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IRELAND

(FROM OUR OWN CORRESPONDENT)

SALARIES IN THE POOR-LAW MEDICAL SERVICE

DISCONTENT among poor-law medical officers onthe ground of the inadequacy of their salaries is nota new feature in Irish medical affairs, and it becomesspecially noticeable in any time of economic depres-sion. The medical officer gets a salary of :S200-S350a year for attendance on the sick poor of his district.But of this he has to pay his travelling expenses ;moreover, he has to reside in the dispensary residencefor which the rent is often unduly high. He is

expected to earn the remainder of a livelihood fromsuch private practice as may come his way. In a

good district and when " times are good" for thefarmer he may have a comfortable, though rarely alarge, private practice. In a poor district and whentimes are bad the private practice may be almostnegligible, for many of those who would ordinarilypay the doctor’s fees find it necessary or attractiveto seek his services as " poor persons " and withoutfees. In some cases his income almost disappears forthe larger the number of " poor persons " whom hehas to attend the greater his travelling expenses.The only remedy for the recurring discontent in

this essential public service is that which the profes-sion has long demanded-the establishment of a

State or national medical service. This solution hasbeen recommended by repeated Government com-missions and committees any time during the lastthirty years, but every Government has fought shyof it. At present the Irish Free State Medical Unionis pressing claims for improved and uniform scales ofsalaries for the dispensary officers, and some weeksago a memorandum setting out their case was sub-mitted to the Minister for Local Government andPublic Health, but he saw no useful purpose in

receiving a deputation. Failing getting direct accessthe dispensary group of the Union has issued a

. circular letter to all members of the Dail asking fortheir help in procuring a better scale of salaries. Theclaim is based on (a) increased work ; (b) the lowersalaries for dispensary medical officers than for otherofficers of local authorities ; (c) increases in rent fordispensary residences ; (d) decrease in private practice ;and (e) the increased cost of medical education,including the post-graduate work necessary for a

dispensary appointment.A suggestion was recently put forward by the

county medical officer of Meath, Dr. T. F. O’Higgins,which if adopted would do something to relieve thepresent dissatisfaction. The poor-law medical officer,in addition to his duties as medical attendant on thesick poor, is also, by virtue of his appointment,medical officer of health for his district. Formerlyhe was the sole officer in country districts, but thecounty medical officers of health who have sincebeen appointed have a superior authority. For theirduties in this capacity the dispensary officers receivea very small salary, varying from j610 to JE30 a year.Many attempts have been made in the past tostandardise these salaries at a reasonable figure, butthe local authorities have been unwilling to pay more,and the Department of Local Government and PublicHealth has not been encouraging. Dr. O’Higgins hassuggested that the salaries should be standardised at9100 a year, and that it should be the duty of thedistrict medical officer to undertake such duties asimmunisation against diphtheria and such otherancillary work as he might recommend to the local

authority. The proposal has attracted both thelocal authority of county Meath and the medicalprofession of the county. If it were to receive

general approval throughout the country it woulddo away with the present unpleasant impasse regard-ing payment for immunisation, and would make asubstantial improvement in the emoluments of

dispensary doctors. The Medical Union has invitedits members in the different areas throughout thecountry to consider the proposal and express theiropinions.

RESEARCH APPOINTMENTS

The Medical Research Council of Saorstat Eireannhas appointed Dr. R. A. Q. O’Meara for one year toinvestigate the experimental production of thera-

peutic antisera ; the work is to be carried out in theschool of pathology, Trinity College, Dublin, underthe direction of Prof. J. W. Bigger. Dr. J. C. Floodhas been granted a part-time appointment for a yearto study the total body electrolyte ; he will work inthe pharmacological laboratory, University College,Dublin, under Prof. E. J. Conway. Grants-in-aidhave been awarded, for the purchase of apparatus orfor research, to Prof. J. H- Biggart, Dr. P. C.Bresnihan, and Dr. J. D. H Widdess.

SCOTLAND

(FROM OUR OWN CORRESPONDENT)

MENTAL DISEASES

CONTINUED progress in the institutions and clinicsunder his, charge was recorded by Prof. D. K.Henderson in presenting the annual report of the

Royal Edinburgh Hospital for Mental and NervousDisorders. He said that public opinion is becomingbetter informed and more charitably mindedtowards the mentally ill patient. He stressed the

danger of any attempt to divide physical and mentalhealth into separate categories. Clergy and other

lay persons have in recent years been tending toinvade the psychiatric field, and if allowed to do so,they are likely to perpetuate the schism betweenthe physical and mental which medical men have beenendeavouring to heal. It is the physician alonewho realises the risks and complexities of the treat-ment of highly charged emotional disorders. Prof.Henderson said that there can be no arbitrary divisionbetween the sane and the insane. Between thetwo there is a large group of people who are unable.to adapt themselves to ordinary social life. Themembers of this group are very numerous, they formthe most disruptive element in society, and we haveno adequate provision for them. The developmentof a more positive health policy is likely to help thisgroup. With regard to divorce and mental illness,Prof. Henderson said that one of the most disastrousand insidious forms of mental disorder has beendeleted from the Divorce Bill, while other less seriousforms are retained. He was referring to habitualdrimkenness which, " both directly and indirectly,creates greater social disorder and distress than

any other factor, and is one of the most difficult totreat."

PAYMENT OF IIOSPITAL DOCTORS

As I have previously reported the directors of theRoyal Hospital for Sick Children, Glasgow, considerthat their medical staffs should receive reasonableremuneration for their services. In their annualreport they stated that consultations have been