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THE NATIONAL INSURANCE ACT.

THE NEW MEDICAL BENEFIT REGULATIONS.THE National Health Insurance (Medical Benefit)

Regulations (England), 1913, have been issued, andas they came into force nominally on Jan. 12ththey have already taken the place of the ProvisionalRegulations issued in November, 1913. Regulationsfollowing upon provisional regulations at so shortan interval were not expected to contain much thatis new, and with one very important exception-viz., Regulation 44 (2), a separate reference to whichis necessary-the differences between the Regula-tions and the Provisional Regulations call for littlecomment. One lesser difference to be noted isin fixing eight instead of six weeks before thecommencement of a new year for notice to be

given to medical practitioners on the panel ofalterations made by committees in the terms ofservice for the coming year. This is under R. 16,but the concession of longer notice which otherwisewould have been valued by the medical men istaken away by R. 17, which fixes six weeks insteadof four before the commencement of any year asthe limit for notices to be given by practitionersdesiring to leave the panel. There is thereforestill a period of two weeks only wherein to con-sider new conditions. In R. 14 a new clause (7)states that the period for which an insured

person may be allowed to make his own

arrangements shall be the period up to theend of the year in respect of which applicationis made or to the end of the succeeding year,as the committee think fit. Among other artera-tions of a verbal character attention may becalled to R. 30, which is amplified, and containsa new clause enabling a medical man to get rid ofa patient on his list by giving notice to the com-mittee six weeks before the commencement of anyyear, and to R. 17 (3) affecting persons concernedwith the estate of a deceased practitioner.

REGULATION 44 (2).Regulation 44 (2) is entirely new, and so con-

troversial a matter as this should have been fore-shadowed by inclusion in the Provisional Regu-lations, thus securing some opportunity for itsdiscussion before its final adoption. Regula-tion 44 (1) deals with financial arrangements whenan insured person makes his own arrangements forobtaining treatment from " a duly qualified medicalpractitioner," this part differing from the pro-visional regulation, presumably to suit whatfollows, for Clause 2 provides that " Where aninsured person contracts with a person, otherthan a duly qualified medical practitioner, toobtain treatment (whether including drugs andappliances or not) from him for a fixed sum for theyear or any part thereof, the committee may makesuch contribution towards the sum contracted to be

paid, not exceeding in amount the maximum con-tribution payable in the case of a person whocontracts with a duly qualified medical practitioneras they think fit, but upon any representation beingmade by a society that the treatment is such as willnot adequately protect the funds of the society, thecommittee may either withhold the contributionor may make a deduction therefrom as theymay in any case determine. (3) Save as aforesaidthe committee shall not make any contributionin the case of an insured person making his own

arrangements who obtains treatment otherwisethan from a duly qualified medical practitioner."Clause 4 has also been freshly introduced, and

apparently in this connexion. It will be seen fromthe above that the Insurance Commissioners havedefinitely recognised herbalists, bonesetters, andother unqualified persons generally, as persons.with whom arrangements for " medical treatment"may be made by persons entitled to " medicalbenefit." It is submitted that the wide powersgiven to the Commissioners do not enable themthus to override one of the main principlesupon which the Insurance Act was based. Thiswas the provision for the working classes (fromfunds provided by them, by their employers,and by the State) of medical attendance, which wasto take the place of complete neglect, and was toprotect the ignorant and needy from unqualifiedpersons and from the wiles of the vendor of quackmedicines. The whole Act and every reference init to the treatment to be provided will be found tobear out this contention, and it is to be hopedthat a way may be found of testing the powers ofthe Commissioners thus to authorise the treatmentof sickness by persons not recognised in any Act ofParliament as capable of providing any such treat.ment. The question is of interest, not only to,insured persons, but to their employers, and itwill no doubt receive serious consideration at thehands of the Approved Societies, who, at any rate,can make representations to the Insurance Com-mittees. It will be remembered that by Section 65of the Insurance Act, 1911, Regulations must belaid before both Houses of Parliament " as soon asmay be," and that power is given to the King inCouncil to annul any Regulation upon being prayed

: to do so in an address presented by either House: within 21 days of the Regulation being laid.

before it. ____

THE WORKING OF SANATORIUM BENEFIT.

Dr. S. Vere Pearson has contributed to theBritish Journal of Tuberculosis some interestingnotes upon the present aspects of the provision andadministration of sanatorium benefit. Among pointsof interest to those who seek to prognosticate thefinancial future under the Act attention is called tothe sufficiency of Insurance Act funds for providingsanatorium benefit in rural areas, as contrastedwith their marked insufficiency in urban districts,where tuberculosis is more prevalent. He callsattention to the difficulty found in combining theefforts of voluntary charities with those of local andinsurance authorities, to the abuse of State MedicalService in the case of tuberculosis by patients whoconsult tuberculosis officers when they can affordto pay private fees, and he makes interestingobservations on the combination of preventive withcurative medicine in the case of tuberculosis. Heconsiders that in the present circumstances therigid separation between preventive and curativemedicine, which he ascribes to public healthlegislation, is disappearing year by year.

THE INSURANCE ACT AND THE REORGANISATION OFPHARMACY.

The changes in pharmaceutical practice effectedby the National Insurance Act have rendered

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necessary some considerable modification of the. system of pharmaceutical organisation, and phar-L macists are now engaged in modelling a new

L scheme. Recently a conference of delegates from

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most of the English and Welsh counties and countyboroughs was held in London under the chairman-ship of Mr. Edmund White, president of the Phar-maceutical Society, who was attended by the secre-tary and most of the members of council, and afterprolonged discussion it was resolved that a com-mittee, to be called the Pharmaceutical GeneralCommittee, should be appointed, to be constituted asfollows: The president and secretary of the Phar-maceutical Society, six members of the Council ofthe Pharmaceutical Society (to be appointed by theCouncil), seven panel chemists to be elected bydelegates from the local associations, and twopersons to be appointed by limited companies con-ducting the business of chemists. By this meansa close alliance between the Pharmaceutical

Society’s Council and local organisations ofchemists will be effected. Conferences of delegateswill meet periodically and will decide upon themain principles to be followed by the generalcommittee in matters arising out of the pharma-ceutical service under the Insurance Act.

THE NATIONAL MEDICAL UNION.

A meeting of the Federating Council of this Unionwas held on Jan. 31st, Dr. V. T. Greenyer in the chair.It was announced that the Islington Non-panelAssociation had decided to join the federation, andthat at a meeting of non-panel practitioners inBradford it was resolved to form a local branch inthat neighbourhood. Amongst the correspondencea letter was read from a member of the Unionasking for information with reference to the actionof a neighbouring practitioner in writing to a patient of his to present herself to him for egami- Ination on behalf of the Prudential Approved

- Societies. Considerable interest was evinced onthe point in view of similar cases reported inTHE LANCET a short time ago. In submitting thereport of the Executive Committee Dr. Greenyer ’stated that they had engaged and furnished an office at 346, Strand; that they had secured clerical assist- ance; and that they had discussed and issued to the press a short general memorandum of policyfor purpose of making known the existence of theUnion. It was resolved on the motion of the chair-man that an Organisation Committee be formed with power of co-option, and that a Constitution Com- mittee be appointed to consider the most suitableform of constitution for the purposes of the Union, and to draft proposals thereon, the opinion of the tCouncil being that any questions pertaining toTrade Unionism need not be considered. Upon a Tproposal that the Council rule that no member of the National Medical Union be allowed to signForm 43 LC., considerable discussion arose, and it 1was resolved that this question be referred to a afull general meeting of the Union, with an expres-sion of opinion from the Council that no member a

should be allowed to sign this or any similar form 1

in relation to any patient for whom he has not

already signed such form. c

It was resolved that practitioners attending I

members of the Seamen’s National Insurance* °

Society be not debarred from belonging to the a

Union ; but the Council recommended practitioners not to sign the agreement of this Society. Upon the motion of Dr. J. S. Prowse, instructed

by the Manchester Union, it was resolved thatmembers of the medical profession whose partners are upon the panel, but who do not see their ppartners’ patients and whose deeds of partnership t:

were in existence before the panels were formed,should not thereby be excluded from membershipof the Union if approved by the Council afterrecommendation by their local non-panel associa-tion.A written copy of Regulation 44 (2) was laid

before the meeting by Mr. H. B. B. Greene. This

Regulation is as follows :-Where the insured person contracts with a person other

than a duly qualified practitioner to obtain treatment (whetherincluding drugs and appliances or not) from him for a fixedsum for the year or any part thereof, the committee maymake such contribution towards the sum contracted to be

paid not exceeding in amount the maximum contributionpayable in the case of a person who contracts with a dulyqualified medical practitioner, as they think fit, but upon anyrepresentation being made by a society that the treatment isnot such as will adequately protect the funds of the society,the committee may either withhold the contribution or makesuch a deduction as they may in any case determine.

Whereupon the Council resolvedto protest againstthis Regulation containing provisions which seek tolegalise the treatment of those insured under theAct by persons who are not duly qualified practi-tioners, and instructed the secretaries to bring theterms of the Regulation to the notice of the GeneralMedical Council and to request them to take action.

Medical News.FOREIGN UNIVERSITY INTELLIGENCE.-

Berlin: Dr. Abderhalden, Director of the Halle University1 Physiological Institute, has been appointed Director of the1 Berlin University Biological Research Laboratory, which is

being erected at Dahlem.-Breslau: Dr. Karl Bruck,- Senior Surgeon to the University Dermatological Clinic,cl has been appointed Director of the Altona Municipal1 Hospital for Skin and Venereal Diseases.-Cincinnati (Ohio-

Hiaini Medical Colle,ge) Dr. Simon P. Kramer has been

appointed Professor of Clinical Medicine.-Cracow : Dr.Stanislaus Dománsky, Extraordinary Professor of the Special

r Pathology and Treatment of Nervous Diseases, has been

promoted to Ordinary Professor.-Dresden : : Dr. Nahm-- macher has been appointed to the charge of the newly) established Institute for Radium, Mesothorium, Thorium, andX Ray Treatment in connexion with the Carola Hospital.-Genoa: Dr. Carlo Gallia has been recognised as privat-docent

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of Dermatology and Syphiligraphy.-Gratz: Dr. Josef Hertle,Primararzt of the Provincial Hospital, and Dr. EdouardStreissler, Oberarzt of the University Surgical Clinic, have

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been granted the title of Extraordinary Professor.-Greifs-* qvald: Dr. Walter Loehlein, privat-docent of Ophthalmology,; has been granted the title of Professor.-Lille: Dr. Le Fort hasi been promoted to Assistant Professor of Operative Medicine.-t Melbourne: Dr. Felix Meyer has been appointed Lecturer in

Midwifery and Gynæcology.-.Montreal (Laval University) :’ Dr. Zephir Rheaume has been appointed Professor of

Experimental Surgery.-Munich: Dr. Franz Weber has beenappointed Oberarzt of the University Gynaecological Clinic.-

’ Naples: Dr. Giuseppe Sofrè has been recogniced as privat-docent of Medical Pathology, and Dr. Liugi Marenduzzo asprivat-docent of Medical Diagnosis.-New York (University

. and Bellevue Hospital Medical School) : Dr. Lewis K. Neffhas been appointed to the chair of Clinical Medicine.-

, Odessa : Dr. Kornmann-has been recognised as privat-docentof Pathological Anatomy.-Prague (Bokemiam University) :

, Dr. Heinrich Chalupecky has been promoted to an Extra-ordinary Professorship of Ophthalmology.-Strassburg: Dr.G. Steiner has been recognised as privat-docent of Neurologyand Psychiatry.-Turin: Dr. Piero Boveri and Dr. GustavoMatticolo have been recognised as privat-docenten of Neuro-

logy.- Vienna: Dr. Hans Heyrovsky has been recognised asprivat-docent of Surgery.

UNIVERSITY OF CAMBRIDGE. - The specialBoard for Medical Studies, in a revised report on the pro-posal to apply to the Board of Education for a grant towardsthe expenses of the medical school, state that there are at