1286

ANNOTATIONS

UNEMPLOYMENT AND MEDICAL BENEFIT

WE referred recently to the problem which arisesout of the National Health Insurance Act of 1932,under which many insured persons who have beenunemployed for a long period are expecting to losetheir pension rights at the end of 1935. The Govern-ment’s new National Health Insurance and Contribu-tory Pensions Bill, which was introduced on May 23rd,is intended in a large measure to remove this fearand to put on a new permanent basis the means forcontinuing the pension rights of the unemployed andto protect them against a reduction or suspension ofcash benefits under the health insurance scheme. Allinsured persons on ceasing to be insurably employedhave at present a free insurance period averagingtwenty-one months. The Bill provides that duringthis period the insured person will be fully protectedfor pension and health insurance benefits. Beyondthe period of grace any person who has been con-tinuously insured for ten years before the date onwhich he ceases work, and is now unable to obtaininsurable employment, will have his insurance con-tinued from year to year and, however long this

ensuing period may be, he will be sure of his pensionrights, of medical benefit, and of additional treatmentbenefits. But he will not be entitled to cash benefits,for which, however, he can requalify if he re-entersinsurable employment and pays twenty-six insurancecontributions within two years. The charge in

respect of pensions will fall wholly on the pensionsaccount, but it is anticipated that the existing financialprovisions will suffice and that no additional demandwill be made upon the Treasury. As regards theremission of arrears of contributions, the cost, some1,500,000 per year, will be met from an arrears fundwhich will be provided as to 50 per cent. by an annualExchequer grant and as to the remainder by a levyon the approved societies-and in effect upon theinsured population. Each society will contribute

according to the amount of unemployment and willreceive back a grant in proportion to the amount ofunemployment among its own members ; the arrearsfund will thus be in effect a means of sharing thelosses due to unemployment. The solution of thedifficulty has been achieved broadly upon the linesset out on p. 1128 of THE LANCET of May llth, withthe modification that instead of the whole cost fallingupon approved societies half of it will be met by anExchequer grant. It is matter for encouragementthat since 1932 the percentage of unemploymentamong persons insured under the health provisionshas decreased from 14t to 13.

Before the Bill was introduced the Governmentactuary reported that in respect of the Pensions Actssolvency would be achieved until 1946, with a smallmargin, if the annual contributions by the Exchequerwere maintained at the sums prescribed for thatperiod by the Statute, under which in 1934-1935 theamount is :E13,000,000 rising by 1,000,000 a yearuntil 1942-1943 when it will remain stationary forfour years at 21,000,000. If the average rate of

unemployment for the next ten years should proveto be 13 per cent.. the average rate for the lastfinancial year, the additional cost involved under thenew Bill, so far as pensions is concerned, will becovered by the pensions account until March, 1946.It is interesting to note that the finances of the

pensions scheme have benefited by the fewer deathsamong men and especially among married men, with

the result that fewer claims have been made thanhad been expected. This profit must, however, havebeen diminished by the longevity of widows.

NARCOTIC TRAFFIC IN EGYPT

THE annual report of T. W. Russell Pasha on thework of the Egyptian Narcotics Intelligence Bureaufor 1934, if not as sensational as usual, is full ofstatistical information, heavily documented andillustrated. It deals less with external illicit trafficand more with rounding up small traffickers in opium,heroin, and hashish throughout Egypt. Smugglingstill continues, despite the vigilance of the policeunder Russell Pasha’s able direction ; Suez is a hotbedof the traffic and it is alleged that not less than 3000out of a population of 40,600 are in some way con-nected with the contraband trade. Numerous seizuresof hashish and heroin are reported, often concealedwith an extraordinary amount of ingenuity. A newfeature is the growing habit of resorting to " blacktea " as a narcotic-that is, tea repeatedly boileduntil a heavy dark brown residue is obtained possessingnarcotic and toxic properties which render the addictincapable of work and result in digestive disorders.This black tea habit is said to have arisen from therestrictions placed upon the use of hashish; theperil arising from the latter, by way of cigarettesmoking (marihuana) in the United States and

Canada, is now engaging the attention of the OpiumAdvisory Committee at Geneva. The EgyptianGovernment would support a world-wide outlawingof Indian hemp, but this apparently would not beacceptable to the Indian Government, owing, it issaid, to its association with certain religious rites ofthe Hindus.

FRACTURE DISLOCATION OF THE LOWER

RADIAL EPIPHYSIS

INJURY to the lower epiphysis of the radius is

comparatively common in boys. The lesser degreesof displacement give rise to little or no anxiety,but every now and again a case is seen with a con-siderable backward dislocation of the epiphysis,usually associated with splintering of the shaft

posteriorly. The greater the surgeon’s experiencethe less will be the confidence with which he attemptsa closed reduction ; for it will often fail even after

repeated attempts under full general anaesthesia.On the other hand, although a poor position is thefinal result of treatment, ultimate deformity of thewrist which can be traced to previous epiphysealinjury is not a condition met with clinically. Struckby the fact that he has never seen such a deformityin his work in the out-patient department of theBoston City Hospital, A. P. Aitken 1 has re-examined58 patients at periods of 2-9 years after their dis-

charge from treatment for various degrees of fractureand fracture-dislocation of the lower radial epiphysis.Of the 58 patients, 8 were girls and 50 boys, andthis corresponds with the experience of otherobservers ; thus E. Bergenfeldt 2 described a seriesin which there were 118 boys and 18 girls. In 2 ofAitken’s cases the injury was bilateral; in 28 theposterior edge of the diaphysis was damaged, andin 19 there was an associated injury to the ulnarstyloid. No attempt at reduction was made in 17,but in all the others the position was considered to

1Jour. Bone and Joint Surg., April. 1935, p. 302.2Acta Chirurg. Scand., vol. lxxiii., suppl. xxvlii.; see

THE LANCET, 1934, i., 308.