526 PARLIAMENTARY INTELLIGENCE.

But he was interested in his patients from the momentthey entered the clinic, and he never forgot them.To him the operation was an important part in thetreatment of their illness, but not the only thing thatcounted. He avoided operating when he could.Because he was a master of surgery and yet wasnever mastered by it his name will be rememberedas a great clinician, and his early death will bedeplored by the increasing circle of practitioners whorelied on him for sound advice.

JOHN LAIRD, L.R.C.P. IREL.

THE death occurred at Glenarm, Co. Antrim, lastweek of Dr. John Laird, who practised in Sligo forsome 50 years and retired a few years ago. He was86 years of age. He obtained the licence of the

Royal College of Surgeons in Ireland in 1865, andof the King and Queen’s College of Physicians in1868. Having spent a year or two in hospital workin England, he was elected dispensary medical officerfor the Sligo district while still a very young man.He speedily acquired the reputation of a careful andable practitioner, and for half a century he was oneof the leading physicians and obstetricians in theWest of Ireland. Tuberculosis was and is verycommon in that region, and he gave special attentionto the study of that disease, having a considerablesuccess in treatment. In 1912 he published hisviews in a small book, " Notes on the Treatment ofTuberculosis," of which a second edition, entitled" Tuberculosis: Its Prevention and Treatment,"appeared in 1925. Though the theories he hadarrived at are not likely to be accepted, the bookis the fruit of wide reading and careful observation.Dr. Laird was a man of retiring disposition whotook little part in public affairs, but he was held inhigh respect for his personal and professional qualitiesby the public and by his colleagues.

FREDERICK CLAUDE EVILL, M.R.C.S. ENG.Dr. F. C. Evill, whose death occurred at Worthing

on March 3rd, had been in practice in High Barnetall his life. Born at New Wandsworth in 1861,he was educated at Clifton College and St. Bartholo-mew’s Hospital, London, qualifying in 1886. Hewas then house physician at Brompton and housesurgeon at Bart.’s and at the Central LondonOphthalmic Hospital, before a breakdown in healthoccasioned a voyage to Australia, where he remainedfor six years as surgeon to the Broken Hill Hospital,N.S.W. As a practitioner in an important residentialsuburb he kept closely in touch with scientificmedicine, as his occasional but weighty contributionsto medical literature clearly testify, and hewas for thirty years surgeon to the VictoriaCottage Hospital at Barnet. As a young manDr. Evill was an unusually accomplished amateuractor, and those who may have seen him in hospitalentertainments, notably at Bart.’s and Brompton,will long remember the compelling humour of hischaracterisations. He was also in his early daysquite a good amateur painter.

LEEDS AND BOLTON WORKERS’ PENNIES FORHOSPITALS.—The Leeds Workpeoples’ Hospital Fund hashad a record year. The sum collected in 1928 was .844,560,an increase of over 91000 compared with 1927. Almost thewhole of this sum has been collected in the workshops,factories and clubs in the city, chiefly by means of weeklycollections of coppers. The fund maintains two convalescenthomes in Yorkshire, and last year 614 women and 676 menenjoyed rest and recuperation in them. Grants totalling.833,427 were voted at the forty-second annual meeting.These included £23,077 to the Leeds Infirmary, 23551 tothe Leeds Dispensary, £2959 to the Leeds Women’s andChildren’s Hospital, and .8947 to the Leeds District NursingAssociation. Since its inception the fund has distributedover £1,000,000. The workpeople of Bolton and district

by giving Id. or 2d. from their wages each week, contributedlast year £16,400 in aid of the funds of the infirmary.

Parliamentary Intelligence.NOTES ON CURRENT TOPICS.

MEDICAL MEN AND THE ARMY.IN the House of Commons on Thursday, Feb. 28th, Sir

L. WORTHINGTON-EvANS (Secretary of State for War) intro-duced the Army Estimates for 1929, and said that the Housemight not perhaps appreciate the extent to which men ofeminence in their respective professions were willing andanxious to place their experienced advice and expertknowledge at the disposal of the Army Council. He wouldlike to draw special attention to the assistance which wasgiven to them by members of the medical profes3ion. TheArmy could derive nothing but benefit from a good under-standing between the civilian and the military branches ofthe medical profession, which he was happy to believe wasthe aim of both and which displayed itself in their fruitfulcooperation on many committees. He hoped that as thescope and attractiveness of the Army Medical Servicebecame better known through their advocacy the presentwelcome increase in the number of candidates might continue.They were, however, still suffering from a serious shortageof candidates for commissions in the regular army. Theshortage was, he believed, mainly due to economic reasons.He believed that the Army offered just as good a careeras ever it did.

In the debate which followed,Mr. BECKETT raised the question of the circumstances

under which men are invalided out of the army. He hadhad cases brought to his notice where men who werebeginning to make their way upwards had been dischargedon medical grounds without adequate reason. A lot ofkind things were said about army doctors ; he dare saythey were true. His own experience was at an abnormaltime of rush and he may have been prejudiced. But,however adequate the average army doctor might be as ageneral practitioner, he was not an ultimate authoritywhen it came to the question of a serious and deep-rooteddisease. These men who were discharged had no appeal.The Admiralty had given way on this point and had agreedthat men discharged on medical grounds should have theright of independent appeal. Was it not fair that the Armyshould give a similar concession ?

Replying to the debate, Mr. DUFF-COOPER (FinancialSecretary to the War Office) assured the House that therewas an improvement in the health of our troops in China.

HOUSE OF LORDS.

TUESDAY, FEB. 26TH.LOCAL GOVERNMENT BILL.

The LORD CHANCELLOR, in moving the second reading ofthe Local Government Bill, said that local government inthis country was firmly rooted in our traditions and formedpart of the essential framework of our democracy. Sincethe limits of local government must be defined by statuteand could not have the flexibility of common law, it followedthat as the conditions changed difficulties must arise whichthe old traditions were unable to meet, and developmentmust be hampered by restrictions which by the effluxion oftime had become obsolete. The present system was laiddown in 1888 and had not been substantially altered since1894, and when they recollected the changes which hadtaken place in our civilisation, in the means of transport,and even in the conception of the duties of citizenship sincethat date, it was not surprising that the time had nowcome when a change was almost essential if the efficiencyif the machinery was to be maintained.The first problem with which this Bill occupied itself

was one which had long been recognised as urgently requiringconsideration-namely, the problem of the poor-law. Thepresent system dated back to 183-1, when the presentpoor-law unions were established. Boards of guardianswere set up charged with the responsibility of relievingpoverty within their areas, with powers of raising money,which no local council could interfere with or control, inareas which had remained fixed ever since, although thewhole industrial revolution of this country with all thechanges of distribution of wealth and population which thatrevolution had brought about had taken place after thedate when those boundaries were first allotted. Theboundaries in many cases cut across local government areasand embraced in one union parts of different parishes oreven counties. The poor rate varied to-day in differentunions from 2d. in the £ to 10s. 6d. in the £, and in thesame county they could find one union which levied apoor rate of 7s. in the £ and another which levied one ofless than Is. in the £. It was no reflection on the capacity

527PARLIAMENTARY INTELLIGENCE.

of the men and women who had given many years ofinvaluable service to a very laborious public work to saythat the present system of boards of guardians was obsoletein its construction and unjust in its operation. Its abolitionhad been advocated by every party in the State. That

point was one on which both the Reports of the RoyalCommission of 1909 were agreed and it was the subject ofa unanimous recommendation from the Maclean Committeesome nine years later. Rates were originally levied mainlyfor the relief of the poor and the payment of certain minorcountry expenses. When during the middle of the lastcentury public interest began to awaken to the importanceof public health and to demand from the rates the provisionof adequate social services in the way of drainage, water-supply, and so on, England’s industrial supremacy was stillat that date unchallenged. Any burden which a localfactory was called upon to bear could be passed on withoutundue difficulty to the consumer in markets in which heheld the practical monopoly. All that was changed to-daywhen we found ourselves in every foreign market com-peting bitterly with those who were once our customers andwho were now our rivals. To-day the burden of taxationmight make all the difference between the survival and theextinction of an industry. Of all taxation rates were perhapsthe most burdensome. Now that the rates were the recog-nised means of providing so many social services which inold days were entirely outside their scope, it was not rightthat industry should be called upon to bear the full burdenof their provision without regard to the question whetherthere were funds available out of which to make suchprovision. Proceeding to deal with the

Relationship betzceen the National Exchequer and theFinances ot Local Government Areas,

the Lord Chancellor said that the result of the percentagegrant system was that the amount received by the localauthority depended not upon its need, but upon its expendi-ture. The Government had seized this opportunity so toadjust the relations as to secure that the Exchequer grantshould go where it was most needed and that the provisionof money from the national Exchequer should be regulatedin such a way as still further to redress the inequalitieswhich the spreading of the areas would not completelyextinguish. Three matters had been taken into account-the poverty of the district, abnormal unemployment in thedistrict, and the sparseness of population in the district.In order to make allowance for the poverty of the districtan addition was made to the actual numbers of the popula-tion by taking into account two matters : (1) the rateablevalue ; (2) the number of children under 5 years of age.This latter factor was brought in because it had been foundin practice that the poorer districts were those in which thelarger number of children were to be found. While theformula was admittedly complicated in statement as anarithmetical formula, he claimed that in operation it wasquite simple. By its aid it was believed that a means hadbeen evolved which without any claims to mathematicalaccuracy so adjusted the grant of public money from theNational Exchequer to the various local areas as to ensurethat each received according to its needs and that theinequalities of the past would disappear for the future.Machinery was provided in the Bill for the easy readjust-ment of local boundaries both between districts and electoralareas. Commenting on the provisions of Part I. of the Bill,the Lord Chancellor said that one of the great advantagesof this part of the Government scheme was that the over-lapping which had existed in the past ought in the futureto cease, and that it would be possible by centralisation andspecialisation in selected institutions to provide a far morehighly skilled service than was possible to-day. There waseven power for different poor-law authorities to combinefor the provision of an institution which neither singlymight be able to afford, but which might be essential inisolated cases. The Bill provided that the existing disqualifi-cation of guardians who had received poor-law relief shouldbe extended to the new authorities, but that the dis-qualification should not exist by reason only of the receiptof medical or surgical relief in an institution. Expresspower was given to the county councils for the provisionof hospitals and maternity homes, or for the making of subscriptions or donations to existing hospitals and institu-tions. Provision was made for the recovery from thosewho accepted assistance in these public institutions of acontribution towards the expense, but this did not applyto infectious disease hospitals, including those for thetreatment of tuberculosis and venereal disease, since itwas in the interests of the public at large that persons shouldbe isolated in those institutions as soon as possible. Furtherprovision was made to enable the Minister of Health topostpone the operation of the Bill in those cases in whichit had been found necessary to supersede the existing boardof guardians by reason of their default. Under Part 3 ofthe Bill, which embodied amendments of the law withregard to highways, provision was made for the county

councils as the highway authorities to be given powersunder the Town Planning Act--powers which many peoplethought they ought to have had from the commencement.Provision was made under Part 4 of the Bill for variousminor alterations in local government law ; for instance,the acceleration of the process under which medical officersof health became full-time servants of the State, and themaking of regulations prescribing the qualifications of suchofficers and of health visitors. Provision was further madefor a survey by county councils of the existing accommodationof hospitals for infectious diseases, and the preparation ofa scheme where necessary for the provision of adequateaccommodation. In conclusion the Lord Chancellor askedtheir Lordships to say that the Government had correctlydiagnosed the ills under which local government wassuffering, and that the remedies that they had prescribedwere well calculated to cure those ills. Finality in progressor perfection in execution were beyond human achievement.He made no claim for either in this Bill; but he did claimthat for many years to come the measure would stand outas a landmark in the progress of local government in thiscountry, and as a monument to the vision and courage, tothe breadth of conception, and mastery of detail of theMinister of Health.

Rejection of the Bill Moved.Lord PABMOOR, in moving the rejection of the Bill, urged

that the diagnosis to which the Lord Chancellor hadreferred was wrong, and that the suggested remedies wouldnot cure the ills that existed. The inequity of our ratingsystem consisted in placing on ratepayers the charge ofmainly national services. The Bill did nothing to put anend to that glaring inequity. The poorer districts would beworse off than at present. The excellent work which hadbeen done by poor-law guardians would not be adequatelyperformed in future as the new local bodies were to be givenno responsibility either as regarded policy to be followed,the money to be provided, or the officials to be appointed.He contended that the vast majority of students of thepoor-law system to whatever party they belonged, felt thatthe expense of able-bodied unemployed should be a chargeon the State and not on a particular locality. He thoughtthat the principle of a block grant was a mistake, and thata far better way was to found the grants on efficiency.

After further debate the discussion on the Lord Chancellor’smotion was adjourned.

WEDNESDAY, FEB. 27TH.The adjourned debate on the second reading of the Local

Government Bill was resumed.

Increased Powers of the Ministry of Health.Earl BEAUCHAMP said that it would be idle for the most

determined opponent of the Government to declare thatthere was not a considerable amount of good in the Bill.But it was the business of the Opposition to concentrate oncriticisms, and there was, in the first place, a considerableincrease in bureaucratic powers. There was, running allthrough the Bill, an increase of power to the Minister ofHealth and to the members of the Ministry. With thetwo principles underlying the Bill-the necessity for somechange in local government and the relief from rates-theyall agreed ; his criticisms were as to the methods by whichit was proposed to apply these principles. In regard to thereform of the poor-law the Government proposals were notbold enough. The problem of the able-bodied unemployedwas entirely shirked. Was there not something in thecomplaint that the county councils would be having toomuch work placed upon them and that their duties wouldbe increasing to such an extent that it might become difficultin the future to find people to undertake them ? The Billdid not break up the poor-law, but transferred the work toother bodies. Poor-law functions, he suggested, ought tobe split up in three directions-the oversight of mentaldeficiency in children should be given to county and boroughcouncils ; relief of the able-bodied poor should be delegatedto the insurance committees of which they had heardsomething, and linked up with unemployment insurance ;and the relief of the other poor should be dealt with byHome Assistance Committees. Referring to the maintenanceof health services, Lord Beauchamp said he distrusted thesystem of block grants. Percentage grants had not donebadly on the whole, and he suggested that there might bea combined system beginning with block grants, followed bypercentage grants, so as to encourage local authorities tospend more on health services than they were spending now.

A Constructive Measure.Lord DAWSON said that whatever opinions might be held

on the Bill all would be agreed that it was a great constructivemeasure which showed vision and far-reaching knowledge.For himself, in spite of the lucid exposition given by theLord Chancellor, he still found himself in the mazes of

derating. He proposed to limit his remarks to Part I. of

528 PARLIAMENTARY INTELLIGENCE.

the Bill, of which he had some knowledge, and particularly i’to that part of it which concerned the foundations of’hospitals. He did so with less hesitation because in theHouse of Commons pressure of time was such that discussionwas strictly limited. In the clauses of Part I. there wereprovisions which enabled and, more than that, might easilyencourage councils to found general hospitals for the’treatment of general medical and surgical disease. Whether

. this was a right or wrong policy it was a new departure andone which probably ushered in a new era in the adminis-tration of medicine in this country. He was inclined tothink that the proposals were right if they were suitably..safeguarded. He asked the House to imagine the wholefield of curative medicine, of which neither the councils northeir medical advisers had had any previous knowledge orexperience. They had gained a certain limited knowledge,in the application of curative medicine in the tuberculosisclinics and in maternity. As regarded that large field of;general surgery and medicine treated in the general’hospitals of this country their experience amounted to

extremely little. The fact that the councils had run poor-lawhospitals was butlittle.training for the running of big general- hospitals such as they ’knew them and understood them.’These powers which were given in the Bill would enable thecouncils not only to convert poor-law hospitals into generalhospitals, but give them the power of founding generalhospitals. These powers came at a time when the demand.for hospital accommodation was increasing throughoutthis country. The fact was that the hospitals were no longerthe need of a class ; they were the need of the whole nation.’They used to be for the sick poor ; now all were poor and.sometimes sick. Anyone might need a hospital in these.days. The progress in knowledge demanded it. Socialand economic conditions demanded it. The first reasonwas the progress of knowledge.

Team Work Necessary. ,

The art of medicine, Lord Dawson continued, now called,to its aid a number of sciences, sciences mobilised on itsbehalf. These new sciences required team work. Years agoa cough or a disease of the chest required a stethoscope and .a bottle of medicine. To-day they required besides theclinical knowledge of the physician the radiologist and thebacteriologist. A surgeon who wished to operate on thestomach now required besides his own skill the skill perhapsof the chemist or the radiologist. In other words, there wasthe necessity of bringing together many branches of know-ledge which had to act in coordination if they wished toattain their result. That could only be done by organisation.Each of these specialties required its equipment. Theseequipments had to be brought together not only for efficiency,but for cost, because they had this striking fact that themore science progressed the greater the cost of treatmentbecame. Therefore, but for what he might call massproduction, a large proportion of the community would bewithout those benefits. That, then, was a reason whypeople in increasing numbers needed institutional treatment,which in other words was hospital treatment. It was a factwhich had to be admitted that the voluntary hospitals ofthis country could not entirely fulfil those functions. Itseemed to him that the question-he had no doubt that itwas before the Government when they drew up the Bill-was how this hiatus was to be filled up. There was oneway in which there could be a considerable extension of aform of cooperative hospital in those homogeneous com-munities which were increasing in number and were knownas garden cities and garden suburbs. There was great scopethere for a system of cooperative treatment and for

- cooperation in matters of health. By linking up thesecooperative health societies with the insurance companiesthere could be a certain solution of the difficulty of hospitalprovision. Even when that was allowed for there stillremained a large gap to be filled. That was why he thoughtit was proved and a case made out that further hospitalprovision was needed. In short, it came to this, that allthe conditions of to-day tended to move the location ofillness from the home to the institution and the need for-this hospital accommodation was great. They had toremember, however, that neither the councils nor theirmedical advisers had had up to now any experience of thecurative treatment of disease. If, for example, they tookthe medical staffs who advised the councils they consistedof medical officers of health and certain people who lookedafter the clinics. Their experience was limited to their owndomain and very excellent work they did; but theirexperience of curative medicine was little or none ; yet theywould be called upon under this Bill to fulfil those importantfunctions.

Hospital Organisation.It must be borne in mind that four-fifths of the medical

men of this country were engaged in curative medicine.It was in this respect that he thought that Part I. of theBill was defective. It seemed to show a lack of appreciation .of the essential conditions of success. It was almost as if

it said in effect to the Public Assistance Committees : " Youcan convert your poor-law hospitals if you wish. You canbuild large hospitals if you wish. I would like you to coopta few people who know something about the running of ageneral hospital, but I will not force you to do so." Nodoubt some councils would think that anybody could founda hospital. A hospital was not a building made withhands ; it was an organisation, an assemblage of greattraditions. The hospital service of this country had grownup through the years. Its efficiency, its flexibility ofadministration, its public spirit, and its warmth of hearthad all gathered round what was called the voluntary system.That system had made the hospitals of England famousthroughout the world. More than that, these hospitals drewto their service the young man of talent. It was hisgreat ambition to get there. There he worked for yearsat a pittance in order to gain experience. There heearned his reputation. and his discipline. There he got thatcurious atmosphere of knowledge and service. That wasthe current of events. That was the recognised road withinthe profession. Further than that, it was from these hospitalsthat the nurses came. Was it not obvious that the voluntaryhospitals of the country should be made the centre, thekernel round which any new hospital system should be built,and that any legislation should provide that this mode ofprogress was not only permitted but secured ? Surely thecorrect policy was to foster the voluntary hospital, remem-bering that it was a very tender plant, and might easily bekilled. Let the voluntary hospital lead, let it direct themin building up what he admitted was needed-that was anew and extended hospital policy for the country. Thedangers of not doing this were very real. Supposing theirwas no coopted minority on these Public AssistanceCommittees. Supposing, for example, they had a free handto do what they wished. Supposing (and this was notimagination) a council was returned committed to thepolicy of a whole-time medical municipal service. Thatcouncil would set out to build up a service independent ofthe voluntary hospitals, competing with them and over-

lapping them, and there was no one to say them nay.That was no mere figment of the imagination. There wereat this moment boroughs running, or trying to run, a

municipal service. There were certain people who avowedthat their object was to set up municipal hospitals and tostaff them with a full-time staff and run them as a form ofmunicipalised service. That, surely, would be a disaster.How were they going to get their staff ? He presumed theywould advertise for it, just as if skilled men like physiciansand surgeons grew like gooseberries on a bush. It hadalready been tried. Advertisement did not bring the rightpeople. It did not secure that round pegs went into roundholes, and there had been already consequences which werelamentable, resulting from the wrong people staffinghospitals and doing work for which they were not trainedand not suited. That was a very serious danger. If theypermitted the councils, whose experience of running curativemedicine was up to now small and had almost reacheddiminishing point, to undertake that new venture withoutany form of cooption of people who were skilled on the onehand in, the administration of hospitals, and on the othernanci witnout any assistance irom doctors wnose lives were

spent in doing the work of curative medicine, there was avery serious danger. He pleaded with the Government tomake it compulsory that there should be cooption of aminority on these Public Assistance Committees. It wasdone in the case of education. If it was sound to do it foreducation why not do it for health ? There was no argumentfor the one which was not applicable to the other. Whenthe Bill was before the House of Commons the Governmenthad not been able to take a full measure of the oppositionto the Bill, and he had no doubt that when they madecooption optional they did it because they did not wishto increase the opposition in the country. But it was surelyclear now that the country was in favour of the Bill andthere was no longer therefore an excuse for not doing thatwhich all those people who were connected with the adminis-tration of public health outside the official world were infavour of doing. The medical profession by practicalunanimity had requested that the cooption of the minorityskilled in hospital work should be made compulsory, andthey appealed very strongly to the Government to concedethat point. King Edward’s Hospital Fund had taken thesame line and on the merits he asked the House whetherthey would start a new measure and a sound venture, onethat might lead to a wide establishment of municipalhospitals for curative medicine in this country and neglectall the traditions and the knowledge that had been gatheredduring the years.

A Simple Remedy.There was one other amendment which he would urge

on the Government. Up to now the medical staff of the, health services of this country had been run by a small

number of medical men. They had been men who had: specialised in preventive medicine. They had consisted in

529PARLIAMENTARY INTELLIGENCE.

the country of medical officers of health, tuberculosis officers,school medical officers, and he would guard himself by sayingthat there was no one who admired their work more thanhe did, but it was a work of a strictly limited application.’They had never had anything to do with disease. Many ofthem had never had any contact with hospitals since theirstudent days. How could these men be expected wiselyto advise their councils on this large question of curativehospitals ? Ever since the Ministry of Health Act waspassed it had been a most regrettable fact that the policyof the official doctor-the doctor who was paid by fee, themedical officer of health and the officers he had alreadynoted-proceeded on lines totally divergent from that ofthose doctors who constituted four-fifths of the professionand who belonged to the curative branch. That divergencewas lamentable. It was a serious matter when the councilonly had to deal with preventive medicine, and it was astill more serious thing if this divergence should continuenow-this divergence for which the Ministry of Health hadbeen responsible ever since it was founded. To meet thathe suggested quite a simple method which had been beforethe Ministry of Health for some time, and that was thatthere should be set up under the chairmanship of themedical officer of health an advisory council of doctors ineach district which the council administered. This simpleremedy would bring the experience of the men who knewto the benefit of the medical men who had to administer.He believed that the hospital policy in the Bill was capableof great and continued benefit to the community, and if onlythe Government would accept the safeguards which he hadadumbrated in the form of amendments at a later stagethey would ensure that the scheme not only brought aboutreforms, but opened up avenues of progress which wouldlead to the greater health of the people, in which respectthey would fain see this country lead the way.

Further Criticism of the Bill.Lord THOMSON said that an expert in local government,

of 35 years standing, had told him that the Bill was a gamble,that it was based on figures which were guesswork, and thatthe formula provided a rule-of-thumb, but embodied noprinciple. The money which would be given to industrywas so small in each case that it would not do any good.In his (Lord Thomson’s) view the Bill was timorous because

’ it did not attack the central and urgent problem of thenecessitous areas.Lord CRANWORTH said that he welcomed the Bill because

it made a first attack on the pernicious tyranny of thepercentage grants under which so much public money hadbeen wasted. He believed that, viewed as a whole, the Billwas the best measure brought forward since the war.

Earl RUSSELL said that he must take strong exceptionto that part of the Bill which dealt with recovering thecost of maintenance of persons in various institutions. Itread as if it must be the duty of the local authority to collectthe costs to the last farthing, and in Committee the

Opposition would endeavour by amendments to soften theharsh character of that proposal. They would also seekto obtain security of tenure for the officials of the localauthorities. On the general question of rating relief hesaid that to give relief to the rich and to put additionalburdens on the poor was not the Labour Party’s conceptionof justice. It should not be beyond the wit of man todevise a method which, while giving relief to the individual,- did not enrich big firms.

Reply to the Debate. IThe Earl of ONSLOW (Paymaster-General), replying to thedebate, said that the Bill had not been wholly condemned by.any speaker. Lord Beauchamp had complained that thebureaucratic powers of the Minister had been greatlyenhanced. But where they had arrangements for thetransfer of areas and the adjustment of boundaries, therewere found to be disagreements, and it was generallyrecognised that the only person to whom those disagreementscould be referred was the Minister, who was entrusted with ithe business of local government. Dealing with the Icriticisms of the purposes for the reform of the poor-law, Ithe noble Earl said that the principle of the Act of Elizabethhad not been really interfered with. The statement had Ibeen very freely made that the Bill did not break up the Ipoor-law. The fact was that the Bill dealt with the transferof the poor-law powers from the guardians to the counties,and county boroughs. It did not pretend to break up thepoor-law at this time. But it was intended to encouragethe break up of the poor-law, and the adoption of thetransferred functions under other Acts so far as it waspossible. The Bill had been criticised as being too long,,and if they had attempted to amend the huge ConsolidatedPoor Law Act of 1927 the Bill would have been greatlyoverweighted. Also, any such attempt at present wouldmean that they would not have the advantage of being able,to discuss the amendment of the poor-law with those whowere responsible for it, because the guardians, under the Bill,

were in a moribund’condition, and the counties and countyboroughs had not yet come into their inheritance. But itwas recognised that the existing poor law and the existingpoor-law arrangements must be discussed with a view toreform, and therefore it was proposed to initiate discussions,at a convenient time after the passing of the Bill, with theassociations representing the poor-law authorities as towhat changes might be necessary in the Act of 1927.Another criticism had been that the Government had nottaken unemployment out of the Bill and dealt with it as anational service. But, had they adopted a national systemof dealing with the able-bodied unemployed, it would havebeen impossible to avoid a rigid bureaucratic organisation,with far more hard-and-fast rules than was necessary underthe organisation proposed in the Bill, and with an army ofofficials. Also. it would have been necessary to have twoauthorities dealing with same people-the national authoritydealing with the well and able-bodied, and the local authoritydealing with the sick and unemployed. The result of thatwould have been constant confusion, overlapping, delay,and dissatisfaction. Further, it would be difficult toadminister such a service nationally without a return to theprinciple of the " dole."The motion for the rejection of the Bill was negatived by

102 votes to 20-majority against, 82.The Bill was then read a second time.

THE BILL IN COMMITTEE.On Tuesday, March 5th, the Local Government Bill was

considered in Committee, the Earl of DoNOUGHMORE inthe chair.

Provisions as to the Alternative Powers of Giving Assistance., The Marquess of READING moved an amendment toClause 4 providing that in so far as administrative schemesprepared by councils under the clause related to hospitalsthe councils should take reasonable steps to seek and tocontinue to secure full cooperation with every voluntaryhospital within or serving the area of the council. Hestrongly urged the Government to accept the amendment.Lord DAWSON also had an amendment down on the

Order paper to the following effect :-" A council, in preparing a scheme under this section, shall

have regard to the desirability of consulting (a) any body existingin the area which is so constituted as to be representative ofthe voluntary hospitals in the area, and (b) any body existingin the area which is so constituted as to be representative ofthe duly-qualified medical practitioners in the area, includingthose on the medical and surgical staffs of any voluntary hos-pitals in the area."

The Earl of ONSLOW (Paymaster-General), who repre-sented the Ministry of Health, said that he was preparedto move the following new clause in order to meet theviews that had been expressed on behalf of the voluntaryhospitals :- -

" The council of every county and county borough shall -

make such arrangements as they think desirable for securingthat the functions transferred to them under this Part of thisAct with respect to the provision of hospital accommodationwill be discharged after consultation with such body, if any,within the county or county borough as they consider torepresent the voluntary hospitals in the area."

In the debate which followed the view was expressedthat the Government’s new clause was too vague in itsterms, and it was also criticised on the ground that it didnot meet Lord Dawson’s point in regard to the consultationof the medical profession in each area.The Earl of ONSLOW assured the House that it was the

wish of the Government to settle the matter in accordancewith the desires of the House. He undertook to have theclause redrafted before the Report stage, and he hopedthat in its altered form it would be acceptable both to LordDawson. and to the rest of the House.The Marquess of READING withdrew his amendment.Lord DAWSON, in intimating that he would not press

his amendment, said he hoped that they would get some-thing more out of the Government.

HOUSE OF COMMONS.

WEDNESDAY, FEB. 27TH.Sterilisation of the Unfit.

Colonel WEDGWOOD asked the Minister of Health whetherhe had received a petition signed by many doctors andeugenists, asking for the sterilisation of criminals and mentaldefectives, and whether the Government intended to takeany sort of action in the matter.-Mr. CHAMBERLAIN replied :I have received a resolution urging that an inquiry shouldbe held into the best method of dealing with mentaldeficiency, including a special inquiry into the possibilityand advisability of legalising sterilisation under proper

530 PARLIAMENTARY INTELLIGENCE.

safeguards and in certain cases. I am not yet in a positionto indicate the intentions of the Government in the matter.

THURSDAY, FEB. 28TH.TPork7nera’s Compensation Statistics.

Mr. TINKER asked the Home Secretary if he was awarethat the workmen’s compensation statistics presented toParliament each year did not give a complete list, and thatno returns were given from agriculture, road transport,building, and many other industries and occupations ; andif he intended to ask Parliament to extend Section 42 ofthe consolidating Act of 1925 which gave him powers tocall for returns from seven great industries, so that all whocame under the Workmen’s Compensation Act must makereturns.-Sir WILLIAM JoY?ssorr-HzcKS replied : Yes, Sir,the present Regulations under Section 42, which requirereturns to be furnished, do not extend to all industries.The hon. Member will find the reasons for this explained inthe Introduction to the Statistics for 1908. The reasonsstill hold good, but the extension of the Regulations toother industries is noted for consideration as soon as condi-tions permit. No fresh legislation is required for the purpose.

Scavenging in Rural Areas.Rear-Admiral BEAMISH asked the Minister of Health

whether he would issue an order or introduce legislation toamend Section 42 of the Public Health Act, 1875, to permitof scavenging and cleaning over limited areas of ruralparishes and to charge the expenses to that area, and therebycontrol the growing heaps of insanitary household rubbishwhich now disfigured so many villages.-Mr. CHAMBERLAINreplied : I have no power to issue an Order for this purpose.The matter has been noted for consideration when anopportunity for legislation arises. I doubt, however, whether legislation would be the most effective cure, and it islikely that improvements would be effected if local authoritieswould use more freely their influence and their powers.

Health of the Mercantile Marine.Sir RiCHARD LUCE asked the President of the Board of

Trade if the necessary sickness and mortality statistics wereavailable or in process of preparation for the use of thejoint committee appointed by the Board of Trade and theMinistry of Health to consider matters affecting the healthof the mercantile marine.-Commodore KING replied : Inaddition to the statistics published by the Registrar-Generalof Births and Deaths there is an annual return published bythe Board of Trade of all deaths which occur on shipsregistered in the United Kingdom. The question whetherthese statistics can be improved or supplemented is beingconsidered by the Joint Advisory Committee.

A dmission of Starved Persons to Hospitals.Mr. GARDNER asked the Minister of Health whether his

attention had been drawn to an account of an inquest atthe court of the city coroner, held on Feb. 18th, on a manfound by a police constable starved and ill on the pavementoutside Holborn Viaduct station ; whether he was awarethat the man was taken to St. Bartholomew’s Hospitalbecause there was an arrangement not to send cases to theCity of London poor-law hospital after 9 P.M., and thatthe man was refused admission and taken elsewhere andthere refused and then brought back to St. Bartholomew’s,and then put into an isolated room and found dead on thefloor at about 1.30 A.M. ; by what poor-law authority thisarrangement was made and when, and whether it was knownto the poor-law inspector or at the Ministry of Health ;whether any similar arrangement existed elsewhere and, ifso, where ; whether he would inform the superintendentsor masters of all poor-law hospitals that they must admitall cases of starvation and exposure brought by policeofficers without any order from the relieving officer ; andwhether he would revive the lists of starvation cases whichwere published from about 1870 till 1918.-Mr. CHAMBERLAINreplied : The reply to the first part of the question is in theaffirmative. In reply to the second part there is not, andcould not legally be, any arrangement preventing theadmission of cases to the poor-law infirmary of the city ofLondon Union or any other infirmary during prescribedhours of the night. The arrangement made between theguardians and St. Bartholomew’s Hospital is that where abed is available at the hospital cases shall not be sent onto the infirmary during the night, but shall be kept untilthe morning and then removed, and this arrangement seemsto me a very proper one. If the patient had been sent tothe infirmary he would have been admitted, as in fact I aminformed that many other persons are admitted both byday and by night. As regards the last part of the questionI do not think that any useful purpose would be served bya revival of the returns.

I, Medical Records in the Army.Mr. SHEPHERD asked the Secretary of State for War

whether there was any trace of rheumatism in the Army

medical history of Mr. G. J. Ross, Louisa-street, Darlington,late trumpeter, Royal Artillery.-Mr. DUFF COOPER replied tThe medical records of soldiers are confidential documents,and it would be contrary to the established practice tudisclose details from them.

Dr. VERNON DAViES : Does not the hon. gentleman seethat in the case of an appeal a person is handicapped if hecannot get any particulars of the medical history of the-case ? He is placed in an absolutely impossible position.

Mr. COOPER : The previous history is open to the peopleadvising the appellant.

Dr. DAVIES : The hon. gentleman has just indicated thatit is not.

The Traffic in Heroin.Mr. CECIL WILSON asked the Home Secretary whether,

seeing that the heroin available for internal consumption in1924 was 909 kilogrammes, that the manufacture and importsin the following year was 344 kilogrammes, the exports andre-exports 236 kilogrammes, and the weight available forinternal consumption 108 kilogrammes, he could explainwhat became of the balance of 1017 kilogrammes in 1924and 1925, seeing that this was many times the quantityavailable for internal consumption in other years.--Sir,WILLIAM JoTNSON-HiCKS replied : The explanation is thatthe figures include 745 kilos of heroin in 1924 and 15 kilosof heroin in 1925, which were not used as such, but werereconverted into morphine. If these figures are subtractedfrom those quoted by the hon. Member as available forinternal consumption, it will be found that the balance ineach year approximates to the general annual average ofthe surplus of heroin imported and manufactured over thatexported and re-exported. The bulk of the heroin so .

reconverted consisted of illicit consignments to the FarEast which were seized at Hong-Kong and sent home to.this country for disposal.

Mr. WILSON: Can the right hon. gentleman say whetherthe amount of 108 kilogrammes is not in excess of thatrecommended by the Committee of the League of Nationsand that the Chinese coolies do not destroy all the heroin thatis seized in this way and whether we are making a profitout of it.

Sir W. JoYNsox-HicKS : The heroin is not destroyed,but is sent over here in order to be utilised for medicinalpurposes. .

MONDAY, MARCH 4TH.Protection of Drivers against E:cposure.

Mr. SHEPHERD asked the Minister of Transport whatregulations prevented the provision on omnibuses, tram cars,taximeter-cabs, and other public vehicles, of adequateprotection for their drivers against exposure to the weather.-Colonel AsHLEY replied : There are no general regulationswhich would prevent the provision on public service vehiclesof adequate protection for their drivers against exposure tothe weather, but there are, I understand, local regulationsmade by certain local licensing authorities limiting the useof windscreens on vehicles licensed to ply for hire.

Protection of Civil Population against Poison Gas.Mr. ROBERT MORRISON asked the Prime Minister whether

the scheme which had been prepared for the protection ofthe civil population against poison gas in future warfarewould now be submitted to the local authorities in orderthat arrangements might be commenced for training thenecessary personnel, as had already been done in othercountries.-Mr. BALDWIN replied : As I indicated to thehon. Member on Feb. 12th, the problem of the protection ofthe civil population against gas attack is being closelystudied in all its aspects. Further work, however, remains.to be done before any scheme can usefully be communicatedto the local authorities.

Death at Whipp’s Cross Hospital.Miss LAWRENCE asked the Minister of Health whether his

attention had been directed to the circumstances attendingthe death of Miss Sarah Dicks at Whipp’s Cross Hospital;whether he was aware that no communication of the deathwas made to the relatives of the deceased, a message beingsent only to her lodgings ; and whether he would causeinquiries to be made.--Sir KINGSLEY WOOD replied: Thiscase was reported to my right hon. friend by the medicalsuperintendent of the hospital. He learns that the casewas put on the danger list immediately after admission andwas visited by relatives who were informed that they couldstay with the patient as long as they chose. The last visitpaid by the relatives was within an hour of the patient’sdeath which took place at 8.55 P.M. on Jan. 21st. Inaccordance with the usual practice of the guardians, whichmy right hon. friend considers a proper one, the relativeswere not informed of the death that night, but noticewas sent by special messenger at 8 o’clock on the

following morning to the address furnished on the hospitalbed-card.

531MEDICAL NEWS.

TUESDAY, MARCH 5TH.Use of Cocaine in Poor-law Institutions.

Mr. DAY asked the Minister of Health whether he had

received any complaints of large amounts of cocaine usedin any of the poor-law institutions in England and Wales ;and if it was his intention to set up an inquiry into thesecharges.-Sir KINGSLEY WOOD replied : My right hon.friend has received no formal complaint of this kind, buthe is aware of one instance in which a poor-law medicalofficer has used considerable quantities of this drug for hisown treatment. The officer has resigned his appointment,and my right hon. friend sees no reason for further actionon his part.

Disease Germs in Bombs.Lieut.-Commander KENWORTHY asked the Secretary of

State for War whether the War Office had information tothe effect that bombs or shells carrying disease or plaguegerms were used by the German forces on the Westernfront during the great war.-Sir L. WoRTHiNGTON-EvANSreplied : No, Sir. The War Office has no other informationthan that contained in the Official History of the War,Vol. II., Medical Services, Chapter 17.

Medical News.UNIVERSITY OF CAMBRIDGE.—At a congregation held

on March 1st the following degrees were conferredM.B. and B.Chir.-J. A. Hartley and J. D. Procter.M.B.-A. J. Dix-Perkin.

The Council of the Senate have presented a report on anoffer to equip a nutritional laboratory, which ha3 beenmade by the Medical Research Council through theirsecretary, Sir Walter Fletcher, and recommend that theoffer should be gratefully accepted.

SOCIETY FOR THE STUDY OF INEBRIETY.-At therooms of the Medical Society of London, 11, Chandos-street, Cavendish-square, W., on Tuesday, April 9th, at4 P.M., Dr. J. D. Rolleston will open a discussion on Alcoholin Therapeutics.

TUBERCULOSIS OF BONES, JOINTS, AND LYMPHGLANDS.-A course on this subject will be held at theHôpital Maritime at Berck Plage, Pas de Calais, France,from March 25th to 30th, under the direction of Dr. EtienneSorel. Information can be got from Dr. Delahaye at thehospital.THE Minister of Health has expressed his approval

of a proposal to invite the International Union of LocalAuthorities to hold their next congress, which is due to takeplace in 1932. in this country.

SOFIE NORDHOFF-JUNG PRIZE.—This prize, offeredfor the best work in recent years on the investigation ofcancer, has been awarded to Prof. Katsusaburo Yamagiwa,of Tokyo, for his research on the experimental productionof cancer by cutaneous irritation.

A BRITISH SANATORIUM AT MONTANA (SWITZER-LAND).-A new sanatorium, known as The British Sana-torium Montana, has recently been opened at this favouredspot high up in the valley of the Rhone by Dr. HilaryRoche, late medical superintendent of the Palace Sana-torium, Montana. The new sanatorium is intended for thereception of British patients only.FINANCES OF UNIVERSITY COLLEGE HOSPITAL.-

A festival dinner took place at the Mansion House last weekin support of the appeal for .830,000 to pay off the accumu-lated debts on this institution, and to provide the nucleusof an adequate reserve. Prince George, the President,who was in the chair, announced at the close of the eveningthat the entire sum, and a little more, had been obtained.

RESEARCH ON RHEUMATOID ARTHRITIS. - Thebequest of i0300 to the University of Manchester, under thewill of the late Miss Amy Henrietta Worswick, will bedevoted in accordance with her wishes to the investigationof the causes and treatment of rheumatoid arthritis. Atemporary fellowship of the value of i0150 per annum willbe offered, and application may be made to the Registrarbefore Oct. 15th next by any person who has obtained amedical qualification registrable in the United Kingdom.GENERAL LYING-IN HOSPITAL.-It was stated at

the annual meeting last week that among 1043 cases ad-mitted last year there were only three deaths. Under thecovenants of the lease the premises have to be rebuilt nextyear, and 19,500 is still required to meet the cost.

LONDON REFRACTION HOSPITAL.-On Thursday inlast week the Countess of Mayo opened the enlarged premisesof this hospital in Newington Causeway, S.E. It was

originally established in 1922, and in the first year 563patients were treated ; last year the number was nearly6,000. The institution has been built and equipped bythe Institute of Opthalmic Opticians which is now askingfor help towards its maintenance, the cost having outgrownthe means of the institute.

INSTRUCTION FOR D.P.H.-A three months’ courseof lectures and demonstrations on clinical practice and inhospital administration will be given at the North-Eastern Hospital, St. Ann’s-road, Tottenham, London, N.by Dr. F. H. Thomson, the Medical Superintendent, onMondays and Wednesdays at 4.45 P.M.. and alternateSaturdays at 11 A.M., beginning on Monday, April 8th.Particulars may be had from the Clerk to the MetropolitanAsylums Board, Victoria Embankment, E.C.4.

POST-GRADUATE COURSE AT WEST LONDON HOS-PITAL.-A syllabus has been issued of the lectures anddemonstrations to be given in connexion with the post-graduate course to be held at the West London Hospital,Hammersmith, from March llth to 23rd. The course willdeal with general medicine, surgery, and the special depart-ments, with special reference to recent advances, and therewill be daily sessions from 10.30 A.M. to 5.30 P.M.. excepton Saturdays, when only the mornings will be occupied.The syllabus is obtainable from the Dean of the Post-graduate Medical College, who should be addressed at theHospital, Hammersmith, W.6.FELLOWSHIP OF MEDICINE AND POST-GRADUATZ

MEDICAL ASSOCIATION.—Particulars of lectures and demon-strations during the coming week will be found in ourMedical Diary. Fixtures for April include a practitioners’course at the London Temperance Hospital, and courses intropical medicine at the London School of Hygiene andTropical Medicine, in electrotherapy at the Royal FreeHospital, in medicine, surgery, and gynaecology at theRoyal Waterloo Hospital, and in neurology at the WestEnd Hospital for Nervous Diseases. Copies of all sylla-buses, and details of the general course of work in theLondon hospitals affiliated to the Fellowship may be hadfrom the Secretary at 1, Wimpole-street, W.1.

A DEPUTATION ON PUBLIC HEALTH QUESTIONS.-Mr. Amery (Secretary for Dominion Affairs), Mr. NevilleChamberlain (the Minister of Health), and Mr. Betterton(Parliamentary Secretary to the Ministry of Labour) latelyreceived a deputation from the General Council of the TradesUnion Congress. In reply to the suggestion that thepossibility of securing reciprocity with the Dominions insocial insurance should be placed on the agenda of the nextImperial Conference, Mr. Amery said that apart from theIrish Free State the Dominions had not yet put into forcecomprehensive schemes for health, pensions, and unemploy-ment insurance on lines corresponding to those in existencein this country, and consequently a scheme of generalreciprocity was at present impossible. The matter hadbeen considered by the Imperial Conference in 1926, sincewhen it had been taken up with the Dominion Governments’

‘

and some progress was being made. A health insuranceBill had been introduced into the last CommonwealthParliament, and was likely to be reintroduced, and in

South Africa a Royal Commission was considering thequestion of health insurance. He promised that, if theGovernment were returned to power, the question shouldbe on the agenda of the next Conference. The deputationalso submitted resolutions urging the Government to takefurther measures for dealing with the present housing situa-tion by an extended building programme and the demolitionof slum areas, and requesting the Minister of Health to givefacilities to insurance committees so that Section 107 ofthe National Health Insurance Act, 1924, which is directedagainst bad housing and other conditions, may be madeoperative. This section enables inquiries to be made intothe causes of excessive sickness in particular localities.Stress was also laid on the need for mora women sanitaryinspectors, the Trades Union Congress having agreed " thatat least one whole-time woman sanitary inspector shouldbe appointed on the staff of every metropolitan boroughcouncil and on the staff of every local authority adminis-tering a large industrial area." Finally a resolution on theabolition of privately owned slaughter-houses was broughtforward. In his reply Mr. Chamberlain said that Section 107of the Insurance Act had not proved workable in practice.The appointment of women sanitary inspectors could notbe pressed upon the smaller authorities who employedone sanitary inspector only, but he agreed that in themetropolitan boroughs and other large authorities theappointment of women was desirable. As opportunitiesoccurred he would be prepared to encourage the institutionof public slaughter-houses.