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THE POOR-LAW MEDICAL OFFICERS’ASSOCIATION AND REFORM OF

THE POOR-LAW.

THE Poor-law Medical Officers’ Association is trying toobtain from its members information upon which a

scheme of Poor-law medical reform may be constructedin accordance with the ideas of the existing Poor-lawmedical service. Members of the Poor-law medicalservice have received from the honorary secretary of theAssociation the following schedule of questions, with anurgent appeal that they may be answered at once, and thusenable the Association to estimate with some accuracy thereal opinion of the whole service. In every case a stampedenvelope has been enclosed for an answer, so that theminimum of trouble has been given to those whom it isdesired to help.

Qztestions Subnaitted to the Poor-law Medical Service of Englandand Wales.

1. Are you in favour of the abolition of boards of guardians through-out England and Wales?

2. What authority would you propose to administer public medicalassistance in the interests of the public and the medical profession ?(a) A specially elected "ad hoe" authority? (b) A Statutory Committee ’of the County Council, as suggested in the Majority Report of theRoyal Commission ? P (e) Abolition of any special Poor-Jaw authority asrecommended in the Minority Report?

3. Should any difference be made between medical, and other publicrelief, beyond non-disfranchisement in the case of the former?

4. Should there be any "test" or "deterrent" such as the presentmedical order to regulate the granting of medical relief to poorapplicants ? Or should the latter be permitted to claim public assist-ance subject to no other liability than having to pay the cost of thesame if proved to be in a position to ?

5. Are you in favour of a public assistance medical scheme based onprovident dispensaries subsidised by the State and contract practicegenerally ?

6. Are you in favour of a public medical service, based on anamalgamation of the present Poor-law Medical Service, with theSanitary Medical Service ?

7. Do you approve of the district medical officer being made relievingofficer so far as medical relief is concerned?

8. Are you in favour of "whole time" or "part time" appointmentsin any reformed public assistance medical service ?

9. Are you in favour of a reform of the present Poor-law system ? Orwould you prefer a "break up " ot the present system ?

10. Do you think the needs of the State sick poor would be betterattended to by a distinct and separate medical service ? Or by asanitary service in which Poor-law medical officers were blended withmedical officers of health ?

11. Do you think that a " Unified Medical Service," that attended toall " poor " applicants with no other test, or deterrent than the liabilityto be compelled later to pay the cost of the same, would, or would not,be dangerous to the interests of all general practitioners in poordistricts ? P

12. Enumerate the reforms that in your opinion are required in thePoor-law Medical Service as at present existing.

A covering letter, signed by Mr. D. B. Balding and Dr.Major Greenwood, respectively chairman of council and

honorary secretary of the Poor-law Medical Officers’ Asso-ciation, points out that in the present critical condition ofthe Poor-law system of the country a strong organisation ofexisting Poor-law medical officers should be promoted. " Sothat the interests of the present officers may be safeguarded,whatever reforms may be introduced, and that our servicemay have its proper influence in guiding public opinion inthe direction these reforms should take : to the end that thewants of the sick State poor shall be efficiently attended towithout injury to the interests of medical practitionersgenerally, or unduly pauperising the lower classes of thenation." They proceed to point out that although in thepresent unsettled political situation there does not seemmuch likelihood of immediate legislation, there can belittle doubt that one of the first efforts of a settled

government will be to reform the Poor-law, while they findthat both Reports of the Royal Commission on the Poor-lawsdo the present Poor-law medical service scant justice.We hope that a large proportion of those concerned will

answer the questions, as it is most desirable that an attemptshould be made to formulate in the name of the existingPoor-law medical service some scheme of medical reform.The views of the service ought to carry great weight, ashaving hitherto had entire medical charge of the State poorof the country, while according to the Reports of the RoyalCommission the members of the service have not been foundwanting in zeal or ability. The questions cannot all beanswered either easily or briefly, and in several of them thePoor-law medical officers will have to decide whether their

views are held from motives of public policy or frjm privateinterest. But any large consensus of opinion from themshould have considerable weight.

THE BEIT MEMORIAL FELLOWSHIPS FORMEDICAL RESEARCH.

THE magnificent endowment of medical research made byMr. Otto Beit in memory of the late Mr. Alfred Beit is freshin our readers’ memory. No time has been lost in makingthe awards of the first batch of Fellowships, which will datefrom March 1st, 1910. There were 70 applicants and 10.Fellowships have been awarded, each being of the annualvalue of E250 and tenable for three years, which the Fellowsundertake to spend in prescribed medical research work insome institution authorised by the trustees. It will be seenfrom the list of the new Fellows that most of their work is tobe carried out in places connected with the University ofLondon. The list in alphabetical order is as follows : Mr.George Harold Drew, B.A. Cantab., Scholar of Christ’sCollege, Cambridge, Schreiner University Scholar. Cam-bridge, and University Scholar, St. Mary’s Hospital. Mr..Drew is official research worker at the PlymouthLaboratory of the Marine Biological Association ofthe United Kingdom, and will carry out his authorisedresearch at that laboratory and at zoological stations atNaples and at Roscoff, France. He will investigate thezoological distribution of cancer and study experimentally themode of origin of neoplasms. Mr. Frederick William Edridge-Green, M.D., B.S. Durh., F.R.C.S. Eng., whose investiga-tions into the subject of colour-vision and theories of visionhave been described in our columns, and who was formerlyadviser to the Board of Trade on eyesight and colour-blind-ness, and a member of the International Code of SignalsCommittee, will undertake a research into various problemsconnected with vision and colour vision at the PhysiologicalInstitute, University College. Mr. Edward Hindle, B.Sc.Lond., late demonstrator and research assistant at the

Liverpool School of Tropical Medicine and instructor in

parasitology in the University of California, has been

appointed to investigate the morphology and treatment ofprotozoal blood parasites, especially spirochseta Duttoni andtrypanosomiasis, at the London School of Tropical Medicineand in Uganda. Mr. Thomas Lewis, M.D. Lond., D.Sc. Wales,M.R.C.P. Lond., Fellow of University College, London, andassistant physician tD the Seamen’s Hospital, Greenwich,will continue important investigations on the mechanism ofirregularities of the heart at University College HospitalMedical School. Mr. Gordon Clunes McKay Mathison,M.D. Melb., will enter upon a research at the Instituteof Physiology at University College, London, in which he isassistant, upon (a) the nervous control of respiration ; (b) theeffect on respiration of changes in the chemical compositionof the blood; (c) the mechanism of biliary secretionand its general effect in digestive processes. Mr. Otto

May, M.B., B.C. Cantab., M.R.C P. Lond., Scholar of St.John’s College, Cambridge, and Research Scholar of theBritish Medical Association, late demonstrator of anatomy andof physiology at Cambridge and now physician to out-patientsat the Evelina Hospital, will undertake a clinical andexperimental research upon the lesions of peripheral nervesat University College. Mr. Edward Mellanby, M.A., M.B.,B.S. Cantab., scholar and research student of EmmanuelCollege, Cambridge, at present demonstrator of physiologyat St. Thomas’s Hospital, will work at that school on therelation of the excretion of creatinin to morbid conditions ofthe liver. Mr. Frederick Parlett Fisher Ransom, M.D.,C.M. Edin., late assistant to Professor von Behring and toProfessor Hans Meyer in Halle and Marburg, will investigatethe mode of action of caffeine, theohromine, and alliedsubstances on the muscular and nervous systems at thePharmacological Laboratory, Cambridge, and at King’sCollege, London. Mr. Sidney Russ, D.Sc. Lond., Cloth-workers’ scholar of University College, London, -anddemonstrator of physics at the University of Man-chester, will investigate the association of radio activitywith cancer from the physicist’s side in connexion withDr. W. S. Lazarus-Barlow’s elaborate work on thatsubject, which he described last year in his Croonianlectures. Miss Ida Smedley, D. Sc. Lond., Bathurst student,

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Newnham College, Cambridge, and research student in

chemistry of the Royal Institution, at present assistantlecturer in chemistry at Victoria University, Manchester, willconduct a research at the Lister Institute on the formation offat in the organism. To this lady and to these gentlemen weoffer our congratulations on the honour of being the first toparticipate in the most notable benefaction that has beenbestowed upon medical research in this country. We shallawait with interest the fruits of their several investigations.

LONDON COUNTY COUNCIL MEDICALAFFAIRS.

Medical Treatment in Hrc7rzpstead An Experiment inSchool Clinics.

THE period for which the London County Council acceptedthe offer of the Hampstead Council of Social Welfare toprovide medical treatment for school children in Hampsteadhaving expired, the day schools subcommittee reported to theEducation Committee on Feb. 23rd as to the permanentprovision to be made for the children. The subcom-mittee passed no verdict on the experiment which hadcome to a conclusion, but stated that the medical practi-tioners of Hampstead had formed themselves into an associa-tion under the title of the Hampstead Public Medical Service,and were prepared to provide treatment for 400 children

(the number likely to need it) suffering from affectionsof the eye, ear, nose, and throat, and from ringworm, at acost of E155 per annum. The conditions agreed upon werethat the medical men should provide and fit up a specialdepartment to be approved by the Council. Treatmentwould-be arranged as follows : 10 eye cases once a fortnight,6 ear, nose, and throat cases once a fortnight, 2 ringwormcases fortnightly-one clinical assistant being appointed ineach department. Payment would be at the rate of E50 perannum per assistant, for each half day’s service a week,together with a payment of 2s. per patient in respect of eye,ear, nose, and throat cases, and of 7s. in respect of ringwormcases. The subcommittee advised that this offer be accepted,and this was agreed to after some discussion.

Mr. SANDERS objected to two of the clauses in the

suggested agreement: (a) "The hours of attendance mustbe made to suit the convenience of the Hampstead PublicMedical Service"; and (b) "No grant shall entitle theLondon County Council to representation on the committeeor to interference in any way with the work of the depart-ments concerned." Mr. Sanders urged that the Councilmust not treat a body of professional men organised forbusiness purposes in the same way that it would treata public institution like a hospital. It was possibleto make out a case for not demanding control ofwork done by the hospitals, but the fact that the

Hampstead medical men described themselves as a" Public Medical Service " did not make them one. If a

body of teachers organised themselves in a similar way forthe purpose of carrying on teaching the Council would notmake grants, at any rate, without strict supervision.

Dr. BEATON said that on general lines this proposalmarked a distinct advance in the right direction, for it wasvirtually setting up a school clinic. If it was to be of valueto the Council, however, there must be a measure of control.

After some discussion it was agreed to substitute forClause (a) the words, "The hours of attendance must bearranged to suit the convenience of both parties," and thecommittee then considered the question of supervision.

Dr. BEATON thought that if the Council did not make anyconditions as to inspection the medical officer would be freeto visit the premises at any time.The Rev. J. SCOTT LIDGETT, however, argued that unless

the Council claimed the right of inspection, that right wasnot inherent in a private arrangement of this kind.

Mr. JAY (chairman of the subcommittee) said that each ofthe medical men taking part in the scheme had been

approved by the Council’s medical officer for education.Mr. DAVIS thought inspection of the work of treatmeni

was quite unnecessary.The Rev. STEWART HEADLAM said there was no disgrace

in being inspected and medical men must not mind it if the3received grants of public money.

Mr. JAY deprecated the insertion of a clause in the agree-ment providing for inspection. These were men the Councilcould trust, and he had no doubt every facility would begiven the Council’s medical officer to see the work as it was

being done. To put in a definite clause might cause

irritation.The Rev. J. SCOTT LiDGETT : It is not suggested in an

unfriendly spirit, but only as a guarantee to the public. The

spread of medical treatment on these lines without anysupervision would be dangerous. Dr. Kerr ought to beallowed to keep in touch with the medical men carrying outthe work.Members on both sides of the chamber having spoken in

support of this view, it was agreed to substitute for the words" the Council shall have no right of interference " the wordsnothing in this agreement shall prevent the Council’s

representative from visiting premises when treatment is beinggiven." On March lst the scheme came before the Counciland was approved as amended by the Education Committee.

Recovery of Cost of Medwal Ireat’l7lent.As stated in THE LANCET of Feb. 19th, p. 525, a report

presented to the Education Committee of the London CountyCouncil on the subject of the recovery from parents of thecost of medical treatment was withdrawn for further con-sideration. On Feb. 23rd the subject was again considered,the subcommittee presenting a scale based, not on the fullcost to the Council, but showing the remissions which, as ageneral rule, would be allowed to parents unable to pay thefull amount. The tentative consent of the Finance Com-mittee had been obtained to this method of dealing withthe matter. The remissions began at 1. and Is. 4d.to a parent having what the committee called a "standardfamily" and earning .61 a week, and decreased as the salariesincreased, the size of the family also being taken intoconsideration.

Mr. BRAY criticised the charges as "extortionate," andan amendment was moved to reduce the charge for ring-worm to a nominal sum of ld. per attendance.

Mr. SANDERS said it was a rule in the public medicalservice that contagious diseases should be treated at the

public cost.Miss ADLER urged that it would be more economical fromthe Council’s point of view to provide free treatment of ring-worm in order that the children might be cured in theshortest possible time and so prevent the loss of Governmentgrants.

Mr. JAY, chairman of the subcommittee, replied that theparents were exceedingly gratified at the speedy cures

effected by the X ray treatment, and he was sure they wouldpay the proposed charges willingly.The amendment was lost by 15 votes to seven, and the

scale was then approved.

ADAMS v. POMEROY.

THE fund raised to reimburse Dr. Martha Adams in

respect of her legal expenses, incurred as the result of theaction Adams v. Pomeroy, is now closed. Dr. Adams’s out-

of-pocket expenses amounted to a sum of about :E100, whichwas not covered by the taxed costs. It was felt that this

charge should not be allowed to fall on. the plaintiff, andwith the cooperation of the Britis7i Medical Journal andTHE LANCET an appeal was made to the profession. Therewas a generous response from individual members of the pro-fession, and this has been supplemented by a grant from.THE LANCET which now completes the required sum. Onbehalf of those responsible for the inauguration of this

appeal the honorary secretary wishes to express recognitionof the sympathy and help which have been shown in thematter.

Dr. L. Garrett Anderson gratefully acknowledges the-

following contributions which she has received since the

publication of the last list of donations :—

B s. d. B s. d.THE LANCET Relief Fund 20 0 0 Dr. Owen Berkeley-Hill... 220

Miss F. Dayenport Fhl1 ... 1 1 0 0 , O Already acknowledged ... 78 19 6, .

Sir Richard Douglas .

Powell ............ 3 3 0 . Total...... :E106 4 6