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retired (dated August 20th, 1913). Major Archibald B.Gemmel to be Lieutenant-Colonel (dated August 20th, 1913).

Sanitary Service: Alfred Greenwood to be Major (datedAugust 20th, 1913). Major Alfred Greenwood is appointedSanitary Officer of a Territorial Division (dated August 20th,1913).

‘

Attached to Units other than Medical Units.-LieutenantRichard C. Clarke to be Captain (dated May 22nd, 1913).Lieutenant James L. Wilson resigns his commission (datedAugust 20th, 1913).For Attachment to Units other than Medical Units. -Duncan

Davidson to be Lieutenant (dated July 10th, 1913).DEATHS IN THE SERVICES.

Surgeon-Colonel John Richardson, LM.S. (retired), in his.seventy-seventh year, on August 13th. He served with theBhutan expedition, 1864-66, and was present at the capture- of Buxa and the Bala Pass and the storming of stockadesabove the Pass (medal with clasp). He was appointed anHonorary Physician to the King in 1903.

BRISTOL AND WESTERN COUNTIES.

(FROM OUR OWN CORRESPONDENTS.)

Hospital Sunday Fund at Bristol.THE final statement of the Lord Mayor’s Hospital Sunday

fund for 1913 shows that during the year £1957 was

received, an increase of £63 over 1912. The number ofcollections made was 548, an increase of 18 compared withthe previous year. The Bristol Hospital Sunday Fund wasestablished 16 years ago, and only twice has the sum of£2000 been raised.

Bristol Tuberculosis Officer.The Bristol health committee at a special meeting

recently interviewed five candidates for the position oftuberculosis officer for the city and county of Bristol. Mr.C. J. Campbell Faill, medical officer of the Redcliffe Tuber-culosis Dispensary, Bristol, was unanimously elected to the

post.Bristol Insurance Committee: Medical Referee’s Salary.Dr. B. M. H. Rogers, who was appointed to act as medical

referee to the Bristol Insurance Committee for three monthsat E50, appealed for an increase of salary at the end of thatperiod, stating that the number of cases referred to him hadincreased from 72 in the first to 100 in the last month. Thechairman of the committee said the Government could notundertake responsibility for this salary, which should be paidby those who derived most benefit from the work of thereferee-namely, the Approved Societies. An increasefrom £50 to £75 for the ensuing three months was approved.

Bristol Education Committee and Errors of Refraction.The Bristol Education Committee has offered to the Eye

Hospital and Dispensary £100 and £50 respectively for thetreatment of errors of refraction of the eye in school children,not more than 400 cases per annum at the former and 200 atthe latter, with 5s. per head for each case in excess of thesenumbers, the patients to be seen at special hours, the Educa-tion Committee to check attendances and maintain order.’This arrangement has been proposed because these twoinstitutions have been encumbered in their work by thelarge increase in refraction cases coming to them as a result of school inspection.

School Clinies in Gloucestershire.Dr. J. M. Martin, school medical officer for the county

,of Gloucester, has reported in favour of the establishment ofschool clinics at Stroud and at Kingswood. The latter is aneastern suburb of Bristol, which, however, lies within theadministrative area of Gloucestershire. As present there isno school clinic in Bristol, but Dr. Martin claims that it isnecessary to establish these two if children are to be treatedfor those defects which are discovered by school medicalinspection. He says that the number of children who havesecured treatment for these defects has risen in three yearsfrom 65 to 80 per cent., a higher percentage than obtainswithin the Bristol area. The cost of equipping two clinicswould, it is said, amount to £80, and the annual maintenancewould cost £180.

Tlte Slums of Exeter.At the last meeting of the Exeter city council exception

was taken to a reported statement of the chairman of thehealth department of East Ham, London, that he thankedGod they had no such buildings in East Ham as some of thehouses in Exeter. It was remarked that East Ham was a" I mushroom" compared with Exeter, that the city autho-rities were getting rid of many of these old houses, and thatno doubt in the future many more would be demolished.

The National Insurance Act at Exeter.

At the last meeting of the Insurance Committee for Exeterit was reported that 12,315 persons had accepted the paneldoctors, leaving about 4000 still unallotted. The com-mittee decided to arrange for the allocation of these cases.The total expenditure in connexion with the administrationof the Act in Exeter was R3337, of which sum medical menand chemists had received .61600.

The Tenure of District Medical Officers.The Torrington (Devon) board of guardians recently

appointed Dr. Clements and Dr. J. P. Lusk medical officersfor the Winkleigh and Dolton districts respectively, but

although these gentlemen resided in their districts the

guardians, contrary to regulations, made the appointmentfar one year only. The Local Government Board demurredto this, and said the appointments must be made per-manently. The guardians eventually decided to complywith the directions of the Local Government Board.

August 20th.

SCOTLAND.

(FROM OUR OWN CORRESPONDENTS.)

Tuberculosis Treatment in Scotland.

THE Local Government Board of Scotland, which has

recently been in correspondence with the Treasury regardingcertain questions which have arisen as to the method ofdistribution of the proposed maintenance grant in aid of thecost of treatment of tuberculosis, has issued a circular on thesubject to clerks of local authorities. The Board points outthat under Section 17 (1) of the National Insurance Act anInsurance Committee may extend sanatorium benefit to

dependents of the insured, and where the county councilor town council and the Treasury sanction the estimatedexpenditure, one-half of the excess of expenditure over thecommittee’s funds available for sanatorium benefits will be

paid out of the rates, and the other half out of the grant,Section 17 (3). In this case the grant will be paid to theInsurance Committee. For the remainder of the population--that is, the population other than the insured or dependents ofthe insured-the responsibility for treatment will rest with thepublic health local authority, who will receive payment outof the grant to the extent of one-half of their expenditure ontuberculosis incurred under schemes approved by the Board.If the county council or town council decline to sanction theestimated expenditure of the Insurance Committee, and if (forthis or any other reason) the Insurance Committee’s arrange-ments do not include treatment of all insured persons anddependents, then the responsibility for treating such personsand dependents as are not included in the committee’sarrangements, as well as the remainder of the population,would fall on the public health local authority, a3d one-halfof the cost would be met out of the grant. Among theconditions the Board propose to attach to participation inthe maintenance grant are : That the scheme of the local

authority for the prevention, detection, and treatment oftuberculosis shall have been approved by the Board, andshall continue to their satisfaction ; that no grant shall begiven towards the cost of treatment in an institution not

approved by the Board ; that the salaries, qualifications,duties, and respective relations to each other and to themedical officer of health, of the tuberculosis officer, themedical superintendent, and matron of the sanatorium, themedical officer and matron of the tuberculosis hospital, andthe medical officer in charge of the tuberculosis dispensary,shall be approved by the Board. As regards grants payableto Insurance Committees under Section 17 (3) of theNational Insurance Act, the final payment or adjustment

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will be made by the Board on the expenditure as auditedunder Section 60 of the Act.

Graeeful Generosity.Of the £100 recently voted by the Aberdeen Insurance

Committee to Dr. Matthew Hay, medical officer of health ofAberdeen, and professor of public health and forensicmedicine in the University, for service and advice renderedby him to the committee since the passing of the In-surance Act, Dr. Hay has handed £50 to Dr. G. S. Banks,the assistant medical officer of health, who has also beenclosely associated with the work of the committee. Theother £50 has been set aside by Dr. Hay as the nucleus ofa fund which will be at the disposal of an after-carecommittee to be applied for the benefit of patients after theyleave the hospital.

The City Hospital, Aberdeen.The public health committee of the Aberdeen town

council has decided, on the recommendation of the medicalofficer of health, to appoint a resident medical officer to theCity Hospital, Aberdeen, at a salary of £200 per annum, anda resident assistant at a salary of £100 per annum. Formerlythere was only one resident medical officer, but the workof the hospital has increased enormously of recent years,partly on account of the National Insurance Act and partlyfrom other causes. Last year 1994 patients passed throughthe hospital, and there were as many as 340 cases in thehospital in a day. The recent extension will also entailextra work.

presentation to Dr. G. S. Trail, Strichen.At a recent meeting of the Buchan Medical Society

Dr. G. S. Trail was presented with a silver-mountedinkstand bearing the following inscription : ’’ Presented toDr. Trail, Strichen, by the Buchan Medical Society on hissemi-jubilee as secretary of the society." Dr. Trail wasnominated secretary and treasurer to the society for thecurrent year.August 19th.

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IRELAND.

(FROM OUR OWN CORRESPONDENTS.)

The Question of Medical Advisers under the NationalInsurance Act.

THE medical advisers appointed by the Irish InsuranceCommissioners held a meeting recently in Galway, at whichthey constituted themselves a board of advisers to the

Approved Societies and County Insurance Committees inthat county. The following resolution was adopted :-That our attention having been called to various statements made to

the effect that our appointments as medical advisers to the ApprovedSocieties will interfere with the proper discharge of our duties as dis-pensary doctors by taking us occasionally out of our districts for ashort time, we beg to point out that the dispensary regulations neverintended to confine a medical officer to his district all the year round.It is quite usual for dispensary doctors to attend meetings of theguardians and district councils, and attend the clerk’s office on registra-tion duty, sanitary and other matters, as well as to attend privatepatients out of their districts, and no objection has ever been madeto this, although such temporary absence was often sudden and unfore-seen. As medical advisers we have only to attend very occasionalcases of persons claiming sick benefits where a doubt might arise.Moreover, the medical adviser has never to leave his district suddenly,as he has to arrange with the medical attendant of the insured persona day and hour for examination.

This resolution, as an attempt at defence, falls short of itsobject. The medical advisers say that they have only toattend °° very occasional cases," but in the agreement whichthey have signed they undertake "to examine, free of

charge, any insured person resident within the scheduledarea who shall claim or be entitled to, or is in receipt of,sickness or disablement benefit." As the scheduled area

must necessarily be much larger than the dispensarydistrict, under these terms it would be essential for themedical adviser to be out of his district very frequently. Inthe light of the reply of the Vice-President of the LocalGovernment Board to the deputation from the Irish MedicalAssociation, an account of which appeared in THE LANCETof August 9th, it is clear that the Local Government Boarddoes not consider that the medical advisers can carry outtheir duties as dispensary doctors under the present scheme.It was also stated at the meeting in Galway that there was

no breach of etiquette in granting certificates to the patientsof another doctor. The following resolution passed at ameeting of the County of Dublin Medical Organisation is ananswer to this view :-

That in the opinion of the County of Dublin Medical Organisationthe tenure of the post of medical adviser in respect of insured persons,either to the Irish Insurance Commissioners or to an Approved Society,without the sanction of the profession of the district, as expressed bythe Local Medical Committee, is contrary to professional ethics.

The County of Dublin Medical Organisation also instructedtheir representatives on the Irish Medical Committee to callupon the licensing bodies to look upon the action of themedical advisers as procuring practice by unworthy means,and to deal with them accordingly. I may mention that thename of Dr. J. J. McGrath, the recently elected super-intendent of Peamount Sanatorium, was included in a recentlist of medical advisers to the Insurance Commissioners.Dr. McGrath has stated publicly that he is not acting, nordoes he intend to act, in that capacity. Mr. M. J. Glancy, atAthlone, has also tendered his resignation as medicaladviser, and in other districts difficulties are arising owingto the inability of the medical advisers to obtain cooperationfrom their fellow practitioners in cases of emergency or

during their temporary absence.A meeting of the county Wexford medical practitioners

has unanimously adopted a resolution condemning the actionof any medical man accepting a medical advisorship underthe Insurance Act, and refusing to have any dealings pro-fessionally (except in urgent cases) or socially with anymedical man accepting such appointments contrary to thewishes of the profession. A further resolution described theduties allotted to medical advisers, including, if necessary,the removal of dressings, &c., of other medical men’s

patients without their consent, as a gross violation ofmedical etiquette," and expressed the opinion that medicalmen so acting should be reported to the General MedicalCouncil.

The Medical Profession in Cork and the NationalInsurance Act.

The following two resolutions have been passed by thepractitioners in county Cork :-

1. That in consequence of the tyrannical action of the Irish InsuranceCommissioners in appointing medical advisers for the certification ofinsured persons for sickness and sanatorium benefits in Dublin,Limerick, and Waterford, in opposition to the unanimous opinion andwish of the Irish medical profession, the members of the Cork medicalprofession will at the earliest possible date (legally) take the necessarysteps to effect reputation of the panel system as at presentadministered, and obtain the resignations of all members of theprofession in the borough who have signed agreements with theCommissioners.

2. That we, medical practitioners of the county of Cork, adhere to ourprevious resolution on the question of medical certification for sicknessbenefit under the Insurance Act-i.e., a minimum fee of 2s. 6d. perannum per insured person-and that we request members of the pro-fession in County Cork who have joined the panel to consider theirposition, in view of the action of the Insurance Commissioners insistingon the appointment of medical advisers.

Overcrowding in Irish Asylums.In the course of a discussion on the overcrowding of the

Mullingar District Lunatic Asylum at a meeting of the jointcommittee, the resident medical superintendent said thatthere were 81 male and 88 female inmates too many in theasylum at present. The average increase per year had been15 patients. It was decided to leave the matter over till theOctober meeting in order that Dr. Gavin might furnish areport on the feasibility of extending the short dormitories.According to a recent report of the resident medical super-intendent of the Monaghan and Cavan Asylum, the numberof patients in the asylum at present is 943. As accommoda-tion was only provided for 793, there is considerable over-crowding ; and if the admission rate continues at its presentlevel, which is about 25 per month, it will be necessaryfor the committee to provide some temporary relief withoutdelay. It is impossible to add beds, especially on the-female side

The Medical Struggle in Londonderry.Some time ago, in accordance with the refusals of the

local medical profession to accept the terms offered to themfor attendance on insured persons, an office was opened anda public medical service established, the insured populationbeing invited to join in the medical movement. To this.departure the societies responded by bringing two medicalmen to Londonderry. These men, however, found that theycould not keep pace with the work, and both left the city,.