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by the dissentients, the proposals covering (1) the treporting by medical officers of venereal disease clinics, iand by private practitioners, of cases of syphilis and igonorrhoea in infants, children, and adolescents up to 1the age of 18 to the school medical officer with a 1

request that the school nurse might follow up caseswhich failed to attend; and (2) Government action 1

making it compulsory for every medical man totreat his own patients. 91 per cent. of repliesattached importance to the proposal that legislationconcerning the suppression of venereal disease shouldbe a public health matter, and should not be combinedwith legislation aiming at the suppression of prosti-tution ; 92 per cent. favoured the confidential treat-ment of persons willing to continue such treatmentuntil they are non-infective, and notification of thosewho discontinue treatment while still infective ;some replies favoured the first part of this proposal,but not the second. 85 per cent. of those personsor bodies questioned saw no reason why publichealth regulations requiring the compulsory con-

tinuous treatment of infective persons should notbe impartially administered between the sexes. Therewas apparently general agreement that any limitedform of notification and compulsory treatmentintroduced should only be operative towards thosewho had discontinued treatment, and that otherwiseconfidential treatment should be retained.

In our last issue we dealt with the report of theCommittee appointed by the New Zealand Minister ofHealth to inquire into the position with regard tovenereal disease in the Dominion. Among therecommendations of the Committee was one relating tolegislation providing for " conditional notification ofvenereal disease," by which it would be the duty ofa doctor to notify to the Health Department, bynumber or symbol only, each case of venereal diseasehe treated. The terms of the recommendation werethat if a patient refused to continue treatment untilcured, and would not consult some other doctor orattend a clinic, it should then be the duty of thedoctor to notify the case by name. If the patientcontinued recalcitrant, the Director-General of Healthshould be empowered to apply to a magistrate forthe patient’s arrest and detention in a public hospitalor other place of treatment until he should be non-infective. The Committee also reconllllended provisionto deal with cases where persons suffering fromvenereal diseases were not under medical treatmentand were likely to infect others. The Director-General should be empowered to call on such a personto produce a medical certificate, which might beprocured free of charge at any hospital or venerealdisease clinic. If the person refused to produce such acertificate he or she could then be taken before amagistrate, who might order a medical examination.Penalties, including detention in a prison hospital,should be provided for recalcitrant cases, and allproceedings should be private unless the defendant Idesired a public hearing. Action along these lineshas already taken place in Queensland, as recorded inthe annual report for 1922 of the Commissioner ofPublic Health for the State. " In accordance withSection 159 (6) of the Health Acts, 1900-1917," 448male patients attending the Brisbane clinics werenotified for failing to report themselves at least oncein every four weeks. Of these, 418 were written toand warned of the consequences of their action ; 205thereupon reported back to the clinic or official advicewas received that they were again under medicaltreatment for venereal disease. The services of thepolice were requisitioned in 221 cases ; the result oftheir action in these cases, and in 127 cases regardingwhom no information was at hand on June 30th, wasas follows : Not traced, 208 ; warned, 74 ; dead orleft State, 13 ; in gaol, 2 ; certificates of cure received,6 ; reports not to hand regarding 45. Nine of thepatients who did not comply with the warnings giventhem were proceeded against, and fines ranging from22 to <85 were imposed. Three other defaulters werefound to have left the State, and proceedings againstthem were withdrawn. Four of the women attending

the female clinic were written to during the year forfailing to continue medical treatment, with the resultthat three again reported, and the other transferredto another medical practitioner, from whom therequisite official advice was received. Anotherwoman, written to in the previous year, was warned bythe police, and on reporting was found to be free of thedisease and given a certificate of cure.The Council for Combating Venereal Diseases, having

considered the American system of notification bynumber and compulsory detention, and variousContinental systems, state in their report that these-contain possibilities of grave abuse, their administra-tion tending to result in a form of regulated prosti-tution, the compulsory clauses being exercised largelyin relation to women. Dominion legislation, likethat quoted above, being more in accordance withprinciples acceptable in this country having beenapplied in the Dominions, the Council communicatedwith the Provincial Health Departments in Canada ;the replies received showed that Canadian medicalofficers are practically unanimous in believing thatthe system of confidential notification does notprevent people seeking treatment. The N.C.C.V.D.finds in this country evidences of a steadily-growingpublic opinion in favour of some form of compulsorycontinuous treatment.

HONOUR TO THE STRETCHER-BEARER."DANS LES BOUES DE LA SOMME."

THE Service de Sante, the medical corps of theFrench Army, was recently honoured by the city ofParis, which presented to the Medico-Military Schoolof Val-de-Grace a fine sculptured group representingtwo stretcher-bearers carrying a wounded man tosafety through the mud of the Somme. This group,exhibited at the Salon in 1921, and bought by theFine Art Commission of the city, is the work of ayoung sculptor, Mr. Broquet, who was himself an

infantry stretcher-bearer and was wounded during:the war. The group has been set up in front of the

A sculptured group representing two stretcher-bearers carryinga wounded man to safety. The group in its setting in frontof the main entrance of the Val-de-Gtrace Medico-MilitarySchool, Paris.

main entrance, at Val-de-Grace, as a monument tothe valour of the " other ranks " of the Service daSante, the officers being commemorated by theirnames on memorial tablets dedicated on the sameday, during May, 1922. The President of the FrenchRepublic, the Minister of War, the President of theMunicipal Council of the city of Paris, Marshal Joffre,and other notable persons were present ; the occasion

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took the form of a national tribute to the medicalservice of the army. Mr. Cesar Caire, the presidentof the Paris Municipal Council, recalled that where-ever the " poilu," the real victor of the war, hadgone forward, the stretcher-bearer had always beenwith him to succour him if he fell. Mr. Viry, a seniormedical officer, and president of the Friendly Society

A nearer view of the group, giving more detail. I

of Past and Present Students of Val-de-Grace, regretted I,it had not been found possible to commemorate onthe memorial tablets the names of the auxiliarymedical officers who had fallen in the war ; only thoseof the regular service appeared, space and moneybeing alike wanting. Others who should also becommemorated were the 69 chaplains, and manynurses who were killed. One hundred and tendoctors had been killed ; 9000 stretcher-bearers haddied, 5000 of them from wounds in action. Thetablets and the monument were accepted on behalfof the school by the Director, Medical InspectorJacob, who pointed out the realism of the group,which he said, portrayed the kind of thing many ofthose present had seen on the battle-fields of theSomme. The work of the stretcher-bearers, heconcluded, had saved 60 per cent. of the Frenchwounded, which meant that from February, 1918, tothe Armistice they returned half a million of men tothe firing line. Mr. Maginot, Minister of War, asso-ciated himself with the homage there rendered to theService de Sante, officers, stretcher-bearers, andnurses, whether of the regular service or of thereserve. At the conclusion of the proceedings,Mr. Millerand, President of the Republic, presentedto the school the Croix de Guerre, granted because ofthe devoted pursuit of science and spirit of sacrificefor others displayed therein during the war.We are indebted for the photographs here repro-

duced to Dr. Visbecq, Medecin Chef de la SectionTechnique, Service de Sante, Paris.

Public Health Services.SOME POINTS FRO1B! THE GUILDHALL CONFERENCE

ON HEALTH INSURANCE.THE procedure at the Guildhall Conference of

bodies interested in the medical service under theNational Health Insurance Acts necessarily resultedin the ventilation rather than the orderly discussionof difficulties. For their solution we must await theformation of sectional conferences by the StandingCommittee appointed at the Conference. Nevertheless,some important points were made. Sir William GlynJones, in his opening remarks on " Title to Benefit," Ibrought out the fact, which is hardly yet generally Ifrecognised, that panel doctors are not paid forindividual insured persons on their list but that they

collectively are responsible for the provision of medicalbenefit to the whole of the insured persons in the area.The share of the local pool due to each individualpractitioner is measured by the relation of his listto those of his colleagues. The figure is measured inunits of credit, the credit varying with the acquisitionof newly signed medical cards and the loss of recordcards, which the practitioner has to return to theinsurance committee to be transferred when theinsured person elects to make a change of doctor.Migration of population and change of address amonginsured persons have rendered registration bothdifficult and costly. But its total abolition on thescore of economy would lead either to payment on anattendance basis or to a State service. Sir William

Glyn Jones was probably right in suggesting thatmore accuracy would prove too expensive and thatit was doubtful whether doctors would do better onany other system.

In the discussion on "Efficiency of Service Ren-dered " surgery accommodation was the first andindeed the main subject of criticism. Mention wasmade of the " insanitary atmosphere in the waiting-room," and speakers on the medical side admitteddefect. It must be remembered, however, that inindustrial areas the housing shortage has made itvery difficult for medical men to find suitable premises,and that the cost of adapting old houses has beenprohibitive. The matter rests in the hands of theinsurance committees, and panel committees haveshown little reluctance to assist in securing all-roundimprovement. The insured person has his own

preferences which are not necessarily hygienic. Wecall to mi!..1.d a suburban area where insured personscrowd on to a practitioner’s list because they like theopen surgery system, although the accommodation isnot to be compared with that of a professionalneighbour who admits them by the front door intohis single consulting-room and a well-furnishedsurgery where he sees private patients as well. Thedesire expressed by trade-union representatives thatthe doctor should furnish insured persons withprivate cards showing surgery hours and the namesof his partners is already met in many places.The Medical Service Subcommittees came in for much

adverse criticism. These tribunals are admittedly notas effective as they might be, but it is difficult to seewhat could be put in their place. They actuallyserve a useful purpose, and so long as the systemremains of admitting all registered practitioners to thepanel there must be some instrument for reviewingthe service and winnowing out the chaff. Sir AlfredWarren, one of the whilom severest critics of themedical service, spoke up for these much-abusedcommittees, hinting that approved society representa-tives were only treated as hostile witnesses when theyacted as such. No doubt there is room for educationin all parts of a health service, for here efficient workimplies that each unit must know how best to cooperatewith every other.

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PUBLIC HEALTH IN LOCAL ACTS.Parliament passed 120 local and private Acts

during 1922. Their provisions for local gas, water, andelectricity undertakings, for trams, railways, andcanals, for drainage, pilotage, and fisheries, and forschools, trusts, and Irish divorces are neither veryexhilarating to read nor very easy to find, but thereare some instructive passages about public health whichare worth exploring. For if we find out what newpowers our local authorities are obtaining, we can seein what respects the general standards laid down forthe whole country by the Public Health Acts arethought to be inadequate. Public health legislationin England has usually thus developed from the par-ticular to the general. One progressive municipalitytakes a step forward ; others move up abreast of it ;and finally the pace they set is taken up all over thecountry and the whole line moves forward together.It was a local Act obtained bv Manchester in 1844which formed the basis of much of our first PublicHealth Act in 1848. The same tentative and experi-