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Baoteraologioal Research Laboratory for Sù1dh AfricaIt is understood that the Chamber of Mines is about to

hand over to the Government a sum of <E40,000 for theerection and equipment of a central laboratory at

Johannesburg for the carrying out of research work intohuman diseases, on the understanding that the Governmentwill maintain the same in a suitable manner. The Govern-ment will, no doubt, readily agree, as the need for such aninstitution has been recognised for many years.

Medioal Men and the Lay Press.There is an unfortunate tendency in South Africa on the

part of many medical men to use the lay press irregularlyfor the purposes of self-advertisement. One cannot but bestruck by the frequency with which newspaper announce-ments appear recording the arrival or departure of practi-tioners and a statement of their professional work or attain-ments. Reports of interviews with practitioners in whichtheir names appear as advancing opinions on diseases inwhich they are interested or on medical matters generally ofinterest to the public are not uncommon. The MedicalCouncils of the different provinces have endeavoured to

suppress these unfortunate practices, and with a fairmeasure ef success. It is by no means easy to do so com-pletely, however, as the arrival of a new practitioner in acountry village in South Africa is a matter of interest to thereaders of the local paper, and if a glowing account of sucha practitioner’s professional career does appear in the localpaper it is quite likely that the practitioner had no sharein publishing the article. Recently the whole subjectagain came before a meeting of the Transvaal MedicalCouncil, when the executive committee of the councilasked the council to record definitely their opinion thatthe practice is unprofessional and its authors liable tothe penalties of the Medical and Pharmacy Ordinance.The resolution drafted by the executive committee was basedupon an opinion obtained from the law officers of the Crown,but the council regarded it as too sweeping and referred it toa committee for modification. The profession is hoping thatthe Government may be induced to bring in a Medical andPharmacy Act for the whole Union next session, so as toestablish one Medical Council for South Africa. Many of therulings of the different Medical Councils are not in completeagreement, and therefore legislation to place all practitionerson the same footing is required. Moreover, there should beone law relating to the registration of practitioners, for thesale of poisons, and the like. At present the fee for registra-tion varies in the different provinces, and a medical manregistered in the one province is not permitted to practise inanother without registering also in accordance with the lawof that province. A draft Act approved by the differentMedical Councils was actually prepared and lodged with theGovernment some months ago, but nothing further has beenheard of it. The principles contained in that draft havenot yet been disclosed to the profession.

Death of a Well-kno7vn South African Practationer.On April 22nd a well-known practitioner in South Africa

met his death under unusually sad circumstances. Mr. H. L.Walcott settled in Cape Colony in 1880 and was for manyyears in practice at Oudtshoorn. About six years ago hewent to Vryburg, in Bechuanaland, and on the death ofDr. Nagent was appointed district surgeon and railwaymedical officer. On April 22nd, while on a holiday trip toCape Town, he was found in his room dead, and an inquestrevealed the cause of death as acute heart failure. Mr.Walcott leaves a wife and a young family. A memorialservice was held at Vryburg, which was largely attended bypatients and by the heads of the various Civil Service depart-ments and members of the Cape Mounted Police. Mr.Walcott was a sound practitioner with many sterlingqualities, which endeared him to a host of patients andfriends.May 2nd.

BELFAST OPHTHALMIC INSTITUTION.-Themedical report submitted at the recent annual meeting ofthis charity showed that during 1910 in the extern depart-ment there had been treated 1728 new eye cases and 1000patients suffering from diseases of the ear, nose, and throat,while in the wards 146 more serious cases were received.

IFinancially, the treasurer said they would require an additionalZ60 annually to keep them entirely free from debt. J

THE GENERAL MEDICAL COUNCIL.THE ACTION OF THE COUNCIL IN RELATION TO

THE NATIONAL INSURANCE BILL.

The PRESIDENT of the General Medical Council, at themeeting on Monday, May 29th, submitted to the Council thereport of the National Insurance Bill Committee, which wasin the following terms :-The committee has considered the National Insurance Bill now

before Parliament in so far as its proposals relate to the provision of" medical benefit" for a very large proportion of the population. TheCouncil, in the exercise of its statutory functions, has necessarilybecome familiar with the conditions under which medical practice hashitherto been carried on in this country. Having regard to these con-ditions, it has in the public interest endeavoured, both by educationaland by disciplinary methods, "to secure the maintenance of suchstandard of proficieucy" as shall sufficiently guarantee, on the part ofregistered practitioners, "the possession of the knowledge and skillrequisite for the efficient practice of medicine, surgery, and midwifery"(Medical Act, 1886’. The Council cannot fail to recognise that under theorganised system proposed in the Bill the existing conditions will beprofoundly altered. The alterations will affect the relations of themajority of the members of the profession to the State and to thepublic. The manner in which they conduct their practice will inimportant respects be controlled by new authorities, which need notpossess any professional character or experience, and which are notrestrained from imposing conditions that are inconsistent with profes-sional efficiency and freedom. The voluntary hospitals and othercharitable institutions, which are now largely supported by thecontri-butions of both employers and employed, have hitherto afforded thoseopportunities for clinical study that are indispensable for efficientmedical education. There is danger that, under the new conditions,the resources of these institutions will be diminished and theirusefulness for this purpose impaired. Changes, whose full effectit is impossible to forecast, will take place in the sanitary andpreventive departments of public health administration.As a result of these and other consequences of the legislation pro-

posed it may well happen that the prospects and attractions of medicineas a professional career will be so far depreciated that the numbers whoenter upon it will no longer be sufficient for the necessities of thecountry. Already the steady decline in the number annually admittedto the Medical Register, which has fallen from an average of 1455 duringthe period 1891-95 to an average of 1117 during the period 1906-10, givescause for some misgiving. Any considerable reduction below thepresent rate of supply would be of serious import to the public.For these reasons, which specially concern the General Council of

Medical Education and Registration of the United Kingdom, the com-mittee think it highly expedient that steps should be taken to impressupon the Government the necessity of introducing into the Bill suchamendments and additions as will safeguard the important interests inquestion. In particular, the committee desires the support of theCouncil in making representations to the following effect :-

1. That (a) the Insurance Commission, (b) the Advisory Committee,(c) every Local Health Committee, should include members who areduly qualified medical practitioners.

2. That "medical benefit" and "maternity benefit" should beadministered by the local health committees, and not by "approvedsocieties." "

3. That in respect of the administration of "medical benefit," the" arrangements with duly qualified medical practitioners " made by thelocal health committees should be such as to admit of free choice of themedical practitioner on the part of the insured person; and that inrespect of the administration of "maternity benefit" the like freechoice of the medical practitioner or midwife on the part of the personreceiving " maternity benefit" should be admitted.

4. That in respect of the grant of subscriptions and donations tohospitals and other charitable institutions, contemplated in Clause 17of the Bill, the governing conditions should be assimilated to those setforth in Clause 15 (1) with regard to the administration of " sanatoriumbenefit."

5. That in respect of the provision to be made for "the supply ofproper and sufficient drugs and medicines" under Clause 14 (2). thesupply of proper surgical dressings and appliances should be included;and further, that steps should be taken to ensure that the drugs andmedicines are of the standard required by the British Pharmacopoeia,and that the dispensing of prescriptions is carried out by qualifiedpersons.

6. That medical benefit" should include provision for consultationsand for operations when these are necessary.

7. That, in the case of an insured woman, it should be made clearthat sickness benefit "accrues in addition to "maternity benefit"; andfurther, that in cases attended by a midwife the local health committeeis empowered to pay for the attendance of a medical practitioner,should such attendance be called for by the midwife in accordance withthe rules governing her practice.

8. That in Clause 59 (7), applicable to Ireland, it should be madeclear that "deposit contributors" are not limited in their choice ofmedical practitioners to the medical officers of health for dispensarydistricts.

The report was received and entered upon the minutes.The PRESIDENT moved that the following recommendation

of the committee be adopted as the finding of the Council :-That the Council instruct the committee to press upon the Govern"

ment the importance of amending the National Insurance Bill in thesense of the suggestions contained in this report, and to make repre-sentations on such other matters relevant thereto as may arise whilethe Bill is under the consideration of Parliament.

He said that the points dealt with in the report werewithin the province of the Council, and it was incumbentupon it to see that the Government was duly impressed

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by the tendency of the changes contemplated, and also 1

to see whether it could safeguard the interests withregard to which changes were proposed in the Bill. The 1

various points which the members of the committee 4

considered of importance were set forth in the earlier 1

part of the report. It appeared certain that a very I

large proportion of the medical profession would in futurebe subjected to authorities which had no necessary pro- Ifessional character and experience. As one of the authorities ifor maintaining the efficiency of medical practice theCouncil regarded that as a vital point. The committeethought that in regard to all the bodies who were to exer-cise such authority means should be taken to secure thatmedical and professional opinion should be represented-all the bodies from the Insurance Commission to the LocalHealth Committees. A proper working of this scheme couldonly be secured if medical opinion and experience were avail-able for the purposes of these bodies. The committee there-fore pressed for the inclusion of medical representatives onthose bodies. The members of the committee thought itextremely important to make this recommendation, as theBill proposed to place the medical benefit in all kinds ofhands, one of them being the approved societies and anotherthe local health committees. What was the position ofmedical men in regard to these friendly societies ? 7 It was

perfectly obvious that just and right relations could scarcelybe maintained if the medical officers in a locality weresubject to the unrestricted control of bodies constituted fordifferent purposes, such as friendly societies. The committeethought that if health committees were to be established"medical benefit" should be given by means of them.Next the Bill provided that in regard to the administrationof "medical benefits," arrangements with duly qualifiedmedical practitioners were to be sanctioned under which theinsured persons in the neighbourhood were to have a par-ticular medical man. The committee thought that thereought to be a free choice of the medical practitioner on thepart of the insured person. If this were not done, he believedthere would be on an enormous scale all the evils ofunrestricted club practice. With regard to "maternitybenefits," the committee also thought that the insuredwoman should be free as to the choice of the practi-tioner and midwife in order that the approved con-

fidential and fiduciary relation which ought to exist betweenpatient and medical man should be retained. Otherwise themedical profession might become a trade and not a profession.The clause as to hospitals touched the Council very closely,because it was to the hospitals that the medical professionwere indebted for clinical study. The committee felt thatthe new arrangements proposed would probably very seriouslyendanger the resources of those hospitals which were solargely charitable. It might happen that the opportunitiesfor clinical study would be gravely curtailed. If the Councilcould guard against this by any arrangement, such as thearrangement with regard to sanatoriums in the Bill, it wouldbe doing a good thing. The committee thought that somesafeguard should be introduced as to contributions inrelation to hospitals as was already introduced as tosanatoriums. The Bill left the matter of contributions tohospitals entirely to the friendly societies, which mightname any conditions, and such conditions might be highlyinacceptable if the proper working of a free and voluntaryinstitution was kept in mind. In the case of sana-

toriums the conditions made were to some extent under thesupervision of the Insurance Commission and the local healthcommittee. What was laid down for the sanatoriums couldnot be bad for any other institution. As to the fifth represen-tation of the committee, which related to the subject of thesupply of sufficient drugs and medicine, it might occur tothe local health committees or approved societies to start astore of their own for the issue of drugs and medicines totheir patients. If such a store of distribution were startedthere would be no security to the public against the issue ofdrugs or medicines which did not conform to the standard ofthe British Pharmacopoeia. Such would not be I I selling"

"

within the meaning of the Act. The committee thoughtthat it should be made clear that that danger was not tobe encountered in future. It also seemed right thatit should be laid down that, when prescriptions were

no longer to be carried out by the practitioners whoprescribed, the dispensing should be done by qualifiedpersons. A minor point was that the committee thought

that " medical benefit " should include something more thanwas put down in the Bill. The members were of opinionthat it should include provision for consultation in medicalcases and surgical operations, because the ordinary practi-tioner did not always care to do such work unassisted. Thecommittee had inserted a representation with regard toII maternity benefit" and II sickness benefit." They were twodistinct things. When a midwife was bound to call in amedical practitioner she ought to be able to know that themedical practitioner was paid. The proposals in regard toIreland were a little difficult to follow, and it appeared that"deposit contributors " might be limited to the choice of asingle medical practitioner in the district. If that was notintended the point ought to be made clear. The importantmatter was that in great changes carried out without suffi-cient safeguard they might find after a little that the medicalprofession would cease to be attractive because it hadceased to be a professional career in which a man of liberaleducation could hope to obtain satisfactory conditions.If that were the case a great danger to the country wouldarise because the supply of duly qualified medical menwould be insufficient for the needs of all classes of thecommunity, and for the needs of the military and navalservices, and also the public health services in all theirbranches of activity. If that should happen as a result,it would concern the Council to see that the danger didnot become greater. For these reasons he commended therecommendations to the Council. These were the cardinalpoints which directly concerned the work and duty of theCouncil.

Dr. NORMAN MOORE seconded. He could not help feelingthat this report was a satisfactory one, and he felt that ithad been kept within the powers of the Council and thesubjects on which it was entitled to express an authoritativeopinion. That was very largely due to the President. Hedwelt on the need of giving the public a free choice..ofpractitioner.

Sir FRANCIS CHAMPNEYS emphasised the necessity ofhaving the medical practitioner paid when he was called inin an emergency case by a midwife.

Dr. LANGLEY BROWNE thought that it was desirable thatpatients should have freedom of choice. He stronglysupported the motion.The motion was agreed to unanimously.

BRITISH MEDICAL ASSOCIATION:REPORT OF SPECIAL REPRESENTATIVE MEETING

TO CONSIDER THE ACTION TO BE TAKENON THE NATIONAL INSURANCE BILL.

A SPECIAL representative meeting of the British MedicalAssociation was held in London at the Examination Hallof the Royal Colleges of Physicians and Surgeons on

Wednesday, May 31st, principally for the consideration ofthe National Insurance Bill as affecting the medical profession.This meeting of over 150 representatives from the variousdivisions of the Association, and as many members of Counciland unofficial members, was perhaps the most important stepthat has yet been taken by the profession in this vital matter,and its deliberations were conducted with a full sense of the

responsibility which lay upon it. After preliminaries, themeeting resolved itself into committee in order to be morefree to consider its very difficult business. Dr. E. J. Maclean,the Chairman of Representatives’ Meeting, resigned the chairto Mr. T. Jenner Verrall, Deputy Chairman, in order that hemight be in a position himself to propose the 50 and moreofficial resolutions before the meeting.The delegates sat from 10 A. M. till midnight, and the pro-

ceedings were controlled throughout most admirably by thechairman. Representatives of the lay press were notadmitted, and we are indebted to the authorities of theBritish Medical Association for permission to publishthis report from our representative. Three medical Mem-bers of the House of Commons-Dr. Christopher Addison,Dr. John Esmond, and Dr. A. P. Hillier-were presentby invitation, and their sympathetic remarks were mostcordially received by the meeting. Motions 12 to 35dealt with the general desirability of a scheme ofnational insurance and outlined the general requirements of