153

of glycerin to this preparation should give to itbetter keeping properties. Tincture of stramoniumis now assayed, and the Pharmaeopœia. state thatits strength has been decreased. A correspondingincrease of its maximum dose to 30 minims has beenmade.The Commission has changed the composition of

36 articles and preparations. Some have alreadybeen noted ; of the remainder only a few requireexplanation. Ipecacuanha wine is no longer tobe found in the Pharmacopoeia. In accordancewith the terms of an international agreement that" no potent drug shall be prepared in the form ofa medicinal wine " it has been replaced by tincture

of ipecacuanha, prepared with glycerin, alcoholand water and containing the same proportion ofalkaloids. Flexile collodion, the only collodion inthe book, is now prepared with colophony and shouldprove a superior preparation from the standpointof covering power and flexibility. The soap solutionof cresol will be known by the official name " Lysol,"implying an antiseptic with fixed 50 per cent. cresolcontent. Finally Dover’s powder now is made bydiluting the ipecacuanha and opium with lactose, areasonable change from potassium sulphate.The more important Additions will be summarised

in the sequel.(To be concluded.)

PANEL AND CONTRACT PRACTICE

Insurance Acts Committee

THE report of the proceedings at the June meetingof the Insurance Acts Committee is published ina recent supplement in the British Medical Journal,and the following notes show the importance of thework done.

(

Statements were made recently in the House ofCommons (where special privileges exist) by Mr.F. A. Macquisten which were derogatory to insurancepractitioners. This was discussed, and the opinionis expressed that the Minister of Health should beasked to reply from his place in the House. Thereport of the Donoughmore Committee was also 1considered, and held to bear out a principle for which the profession has striven and secured in the administration of the Insurance Acts. ’

During 1931 statistics of attendance on insured ]persons were received in respect of 1100 practices, representing 1683 doctors and 1,600,000 insured persons. The chairman, Dr. H. G. Dain, said they much appreciated the valuable work done by these diligent keepers of records, and he hoped that their efforts would not be relaxed. ]

A scheme for pensions for practitioners was

discussed and it was hoped that no one company wouldsecure a monopoly of the business ; a scheme wouldbe devised with a common form of policy in whichconditions, premiums, and benefits offered by the several companies would be identical. There wasan outstanding difficulty with regard to differencefrom an insurance point of view of men and women.The next discussion was about the retirement of

aged and infirm practitioners. The idea is by meansof the National Defence Trust to bring about

voluntarily the retirement from insurance practiceof aged and infirm practitioners, but the meetingappreciated the delicacy of the situation.

.

On the question of range of service, under Article 43of the Regulations, the decision of referees can onlygovern a particular case in question. The Ministryof Health have written to the Insurance Acts Com-mittee suggesting an alteration whereby a furtherdecision in a similar service would not be necessary,but it was stated that the committee had replied tothe Ministry that practice varied in different localities,and what might be fair for one area would not befair for the whole country. Discussing the reportsof the medical service subcommittee, it was held thatcases should be private and confidential until thereports had been passed by the main insurancecommittee. At present these reports are circulatedto the press on the agenda papers of the maincommittee, with occasionally hardships to personscriticised thereon.

At the present time Is. 3d. is allowed for eachL00 patients on a doctor’s list for payment for drugslecessarily or ordinarily administered by a practi-tioner, and drugs and prescribed appliances neededfor immediate administration or application. Inlebate it was thought that changes in medical practice:equired a revision of these terms, and it was suggestedthat the wording might be altered to "...

lecessarily provided or administered by the practi-ioner in an emergency."

SCOTTISH PANEL AFFAIRS

An important conference took place in Edinburghbetween the Department of Health and representatives)f local authorities on the one hand, and the ScottishCommittee and the Insurance Acts Subcommitteeon the other hand, with a view to the employment ofpart-time practitioners in the health scheme of thelocal authorities. There is to be a Scottish panelconference on Oct. 5th, 1932, to be held at theScottish House of the B.M.A., to consider the Scottishpart of the Insurance Acts Committee’s annual report.The findings of the conference will be reported to themain annual conference in London.

CONFERENCE IN DUMFERMLINE

Over 120 delegates of Scottish friendly and approvedsocieties met in Dumfermline recently, and there wasthe usual criticism of the laxity of the panel doctorin certification, although it was admitted by thesocieties that errors generally arose from taking thepatient’s statement as true.

-

Dr. J. L. M. Symns, a regional medical officer forScotland, gave an address on certification, and thoughtthat abuses would continue as long as it was so easyto join the panel list and so difficult to be removedfrom it.- Neither doctor nor patient had sufficientknowledge of insurance principles. He thoughthealth lectures often produced introspection andmorbid over-care, while easy money and lack of

employment formed a complex which medical menfound it very difficult to handle. There was lackof confidence between the medical profession andapproved societies and too many diehards on bothsides ; mass accusations had done incalculableharm, and while the doctor’s reaction was to let casesgo to reference, the societies referred more and morecases. The financial side of sickness benefit has

naturally been so stressed that practitioners havecome to feel that a society cares for nothing else.Dr. Symns thought doctors should refer cases of realdifficulty, and that the patient, being informed, willnot object. The man who really runs his practice, hesaid, always beats the man who is run by his patients ;and patients who are lost on the way are never worthkeeping. He held that meetings between approved

154

societies and doctors should be continued, andrecommended that final year students should havesystematic lectures on insurance practice, given bythose who know the difficult problems the youngpractitioner will have to face. Much closer contactwas necessary between the doctor and the hospital;the present state of hospitalisation of the country is

a source of genuine anxiety to all and is indirectlya source of prolongation of certification and ofconsiderable expense. Dr. Symns ended by visualis-ing the development of a system by which the resultsof modern and tried forms of treatment will bedistributed to the practitioner to aid him in treat-ment and expedite the recovery of his patient.

PUBLIC HEALTH SERVICES

SCHOOL MEDICAL SERVICE

Edinburgh School Health Inspection :

Dr. John Guy, medical officer of health of

Edinburgh, has submitted certain proposals in revisalof the present methods of medical inspection of school-children. In his view, three years is too longan interval between examinations, and his ideal ’would be a complete examination for each child

every year. In the primary schools he proposesto make some modification of the present arrangementsfor an experimental period of twelve months. The

following routine would remain unchanged. A fullexamination and completion of the medical schedulefor all infant entrants ; the routine examination insecondary schools, and in

"

special " schools ; the

present system of seeing cases specially referred tothe doctor by the teachers ; special annual examina-tion of children on the free food roll; the statutoryexamination of employed school-children ; theendowed schools, and the Royal High School. Thealteration would thus concern only the routineexamination of children aged 9 and 12, and thoseleaving school. The proposed alterations are : (1)omission of the routine examination of the 9- and12-year olds, and substitution of a class-room inspec-tion by the doctors. Any child not considered upto standard by teacher or doctor would be noted fora further and complete examination ; (2) institutionof a special examination of vision and hearing atthe age of 7 ; (3) examination of "leavers

" one full

year before leaving, instead of, as at present, a shorttime before leaving. If the child needs furtherexamination, the parents would be notified andrequested to be present. The report has been

approved by the public health committee.

The following are reports of school medical officersfrom a city, borough, a,nd county :—

City of LeicesterIn these days when there is a tendency for the

reports of school medical officers to be cut down tobare lists of duties performed, it is a pleasure to readDr. A. Warner’s survey of progress, which containsmuch information that is of more than local or

temporary value. A few of the remarkable contrastsbetween the condition of the children in 1906 and 1931show the improvement made. 1906. 1931.

Per cent. Per cent.Verminous bodies .... 9-4 ...... 0.8Verminous heads.... 6 ...... 0,02Poor clothing...... 14 ...... 0-3Poor boots...... 9 ...... 0.46Poor nutrition...... 10 ...... 0-03

In the 25 years the Leicester boys aged 12-13 are.on an average, 1 inch taller and 6 lb. heavier, and thegirls, 1 inches taller and 8 lb. heavier.During the past year a special study has been

made of school furniture, since incorrect posture atschool is now recognised as a cause of both spinalcurvature and myopia. Bad seating arrangementsare common. Exact descriptions are here given,with illustrations, of the correct attitude for oral work,reading, and writing, and accurate specifications ofdesks and seats are also supplied. Where classes arelarge, Dr. Warner favours dual desks ; for childrenin the infant department chairs and tables of appro-priate size. He points out, however, that whilescholars must sit badly on the old, ill-constructeddesks, they may sit badly on the best of new ones.

Dr. T. A. Carson reports that nearly half thecases treated in the artificial sunlight clinic wereinfants from the infant welfare centre. While amongthe infants the best results were obtained in ricketychildren, among the older boys and girls cases ofanaemia and debility seemed to derive much benefit.Mr. J. A. Keen, the aural surgeon, discusses hsemorrhage after tonsillectomy, and he finds that as a

rule it can be checked without difficulty by injectionof coagulin ciba. Speech classes were started inNovember last, and results of high value are expectedfrom them.

Borough of SmethwickDr. H. Paul gives an adequate account of school

work in Smethwick. The new " Firs " Clinic findsaccommodation for infant welfare work and fordental and ophthalmic treatment, with a minorailment room, a kitchen where tea and light refreshments can be prepared, and a toddlers’ room pleasantlydecorated. Well-equipped premises are providedfor orthopaedic work for which the SmethwickCripples’ Union are responsible since the borough hasno orthopeadic scheme of its own. The chest clinicis housed in a special section which can only bereached through a separate entrance and is thuscompletely cut off from the rest. This precautionmay seem a little meticulous, but it at least removes,as a possible excuse for non-attendance at the otherclinics, the fear of infection. No provision is madefor throat operations ; these are all carried out at theBirmingham Hospital, which has a long waiting list.Less malnutrition is recorded than in the two previousyears, in spite of the continued and deepened industrialdepression. Most of the cases thus classed, moreover.refer to children of poor and subnormal physique,and real malnutrition is not common. The schemeof the education committee for the feeding of necessi-tous children is said to be so complete and so simplethat no child need go hungry, and such children asare found to be badly nourished owe their conditionusually to improper rather than to insufficientfeeding, or to some error of metabolism. Thearrangements are certainly thorough ; 96,617 mealswere provided last year, and a new milk scheme wasorganised. In January, 1932, 3452 children werehaving midday milk regularly-i.e., more than one-quarter of all the pupils-and more than 2000 of thempaid for it. Dr. Paul adds a tribute to the work ofthe teachers, who bear the extra work which the milkscheme entails, and he is convinced that incalculablegood is being done.

In these ways malnutrition is being prevented;for established cases the treatment is usually a period