SUPPLE13M1ENT Cz TO TIIE BRIT5ISH MEDICAL JOURNAL. LONDON: SATURDAY, MAY 27TH, 1905. CONTENTS. Page Page MATTERS REFERRED TO DIVISION3: Lareashire and Cheshire Branch: Blackburn Division ...... 279 Routh-Eastern Branch: Croydon Division ...... 279 ANNUAL REPORTs OF COUNCIL AND COMMITTEES: Sou,hern Branch: Portsmouth Division ...... 279 Report of Council, 1904-5 ...... 225 ... Wales,, Winchester Division ...... 279 Balance Sheet for 1904 ...... 228 South Wales and MonmouthWhire Branch: Cardiff Division ... 280 Yorkshire Branch: Harrogate Division ...... 280 Annual Report by the Medico-Political Committee ... *.. 935 Appendices . .. 244 ASSOCIATION NOTICES.-NOTICu OF CHANGE OF BOUNDARIES National Deposit Friendly Society ... 250 oF DIvIsION AND BRANCRES.-J}ANCH AND I)MSION MBETINGS Report on Death Registration and Amendment ofCiloronear's TO BJI -LD ...... M8 Law ...... 251 'The Coroners Bill ...... 253 MEETING OF BRANCH AND DIVISION SECRETARIES AT Mfedtcal Acts Amendment Bill ... 2s LE[CESTER ...... 282 Pablic Health Bill ...... 209 BRITISH MEDICAL ASSOCIATION : SEVENTY-THIRD ANNUAL Annual Report of the Ethical Committee ...... 273 MEETING PROGRAMME ...... 282 Report of Medical Defence Committee ... 276 GENERAL MEDICAL COUNCIL.-President's Address ...... 283 PROCEEDINGS OF STANDING COMMITTEES: CENTRAL MIDWIVES BOARD ...... 285 SECRETARIES OF BRANCHES AND DivIsIONS COMMITTEE VITAL STATISTICS...... _" 286 ScoTrISH COMMITTEE ...... 277 NAVAL AND MILITARY APPOINTMENTSB...N.8 _._ 286 ..277 . . ANNUAL MEETING (SECTIONS) COMMITTEE ...... 277 VACANCIES AND APPOINTMENTS 286 BIRTHS, MARRIAGES, AND DEATHIS _ 287 PROCEEDINGS OF COUNCIL ...... 277 DIARY O THE WEEK ...... 287 MEETINGS OF BRANCHES AND DIVISIONS: BOOKS RECEIVED...... _ 287 Border Counties Branch: North Cumberland Division ...... 278 .* . . 288 Dorset and West Rants Branch i ...... 278 CALENDAR O. SPECIAL NOTICE TO MEMBERS. Every member Is requested to preserve this "Supplement," which contains matters specially referred to Divisions, until the subjects have been discussed by the Division to which he belongs. BY ORDER.

ship of your Association, not only at home but throughout the empire. Your Council has taken steps to make more MATTERS REFERRED TO DIVISIONS. widely known the advantages of membership, and has issued a number of recruiting circulars with satisfac- tory results. The Association now numbers 19,500 mem- ANNUAL REPORTS OF COUNCIL bers, being an increase of 6oo on the previous year. AND There are still members of the medical profession COMMITTEES who fail to appreciate the necessity of joining your Asso- TO BE PRESENTED TO THE ciation, but your Council feels confident that as the profession realizes the great influence the British Medical Annual Representative Meeting, Association is able, to exercise in all matters of common TO Bi HE1LD IN interest, the number of those who hold aloof will rapidly THE HALL OF THE Y.M.C.A., LONDON ROAD, LEICESTER, diminish. The activity throughout the Divisiions and **1 Branches has beez reflecte4 in the number, of Council ON and Committee meetings held in London. Your Council JULY 24th, 1905, and following days (as may desires to express again its thanks to those members who be necessary). have done such excellent work in the Divisions, in the Branches, and at head quarters, and especially to the Chair- men of Committees and the Division and Branch executive REPORT OF COUNCIL, 1904-5. officers who by their zealous and unselfish labours have contri- (1) ON the occasion of the seventy-third annual meeting of the buted so largely to the continued success of your Association. British Medical Assiociation to be held at Leicester, your Council is able to report that the activity throughout the DEATHS OF FORMER MEMBERS OF COUNCIL. Divisions and Branches referred to last year has been well (2) Your Council is glad to report that since meeting you at austained., This is evidenced in a marked degree by the Oxford it has not to record tbe loss by death of any member increase in the number of meetings held and in the mcmber- of the Cuncil. However, death has removed-(58)former 226 2aumW KMIUnoLJYJzOURNE I1 ANNUAL REPORT OF COUNCIL. [MAY 27, 1905, members. and your Council deplores the loss of Dr. William and as a Vice-President. Further, Sir Constantine Holman, Vawdrey Lush and Dr. Ogilvie Grant. Dr. Vawdrey Lush by his long and successful labours, has done much to rendered valuable services on the Council from I883 to 1889 establish the medical charities on a sound financial footing. as the representative of the Dorset and West Hants Branch; also as Honorary Secretary and Treasurer of the same Branch MEDICAL BENEVOLENT TNSTITUTIONS. from its foundation twenty-one years ago. Dr. Ogilvie Grant (5) During the year I904 some £700 was received through represented the Northern Counties of Scotland Branch on the the office on behalf of the British Medical Benevolent Fund, Council from i886 to i9oo, and acted as President of the Branch the Royal Medical Foundation of Epsom College, and the in 1903. Royal Medical Benevolent Fund Society of Ireland. Your Council sincerely hopes that each year these most deserving DEATHS OFl MEMBERS OF THEI ASSOCIATION. institutions may receive still greater support from members (3) Your Council regrets to have to record the deaths since of the profession, and that by the influx of additional funds April, 1904, of the following members of the Association: their sphere of usefulness may be still further increased. Dr. J. Alexander, President of the South-Western Branch; Dr. John Anderson, Mr. Robert Kendray Archer, Mr. Herbert THE JOURNAL. William Allingham, Dr. Edward Adam, Dr. Charles Greasley (6) The Council believes that the maintenance of the BRITISH Armson, Mr. Samuel Hollingaworth Agar, Mr. James Payne MEDICAL JOURNAL at a standard of excellence which entitles Baker Auckland. New Zealand; Dr. Henry Briggs, Dr. it to take a leading place among the medical journals R. M. Brown, Dr. George Watson Beattie, Dr. HerbeIt of the world is among the most effective means which Blaxland, Lieutenant-Colonel P. H. Benson, I.M.S., SirWilliam the Association possesses of promoting the medical Mitchell Banks, M.D., LL.D., who gave the address in and the allied sciences, and maintaining the honour Surgery at the Montreal meeting in 1897; Sir Frederick and interests of the medical profession, the objects Bateman, M.D., a former member of the Association; Dr. for which it exists. The JOURNAL presents to members Harry Arthur Benham, Professor Ambrose Birmingham, every week original articles on clinical and pathological Mrs. Sinclair Coghill, M.B.; Dr. John Joseph Cranny, subjects, short papers and memoranda on experiences Surgeon Cecil E. C. Child, R.N.; Mr. William Henry in general practice, reports of cases from hospitals throughout Copley, Dr. William Carmichael, Mr. Richard J. Dearden, the British Empire, reports of the Lcientific proceedings of Dr. Nathan Smith Davis, Dr. Honry William Drew, Branches and Divisions of the Association and of medical Dr. Robert Taylor Sumner Eagar. Mr. Charles Bolton Elliott, societies, and reviews of current literature. It has the advan- Mr. Branford Edwards, Dr. Nieholl Evans, Dr. Maurice tage of the services of special correspondents in the principal Griffith Evans, Dr. Alfred John Freeman, Major Alexander cities of Europe and the British colonies and dependencies, as Samuel Faulkner, I.M S., Dr. Thomas Greer, Major John Henry well as in Scotland and Ireland and the chief cities of Greenway, Mr. Roger Portington Goodworth. Dr. Dan Astley England and Wales; these keep members informed of the pro- Gresswell, Dr. Alexander LockhartGillespie, Dr. Ogilvie Grant, gress of medical science in these countries, and of occurrences formerly a member of the Central Council and President of of importance to the profession. Matters of current the Northern Counties of Scotland Branch; Dr. Ambrose interest are discussed weekly in the editorial columns, Arnold Guillaume Gye. Mr. Alfred Vavasour Griffiths, and from time to time topics newly arising, upon which it is Dr. Robert Hartley, Dr. William Alexander Hepburn, important that the profession should have trustworthy Dr. Thomas Hill, Dr. W. G. Holloway, Mr. Isaac Harthan, information both for its own guidance and that it may Mr. Samuel John Hutchinson, Dr. Frederick Henry Hume, influence public opinion in the right direction, are made the Dr. John Harker, Dr. Geoffrey Edward Hale, Mr. Harry subject of special reports. In this way the question of the Harlock, Mr. Thomas Johnston, Surgeon-General J. Jameson, family care of the insane poor in Scotland and on the Con- C.B., K.H.S.; Dr. Charles Kelly, Dr. Rustonjee Naserwanjee tinent-a system as yet undeveloped in England and Wales Khory, Mr. H. Selby Little, Mr. John Lilly Lane, Dr. William and the principles which should determine the attitude George Vawdrey Lush, Honorary Secretary and Treasurer of of the profession towards the many problems arising in the Dorset and West Hants Branch from its foundation connexion with school hygiene, have been reported on by in I883; Dr. Maurice E. Ling, Lieutenant-Colonel John experts. Stannard Mac&dam, ret. A.M.S., Dr. Alexander Dall The progress of medicine and the allied sciences, the great MacDonald, Mr. David Steele Moon, former President of the activity displayed in every department of medical investiga- Dundee Branch; Mr. Jobn New Moore, Dr. William Alexander tion, andthe interest in the medico-political work undertaken McKeown, Dr. Daniel Moore, Dr. Thomas Morton, Vice- by the Association make calls upon the space of the JOURNAL President, Metropolitan Counties Branch; Dr. James Milne, which become more pressing from year to year. The subject Dr. James Munro, Fleet-Surgeon Donald McIver, R.N.; Mr. has long engaged the attention of your Council. Ten years Hugh Prytherch, Mr. Ernest Willmer Phillips, Mr. George ago the addition to each weekly issue during the autumn of Edward Power, Dr. C. D. F. Phillips, Dr. George Vivian supplementary pages to provide increased space for the early Poore, Mr. Thomas Henderson Pounds, Mr. Thomas Percival, publication of the proceedings of the Sections of the Annual Mr. Francis Ctbbon Rogers, R.N., Chairman of the Meeting was sanctioned; the plan has been continued, with Dartford Division of the South-Eastern Branch; Inspector- the result that the Association is enabled to publish these General Maxwell Rodgers, Sir David Palmer Ross. C.M.G., a proceedings more speedily, it is believed, than is found pos- former President of the British Guiana Branch; Mr. George sible in connexion with any other medical congress, national Lewis Rugg, Dr. John Buxton, Dr. James Burn Russell, or international. Dr. William Augustus Raper, Dr. W. A. Skinner, Honorary Rather more than two years ago the plan of publishing Secretary of the Natal-Branch; Sir John Simon,' K.C.B., special SUPPLEMENTS to contain the business proceedings of F.R.S., Dr. George James Silver, Mr. A. Quarry Silcock, the Association and its Council and Committees, and of Dr. David Smith, Surgeon-General William Thom, Mr. Branches and Divisions, as well as Bills before Parlia- William Tumrner, Dr. Eric M. Thomson, Dr. D. G. Pearce ment and other official matter, was instituted. For Tb.mson. Dr. RobertSt3evenson Thomson, Lieutenant-Colonel the first two years these SUPPLEMMENTS were issued at Rdiravd Denham. T9mlin'on, ret. A.M.S., Mr. Alfred Ellis irregular intervals, as mattercame to hand. Thispracticewas VTaughan, Dr.-Achille Vintras, Lieutenant-Colonel John found to present certain inconveniences, and since the Henideron Wbrittaker, ret. A.M.S., Dr. Lourenzo Whitfield, beginning of this year a SUPPLEMIENT has been issued weekly. Dr. ames Wallade, Dr. Henry Wilson. Owing to the fact that the amount of space required for the publication of the proceedings of the Association is not and I Tric MEDAL OF MERIT. cannot be uniform, it has been found desirable, in order to (4)The Gold Medal for distinguished merit, founded in i877, prevent waste of space and to allow the necessary elasticity, was instituted as a means of recognizingthe efforts of mem- to transfer to the SUPPLEMENT certain frequently-recurring bers of the profession who have cqospicuously raised the matters of a semi-official kind. character of the medical profession by scientific work, by ex- traordinary professional services, or by special services THEI LBRARY. rendered to the British Medical Association. Your Council (7) During the past year the value of the Library has been has decided to award this medal to Sir Constantine Holman, more than ever appreciated by members, and the attendances M.D., who has been a member of your Association for over have been the highest yet recorded. In 1903 the Library was fifty years, and throughout has rendered distinguished closed for about two months, so the attendances for 1902, services to your Association, through the South-Eastern amounting to 4,867, are given for comparison with the year Branch, as a member of your [Central Council, as Treasurer, under review, in which they amounted to 5,780. The Library MAY 27, 1905.] ANNUAL REPORT OF COUNCIL. [Bvxra i.&o 227 still suffers from lack of space to conveniently house the until the Royal Commission on tJnderground Railways books and periodicals. In aldition to works of reference, the appointed some time back has made its report. Library is possessed of a carefully-selected series of English Your Council is pleased to report that the portions of and foreign medical journals, which are regularly filed, as your property not required for the conduct of your busi- well as a large collection of theses and sanitary reports. ness have been let off throughout the year 1904. The Library has also received during the year over I,ooo Your Council is considering the whole question of the volumes from members and others, and your Council desires accommodation of all the departments at the offices of the to express the grateful thanks of the Association to these Association, but at the time of drafting this report has not generous donors. arrived at any definite recommendations. During the year it has been possible to present to certain Branches forming libraries over 700 duplicate volumes. THE 1904 BALANCE SHEET. Members are reminded that the Library now possesses (12) Your Council, in submitting the Balance Sheet for the complete setq of some of the best indices to the medical yearendingDecember3lst. 1904,cannotahow aslargeanexcess literature of the world, including the Tahrbiucher of Schmidt of income over expenditure as in the previous year. and of Canstatt, the Index Medicus (both series), the United However, the estimated balance of £3,350 has been exceeded States Surgeon-General's Catalogue, and the parts that are by some £1,700, and your Treasurer was enabled to invest more particularly interesting to members of the Royal £4,200 in iank of England Stock, thus bringing your balance Society's Catalogue of International Literature. of assets up to £101,397. In reviewing the past year it is satisfactory to note that THE LEICESTER MEETING. the revenue from all sources has not only been main- (8) four Council has arranged that the scientificwork of the tained, but has shown a general expansion. This expansion Leicester Meeting shall be conducted in twelve sections, as also applies to the expenditure, a natural sequence follows: Medicine; Surgery; State Medicine; Industrial of the general activity tthroughout the Association. The Hygiene and Diseases of Occupation; ihryngology, Otology cost of printing and composing the JOURNAL has increased and Rhinology; Navy, Army, and Ambulance; Obstetrics and by £1,coo, but it happened that fifty-three issues of the {ynaecology; Ophthalmology; Psychological Medicine; JOUIRNAL were published as against fifty-two in the year 1903. Pathology; Dental Surgery ; and Tropical Diseases. The compositors' wages amount to more than in I903, Dr. Henry Maudsley, late Professor of Medical Jurisprud- as a result of the publication of more SUPPLEMMINTS and an ence in University College. London, will deliver the address increase in the number of pages per week. In 1903 the total in Medicine, and Mr. C. J. Bond, F.R C.S., Surgeon to the number of pages of reading matter as apart from the adver- Leicester Infirmary, the address in Surgery. tisements amounted to 3.700, while in the year under review Owing to the great suecess of the free and popular the total was 4,024. This increase is largely dlue r.o the lecture given at Oxford by Dr. George Bagot Ferguson, your number of SUPPLIEMENTS, the pages exceeding by 200 the Council has invited Professor William Stirling, M.D., to number published in the corresponding period of 1903. Con- deliver one at Leicester, and he has chosen as his subject sequently the cost of machining increased, more paper was "Fatigue and Repose." used, and a heavier JOURNAL resulting. necessitated addi- Your Council has most carefully considered what arrange- tional postage for the copies sent out of the United Kingdom. ments can beet be made for the greater comfort of the Repre- A variation of one halfpenny per copy on the foreign edition eentative Meeting, and how more time can be found for the represents £1o per week. large amount of work which will require the attention of the The general Aesociation expenses show an increase Representatives. It is felt this can best be arranged by com- of nearly £i,ooo. At Oxford, owing to the larger attend- mencing the business of the meeting at 2 o'clock on Monday, ance at the annual meeting, 8,coo Daily Journals were July 24th, instead of on the Tuesday as in former years. This required, as against 3,500 at Swansea. The repairs and will enable the Representative Meeting, should it think upkeep of your property entailed rather more expenditure. proper, after an adjournment for dinner, to resume its session Tee legal expenses were greater, as it was necessary to employ -on Monday evening, and to meet again at IO o'clock on counsel to draft the Medical Acts Amendment and Public Tuesday morning. Health Bills. The Church Service is fixed for 5 o'clock on Tuesday The Year Book cost £342 to produce and £155 for postage; afternoon, the meeting of Division and Branch Secretaries but against this must be set the paymentd ior the adver- for 6 o'clock, and the President's address for 8.30. The tisements contained in it. The agenda and minutes of the Address in Medicine for Wednesday evening at 8 o'clock, Oxford Representative Meeting were much bulkier than and the Address in Surgerylfor Thursday afternoon at 2 o'clock, those for the Swansea Meeting. 'The printing and circulation while the Free and Popular Lecture will be given at 8 o'clock of the report on the Poor-law system of Ireland entailed an on Friday evening. outlay of £5o. The cost of the office postage and stationery YEAR B6OK. was higher, owing to the larger number of documents sent (9) The first issue of the Year Book in 1904 consisted of I68 out to the Association. pages. So much was it appreciated throughout the Associa- The increase in the rates is likely to be more marked, as the tion, that it has been published for 1905, and increased in quinquennial revaluation is now under consideration through- size to 406 pages. This enlargement is due more especially out the metropolitan area. The office salaries and wages show to the publication of an alphabetical list of members extend- an increase of £450; and the Representative Meeting, Council, ing to I90 pages, and the inclusion of the Memorandum, and Committee expenses an increase of nearly £5oo. For the Articles, and By-laws of the Association. Various other addi- Library your Council has spent £1co in the purchase of tions and improvements have been embodied, and it is books, and has written off£250 against depreciation. hoped each year to make it more complete as a book of ready Turning to the sources of revenue, an increase of member- reference for all matters connected with the Association. ship must always be the most satisfactory feature for your Council to report. The increase from this source in l904 ANNUAL EXHIBITION. amounts to £850, and demonstrates the growing hold of (io) For the first time in the history of the Annual Exbibition the Association upon the medical profession. of Food and Drugs, the management was conducted last year The income from advertisements shows an increase, in round from the head office of the Association instead of by a local figures £1,ooo, but this to a large extent is due to the 53 issues committee. This proved satisfactory, not only to the local of the JOURNAL as against 52 in 1903. The JOURNAL has not ,executive but to the exhibitors themselves. escaped the effects of bad trade so general throughout the year under review. The tendency with the larger THE PREMIISES AND OFFICES OF THE ASSOCIATION. advertisers has been to curtail expenditure in advertising. (ii) Your premises are again threatened bycoming tube rail- Such losses, however, have been more than counterbalanced ways, and have been scheduled by three companies seeking by the introduction of new clients, whereby the advertising powers in the immediate neighbourhood of the Strand. The interest of the JOURNAL has been spread over a wider area. -Central London (New Lines); the Great Northern, Piccadilly, Your Council is pleased to report that the revenue from and Brompton (No. 2), and Hammersmith, City, and North- advertisements, amounting to some £21,5oo, has been earned East London have lodged Bills in Parliament, to all of which with a minimum of loss from bad debts, represented at under vour Council has dissented. The last-named has been re- one-tenth per cent. As advertisements are received from j ected by the Committee specially examining these proposed clients in all parts of the United Kingdom, on the Continent, Lneasuree. It is difficult to forecast the chances of the other and elsewhere, such a record will compare favourably with two companies of securing the powers they desire to attain that of any other newspaper published. l W 22 "'i'KM 27, BWMMz KURICAX JFOURNAZ ANNUAL REPORT OF COUNCIL. '[MAY 1905

rI,ti '1 b ica

IBalanMXce Shxeet 31Lst ]Deceimlber, 1L904.o

LIABILITIES. ASSETS. £ s.d. To Subscriptions paid in advance...... 611 8 3 By Subscriptions-Amount due...... 1,692 7 6 S Advertisements ditto.8...... 92 0 11 Advertisements-Amount due...... 3,290 12 Contributions...... 7601 3 Sundry Sales-Amount due...... I149 7 ) Rteporting...... 64 11 6 Furniture and Fixtures...... 1,3-37 0 11' 63 3 Engraving...... 55 15 1 Library...... 2,198 . 15 0 Prisiting Journal...... 487 7 0 Plant and Type...... 1,217 .. .. 6 Paper for Journal...... 681 17 3 Accrued Rents ...... 110 9 Miscellaneous Printing ...... 173 14 7 Freehold, 2 & 3, Harvey'ls Buildings, bought atrPublic Auction Stationery...... 857 2 1894 ...... 4,640 0 0- Repairs...... 42 18 5 Freehold of 429, Strand, 2, 3, 4 & 5, Aga'r"Street .. 0 0 Legal Charges...... 21719 0 at price paid 1898 .£7...... C49,000 Rtates and Taxes, Insurance and Electricity...... 464 13 5 Redemption of Land Tax...... 880 0 0 Plant andt Type ...... 4617 i Improvements by Alterations of General Office, 1903 1,500 0 0 0 V Editorial Expenses ...... 56 ...... 24 _81,9380

.. 10 ...... 24 4 Sundries...... I-NVESTMNENqTS AT COST- Library, Books, etc...... 3864 8 £,1,800 Bank of England Stock at 331-bought .. .. 10 Loan from Banikers .. ..446 March, 1903...' 5,965 10 0 Subscriptions due to Branches on December 31st, 1904.....162 11 4 £,21.400 Bank of EOngla"nd Sto~ck at 304-b~ought April, 1904 ...... 4,268 7 6 TOTAL LIADILITIEs .. .. 5,092 5 3 - 10,233 17 6 19 0 ,,Cash at Office...... 76 Surplus Accoiint- ,,Cash at Bank being Branch Subscriptions inhandiDec. 31"st,190"4 162 11 4i Balance on Janluary 1st, 1904...... 96,621 7 6 Amount voted to Office Staff Super- annuation Fund for 1904 ...... 300 0 0 96,321 7 6 of Capitation GrantsB held by the various Branches. Balance of Income over Expenditure for 1904 brought from Revenue Account.....5,075 14 6 Balance, being total of excess of Assets over Liabilities ... 101,397 2 0 £106,489 7 3 £106,489 7 3J

Rteventue, or Pr-ofit and Loss Account for Year ending 31st December, 1904.

1903. 1904. 1903. 1904 £ £ S. £ s. d. £ S. d. s. d. d. 18 6 6 ...... 23,721 4 Editorial...... See Abstract A.. 6,098 10 0 6,027 19 4 Subscriptions 24,5;84 do. arrears of former ...... 442 13 10 300 17 3: of Jouirnal ... B . 20,897 8 1 21,92-3 8 years Expenises Printinig ,,1 15 2 a Advertisements ...... 20,480 5 5 1,465 5 Association ... ,, ... 5,547 1(t 5 0 10 General Expenises 6,gio 4 8 i6 xx ...... 1,870 Office Salaries aind Wsges ... ,, D 3,892 11 4 4,349 5 5 Sundry Sales -Journal . Z,26z Readingand Binding Covers,&c. 182 17 11 r35 14 2 Rtepresentative Meetinig, Council 119 7 2 io8 x 6 andt Committee Expenses ... E,..E 1,606 4 3 2.0o96 14 9 Reprints ...... 257 13 9 4 Interest oni Investments and Rents 1,041 13 6 1,120 2 9 Library...... ,, p.. 257 4 66 1 3 0 0 Returned Scientific Grants ...... 50 4 cl .. 0 0 W9irit't'en off towards Depreciation .. 250 250 32 12 8 ...... 2aI0 00 Plant-Written off towards Depreciationi. r500 0 0 500 0 Sale of Waste, &c. .. I Discounts Printing, Paper, &c. 849 17 3 913 2a4 Capitation Grants to Branches .. 2,955 16 10 3.389 1 9 onl ... 0 0 Amount unexpended on alterations as estimlated~ Cost of Alteration to General Office 2,119 128 .. .. 2!5 Less amount carried to Balance Sheet 1,500 0 0 for in. last yeir's accounts .. 619 0 0 Subscriptions:-Written off for Deathis, Arrears,&c. 611 7 5 710 6 3 43,236 2 1 46,014 IS 4

carried to Balancee Slheet ...... 5,571 10 1 5,075 14 6 12 £C48,807 12 2 51,090 12 10 £C48,807 12 2 5I.o9o 1o

Abdrwat .4.1 Abstract B.] EDITORIAL. ExpmxNsEs OF PRINTING JOURNAL. 1903. 1904. 1903. 1904. £ s. d. £ s. d. £ s. d. £C s. d. 0 0 1,000 0 0 Salaries :-Editor .. 1,000 Comnpositors' Wages and Machining Journal 8,228 9 5 8,797 13 7 .. 0 Assistant Editor 750 0 750 0 0 for Journal ...... 8,1509 12 2 8,86z 13 3 187 Jo 0 200 0 0 Paper Sub-Editor for of Journal ...... 3,743 16 a 3.93' 19 0D 366 12 0 13 6 Postage Dispatch Clerical Staff 39 Address Bands for issuing Journal ...... 415 10 2 332 9 10, Contributions .. 2,912 10 6 2,920 0 5

Reporting ...... 253 10 8 245 3 10 5 Engraving ...... 397 5 8 287 x6 29 14 4 2 1904 there were 53 JOURNALS Legal Expenses . .. .. 27 XI [In printed, 79 19 5 in 52 JOuTRNALS.) Postage .. .. 78 XI 3 1903, An-alyses 9 Travelling Expenses, Papers, &c. .. 118 I11 114 5 0 Cost of Journal Slips circulated to the Press 4 17 6 4 i6 8

26,098 10 0 -,,C,,6,027 19 4 £6,098 10 0 £6,027 19 4 ~ ~ ~ ~ 20,897 8 1 £21,923 15 6 SUPPLEMENT TO T 2T29 MAY 27, 1905.]l ANNUAL REPORT OF COUNCIL. [BasTsss MEDICAL JOURNAL 2 Abstract C.] GENERAL ASSOCIATION EXPEJN8ES. Abstract E.] 190& 19. £ s. d. £ s. d. REPRESENTATIVE MEETING, COUNCIL AND COMMITTEE EXPENSES. Annual Meeting-Cost of Daily Journal, etc. ... 120 19 0 189 x3 0 1903. 1904 of ... 36 0 9 4 9 2 A t Expenses Sections £ s.d. £ s. d- Arcliitects' Fees ...... 200 0 0 - ANNUAL REPRESENTATIVE Fares 255 8 5 7 5 Auditors' Fee ...... 105 00 0 MEETaIG-Railway 244 0 os o COuNcIL-Railway Fares ...... 703 0 4 678 25 7 Bank Charges ...... 45 3 10 39 IX 4 Cleaning Offices ...... 158 17 0 I6X 4 6 &c. Coals and Coks ... 52 2 6 53 o 6 COMMITTEES-Railway Fares, Printing, Annual 22 a Compositors' Sick Fund ...... - 2020 0 Meeting Committee ... 15 5 2 XX Donation to Charing Cross Hospital ...... 1010 0 2O XO 0 Arrangement Committee ...... 18 2 3 8 22 0 General Repairs ... 155 11 11 20725 4 Assistant Secretary Committee ...... 4 4 0 grant to 100 Chloroform Committee ...... 46 6 0 20 29 Imperial Vaccination League, 00 - of Arms Committee Legal Expenses ...... 200 0 6 394 23 2 Coat ...... Committee re Dental Section ...... Miscellaneous Printing ...... 500 17 7 559 2 5 Colonial Committee ...... 8 2 1 s0O I8g z6 Year Book-Printing, &c. - 34228 o - Committee of Chairmen ...... 33 9 M 9 Postage...... 255 13 6 Ethical Committee ...... 52 3 3 767 4x Agenda and Minuites for Representative Meeting ... 8 9 0 88 22 9 Committee Reports of Poor Law System Ireland (4,000) - 50o 6 0 Hospitals ...... 19 2 10 125 7 _ Income Tax Committee ...... 1 12 6 Office-General Postage ...... 476 15 11 53 219 0 Joint Committee of Office Petty Cash ...... 107 10 4 x52x6 5 British Medical Association Pension, late General Secretary 600 0 0 6oo o o and Medico-Psychological Association ... 1 17 8 Rates and Taxes, Insurance, Gas and Electric Light 794 4 4 82128 6 Joint Committee on Fees to Medical Witnesses ... 3 14 8 Reporting Council and Finance Committee Meetings 102 18 0 xO0 6 6 Journal and Finance Committee-Special Meeting 20 18 4 Medical Defence zx6 O Reprints ...... 6 12 1 2 Committee ... 92 16 0 9 a 75 xx Medical a Research Scholarships 612 10 0 6So o o Secretary's Committee ...... 29 0 Medico-Political Committee ...... 122 17 5 3559 8 Scientific Grants ...... G 350 000 3O o0o Committee Special (}rant Chloroform Committee 100 0 0 0OO 0 0 Organization 147 8 0 273 3 c Premises and Committee ...... 16 0 11 Stationery for Office ...... 332 13 11 453 * 7 Library Public Health Committee ...... 29 8 5 76 2x Sundries ... I ...... 154 13 1 122 9 2 Reorganization Committee ... 4 9 10 Travelling Expenses ...... 156 0 8 284 x6 2 ... Royal Naval and Military Committee..tee 9 14 8 53 233 Scientific GrantsCommittee 22 19 4 15,547 10 5 O XO 46,5ro Scottish Committee ... 10 12 2 a 27 4 Abstract D.] OFFICE SALARIES AND WAGES. 1903. £ s. d. £ General Secretary ...... 600 0 0 800 o o Medical Secretary ...... 600 0 0 65o0 o o Assistant Medical Secretary ...... 122220 Assistant 0 0 Secretary ...... 250 Clerical Staff ...... 11 4 2,392 2,636 23 5 F'inancial Secretary (the late), January to September 300 0 0

£3,892 11 4 £4,349 5 5 £1,606 4 3 £2,096 14 5t

Abstract F.] LIBRARY. £ s.d. £A . d. £ s. d To Balance ...... 2,255 12 1 By Librarian's Salary . ... 250 0 0 Purchase of Books ...... 93 11 5 ,, Printing and Posting of Circulars and Binding Books ...... 36 0 3 Insurance ...... 7 4 4 Book Shelves ...... 63 2 6 257 4 4 Librarian's Salary ...... 250 0 0 Amount written off for Depreciation ... 250 0 is Printing and Postage of Circulars and Insurance of Books ... 7 4 4 Balance carriedto Balance Sheet ... 2,198 6 3) £2,705 10 7 22,705 11) 7

TKUXt S T F U W D S. ,AfeSWarf Sunb. Investment of 2579 4 per cent. Caledonian Railway Debenture Stock, in the name of the British Medical Association. 1904. £ s. d. 1901. £ s. d. Jan. 1. To Balarce brought over from 1903 ...... 12 10 4 Dec. 31. By Balance carried down, being cash at Bank ... 34 11 X Intereat ...... 22 0 9 £34 11 1 234 11 I itbfe~more Suzb~ Investment ot 2666 1is. 4d. S per cent. North British Railway Debenture Stock, in the name of the British Medical Association. 1904. £ s. d. 1904. X s. d. Jan. 1. To Balance brought over from 1903 ...... 107 13 5 July 26. By Award, John Herbert Parsons, M.B., F.R.C.S. ... 50 0 0. Interest ...... 20 3 6 ,, Mr. Stanley, Engrossing Certificate ...... 1 17 6' Balance carried down, being cash at Bank ... 75 19 5

£127 16 11 £127 16 11 Office Afiff AuVerannucafton !unb, 1904. £ s d. £ 8. . Jan. 1. To Balanee brought over from 1903 ...... 885 9 1 By Balance carried down- Transfer from Association Surplus Account ... 300 0 0 ,, Investments at cost-@600 Cape of Good Hope 3 per cent. Interest ...... 34 14 6 Stock, bought ( 921, Dec., 1902 ...... 558 1 0 £100 Bank of England Stock, bought Dec., 1903 ...... 318 19 4 £110 Bank of England Stock, bought @ 299k, Dec., 1904 ... 330 10 31 Cash at Bank ...... 12 13 0 £1,220 3 7 £1,220 3 7

We certify, in accordance with the provisions of the Companies Act, 1900, that all our requirements as Auditors have been complied with. Having examined the above Balance Sheet, dated 31st December, 1904, with the books and vouchers of the' Association, and having inspected the Deeds of the properties, 429, Strand, 2, 3, 4 and 5, Agar Street, and 2 and 8. Harvey's Buildings deposited with your Bankers, and havtng verified the investments held on account of the Association and of the, above Trust Funds, we report that the Balance Sheet is in our opinion properly drawn up so as to exhibit a true and correct view of the state of the Association's affairs as shown by the books of the Association. 3, Frederick's Place, Old Jewry, E.C., 27th March, 1905. PRICE, WATERHOUSE & CO. 230 Da,xNrn&Bapn= Muw"louaw- 1W"j ANNUAL REPORT OF COUNCIL. [MAY 27, 190S. In conclusion, the revenue of the Association has increased Dr. John T. Hewetson, Miss Janet Lane-Claypon; while Dr. by some £2,300, and the expenses are greater by some £2,800. Thomas Evans is the Ernest Hart Memorial Scholar. Asa result, the balance of income over expenditure for last year, amounting to £5,075, is £500 less than for the year SPECIAL CHLOROFORM COMMITTEE. 1903. (i8) The Committee appointed by the Council and reap- pointed in July, 1904, have to report that the following work ESTIMATE OF RECEIPTS AND EXPENDITUERE FOR 1905. has been carried out since their last report to Council (March, (13) Your Council submits the following estimate of the prob- 1904):' ablereceipts and expenditure for the yearending December3ist, The lines of the Committee's work may be briefly 1905, and for comparison the amounts actually expended and described: received during the year 1904: (a) The effects of chloroform when perfusing themammalian heart isolated from thebody. Continuing theirresearch upon Expenditure. this subject, Professor Sherrington and Miss Sowton have 1904. I905. during the past year ascertained that chloroform exhibited in d. s.d. To blood produces less than one-twelfth its depressant effect Printing JOURNAL ... 2I,923 0 0 22,400 0 0 Editorial ...... 6,027 0 0 6,oco o o upon the heart's action as compared with the effect of chloro- General Association Expenses ... 6,Szo o 0 7,000 0 0 form similarly perfused when dissolved in saline solutions. Office Wages and Salaries 4,349 0 0 4,500 0 0 that the of done to the heart is Repressntativo Meeting, Council and Com- And, further, degree damage mittees ... in case of chloroform ...... 2,o96 o o 2,300 0 0 the in blood less than in that of chloro- Library ...... 507 0 0 600 form in saline. In other words, the heart is less damaged Plant Depreciation ...... 500 0 0 700 0 0 a solution of a Grants to Branches by chloroform when presented in blood vehicle 3,389 o o 3,400 0 0 written than when in a saline solution. The of this fact subscriptions off 710 700 0 0 importance Estimated Balance ...... is since 4.300 0 0 great, in certain Qonditions of the human blood its character may undergo variations approximating on the one r466.0x o o 650,900 0 0 hand to the composition of saline, and on the other to the physiological norm, and chloroform dosage would under Receipts. such conditions assume the greatest importance in the 2904. I905. direction of obviating danger. )£ s. d. £ s. d. By Subsnriptions ...... (b) These observers point out that there are two 24,885 0 0 25,000 0 0 possible Advertisements ...... 21,465 0 0 22,000 0 0 explanations of the facts- noted: (a) physiological salines Sundries: Sales of JOURNAL, etc. 0 0 ... 3,620 3,700 0 0 probably favour the heart's activity leus than and Investments and Rents blood, ...... X,220 0 0 2,200 0 0 (b) in equal quantities of chloroform dissolved in the two fluids the tension is greater in the saline than in the blood. 451,090 0 0 0 0 £50o90O Professor Sherrington and Miss Sowton are continuing this research, and their further results will later be placed before PRINTING AND STATIONERY DEPARTMENT. the Association. (14) At Otford, the Representative Meeting passeda resolution (c). As was previously indicated to the Council, Mr. Vernon requesting the Council to take into consideration the advisa- Harcourt's chloroform inhaler, the principle of which renders bility of creating at head quarters a printing and stationery exact dosage possible, has been subjected to careful experi- department, from whieh all printing could be supplied to the ment. During the past year Mr. Harcourt has investigated Divisions and Branchts. The Council has carefully con- the error arising from variation in the force and rapidity of sidered the matter, and now reports that the time is not ripe inspiration, as well as that due to differences in the depth of for undertaking at the central office the printings of Divisions the fluid in the chloroform vial. His results, which form an and Branches. appendix to the Committee's report, indicate that this error is slight and is practically confined to the period of induction. OFFICE STAFF SUPERANNUATION SCHEME. The mechanical details of the structure of the inhaler have (i5) Last year the General Meeting voted a further sum to the been considerably improved. With the aid of this instru- Office Staff Supprannuation Fund, bringing the total up to ment the Committee are now engaged upon what they hope £1,220. The Representative Meeting on considering the will prove a useful research. The exact percentages of question passed an instruction that before the Fund be chloroform in the inspired air and those in the expired air administered a scheme be formulated and submitted for during induction and maintenance of narcosis are being approval. Your Council has now drafted a scheme on the ascertained. It is hoped to arrive at, in this way, the inter- lines of the Poor-law Officers Act as to rates of benefit, action between chloroform of various known strengths and the ,whereby it is optional on the part of your present staff to tissues of the body. join, but compulsory on all becoming members of it sub- (d) In the past year Sir Victor Horsley, Mr. Harcourt, and sequently to the scheme coming into operation. The bene- Mr. Bvles were engaged upon a research which is germane to fits are to be restricted to those whose salaries do not reach the question referred to above-namely, the behaviour of £250 per annum, and contributions to the Fund will be re- chloroform towards blood. The anaesthetic was inhaled, and quired of 2§per cent. on the salaries. In the case of men the blood of the animal was then dealt with and chloroform joining at the age of 5o and upwards a contribution of 3 per recovered from it. As in the work of other observers, it was cent. will be necessary. found that the chloroform could not be recovered from blood The scheme has been submitted to an actuary for report so completely as in the case of its solution in saline. as to its financial soundness, but at the time of preparing It, in fact, was held or " fixed " by some constituent of the this report the opinion of the actuary has not been re- blood. Here again the Committee feel that important prac- ceived, although it is expected that the full proposals will be tical results are likely to ensue upon the prosecution of the ready for the consideration of the Representative Meeting. research mentioned, as it is obviously of the greatest impor- Your Council hopes that the General Meeting will each tance to recognize for certain whether chloroform vapour year vote a sum of not less than £300 towards the Fund, as a enters the lungs and the blood stream, and readily leaves recognition of the good and faithiul work accomplished by when the incoming air has a negative chloroform tension, or your office staff. whether a largepereentage is " fixed" and so retained by the AUDITORS. tissues of the organism. (i6) Your auditors,Messrs. Price, Waterhouse, and Co., have (e) The work which the Committee has executed since its again examined and audited your books during the year 1904, original appointment has resulted in showi:ng that it is pos- and under Article xviii (a) and in accordance with the Com- sible to regulate the dose of chloroform administered by panies Act, I900, they seek and are eligible for re-election. inhalation with substantial accuracy. The Committee is now engaged upon the equally important questions of the minimal COMMITUEES. dose requisite to produce narcosis and that which is liable to SCIENTIFIC GRANTS OOMMITTEE. induce dangerous symptoms. The investigation of these pro- (17) During the past year your Council voted £1,ooo to the blems has evidently a practical bearing, and the work would Scientific Grants Committee, made up as follows: £350 in therefore Leem to be worthy of the continued support of the twenty-five grantsvarying from £5 to £40 in aid of various Association. researches, and £65o in Research Scholarships, one scholar- Bee Report ot special Chloroform Committee of the British Medical ship and three Association presented at the annual general meetiDg at OXford, July, of £200 per annum, scholarships at £150 per and annum. The 2904, published in the BRITISH MEDICAL JOURNAL for July 23rd, present holders are: Dr. J. 0. Wakelin Barratt, 1904. .", M. ANNUAL REPORT I- MAY 279 1905.]Miy 27, 1905.] ANNUAL REPORT OF.COUNCIL.OF .COUNCIL. ~~~~~~~~~~~~3Iaromus .a3t HOSPITALS COMMITTEE. land) Bill, the questien of e4rticates of unfitness to.attend (I9) At Oxford the Council submitted for the approval of the school, and the legal position of the medical witnesses for Representative Meeting certain resolutions relating to hos- the defence in criminal cases. The Committee is glad to! pital management. At the time it was reported that your report that the necessities of the Poor-law medical servlte Council hoped to get these Principles approved not only by have at last received official recognition, and are now, likely the medical profession, but by laymen specially interested in to be dealt with by legislation at the instance of the Scottish hospital management. The best means of attaining this end Local Government Board. was considered to be to first have a conference with leading medical men not members of the Hospitals Committee. COLONIAL COMMITTEE. This conference took place, and as a reFult certain verbal (23) Last year the Colonial Committee reported that it pro- alterations were made in the suggested Principles submitted posed to investigate the question of Colonial registration and to the Oxford meeting. Then invitations were sent out to medical reciprocity in Australasia, and accordingly represen- the leading hospitals and institutions throughout the United tations were made to tlie Colonial Office urging the expediency Kingdom, as well as to many men known to be specially of only registering in Australasia those medical qualifications interested in hospital management. As a result, on which are obtainable in Great Britain and Ireland. These March 2nd a conference took place, when some eighty representations were transmitted by the Colonial Secretary to. ladies and gentlemen, drawn from all parts of the the Governors of the States of the Australian Commonwealth United Kingdom, were present. The conference proved for the consideration of their Ministers. of great value, and as a result twelve laymen were The Queensland Medical Board has replied through the appointed to confer with the Hospitals Committee and Colonial Secretary to the effect that it favours the suggestion consider all matters pertaining to the management of hos- of the British Medical Association, but thinks the proposal pitals. Your Council hopes and believes that this exchange impracticable as the law now stands. The Queensland of ideas between the medical men and laymen on the proper Medical Board will, however, draft a Bill correcting working of hospitals will lead to improved conditions, and the defects of the existing Act. In connexion with redound to the benefit, not only of the institutions, but of the this it is also interesting to note that the Medical public and the medical profession at large. Section of the Royal Society of Tasmania has passed a resolu- tion to the effect that it is expedient that only those medical MEDICAL DEFENCE COMMITTEE. qualifications which are available for registration in Great (20) At Oxford this Committee presented a schemeof medical Britain and Ireland be registered in Tasmania. This resolu- defence which was referred back with an instruction to make tion was forwarded by the Premier of Tasmania through the provision for amalgamation with the Association of existing Colonial Secretary. medical defence societies. Accordingly the Committee The Committee also had under consideration the draft of arranged a conference, when representatives from the Medical an Ordinance to provide for the registration of medical Defence Union and the London aud Counties Medical Protec- prac, itioners in Ceylon. when objection was taken to Clause 2 tion Societies attended, but expressed views on behalf of (2) (h), of the Draft Ordinance: their Societies distinctly against amalgamation. 2 (2) (b) In the case of a person claiming to be qualified The Medical and Dental Defence Union of Scotland and the otherwise than under the said Acts, a certificate of the Irish Medical Association (Medical Defence Department) did Council of the Ceylon Medical College that such not send representatives, but the former wrote saying that person is entitled to be registered under this they were of opinion that the interests of their members Ordinance. would be best promoted by their Union maintaining an inde- and representations were made to the Ceylon Council asking pendent existence, and the latter to the effect that it was not that this clause might be eliminated from the Ordinance. at present aware of any advantages to be derived from a con- The Colonial Secretary has replied that after careful consi- ference on the subject. deration he regrets that he does not feel justified in inviting The Committee has drafted a scheme of medical defence, the Ceylon Government to entertain the suggestion of the with a covering memorandum, which has been issued to the Colonial Committee. The Colonial Secretary has, however, Divisions with a request to the Division Secretaries that they suggested to the Governor of CGylon that provision should be will defer consideration of the scheme until the Divisions made in the Ordinance that certificates should not be granted also have before them the report on the proposed alteration to persons claiming to be registered under a degree or diploma of the Memorandum of Association. granted in a foreign country unless that country allows persons to practise who are entitled to be registered and to. PROPOSED ALTERATION OF THE MEMORANDUM OF practise in Ceylon. ASSOCIATION. The Committee is also collecting information as to any pro- (21) At Oxford the Representative Meeting gave'instructions posed medical legislation for the registration of medical prac- forsteps to be takento alter the Memorandumof Association on titioners now under consideration of various Colonial Govern- the lines laid down in what are known as the Birmingham ments, and it hopes to be able to report on this on a future resolutions. The Committee of Chairmen on submitting occasion. these instructions to the Solicitor of the Association learned MEDICO-POLITICAL COMMITTEE. for the first time that in his opinion the provisions contained (24) The Medico-Political Committee has heldseven meetings in the Birmingham resolutions would not permit of the since the last Annual Representative Meeting, and has been Association undertaking "individual" medical defence, called upon to consider a large number of- important matters an opinion which was confirmed by counsel. Your Council affecting the public relations of the profession, which have was further advised that it would not be wise to go to the been referred to the Committee by the Annual Representative Court for confirmation of the Birmingham resolutions until Meeting at Oxford and by your Council, or have been brought these had been reaffirmed by the Association in general meet- to the notice of the Committee by Branches and Divisions or ing, having regard to the fact that the resolutions were passed by individual members of the A',sociation. as far back as i896. Such being the case, before going to the Your Council received from the Annual Representative Court for any alteration of the Memorandum, the necessary Meeting at Oxford the following instructions relative to resolutions must be passed by an extraordinary general meet- medico-political matters: ing and confirmed by a subsequent meeting. Minutes of the Representative Meetinge. Your Council, on being advised that the Birmingham reso- Minute 93.-That the representation of the medical pro- lutions would not give the powers for the undertaking of fession in Parliament at the present time is inade- individual medical defence, requested the Solicitor to instruct quate, and, in the interetts of the public and profes- counsel to so draft an amendment to Clause 3 of the Memo- sion alike, should be improved, and that the Council randum as to cover this and other matters which your Asso- be instructed to consider how this may be effected. ciation at some future date might desire to undertake. Cer- Minute IO4.-That it is advisable that, having regard to tain points in this Draft have not yet been completed, but the purity and reliability of the lymph supplied to your Council hopes at an early date to be able to make a full the public vaccinators by the Local Government report on the subject for the information of members of the Board, every practitioner should be put on the same Association. footing as public vaceinators in respect of the Govern. SCOTTISH COMMITTEE. ment supply of vaccinie lymph. (22) Since the last report the Committee has twice met in Minute 115.-That it is desirable that the Central Council Perth and once in Dundee. The chief subjects dealt with draw the attention of the medical profession indi- have been the Poor-law medical service, the Education (Scot- vidually to the fact that by recommending by nazie 232 Ban.. N,WCAz Jouu&LtJ ANNUAL REPORT OF COUNCIL. [MAY 27, 105. certain drugs and certain preparations of those drugs, Your Council having received from the Midland Medical they are not only allowing themselves to be used Uni3n a communication relative to the difficulties ex- indirectly as touts for wholesale druggists, but are perienced by medical practitioners in dealing with also helping their patients to form, either in them- cases in which crime is suspected, and suggesting the selves or others, serious habits of drug abuse. appointment of Crown Referees, the Medico-Political Com- mittee, by instruction of your Council, considered the Your Council, upon consideration of these instructions, matter and have presented a report, which was approved ,referred all of them to the Medico-Political Committee for by your Council, to the effect that the power of calling in -consideration and report to your Council. another practitioner in consultation alfords sufficient protec- The Committee has prepared a scheme and definite pro- tion to medical practitioners in cases of the kind in question posals upon the matter of Parliamentary representation, if they will uEe this power, and that the appointment of a which have been carefully considered by your Council, and special class of Crown Referees for dealing with such cases are now submitted for the consideration of the Divisions, in would be more likely to defeat than to promote the object in preparation for the Annual Representative Meeting. view. With reference to the supply of Government vaccination On the reeommendation of the Medico-Political Committee lymph to private practitioners, on the recommendation of the your Council have decided to approach the Home Office with Medico.Political Committee, a deputation, composed of the a view to obtaining a much-needed reform in the law rela- Chairman of Representative Meetings, the Chairman of the tive to the publication and display of indecent advertise- Mkedico-Political Committee, and the Medical Secretary, were ments, and in this matter are co-operating with the London appointed to seek an interview with the chief medical officer Council of Public Morality. of the Local Government Board. They were accorded an A case having been brought to the notice of the Association interview with him and an Assistant Secretary to the Bo3rd. of the objectionable conduct of a medical practitioner not re- It appears, as the result of the deputation, that whilst the gistered in the United Kingdom, your Council after careful Local Government Board recognizes the desirability of the consideration, have decided that the Association should take provision, in the public interest, of Government lymph for all action for the protection of the interests of the medical pro- primary vaccinations by private practitioners, the opposition fession in relation to such cases, and that in the case in ques- of the Treasury is feared on account of the expense thereby tion such action as might he found possible under the existing entailed. law sbould be taken. Upon the subject of the abuse of drugs, the Medico-Political With the development of the local organization of the 'Committee submitted for the consideration of your Council a Association it has become possible for local questions affecting memorandum for communication to the medical journals; the honour and interests of the profession to be dealt with but, on consideration, it appeared preferable that this matter through that co-operation of the Divisions as local medical should first be considered by the Divisions, and a memo- societies with the central executive of the Association which randum containing definite proposals has accordingly been was one of the principal objects of the reorganization of the submitted by the Medico-Political Committee to the Divi- Association. sions. The replies of the Divisions on this matter have not The most signal example up to the present of the assistance been received in time for definite recommendations by your which the Association has thus placed itself in a position to Council to be included in the present report. render to the profession has been the action taken in connexion The Annual Representative Meeting also gave instructions with colliery appointments in South Wales. In June, 1904, that five matters laid before them in the report of the the attention of the Medico-Political Committee was drawn to Medico-Political Committee should again be submitted to difficulties existing in connexion with certain appointments of the Divisions. As regards three of these-the interim report medical men under the Ebbw Vale Workmen's Doctors Fund, on contract practice, the Medical Acts Amendment Bill, and and with the approval of your Council the Medical Secretary the proposals as to consultation of medical witnesses-the was instructed by the Medico-Political Committee to make a object of the reference was to obtain further consideration tour of investigation of the South Wales colliery districts. of these important matters by the Divisions prior to a This was carried out in September, I904, when the Ebbw definite decision by the Representative Meeting on behalf Vale and many other appointments were investigated, and of the Association. the Medical Secretary met in conference the Branch Council On the remaining two matters-namely, the legal position and officers of the various Divisions. As a result the of medical men in the matter of supplying information to Divisions of the South Wales Branch adopted rules to coroners, and the proposals as to the reorganization of the enable them to deal effectively with such disputes as Local Government Board-the Representative Meeting at might from time to time arise in connexion with colliery Oxford approved the recommendations of the Medico-Political and other appointments. These were first applied by the Committee, and ordered that they be communicated to the Cardiff Division in respect of an appointment at Abergwynfi. Divisions with a view to local action being taken in support Shortly afterwards circumstances led the Monmouth Division of the policy thus adopted by the Association. to intervene in the matter of a proposed fresh appointment to The submission of these matters to the Divisions was the Ebbw Vale Workmen's Doctors Fund. As a result of the delayed owing to the desirability, in the opinion of the Chair- action taken by the Monmouth Division and South Wales man of Representative Meetings and of the Medico-Political Branch, in co-operation with the Medico-Political Committee Committee of accompanying the documents with notes which of the Association, all the medical officers of the fund and should explain the circumstances in which the matters were the private practitioners in the district first of all entered into again referred to the Divisions, and to assist the Divisions in an agreement to act on common lines. and under the guidance their deliberations. of the Monmouth Division and South Wales Branch. Secondly, The question of the most convenient method of bringing those practitioners in the district who were not already mem- before the Divisions matters referred to them has been under bers of the Associ4tion joined the Association in recognition the consideration of the Medico-Political Committee as well of the efforts which it was making for the benefit of the !s of the Organization Committee, and the conclusions arrived profession; and, thirdly, medidal men *from various sat by the two Committees and approved by the Council will parts of England who were invited by the Committee of the be found stated in that part of the present report which relates fund to meet them as selected candidates with a view to to the work of the Organization Committee. making an appointment of considetable vaiue, unanimously The attention of the Medico-Political Committee has also declined to accept the appointment, except upon such terms lbeen drawn to certain inconveniences resulting from the pub- as should be approved by the South Wales Branch of the lication, before any decision by the Association has been Association. arrived at, of the expressions of opinion of Divisions on Having regard to the fears which have from time to time matters referred to them for consideration, and your Council been expressed as to the possibility of obtaining such united has approved a recommendation of the Medico-Political Com- action by the profession, in matters of this kind, and sugges- mittee that detailed reports of Divisions on references still tions that, even where the medical profession in the district under consideration by Committees of the Association should were united, outside practitioners would always be found to not be published in the JOURNAL before they have been re- accept appointments on terms which were regarded with dis- ported to the Committees concerned. Arrangements have favour by the local profession, your Council has placed on been made so that in connexion with the reference of each record its gratification at this proof of the value of the matter Honorary Secretaries of Divisions shall be informed orgsnization of the Association for promoting medical union, as to those portions of the reports of their meetings which and its appreciation of the action of the individual practi- cannot be published until after consideration by Committees. tioners who in this inetance showed their loyalty to their [Banftpql.3c::0 =2 AA.Y 27, 1905-1 ANNUAL REPORT OF COUNCIL. IOVAWAZ 233 Mi- 27, 1905.] ANNUAL REPORT OF COUNCIL. TE3 2&3 professional brethren in circumstances which exposed them to Branches with reference to Poor Law, Public Health, or Hos- considerable financial temptation. pital appointments. The Medico-PoliticalOommittee has reported to your The Ethical Committee has continued to take action Council upon many other matters which have been dealt successfully in the matter of trade advertisements containing with in pursuance of instructions received by the Committee the names of medical practitioners and also in the matter of from the Annual Representative Meeting, but it does not undesirable newspaper notices of medical practitioners. appear to your Council necessary that these matters should Your Council would draw attention to the increasing be narrated in the present report. seeing that they will be number of cases submitted for the consideration of the fully explained in the Annual Report presented by the Central Ethical Committee as evidencing the appreciation by Committee. the Association, and by the profession generally, of the exist- ence of a central representative body for the investigation ETHICAL COMMITTEE. and decision of questions of medical ethics. (25) The Ethical Committee has met three times since the last annual meeting, and has advised the Council upon various PUBLIC HEALTH COMMITTEE. rules submitted by Divisions and Branches, and has also been (26) The principal matters affecting Public Health which called upon to consider many questions submitted by members have engaged the attention of your Council during the year of the Association, or by Divisions, or Branches, either as have been the effort to improve the conditions of tenure of touching the conduct of members of whom complaints have office of medical officers of health, and the question of revac- been made, or in connexion with applications for advice on cination. ethical subjects. The Bill of the Association framed some years ago, and Since the last report of your Council. I Branch and 9 repeatedly introduced into Parliament through the kind Divisions have adopted, with slight modifications, the Model offices of Sir Francis Sharp Powell, failed to obtain Rules of Ethical Procedure, and your Council has, on the Parliamentary support. On careful consideration the advice of the Committee, approved such Rules. Public Health (Committee advised your Council that, In the same period Io Divisions have submitted Ethical in their view, this was in part at least due to the Rules to regulate the conduct of their members, including 9 inclusion in the Bill of proposals as to superannuation which Divisions who have adopted with the approval of the Council incurred hostility from some who would not oppose the other the Rules as to appointments and kindred matters originally provisions of the Bill. As your Council concurred in the adopted by the Bradford Division. view of the Public Health Committee that the provisions as Ten Divisions have, with the approval of your Council, to security of tenure of officers of health were of primary adopted the model Rule Z, relating to the issue of notices to importance, it was decided that the Bill should be redrafted, members in certain cases, which was approved by your Coun- omitting the superannuation proposals. cil twelve months ago and subsequently by the Annual Repre- As a result of very careful consideration on the part of the sentative Meeting at Oxford. Public Health Committee and of your Council, it was decided Difficulties which have arisen in certain Divisions in dealing to retain in the Bill, with the provisions as to security of with ethical cases having been brought to the notice of the tenure, provisions relating to the qualification of officers of Ethical Committee, the Committee appointed a Subcommit- health. tee to investigate the existing machinery of the Association It was also decided to comply with the desire of the for dealing with ethical matters, which Subcommittee was Sanitary Inspectors' Association that provision should be assisted at one of its meetings by the attendance of the made in the Bill with regard to sanitary inspectors analogous Honorary Secretaries of Branches and Divisions in which to those relating to medical officers of health. difficult cases had arisen. The Bill thus modified was finally approved by your Counci} Arising out of the report of the Subcommittee the Commit- in November last. tee has recommended your Council to approve, and your Dr. Hutchinson, who consented to take charge of this Bill, Council has approved, a modified form of the Model Rule Z, was unfortunately unsuccessful in the ballot for private mem- adapted in order to be suitable for adoption by Branches. bers' Bills, but the Bill has, nevertheless, been introduced Your Council has also approved a recommendation of the by him, and is supported by the following influential mem- Ethical Committee, arising out of the Report of the Subcom- hers of Parliament: Sir Walter Foster. iSir John B. Tuke, mittee, that Branches should be advised to adopt rules making Mr. W. Abraham, Mr. Fenwick, Mr. Ernest Gray, Major specific provision for appeal from their decisions to the Jameson, Colonel Heneage Legge, and Mr. T. P. Whittaker. Central CJouncil. Your Council is making efforts to obtain for the Bill the The Ethical Committee reports that certain of the model approval and support of the Local Government Board. Rules of Ethical Procedure originally framed by the Com- In pursuance of the decision of the Annual Representative mittee are being reconsidered in the light of the experience Meeting at Oxford, your Council is continuing as regards now obtained of the operation of these Rules. vaccination the policy previously adopted, of supporting in It having appeared that confusion has arisen between the every way possible the Bill promoted by the Imperial Ethical Committee of the Association and the Ethical Com- Vaccination League. The Divisions have been requested, mittees of Branches and Divisions, your Council has adopted as occasion may arise, to support the Bill by repre- a recommendation that the regulations of the Association sentations to members of Parliament in their respective should be altered so that the term "Central Ethical Com- districts. Inasmuch, however, as Sir John B. Tuke,. mittee" shall be used as an alternative designation of the who has charge of the Bill, was unsuccessful in the Ethical Committee of the Association. ballot, And, having regard to the reply given on behalf One case has been submitted by a Branch for the considera- of the Government to the inquiries of the Duke of North- tion of the Council with regard to the possible expulsion of a umberland in the House of Lords, there appears to be no member, but the Council, on the recommendation of the prospect of the Bill receiving consideration in the present' Ethical Committee (confirming a suggestion made by the session. Your Council regrets that the dangers to the com- Division to which the accused member belonged), has decided munity resulting from the imperfections of the present law that, having regard to the special circumstances of the case, as to vaccination receive so little recognition from those the resignation of the member, which he tendered at the Departments of State which are concerned in matters relating time when his conduct was called in question, should be to Public Health. accepted. Proposals having been made by the Sanitary Institute that In connexion with this case a question arose as to the a Congress on School Hygiene should be held in the year interpretation of Section (e) of Article XLIV, and, on the i906, your Council has decided to take steps in order that recommendation of the Ethical Committee, your Council will the British Medical Association may be duly represented in propose in due course that the Section in question be any Committee formed to make arrangements for the amended by making provision for an inquiry by a Division as Congress. well as by a Branch, and specifying what shall be deemed to The attention of the Association having been drawn to a be the " commencement" of an inquiry. case of unjust treatment of a Poor-law medical officer and On the recommendation of the Ethical Committee, your public vaccinator by the Board of Guardians by whom he was Council has decided to extend the scope of the warning notice employed, action was taken in his support by the Division of which has been inserted in the advertisement columns of the which he was a member, and your Council has approved the BRITISH MEDICAL JOURNAL with respect to club and similar recommendation of the Ethical Committee that warning appointments, and in future auch notices will be inserted on notices shall in future be inserted in the advertisement the application of Honorary Secretaries of Divisions or columns of the BR1TISH MEDICAL JOURNAL in reference tc, sumumu! To - 234 ]bar= N=D7. 1@Uwn I ANNUAL REPORT OF COUNCIL. [MAY 27, 190S. appointments under the Poor-law and local sanitary mond and Northallerton Division has been merged in the authorities as have hitherto been inserted with reference Darlington Division of the North of England Branch; (d) the to club and similar appointments. Crewe Division, except Sandbach, has been absorbed in the Chester Division. NAVAL AND MILITARY COMMITTEE. Seven Branches and four Divisions in the United King- (27) Your Council, through the Royal Naval and Military dom and three Colonial Branches have submitted Rules for Committee, has, during the past twelve months, given close approval. The Rulessubmitted by Home Branches included attention to matters affectirng the Royal Navy Medical those adopted by the Gloucestershire Branch for constituting Service, the Royal Army Medical Corps, the Indian Medical the Forest of Dean a Section of that Branch. Service, and the Medical Services of the auxiliary forces. The In the Rules submitted by Colonial Branches the Organiza- following report deals with the principal matters considered, tion Committee has noted certain Rules which conflict with but action has also been taken on questions of detail sub- the regulations of the Association, and which in one instance mitted by individual officers of the services named: the Branch has reported that it considered to be desirable, In the annual report presented to the Representative having regard to special local requirements. The Council Meeting at Oxford, your Council expressed its regret that on has approved the recommendation of the Organization Com- the new Army Council the Army Medical Service is not to be mittee that it be pointed out to Colonial Branches that a represented, and statedl that action was being taken through special Colonial Constitution Committee is sitting to consider the Royal Naval and Military Committee to make representa- what alterations in the regulations are necessary to meet tion to the War Office, asking that this omission be rectified. the special requirements of those Branches, and that condi- Considering that the absence of direct representation on the tions which appear to require the adoption of Rules not Army Council must interfere with the efficiency of the Army consistent with the present Regulations would be most Medical-Service, your Council has urged upon His Majesty's satisfactorily met by reporting to the Special Committee the Government the necessity of providing for such representa- alterations of Regulations which seem desirable. tion. The attention of the Council having been drawn to diffi- Communications to this effect were made to the War Office culties arising in Branches as to the most suitable form of Reconstitution Committee, but the Secretary of that Com- voting paper for the election of members of Council, the mittee was directed to poirnt out to the British Medical Organization Committee was instructed to prepare a model Association that it appeared to the Committee that the form, which has been approved by your Council, and issued as Medical Service of the army would under their proposals a suggestion to Branches for this purpose. occupy a position of distinctly greater influence than The Committee has also been instructed by your Council previously. to prepare and issue to the Divisions and Branches model Your Council cannot agree with this statement, and has forms of the annual reports which these bodies are required made renewed representations to the War Office, but without under By-law 9 to furnish. The forms of these reports will result. again be considered by the Organization Committee at its Your Council must express its regret that the attitude of first meeting after the annual meeting at Leicester, and any the War Office in this matter indicates a grave failure on the suggestions by Divisions and Branches in reference thereto part of that Office to appreciate the importance of the medical will receive the careful attention of the Committee and of service in maintaining the efficiency of an army, a.nd the neces- your Council. sity for central co-ordination of that service with other depart- Your Council received an instruction from the Annual ments of military administration. Representative Meeting at Oxford to consider the most On the question of the position of medical officers of the effective means of increasing the membership of the Associa- militia in respect of certain allowances, the Committee, as a tion. Having received a report from the Organization Com- result of correspondence with the War Office, made the fol- mittee thereon, your Council approved the isLue of a circular lowing recommendation, which has been approved by your to the Divisions suggesting that one means to this end Council: would be the issue from time to time of circulars to non- "$That in any future embodiment of the militia officers members drawing their attfntion to the work of the Associa- of the Militia Medical Service should be entitled to, and tion, and the Committee prepared adraft of such a circular as receive, the rates of pay of corresponding ranks in the a basis for consideration. At the request of various Divisions B.A.M.C., as a matter of course and not as an exceptional 4,860 copies of this circular have been printed and issued to measure." the Honorary Secretaries of Divisions for circulation to the non- Your Council has drawn the attention of the India Office to members in the area of those Divisions. various matters affecting the L.M S. and officers of the The Organization Committee having also been instructed R.A.M.C. when serving iu Inidia; these included the follow- to consider the difficulties experienced by Divisions in ing: (a) the injustice to officers of the I.M.S. of the Govern- dealing with matters referred to them for considera- ment order restricting the fees to be charged by them to tion, consulted the Medico-Political Committee there- native private patients whom they may attend, and also the on, and as a result a circular was issued to the breach of the obligations of professional secrecy involved in Honorary SecTetaries of Divisions inviting an expression the requirements of the order of the Governor-General in of opinion as to the relative convenience (a) of printing Council that a medical officer ahall report to his official reports which are referred to Divisions for considera- superior a full medieal statement of a case of a privatepatient tion in the SUPPLEMENT only, or (b) of reprinting sufficient attended by him; (b) the ruling that an officer of the R.A.M.C. ecopies for circulation through the HonoraTy Secretaries of transferred to a station carrying a higher rate of charge Divisions to all members of the Association. A draft letter was allowance must be viewed as transferred to a more lucrative also submitted for the consideration of Divisions drawing the appointment for the purposes of paragraph 103 (2) of Army attention of members to the importance of preserving the Regulations of India (vol. x). SUPPLEMENT for use at meetings at which matters referred may be under consideration. The replies of the Honorary ORGANIZ &TION COMMITTEE. Secretaries of Divisions were, by a large majority, iz favour of (28) The Organization (Jommitte e has held six meetings since the use of the SUPPLEMENT rather than printing reports the annual meeting of the Association, and has considered separately for circulation to members, and in response to and advised your Council upon various changes proposed in applications received 6,90o copies of the circular relative to the boundaries of Divisions and Branches, upon Rules sub- the use of the SUPPLEMENT have been issued by the Honorary mitted by various Divisions and Branches for the approval of Secretaries to the members of their respective Divisions. your Council, upon changes required in the Articles and In the Minutes of the Organization Committee reports By-laws of the Association, and upon other important have been presented to your Council of visits paid by the questions affecting the organization of the Assoeiation. Medical Secretary to the following Branches and Divisions: As regards the boundaries of Divisions and Branches, the Border Counties, North of England, South Wales, and more important changes effected by the Council during the South-Western Branches; and the Coventr, Eastbourne, year were: (a) The Notth Wales and Shropshire Branches, Isle of Wight. Marylebone, Monmouth, North Suffolk, which were nnited by their request at the commencement of Reigate, Stratford, South Essex, Tottenham, and Wandsworth 1903, have found it more convenient to work as separate Divisions. Branches, and the Council has approved that they be recon- In diseharge of the duty imposed upon your Council by stituted as such; (b) on their application the Canterbury and Article XXVII, the Divisions of the Association have been Faversham Divisions have hben united to form one Division; grouped to form 170 constituencies for the election of Repre- (c) in compliance with a petition from the members the Rich- sentatives for the year 1905-6. W A COMMITTEE. [wL' n 235 MAY--27,0 1 ---.pg9051.. MEDICO-POLITICAL

Your Council has also, in exercise of the power conferred to Coroners be approved. Resolved: That a copy of the upon it by By law 23, grouped the Branches of the United Memorandum be forwarded to the Divisions. Kingdom as in the year 1904-5. Your Council has taken into careful consideration the repre- II.-Instructions of the Representative Meeting to the Council sentation of Colonial Branches on the Council, having regard referred by the Council to the Medico-Political Committee. to the Report which by direction of your Council was circu- lated at the commencement of the year 1904 to the Colonial 5. Minute 93.-That the representation of the medical pro- Branches. It has appeared to your Council that the fession in Parliament at the present time is inadequate, time has now arrived when the Branches not in the United and in the interests of the public and the profession Kingdom should be represented on the Council on approxi- alike should be improved, and that the Council ibe mately the same numerical basis as the Branches in the instructed to consider how this may be effected. United Kingdom, and representatives have been assigned to these Branches on this principle, allowance being made for 6. Minute 104.-That it is advisable that, having regard to special difficulties of co-operation in election. the purity and reliability of the lymph supplied to the On the recommendation of the Organization Committee public vaccinators by the Local Government Board, that it is advisable that a conference of the Honorary every practitioner should be put on the same footing as Secretaries of Divisions and Branches should be held at public vaccinators in respect to the Government supply Leicester, your Council has approved the holding of such a of vaccine lymph. conference, and the arrangements have been entrusted-to a Secretaries who are Committee composed of those Honorary 7. Minute II5.-That it is desirable that the Central Council members of your Council. draw the attention of the medical profession individually ANDREW CLARK, to the fact that by recommending by name certain drugs are not May 17th, 1905. Chairman of Council. and certain preparations of those drugs, they only allowing themselves to be used indirectly as touts for wholesale druggists, but are also helping their patients to form, either in themselves or others, serious habits of drug abuse. ANNUAL REPORT BY III.-Instructions of the Representative Meeting to the THE MEDICO-POLITICAL COMMITTEE Medico-Political Committee. 8. Minute 31.-That the Medico-Political Committee be in- To the Annual Representative Meeting, 1905. structed to transmit the re-olution of this meeting, respecting the Report on the National Deposit Friendly Society, to the Divisions with proposals for concerted TWELVE instructions of the Annual Representative Meeting action. to medico-political matters have received at Oxford relating (The resolution referred to was as follows: " The Chair- consideration from the Medico-Political Committee during man presented the Report of the Committee on the the year. Four of these were instructions that reports placed National Deposit Frieudly Society, which was con- before themeeting should be referred again to the Divisions- sidered and approved.") in two cases with a view to further deliberation, and in two cases in order that action might be taken to give effect to the 9. Minute 44.-A resolution to refer the Report on Death Certification back to the Medico-Political Committee resolutions of the meeting; three instructions of the meeting consideration and report to the Divisions. to the Council were referred by the Council to the Medico- for further and report; five Political Committee for consideration 10. Minute 58.-With reference to the Coroners Bill, as to matters were referred by the Meeting directly to the Com- which the Committee reported the action which they mittee. had taken during the past year, it was agreed: That before submitting the Bill to Parliament the The instructions were as follows: Medico-Political Committee should incorporate in it any provisions which the Committee might deem ex- I.-Instructions that Matters be Referred again to the Divisions. pedient, having regard to matters recently considered of coroners 1. Minutes 28 and 29.-Resolved: That the individual mem- by the Committee concerning the relation bers of Friendly Societies be entitled to choose the to the medical profession. medical man by whom they desire to be attended. Resolved: That the foregoing resolution and the 11. Minute 64.-That, as the Midwives Act, 1902, contains propositions contained in the Interim Report on no provision f^- the payment of medical practitioners, Contract Practice be referred to the Divisions. it be an instruction to the Medico-Political Committee to take steps for the amendment of the Act, by the of a section or otherwise, in order to pro- 2. Minute 57.-Resolved: That the Report concerning the introduction in desirability of consultation between medical witnesses vide just remuneration for medical men when called in legal cases be referred to the Divisions. to assist midwives in cases of danger or difficulty. 12. Minutes 69 and 70.-That the Medical Acts (Amend- 3. Minutes 52 and 53.-Resolved: That this meeting of the ment) Bill, as a whole, be referred to the Divisions. Representatives of the British Medical Association, That it be an instruction to the Medico-Political Com- having special knowledge and experience of the gravely mittee that an epitome of the principles of the defective constitution and status of the Local Govemr- Medical Acts (Amendment) Bill be included among ment Board (England and Wales) in regard to the the documents sent to the Divisions, with a request administration of Public Health, requests the Govern- will vote those ment to show its recognition of the urgent necessity of that the Divisions upon principles. reorganizing the Local Government Board by appointing each of the fore- a Royal Commission to report upon the whole question. The Committee has carefully considered Resolved: That a copy of the foregoing resolution, going matters, and reports thereon have from time to time together with documents relatiing thereto, be sent to been furnished to the Divisions as they have been prepared, the Divisions with the request that their Parliamentary as well as upon certain other questions which have been representatives support the proposed appointment of brought under the notice of the Committee. a Royal Commission. The following table exhibits succinctly the nature and origin of the matters that have come before the Committee 4. Minutes 59 and 6o.-Resolved: That the Memorandum action taken on each, and the on the present position of Registered Medical Practi- during the past year, the tioners in the matter of furnishing certain Information result. 236 "M I MEDICO-POLITICAL COMMITTEE. [MAY 27, I905-

A.-Xatters Arising out of Instructions of the Annual Representative .Meeting of 1904. I.-Instnmtzone that Matters be Referred Again to the Divi8ions. Subject. Origin. Action Taken and Reslult.

i. Interim report on con- Instruction that the Report of the Report issued accordingly. 76 Divisions report having ttact practice Committee be referred again to the considered the proposals formulated in this Report. Divisions for further consideration, Analysis of replies presented herewith. together with a special resolution of the meeting with respect to the dis- tribution of the work of Friendly Societies -2. Consultation of medical Instruction that the Report of the Report issued accordingly. 79 Divisions have con- wltnesses in legal cases Committee concerning the desira- sidered the matter to date. Analysis of replies bility of such consultation be presented herewith. referred again to the Divisions for further consideration 3. Reorganization of the Instruction that the documents laid Report issued accordingly, with explanatory memo- Local Government Board before the meeting in reference randum to be sent to members of Parliament. thereto be issued again to the Divi- 22 Divisions have intimated their intention of sions, with a request that they approaching members of Parliament. approach their Rspresentatives in Parliament with a view to securing the appointment of a Royal Com- mission to consider the subject 4. Legal position of medi- Instruction that the Committee's Report circulated accordingly and copies supplied for cal men in respect of Report on the subject be com- distribution to all practitioners in the area of those information supplied to municated to the Divisions for their Divisions who desire so to distribute it. 10 Divisions coroners information have applied. Ir.-Iastru,tions of the Reprasentativs MJstirtg to the Csuncil refdrrei by the Council to the Medico-Political Committee. 5. Representation of the Instruction to the Council to consider A Subcommittee appointed of members of the Com- medical profession in how special representation may best mittee and members of the Association who have Parliament be secured previously paid attention to the subject. Report submitted by the Committee to the Council, approved by the Council, and presented herewith.

fi. Supply of Government Instruction to the Council that it is Deputation met the Chief Medical Officer and an lymph to private practi- advisable that every practitioner Assistant Secretary of the Local Government Board; tioners should be nut on the same footing application made for the President of the Local as Public Vaccinators in respect of Government Board to receive a deputation. Government cupply of vaccine lymph 7. Drug abuse arising Resolution that it is desirable that On consideration held advisables first to bring the through practitioners or- the attention of members of the matter under the notice of the Divisions of the Asso- dering special prepara- profession be drawn individually to ciation, together with recommendations as to pre- ,tions by name to their the evils thus arising vention of drug abuse throuigh the unauthorized patients repetition of prescriptions. Report presented here- with. Ill.-1Iit.tructions of the R1preientative Meeting to the Medico-Political Committee. S. National Deposit Friend- Instruction to circulate the Com- Report circulated accordingly with Memorandam con- ly Society mittee's report, which was ap- taining proposals for concerted action. proved by the meeting, for the in- formation of the Divisions, with proposals for their concerted action 9. Death certification and Instruction to the Medico-Political The whole subject reconsidered: Report circulated to registration Committee to further consider and the Divisions, and presented herewith. report to. Coroners Bill ... Referred for further consideration and Reconsidered, amplifed, and referred again to the inclusion of special provisions Divisions, with the Death Registration Report. Copy of amended Bill presented herewith. a . Amendment of the Instruotion to take steps to obtain Memorandum circulated to the Divisions to ascertain Midwives Act statutory provision for the payment the opinion of the Association on certain special of medical men called in to assist points. Analysis of the replies presented herewith. midwives Memorial prepared for presentation to the Privy Council, and submitted herewith.

(2. Medical Acts Amend- Instruction to refer the Bill again Instraction carried out. Abstract of the replies of the ment Bill to the Divisions for further consi- Divisions will be laid before the Representative deration, with an epitoms of the Meeting. principle3 [ SVL=W 10 T13 MAY 27, 1905.] MEDICO-POLITICAL COMMITTEE. uIn'z. XIDfCAL J01UaA1 237

B.-Other Matters.

Subject. Origin. Action Taken and Result.

13. Fees of medical wit- Resumed consideration of a matter Considered Home Secretary's orders of November, nesses before the Committee in July, 1904 1903, and July, I904. Eviidence of the operation of these orders at present insufficient. Committee collecting further evidence.

(4. Payment of medical Brought under the notice of the Com- Inquiries made of the police authorities throughout practitioners called in by mittee by the Editor of the BRITISH the United Kingdom. Analysis of replies and report the police in emergency MEDICAL JOURNAL presented herewith. cases

I5. Payment of medical men Continued Minute from Committee of Analysis of the replies of Education Authorities to the for certificates of unfitness 1903-4. inquiries of thi Committee presented herewith. AlPo, to attend school the legal position of medical practitioners in the matter ascertained, and a report thereon has been circulated for the information of the Divisions. r6. Positionof postal medi- Continued minute ...... Communication with the Postal Medical Officers' cal officers Association. On their advice action deferred.

[7. Unduly repeated dis- Conference with representatives of Report containing proposals for consideration issued pensing of prescriptions Pharmaceutical Society in July, to Divisions, together with Report on Abuse of Drugs 1904 due to ordering by name. Report and analysis of replies presented herewith. c8. Coroner for South-West Continued minute Further communication addressed to the Lord Chan- London cellor; no reply received. Further action in progress.

(9. Government certificate Continued minute ...... Memorial sent to the Board of Education. of secondary education go. The position of medical Complaint by a member of a case of Memorandum containing inquiries addressed to the men in connexion with alleged injustice Divisions of the Association. Report based on the ambulance competitions replies presented herewith. aq i. IndecentAdvertisements Brought under notice by a member of With the approval of the Council, Home Office ap- Act the Committee proached by the Association in conjunction with the London Council of Public Morality.

22. Pablic Health Bill Action by the Public Health Com- Bill introduced. mittee

23. Clause in Corporation Application from the Division con- The Bill opposed by the Association, and the clause in Bill for preventing pOst- cerned question withdrawn. mortem examinatiQns in private houses

24. Administration of Mid- wives Act: (a) Advertisements Communication from a Division Midwives Board declare the matter beyond their province. Through action of Division advertiEement suppressed. {b) Calls by midwives Attention drawn by a member of the Communication to the Midwives Board pointing out for medical assist- Committee the objections thereto. ance ()Nurses' Registration: Giving effect to resolution of Annual The Chairman of Representative Meetings and (a) State registration Representative Meeting at Oxford Dr. H. Langley Browne gave evidence before the House of Commons Committee. MI mm n MM COMMITTEE. 2 23823 Bamm MmmlouzxAaDIk-JO1LI iMEDICO-POLITICAL [MLMAYY 2,7, 1905-9

Subject. Origin. Action Taken and Result.

(b) Proposed Company for Resolution of the Council Representatives of the Association attended before the Registration ot Nurees, Board of Trade to oppose the incorporation of the proposed company.

26. Certifying factory sur- Communication from Factory Sur- Government Bill interfering with the present position geons geons' Association of factory surgeons opposed.

27. Insurance examination Commun4cation from Norwich Divi- Report presented herewith. Further information being fees sion collected.

28. Unregistered medical Communication from Editor of the Investigation commenced; offender disappeared. On practitioners BRITISH MEDICAL JOURNAL recommendation of Committee, Council decided tco take action in similar cases.

The Committee presents the following more detailed state- ment, or candidates for Parliament, in order to secure their ment as to their deliberations and the action they have taken support for the proposed appointment of a Royal Commis- upon each of the matters contained in the foregoing table. sion. To those DLvisions which have decided to take this action a short pr6cis (a copy of which is appended hereto-see I. CONTRACT PRACTICE. Appendixp. 248) of the opinions of the Association on the subject (a) Interim Report. has been forwarded, as a convenient method of bringing the The proposals contained in the Interim Report submitted to matter more readily to the notice of members of Parliament the Annual Representative Meeting at Oxford (of which a and others. eopy is appended hereto for purposes of reference, see Appendix, p. 242) having been circulated to the Divisions for 4. LEGAL POSITION OF MEDICAL MEN IN RESPECI OF their further consideration as directed by the meeting, a INFORMATION SUPPLIED TO CORONERS. pr6ci8 of those findings of Divisions which have been com- The Memorandum on this subject (see Appendix, p. 249) municated to the Committee up to the time of the preparation has again been issued to the Divisions, as directed by the of the present report is appended (see Appendix, p. 242). Representative Meeting, in order to facilitate united action in the matter, and several Divisions have arranged for the dis- (b) Contract Practice Inquiry tribution of the Memorandum to all medical practitioners During the year further replies bave been received to the within their areas; copies for this purpose were supplied iron inquiries which were originally circulated in March, 1903, as to the head office. which a preliminary report upon the earlier replies was laid In this matter again several Divisions have misunderstood before the Annual Representative Meeting at Oxford. The the object of the reference, and have discussed the subject whole of the replies received are now in process of being com- de novo. pletely analysed, and a final report on the matter, which it is 5. REPRESENTATION OF THE MEDICAL PROFESSION IN proposed to issue to the Divisions before the end of June, will PARLIAMENT. be laid before the Representative Meeting at Leicester. The instruction of the Annual Representative Meeting to Reports upon certain special aspects of the subject are also the Council of the Association, to consider the best means of being prepared by the Committee. improving the representation of the medical profession in 2. CONSULTATION OF MEDICAL WITNESSES IN LEGAL CASES. Parliament, has received the very careful consideration of the The Report on this matter, which was issued shortly before Medico-Political Committee and of the Council of the Asso- the Representative Meeting of 1904, having, by direction ciation. of the meeting, been again issued to the Divisions, an analysis The resolutions finally arrived at by the Council, after con- of the replies of the Divisions received up to the preparation sidering the recommendations of the Medico-Political Com- of this is herewith p. mittee thereon, are appended to this report. (See Appendix, Report presented (see Appendix 245.) p. 249.) In the Report in question the Committee pointed out that The recommendations presented are believed by the the scope of the questions submitted to the Divisions in their Council and Committee to embody the most effective means original Memorandum had apparently been somewhat mis- of carrying out that which is desired, but it is recognized understood by some Divisions. This inference is confirmed that they could not be carried into effect immediately. by the fact that as a result of further explanations given in The Committee has still under consideration the question the Report, several Divisions, which previously had expressed of any supplementary means which can be adopted by the an opinion adverse to the consultation of medical witnesses, Association in order to increase the Parliamentary influence have now replied favourably tbereto. of the medical profession. The Committee recommends that the Annual Representa- One effective means to this end is that which the Committee tive Meeting should now formulate a definite opinion of the had made use of as far as possible during the last session of Association on the subject. Parliament namely, to co-operate in every way practicable 3. REORGANIZATION OF THE LOCAL GOVERNMENT BOARD. with the present medical members of Parliament; and the Asdirtcted by the Annual Representative Meeting, the docu- Committee expresses its appreciation of the cordial ments relative to this matter have been again communicated co-operation which it has received from several of these to the Divisions in order that thev might take local action in gentlemen. support of the resolution of the Meeting, that steps should be 6. SUPPLY OF GOVERNMENT LYMIPH TO PRIVATE taken to secure the appointment of a Royal Commission to PRACTITIONERS. consider the whole subject. The instruction to the Council, to endeavour to secure that In the memorandum accompanying the reissued Reports Government lymph should be supplied to private practitioners attention was carefully drawn to the fact that the as well as to public vaccinators, having been referred to the object of the reference was to secure action by the Divisions Medico-Political Committee, the Committee appointed the on the matter, which had been decided in principle by Chairman, the Chairman of Representative Meetings, and the Annual RepresentatiVe Meeting as the outcome of a the Medical Secretary as a deputation to confer on the previous reference; nevertheless many Divisions have dis- subject with the Chief Medical Officer of the Local Govern- ecussed the whole subject and forwarded resolutions thereon. ment Board, with whom was associated Mr. Monro, an 22 Divisions, however, have given effect to the object of the Assistant Secretary of the Board. The deputation gathered reference, by deciding to approach local members of Parlia- that the view of the Local Government Board was favourable mummumm . 239 MAX 279 1905-1 M EIOPLTCLCMEDICO-POLITICAL COMMITrEE.ITE.Lamub&ilbrom Kmo",FovzKa1IA MAY 27. iqo5.I to the supply of lymph for all primary vaccinations, but not ment Bill, and was forwarded to the Divisions, together with at present for revaccination, on account of the irregularity of reprints of the Bill and of the Explanatory Memorandum demand, and that the difficulties in the way. are chiefly due to previously issued. the opposition of the Treasury. The Committee now awaits the decision of the Representa- Efforts are being made at the time of the preparation of this tive Meeting on the principles of the Bill, before proceeding report to induce the Preesident of the Local Government to finally settle the details of the draft to be laid before Board to receive a deputation on the matter. Parliament. 13. FEES OF MEDICAL WITNESSES. 7. DRUG ABUSE ARISING THROrGH PRACTITIONERS ORDERING Immediately after the Annual Representative Meeting SPECIAL PREPARATIONS BY NAME TO THEIR PATIENTS. of 1904 the question of the operation of the Home Secretary's The instruction of the Representative Meeting, that the Order of November, 1903, which had previously been raiFed by attention of medical practitioners throughout the country an individual practitioner, was brought to the notice of the should be drawn individually to this abuse, was considered by Medico-Political Committee of the Association by the Police the Medico-Political Committee, by instruction of the Council, Surgeons' Association. The Committee appointed a Sub- and it was considered that the object would most conveni- Committee, including gentlemn n who had paid special atten- ently be attained by means of a communication to all the tion to the subject, to investigate the operation of the new medical journals; the Council, however, on further considera- Order of the BRome Office. That Order was the result of pro- tion of the matter, was of opinion that a more definite opinion longed action by the Association in co-operation with the by the Association should first be obtained from the Divisions. Police Surgeons' Association to obtain mot e equitable re- A question on this subject was accordingly included in the muneration for medical witnesses. At the time it was pro- memorandum addressed to the Divisions on drug abuse mulgated it was understood that the intention was to improve generally, and a report on the whole matter will be found in the remuneration of medical men in cases coming before the the Appendix, p. 249. courts. Individual cases appeared, however, to indicate that the Order was somewhat illusory in this respect, and the Sub- 8. NATIONAL DEPOSIT FRIENDLY SOCIETY. committee, after careful consideration, has presented the The Committee gave effect to the instruction of the Annual following report, which the Committee presentsto the Repre- Representative Meeting, to forward to the Divisions their sentative previous report, as approved by that meeting, with proposals Meeting. for concerted action, and a copy of the memorandum and Report and Recommendations. recommendations issued with this object will be found That no immediate action is advisable, but that the appended (see Appendix, p. 250). At the time of the preparation Committee should continue to watch the subject, with a of this report 26 Divisions have communicated their decision view to action when sufficient evidence of the operation to take local action to give effect to the recommendations of of the Home Secretary's Order shall be available. the Committee. Five Divisions have intimated general That the Committee should take steps to make it known dissent from these recommendations. that the Association will be greatly assisted in dealing While the memorandum was und.- r consideration, comumuni- with the matter, if medical practitioners concerned in cations were received from the National Deposit Friendly cases which illustrate the operation of the Home Secre- Society, taking exception to the finding of the Annual Repre- tary's Order will communicate statements of the facts to eentative Meeting at Oxford, and to the action of the Com- the Medical Secretary. mittee in presenting a report to that meeting without first conferring with the Society. Subject to the approval of the Annual Representative Meet- The Committee, considering that the course thus suggested ing, the Medico Political Committee proposes to continue to by the National Deposit Friendly Society would have been watch the subject, and if evidence shall be obtained that the unconstitutional in respect of the relationship of the Medico- operation of the Order is serioubly inequitable as affecting Political Committee to the Representative Meeting, and medical practitioners, the Committee will recommend that further considering that the National Deposit Friendly Society further action be taken. had entirely misconceived the nature and object of the action of the Association in the matter, pointed these facts out to the I4. PAYMENT OF MEDICAL PRACTITIONERS CALLED IN BY THR Society, but owing to the discourteous character of further POLICE IN EMERGENCY CASES. communications received from the Society the correspondence The question of the payment of meaical practitioners was broken off. called to emergency cases by the police was referred to the same Subcommittee, which included police surgeons of 9. DEATH CERTIFICATION AND REGISTRATION. experience. At the instance of the Subcommittee enquiries The proposals relative to death registration have been have been addressed to the police authorities in all the large thoroughly reconsidered by the Committee, and a full report towns in the United Kingdom and the result of these has been issued to the Divisions, and is reprinted herewith. enquiries is stated in a special report. (See Appendix, (See Appendix, p. 251.) p. 265.) the Subcommittee which 10. CORONERS BILL. Appended is also the Report of The Coroners Bill has also been thoroughly revised by a the Committee has adopted, and submits for the consideration Subcommittee including representative coroners, and has of the Representative Meeting. (See Appendix, p. 265.) been circulated to the Divisions. (See Appendix, p. 253.) 15. PAYMENT OF MEDICAL MEN FOR CERTIFICATES OF UNFIT- xi. AMENDMENT OF MIDWIVES ACT. NRKSS TO ATTEND SCHOOL. In pursuance of the instruction of the Annual Representa- Shortly before the Annual Representative Meeting the tive Meeting at Oxford that steps be taken to secure the Committee made enquiries of the Education Authorities in amendment of the law in order to make provision for the pay- the United Kingdom, and a prgcis of the replies was laid mnent of medical men called in to assist midwives, the Com- before the Committee in October, and is presented here- mittee addressed a series of questions to the Divisions with a with (see Appendix, p. 265). It appeared to the on Committee that the most successful action for remedy- view to ascertain the opinion of the Association certain in p. On consideration of ing the from which the profession suffers important points (see Appendix, 255). injustices rather than the replies of the Divisions, of which a pricis is appended (see this matter would be taken locally centrally, Appendix, p. 257), a memorial was prepared for presentation to and the Committee, therefore. having made careful enquiries the Privy Council, but as it appeared to the Committee that as to the legal position of medical practitioners ordered the circulation of a on the matter to the Divisions. It was such a memorial must contain some statement of the views report in this of the profeesion as to the minimum fees which should be thought desirable that, as the information contained charged in such cases, and as the replies of the Divisions do report was intended solely for the asaistance of members of not definitely indicate what is desired under this head, it the profession, copies should be supplied to Honorary Secre- has been decided to lay the matter before the Representative taries of Divisions for circulation to the members of their Meeting prior to taking any Parliamentary action. (For Draft Divisions. This has been done. Mlemorial, see Appendix, p. 256.) POSITION OF POSTAL MEDICAL OFFICERS. I6. Officers 12. MEDICAL ACTS AMENDMPNT BILL. The question of the position of Postal Medical was before the Committee by a Division of the Asso- As directed by the Representative Meeting, an epitome brought at was prepared of the principles of the Medical Acts Amend- ciation shortly before the Annual Representative Meeting 20 UPPLMxENTT T) TH 1 240 BRITISH MEDIC&L JOURNA,: I MEDICO-POLITICAL COMMITTEE. [&Iiy 27, 1905.

Oxford, and the Postal Medical Officers' Assoeiation were a Memorandum, of which a copy is appended (see Appendix, asked to furnish the Committee with their views on the p. 267), was prepared and transmitted to the Board of Educa- matter. That Association replied, that they were, at the time, tion, and the Board promised to give it careful consideration. approaching the Postmaster- General on the subject. and asked that any action of the Association might be deferred until this 20. TBE POSITION OF MEDICAL MEN IN CONNEXION WITH had been done and a reply of the Postmaster-General had AMBULANCE COMPETITIONS. been received. The Committee decided to act in accordance A complaint from a member of the Association, as to with this suggestion, and up to the present have not been in- inequitable treatment of local members of the profession in formed of the result of the communication to the Postmaster- respect of fees paid to them in connexion with Ambulance General by the Postal Medical Officers' Association. Competitions, brought under the notice of the Medico-Poli- The Postal Medical Officers' Assoeiation pointed out that tical Committee the general question of the present position the chief difficulty in dealing with these appointments is the of the profession with respect to Ambulance Work, and it large number of candidates for each vacancy, irrespective of appeared to the Committee desirable that this work should the terms on which it is offered, and the Committee are now be placed on a definite basis, either of business or philan- gratified to be able to report that in at least one instance a thropy as the Association may decide. Division of the Association has taken local action to prevent A Memorandum, of which a copy is appended (see Appendix, candidature for such appointments upon inequitable terms. p. 268), was accordingly circulated to the Divisions, submitting for their consideration certain questions, and a report on the REPEATED DISPENSING OF PRESCRIPTIONS. replies of the Divisions is also appended to this Report. The 17. IUNDULY appear to in is On resuming its duties after the vacation, the Medico- replies indicate that opinion the Association ripe Political Committee received a of a Conference of for a declaration that ambulance work has reached a position in report which it should be treated by the profession as a matter oi certain representatives of the Committee with representatives business and not of If this conclusion is of the Pharmaceutical Society as to the beat means of pre- philanthropy. venting abuses which result from the repeated dispensing of approved by the Annual Representative Meeting it will rest prescriptions, after the time for which they were originally with the Divisions to take local action to give effect to these intended to be principles. dispensed. 21. INDECENT ADVERTISEMENTS ACT. The purport of the report of the Conference was that, while of the drawn to the matter could only be fully dealt with by a change in the The attention Committee has been law, much could probably be accomplished by the voluntary certain defects in the present Indecent Advertisements Act. of the medical with chemists. To Advertisements of an objectionable nature may be inserted in co-operation profession newspapers, an offence Act promote such co-operation the Committee issued a memo- which it would be under the to randum to the which is here- advertise in any public place, and also the existing restraint Divisions, presented upon the public exposure for sale of certain articles is with (see Appendix, p. 265), and which contained inadequate. certain rccommendations. An analysis of the replies of The Council of the Association has resolved that action, the Divisions to these recommendations, received up to in co-operation with the London Council for the Promotion May 20th, is also presented herewith, and the Committee of would ask the Representative Meeting to consider the advisa- of Public Morality, should be taken to draw the attention bility of approving the recommendations on behalf of the the Home Office to these defects in the law, and to suggest Association. amendments, and a memorial on the matter has been pre- pared, and will shortly be communicated to the Home Office accordingly. X8. CORONER FOR SOUTH-WEST LONDON. The Medico-Political Committee to the Annual reported 22. SECURITY oF TENUREm OF HEALTH OFFICERS. Representative Meeting at Oxford the communications with (a) .Mledical Officers of Health. the Lord Chancellor to date. including the letter of July ist, The question of security of tenure of Medical Officers 1904, from the Chairman of Council and the Medical Secretary of Health has again received the earnest attention of the asking when a further communication from the Lord Chan- Public Health and Medico-Political Committees. After care- cellor might be expected. As no reply was received from the ful consideration it was decided that the Public Health Bill Lord Chancellor a subsequent letter had been written to should be redrafted so as to leave out the provisions as to the Prime Minister drawing his attention to the matter. Im- superannuation of Medical Officers. These it was thought had mediately after the Representative Meeting a reply was previously overloaded the Bill and deprived it of some Par- received from the Lord Chancellor (see Appendix, p. 266). liamentary support This letter that it would otherwise receive. was acknowledged on August 4th, 1904 (see The redrafted Bill was approved by the Council of the Asso- Appendix, p. 266). After a sufficient interval a further letter ciation in November, and Dr. Hutchinson has assisted the was addressed to the Lord Chancellor on January 5th, 1905 Association by introducing the Bill, supported by (see Appendix, p. 266>, No reply to this letter has been received. Sir W. Foster, Sir J. B. Mr. W. Abraham, Mr. Fenwick, In November the Conference of Medical Societies when Tuke, Mr. E. Major Jameson, Colonel Heneage and to the Lord Chancellor Gray, Legge, deciding again approach resolved also Mr. T. P. Whittaker. to take certain action the through London County Council. Dr. Hutchinson was unsuccessful in the ballot, and, there- Accordingly, at the instance of the British Medical Associa- fore, in the present congested condition of a return from the Public parliamentary tion, Control Committee was asked business, the Bill has no prospect of being carried in the for and a promise obtained that it would be furnished, con- present Session unless the Government will take it up. of the number of taining particulars post-mortem examina- Efforts have been made, but up to the present without success, tions in connexion with the London Coroners in which the to induce the President of the Local Government Board to special pathologists elected by the London County Council receive a deputation. had been employed. The promised return has not been The Divisions of the Association have been requested to received at the date of this report, but in the meantime action approach local Members of Parliament and candidates to is being taken in another direction agreed upon by the Con- secure in ference of Medical their support for the Bill, and for their assistance Societies, namely, that the British Medical bringing it to the notice of a of Association is at the Annual these gentlemen short pricis challenging Audit of the accounts the reasons in favour of the Bill and the proposals contained of the London Council fees which have County been said in it has been prepared. (See Appendix, p. 270.) through Mr. Troutbeck in contravention, it is believed, of the Coroners Act. (b) Public Vaccinators. In connexion with the question of security of tenure, the I9. GOVERNMENT C(ERTIFICATE OF SECONDARY EDUCATION. attention of the Representative Meeting is drawn to the In August of I904 a Memorandum was addressed by the recommendation in the Report of the Departmental Committee Board of Education to various Education Authorities, of the Local Government Board on Vaccination Expenses, that containing suggestions by a Committee appointed by Public Vaccinators should enjoy the same security of tenure the Board with reference to the proposed Govern- as medical officers of health. The defect of the present ment Certificate of Secondary Education. As several position is illustrated by a recent instance in which the Asso- of the proposals in the report were contrary to the views ciation was called upon to intervene on behalf of a Public of the Association with respect to preliminary general Vaccinator, who was dismissed from his appointment because education of medical students, as stated in the Report he had resigned his underpaid Poor-law appointment, the approved by the Annual Representative Meeting at Oxford, Guardians desiring to use the Vaccination appointment as a r t PPI.E?MT TO THU MAY 27, 1905.7 MEDICO-POLITICAL COMMITTEE. BRITISH MUDICLL JOURNAL 241 I i,peans of inducing another medical practitioner to accept the Commons, and offered to give evidence before the Committee. pIoor-law appointment at the low rate offered. Owing to tbe The Committee was not reappointed by the House of intervention of the Association and the action taken by the Commons until late in the present session, but has now Division concerned, no practitioner applied for the appoint- resumed the investigation of the subject, and on May i8th the ment, and the Guardians found themselves obliged to re- Chairman of Representative Meetings attended to give appoint their former officer to both appointments, granting evidence. the increase he had asked for in his salary for the Poor-law In the meantime a Division of the Association represented appointment. While exemplifying satisfactorily the power to the Medico-Political Committee the importance of of the Association, by co-operation of the Central Executive specially watching the interests of general practitioners in the withthe Divisions, to defend practitioners frominjustice of this matter, and the Committee requested the Chairman of kind, the case also demonstrated the defect of the present law Representative Meetings to associate with himself certain in permitting local authorities so to deal with medical officers. representatives and general practitioners. Dr. H. Langley Browne, President of the Birmingham and District General 23. PROPOSAL TO PREVENT POST*MORTEM EXAMINATIONS IN Practitioners' Union, was accordingly requested by the Chair- PRIVATE HOUIsES. man of Representative Meetings to accompany him, and gave In February the attention of the Committee was drawn evidence with him on the date named. In his evidence the by a Division of the Association to the following Clause, in a Cbairman of Representative Meetings mentioned the notice Bill promoted by the Corporation of a Borough in the area of of motion on the Agenda of the forthcoming Representative the Division: Meeting, proposing that the resolution of the Representative No post-morten examination shall be performed in any Meeting at Oxford be rescinded. private dwelling house within the borough without the After the Chairman of Representative Meetings and Dr. H. written authority of the medical officer ot health. Langley Browne had given evidence, the Committee heard as Any person performing or assisting in performing any post- a witness a representative of a medical association, who in the mortem examination without such authority shall be liable course of his evidence suggested that the Britibh Medical to a penalty not exceeding ten pounds. Association did not represent general medical practitioners. Having regard to the obsLruction to the work of private The Medical Secretary thereupon tendered himself as a wit- practitioners which such a provision would occasion, the ness, and gave evidence as to the membership of the Associa- Cammittee decided to oppose the enactment thereof in tion, as to the constitution and composition of the Represen- every way possible, including making representations to the tative Meeting, being compoeed almost entirely of general Home Office if necessary. Through the co-operation of Dr. practitioners, and elected by local bodies the majority of Hutchinson and Sir Walter Foster, who at the instance of the whose members are general practitioners, and pointed out Committee put down notices of objection to the Bill, and that one of the two witnesses who had given evidence on through the local action of the Division in presenting a peti- behalf of the Association was President of a Society composed tion from all members of the local piofession to the Uorpora- of general practitioners exclusively. tion, the Association wassuccessful in securing the withdrawal of the Clause. (b) Proposed Company for Registration of Nurses. 24. ADMINISTRATION OF THE MIDwivES ACT. The attention of the Asociation has aleo been drawn to Apart from the general question of the amendment of the application of a proposed Company, whose object is the the law with respect to the payment of medical men called to examinat,on and registration of iuurses, for incorporation assist midwives, already reported, the Committee has had under the CompaniesAnt, and for the license of the Board of under consideration various questions affecting the Trade to dispense with theuFe of the word "Limited." adminis- The Council of the Association appointed a deputation tration of the present Act, two of which are in a position for composed of thes Chairman of Represetntative Meetings, the report. Chairman of Council, Dr. H. Langley Browne, and Dr. (a) Advertisements. at the of the The first of these relates to an advertisement issued by a Galton to attend hearing matter by the Board of Trade and to give evidence on behalf of the Association in NursingHome which provides midwives. On the application opposition to registration of the Division concerned, the Committee addressed a com- the of nurses by a private Com- munication to the Midwives B3ard asking them to deal with pany. the advertisement, but the Board replied that the subject- 25. CERTIFYING FACTORY SURGEONS. matter of the complaint did not appear to fall within the In February the attention of the Medico-Political Com- scope of the duties of the Board. Inthe meantime, however, mittee was drawn by the Association of Certifying Factory the Division had communicated directly with the proprietord Surgeons to the fact that a B.ll promoted by the Home of the home, with the result that they agreed not to- issue Office-the Accidents (Mines and Factories) Bill-was now any advertisement obnoxious to the medical profession. before the House of Commons, proposing to give effect to a recommendation of the Departmental Committee on the (b) Form of Call to Medical Men called to asss't Milwives. certification of industrial accidents. 'fTheattention of the Committee was also drawn to the form The recommendations of the Committee in question were of notice sent by midwives to medical practitioners request- carefully considered at the time by the Medico-Political Com- ing assistance in difficult cases. It appeared to the Com- mittee, in conjunction with the Factory Surgeons' Associa- nittee that the form in question was misleading and objec- tion, and were deemed undesirable in the public interest. tionable in certain respecte, and representations thereon as proposing to supersede medical expert examination and were made to the Midwives Board. The Midwives Board report byreports of lay persons in matters essentiallyre- painted out that the form is that prescribed in Rule19 (2)of quiring medical knowledge. The Committee applied to the t.he Rules of the Board, which have been approvedby the Home Office to be heard by deputation on the matter. Beyond Privy Council, and that the Board has no power now to a formal acknowledgement, no reply was received from the alter the. Rules, which are in force until August.I906. Home Office, but medical members of Parliament, at the in- The Cammittee is still in communication with the Board stance of the Association, put down notices of objection to on the matter. and a further Report thereon will be pre- the Bill. It is also opposed by Labour representatives as Lented to the Representative Meeting. tending to diminish the existing saleguards against accident to those employed in factorles. 25.N URSES' REGISTRATION. (a) StateRegistration. 27. INSURANCE EXAMINATION FEES. Eaving regard to the following resolutions of the Annual The matter of Life Insurance Examinations, on which Representative Meeting at Oxford: the Medico-Political Committee, after consideration of a Minute 66: Memorandum by the Norwich Division, reported to the "That this Meeting approves the principle of the Annual Representative Meeting at Oxford, has again been Registration of Nurses," brought to the notice of the Committee by the Norwich 'and Minute 67: D.vision through a report of which a copy is appended to the "That the foregoing Resolution be transmitted to the present report. (See Appendix,p. 270.) Select Committee of the House of Commons which Afier careful consideration ot thti matter the Committee is now sitting," recommends that the Annual Representative Meetirgshould the Chairman of Representative Meetings transmitted the call upon the Divisions to consider the question of Insurance former resolution to the SelectOommittee of the House of Fees, with thesuggestion that each Division should adopt 2 Sup. SUPPLNEN'T TO THE 24. BRITSH. MmDICAL JOURNALJ MEDICO-POLITrCAL COMMITTEE. 27, 2m.[M;iYr 105o. Rules and resolutions for the guidance of its members, and of (5) That Children under the age of 5 should notv be those of the profession who, though not members of the admitted under contracts at minimal rates, except in Association, are prepared to support the Association in the the case of the family composition fees included in matter. Clause (a). The Medico-Political Committee has also given instructions (6) That in all such contracts the right be reserved to that further information should be collected, and this when each medical officer to decline to attend as a member prepared will be fmrnished for the assistance of the Divisions of such service any person whom he may consider to in dealing with the subject. be unfit for membership in respect of financial posi- tion, but that such provision should be made as the 28. TJNREGISTEBRED MEDICAL PRACTITIONERS. governing body of the service may approve to prevent A case brought to the notici- of the Committee by the hardship resulting from the retrospective application Editor of the BRITISH MBDICAL JOURNAL has raised the ques- of this rule. tion of action by the Association with respect to unqualified (7) The rates above specified are not intended to apply to medical practitioners who bring themselves within reach of night visits, obstetric cases, operations, or serious the law. The Council of the Association has approved a accidents, by the term "serious accident" being recommendation of the Committee that in such cases such meant an accident which causes incapacitation for action as is possible should be taken by the Association. more than a week.

ABSTRA'CT OF REPLIWR OF DIVISIONS UPON`sTHB APPENDICES. PROPOSITIONS CONTAINED IN THE MEDICO- Item I In Report.] POLITICAL oOM.\IrrTEE'S INTERINI REPORT ON CONTRAC,r PRAOTICE, REFERRED TO THE INTERIM REPORT ON CONTRACT PRACTICE. DIVI4lON i BY INSTRITCTION OF THE ANNUAL (Presented to the Annual Representative Meeting at Oxford. REPRESENTATIVE MEErING OF 1904. The Medico-Political Committee has given careful con- Up to the date of the preparation of this report (May 16th, sideration at several meetings to the matters arising out of 1905), 76 Divisions had replied to some or all of the proposi- the following instruction of the Annual RepreEentative Meet- tions. The replies are as follows: ing of 1903: That it be an instruction1 to the, Medico-Political Com- ON PROPOSITION (1), NAMELY: mittee to investigate the economic conditions of contract "N ecessity of Contract Practice. practice, as carried on in various ways in this country, to re- That it is inevitable in present conditions that there should port thereon to the next Annual Representative Meeting, and be in some parts of the United Kingdom some system of. to present an interim report to the Council on any points contract medical service of the poor." which appear to call for action during the year. It has appeared to the Committee necessary that the investi- 69 Replies. gation which it was instructed to make into the economic 63 Divisions conditions of contract practice should be conducted in two express unqualified approval. principal branches, namely: 2 Divisions (a) By addressing direct inquiries to those Medical approve the proposition, provided the words " of Practitioners who are actually engaged in such the poor " be omitted. practices ; 1 Division (b) By collating the information derived from the reports approves the proposition, provided the word of various medical societies which have given special "spoor" is suitably defined. consideration to the subject, and from the reports 1 Division of the Secretary of the Committee on the conditions approves the proposition, provided the word found in various Divisions which he has been called "poor" be defined to include those earning less upon to visit. than 2585 a week. For the purpose of the inquiries under Head (a), the Com- I Division mittee has formulated a series of questions, of which copies approves the proposition, provided the words "of are appended to this report, and which, with the sanction of the poor " be altered to read " for those unable to the (Jouncil, and by the kind assistance of the Honorary pay ordinary medical fees." Secretaries of Divisions, are being distributed through the 1 Division agency of the-Divisions to individual Medical Practitioners. is of opinion that Contract Practice is not From the information obtained under Head (b) the Com- necessary. mittee has been enabled to arrive at the conclusion that, while on certain aspects of contract practice, any definite pro- ON PROPOSITION (2), NAMELY: nouncement by the Association must be deferred until the "Medical Control. results are ascertained of theinquiriesaddreesed to individual That where the department of Contract Practice relates practitioners, there are other aspects on which opinion has wholly to medical work, it is essential that medical men. already ripened sufficiently for certain propositions of an should be adequately represented on the management." axiomatic character to be formulated at the present stage for consideration by the Divisions. 69 Replies. These propositions are as follows: 63 Divisions (i) That it is inevitable in present conditions that there express unqualified approval. should be in some parts of the United Kingdom some 2 Divisions system of contract medical service of the poor. express unqualified disapproval. (2) That where the department of contractpractice relates 1 Division wholly to medical work, it is essential that medical approves, provided the words "-the medical. men should be adequatelyrepresented on the manage- staff" be sutstituted for " medical men." ment. 1 Division (3) That it should be a fundamental principle of the con- approves, provided the words "or in part" be stitution of all such departments, that every medical interpolated after the word "wholly." practitioner in the district for 'which the service 1 Division provides, who wishes so to act, should be a medical approves, provided the word "adequately" is officer of the service, provided that he conforms to the suitably defined. rules of the service. I Division k44) Th&t, in.present conditions, the lowest fee to be fixed disapproves the proposition as being impractic- in any district, as the minimum to be paid to each able. medical officer annually foreachindividual-whom he is under contract to attend, should be 5s., subject to ONIPROPOsITION (3), NASMELY: such composition-fee, if any, as may be locally deter- "Distribution of Work. mined upon in the case of families having more than Tihat it should be a fandamental principle of the constitau th reechildren. tion of a11 such departmentE, -that every medical practitioner T 3 MAY 2.7, 1905.1 MEDICO-POLITIGAL COMMITTEE. LBamexr 5UPrflrNM=WALuJVuM.'To 24; = in the district for which the service provides, who wishes so 3 Divisions to act, should be a medical officer of the service, provided approve of the-proposition subject to there being that he conforms to the rules of the service." no composition fees. 1 Division 69 Replies. approves aubject to the local Division concerned 57 Divisions determining the composition fee. express unqualified approval. 1 Division 9 Divisions approves provided that the composition fee refers express unqualified disapproval. (1 of these to children only. mentions that it approves of the way in which 1 Division Contract Practice is allotted at present-namely, advocates a minimum fee of 8s. 8d. by ballot by the members of the Societies.) 1 Division I Division adds, at the endof the proposition, the words, approves, provided the proposition be altered to "under the age of i6."1 begin; "That it should be a fundamental prin- 1 Division ciple, that where a Public Contract Medical Ser- disapproves the proposition as not being applic- vice exists, every medical practitioner . ..." etc. able to all forms of contract work, for example, 1 Division family clubs. disapproves the proposition, as tending to 1 Division encourage Contract Practice. disapproves the proposition as not differentiating 1 Division sufficiently-between Friendly Societies and Clubs. disapproves the proposition as impracticable. ON PROPOSITION (5), NAMELY: ON PROPOSITION (3A), NAMELY: "IEclusive of Infants. "Friendly Sqcieties: Choice of Medical Attendant. That children under the age of 5 should not be admitted That the individual membeis of Friendly Societies be en- under contracts at minimal rates. except in the case of the titled to choose the medical man by whom they desire to be family composition fees included in Clause (4)." attended." 64 Replies. 66 Replies. 49 Divisions 53 Divisions express unqualified approval. state unqualified approval. 6 Divisions 3 Divisions express unqualified disapproval. state unqualified disapproval'. 2 Divisions 1 Division approve, provided the members be not, allowed states, as above, that a rate of 48. iF accepted for to change their medical attendant more than once young and old in its local Public Medical Service. a year. 1 Division prefers to read " under the age of lo." 1 Division 1 Division prefers to read " under the age of 14." approves, if the proposition be modified to read: 1 Division " That in the event of a Friendiy Society Medical advocates that children under the age of 5 be not Club joining such a service, the individual mem- admitted at minimal rates. bers of such Club shall be entitled to choose the 1 Division medical man by whom they desire to be advocates that such children be not admitted attended." under contract rates at all. 1 Division 1 Division approves, on condition that present holders of advocates that children under the age of I4 be not such. Societies be not interfered with. admitted under contract rates- at.all. I Division 1 Division approves if by "individual" be- understood considers that children under the age of 5 should "adult male." not be admitted at minimal rates under contracts 1 Division with Friexidly Societies. approves provided "medical officer of the srvice" 1 Division be substituted for "medical man." would admit children of any age at the minimal 1 Division rates. disapproves of the proposition, as tending to 1 Division encourage Contract Practice. disapproves of thepropositionaasnotdifferentiating I Division sufficiently between-Friendly Societies and Clubs. disapproves of the proposition as being unwork- 1 Division able. considers the proposition unnecessary "if each 1 Division child admitted at 55." disapproves of the proposition on the ground that choice of medical attendant is "incompatible ON PROPOSITION (6), NAMELY: where stipulation is made for a fixed fee." " Provision against Abuse. That in aIll such contracts the right be reserved to each ON PROPOSITION (4), NAMELY: medical officer to decline to attend as a member of such "Minimum Rate. service any peraon whom he may consider to. be unfit for That, in present conditions, the lowest fee to,be fixed in membership in respect of financial position, but that such any district, as the minimum to be paid to each medical provision should be made as the governing body of the service officer annually foreach individual whom he is under contract may approve to prevent hardship resulting from the retro- to attend, should be 5s., subject to such composition fee, if spective applicationwof this rule." aU, as may be locally determined upon inthe case offamilies having more than, three children." 66 Replie. 46 Divisions 67 1eplies.. state unqualified approval. 51 Divisions 11 Divisions. express unqualified approval. approve the principle with various modifications 4 Divisions -a to detail. advocate a. minimum of 6s. 3 Divisions, 3 Divisions disapprove of any retrospective clause. speak of a minimum of4s. (Oneof theseDivisions 2 Divisions mentiones that this is te rate in fore. in the disapprove the proposition as impracticable. local Pulblic Medical; Service, for- ohildren and 1 Division adultaalike) and-that at present.theDivlWon does rejects the proposition, pending theilecision of a nob see lts-way to alter it.) wage limit. tPPLEMr!'T TO THE 1 24 4 B^ITISH MEDICAL JOtEMALJ MEDICO-POLITIOAL COMMITTEE. [MAY 27, 19o05 1 Division member. The reforms contained in the propositions are approves it, provided the right of choice is made advisable and much to be desired, but it is impossible to reciprocal. carry them out wiLhout the co-operation of the whole pro- 1 Division fession." rejects the proposition as unnecessary. 1 Division states: "That the best way of securing the re- 1 Division forms contemplated in sections (2), (3), and (3k) would be by rejects it as placing the medical officer in an forming all the practitioners in the district for which the awkward position. service provides, who may be willing to take service under the organization be it club, friendly society, or provident. dispensary, into a medical board, empowered to deal with ON PROPOsITION (7), NAMELY: medical matters, and acting under the lay board much as the "Sspecial Services. medical board of a hospital acts under the lay board. Such a The rates above specified are not intended to apply to night medical board should have power to make representations to visits, obstetric cases, operations, or serious accidents, by the the lay board as to financial suitability of the beneficiaries of term 'serious accident' being meant an accident which the club or dispensary." causes incapacitation for more than a week." 1 Division mentions that the members of the British Medical Associati9n resident in the Division area have 65 ReplFies. drawn up an agreement regulating Contract Practice, which 43 Divisions they anticipate will be signed by all practitioners in the state unqualified approval. district. 22 Divisions 1 Division has resolved: "That it is desirable, should any approve conditionally to various alterations being such service be organized, that the management of Contract made (see below). Practice be carried out by the respective Divisions." And 1 Division resolved: "That this Division is of opinion that all contract medical work sbould be based upou pay- Alterations Referred to. ment of a fixed sum for separate items-that is, visits paid 6 Divisions or medicines, etc., given. The amount for the varioua would omit "night visits." items to be agreed upon for a term between the contracting 1 Division requires a definition of "night" in hours. parties." 1 Division would omit "obstetric cases." Item 2 In Report.] 1 Division would omit "operations." THE DESIRABILITY OF CONSULTATION BETWEEN 2 Divisions MEDICAL WITNESSES IN LEGAL CASES LIKELY TO would specify, under "operations," only those BE BROUGHT BEFORE THE COURTS. requiring an anaesthetic. 1 Division Minute 57 of the Representative Meeting. would specifieally limit "operations," so as to That the Report concerning the desirability of consultation between medical witnesses in legal cases be referred to the exclude trivialities. Divisions. 5 Divisions would omit "serious accidents." REPORT OF THE MEDICO-POLITICAL COMMITTBs TO THE REPRE- 5 Divisions SENTATIVE MEETING, REFERRED FOR CONSIDERATION BY THE would omit definition of "serious accidents." DivisioNs. 1 Division requires a better definition of "serious accidents." The inquiry concerning the desirability of consultations being 1 Division held between medical witnesses which the Medico-Political Com- approves, provided the proposition does not apply mittee, acting upon a resolution of the Scottish Committee, ad- to accident clubs. dressed to the Divisions of the Association in March last, has 4 Divisions elicited replies from 125 Divisions. 108 replies were received in would lengthen the time of incapacitation neces- time to be considered by the Committee while preparing the sary to constitute a " serious accident "; of these Report now presented, and these have been classified under seven 1 mentions "a fortnight" and 2 " a month." heads: (a) Divisions who thought it unreservedly desirable that 2 Divisions medical witnesses should meet in consultation ... 46 would insert "consultations. (Of these 15 use the phrase "desirable as a rule" or 1 Division "desirable whenever possible," or some equivalent would ineert "special visits." expression). 1 Division (b) Divisions who thought it desirable, subject to certain would insert "venereal diseases." specified conditions ...... 7 1 Division (The principal conditions attached were as to consent of would inEert "notifiable infectious diseases." the parties or of their legal advisers, or as to ap- 1 Division proval of the Judge). would insert "anaesithetics." (c) Divisions who thought it " desirable if practicable." ... 9 1 Division (d) Divisions who thought it "desirable but impractic- would insert special mention of "fractures." * able," ...... 5 (e) Divisions who thought it undesirable ...... 33 OTHER OPINIONs EXPRESSED BY THE DIvisaiors. (f) Divisions who thought that the object aimed at would 5 Divisions have passed resolutions to take no action in the be better attained by the appointment of medical meantime, or not to consider the Report. assessors ...... 4 1 Division, while generallyapprovingthepropositions, states (g) Divisions who report that they were unable to arrive that the subject is too complex to be summed up in these 7 at a conclusion or declined to discuss the subject ... 4 propositions, and that the Association is not in a position to The Committee has carefully considered the whole subject, make its proposals effective without the loyal co-operation of giving special attention to the opinions expressed by the Divisions, every medical practitioner. and the difficulties which they have mentioned. 1 Division states that the proposals should be applicable The foregoing analysis shows that while a majority of the only to those cases where medical men combine to form a Divisions whose replies are dealt with are in favour of the con- public medical service, but that as far as possible all new sultation of medical witnesses, a considerable minority are at clubs should be formed on the model suggested- by the pro- present opposed to such procedure, and there is evidently doubt posals. in the minds of some as to its practicability. 1 Division states: "Contract practice is necessary for the Such opposition and hesitation appear to have arisen in part working classes under present conditions. There should be a from a misunderstanding of what was proposed under the term wpge limit. The minimum fee should not be less than 58. per "consultation," partly, perhaps, from the fact that the question r uStI OXEbNT TOTHE MLY 27, 1905.1 MEDICO-POLITICAL COMMITrEE. MEDICAL JOURNAL 24 aAX [BBJTIOH iOo5.] ML5 submitted by the Committee was purposely stated in general ABSTRACT OF THE REPLIES OF DIVESIONS ON TEHF terms, in order to elicit a full expression of opinion. (COONSULTATION O F MEDICAL WITNE3SES, AS Two points appear to have given rise to special difficulty, RE3FERRED TO THE DIVISIONS BY THE ANNUAL namely (a) the fear that the consultation of witnesses might REPRESENTATIVE MEETING OF I904. legally constitute "collusion," and (b) the fear that parties to cases or their legal advisers might object to such consultations. Up to May 20th, 1905, 78 Divisions have communicated Both points are, therefore, specially considered in the subsequent their findings; of these- paragraphs of this report.* I.-58 Divisions The Committee submits to the Divisions the following general approve the principle of such consultation. conclusions on the principles of consultation of medical wit- II.-6 Divisions nesses: deem it impracticable. 1. Medical evidence in legal cases is of two kinds I[I.-6 Divisions (a) Questions of fact, e.g., as to the amount of injury or deem it undesirable. disease present in the patient. 1V.-4 Diviaions (b) Questions of opinion and expert knowledge. think no Rule should be laid down by the 2. Medical evidence at the present time suffers from the disad- Association. vantage of being occasionally conflicting under both heads, and V.- 3 Divisions differences between medical witnesses in their statements as to prefer appointment of medical assessors. questions of fact expose them to accusations of partisanship, which (3 Divisions approving the principle suggest. are prejudicial to the credit of the profession and to the value of assessors in addition). medica? evidence. VI.-1 Division 3. The determination of matters of fact must be arrived at by considers such consultation undesirable as the ordinary methods of medical examination, and such examina- regards Scotland. tion for purposes of evidence is clearly best carried out by the wit- nesses for the two sides simultaneously, in order that the condi- tion of the patient may be observed by both at the same time and Item 3 In Report.] under the same circumstances. 4. Such associated examination has the further advantage that REORGANIZATION OF THE LOCAL GOVERNMENT it diminishes the danger of any material fact being overlooked BOARD. by the medical advisers of either party. Minutes 52 and 53 of the Representative Meeting. 5. This system would in many cases put each party in more com- 52. Resolved: That this nieeting of the Representatives of the plete possession than they could otherwise enjoy of the knowledge British Medical Association, having special knowledge and obtainable by medical examination, and would thus diminish the experience of the gravely defective constitution and status of number of cases which now only come before the Courts through the Local Goverrment Board (England and Wales) in regard to imperfect knowledge of material facts by one or both parties. The the administration of Public Health, requests the Government diminution of litigation thereby affected would benefit not only to show its recognition of the urgent necessity of reorganizing the the parties immediately concerned, but also the community. Local Government Board by appointing a IRoyal Commission to 6. Although it is not supposed that such combined examinations report upon the whole question. would necessarily be followed in every case by ordinary consulta- 53. Resolved: That a copy of the foregoing Resolution, tion between the medical practitioners concerned, yet such con- together with the documents relating thereto, be sent to the sultations should as far as possible be held. Divisions with the request that their Parliamentary Representa- 7. The procedure above indicated has the great advantage, both tives support the proposed appointment of a Royal Commission. to the profession and the public, that it tends to place the medical In witness in his true position as a witness of scientific fact, and not pursuance of the Resolution the following documents are as an advocate or partisan of the party by whom he is employed. appended:- 8. The above considerations have for a number of years governed (A) Local Government Board Bill. The Bill was drafted to the action of many medical practitioners, and the procedure now indicate the kind of reorganisation of the Local Government suggested for more general adoption by the Association was carried Board which the Association thinks desirable. out with success by the profession in Leeds, the effect being that (B) A Memorandum which was communicated, with a copy the estimation of professional evidance in that district was un- of the Bill, to the Treasury Committee which had the subject questionably raised, and both Judges and leading members of the under consideration. Bar expressed their emphatic appreciation of the good results (C) A Memorandum by the Medico-Political Committee sub- attained. mitted to the Representative Meeting, in reference to the Report 9. It has been feared by some that such consultations would in of the Treasury Committee. the eyes of the law constitute "collusion" between witnesses, but it appears to the Committee that the term "collusion" is wholly (A.) LOCAL GOVERNMENT BOARD BILL. inapplicable to the case of consultations between medical men, who meet for the purpose of coming, if possible, to a joint con- MEMORANDUM. clusion as to the facts of the case. THE objc.t of this Bill is to substitute for the Local Government 10. It is the belief of the Committee that as soon as the more Board as at present constituted a Board containing a Parlia- ethical procedure herein indicated has become the recognised prac- mentary president and vice-president and four expert members. tice of the medical profession, any objection which lawyers or The Board would continue, as at present, to have a Parliamentary their clients might entertain to consultation between their medical secretary, and so would have three instead of two representatives witnesses would tend to be regarded as an indication that there in Parliament. was some element in the case which would not bear unbiassed The present Board was constituted in 1871 on the analogy of examination. Consequently the practice of raising such objections those Government Departments which represented as a matter would prejudice the case of the party objecting, and in a short of history Committees of the Privy Council. It comprises as time would cease. ex-officio members the principal Secretaries of State and some 11. A few Divisions have suggested that the difficulties arising other great officers of the Crown, but it is not, and probably through the conflict of medical evidence might be met in another never was intended to be, a working body for the despatch of wav, namely, through the appointment of medical assessors. business. It is believed never to have met. The Committee, while fully appreciating the value, both to the The work of the Local Government Board is growing in variety public and to the profession, of the regular appointment of medical and importance, and can only be transacted with the aid of assessors for the assistance of Courts when medical evidence is persons possessing high professional qualifications. At present being submitted, is of opinion that this reform should not be pro- the expert officers of the Board are merely its servants, and cans posed in substitution for the system of consultation of witnesses tender advioe only upon invitation. It is considered that the explained in the present Report, but should be urged as an inde- efficiency of the Board would be increased if the Board itself pendent reform. comprised expert members who could initiate matters for discus- sion. A third Parliamentary representative, who might be a The Medico-Political Committee submits the foregoing con- Peer, would also be of advantage. siderations to the Divisions in the hope that, as the result of their A preoedent for the cbange proposed will be found in the con- mature deliberations thereon, a procedure conducive to justice stitution of the Local Government Board for Scotland (see the and consonant with the best traditions of the profession may Local Government (Scotland) Act, 1894), which includes two pro- receive the formal sanction of the Association. fessional men. The Local Government Board as proposed tn be reconstituted would also be similar to the present Board of * As to (a) see paragraph (9), below, and as to (b) ,ee paragraph (to). Admiralty. 246 SUPPI,V.'ItPM'T TO THE BRIT14a MEDICAL JOURNAll M EDIOO-POLITIOAL COMMIT rEE. [&TAY 27, 150.5, = I The Bill proposes to recognise the importance of the office of (B.) MEMORANDUM. the President of the Local Government Board by raising him to To Tz COXMITrM ON THES ORGANISATION, lUTIES, AND PAY, the rank of a Secretary of State. OF THE BOAD oF TBADE AND THU LocAL GOVERNMENT The amendments and repeals introduced into the Bill are Bouw. merely consequential on the foregoing proposals. I. The British Medical Association, as representative of the Medical Profesaion in the United Kingdom, desires most respect- LOCAL GOVERNMENT BOARD BILL, 1904, fully to draw the attention of the Committee appointed to consider ARRANGEMENT OF SECTIONS. the Organisation, Duties, and Pay of the Board of Trade and Section.- the Local Government Board to certain conclusions at which- 1. Changes in the constitution of the Local Government the Association has arrived concerning the organisation of the Board. Local Government Board, which organisation in its working 2. Amendments of Local Government Board Act, 1871. most materially affects the efficiency of Public Health Adminis- 3. Short construction and tration in England and Wales. title, repeals. II. The conclusions of the Association are based upon the DRAFT of a BILL to amend the constitution of the Local Govern- following facts and considerations: ment Board. (1) The,facts coming constantly under the notice of all medical practitioners, and especially of those who are officially BE IT ENACTED by the King's Most Excellent Majesty by and concerned in. Sanitary Administration, as to (a) the pre- with the advice and consent of the Lords Spiritual and Temporal valence of preventable disease, and (b) physical unfitness, and Commons in this present Parliament assembled and by the among the population of this country, due to causes which authority of the same as follows: it is believed could in a great degree be removed by better 1. Changes in the constitution of the Local Government Board.- central and local administration. From and after the passing of this Act the following changes shall (2) It is recognised -by the Association that the causes which be made in the constitution of the Local Government Board (in this have thus come under its notice as prejudicially affecting Act called " the Board "): the health of the community are in part due to the (1) The president of the Board shall be a of ignorance and vice of individuals, in part to the lack of State. Secretary instructed public opinion among the electors and members (2) The ex-officio members shall cease to be members of the of Local Authorities, 'and in part to a want of co-ordi- Board. nation of Local Authorities dealing directly or Indirectly (3) There shall be a vice-president of the Board who shall with questions of Public Health; but it is also believed be appointed by His Majesty at any time after the pass- that many grave evils are directly traceable to defective ing of this Act and shall hold office during His Majesty's organisation of those Departments of the Central Govern- pleasure. ment which deal with matters of Public Health, and to a (4) here shall be four additional members of the Board who want of proper co-ordination of these Departments with shall be appointed by His Majesty on the recommenda- one another and with Local Sanitary Authorities. tion of the president of the Board at any time after the (3) The British Medical Association believes that the first and passing of this Act and from time to time as vacancies most pressing need in this matter is the establishment shall occur, and shall hold office during His of an efficiently constituted Central Department to which pleasure. Majesty's all matters affecting Public Health should be specially (5) Of the additional members of the Board one shall be a referred. barrister-at-law or- solicitor of the Supreme Court of not (4) It is not, however, suggested that this should be a new less than twelve years' standing in either case, one shall separate branch of the Government. be a person qualified to be appointed the medical officer The Association appreciates that in this country the of health of a county under Sub-section 2 of Section principle of extensive devolution of sanitary administration 18 of the Local Government Board Act, 1888, one shall to Local Authorities must be fully recognised in any be a member or associate member of the Incorporated attempt to deal comprehensively with the organisation of Institution of Civil Engineers, and one shall be a person such administration, and that it follows from the accept- experienced in the administration of the Poor Law ance of this principle that the central administration of Acts. Public Health cannot, with advantage, be taken from the - (6) There shall be paid out of moneys provided by Par- department which is concerned with Local Government in liament to the vice-president and the additional members general, and, therefore, that attempts to make more of the Board such salaries as the Treasury may from time efficient the central organisation of Public Health Adminis- to time determine. An additional member shall not tration must be directed to reform in the organisation of engage in private practice or employment, but an the Local Government Board. inspector or other officer of the Board may be appointed (5) The defeots in the present organisation of the Local an, additional member. Government Board are traceable chiefly to circumstances 2. Amendments of Local Government Board Act, 1871.-The in its origin and development, to which reference must word " vice-president " shall be inserted in Section 4 of the Local briefly be made. Government Board Act, 1871, after the words "the president," In theory, the Local Government Board is a Committee and in the second paragraph of Section, 5 of -hat Act after the of he Privy Council. In practice, the responsibilities words "the president or " and the words " and the office orvice- and duties of the President of the Local Government Board president" shall be inserted in Section 4 of that Act after the are exactly analogous to those of a Secretary of State. words "the office of president." The fact that the President is not a Secretary of State 3. Short title and construction.-(1) This Act may be cited as detracts from his influence with Local Authorities, and the Local Government Board Act, 1904, and shall be construed diminishes the status and emoluments of the officers of as one with the Local Government Board Act, 1871, and that his Department. It has been said on behalf of the Act and this Act may be cited as the Local Treasury, that the reason why the position and salaries of "Board Acts 1871 and 1904. together Government officers in the Local Government Board are inferior to (2) The enactment specified in the Schedule to this Act is those of officers in the office of a Secretary of State is that thereby repealed to the extent mentioned in the the duties discharged by the officers of the Local Govern- that Schedule. third column of ment Board are of less importance to the State than those discharged by the officers in the office of a Seacrtary of SCHEDULE. State. ENACTMT REPEALED. The Association ventures most strongly to dissent from this view, and to assert that the duties of the Local Chapter. Short Title. Extent of Repeal. Government Board are of the first importance to the welfare ,of the country, in relation especially to Public Health, using that term in its widest 34 and 35 Vict. The Local 51overn- SectionThree from "andofthe fol- sense, to include not only sanitary c, 70 meint Board Act, lowingex officio members" to administration, but also poor law administration, and the 1871 "Chancellor of the Exchequer" revision of schemes of water supply and drainage, and in and from " no payment "to "the addition such matters as the effect of improper conditions of Local Government Board&but." housing and employment in producing disease and physical In. Section Five the words "one of deterioration, and.the organization of locomotion as affecting the ex-officio members." the distribution of the population. The Medical Department of the Local Government Board St '1-1,7'Mf7N-T TO THE MA'y 27, 1 '05.1 MEDICO-POLITICAL COMMITTEE. 1-HPL-ITISIT'l- MEDICAL JOURNAL 247 was transferred to it from the Privy Counnil, at the time realises the magnitude and complexity of the problems that arise when the Act of 1875 came into force. The personnel of for consideration in this connection as affecting both the central the Department has since been largely increased, and the and the local government of this country, and recognises that responsibilities and duties placed upon it have grown in many years must naturally be required for the complete attain- importance with the progress of sanitary legislation, but ment of those reforms which medical opinion indicates as neces- the status of the Department has not undergone any cor- sary or desirable. responding improvement. But the Association has not merely dealt with this matter in III. Having regard to the foregoing facts and considerations, a critical spirit. It has, through its Committees, reviewed the the Association has arrived at the following conclusions which whole position from a medical standpoint, and has become con- *it ventures most respectfully to urge upon the Committee, vinced that the proper commencement of well-directed reform namely:- in this matter must be sought through the establishment of a (1) That the President of the Local Government Board should Central' Government Authority appropriately constituted in be a Secretary of State, and that that Department in all respect of (a) its internal organisation, (b) its status among matters of status and emolument should be raised to an public Departments, and (c) the arrangements for its co-ordination equality with the existing Departments of Secretaries of with those local authorities with whom in this country rest State. chiefly the details of public health adnministration. Further, the (2) That the President should be assisted and advised by a Association considers that the reforms stated under (a) and (b) Board, meeting for the transaction of business, and con- are of primary consequence and yet require such relatively simple sisting of, in addition to himself, a Vice-President and a changes in the law as to be capable of immediate accomplishment Parliamentary Secretary, each of whom should be a Peeer if approved by the Government. or a Member of the House of Commons, and of a certain The British Medical Association, therefore, after thorough number of expert members. It will be observed that such discussion of the primary questions involved, drew up certain a constitution would be in accordance with the precedent conclusions thereon and embodied these in a Bill which wa3 established by the creation of the Scottish Local Govern- published in February of this year in the BRITISH MEDICAL ment Board, and follows also the analogy of the Admiralty JOURNAL, proposing a complete scheme for the reconstruction Board and the Army Council. of the Local Government Board of England and Wales. (3) That, inasmuch as Public Health Administration would be The Local Government Board at present is theoretically com- an important function of the Board, one of such experts posed of the foLlowing members: a President, the Lord President should be a Registered Medical Practitioner, who should of the Council, the Lord Privy Seal, the Secretaries of State, and have had special experience in Public Health Administra- the Chancellor of the Exchequer. As a matter of fact it never tion. meets, and its functions are performed by the President, who acts Having regard to the fundamental importance -of these in the name of the Board. proposals, the Association has had prepared the Bill, In the Bill of the Association (a) as regards the internal embodying the said proposals, of which a copy is appended organisation of the Local Government Board as the Department to this Memorandum. of State chiefly concerned in the administration of public health, The Association would further venture to suggest that, provision was made for the establishment, in place of the present in conjunction with the proposed re-organisation of the fictitious Board, of an effective Board containing expert members, Board, (a) the duties of the Department should be extended following the precedent of the Loca,l Government Board in so as to comprehend the duties in respect of the administra- Scotland; and (b) as regards the status of the department, that tion of the Medical Acts, the Dentists Act, the Midwives the President of the Board should be made equal in rank with the Act, and the Pharmacy Act, which are at present imposed Principal Secretaries of State. upon the Privy Council; and that (b) the propriety of Upon approaching the Government in the hope of enlisting its transferring the duties under the Adulteration Acts and interest in these much-needed reforms, the Association was met Factories Acts to the Local Government Board, as the with the objection that a Committee was then sitting under th,e Central Health Authority, also arises for consideration. chairmanship of the Earl of Jersey to report on "the position and the Local February, 1903. and duties of the Board of Trade Government Board; and whether any, and if so what, alterations should be made in the constitution and status of those offices; also whether, (C.) MEMORANDUM in the int,erests of administrative efficiency, any rearrangement -of ON THE REPORT OF THE TREASURY COMMITTEE duties between those and other Government Departments is APPOINTED TO CONSIDER THE POSITION AND desirable." DUTIES OF THE BOARD OF TRADE AND OF THE This Committee had been appointed by the Treasury on July LOCAL GOVERNMENT BOARD OF ENGLAND AND 18th, 1903. The other members were Sir John Gorst, AI.P., Sir WALES. James Mackay, a member of the Council of India and of the FoR PRESENTATION TO zEm ANNUAL REPRESENTATIVE MEETING. Committee on the Board of Trade (1898-9), Sir Charles Ryan, K.C.B., a former Controller and Auditor-General, and Mr. Alfred TEE British Medical Association has carefully considered the M.P. for Oldham. Sir John Gorst and was the to Emmott, resigned, report of a Committee* appointed by Treasury inquire, succeeded on February 1st, 1904, by Sir George Ryder, K.C.B., under the chairmanship of the Earl of Jersey, into the constitu- Chairman of the Customs Commission. The constitution of this tion, duties, and pay of the Board of Trade and the Local Govern- which did not include with Board. The interested in that Committee, any person acquainted ment Association, being specially public health or Poor Law administration, and the fact that it was part of the reference of the Committee which concerns the Local appointed by the Treasury, which is prone to look upon questions Government Board as being the Department of State chiefly of policy mainly from the financial point of view, did not give responsible for the public health, has observed with disappoint- grounds for any sanguine expectation that its report would deal ment and regret, the omission from the Treasury report of any with the questions of the status and organisations of the Local reference to the fact that the administration of public health is Government Board from the point of view of what was generally very seriously affected by the present status and organisation of expedient for the public health of the country. the Board. the Association was referred to the Com- The Association such an omission as a matter of As, however, Treasury regards grave mittee, an application was made thereto that the Committee importance to which 1the attention of the public and of the should hear evidence from the Association on the subject of those Government should be drawn. material changes in the constitution of the Local Government The Association, which includes over 15,000 members of the Board which appeared to the Association necessary in the interests medical profession practising in the United Kingdom, has con- of health administration. stantly had brought under its notice the dangerous defects of the public administration in this of health and has The Committee declined to hear the evidence offered by -the country public matters, instead that a written for a time been the need for Association, and requested communication long profoundly impressed by should be forwarded from the Association. A memorandum was extensive official reform in our methods of preventing disease and embodied in the degeneration if the health and physique of the nation are to be accordingly presented in support of the proposals was also maintained at an adequate standard. The Association fully Bill of the Association, which appended. The Association also had the privilege of laying its views by a * The precise terms of the reference to the Committee are as follows: - before the President of the local Government Board, "That there should be appointed a Committee to consider the position deputation an and duties of the Board ofTrade and the Local Government Board, and who, while expressing himself as opposed to the formation of to report whether any, and if so what, alteration should be made in the! effective Board, undertok to bring before the Treasury Committee constitutiont and status of those offices; also whether in the interests of the views of the Association a to the desirability the aiministrative efficiency any rearrangement of duties between thoee ad, oT raising other Government departments is desirable." status of his Ministerial offioe. 2 8UPP.r.YM%r TO Til 1 248 BRITISH MEDIC&L JOURN.L J M EDIOO-POLITICAL COMMITTEE. [ 27, 1905.

It appears from the report that the Treasury Committee took the magnitude as the adaptation of the Local Government Board evidence.of Sir Michael Fuster as representing the Public Health to the present needs of the nation in respect of public health Committee of the House of Commons, who expressed the opinion administration, and the further questions of the part to bs that a special department of the Local Government Board should played by central and local authorities respectively in such be,created to deal with public health administration. administration, and the duties which should be assigned to the The Association regrets to find that in the report of Lord expert members of an efficient Board. Jersey's Committee there is no evidenoe that the Committee gave The British Medical Association deeply regrets that the oppor- any consideration to the constitution of the Local Government tunity afforded by the appointment of Lord Jersey's Committee Board as affecting the efficiency of public health administration. to commence the reorganization of public health affairs in this Furbher, the only reason assigned by the Committee for not country has thus been lost. recommending any change in the constitution of the present The Association, however, hopes that inasmuch as the nation fictitious Local. Government Board is that the Board consists recognizes more and more the importance of social and sanitary entirely of members of the Cabinet. as distinguished from purely political reforms, and that the The Committee, though freely condemning the imaginary nature maintenance of the physical and mental health of the people is of the Board of Trade, does not explain how the equally the one true foundation of national prosperity, the question of imaginary Local Government Board, which never meets, can the reorganization of the Local Government Board and of the possibly be rendered efficient by the fact that its members are public health administration of the country will be soon reopened members of the Cabinet, that is, are great officers of State, each and entrusted to an inquiry by a Royal Commission, the procedure holding an office the duties of which demand his whole attention. of which in the opinion of the Association would be more likelv an so Apparently in justification of its failure to recommend the to secure adequate pronouncement on vital a question as termination of this fiction of the Constitution, the Treasury Com- the safeguarding and furtherance of the health of the people. mittee also referred to the comparatively recent creation of two other purely nominal Boards-the Board of Agriculture (1889) and MEMORANDDUM ON PROPOSALS OF THE WSOOITATION the Board of Education (1899). W[IlH RESPEOP 10 THE REORGANISATION OF Neither has the Committee dealt satisfactorily with the proposal to raise the status of the President of the Local Government THE LOCAL GOVERNMENE BOARD. Board to that of a Secretary of State, though Paragraph 16 may (X) It is being increasingly recognised that the health of the be taken to confain the reasons for not making this recommenda- community is one of the greatest of national interests, and tion. In this paragraph, while recognizing that the adminis- tbat the protection of public health is one of the most trative business of the office of the Local Government Board is important duties of Government both centrally and locally. laborious and important, and the parliamentary business especially (2) The central control of matters affecting public health is heavy, the Committee has made two statements which it would at present divided amongst several Departments of State. seem to have thought justified it in refraining from recommending It is to the interest of the country that it should be co- any change in the Local Government Board beyond certain ordinated by being brought uhder one Department. increases of the salaries of the President, the Parliamentary (3) As a result of the adoption of the principle of decentrali- Secretary, and the Permanent Secretary. These statements are: sation of public health administration in this country, the (1) That "the jurisdiction of the Local Government Board is Local G )vernment Board is the Department limited and Wales." chiefly concerned to England in of and the a the Local Government questions public health, formation of separate (2) That Board "is not charged with the Ministry of Pubtc Ilealth (such as some have proposed) main responsibility for the decision of great questions of policy." would probably be impracticable. On both points the British Medical Association strongly dissents (4) It is therefore considered that the co-ordination of from the conclusions of Lord Jersey's Committee. In the matter central administration concerning matters affecting public of jurisdiction the Association would urge that questions of public health would best be effected hy entrusting all duties of the health and prevention of disease affect all parts of the United kind to the Local Government Bo3rd. Kingdom equally, and that this principle is already recognized in (,) Among the duties which could, it is thought, with certain cases in regulations of the Local Government Board. In advantage be transferred to the Local Government Board, if a matter of such importance as public health the present demar- thus converted into a Ministry of Public Health, are:- cation of the duties of the several Departments of State concerned (a) From the Privy Council-the administration of the should not be rigidly adhered te when modification would be Medical Acts, the Dentists Acts, the Pharmacy Acts, conducive to efficiency of administration. and the Midwives Act. It appears to the Association that in matters of public health (b) From the Home Offlce-thp administration of the efficient administration would be best attained by treating the Factory Acts, and of the Food and Drugs Adultera- United Kingdom as an administrative unit, and that the Local tion Acts. Governnient Board should therefore be so reorganized and given such jurisdiction in health matters as would correspond to this (6) To enable the Department to deal efficiently with these principle of organization. duties, it is considered that changes should be made in the So, also, if in any other matters of Local Government it were status and internal organisation of theBoard. found expedient that each part of the United Kingdom should (7) As regards status, it is held that the Board should be form a separate unit, it appears to the Association that this would placed on an equality with the other chief Departmen-ts of be better attained by reform of intradepartmental organization State, and therefore that the head of the B jard should be than by the sacrifice of the unity of public health administration. given the status and emoluments of one of the Principal On (2) the Treasury Committee does not define what it means Secretaries of State. by "great questions of policy," and in the absence of such (8) As regards organisation, it is considered that the present information the Association is unable to understand why this constitution of the Board, as, in theory, a Committee of the term does not plainly apply to questions of national pQlicy in Privy Council, which in practice does not meet, is unsatis- relation to public health. factory, and that for the proper consideration of the matters The prevention of epidemic and endemic disease; the protection with which the Department should deal, specially those of the kingdom from invasion by zvmotic diseases, such as cholera affecting Public Health, it is necessary that it should be or plague; the construction and regulation of the water supply administered by an effective Board including members of the of great centres of population; the housing of the working classes, Government, and experts with administrative duties. and the purity of the food supply may be all instanced as questions (9) Following the analogy of the Scottish Local Government which raise "great issues of policy" affecting our relations with Board, which has been found to work satisfactorily, and also foreign States, important commercial considerations, the con- of the Board of Admiralty and the Army Oouncil, it is proposed stitution and administration of local public authorities, their that the Board shall consist of- co-ordination with one another and with the oentral adminis- (a) A President, who would be a Cabinet Minister, a Vice- tration, and the adjustment of the financial burdens of the President, and Parliamentary Secretary, all of whom eountry, both national and local. would be members of one or other House of Parlia- Thus, for the decision of great questions of policy, the Public ment. HIealth Department of a Government is as much responsible as (b) Experts, of whom four are" suggested, namely: a any other office of State. medical, a legal, an engineering, and a Poor-law, While drawing attention to the fact that the report of the member. Treasury Committee fails to fulfil the scope of the reference to (io) To secure responsibility to Parliament it would be the Committee the British Medical Association recognizes that necessary that the President of the Board should not be this failure may have been due to an appreciation by the Com- bound by the decisions of the Board, but should be free to mittee of its own incompetence to deal with a problem of such override them if he thought proper, but the resolutions of the MAY MEDICO-POLITICAL COMMITTEE. r SUPPI.tINT TO THE 27, 1903.1 ~~~~~~~~~~~~~~27,19JNEDIC.].DC-OLTOMOR L Barisit MEDICAL JOURNA~L 249 Board would be minuted, with the decision of the President are rendering services to the State in excess of any in any given case to override the resolution of his colleagues, obligations resting upon them; and that where the and such minutes should be available for the information of assistance thus voluntarily given is not duly recog- Parliament when required. nised by Coroners, members of the medical profession (i i) To secure the effective consideration of these and other may find themselves compelled to refuse to continue reforms neede-d ia the national administration of puiblic such assistance. health, the British Medical Aesociation urges that a R:yal Commission should be appointed to investigate the whole subject. Item 5 In Report.] Candidates for Parliament are asked to Eupport this proposal. RECOMMENDATIONS OF THE. COUNCIL OF THE ASSOS CIATION AS TO IMPROVING THE PARLIAMEN- TARY REPRESENTATION OF THE PROFEiSION. Item 4 In Report.] x. That Members whose candidature for Parliament is supported by thp profession should recognise reEponsibility THF PRESENT POSITION OF REGISTERED MEDICAL to isome organised body representative of the profession. PRACTITIONERS IN THE MATTER OF FURNISHING 2. That the organised body should be the British Medical CERTAIN INFORMATION TO CORONERS. Assoeiation. Minute 60 of the Representative Meeting. 3 That the British Medical Association should select two Resolved: That a copy of the Memorandum be forwarded gentlemen, one on each side of polities, and arrange as to to the Divisions. their becoming candidates at the next General Election. 4. That financial support should be given to these candidates MEMORANDUM BY THIM MEDICO-POLITICAL COMMITEE. by dednite grants for election expenses. Cases which have from time to time been brought to the 5. That when the funds of the Association permit of it the notice of the Medico-Political Committee, clearly indicate the necessary exppnditure should be met from the general funds unsatisfactory position in which medical men are placed at of thp British Medical Association. present, in the matter of furnishing information to Coroners 6. That the candidateq should he selected as in the scheme upon which decisions as to the propriety of holding inquests for nomination for the General Medical Council. may be based. Medical practitioners throughout the country have made a practice of supplying to Coroners such particulars of facts within their knowledge concerning the death of patients Item 7 In Report.] attended by them, as may assist the Coroner in deciaing THE RECOMMENDATION OF DRUGS AND whether an inquest is necessary, and, if necessary, what PROPRIETARY ARTICLES BY NAME.* evidence shall be called thereat. In a few districts, the ser- vices thus rendered by practitioners in their professional The Annual Representative Meetingf of the British Medical capacity to the State have been duly recognised by Coroners Association held at Oxford, passed the following instruction to by the payment of suitable fees. This, however, is not the the Council, which the Council referred to the Medico-Political rule, and several instances have been reported to the Com- Committee. in which Coroners even mittee, have not thought it necessary Minute 115.-"That it is desirable that the Central to accord a courteous acknowledgment of the help they have thus received. There are again cases in which Coroners have Council draw the attention of the Medical Profession indi- accused medical men of neglect of in not such vidually to the fact that by recommending by name certain information. duty, supplying drugs and certain preparations of those drugs, they are not Such an attitude on the part of Coroners must be inter- only allowing themselves to be used indirectly as touts for preted as indicating that they hold an entirely erroneous view wholesale druggists, but are also helping their patients to of the position and duties of registered medical practitioners, form, either in themselves or others, serious habits of drug in respect of cases in which the circumstances attending the abuse." death of under care patients theix may be the subject of consideration of this instrtetion the inquiry, and such an erroneous view is apparently also pre- Upon Medico-Political valent among the public, and even members of CommiLtee issued the following Memorandam and Recom- the medical among many mendations to the Divisions on the subject. profession. For the of the matter to the notice of The question arises, therefore, of the advisability of a pro- purpose bringing indi- nouncement by the British Medical Association, with the vidual members of the profession, it is proposed to address a object of securing a proper recognition of the true relation of communication to the Medical Journals, but prior to taking, this medical practitioners to the State in this matter. In such a step the Medico-Political Committee considers it expedient that pronouncement, it would appear that the following considera- the matter should be laid before the Divisions, in conjunction tions should receive notice:- with the kindred subject of the abuse of drugs resulting from the (1) That no legal obligation rests at the present time on unduly repeated dispensing of prescriptions. medical practitioners, as such, to render any assist- The Committee is of opinion that the object contemplated by ance to Coroners in the investigation of the cause of the resoluition of the Annual Representative Mleetiilg would be death, other than that of making a "post-mortem" attainied if ruiedical practitioners would observe the rule of not examination when so ordered by a Coroner in recommending drugs or special preparations to their patients by writing, and that of attending to give evidence at name, but always ordering them by prescription. an inquest when duly sunimoned so to do. (2) That, under present conditions, the practice, whereby medical practitioners furnish to Coroners information Recommenda tson. of the kind considered in "That medical practitioners should observe the rule of this memorandum, not not drugs or special preparations to their being defined or required by law, is entirely informal recommending and irreglilar. patients by name, but always ordering them by prescrip- (3) That if a preliminary inquiry by the Coroner is to be tion." regarded as an integral part of the procedure sanc- tioned by the State for the investigation of the cause Abstract of Replie of Divisions on the Subject. of death, it would appear that the procedure therein Up to the time ot the preparation of this R_port (May 23rd, should be definitely regularised by legislation, which 1905), 57 Divisions have replied. should prescribe the respective obligations of Of these, Coroners, medical practitioners, and others who may 43 Divisions assist in the inquiry, and that definite provision approve the recommendation. should be made for the adequate remuneration of the 8 Divisions several parties concerned in respect of the services are definitely adverse. thus rendered. 2 Divisions (4) That, pending such action by the legislature, it is do not wish to express any opinion. necessary to lay stress upon the fact that medical 1 Division practitioners, who furnish the information indicated, states that it is impracticable. S8PPIEHIMT TO THU A50 BRITISH MEDICAL JOUUl.Lj MEDICO-POLITICAL COMMITrIT :[AT27, 1905.

I Division (d) That Divisions, should use their utmost endeavours to states that it should be amended as follows: induce members of the profession within their area "That medical practitioners should observe the who do not belong to the Association to act upon these rule of not recommending drugs or special Rules. preparations to their patients by name, but as APPENDIX. far as possible always ordering them by prescrip- tion, as otherwise a doctor could not order, say, REPORT ON NATIONAL DEPOSIT FRIENDLY an alum douche without a prescription." SOCIETY. 1 Division (Con8idered by tVe Annual Reprsentative Meeting at " heartily agreed with the desire to prevent the Oxford, 1904.) abuse of drugs, but came to no definite decision The Medico-Political Committee has fully inquired into as to the best means of carrying it out." the relation of the work of the National Deposit Friendly I Division Society to that of the medical profession. I"would like further information as to the scope Regarded in its relation to the medical profession, the of the proposed inquiry. The Division is unani- National Deposit Friendly Society differs from other friendly mous that all proprietary medicines should bear societies (i) in the fact of paying in each district, to certain a statement on the bottle, giving the ingredients members of the fees for services rendered; also and uses." profession, specific (2) in that the Society professes to recognize no individual practitioner as distinctly an officer of the Society, but repre- sents -that every member may be attended by any registered Item 8 In Report. medical practitioner in the district whom he may select. The medical men thus acting for the Society do so under the WATIONAL DEPOSIT FRIENDLY SOCIETY. special circumstances about to be described. The scale of fees paid by the Society is determined by Rule Concerted P)roposals for Action by the Division8 of XVI, Section xiv, Subsection i, as follows:- the, British Medical Association uith respect to Subsection x.-The following charges are authorized to be made by the medical practitioners. They are subject to modiflcations by the National Deposit Friendly Society. the General Committee for special reasons, on the application of any medical offleer, and the recommendation of any Divisional Tux Annual Representative Meeting of the Association at Committee:- Oxford in 1904, having considered the appended Report of the MEDICAL CASES. Medico-Political Committee on the National Deposit Friendly - s.d. Society., approved the same and passed the following resolu- One visit and medicine for two days 0... ,. o 2 6 tion in reference Each intermediate visit in dangerous cases thereto;:- Extra per mile, if beyond two mles (outward). (This That the Committee be Medico-Politioal instructed to transmit the charge also applies to surgical cases) ...... o o 6 resolution of this Meeting respecting the Report on the National one attendance at surgery and medicine for two days o I 6 to the Deposit Friendly Society Divisions, with proposals for con- One fresh supply of medicine for two days ... o o certed action. If the member is entitled to over 5s. daily sick pay, Before the Committee had the opportunity of extra per visit or attendance for every is. above 58. o o 6 considering Extra- visit between the hours of g and 8 a.m. this instruction a communication was received from the per p.m. the following day ...... o National Deposit Friendly Society which showed that they Extra per attendance at surgery between the same had misconceived the intention and of the purport Report of hours ...... o o 6 the Committee. The Committee therefore thinks it desirable, in-presenting the proposals which it was instructed to sub- SURGICAL CASES. mit, to make clear the principles to which those proposals are Compound fracture of the thigh intended to give effect. Compound fractures or compound dislocation of the In the opinion of the Committee the relation of the profes- leg ...... 5 0 0 sion to the Society should be that which is apparently con- Amputation of leg, arm, foot, or hand ...... templated by some of the rules of the Society, but with which The operation for strangulated hernia (or rupture) ... J of fractures or dislocations - other of its rules and the action of some of its local agents Treatment simple simple of ...... 0 0 are inconsistent. thigh orleg 3 Removal of cancerous or other tumours of magnitudo 3 0 0 No medical practitioner should be or as regarded treated Treatment of dislocations or fractures of the arm ... I o O an officer of the or as specially Society under any obligation Treatment of fracture of clavicle or ribs ...... I' 0 to charge to a patient who happens to be a member of the Treatment of dislocation of lower jaw ...... o zo 6 Society the fees laid down in the Society's scale. One of the Minor operations without anaesthetic (teeth extraction rules-of the Society specifically lays down that any member excepted) ...... o zo 6 may call in any medical practitioner, and this rule should be Minor operations with anaesthetic ... .. I catheter ...... o 2 6 consistently carried into effect by the Society. PassiDg Passing catheter, if at patient's house, extra ... o 2 6 Tooth extraction, if at surgery, or by qualified dentist o o RECOMMENDATIONS. Fee to be paid by candidate for examination: The Committee therefore recommends that the Divisions For a contribution of as. per month ...... o I O should by Rules or by resolutions require their Members to For each Is., or part thereof, above that amount, observe the following procedure with respeot to the Society: extra ...... o o 6 (a) That no Member of the Association should give an The rates prescribed under the said rules are, in the opinion undertaking to charge members of the National Deposit of the Committee, too low. Friendly Society according to the scale laid down by The local agent of the Society often visits the practitioners the rules of the Society instead of the ordinary fees in a district, and invites them to accept work under the terms properto their circumstances; of the Society-that is, according to the scale of fees deter- (b) That in dealing with members of the Society the medical mined by the rule above mentioned. practitioner should look to the patient absolutely for It naturally follows, when it becomes known that individual his fees and should not recognize the Society in the medical practitioners will accept the Society's scale, thiat those matter. The member of the Society should himself members of the public who belong to the Society will employ pay the doctor according to the ordinary scale of fees those practitioners, to the exclusion of their neighbours, and for persons in his circumstances, and should recover, thus underselling is brought about fudependently, from the Society the amount due to There is the further danger that the scale of fees of the him in respect of the attendance under the Society's Society will become recognized in the district as adequate and scale; customary. (c) That no Member of the Association should permit his To be consistent with the claim stated in Clause (2), the name to be used by the officers of the Society as wording of the rule cited should be altered so as to make specially acting, in any honorxary capaeity or otherwise clear that the provisions as to fees, stated therein, relate for the Society in any district, and that it should be entirely to the agreement between the Society and its mem- left to each patient to choose his medical attendant bers, and do not affect the charges made by medical practi- without bias from the Society; tioners to members of the Soiety. TO u'rP.1F,rxMT 22 MAY 27, 1905.) MEDICO-POLITIOAL COM WITTEE. L UJTSH MEDICOL JOURNaL, = I The Committee has had evidence before it, moreover, that made him the proper person to certify as to the cause of in point of fact medical officers are appointed by the Society, death, might be unable, withoutmaking a long journey, to either as consultants or otherwise, and that their names have view the body of the deceased as required in order to been published in prospectuses issued by divisions of the eertify as to the fact of death. Society. On this point it is stated bythe general secretary of recommends that certificates of the Society that the appointment of these medical officers is The Committee therefore purely honorary. the fact of death and of the cause of death should be It is also to be noted that the Society does, in fact, in each entirely separate documents. (See Recommendations 4,5, district distinguish between those medical practitioners who and 7.) have indicated willingness to accept -the scale of charges (d) The Committee has taken into consideration 'the drawn up by the Society, and those who have not. views expressed in the Representative Meeting at Oxford in I904 as to Clause 6 (see Appendix A) of the Committees CoNCLuSION. proposals as then presented, and' has accordingly so framOd Until the rules of the Society are amended it Is not, in the the recommendations under this head as not to preclude opinion of the Committee, desirable that individual medical the practitioner previously in attendance on the deceased, men should allow themselves to be recognized, directly or or called in at or about the time of death, from conduct- indirectly, as specially acting for the Society in any district, ing, or assisting in, the post-mortem examination in cases or as willing to accept payment on the scale laid down in in which he is unable to certify as to the cause of death. the rules of the Society. (See Recommendation Io.) (e) The Committee has considered the instruction of the Items 9-and 10 In Report.] Representative Meeting that provision should be made in the Coroners Bill to meet the difficulties arising under the present law as illustrated by the procedure of the iWeptrt Coroner for South-West London. ON These difficulties would in part be removed by the recommendations of the Committee to which reference DEATH REGISTRATION AND AMEND- has already been made. MENT OF CORONERS' LAW. It has appeared, however, tothe Committee, that specific provision is required againist the tendency to exclude from To be Presented to the Annual Representative Meeting, Leicester, .post-mortem examinations in which the services of a special July, 1905. pathologist have been thought to be required, the medical THE Medico-Political Committee has considered the practitioner previously associated with the came. matters arising out of the following instructions of the' The Committee has, therefore, recommended the inclu- Annual Representative Meeting at Oxford to the, Com- sion, in the Death Registration proposals (see Recom- mittee: mendation io), and in the Coroners Bill, of a provision Minutes 43 and 44: that the special medical officer of the' coroner, when On- consideration of the proposals formulated by the making a post-mortem examination by order of the coroner, Medico-Political Committee for the amendment of the shall have associated with him the practitioner, if any, who 1aw as to Death Certification and Registration (see had attended the deceased during life or was called in at or Appendix A), about the time of death. Resolved: That the report be referred back to the Medico. (f) While preserving the principle that the certificate of Politieal Committee for further consideration and report the cause of death, and the information contained therein. to the Divisions. -shall be confidential, the Committee has provided that this Minute 58: shall n-ot interfere with the right of access of the coroner With reference to the Ooroners Bill (see Appendix B), as 4and medical officer of health to such information. (See to which the Committee reported the action which they 1tacommendation 5 (b).) had taken during the past year, it was agreed: has to the Committee desirable that the That before submitting the Bill to Parliament the Medico- (g)-It appeared should include those Political Committee should incorporate in it any pro- proposals on Death Registration visions which the Committee might deem expedient, Clauses of the Coroners Bill which relate to the payment having regard to matters recently considered by the of fees to medical practitioners for information supplied to Committee concerning the relation of Coroners to the coroners, and, similarly, that the Coroners Bill should medical profession. include those Clauses of the proposals as to Death Regis- duties and of coroners. In addition to the propositions on Death Registration tration wh4eh affect the powers anid Stillbirth and the Coroners Bill, named in the refer- TO THE DIVISIONS. ence, the Committee has had before it the recommenda- QUESTIONS SUBMITTED tions, contained in the Report of the Select Committee of The following Recommendations: the House of Commons (1893) on Death Registration, and 1.-As to Registration of Deaths and Disposal of Dead proposals formulated in 1895 hy the Public Control Com- Bodies; mnittee of the London County Council as regards Coroners' I.-As to Registration of Stillbirths and Disposal of the Law Amendment. (See Appendices C and D.) Bodies; and On further consideration of the proposals as to Death III.- The (Redrafted) CoronersBill; Registration it has appeared to the Committee: are the provisions which the Committee recommends that the As8o- Tbat it is that the Association in ciation should seek to have embodied in legislation at the firit (a) desirable moving Divisions are to them in for reform of the law on Death sbould opportunity. Trhe requested consider Registration present order that a vote may be taken upon then in the Representatiie a complete scheme for the amendment of the law as to the at disposal of dead bodies, in order to afford complete pro- Meeting Leicester. tection to the pulblic. RECOMMENDATIONS. That to effect this it is in addition to (b) necessary, pro- REGISTRATION DEATHrS AND DISPOSAL oF DEAD hibiting regiitration without the production of medical (T.) oF BQpDxs. certificates, to prohibit disposal of bodies witbout regis- to a dead body not tration or a coroner's and this i. It shall be made an offence retain order, proposals having buried or otherwise legally disposed of beyond a period not object have been included by the Committee among its exceeding eight days except by permiission. of a magistrate or recommendations. (See Recommendations I-3, I5 and I6.) coroner. (c) The former proposals of the Committee suggested that 2. It shall be made a penal offence to bury, cremate, or the same practitioner should certify as to the fact and as otherwise dispose of a body except upon a buria order-issued to.the cause of death; it has appeared, however, to the by a registrar-or coroner. Committee, on further consideration, that in many cases 3. No burial order shall be issued by a regiatrar until the ,the practitioner whose previous knowledge of the deceased death has been registered. SuPPr.FmENT TmT 1 252 BRITISUIMEDICAL JOUCIL.4 j MEDICO-POLITICALMEDICO-POLITICAL OOMMITTEE. [MAY 27, 1905-

4. No death shall be registered except upon the production coroner in all cases of death in which the coroner shall so to the registrar of (a) a certificate of the cauee of death, and direct. (b) a certidcate of the fact of death, or, if such certificates be 13. The Burial Order, after it has been acted upon, shall be not produced, upon a certificate of the coroner in accordance returned to the registrar who issued it, with an endorsement with the Coroners Act, x887, s. 4. showing the date, place, and mode of disposal of the body. 5. Certificate of the cause of death- Every person in charge of a cemetery, burial ground, (a) A certificate of the cause of death shall be a certificate churchyard, crematorium, or otber Dlace legally authorized by a registered medical practitioner who has attended the for the disposal of dead bodies (a) shall, alter a Burial Order deceased, and shall be upon a statutory form [see Schedule has been acted upon, endorse the same, and (b) shall keep a (i)] issued by the Registrar-General, which shall include register of all bodies buried or otherwise disposed of, which statements as to the duration of attendance and the date of shall show the name and age of the deceased and the name the last attendance. The medical practitioner shall transmit and address of the persons conducting the burial or crema- the certificate of the cause of dtath in a sealed envelope tion. Any pereon failing to obey these piovieions shall be direct to the registrar. liable to a penalty. (b) The certificate of the cause of death shall, subject to the discretion of the Registrar-General, be a confidential (II.) REGISTRATION OF STILLBIRTHS AND DISPOSAL OF THE document, and the information contained therein shall be BODIES. entered by the registrar in a register which shall not be open 14. It shall be made an offence to retain thebody of a atill- to public inspection, provided that nothing in this Clause borii child not buried or otherwise legally disposed of beyond a shall affect the right of access of a coroner or medical officer period not exceeding eight days except by permission of a of health to the register. magistrate or coroner, and it shall also be made an offence to (c) For each such certificate a fee of 25. 6d. shall be paid by bury, cremate, or otherwise dispose of such body except upon 'the local Sanitary Authority. a burial order issued by a registrar or coroner. 6. It is nevertheless provided that sbould any registered I%. No burial order snall be issued by a registrar until the medical practitioner be of opinion that death has arisen stillbirth has been regietered. from or been accelerated by any violence, directly or in- i6. No stillbirth shall he registered except upon the pro- -directly, or through neglect, or poison or other unnatural duction to the registrar of a certificate in the statutory form cause, he shall not grant any such certificate of death [see Schedule (iii)] by a registered medical practitioner who as aforesaid, but shall forthwith report t) the coroner for has viewed the boay. the district, and for such report shall receive a fee of '7. The foregoing provisions on registration of deaths and sos. 6d. stillbirths referring to the coroner sball in Scotland, mutatis 7. Certificate of the fact of Death.-A certificate of the fact mutandis, apply to the Procurator Fiscal. of death shall be a certificate, upon a statutory form [see Schedale (ii)] issue(d by the Registrar-General, by a Tegiatered medical practitioner who has viewed the SCHEIDULE. tody, and who shall be the practitioner who certifies Draft Forms of Certiflcates byMedical Practitioner. the cause of death, or failing him, any practitioner (i.) who ehall have attended the deceased during life or Certificate of Cause of Death. ehall have been called in at or about the time of death, or I HERIEBY certify that L attended...... otherwise a special medical officer appointed as provided in of...... who, as I am informed, died on the. *Clause 12. For each such certificate a fhe of 28. 6d. shaRl be. day of...... and that to the best of my knowledge and paid by the local Sanitary Authority for a body seen within belief the cause of death was as hereunder written. 4hree miles of the practitioner's registered addresp, and an Primary disease ...... additional 23. for each mile or part of a mile beyond such Complications ...... diistance. Duration of attendance for these illneses...... 8. The Registrar-General shall, from lime to time, furnish Date wben last seen alive* ...... Forms of Certificates of Death to every registrar, who shall * Wben this date is more than eight days prior to the date of 'deliver these as required to registered medieal practitioners death, the Registrar shall forthwith report to the Coroner for their use. The forms of the said certificates shall be or Procurator Fiscal. prescribed by Statute, and no other certificates of death than Witness my hand, etc ...... those given on the statutory forms shall be accepted as valid Name ...... certificates. Registered medical pracLitioner. 9. In all cases where no certificate of the cause of death is Address ...... produced, or where in such certificate the date of the last Date ...... attendance is more than eight days prior to the date of death, the registrar shall forthwith report to the coroner. (ii.) Where any certificate signed by a registered medical practi- Certificate of Fact of Death. tioner does not strictly conform in every particular with the I hereby certify that on the...... day of...I statutory form, the registrar shall refuse to register the death, and shall at once report to the coroner. personally at fea...... vieweda male dead body said to io. The coroner on receipt of such report may call upon be* that of ...... of .whose apparent the practitioner in attendance, if any, to furnish a report, * Tho words "said to be " are to be struck out when the body is -after making a post-mortem examination if so directed, and identified by the practitioner signing the certificate. he may also, and it no medical practitioner has been in iee was.. and that death had taken place recently. attendance he shall, instruct the special medical officer of Name of person identifying the bodyt ...... the district to investigate and report, after making a post- Addressd. 4nortem examination if so directed. In such investigation the t This is, wlien possible, to be the registered medical practitioner special medlical officer shall have associated with him the signing the certifieate. usual medical adviser, if any, cf the deceased, or any Witness mv hand, etc...... registered medical practitioner who may have been called to Name ...... see the deceased at or about the tim of death. Registered medical practitioner. ii. (i) A coroner shall pay to any duly qualified medical practitioner whom he may consult or who may on his requisi- Address ...... Mion have reported as to the cause of any death on which no Date ...... inquest is held a fee not exceeding one guinea. (ti) A coroner shall be reimbursed by the locil authority (iii.) any payment made under this section upon rendering within Certificate of Stillbirth. four months an accoun4t of that payment as if ik was an I hereby certify that on the...... day or...... I have expense reasonably incurred in and about the holding of an at viewed the of a fale child said to inquest, and Sections 26 and 27 of the Coroners Act I887 shall ...... body apply accordingly. be* the child of...... (Mother's name and address) 12. [n every coroner's district there shall be appointed by * The words " said to be " are to be struck out when the body is the County Coincil one or more special medical officprs identified by the practitioner signing the certificate. whose duty shall be to examine the body and report to the and that the said child was stillborn. MAY guarrifi ExCN TiorHou 127, 1S05.] MEDICO-POLITICAL COMMITTEE. [BRITISH MDICL JOURTA 2535 -Ia Witness my hand, etc...... practitioner for making a po8t-mortem examination with. Name...... out the previous direction of the coroner. Registered medical practitioner. (ii) A registered medical practitioner shall not be required Address...... without his consent to make analysis of the contents of the Date ...... stomach or intestines or other part of the body, and any such practitioner or other persons whom the coroner shall deem (III.) CORONERS BILL. competent and who shall make such an analysis in pur- [As the result of further consideration of thiu Bill, the Com- suance of the previous direction of the coroner shall be in,ttee have incorporated in it those Recommendatins concerning entitled to receive such remuneration not exceeding .Registration of L)eaths and Stillbirth. (see above) which afect the five guineas as the coroner shall certify in writing to be duties and powver8 ofcoroners.] reasonable. THE CORONERS BILL. 5.-Remuneration of Medical Practitioner Reporting to Coroner in Cases in which no Inquest i8 Held. ARRANGEMENT OF CLAUSES. (i) A medical practitioner reporting to the coroner as CLAUSE. provided for in Clause i, Section (i), shall for such report i. Notification of death to coroner. be paid by the coroner a fee of ios. 6d. 2. Appointment and duties of special medical officers. A medical to the coroner as 3. Procedure of coroner. (ii) practitioner reporting 4. provided for in Ckause 3, shall for such report be paid by Remuneration of medical witnesses. the coroner a fee not exceeding one guinea. 5. Remuneration of medical practitioner reporting to (iii) A coroner shall be reimbursed by the local authority coroner in cases in which no inquest is held. any payment made under this Clause upon rendering 6. Regard to be had to deaths invesLigated without within four months an account of that payment, as if it inquest in fixing salary of coroner. was an expense reasonably incurred in and about the 7. Fee to coroner for attendance at trial. holding of an inquest, and SectioDS 26 and 27 of the 8. Repeal. Coroners shall 9. Extent of Act. Act, I887, apply accordingly. to. Short title and construction. 6.-Regard to be had to Deaths Investigated without Inquest in Fixing Coroner's Salary. 1.-Notification of Death to Coroner. At any quinquennial revision of a coroner's salary regard (i) It is hereby provided that should any registered shall be had to the number of deaths the causes of which medical practitioner be of opinion that the death of any he has investigated without holding an inquest, as if in patient attended by him has arisen from or been accele- each case an inquest had been held. rated by violence, directly or indirectly, or through neglect, or poison, or other unnatural cause, he shall not ,.-Fee to Coroner for Attendance at Trial. grant any certificate of the cause of deatb, but shall A coroner attending at any court before or at the open- forthwith report to the coroner for the district. ing thereof in pursuance of Subsection 3 of Section 5 of the (ii) In every case where no certificate by a registered Coroners Act, 1877, shall be entitled to a fee of two guineas medical practitioner of the cause of death is produced, or for each such attendance, and, in addition, to reasonable where in such certificate the date of the Just attendance is travelling expenses, and such fee and such expenses shall more than eigbt days prior to the date of deatb, or where form part of the expenses of the prosecution. in any other particular such certificate does not strictly conform with the statutory form, the registrar shall forth- S.-Repeal. with report to the coroner. Section 22 of the Coroners Act, 1887, is hereby repealed. 2.-Appointment and Duties of Special MIedical Officers. 9.-Extent of Act. In every coroner's district there shall be appointed by This Act shall not extend to Scotland or Ireland. the County Council one or more special medical officers whose duty sball be to examine the body and report to the 10.-Short Title and Construction. coroner in all cases of death in which the coroner shall so This Act mav be cited as the Coroners Act, I9o6, and direct. shall be construed as one with the Coroners Act 1887 and 3.-Proccdure of Coroner. I892. A coroner on receipt of such Teport from a registered (A.) medical practitioner, or from a registrar, as is provided for AMENDMENT OF THE LAW REL&TING TO DEATH in Clause I, may call upon the practitioner in attendance, if CERTIFICATION AND REGISTRATION. to furnish a after a exami- any, report, nmaking post-mortem FORMULATED BY nation if so and he and if no medical PRINCIPLEs MEDICO-POLITICAL COMMITTEE. directed; may also, (As submitted to the Annual Representative MIeeting at practitioner has been in attendance he ahalJ, instruct Oxford, 1904.) the special medical officer of the district to investigate and Provisions which the Medico-Political Committee recom- report, after making a po8t-mortem examination if so mends for submission to the Registrar General and Govern- directed. In such investigation the special medical officer ment: shall bave associated with him the usual medical adviser, i. Every death must, if possible, be certified by a registered if any, of the deceased, or any registered medical practi- medical practitioner who has been previously in attendance tioner who may have been called to see the deceased at or upon the deceased. It shall be the duty of such practitioner about the time of deatb. to view the body after deatlh, prior to certifying. 2. For such certificate and visit a fee shall be paid by the 4.-Remuneration of Medical Witnesses. Local Sanitary Authority, such fee to be 23. 6d. for a case seenI (i) A registered medical practitioner who bas attended within a distance of one miJe Irom the practitioner's registered at a coroner's inquest in obediencm to a summons of the address, and an additional 28. for each mile or part of a mile coroner under the Coroners Act, I887, sball be entitled to beyond such distance. such remuneration as follows is to 3. The medical practitioner shall transmit to the Registrar receive (that say): a For on which such so attends direct the certificate in sealed emvelope. (A) every day practitioner 4. The certificate shall be a confidential document, subject to give evidence at an inquest one guinea; to the discretion of the Registrar- General. (B) For making a po8t mortem examination of the 5. All deaths which are not certified by a registered medical body of the deceased without an anal3 sis of the practitioner shall be referred to the Coroner, or in Scotland to contents of the stomach or intestines or other part the Procurator Fiscal. of the body one guinea; 6. In every Coroner's district there shall be appointed by Provided that no remuneration shall be paid to a medical the County Council a Special Medical Officer, whose duty it 8"rrianmZDILMr.= JGRI1u -MEDICO-POLITICAL COMITEECOMMITTEE. [Mv2, 95 254-~~~~~~~MDC-OIIAU [M-AY '27, 1905- sball be to examine the body and report to the Coroner in all of Subsection 3 of Section 5 of the Coroners Act 1877 shall be cases of death where no registered medical practitioner is able entitled to a fee of a guinea for each such attendance and that to give a certificate. In such investigation the Special fee shall form part ot the expenses of the prosecution. Medical Officer shall have associated with him the usual 6. Repeal.-Section 22 of the Coroners Act I887 is hereby medical adviser (if any) of the deceased, or any registered repealed. medical practitioner who may have been called to see the 7. Extent ofAct.-This Act shall not extend to Scotland or deceased at orabout the time of death. Ireland. 8. Short title and .construction.-This Act may be cited as (B.) the Coroners Act 1902 and shall be construed as one with the THE CORONERS BILL, 1902. Coroners Act I887 and 1892. (As submitted to the Annual Representative Meeting at Oxford, (C.) 1904.) SELECT COMMITTEE OF THE HOUSE OF COMMONS ARRANGEMENT OF CLAUSES. ON DEATH CERTIFICATION, i893. Clause. I. Notification of death to Coroner by Registrar where no SUMMARY OF PRINCIPAL RECOMMENDATIONS. medical certificate. 2. Remuneration of medical witnesses. (i) That in no case should a death be registered -without 3. Remuneration of medical practitioner consulted by production of a certificate of the cause of death signed by a Coroner without inquest. registered medical practitioner, or by a coroner after inquest, 4. Regard to be had to deaths investigated without or in Scotland by a Procurator Fiscal. inquest in fixing salary of coroner. (2) That in each sanitary district a registered medical prac- 5. Fee to Coroner for attendance at trial. titioner should be appointed as public medical certifier of the 6. Repeal. cause of death in cases in which a certificate from a medical 7. Extent of Act. practitioner in attendance is not forthcoming. 8. Short title and construction. (3) That a medical practitioner in attendance should be required, before giving a certificate of death, to personally DRAFT OF A BILL inspect the body, but if, on the ground of distance or for other TO AMEND THE LAW IN RELATION TO CORONERS. sufficient reason, he is unable to make this inspection himself he should obtain and attach to the certificate of the cause of BE IT EN&ACTED by the King's Most Excellent Majesty by death a certificate signed by two persons, neighbours of the and with the advice and consent of the Lords Spiritual and deceased, verifying the fact of death. Temporal and Commons in this present Parliament assembled (4) That medical practitioners should be required to send and, by the authority of the same as follows:- certificates of death to the registrar, instead of handing them 1. Notification of death to Coroner by Registrar where no to the representatives of the deceased. medical certificate.-A Registrar shall, in the case of every That a form of certificate of death should be prescribed death brought to his knowledge, without a(certificate of cause and(a)that in giving a certificate medical practitioners should of death signed by a legally qualified Medical Practitioner, be required to use such form. forthwith give notice of the death to the Coroner within (6) That it should&be made a penal offence to bury-or other, whose jurisdiction the death occurred, and a Registrar shall wise dispose of a body, except in time of epidemic, without noti register the death until he has received an intimation an order from the registrar stating the place and mode of dis8 from the Coroner that the Coroner does.not think it necessary posal, which order, after it has been acted upon, should be to hold an inquest. returned to the registrar who issued it. 2. (i) Remuneration ofmedical witnesses.-A legally qualified (7) That it should be made an offence to retain a dead Medical Practitioner who has attended at a Coroner's inquest body unburied or otherwise legally disposed of beyond a in obedience to a summons of the Coroner under the Coroners period not exceeding eight days, except by permission of a Act, I887, shall be entitled to receive such remuneration as magistrate. follows (that is to say):- (8) That the practice of burial in pits or common graves (A) For every day on which such Practitioner so attends to should be discontinued. give evidence at an inquest one guinea: (g) That stillbirths which have reached the stag& of devplop- (B) For making a post-mortem examination of the body ment of seven montbs should be registered upon the certificate of the deceasea without an analysis of the contents of a registered medical practitioner, and that it should not be of the stomach or intestines or other part of the body permitted to bury or otherwise dispose of the stillbirth until one guinea; an order for burial has been issued by the registrar. Provided that no remuneration shall be paid to a Medical (io) That, subject always to the discretion of the Crown Practitioner for making a post-mortem examination without Office, the result of precognitions taken by the Procurators the previous direction of the Coroner. Fiscal in Scotland, or the precognitions themselves, should (ii) A legally qualified Medical Practitioner shall not be be communicated to the representatives of the deceased when required without his consent to make analysis of the contents is made for the same. of the stomach or intestines or other part of the body-and application any such Practitioner or other persons whom the Coroner shall deem competent and who shall make such an analysis (D.) in purance of the previous direction of the Coroner shall CORONERS' LAW AMENDMENT. be entitled to receive such remuneration not exceeding five guineas as the Coroner shall certify in writing to be RESOLUTIONS PASSED BY THE LONDON COUNTY reasonable. COUNCIL IN I895. 8. (i) Remuneration of Medical Practitioner consulted by Coroner without inquest.-A Coroner shall pay to any duly (a) That in no case should a death be registered without qualified Medical Practitioner whom he may consult as to production of a certificate of the cause of death, signed by a the cause of any death on which no inquest is held a fee not registered medical practitioner or by a coroner after inquiry. exceeding one guinea. (b) That a medical practitioner in attendance should be (ii) A Coroner shall. be reimbursed by the local authority required, before giving a certificate of death, to personally any payment made under this section upon rendering within inspect the body and identify it as the body of the person he four months an account of that payment as if it was an has attended; and should include in his certificate a state- expense reasonably incurred in and about the holding of ment pointing to the absence of accident, poison, violence, or an inquest and Sections 26 and 27 of the Coroners Act I887 criminal neglect; and that the coroners be required to hear shall apply accordingly. evidence from representatives of the families of the deceased 4. Regard to be had to deaths investigated without inquests in whenever it is alleged that death has been caused by accident. f&ring Coroner's salary.-At any quinquennial revision of a (c) That a form of certificate of death should be prescribed Coroner's salary regard shall be.had to the number of deaths and that in giving a certificate, medical practitioners should the causes of which he has investigated without holding an be-required to use such form. inquest as if in each case an inquest had been held. (d) 'That medical practitioners should be required to send 5. Fee to Coroner for attendance at trial.-A Coroner attend- certificates of death to the registrar instead of handing them ing at any court before or at the opening thereof in pursuance to representatives of the deceased. SuPPrL15BNT To TUB MAY 27, 1.905;j MEDICO-POLITICAL COMMITTEE. [BRITISH MBDICAL JOURNAL -)2555 (e) That it should be made a penal offence to bury or other- Midwives Act of any provision as to the payment of medical wise dispose of a body without an order from the registrar practitioners under these conditions. etating the place and mode of disposal, which order, after it Before steps are taken in the name of the Association to has been acted upon, should be returned to the registrar who obtain whatever amendment of the law may be needful for the issued it. purpose, it appears to the Committee necessary that it should (f) That it should be made an offence to retain a dead body be in possession of the opinions of the Divisions of the unburied or otherwise legally disposed of beyond a period not Association on certain specifcquestions. exceeding eight days, except by permission of a magistrate. Assuming that public provision of some kind for the pay, (g) That the certificate should be endorsed by the burial ment of medical practitioners who assist midwives is neces- authority with the date of interment or disposal and the sary or desirable, two groups of proposals with this, object place where the body is buried, and returned to the registrar have come under the notice of the Medico-Political Committee by the burial authority. as having been made by persons who have given special (h) That when the medical practitioner is unable to certify, attention to the subject, and the Committee considers that be should be required to report direct to the coroner. these should be laid before the Divisions to assist them in Relations, friends, and others having cognizance of suspected judging how public provision could best bpmade. cases should also be required to report them to the coroner. (i) The first proposal is that the County Councils or (i) That every case of death after surgical operattons should Local Supervising Authorities should themselves under- be reported to the coroner with a view to preliminary inquiry take to arrange that there shall be in every district some and. if necessary, the holding of an inquest. doctor or doctors on whom midwives can rely to attend - ) That medical investigators should be appointed: when summoned, and that the County Councils should i. To inquire into causes of all uncertified deaths, make themselves responsible to such doctors for their assisted by qualified and responsible inquiry officers. remuneration. ii. To examine the body in all such cases, and make It is proposed that the County Councils, having paid post-mortem examination where necessary. the fees (or salaries, as the case might be) in the first iii. To report the result to the coroner sitting in instance, should recover from the patient, if able to sfford court, who will then decide as to necessity for holding it, or, in the case of persons unable to pay, from the Board formal inquest. of Guardians under some standing arrangement. iv. To give evidence at inquest and act as medical As to the mode of remuneration of the doctors it has adviser to the coroner. been proposed that this might be either. (k) That London should be divided into districts so arranged (a) by fee for each case according to a fixed scale; or as to give approximately equal amount of work, and that (b) by salary paid to those who undertake to act when coroners be paid by salary not dependent on the number of called upon, the salaries being readjusted from inquests held. time to time in accordance with the actual work (1) That franchise districts should be abolished. done. (m) That a court or courts should be provided for each dis- The reason is put forward in favour of the latter course, trict, with a, coroner, clerk, inquiry officers, and other that it would prevent any suspicion of collusion between necessary officials as in police courts. individual medical practitioners and individual mid- (n) That one or more medical investigators should be wives. attached to each court, and be paid by salary. (2) The alternativp proposal is to dispense with the (o) That the office of deputy-coroner should be abolished as intervention of the County Councils, the medical practi- unnecessary in London. tioner looking for payment directly to his patient, except (p) That inquests should be held and evidence taken by the in the case of those who may be suitable objects for medical coroners in all cases where the reports of the medical investi- relief, and with regard to these looking to the Board of gators show further inquiry to be necessary, and in all cases Gniardians. of violent or su;picious death. The question arises as to how the practitioner is to (q) That viewing the body by a jury should no longer be know, when attending, whether, if the patient should obligatory. prove unable to pay, the GuaTdians would recognize the (r) That the number of jurymen should be reduced to one- obligation. By the nature of the case the attendance half of the present number, ie., to not less than six or more will, as a rule, be a matter of urgency, and it is essential than eleven. that time should not be lost in obtaining an order from (s) That in cases involving subsequent criminal proceedings, the relievin-g officer, and in investigations by him as such as murder or manslaughter, or other criminal offence, to the suitability of the applicant for medical relief of the the coroner shall have full power to bind over all witnesses. kind. (t) That proper records of all cases dealt with by the court, It is suggested that this difficulty can be in great part -whether inquests be held or not, should be kept as records of overcome by the application of the " loan system," that the county. is, that the relieving officer should, without waiting for (u) That the court should have jurisdiction in cases where investigation, issue an "order on loan," the Guardians the body is lying in the district to which it is attached, recovering the fee from the patient if able to pay. except in-cases of accident, etc., where more than one death At present, the "loan system," as regards medical relief, has taken place, when the jurisdiction should be with the is only applicable to attendance by the Poor-law medical court for the district in which such accident, etc., occurred. officers, and for extension to other practitioners an altera- (v) * ** That coroners' juries should be summoned by rota. tion of the law would be required. If payments were made through the intervention of County Councils it might possibly be difficult for the Item 11 In Report.] local profession to determine the rates of payment, and it would probably be specially difficult for the profession to MEMORANDUM ON THE PAYMENT OF MEDITCAL control by united action the salaries paid under proposal PRACT[TIONERS CALLED IN TO ASSIST MIDWIVES. (i) b, if the Councils attempted to restrict the work in The Annual Representative Meeting instructed the Medico- each district to a few selected practitioners. Political Committee to take action to secure the amendment On the other hand, it might be easier under Scheme (2) of the law in order to provide just remuneration for medical for the profession, by local agreement arrived at tbrough practitioners when called to assist midwives in cases of danger the agency of the Divisions of the Association, to fix the or difficulty. scale of fees to be charged by medical practitionere when As a result of inquiries from the County Councils and calle-d in. County Borough Councils in England and Wales, the Com- The Medico-Political (Committee would ask each Division, mittee has ascertained that no local supervising authority after consideration of the foregoing Memorandum, to answer has taken any steps to make provision for such payment, and the following sp"cific questions: that (with the possible exception of one or two Councils who (X) Does the Division consider it, on the whole, desirable have special Acts of Parliament) the Supervising Authorities that any public provision made for the payment of medical Ihave, at present, no legal authority to make such payments. men;called in to assist midwives should, in the first instance, Therefore, as the law now stands, medical practitioners called cover every case, or should the public authority only-pay'in in by midwives can look only to their patients for payment. those cases in which the-patient is unable to pay? The Central Midwives Board have themselves drawn the (2) If payment in all cases is to be made in the first instance attention of the Privy Council to the omission from the by the Public Authority, should it be an absolute payment or 256 StFPL7MINT TO T6UE m BRITISH MEDICAL JOURNALj MEDICO-POLITICAL COMMITTEE. [MAY 27, 1905. should the fees be recoverable from those patients who can public provision of some kind should be made to remove afford to pay ? the difficulties at present existing, and the Association (3) Should the provision be made through the County would suggest that such provision ahould be made subject Council or Lrcal Supervising Authority or through the Poor to the following conditions: L3w Authorities ? i. Inasmuch as the calling in of a registered medical (4) If through the Poor Law, shnild attendance, in all cases, in cases of the kind under notice is not at the be given by the Poor-law District Medical Officer, or should it practitioner the midwife be left open for any medical man whom the patient desires, discretion of the patient, but is required of and who is willing to act, to be called in? under virtually a statutory regulation, public provision (5) What scale of fees would meet the necessities of the should be made to guarantee that the medical practitioner case? so called in will, in the first instance, be remunerated by The Committee would suggest that in answering these some local public authority. questions, the following aspects of the subject require con- 2. The public authority sahould have power to recover the sideration: fees so paid from those patients who on inquiry are found (a) The interest of the puerperal woman. to be able to pay. (b) The question of extension of pauperism. 3. The payment should be made through the County (c) The satisfaction of the individual practitioner. Council, or the local supervising authority, in preference (d) The interest of the medical profession. to the Poor-law authority. In addition to answers to the above specific questions, the 4. In each district a list should be prepared of all Committee would be glad to receive any information which medical who are williDg to undertake the each Division may be in a position to give as to the practical practitioners to each working of the Midlwives Act in the area of the Division. duty, and a copy of this list should be supplied For Abstract of R?plies of Divisions, see p. 257. midwife practising in the district. 5. It should be left to the patient to call in either the nearest practitioner or some other selected by her, through DRAFT M.EMORIAL. whatever authority the payment is made. MEMORANDUM of CONSIDERATIONS to be SUB- 6. Where a registered medical practitioner is called in MITTED tothe LORD PRESIDENTof HIS MAJESTY'S in case of emergency the fee paid should be not less than PRIVY COUNCIL concerning the PRESENT POSIEJON two guineas. of MEMBERS of the MEDICAL PROFESSION when called by MIDWIVES to their assistance in pursuance of the requirements of the MIDWIVES ACT, I902. Item 12 In Report.] BILL. THE British Medical Association begs leeve most respect- MEDICAL ACTS AMENDMENT fully to bring to the attention of the Lord President of the THz Medico-Political Committee in submitting the Medical Acts Privy Council, as the body appointed by Parliament to Amendment Bill for the consideration of the Divisions, prepara. control the administration of the Midwives Act, the follow- tory to an expression of opinion thereon by the Annual Repre- ing considerations with respect to the position in which sentative Meeting at Oxford, reported as follows: registered medical practitioners have been placed as the 1. That, as the result of the preliminary discussion of the draft Bill the Divisions, consequent upon the result of certain provisions of that Act. original by in 1903, Under Section 3 of the Act the Midwives Board is circulation of the Bill by order of the Council August, expressions of opinion were received by the Committee from appointed, and the duties and powers of the Board are 109 Divisions, prior to April 13th, when the Committee com- prescribed, among th ese being: menced the work of revision. Under Subclause i (e) of the Section to frame RulFs 2. That the Committee had given the most careful attention regulating supervising and restricting within due limits to the replies of the Divisions, and in revising the Bill had the practice of Midwives. adopted (a) those changes in the draft previously submitted Under Subclause I (f ) to frame Rules decidiDg the con- which had appeared to the Committee to be generally de- ditions under which midwives may be suspended from sired; (b) many valuable suggestions made by individual practice. And under Subsection 5 to decide upon the Divisions on points of detail. removal from the Roll of the name of any midwife for dis- 3. That the Committee had also taken into consideration, from time to time laid and in many instances adopted, amendments in the Bill which obeying the rules and regulations had been put forward by the British Dental Association. The down under this Act by the Central -Midwives Board, or circumstances in which such amendments received considera- for other misconduct, and also to decide upon the restora- tion from the Committee were stated in the proceedings of tion to the Roll of the name of any midwife so removed. the Committee, published in the SUPPLEMENT of the BRITISH The B.ard hat accordingly framed Rales under Seetion MEDICAL JOURNAL of May 7th, 1904 (pp. 108 and 109). 3, and these Rules have been approved by the Privy 4. That the Bill as amended by the Committee had been Council, and have thereby become valid in accordance submitted to an expert Parliamentary draftsman and by him with the provisions of the Act. recast into its present form. Among the Rules so approved is Rule I7, which provides 5. That the Committee was of opinion that in a matter of that in certain specified circumstances a midwife must such consequence to the medical profession as an extensive decline to attend alone, and must advise that a registered amendment of the Medical Acts it was highly desirable that no measure should be laid before Parliament by the British medical practitioner must be sent for. Medical Association until time had been allowed for all the It results from tbe operation of these Rules that medical detail of to assistance consideration necessary not only to perfect every practitioners are called upon frequently give the proposals made, but also to secure the greatest attainable to midwives in cases which from their nature are, as a rule, agreement in the profession. cases of urgency, and in whicb, therefore, there is no time 6. That the Committee therefore recommended to the either for inquiry as to the ability of the patient to pay for Representative Meeting that after matters of principle had the services thus rendered or for obtaining from a relieving been determined by the approaching meeting at Oxford, the officer an order for relief under the Poor Law. It would Bill should be referred back to the Committee for further appear, moreover, that if such provision were made under consideration of details and points of drafting, and submitted the Poor Law, in the present state of the law, only the again to the Divisions with a view to final consideration and Poor-law Medical Officer for the district could be sum- adoption, if approved, by the Annual Representative Meeting of the case of 1905. moned, whereas the exigencies may require 7. That if the Divisions approved the foregoing recom- that the nearest medical practitioner should be summoned, mendation they might find it sufficient at that stage to give or it may be thougbt proper tbat, if time permits, patients such consideration to the Bill as would prepare the way for own medical in such cases should be allowed to select their a decision of the principles thereof. attendant3 for the purpose. 8. That the Comnmittee, for the assistance of Divisions in The British Medical Association having given careful considering the Bill, had authorized the preparation of the consideration to the matter, would most respectfully Memoranda presented herewith, (I) to explain the principles suggest for the consideration of the Privy Council that on which the Bill was based, (II) to explain the principal gurpl.rmmff To -MN MA'f 27, MEDICO-POLITICAL COMMITTEE. [BRI'mon U=ic&t, JOUR--4.&L 257 1905.1 MAY27,1905.]MEDICO-POLITICALCOMMITTEE.257~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~-- IteminRepiort.] MIDWIVES ACT. PAYMENT OF MEDICAL PRACTITIONER3 CALLED TO ASSIST MIDWIVES. Ab8tract of the Rsplime of Divi8ion to the Inquiries of the Committme Up to the date of the preparation of the present Report (April, I905) 79 Divisions have communicated to the Committee their opinions upon some or all of the questions submitted.

Question Submitted. Replies of Divisions. No.

I. Does the Division consider it, on the whole, desirable Payment in every case ...... 57 that any public provision made for the payment of Payment only if patient unable ...... 12 medical men called in to assist midwives should, in the first instance, cover every case, or should the Public Authority only pay in those cases in which the patient is unable to pay?

2, If payment in all cases is to be made in the first Fees should be recoverable ... instance by the Public Authority, should it be an absolute Payment should be absolute ...... 8 payment or should the fees be recoverable from those patients who can afford to pay?

3. Should the provision be made through the County Provision through County Council ... .. 12) Council or Local Supervising Authority or through the Provision through County Council or Local Supervising 53 Poor-law Authorities? Authority ... 20 Provision through Local Supervising Authority ... Z Provision through Poor-law Authorities ...... '3

4. If through the Poor Law, should attendance. in all It should be left open ...... 51 cases. be given by the Poor-law District Medical Officer, or By Poor-law Medical Officers only...... x should it be left open for any medical man whom the patient desires, and who is willing to act, to be called in ?

5. What scale of fees would meet the necessities of the Poor-law Scale...... 7 case? Poor-law Scale and 3s. 6d. for day and 78. for night visits 2 Poor-law Scale and mileage ...... 2 Minimum i guinea ...... 18 /2 or 2 guineas per case ...... 9 2 guineas and mileage .. - ...... 2 Minimum Q2 or 2 guineas ...... 4 Stratford Division Scale ...... 14 Poor law Scale inadequate ...... Central Midwives Board Scale (modified) ...... Local Government Board Scale for operations, after- attendance Ss. per visit ...... On a liberal scale, to cover increased cost of septicaemia I

Six Divisions express opinions which cannot be classified with respect to the questions su-bmitted by the Committee. Of these: One Division regards statutory provision for the payment of medical men as undesirable, and proposes the following alternative: That when a registered midwife is engaged to attend a woman in her labour, it shall be her duty to see that the patient makes arangement with a medical practitioner to the effect that in the event of the labour becoming abnormal he will attend, and also that the midwife shall enter into her engagement book the name of the medical practitioner selected. Failure to comply with this rule, or for the midwife to advise or recommend that any particular practitioner be selected, shall be a misdemeanour. One Division considers the existing Poor-law arrangements sufficient. One Division considers that the suggestions in the memorandum of the Committee would lead to abuse, no public provision being necessary. One Division considers the suggestions in the memorandum impracticable. Two Divisions state that in their view no action is necessary.

A few Divisions, in response to the request of the Committee for information as to the general working of the Act, have forwarded valuable reports, which have been filed for reference when occasion requires. £ ~ 8UPPLYMMTtsrr T8O TH 1 - [MAY 27, 1905. 25P ISRIWItgj:tIRPRt MEnicLalXJ)lk;&1U OVUAAALJJOURNAL1 MEDICO-POLITICAL COMMITTEE. - = points of difference between the Bill as submitted to the the division of the work of registration; (b) that apart from regis- tration no duties devolve Branch Councils whigh could not be Divisions in August, 1903, last, and as then submitted. upon under the con- performed equally well by the Committees proposed The Annual Representative Meeting, at Oxfotd, upon Bill. aideration of the foregoing Report, and of the Bill and accom- of the and panying Memorandum, resolved as follows:- 2. To simplify the financial arrangements Council, thus also promote economy in administration. Minute 69.-That the Medical Acts Amendment Bill, as to a whole, be referred -to the Divisions. 3. To give statutory powers to the Council provide pensions or contribute to funds for its officers. (Section Minute 70.-That it be an instruction to the Medico-Political superannuation kind of Committee that an Epitome of the principles of the Medical 6 is so drawn as to enable the Council to adopt any Acts (Amendment) Bill be included among the documents superannuation scheme which may be found suitable.) ssent to the Divisions, with a request that. the Divisions will vote upon those principles. D.-REGISTRATION (PART III). The of this Part fall under two principal heads:- An Epitome of the principles of the Bill has accordingly been provisions the medical and prepared, and is now submitted to the Divisions, together with (1) affecting the students' registers; (2) affecting the Bill, and the following Explanatory Memorandum as pre- dentists' registers. 1. The statutory creation of a students' register under the abso- viously submitted. lute control -of the Council is provided for. The necessity for such a register has long been recognised by EXPLANATORY MEMORANDUM. the General Medical Council, but the efforts of the Council to I.-PRINCIPLES OF THE BILL. establish it have been thwarted by the determination of the A.-GENERAL REMARKS. English Royal Colleges to maintain against the Council what they 1. Purpose and Form of the Bill.-The Bill being framed for conceive to be the privileges conferred upon them by their the amendment of the Medical Acts, is drafted in such form as charters. to be construed with those Acts. From this principle of con- The sections relative to the students' register would further (a) struction it follows: confer upon the Council definite control over preliminary examina- (a) That it is not proposed to repeal any of the Medical Acts tions, thus securing a uniformity of standard in this most im- except so far as may be naecefsary to bring these Acts into agree- portant matter; (b) fix the age of commencing medical study at ment with the Bill: seventeen as a minimum, in accordance with the opinion already (b) That provisions which are contained in the Acts are not expressed by the British Medical Association. repeated in the Bill except when needful for clearness, as, for 2. With reference to the medical and dentists' registers it is example, certain provisions as to nomination of members of the provided in this Part: General Council by the Crown. (a) That registration should be annual, the object being to keep (G) That terms, such -as "the General Council," which are the register correct and to facilitate the detection of unregistered defined in the Acts, are used in the same sense in the Bill, without practitioners, especially of those who personate registered prac- further definition. titioners. of a 2. Provisions as to Dentists.-In the Bill the precedents of the (b) That an annual fee of one pound should be paid instead Medical Acts of 1858 and 1886, which included provisions affecting single payment of five pounds, the object being to raise the income both the medical and dental professions, have been followed, in of the Council to an adequate amount. preference to that of the Dentists' Act, 1878, which affected one The necessity for this proposal is shown by the following con- profession only. If this principle receives the approval of the siderations: British Medical Association, as it has that of the British Dental (i) The present income of the General Medical Council is in- Association, and if it is sanctioned by Parliament, the legislation sufficient for its present expenditure, and even under the affecting the constitution, duties, and powers of the General existing law the work of the Council is crippled by want Medical Council will be brought into more convenient form for of funds. practical purposes. (ii) The provisions of the Bill as to the increase of direct 3. Arrangement of the Bill.-The Bill is divided, for con- representation, as to the conduct of final examinations venienoe of reference, into Parts, each of which relates to a by the Council (the "one-portal system"), and as to the definite group of reforms. In each of the following Sections of prohibition of unqualified practice, making it the duty this Memorandum one Part of the Bill is dealt with. of the Council to protect the profession and the public by enforcing the penal clauses (Part V), will entail B.-CONSTITUTION OF THB GENERAL COUNCIL (PART I.). considerable increase of expenditure. Such expenditure The principles underlying this Part of the Bill are: will be in the interest of the profession as well as of 1. That the representation of the Crown on the Council should the public, and the only funds out of which it can be remain unaltered. defrayed are those derived from medical and dental 2. That those existing universities which have medical faculties registration fees. should be 'represented on the Council, and that, as such repre- (c) The privileges conferred by registration upon medical and sentatives sit on the Council primarily as educational experts to dental practitioners in respect of their practice are clearly defined, ,.dvise the Council in its duty of controlling medical education and the anomalies and injustice of the existing law being removed. examinations, each university should be permitted to appoint its Among the privileges of medical registration it is proposed to representative in such manner as it may deem most expedient. include the to use the of "doctor" as a prefix to the That as the medical with one right style 3. inasmuch corporations, excep- name, thus recognizing by statute the customary usage of the +ion, are not- educational bodies, and no longer discharge those public in reference to medical practitioners, and doing away with functions on behalf of the medical profession for which their distinctions which the great differences in status of nominally charters were originally conferred, they should not be represented examinations have rendered arbitrary and unjust. en the Council on- an equality with the universities, but that their equal qualifying ,historic positions should be recognised by representation in a reduced degree. E.-EXAMNATIONS (PART IV). 4. That the direct representation of the medical profession The principal changes in this Part of the Bill are: ahould equal that of all the bodies above named, anT that, to 1. The institution of the "one-portal" system for admission secure adequate representation of every part of the United to both the medical and dentists' registers, by means of final Kingdom, a topographical method of election should be adopted. (State) examinations under the absolute control and sole manage- 5. That the principle of direct representation on the Council ment of the Council. ehould be extended to the dental profession. 2. Definite statutory provision for complete control by the Other amendments have been included in this part which are Council of the medical curriculum, beginning with the preliminary oonsequential on the foregoing or will simplify the procedure of examination, and for the effective supervision and control of the election. intermediate examination, subject only to a possible appeal by Statutory provision is proposed for the election of a Vice- examining bodies to the Privy Council. President of the Council. F.-OFFENCES (PART V). C.-BRANCH COUNCILS AND FINANCE (PART II). under the heads of those The objects of this Part of the Bill are: The provisions of this Part fall (1) 1. To .simplify the administration of the Council, and reduce affecting registered persons, whether students or practitioners, (2) expenditure by doing away with the cumbrous machinery con- those affecting unregistered persons. "sequent upon the Branch Council system provided by the Act of (1) As regards offences by registered persons: 1858. Experience has shown (a) that no. advantage results from (a) It is sought under Sections 21 and 22 to extend or ime M 5Pur1- YTH.U 2 5 MAT 27, i9o0.1 MEDICO-POLMCrAL COMMITTEE. BI TISH MEDICAL JOuA!uL J

prove the powers and procedure of the General Council the mode of appointment of representatives of universities and in certain matters, the importance of which has been corporations. shown by experience. These matters are: 2. In accordance with the opinions expressed by many Divisions, a topographical system of election of direct (i) That the Council be enabled to inflict minor penal- (medical) representa- tives is proposed, and a draft schedule of electoral areas is sub- ties, and therefore to adjust penalties to offences. mitted for consideration. (ii) That the Council should be able to compel 3. The Committee recommends that in the larger Coumcil now attendance of witnesses, to take evidence on oath, proposed the dental profession should be accorded three direct and to award costs. representatives. (iii) That removal from the register should involve under penalties, disuse of medical degrees (includ- C.-BRANCH COUNCILS AND FIANcE (PART II). ing diplomas, etc.) The proposals under these heads formerly submitted received the general approval of the Divisions. advice the (b) In view of the creation of a statutory students' register On the df students are brought within the disciplinary powers draftsman the abolition of the Branch Councils has been carried the Council. out in the present draft in form, as it was in the previous draft for certain for (c) Section 27, which prohibits certain acts of registered in substance, except advisory functions whicb

practitioners, is directed against abuses which tend Committees are now proposed to be constituted. facilitate practice by unregistered persons. D.-REGISTRATION (PART III). (2) Other sections of this part are designed for the more effectual 1.-Registration of. students.-The provisions relative to the protection of the public and the profession against various registration of students, contained in Part II of the former draft, of unqualified practice, Section (23) definitely prohibitixig having been generally approved, have undergone no change of or dental treatment for gain, and also habitual medical or dental substance, except that of incorporating therein (a) the principle practice, Section (24) dealing with invalid certificates, Section approved by the Association, that medical study shall not com- with bogus "diplomas," and Section (26) with the objectionable mence before the age of 17 years, and (b) the provision that the use by traders of the names of medical or dental practitioners, name of a student who has ceased medical study ghall be removed while Section (30) provides against the growing abuses of company from the register, subject to provision for reinstatement. practice. 2. Provisions as to annual registration.-Exception has been Sections 23 and 25 are to be read in connexion with taken by many Divisions to different aspects of these proposals, definition clauses in Section 31 (Part VI). but the majority of Divisions have approved the principle of In Part VI, Section 34, the "second schedule" is referred to. annual registration and also the principle of an annual fee. A It has been thought desirable to defer the preparation consensus of opinion has been shown in favour of allowing a longer schedule, which is a highly technical matter, until the principles period for the payment of the fee, and of facilitating restoration of the Bill have b-een definitely decided by the Representative to the register of names removed through illness or inadvertence. Meeting. Provisions to meet these requirements are contained in the draft now submitted. II.-COMPARISON OF THE BILL AS NOW SUBMITTED 3. Privileges of registration.-Many Divisions have pointed out WITH THE DRAFT SUBMITTED TO' THE that no provision is made for any recognised title.to be conferred DIVISIONS IN AUGUST, 1903. on those passing the State medical examination, and several Divisions have proposed that the title "doctor" should be IN THE BILL AS A A.-CHIANGES WHOLE. accorded to all registered practitioners. The Committee recom- 1. Changes in Form.-In respect of form the Bill has mends that this proposal be adopted, and Section 13, Sub- entirely revised, and made more simple and concise in section (3) is inserted for the purpose. While this hasnecessitated some rearrangement of the Parts, the general order of the Bill has been preserved as far as E.-EXAMINATIONS (PART IV). Provisions as to Branch Councils, formerly contained in PartI. The provisions of this Part, which corresponds generally II have been consolidated with the former Part V to form Part with Part III of the former draft, have received.general approval of the present draft. Part II of the former draft concerning from the Divisions. The.principal changes made are: students' registration, together with Part IV, concerning the 1. Curriculum.-The omission,to which certain Divisions drew system of annual registration, together form Part III of attention, of any specific provision giving the Council control present draft. The other Parts retain their former order, over the medical curriculum, has been remedied (Section 19). are renumbered. 2. Assistant Examiners.-Objection having, been taken by some 2. Dentists' Amendments.-The incorporation in the Bill Divisions to the clauses relative to the appointment and remunera- amendments of the Dentists' Act has occasioned consequential tion of assistant examiners, the Committee -has withdrawn the changes in every Part, except Part II. proposal that such examiners should be paid by the examining body whom they are appointed to assist, and now recommends B.-CHANGES MADE IN THE SEVERAL PARTS OF THE: BILL. that they should be paid, if at all, by the Council. CONSTITUTION OF THE BILL (PARTI.) 3. State Examinations.-The section relative to the State 1. Objections raised by many Divisions to the suggested medical examination (in which provision is also made now for grouping of Universities, and to the plural voting resulting State dental examinations) has been made more general in terms, from the system proposed in the former draft for electing the more detailed regulations being left to the Council. sity and corporate representatives, have been very carefully F.-OFFENCES (PART V). sidered by the Committee. The important clauses contained in this Part, which corresponds The purpose of the former proposal was to reduce the size to Part VI of the former draft, have received the most careful the Council simultaneously with an increase in the ratio consideration from the Committee, from the Solicitor of the representatives to other members of the Council. Association, and from Counsel, who has redrafted the Bill. As To abandon the grouping of universities while maintaining affecting the dental profession, they have also been considered'by relative strength of the direct representatives involves the the legal adviser of the British Dental Association, by whom of a numerically large Council. Full consideration, however, valuable practical suggestions have been made. The previous the greatly increased duties which would devolve upon the draft having been generally.approved by the Divisions (exceptais under the Bill leads the Committee to conclude that the Council, regards the former Clause 34), the changes made. will be found to as now proposed to be constituted, would not have many be mainly of a drafting nature, devised more effectively to secure members for the work to be done, in Committees and the objects of this part of the Bill. The Committee therefore has modified its former recommendation The changes of substance are: on this point as regards the universities, but, for reasons 1. In Section 25, corresponding with former Clause 29, provision in the former part of this Memorandum, still recommends has been inserted to exempt recognised universities from the grouping of Corporations. operation of the Section, the object of which is to prevent the The Committee recognises also that the opinion of the issue of bogus diplomas. tion, as expressed by the Divisions, is unfavourable 2. In Section 27, corresponding with former Clause 24, to which posal that each existing medical practitioner should vote (a) in its previous form exception was taken a number of registered in the election of a direct by large practitioner representative, Divisions, words have been inserted to meet the chief objectio'ns and also (b) as a graduate or diplomate in the election of a sentative or representatives of any body or bodies whose raised, namely: or diploma he may hold. The Committee recommends (a) The clause will no longer apply to a locum tenen or direct representation of all registered practitioners should he assistant, acting as such for a shorter period thanOhree maintained, and that no provision be made in the Bill months. 260 SUJrPLEMENT TO THU 1 P,M. -~~~~~~~~MDC-OIIABITSH MEDICAL JouIALI mmico-powuuLcommmCO[ErE- [MAY 2727, 1905-95 (b) Charitible institutions are exempted. 2. That the granting of bogus diplomas be constituted an 3. The important Section 30, to prevent medical or dental offence. practice by companies, has been inserted. 3. That the signing of medical certificates by unregistered persons be made an offence. G.-SUPPLEMENTARY PROVISIONS (PART VI). 4. That the improper use of the names of registered prac- No changes have been made in this Part which appear to require titioners in connection with the sale of drugs, appliances, etc., comment in this Memorandum. be made an offence. 5. That medical or dental practice by companies be prohibited. EPITOME OF THE PRINCIPLES OF THE BILL. (III) RECOMMENDATION AS TO PROCEDURE. (I) INTRODUCTORY. The Medico-Political Committee would suggest that the The Bill proposes reforms: Divisions should, categorically, express approval or disapproval (A) In the composition and mode of election of the General of each of the propositions stated. Medical Council. With regard to the provisional scheduile of electoral areas, (B) In the administrative arrangements of the Council. each Division should make any suggestion it thinks fit (C) In the control of education by the Council. regarding its own district. (D) In the registratioin of medical and dental practitioners. (E) In the disciplinary powers of the General Medical (DRAFT) MEDICAL ACTS AMENDMENT BILL. Council. ARRANGEMENT OF SECTIONS. (F) In the legal position of the practice of medicine and PART I.-Constitution of the General Council. surgery by unqualified persons, and the rights of SecticDn. 1. Members of General Council. registered practitioners. 2. Tenure of office of members of General Council. (II) IT IS PROPOSED AS REGARDS: 3. Regulations for election of direct representatives. (A) Composition and Mode of Election ofthe Council. 4. Election of Vice-President of General Council. 1. That the direct representation of registered medical and PART II.-Branch Councils and Finance. dental practitioners on the Council be increa.9ed so that direct 5. Abolition of Branch Councils. representatives compose at least half the Council. 6. Power to pension officers of Council. 2. That the direct medical representatives be elected by con- PART III.-Registration. stituencies topographically defined, each constituency electing 7. Registrar to be a medical practitioner. one representative. 8. Provision of a students' register. 3. That those universities which have medical, faculties 9. Examinations to be confined to registered students. continue to be represented on the Council by oine representa- 10. Removal of student's name who has ceased to study. tive each, elected in stich manner as eachl body may determine. 11. Regulations for annual registration. 4. That the Liceusing Corporations be grouped to form three 12. Provisions for certified copies of dentists' register. constituencies, one for England and Wales, one for Scotland 13. Privileges of registered practitioners. and one for Ireland, each constituency electiing one represen- PART IV.-Examinations. tative. 14. Passing of examinations requisite for admission to register. (B) Administrative Arrangements of the Council. 15. Provisions as to registration of persons passing examina- 1. That the Branch Councils be replaced as regards some of tions. their functions by Committees of the Couincil. 16. Provisions as to intermediate examinations. 2. That the financial admirnistration be consolidated by 17. Control by Council of intermediate examinations. transference to the Central Office of the Council. 18. Provision for defects in intermediate examinations. 19. General Council to prescribe courses of study. (C) Control of Edetcation. 20. State medical and dental examinations. 1. That the Council have comiplete control over the standar(d of preliminary general education andI over the medical PART V.-Offences. 21. Removal of name from register. curriculum. 22. Procedure and powers of General Ccuncil on an in- 2. That the registration of students be placed under the quiry. direct control of the Counicil. 23. Prohibition of practice by unregistered persons. 3. That the minimum age of registration of students be 17. 24. Prohibition of unregistered person signing certificate. 4. That the intermediate examinatioin remain in the hands 25. Penalty for granting unrecognized degrees. of the universities or corporations uaider the supervision of the 26. Prohibition of improper use of name of registered prac- CounciL titioner. 27. Prohibition of certain acts of registered practitioners. (D) Registration of Medical and Dental Practitioners. 28. Application of penalties. 1. That there be a one, portal system of admission to the 29. As to prosecutions. Register, through a State final examination controlled and 30. Provision against offences by companies. managed by the Couincil. PART VI.-Supplementary Provisions. 2. That registration be annual. 31. Definitions. 3. That there be an annual registration fee of £1. 32. Exception for foreign practitioners. 4. That the privileges conferred by registration be clearly 33. Saving for midwives. detined. 34. Repeals and amendments. 5. That one privilege of registration as a medical practitioner 35. Short title and construction. be the right to use the prefix Dr. A BILL to amend the Medical Acts and to further regulate the practice of Medicine, Surgery, Midwifery, and Dentistry. (E) Disciplinary Powers of the Council. BE IT ENACTED by the King's Most Excellent Majesty by and 1. That the Council have power to suspend a practitioner with the advice and consent of the Lords Spiritual and Temporal without absolutely zenioving his name from the register. and Commons in this present Parliament assembled and by the 2. That the disciplinary powers be extended to include authority of the same as follows:- Medical and Dental Students. PART I.-CONSTITUTION OF THE GENERAL COUNCIL. 3. That the procedure be made more effective by increasing 1. Members of General Council.-(1) The General Council shall ,the powers of the Council in respect of witnesses, and in other consist of the following members: ways. (a) Five members nominated from time to time by His Majesty with the advice of His Privy Council three of (F) (7nqualt/ed Medical or Dental Practice and Protection of whom shall be nominated for England and Wales one for Reqistered Practitioners. Scotland and one for Ireland. 1. That the habitua.l practice of miedicine or dentistry for (b) One member chosen from time to time by each of the gain by unregistered persons be definitely prohibited. following bodies: [ St'P TUMYF-T TO THN 261 MAY 27, 1905.1 MEDICO-POLITICAL COMMITTEE. L1BRiTI.H NMF.DICkL JOURNAL

The University of Oxford. representative provide for an election of a new direct representa- The University of Cambridge. tive for the vacant place. The University of London. (4) The election of the direct representatives shall be conducted The University of Durham. in such manner as may be provided by regulations to be made The Victoria University of Manchester. by the General Council with the sanction of the Privy Council The University of Birmingham. provided as follows: The University of Liverpool. (a) The nomination shall be in writing and the nomination The University of Edinburgh. paper of each candidate shall be signed by not fewer than The University of Glasgow. twelve persons entitled to vote in his election. The University of Aberdeen. (b) If more than one candidate shall be nominated for a The University of St. Andrews. vacancy a poll shall be taken by voting papers and the The University of Dublin. registrar shall send a voting paper to each person entitled The Royal University of Jreland. to vote at his registered address but the accidental 4e) One member chosen from time to time omission to send a voting paper in any particular case followving groups of medical bodies: shall not avoid the election and any person entitled to (i) The Royal College of Physicians of vote to whom a voting paper has not been sent in pur- College of Surgeons of England and the Apothecaries suance of this Act may on application to the registrar Society of London. obtain one from him. (ii) The Royal College of Physicians (c) In the election of dental representatives each person Royal College of Surgeons of Edinburgh and entitled to vote may vote for any number of candidates Faculty of Physicians and Surgeons Glasgow. not exceeding the number of vacancies but not more than (iii) The Royal College of Physicians one vote may be given to any one candidate. Royal College of Surgeons in Ireland (d) In the case of an equality of votes on any poll the President of the General Council shall be entitled to a

of the fetter addressed to the President Council. register by the registrar of a Branch Council shall be (4) If any member shall be found by made in the general register by the registrar of the and Wales or Ireland to be lunatic or General Council. Scotland to be insane or shall become (4) All property of the Branch Councils shall pass to and vest thereupon be vacant. in the General Council and all debts and liabilities of the (5) If the place of any member of the General Council Branch Councils shall become debts and liabilities of the some other person shall be elected or appointed General Council. of a direct representative that other person shall (5) The officers and servants of the Branch Councils shall only for the remainder of the term for which become officers and servants of the GeneralCouncil. place is vacant waselected provided that (6) The members of the General Council elected or appointed time when not more than twelve months from or for Scotland and Ireland respectively shall form term for which the direct representative committees to which the General Council shall refer such was elected an election shall not be held matters specially affecting Scotland or Ireland as the that term. General Council may thinkfit. (6) The powers of the General Council 6.Power to pension olficers of Council.-The General Council the happening of any vacancy. may award to any registrar or other officer on his retirement from such pension or gratuity as the General Council 3. Regulations for election of direct representatives.-(1) office having just. direct representatives other than the dental regard to his services may think

be elected each for one of the electoral areas PART practitioners III.-REGISTRATION. schedule to this Act by the medical not resident in that area. 'I. Registrar to be a medical practitioner.-A person shwll (2) It shall be lawful for the General be qualited to be appointed registrar of the General Council unless be a registered practitioner provided that this section sanction of the Privy Council to alter the he shall shall not affect the tenure of office of a registrar before the event of an increase in the number of appointed the commencement of this Act. to increase the number of electoral areas and provision for the election of the additional s. Provision of a students' register.-(l) The registrar shall keep

(3) The registrar of the General Council shall a register of medical and dental students insa;methe manner and officer for the election of direct representatives on the same conditions as nearly as may be as the registers of less than twenty-eight days nor more than medical and dental practitioners and shall enter therein the name the expiration of each period of five years of every person who shall- representatives are elected provide for another (a) have passed a preliminary examination approved or held representatives. The registrar shall also by the General Council; mnay be after the occurrence of any vacancy (b) bee not less than seventeen years of age; 26.2 SU-PPf,'r,MrNT TO THE M EDICO-POLITICAL COMMITTEF. FMA,y 27, 1190.5- BRI-4!,LM MEDICAL JOURNAL] C a unless he has a final-examination Act .. (c) have paid to the General Council fee of one pound. practitioner passed (in this (2) The register shall be in two parts one for medical students called the " state dental examination "). and-one for dental students and shall show the place and date of (2) Any person who shall produce to the registrar on an appli- bir.th of each student, the place where he proposes to; study and cation for registration as a medical practitioner such evidence of the nature-of the preliminary examination passed by him. his having passed the state medical examination or on an appli- (3) The registrar shall at any time upon the request in writing of cation for registration as a dental practitioner of having passed any student and on payment of such fee not exceeding one pound the state dental examination and in either case such evidence of as the General Council may prescribe transfer his name from one identity as the General Council may require shall on payment part of the register to the cther pa-rt. of a fee of one pound be entitled to be registered as a medical or dental practitioner as the case may be. 9. Examinations to be con fned to registered studenfx.-(t) After' 15. Provisions as to rei8stration o( persons pamsn examina- the thirty-first day of December one thousand nine hundred and tion.-(1) The medical and dentists registers shall in the case no person shall be admitted to an intermediate examination of a person registered under the last preceding section show the hereinafter provided for unle6s he is registered as a medical fact that the practitioner has passed the state medical examina- atudent. tion or state dental examination as the case may be and shall also (2) After the thirty-first day of December one thousand nine show any medical degree granted to -the practitioner by any hundred and no person shall be admitted to the state recognized university or medical body. dental examination hereinafter provided for unl-ess he is regis- (2) The registrar may require the production of such evidence tered as a dental student. and the payment of such fee as the General Council may prescribe (3) The General Council shall have power if after due inquiry before entering any such medical degree on the register. ssufficient cause be shown to antedate the registration of any 16. Provisions as to intermediate examinations.-(1) The inter- student. mediate examination shall be an examination in such subjects as .10. Removal of student's name ho hus ceased to study.- the General Council may prescribe and may be held by any (1) The General Council may remove from the register the name recognised university or medical body. of any student who has in the opinion of the Council-ceased for (2) Any body by this section authorised to hold an examination a period of not less than. five years to pursue a course of pro- may combine with any other such body situate in the same part fessional study. of the United Kingdom for holding a joint examination. (2) The General Council may restore to, the register any name (3) If in the opinion of the General Council an insufficient so. removed on the payment of a further registration fee of one number of intermediate examinations shall have been held in any pound. part of the United Kingdom before the first day of November in I11. Regulations for annual regi8tration.-(1) Every registered any year the Council may hold an intermediate examination. medical or dental shall on or before 17. Control by Council of intermediate examinations.-As to practitioner the thirty-first examination held after the day of day of December in each year send tQ the registrar an appli- any intermediate thirty-first cation for continuance of the entry of his name on the medical December one thousand nine hundred and five- or dentists' register for the ensuing year together with a fee )f (1) The General Council may give such directions as it maJ one pound and the registrar shall thereupon cause the applicant's think fit as to the standard of proficiency to be required nanme to be entered on the register for the ensuing year and thereat and generally as to the conduct thereof and the shall send to him a certificate of registration. examining body shall conform to any direction so give& (2) The registrar shall on or before the tenth day of November notwithstanding any special privilege or exemption con- ineach year send.to every registered medical or dental practitioner tained in any Act of Parliament or Charter. a form of application for registration and a notice requesting (2) The General Council may appoint examiners with or with- payment of the registration fee and containing a warning to the out remuneration to act with the examiners appointed by effect that if it be not paid aid application made for continuance the examining body, provided that no member of the of the entry of the name before the first day of March next the General Council shall be appointed examiner at a remu- name of the registered practitioner in default will. be removed neration. from the. medical or dentists' register of that year and the registrar shaU remove the name of a practitioner in default 18. Provision for defects in intermediate examinations.-(1> accordingly. The General Council may at any time on the report of an (3) A medical or dental practitioner registered. before the examiner appointed by them by resolution declare that the passing of this Act shall not be affected by the provisions of this standard of proficiency required by an examining body at aD section until five years from the passing of this Act- and this intermediate examination is insufficient and thereupon unless the section shall not apply to any so as he examining body shall within three months of the date of the practitioner long hold's a an to the Council the examina- commission in His Majesty's navy or army and is not engaged resolution present appeal Privy in private practice within the United tions of that body shall on the expiration of those three months Kingdom. cease to rank as examinations for the purposes (4) The registrar shall at any time restore to the medical or intermediate dentists' register the name of any practitioner which has been this Act. removed under this section in consequence of his absence from (2) On an appeal under this section by an examining body the the United Kingdom, illness, or Privy Council may after giving the General Council an oppor- satisfactory proof being given inadvertence,of the identity ofotherwise,the applicantupon tunity of being heard report to His Majesty as to the standard and on the payment of the registration fees in arrear. of proficiency required at the examinations of that body and 12. thereupon it shall be lawful for His Majesty by Order in Councii Provi,8ion for certified copies of dentists' register.-If the to direct that the examinations of that body either shall or shall name of any dental practitionert does not appear in the copy of the dentists' register printed under the direction of the General not continue to rank as intermediate examinations for the pur Council, a certified under the poses of this Act. copy hand of the registrar of the General Council to courses of The entry of the name of that practitioner on the-dentists' register 19. prescribe tudy.-(l) shall be evidence that he is under the Dentists General Council shall prescribe such courses of study as they 1878. registered Act, think proper as qualifications for admission to the state examina7 tions and shall have power to make regulations with respect to 13.-Privileges of registered practitioners.-(1)Subject to the the nature and periods of such courses of study, to the oider in provisions of this Act no other than, a titioner person registered prac- which they shall be undertaken, whether before or after the shall practise medicine surgery midwifery or dentistry and to the where be or any branch thereof and for intermediate examination, places they shell habitually gain in the United undertaken,.provided that no recognition shall be given to any Kingdom. course of student before the of dental are study pursued by any entry his (2) Registered practitioners who not also registered name on, the students' medical practitioners, shall be limited to the of register. A practice dentistry. (2) The General Council shall have power for the purposes of (3) registered medical practitioner may use the style of to with or without doctor as a to his name. this section; appoint inspectors remuneration prefix to visit any medical or dental school or hospital, provided that no member of the General Council shall be appointed impector P?ART IV.-EXAMINATIONS. at a remuneration. 14. Pasing of examinationsrequisite for adminsion to register. 20. State medical and dental examination.-(1) The state -(1) After the thirty-first day of December one thousand nine medical examination shall be an examination held by the General hundred and no person shall be registered as a medical Council for the purpose of testing the fitness of persons to praetise practitioner, unless he has passed an intermediate examination in. medicine surgery and midwifery and any branch thereof. and also a final examination (in this Act called the "state medical (2) No candidate shall be admitted to the state medical oxamination ") and no person shall be registered as.a diental exanmination unless he shall have produced satisfactory evideaem [ RurIrEtEwT TI)O ¶TU M*Y 27, 1905.] MEDICO-POLITICAL COMMITEE. BRITISH MEDICAL JOURNAL 263

a to the General Council of having completed courses of study the Ulnited Kingdom and also may order that a writ of prescribed by the General Council and of having passed an inter- habeas corpus ad testificandum shall issue to bring up mediate examination and also shall have paid such fee as the a prisoner for examination before the General Council; General Council may prescribe. (4) The General Council may administer oaths to or take the (3) The state dental examination shall be an examination held affirmations of witnesses; by the General Council for the purpose of testing the fitness of (5) The General Council may assess the costs of the inquiry persons to practise dentistry and any branch thereof. and if they think fit may direct payment thereof either (4) 'No candidate shall be admitted to the state dental examina- by the person whose same is in question or by any com- tion unless he shall have produced satisfactory evidence to the plainant and the person directed to pay the costs shall General Council of having completed courses of study prescribed pay the same to the General Council or as they may by-the General Council and also shall have paid such fee as thf direct accordingly; General Council may prescribe. (6) A certificate under the seal of the General Council that a (5) The state medical examination and the state dental examina- sum is owing by any person for costs under this section Ition shall each be held once at least in the year one thousand shall he conclusive evidence of the fact. sine hundred and and every succeeding year in London 23. Prohibition of practice by unregistered persons.-Any per- Edinburgh Dublin and such other places (if any) as the General son other than a registered medical or dental practitioner who- Council may think fit. (1) applies any medical or dental treatment to any person (6) The written questions in any one state examination shall without the supervision of a registered medical or dental be identical and set simultaneously in every place of examination, practitioner and demands or receives any valuable con- but such part (if any) of an examination as may consist of oral sideration for such treatment whether by way of questions may be held at the different places of examination either remuneration gratuity or otherwise or in succession or simultaneously. (2) holds himself out as practising or competent to practi3e (7) Subject to the provisions of this Act the General Council medicine surgery midwifery or dentistry or takes or uses shall have the entire management and control of the state the style or title of physical surgeon doctor of medicine examinations and shall have power to make regulations in or dentist or any other style or titie whether expressed cespect to by words or by letters only implying that he possesses the '(a) Times, places, mode of conduct and notice of examina- skill or knowledge necessary for that practice tions. shall be deemed to have committed an offence under this Act and (b) The appointment and removal of examiners and their re- shall be liable on conviction on indictment to imprisonment for muneration by fees or otherwise provided that no member six months with or without hard labour and alternatively or in of the General Council shall be appointed examiner. addition to a penalty not exceeding one hundred pounds for each conviction to a penalty not Xc) Any other matter or thing as to which the General offence and on summary exceeding Council may think it expedient to niake regulations for forty pounds for each offence. the purposes of this section. 24. Prohibition of unregistered person signing certificate.-Any person not being a registered medical practitioner who shall sign any certificate of death still-birth or sickness or any certificate PART V.-OFFENCES. purporting to be a medical certificate or by the issue of which it 21. Removal of name from register.-(1) Where a registered is implied that the person signing it as a person possessed of practitioner or student either before or after the commencement medical skill or knowledge shall be deemed to have committed an of this Act and either before or after registration has been con- offence under this Act and shall be liable on summary conviction victed in His Majesty's dominions of any felony or misdemeanour to a penalty for each offence not exoeeding twenty pounds. -or elsewhere- of an offence which if committed in England would 25. Penalty for granting unrecognised degrees.-Any person be a felony or misdemeanour or has been guilty of conduct in- other than a recognised university or medical body who shall grant famous or disgraceful in a professional respect or unfitting him any medical degree to a person not being a-registered medical or for admission to the profession that practitioner or student shall dental practitioner shall be deemed to have committed an offence be liable to have his name removed from the register. under this Act and shall be liable on summary conviction to a (2) The General Council may cause inquiry to be -made into penalty for each offence not exceeding fifty pounds. the case-of a person alleged to be liable to have his name removed 26. Prohibition of improper use of name of registered practi- under this section and on proof of such conviction (not being a tioner.-Any person who shall in selling or advertising for sale conviction for a political offence out of His Majesty's dominions any article of food or drink or any medicine d,rug potion wash or nor for an offence which does not in the opinion of the General ointment or any preparation or apparatus intended for use in 4Council either from its trivial nature or other 'circumstances dis- medicine surgery dentistry or midwifery or alleged to possess qualify a person for professional practice) or of such infamous curative or preservative qualities when applied to the human or disgraceful or unfitting conduct shall cause the name to be body- removed from the register. (1) make any false representation as to an act done or opinion (3) The removal of a name from the register under this section expressed by any person then or formerly registered as a mnay be either indefinite in time or for such period as the General medical or dental practitioner whether alive or dead or Council may think proper and the General Council may at any (2) use the name of any such person after receipt of notice time, either after or without inquiry as they may think fit, from him or his legal personal representative or from the restore to the register a name removed under this section upon General Council requesting that the use be discontinued; payment of such fee not exceeding any unpaid annual registration an offence under this Act and fees as the General Council may fix or may vary the period of shall be deemed to have committed removal. sh.al be liable on summary conviction to a penalty for each offence register under this section -shall not exceeding twenty pounds. (4) A name removed from the practitioners.- not be restored except by direction of the General Council or by 27. Prohibition of certain acts of registered order of a court of competent jurisdiction. Any registered medical or dental practitioner who: (5) Any person whose name is removed from the register under (1) practises under any name other than that under which he this section and who shall during the period of removal use any is registered; or mnedical degree, shall be deemed to have committed offence (2) practises for a period exceeding three m.onths whether as under this Act and shall be liable on summary conviction to principal or as assistant to or deputy of another prac- penalty for each offence not exceeding twenty pounds. titioner in or from any building not being a hospital or 22. Procedure and powers of General Council inquiry.- other institution of a charitable or public nature and does Upon or for the- purposes of any inquiry held or to be held under not cause his name to be displayed in legible characters this part of this Act : on the cutside of that building an offence under this Act and (1) The General Council may employ such legal or other shall be deemed to have committed assessors or assistants as they may think necessary or shall be liable on summary conviction to a penalty not exceeding twenty pounds for every day on which he 'has so practised. proper; from (2) The registrar and the person whose name is alleged to be 28. Application of penalties.-Any sum of money arising or to to a conviction and the recovery of penalties under this Act shall be liable to be removed from is sought be restored place the register may sue out a writ of subpeena ad testifi- paid to the General Council whether the conviction takes candum or a writ of subpcena duces tecum. within the Metropolitan Police District or elsewhere. any 29. As to prosecutions.-A prosecution for any offence men- (3) The High Court or a judge thereof may order that the General such writ may issue to compel the attendance before the tioned in this part of this Act may be instituted by General Council of a witness wherever he may be within Council. SurPr,LwT W 1TT '264 BRITISH MEDIC&L POURYAiLj MEDIOO-POLIT[CAL COMMITTEE. [M1AY' 27, (1(05' 30. Provision against offences bay companies.-(1) In this part NAMr. AiRwA. of this Act the word person includes a corporation and any body The County of Chester, except of persons corporate or unincorporate. the Hyde Parliamentary (2) Every director or other officer of any company who shall Division and the Boroughs knowingly and wilfully authorise or permit the commission by of Stalybridge and Stock- the oompany of an offence under this Act shall be liable to the port. same penalty or term of imprisonment as that to which the com- III. F AST LANCASHIRE In the County of Lancaster, pany is liable or would be liable if it were a natural person. the following Parliamentary (3) If a company shall make default for seven days in pay- (1,450 Practitioners). Dar- this Act, that oompany constituencies, namely: ment of any penalty imposed under wen, Blackburn, Clitheroe, shall be deemed to be unable to pay its debts within the meaning Burnley, Accrington, Rossen- of the Companies Act 1862 and may be wound up by the Court dale, Middleton, Rochdale, upon the petition of the General Council. Heywood, Bury, West Houghton, Bolton, Ratcliffe- PART VI.-SUPPLEMENTARY PROVISIONS. cum.-Farnworth, Prestwich,. 31. Definitions.-In this Act the expression "medical or Oldham, Ashton, Gorton, dental treatment" includes the application of any real or pre- Manchester, Salford, Stret- tended art science method or system relating to the prevention ford, and Eccles. cure or alleviation of any disease or defect of or any injury to In the County of Chester the the human body and the performance of any surgical or dental Hyde Parliamentary bivi-. operation. sion, and the Boroughs of The expression "medical degree" includes every degree title and diploma certificate or licence having reference to medical or Stalybridge Stockport. dental knowledge or skill or capacity to apply medical or dental IV. YOSMRsA (NORTH AND The North Riding of the treatment. WEST) County of York, except the The expression "recognized university or medical body" mean3 (1,390 Practitioners). Cleveland Parliamentary a university or medical body entitled either alone or jointly to Division, and the Borough of choose a member of the General Council. Middlesbrough. 32. Exception for foreign practitioners.-Nothing in this Act The West Riding of the Cownty shall prevent any person not being a British subject who shall of York, except the Parlia- have passed the regular examinations entitling him to practise mentary Divisions of Hallam- medicine or dentistry in his own country from being called into shire, Rotherham, Doncaster, the United Kingdom for the purpose of consultation with a and Osgoldcross, and the Par- registered medical or dental practitioner and duly acting for the liamentary Borough of Shef- time being as a registered p'ractitioner or from being and acting field. as the resident physician or medical officer or dentist of any The City of York. for relief, of in hospital established exclusively the foreigners V. NORTH-EAST MIDLAND The East Riding of the County sickness provided always that he does not habitually engage in (1,440 Practitioners). of York. medical or dental practice in the United Kingdom except as such In the West Riding, the Parlia- resident physician medical officer or dentist. mentary Divisions of Hallam- 33. Saving for midwives.-Nothing in this Act shall affect shire, lotherham, Doncaster, or modify the provisions of the Midwives Act 1902 or renier and OsgoldcroEs, and the, illegal any act or thing done by any woman in connexion with Borough of Sheffield. midwifery which would not have been illegal if this Act had not The Counties of Derby, Not- been passed. and Lincoln. 34. Repeals and amendments.-The enactments mentioned tingham, in the second schedule annexed hereto are hereby repealed to the VI. WALES AND THE BORDER Wales. extent mentioned in the third column of that schedule and are COUNTIES In England, the Counties oS hereby amended to the extent mentioned in the fourth column of (1,390 Practitioners). Shropshire, Hereford, anA that schedule. Monmouth. 35. Short title and construction.-(1) This Act may be cited as VII. WEST MIDLAND The Counties of Stafford, War- the Medical Act 1905 and may be cited and shall be construed Practitioners). wick and Worcester. as one with the Medical Acts. (1,360 (2) The expression "the Medical Acts" shall include ths VIII. EAST AND EAST MIDLAND The Counties of Leicester, Dentists Act 1878 and that Act shall be deemed to be included (1,410 Practitioners). Rutland, Northampton, in the group of the "Medical Acts" mentioned in the Second Bedford, Huntingdon, Cam- Schedule to the Short Titles Act 1896. bridge, Norfollk, and Suffolk. IX. SOUTH-WESTERN The Counties of Somerset (ex- SCHEDULE I. (1,440 Practitioners). cept so much of the Par- ELECTORAL areas for the election of Direct Representatives on liamentary Borough of Bristol the General Medical Council: as is situated therein), J)or- set, Devon, and Cornwall. A.-ELECTORAL AREAS IN ENGLAND AND WALES. X. SOUTH MIDLAND AND SOUTH The County of Gloucester NAME. AREA. (1,400 Practitioners). with the Parliamentary 1. NORTH OF ENGLAND The Counties of Northumber- Borough of Bristol. (1,340 Practitioners). Iand, Cumberland, Westmor- The County of Wiltshire. land, and Durham. In the County of Oxford, the' In the County of Lancaster, Banbury and Woodstock the North Lonsdale and Lan- Parliamentary Divisions, and caster Parliamentary Divi- the City of Oxford. sions. The County of Hampshire, ex- In the County of York, the cept the Basingstoke andc Cleveland Parliamentary Di- Petersfield Parliamentary, vision, and the Borough of Divisions. Middle-brough. XI. SOUTHI-EASTEKRN The County of Kent, except II. WEST LANCASHE AND In the County of Lancaster, (1,420 Practitioners). the Parliamentary Divisione CITES.IRE the following Parliamentary of Sevenoaks and Dartford,. (1,460 Practitioners). constituencies, namely:- and the Boroughs of Green- Blackpool, Preston, Chorley, wich, Lewisham, and Wool- Wigan, Hindley, Leigh, wich. Newton, Warrington, St. The County of Sussex. Helens, Widnes, Liverpool, In the County of Surrey, the Bootle, Ormskirk, and Guildford Parliamentary Southport. Division. M COMMITTEE. SUPPLEMENT TO THUE . MAY 27,.1 1go5.]- - , EDICO-POLITICAL flTrs.L MmDICkL JOURNAL 265 NAME. AREA. IL. IRELAND. XII. to XVII. METROPOLTTAN The Counties of Middlesex, The inquiries made have elicited the information that thb (8,400 Practitioners; Essex and Hertfordshire. whole of Ireland, with the exception of Dublin City, is policed to be divided into six The County of Surrey, except by the Royal Irish Constabulary. With the exception of electoral areas). the Guildford Parliamentary Dablin City, the rules and practice of the Irish Police in the Division. matter of summoning medical practitioners, other than police In the County of Kent, the surgeons, to attend emergency cases are those contained in Parliamentary Divisions of the Regulations of the Royal Irish Constabulary. The rules Sevenoaks and Dartford, and and practice of the Dublin Police Authorities are similar. the Boroughs of Greenwich, Lewisham, and Woolwich. (a) As to Fees in Ireland. In the County of Hampshire, If the services (on a visiting ticket," obtained from the the Basingstoke and Peters- Relieving Officer) of a dispensary doctor are not available, field Parliamentary Divi- and some other medical practitioner has to be called, the .J sions. Constabulary hold themselves responsible for the fee (6' is.; The Counties of Berkshire and if detained more than three hours, £2 23.). Buckinghamshire. The City of Dablin Police hold tnemselves responsible for In the County of Oxford, the "the ordinary fee." Henley Parliamentary Divi- (b) As to Conditims of Payment in Irdlznd. sion. If the patient is in a position to pay, he does so. Failing B.-ELECTORAL AREAS IN SCOTLAND. his so doing, the Royal Irish Constabalary and City of Dublin NAmE. AREA. Police. respectively, hold themselves responsible for the (. NouTH SCOTLAND The Counties of Inverness, doctor's fee as above. (960 Practitioners). Perth, Stirling, Clackman- The Regulations both of the Royal Irish Constabulary and nan, Kinross, Forfar, and the of the City of Dublin Police make it a condition, as regards Counties north thereof. the payment of the fee by them, that the doctor has been II. WEST SCOTLAND The Counties of Ayr, Lanark, actually summoned to attend by the Police. (1,400 Practitioners). Re n f r e w, Dumbarton, Argyll, and the Isles. REPORT. III. SOUTH AND SOUTH -EAST The remaining Scottish Coun- The Medico Political Committee preeents to the Represen- SCOTLAND ties. tative Mteting the following report: (1,330 Practitioners). That, in the opinion of the Committee, the facts ascetained as a result of the inquiries which have C.-ELECTORAL AREAS IN IRELAND. heen addressed to the Police Authorities throughout the NAME. AREA. United Kingdom do not indicate any grievance calling for C. NORTH IRELAND The Provinces of Ulster and action by the Association, but that in a few places there (1,200 Practitioners). Connaught. appears to be reason for action, and the Association should In the Province of Leinster, the render such support to the Divisions concerned as may be Counties of Longford, West required if they desire to move in the matter. Meath, Meath, Louth, and King's County. Item 15 In Report.] {I. SOUTH IRELAND The Provinces of Leinster, ex- *(1,350 Practitioners). cept the Counties of Long- REPORT ON TIIE REPLIES OF COUNIY COUNCIT.S ford, West Meath, Meath AND COUNTC,LS OF COUNTY BORoTUGHS CON- Louth, and King's County. CERNING THE PAYMENT OF NKDICAL PRACTI- The Province of Munster. T ONERIB FOR C ERT IFiCATES OF UNFITNESS OF CaILDREN TO ATlEND SCHOOL. Item 14 In Report] In re ponse to a circular which, by inatruction of the Medico. REPORT ON REPLTES TO INQUIRIES AT)DRE:SSED TO Political C ,mmittee, was addressed to all the County Councils POLTCE AUTHORITfES AS TO THEIR RULAE AN) and Countils of County Boroughs in Eagland and Wales, in- PRtCT1CE IN THE MATTER OF StUMMONING quiring what provision, if any, has been made for the pavment OTHER of mpdical men who give certificates required by the Educa- ME,DfCAf. PRACTITIONERR. THAN POLICE tion Authorities, of unfitness of children to attend school on SURGEONS, TO ATTEND EMERGENCY CASES. the ground of ill.healtb, r#plies have been received from 39 I.-ENGLAND AND SCOTLAND. Couuty Councils and 59 County Borough Councils. Inquiries were sent to the Police Authorities of the siixty-five Among these, ii C junty Councils and ii County Borough English towns of a population of so coo or more, and to the Councils state that they pay fees for such certificates; in 6 Authorities of the twenty-one Scottish towns of a population cases it is stated that such certiflcates, when reqnired, are of 25,ooo or more. Up to May, 1935, 68 of these Authorities given by a salaried medical officer appointed by Ihe Education had replied. Authority, and in 70 cases it is stated that no provision has (a) As to Fees. bFen made for this purpose. 89 state that they hold themselves responsible in such The fees usually paid for such certificates vary from is. to cases for any reasonable fee charged by the doctor. 2s 61. This fee is stated to vary from 3s. 61. to ios. 6d., Several authorities distinguish between cases seen at the or more, according to circumstances. doctor's surgery and cased visited by the doctor before 21 have a fixed scale of fEes which they pay to doctors certifying. in such cases. These vary from 23. 6d., 39. 6d., or A fee of jos. 61. is paid by the Leeds Corporation when a 59., for a day call, to 78. 6d., ios., or (in two cases) visit from their special medical officer is required to certify Io3. 6d. for a night call: in a case of poverty, or a case in which a medical certificate 4 Police Authorities state that all work of the kind is obtained by the parents does not satisfy the education done by one or other of their police surgeons or authorities. deputy police surgeons, or sent to hospital. A fee of 58. iq paid by the Oxford Corporation when a visit 4 Police Authorities state that they do not hold them- is required. These are the only cases in which the fee paid selves accountable for such fees. exceeds 28. 61. (b) As to Conditions of Payment. Some authorities who make no payment state that this With two exceptions all the sixty Police Authorities who practice is the result of careful consideration of the question. may in such circumstances summon a doctor other than a police surgeon, and who hold themselves responsible for his Item 17 In Report.] fee, make it a condition, as regards the payment of the fee by THIE UNDULY REPEATED DISPENSING OF them, that the doctor has been actually summoned to attend PRESCRIPTIONS. he the Poliee._ (a) Memorandum Circulated to the Divisions. * It wilibe understood that the partic ,larsas to number of practitioners are merely approximate, ani stated for the assistance of member.q of the The Medico-Political Committee has very carefully considered Associaticn.-Tdhey would not form partof theactualSchodule of the Bill. the subject of the abuses which now prevail in connection with 266 nBf1TXIO;SePrrPr!V'MEDICALT TOJOUNAL]rTE I1 M EDICO-POLITICAL COMMITTEE. [MDAY :27, 1905. -I the repeated dispensing of prescriptionis beyonid the intention of 1 Division the prescriber, atnd has had the advantage of a conference with states that they! should form the basis of some representatives of the Pharmaceutical Society. legal enactment. In the present state of the law, the prescription is the property 1 Division of the patient to whom it is giveil by the prescriber, and may (which has expressed no other opinion)ytates that "steps should be taken to prevent, if possible, be repeated as often as the owner desires. chemists repeating a prescription without orders The owner, however, can only claim the right to have from a medical man." prescriptions dispensed in accordance with the terms thereof, 1 Division and if, therefore, directions as to the nuimber of times for which states that there shouldbe "aclauseforbidding a prescription was to be repeated or as to the period within chemists to supply patients with copies of pre- which the prescriber intendied that the administration of the scriptions." drugs indicated in the prescription should be conifined, were 1 Division made an integral part of the prescription, the dispenser would states that proposals (a) and (b) have been dis- be justified in refuising to (lispense the prescriptionl otherwise approved as being useless for the purpose. than in accordance with such instructions. Entirely to prevent the abuses in question, certain alterations Item 18 In Report.] of the law would be required. Before attempting to obtain new legislation the Committee is FURTHER CORRESPONDENCE WITH THE LORD of opinion that a considerable improvement in the existing CHANCELLOR. position could be effected by voluntary action of the medical Jox4 profession in the following respects: 8 HousE OF LORDS, S.W. 29th July, 1904. (a) That members of the profession should adopt the practice SIR;-With reference to the letter of the ist inst., signed by of indicating on every prescription the period, or the number of yourself and Mr. Smith Whitaker, and previous communica- times, for which it is intended to be dispensed. tions, the Lord Chancellor has not found it possible to give (b) That, in order to prevent copying, all prescriptions should time for a minute examination of all the facts and arguments be signed by the prescriber with his full name and address, and which have been placed before him in the controversy. not merely initialled. Though his Lordship's present impression is not in favour of the Coroner's practice, his Lordship does not as yet see that (b) Analysis ofReplies ofDivisions. there is such a case as would found the exercise of the only 46 Divisions have replied upon this subject up to the time jurisdiction which he possesses, namely, to remove a Coroner of preparation of this prdcis (April, 1905). for misconduct in his office. Those findings of the Divisions which can be classified with I am, Sir, reference severally to the three questions submitted by the Your obedient Servant, Committee are as follows: (Sigued) K. MUIR MACKENZIE. On Recommendation (a), namely: ANDREW CLARK, Esq., F.R.C.S. BRITISH MEDICAL ASSOCIATION, "That members of the profession should adopt the prac- MEDICAL SECRETARY'S OFFICE, tice of indicating on every prercription the period, or the 429, Strand, W.C. number of times, for which it is intended to be dispensed," August 4th, 1904. 32 Divisions SIR,-On behalf of the British Medical Association and approve the proposal. other Medical Societies who have jointly approached the 4 Divisions Lord Chancellor in the matter of certain procedure of the are definitely adverse. Coroner for South-West London, I am instructed to acknow- 1 Division approves (as far as practicable). ledge the receipt of your letter of the 29th July (No. 34) 1 Division addressed to the Chairman of the Conference of Medical approves, but thinks it would be of no avail for Societies, Mr. Andrew Clark, F.R.C.S. the purpose. I am further instructed to request you to convey to the 1 Division Lord Chancellor the thanks of the Association and Medical considers that it is not practicable. Societies for communicating to them the view at present, 1 Division taken by his Lordship upon the important matters which is of opinion that the matter should be left to they have felt it to be-their duty to submit for his Lordship's individual discretion. consideration. 1 Division Having in view the gravity of the issues involved as suggests that it should take the form that no pre. affecting the public welfare and the keen interest with whiich scription should be repeated by a chemist without his Lordship's decision upon those issues is awaited by the being redated and initialled by the doctor. Medical Profession at large, I beg to inform you that I have 1 Division been instructed to hand your letter to the Editor of the BRITISH would add the rider that the prescription be not MEDICAL JOURNAL for publication in the next issue. dispensed to any other person than the person It is inferred from the terms of the letter in question that prescribed for. the favour of a further communication of the Lord Chan- cellor's judgement may be looked for when circumstances On Recommendation (b), namely: shall have permitted his Lordship to examine the particulars "That, in order to prevent copying, all prescriptions which the Association and Medical Societies have had the should be signed by the prescriber with his full name honour to lay before him. and address, and not merely initialled," I am, Sir, your obedient servant, :32 Divisions (Signed) J. SMITH WHITAKER, approve definitely. Medical Secretary of the British Medical Association, 6 Divisions Secretary of the Conference of Medical Societies. disapprove. The Permanent Secretary, 1 Division Lord Chancellor's Office, adds the following rider: "That the Committee House of Lords. be asked to state whether the substitution of the OFFICES OF THE BRImsH MEDICAL ASSOcTION, full name for the initials of the.prescriber.at the 429, STRAND, W.C. end of a prescription will in any way prevent (x) the prescription beingoopied ; ,() the preacrip- ~Mr LoRD, January 5th, I9o5. tion being made up without being re-signed ?" On.behalf;of the Medical Societies who:have on severaI 1 Division occasions addressed your Lordship with reference to the pro- states that they fail to see 'how this recommenda- cedure oif Mr. 3ohn Troutbeck, Coroner forWestminsterand tion would prevent.ooping. South-West London, we-are directed :to -write forthe purpose XQi O ses (a) and (b) taken togethr, ofinquiring whether an opportunity has yet presented itself 8UPPLEMENT TO TE MAY 27, 1905.] MEDICO-POLITICAL COMMITTEE. LBETI8H MEDIC&L JOURNAL 267 for your, Lordship to give the documents which we have sub- dates I referred him to the Workhouse Master and supplied mitted in this matter the consideration which in the letter of him with the telephone number, but as to the Medical par- the Permanent Secretary to the Lord Chancellor, dated ticulars I said I could not possibly answer offhand, but that I July 29th last, it was stated that you had up to that time been must first refer to my books kept at the Workhouse and not at unable to give. my private house from which I was then speaking, that I If such opportunity has presented itself we would most should be at the Workhouse at 9 o'clock the following morn- respectfully crave from your Lordship an early pronounce- ing, and could then give the required particulars. He ment upon the matter. then said he would be at the Infirmary the next morning to If however opportunity has not yet been afforded to your see the Medical Superintendent, and would see me and let Lordship to take into your consideration the circumstances' me know if I should be wanted at the Inquest. placed before you may we with all deference express the hope On Friday morning at the Workhouse I got out the par- %bat the matter may be deemed by your Lordship deserving ticulars (produced) and left word at the Gate that the of your special and early consideration. Coroner's Officer could see me directly he came (the Master's We append for your Lordship's information a caee which Clerk told me that the Officer had been to the Workhouse the further exemplifies certain of those irregularities associated previous day and had been told he could see me at my hou-e with Mr. Troutbeck's procedure which have already been at 2 o'clock that afternoon). At about half-past io Dr. N. brought under your Lordship's notice by the communications telephoned to me at the Workhouse that he had suggested previously addressed to you. We would most respectfully that it was necessary for me to give evidence as to the state of aubmit that an official commaunication to a witness for the the child on admission and while at the workhouse, and that parpose of judicial procedure should be made in writing. he was going to make a Post-mortem Examination at 12.30 that We are, dav. Your Lordship's most humble obedient Servants, I left the Workhouse a few minutes before I I, and asked (Signed) ANDREW CLARK, that should the Coroner's officer call he be told that [ }should Chairman of Joint Committee repre- be at the Infirmary from 12.30 to I o'clock, and that after senting the British Medical AF80- elation. tb¢ South-West London 3 o'clock I could be seen at my own house. I attended the Medical Society. the Medical post mortem examination (which confirmed my diagnosis on Defence Union, Limited, and the transfer), and later, bping near the Workhouse, cal led again London and Counties Medical Protection Society, Limited. to see whether the Officer had been and found he had not. (Signed) J. SMITH WHITAKER, Except for the conversation on the telephone on Thursday Secretary of Committee. night I neither saw or heard from the Coroner or his officer, To the Right Honourable the Lord Chancellor. even as to the time atnd place of the inquiry. Legally, I should have been quite justified in refusing to CASE OF J. L., ATTENDED BY DR. D. give any particulars whatever except in the form of evidence The following summary statement is based entirely upon before the Jury, but as a matter of fact they were available the appended documents, which are: for the Officer, if he had taken the trouble to come eithtr to (a) A report taken from the Weekly Dispatch of an inquest the Workhouse or my house. at which Mr. Troutbeck.made reflections upon the conduct of The censuring of Medical Men in their absence is, of Dr. D. in respect of the case of an infant attended by him; course, no new thing in the local Coroner's Court, but I (b) A copy of a report subsequently presented by Dr. D. would suggest to the mind of any person of common sense or to the Guardians of the Poor of the --- Union, by fairness the value of any such censure would depend upon whom he is employed as medical officer to the workhouse. whether it was based upon a true statement of facts, or, as in In his capacity as medical officer of the - Union this case, upon baseless insinuations. Workhouse, Dr. D. attended an unnamed child (after- The Coroner is reported to have said that "he could not wards named J. L.), who was eventually transferred to help observing the unsatisfactory way Dr. D. does his the Infirmary, and died there on October 22nd, business." After nearly twenty years' service as your 1904. On October 27th Dr. D. received at his private Medical Officer-during which time I have received many r.esidence at about 9 30 p.m. a telephone message from the evidences that my work has at least not been unsatisfactory coroner's officer, desiring certain particulars which Dr. D. to your Board-I venture to return the compliment then promised to furnish next day at the workhouse, where (Signed) A. E D., the books were kept from which the particulars must be Medical OJlicer. obtained. The coroner's officer did not keep the appointment Report of Workhouse Committee. next day, and the only communication which Dr. D. Your Committee investigated the matter, and after received from the coroner or any one representing him was the hearing the Medical Officer's report on the subject, are of telephone message already mentioned. opinion that the Coroner's remarks with regard to Dr. The Coroner having, at the inquest on October 29th, cen- D. were not founded on facts, and that the want of sured Dr. D. in the terms stated in the appended news- information referred to by the Coroner was due to the pecu- paper report, the matter was conEequently investigated by liar way in which the Coroner's Officer dealt with the the Gaardians who, by resolution of which a matter. copy is appended at the end of Dr. D.'s Report, exonerated Dr. D. from blame. In conjunction with the foregoing case the Lord Chancellor Item 19 In Report.] is most respectfully requested to consider that of the inquest MEMORANDUM TO THE BOARD OF EDUCATTON CO9- on M. J. C. reported to the Lord Chancellor in a communica- CERNING THE CIRCULAR ISSUED BY THE BOARD tion from the Medical Societies, dabed May 17th, I904, in IN JULY OF THE PROPOSED INSTITUTION OF A which case Dr. A., who had been in attendance on the GOVERNMENT CERTIFICATE OF SECONDARY deceased, furnished particulars, the receipt of which was not EDUCATION. acknowledged, and re3eived no communication from the ,,Coroner until the morning of the inquest. A telephone The British Medical Association, having for some cqnsider- mespage was then received at a timewhen he was not at home, able time given very careful attention to the question of the asking him to go at once to the Coroner's Court as the inquest standard of Secondary Education which should be required as was in progress and his evidence was required. a condition of entrance upon the technical studies for pro- fessions, and having upon this subject arrived at certain [CoPY.] definite conclusions which are set forth in a Memorandum -RE " WEEKLY DISPATCH" REPORT OF INQUEST ON J. L. ON communicated to the Board of Education on July 6th, begs to 29TH OCTOBER, 1904. submit for the consideration of the Board of Education the Report to Workhouse Committee, 3rd November, 1904. following comments on the proposals cont%ined in the Report At about 9.30 on the evening of Thursday the 27th ultimo of the Consultative Committee issued by the Board in July. someone, who stated he was the Coroner's Officer, rung me up (i) The British Medical Association would represent on the telephone at my house. He stated that a young that those bodies which bave so far been consulted by the unnamed child (afterwards called J. L.), who had been in the ConsultatiVe Committee are chieflyteaching or examining workhouse and was, after ten days in the Infants Block, institutions, and that, the Board of Education should have, transferred to the Infirmary on the 22nd altimo, had died equal regard to the experience of bodies like the British there; he wanted to know the age when admitted, the state Medical Association which have special opportunities of on admission, on transfer, and several other questions; as to ascertaining the results of various systems of tuition and Q TO THE 1 2 268 UPPLrMEr" COMMITTEE. [May 27, 1905. B6iTIsH MEDICAL OURNAL J MEDICO-POLLTICAMEDICO-POLITICAL COMMITTEE. [ATAY 27, 1905. of various examinations, as exhibited in the after-history The time seems opportune for a decision by the profession of those who have been submitted to them. as to (X) how far the ambulance work of the profession should (2) The Medical profession, from its long experience of remain philanthropic, and (2) how far it. should now be dealt the system of multiple examining bodies in professional with as a matter of business. The Medico-Political Com- subj ects, has special knowledge of the resultant inequalities mittee, therefore, thinks it well to refer the whole matter for of standard, and of the difficulty of effecting improvements the consideration of the Divisions, with a view to its decision in face of the opposition of established interests. by the Representative Meeting at Leicester. (3) The Britiskh Medical Association is unable to concur in the proposal that, in lieu of a single standard examina- QUESTIONS SUBMITTED:- tion as originally suggested by the Head Mas* rs' Each Division is asked to answer these specific questions: Conference. there bhould be an indefinite nuinber of (i) Which (if any) of the following services- examinations managed by separate bodies, and it is in a (a) Ambulance Instruction po)sition to say that a large msj )rity of Members of the (b) Ambulance Examinations, AMedical profession hold that the standard of Secondary (c) Judging in Ambulance Competitions, E'ducation required for entrance to the Medical profession should be treated as a matter of philanthropy ? should be uniform, and that any system which so con- stantly tends, as does that of multiple examining bodies, (2) What arrangement as to fee3 and other matters to degradation of the standard, should be avoided. would be suitable in each district for those services whic-h (4) The Association would therefore submit that the the Division considers should be treated as a matter of examination in Secondary Education should be conducted business? by a central body, appointed by the B3ard of Education, and including representatives of the Univeraitie8 and Abstract of the Replies of Divisions to the Inquiries of the teaching bodies. and that on the results of examinations Committee. so conducted a Secondary Education certificate should be 45 Divisions have replied to the inquiries of the Committee given. on this subject up to the date of the preparation of the preseib. (5) To serve the purposes of Medical E3ucation the report (April, 1905). Association would also submit that candidates should be (I) In reply to Question (I), namely: required to be over 17 years of age, and that the standard Which (if any) of the following services- prescribed for the Secondary Education Certificate should (a) Ambulance Instruction, be one suitable for candidates of this age. This does not (b) Ambulance Examinations, exclude the possibility of providing a lower certificate for (c) Judging in Ambulance Competitions, professions for which such provision may be thought should be treated as a matter of philanthropy? desirable. As regards (a) the replies are: (6) The inspection of schools contemplated in the pr(- 33 Divisions posals of the Consultative Committee should, in the as a matter of business. opinion of the Association, be organised independently of 1 Division the conditions of admission to the examination for the as a matter of philanthropy. Secondary Education Certificate, in order to avoid inter- 1 Division ference with the uniformity of examination standards. as a matter of philanthropy in the case of the (7) A system of retrospective reports such as is pro- St. John Ambulance Association, but with posed, especially if partly confidential, must also be Education Committees as a matter of business. regarded as quite foreign to the purpose of an examination 1 Division intended to serve as the gateway to professional education, as a matter of business except in the case of and it may be questioned whether it would not confer a charitable institutions. most dangerous power upon the teacher, and have a 1 Division perilous influence on the morale of the school. Testi- that it should be left to the discretion of the monials of character when required have their own value, individual practitioner to charge or not as he which is and should be quite separate from the results of may think proper. examination. As rpgards (b) replies from (8) In any satisfactory system of tests for entrance on 33 Divisions professional education, examiners and teachers should, so as a matter of business. far as the individual candidates are concerned, be eeparate 1 Division persons. Absolute purity is an essential condition for the that Education Committees should be required acceptance of such tests, and this cannot be guaranteed to pay the Examiners. unless examiner and teacher are separate. As regards (c) the replies are: 30 Divisions as a matter of businees. Item 20 In Report.] 4 Divisions as a matter of philanthropy. THE RELATIONS OF THIE MEDICAL PROFESSION 2 Divisions TO AMBULANCE WORK. that each case should be dealt with on its merits MEMORANDUM SUBMITTED FOR CONSIDERATION BY THE by the individual practitioner. DIVISIONS. In addition to the foregoing replies, dealing with (a), (b), UNTIL a few year3 ago the services of medical practitioners in (c) 5Everally, 6 Divisions have given general answers to the work of the Arnbalance Association were clearly a matter question (a). of philanthropy. No honorarium was paid to lecturers, and the These are as follows: examiners received an honorarium which was an acknow- 1 Division, ledgement but not remuneration for the work done beyond that generally charges should be made for the actual instruction. The services of the medical profession services in question, but each case should be were recognized by the conferring of Honorary Life Member- judged on its merits, and it should be left open to ship 'of the St. John Ambulance Association, -and in other Members.to give their services free. similar ways. 2 Divisions Within the past few years, owing to the recognition of ambu- that the matter should be left to individual lance work as a subject of technical education, and its conse- practitioners to decide. quent claim to participate in local grants, the medical 1 Division instructors are now in some cases paid a fee for their services. that it must be determined according to circum- Recently, also, the establishment of ambulance brigades and stances. shield competitions has materiaUy altered the demands of the 1 Division ambulance services upon the medical profession. Ambulance that there is no need to alter present arrange, work has, however, never lost its character of being, in part at ments. least, & philanthropic service by the medical profession. The 1 Division value to employers of ambulance knowledge in the employ6s, that it should be gratuitous, except in the case and the financial re3ponsibility of employers for accidents to of classes where pupils pay fees, and classes workmen, are now greatly extended. arra-gcd by employers of labour or corporations. r S.PP'LYMENT TO T}lE MAY 27, 1905.] MEDICO-POLITICAL COMMITTEE. LBRITISH MEDICAL JOURNAL 269 (2) With regard to Question (2), namely: A BILL What arrangement as to fees and other matters To amend the law relating to the qualification and tenure of would be suitable in each district for those services which and and the Division considers should be treated as a matte of office of Medical Officers of Health Inspectors business ? for other purposes. the replies vary very widely:- BE IT ENACTED by the King's Most Excellent Majesty by 5 Divisions and with the advice and consent of the Lords Spiritual and that it should be left to individuals to fix their Temporal and Commons in this present Parliament assembled own fees. and by the authority of the same as follows:- 2 Divisions 1. Qualification of medical officers of health and sanitary that fees should be fixed according to District or inmpectors.-(i) A person shall not after the twenty-ninth day Division. of September One thousand nine hundred and eight be 2 Divisions appointed a medical officer of health unless he is a duly approve the St. John Ambulance scale. qualified practitioner and unless either- Of those Divisions which name specific amounts- (a) He is registered on the medical register as the holder (a) For Lectures: of a diploma in sanitary science public health or £s. d. state medicine under section 21 of the Medical Act 2 Divisions o io 6 per lecture. i886 or 1 Division o 15 0 it ,, (b) He has for three successive years before the com- 10 Divisions I ,iO i i mencement of this Act served as a medical officer of 1 Division 3 3 o per course.* health of a district or combination of districts with a 5 Divisions 5 5 0 ,. .. population aocording to the last published census of 1 Division 8 8 o ,, .. not less than fifty thousand or (b) For Examinations: (c) The Local Government Board consents to his appoint- The fees suggested vary from a minimum of I guinea ment. to a minimum of 3 guineas. (2) A person shall not after the twenty-ninth day of Sep- In some cases it is suggested that the fee should be tember One thousand nine hundred and eight be appointed a I or 2 guineas and expenses. sanitary inspector unless either One Division suggests an extra charge if the class (a) He is the holder of a certificate of such body as the examined is over 30. Local Government Board may from time to time (c) For Judging: approve that he has by examination shown himself Very few suggestions have been made: i guinea, competent for the oflice or I guinea per hour, and 3 guineas, are the amounts (b) He has for three consecutive years before the com- named by some Divisions. mencement of this Act served as a sanitary inspector of a district or combination of districts with a popu- lation according to the last published census of not- Item 22 in Report.] less than twenty thousand or (c) The Local Government Board consents to his appoint- PUBLIC HEALTH BILL. ment. 2. Tenure of oflice.-(X) A medical officer of health or QUALIFICATION AND TENURE OF OFFICE OF sanitary inspector shall not hold office nor be appointed for a MEDICAL OFFICERS OF HEALTH AND limited period only and shall be removable only subject to an SANITARY appeal to the Local Government Board. INSPECTORS. (2) This section shall apply to every medical officer of health MEMORANDUM. or sanitary inspector whether appointed before or after the The main objects of this Bill are to ensure that none but commencement of this Act and notwithstanding any contract those properly qualified shall be appointed as medical officers to the contrary. of health or sanitary inspectors and to give all such officers 3. Urban authority may appoint several inspectors.-An and inspectors similar security in their tenure of office to that urban authority shall have power to appoint two or more enjoyed by poor law medical officers and metropolitan medical sanitary inspectors. officers of health. As the law stands no qualification is 4. Administrative provisions.-(i) Section 24 of the Local required for a sanitary inspector except in London and as a Government Act i888 ahall be construed as if in subsection 2 general rule a medical officer of health or sanitary inspector thereof the reference to regulations made by order under the is appointed from year to year only and thus has no true Public Health Act 1875 included a teference to this Act or security of tenure. Poor law medical officers and metro- regulations made by order hereunder. politan officers of health are not appointed for limited periods (2) Save as in this Act expressly provided nothing herein only and are removable only by or with the consent of the contained shall abridge or diminish the powers conferred upon Local Government Board. the Local Government Board by the Public Health Acts or the The duties of medical officers of health and inspectors are Publie Health (London) Act i8gi. so important and responsible that they ought to be entrusted 5. Definition of " Sanitary inspector," 38 and 39 Vict. c. 55, only to fully qualified persons whose position is satisfactorily 54 and 55 Vict. c. 76.-In this Act the expression "sanitary secured. inspector" includes an inspector of nuisances and a sanitary Except in London urban sanitary authorities have no legal inspector appointed under the Public Health Act, 3875, or the power to appoint more than one sanitary inspector. It is Public Health (London) Act, 189I, and an inspector of desired to extend the metropolitan powers to all urban nuisances shall henceforth be designated a sanitary inspector. sanitary districts. 6. Saving for Officer8 of Local Government Board and County In London the sanitary inspector is so called by law but Councils 51 and 52 Viet. c. 41.--Nothing in this Act shall apply outside London the law names him "inspector of nuisances." to a medical officer of health or sanitary inspector appointed It is proposed that the London name shall be universally by the Local Government Board or by the council of any used. county under the Local Government Act i888. 7. Repeal of Enactments.-The enactments specified In the ARRANGEMENT OF CLAUSES. schedule to this Act are hereby repealed as from the twenty- CLAusEN. ninth day of September One thousand nine hundred and Qualification of medical officers of health and sanitary inspectorsI eight to the extent mentioned in the third column of that Tenure of office ...... 2 schedule. Urban authority may appoint several sanitary inspectors 3 Administrative provisions ...... 4 8. Extent of Act.-This Act shall not extend to Scotland Definition of "sanitary inspector'" ...... 5 or Ireland. Saving for officers of Local Government Board and County Councils 6 S. Construction of Act, 54 and 56 Fict. c. 76.-This Act shall Repeal of enactments ...... 7 as Health Acts and so far as this EXteDt of Act...... 8 ... be read one with the Public Construction of Act ...... Act applies to London with the Public Health (London) Act Short title and commencement of Act ...... to i891. * The number of lectures constituting a course being specified by 10. Short Title and Comm3ncement of Act.-This Act may be I Division as 5, by I Division as 6, the others unspeeified. cited as the Public Health (Officers) Act 9o50 and shall (ome SUPPLFMENT To THU 270 BitITiSM, MEIDICAL.'JOUILKAL MEDICO-POLITICAL COMMITTEE. [MAY 27, 11905. L into operation on the twenty-ninth day of September One which comprises forty-five membersof the Medical Profession thousand nine hundred and five. in this City, appointed recently a Committee to inguire into and report on the present scales of remuneration offered for SCHEDDULE. Medical Examinations by Insurance Companies-in Norwich, ENACTMENTS REPEALED. and the character of the Examinations demanded. An abridged Report is enclosed herewith. Section and Chapter. Titleor Short Title. Extent of Repeal. This action was taken because of a feeling which has become stronger of late among the Members of the Division, that in many instanees the work demanded by Insurance Companies S4 and 55 Vict., c. 76 ... The Public Health (Lon- Section 308, subsection from their Medical Examiners was disproportionate to the (189I) don) Act, z8i. (2). Fee paid for Examination. The Committee's Report was laid before the last General MEMORANDUM ON THE PUBLIO HEALTH BILL OF Meeting of the Division, and was appoved. It was then THE ASSOCIATION. resolved to send to the Insurance Companies doing business (A) Con8siderations which have led to the Drafting ofthe Bill. in Norwich a statement embodying the main facts in the (i) The duties of Medical Officers of Health and Sanitary Roport. I should be glad to receive from you any opinions Thspectors are of vital importance in the Public Health which your Board may choose to express on the points raised Alministration of the country. in this Report. (2) These Officers, particularly the Medical Officers of Health, I may add that this question is one in which most of the ',have duties for which they are in effect directly reeponsible to members of the Medical Profession take a keen interest, and the Local Government Board. the view that the present rates of remuneration are in many (3) The proppr performance of these and other duties some- cases unsatisfactory is widely held. You will see from the times obliges Medical Officers of Health and Sanitary Inspec- enclosed Report that many Companies* ( tors to act in opposition to the private interests of individuals, give an adequate Fee for each Examination. when those interests confl ct with the interests of- the commu- I am anxious to place your reply to this communication nity in respect of Pablic Health:-for example, in the con- before an early meeting of the Members of the Division, as demnation of insanitary prop,rty. they are naturally most desirous of knowing your views upon (4) The influence of such interested private persons upon this matter. local authorities is sometimes exerted to obtain the dismissal I am, yours very faithfully, of a Medical Officer of Health or Sanitary Inspector for H. A. BALLANCE, reasons arising not- through neglect, but strict performance, 46, Prince of Wales' Road, Norwich, Hon. Sec., Norwich Division, of his duties,. April 27th, I904. British MedicAlAssociation. (5) At present a large proportion of these officers are ap- To the sixty letters, eighteen replies were received. The pr)iated annually, or for other short periods, and the Local replies in six cases came from offices which give a fee of not G vernment Board cannot interfere if the local authority less than a guinea for .each examination, but it must not be decides not to reappoint a Medical Officer or Inspector, even understood that this is the total number of Companies which though the Board mav be satisfied that the refusal to reap- pay upon this scale. point is due not to inefficiency, but to personal considerations Of the twelve remaining offices, one pays a guinea for all of the.kbid examinations for proposals of over o100, two a guinea for already explained. examinations for proposals of over /20a, and the otht',r nine (B) The Chief Proposals of the Bill. do not commence to give a fee of a gutnea until the amount of It is proposed, therefore, that Medical Officers and Sanitary the proposal reaches a still higher figure. Inspectors shall not be appointed for limited periods, and that With regard to the Companies which pay a fee of not less -they shall onlv be removable subject to an appeal to the Local than a guinea for each examination, the Secretary of the -Government Board. London Life Association writes: "The Association never Concurrently with this, it is proposed that the qualifieations pays a medical man less than one guinea, for it expects an which at present are required under the Public Health Acts examination to be equally carefully made irrespective of the for Medical Officers of Health of Boroughs of over 50,000 amount of the proposal." population, shall in future apply to all Medical Officers of The M4nager of the Legal and General Life Assurance Health, power being given, however, to the Local Government Society writes: "It has always been our practice to,pay the B,ard to waive this condition where they think an emergency full fee for an examination, thinking as we do that the requires, as for A time there might not be sufficient supply of amount of the proposal concerns the Office and not the fully qualified Medical Officers of Health to fill all the vacan- Medical Examiner." -cies in the country. The Medical Referee of the Hand-in-Hand Fire and Life Similarly, and subject to like conditions, it is proposed that Insurance Society writes: " My office is particularly generous an adequate statutory qualification shall be prescribed for in this m%tter; they not only always pay a guinea for a Sanitary Inspectors. Medical Examination, but frequently, if there is much trouble in making a report, pay two or even three guineas Rtem 27 In Report.] for it." The Executive Committee fully agrees with the reasons REPORT OF THE EXECUTIVE COMMITTEE OF THE expressed in the first two letters for the payment of a uniform NORWICEL DiVISION OF THiE BRITISH fee, and would venture- to suggest.that, in view of the flourish- MEDICAL ASSOCIATION ing condition of the offices concexned, the adequate-remunera- UPON THE tion by Insurance Companies of their Medical Officers is not REPLIES RECEIVED FROM CERTAIN INSURANCE COMPANIES IN incompatible with financial success. RESPONSE TO A CIRCULAR LETTER FROM THE DIVISION, The Actuary of the Northern Assurance Company encloses a *CONTAINING A COPY OF THE REPORT DRAWN UP BY A COM- circular issued by his Company to its; Medical Examinersas MLITTEE APPOINTED BY THE DIVISION TO CONSIDER THE FEES far back as the year i865. The circular states that the OFHFERRD FOR MEDICAL EXAMINATIONS IN CONNEXION WITH Directors felt the objections urged by the medioal profession LIFE AND SICKNESS INSUANCa WORK. to the practice of regulating the fees of the Medical Examiners THE Honorary Secretary of the Norwich Division forwarded by the amount of the Insurance to be unanswerable, and that the following letter to sixty Life and Sickness Insurance they had determined for the future to pay a fee of one guinea Societies throughout the Kingdom, together with a copy of irrespective of the amount of thi.proposal. At the same time 'the Report drawn up by a Cammittee of the Division upon the Directors asked their Medical Excaminers to accept a fee the fees offered for Medical Examinations by Insurance Com- of half-a-guinea for "reports filled up by them in the character panies having offices or agents in Norwich, which Report was of Referee of the applicant for assurance, as distinguished published in the SUPPLEMENT of the BRITISH MEDICAL from that of Examiner and Adviser of the Company." The JOURNAL, March I9th, 1904, P. 33. Company was obliged to obtain both reports in the majority [COPY OF LETTER.] of cases. From the forms submitted by the Actuary it To the Secretary of the appears that, in addition to there being no personal examinear ...... Inranee Company. tion asked for, there are many fewer questions to be answered *It the Company was one which paid a fee of not less than a guineafor DeAR SNi, each examination, the words "your own beiDg one" were-hero-inserted -The Norwich Division of the BYritish Medical Association, between brackets. [r WPPI3 TOToU 271 MAY 27, 190. MEDICO-POLITICAL COMMITTEE. LDlBWTSH MZDIC&L JOUSA 271 by a medical man in the character of Referee of the applicant Offices of the United Kingdom, and that the Industrial for assurance, than by one who is acting as Examiner and Assurance Companies issue annually an additionaltwenty- Adviser of the CompaDy. two millions. The volume of work done by the medical pro- Of the twelve Offices which pay their Medical Examiners a fession therefore in connexion with Insurance Societies is not fee of less than a guinea for the smaller policies, which, it small. would appear, not infrequently lapse at the end of the first From one of the Offices comes the suggestion that the only year, the common excuse was that expreseed in the reply way by which the Medical Referee'c-ould obtain a guinea for from the Actuary of the Star Life Assurance Society, namely: an examination in connexion with the smaller policies would "That the premium received for such policies is not sufficient be by the proposer paying half the fee, and this appears to be to carry the initial cost of obtaining the business plus a full impracticable. fee of one guinea." One Society submits the specimen forms appended. In justification of this practice the same letter alludes to The Executive Committee entertains the same objection to the varying scales of fees charged in private practice by the sliding scale of fees depending on the value of the policy medical men depending on the fiancial position of their under the Industrial and Middle Class Branches, as it does to patients. But in the case of a Medical Examination for Life the fees, varying for the same reason for work done in con- Insurance the medical man is the servant of the Company, nexion with the higher policies. the financial status of which does not vary after the manner It is stated by the Secretaries of certain of the Societies which is usual among patients in private practice, and the that in their examination forms far fewer questions are asked Executive Committee suggests that a complete answer is than in the specimen forms submitted in the Report from the given in the second quotation from the letters received from Norwich Division, published in the SUPPLEMENT of the those offices which pay a uniform fee of one guinea (see BRITISH MEDICAL JOUIRNAL of March igth, 1904. page 270) to the position taken up by the Actuary of the Star It will be conceded that Insurance Societies which do the Li e Assurance Society. In addition, it must be remembered great proportion of their business in sums of- £50 to £20o that a small fee received by a medical man in family practice cannot be expected to pay a guinea for each examination, but is probably one of a series of small fees for attendance upon in these cases the amount of work which the Societies require an individual suffering from an illness of some duration; and of Medical Referees must not be so arduous as in the cases of this situation offers a sharp contrast to that in which an in- those Societies which do a large part of tbeir business in the dividuil, who wishes to insure his life, pays a single visit to higher policies. a medical man, and the interests of the Insurance Company It is quite possible that with regard: to the shorter forms for a number of years are then based upon the result of this such as are reproduced in this Report, an understanding one visit. between the Insurance Companies and the Medical Profession Three of the Companies suggest that if objection is taken could be brought ahout, satisfactory to both parties, by which by medical men on a large scale to the inadequate fees paid a fixed fee of considerably less than a gainea could be agreed frequently for the smaller policies, it may be to the interest upon. of tVe Insurance Societies in the future to dispense altogether The Executive Committee still holds that the fee,to be paid with medical examinations, at any rate for these smaller to the Medical Examiner should be proportionate to the olicies. An interesting paper, read in February, i904, by amount of work expected from him, and recommends that this Mr. Jt)hn Nicoll. F F.A., A.I.A., entitled "Life Insurance Report, if approved by the Division, be forwarded to the without; Medical Examination," together with the subsequent Medico Political Committee of the Association, with a request dioeussion, will be found in the Transacti3ns of the Faculty of that that Committee should consider whether it is desirable Aetuaries, vol. ii, pert iv, p. 57. that some action by the Association be taken upon this In the letter received from the Actuary of the Sbar Life subject. Ass'irance SJciety it is stated that about two million policies Norwich, January, x905. for " ordinary" life basiness are issued every year by the Life

INDUSTRIAL CERTIFICATE. Doctor to call......

...... ASSuRANCE SOCIETY. . ASSURANCE SOCIETY No. I9. No. 19 CERTIFICATE OF MEDICAL EXAMINATION. This portion to be retained by Medical Name of Proposed...... Officer, and presented with account. Age...... * Note if understated. Address Name ...... infull...... full ...... Residence ...... Agency...... Age ...... Signature of the person examined...... Dr.'s Name...... I certify that I have this day examined the person herein specified, and find h. free Agency ...... from any consLitutional disease, aid a fit and proper person to become a Member of the.Assurance Society; further, that ...... affixed h. Amount Assured, £ signature hereto In my presence. * I consider the age understated by ...... years. Date of Examination...... i Siynature of Referee...... Date .Ad2ress ...... &cy. If the Proposed is not a fit and proper person, write "REJECTED" across the If the Proposed is not accepted, please write "REJECTED" across the tocument. document. SGA. E OF FEEcS. Under £30 *-e 25. 6d. ., £so *0. 38. 6d. -£75 a... .N 4X. 6d. £100 .s. 78. 6d. 0*0 Over £ioo 8S. od. 272 BITT1OH MEDICAtL JOURNAL] M /1/TCO-POLITIOAL COMMITIEE [NAY 27, 190.)

MIDDLE CLALSS BRANCH;

...... ASSURANC SOECIETY.

MEDICAL REFEREE'S REPORT.

I have this day examined , residing at and herewith append my report. Date I90 Signed , Medical Officer.

PARTICULARS OF PROPOSED ASsURANCE. AGENCY

Date of Entry. Age. Premiom. Sum Assured. When Payable. AGENT

QUESTIONS. A NSWRIIS. I.--Does the proposer appear in good circumstances and able to keep up assurances ? 2.-Does the age appear to you greater than what is stated above ? If so, how much? 3. Is the proposer the subject of hernia, and if so, are you satistied a proper truss is worn'? Haws the proposer any physical defect or infirmity ? 4. Has the proposer suffered from asthma, bronchitis, gout, rheumatic fever, or any serious illness ? If so, please state date and dura- tion of last attack, and whether, in your opinion, the life is affected thereby. 5.-Is there any reason to apprehend paralysis, epilepsy, apoplexy, or insanity ? 6.-[s there any reason to suspect liver or kidney disease? 7.--Are the heart and langs normal in every respect and perfectly free from disease? 8.-- Have you any reason to suspect irregular or intemperate habits ? 9.--.Are the parents alive ? If not, state age at death and cause of death. io.-Have anv of the brothers or sisters died from phthisis, or is any member of the family now suffering from that disease? lf so, please give particulars. iI.-Are there anv other circumstances connected with the proposer with which you think the Society should be acquainted ? 12. aCn you confidently recommend the Directors to accept the pro- posed life as a healtby one?

Signature ofProposed Member

The Medical Re'eree is requested to obtain the Signatuire of the Person to be examined. before proceeding with the Examination, in order to identify tle Proposer. When Examination is completed, Releree is desired to forward this Form direct to Chief Office. The scale of fees for this Certificate is the same as that for the Industrial. For the " ordinary " business, in which a more detailed eximination is required, a fee of ten shillings and sixpence ts paid. SUPPi.MENT TOTHE 273 MAY 27, 1905.] ETHICAL COMMITTEE. EBRITISH MEDICAL JOURNAL 273 -I 112 Divisions have communicated their opinion on the ANNUAL REPORT OF THE ETHICAL subject, and these replies have been classified as follows: 54 Divisions, without reservation or qualification, express COMMITTEE. themselves as adverse to the advertising of medical [INTERIM REPORT.] practitioners in connexion with hydropathic esta- THE of the blishments. Ethical work Association transacted at the three 25 are not only adverse to such advertising, but think meetings of the Ethical Committee which have been held that the same rule should be applied to similar since the last Annual Meeting of the Association is reviewed institutions. in the Annual Report of the Council which is presented con- i6 Divisions would restrict their condemnation to the advertising of those practitioners who do not give currently with this Report. time to work. a of their whole the Further, complete review the work of the year, for pre- There are thus 95 Divisions who condemn the practice. sentation to the Annual Representative Meeting, will be On the other hand- circulated to the Divisions shortly before the Annual 3 Divisions express the opinion that this subject cannot Meeting. advantageously be considered apart from the wider The Ethical Committee, therefore, has not thought it one of the ethical position of proprietary institutions in general. necessary to submit to the Divisions at the present monlent Divisions state that they have no experience of the a separate report containing the same matter which is set matter, and therefore do not feel competent to express forth in the Report of the Council as regards ethical matters, an opinion, but presents this interim report for the purpose of submitting and I Division, "That the advertising of medical practi- to the Divisions in preparation for the Annual Represen- tioners in connexion with hydropathic establishments does not call for any interference." tative Meeting, the following Report, Memorandum, and Division is of opinion "That there is no occasion for Letter: prohibiting the advertising of the names of medical (A) For the consideration of the Divisions is submitted the attendants in connexion with hydropathic establish- Report containing proposals with respect to the advertising ments provided that it is made clear that other of medical men in connexion with and similar medical practitioners than those advertised are at hydropathic liberty to attend." institutions, which has already been issued to the Divisions, Division has resolved "That this Division is of opinion and is here reprinted for convenience: that all medical practitioners living in the town (B) For the information of the Divisions is presented a where hydropathic establishments are advertised Memorandum setting forth the present organization of the should be allowed to attend cases in such establish- Association for dealing with ethical matters. ments." With these may be mentioned a rider, added by one (c) The Committee also submits, for the information of the Division included above, to the effect "That all Divisions, a communication which on the recommendation of visitors to such establishments should have the your Committee the Council has decided to forward to the option of choosing their own medical attendant." General Medical Council in order to draw attention to the The result of the inquiry would thus appear to be to justify importance of warning medical practitioners against canvass- a pronouncement on bebalf of the Association that the names of medical practitioners should not be advertised in connexion ing and advertising. with hydropathic establishments. RECOMMENDATION. (A.) The Committee is of opinion that members of the pro- ADVERTISING OF THE NAMES OF MEDICAL PRAC- fession who act as medical officers to bvdropathic and similar TITIONERS IN CONNEXION WITH HYDROPATHIC establishments should make it a condition of their engage- AND SIMILAR ESTABLISHMENTS. ment that their names shall not be inserted in any advertise- I ments of such institutions except in advertisements in TEIE Committee, by a circular letter in March, I904, asked the medical journals. Divisions in the United Kingdom to express their opinion The suggestion of certain Divisions that the practice of upon the advertising of medical practitioners in connexion hydropathic establishments should be thrown open to all with hydropathic establishments. in which are situated raises The inquiry of the Committee was accompanied by the practitioners in the district they memorandum: quite a different issue from that submitted by the Committee, following and may perhaps be made the subject of a separate inquiry Complaints frequently reach the Editor of the JOURNAL of be for a the advertising of medical practitioners in connexion with when professional opinion shall appear to ripe pro- hydropathic establishments. These complaints usually come nouncement thereon. from other medical men in the neighbourhood who are not QUESTION SUBMITTED. connected with any hydropathic establishment, and the Is the Division of opinion that a definite pronouncement grievance seems to be that the practitioners so advertised are should be made by the Representative Meeting on behalf of also engaged in general familypractice, and are thus the com- the Association to the same effect as the opinion of the Com- petitors of the complainants who feel that theee advertise- mittee stated above, namely: ments are therefore unfair. That members of the profession who act as medical officers A connected grievance is that many of the hydropathic of hydropathic and similar establishments should make it a establishments try to compel all their visitors to accept the condition of their engagement that their names shall not be services of the medical officer of the establishment, and inserted in any advertisements of such institutions except in oppose the employment by visitors of any outside medical advertisements in medical journals ? practitioner. So long as the medical officers of hydropathic establish- (B.) ments were resident officials, and gave their whole time to MEMORANDUM ON THE PRESENT ORGANIZATION the work, these complaints do not seem to have been made, FOR DEALING WITH although the way in which they were and still are advertised OF THE ASSOCIATION at railway stations and in railway guide books is not in ETHICAL MATTERS, AS DETERMINED accordance with the general rules of the profession respecting I. BY THE REGULATIONS OF THE ASSOCIATION; advertising. This seems to have been the thin edge of the IH. BY THE RULES OF DIVISIONS AND BRANCHES; wedge, by means of which a very undesirable practice has III. BY THE PROCEDURE ADOPTED BY THESE grown up, until it has obtained dimensions which make it AND BY THE ETHICAL necessary to consider whether any steps can be taken to BODIES CENMRAL check it. It would be obviously unfair to condemn without COMMITTEE. due notice those who have been allowed for many years to I.-REGULATIONS OF THE ASSOCIATION. have their names advertised; but, by a reference to the A.-Contained in the Articles and By-laws. Divisions, full consideration will be obtained before any pro- The action of the Associationlin ethical matters rests funda- nouncement by the Association is made. mentally upon the following regulations:- TO TH 2 iprpPX.aENT 2I4t IBRITISH M]EDIC&L JOURYAL] ETHICAL COMMITTEE. [MAY 27, 1905'

BY-LAW I.-" . . . Every candidate for Membership BY-LAW 40, SECTION (7).-" An Ethical Committee shall of the Association shall apply . . stating his be appointed . . . wbich shall advise the Council agreement, if elected, to abide by the Regulations and on proposed Rules of Divisions and Branches relating By-laws of the Association, and the Rules of such to Professional conduct, shall investigate and report to Division and Branch to which he may at any time the Council upon the cases of Members whose conduct belong. a . ." is to be considered by the Council, shall adjudicate in This By-law deriving its force from- cases of disputes on ethical questions referred to it by ARTICLE IL." . . . elected in such manner Members of the Association, and generally shalladvise, and upon such conditions as may be prescribed and, where so directed, act for the Cotincil, on all . . by the By-laws "; questions of Professional conduct. . . ." and from- A Member is bound, therefore, as regards matters of pro- ARTICLE XLVII.- X . . the rights and obliga- fessional conduct: tions of every Member . . . shall be such as (a) By any Articles and By-laws specific-ally relating thereto, may . . . be prescribed and determined by of which there are at present only the above-quoted Articles or in accordance with By-laws . XLII, XLIII, XLIV. and IX; BY-LAW II.- (b) Under Article XXXV he is bound by a resolution of the (a) " Subject to the Regulations and By-laws of the Representative Meeting specifically relating to professional Association, each Division and each Branch shall conduct, provided that such resolution is carried by a majority be free to govern itself in such manner as it of two-thirds of those present and voting; shall think fit, and for that purpose to make (c) He is bound by the Rules of the Division and Braneh of . . such Rules as it thinks fit, and to repeal or which he may at any time be a Member; alter the same. . . ." (d) By By-law 40 (7) the Ethical Committee has power to (b) " The Rules so made and for the time being in in between force shall be binding on the Members consti- adjudicate disputes Members. tuting the Division or Branch. . . ." B.-Existing Regulations affecting Professional Conduct, other BY-LAW 12.-"The Rules made by Divisions and Branches than those containea in the Articles and By law8. shall be submitted for approval to the Council, and On taking up its duties under the ntew Constitution the shall not come into operation unless and until Ethical Committee considered two general questions:- they ari- approved by such Council." Whether it was desirable to attempt at once to frame an ARTICLE XXXV.-" A Resolution of any Representative ethical code for the Association. Meeting . . . which . . . relates to . . . Whether it was desirable to require all Divisions and matters affecting the honour or interests of the Branches to be subject to the same Rules, or to allow Medical Profession, and is carried by a majority of these to vary according to local conditions and two-thirds of the votes given thereon . . . shall opinions. be deemed to be a decision of the Association. As regards framing an ethical code for the Association, the ,, Committee decided that it was not desirable to attempt at ARTICLE XLII.-" Any Member of the Association . . . once to frame a code. convicted in a Court of Justice of any felony or mis- The Committee has from time to time made pronounce- demeanour, or whose name shall have been erased ments upon questions submitted to it, and these when from the Medical Register under Section 29 of the approved by the Council and by the Representative Meeting Medical Act, i858, or who shall have forfeited by mis- become binding upon Members. conduct the Medical Qualification by virtue of which These decisions have come before the Representative he became eligible for Membership . . . shall, Meeting in the Annual Report of the Committee, which has ipso facto. cease to be a Member of the Association." each time been approved en bloc. It is perhaps a question for ATTIOLE XLI II.-" Any Member of the Association whose consideration whether such approval should be deemed to conduct shall, upon due enquiry, be deemed . . . make all the decisions set forth in the Report binding as laws detrimental to the honour and interests of theMedical under Article XXXV. The Ethical Committee has no power Profession, or calculated to bring the profession into to make general- rules, binding on the condue.t of all Members. disrepute, may be expelled from Membership. . . .' Such rules would have to be duly submitted to the Repre- sentative Meeting. ARTICLE XLIV.- In general, matters are only decided by the Representative (a) "TThe Council shall have power on the representa- Meeting after three montha' notice. The Report of the tion of any Branch . . . to expel from Member- Ethical Committee, on the other hand, must be brought as ship of the Association any Member of such Branch nearly up to date as possible, and therefore can only be issued whose conduct shall be held to be such as renders shortly before the meeting. him liable to expulsion under Article XLIHI." It might perhaps be convenient that expressions of opinion (b) "Each Branch out of the United Kingdom having a which were intended to have the effect of laws of the Associa- Membership of not less than 30 shall have power tion should be brought before the meeting by definite to expel from Membership of the Associa- recommendations Issued by the Committee at least three tion any Member of such Branch whose conduct months before the shall be held to be such as renders him liable to meeting. expulsion under Article XLII[." II.-LOCAL R:EGULATIONS-R-ULES OF DIVISIONS AND (c) "A majority of two-thirds of those present and voting BRANCHES. whether in the Council or in a Branch Meeting shall As regards these the Committee advised that Rules should be be required for the purpose of exercising the powers allowed to vary in different distriets, provided that the Central conferred by the last two preceding clauses." Council, when asked to sanction Rules as to professional con- (cd) " When a Member is expelled he shall ip8o facto duct, should be satisfied that they were approved by a suffi- cease to be a Member, but shall be liable to pay to cient majority of those concerned. the Association all sums due from him to the Asso- The Committee bas not made, and bas not recommended ciation or any Division or Branch thereof, at the the Council to make, any suggestions to Divisions and time of his expulsion." Branches except upon questions of procedure (as to which (e) J' No Member in regard to whom a representation as see below, Section 111). aforesaid has been made or whose conduct is under Different Divisions have adopted Rules often taken from the investigation, or is the subject of inquiry by the rules of local Ethical Societies. These have been approved Council or by a Branch, shall be capable of effec- from time to time by the Council (subject to modification in tively resigning his Membership of the Association some instances), and have served as models upon which other until the decision of the Council or Branch be made Divisions have based their Rules. known." Early in 1904 the Bradford Division asked the Medical ARTICLE IX.-" . . . No person whose former Member- Secretary to draft for them a short set of Rules relative to shipshall have been forfeited under the provisions of questions of Contract Practice and Appointments. These Articles XLII, XLIII, and XLIV, or any of them, were based entirely upon Rules alreaay sanctioned by the shall be eligible for re-election by any Branch Council Council, and have been found convenient as suggestions for without the sanction previously obtained of the other Divisions who required Rules of the kind. Counoil of the Asociation." Several Rules of Divisions have contained provisions that SuPPIIr'tA-T TOTHR 275 MAY 27, 1905.1 ETHICAL COMMITTEE. LBBItISH MIEDICAL JO ArN&T. - members of the profession who violated generally-acceptedt issuing a general warning notice to medical practitioners 31 laws of professional conduct, or special local Rules, should be1 against the practices of canvassing and advertising for the excluded from professional recognition. To give proper effectL purpose of procuring patients. to these decisions it was found that they must be com- Cases are constantly brought under the notice of the municated to all Members of the Division concerned, andt British Medical Association of such canvassing'and adver- as this raised certain questions of great difficulty," special con- tising by medical practitioners, or by lay bodies by whom sideration was given to this matter in the spring of the yearr medical practitioners are employed, by means of door-to-door 1904, with the result that a special Rule dealing with the visitation, distribution of cards and handbills, or newspaper subject was drafted as a suggestion to the Divisions, known notices. These cases have been carefully investigated by the for convenience as Rule " Z." Ethical Committee of the Association, and the medical In at least three districts the question has arisen whether practitioners concerned have been asked to give such explana- Branches could adopt some analogous rule, and it was in tion as they think proper for the assistance of the Committee connexion partly with this question that the Subcommittee in considering whether the cases should be reported to the was appointed. General Medical Council. The reply repeatedly received has been that the medical practitioner was not aware that there III.-PROCEDURB IN ETHICAL CASES. was any professional objection to such canvaesing or The general principles underlying the present procedure of advertising. the Association are as follows:- We forward, as an example, the correspondence of the I. Inasmuch as the only sanction by which a body like the Committee with a practitioner whose name, address, British Medical Association can enforce its decisions as surgery hours, and fees were printed on cards which were regarda its own Members is the power of expelling an offender distributed in the neighbourhood of his residence, and who, from Membership and as this power, as regards Members in it will be seen, pleaded that he was not aware of any objection the United Kingdom at least, is vested absolutely in the to such distribution. We enclose also copies of cards, hand- Central Council, every decision must in the last resort be bills, and newspaper advertisements which have at times been enforced by an appeal to the Central Council. brought to the notice of the Ethical Committee of the Asso- 2. On the other hand, it Is recognized that questions of fact ciation, and appear to that Committee to be of a gravely un- should be investigated in the first instance on the spot, and desirable nature. that for this purpose the Division furnishes the most con- The Ethical Committee and Council of the British Medical venient instrument available for the Association. Association would submit for the consideration of the General 3. In many instances also the Division is quite competent Medical Council: to deal with the case entirely. (I) That advertising, including canvassing, by medical prac- 4. In a Division, while the Ethical Committee thereof may titioners for the purpose of procurin,g patients is injurious to conveniently make the first investigation and report as to the the interests of the public as well as of t'he medical profession, facts, the finding of the Division must be that of a general and that the disciplinary powers conferred upon the GeneraI meeting of the whole Division, to which the Committee Medical Council forthe public protection, under Section XXIX reports. of the Medical Act, i858, would be exercised to the advantage 5. In a Branch, on the other hand, by hypothesis a general of the community by the Council declaring its disapproval of meeting cannot be representative of the whole Branch, and, systematic canvassing and advertising for the purpose of pro- therefore, in the Model Rules which have been suggested by curing patients, by cards, handbills, newspaper notices or the Committee, the decision of ethical matters as regards a other means; Branch rests with the Branch Council, acting upon a report (2) That although, as the Association recognizes, the furnished by the Ethical Committee of the Branch. General Medical Council possesses no statutory authority to 6. A dispute or complaint would in general come in the formulate By-laws for the regulation of the medical profes- first instance before the Ethical Committee of a Division, sion, but can only deal with each case brought before the which reports upon the facts to a general meeting of the Divi- Council on its merits, nevertheless, the action of the Council sion. The Division in pronouncing judgement may either in formulating from time to time declaratory resolutions (a) endeavour to decide the matter, or (b) may postpone deci- (such as those adopted on November 27th, 1897, and June 6tb, sion pending an application to the Central Ethical Committee x899, relating respectively to the employment of unqualified for advice on a question of principle, or (c) may report to the assistants, and association with Medical Aid Societies which Branch Council that the matter is one that in their judgement canvass and advertise), has been of great benefit to the pro- should be brought before the Central Council under fession, and the present case appears to the Council of the Article XLIV. British Medical Association to be one in which those In case of decision by a Division it is open to either party precedents might with advantage be followed; to appeal to the Branch, which means, as explained, the (3) That the issue of such a notice would notonly be helpful Branch Council. to those medical practitioners who, under present conditions, Thus a matter may come before a Branch Council (a) on are actually ignorant of the past decisions of the General appeal from the decision of a Division, or (b) on a Report by Medical Council in cases of canvassing and advertising, and a Division that a matter should be brought before the Central thus inadvertently offend, but would deprive those who Council under Article XLIV. deliberately offend of an excuse which they at present put A matter may come to the Central Ethical Committee, forward. either (a) on an appeal from the decision of a Branch Council, We are, Sir, or (b) on an application from a Division for advice on a Your obedient servants, question of principle, or (c) in consequence of representations having been made by a Braneh Council. to the Central Council ANDREW CLARK, under Article XLIV. Chairman of Council of the British A matter may also coMne before the Central Ethical Com- Medical Association. mittee on a direct appeal.-from the parties to a case asking ROBERT SAUNDBY. that it should adjudicate, but if there is a dispute as to facts Chairman of the Ethical Committee the Committee refers it to the Division for preliminary of the Association. investigation. J. SMITH WHITAKER, Medical Secretary. (C.) D. MacAlister, Esq., M.A., M.D., F.R.C.P., President of the General Coun6il of Modical Education REQUJEST TO THE GENERAL MEDICAL COUNCIL TO and Registration, 299, Oxford Street, W. ISSUE A WARNING NOtICE AGAINST CANVASS- = ING AND ADVERTISING. LIBRARY OF THE BRITISH MEDICAL Offices of the British Medical Association, ASSOCIATION. 429, Strand, W.C. MEmmBERS are reminded that the Library and Writing Rooms May 22nd, 1905. of the Association are fitted up for the accommodation of Sir,-In pursuance of a resolution of the Council of the the members in commodious apartments, at the office of the British Medical Association, confirming a recommendation Association, 429, Strand. The rooms are open from io a.m. of the Ethical Committee of the Association, we ask the to 5 p.m. Members can have their letters addressed to them General Medical Council to consider the desirability of at the office. 2 7 6 SUPPLEMPNT TO TI!! BRITISH MEDICAL JOURNAL] MEDICAL DEFENCE COMM[TTEE. [MAY 27, 1905. = I to act for England and Wales). The Central Medical Defence REPORT OF THE MEDICAL DEFENCE Committee to consist of I5 members, including a representa- COMMITTEE. tive from the Scottish and Irish Committees respectively, EXPLANATORY MEMORANDUM. with 6 members elected by the Council and 7 by the AT Oxford a Committee appointed by the Council of the together Association submitted to the Repreeentative Meeting a Representative Meeting. scheme for medical defence. This scheme was referred back by the Representative Meeting with the following. instruc- Election of Scottishand Irish Committees respectively. tions: Election by the representatives from Scotland and Ireland That instead of appointing a new Committee, the ques- present at the Annual Representative Meeting of a Scottish tion of the principle of medical defence be referred back to Medical Defence Committee, and an Irish Medical Defence the original Committee appointed by the Council. The Scottish Committee to consist That it be an instruction to the Committee, in framing Committee respectively. any scheme of medical defence, to include both collective of io members and the Irish Committee of 8 members. and individual defence. That it be an instruction to the Medical Defence Com- Appointment of Secretaries and Additional Officers. mittee to state in their scheme or statement which shall 3. Appointment by the Council of a Medical Defence Secre- be submitted for the approval or otherwise to the Divisions salaried in what way it provides for the amalgamation of the existing tary of the Association who shall be a whole-timed Medical Defence Societies. officer of the Association. That any scheme prepared by the Committee shall be The Central Defence Committee to have power to appoint submitted to the Divisions before March 31st, 1905. additional officers. Accordingly the Medical Defence Committee drafted a fresh scheme, and invited representatives from kindred Medical Central Committee's Decision to be Final. Defence Societies to confer as to the best steps for amalgama- 4. The final decision whether the Association shall take up tion of all Defence Societies with the British Medical Asso- and ciation. This conference took place on January 12th, when the defence of any given case shall be vested wholly representatives from the Medical Defence U.-ion and the Lon- without reserve in the Central Defence Committee. don and Counties Medical Protection Society attended, but the views they expressed on behalf of their Societies were dis- Disputes to be Decided by Arbitration. tinctly opposed to amalgamation. The Medical and Dental 5. All disputes which arise between members of the Medical Defence Union of Scotland wrote eaying they were of opinion of the Association and which are referred that the interests of their membprs would be best promoted Defence Department by their Union maintaining an independent existence, and to the Defence Department shall be decided, if necessary, by the Irish Medical Association (Medical Defence Department) arbitration. wrote saying that it was not at present aware of any advan- The arbitrators shall be selected by the disputants, subject tages to be derived from a conference on the subject. to the of the Central Defence Committee. Uoncurrently with the Medical Defence Committee, a Com- approval mittee, with an instruction from the Reprfsentative Meeting Control of Funds by the Central Committee. to alter the Memorandum of Association on the lines of the Birmingham resolutions, has been sitting. The Birmingham 6. The Central Defence Committee to have absolute control resolutions, it had always been understood, when confirmed of the funds allotted for the Medical Defence Department of by the Court, would give the necessary powers for the Asso- the Association. ciation to undertake individual medical defence. However, upon these resolutions being submitted to the solicitor, he Grant to Scottish and Irish Committees. expressed the opinion that the Birmingham resolutions, even Capitation if passed by the High Court, would not necessarily give the 7. The Central Defence Committee to allow the Scottish Association such powers. This op.nion was subsequently and Irish Defence Committees respectively to expend a certain confirmed by Counsel. sum per head of the membership of the Association of that The Committee on the Memorandum of Association has caused clauses to be drafted covering the various instructions country. of the Representative Meeting, one of which is to provide for Finance. individual medical defence. At the next meeting of the 8. That the Subscription be raised to 358. Council, the Chairman proposes to move that an Extra- ordinary General Meeting be summoned at Leicester to con- sider the proposed alterations of the Memorandum of Asso- ciation. On these alterations being approved, individual medical defence will be provided for, though in addition @r22tI"gS tiyfStatt cu tttsz it will be necessary to obtain the sanction of the High Court before the proposed alterations in the Memorandum SECRETARIES OF BRANCHES AND DIVISIONS can be carried into effect. Counsel has expressed the opinion COMMITTEE. that there is a doubt as to whether the High Court will sanction the Association undertaking individual medical Wednesday, March 8th, 1905. defence. A MEETING of Secretaries of Branches and Divisions who are was held at the office of the The now submits for the members of the Central Council Committee consideration of the Association, on Wednesday, March 8th, when there were Divisions the following draft scheme of medical defence: present: Dr. R. C. BUIST (in the chair), Mr. Andrew Clark (Chairman of Council). Dr. G. W. Crowe, Dr. E. Rowland DRiFT SCHEME MEDICAL DEFENCE. Fothergill, Dr. James Hamilton, Dr. Charles James Morton, Mr. C. EI. Watts Parkinson, Dr. Edwin Rayner, Dr. Cecil Amalgamation ofE.visting Societies. E. Shaw. APPOINTMENT OF COMMITTEE. 1. Invitation to the Medical Defence Union, to the London The resolution of the Council appointing the Committee and Counties Medical Protection Society, and to the Medical was read as follows: and Dental Defence Union of and other like Scotland, Socie- That it is advisable that a conference of the Honorary Secretaries of ties engaged in Medical Defence, to merge themselves in the Divisions and Branches should be held at Leicester. That the British Medical Association to form one professional arrangements for this year be made by a Committee of those uem- department for'the provision of medical defence. bers of Council who are Secretaries of Branches or Divisions, with power to co-opt other Honorary Secretaries. Election of Central Committee. It was resolved that a conference of Secretaries should be held at Leicester on Tuesday, July 26th, at 6 p.m., that 2. Election by the Representative Meeting and Council of all questions notified for discussion by the conference mustbe a Central Medical Defence Committee (this Committee also received by the General Secretary on or before June s5th, and [ PROCEEDINGS StrPPrEMEr To THU 277 COUNCIL.------MEDICAL JOURNAL *Mi'Y--- 27.-/7 .7-j.j100-1 ------OF-- - [BRITISH that he should circulate the list of subjects to the Secretaries the Annual Meetings separately as Transactions, it was of Divisions and Branches. resolved: That the Council be recommended to ask the Chairman of the Repre- COMMON ROOM FOR DIVISION AND BRANCH SECRETARIES. sentative Meeting to point out to the Representative Meeting that A reeolution was adopted recommending the Council to the proposal of the Dundee District Branch to publish the prooeed- a common room for the use of Division and Branch ings of the Sections of the Annual Meeting in a separate volume of provide would not only a great deal of money, but would tSecretaries during the week of the annual meeting. Transactions cost such It was also resolved that Chairmen of Committees be injure the JOURNAL, and involve a delay in the publication of invited to refer to the conference any special matters upon proceedings. which they would like the opinion of Division and Branch *Secretaries. ASSOCIATION INTELLIGENCE SCOTTISH COMMITTEE. PROCEEDINGS OF COUNCIL. April 28th, 1905. AT a meeting of the Council held, by kind permission of the A MEETING of the Scottish Committee was held in Dundee Asylums Board, London, in their Board Room, Royal Infirmary on Friday, April 28th, when there were Metropolitan present: Professor D. W. FINLAY (in the chair). Dr. R. C. on Wednesday, May 17th, 1905. LUist, Dr. Bdifour Graham, Dr. Hamilton, Dr. Munro Moir, Present: ,Dr. Moorhouse, Dr. Taylor, and Dr. Nasmyth (by request of Mr. ANDREW CLARK, D.Sc., Chairman of Council, in the Char. ithe Committee). Dr. T. DRUSLYN GRIFFITHS, D.Sc., Past-President. Sir VICTOR HORSLEY, F.R.S., Chairman of Representative MeeUnp. LICENSING (SCOTLAND) ACT, 1903. Dr. E. MARKHAM SKBERRITT, Treasurer. After considering an opinion from the Solicitor to the Dr. JOHN FORD ANDERSON, London. Dr. R. MCKENZI JOHNSTON, Edn- Association, it was resolved to take steps to have a question Dr. JAMES BRASSEY BRIERLBY, Old burgh. to Trafford. Mr. R. H. KINSEY, Bedford. put to the Lord Advocate in the House of Commons as Dr. R. LANGLEY BROWNz, West Dr. C. W. MARRIOTT, Reading. whether the term" medical official" in the saving Clause 55 Bromwich. * Professor J. T. J. MORRISON, Bir- was intended to mean a registered medical practitioner (see Dr. R. COcHRANE BUIsT, Dundee. mingham. May 20th, IIII). Dr. W. A. CARLINB, Lincoln. Dr. C. J. MORTON,. London. BRITISH MEDICAL JOURNAL, 1905,P. Mr. PEARSON R. CRESSWBLL, C.B., Dr. JAMEs MURPHY, Sunderland. Dowlais. Mr. D. A. O'SULLIVAN, London. 'MEDICAL REPREMENTATIVE3 OF THE DEFENCEAT OFFIOIAL Professor DAVID W. FINLAY, M.D., Mr. C. H. WATTS PARKINSON, Wim- AUTOPSIES IN CRIMINAL CASES. LL.D., Aberdeen. borne Minster. the the Secretary, and Dr. Dr. E. ROWLAND FOTHERGILL, Lon- Dr. EDWIN RAYNER, Stockport. The Chairman of Committee, don. Dr. CECIL E. SHAw. Belfast. Maxwell Ross were appointed a Subcommittee to bring the Dr. JOHN H. GALTON, Upper Nor- Professor W. R. SMITH, M.D. (Malta xnatter of the medical representatives of the defence at wood. and Mediterranean Branch), Lon- autopsies in criminal cases under the notice of the Dr. JOsEPH J. GIUSANI, Cork. don. official Dr. BRUCE GOFF, Bothwell. Mr. W. D. EPANTON, Hanley. 'Lord Advocate. Dr. DAVID GOYDBE, Bradford. Dr. F. 0. STEDMAN (Eong Kong Dr. MAJOR GREENWOOD, London. Branch), Torquay. ASSOCIATION HOUsE IN SCOTL&ND. Dr. JOSEPH GROvES, Carisbrooke. Fleet-Surg. J. LLOYD THOMAS, R.N., The suggestion from the President of the Stirling Dr. JAMES HAMILTON,(Glssgow. Portsmouth. Branecl Dr. J. HUNTER, South Shields. Mr. T. JENNER VERRALL Brighton. that in the interests of the members of the Association resi- R. Dr. NoFRMAN WALKER, Eainburgh. ,dent in Scotland an Association house, including a library, for and the use of all the members of the Association should be The minutes of the last meeting having been printed in was referred to the Councils of the circulated, and no objections received, were taken as read and established Edinburgh, signed as correct. 'Scottish Branches for their opinions. apology for non-attendance from the Pre- Read letters of Dr. EDUCATION (SCOTLAND) BILL. sident, President-elect, Sir Francis Lovell, K.C.M.G., E. G. Barnes, Dr. James Barr, Dr. M. Beverley, Dr. Edward J. The following resolutions were adopted: Cave, Dr. H. Radcliffe Crocker, Lieutenant-Colonel E. F. 'That steps be taken to have added as Clause 46 (4), "1The school board Drake-Brockman, I.M.S. (ret.), Dr. T. Arthur Helme, Dr. if required by the Department shall provide for the medical exami- Thomas S. Kerr, Dr. C. G. D. Morier, Mr. W. Jones Morris, nation and supervision of the pupils attending schools within their Dr. J. Murray. Dr. F. M. Pope, Dr. J. Maxwell Ross, Professor education distriot to such extent and under such conditions as may Robert Saundby, Mr. John Lynn Thomas, C.B., Major C. E. from tlme to time be prescribed by any code or minute of the I.M.S. Department and for the purposes of this section may appoint such Williams, the deputation, medical officers to be approved by the Department as may be neces- The Chairman of Council reported that sary or may arrange with any local authority aoting under the consisting of the Chairman of the Representative Meetings, Pablic Health (Scotland) Act to conduct the examination and super- Chairman of Council, Dr. Langley Browne, and Dr. Galton, vision on their behalf." .e- -W attended the sitting at the Board of Trade on May sth, i9o5, What steps be taken to delete in Clause 46 (2), the words, " or the and stated their objections to the granting of a licence for the sanitaryinspector as the case may be." incorporation of the Incorporated Society for Promoting the Higher Education and Training of Nurses. Sir Victor Horsley, F.R.S., as Chairman of the Representa- ANNUAL MEETING,(SECTIONS) COMMITTEE. tive Meetinigs of the British Medical Association was author- ized to attend a deputation to the Prime Minister for the pur- April 7th, 1905. of the Association regarding A MEETING of the Annual Meeting (Sections) Committee was pose of given evidence on behalf at the Office of the Association on Friday, April 7th, the prevalence and treatment of venereal disease. theld (Chair- The minutes of the Committee of the Secretaries of o905, when there were present: Professor SAUNDBY Branches and Divisions on the Council relative to the arrange- ,man), Mr. Andrew Olark (Chairman of Council), Dr. W. J. and Division Secretaries at Tyson, and Dr. Norman Walker. ments for a meeting of Branch The reported that, in accordance with Minute of Leicester were approved. CEAIRMAN to The minutes of the Medico-Political Committee were then 'Council 731, the Sections Committee had lBeen requested and the following recommendations approved: eend in for the information of this Committee the subjects it considered, be taken on certain points under the ,was proposed to discuss in the various Sections at Leicester, That Counsel's opinion this to Truck Act and the Companies Act affecting Contract Practice. and that all the Sections had forwarded information as a rule it is inadvisable that detailed reports of .be satisfaction of the Committee. Taat still under consideration by Com- The CHAIRMAN reported that he had received and had Divisions on references have of the Navy, mittees should be published in the JOURNAL before they granted a request from the Honorary Secretary been reported to the Committees concerned. Army, and Ambulance Section for permission to invite Lord matters are referred to the Divisions for con- 'Dundonald and Sir John Furley to read papers in that Section. That when which that the action of the Chairman be sideration information be given to the Divisions as to -and it was resolved of such matters would, by instruction, not be included in :approved. Division Meetings published in the JOURNAL. On consideration of the resolution ofrthe Dundee District the, reports of reported, for facility of reference, and to relieve the space The Chairman of the Medico-Political Committee ;Branch, that as a matter of urgency. the action taken as to a medical 'of the BRITISH MEDICAL JOURNAL, the Journal Committee the result to date, when ,conider the abvisability of publishing the proceedings of appointment at Ebbw Vale and TO 8 THZ 2727 HRITI8HSUPPI..MENTMEDICAL JOURNALJ MEETINGS OF BRANCHES AND DiVISIONS.DlVISIONS. LMAY 27, 1905. the Council expressed its gratification at the attitude of tive to the proposed alteration of the Memorandum of Asso- the medical practitioners who were candidates for the ap- ciation was referred to the Officers of the Association to pre- pointment and its satisfaction with the services of the Medi- pare a full report. cal Secretary in the matter. The reports of Branches, furnished in accordance with The Council approved the rec3mmendation of the Commit- By-law 9, were considered and ordered to be published in the tee relative to the insertion of a note in the BRITISH MEDICAL JOURNAL. JOURNAL upon the labelling of medicines containing poison It was further decided that it is desirable, before the annual sunplied by registerf d medical practitioners. reports received from the Branches of the Association are- Having considered proposals formulated by the Medico- submitted to this Council another year, that they be con- Political Committee, In pursuance of an instruction from the sidered in detail by the Organization and Finance Com- Council to consider and report upon the subject of improving mittees, and be presented with reports by the Chairmen of the representation of the medical prnfession in Parliament those Committees. referred to the Council by the Annual Representative Meeting It was resolved that there be a Science Committee, to con- at Oxford, and having made certain emendrtions, the Council sist of twelve members appointed by the Council. to under-- adopted the following recommendations for the consideration take the woTk at present done by the Scientific Grants, of the Annual Representative Meeting at Leicester: Annual Meeting (Sections), and the Science Co-ordinatioD i. That Members whose candidature for Parliament is sup- Committees. ported by the profession should recognize responsibility to That the Journal and Finance Committee shall advise some organized body rf presentative of the profession. the Council on the administration of, and when necessary the 2. That the organized body should be the British Medical appointment of administrators for, any funds held in trust by Association. the Association and of the Superannuation Fund. 3. That the British Medical Association should select two That the Organization Committee shall adviEe the Council gentlemen, one on each side of politics, and arrange as to their on the Articles, By-laws, and Standing Orders. becoming candidates at the next General Election. Taat the Election Returns Committee be instructed tor 4. That financial and otber support should be given to these prepare list of nominations for the following Committees: candidates by definite grants for election expenses and by (I) Journal and Finance; (2) Premises and Library; (3) Public approaching voters through the Divisions of the Association. Health; (4) Colonial; (5) Naval and Military; (6) Medico- 5. That when the funds of the Association permit of it the Political; (7) Ethical; (8) Organization; (9) Arrangements; necessary expenditure shoulfi be met from the funds (io) Hospitals; (ii) Science. of the British Medical Association. That an Irish Committee be appointed consisting of 6. That the candidates should be selected as in the scheme one Branch or Division Secretary from each Irish Branch, the for nomination for the General Medical Council. Irish members of the Central Council, and one elected The minutes of the Annual Meeting (Sections) Committee member from each Branch. fn the case. of the Leinster and were then considered. Ullster Branches such elected members shall be practitioners The Council decided to ask the Chairman of the Represen- not resident in Dublin or Belfast. It shall have an honorary tative Meeting to point out to the Representative Meeting secretary resident in Ireland, and shall meet at such place that the proposals to publish the proceedings of the Sections and time as the Committee may itself direct, provided that of the Annual Meeting in a separate volume of Transactions such meetings be not always held in one town. It shall would not only cost a great deal of money, but would injure report to the Council on any matters specially concerning the JOURNAL, and involve a delay in the publication of such Ireland. proceedings. The minutes of the Hospitals Committee were then con- sidered and approved. The minutes of the Scottish Committee were then con- of Brandets aub Dibinhts. sidered, and the following recommendations approved: J*tetings That steps be taken to have added as Clause 46 (4), " The [The proceedings of the Divisions and Branches otthe As8ocia- School Board if required by the Department shall provide for tion to and Clinical the medical examination and supervision of the pupils attend- relating Scientific Medicine, when reported ing schools within their education district to such extent and by the Honorary Secretarie8, are published in thte body of the under such conditions as may from time to time be prescribed JOURNAL.] by any code or minute of the Department and for thepurposes of this section may appoint such medical officers to be BORDER COUNTIES BRANCH: approved by the Department as may be necessary, or may NORTH CUMBERLAND DivisIoN. arrange with any local authority acting under the Public A MEETING of this Division was held at Penrith on Friday, Health (Scotland) Act to conduct the examination and super- April 14th, Dr. DOUGHTY (Dalston) in the chair. vision on their behalf." Matters Referred to Divi6ions.-A discussion then took That steps be taken to delete in Clause 46 (2), the words, place on the memorandum re the Midwives Act, and the "or the sanitary inspector as the case may be." conclusions have been conveyed to the Medico-Political The minutes of the Organization Committee were then con- Committee. The other matters referred from the Representa- sidered, and the following recommendations approved: tives Meeting, I904, and the Medico-Political Committee oF That the South-Eastern Counties Division (Edinburgh the Association, were named to the meeting, and it was Braneb) and Lincoln Division (Midland Branch) be granted resolved that no action be taken by the Division. separate representation if upon inquiry it is found that the Dinner.-The meeting was followed by a dinner. total membership formerly credited to them had been arrived at in error. That the Rules submitted by the Sheffield Division be DORSET AND WEST HANTS BRANCH. approved. THE annual meeting of this Branch was held at -the Crown That the desires of the present members of the Crewe Hotel, Blandford, on Wednesday, May 17th, Mr. A. J. H. Division be given effect to as regards the absorption of that CRasPI, President, in the chair. Division by the Chester and other neighbouring Divisions, Confirmation of Minutes.-The minutes of the last meeting and that the boundaries be tuch as the Lancashire and were read and confirmed. Cheshire Branch Council may define. Introduction of Newa President.-The PRESIDENT resigned the That the transfer of Berkhamstead, Hemel Hempstead, chair, and introduced his successor, Dr. E. Hyla Greves, of Abbots Langley, and King's Langley from the Aylesbury Bournemouth. Division of the South Midland Branch to the Watford Division Vote of Thanks to the Retiring President.-A cordial vote of of the Metropolitan Counties Branch be approved. thanks was accorded the out-going President for his services, That the Aberdeen and Staffordshire Branches be accorded and Mr. CaEsPI suitably responded. independent representation in the Council. Deceased Members.-The HON. SECRETARY reported the The Annual Report of Council was then considered, and deaths of three members since the last meeting-namely,. after certain amendments had been made it was approved and Drs. Lush, W. Turner, and Morley Rooke.-Dr. SNow, in feel- ordered to be submitted to the Secretaries of each Branch ing terms, referred to the great loss suffered by the Branch by and Division and pablished in accordance with By-law 34. the death of Dr. Vawdrey Lush, the Hon. Secretary anc (See page 225.) founder; and Mr. W. Turner, a Vice-President; and Dr. The consideration of Mr. Beaufort Palmer's opinion rela- Morley Rooke, and proposed a vote of sympathy with the MEETINGS OF BRANCHES AND DIVISIONS. UrPPLK TO,=X -MAY 27, 1905.1 BRITISH MEDICAL JOURNAL v 7 relatives of the deceased. This was seconded by Mr. PARKIN- Next Meeting.-It was decided to hold the next meeting at EON, and resolved. Sutton on October I9th. .Representative on Central Council.-The HoN. SECRETARY School Certificates.-A resolution brought forward by Dr. reported that Mr. Parkinson had been duly nominated and re- Hucoo that no practitioner accept a fee of less than half a elected unopposed as Representative of the Dorset and West crown for a certificate for school attendance was adopted Hants and West Somerset Branches on the Central Council of unanimously. the Association. Vote of Thanks to the Retiring Chairman --Dr. GRIPPER pro- Treasurer's Report.-The Treasurer's report was read, and on posed a cordial vote of thqnks to Dr. Rosser, the retiring the proposition of Dr. SIMmoNS, seconded by Dr. HUMPHREYs, Chairman.-This was heartily agreed to.-The chair was then was received and adopted. taken by Dr. J. WAYTE. Increase of Membership.-The HON. SECRETARY reported thA Cases.-The following cases were then shown:-Dr. J. tiumber of members of the Branch had increased to over 200. WAYTE: (I) Teale's amputation for tuberculous disease of the Summer Meeting.-Dr. COMYNS LEECH propoeed, and Dr. ankle joint and necrosis of the lower end of the tibia; I3ATTERBURY seconded, and it was resolved, that the summer (2) parotid tumour; (3) carcinoma of the buttock; (4) loose mneeting be held at Sturminster Newton. cartilages of the knee joint.-Dr. RICDFER14: (i) Lymphade- President's Address.-The PRESID1ENT then delivered an noma, with detailed report of the blood ; (2) lichen with address on warning signs of organic disease.-Dr. ComyNs zonular distribution simulating herpes; (3) spastic diplegia, LIEECH proposed, and Mr. CRESP1 seconded, a cordial vote of twocases; (4) Raynaud's diseaee, early btage.-Mr. WRAY: thanks to the President for his instructive and interesting Gtumma iris.-Dr. MALE: (I) Rodent ulcer treated by x-rtys-; -address.-This was carried by acclamation. (2) Arthritis and periostitis of doubtful origin in a child, with Communications.-Dr. T. SANDIERSON WELLS read a paper on skiagraphs.-Mr. CRESsY: Notes on three caaes of tubal ,the substitute feeding of infants. The paper was discussed by pregnancy, and on a case of Caesarean section.-Mr. WILLOCK: rthe PRESIDENT, Drs. BATTERBURY, SIMMONS, FIELDING, and Head and neck of the femur passed pfer vaginam.-Dr. ADDEY: .others, and Dr. WELLs replied.-Mr. PARKINSON made a prac- (i) Charcot's joint; (2) hypertrophy of the feet. tical suggestion as to the method of removing an adherent Dinner.-Twenty-one members dined together after the iplacenta. meeting. Dinner.-The members subsequently dined together at the tiotel. SOUTHERN BRANCH: PORTSMOUTH DIVISION. LANCASHIRE AND CHESHIRE BRANCH: THE annual Divisional meeting was held at Portsmouth on BLACKBUIRN DIVISION. May :7th, Dr. HACKMAN in the chair. THe annual meeting of this Division was held at the Old Bull Election of Officers.-The following gentlemrn were elected Hotel, Blackburn, on Tuesday, May i6th, Dr. BARR, Presi- officers for the ensuinng year: Chairman, R. Emmett, M.D.; -dent, in the chair. Vice-Chairman, B. H. Mumby, M D.; Executive Committee, Confirmation of Minutes.-The minutes of the last meeting Dra.,Kyffin, Key, Norman, Dove, Blakekwood Routh, Carling, were read and confirmed. G. Morley, J. L. Wright, and M. Way; Representatives on Annual Report.-The Secretary read his annual report. Branch Council, Drs. Claremont, J. Green. and Blackman; Election of Officers -The officers for the ensuing year were Representative in Representa five Meetinys of the A*sociation, Dr. then elected as follows: President: Dr. Cunliffe. Vice-Presi- J. Ward Cousins; becretary and Treasurer, Mr. C. P. Childe. -dent: Dr. Ballantyne. Secretary: Dr. Greenwood. Representa- Proposed Meeting of Southern Branch at Portsmouth in 1906.- .tive for Representative Meetings: Dr. R. C. Holt (Burnley) was On the motion of Dr. CLAREMUNT, set,onded by Dr. McELDOW- declared elected as the nominee of this Division and the NEY, an invitation was sent to the Southern Branch to meet 6Secretary was instructed to send an intimation to this effect in Portsmouth in i9o6, and Dr. Mumby was nominated Presi- to the Burnley Division, together with an explanatory letter dent of the Branch for that )ear. stating that the Divisional meeting on April :4th, 1905, was Matters Referred to Divisions.-Tbe following questions re- inot an annual meeting, and that, therefore, the nomination of ferred to the Divisions were considered: Nationial Friendly Dr. Nashat that meeting was out of order. Members ofBranch Society; the relation of the medical prolession to ambulance Council: Drs. Wells and Gifford. EBecutive Committee: Drs. work; the report of the Ethical Committeeon the advertising of 43annister, Martin, Willet, and Aitken were declared elected. the names of medical practitioners in connexion with hydro- Medical Offier ofDarwen livision.-Resolved that the Secre- pathic and similar establishments; tbe report of the Medico- tary send a report to the BRITISH MEDICAL JOURNAL re the Political Committee on the present position of registered iposition of the Medical Officer of the Darwen Division of the medical practitioners in the matter of furnishing certain in- 5Blackburn Union when the matter had been concluded formation to coroners; the repot t of the Medico Political Com- satisfactorily. mittee on the desirability of consultation between medical Annual Dinner.-It was resolved that this Division shall witnesses in legal cases ; the report of the Medico-Political have its first annual dinner next October or November. Committee on the prevention of the abuse of drugs ; the Presidential Address.-It was resolved that the President of interim report on contract medical praetice; the Medical Acts 'this Division shall give a Presidential Address each year. Amendment Bill; the report of the Medico-Political Com- Vote of Thanks to Retiring Offleers.-It was resolved that mittee on death registration; the report of the Medico-Politi- ,thanks be given to the retiring President, Dr. Barr, and the cal Committee on theamendment of coroners' law. The reso- other retiring office-bearers. lutions passed on these questions have been communicated to the Medico-Political Committee.

SOUTH-EASTERN BRANCH: WINCHESTER DIVISION. CROY DON DIVISION. A GIENERAL meeting of this Divisit n was held on April igth THE annual meeting of this Division was held at the Croydon at 3.30 p.m. at St. Patrick's Hall, Trafalgar Street, Win- General Hospital on May i8th. Dr. ROSSER occupied the chester. chair during the transaction of the Association business. Matters Referred to Divisions.-The following matters were Confirmation of Minutes.-The minutes of the previous considered:-Medical# Acts Amendment Bill: The Bill was meeting were read and coufirmed. approved of generally, but the title of " doctor" being con- Dr. Own Fowler.-A letter was read from Dr. C. Owen ferred on all registered was objected to.-National Deposit Fowler thanking the members for the resolution passed at the Friendly Society: The recommendations of the Medico- last meeting. Political Committee were adopted.-The Public Health Bill Election of Offlcers.-The following officers were elected for was approved.-The Revaccination Bill was approved.-With the coming year:-Chairman: Dr. T. R. Adams. Vice- regard to advertising the names of medival practitioners in Chairman: Dr. W. Rosser. Honorary Secretary: Mr. Willock. connexion with hydropathic and similar establishments, it Branch Council Representatives: Dr. 1'. R. Adams and Dr. S. was resolved that these names should not appear.-Death Parsons Smith. Direct Repreeentative: Dr. J. J. Macan. registration: Questions I and 2 were answered affirmatively.- -Executive Committee: Mr. Horsley, Dr. Fowler, Mr. Newby, Coroner's Law: Question 4. i (a) was answered affirmatively; Mr. S. G. Reid, Dr. Redfern, Dr. Duncan, Mr. Wray, Dr. Question 4, I (b) was answered affirmatively, fee £2 28.; Ques- Carpenter, Dr. Wayte, Dr. Gripper, Mr. Cressy, Dr. Hugo, tion 5 (i)was answered affirmativs ly, fee Ios. 6d.; Question 5 (ii) and Dr. Meredith Richards. was answered affirmatively, fee /: is. 280 BRITISHSupp[..M.zoTrMEDICALToJOURsALJTill 1 ASSOOIATION NOTICES. [MAY 27, 1905.

I SOUTH WALES AND MONMOUTHESHIRE BRANCH: BRANCH AND DIVISION MEETINGS TO BE HELD. CARDIFF DivisioN. ABERDEEN BRANcH.-Election of Member of Council: It is requested THEB annual meeting of this Division was held in the rooms of that nominations for election of member of Council be sent to Dr. J. F. Christie, 7, Alford Place, not later than Saturday, June ist. Each candi- the Oardiff Medical Society, I41, Queen Street, on Thursday, date must be nominated by at least three electors. If more than one. May i8th, at 3.30 o'clock. member is nominated for election, then voting papers will be sent to each Con/irmation of Minutes.-The minutes of previoUs ordinary elector during the first week in June. and special meetings were read and confirmed. Election of Officers.-The following were elected officers BATH AND BRISTOL BRANCH.-The seventh ordinary meetiDg of the for the ensuing year: C(hairman. Charles T. Vachell, M.D.; Session will be held at the Medical Library, University College, Bristol, Vice D. on Wednesday evening, May 31st, 1905, at 8 o'clock, Mr. R. J. H. Scott, Chairman, R. Paterson, M.D.; and Secretary, Ewen J. President, in the chair. The following specimens will be shown: Dr. Maclean, M.D. Representatives of the Division on the Branch Walter C. Swayne, (a) chorion-epithelioma; (b) fibroids removed by Council: Drs. J. T. 'lhompson, Thomas Wallace, H. R. Vachell, myomectomy during pregnancy; (c) carcinoma of cervix uteri and J. Powell, W. Randall. Executive Committee: Drs. T. Garrett dermoid cyst removed simultaneously by the abdominal route; (d> ovarian cyst. Dr. J. Odery Symes, a preparation showing granular deo- Horder, W. Mitchell Stevens, Messrs. J. Lynn Thomas, and generation of erythroeytes from chronic lead poisoning Dr. Carey William Sheen. Dr. J. Tatham Thompson was re-elected the Coombs, a case of removal of gall-stone from the jejunum. Dr. Theodore. Representative of the Division in the Representative Meetings Fisher, some cases of oedema of unusual origin. Dr. Walter C. Swayne,. the prevention of ventral hernia after abdominal sections. Dr. G. Parker, of the Association. notes on i case of aneurysm of the circle of Willis. Drs. P. Watsoa Report of Executive Committee.-The annual report of the Williams and G. Parker, on masked diphtheria and its notifSability. At Executive Committee was received and adopted. meeting of the Branch Couneil will be held at 7.55 p.m. The following candidates will be balloted for: Basil H. Pain, M.B., B.C.Cantab., Annual Representative Meeting.-The consideration of the M.R.C.5., L.R.C.P.Lond., Bath; C. E Campbell-Horsfall, M.B., Ch.B.Vict:, business of the[Annual Representative Meeting was postponed Clevedon.-NEWMAN NEiLD, W. M. BEAUNONT, Clifton, Honorary to a special meeting. Secretaries. Matters Referred to Divisions.-The meeting granted to the Executive Committee authority as to procedure with regard BATH AND BRISTOL BRANCH: BRISTOL DivIsIoN.-The annual meeting to the following measures: The Pablic Health Bill, the Local of the Division will be held at the MecLical Library, University College, Bristol, on Thursday evening, June 8th, at 8 o'clock. Business: (a) To- Government Bill, and the Revaccination Bill. elect Officers, the Representatives of the Division on the Branch Council- Vote of Thanks to Retiring Chairman.-The meeting con- (b) To elect the Representative of the Division in Representative Meetings. cluded with a hearty vote of tbanks to the retiring Chairman, of the Association. (c) To receive the annual report of the Executive Committee. (d) To coDsider the business of the Annual Representative. Dr. Thomas Wallace, for the efficient manner in which,he had Meeting. (e) To make new rules or alter or repeal existing rules. (f) To- discharged the duties of his office during the past year. transact any business that may be transacted at an ordinary meeting.-- NEWMAN NEILD, Clifton, Honorary Secretary. YORKSHIRE BRANCH: HARROGATE DLvIsioN. BATH AND BRISTOL BBANCH: TROWBRIDGE DrvIsION.-The annua) meeting of this Division will be held at Trowbridge on Tuesday, May 3oth. A JOINT meeting of this Division and the Harrogate Medical Hour and place of meeting will be announced at a later date. Business- -Society was held at the ProFApect Hotel, on Thursday, May (I) Such as is laid down in Rule xI. (2) Matters referred from CentraJ sIth, at 5.30 p.m., Dr. SOLLY, Vice-Chairman, presiding. Association.-J. TuBB-THOHAS, The Halve, Trowbridge, Wilts, Honorary Confirmation of Minutes.-The minutes of the previous secretary. meeting were read and confirmed. BIRMINGHAM BHANCH.-The annual meeting of this Branch will take Election of O.ficers.-The following officers were elected for place at the Medical Institute, Edmund Street, Birmingham, at 4 o'clock. the ensuing year: Chairman, Dr. Solly; Vice-Chairman, Dr. on Thursday, June 8th. The dinner will take place at the Grand Hotel Mouillot; Honorary Secretary, Dr. Gibson; Representative for at 7 o'clock the same day.-T. SYDNEY SHORET, 0. J. KAUFFMANN, Honorary Representative Meeting, Dr. l)aggett; Representative on Branch Secretaries. Council, Dr. Solly; Executive Committee were re-elected en bloc, BIRMINGHAM BRANCH: COVENTRY DIvIsION.-The annual meeting of with the addition of Dr. Rutherford. this Division will be held at the Coventry and Warwickshire Hospital ore Matters Referred to Divisions.-The memorandum as to Tuesday, June 6th, at 8 30 p.m. Agenda: (I) To elect officers, the Repre- rendering assistance to midwives in difficult cases was con- sentative on the Branca Council, and the Executive Committee for the' sear. (2) To receive the annual report of the Executive Committee for sidered and report made to Medico-Political Committee. The I904, whiCh is to the following effect: In accordance with the require- memorandum as to the relations of the medical profession as nients of By-law 8 of the Association, the Coventry Division presents the' to ambulance work was considered and reported on that it following report of its proceedings during 1904, its numbers, and a. financial statement, in the form prescribed by the Council of the Asso- should not be treated as a matter of philanthropy. The ciation, to the Council of the Birmingham and Midland Counties Branch. Public Health Bill of the Association was considered and During the year seven meetings of the Division have been held; at these agreed to. meetiDgs papers on medical subjects have been presented and questions. Doctors and their Professional Brethren.-Dr. MOUILLOT of medico-political and ethical import have been discussed. The average' Spa attendance at these meetings has been 25, which is an increase on that of' read a paper entitled the Relations of Spa Doctors with their the previous year. The number of members of the Division is 40. In. Brethren. The paper, which will be published, was discussed addition to these meetings there was a joint meeting of the Divisionw by Drs. HUNT, GIBsoN, BAIN, BRONNER, DAVEY, and SOLLY. with the Tamworth and Nuneaton Division for the purpose of electing a- Bepresentative for the Annual Representative Meeting. During the year Dinner.-The members and friends afterwards dined the Division has instituted a voluntary book section, with an annua- together. subscription of Ioo. 6d.;* g members have joined this section, which makes a joint subscription to Lewis's Medical Circulating Library; each. member is entitled to one volume at a time. In presenting the annual To ensure the insertion notices in this column flnancial statement, the Division takes the opportunity of drawing the. 004't of they attention of the Branch Council to By-law I7 of the Association, which Must be received at the Central Offices of the Association not requires the Branch to pay to each Division of the Branch such sum pe- later than the on member as the Branch Council may consider necessary to defray the. first post Tuesday. expenses of the Division. This Division carries on, and proposes to carry, on, an active series of meetiogs throughout the year. Totalling the' ordinary meetings and the Committee meetings, the number of sum- monses to atteind meetings amounted to 360 in 1904; the amount paid by' Z ZZTIatilr ja tw . the Branch to the4Division amounts to i -d. for each summons to cover the total expenses in connexion with these meetings, andwithout making any allowance forexpenses involved by thedistribution of otherctrulars, NOTICE OF CHANGE OF BOUNDARIES etc., requested by the Council of the Association; the Division submits that it cannot be easy for the Branch Council to consider the allowance OF DIVISION AND BRANCHES. made sufficient to defray the expenses of the Division in accordance. with the By-law. The Division also wishes to point out that the practice adopted by the Branch Council of making the grant provisional on the' THE following changes have been made in accordance with expenditure reaching the amount of the grant makes it impossible for a. the of the and take effect from Division to have any funds in hand, but does not eliminate the possibility regulations Association, the of a deficit; and, shortly, that an arrangement that causes economies. date of publication of this notice: effected by a Division to benefit not its own financial position but that of The Crewe in the Branch is inequitable. Division to be absorbed the Chester Division, Financial Statement. except Sandbach which is transferred to the Stock- Dr. 6 s.d. or. s.-dd and East Cheshire Grant received from Hire of Rooms ...... o a> port Division. Branch Council - 4o Secretarial Expenses, Sta- Berkhamsted, :Hemel Hempstead, Abbot's Langley and members at 1s. per head 2 0 0 tionery and PrintiDg 3 S 0. King's Langley to be transferred from the Aylesbury Balance due to Treasurer I o Clerical Aid, etc. .o o , Division of the South Midland Branch to the Watford 3 50 3 5 Cb F. L.HAA MAN BROWN Audo. Division of the Metropolitan Counties Branch. F. A. COLLINGTOM udLor. MAY 27, 1905.] &SPPLExUNT TO THJ O ASSOCIATION NOTICES. [BRIISH MEDICAL JOURNAL 28 t a (i) To consider the following recommendations of the Committee: GLASGOW AND WEST OF SCOTLAND BRANCH.-Election of Representa- (a) That in Rule xI "December" be substituted for "January" as a tives: Notice is hereby given that nominations must be intimated to me, month in which an ordinary meetiog of the Division shall take place. as Secretary of this Branch, on or before Wednesday, June 14th.-CBAS. H, b) That the Division pass the following ethical resolution: "That in NICOLL, 4, Woodside Place, Glasgow, Honorary Secretary. future no member of the profession in the area of the Division sball ;apply for the medical officership of a Friendly Society." (c) That the LANCASHIRE AND CHESHIRE BRANCH: LIVERPOOL (NORTHERN) DIvIsION. Division authorize the Committee to take any steps which may appear -The annual desirable to forward the passing of the Public Health Bill now before meeting of the members of this Division will be held at the Parliament. (4) To thank the Committee of the Coventry and Warwick- Medical Institution, uI4, Mount Pleasant, on Wednesday, May 31at, at shire for the continued use of their Board room for the 4 p.m. Agenda: (x) Annual report. (2) Election of officers, Representatives Hospital pur- on Branch Couneil, Executive Committee, and a Representative for the poses of the Division.-E. H. SNELL, Knighton House, Coventry, Honorary Annual Representative Meeting. (3) Alteration of Rules. (4) To consider Secretary. Report on Death Registration and Amendment ot Coroners' Law (see BORDER COUNTIES BRANCH.-The annual general meeting of this SUPPLBMeNT, March IIth). (5) Memorandum as to School Certificates. Branch will be held at the County Hotel. Carlisle, on Friday, June x6th, (6) Notices of motion for Representattve MeetiDg (see SUPPLEMEATS, at 3.30 p.m., when Sir James Crichton-Browne, M.D., will deliver his April iSt, 8th, 35th, 22rd, and May 33th). (7) Medical Defence (see SUe- Presidential Address.-FRANcIs R. HILL, 62, Warwick Road, Carlisle, PLEMENT, April isl). (7) Any other ousiness.-A. W. GERMAN, Honorary Monorary Secretary. Secretary of the Division. COUNTIES AND BORDBE BRANCH NORTH LANCASHIRE AND SOUTH WEST- MBTROPOLITAN COUNTIBS BRANCH.-NOtieC Is hereby given that nomi- MORLAND BRANCH.-Notice is hereby given that nominations for the post nations of candidates for the five offices of Representatives of the Branch of Representative of these two Branches jointly on the Central Council of on the Central Council for the ensuing year must be made in writing to Tfle Association must be sent to me not later than May 27th. A nomina- GEFORGE ROWALL, 6, Cavendisn Place, W., on or before Saturday. June zoth. tion paper in favour of the present representative has already been sent Nominations not made bya Division require, bv the present Rules of the in, and Dr. Maxwell Ross has signified his willingness to accept office if Branch, to be signed by twelve members of the Branch. elected.-FwNcis R. HILL, Carlisle, Honorary Beeretary, Border Counties Branch. METROPOLITAN COUNTzES BRANCH: WESTMINSTER DIvISiON.-The *CANTERBURY AND FAVERSHAM WITH THANET DIvrsIo2;s.-A combined annual meeting will be held at 20, Hanover Square, on Wednesday, June ameeting of the Canterbury and Faversham with Thamet Divisions will be 14th, at 4.30 p.m.-W. KNOWSLBY SIBLEY, M.B., 7o, Duke Street, W., held on Thursday, June 1st, at 4 o'clock, at Canterbury Hospital, pre- honorary becretary. ceded at 3.IS by a meeting of the Canterbury and Faversham Division. Agenda: For Canterbury and Faversham DivisioD. (X) To read and con- MIDLAND BRAiNCH.-The annual meeting of this Branch will be held at firm minutes of last meeting. (2) Time and place of next meetiDg. (3) To the Infirmary, Leicester, on Thursday, June Isth, at 4.30 p.m. Tea will be alter or repeal existing rules, or to make new ones (if desired). (4) Any provided before the meeting. Copy of resolution of Branch Council other business. (5) Election of officers. For combined meeting. (t) To passed January izth, g90o "That a business meeting only of the Branch read and confirm minutes of last meeting. (2) Election of Representative beheld in June next.' The Branch Council will meet at 3.30 p.m. for Representative Meeting at Leicester. (3) To consider proposed resolu- Agenda: Minutes. Report of Branch Council and annual financial state- tions to be submitted to the Representative Meeting.-WILIAM GossE, ment. Election of Branch officers. Any other business.-AsTLry V. A. R. HENCHLEY, H. M. RAVEN, Honorary Divisional Becretaries. CL ARKE, Honorary Secretary and Treasurer.

DUNDEE BRANCH.-The annual meeting of this Branch will be held MIDLAND BRANCH: BOSTON AND SPALDING DIvIsION.-The annual in the Students' Union, Dundee, on Friday, June 2nd, at 4 p.m, to elect meeting of this Division will be held on Tuesday, May 30th, at the office-bearers and to considerthe report on Medical Defence.-R. C. BUIST Red Lion Hotel, at I p.m. Luncheon will be provided at 2.45 p.m.; and A. P. Low, Honorary Secretaries. tickets, 38. 6d. each (exclusive of wine). Agenda: Election of officers; programme or the year; discussion of some proposals of the Medico- Ethical Committee, etc.; aDy other business.-A. E. WILSON, Honorary EAST ANGLIAN BRANc.-The annual meeting of the East Anglian Boston and Division. t Branch will be held at Norwich on Thursday, June 29th. Secretary, Spalding EAST ANGLIAN BRANCH.-Notice is hereby given that nominations of NORTH OF ENGLAND BRANcH.-Nominations for the office of Repre- members for the office of Representative on the Central Council of the sentative of this Branch on the Council of the Association must Association, each signed by not less than three members, must reach me reach me not later than May 30th. There are two vacancies, and the not later than May 3ist.-B. H. NICHOLSON, M.B., East Lodge, Colchester, present Representatives, Drs. Murphy and Hunter, are both eligible, and General Becretary of Branch. offer themselves for re-eiection.-ALFRED Cox, Cotfield House, Gateshead, Honorary Becretary. EDINBURGH BRANCH.-The summer meeting of the Branch will be held at Hawick on July ist. Trains from Edinburgh (Waverley) 1030 a.m. NO}RTH WALES BRANCH: SOUTH CARNARVON AND MERIONETH DIvISION. Provisional arrangements: Meeting of Branch, I2 I5. Motor drive to --The annual meeting of this Division will be held at the Golden Lion Stobs, Hermitage Castle, Neweastleton, Peuton Linns, Canonbie, Lang- Hotel, Dolgelly, on Wednesday, May 3ist, at 2 p.m. Agenda; (X) To read holm, MoBspal anl Branxholme. Starting at I p.m. Golf match on minutes of last meeting. (2) lo read correspondence, etc. (0) to appoin,t Hawick Links, 1.45. Dinner at Tower Hotel, 6 30. Dr. Allan Jamieson, Chairman for 1905-6. Vice-Chairman, Secretary, Representative to Repre- President, in the chair. In order to facilitate arrangements members sentative Meeting, Representatives on Branch Council, Members of the who intend to be present are requested to intimate their intention to one Executive Committee of Division. (4) To nominate Representative of of the Secretaries as soon as possible. and whether they propose to golf the North Wales and Shropshire (grouped} Branches on the Central or to motor. -NORMAN WALKER, 7, Manor Place, Edinburgh, A. LGAN Council of the Association. (The present Representative is eligible for TURNER, 27, Walker Street, Edinburgh, Honorary Secretaries. re-election.) (5) To receive annual report of the Executive Committee, with its recommendations regarding the matters referred to it for con- sideration by the Representative Meeting. (6) To consider the agenda of EDINBURGH BEANCH: BOUTHERN DivISION.-The annual meeting ot the Representative Meeting to be held at Leicester on July 24th, et seq. this Division wilt be held in the Oddfellows' Hall, Forrest stoad (Etoom 6), Members will greatly oblige byconsulting the SUPPLEMENT of the BRITI,it on Thursday, June 3ist at 8.I5 p.m. Business: (X) Minutes. (2) Annual MEDICAL JOURNAL of May 13th, and note any matter they expressly wish report. (3) Treasurer's statement. (4) Rule for vacancies occurring to call the attention of the to-and officers. Election of officers. Election ot meeting please briog WUPPLEXENT among (5) (6) Representative with them. Dr. Jones will open a discussion on the to Representative Meetings. (7) Election of Representatives on Branch Hugh (Doigelly) treatment of pneumonia. D . J. Hill Abram has signified his intention Council. (8) Election of Executive Committee. (a) Recommendation as of taking part in it. It is hoped all members who intend being present to annual retiral of a proportion of Committee. (o) Question of medical at the meeting will be prepared to take part. The following papers will certificates of unfitness to attend school. (io) Question of payment of be read: Edgar Stevenson, F.R.C.S.: A case of exostosis of the orbit. medical men called upon to assist midwives. (iI) Any other competent Rushton Parker, F.R.C.S.: Case of large calculus removed from ureter business.-MICHAL DEWAR, 24, Lauriston Place, Edinburgli, Honorary by suprapubic cystotomy. W. Thelwall Thomas, F.R.C B.: Recent cases Secretary. of suprapubic cystotomy. Luncbeon at l.I5 p.m.-W. JONES-MOaRIs, Is-y- Ooed, Portmadoc, Honorary Secretary. EDINBUBRGH AND FIFE BRANcHBs.-Notice is hereby given that pominations of elective members of the Council of the Association for these Branches must be made in writing on or before June 3rd, to NORTH WALES BRANC{H: NO3TH CARNARVONSEIRE AND ANGLESEY A. LoGAN TURNE}R, M.D.. 27, Walker Street, Edinburgh, Honorary DivIsIoN.-The annual meeting of this Divlsion will be 'held at the Sweretary Edinburgh Branch. British Botel, Bangor, on Tuesday, May 30th, at p.m. Agenda: (z) To read the minutes of tbe last meeting. (2) Io read correspondence. (3) To EDINBU1RGH BRANCH: SOUTH-EASTEiN COUNTIE8s DmsION.-As ar- elect Chairman, Vice-Chairman, Honorary Secretary, Representative to ranged at last meeting of vivision, the annual meeting will be held on Representative Meeting, Representatives on Branch Council, and mem- Saturday, June 17th, in the Railway Hotel, Newtown St. Boswells, at bers of the Executive Committee of the Division Jor 1905-6. (4) To nominate 3 o'clock. Business: (i) Election of office-bearers. (2) The consideration of Representative of the North Wales and Shropshire (grouped) Branches memoranda regarding the National Deposit Friendly Society. the Local on the Central Council of the Association. (5) To receive the annual Government Amendment Bill, the relation of the medical profession to report of the Executive Committee. (6) To coDsider the agenda of tile ,ambulance work, etc. (3) Instructions to representative In regard to Representative Meeting to be beld at Leicester in July. Members will the agenda of the annual meeting of the Association at Leicester. (4) please consult and bring with them the BUFPLEMENT to the BRITISH Other matters of urgent importance to the Division. It is boped that MaDICAL JOURNAL of May 13th. (7) Paper by Corbet W. Owen, M.B.: members will do their utmost to be present. Dr. Hamilton gives notice Notes on a case of acute lead poisoning. A meeting of the Executive of the following motion: "That the Division recommends to the Repre- Committee will be held at I p.m.-H. JONES ROBERTS, Pen-y-gIoes, aentatIve Meeting the desirability of appointing a Committee to consider Honorary Secretary. the question of the formation of a fund for the relief of the widows and orphans formerly dependent on deceased members of the Association."- annual of this Branch W. HALL CALVERT, Honorary Secretary. SoUT-EAsTERN BRANcH.-The meeting will be held at the Guildhall, Canterbury on Wednesday, June lISt, at 2.15 p.m. Dr. Whitehead Reid President-Welect, kindly invites members to lunch at FIFE BRANCH.-The annual meeting will be held on June 'St, at 3.15 p.m., the Royal Fountain iotel, between I and 2 o'clock. Agenda: In addition in the Hotel, Thornton, as per circular issued to the. members.- to any business that may be transacted by an ordinary meeting. (I) To BALFOuR -R. GRAHAM, Leven, Honorary Secretary. receive the report as to election of officers of the Branch. (2) To receiv TO THE 282 ]BRITISHStPPLFM2NTMEDICAL JOUIINAL1 THE ANNUAL MEETING. rMAYI --- 2-7,0 7 10- = .1-j- I the annual report of the Branch Council. (3) Mr. J. H. Ewart will move titioner and Appendicitis. Lunch will be served at the Beach Hotel at "That Honorary Sewrotaries of Divisions be ezofflcto members of the 1.30 p.m., the cost of which will be defrayed out of the Branch funds in Branch Council" After the meetiDg expeditions will be arranged to the the case of those members who signify to Mr. Gordon Henry, Blair Cathedral and other places of interest in the city; to the Sanatorium and Lodge, MineheQd, by June 6th, their intention of being present. In the Sewage Farm, and to the Ca0terbury Asvlum. Dinner at the Royal case of others and of guests a charge of 28. 6d. will be made, in all cases Fountain Hotel, 6.xz tor 6.30; charge, 7.- Wine will be supplied by local exclusive of wine, etc. After lunch the golf links will be at the disposal members. Those who propose to be present are requested to signify their of members, or they will be driven to the polo ground, where a match intention to Dr. Heachley, I, London Road, Canterbury, not later than will be played, and where they will be entertained to tea.-W. B. WINCK- Saturday, June x7th.-H. i. STEWART, Honorary Secretary. WORTH, Honorary Secretary, Taunton. BOUH-AsTEN BwNcH: BIERGHTON DmSIoN.-A meeting will be held at the Dispensary, 1X3, Queen's Road. Brighton, at 4.30 p.m., on the fourth Wednesday in May (24th), June (28th), annual meeting, October (25th), MEETING OF BRANCH AND DIVISION November (22nd). Members wishing to read papers or show cases at the meetings are requested to give at least a fortnight's notice to the SECRETARIES AT LEICESTER, M.D., Honorary Secretary, KYDING MARSH, o9, Backvllo Road, Hove. JULY 25, 1905. SOUTH-EASTERN BRANCH: NoRwooD DrvIsioN.-The next meetiDg of THE Council of the British Medical Association has this Division will take plaoe at the Art Club, Blackheath, on Thursday, sanctioned a conference of the Branch and June 8th, at 4p.m- Aithur Roper, M.D. (Lewisham), in the chair. Dinner Divisions at 6 p.m.; charge 78, exclusive of wine. (1) Minutes of last meeting. Secretaries to be held on the Tuesday of the Annual (2) To decide where the Dext mee tog shall be held, and to nominate a Meeting week.-namely, July 25th-at 6 p.m., in a room to member of the Division to tak'- the chair thereat. (3) ro elect officers, be set for the the Representatives of the D vision o0' the Branch Council, and ordinary apart purpose. members of Executive Conmtittee. (4) To elect the Representative of the Branch and Division Secretaries are invited to notify Division in Representative Meetings of the Association. (5) To receive any subjects they maywish tobringbefore this conference. the annual report of the Executive tuommittee. (6) To consider business All matters to be of Annual Meetiig. To consider rules considered must be notified to the Kepresentative (7) existing and General discusswhether any alterations are recessary. (8)Anyotherbusiness Secretary of the Association, 429, Strand, W.C., om The followie g p4pers will be read: Lauriston Shaw, M.D., F.R.C.P.: The or before June I5th. muscle of the stomatli ID the treatment ot its diseases L. A. Dunn, MS., F.R.u.S.: Some remarks upou the surgical treatment of carcinoma of the The General Secretary will as early as possible after stomach. J. Purves Stewart, M D.: The dtagnosis of tabes in June I5th circulate to the Branch and Exhibition of dorsalis its Division Secretaries earliest stage. instruments, etc., by Messrs. Down Bros. a list of the notified him Members desirous of exhibiting specimens or reading notes of cases are subjects for discussion by the invited to communicate at once with the Honorary Secretary. All mem- conference. bers of the South Eastern Branich aie invited to attend and to introduce professtoual friends, but will he unable to vote on Divisional questions. The Honorary deoretary would be toiuch obliged if members would kindly inform him by post card, to reach him by the first post on Tuesday before the meet-ing, whe!her they luteud, if possible, to be present at the meet- ing, and if likely to remain to dinner. By so doing they will very materi- %ri isb At bItrat 55soriatt*on ally facilitate arratgements and promote the success of the meeting.- HENRY J PRAsOLI-Y, ludor House, Anerley, Honorary Secretary; ARTHuR W. SoPxR, Assistant Honorary Secretary. SEVENTY-THIRD ANNUAL MEETING. THE seventy-third annual meeting of the British Medical SOUTH-EASTERN OF IRELAND B5tANcT.-Nominations for the office of Association will be held at Leicester on Monday, Tuesday, two Represenxtatives on the Central Council, in conjunction with the Wednesday, Thursday, and July 26th, Leinster Branch, must be sent on or before June 3rd to E. Friday, 24th, 25th, 27th, Carlow, Honorary Secretary. J. FAREtE, and 28th, 1905. President: WILLIAM COLLIER, MI.D., F.R.C.P.Lond., Phy- SOuT3H WALES AND MONMOUTH5HIRE BRANCH.-The annual meetiDg sician, Radcliffe Infirmary, Oxford, and Litchfield Lecturer iD of this Branch will be held at Cardiff on June 8th.-FRANK G. THOMAs, Medicine, University of Oxford. Honorary Becretary. t President-elet: GEORGBE . FRANKLIN, F.R.C.S., Honorary SOUTH-WESTERN BRANCH.-The sixty-sixth annual meeting will be held Surgeon, Leicester Infirmary. on Thursday, June z5th, at the Athenaeum, George Street, Plymouth, at Chairman of Representative Meetings: Sir VICTOR HOBSLEY, 3 p.m., when Dr. i. ki. Clay will resign the chair to Mr. G. Jackson, who F.R.S. will deliver hts inaugural addi ess. The report of the Branch Counciland annual fiaaucial statemeut for the year i904-5 will be presented to the Chairmnan of Council: ANDREWCLARK, D.Sc., F.R.C.S. meeting, and the oticers of the Branch be elected for the year I9o5-6. The reports fromn the Divisions ot the Branch on the resolutions proposed Treasurer: EDWARD MARKHAM1 SKERRITT, M.D., F.R.C.P. and carried at the Truro intermediate meeting on March 2nd, xgos, and An Address in Medicine will be delivered by HENRY submitted to the Divisions for their consideration, will be brought before the meeting for coufirmation. Luncheon, by kind invitation o6 the Pre- MAUDSLEY, LL.D., M.D., F.R.C.P. sident-elect, will take place froml tO2.30 p.m. at Goodbody's Restaurant An Address in Surgery will be delivered by CHARLES JOH19 Bedford Street. After the meeting Dr. Turner kindJy invites membersto BOND, F.R.C.S. inspect the ancient and historteally interesting mansion, Plympton House, where tea will te provided. frains from Millbay to Plympton, A popular lecture will be delivered by Professor WILLIAM s. p.m., and from Piympton to Millbay, 635 p.m. The annual dinner will STIRLING, D.Sc., M.D., F.R.S.E. be held at 7 p.m. atGoodnody's Restaurant, Bedford Street. Tickets, (ex- clusive of wine) 6s, which can be had from the Honorary Secretary of the Branch. On Friday, June I6th, the members of Plymouth, Devonport SECTIONS. and district, cordially invite their colleagues to a luncheon, and an ex- The annual meeting at Leicester will comprise 12 Sections cursion by steamer to the breakwater, and thence up the Hamoaze shown in the Cotehele will be by kind of to as subjoined list. The Sections will meet or (which vibited permission the Right Hon. The and Earl of Mount Edgeumbe). MDembers who accept this invitation are Wednesday, Thursday, Friday, July 26th, 27th, and 28th, invited to bring their wives or lady friends (limited to two). Notice will from I0a.m. to Ip.m. be given at the meeting and dinner on the xsth of the time and place of The President, Vice-Presidents, and Secretaries of each departure of tnis excursion; and those who wish for furtber details Section constitute a should communteate with Dr. Webber, 4, Queen Anne Terrace, Plymouth. Committee of Reference for that Section. The Honorary Secretary begs to intimate to those memberswho purpose Papers read are the propertv,of the Brituh Medical A88ociation, the to Plympton House, (2) the annual and cannot be elsewhere than in attending (X) visit that dinner, (3) the published the BRITISH MEDICAL excursiou to tiotehele, they must inform him on or before June 8th, JOURNAL without and at the same time forward the amount of the dinner ticket,in order special permission. that the necessary arrangements may be made.-G. YOUNG EALEIS, No paper must exceed iSminutes in reading, and no sub- Matlock Terrace, Torquay, Honorary Secretary. sequent speech 1ominutes. ULsTER annual of BRANCH.-The meeting this Branch will be on MEDICINE, June at co. held Wednesday, 2Ist, Warrenpoint, Down. The meeting will elect FRANK for the ensuiog yeir a President, Treasurer, Secretary, and (with the President: M. POPE3, M.D., F.R.C.P., 'Leicester. Connaught Brauch) t.wo members of the Central Council. Nominations Vice-Presidents: REGINALD PRATT, M.D.,M.R.O.P., Leicester; for these offices must be sent to the Honorory not ROBERT WILLIAM to Secretary later than PHILIP, M.D., P.R.C.P.Edin., Edinburgh; May3Ist. Attention Is called Rule 4, according to which the President WILLIAM BRAMWELL shall be a member of the Branch who lhas not held thesaid office during RANSOM, M.D., F.R.C.P., Nottingham. the previous five sesrs, and wbo must not be a member of the same Honorary Secretarie: BERTRAND DAWSON, M.D., B.SC., Division as his predecessor -CECiL E. SHAW, F.R.C.P., 32, Belfast. M.D., Honorary Secretary, Wimpole Street, Cavendish Square, W.. I8,College Square EIast, WILLIAM MITCHELL STEVENS, M.D., M.R.C.P., 21, St. BRANCH.-The Andrew's Crescent, Cardiff; FRANK HARWOOD JACOB, M.D, WEST SOXERSET sixty-second annual meeting of this M.R.C.P., 28, Regent Street, Branch will be held at the Reach Hotel, Minehead, on Friday, June gtb, Nottingham. at 12.30 p m., when Mr. Gordon Henry will preside. Agenda: Minutes of last meetinji annual r- po, t of Council; Treasurer's report; election of SURGERY. President-elect; electionof Representative; election of other Presidnt: Sir eletion of Ethical Committee. President's address: offliers; CHARLESBBNT BALL, M.Ch., F.R.C.S., Dublin. The General Prac- VicUePresidents: CLAUDEDouGLAs, F.R.O.S., Leicester; HERY S(urpr.r1r-%T To Tnz 2Q MAY 27, 1905.] GE1NERAL MEDICAL COUNCIL. BRITISH MEDICAL JOURNAL 283 2 JOHN BLAKESLEY, F.R.C.S., Leicester; JAMEs HENDERSON TROPICAL DISEASES. NICOLL, M.B., O.M., Glaegow. Honorary Seretarie8: PERCY President: RUBERT WM. BOYCE, M.B., F.R.S., Liverpool. FuRNIVALL, F.R.C.S., 28, Weymouth Street, W.; OECIL Vta-Pre*idents: ANDREW DUNCAN, M.D.. London; FLEMING EDWARD MARRIOTT, M.C., F.R.C.S., I,I Welford Road, MANT SANDWITH, M.D., F.R C.P., Londion. Honorar Secre- Leicester. taries: GEORGE AYLWIN CLARKSON, F.R.C.S., I73,London STATE MEDICINE. Road, Leicester; JOHN M. HENDRIE MACLEOD, M.D., iI, Harley President: PHILIP BOOBBYER, M.D., Nottingham. Vce-, Street, W. Presidents: NINIAN MOINTIRE FALKINER, M.D., Dublin; JOHN HERBERT HAWKINS MANLEY, M.D., D.P.H., West The Honorary Local Secretaries are: Bromwich; THOMAS ROBINSON, M.R.C.S., D.P.H., Leicester. ASTLEY V. CLARKE, M.D., Honorary Seretaris: WM. WILLIMS, M.D., D.P.H., County 37, London Road, Leicester. Health Department, g, The Parade, Cardiff; Cs. KILLICK MILLARD, M.D., D.Sc., Town Hall, Leicester. FELIX BOLTON CARTER, M.S., 99, London Road, Leicester. INDUSTRIAL HYGIENE AND DISEASES OF OCCUPATION. President: Hy. WM. LANGLEY BROWNE, M.D., West PROGRAMME OF PROCEEDINGS. Bromwich. Vice-President8: ALEXANDER CAMPBELL M.D., Dundee; JOHN COLLEY SMYTH BURKITT, M.D., b.P.H., MONDAY. THOMAS MORISON London. e p.m.-Annual General Meeting followed by Reprosentative Leicester; LEGGE, M.D., Honorary Meeting. ecretaries: CLEMENT FREDERICK BRYAN, M.R.C.S., , Hum- berstone Road, Leicester; THOMAS WATTS, M.D., 34, Church TuESDAY. Street, Hyde. g a.m.-Meeting of z905-i9o6 Council. to a.m.-Representative Meeting. LARYNGOLOGY, OTOLOGY AND RHINOLOGY. 2 p.m.-Adjourned General Meeting, followed by Representa- President: FREDERICK WILLIAM BENNETT, M.D., Leicester. tive Meeting. Vce-Presidents: WILLIAM ARTHUR CARLINE, M.D., Lincoln; 5 p.m.-Church Service. JOHN MIDDLEMASs HUNT, M.B., Liverpool. Honorary &ecre- 6 p.m.-Meeting of Division and Branch Secretaries. taries: ALE2x LEWIS MACLEOD, M.B., 89, Hinckley Road, 8.3o p.m.-President's Address. Reception of Distinguished Leicester; CHAS. HERBERT FAGGIE, M.S., F.R.C.S., 22, St. Guests. Thomas's Street, London Bridge, S.E. WEDNESDAY. NAVY, ARMY AND AMBULANCE. g a.m.-Council Meeting. HENRY so a.m. to x p.m.-Sectional Meetings. President: Surgeon-Lieutenant-Colonel WALTER 2 p.m.-Address in Medicine. Adjourned General Meeting KULLMARK, M.R.C.S., London. Vice-Presidents: Surgeon- Lieutenant-Colonel ROBERT BRADSHAW SMITH, V.D., L.R.C.P., followed by Representative Meeting. Hinckley; Lieutenant-Colonel EDMOND MONKHOUSE WILSON, THURSDAY. G.B., C.M.G., D.S.O.. S. Farnboro'; Fleet Surgeon ALEXANDER g a.m.-Meeting of Council. J. J. JOHNSTON, R.N., Haslar. Honorary Secretaries: Fleet Io a.m. to I p.m.-Sectional Meetings. Surgeon EDWARD JAMES BIDEN, R.N. (Ret.), 29, Osborne 2 p.m.-Address in Surgery. 3.30 p.m.-Representative Meeting (if business not already Road, Southsea; Captain WM. PEMBERTON PEAKE, M.R.C.S. concluded). E.A.M.C.V., 21, Oxford Street, Leicester ; Captain EDWIN 7.30 Dinner of the Association. CHARLES MONTGOMERY-SMITH, R.A.M.C.VOI., 36, Abbey Road, p.m.-Annual St. John's Wood, N.W. FRIDAY. 9 a.m.-Meeting of Council. x a.m. to x p.m.-Sectional Meetings. OBSTETRICS AND GYNARCOLOGY. 2 p.m.-Meetings of Divisions and Branch Secretaries. President: HERBERT RITCHIE SPENCER, M.D.,F.R.C.P. London. S Lecture. Vice-Presidents: HENRY MEADOWS, M.B., Leicester; Professor p.m.-Popular FHENRY CORBY, M.D., Cork; FRANCIS RICHARD CASSIDI, M.D., Derby. Honorary cretaries: MONTAGUE WaM. WILLIAMS, M.R.C.S., 45, London Road, Leicester; Miss LOUISA GENERAL COUNCIL GARRETT ANDERSON, M.D., 114 A, Harley Street, W. OF I OPHTHALMOLOGY. MEDICAL EDUCATION AND REGISTRATION. President: GEORGiE ANDREAS BERRY, F.R.C.S.Edin., Edin- burgh. Vice-Presidents: WM. MARDON BEAUMONT, M.R.C.S., Bath; EDWIN COLLIER GREEN, M.R.C.S., Derby. Honorary SUMMER SESSION, 1905. Secretaries: ROBT. WALLACE WESLEY HENRY, M.D., 6, Market Street, Leicester; JOHN HERBERT PARSONS, F.R.C.S., 27, Wim- THE eighty-first session of the General Council of Medical pole Street, Cavendish Square, W. Education and Registration of the United Kingdom com- PSYCHOLOGICAL MEDICINE. menced at the offices of the Council, Oxford Street, London, President: ALEXANDER REID URQU1HART, M.D., Perth. Vice- on Tuesday, May 23rd, 1905. Presidents: ROTHSAY CHARLES STEWART, M.R.C.S., Leicester; THEOPHILuS BULKELEY HYSLOP, M.D., London. Honorary PRESIDENT'S ADDRESS. Secretaries: ARTHUR MOLYNEUX JACKSON, M.B., Nottingham Changes in the Council. County Asylum Radcliffe;on-Trent; JOHN WIGMORE GENTLEM1EN,-At the opening of our eighty-first session it HIGGINSON, M.RA.S., Hayes Park Asylum, Hayes. falls to me to begin with a sad announcement. By the death of Dr. Charles R. C. Tichborne, our colleague for nine years, PATHOLOGY. the Council has lost the services of a member whose zeal and President: FREDERICK WALKER MOTT, M.D., F.R.C.P., Scientific attainments were highly valued by the -Pharma- F.R.S., London. Vice-Presidents: THEODORE SHENNAN, M.D., copoeia Committee. He was ever ready to give us the Edinburgh; Professor ARTHUR HAMILTON WHITE, L.R.C.P.I., -benefit of his special knowledge of pharmacy and pharma- Dublin. Honorary Secretaries: JOHN WILLIAM H. EYRE, ceutical chemistry, and, at the instance of the Committee, he M.D., Guy's Hospital, S.E.; THOMAS VILLIERS CROSBY, M.D., often undertook laborious researches with a view to the 91, St. Peter's Road, Leicester. improvement of the Pharmacopoeia. His death will be felt as a loss, not only by the Council, but by all who are interested DENTAL SURGIERY. in pharmaceutical science. In your name I have ventured to President: MORTON ALFRED SMALE, M.R.C.S., L.D.S., address a message of condolence to bis family. The Apothe- London. Vice-Presidents: EDWARD LLOYD-WILLIAMS, M.R.C.S., caries' Hall of Dublin has appointed as his successor the L.R.C.P., L.D. S., London; FRANCISJOHNLANKESTER, M.R.C.S., Chairman of its Governors, Dr. Arthur Atock, to whom we L.D.S., Leicester; Honorary Seeretaries: Wm. ARMSTON VICE, offer a cordial welcome. M.B., L.D.S., ig, Belvoir Street, Leicester; JOSEPH GEORGIE We shall miss also the genial preFence and the Celtic fervour TURNER F.R.U.S., L.D.S., 12, George Street, Hanover of Sir Charles Ball, who since igoo has worthily represented Square, 2W. the Royal College of Surgeons in Ireland. In the Council TO THE 284.284 BBLiismBxTxuI.luAL]TMEDICAL JOURNALJ GENERAL MEDICAL COUNCIL. L.----[MAY 27,-07 190, -.,- -- .r. s and in the Executive Committee his sound common sense been most active in pressing the matter on the attention of the- and his enlightened interest in the medical service of the Government; and I communicated a fuill report of the case, Army were fully recognized. We rejoice that, not failing courteously furnished by the British Dental Association, to. vigour, but increasing demands on his time and thought the Lord President. The purpose of these questions and comn- deprive us of his services here. We can but wish him ever- munications was to ascertain what steps could be taken to, growing success elsewhere, and assure him of our grateful procure a similar declaration of the law in Great Britain. The remembrance. The vacant seat is taken by Sir Thomas replies will be laid before you. The last of them, received on Myles, whose reputation as a surgeon and a Past-President of Saturday, is of primary importance to tbe dental profession; his College has procured him a distinguished place in Irish but the underlying principle admits of a much wider applica- professional life. tion. The documents indicate that definite advance is being made in the direction desired by the Council in its Resolution The Council's Legal Adviser. of May 31st, I904 (Minutes, vol. xli, p. 87), and you will Another loss, which touches the Council nearlv, I have still doubtless refer them to the Companies Bill Committee for ita to announce, and I do so with deep regret. We are to lose information. the wise counsel and clear guidance which for some quarter of Anatomy Acts. a century Mr. Muir Mackenzie has ever been reAdy to afford As the result of a ennfidential communication from the uq. Soon after -the rising of the Council in November, Mr. Army Couneil, this Council on November 22nd, i904', Mair Mackenzie was appointed to an important judicial office appointed a Committee to inquire into the operation of the -that of Official Referee of the Supreme Court. The nature Anatomy Acts and their effect on the teaching of anatomy and and extent of his new duties are such as to preclude him not practical surgery in Great Britain. A further communication only from advising us as Counsel, but from acting as legal from the War Office was received in March, from which it is assessor in our domestic forum. Personally I had hoped apparent that the inquiry you directed is of pressing impor- that for a time at least we might continue to have his aid in tance. To facilitate the work of the Committee, I have- the latter quasi-judicial capacity; but this appears to be opened communications with a number of the authorities impracticabie. With his characteristic kindness, however, he concerned, and the information thereby obtained, much of has consented to help us during the transition by such friendly which is of a confidential character, will require carefunA assistance as an amicus curiae can offer; and I look forward consideration. to his presence with us during some part of our penal The Council's House. sittings. The Office Site Committee, with the valuable aid of your Every member of the Council who has had experience of Solicitor, has heen occupied in arranging for the fature its work, and assuredly not least the member who occupies tenancy of the Council's house in Hanover Square, the exist- this Chair, must feel that in parting with Mr. Muir Mackenzie ing lease of which expires at Midsummer next. The negotia- we are parting with a wise and trusted friend. His un- tions have been protracted and sometimes difficult; but I rivalled knowledge of medical law, his vast experience of may be allowed to anticipate the Report of the Committee so procedure, his practical sagacity. and his unfailing tact and far as to say that we have now found a satisfactory tenant, at courtesy to all, have made for him an enduring place in our a rent considerably larger than that hitherto obtained, and regard. The services he has rendered for a long series of on conditions which the Council has already approved in years to this Council, and through the Council to the advance. medical and dental professions, are measured by the sense of Finance. impoverishment and personal loss of which we are all conscious The Council will also learn with satisfaction that the to-day. accounts for the year I904 are more favourable than those for For your President, on whom, as I have learnt during the any year since i895. At the end of I903 our deficit was some last few months, a heavy responsibility lies when the Council £2, 165; at the end of 1904 it was only /2 I8, or about one-tenth is not in session, the absence of so wiee an adviser is especially as great. The Finance Committee will report on the items grave. It is therefore doubly fortunate that Sir William which have contributed to this substantial improvement; but Turner has consented to retain his seat as a member, and to it is noteworthy that the result is attributable, not to any afford to the Council and to myself the benefit of his ripe increase of ordinary income, but to greater economy of expen- experience and judgement. To-morrow we hope to see him in diture. Whether this degree of economy can be maintained his place at my right hand, as our Nestor who has " passed in future years without impairing the Council's efficiency it is the Chair." difficult to forecast. Bat though I may be, as I have been, The Executive Committee empowered me to procure, eharged with incurable optimism regarding the Council's through our Solicitor, the services of Counsel for the prepara- finances, I still think tbat, in ordinary years. equilibrium tion and presentation of the cases to be deal with this Session. between income and expenditure is possible of attainment, Mr. Sydney G. Lushington-who has succeeded Mr. Muir even without the aid of fresh legislation; and I am Mackenzie as Standing Counsel to the Board of Trade, and strengthened in this belief by the opinion of the Finance who has long been professionally associated with him-will Committee. If the vigilance of your officers is supported by accordingly attend to assist us during the inquiries of the the resolve of the Council to discountenance all expenditure week. Before the end of the meeting I shall ask the Council of time and money that does not directly conduce to efficiency, to instruct me as to the arrangements they desire to be made it is not extravagant to hope that the accounts of the coming for the future. years may be even more satisfactory than the last. The Medical and Dental Companies. closing year of office of my distinguished predecessor in ther I would now allude briefly to certain matters which have Chair has shown us what can be done in this direction, and occupied my attention during the recess. it will be my ambition to assist to the best of my power- In accordance with your Resolution of November 29th, I in maintaining the ground we have gained under his leader- addressed a communication to the Lord President of the sbip. Privy Council on the subject of Medical and Dental Companies, But while we strive after economy on the one hand, we and of the abuses to which they give rise. The Lord Presi- must not neglect any legitimate means for the improvement dent, in reply, asked for detailed evidence in support of our of our income on the other. Where the equilibrium is. representations. This evidence the Registrar, with the help precarious even a small addition to the right side of the- of neLb2rs of the Companies Bill Committee, was i nLbled to balance is impoitant. Dr. Mackay's suggestion-that the- collect and to forward. It is now under the Lord President's fees for the restoration of lapsed names to the Begisters, and consideration. for the registration of higher titles, ahould be sliyghtly raised It will I e remembered that, according to the judgement of -has proved to be fruitful, for it has added over £400 to the a Chief Baron Lalles, Dental Company, whose proposed title is ieceipts of the year. The higber fee, so far as it represents a sach as to mislead the public into supposing that its business fine for negligence, will incidentally tend to keep the is carried on by qualified perdons, may lawfully be refused IRegisters more correct. The fee for recording additional registration under the Joint Stock Companies Acts. The qualifications. being as it were a small tax on new dignities, question arose whether a Company alreadv registered, whose is paid with comparative complacency by the newly dignified. title was open to the same objection, might lawfully remain Dr. Mackay's proposal is thus abundantly justified, and the- upon the Begister. A judgement in the negative has now been Chancellor of the Exchequer iu sear.h of fresh sources of given in the High Court of Justice in Ireland hy the Master revenue might well take cuunsel with him. ox the Rolls, in the case of the Attorney-General versus Appleton and others. This important decision was made the The Students' Igijters. subject of questions in Parliament by Sir John Tuke, who has The suggestion has been made from an important quarter S TO MAY 27, 1S05.] 'CENTRAL MIDWIVES BOARD. UPPLIMENT TOU2B2 8 LBRIn1sH JOURNAL > a that one of the services gratuitously performed by the Council course retain fall freedom as to the adoption or otherwise might be made self-supporting in a similar way. I refer to of any suggestions which may be offered by this and other the maintenance of our Students' Registers. The General Committees of Reference. There is, however, good ground for Registrar, with the help of the Branch Registrars, has the hope that the orderly system thus instituted may enable ascertained that the ordinary expenditure on this branch of the Committee. in due course, to submit to you a revised our work-for printing, postage, salaries, and time occupied Pharmacopoeia that will adequately represent the best phar- in Committees and Councils over its details-may be esti- maceutical science and practice of the time. mated at about £4co a year. Against this outlay the only Oither Businesa. are some £20 a year for late or exceptional receipts from fees The various Standing Cammiltees will have Reports to pre- a were cer- registration. If fee, say, of 55., charged for the sent on matters referred to them, but probably none of these tificate of registration in ordinary as well as exeeptional will offer serious difficulty or occupy much of your timp. cases, the actual cost would just be covered and the Council's Several penal cases will be submitted for inquiry on Wednes- re- funds would be relieved to a corresponding extent. It is day and Thursday. They involve charges of a grave kind, and such a no new legislation would be presented that for step will require your serious consideration; but some of them at required, that the Students' Registers might remain on their least are not likely to be protracted. present "voluntary" basis, that the trifling fee would be Unless unforeseen questlons arise for discussion, the busi- readily paid and easily collected, and that the future action of ness of the'Council should thus be compassed by Saturday' the Council and of the Licensing Bodies in regard to students' The Session we open to-day need, in fact, involve no undue no repre- registration would in wise be prejudiced. If these strain on the time or on the finances of the Ciuncil. sentations are jnst-and I offer them for your mature con- sideration-the Council might be wvell advised to make the The President's Duties. exrperiment. Let me add, in closing, that during the recess I have paid Structural Alterations. some twenty visits to the office on the Council's business, and The improvements in the office sanctioned at the last that I have thus endeavoured to keep in i rnmediate touch with meeting have been carried out under the supervision of the all that concerns itq activity. Mv own College of St. John'p, General Registrar, and, thanks to his care and forethought, and the Medical Board of my University, have released me the cost has come well within the estimate. The equipment from certain claims upon my time and energy in order that I required for the better keeping of the Register8 and of the maybe the freer to devote both to the Council's work. If I can of Committees, or to any documents relating to registration has now been provided; thus be of service to the Chairmen and the new system, already tried and approved in the Dental other members of the Council, in the preparation of matters Department, is being rapidly applied to theothers. The expense to be submitted for its consideration, I tIust they will not in this case will certainly contribute to efficiency. The like scruple to give me the opportunity of assisting them. statement may also be made regarding the outlay on cleaning and redecorating the Council Chamber. This work had been postponed until it was certain that our occupancy of the CENTRAL MID WIVES BOARD. premises would continue. When the doubt was finally re- A MEETING of the Central Midwives Board was held on May moved the Registrar was instructed to put the chamber and igth, at 6, Suffolk Street, Pall Mall, with Dr. F. H. CHAmPnEYs galleries into tenantable condition. The work of the Council in the chair. will go forward with greater zest when it is carried on in APPLICATIONS FOR ExTENSION OF TIME FOR CERTIFICATION. brighter surroundings and in purer air. A letter was received from a Cleik of the Privy Council transmitting an appeal for extension of time on behalf of a Inspections and Visitations. woman whose claim to be certified under Section 2 of the Act The supplementary inspections of theUniversities of Oxford was made after March 31st last. A letter was also received and London have now been completed in accordance with from the Medical Officer of Healt.h of Ddvonport to the same your directions. The Reports, which will be brought before effect in a similar case. The Board decided that answers you by the Examination Committee, are in my opinion highly should be sent stating that the Board regretted that they satisfactory. As the Final Examinations of the University of were unable to comply with the requests. Edinburgh began on Saturday last, it became necessary to arrange for their supplementary inspection withont waiting MIDWIVES AND HOMES RUN FOR PROFIT BY THE LAITY. for the gathering of the Council. The Executive Committee A letter was received from Dr. E. R. Fothergill, Honorary accordingly requested Professor Howard Marsh, of Cambridge, Secretary of the Wandsworth Division of the Metropolitan to report as Inspector on the surgical part of the examinations, Counties Branch of the Britiah Medical Association, inquiring and he has kindly agreed to visit Edinburgh now, and again if midwives may legally engage thpmselves to homes run for in June, for this purpose. profit by members of the Jaity. The conclusion the BoaTd The cycle of visitations and inspections of the Final Ex- came to on the subject wss that the Board was prepared to aminations will thus be at an end during the summer. As on discuss any case of the kind on its merits. previous occasions, you will doubtless desire that the Examin- THE1 ADMINISTRATION OF THE MIDWIVSs ACT. ation Cornmittee should present to you as soon as possible a A letter was read from the Clerk of the Breconshire County general Report on the whole series, in which the results and Council enclosing a report and scheme adopted by his Council conclusions arrived at are summarized in a convenient for the adminisbration of the Midwives Act and inviting the form. criticism of the Central Midwives Board thereon. The con- At the close of last Session a wish was expressed that the sideration of this matter was postponed and the Clerk of the Standing Orders relating to the Visitation and Inspection of Breconshire County Council was asked to furnish copies of Final Examinations might be revised, with a view to removing the report and scheme for distribution to the members of the ambiguous or redundant expressions from the text. I have Board. submitted to the Executive Committee an altered form of the THE ASTON UNION INFIRMARY. Rules, which, after consideration and amendment, they will A letter from the Clerk of the Guardians of the Aston Union bring before the Council for its approval. was read in which inquiry was made concerning the reaeon why the Central Midwives Board refused to approve the The Britiih Pharmacopoeia. Aston Union Infirmary as a Training School for midwives. The PharmacopoeiaCommittee has for some time had under The Secretary was instructed to reply that it was not the consideration the question of organizing in a mote convenient of the Board to reasons in such caEes. manner than hitherto the researches and inquiries that are practice give necessary for the effective revision of the Pharmacopoeia. It MIDWIVES TO BE CITED TO APPEAR BIFORE THR BOARD. has decided that it is expedient to appoint Committees of The Clerk to the Farnbol ourh Urban District Council for- Reference to advise it on points of Chemistry, Botany, Phar- warded a report from the Mtdical Officer of Health of that macology, and-Pharmacy. With the courteous assistance of District recommending that a certain midwife should be the Pharmaceutical Societies of Great Britain and of Ireland, removed from the Roll because she refused afler due warning a Committee of Reference in Pharmacy has first been ap- to supply herself with the necessary appliances. The Board pointed. It consists of expert pharmacists, with Mr. Walter directed that this midwife should be cittd to appear. Hills as Cbairman, and Professor Greeniah as Secretary, to A letter was received from the Honorary Secrttary of the whom questions relating to pharmacopoeial pharmacy will be Birkenbead Maternity Hospital reporting that a certain referred for investigation and report. The Pharmacopoeia midwife had been dismissed from employment as Districe Committee, acting as it does on beha1f of the Council, will of Midwife on account of a charge of drur'kenneEs. The Board SUPPF,r.MET TO THE aRITIoH MEDICAL JOURtNAL NAVAL AND MILITARY APPOINTMENTS. [MAr 27, 1905. decided that in this case also the midwife should be cited to number of scarlet fever cases in these hospitals and in the London Fever Hospital at the end of the week was 2,21t, agaiDSt 2,182, 2,152, and 2,177 at appear. the end of the three preceding weeks: 3t9 new cases were admitted during A CERTIFICATE REFUSED. the week, against 255, 235, and inl the three prereding weeks. An application from a woman to be certified by the Board 319 as a midwife was considered, together with a communication thereon from the Clerk of the Cardigan County Council. It was stated that the woman had been convicted on three successive days in one week of being drunk. This application was refused by the Board. ROYAL NAVY MEDICAL SERVICE. THE following appointmeDts have been made at the Admiraltv: JOHN G. PEBBLES. MiKS., THoMAS W. MYLES, M. 8, and CHARLES M. WOODS, Sur- RECOGNITION OF TEACHERS. geons, to the Glory, for disposal, May 16th; WILLIAM H. POPEB, Surgeon, Mr. E. PARKER YOuNG discussed in detail the applications to the Donegal, May I6th; ELYSTAN G. S. O'LEARY, Surgeon, to the for recognition as teachers of midwifery made by certain Sapphire II, May I6th; DAvID R. VIcKERY, Surgeon, to the Dryad, on becoming an independent command; FRANcIS J. GOWANS, Surgeon, to general practitioners. He considered that if the Board the Leda, on its becoming an independeut command; HENRY WOODS, refused to sanction as teachers general practitioners who were M.B.. Surgeon, to the Circe, on its taecomtng an independent command; qualified for such work an injustice would be done to women EDWARD B. KENNY, M.B., Surgeon. to the Hebe, on its becoming an inde- who were anxious to become midwives. Many general prac- pendent command; JOHN SHiPsEY, M.B., Surgeon, to the Speedwell, on its becoming an independent command; LIJWAOD U. WARD, Fleet Surgeon, titioners were perfectly competent to act as teachers of mid- to the uarnarvon, May 25th; HENuY E. BOUTH, Fleet Surgeon, to the wifery, though they might not have held any special .Emnerald, May 25th. appointments bearing on the subject. If the Board wished to EDGAR W. LIvEsAY has been appointed Surgeon and Agent at Alderney, make the Midwives Act work then the general practitioners May 16th. who have been in practice for many years, and have attended ROYAL NAVAL VOLUNTEER RESERVE. a large number of midwifery cases, and who were perfectly MR. G. R. HARLAND has been appointed a Lieutenant, and attached to the competent to teach, should be recognized as teachers. Women Tyneside Division, May z7th. wishing to become midwives should not be put to the expense of travelling some thirty miles to attend lectures in conse- ROYAL ARMY MEDICAL CORPS. quence of the refusal of the Board to sanction as teachers LIEUTENANT-COLONEL A. H. BURLTON retires on retired pay, May 17th. He was appointed Surgeon, Marcit 6tb, t8io; Surgeon-Major, March 6th, local general medical practitioners. Mr. Parker Young con- 1892; and Lieutenant-Uolonel, March 6th, ig9o. He has no war record in cluded by formally moving that two general practitioners the Army Lists. whom he named should be recognized as teachers. Major C. H. BURTCHABLL, from the Seconded List, to be Major, May Dr. DAKIN contended that the Board had been quite impar- 3rd. He was placed on the Seconded List tor service with the Bouth tial in recognizing teachers, and the CHAIRMAN declared that African Constabulary, May 3rd, 1902. there had been no such thing as boycotting of general practitioners. INDIAN MEDICAL SERVICE. After some further consideration Mr. Parker Young's LIBUTENANT-COLONEL R. MACRAE, M.B, Beugal Establishment, is pro- motion was not agreed to. moted to be Colonel, from February 12th. He was appointed Assistant Surgeon, March 31st, I875. anud bicame Ba igade-Surgeon-Lieutenant- Colonel, March 318G, I895. He served during the Afghan war in 1878-80 in THE BELFAST MATERNITY HOSPITAL. the operations in the Kuram Valley, in the .1 ugdullack Pass, in the expedi- Sir WILLIAM J. SINCLAIR moved that the resolution of the tion to Sherpur in December, 1879, and in Kotoistan and in the Logor and Board of March 23rd, I9o5, refusing the request of the Belfast Maidan Valleys, receiving the medal with clasp. Maternity Hospital for the recognition of its certificate as an approved qualification under Section 2 of the Midwives Act VOLUNTEER RIFLES. be rescinded. He urged that the B ard had refused this re- HENRY M. MACNAUGHTON-JONES, M. B (late Surgeon-Lieutenant zatMiddle- quest of the Belfast Maternity Hospital not because of the sex Royal Engineers Volunteers) to be Surgeon-Captain, 4th Volunteer fault of the hospital but in consequence of the delay which Battalion the Royal Fusiliers (tity of London Regiment), and to be borne as buperaumerary whilst commauding the Bearer Company of the Ist had been caused by the Board itself. Sir William Sinclair London Volunteer Iafantry Brigade, April 22ud. contended that the Board had made a serious mistake, that Supernumerary burgeon-Lteuteuant-. olouel G. S. ELLISTON (Brigade- the Belfast Maternity Hospital had a right to have its certi- Surgeon-Lieutenant-Colonel, senior Medical Officer Hlarwich Volunteer Infantry Brigade) is granted the honorary rank of Surgeon-Colonel, May ficate recognized, and that the action of the Board was a great xgth. hardship to a considerable number of women. The undermentioned gentlemen are appointed Surgeon-Lieutenants in As this motion was not seconded the matter was not farther the corps specified, dated May aqth: AitLC1BALD AULD (late Lieutenant), 2nd Volunteer Battalion the East Yorkshire Regiment; CHARLBs A. LEEs discussed. (formerly Captain), 4th (tiuuts) Volunteer Battalion the Bedfordshire NuMBER OF WOMEN ON THE ROLL. Regiment; JOHN W. LEITCH, 3rd LanareshLre Regiment. Applications for certificates under Section 2 of the Act from Surgeon-Lieutenant-Colonel S. B. MASON, 4th Volunteer Battalion the 82 women were considered and their names were ordered to be South Wales Borderers, is granted the honorary ranlk of Surgeon-Colonel, May 19th. entered on the Roll. The total number on the Roll was reported Mr. WILLIAM LLOYD to be Surgeon-Lieutenant in the 22nd Middlesex to be 22,289. (Central London Rangers), April 17th. Atital itatistirli. iBataudtz iub Aqpttiututeutz. HEALTH OF ENGLISll TOWNS. This list of vacancies is compiled from our advertisement columns, wohere full I. seventy-six of the largest English towns, including London, 8,827 particulars wil be found. To ensure notice in this column, advertisements births and 4,3oo deaths were registered during the week ending Saturday must be received not later than the first post on Wednesday morning. last, May 20th. The annual rate of mortality In these towns, which had been I6 5, I5 4, and I5.0 per ,ooo in the three preceding weeks, further VACANCIES. declined last week to 14 4 per,I,oco. The rates in the several towns ranged Resident from 6.o iu Kings Norton, 7.3 in Wolverhampton, 7.4 in Hornsey, 7 8 in BETHLEM HOSPITAL.-Two House-Physicians. Honorarium, Barrow-in-Furness 8.7 in Rotherham, and 8.9 in East Ham and in Norwich, £25 each per quarter. toT9.2 in Rhoudda, x9g8 in Merthyr Tydfil, 21.5 in West Bromwich, 22 4 in BIRMINGHAM AND MIDLAND HOSPITAL FOR SKIN AND URINARY Tynemouth, 22S in Preston, and 26.0 in Middlesbrough. In London the DISE &SEs.-Clinical Assistant. Honoiarium at the rate of 52 guineas rate of mortality was 14 I per I,000, while it averaged 14.5 per z.ooo in the per annum. seventy-five other large towns. The death-rate from the principal infec- BODMIN: CORNWALL COUNTY ASYLUM.-Junior Assistant Medical tious diseases in the seventy-six towns averaged 1.5 per z,ooo; in London Officer. Salary £135, rising toX £55, per annum. this death-rate was equal to 1.3 per ,ooo, while among the seventy-five other CANCER HOSPITAL, Fulham Road, S.W.-Assistant House-Surgeon. large towns the rates ranged upwards to 3.2 in Leyton, 3.8 in Warrington, Salary at the rate of £70 per annum. 4.o in Sheffield,4.9in Coventry,5 oin Smethwick, and7.7in WestBromwich. Measles caused adeath-rateof z.8 in Wigan, 2.1Iin Rhonddaand In Merthyr CHELSEA H03PITAL FOR WOMEN, S.W.-Clinical Assistant. Tydfil, 2 5 in Smethwick. 3I in Warrington, q.3 in Sheffield.49 in Coventry. CHEST,ER GENERAL INFIRMARY. - House-Physician, resident. aud 6.2 in West Bromwich; whooping-coueh of I3.z In Willesden, 13 in Salary, £go per annum. Aston Manor, 1.4 in South Shields and in Newport (Mon.), x.8 in Leyton DUDLEY: GUEST HOSPITAL.-Two Honorary Surgeons. andin Preston, 2.2 in Tottenham, 2.5 in Smethwick. and 2.9 in Tynemouth; EXETER: ROYAL DEVON AND EXETER1 HO3PITAL.-Male Assistant and diarrhoea of 1.2 in West Ham, and z.5 in West Bromwich and in House-Surgeon, resident. Salary. £60 per annum. Grimsby. The mortality from scarlet fever, from diphtheria, and from enteric fever showed no marked excess in any of the large towns. One HOSPITAL FOR DISEASES OF THE SKIN, Stamford Street, S.E.- fatal case of small-pox was registered in London, but none in any of the Clinical Assistant for Out-patients. seventy-five large provincial towns. The Metropolitan Asylums Hospitals H03PITAL FOR SICK CHILDREN, Great Ormond Street, W.C.-(i) contained 15 small-pox patients at the end of last week, against I7 at the Assistant Physician (2) Anaesthetist. 'Honorarium, zS guineas. end of each of the two preceding weeks; 3 new cases were admitted dur- LEEDS UNION.-Assistant Medical Officer for the Indoor Institutions ing the week, against 4, 4, and 2 in the three preceding weeks. The in Beckett Street. Salary, £430 rising to £zso per annum. TO TIlE MAY DIARY. r PLIrT 27, 1q905.] LBITinSa MZDICAL JOURNAL 287 LONDON TEMPERANCE FIOSPITAL, Haampstead Road, N.W.-Assistant SATURDAY. Resident Medical Offl¢er. Honorarium at the rate of 5o guineas per annum. OTOLOGICAL SOCIETY OF THE UNITED KINGDOM. 1o a.m.-Extra-Metrc- NORTH-EASTERN HOSPITAL FOR CHILDREN, Hackney Road, E.- politan meeting at Pathological Theatre, Victoria Univer- Assistant P1tyslelaD. bity, Manchester. NORWICH: JENNY LIND INFIRMARY FOR CHILDREN. -Lady POST.GBADUATE COURSES AND LECTURES. Resident Medical Officer. dalary, £5o per annum. CHARING CROSS HOSPITAL, Thursday, 4 p.m.-Dermatological Demon- NOTTINGFRAMS HIRE CONqTTMPrlON SANATORIUM, Mansfield. - strationa. Lady Resident Medical officer. Salary, £Ioo per annum. MEDICAL GRADrATES' COLLEGB AND POLYCLINIC, 22, Chenies Street, W.C. PLYMOUTH: SOUT' DEVON AND EAST CORNWALL HOSPITAL.- -The following alinical demonstrations have beenarranged Assistant House- Burgeon. Salary at the rate of £50 per annum. for next week at p.m. each day: -Monday, Skin ; TuesdNay, ROYAL EAR HoSPIrAL, Dean Street. Soho.-House-Surgeon, non- Medical; Wednesday, Surgical; Thursday, Surgical; resident. Honorarium at the rate of annum. Frida'r, Ear. Lectures at 5.is p.m. each day will be given £4o per as follows: Monday, Some Acute Nervous Diseases in SAMARITAN FREE HOSPLTAt, FOR WOMEN, Marylebone Road, N.W. Early Life; Tuesday, The Treatment of Acne Vulgaris; -Anaeslhetist. Honorarium, 20 per annum. WedDesday, Pneumonia in Children.; Thursday, Some SCARBOROUGE H03PITAL AND DISPENSARY.-Junior House- Practical Points Concerning the Use of Midwifery Surgeon, resident balary at the rate of 48o per annum. Forceps. SOMERSEr AND B 4TF ASYLUM, Wells.-Second Assistant Medical NORTH-EAST LONDON POsT-GRADUATE COLLEGE, Tottenham Hospital, N., Officer. Salary, £130 ri.ing to £r5o per annum. 4.30 p.m.-Monday, Central and Peripheral Lesions of the STAFFORDSHIRE GENE t aL IN FIRRAARY.-House-Surgeon, resident. Spinal Cord. Salary, £r2o per aunum. SAMARITAN FREE HOSPITAL FOR WOMEN, Marylebone Road, N.W.- WINSLEY: iAN ATORIRIU FOR POORER CONSUMPTIVES.-Resident Thursday, 3 p m., The Diagnosis of Uterine Cancer. Medical Officer. Sal *ry, £200, rising to £3oo. WEST LoNDON POST-GRADUATE COLLEGE, Hammersmith, W.-The fol- lowing lectures and demonst,rations have been arranged CERTIFYING FACTORY SURGEONS.-The Chief Inspector of Factories for next week, at 5 p m. each day: Monday, Mental De- announces a vacavcv In the office of Certifying Factory Surgeon at ficiencey in Children, withcases; Tuesday, Clinical Aspects New Ross, co. Wexford. of Pneumonia; Wednesday, Question of Insanity from Standpoint of Medical Practitioner; Thursday, On In- juries of the Elbow; Friday, Finsen, Ultra-violet, and APPOINTMENTS. other Methods of Photo-therapy. BEAUMONT, W. H.. M.B., B.C.Cantab., Certifying Factory Surgeon for the Sedberg District, Yorkshire. RIDGEs, E. Chittenden, H. 0., B S.Durh, M R.C.S.Eng., L.R.C.P.Lond., BOOKS, ETC., RECEIVED. Honorary Anaesthetist to t.he Victoria Hospital for Children, Chelsea. The Practice of Medicine. By James Tyson, M.D. Third edition. Lon- CUNNING, Joseph. M B. B S Melh, F.R C.S.Eng., Assistant Surgeon to don: Rebmain, LimLited. 1905. 24S. the Victoria Hospital for Children, London, S.W. Mucous Membranes, Normal and Abnormal, including Mucin and ELWELL, R. G.. B C.Camb, Resident Assistant Medical Officer at the Malignancy. By William Stuart-Low, F.R.C.S. London: Baillidre, Lewisham Uaion infirmary and Workkouse. Tindall and Cox. 1905. 2s. 6d. GITTINS, A. B, bI.R.C.S. L.R.C.P., District Medical Officer of the New- Aesthetic Acres. By C. F. Dowsett, Winklebury, Basiugstoke. 1905. castle-under-Lyme Uuion. Manual of Diseases of Children. By James Burnet, M A., M.B., M.R.C.P. HEATON, Clharles, H D. Brux., M R.C S.Eng., L.R.C.P.. Honorary Assistant Edin. Edinburgh: E.andS.Livingstone. I905. 6s.6d. Visiting Surgeonr to the Royal dea-Bathirg Hospital, Margate. Alcohol: A Poison. Sir Frederick Bart.. LL.D., LAwsoN, T. C., M . L S. By Treves, G.C.V.O., R..nS Eng A.. Certifying Factory Surgeon for the etc. London: _ hurch of England Temperance Society, id. Stokenchurch Ui8trict, Buckinghamshire. An Inquiry into the Phenomenas Attending Death by Di owning and the MANBY, W. E.. M.B., B 3 Carnb, Certifying Factory Surgeon for the Means of Pi omotiug Resuscitation in the Apparently Drowned. Re- Bridport District, Dorsetshire, and Medical Officer of Health for the port of a Committee appointed bs the Royal Medical and Chirurgical Borough ot Bridport. Societly. London: Log,gmans, Green and o..o I904. 5s. SARGENT. P. W. G. M A., 1.B., B.C.Cantab., F.R.C.S., Surgeon to Out- The A.B.-Z. of Our Own Nutrition. By Horace Fletcher. Experimentally patients, Victoria Hospital for Children, Chelsea. assisted by Dr. Ernest van Someren and Dr Rubert Higgins. Lon- BOLINGBROKE HOSPITAL, S.W.-The folowing appointments have been don: B. F. Stevexns and Brown; and New York: Frederick A. Stokes made to the houorary stFaff. Company. 58. Physician: H. Campbell Thomson, M.D., F.R.C.P. The New Glutton or Epicure. By Horace Fletcher. London: B. F. Surgeon: D'Arey riower, F R C.S. Stevens and Brown; and New York: Frederick A. Stokes Company. Assistant Surgeon: Charles Ryall, F.R.C S. 2904. 48- Surgeon to Ophthalmic Department: W. I. Hancock, F.R.C.S. Weston-super-Mare. Edited by G. W. May. London: The Health Resorts Anaesthetist: H. C. Twigg, M.B., B.Ch. Association. i9o5. Free on application to the Town Clerk. Die Krankheiten der Nase urd des Naqenrachens mit besonderer Berucksichtignug der rhinologischen Propadeutik. Von Dr. Carl Zarniko. ZweiteAutiage. Berlin: S. Karger; andLondon: Williams BIRTHS, MARRIAGES, AND DEATHS. and Norgate. 2905. xis.6d. The charge for inserting announcements of Births, Marriages, and Deaths is The Maintenance of Health in the Tropics. By W. J. Simpson, M.D., 38. 6d., which sum houd be forwaraed in post-office orders or stamps with F.R.C.P. Published uuder the auspices of the London School of the notice not later than Wednesday morning, in order to ensure insertion in Tropical Medicine. London: John Bale, Sons and Danielsson, the current issue. Limited. 2905. 28. 6d. Transactions of the College of Physicians of Philadelphia. Third Series. BIRTH. Volume the twenty-sixth. Philadelphia: Printed for the College. BATE31AN.-On the Igth May, at 86, Avenue Road, Regent's Park, N.W., 1904. the wife of A. George Bateman, M.B., C.M., of a daugAiter. Methods of Morbid Histology and Clinical Pathology. By I. Walker Hall, M.D., and G. Eterxheimer, M.D. Edinburgh and London: DEATH. William Green and Sons. I90S. NIGHTINGALE.-On May gtb, at g9 Campden Fill Road, KensingtoD, W. Alkohol und Kaffee in ihrer Wirkung aut Herzleiden und nervose (the restdence of her son. Percy Athelstan ightingale, M.D.), Frances Stbrungen. Von Dr. Hans Stoll. Zweite Aufiage. Leipzig: Benno Emma, widow of Percy Nightingale, Inspecting Commissioner, Cape Konegen. 3905. M.0 50. of Good Hope. I'Agent Pathog6ae de la Syphilis. Nature, Culturet, Inoculations, Vaccination prdventive. PAr le Dr. Henri Pommay. Paris: A. Maloine. I905. Fr. 3. How to Live: A Short Account, in Simple Words, of the Laws of Health. DIARY FOR NEXT WEEK. Writteu for the Older Pupils in Primary Schools. By Richard Caton, M.D., F.R.C.P., J.P. London: Williams and Norgate. 1905. 3d. MONDAY. Chrysanthemums for Garden and Greenhouse. By D. B. CraLe, F.R.H.S.. F.N A.G.A. Edited by T. W. Sanders, F.L.S., F.B.H.S. London: ODONTOLOGICAL SOCIETY OF GREAT BRITAIN, 20, Hanover Square. W., W. R. and L. Collingridge. 2s. 6d. 8 p.m.-Communication: Mr. John Murray, F.R.C.S., on a Case of Odontome, and the specimen will be shown to- Das biologische Verfahren zur Erkennung und Unterscheidulg von gether with a lantern slide and microscopic section. Menscnen- und Tierblut sowie anderer Eiweisssubstanzen und seine Dr. Anwendung in der forensischen Praxis. Ausgewltblte SamMluDg Paper: W. D. Miller, of Berlin, Some Studies on the von Arbeiten und Gutachten von Prof. Dr. Uhlenhuth. Jena: Gustav Anatomy of the Teeth, and their Practical Application. Fischer. I9o5. M.3. WEDNESDAY. The Mosquito-Malarial Theory and Malaria Prophylaxis from the Latent BRITISH BALNEOLOGICAL AND CLIMATOLOGICAL SOCIETY, 2o, Hanover Phase. Bv Hajor G. ki. Fink, I.M.S.(ret.), M.R.C.S.Eng., L.S.A.Lond. Sqtuare, W., p5m.-General meeting, 5 30 p.m. Paper: Dr. London: W. Straker. 1905. William Murray, The Limitations of Treatment. Les Moustiques. Histoire Naturelle etMddicale. Par Raphail Blanchard, TRURSDAY. Paris: '. R. de Rudeval. 10os. F.25. Lehrbuch der Kinderheilkunde fuir Aerzte und Studierende. Von Pr NORTH-EAST LONDON CLINICAL SOCIETY, Tottenham HospItal, 4 p.m.- med. Bernhard Bendix. Vierte Autlage. Berlin and Wien; Urban Clinical Cases. and Schwarzenberg. o905. M.I32. FRIDAY. The Rheumatic Diseases. By J. Odery Symes, l.D.ond.,, D.P.l.4 LARYNGOLOGICAL SOCIETY, 20, Hanover Square, W., 5 p.m.-Cases and M.R.C.S., L.R.C.P. London and New York: JhnLane.- I505. se. specimens will be shown by Messrs. Thomson, Waggett, * In forwarding,books the publishers are requeateod h Thorne, Kelson, De Santi, and others. sellng price. 288 i4nm oAs [M,&Y 27, 1905- CALENDAR OF THE ASSOCIATION.

Month. Day of Week. Meotnp to be Hold. Month. Day of Week. Meetings to be Hold. lay 28...&unbap.. South-Eastern Counties Division, Edinburgh to 29...MONDAY . JunO 17...SATDAY... Branch, Annual Meeting, Railway Hotel, Boston and Spalding Division, Midland Branch, Newtown, St. Boswells, 3 p.m. Annual Meeting, Red Lion Hotel, 1 p m. , 8...iSunbav.. Folkestone Division, South-Eastern Branch, Grants I Annual Meeting, Hotel Wampacli, 7 p.m. also M IONDON: Scientific Committee, 3 p.m. meeting of Foikestone, Dover, and Ashford *§19-MO10NDAY *e Election of Representatives: July 3rd. 20..T%UZDAY oe s 30...TUUDTy NorthConstituency,Carnarvonshire7.30 p.m.,andDinner.Angleseys.3e p.m.Division, Notices of Motion for QuarterlyCouncil Meet- North Wales Branch, Annual Meeting, British Ing must be given to General Secretary on Hotel, Bangor, 2 p.m; Executive Commit- or before this day. tee, I p.m. 21...WBDNZBDAY South-Eastern Branch, AnnualMeeting, Guild- Trowbridge Dlvislon. Bath and Bristol Branch, hall, Canterbury, 2.15 p.m. Annual Meeting, Trowbrldge Ulster Branch, Annual Meeting, Warrenpoint, Scientific Grantees have to report Ito Council co. Down. on or before this date. Aitrincham Divislon Lancashire and Cheshire Bath and Bristol Branch, Medical Library, Branch, Annual lieeting, Board Room, University College. Bristol, 8 p.m. 22...THUUsDAY... CityAltrinchamDlvlsion,Infirmary,fetropoNtans p.m.Countie Branch, 8I...WUDNKsD&Y LiverpoolCheshire (Northern)Branch, AnnualDivision,MeetiDg,LancashireMedicaland Great Eastern Hotel, Liverpool Street, E.C., Institution, 114. Mount Pleasant, 4 p.m. 4 p.m. South Carnarvon and Merioneth Division. Os 23-IrRIDAZ . North Wales Branch. Annual Meeting, ,, 24SATURDAY... Golden Lion Hotel, Dolgelly, 2 p.m. Note that in order to facilitate the procedure 25a.4.unbar.. of the Council for the appointment of Com- mittees. Branch Secretaries are requested .. 26-..MONDAY ... to send in to the General Secretarv the 27 TuIDAY ... LONDON: Organization Committee, 10.30 am. ElectiOn Returns of their Branch Repre- Brighton Divislon, South-Eastern Branch. An- sentatives by June 27th. 28...WUDNNsDAY nual Meeting, 113, Queen's Road, Brighton. Canterbury and Faversham with Thanet 4.30 p.m. Jiu1e 1.-THURsDAY.... Divisions, South-Eadtern Branch, Combined {fEEast Anglian Branch, Annual Meeting, Meeting, Canterbury Hospital, 4 p.m.: pre- 29..Tzi&DAY.. ceded by meeting of Canterbury and Faver- Norwich. sham Division, 315 p.m. 3G-JIDAY Association Research Scholarships expire. Fife Branch, Annual Meeting, in the- Hotel, Research Scholarships date from now. Thornton. 3.15 p.m. 1...A TURDAY... Edinburgh Branch, Hawick, 12.15p.m.; Dinner, Southern Division, Edinburgh Branch, Annual Tower Hlotel, 6.30 p.m. Meeting. Oddfellow.' Hall (Room 6) 8.15p.m. LONDON: Officers of the Association, reAltera- to 2...SRunbav. tion of Memorandum, 3 p.m. Division Returns of Representatives and 4 p.m. Branch Returns for Council this day week. S9Superannuation Committee, 3...MONDAY --' Last day for electing Representatives of SUBWAY Matters for consideration by Quarterly Divisions for Ethical Committee should be notified to the _- Representative Meeting. Medical Secretary on or before thin daV. ., 4...Tuz8DAY Dundee Branch, Annual Meeting, Students' 5 WBDNEBDAY LONDON: Central Council, a.m. Union, Dundee, 4 p.m. Io ,...oSuRDAY... 6..-THUDAY... to 4 . ^-Unba2. 7... IDAY ,, 65.MONDAY Coventry Division. Birmingham Branch, An- 8-8mUTUIDAY... ,,9 6..oTUDAY .*..s nual Meettng, Coventry and Warwickshire Hospital, 5.30 p.m. -Last day for Division Secretaries to send ,, 7...WEDNR5DAY. LONDN: Medlio-Political Committee. General Secretary returns of election of Birmingham Branch, Annual Meeting. Madt- 1O.-MoNIDAY Representatives. cal Institute. Edmund Street, Birmingham, Refer to Notice of June ist as to forwarding 4 p.m.; Dinner. Grand ti otel, 7p.m. returns of Election of Branch Representa- Bristol Division, Bath and Bristol Bratich, Medi- tives. 8...TEUB8DAY..j. cal Library, University College, Bristol, 8p.m. 11...TuusDAv Norwcod Divislon, South-Eastern Branch, Art (Last day for Branch Representatives to Club, Blackheath, 4 p.m.; Dinner, 6 p.m. 12...W NEsDAY nominate Candidates for uo-option to the South Wales and Monmouthshire Branch, Council. Annual Meeting, Cardiff. Wandsworth Division. Metropolitan Counties 9.o.FMDAY West Somerset Branch. Annual MeetiDg, 13... Branch, Clapham 4 "' *" Betch Hotel, Minehead, p.m. THURDAYv Junction, p.m. tTURDAY.. 12.33 *v14 .. Tit1DAY i...Xunbal?. 15...SATTDAY 12...MoNDAY ... Bank Holiday. IMatters for consideration by Organization 1,... *unbal2@. 13-Tus8DAY ...< Committee on June 27th should be notified 17.].MONDAY to Medical Secretary on or before this day. I Westminster Division, Metropolitan Counties . 18 TUSDAY 14...WBDNBSDAY - Branch, Annual Meeting, 20, Hanover 1,19i9...WwDNEsDAv... WEDNESDAY Square, 4 30 p.m. City Division, Metropolitan Counties Branch, The last day upon which the General BoSer ...TRSDAY... (reat Eastern 20 Hotel, Liverpool Street, E U;. tary cat rteeive references for the Con- 4p.m.4 ference of Branch and Division Secretaies 21 ..RIDAY 15... S on July 25th at Leicester. Midland Branch, Annual Meeting, Infirmary, 22-..SATURDAT... Leicester. 4 30 p.m. South-Western Branch, Annual Meeting, Atlhenaenim, George street, Plymouth, 3 p.m. 21...MONDAY LoNDON: Ethical Committee. 16...J WllDAY s.ee Border Counties Branch, Annual Meeting, 25...TuzsDAY 'County Hall, Carlisle, 3.30 p.m. 26..WBDNSsDAY ANNUAL MEETING. ThA sventy-third annual meeting of the Assoczation will be held at Leoeter on Juy 14th, 15th, 26th, 17th, and 28th. The Honorary Local Secretarise are Dr.' Astey V. Clarke, 87, Loudon Road, Leioester, and Mr. F. Bolton Carter, M.S., 99, London Road, Leister; the Honorary Secretary of the Pathological Musm is Dr. Robert Seetre,119, London Road, Leicester. The 'Annual Ge,wal Meeting for business will begin at 1 p.m. on Monday, July f4th, and the fir8t sessio of the Annual Retrentativs Meeti wUl be held inmediately afterwards. The first mnetings of the Section. wiU begin at 10 a.m. on Wednesday, July ndAo Prne4ad publishd by t,hc Brit-ish Mledical Association at their Offic. No. 42, St'anc, jn tJ10 j'rish of St. Mrtln-hi-the.Pields. in the County cf Middieseg