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the writings of Dr. Bell and other clinicians willbe welcomed and incorporated.

I am, Sir, yours faithfully, ISWALE VINCENT.

University of Manitoba, Winnipeg, Jan. 6th, 1914.

DOSAGE AND THE METRIC SYSTEM.To the -Editor of THE LANCET.

SIR,-I have read with very much interest Dr. C. 0.Hawthorne’s able paper on Dosage in THE LANCETof Jan. 24th. With reference to his advocacy ofthe use of the metric system in dosage, I wouldinform both him and your readers that I havereceived an official notification from the GeneralMedical Council that all measures in the nextedition of the Pharmaeopceia will be in the metricsystem, including those referring to dosage, but thatin order to facilitate the use of the Pharmaeopceiaby medical men dosage will be given alternativelyin the Imperial system also ; the latter will be theonly use of the Imperial weights and measuresthroughout the work. This procedure, whichappears to meet Dr. Hawthorne’s suggestions, hasreceived in advance the approval of the pharma-cists, and this association has taken the liberty ofsuggesting a similar procedure on the part of allthose who are responsible for the preparation ofunofficial pharmacopoeias. I

I am, Sir, yours faithfully, jG. E. M. JOHNSON,

Secretary, the Decimal Association.Finsbury-court, Finsbury-pavement, E.C., Jan. 26th, 1914.

A NATIONAL MEDICAL SERVICE.To the Editor of THE LANCET.

SiR,-Though agreeing that the possibility for apatient to be attended by the doctor of his or herchoice is of considerable value, I think it is puttingthe case too strongly to maintain that " the freechoice of a doctor is the matter upon which every-thing turns." If it is of such importance, whyis it that in the past the great majority of the

population have been deprived of that right with-out protest ? Why is it that even now it is deniedto that most unfortunate section of society,the recipients of Poor-law relief ? Their desti-tution, which brings them under the Poor-law, is generally the result of sickness, andit is of great importance to restore these

patients to health as quickly as possible andso to make them once again self-supporting. Yet

they are chained to a doctor selected for them bythe guardians, and no insistent demand has beenmade by the profession to extend to them the rightof "free choice," which just now is said to be ofsuch great therapeutic value. The public has not IIbeen loud in its demand for this right, and thequestion arises whether the doctors’ demand ispurely altruistic and for their patients’ good, or

whether at the bottom there is not a feeling on thepart of each individual doctor that he stands togain.You state that at the recent conference of

Friendly Societies a proposal in favour of a StateMedical Service was rejected by a substantialmajority. This is true; but it was rejectedin favour of the Friendly Societies’ control ofmedical benefits, which would abolish the rightof " free choice." The Scottish Clerks’ Associationproposed a resolution that steps should be taken totransfer the administration of medical benefits to

the Approved Societies under the Insurance Act.As a direct amendment to this, Mr. T. W. Huntley,of Newcastle-on-Tyne, moved a resolution in favourof a State Medical Service, which was afterwardsaltered to " a full-time salaried medical service."This was lost by 89 to 16, and the original resolu-tion was carried. A resolution standing in thename of Mr. George Cronin, of the ManchesterUnion, in favour of a State Service was then putand lost by 65 to 22. During the discussion no onepleaded for the present panel system with its freechoice of doctor. The fight was for control by theFriendly Societies versus a State Medical Service,and of the two alternatives the great majoritywere in favour of the former. And the fight isnot over; the Friendly Societies mean to gaincontrol of the medical benefits and of the doctorsif they possibly can. From the point of view ofthe medical profession there is nothing to be saidin favour of the control of medical benefits by theFriendly Societies, but there would be many advan-tages in a State Medical Service, and as the trendof events is rapidly leading that way it would bewiser for the profession itself to prepare a schemewhich would not be unacceptable to its membersrather than allow a scheme prepared by Govern-ment lay officials to be thrust upon it. It would be

possible under a State Medical Service to extendthe possibilities of " free choice " to practically thewhole population, and at the same time to do awaywith certain evils which are inherent to thenecessity of catering for patients.

I am, Sir, yours faithfully,CHARLES A. PARKER.

Upper Wimpole-street, W., Jan. 26th, 1914.

THE NATIONAL INSURANCE ACT : THESURPLUS FUNDS.

To the Editor of THE LANCET.

SiR,-In your issue of Jan. 10th, p. 149, you madesome observations on a correspondence which hastaken place with regard to the funds for medicalremuneration retained by the London InsuranceCommittee. I should like to call attention to a

point which has not been given due prominence inthis correspondence.The new agreements were signed, not in April,

but before March 22nd, 1913, at which date wewere still under the impression that an allocationof the residue would be made between April lst and14th, and Circular M.B. 9 of March 18th, which accom-panied the agreements and directed their returnbefore March 22nd, contains a reference to the

coming allocation. It was not until the early daysof April that we were informed that the allocationwas postponed.No medical man who is not in the habit of signing

in blind faith unread documents would have signedthat agreement accepting remuneration accordingto the schedule except on the understanding thatan allocation would have been made by April 14th.The failure to make the allocation is no reason for

repudiating the agreements; the worst that can bealleged against the committee is that their clerkwas culpably optimistic as to the ability of his staffto cope with their enormous task, seeing that bythe end of October they had only been able to traceabout 40 per cent. of the insured who had chosentheir medical attendants. But I think it is a validreason for excluding from the operation of theschedule the remuneration due from those entitled