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PARLIAMENTARY INTELLIGENCE

NOTES ON CURRENT TOPICS

Specialist Medical Treatment and Local AuthorityControl

ON the motion for the second reading of theHertfordshire County Council Bill in the Houseof Commons on June 26th,

Sir MURRAY SUETER said that Part IV of theBill dealt with establishments for massage andspecial treatment. The object was to save the publicfrom being imposed upon by spurious practitionerswho were very active in connexion with electricaltreatment. He (Sir M. Sueter) could give the Housean example of electrical apparatus being in improperand ignorant hands..When he was in H.M.S.Benbow at Portsmouth they were experimentingwith X ray apparatus, and they had a Ronfgen raytube and a fluorescent screen. They used to takephotographs of the torpedo lieutenant’s hands, andas they were experimenting one day they thoughtthey would like to see what was in the doctor’s brain.They put the Rontgen ray tube in front of thedoctor’s brain and examined it through the fluorescentscreen. They saw that the tissue of the brain wasdifferent and they were delighted with the examination.But in the morning when the doctor was combing hishair it came out in handfuls: he was perfectly baldon one side. They had destroyed all his hair on thatside. The doctor was rather annoyed, but fortunatelyin a few weeks’ time it had grown again and all waswell. That was an example of the danger of suchelectrical apparatus being in improper hands. Thepromotors of the Bill sought to have powers to dealwith this matter.

Dr. O’DONOVAN said that the purpose of theBill had his heartiest concurrence, but he thoughtthat certain aspects dealt with in Part IV oughtto be made public so that the Committee which wouldexamine the Bill could see what his profession wasthinking of this Private Bill legislation which wasaffecting professional work. Bills very similar tothis had gone through Committee before, and thismeasure appeared in its present form largely becausethat was the form in which previous Private Billshad been passed by Private Bill Committees. IfClause 48 and the consequent Clauses of this measurebecame enshrined once more in an Act of Parliamentwithout a variation of its wording men and womenwho practised massage, manicuring, chiropody, electrictreatment, radiant heat treatment, light treatmentand vapour or other bath treatment, would becompelled to notify the chief of police of theirintention to practise these special branches of bio-physical medicine. As Part IV stood without

explanatory amplification he suggested that itsimputations were offensive to a great body of usefulpeople and bore no relation to the conditions underwhich they carried out their work to-day. He wasentitled to say that, for since 1921 he had been ateacher, an examiner and a practitioner in this specialpart of medical treatment and he had not discoveredthat those whom he examined, those whom he taught,or those with whom he daily worked, were so undesir-able that they should be subject to the attention ofthe county police.

Medical practitioners were given a certain freedomfrom the oppressive restrictions in Part IV, thatwas to say, it was not required that every medicalpractitioner should notify the police of his desireto practise special branches of medicine. Butmedical practitioners, perhaps London experts, whowished to practise in Hertfordshire any of thesespecial branches of medicine, were required annuallyto produce from Hertfordshire practitioners a certi-ficate that they were fit to carry out the specialtechnique of their work. It would be a fair andappropriate observation to make that Hertfordshire,even in its county town, had not a panel of experts

who were competent to certify as to the competenceof experts who might go to practise there. It wasstrange that this county council should wish a certifi-cate of special competence on the part of doctorswho practised a very minor branch of medicine,and yet was not particular as to the special fitnessof those who were to operate in more dangerous,more venturesome and more serious ways. Anypractitioner in Hertford could deliver women indifficult labour without being required to prove hisspecial competence to the Hertfordshire CountyCouncil, but should he install a mercury lamp or anX ray apparatus he became a suspected person whomust year by year prove his fitness. Furthermore,nurses, specially trained and certified by the CharteredSociety of Massage and Gymnastics, were to be underthe same obligation of producing yearly certificatesof their competence. Although a doctor or a speciallycertified massage nurse might become licensed ina simple way, nevertheless, the county council askedpowers to pass by-laws instructing them how theyshould keep their records. Up to now a professionalman had been entitled to keep his records and conducthis business in the way best suited to his personality,but this county council wished powers to pass by-lawsso that his card index and professional records shouldbe such as commended themselves to the council’sadvisers.There was another point. The county council

wished, properly or improperly, to set up a form ofMedical Register of its own, for it not only askedthose who practised these special forms of treat-ment to submit their technical qualifications, butit asked powers to set out in its own behalf whatthose qualifications should be. In other words,through this Bill and similar Bills there would beup and down England a multitude of minor quasi-responsible General Medical Councils. Therewere two incorporated societies of chiropodists inEngland who seriously taught their students, whotrained them and examined them well, and grantedthem certificates, but the Hertfordshire CountyCouncil, without waiting for action at the hands ofthe Privy Council which was seeking to promote aCharter for the registration of chiropodists, wouldset up its own register of chiropodists; and thenthose who had successful boot shops and paid largerates could plant tame chiropodists in their backrooms and claim all the privileges of those whowould benefit by registration at the hands of thePrivy Council which could not be long delayed.That seemed to him to be a real wrong.There was much professional feeling in this matter.

They had heard from the member for Hertford(Sir M. Sueter) his experiences with X rays. Thoseexperiences, inaccurately and wrongly reported, werenevertheless experienced at the hands of a registeredmedical practitioner, not at the hands of an undesirableperson. Those experiments on a doctor’s head,presumably with the doctor’s consent and not underAdmiralty orders, were carried out presumably bya registered medical practitioner. What ever doseof X rays the gallant Admiral gave to the doctor’shair that hair could not fall out the next day. Itwould take three weeks to fall out. -

Sir M. SUETER: The next morning the doctorcame down and told us that his hair had fallen out.When I said his hair grew again in a few weeks it mayhave been a few months, but it grew successfullyand he did not have any bad effects afterwards, butit actually happened and I saw it. It was in theearly days of X rays.

Dr. O’DoNovAN said he wondered if the gallantAdmiral would take it from him that X rays inthose days and X rays in these days would behavein exactly the same way. Their difference mightbe explained by the fact that when the Admiralwas doing those experiments with X rays he (Dr.O’Donovan) was also doing them, but he had beendoing them ever since, and the Admiral might be

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a little behind current medical practice. Nevertheless,the fact remained that X rays were a dangerousweapon in the hand of inexperienced or unskilledoperators, but this clause in the Bill did not excludein any way the use of X rays by anybody. Itexcluded electrical treatment or other similar treat-ment, and he and his professional colleagues wouldbe pleased to go into any court of law and give expertevidence that X ray treatment and radium treatment,which was even more dangerous, were in no properand strict use of the word electrical treatment orsimilar treatment. Any argument founded on SirM. Sueter’s experience was only an argument thatthis definition clause should be re-drafted, that expertadvice should be more widely sought in this work,and that a county council should not put itself in alamb-like manner into the hands of those who wereprofessional parliamentary draftsmen.The Bill was read a second time.

Diseases of Animals Bill

In the House of Commons on June 26th Mr. ELLIOT,Minister for Agriculture, moved the second readingof the Diseases of Animals Bill, which has alreadypassed through the House of Lords. He said thatthe main objects of the measure were first, to bringpoultry within the provisions of the Diseases of AnimalsActs, and second, to provide for the regulation ofthe manufacture and importation of certain therapeuticsubstances intended for veterinary purposes. Theprovisions under which they were now made andsold were very unsatisfactory and representationshad been made to the Ministry for some time byagricultural interests. A standard for one of thesesubstances was recommended by the Cattle DiseasesCommittee of the Economic Advisory Council. TheBill would go to Committee where there would befull opportunity for examining it in detail.

Mr. T. WILLIAMS said that the Labour Oppositionoffered no objection to this Bill; they thought itwas very useful.The Bill was read a second time and committed to

a Standing Committee.

Health Services and Housing in ScotlandOn Friday, June 28th, the House of Commons

went into Committee of Supply on the ScottishEstimates. Captain BOURNE, Deputy Chairman ofCommittee, was in the chair. On a vote for £ 2,062,724,to complete the sum necessary to defray the chargefor salaries and expenses of the Department ofHealth for Scotland, Mr. SKELTON, Under Secretaryof State, pointed out that the health of the nationhad never been so good, improvement being manifestedin every direction save maternal mortality, wherethere had been a slight rise compared with last year,although it was about the same as the average of thelast five years. A report on maternal mortalitywhich had long been subject to anxious examinationby experts, would, he said, be published in a few days,and was of a more intensive and exhaustive characterthan any previous examination of the question ineither England or Scotland.The Public Health Services Committee, which was

appointed last year by the Secretary for Scotland,was carrying on its work with great energy andvigour, although he regretted to say that the chairman,Sir John Dove-Wilson, unfortunately died quiterecently. He had been succeeded by one who would,he thought, command respect and approval in everysection of the community, namely, Prof. Cathcartof Glasgow.

Dealing with the progress of housing Mr. Skeltonsaid that the number of houses completed in 1933numbered 20,915, but then, of course, subsidies toprivate enterprise were still going strong and therewas not the same concentration on slum clearance.Of that figure of 20,915 houses 15,000 were localauthority houses, and the- balance were privateenterprise houses. Last year the total was 18,417,14,700 being local authority houses and 3,600 privateenterprise houses. The most recent figures of

completions showed that they were again increasingthe numbers. In the first five months of 1934 6056houses were completed, and in the first five months ofthis year 6,500, an increase of practically 500. Ona rough estimate he believed that the local authoritiescompletions, which were 14,719 for last year, mightbe in the neighbourhood of 17,000 for next year.They had this year the highest number of localauthority houses under construction that therehad ever been. At the end of May this year therewere 18,119 local authority houses under construction,whereas in May last year there were only 14,488,and in the year before 17,035. Most striking of allwas the progress of slum clearance under the presentfive-year plan, which began on Jan. 1st, 1934.The local authorities estimated their needs over theperiod to be 61,316 houses. The actual further buildingprogrammes submitted provided for 47,900 houses,or 78 per cent. of the total. Many of the localauthorities had undertaken that if it was possiblethey would increase their programmes to such anextent that 92 per cent. of the needs would be under-taken in the five years. Mr. Skelton concluded bygiving the figures dealing with the tenders for newhouses which proved the skill and energy with whichScottish Local Authorities as a whole had undertakenthe work dealing with the slums.At the middle of June, 17 t months after the

beginning of the five-year plan, tenders had beenapproved for 30,681 houses out of the 47,900, andof the 30,000 odd tenders approved only 6000represented houses which had not been either begunor completed. That showed the zeal and energywith which the Scottish local authorities as a wholehad undertaken the work of dealing with slumsin the course of this new period. The momentumwith which slum clearance was being tackled showedno signs of slackening. No tenders were beingapproved for two-room houses, and a very considerableproportion of the tenders were for four-room andsome for five-room houses. Under the provisionin the Rural Workers Act the reconditioning of farmcottages went steadily on. In the vast majority ofcases of people removed from slums there was

immediate and strong response to the improvedconditions. It was also true that in the sphere ofhealth the population of Scotland was increasinglyresponsive to the efforts that were made by publichealth authorities. Maternity and child welfarecentres were constantly increasing in popularity.

Sir A. SINCLAIR said that they were glad to knowthat, broadly speaking, the health of the people ofScotland was good and was improving, but it stillremained true, as was pointed out in the annualreport of the Department of Health, that the publicdemand for hospital treatment was increasing.Unfortunately this demand was not being met.In regard to hospital services the report said :

"

Recently a study was made of the records of a largenumber of consecutive patients admitted to the medicalwards of one of the best of our general hospitals. It wasfound that many of them had been ill for months or yearsprior to admission. Pressure on bed accommodationwas so great that the duration of in-patient treatmenthad to be kept as short as possible. Only 26 per cent.of the patients reviewed remained in hospital for morethan one month, and only two per cent. for more thanthree months. It is not surprising, therefore, that ondischarge from the hospital more patients were classifiedas ‘ relieved ’ than as ‘ cured ’." The report added :" It is impossible to regard such results with equanimity."This was a serious matter and it was impossible toregard the condition of the hospitals in Scotlandwith equanimity. He would ask the Governmentto state what they were doing to remedy the state ofaffairs. A doctor who had returned after a numberof years in the Malay States to take up an appointmentin Scotland recently, told him that the hospitalservices in Scotland were inferior to those in theMalay States. He (Sir A. Sinclair) was incredulous,but this doctor’s opinion was not inconsistent with

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the stern and sombre warnings addressed to the localauthorities in the report of the Department of Health.At the present moment there was no more seriousneed under the heading of public health in theHighlands of Scotland than an increase in the water-supply. He impressed on the Government thevital importance of that cardinal requirement.

Sir IAN MACPHERSON, in regard to the Highlandsand Islands Medical Service, said that it was noteconomy and had not been the original intentionto transport patients from the islands to a centralhospital, while he disagreed with Sir A. Sinclair inregard to the superiority of hospitals in Malay overthose in Scotland.

Sir CHARLES MACANDREW, on the question ofmaternal mortality in the report of the Departmentof Health, said:

" The total number of midwives enrolled by the CentralMidwives Board for Scotland since the roll was establishedin 1915 up to the 31st March, 1934, was 11,002, of whom7440 were enrolled after passing the Board’s examination."That perhaps might account for the rate of maternalmortality. It seemed extraordinary that over 3500midwives who could not pass the examinationshould be on the roll. Midwives who could not passthe examination, but who were nevertheless on theroll, might do enormous damage to health in Scotland.Referring to venereal diseases the report said :

" In the absence of any system of notification theincidence of venereal diseases in the countrv is unknown."It might be that legislation was required to make itnotifiable. The report said :

" Infected mothers often show great anxiety for the healthof their children and bring them willingly to the centresfor observation, and for treatment if necessary. In oneor two areas, also, infected parents have been persuadedto allow their children to be admitted to hospital forintensive observation."

Was it not possible to make it compulsory for doctorsto notify these cases ? Then there was the questionof the teeth of the children. The dental staffsconsisted of 48 whole-time and 35 part-time dentists,and the report said :

" It is very doubtful whether the existing dental staffscan adequately supervise the condition of the teeth ofthe children, especially since much of their time is occupiedin attending to casual cases, that is, children suffering fromtooth-ache whose teeth may be beyond saving."If a little of the money which ought to be saved onother things could be devoted to the dental serviceit would be of great benefit to the children. It wasmost regrettable to learn that at this age the teethof many children were beyond saving. Anyone whohad had an opportunity of seeing the holiday campsmust be aware that the sanitary conditions wereanything but satisfactory. He suggested that itmight be a desirable thing if some of the medicalofficers attached to territorial units were allowedto inspect these holiday camps because they hadmuch more experience of camps than the officialsof the Department of Health.Mr. MAXTON said that he was interested to know

that the number of persons who had to apply forpoor relief per thousand of the population in Scotlandin 1934 was precisely the same proportion as had toapply in 1867. That was rather a distressing figure.It showed that over a period of 70 years there hadbeen no substantial change made in the ratio ofvery poor people to the total population. He alsofound that the cost in one district of maintainingthe poor in poor-law institutions-the sick poor, theable-bodied poor, and the insane poor-fell as low as5s. a week. That was an appalling figure. Abovethat figure of 5s. a week there were all sorts of variations.He was sure that for the money that it had cost tokeep poor people in poor-law institutions in Scotlandin general there could not be inside those institutionsthe amenities of life that were certainly made possibleby the Scottish Poor Law Act which was recentlypassed. He hoped the Government would inquire

whether the local authorities were in fact operatingthe new Poor Law Act in the way that he believedand hoped that it would be operated.

Dr. G. A. MORRISON raised the question of thereports of the medical officers of schools with refer-ence to the large number of children who on comingto school were found to be suffering from easilyremediable defects. The inspectors of the EnglishBoard of Education used this as one of the strongestarguments for the institution of more nursery schools,especially in the large cities. His wife, in connexionwith her experience in a girls’ club in Aberdeen,had been struck by the number of girls of 17 and 18years who had very bad teeth, and in some cases

almost no teeth at all. The gap between the timewhen boys and girls received skilled dentalattention at school and the time when they were due toreceive dental benefit from some approved societywould be to some extent closed if there was an ex-tension of the provision of dental attention to thejunior instruction centres.

Mr. SKELTON, replying to points raised in thedebate, said the question of the provision of hospitals,which had been mentioned by Sir A. Sinclair, wasone on which the Government could not interferewith the local authorities. The 1929 Act increasedfacilities for proper hospital accommodation bymaking it easier for local authorities to combinefor the purpose of hospital building and maintenance.He regretted to say that it had not always been takenadvantage of, and while he agreed that progresshad been slow, he did not propose to relax pres-sure on local authorities to get on with the workof hospital accommodation wherever it was insuffi-cient. He entirely agreed with the observationsin the report of the department that much requiredto be done before the matter could be regardedas satisfactory, and that would be borne out, hethought, by the maternal mortality report, butunder existing legislation, apart from exertingpressure on local authorities, there were no sub-stantive steps which the Secretary of State or hecould take on this topic of the supply of hospitals.He could assure the committee that the Governmentwould not forget the question of Highland water-supplies. In regard to the employment of unqualifiedmidwives, it was not possible to apply the provisionsof the last Act to persons who were midwives whenthe Act came into operation. The question ofdental service again was primarily a matter for thelocal authorities. With regard to camps and theirsanitation, local authorities already had considerablepowers in making by-laws for the control of suchcamps.Further discussion of the Note was adjourned.

Voluntary Hospitals (Paying Patients) BillThe Voluntary Hospitals (Paying Patients) Bill

and the St. Bartholomew’s Hospital Bill;were broughtdown from the House of Lords and read a first timein the House of Commons on Monday July lst.

University of Durham BillIn the House of Lords on Tuesday, July 2nd, the

University of Durham Bill was read the third timeand passed.

Housing (Scotland) BillThe Housing (Scotland) Bill passed the Report

stage in the House of Commons on Tuesday, July 2nd.The Public Health (Water and Sewerage) (Scotland)Bill and the Criminal Lunatics (Scotland) Bill wereread a second time.

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HOUSE OF COMMONS

THURSDAY, JUNE 27TH

Workmen’s Compensation InquiryMr. TOM SMITH asked the Home Secretary if he was

in a position to make a statement with regard to theinquiry taking place into the working of the Workmen’sCompensation Act.-Sir JOHN SrMON replied : A general

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inquiry into every aspect of the working of the Workmen’sCompensation Act would be a large undertaking, whichwould take up much time, but I have been consideringwhether there are not some specific questions which couldbe more speedily examined, and I hope it may be possibleto make a statement on the subject very shortly.

Mr. SMITH : Will the right hon. gentleman keep inmind the specific question which was sent to his prede-cessor by the Miners’ Federation of Great Britain relatingto a legal decision with regard to miners’ nystagmus ?

Sir J. SiMON : One of the specific matters which I hadin mind when I gave my answer was the case of miners’nystagmus.

Physical Training in SchoolsMr. HALL-CAINE asked the President of the Board of

Education in what approximate proportion of primaryand secondary schools, respectively, at the present time,physical training was carried out in special costumes asopposed to the ordinary clothes of the pupils ; and inwhat proportion the physical training of boys was super-intended by male instructors.-Mr. STANLEY replied : Iregret that the information in my possession does notenable me to reply to the first part of the question. The

provision of special costumes for physical training is

encouraged by the Board and is becoming more general.I have no information as to the proportion of schools inwhich boys are taught by male instructors. In elemen-tary schools the instruction is given by the class-teachers,who in the case of senior boys’ departments would bemen ; in boys’ secondary schools there is generally a maleinstructor on the staff.

Care of Deaf Persons

Mr. HuTCHisoN asked the Minister of Health whetherhe proposed to introduce or give facilities for a Bill dealingwith the disability of deafness ; and whether he wassatisfied with the adequacy of present arrangements forthe care of such persons.-Sir KINGSLEY WOOD replied :I am not at present satisfied that special legislation onthis subject is necessary. My hon. friend is no doubtaware of the report prepared by the late Dr. Eichholzon the condition of the deaf. That report did not recom-mend any further legislation, but advocated certainmeasures which were commended to local authorities ina circular issued by my department in May, 1933. The

Ministry are continuing to impress on local authoritiesthe importance of giving financial assistance, where

necessary, to those voluntary agencies which are doingvaluable work in finding suitable employment for deaf-and-dumb persons.

Mortgage of Insurance Medical PracticesMr. LOGAN asked the Minister of Health if he was aware

of the mortgaging and transfer of medical practices inconnexion with panel patients controlled by financialhouses ; and if he was prepared to investigate this matter.-Sir KINGSLEY WOOD replied : My attention has beendrawn to arrangements by which medical practitionersare able to obtain loans on the security of their incomefrom insurance practice ; but in the absence of specificevidence that these arrangements are exercising a pre-judicial effect on the insurance service, I do not thinkthis is a matter in which it would be proper for me tointervene.

Mr. LOGAN : Is the right hon. gentleman aware that Idid send him a press cutting in which definite statementswere made and will be make investigations into thismatter ?

Sir K. WOOD : It is difficult for me to begin to examinestatements in the press. If the hon. Member has anyparticular facts of his own knowledge I shall be glad tohave a talk with him about them.

Mr. RHYS DAvIES : Will the right hon. gentleman begood enough to look at the report sent to his predecessorby the Association of Insurance Committees on this

subject ? 2Sir FRANCis FREMANTLE : Is it not a fact that patients

always have a choice of doctor and therefore they cannotbe sold except from the point of view of goodwill andsubject to the wish of the patients ?

Cost of Milk to HospitalsMr. GRAHAM WHITE asked the Minister of Agriculture

if any estimate had been made of the additional cost ofmilk to voluntary and other hospitals since the MilkMarketing Board was instituted ; and if the Board and/orthe Government proposed to take any action to relievethe hospitals of this additional burden.-Mr. ELLIOTreplied : I would refer the hon. Member to the repliesI gave on May 2nd, to which at the moment I have nothingto add.

Mr. T. WILLIAMS : Will the right hon. gentleman makerepresentations to the Milk Marketing Board on thequestion of ’ granting hospitals and such institutionstreatment similar to that received by ice-cream vendors ?Mr. ELLIOT : It is difficult to suggest that a certain

class of individuals should bear the loss on the supplyto hospitals unless it is suggested by the people whosupply hospitals.Mr. WILLIAMS : Is the right hon. gentleman aware

that the consumers and the producers as the case maybe are really bearing a large loss on milk sold to ice-creamvendors ?

-

No answer was given.

Child Labour in the Fields

Mr. Bun,wETT asked the Secretary of State for Scotlandhow many local authorities used the powers given tothem under the Children and Young Persons (Scotland)Act, 1932, to restrict or prohibit child labour in thefields.-Mr. SKELTON, Under-Secretary of State for Scot-land, replied : No education authority in Scotland hastaken power by by-law, under the Act mentioned, to.prohibit entirely the employment of children in agri-cultural pursuits. In five areas the statutory minimumage for employment of 12 years has been raised by by-lawto 13 years for all employment, including agriculturalwork, though in one of these areas the higher age limitapplies only to girls. Thirty-three of the 35 educationauthorities have made by-laws as to the employmentof children, and in each case the by-laws include provisionsfor regulating the hours and conditions on which childrenmay be employed.

MONDAY, JULY 1ST

National Health Insurance AppealMr. 1/UNN asked the Minister of Health whether he

would give the reason for the delay in not setting downfor appeal to the High Court the case of Mrs. K. Slaughter,of 112, Brentwood-road, Romford, Essex, against thedecision of the referee appointed under Section 90 of theNational Health Insurance Act, 1924.-Mr. SHAtCEspBABE,Parliamentary Secretary to the Ministry of Health, replied :The Referee appointed under Section 90 of the NationalHealth Insurance Act, 1924, acceded to the request ofMrs. Slaughter to state a case for the decision of the HighCourt on a question of law. There has been some unavoid-able delay but my right hon. friend is informed thatthe terms of the case have now been settled and signedby the Referee and forwarded to Mrs. Slaughter’s solicitors,who are, therefore, now in a position to set down thecase for hearing.

Lung Trouble among Barytes MinersMr. DUCKWORTH asked the Secretary for Mines whether

his attention had been drawn to the frequent occurrenceof lung trouble among barytes miners and quarrymenin the Minsterley and Pontesbury district of Shropshire,and in particular to the death from silicosis of JohnRichards, of 9, Top-road, Pontesbury Hill, on May 21st;whether His Majesty’s inspectors of mines had inspectedand reported upon the conditions under which work wascarried on; and whether he was satisfied that everypossible precaution was being taken to safeguard the workersfrom this danger.-Captain CROOKSHANK replied : I havereceived no information of cases of industrial pulmonarydisease in this district except at one barytes mine : andat this mine proper precautions are being taken followinga thorough inspection of the conditions by H.M. Inspectors

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of Mines. The case of John Richards has not previouslybeen brought to my notice and I am having it

investigated.

Accidents in the Building TradeMr. JOEL asked the Home Secretary whether any

information had been laid before his department to showthat accidents in the building trade were increasing;and whether insurance companies were now makingexhaustive inquiries as to the cause.-Sir J. SzMOi.r replied :If the figures for the last five years be compared therewould not appear to be any material change in the propor-tion of accidents in this trade, and I am advised that theincrease in 1934 over 1933 may be fully accounted forby increased building activity and by better reportingof accidents to the need for which the special attentionof employers was recently drawn, It has, however, beenrecognised by my department for some time past thatthe situation calls for further inquiry and I have justappointed Mr. G. S. Taylor, Deputy Chief Inspector ofFactories, specially assisted by three other inspectors,to make a report, after consultation with bodies concernedand after any necessary inquiries, reviewing the accidentrisks in the building industry and the precautions alreadyadopted, whether by way of regulations or otherwise, witha view to advising as to what further measures may bedesirable.

Infection of Workers Due to Paint SprayingMr. JoEL asked the Home Secretary if the information

in his department showed that there was any increasein infection of workers due to paint spraying.-Sir JOHNSIMON replied: I have no information indicating anyincrease of illness from this cause.

Accidents Due to Electrical Apparatus inPrivate Houses

Mr. TEMPLE Moitpis asked the Home Secretary howmany fatal accidents there were during 1934 from theuse of electrical apparatus in private houses ; and whetherhe was satisfied that existing legislation was sufficient toprevent the sale of articles which could not be used withsafety by inexperienced persons.-Sir JOHN SiMON replied :Accidents from the use of electrical apparatus in domesticpremises are not reportable to the Home Office, butfifteen fatal accidents of this kind came to the noticeof the department during 1934. The law does not

prohibit the sale of electrical appliances on the groundthat they may be dangerous to inexperienced persons,but only a few instances have come to the notice of thedepartment in which exception could reasonably betaken, on grounds of danger, to electrical apparatusplaced on sale, and in such cases manufacturers generallyhave shown themselves ready to remedy the defects,when pointed out to them.

FELLOWSHIP OF MEDICINE AND POST-GRADUATEMEDICAL ASSOCIATION.-A course in urology will be givenat the All Saints’ Hospital from July 8th to 27th ; itwill occupy the afternoons and evenings with clinicaland cystoscopic demonstrations. A week-end course ingeneral medicine and surgery is to be held at theSouthend General Hospital on July 13th and 14th, andan afternoon course in Dermatology at the BlackfriarsSkin Hospital from the 15th to 27th. A panel ofteachers who are prepared to give clinical instruction attheir in-patient and out-patient clinics is preparedby theFellowship. Particulars may be had from the Secretaryat 1 Wimpole Street, London, W.I.

WESTMINSTER HospiTAL.—On June 26th thePrince of Wales laid the foundation - stone of thenurses’ home which is to be the first building of thenew Westminster Hospital. As recounted in our issueof June 22nd, the new building is to be erected onthe west side of St. John’s Garden’s, not far from LambethBridge, and will accommodate 40 sisters, 200 nurses, 15pupils undergoing preliminary training, and 50 domesticstaff. It was announced that Mr. Myerstein has presenteda cheque for 10,000 for the medical school building.

BRITISH POSTGRADUATE MEDICAL

SCHOOL

THE FIRST REFRESHER COURSE

A COLLECTION of practitioners of different agesand widely varying experience assembled for thefirst intensive refresher course held at the BritishPostgraduate Medical School from June 17th to

29th, only a month after the school was formallyopened. The staff of the school was supplementedon this occasion, and will be also in the future courses,by outside specialists, this time represented byDr. C. W. Buckley, Dr. L. S. T. Burrell, Dr. E.

Mapother, and Dr. J. A. Ryle. The sessions on eachday were from 10.30 A.M. to 1 P.M., and 2 to 4.30 P.M.,with fifteen minute intervals in the course of eachmorning and afternoon.

FIRST WEEK

Dr. F. R. Fraser, professor of medicine, welcomedthe students with what was described by one of themas a " really refreshing preamble which justified thetitle of the course." He spoke sympathetically oftheir common experience of the many psycho-logical problems which block the way to success inmany cases which should be curable. The partplayed by psychic trauma in general structuraldisease is, he holds, a major one. The practitionerhas it in his power to increase the health and happi-ness of mankind and to treat the individual (notthe mass) to be better fitted for his environment.He must remember that the governing motive thattakes the patient to the doctor is fear-fear in rela-tion to his life or to his efficiency. It is prognosisthat he wants, and this necessarily implies diagnosis,not merely anatomical diagnosis, but a realisationof the actual disease process and the stage it hasreached. Prof. Fraser discussed the determinationof the data involved and emphasised the value ofhistory-taking as against mere physical examination.Whilst history-taking is subjective and symptomatic,physical examination is objective and structural.The majority of medical out-patients have no objec-tive physical signs, but if they have it is criminal tomiss them. The patient must be investigated as abiological entity in order to discover his environ-ment, and the cause of his possible misfit in life. Inthe elaboration of this detective game questions onpast health rather than on the more familiar pastillnesses are important-e.g.,

" did you play games 1 "Two case-histories were detailed, one of a clergymanand the other of a girl clerk, to illustrate the import-ance of digging out the psychological basis of diseasein spite of an apparently obvious anatomical diag-nosis. Prof. Fraser doubted, rather wickedly, if

Harley-street could live, given on the part of eachmedical practitioner the gift for good history-takingand a more highly developed faculty for using theeyes.With these encouraging words, which established

a friendly understanding, Prof. Fraser passed on toa demonstration of his own methods of physicalexamination on a variety of interesting cases.

In the afternoon Dr. Burrell followed with a rapidbut fairly exhaustive survey of the main problemsof pulmonary tuberculosis. Among the lessons tobe drawn from his teaching were that in diagnosissymptoms are more reliable pointers than physicalsigns, which may be absent; that a differentialleucocyte count and an estimation of erythrocytesedimentation-rate may have prognostic significance ;