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practitioner, may either transfer with the consentof both practitioners, notified by their signatureson the appropriate space of the medical card, or withthe authorisation of the Insurance Committee, whichwill be given as a matter of right but with effectonly after the expiry of 14 days after application.Under the latter alternative the insured person mustsend to the Insurance Committee his medical cardwith a letter stating his intention to transfer, and themedical card will be returned to him with a slipattached authorising transfer after the appropriatedate. This slip should be completed by the insuredperson and signed and dated by the practitioneraccepting him for treatment. The card with the slipattached should then be forwarded by the practitionerto the Committee. Acceptance cannot be registereduntil the date named, and in the meantime theinsured person should continue to obtain treatmentfrom the former practitioner.A new form of medical card is being prepared which

will contain instructions as to the new procedure,but it is not possible, for reasons of economy, to makea general issue of new cards to all insured persons.Cases will therefore occur in which insured persons inpossession of old medical cards will apply as at presentfor acceptance by a new practitioner. In such casesyou are requested to be good enough to inform theinsured person that, as he is already on the list ofanother practitioner in the district, it is necessarythat he should obtain either the written consentof the latter to the transfer or the authorisation of theInsurance Committee. The practitioner on whoselist the insured person is included can give his consentin cases where old cards are presented, by writingacross Part A the words " I consent to transfer " andappending his signature and the date. The insuredperson and the new practitioner should then completePart B. The new style of medical card will providea space Part C to be completed by both practitioners,in cases where transfer is made by consent.To assist the Committee in bringing the change of

procedure to the notice of insured persons, I am torequest you to be good enough to exhibit the accom-panying poster containing the new instructions in aprominent place in your waiting-room. Furthercopies of the poster can be obtained on applicationto the Committee.

I am to add that the new regulations do not inany way affect the existing procedure regarding theacceptance of persons not already on the list of anotherpractitioner practising in your district, of temporaryresidents, or of persons on the lists of approvedinstitutions.

Text of the New Regulations.16.-(1) An insured person, other than a member of an

institution or a person who is permitted or required to makehis own arrangements for obtaining treatment, may at anytime make application for acceptance by an insurancepractitioner notwithstanding that he is at the date ofapplication included in the list of another practitioner, andif accepted shall forthwith be entitled to obtain treatmentfrom the practitioner to whom application has been made.Provided that if the insured person is at the date of the

application included in the list of another practitioner andhas not removed permanently or temporarily outside thedistrict within which the practitioner has undertaken toprovide treatment the application of such insured personshall only be accepted if either :-

(a) both the practitioner in whose list the insured personis included and the practitioner to whom he appliesfor acceptance consent to the transfer, and suchconsent is signified by the practitioners in accord-ance with the instructions printed on the medicalcard; or ’

(b) the insured person has forwarded to the Committeehis medical card together with a notice of his desireto transfer and not less than fourteen days aftersuch notice is received by the Committee theinsured person and the practitioner to whose listhe proposes to transfer have signed a statement ina form approved by the Minister and issued bythe Committee indicating the agreement of theinsured person and the practitioner that the transfershould be effected, which form shall be attachedto the medical card by the Committee.

Poster to Exhibit in Waiting-room.The poster (referred to above) regarding change of

doctor is couched in the following terms :-After Oct. lst, 1927, if you wish to change your doctors

and if you are still living in the district in which your presentdoctor practises you should proceed as follows :-

Either (1) You may transfer with the consent of yourpresent doctor and of the new doctor ; in that case you musttake your medical card to be signed by both doctors, andleave it with the doctor to whom you wish to transfer.Or (2) You may send your medical card to the Insurance

Committee with a letter stating that you wish to changeyour doctor. It is not necessary to give the reasons whyyou wish to change. The card will then be returned to youwith instructions as to when and how you may transfer.Until you have complied with the instructions sent to youregarding transfer, you should continue-to obtain treatmentfrom your present doctor.

If you have not chosen a doctor, or if you have removedeither temporarily or permanently from the district in whichyour present doctor practises, it is not necessary for you towrite to the Committee. All you need do is to take yourmedical card to any insurance doctor you wish to choose. Ifyou are not in possession of a medical card you should com-plete a form of application (Form Med. 50) to be obtainedat the nearest post office and send it to the Committee.

Postage must be prepaid on all letters to the InsuranceCommittee.

SCOTLAND.(FROM OUR OWN CORRESPONDENT.)

The Progress of Housing.IN 1928 the question of housing subsidies of every

sort falls to be reconsidered, Scotland having obtainedan extra year, since, for sufficient reasons, housingprogress was not equal to that of England. But atlast Scotland seems to have got into her stride, andthe large programme projected by the ScottishHousing Commission is in a fair way to be realised.During 1927 the various housing schemes, includingthose for slum clearance, have begun to bite into themass of arrears. It is noticeable that in the courseof eight years Scotland has largely ceased to be astone-house country, and has largely become a " brick-and-harl " or cement-block country, although Aber-deen has stuck almost entirely to granite and noAberdonian would wish it otherwise-at least, in themain areas of the city. But on its fringes and par-ticularly in Deeside, which for seven miles on thenorth is thickly peopled with villas, " brick-and-harl " or cement-block is making an impression.Elsewhere in Scotland brick and cement can stillundersell stone, in spite of the innumerable quarries,and what Carlyle and his mason father would havesaid of this decline of the mason’s craft can be guessedfrom the Latter-Day Pamphlets. But Carlyle couldnot have failed to perceive that the country has manythousand more houses than it boasted ten years ago,when the Scottish Housing Commission reported in adocument that was not shelved.The monthly returns for 1927 show that the number

of houses finished has not once fallen below 1000 permonth, and the average approaches 1550. If thisrate is maintained for the next five months, the yearwill have the handsome record of 18,500 houses, andto these may be added 2500 steel houses erected underthe direct control of the Scottish Board of Health.If we total the houses finished, those now building,and those already tendered for (including subsidised" private enterprise " houses), we get a numberapproaching. 115,000 houses, not including the manystructures erected without subsidy.

The One-room House.The lessons of Dr. J. Burn Russell’s famous lecture

or sermon on " Life in One Room," which prompted

a cardinal chapter in the Report of the HousingCommission, is brought to memory by Dr. A. S. M.Macgregor, the present medical officer of health forGlasgow, in his annual report. For this includes aspecial inquiry by Dr. J. A. Wilson on the age-factorand housing-factor in the incidence of pulmonary

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tuberculosis in the east end of Glasgow. Dr. Wilson 1finds that a marked and rapid fall has taken place in the extent to which adults over 25 years of age are (

affected. He notes that in the case of males an (

increase in the size of house is associated with adiminished incidence of the disease, most marked in ]the young adult and at ages from 46-65 years. As i

between the one-room and the two-apartment house,the two-apartment house shows a greater incidence atages 11-15 and 21-25. At all other ages, the one-roomhouse has the greater incidence. In the case offemales, at all ages, except 6-10 years and over 66years, the improvement in the housing status is

represented by a marked decline in incidence. If wetake the one- and two-apartment houses as againstthe three-apartment, the decline in incidence is verystrikingly shown in the three-apartment house. Tothose familiar with the area investigated, the " func-tional" difference between the one-apartment andtwo-apartment house is largely nominal; but, evenso, the two-apartment house scores. This investiga-tion emphatically confirms the Royal Commission’schapter, in which the many Glasgow investigationswere fully recognised. The disconcerting fact remainsthat in this area the one-apartment houses rise to26 per cent. of the whole, the two-apartment houses53 per cent., the three-apartment 16 per cent., whileonly 5 per cent. of the houses are of four or morerooms. Thus 79 per cent. of the houses are of oneor two apartments. Dr. Wilson comments : " Thesegraphs, it is suggested, demonstrate in a forceful waythe important bearing of housing on the incidence ofthis disease, the larger houses being associated witha diminished incidence in most age-groups. Muchhas been written in condemnation of the one-apart-ment house, and if further condemnation were neededthe material is to be found in these results. But ithas to be remembered that the house, in an industrialarea, is only a reflex of the economic condition ofthe inhabitants, so that any scheme of preventionmust deal with the problem from both angles."This fresh investigation deserves minute study.

The McKelvie Isolation Hospital, Oban.On the occasion of the opening on Sept. 8th of the

new pavilion attached to this hospital, Sir Leslie Mackenzie, as a member of the Scottish Board ofHealth, delivered an address in which he testified tothe great generosity of the original founder, the lateDr. R. B. McKelvie, and the maintenance of civicspirit shown by Mr. Macpherson and his sister in

providing funds for the extension and equipment ofthe institution. He reminded his audience that Dr.McKelvie’s first gift of £1000 was later increased to£1500 when the estimate of the cost of erecting thefever block had to be revised. During the lapse of30 years new needs have been revealed, and theseare being met by the recent extension, so that SirLeslie Mackenzie was able to congratulate the cor-

poration of Oban on now possessing, with its recentaddition, an effective modern institution of 42 beds.Sir Leslie Mackenzie closed his address by reviewingthe situation brought about, especially in urbancommunities, by the compulsory notification ofinfectious disease, made compulsory in Scotland justafter the foundation of the McKelvie IsolationHospital. He said :-

" It is 30 years since compulsory notification was madeuniversal in Scotland. This was done through the PublicHealth Act of 1897. The ordinary and well-known infec-tions like typhoid fever, typhus, small-pox, scarlet, diph-theria, erysipelas, puerperal fever, and some others weresubjected to compulsory notification. Since that time manyother diseases have been added, and the list of notifiablesnow approaches 30. Some have come into the list at onedate and some at another. Notification applies perfectlyto some and imperfectly to others. But look at the broadfact. In the 30 years since 1897, the medical men havenotified 1,450,818. Of these, 770,000 have been removedto hospitals under the management or control of the localauthorities for public health. These vast numbers will givesome idea of the problem that constantly faces the PublicHealth Local Authorities of Scotland, which at presentnumber over 300. Take one or two special diseases. In

these 30 years, there were notified 137,705 cases of pulmonarytuberculosis. Of these, 66,122 were removed to hospitalsor sanatoria. But notification has applied to tuberculosisonly since the year 1906, when notification was voluntary,and compulsory since about the year 1910. The numbersnotified rise as high as 9000 a year, though recently therehas been a falling off until in 1926 the number notified was6669. Non-pulmonary tuberculosis has been notifiable since1914. The total notified in those 13 years has been 60,454.Of these 17,232 were removed to hospital. The totals for

pulmonary and non-pulmonary tuberculosis were : 198,159cases notified, 83,354 cases removed. The disease is goingdown, but with those massed figures before us we can realisehow much there is still to do. Take, now, typhoid fever.In the 30 years there were notified nearly 63,000 cases. Butwhereas in the early years the notifications ran up as highas 5600, the notifications in the last ten years have never,in a single year, exceeded 800, and in some years the notifi-cations have fallen below 400. Obviously, typhoid fever isnow under effective control. As to typhus fever, even in1892 it was comparatively rare. Now we have had at leastone year in the 30 without a single case, and one year thenotifications were as low as two, although the disease cropsup in little outbreaks unexpectedly still. As to small-pox,it is enough to say that in 1926 only one case of small-poxwas notified. This year the record will not be so good, butsmall-pox is also under effective control. Of scarlet fever,the numbers notified in the 30 years approached 530,000.The disease is still very widely prevalent, but, thanks toimproved hospital accommodation and improved nursing,the death-rate has remained low. Of diphtheria, the totalnumbers in 30 years were about 207,000. It is still tooprevalent, but the new methods of dealing with scarlet feverand diphtheria are already beginning to have an effect,and as the generation goes on the effects will be still moremanifest.... In the year 1919 acute primary pneu-monia and acute influenzal pneumonia were subjected tocompulsory notification. In the eight years since then therehave been notified nearly 84,000 cases. Pneumonia, as hasbeen shown in detail in the report of the Scottish Board ofHealth for 1925 and again in 1926, is one of the most danger-ous and fatal and prevalent of all the diseases in Scotland.The large local authorities have treated many thousandsof cases, and although it is yet too soon to draw conclusions,there is little doubt that the terrible death-rate from theseforms of lung disease will gradually yield to the better manage-ment and nursing possible in well-equipped hospitals."The new extension has been made especially to

meet the problems presented under Maternity Serviceand Child Welfare schemes.

UNITED STATES OF AMERICA.

(BY AN OCCASIONAL CORRESPONDENT.)

The Negro Population.Dr. Louis L. Dublin, of the New York Metro-

politan Life Insurance Company, has recently com-piled some statistics about the negro in the UnitedStates, and publishes them, together with his con-clusions, in the American Mercury for September.The first figures relating to the coloured populationwere, he says, collected in 1790, when there were757,208 negroes in the country. In 1920 the numberhad increased to 10,4:63,131, but whereas in 1790 thenegroes amounted to 19’3 per cent. of the totalpopulation, in 1920 they amounted to only 9-9 per cent.The health conditions of the negro in America haveimproved almost pari passu with those of the whiteman. Dr. Dublin’s figures show that the expectationof negro males at 50 is only a year less than thatof white males, and of negro females only a littleover two years less. According to the books of theMetropolitan Life Insurance Company, in 16years the mortality record of the coloured policy-holders showed a decline of 16’3 per cent. Marked

: improvement has been exhibited with regard todeaths from tuberculosis, pneumonia, and com-

municable diseases, though certain degenerativediseases continue to be very prevalent. In the cities,and more especially in the northern cities, to whichthe negroes have emigrated, there has been generallyan increase in the death-rate and a decrease of the

, birth-rate, and it is only in the rural districts of the; south that there is now an appreciable excess of

births over deaths. Dr. Dublin estimates that theL negro population in A.D. 2000 will be about 14,500,000,