244

societies, employers of labour, insurance companies, or

other bodies, or (iii.) under any contributory scheme ; and(c) Private Patients.-Those who pay for special accom-

modation and who arrange for medical treatment feesindependently of the hospital.

An In-patient Tariff.Finally, an important debate put on record the

views and policy of the British Medical Association inrespect of a tariff for in-patients. The followingmotion, including verbal amendments, which thechairman of the Hospitals Committee was permittedto make, was carried :-When the board of management of a voluntary hospital

enters into a financial arrangement with an employer oflabour, a public authority, approved society, insurancecompany or any other body, or under a contributoryscheme for the reception of patients, such arrangementsshould be taken to cover the full cost of maintenance andtreatment, and should provide as follows :-

(a) Payments made for tariff in-patients should be forwork done based upon a tariff of fees agreed upon from timeto time between the contracting parties ; such tariff of feesmaking full allowance for provision of hospital accommoda-tion, maintenance, and payment of medical staff.

(b) The accounts of the hospitals should be kept so as toshow the cost of this hospital benefit.

(c) Inability to pay for adequate treatment as a privatepatient, whether in the hospital or outside, should be theconsideration for the admission of all tariff patients forhospital treatment.

(d) All persons, whether insured under the NationalHealth Insurance Acts or not, whose income from all sourcesdoes not exceed the limits of a specified scale, should beeligible for hospital benefit on tariff rates. The hospitalshould reserve its right to challenge admissions. Thefollowing maximum scale is suggested, subject to economicand local variations and to periodic revision :—

CLASS l.-Limit of Income- £ 200.(a) Single persons over 16 years of age.(b) Widow or widower without children under 16

years of age.CLASS 2.-Limit of Income 2250.

(a) Married couples without children under 16 years of age.(b) Persons with one dependent under 16 years of age.

CLASS 3.-Limit of Income ;&bgr;300.(a) Married couples with a child or children under

16 years of age. ’

(b) Persons with more than one dependent under 16,

years of age. ,

(e) For those persons whose income places them beyondthe agreed specified scale for tariff patients arrangementsmay be made to receive them as private patients.

(f) The ordinary hospital routine of admission, trans-ference, and discharge of patients should not be modified fortariff patients, nor should any preferential treatment begiven to them.

(g) No tariff patient should be admitted without therecommendation of the attending practitioner, except in thecase of emergency.

Election of Officers.During the meeting it was announced that Dr.

G. E. Haslip had been re-elected Treasurer of theAssociation for the period 1922-25, and that for the Iperiod of 1922-23 Dr. R. Wallace Henry had beenelected Chairman and Dr. H. B. BrackenburyDeputy-Chairman of the Representative Body.

LONDON RESOLUTIONS ON A STAFF FUND.-The £

following resolutions have been passed as a result ofa conference between representatives of the medicalstaffs of the following London teaching hospitals :-St.Bartholomew’s, St. George’s, Guy’s, King’s College, St.Mary’s, Middlesex, St. Thomas’s, University College,Westminster, and the Royal Free.

1. That under present conditions, in the case of patients whocontribute towards, but pay not more than, the whole cost oftheir maintenance in a voluntary hospital, it is undesirable thatany portion of such contribution should be allotted to a stafffund. (Adopted with no dissentient.)

2. That when the State, a municipal or other public body paystowards the accommodation, maintenance and treatment of apatient, or group of patients, in a voluntary hospital, a per-centage of such moneys should be allocated to a staff fund.(Adopted, Guy’s, Middlesex, and Unive1’sity College dissenti7.)

3. That when a special clinic is held by a member of a hospitalstaff for the treatment of patients sent by the State, a municipalor other public body, the member of the staff taking such aclinic should be adequately paid. (Adopted, Guy’S dissenting.)By the term maintenance in the first resolution is understoodthe cost per bed as calculated for the purpose of the returnmade by each hospital to the King’s Fund.

INTERNATIONAL HYGIENICAGREEMENT:

PUBLIC HEALTH QUESTIONS AT THE LEAGUEOF NATIONS COUNCIL.

Report of the Health Committee.DURING the session of the Council of the League

of Nations last week at St. James’s Palace, presidedover by Mr. Quinones de Leon (Spain), a report waspresented on the work of the third session of the-Health Committee of the League, which had beenheld in Paris on May llth-16th. This report relatedamong other matters to the progress being made withresearch work on the standardisation of sera whichhad been decided on at the International Conferenceon the subject held at the British Ministry of Healthin December last.l The research work initiated bythe Conference is progressing favourably. In th&case of diphtheria antitoxin, it is hoped that theinternational standard will shortly be finally settledby the adoption of the unit used in America andGermany. An understanding in regard to an

international unit for tetanus seemed also in sight.Progress is being made with the comparative studyof the serodiagnosis of syphilis. A subcommitteehad investigated the information available from theScandinavian countries, Belgium, and Switzerland, inregard to the quantities of morphine, cocaine, and otherdangerous drugs which are legitimately required formedicinal purposes. This inquiry is continuing.The Health Committee had considered the positionof different countries in regard to the adoption ofthe standard nomenclature of causes of death. Itappeared that the international agreement on thesubject which was drawn up in Paris in 1920 hadfrom various accidental circumstances not beenofficially circulated, and that Belgium and some otherimportant countries have not on this account begunto classify deaths in the present decennium accordingto the last revised nomenclature. The HealthCommittee had arranged to expedite the officialpublication, and recommended the Council to impresson all countries which are members of the League theimportance of adopting the revised code. Othermatters considered included the development of thework undertaken at G-eneva for the dissemination ofnews relating to epidemics. The special informationabout typhus and cholera in Eastern Europe whichthe League’s Epidemic Commission obtains is nowregularly published in fortnightly bulletins. It wasdecided that this work should be continued and thatprovisionally the duties of the health organisation ofthe League as regards public health intelligence andsanitary statistics should be mainly in the nature ofinvestigations and studies of special problems, andthe question of a larger and more general service forepidemiological intelligence was deferred. Proposalswere made for inquiries as to the spread of sleepingsickness and tuberculosis among native populations.of Equatorial Africa, and the Health Committee wasconsidering a proposal by Dr. Miyajima for theinvestigation of epidemics in Manchuria. The Com-mittee had considered the recommendation of theAssembly of the League to add to their number a" medical woman experienced in public healthmatters," and recommended the nomination of Dr.Josephine Baker, Director of the Bureau of ChildHygiene, of New York City. In addition, Dr. CarlosChagas was suggested as a South American member.Important sections of the report were devoted to theinquiry of the recent Commission on quarantinemeasures in the Near East2 and to the work of theEpidemic Commission, and the resolutions of theWarsaw Conference relating to epidemics in EasternEurope.

1 THE LANCET, 1921, ii., 1331, 1339.2 THE LANCET, July 1st, 1922, pp. 25, 32.

245THIRD INTERNATIONAL CONGRESS OF THE HISTORY OF ME UICINE. medicine.

Discussion ; Eastern Europe Epidemics, the Inter-national Sanitary Convention; and the Contri-

butions from the Rockefeller Foundation.On Thursday afternoon, July 20th, at one of the

public sessions of the Council, Mr. Viviani (France)presented a report on the document above referredto, which was accepted. He drew attention to theconfusion which at present exists in the internationalarrangements relating to the prevention of epidemicdiseases in the Near East and proposed a resolution,which was adopted, congratulating the Near EastCommission of the League on its important contribu-tion to the solution of this subject in its relation tothe revision of the International Sanitary Conventionof 1912. The Council decided to draw the attentionof the Governments which are members of the Leagueto the great importance of the International SanitaryConference which ’the French Government proposesto convene to revise this Convention, including thoseparts of it which relate to the Near East. The reportof the Near East Commission was formally presentedto the Office International d’]Hygi6ne Publique, andthe Secretary-General was authorised to put thetechnical services of the League of Nations at thedisposal of the French Government when the Inter-national Sanitary Conference is held. Mr. Vivianialso referred to the great importance of action by theGovernments represented at the Warsaw Conferenceto give effect to its recommendations in regard to theRussian epidemics.- He stated also that the Rocke-feller Foundation had expressed its willingness to put$30,000 yearly for five years at the disposal of theHealth Organisation of the League for a service ofepidemiological and statistical information, as wellas a sum of$60,000 a year for three years for assistingthe interchange of public health officials of differentcountries. He proposed that the Council shouldexpress its gratitude to the Rockefeller Foundationfor its collaboration and should remit the proposalsto the Health Committee to work out detailed schemesfor the administration of these sums.

Mr. H. A. L. Fisher (Great Britain) emphasisedthe seriousness of the reports received in regard tothe spread of epidemics in Russia. He was informedthat cholera was very seriously prevalent over wideareas in Southern Russia and in the Ukraine, andthat the news of its spread is becoming steadilyworse. The programme of the Warsaw Conferencerequired the raising of an immediate sum of 21,500,000by the contributions of the Governments representedat Genoa. It was very desirable that this programmeshould be carried out, but the chances of obtaining thesum referred to in present economic circumstanceswere not encouraging. Nothing, however, could bemore regrettable than to close down at this juncturethe admirable work of the League’s Epidemic Com-mission. The British Government took the viewthat a relatively small sum, if made available atonce, would enable a very material and importantpart of the Warsaw programme to be carried out.This part of the programme related primarily to thefrontier measures, which should be taken not onlyin Poland and in the border States but also on theRussian side of the boundary. It was also verynecessary to deal with the prevention of the spread ofinfection by shipping from the cholera-infected portsof the Black Sea. He did not, however, wish torestrict the utilisation of any available funds toorigidly and everything possible should be done withinRussia itself to assist in minor but important ways,like the supply of drugs in Russia on important linesof communication. He emphasised the impossibilityof application for a grant being made to the BritishParliament even for the smaller programme hereferred to, in the absence of assurances that similaraction would be taken by other Governments.The resolutions relating to the Near East Com-

mission and the revision of the International SanitaryConference of 1912 were of special importance. TheBritish view was that the revision of this Conventionis becoming a matter of much urgency, not only in

the interests of good public health administrationbut also in the interests of commerce. It is notconsidered desirable or necessary that, the assemblyby the French Government of the InternationalSanitary Conference to revise this Convention shouldbe delayed on account of political uncertainties in theNear East. That part of the Convention which relatesto sanitary and quarantine measures in the NearEast could be revised on its technical basis withoutwaiting for the conclusion of a new Treaty of Peace.

In view of the fact that the proposals for workin collaboration with the Rockefeller Foundation arebeing remitted to the Health Committee of theLeague, it seemed inadvisable for the Council tospecify now too definitely the exact purposes to whichthis assistance will be applied. Mr. Viviani acceptedthis view, and agreed to a modification of the resolu-tion for the purpose. At the same time he consideredthat the Council should not approve new proposalsfrom the Health Committee which involved additionalexpenditure on the League. If the money came fromoutside sources the matter was different.The report and resolutions were then adopted.Representation of Germany on the Health Commitlee.On Friday, July 21st, the Council of the League

also adopted a report from the Secretary-Generalon the Warsaw Conference resolutions which includedan expression of appreciation to the American RedCross for a gift Of .85000, and a recommendation tothe Health Committee to coopt a German member.

THIRD INTERNATIONAL CONGRESS OFTHE HISTORY OF MEDICINE.

(Concluded from p. 198.)

THE first session of the Congress on Tuesday,July l8th, was devoted to a discussion on some of thehistorical aspects of epidemic and endemic disease.Dr. Tricot-Royer, of Antwerp, read a paper on Lesordonnances du Magistrat d’Anvers contre les maladiescontagieuses. Dr. A. Cavvadias, of Athens, followedwith a paper on the Cult of Asklepios and MedicalScience, in which he pointed out that the cult, dealinglargely in miraculous cures, bore no relation whateverto rational medicine, the two systems developingindependently and owing nothing to each other.Prof. W. R. Simpson spoke on the Preventive Aspectof Endemic Disease in Ancient and Modern Times.Mrs. Singer drew attention to a thirteenth-centuryLatin translation of the Sixth Book of " The Epi-demics." Prof. Jeanselme contributed a paper which,in his absence, was read by Dr. Laignel-Lavastine onthe relationship existing on the one hand betweenplague and famine-particularly a dearth of cereals-and on the other hand between plague and floods orearthquakes, any of these circumstances leading tothe rats being compelled to forsake the sewers. Dr.Torkomian, of Constantinople, emphasised the claimsof Armenia to have been one of the earliest countriesto practise vaccination against small-pox on theintroduction of this method from China, where it hadbeen known from time immemorial. In a subsequentpaper Dr. Torkomian gave the evidence for believingthe ancient Armenians to have been possessed of arudimentary knowledge of anatomy.The second and third sessions were devoted mainly

to the history of anatomy, several papers of extra-ordinary interest being read, many of them illustratedby epidiascope slides. Among these must be men-tioned a paper by Mr. W. G. Spencer on the"

Epitome " of Vesalius on vellum, in the BritishMuseum Library, and Dr. T. Wilson Parry’s paperon the collective evidence of trephination of thehuman skull in Great Britain during mediaeval times,illustrations being shown of several specimens asso-ciated with prehistoric trephination in Great Britain,as well as cases of posthumous trephination. Dr.F. K. Lander, who took for her subject Women as

1 This paper appears on p. 258 of this issue of THE LANCET.