THE NATIONAL INSURANCE ACT.

THE NATIONAL INSURANCE ACT.

354 THE NATIONAL INSURANCE ACT. THE ADMINISTRATION OF MEDICAL BENEFIT. LITTLE information is at present available as to how far medical benefit, in f...

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354

THE NATIONAL INSURANCE ACT. THE ADMINISTRATION OF MEDICAL BENEFIT. LITTLE information is at present available as to how far medical benefit, in fact as well as in name, has been provided by the Insurance Committees for insured persons throughout the country. As this benefit only became due on Jan. 15th last, anything approaching full and complete returns could hardly be expected so soon, and the very partial accounts which have appeared in the lay newspapers give small help in reviewing the position. It is clear, however, that the stand made by the medical profession in London has been maintained in spite of the formal release from the pledge given on Jan. 18th by the Representative Body of the British Medical Association*. As a consequence the London panel is still far from adequate, and complaints have been made in coroners’ courts and elsewhere that insured persons in various parts of the metropolis are suffering from a shortage of medical attention, and that many practitioners on the London panel are overwhelmed with the duties placed upon them. This serious state of affairs demands an immediate remedy, a sad significance having been given to the latter allegation by the inquiry into the death of a practitioner at East Ham. The London Insurance Committee, since it is bound to supply an adequate medical service, must by some means or other increase the number of medical men upon the panel, if the demand by the London Medical Committee that insured persons should be allowed to contract out of the Act cannot be

granted.

-

RESIDENT STAFFS

deputation from the Sutton urban council waited upon the members of the Metropolitan Asylums Board on Jan. 25th. The spokesman was Dr. G. H. J. Hooper, honorary medical referee to the Royal National Hospital for Consumption, and the object of the deputation was to protest against the establishment of a tuberculosis sanatorium in the town. Dr. HOOPER said that the public in Sutton were terrified at the proposal to establish a sanatorium in their midst, and, as a medical man, he thought that there was some cause for their fears. To the south of the Downs School there was some small property, and immediately opposite there was an elementary school. On the north side was a large eligible building property, which was regarded as the plum"" of the district. The people interested in the development of this property and those living in the vicinity were horrified at the idea that these poor patients should be treated at the school. Near the building was a farm from which a large number of residents were supplied with milk. He received milk from that farm himself, but if the school were used as a sanatorium he would refuse to have milk from that farm, and other people would do the same. He did not regard a building intended for the accommodation of 600 girls as suitable for a sanatorium for 300 patients. The consumptives could not be kept within the four walls of the Downs estate ; they must have exercise, and would be found walking over the Downs and in the streets of Sutton. That involved a danger to the inhabitants. It might be replied that the patients would be supplied with the necessary utensils, but would they use them? It was not a fancy to say that it would mean ruin to Sutton to have 300 tuberculous patients wandering over the Downs and in the town. The inhabitants asked the Board to help them if possible ; they knew they could not object to having institutions built in their midst, but in addition to the sight of suffering humanity there were questions of risk and also of sentiment involved. He did not think the Downs School, from its exposed situation, was suitable for a sanatorium, and thought that a more suitable place could be found without injuring a prosperous residential town. Sir EDWARD WHITE, a member of the Board, pointed out to Dr. Hooper that the Brompton Hospital was in the midst of a purely residential neighbourhood, and that the patients could be seen from the road taking exercise in the grounds. Dr. HOOPER replied that patients were only kept at the Brompton Hospital until they could be sent to a more suitable place. Professor W. R. SMITH : The local cases of tuberculosis walk about Sutton? Dr. HOOPER agreed that this was so. Mr. W. DENNIS, the chairman, thought it would not be fair that the deputation should go away under the impression that the arrangements to which they objected could be completely abandoned after having received the approval of all the authorities and Government departments concerned. These arrangements would only obtain until March, 1914, though he could not promise that they would not be continued after that date. Neither could he say whether it would be possible to keep the patients within the boundaries of the institution. He could assure the deputation that in arriving at its conclusion the Board had had advice which it thought thoroughly reliable and good. No discussion took place after the deputation had withdrawn.

INSTITUTIONS AND MEDICAL BENEFIT. The finance committee of the Metropolitan Asylums Board on Jan. 25th reported as to the arrangements to be made for medical benefit of the insured members of the staff, comprising some 1800 persons, of whom 1750 were women, practically all being entitled to residential emoluments. In the case of the non-resident staff the committee said there was no reason why they should not proceed as ordinary insured persons, selecting their medical attendant from the panel or otherwise conforming with the regulations. The case of the resident insured staff, however, was entirely different. Under the Regulations, any or all of the medical men on the local panel might be chosen by different individuals of the resident staff of any institution. This could hardly fail to give rise to the greatest difficulties, even if the managers were willing to allow outside doctors free access to their institutions. The medical superintendents of the Board’s London hospitals were unanimous as to the impracticability of such a position. The Board’s medical officers were required to attend sick members of the resident staff, although the staff could not demand treatment as a right. In view of the serious considerations of administration and discipline, and the questions of medical responsibility involved, informal inquiries were made of the Insurance Commissioners, who advised that the Board should communicate with the Insurance Committees for the areas concerned, with a view to their allowing the resident insured staff collectively, in lieu of receiving medical benefit under arrangements made by the Committees, to take their medical benefit direct from the Board. The Board would guarantee treatment, medicines, &c., practically on the lines volunA NATIONAL INSURANCE ACT CHART. tarily followed heretofore, some modifications in the matter of records being made, and the Board would be entitled to We have received a copy of an ingenious chart,40 inches claim from the Insurance Committees in respect of this wide by 30 inches deep and printed in colours, which sets service. While individual employees were under no obliga- out in clear, terse language the provisions of the National tion to accept this proposal, the committee expressed the Insurance Act, and arranges this mass of digested informahope that they would do so. The Board approved the tion upon an orderly system, whereby any point that is in arrangements suggested by the committee. doubt may be brought to a focus with the least possible waste of time. This result has been obtained by what the PROTEST AGAINST THE ESTABLISHMENT OF A SANATORIUM compilers call a scientific method of functional analysis. AT SUTTON. Although their own explanation of their method is someIn regard to the arrangements, now almost completed, for what obscure, the method itself in its application to a complex The subject matter of the reception of tuberculous persons entitled to sanatorium Act of Parliament is quite simple. benefit at the Downs School, Sutton, Surrey, the Metro- the Act, having been reduced to its most wieldy proportions, politan Asylums Board having entered into an agreement is rearranged in seven vertical columns according to the seven with the London County Council for this purpose,a 2 Chart of the National Health Insurance Act. Published by the Association of Standardised Knowledge, Limited, of 15-16, Buckingham1 THE LANCET, Dec. 14th Price W.C. 1s. and 3s. 6d. (p. 1671) and 21st (p. 1743), 1912. street, Adelphi, London, .

OF

355 " functions " postulated by the compilers. The names given to these functions are not very happy, but the central idea is sound, and the system works. The essence of the Act, thus grouped into parallel columns, is further divided horizontally by headlines into five levels, corresponding to the five main groups of persons concerned in the working of the Act. Assuming that this chart claims to be merely a summary and guide to the Act and to nothing but the Act, it is a remarkable achievement in graphic analysis. It is not a commentary in the sense of making comments, and it does not touch the Regulations and Rules. It therefore makes no attempt to clear up those difficulties of procedure upon which the Act itself is vague or silent, and it treats the medical profession in the same airy fashion as does the Act. Hence the chart has the defects of the Act to which it is an index, while its merits are all its own. We believe that it will prove a great convenience to all who are engaged in the administration of the Act.

Medical News. SOCIETY

OF

APOTHECARIES

OF

LONDON.-At

examinations held recently the following candidates passed in the subjects indicated :Surgery.-E. M. Brand (Section II.), Royal Free Hospital. Medicine.-G. M. Cordingley (Sections I. and 11.), Royal Free Hospital ; G. E. Cuttle (Section I.), Manchester; R. B. F. Frazer (Sections 1. and IL), Charing Cross Hospital; and J. W. Harrison (Sections 1. and II.) and G. R. Lynch (Section I.), St. Mary’s Hospital. Forensic Medicine.-J. A. A. Boddy, Manchester ; G. M. Cordingley, Royal Free Hospital ; R. B. F. Frazer, Charing Cross Hospital; and H. C. C. Hackney, King’s College Hospital. Midwifery.-G. M. Cordingley, Royal Free Hospital; G. E. Cuttle, Manchester ; J. A. Prendergast, Leeds; and L. C. Smith, London Hospital. The diploma of the Society was granted to the following candidate, entitling her to practise medicine, surgery, and midwifery:-E. M. Brand.

FOREIGN

UNIVERSITY INTELLIGENCE.-

BerlizaDr. Jacob Wolff, author of several monographs

on

influenza and other matters coming largely under the notice of the general practitioner, has been granted the title of Professor.-Gratz :: Dr. Eugen Petry, vrivat-doeent of medicine, has been granted the title of Extraordinary Professor.-Munich :Dr. Walter Spielmeyer, the chief of the Laboratory of Cerebral Anatomy of the University Psychiatric Clinic, has been granted the title of Extraordinary Professor. Dr. illeinhard von Pfauncller, extraordinary professor of children’s diseases, who was recently offered the chair of his specialty at two other universities, has been induced to remain in Munich by being appointed Ordinary Professor.Vienna :Dr. Emil Redlich has been appointed Extraordinary Professor of Psychiatry and Neurology, and Dr. Wolfgang Pauli Extraordinary Professor of Medicine. Dr. Wilhelm Roth, privat-docent of laryngology, Dr. Emil Schütz, privat docent of medicine, Dr. Heinrich Winterberg, privat-docent of general pathology, Dr. Gabriel Nobel, privat-docent of dermatology, Dr. Sigmund Erben, privat-docent of medicine, Dr. Stephan Weidenfeld, privat-docent of dermatology, Dr. Karl von Stejskal, privat-docent of medicine, Dr. Otto Marburg, privat-docent of neurology, Dr. Wilhelm Falta, privat-docent of medicine, Dr. Josef Meller, privat-docent of ophthalmology, Dr. Robert Daerr, privat-dooent of pathology, Dr. A!fred Exner, privat-docent of surgery, and Dr. Egon Ranzi, privat-docent of surgery, have been granted the title of Extraordinary Professor. Dr. Albert Miiller and Dr. Dr. Wilhelm Neumann have been recognised as privatdoeenten of Medicine.-Würzburg : Dr. Helly, privat-docent of pathological anatomy, and Dr. Liidke, privat-docent of medicine, have been promoted to Extraordinary

and

21st,

at 8.15 P.M., at

the

Royal Sanitary Institute,

Mr. H. Percy Boulnois; M.Inst. C.E., on " Hygiene of the Home." The chairman of the Chadwick Trust, Sir William J. Collins, will preside, on the first evening. Students and the general public will doubtless welcome these lectures, with their information and suggestions concerning the hygienic value of life’s’ most intimate environment. In April Dr. J. T. - C. Nash will lecture on ’’The Evolution of Epidemics," to bedelivered at the London County Hall, Spring Gardens. Sir Alexander Binnie, M.Inst.C.E., will be the chairman on behalf of the Trust at the first lecture. In June Dr. F. W. Mott will give a course at the Royal Society of Arts under the title of I Nature and Nurture in Mental Develop-ment." Sir James Crichton-Browne, also a Chadwick. Trustee, will preside at the first lecture. Among the lectures in contemplation for the provincial cities are those on "The Public Milk-supply: Some Criticisms and Suggestions from the Public Health Standpoint," by Professor Henry R. Kenwood at Manchester; and on "Watersupply," by Mr. E. P. Hill, M.Inst.C.E., at Birmingham. Glasgow, Bristol, and other cities of the kingdom will also be provided with Chadwick public lectures during the year, all of which will be open to the public, but will aim also toattract post-graduate and advanced students of engineering, medicine, and other cognate sciences. The secretary to the Trust, to whom all communications should be addressed, is Mrs. Aubrey Richardson, 8, Dartmouth-street, Westminster.

Buckingham

Palace-road, by

FORTY-SECOND

CONGRESS

OF

THE

GERMAN

SURGICAL ASSOCIATION.-This Congress will take place in Berlin in the Beethovensaale der Philharmonie (entranceKothener Straase, 32), from March 26th to 29th next. This hall has been chosen by the committee from a great numberinspected, and it is hoped that this year certain inconThere is a veniences of previous years will be avoided. and in number of members consequence (2179), they large are begged to curtail their papers as much as possible. Some of the chief papers to be submitted will be Duodenal Ulcer, by Herr Kuttner (Breslau); Brain and Spinal Surgery, by Herr von Eiselsberg and Herr Ranzi (Vienna) ; and the Treatment of Joint and Bone Tuberculosis, by Herr Garre (Bonn). The President for the year 1913 is Dr. 0. von Angerer, Munchen-Harlaching (Willroiderstrasse, 8.), and the treasurer is Herr Melzer, Langenbeckhaus, Ziegelstrasse, 10 and 11, Berlin, N. 24.

LITERARY INTELLIGENCE.-Mr. Murray’s quarterly list for January, 1913, contains among his forthcoming works several on subjects having more or less professional interest for the medical man. Among these may bementioned" Practical Agricultural Chemistry," by S. J. N. Auld, D.Sc., and D. R. Edwardes-Ker, B.A. ; " Comparative Anatomy of Vertebrates," by Professor J. S. Kingsley, of Tufts College, Mass. ; "The Reduction of Domestic Flies," by Edward Halford Ross, M.R.C.S. Eng., L.R.C.P. Lond. ; ’’ Further Researches into Induced Cell Reproduction and Cancer and other Papers," by H. C. Ross, M.R.C.S. Eng.,. J. W. Cropper, M.B. Liverp., E. H. Ross, M.R.C.S. Eng.,. H. Bayon, M.D., W. J. Atkinson Butterfield, F.I.C., and S. R. Mowlgarkar, F.R.C.S. ; "The Problem of the Gasworks, Pitch Industries, and Cancer" (anonymous) ; "Problems of Life and Reproduction"(Progressive Science Series), by Professor Marcus Hartog, D.Sc. ; "The Interpretation of Radium,"by Frederick Soddy, M.A. ; and "Heredity," by Professor J. Arthur Thomson.

NATIONAL DENTAL HOSPITAL.-The annual general meeting was held on Jan. 22nd, at Great Portlandstreet, London, Mr. Alfred Farquhar being in the chair.

The balance sheet showed a debt of 467, and friends arebegged to help the committee to reduce this amount. The report showed that during the year grants had been, Professorships. received from King Edward’s Hospital Fund for London, THE CHADWICK TRUST.-This founded £250 ; King Edward’s Hospital Fund for Improvements,. in 1895 under the will of the late eminent sanitarian, £200 ; and the Metropolitan Hospital Sunday Fund, Donations had also been received from’ Sir Edwin Chadwick, has arranged for a series of public 44 16s. 2d. the Worshipful Company of lectures to be delivered during this year in London and Smith’s Charity, 250 ; The object of the Trust is the I Goldsmiths, £ .25 ; Messrs. Bass, Ratcliff, and Gretton, certain provincial towns. promotion of sanitary science in all or any of its branches in ’, 10 10s. ; Mr. Harold Ridges Rowe, South Africa, A legacy was various ways indicated by the founder, or otherwise at the £10 10s. and Miss M. E. Swaine, £10. The first of the courses of received, per the trustees of the late Miss M. Gibbon, for discretion of the trustees. Considerable improvements have been 19s. 4d. lectures will be given on Friday evenings, Feb. 7th, 14th, &175

Trust,