. Justice Talbot sentenced to five years’ penal servitude a man of 43, described as a herbalist, who pleaded guilty to a charge of supplying noxious things to a number of women knowing they were to be used for the purpose of procuring miscarriage. Prosecuting counsel said that the accused had no medical knowledge : he had been a stoker in the Navy. His shop in Notting Hill Gate was in such an appalling state of dirt that it was a danger to the community for that reason alone. The judge observed that the prisoner’s conduct was not only illegal in the highest degree but also dangerous to health. In another case a few days later Mr. Justice Avory inflicted a sentence of seven years’ penal servitude at Bristol Assizes in respect of illegal operations and other illegal acts charged as having been committed at Bath, Bristol, Bridgwater, Cardiff, and London. The prisoner made the somewhat impudent defence that what he did was merely a pretence intended to satisfy the women that they There were allegations also were having treatment. of conversion of money and of indecent assault; the judge stated he had never met a case containing so many circumstances of aggravation. In the Central Criminal Court case (first mentioned above) it was suggested on the prisoner’s behalf, in mitigation of sentence, that he had acted in ignorance of the law. The severity of these sentences may serve to remove such ignorance, if it exists.
judges
1. An Insurance Committee shall have power to recover from a practitioner by deduction from his remuneration or otherwise the cost of any substance or article prescribed by the practitioner on the official form which is not a drug or medicine, or an appliance included in the Second Schedule to the principal Regulations, and shall pay the amount so recovered into the Chemists’ Fund. 2. If any question arises as to the recovery of any sums under the preceding Article, or if any question arises in the course of an investigation, or otherwise, for determination whether a substance or preparation is one which should be ordered for or supplied to an insured person, the Committee shall refer the matter to the Panel Committee. If the Panel Committee and the Committee disagree, the matter shall be submitted to Referees appointed under this Article for decision in such summary manner as, subject to any rules made by the Minister in that behalf, may be directed by the Minister ; and the decision of those Referees, given after hearing such parties and taking such evidence, if any, as they think just, shall be final. For the purpose of giving effect to this Article the Minister shall, upon any such question arising, nominate as Referees two practitioners (who shall be selected from any panel of practitioners set up by the Minister for the purpose, or if no such panel exists, from among practitioners in actual practice) and one barrister-at-law or solicitor in actual
practice.
The Referees may decide any question coming before them a majority, but subject as aforesaid, their procedure shall be such as they may from time to time determine. If on any question referred to the Panel Committee under this Article the Committee and the Panel Committee are agreed, the Committee shall report the matter to the Minister, and the Minister may, if he thinks fit, refer the question for decision to Referees in the manner provided in this Article, and the foregoing provisions of this Article shall apply
by
accordingly.
OCCUPATION IN HOSPITAL.-The New York City The Committee hold that the Insurance Committee Committee, a voluntary body, have formed a Visiting take action 1 should under paragraph of the suggested Hospital Occupation Committee which devotes itself to the regulation when the substance prescribed (a) is included promotion of occupational therapy. In the Bellevue in a list, issued by the Insurance Committee to the Hospital children carve wooden rabbits in order to maniinsurance practitioner, of substances considered by pulate fractured wrist-bones which are mending; other the Insurance Committee never to be drugs, or (b) is patients work objects resembling spinning wheels which are really treadles for restoring strength to injured ankles. adjudged by the Panel Committee in the course of an Wool, raffia, leather, and beads are distributed with instrucof a or not to be otherwise prescribing investigation tions how to make pretty things of them. The members drug in the circumstances in which it has been of the Occupation Committee act as voluntary helpers to prescribed, or (c) is of such a nature that obviously it regular staff of occupational therapy officers, giving to the work such time as they can spare. cannot reasonably be considered to be a drug.
I
I
the
*