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Remuneration of the Visit’lng Radiologist.The minimum fee per visit of a consultant called

in to a patient in a transferred hospital should betwo guineas, with mileage in addition where necessary,and the minimum fee for each operation performedin such circumstances should be five guineas, the feefor a major operation being not less than ten guineas.Where the remuneration of a consultant for regular

periodic visits to a transferred hospital is on a salarybasis, the amount of that salary should be a matterof arrangement between representatives of the localmedical profession and the appointing authority,but regard should be had to the minimum fees laiddown in the foregoing paragraph and/or to the basisof 22 12s. 6d. for consultant sessions of not morethan two hours, with an allowance for mileage wherenecessary.

It is further agreed that case sheets and recordsof patients treated in hospitals including X ray filmsand prints should remain in the custody of thehospital; they must be regarded as confidentialdocuments, and access to them allowed solely to themembers of the visiting staff of the hospital.

The Services.ROYAL NAVAL MEDICAL SERVICE.

Surg. Lt. F. B. Quinn to be Surg. Lt.-Comdr.

ROYAL NAVAL VOLUNTEER RESERVE.

Surg. Sub.-Lt. D. R. Goodfellow to be Surg. Lt.

ROYAL ARMY MEDICAL CORPS.

Maj.-Gen. R. S. Hannay, late R.A.M.O., retires on retd.pay.

Col. H. C. R. Hime, late R.A.M.O., to be Maj.-Gen., viceMaj.-Gen. R. S. Hannay.

Col. 0. R. Evans, late R.A.M.O., having attained the agefor compulsory retirement, is placed on retd. pay.The undermentioned Lt.-Cols., from R.A.M.C., to be Cols. :

C. D. Myles; vice Col. C. R. Evans, and H. R. Bateman, viceCol. H. C. R. Hime.Temp. Lt.-Cols. to be Lt.-Cols. : Maj. J. S. Dunne, vice

Lt.-Col 0. D. Myles, and Maj. and Bt. Lt.-Col. C. M. Drew,vice Lt.-Col. H. R. Bateman.

Majs. to be temp. Lt.-Ools.: Bt. Lt.-Col. F. A. McCammonand A. Dawson.

Lt. (on prob.) N. H. Lindsay from the secd. list is restd.to the estabt.

ARMY DENTAL CORPS.

Maj. D. Blair to be Lt.-Col.

INDIAN MEDICAL SERVICE.

Capt. E. T. N. Taylor to be Maj.Lt. M. G. Kelley to be Capt. (prov.).The undermentioned officers retire : Col. W. D. A. Keys,

Lt.-Col. H. H. Broome, Lt.-Col. W. C. Ross (on accountof ill-health), and Maj. E. Calvert.

HARROW HOSPITAL.-The annual report, whichcontains a foreword by Lord Moynihan, shows that lastyear’s record of patient-days (12,873) is an increase of10 per cent. By direct payment and through their con-tributory associations the patients provided 22399, whichrepresents fully one-half of the cost of maintaining thehospital for the year. The district nurses and healthvisitors of the Harrow District Nursing Fund paid over12,000 visits to 402 new cases. The cost averaged la. 4d.per visit.

A RAT-RIDDEN HOSPITAL.-Dr. 0. F. McCarthy,medical superintendent of Cork Mental Hospital, reportsthat the institution is infested by " thousands of rats."The hospital’s rat-catcher formerly accounted for 1200a year, but poison has failed, and floor boards often haveto be taken up to remove the dead rats. One of the patientsis stated to be suffering from rat-bite fever, having beenbitten by a rat which she caught in her hand. A professionalrat-catcher is to be engaged.

Public Health Services.

SCHEMES FOR THE PREVENTION AND

TREATMENT OF TUBERCULOSIS.

BY C. O. S. BLYTH BROOKE, M.R.C.S. ENG., D.P.H.,TUBERCULOSIS OFFICER, STOKE-ON-TRENT.

AT a time when local government is in a state ofreorganisation, it is opportune to consider the workingof the schemes for preventing and treating tuberculosis.These vary much in efficiency, although all of themhave evolved along the lines originally suggested bySir Robert Philip. National expenditure on tuber-culosis is colossal, and there is a loss to industrythrough ill-health of many millions of working days,as well as a continued, though somewhat decreasing,actual loss of life. Yet the true nature of the diseasehas been definitely known for nearly fifty years, andits manner of spread by infection is being dailydemonstrated. The only sure road leading toreduction in incidence is to reduce the chance at anyage of encountering massive infection. Experienceat village settlements shows that the incidence of thedisease can be reduced to a vanishing point ; atPapworth and Preston Hall no single case of tuber-culosis has occurred among the non-tuberculouspopulation. It is well known, too, that a largenumber of cases of tuberculosis can, if not cured, bebrought to a state of moderate working capacity bymeans of adequate treatment and after-care. Ourpresent schemes fail because they omit to providesome necessary link in the chain ; most frequentlymissing is the adequate supervision of those chroniccases which are responsible for the widespreaddissemination of tubercle bacilli.The essential aspects of prevention are the provision

of a pure milk-supply and the isolation of everyopen case of tuberculosis, understanding by isolationthe provision of accommodation under more or lessideal hygienic conditions. When the reorganiseddepartments have become stabilised, many of thepresent extravagant schemes ought to be overhauledand in many cases set upon a firmer basis. In othercases where more money should be spent, it wouldsoon reduce the incidence and mortality of tuber-culosis to such an extent as to result in an actualsaving.

The Dispensary.The dispensary, which is boun, to remain the centre

of any scheme should be adequately staffed withclerical assistance in order that proper records maybe kept, without too much time being spent bymedical officers on details of administration. Thechief tuberculosis officer must have wide clinicalknowledge, with opportunities of doing generalmedicine. If it is inadvisable for him to engage ingeneral practice, he should have charge of medicalbeds in some hospital and be allowed to engage inconsulting practice ; for the taking over of the poor-law hospitals should make this easy. Further, if heis to be a useful consultant in cases of tuberculosis,he must keep in touch with its treatment by havingcharge of sanatorium beds.The dispensary must not be allowed to confine

itself to pure routine work. It must remain a centrefor consultation in doubtful cases, and a place whereknown patients can be seen by an expert when anyradical change in treatment may be advisable ;occasionally, too, it may be used for carrying outcertain lines of treatment such as pneumothoraxrefills, &c. Frequent attendance at the dispensaryis to be strongly discouraged, except where it isneeded-on non-medical grounds-for after-care ofpatients. No one can examine many chests carefullyat one sitting, and a rough examination engenders scareless clinical work at other times. To do no more