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if poor women got more medical treatment in con-sequence of the Act than they did before it cameinto force. In other large towns this was doubtlessthe case, but at Bristol there was such a numberof charities at the disposal of the poor that it wasnot so likely that the Act would bring to lightpatients who had previously been neglected. Therewere two general hospitals appealing for subscrip-tions by the rivalry of their out-patient depart-ments and extensively advertising the number ofpatients treated. Then there was, he pointed out, acharitable dispensary, employing a staff of visitingmedical officers, and, of course, there were quite anumber of hospitals for special diseases. Now allthis is reduced. The nine visiting medical men ofthe dispensary do not attend to insured persons, butthey attend to uninsured women and children, and Ihave nearly as much to do as before the Act. It Ifhad been calculated that more than one out of Ivery three inhabitants of Bristol used to receive I,gratuitous medical aid. Consequently it would be,difficult to find, even among the poorest paid i,workers, women who had not been able to obtainthe medical attendance they needed. The fear isnot so much in regard to the amount of medical.attendance available but rather as to its quality. ,

The Act, more than one practitioner remarked, ’,did not make for quality. It created a stereotypedpractice. The practitioner will not rise becausehis ,patients will always remain 7s. patients.-Formerly, as a practitioner increased in know-ledge and experience, he secured a better class ofpatients. He obtained better paid work, had moreleisure for study, and devoted more time to hispatients. Now the object is to give less time tomore patients. Then the restrictions as to pre-scriptions must be remembered, and no allowance ismade in Bristol for what in emergency cases must,be provided. At Birmingham ls. per quarter andper 100 insured persons is allowed, making J62 perannum for each 1000 insured persons, and not ;E50,.as erroneously stated when speaking of that town.1At Bristol, however, there is no such allowance, sothe only way to get a bandage back is to prescribetwo when but one is wanted for the second dress-

ing, and the panel practitioner then repays himselffor what he had already used.There is a danger that the panel practitioner

will lose prestige, and medical men not on thepanel are seeing daily as private patients insuredpersons. At Bristol some .:B3000 have accumulatedfrom the payments effected on behalf of personswho have not enrolled themselves on a panel list.

They n(t<W ask by what right should a panel practi-tioner receive money from a person who has never.asked for or obtained anything from the panel, buthas paid full fees for whatever medical assistancehe needed. The right of the individual to contractout of the Act is therefore insisted upon in variousquarters .at Bristol.

(To be continued.)

1 I have to regret this slip in my article of Nov. 29th, 1913, p. 1573.-Your Special Commissioner.

WEST LONDON MEDICO-CHIRURGICAL SOCIETY.-The annual dinner of the society will take place on

Thursday, Feb. 19th, at 7.30 for8 o’clock, at the WharncliffeRooms, Hotel Great Central, Marylebone.road, N.W. Duringthe evening the society’s triennial gold medal will be pre-sented to Professor Arthur Keith, F.R.S. Tickets, price’7s. 6d. (exclusive of wine), should be obtained beforehandfrom the senior secretary, Dr. Alfred C. Warren,41, Lawsdowne-road, Holland Park-avenue, W.

Home and Foreign Notes.(FROM OUR OWN CORRESPONDENTS.)

MANCHESTER.Medical Men and the National Insurance Acts :

a Limitation of Income Scheme.ON Jan. 14th the second year of medical benefit

under the National Insurance Act begins, and themedical men in this city and district are con-

sidering renewals of their contracts with theInsurance Committees. In Manchester and Salfordmedical men are paid out of pooled funds for theirservices. In many ’other places the capitationsystem obtains. As a result of conferences betweenall concerned it is proposed to overcome the diffi-culties attributed in Manchester to over-attendanceby a limitation to &pound;800 a year of the income which apractitioner may make out of his insured practicedI am informed that, with a few exceptions, all themedical men whose names were on the panel duringthe past 12 months have signed agreements in-

cluding the proviso limiting an individual incomeearned under the Acts to &pound;800 a year. The list ofdoctors who will serve on the panel for the forth-coming year will be revised early next week.National Insurance : Reduction of the Drug Bills.The sum of 2s. per insured person has not been

found sufficient to meet the drug bills here. TheManchester Medical Committee have now agreedwith the Manchester Insurance Committee toreduce as far as possible the expenditure of thedrug fund. In future the Medical Committee will

inspect all prescriptions, and if necessary deal withthem under regulations. Any practitioner orderingdrugs or appliances in a manner contrary to theinstructions of the Committee will be asked to

explain, and failing a satisfactory explanationthe cost of such drugs or appliances willbe deducted from the sums payable to himby the Insurance Committee and will be trans-ferred to the drug fund. The Medical Com-mittee have issued to the medical men servingunder the National Insurance Acts a list of in-structions to be observed in prescribing, requiringthat prescriptions must be made as simple as

possible; that medicine sufficient for four or fivedays should be ordered, and only when the practi-tioner is satisfied that a supply is required; thatpractitioners must satisfy themselves that theamount of medicine or appliances prescribed hasbeen used by the patient before a new prescriptionis given; that extract of malt and cod liver oil arenot to be prescribed except in tuberculous casesnotified as such, and these should be urged to applyfor sanatorium benefit ; that ’flavouring agents mustonly be prescribed when required for their medicinalvalue or to disguise distinctly nauseous drugs ; andthat expensive proprietary drugs must not beprescribed.

Salford and its Consumptive Children in theStreets.

At the last meeting of the Salford town council aquestion was asked if it was true that 400 con-sumptive children who are not permitted to attendthe day schools on account of the danger to otherchildren are allowed to run about the streetswithout being adequately cared for. It was

1 For the exact scheme submitted to medical men see p. 214.

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admitted that the general statement of the case wascorrect, though the numbers were not authenti-cated. It appears that the education committeesome time ago asked the council to authorise the

expenditure of &pound;500 to establish an open-air schooland that the council did not approve the proposal.The matter will be brought up again.

Some Statistics regarding School Children. - _

Some interesting statistics have been publishedregarding the school children of Manchester. Anexamination of 500 boys and 500 girls of 13 yearsof age shows that the average height of the boysin poor-class schools was 52 inches, in mediumschools 54, and in good schools nearly 57. In poorschools the average weight was 70 lb., in mediumschools 73! lb., and in good schools nearly 82 lb.The figures for girls were: height, 54, 54, and57 inches respectively, and their weights were

75 lb., 77 lb., and 83 lb.Jan. 12th.

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SCOTLAND.

Scottish Poor-law Medical Officers’ Association.THE report of the committee of this association

for the year 1913 has just been issued from theheadquarters at Glasgow. The work of the year isbriefly summarised under the headings VacantAppointments, Appeals to the Association, Pul-

monary Tuberculosis Regulations, the InsuranceAct, &c. The death of the treasurer, Dr. MatthewMartin, is recorded with regret. The annual meet-

ing will be held to-day (Friday, Jan. 16th) at theSt. Enoch Hotel, Glasgow, at 4.30 P.M. An effort isbeing made to enlarge the membership of theassociation, and members of the Poor-law medicalservice in Scotland are asked to communicate withthe secretary, Mr. W. L. Muir, 1, Seton-terrace,Glasgow East.

A Scottish HospitaZ Exhibit.At the International Kinematograph Exhibition

and Conference to be held in Glasgow fromFeb. 17th to 26th next there is to be an exhibitionof models, plans, photographs, furniture, surgicalequipment, and other things connected with hos-pital work. The main object of this exhibit is to

bring together a collection of articles illustratingnew features in construction, equipment, or

working.Granite Trade and Phthisis.

Attention has again been directed in Aberdeen tothe prevalence of consumption among workers inthe granite yards. A prominent member of theAberdeen granite trade says difficulty is experi-enced in getting the men to wear respirators, evenalthough they admit their usefulness. Even the

lighter and more comfortable and modern respi-rators are thrown aside at the first opportunity.The real remedy lies in preventing the dust fromgetting into the atmosphere, and large roomy, airysheds would do much towards fighting the preva-lence of the disease. The new sheds, thoughmore comfortable in winter, are not so freefrom dust as the old-fashioned variety, but themedical officer of health thinks they are reallybetter than the old ones, because of the men’s

immunity from chills and draughts. There is nodoubt that masters would cooperate with the men,and would welcome any scheme by which the men’shealth would be improved. In the opinion of oneof the workers, who takes a keen interest in thematter, what the men really want is the interfer-ence of a Government Department to make

regulations with regard to the dust problem. Themen will not wear the big " air veil " because of itssize and clumsiness. The respirators they mightwear if they were not clumsy, and the piece of cotton-wool over the nostrils and mouth idea commendeditself as effective and simple. The true remedy inhis opinion, however, lay in prevention of dust

getting into the atmosphere.Medical Service in the Highlands.

At a meeting representative of the various publicbodies in Orkney held on Jan. 9th, to consider thereplies to the schedule issued by the Highlands andIslands Medical Service Board, it was unanimouslyagreed to ask for a grant to modernise and extendthe General Hospital at Kirkwall, and it was alsoagreed by a majority to ask for grants for a hospitalat Stromness and at North Ronaldshay. It was

agreed to start a nursing service in those districtswhere there was no resident medical practitioner.It was also agreed by a large majority that a specialboard should be created to administer the medicalfund locally, this board to consist of a committee ofseven members of the county council, who wouldconsult members from parish councils, medical asso-ciations, the Insurance Committee, and town councils.The whole scheme was remitted to the countycouncillors on the committee for final adjustment,when an estimate of the total cost will be forth.coming. On Jan. 9th at Inverness a conferencewas held of the various bodies in the county ofInverness specially interested in the question ofmedical service. Over 100 representative delegatesfrom the mainland and islands were present. Theneeds of the districts were fully discussed, andthe opinion of the majority was that provisionshould be made for a number of medical men,sufficient for the various districts of the county,with adequate accommodation and means of

travelling to the various parts of their districts;provision for consultation between medical menin serious cases and for specialised service; andprovision for hospitals and nursing services atsuitable centres, for means of communicationbetween medical men and hospitals in scattereddistricts, and for conveyance to hospital. A protestwas entered against remitting to the districts to

deal with the question, as against a centralcommittee, but the majority seemed in favour ofdealing with the medical board as districts.Jan. 13th.

IRELAND.

The National Insurance Act.EACH doctor on the panel in Ireland has received

a letter from the National Health Insurance Com-mission (Ireland), dated Jan. 6th of this year,pointing out, in reference to the term of agreementfor certification which expired on Jan. 14th, thatthe Commission, in view of the negotiations atpresent in process, propose to continue the existingpanel arrangements up to the end of the financialyear-March 31st, 1914-on the terms and condi-tions mentioned in the previous agreement, and theCommission would be glad to learn if the paneldoctors are willing to continue to serve for thisfurther period. Further, it is announced that stepsare being taken to have payment made to theseveral panel doctors for the services alreadyrendered by them.

Association of Tuberculosis Officers.A meeting of Irish tuberculosis officers was held