1825THE ANNUS MEDICUS 1912.

months of its first presentation to Parliament. When theChancellor launched the scheme the admirable principlesunderlying much of the Bill obscured the difficulties whichmust arise in many directions, notably with regard to theadministration of medical benefits.

From the first it was shown in our columns that the Bill as

it was presented involved grave risks to the practice ofmedicine, and later disclosures and discoveries onlyemphasised the need for this warning. Time after time we

have insisted that, notwithstanding the general motives ofthe Bill, grave danger must lie in forcing through a schemewhich proposed to improve the public health by a vastextension of club practice. It soon became obvious that theBill as it stood could not be accepted by the profession, andthe British Medical Association took in hand the task of

formulating the minimum demands which should be concededby the Government before the profession would cooperate inworking the scheme. These demands were then known as

"the six cardinal points." Throughout the summer andautumn and into the winter of 1911 the leaders of the

Association carried on negotiations with the Chancellor, andmeanwhile the Bill passed through the House of Commons,undergoing innumerable changes in its course, but not

coming into line with medical requirements in any definiteor satisfactory manner.Then came the great protest of the medical profession,

following the appointment of Mr. SMITH WHITAKER as

a Commissioner and the passing of the Bill into law.So matters stood at the end of 1911, it being agreedthat all possible means should be taken to insure thatno practitioner should undertake medical attendance and

treatment of insured persons under arrangements not in

accordance with the principles and conditions laid down.

During the first six months of the current year the situationremained unaltered, the resistance of the medical professionto the upheaval of their professional life was maintained,and was confirmed at the meeting of the British MedicalAssociation in Liverpool, where, however, opposition wasremoved from the administration of the sanatorium benefitsunder the Act which were to come into force in July, 1912.But the working of the part of the Act dealing with sana-torium benefit has been found difficult, owing to the facts(1) that in many localities the conditions under which themedical profession are invited to do the work were not satis-factory ; (2) that where satisfactory local arrangements hadbeen made with the medical profession these have undergone modification, owing to a new arrangement by which the" tuberculosis 6d." has been offered as a capitation rate uponall insured persons in satisfaction of the domiciliary treat-ment of tuberculosis ; and (3) that there has been no propertime to arrange definite schemes for the systematic treat-ment of those suffering from tuberculosis or for their

sanatorium accommodation when required. The offer of the" tuberculosis 6d." was contained in a statement made byMr. LLOYD GEORGE to the Advisory Committee under theNational Insurance Act, and before this statement was madea further period of waiting ensued, inasmuch as assurances,official and unofficial, had been given that when the Pro-visional Regulations for the working of the administration ofthe medical benefits were completed it would be found thatthe cardinal demands of the medical profession had beenmet.

The Provisional Regulations were officially issued to thepublic at the beginning of October, and they and our

analysis of them will be found in THE LAXCET of Oct. 5th.It became evident at once that the general reluctance towork the Act had not been removed by the Regulations,which, moreover, contained no definite money offers. On

Oct. 23rd Mr. LLOYD GEORGE made the statement to the

Advisory Committee already referred to, which will be found’published at full length in THE LANCET of Oct. 26th. Inthis statement a capitation rate (not, however, uncondi-

tionally) of 8s. 6d. was arrived at in the following way :6s. 6d. for ordinary medical treatment, ls. 6d. for drugs, togo as a rule to the pharmaceutical chemist, a further 6d. fordrugs to accrue to the medical man if not required for extradrugs, and to this the tuberculosis 6d." was additional. TheState Sickness Insurance Committee of the British Medical

Association reported at length upon the Provisional Regula-tions and the money offer made by the Government ; and theCouncil of the British Medical Association, in adopting thisreport for presentation to the Divisions and the Repre-sentative Body, showed clearly that the struggle was still aliveand keen. The Provisional Regulations made no arrangementsfor payment of mileage, made no satisfactory increase inprofessional representation upon the Local Insurance Com-mittees, and instituted a court of inquiry for dealing withcomplaints concerning the administration of medical benefitswhich was regarded as dangerous to professional men, whilethe duty of keeping records of their cases appeared to manyboth to promise an increase of clerical work and a violationof professional confidence. The Representative Body of theBritish Medical Association, having received this report,met on Nov. 19th at the Connaught Rooms, London, and incircumstances which are too recent to need any furtherdetail here deputed five members of the Association-

namely, the Chairman of Council, the Chairman of the

Representative Body, the Vice-chairman of the Repre-sentative Body, Dr. T. A. HELME of Manchester, and Dr.R. M. BEATON of London-to meet the Chancellor and

discuss with him and the Commissioners certain definite

agreed points upon which the medical profession mustcontinue to demand modification’.To the representations and arguments of the five delegates

of the British Medical Association the Chancellor of the

Exchequer replied in the statement published in THE LANCETon Dec. 7th. The Council of the Association sent this

statement immediately to the Divisions and a poll of the

medical profession was taken, non-members as well as.

members of the Association voting upon the general questionof whether the Act should now be worked. The votes were

11,219 against working and 2408 for working, the small size

of the poll leading to much anxious surmise. On Dec. 21st

the Representative Body of the Association met, and after adebate which was prolonged until midday on Monday last,endorsed the view of the majority by 182 votes to 21. At

the same meeting an alternative policy, under which theAssociation would treat insured persons, was outlined by aresolution which will be found on page 1838.

HOSPITAL FUNDS.

Metropolitan Hospital Sunday Fund.Under the presidency of the ex-Lord Mayor, Sir THOMAS

BOOR CROSBY, the Metropolitan Hospital Sunday Fundcollections amounted to £ 67,972 14s. 3d., an increase of

.6957 over last year. The total of the collections in thevarious places of worship was 635,866, or Z1195 less than in1911. St. Paul’s Cathedral, where the King and Queenattended morning service on Hospital Sunday, headed thelist of collections with E4214, and the largest collections

from churches and other places of worship were: Christ

Church, Lancaster Gate, Rev. Prebendary GURDOX, .6949 ;St. Michael, Chester-square, Rev. J. GouGH MCCORMICK,.6608; Holy Trinity, Chelsea, Rev. H. R. GAMBLE, £ 408 ;St. Peter, Eaton-square, Rev. Prebendary STORRS, R399 ;St. Mary Abbots, Kensington, Rev. Prebendary PENNE-

FATHER, .6377 ; St. Mark, North Audley-street, Rev. H. P.CRONSHAW .f:266; St. Paul’ Onslow-square, Rev. Prebendary

1826 THE ANNUS MEDICUS 1912.

-

WEBB-PEPLOE, .6254; St. George, Hanover-square, Rev. F.N. THICKNESSE, £ 247 ; St. Paul, Knightsbridge, Rev. F. L.BOYD, .6228; St. Peter, Cranley Gardens, Rev. W. S.

SWAYNE, .6217; Brompton Parish Church, Rev. A. W.

GOUGH, S210 ; Wimbledon Churches, Rev. J. ALLEN BELL,. £ 196 ; St. Stephen’s, S. Dulwich, Rev. F. E. WHITE, £ 178 ;St. Jude, South Kensington, Rev. Prebendary EARDLEYWILMOT, .6177; St. James’s, Piccadilly, Rev. Canon

McCoRrIICx, S163; Holy Trinity, South Kensington, Rev.H. B. COWARD, .6154; St. Margaret, Westminster, Rev.Canon HENSLEY HENSON, .6141; Westminster Abbey, VeryRev. the DEAN, .6136 ; St. Peter, Vere-street, Rev. R. W.

BURNABY, .6133 ; St. Simon, Chelsea, Rev. W. M. SELWYN,£133 ; Aldenham Parish Church, Ven. the Hon. ArchdeaconGIBBS, S132 ; Holy Trinity, Tulse Hill, Rev. H. WoFFINDIN,..6130 ; Chislehurst Churches, Rev. J. E. DAWSON, £ 127 ;- Christ Church, Mayfair, Rev. E. S. HILLIARD, .6122;Emmanuel, Wimbledon, Rev. E. W. MOORE..B122;Bickley Parish Church, Rev. W. A. CARROLL, £ 121 ;Holy Trinity, Paddington, Rev. C. E. WHITE, .6120;: St. Paul, Avenue-road, Rev. G. A. FORD, £ 117 ; St.

Mary, Bryanston-square, Rev. L. J. PERCIVAL, ,115;‘ :Temple Church, Rev. H. G. WOODS, .6115; Annuncia-

tion Church, St. Mary-le-Bone, Rev. B. D. SHAW, £ 112 ;. All Saints, Margaret-street, Rev. H. F. B. MACKAY, ,6111;,St. Stephens, South Kensington, Rev. Lord VICTOR SEYMOUR,mil; St. John, Penge, Rev. W. SMYLY, Sill; St. John,Paddington, Rev. E. P. ANDERSON, .6103; St. Peter’s,Brockley, Rev. C. H. GRUNDY, £ 103 ; All Souls, Hamp--stead, Rev. C. J. TERRY, .6102 ; St. Mark’s, Reigate, Rev. A.. SIMMONDS, £ 100; St. Columba, Font-street, Rev. A. FLEMING,1).D., .B320; West London Synagogue, Rev. M. JOSEPH, £ 324;Great Synagogue, .6234 ; Essex Church, Kensington, Rev.

-F. K. FREESTON, .6345; Westminster Chapel, Rev. G.

CAMPBELL MORGAN, .B193; City Temple, Rev. R. J.

CAMPBELL, M.A., .6119; Theistic Church, Swallow-street,the late Rev. CHAS. VOYSEY, .6175 ; St. Paul’s Presbyterian,Church, Westbourne-grove, Rev. J. W. WALKER, .693 ; St.John’s Presbyterian Church, Kensington, Rev. E. D. FING-

LAND, .693 ; Victoria Park Christian Evidence Association,,Mr. T. COLE, .683; Greek Church, Bayswater, The Archi-

’ mandrite, .673 ; Brompton Oratory, Rev. H. D. S. BOWDEN,£ 73 ; Church of Immaculate Conception, Farm-street, Rev.C. NICHOLSON, £ 50 ; Dutch Church, Austin Friars, Rev.

. ‘S. B. DE LA FAILLE, £ 47 ; German Church, Camberwell,.Rev. H. HACKMAN, .B46; Metropolitan Tabernacle, Rev.

.A. G. BROWN, .B32; Bromley, Kent, Wesleyan Church, Rev. W. WOOD, £ 30 ; Gordon-square Catholic Apostolic Church,Mr. H. S. HUME, .623 ; Wanstead Society of Friends, Mr. THEODORE GODLEE, .B22.

Among the donations received by the Fund was one of.’..61000 from Mr. WILLIAM HERRING and an anonymousdonation of £ 500. A legacy of £500 was received from the

estate of the late Mr. CHARLES J. ROBIN. There were 257 institutions which applied for grants from the Fund, beingtwo less than in 1911, and a sum of .662,401 was distributed

. among them. The working expenses for 1912 were

£3125 7s. 7d., as against .B3447 17s. 5d. in 1911, being. 4-597 per cent. of the gross receipts as compared with 5-145last year. The average percentage of working expensessince the establishment of the Fund in 1873 is 3-926.

In accordance with an ’undertaking given at the annual

meeting of constituents last December Sir THOMAS CROSBYattended at St. George’s Hospital and made an exhaustiveinvestigation of the work of the Bacteriological and Patho-logical Departments, and the cost of such work. SirTHOMAS CROSBY reported : "I am of opinion, after an

investigation of all the facts, that the piloportionate amountpaid by the hospital and school for -theupkeep of the

laboratories is a fair and proper one, and that the sums

expended upon these departments by the hospital are

properly taken from the general funds, being for the directtreatment of the patients." This report was received by theCouncil at a meeting on March 7th, and was acted upon bythe Committee of Distribution in arriving at the basis of theaward recommended to St. George’s Hospital.

King Edward’s Hospital Fund.At the annual meeting of governors and general council

of this Fund, which was held at St. James’s Palace on

April 20th, it was annoumced that the total receipts ior theyear 1911 were .B235,620 9s. 9d., including a contribution of£ 17,000 from the League of Mercy. The amount at first

allocated for distribution was £ 15’7,500, an increase of

.B2500 over the sum distributed in 1910, but, a muni-

ficent contribution by Sir ERNEST CASSEL of .631,500,part of a gift of f.50,00O to the hospitals of Londonand the provinces in memory of his daughter, enabledthe committee to distribute .B189,OOO. Of this the

hospitals received .B181,200, while the remaining E7800

was distributed among consumption sanatoriums and

convalescent homes taking London patients. Two useful

reports have been issued by the Fund during the year-namely, the Statistical Report on the Ordinary Expenditureof London Hospitals and the Report of the Committee

Appointed to Inquire into the System Prevailing in the

London Hospitals with Regard to the Administration of

Out-patients, a summary of each of which will be foundin THE LANCET of Oct. 5th, pp. 965, 966.At the meeting of governors and general council held

last week at St. James’s Palace it was announced that thetotal amount received for general purposes by the Fund toDec. 16th, after payment of expenses, was .6117,338 10s. 3d.,as against .B184,000 last year, excluding certain dona-tions. The Fund has, therefore, received a check to

the steady rise in its income which has been shown sinceits inception, but by drawing on the surplus of past years ithas been possible to distribute this year £ l57, 500. The

London hospitals will receive .6151,000 and consumptionsanatoriums and convalescent homes .B6500.At the thirteenth annual meeting of the League of Mercy,

which was held at St. James’s Palace on Dec. 16th, it wasannounced that the total sum collected for the year was

19,912, as against .B19,586 in 1911.

Hospital Saturday Fund.The annual income of the Hospital Saturday Fund, which

was founded in 1873 for the purpose of obtaining help forthe metropolitan hospitals and kindred institutions from

those who were not reached through the operations of

the Metropolitan Hospital Sunday Fund, now exceeds

.635.000, which is obtained from some 8000 places ofbusiness. The annual report shows that help is obtainedfrom practically every trade, friendly society, and club,the employees of the London County Council, Port ofLondon Authority, the borough councils, the railway com-panies, the Metropolitan Water Board, the General Post

Office, the Royal Arsenal, Woolwich, the Royal SmallArms Factory, Enfield Lock, the Royal Victoria Yard,Deptford, and so forth, and the members of the Metro-

politan and City police. Since its foundation the Fundhas collected and distributed among the medical charitiesof London .B583,629. In recent years there have beenabout 200 participating institutions. The Fund, recog-nising the great importance of early treatment in cases ofpulmonary tuberculosis, has endowed beds at the BenendenSanatorium, Kent ; at the Mount Vernon Hospital, Hamp-stead, and its sanatorium at Northwood ; at the Fair-

light Home, Hastings ; and at the Eversfield Hospital,St. Leonards. Forty-seven beds are at present endowed, the

1827THE ANNUS MEDICUS 1912.

patients paying, as a rule, 7s. 6d. per week for the firstsix weeks, after which time the rates are arranged in

accordance with the means of the patients and othercircumstances. The sum thus received has enabled the Fund

to assist many applicants who could not otherwise be

relieved. During the first half of the present year the

various departments of the Fund made steady progress,but in the second half the income of the Fund was

seriously affected by the operation of the National InsuranceAct. Up to Dec. 14th the total receipts of the Fund

amounted to £ 23,932, as against £ 25,061 in the correspondingperiod of 1911.

INTERNATIONAL PUBLIC HEALTH AND MEDICALPOLITICS.

Our Special Sanitary Commissioner, as on many previousoccasions, has made interesting investigations during theyear into sanitary questions affecting international relations.

Cholera in Italy.The International Congress on Tuberculosis and the Inter-

national Peace Congress were to have met in Rome duringthe month of September, 1911. They were both postponednominally under different pretexts, in reality because therewas cholera in Rome. The public did not know to what

extent this disease prevailed in Italy, though it was quiteclear from accounts in lay papers that there were many cases.At Leghorn and in small villages near Genoa there wereoutbreaks. On the French frontier from the beginning ofthe year all arrivals from Italy were examined and placedunder medical surveillance for five days, but it is notoriousthat the hygienic conditions of Italy are always interpretedas bad on the French and Swiss sides of the border.It was not till April this., year that the Congress onTuberculosis was able to meet at Rome, and by that time thefull facts relating to the cholera epidemic had been ascer-tained. Our representative at the Congress made an in-vestigation, and was able to give a description of the choleraepidemic in Rome. Naples was the port of origin in Italy,and the disease developed when the travellers reached Rome.There were in all three separate outbreaks, each in a differentpart of the city, and although the number of cases has neverbeen stated, there were some hundreds. The very centre of

Rame, the narrow streets near the Piazza Collona and theHouses of Parliament were affected, and the situation was adifficult one to deal with. Tall overcrowded houses and

(lark, narrow streets naturally favour the spread of epidemics.The sanitary authorities have considerable legal powers toact in Italy. They can condemn insanitary property anddrive the tenants out. But there is as yet no machinerydevised for housing the expelled. A subsidised organisationis wanted capable of and willing to build better housingacccmmodation, and there is no money available for such apurpose. Thus sorely needed measures and excellent lawsremain in abeyance, and Rome is still exposed to graverisks.

Plagite and Cholera Precautions at ltlcerseilles.The menacing prevalence of cholera at Constantinople

and among the troops engaged in the Balkan war renderstopical the reports on the cholera defences at Marseilles,published in THE LAXCET during the summer. Marseilles is

undoubtedly a door between Western and Eastern Europethrough which epidemics are very likely to pass ; precautionstaken there against epidemics become a matter of generalconcern. Luckily the sanitation of Marseilles itself has beenmuch improved of late years, though there still remains a

great deal to be done in the opinion of our Special SanitaryCommissioner. There is yet much overcrowding, and this bypeople who are mostly in a bad sanitary condition, beingmostly Italians and Levantines who are poor and dirty.But the city has much improved. Formerly there were no

less than 13,000 houses that had no sanitary accommodation’whatsoever, and the household filth was simply thrown into the gutter as it was thrown in the Middle Ages.Now only 1400 such houses remain; yet this is-

far too many, especially for a city in the critical

position of Marseilles. While such sanitary defects stillexist it is obvious that every care must be taken to preventthe contamination of quarters well calculated to favour the

spread of disease. Thus it is not surprising to find that theauthorities, under the pretext of disinfecting emigrants andtheir clothes, contrive to detain them for 24 hours, so as tohave ample time for very thorough medical inspection,,frequently followed by the bacteriological examination offæcal matter. This occasions much work and requires alarge staff. Fortunately the material means are forth-

coming. A sanitary tax is now imposed on vessels enteringthe port. It only amounts to from id. to 1½. per ton

capacity, but it produces £ 30,000 a year, and with this some..thing effective can be done to protect the port by watchingover ships, their crews, and passengers when they come fromplague- or cholera-stricken localities. Such surveillance

includes the examination of rats and their occasional

extermination. Here, as in other countries, there is the

overlapping of various authorities, State and municipal, butfortunately at Marseilles the different services are, for the’moment at least, working harmoniously together. At the

laboratory some 40 to 80 rats are examined per day, andsome of these are caught by the port rat brigade under theMinistry of the Interior or Central Government, others bythe town rat brigade under the municipality of Marseilles,and the rival brigades work well together.

Sanitary Progress in America.Our Special Sanitary Commissioner gave a lengthy account

of the International Congress of Hygiene and Demographywhich met in Washington this year. Measures for securingthe State and voluntary control of factories and workshops.were described. This of course differs very much from State

to State. The State of Wisconsin, for instance, goes so faras to render the notification of cases of occupational diseasecompulsory, at least in so far as these may be due to mercury,lead, arsenic, phosphorus, or working in compressed air. In,

New York the main effort for general improvement in

the lot of the working man comes from voluntary associa-tions of employers and employed joining together to

secure proper light and ventilation in workshops. But

all such efforts really depend for success on the generalpublic. It is the purchaser who should make inquiries andshow that he is anxious to buy only such goods as have beenmade under wholesome conditions.

In the war against tuberculosis there has been in Americaa widespread response to public appeal for cooperation, andconsequently a great deal has been done. No less than

£2,900,000 has been spent in the year for the building ofhospitals, dispensaries, the giving of lectures, and other

measures destined to fight this special disease. At firstwhat was done was the result of voluntary effort, now themunicipalities and the States have been induced to assumethe responsibility, and the greater part of the moneycomes from the public purse and not from privatedonations. Last year it amounted to 66.2 per cent.

of the whole, and the previous year to 62-2. In

1909 the States and municipalities only gave 52-5 5 of whatwas spent in dealing with tuberculosis. In this respectNew York and Pennsylvania have done best; Colorado and.the newest States have done the least. There has been a

considerable reduction in the number of cases of tuberculosis,resulting, however, not only from the special measures taken.against that one disease, but rather from the generalsanitary improvements effected in the large towns.