591

THE LANCET.

LONDON: SATURDAY, MARCH 2, 1912.

The National Insurance Act.ALTHOUGH there has been no abatement of genuine

interest in the National Insurance Act within the ranks of

the profession, the past week has been one of comparativequiet in the medical world so far as outward signs go. The

Representative Meeting of the British Medical Association

on Feb. 20th-22nd arrived at conclusions which have broughtit home to all that there is a pressing need for a steadfast

attitude. The state of comparative calm in which we now

are suggests very strongly that the practical compromisereached by the opposing parties in the governing bodyof the Association has been approved by many of their

constituencies, and that some basis of united action has at

last been hammered out. This view depends, of course,

upon the assumption that the Council of the Association, in

whose hands all executive power is vested, intends to carryinto effect the instructions which it has now received. The

policy set out in the leading resolution of the RepresentativeBody, and unanimously agreed upon by the delegates, seems

to stand midway between the courses advocated by extremists

on either side, and has met with little adverse criticism.

But while for the present the tide of comment has receded,

it is clear that the National Medical Union is not content

with a situation that still has its deep anxieties. A moderate

policy which can weld conflicting medical interests without ’,,

estranging public sympathy may carry the day for the ’,medical profession, but it is idle to suppose that the battleis won because peace may be restored within the ranks of

the British Medical Association. In the long and arduous

struggle which is still ahead the advice and support of the

great corporations should prove of real value.The demand that the minimum requirements of the

medical profession should be guaranteed in the Regulations,with a view to their ratification by Parliament, and theintimation that failing this the medical profession will

stand aside from the Act, seem together to strike a meanbetween the wholly non possumus attitude and the

dangerous plan of continuing flaccid negotiations. When the

Act, in a form which all men. saw to lead straight to numerousdifficulties, became law at the close of last year, the

split in the medical profession seemed for the moment

beyond repair-a party which wished to work the Act was

straightly opposed to one which would have none of it, andthe political newspapers worked hard to widen the breach. ;

It was then that we made the suggestion that the

way out of the impasse was for the medical professionto concentrate attention upon the Regulations, and onlyto refuse medical service if these proved to be unsatis-

factory. This proposal, we considered, would avoid the prob-ability of disastrous local bargaining, while avoiding also

the attitude of complete summary refusal. Recent events

have shown that this policy is acceptable to many medicalmen of divergent opinions as a workable basis of union, andif the constituencies of the British Medical Association

can also bring themselves to accept the compromisearrived at by their Representatives, and to stand by it whilethe crisis lasts, the future can be regarded as brighter.Union within our body must exact all the recognition of our

rights which it is in the scope of the Commissioners to

grant ; and if their powers fall short of what some believe of

them, our solidarity will lead the Government to amend theAct, lest a brave scheme for improving the nation’s healthshould fail miserably of its main object.

The Present Position of Salvarsan.ON the first introduction of a new drug it is by no means

easy to express a decided opinion as to its merits, especiallywhen the disease for which it is employed is liable to reappearmany months and years after apparently it has been cured.Of all diseases with which we are acquainted syphilis is

probably the one about which it is most difficult to be

certain that a permanent cure has been effected; for afterintervals which may often be measund by years some mani-festation may appear showing clearly that the virus has beenlatent in the body during the lengthy interval. Therefore

when a new remedy is brought forward as more capable of

effecting a complete and permanent cure of syphilis than was

possible or at least easy by any other method, it is onlynatural that some of those who had many years’ experiencein the treatment of the disease should look askance at a

remedy for which so great a claim was made ; for bymeans of mercury judiciously, persevericgly. and thoroughlyadministered results of the very greatest value have been

obtained..- It is difficult to forsake a tried remedy for a

new drug. Now sufficient time has elapsed since the intro-duction of salvarsan for us to form some idea as to its valueand its’.risks ; it is, however, not yet possible to make anydogmatic statement as,to the position which the remedywill hold in the future-whether in, say, ten years’time it will be widely used or whether it will have

lost much of its" present popularity. That salvarsan

has a great power against the treponema pallidum is

beyond dispute, but the occurrence of a number of fatal

cases has shown that it is by no means free from danger ;we are, perhaps, in a position to inquire whether these

deaths are a necessary accompaniment of the administrationof the drug or whether they, or most of them, might have beenavoided by greater attention to the method and details ofadministration.

It must not be forgotten that salvarsan was not a

natural substance employed empirically, but a substance

obtained as the result of a long series of experiments con-ducted on the most modern scientific lines. The problem