312 THE NATIONAL ASSOCIATION FOR THE PREVENTION OF CONSUMPFION.

county medical officer of health, would retire under the ag!limit in less than two years’ time. Seeing that the presenlproposals involved for the Council’s medical officer a muctenlarged responsibility, and entailed on him the serious ancprotracted task of amalgamating and coordinating the pre.viously divided functions already referred to, the committeeviewed with apprehension the nearness of the retirement ojSir Shirley Murphy. A period of less than two years in whictto consolidate, harmonise, and leave in working ordelfunctions hitherto divided was all too short for any man,and to call on the present medical officer to undertake theresponsibilities, creative and administrative, that were

involved, and this on the eve of his departure, would be outof the question unless his retirement were almost indefinitelydeferred. The committee had conferred with Sir ShirleyMurphy on the subject in all its bearings, and he had statedhis desire to place himself in the hands of the Council, sothat the reorganisation of the Council’s medical work mightbe effected under the best possible conditions.

The Positwn of Sir Shirley M7cr3ty.After careful consideration the committee advised the

Council to arrange for Sir Shirley Murphy to relinquish dutyas chief medical officer of the county at a date not later thanDec. 31st, 1911, while retaining his services in a consultativecapacity for a further period, so that his successor shouldhave the advantage of his large experience, particularly inthe details of medical administration. Sir Shirley Murphyentered the London Cjunty Council service in 1889,being the first chief officer appointed by the Counciland the first medical officer of the County of London.His services to London, said the General Purposes Com-mittee, were in no need of eulogy; the decline in the

figures of the death-rate during the administration of theCouncil testified to the fruitfulness of his labours, while thehonour of knighthood conferred upon him in 1904 recordedthe high regard in which Sir Shirley Murphy’s work in thecause of public health was held. The committee was sure theCouncil would feel great regret at Sir Shirley Murphy’s retire-ment and would desire to grant him the maximum retiringallowance. Sir Shirley Murphy had served the Council for Z2years, and if his service had come within the Superannuation(Metropolis) Act., 1866, the Council could, by adding tenyears to his service, have granted him an allowance of32 sixtieths of his salary. The committee therefore proposedthat the Council should supplement his retiring allowanceby such an amount as would bring the allowance up to<E666 13s. 4d. a year&mdash;viz., 33 sixtieths of his salary of&pound; 1250, and retain his services in a consultative capacity fortwo years from the date of his retirement at such a remunera-tion as would not exceed, with the retiring allowance, hispresent salary. Steps would be taken as soon as possible tofuse the work of medical inspection and treatment in onedepartment under the medical officer before the appointmentof the new medical officer.

In conclusion, the committee referred to the anxietyexpressed by the Board of Education to know at once theCouncil’s proposals to meet with the present situation.If the present proposal was adopted and laid before theBoard in its entirety and followed up with the detailedscheme prepared by the E iucation Committee for carryingout school medical inspection and treatment,2 the Boardwould see that the Council had dealc with the matter in astrong and effectiva way, and would agree, the committeethought, to accept th3 Council’s proposals as the propermethod of organising school medical work. The committee

promised to follow its present report with another next weekdetailing the arrangements to be made consequent on theretirement of Sir Shirley Murphy.At the meeting of the Council it was evident there was

general agreement upon the proposals of the General

Purposes Committee and discussion was very short.An amendment was moved on behalf of the Education

Committee that the proposals of the General Purposes ICommittee should not take effect until Jan 1st, 1912. It i

was urged that the Education Cjmmittee was under a

pledge to the Board of Education to make the scheme ofmedical treatment effective by October next. If betweenthat date and Christmas the while of the administrativework was transferred to another department it would

2 THE LANCET, July 22nd, p. 246.

seriously handicap the Education Committee in the effortto carry out the wishes of the Board of Education.The amendment was agreed to and the recommendations

of the General Purposes Committee were then approved.

THE NATIONAL ASSOCIATION FOR THEPREVENTION OF CONSUMPTION.

THE annual conference of this association took place atthe Caxton Hall, Westminster, on July 19th, 20th, and 21st.Among those present at the opening, when Sir WILLIAM

YOUNGER presided, were the President of the Local Govern-ment Board (Mr. John Burns), Sir Thomas Barlow, SirWilliam Osler, Professor Sims Woodhead, Dr. A. Newsholme,Dr. T. D. Acland, Dr. E. W. Hope, Dr. J. E. Squire, Dr.James Kerr, Dr. J. Niven, Dr. J. J. Perkins (honorarysecretary of the association), Sir W. Treloar, Mr. WaldorfAstor, M.P., Mr. G. Harwood, M.P., Rev. P. ClementiSmith, Miss MacGa,w, and a number of delegates from localauthorities and institutions all over the country.

Sir WILLIAM YOUNGER first read the folloNing telegramfrom the King:-As patron of the National Association for the Prevention of Con-

sumption and Other Forms of Tuberculosis, I congratulate all who willtake part in the annual conference which assembles to-morrow. Isympathise deeply with the association’s work, so far-reaching in itsinfluence upon the future of the human race. I note with interest theimportant questions to be dealt with at the conference, and the namesof the eminent authorities by whom the meetings will be conducted andaddressed.

Opening of the Conference by Mr. John Bnr11.s.Mr. JOHN BURNS expressed his pleasure in attending to

open this useful, practical, and human conference, whichbrought a message of hope to an army of 300,000 people inthese kingdoms suffering from tuberculosis in one or anotherof its forms. The "man in the street " was now deter-mined to cooperate with the medical officer of health,the town and county council, and the private practi.tioner ill this important work. Estimated by its victimstuberculosis in all its forms was a declining disease,and its annihilation ought to be effected in 25 to 30

years till it became only a memory, juat as typhns,leprosy, and the plague were now. In ten years consump-tion had diminished in England and Wales 19 per cent., inScotland 24 per cent., in Ireland 24 per cent., in Germany18 per cent., in London 30 per cent., in Berlin 24 per cent.,and in Paris only 3 per cent. In 50 years tuberculosis haddeclined 50 per cent. for all ages, while for the periodfrom birth up to 25 years it had declined 70 percent. These were encouraging figures. It was inter-

esting to note that the general death-rate also haddeclined 26 per cent.-27 per cent.- in London-andthe infant mortality 30 per cent. in the same period.Another significant thing was that coincidently with thisdecline in the tuberculosis and general death-rates and ininfant mortality the national drink bill had diminished from<E4 12s. to C3 8s. lld. per head-a diminution of 25 percent. in the consumption of alcoholic beverages. Thedecline of consumption was concurrent with increasingsobriety, better housing, growing education, and the socialand moral elevation of the people. To the ratepayer Mr.Burns pointed out that <E 160, 000, 000 were paid every yemrfor health and social service. Out of 4000 Poor-law con-sumptives in Liverpool, 60 per cent. were paupers becausethey were consumptive. Pauperism and tuberculosis actedand reacted on each other, tubercle being the pauperiser,and pauperism the seed plot of tubercle. He gave a simpleillustration as to the value of remedies under the existinglaw quietly enforced. In 1875 the death-rate in the London

garrison of the Guards was 20 4 per 1000 among strong,young, presumably healthy men. To-day it was not morethan 3 per 1000, or seven times less. The same barracks werein use, but they were cleaner ; the windows were more open,and the soldier had adopted the increasing sobriety of thenation, and this combination had brought about the reduction.Similar figures could be shown for the navy and other sectionsof society. Another factor in the reduction was high wages ifaccompanied by wise spending. Mr. Burns warned hishearers against dogmatising on any special means of com-bating tuberculosis. Much could be done by applying some

313THE NATIONAL ASSOCIATION FOR THE PREVENTION OF CONSUMPTION.

of the new methods, but the good could be increasedby exhausting all the agencies calculated to secure

the object they all had in view. Mr. Burns then dealtwith the great advance made by the local authoritiesin regard to the notification of cases of tuberculosisfrom Poor-law institutions and hospitals, and said that theduty incumbent on them was clear in view of the facts thatfrom 30 to 50 per cent. of the cost and numbers of pauperismwas due to sickness, most of which was consumption, that75 per cent. of the cripples had a tuberculous origin, andthat 90 per cent. of hunchbacks, 75 per cent. of the

scrofulous, and 50 per cent. of those who had convulsionswere inflicted with the disease. The Local GovernmentBoard was authorising local authorities to establish dis-

pensaries, to purchase cheap and portable shelters for usein yards, to procure and distribute literature. Localauthorities were more active in enforcing the unsound foodregulation", and the milk and dairy trade had been vastlylevelled up. The Royal Commission, after ten years of

unpaid, disinterested, self-sacrificing, painstaking research,had issued its fourth and final report, which justifiedthe demand for new milk legislation. A Milk Bill wasessential and urgent, and before many months were overthe milk and dairy industry of the country must be placed ona clean, sound, healthy, and permanent basis. Mr. Burnsreferred to the funds and income to be provided under theInsurance Bill for the establishment and upkeep of sana-toriums, and was confident that the money would be

expended wisely and well. He did not doubt that somelocal authorities would accept the Chancellor’s offer of halfthe cost for the wives and children of insured persons insanatoriums, if the local authoriiies would bear the otherhalf, and that others would soon follow.

Professor SIMS WOODHEAD advocated the inclusion ofhygiene in the curriculum of secondary as well as elemen-tary schools. He commended exhibitions and lectures andcaravans, and the work of district nurses and health visitsas educational methods, and said that good educational workhad been done by the Royal Commission. There was sure tobe criticism of the latter, but such criticism only showedthat the public was becoming alive to the subject. He dwelton the influence of alcuholism as a predisposing factor. Butthere was no universal panacea for the disease ; the educa-tional crusade must be a broad and common-sense one, nottoo insistent on any one method, but covering all.

Dr. F. C. SHRUBSALL, assistant school medical officer ofthe London County Council, in a paper onThe Place of the School in the Campaign against Tubcrculosis,pointed out that in the early educational stages the workagainst tuberculosis consisted in the inculcation of personalhygiene. There might come a time when a bath would formpart of every elementary school in large towns, as it did inGermany, Holland, and Scandinavia. One bath was wortha hundred lectures, and cleanliness of clothing would followcleanliness of body. Next winter the Council would providea course of lectures for teachers, showing how they couldassist the antituberculosis campaign. Strict isolation ofsufferers might reduce the prevalence, but it might con-ceivably lessen the natural resistance of the community. Themost effective guard was to cut down the modes of dissemina-tion, which really meant universal cleanliness. Public

opinion, by a rigid standard, could diminish tuberculosis andthose minor affections that paved the way for it.

Sir WILLIAM YouxGER, in a paper on

Tuberm&Ucirc;osis Fxhabitaons and Carat’ans,spoke of the value of travelling caravan exhibitions, suchas that in his own county of Dumfriesshire, which with thelectures to children and alults did much good. The visitof the caravan also might induce property owners to remedydefects in their properties that were injurious to health.

Mrs. HOWARD MARSH, in a paper onThe District Nurse and the Health Visitor,

described the work of the Cambridge branch of the Leaguefor Physical Education and Improvement in Health Visita-tion. Those mothers who had followed the visitors’ coursewere allowed to enter their children to compete in an annualbaby show. The prizes were a Savings Bank book in whicha shilling or two had been placed to the credit of the bestbabies in each of four sections&mdash;viz , weight, firmness of flesh,thickness of bone, general well-being-with mugs as consola-tion prizes for the unsuccessful. She insisted on the necessity I

of character, adequate training, interest in the work, and asense of humour for health visitors.

Mr. J. LISTER STEAD, secretary of the Ancient Order ofForesters, in a paper on

Propaganda gmong the Fricndly S(J(Jieties and Trade andother Organisations of the TVoTkiny Classes,

insisted on the close connexion between poverty and tuber-culosis. The fact that at least that part of the Insur-ance Bill dealirg with tuberculcsis had received generalapproval was a gratifying recognition of a greater nationalresponsibility in a matter which up to now had been left toprivate enterprise. The statistics of the Foresters showedthat in a period of five years 15 23 per cent. of all deathswere due to phthisis’, while those of the Hearts of Oakshowed that the consumptive members in a period of tenyears received average sick pay 75 per cent. in excess of thatto all other members.At the afternoon session of Wednesday, July 19th, Sir

WILLIAM OSLER presided.The Ya11le of Family Znspeet-don and (If Notifioation.

Dr. R. W. PHILIP of Edinburgh said that tuberculosis in theadult was in large part a development from tuberculosis inthe child. The need was for early detection, and the teachingof hygiene enabled every intelligent person to be in somedegree a detective officer. Medical students needed bettertraining in physical and bacteriological methods. Heurgedarevision of the methods of out-patient departments, and saidthat the whole family should always be inspected whenevera case of tuberculosis was discovered. In Edinburgh noinconvenience had arisen from compulsory notification, andthis system had extended in Scotland from eight authoritiesin 1907 to 74 in 1910, and more than half the notifications inEdinburgh came through the dispensaries. He commendedthe plan of linking the London dispensaries together throughthe intermediary of a central council.

Dr. CECIL WALL, assistant physician to the London andBrompton Hospitals, read a paper onThe Hospital Old-patient Department as a -ivackine for the

Detectiorc rf Pulmonary Tuberculosis,and referred to the effect on the hospitals if the InsuranceBill became law. The only members of the community thenremaining unprovided with medical attendance would bechildren under the school age, those between 14 and 16 whowere unemploy<.d. unemployed women, and people between65 and 70 ears. The hospital out-patient departments wouldretain only consultative functions, and he suggested that eachout-patient department should be constituted a consultingcentre for a definite district for the diagnosis and treatmentof tuberculosis.

Dr. JAMES NIVEN described the work done in Manchester.He urged compulsory notification, additional sanatoriums,.and the placing of funds at the disposition of the medicalofficer of health. If the sanatorium benefits under theInsurance Bill were to be separately administered the workwould be impaired. Sanatorium benefit under the Billshould depend on notification having been made to themedical officer of health.

Dr. HALLIDAY G. SUTHERLAND, of St. Marylebone Dis-pensary for Consumption, in a paper on

The Tuberoulosis Dispensary,said that the dispensary formed a centre from which themajority of consumptives were treated-a clearing-housethrough which suitable cases could be distributed amongopen-air schools, sanatoriums, farm colonies, and hospitalsfor advanced cases, and a base from which organised searchcould be made for early and undiagnosed cases.

Other speakers were Miss M. E. BIBBY, Miss HETTYCOWEN, and Dr. E. W. HOPE.On July 20th Sir RICHARD DOUGLAS POWELL presided at

the morning session. He said that the cases with whichthey had to deal were of two classes-the annual crop of newcases and the residuum of tuberculous population. Bydealing with the first successfully the second would cease tobe recruited and would die out. They had to learn whatwas best for each group of cases. Meanwhile, acquired andhereditary immunity had probably long been lessening theproclivity to tuberculosis in civilised communities.

Sir WILLIAM OSLER, in an introductory address, spoke ofthe universal diffusion of tuberculosis. What was necessarywas education, not only of the public, but of the profession.

314 THE NATIONAL ASSOCIATION FOR THE PREVENTION OF CONSUMPTION.

There was too much carelessness in examination amongdoctors, and that would tend to increase under thatworst of all systems that was to be forced uponthe profession-contract practice. The tuberculous patientneeded to be under strict control by a capable doctorand a good nurse, and had to work out his own

salvation with courage and hope. Hardly 10 per cent.of the cases could be treated in sanatoriums, so the hometreatment must be developed. He urged closer associationof the tuberculosis dispensaries with the general hospitals,whose duty it was to take up the work with their laboratoryfacilities and their social service agencies. He dreaded the

group of men whose whole work, knowledge, and life werespent in the tuberculosis dispensary ; they must needs becomenarrow. A closer study of tuberculin was needed, for thosewho used it carefully and persistently had excellent results,which showed that properly used in suitable cases it had anundoubted efficacy. In a few years it would be better knownto what extent and in what manner this remedy could be bestused.

Dr. ARTHUR LATHAM, in a paper onThe Value of the Sanatorium Treatment,

said that the public had not grasped that in manycases, owing to the severity of the disease, sanatoriumtreatment must be useless, in a few cases actuallyharmful, and in many others need not be carried outin an institution. The cardinal factor was not fresh airand food, important as these were, but the constantand skilled regulation of the rest and exercise prescribedfrom day to day. Sir Almroth Wright’s work had disclosedthe reason for this fact, which had been clinically appre-hended by Bremer and Walther. Movement determined thequantity of blood and lymph sent through the lung, andon this depended the amount of poison swept into the

general circulation. It was the question of how muchof this poison the defensive forces were adequate to

cope with that regulated the amount of exercise allowable.Early sanatorium treatment gave more control over thedefensive forces, so that in a large proportion of cases a

man’s capacity for work could be restored. This, added tothe education that made him cease to be a danger to thecommunity, was all the argument needed to support theclaims of the sanatorium. That sanatorium treatment hadnot met with universal acceptance was due to the fact thatmany existing sanatoriums were inefficient, to the im-

proper idea obtaining in some quarters that sanatoriumtreatment was sufficient in itself and a certain cure for

consumption, and to the fact that hitherto sanatoriums hadbeen too costly. Nowadays, apart from the land the initialcost should not exceed &pound;100 a bed and the upkeep shouldbe less than 25s. a week. The difficulty arising from themaintenance of the family in the absence of the breadwinnershould be swept away by intelligent administration of theInsurance Bill.

Dr. JANE WALKER, medical superintendent of the EastAnglian Sanatorium, in a paper on

The Sanatorium Treatment of Cons?,6mption,said that most consumptives, even in the earliest stages,took far too little food, and that of unsuitable kinds. Sheemphasised the importance of adequate food, the overcomingof the dread of a draught, the importance of rest, and theinestimable value of work properly applied; she laid stresson walking. Work was not only physically useful but was acorrective to boredom, which was depressing.

Dr. MARCUS S. PATERSON discussed

The Educative Value of Sanatoria,as also did Dr. J. J. PERKINS. The last-named describedthe method evolved by Dr. Arthur Newsholme at

Brighton of utilising a block in the isolation hospital forsuch consumptives as, while still able to work, were

advanced to a stage where it was impossible to obtain forthem a lasting cure. For such cases some measure of treat-ment was necessary for them from time to time as their

strength failed with continued work, and a short period ofrest, feeding, and change of surroundings provided all theimprovement possible. Such patients were ideal subjectsfor home treatment, but they would be able to carry out thenecessary rule of life at home only if it had been thoroughlydrilled into them in a course of sanatorium training. Insuch cases the educative value was paramount, the few

weeks’ treatment only incidental. After the patient’s returnhome he was kept under surveillance by a band of workers.

, Dr. J. EDWARD SQUIRE read a paper on’ The Home Treatment of Consumptives under the National

l,nsura,nce Bill.

He pointed out that it would be practically impossibleto treat all cases of consumption in institutions during thewhole period for which treatment was required. Few ex-

perienced people now expected arrest of the disease fromthree months’ treatment, so that treatment must be continuedat home under medical supervision. There must, therefore,always be consumptives in all stages of the disease needingto be treated at home. For these the National Insurance Billmade no provision beyond free medical attendance. Itoffered no supervision other than what obtained in someplaces for all, including the uninsured, on notification.The dispensary system provided the most useful and

satisfactory provision for home treatment and super-vision, but the Insurance Bill gave no such advantage.For the advanced consumptive the 10s. benefit would notallow of so keeping his house as to aid recovery or preventthe infection of others. There was no power to insist on theremoval of a consumptive from a house where neglect ofnecessary precautions was a menace to others. When theState found part of the insurance funds it ought to be ableto take necessary steps to prevent infection of those whowere, or would be, insured at its expense. Sanatoriumbenefits under the Bill should be enlarged to include someof the requirements for home treatment, the loan of sheltersfor outdoor sleeping, the means of having a separate room,or at least a separate bed, extra milk, or suitable food. Itwas much to be desired that the National Insurance Billshould allow further consideration to the needs of con-

sumptives who must be treated at home.Dr. J. F. J. SYKES, medical officer of St. Pancras, read a

paper on

The Relationship of Philanthropic and Municipal Agencies inDiagnosis and the Treatment of Persons under

16 Years of Age,in which he said it was in the search for a diagnosisof disease in its early and premonitory stage that the

cooperation of philanthropic and municipal agencies wasmost valuable. He suggested that hospitals and dispen-saries should undertake to diagnose and report on thecondition of contacts sent by health visitors. With regardto children under 16 the Poor-law guardians and theLondon County Council might take action under Section 34of the Children Act of 1908 to commit such children ifneglected to the care of some fit person or society for theprotection of children, but the very bodies having executiveduties in regard to consumptives-viz., the metropolitanborough councils-were purposely omitted from the Act.In a roundabout way their medical officers could searchout ailing persons under 16, and report any neglectto the guardians, so as to obtain for them proper home orinstitutional treatment.

In the afternoon Dr. LATHAM presided.Dr. RALPH P. WILLIAMS, school medical officer of health

of Sheffield, contributed a paper on

Open-air Recovery Schools,in which he said that about 7 per cent. of elementary schoolchildren were mentally dull, and in about half the mentaldulness was due to physical defects, including early tuber-culosis and conditions predisposing to tuberculosis. Hedescribed the Sheffield open-air school for such cases (whichhad resulted at a cost of E700 from the conversion of adisused elementary school), its staff, selection of children,their condition on admission, treatment of the teeth, feeding,milk-supply, personal hygiene, rest, shower baths, and thecosts of maintenance. The results, as estimated by theexamination of the children in October, 1910, were: cured,44; improved, 51; in the same condition, 3. The open-air school was valuable for its educative influence onparents, teachers, and children ; in providing educationfor those too delicate for the regular schools ; in leadingto the placing of simpler schools in suburbs rather thanmassive buildings in cities, and in taking classes in the play-grounds and stimulating nature rambles, as a means for thetreatment of an&aelig;mia, malnutrition, and the pretuberculousstage. Schools of this type should be constructed to

315IMPERIAL CABCER RESEARCH FUKD.

ac commodate at least 2&frac12; per cent. of the elementary schoopopulation.

Miss McGAw, in a paper onTuberoulosis Schools,

said that the amount of tuberculosis among school childrerwas estimated at from 5 to 3 per cent., but that was probableunder the mark ; for medical inspection of schools,as at present practised, was useless, as owing to short.ness of time a sufficiently detailed examination tcdetect the early signs of tuberculosis could not be made,and children under 8 were merely inspected, not examined,unless they were thought to be ill. She spoke of theexcellent results of the Edinburgh Special AntituberculosisSchool, and said that under the Elementary Education Act(Defective and Epileptic Children), 1899, the education

authority had power to establish such schools. She urgedthe need of organising such schools in relation to someantituberculosis institution, so that close medical super-vision might be available, with medical supervision of thehome and the direction of the choice of occupation whenschool was over, in regard to the physical condition of thechild. All schools should be open-air schools-i.e., theyshould all open their windows.

Dr. A. MAXWELL WILLIAMSON, medical officer of healthof Edinburgh, in a paper on

Advanced Cases and Segregation,pointed out that it was hopeless to talk of segregationuntil the essential preliminaries of notification, the estab-lishment of sanatoriums for early cases, and dispensariesdevoted to treatment and prevention had been established.He described what had been done in Edinburgh by the useof a pavilion of the infectious disease hospital for segre-gating late cases. Prior to the establishment of this hos-

pital in 1905, 73 per cent. of deaths from phthisis occurredin the homes of the patients, 14 per cent. in the parish hos-pital, and 13 per cent. in other institutions. Four years later

only 51 per cent. died in their homes, 20 per cent. in thecity’s hospital, 20 per cent. in the parish hospital, and only9 per cent. in other institutions. He urged the rendering suchhospitals markedly attractive to overcome the prejudiceagainst them.At the morning session on July 21stMr. C. S. Loca, secretary of the Charity Organisation

Society, read a paper onThe After-care of Patients.

He cited a series of cases to show the many factors that enteredinto the after-care. One must work through local agencieswith comparatively small areas. Treatment without visitingwould effect little. The establishment of dispensaries wouldaid in detection of contact cases. He criticised the proposedmethod of working of the sanatorium benefit in the InsuranceBill, saying that as the Bill stands, a large sum is to be con-tributed for sanatoriums, but that no suitable means weresuggested to utilise the sanatorium properly from the point ofview of the family needs in long and continuous illness. Thecases he had adduced showed that some such provisionshould be made.

Dr. H. W. MCCONNEL read a paper on the same subject,in which he said that after-care was mainly dependent onindividual effort acting in individual cases, and there was agreat danger in sanatoriums supported by State funds thatthis individuality of the workers would be checked ; thatprivate interest and work would be superseded by officialism,which would be more expensive and less effective. The

working patient scheme, whereby patients were employed inand about the sanatoriums for a small wage, would be

hampered, because these workers would have to be insured,as the Bill stood, and the sanatoriums would have to paythe insurance. These difficulties might possibly be removedby working the State-paid sanatoriums through existingsanatorium machinery, and so keeping its individuality, andfreeing all working patients where work is part of theirtreatment from the action of the Bill.

The rest of this session was given up to general discussion.Mr. WALDORF ASTOR, M.P., read a paper on

’llw Economic Cost to the Community of Tuberculosis.He referred to the well-known figures given in "TheConquest of Consumption" by Dr. A. Latham and Mr. G. H.Garland, and to the records of the German Imperial Office quoted by the Chancellor of the Exchequer in the House of I

Commons, and declared that with these and similar figuresbefore us it is clear that the cost of sanatorium treatment,provided that only suitable cases are selected, would berepaid over and over again by saving in disablement benefits.

Dr. NATHAN RAW read a paper on

The Use of Existing Accommodation azz Dealing withTuberculosis,

in which he paid a complimentary tribute to Mr. LloydGeorge’s clauses with regard to the treatment of consumptionin the National Insurance Bill. Dr. Raw advocated thetaking over of existing institutions, such as small-pox hos-pitals, workhouses, and portions of fever hospitals, which areno longer required for the purposes for which they were con-structed, and so to provide treatment for tuberculosispatients. In this way, a very large number of beds would beavailable throughout the country. Comparatively few cases,in his opinion, will receive any material benefit by suchinstitutional treatment, but nevertheless the provision of

large numbers of sanatoriums throughout the country will domore than anything else to stamp out the disease from ourmidst. Dr. Raw suggested that such sanatoriums should bedivided into four groups : (1) For early cases, with a view tocure ; (2) farm and industrial institutions for arresting thedisease ; (3) sanatoriums for advanced and hopeless cases ;and (4) open-air schools and sanatoriums for children. He

regarded the third group as by far the most important, andthat the transfer to them of advanced cases should be com-

pulsory, and that they should be constructed of the simplestmaterials which can be readily disinfected or destroyed.

Mr. ERNEST J. ScHUSTER, LL.D., read an interesting paperon this critical question:-Will National Health Insurance L’ns2ore National Health ?

In a close r&eacute;sum&eacute; of the proposals under the NationalHealth Insurance Bill, which are intended to affect the

general hygiene conditions of the country, he found manyof the proposed measures to regulate the general conditionsof public health only of problematical value. With theexception of the case of excessive sickness, where inquiryis valuable, the proceedings under the Bill are likely, hethinks, to create an expectation which would probably notbe fulfilled, and further, that the measures affecting theinsured persons individually will not benefit national healthto any appreciable extent unless they are largely supple-mented by voluntary agencies. The importance of main-taining these agencies and supporting them with all possibleenergy by the side of any system of State insurance whichmay be adopted cannot be sufficiently accentuated andimpressed upon the public.

IMPERIAL CANCER RESEARCH FUND.

THE annual meeting of the General Committee of theImperial Cancer Research Fund was held on July 20th atthe Royal College of Surgeons of England, the DUKE OFBEDFORD, K.G., the President, being in the chair. Amongstthose present were Sir William Church, Sir Thomas Barlow,Sir Henry Butlin, Sir R. Douglas Powell, Sir John Tweedy,Sir Henry Morris, Sir Henry Howse, Sir John McFadyean,Sir Francis Lovell, C.M.G., Mr. Edmund Owen, Dr. SidneyMartin, Dr. F. W. Andrewes, Dr. T. H. Craig Stevenson.Mr. S. Forrest Cowell (secretary of the Royal College ofSurgeons of England), Dr. J. A. Murray, Dr. W. H.

Woglom, Mr. R. Clement Lucas, Lady Meiklejohn, MissD. S. Coode, Dr. E. F. Bashford (general superintendent),and Mr. F. G. Hallett (secretary).The adoption of the report was moved by Sir WILLIAM

CHURCH in a speech which was a very able summary of themain points of the

NINTH ANNUAL REPORT.

Report of the Executive Committee.The ninth annual meeting ot the General Committee of the Imperial

Cancer Research Fund was held at the Royal College of Surgeons onJuly 20th last, when the chair was taken by the Right Hon. A J.BALFOUR, M.P. Sir WILLIAM CHURCH, Bart., K.C.B., chairman of theExecutive Committee, presented the annual report, which wasadopted. On the motion of Sir WILLIAM CHURCH, Bart., seconded bySir HENRY MORRIS. Bart., His Grace the Duke of BEDFORD, K.G., wasunanimously elected President of the Fund. Mr. BALFOUR, in movinga vote of thanks to the Chairman and members of the Executive Com-mittee, the sub-committees, officers. and others, spoke of the valuablework done by the Imperial Cancer Research Fund the result of which