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extraordinary measure. A very remarkable state-ment was made at a recent meeting of the EastSuffolk Insurance Committee by the vice-chairman,but it was not reported in the East Anglian DailyTimes. He said: " Had I been a doctor nothingwould have induced me to sign the agreement." Hereferred to the 1914 agreement. Comment is, I

think, unnecessary.I am, Sir, yours faithfully,

T. CUMING ASKIN, M.D. Dub.Alderton, Woodbridge, Suffolk, Feb. 7th, 1914.

To the Editor of THE LANCET.

SIR,-There is no doubt that the profession isdrifting hopelessly with the tide. General prac-titioners are divided into two hostile camps with nopossibility of reconciliation. The Presidents, pastand present, of the Royal Colleges give no advice orhelp. Some other distinguished doctors’ names

are to be found on the committee of a recentdinner in honour of a man who probably is an

important factor in the division. The real causehas been the weakness of half of the medical pro-fession in signing a pledge and then breaking it atthe beginning of last year.These doctors are apparently busy forming

societies to support panel practice. They can savethemselves the trouble ; being Government servants,and badly beaten on their own ground, they arenever likely to obtain reforms worth speaking ofunless they organise a strike, and even then, afterlast year’s fiasco, no one will heed their threats.The politicians, medical and lay, have won the day,and unless something is done I have no doubt thatthe insurance doctors will submerge themselves (asthey have done in Germany) to the level of under-paid artisans.

It may be asked, Is there any remedy for thepresent chaotic condition? It is a fact that a certainamount of contract medical service is requiredin this country; for instance, a labourer with sixchildren earning 30s. a week cannot afford to pay adoctor’s bill; for these a Public Medical Serviceought to be provided. But it must be organised andrun entirely by the medical profession, its disciplineespecially must be in our own hands, and it mustbe a severe discipline. Such a service can and

ought to be formed. It would be voluntary, andthe patients would have free choice of doctors andall the petty annoyances of the Insurance Actwould be swept away. No doctor would feel ashamed to belong to it. Politicians would bedeleted from its council, and with their removaltwo-thirds of the trouble of organisation woulddisappear. I am, Sir, yours faithfully,Streatham, S.W., Feb. 7th, 1914. E. H. WORTH.

A CATALOGUE OF SUFFERING.To the Editor ot THE LANCET.

SIR,-In reply to your correspondent, " M.D.Cantab.," I can assure him that closer attentionwill be given in future to the manner of settingforth to subscribers the disabilities of candidatesfor election to that great charity, the Hospital forIncurables, Putney.No efforts are spared by the board of manage-

ment to ensure that the disability of a candidatefor election is incapable of cure or even of improve-ment. The list of selected candidates represents avery small proportion of the total number of appli-cations for the benefits of the charity. With further

generosity on the part of the public its work could,of course, be considerably extended.

I am, Sir, yours faithfully,A MEDICAL MEMBER OF THE BOARD OF

MANAGEMENT.I Feb. 5th, 1914.

THE NATIONAL INSURANCE ACT.

MEMORANDUM WITH REGARD TO PERSONS MAKINGTHEIR OWN ARRANGEMENTS UNDER SECTION 15 (3)

OF THE NATIONAL INSURANCE ACT.

A MEMORANDUM has been issued by the NationalHealth Insurance Commission in which theCommissioners draw the attention of the InsuranceCommittees to certain provisions in the currentMedical Benefit Regulations as regards personsmaking their own arrangements, in which thoseRegulations differ from the Regulations previouslyin force.The memorandum in paragraphs 2-6 deals with

persons who were allowed to make ’ their ownarrangements for medical benefit during the pastyear, and explains their position when they havenot given the proper notice of their desire to

change their method of obtaining treatment. Suchpersons are to be deemed to have applied to obtaintreatment in the current year in the same manneras in the preceding year. Insurance Committeeswill have to review the individual cases, for whichpurpose a proper form has been provided for issue,and where a committee consider that they mustrefuse a permission previously granted, the insuredperson will revert to the ordinary arrangements.

Paragraph 7 of the memorandum explains the

position of exempt persons who are required tomake their own arrangements. A form has been

prepared, which can be issued by Insurance Com-mittees, and which is also applicable to other personswho by the operation of any income limits fixed bythe committee are required to make their ownarrangements.The next ten paragraphs deal as follows with-

Persons making their own Arrangements otherwise than nithDuly Qualified Medical Prccetitioners.

8. It is within the knowledge of committees that the oldRegulations did not deal under expressly separate provisionswith arrangements made with qualified practitioners andthose made with other persons. It was, of course, con-templated that the great majority of applications underSection 15 (3) of the National Insurance Act, 1911, wouldbe received from persons desirous of making privatearrangements with qualified practitioners ; and this expec-tation has, it is understood, been justified by the experienceof committees, who will, in all probability, continue toreceive the bulk of their applications from persons desirousof making arrangements of that nature. But the Regula-tions did not exclude the possibility of arrangements ofanother class, and it was left to Insurance Committees toconsider the particulars of individual applications with aview to giving or withholding consent, in accordance with aproper exercise of their discretion, upon the merits of eachcase.

9. It is understood, however, that difficulty was expe-rienced last year by committees in some cases in dealingwith the applications of persons desirous of arranging other-wise than with qualified practitioners, practically the wholeof which have, according to the Commissioners’ information,been received from those who wish to obtain treatment frompersons known as "herbalists," on grounds of preferencebased either on a long existing habit, or on some objectionto the treatment given by qualified medical practitioners. Inthe course of their consideration of these cases it is believedthat doubts have occurred to Insurance Committees as towhether their discretion was not fettered by the terms of the