906 CONSTITUTIONAL TRADE-UNIONISM.

medical practitioner, instead of being an agentfor the treatment of obvious disease, recognisesand handles it in its early stages, and becomes alsoa missionary of personal hygiene in its preventiveaspect. And he admits that for this to come aboutthere must be improved education, graduate andundergraduate, and an extension of the facilities fordiagnosis and treatment. Here the declaration ofpolicy on the part of the Ministry with regard tothe hospital question, which was made by Dr. tADDISON to a meeting, convened on Tuesday last bythe Parliamentary Medical Committee, supplementsthe Report of his Chief Medical Officer very appro-priately. The Interim Report of the ConsultativeCouncil on Medical and Allied Services laid greatstress on the need ot hospitals, both to minister tothe sick and to act as centres for the local medicalprofession, and obviously hoped that the voluntarysystem would meet the case, if duly supplementedby the State; independent investigations have con-firmed the shortage in beds throughout the country;and in impending legislation there is a provisionenabling hospitals to be put on the rates. Dr.ADDISON told the Parliamentary Medical Com.mittee that it would be a disaster to the countryif the generosity and enterprise represented by thevoluntary system were lost, but that more than onehalf of our total of beds was already supported byState or rate aid, so that a permissive clause allow-ing freedom of action to communities becomeslogical. The whole matter will be debated at theConference called for Friday, Nov. 5th, at theCouncil Room of the Medical Society of London,when it will become clear that the work of theMinistry of Health in connexion with hospitalshad not reached any stage which could be madethe subject of a definite Report. After all, it is thebusiness of a report to report and not to prophesy.

Constitutional Trade-Unionism.FOR some years past there have been signs of

movements within the British Medical Associationcorresponding to that of the shop-stewards move-ment within the orthodox trade-union. In eithercase they may betoken healthy activity. In 1918 and1919 conferences of the official representatives ofinsurance practice were of a highly controversialand even heated character, the gatherings by nomeans always accepting the advice and guidance oftheir officers. Nothing of this sort was apparent atthe Conference of Representatives of Local Medicaland Panel Committees which took place on Oct. 21st,at the Memorial Hall in Farringdon-street, London.At this Conference Dr. H. G. DAIN, of Birmingham,was re-elected chairman in token of approval ofhis previous two years’ service and the membersof the Insurance Act Committee were entertainedat a dinner given by the delegates to the Conferencein the evening, when Dr. H. J. CARDALE, chairmanof the London Panel Committee, presided, and therewas a lively exchange of good feeling. Suavity indebate is of course a cherished tradition of our publiclife, but it was more than good manners that madethe 1920 Conference harmonious. In the words ofone of the papers tabled at the Conference, therewas a feeling " that the prospects for the futureare so bright" as to render strife unnecessary.

Nevertheless, the constitution of the InsuranceActs Committee did come up for discussion on

the sturdy motion of a North country committeeto abolish it altogether and to substitute in itsplace a central body composed entirely of nomineesof panel committees. The London Panel Committee,

as may be seen from our news columns, hadadopted resolutions to the same effect. Accordingto its present constitution six members of theInsurance Acts Committee are elected by theannual Representative Meeting of the B.M.A., 18members are directly elected by grouped localmedical and panel committees on the basis of1 representative to about 1000 panel doctors, 4members represent outside bodies-namely, theMedical Women’s Federation, the Society ofM.O.H.’s, the Poor-law M.O.’s Association, and theHospitals Committee of the B.M.A. It may behere recalled, a fact often lost sight of in con-

troversy, that the decisions of the Insurance ActsCommittee are not subject to the veto of theCouncil of the B.M.A. One-third of panel practi-tioners are in fact not members of the B.M.A.,and conversely one-third of the members of theB.M.A. are not in panel practice. While, therefore,the B.M.A. is already largely representative of themedical profession as a whole, the Insurance ActsCommittee is representative in a still higherdegree. Owing to a flexible constitution, which isstill being amended, this committee may be regardedas having established itself firmly both amongmedical men and at the Ministry of Healthas a judicial and judicious negotiating body inmedical insurance practice. Its chairman, Dr.H. B. BRACKENBURY, gave it clearly to be under-stood at the dinner that the committee in itsnegotiations with the Ministry of Health is deter-mined not to take up an intransigent attitude, butrather to assist in getting at the truth, while it alwayskept in view the fact that it represented interestsbroader than those of insurance practitioners.The most contentious issue of last year, the

waning capital value of panel practice, was dealtwith at the Conference by the simple expedient ofreiterating the desire to return to the status quoantea, a resolution being unanimously carried askingfor the restoration of the old regulation in thisregard. If restored, two undertakings will be givento avoid abuses which had crept in in the past.Insured persons automatically transferred would beallowed the option of changing their doctor withinsix months, and no panel practitioner would beentitled to resell a transferred panel practice withintwo years without producing a satisfactory reason tothe Insurance Committee. This procedure shelvedany discussion of the important schemes for themaintenance of the capital value of a practice ondeath or other vacancy, worked out in London,Dartford, and Brighton. All these schemes anti-cipate, what, indeed, seems to us inevitable, adepreciation in the selling value of an insurancepractice as time goes on, and this from naturalcauses rather than ministerial malevolence.Dartford’s scheme follows that of the LondonPanel Committee in being compulsory, and impliesthe cooperation of all the practitioners in an area.The Brighton scheme is designed to achieve thesame result on a voluntary basis. It may be hopedthat at some not far distant day the necessityfor any one of these schemes may be removed bythe insertion of a pension clause in the practi-tioner’s agreement. Marketable goodwill is an

asset to those who possess practices, but it doesnot assist in drawing the best kind of practitionerinto insurance work, in so far as it makes thepossession of some residual means after qualificationa condition of entry rather than the possession ofbrains and energy. On the equitable solution ofthis question depends the complete pacification ofthe insurance medical service.