969

THE NATIONAL INSURANCE ACT.

THE NATIONAL CONFERENCE OF FRIENDLY SOCIETIES ANDTHE ACT.

THE National Conference of Friendly Societies opened atthe Hearts of Oak Delegate Hall, Euston-road, London,N.W., on Thursday, Sept. 18th, when Councillor A. H.

Warren, Independent Order of Oddfellows (ManchesterUnity), presided over delegates from all parts of the countryand representing over 7,000,000 members.The proceedings have been fully reported in the -Daily

Telegraph, and we comment upon them in a leading articlethis week. The presidential address was a dignified settingout of the position of Friendly Societies as character-

building organisations, but foreshadowed the debate thatfollowed by the suggestion that malingering and excessivesickness claims were associated with the severance of theold position between the medical profession and the FriendlySocieties of employed and employer.The following resolution was moved by Brother T.

Berrie :-That in view of the excessive expenditure on medical benefit and the

inadequate and unsatisfactory service obtained therefor, and the dangerinvolved to the State Insuracne funds, on account of the present arrange-ments, steps be taken to secure the transference to Approved Societiesof the administration of medical benefits under the National InsuranceAct.

This was seconded by Brother King, who said, according tothe Daily Telegraph, that" they got far better service whenthe societies had the management of the medical benefit. It

ought never to have been taken away from the societies. It

gave them a command over the doctors. They could say tothem that if they did not do their work they would give themthe sack,’ but they could not do that at present, althoughthat was what was required in many cases."The resolution was later modified by Mr. Berrie in the

following way :-That action be continued to secure the transference to Approved

Societies of the administration of medical benefits under the NationalInsurance Act where desired.

An amendment was then moved and withdrawn advocatinga State Medical Service, and after several modificationsanother amendment was moved running as follows :-That this National Conference is of opinion that a full-time salaried

medical service is the only solution of the difficulty of providing anadequate medical service.

This amendment was rejected by a large majority, and Mr.Berrie’s motion, with the omission of the last words, " wheredesired," became the unanimous resolution of the Conference.

A PROPOSED SPECIAL COMMISSION.

Sir Charles Macara, President of the Employers’ Parlia-mentary Association and member of the GovernmentIndustrial Council, recently suggested in a letter to the

press that the questions arising under the National InsuranceAct are too numerous and too complex to be dealt with asthe exigencies of party politics might suggest, and that athoroughly representative Special Commission should be

appointed to consider the question as a whole. I claim,"he says in his communication to THE LANCET, which is

substantially the same as has already appeared in thelay press, "that it is high time the scheme was liftedout of the political cockpit and dealt with as a non-partyand national question." The proposal of a Special Com-mission is virtually a severe criticism of the amendingAct. As all our readers know, under the Amending Actthe medical position is strengthened in minor ways, but theparticular modifications of the measure which we shouldmost desire to see are not included, and while the amend-ments bring into the sphere of medical benefit some 8000or more persons they do not propose to remedy the faults inthe administration of that benefit. The contention of theGovernment would probably be that if the amendingmeasure had not made all persons satisfied with all situa-tions arising under the Act, it is at any rate an earnestof their intention to deal with defects as they arise and astheir reality can be proved. It is a matter of common know-ledge that further amendments and changes in the NationalInsurance Act will have to take place, and Sir CharlesMacara considers that a Special Commission, if properly representative of the ir-terests involved, could fully consider

the facts and make regular and comprehensive proposals forthe removal of abuses in a manner which Parliamentarymethods could not compete with either in rapidity or indirectness. The proposal will, of course, be recognised as a;repetition, rather late in the day, of what was said so oftenand so clearly by thoughtful people when the Bill was firstintroduced into Parliament, that deliberate business-likerevision of the measure was required before the Act wasplaced on the statute book.MALINGERING: THE POSITION OF APPROVED SOCIETIES.

The official inquiry into malingering will necessarilyextend over some time, but some of the Approved Societiesare feeling the strain on their resources so acutely that per-mission has been given to them to employ the services of’medical referees. This can be done either directly orthrough the Local Insurance Committee, at the expense of’the society, but the Commissioners advise that all sucharrangements should be of a provisional nature. At theNational Conference of Friendly Societies the motion urgingupon the Government the necessity of appointing full-timemedical referees in connexion with all insurance questions.was withdrawn.

THE WORKING OF THE ACT IN MANCHESTER.The Manchester Medical Committee has issued its report,

signed by Dr. John D’Ewart, the honorary treasurer, orr

the work done in Manchester under the National InsuranceAct for the quarter ending June 30th. The following aresome of the details. The number of patients increased, withfluctuation, from 24,733 in January to the following numbersfor the later months respectively : February, 40,788; March,.40,230 ; April, 40,838 ; May, 35,929; June, 38,028.Comment is made on the astounding feature of these

figures, which is unquestionably the amount of sicknessdisclosed by the working of the new Act. "Even," says-the report, " when no attention is paid to the thousands ofinsured persons still consulting doctors not on the list, thefact that every month about one-sixth of the insured popula-tion of Manchester require medical attention is by itselfsufficient to dispose of the unfair and untrue statements-made recently in the House of Commons by Mr. Mastermanwhen he charged the Lancashire doctors-because thesickness rate exceeded his estimate-with a deliberate

attempt to smash the Act." The Government was repeatedlywarned that the calculation of the incidence of sickness-

among insured persons was being made upon an unsoundbasis, and Mr. Masterman’s allegation is consequentlyconsidered to be unfair.

In the contrast between the panel system and theManchester scheme the Manchester Medical Committeestates that the Manchester scheme was the more equitable,inasmuch as the bulk of the money available went wherethe bulk of the work was done. This, says the report,has been investigated actuarily, with the result as shownbelow :-

In other words, about 50 practitioners working in thecongested areas take about half the money. The total’

, amount of the bills rendered from Jan. 15th to March 31st, was £34,413 8s., and the amount paid at the rate of 13s. 4d.

in the £ was £20,929. From April lst to June 30th the-bills rendered reached £40,599 14s. 6d, and the amount paidat the rate of 10s. in the f. was f.18,7S2 10s.The Committee draw attention to the marked tendency for-

insured persons to increase their demands for non-routine! visitation, as evidenced by the steady rise in the relation of, ordinary visits to special and night visits, the remedy sug-

gested for which is to insist upon a small fee being sent withthe request for such attendance. A strong and interesting-report closes as follows : ’’ The work done per patient permonth averages about 7s. ; the money provided by Mr. LloydGeorge averages about 4s. As the number of patients cannot-be reduced practitioners are still faced with the alternativesof reducing the work done or definitely accepting the role of

.. ’ philanthropists by order of the Government. "’

970

DIVISION OF OPINION AT WANDSWORTH.

We have received from Mr. George D. Wilson and Dr.H. McD. Parrott, respectively chairman and secretary of theWandsworth Division of the British Medical Association, acopy of the following resolution which was passed at ameeting of the Division held on Sept. 23rd, with a requestfor its publication :-

This meeting of the Wandsworth Division of the British MedicalAssociation is of opinion that the present pro-panel attitude of theAssociation is reacting detrimentally to the interests of members of theprofession in general, and in particular to the interests of non-panelpractitioners, and approves the action of all such members in resigningfrom the Association.

The resolution was -proposed by Dr. Edwin Smith andseconded by Dr. W. E. Barton, and was carried by 21 votesto 14, thus illustrating the deep difference of opinion thatstill prevails in the medical profession as to the NationalInsurance Act.

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REGULATIONS FOR THE APPLICATION OF MONEY MADEAVAILABLE FOR RESEARCH UNDER THE ACT.

The regulations have now been published in the LondonGazette, made by the Joint Committee established under theNational Insurance Act, as to the application of moneysmade available for the purposes of research by Subsection (2)of Section 16 of the Act.The regulations, which are provisional, propose to secure

that all the sums which accrue under the above-mentionedsubsection of the Act to the Joint Committee of theseveral bodies of the Commissioners or to any of theseveral bodies for the purposes of research shall be paidinto a Medical Research Fund, and may be used as the JointCommittee may direct during the financial year in which

they are provided. The following committee, known as theMedical Research Committee, has been appointed : LordMoulton, F.R S. (chairman), Dr. Christopher Addison, M.P.,Mr. Waldorf Astor, M.P., Sir T. Clifford Allbutt, F.R.S.,Mr. C. J. Bond, Dr. W. Bulloch, F.R.S., Dr. Matthew Hay,Dr. F. Gowland Hopkins, F.R.S., and Sir William Leishman,F.R.S. They will hold office for three years, and thereafterthree members will retire every two years, selected as thecommittee chooses, and being eligible for re-election. Casualvacancies are to be filled by the chairman. The names have

already been published in THE LANCET, as have those of theAdvisory Council for Research which has been constituted asfollows: the Right Hon. Lord Moulton (chairman), Miss L. B.Aldrich-Blake, M.D., M.S., Sir W. Watson Cheyne, F.R.S.,Sir William S. Church, Dr. Sidney Coupland, Mr. DavidDavies, M.P., Dr. Sheridan Delepine, Sir James KingstonFowler, Sir Rickman J. Godlee, Sir Alfred Pearce Gould,Dr. David Hepburn, Mr. E. C. Hort, Dr. Arthur Latham, SirJohn McFadyean, Dr. W. Leslie Mackenzie, Dr. J. C.

McVail, Dr. W. J. Maguire, Dr. S. H. C. Martin, F.R.S.,Dr. Robert Muir, Dr. Alexander Napier, Sir George Newman,Dr. Arthur Newshoime, Dr. J. M. O’Connor, Sir WilliamOsler, F.R.S., Dr. A. C. O’Sullivan, Dr. Marcus S. Paterson,Sir Robert W. Philip, Sir William H. Power, F.R.S., Dr.H. Meredith Richards, Dr. Lauriston E. Shaw, Mr. AlbertSmith, M.P., Dr. J. Lorrain Smith, F.R.S., Mr. T. J.Stafford, Dr. T. H. C. Stevenson, Mr. Harold J. Stiles, SirStewart Stockman, Dr. W. St. Clair Symmers, Miss JaneWalker, M.D., Dr. Norman Walker, Mr. J. Smith Whitaker,Sir Arthur Whitelegge, and Dr. G. Sims Woodhead.The Medical Research Committee will appoint a treasurer

Dr such officers as are necessary, and expend sums at itsdiscretion for administrative purposes subject to the ap-proval of the chairman of the Joint Committee ; and will,also prepare schemes for research or inquiry containingestimates of expenditure for submission to the chairman ofthe Joint Committee for his approval, this approval to begiven after consultation with the Advisory Council. The

following payments are to be arranged for :—

(a) To members of the Advisory Council for Research travellingexpenses and subsistence allowances, upon a scale to be approved bythe chairman of the Joint Committee, incurred by them in attendingmeetings of the Council; (b) such sums as the chairman of the Joint’Committee may direct, as honoraria to members of the Medical ResearchCommittee, not being the chairman of the committee or membersof the Commons House of Parliament; (c) to the Medical ResearchCommittee such sums as may be required for the administrativepurposes of the committee ; (d) such sums as the chairman of theJoint Committee may from time to time direct to be paid to theMedical Research Committee for the purposes of any scheme or

schemes approved as aforesaid.

The accounts of the Medical Research Fund are to be z

made up for each financial year, ending March 31st, auditedas the Treasury may direct, and any moneys standing to thecredit of the Fund and not immediately required are to beinvested as investments for Approved Societies in accord-ance with Subsection (2) of Section 56 of the Act. No

moneys are to be paid as salary or fee to any membersof the Medical Research Committee or’ of the AdvisoryCouncil for Research, save as expressly provided in theRegulations, which are the formal enactment of much thathas already been published.

Medical News.MADAME SARAH BERNHARDT AND THE HOSPITALS.

-Madame Sarah Bernhardt’s generous activities on behalf ofthe suffering and the sorrowing are well known, and it seemscertain that the French Hospital in London and CharingCross Hospital, to both of which hospitals she has alreadybeen a generous contributor, will profit greatly by thecharity performance to be given by her at the LondonColiseum on Oct. llth. Their Majesties the King andQueen have promised to attend. The lowest prices will be5s. for gallery seats, the remaining seats varying in pricefrom 1 to 10 guineas and 100 guineas for boxes. There is anatural and special ground for sympathy between MadameBernhardt and the French Hospital, while the patheticannouncement of " five-closed wards " at the Charing CrossHospital, which has always rendered particular service tothe distressed members of the theatrical profession, rendersit a peculiarly fitting object for the generous artistic servicesof the greatest living actress.

PRIZES AT THE SEVENTEENTH INTERNATIONALCONGRESS OF MEDICINE.-In addition to the awards

already announced in THE LANCET of August 16th, Messrs.M. Schaerer, of Bern and Berners-street, London, manufac-turers of complete hospital equipment, have been given thegrand prix for their exhibit, as have also Messrs. CharlesHearson and Co., of Regent-street, London, for theirincubators and specialities. The proprietors of Vittelmedicinal table water (agent, E. Del Mar, Mark-lane, London)have been awarded a gold medal.

UNIVERSITY OF BIRMINGHAM.-At the openingof the winter session at the University of Birmingham onOct. 7th a reception will be held in the Medical Facultybuildings at 7.30 P.M., after which Professor Arthur Keith,LL.D., Conservator of the Royal College of Surgeons’Museum, will deliver an address on The Present ProblemsRelating to the Antiquity of Man."

NATIONAL ASSOCIATION FOR THE FEEBLE-MINDED.-A conference of public authorities in connexion with thisassociation is announced to take place at the Guildhall onOct. 23rd, under the presidency of the Lord Mayor.MEDICAL MAGISTRATES.-Dr. H. J. Clarke and

Dr. A. C. Wilson have been recently placed on the com-mission of the peace for the borough of Doncaster.

BOOKS, ETC., RECEIVED.

CHURCHILL, J. AND A., London.A Manual of Surgery. For Students and Practitioners. By

Francis T. Stewart, M.D., Professor of Clinical Surgery, JeffersonMedical College. Third edition. Price 16. net.

Cancer of the Rectum, its Surgical Treatment. With an Appendixof 445 Cases. Jacksoman Prize Essay. Sixth edition. ByHarrison Cripps, F.R.C.S., Consulting Surgeon to St. Bartholo-mew’s Hospital. Price 5s. net.

On Diseases of the Rectum and Anus. Including the Sixth Editionof the Jacksonian Prize Essay on Cancer. Fourth edition. ByHarrison Cripps, F.R.C.S., Consulting Surgeon, St. Bartholomew’sHospital Price 10s. 6d. net.

Transactions of the Ophthalmological Society of the UnitedKingdom. Vol. XXXIII. Session 1913. With List of Officers,Members, &c. Price 12s. 6d. net.

Saint Thomas’s Hospital Reports. New Series. Edited by Dr.J. J. Perkins and Mr. C. A. Ballance. Vol. XL. 1911. Price8s. M. net.

GILL, L. UPCOTT, AND SON, LIMITED, Bazaar Buildings, Drury-lane,London, W.C.Portuguese Political Prisoners. A British National Protest. Fifthand enlarged edition. Price 6d.