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scheme proves popular, clinics for other specialtiesmay develop in due course, without interfering withthe general features of the hospital teaching.On the surgical side the position is rather different.

A medical specialist is of distinct value for the diagnosisof disease, since the treatment he advises can usuallybe carried out in the general ward. The surgicalspecialist, on the other hand, practises a method oftreatment which he has perfected, and must thereforehave beds at his disposal. To meet this necessitythe surgical staff tend to favour the development oflarger units within which specialties may be developedby the more junior members.

AUSTRALASIA

(FROM OUR OWN CORRESPONDENT)

A FACULTY OF MEDICINE IN BRISBANE

THE Queensland Government, in considering exten-sion of the health services of the State, has appointeda committee to advise on the establishment of afaculty of medical science in the University of Queens-land. There is already a faculty of dentistry.

A JUBILEE APPEAL

On April 5th both houses of the CommonwealthParliament adopted an address of loyalty to theKing to mark the twenty-fifth anniversary of hissuccession. At the same time the Government

launched an appeal for the King George V. andQueen Mary Maternal and Infant Welfare MemorialFund, to be established as Australia’s commemora-tion of the Silver Jubilee. From its own revenuethe Commonwealth Government will give jE50,000,and contributions will also be made by the Stategovernments. A special appeal has been made bythe Governor-General, and the acting Prime Ministerstates that the Royal Australasian College of

Surgeons, the British Medical Association, nurses’ andwomen’s organisations, and industrial associationsare being invited to cooperate. The Governmentproposes that the money collected shall be spentby State agencies through existing channels and ona few main objects. One aim is to secure a measureof uniformity while reserving the general principleof local control. Attention will be paid to post-graduate courses for doctors, the instruction ofmedical students in obstetrics, the theoretical andpractical training of midwives and nurses, the estab-lishment of a self-contained maternity hospital unit,and better equipment and improvement of existinginstitutions, both in the country and in the city.The rate of maternal mortality in Australia is.

higher now than it was in 1911, and it rose from4’72 per 1000 live births in 1921 to 5°13 in 1933.Although the general death-rate has fallen andinfantile mortality has steadily decreased, the death-rate of infants in the first week of life has remainedalmost stationary.

PANEL AND CONTRACT PRACTICE

Title to Medical Benefit

PRACTITIONERS are sometimes in doubt as to whena person newly insured becomes entitled to medicalbenefit. There is, of course, no waiting period formedical benefit as there is for sickness benefit ; thefact of being insurably employed confers an immediatetitle to medical benefit. Some years ago a boy whowas due to commence work for the first time on a

Monday met with an accident on the previous Sundayand required treatment on the day on which but forhis accident he would have commenced work. Hehad just left school and as he had not entered uponhis duties no stamp had been affixed to a contributioncard in respect of him, nor was one due. As, however,he was under a contract of service, the Minister ofHealth held that on the Monday he had becomeentitled to medical benefit and an insurance practi-tioner both claimed and received a fee in respectof a general anaesthetic administered for the settingof a fractured radius. Clause 7 (2) of the Terms ofService may be briefly paraphrased thus. If a

person in applying for treatment represents tha4 heis an insured person but cannot produce a medicalcard, the practitioner must give any necessary medicaltreatment; he may charge a fee by way of deposit,but in that event he must issue a receipt on theform G.P.4 provided by the committee for the

purpose ; he must issue a certificate if he would havebeen required to issue a certificate had the applicantbeen an insured person on his list ; but he must notordei drugs or appliances on an insurance prescriptionform until the applicant’s title to benefit has beenproved. In case of doubt it is wise to follow theprocedure laid down in this clause. If the applicantis not entitled to benefit the doctor retains the fee.If he is entitled his name is added to the doctor’slist as from the date on which treatment was providedand the deposit is refunded to the applicant anddeducted from the practitioner’s remuneration. If

drugs are supplied by the practitioner he may, shouldthe person be proved entitled to benefit, reclaimthe cost from the insurance committee.

Leave of Absence

An insurance doctor recently applied for permissionto be absent from his practice for a period of abouttwelve months in connexion with certain privatebusiness. Clause 11 (1) of the Terms of Serviceprovides that all treatment shall be given by apractitioner personally, except where he is preventedby urgency of other professional duties, temporaryabsence from home, or other reasonable cause, andClause 11 (2) lays it down that a practitioner shall notabsent himself from his practice for more than oneweek without first informing the insurance committeeof his proposed absence and of the person or personsresponsible for conducting his insurance practiceduring such absence. Absence for twelve monthscould hardly be regarded as temporary absencefrom home, and the question to be decided is whetherthe cause given by the doctor for his proposed absenceand for his non-fulfilment of the requirement as topersonal service could be regarded as a reasonablecause. The practice falls within the area of threeinsurance committees and one of these committeeshas already decided in the negative.

Spinal JacketsIn July, 1934, regulations were made providing

that, as from August 13th following, spinal jackets-should be added to the list of appliances which maybe prescribed for insured persons, when required fortreatment of fractures, dislocations, or diseases of thespine. The Ministry of Health has now intimatedthat after consultation with the Insurance ActsCommittee the list of drugs and appliances appendedto the distribution scheme will be extended to includethis appliance. As and when insurance committeesamend their areal distribution scheme it will be

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possible for practitioners either to prescribe or to

arrange for the supply of spinal jackets in the circum-stances mentioned. In the latter event they will ofcourse be entitled to recover the cost from thecommittee.

What is a Partnership ?An insurance committee has approached the

Ministry of Health with a view to determining

whether the reference in the Terms of Service to apartnership refers to the whole of the practice or not.It appears that this question was considered yearsago and that it was then held that the term

" practice "

in Clause 11 (8) must be construed to refer to thewhole of the practice in respect of which the partner-ship exists. If the partnership exists only with

respect to insurance practice the word would haveto be construed accordingly.

PUBLIC HEALTH

Boarding-out of Mental Patients

THE twenty-first annual report of the GeneralBoard of Control for Scotland gives considerable

space to the question of boarded-out patients. Duringlast year 1249 pauper patients were thus cared for.The majority of these patients are defectives, andtribute is paid to the cooperation between the localmedical officer, the public assistance officer, and theBoard which enables the best conditions for the

patient to be obtained. Numbers of patients are

cared for on the outlying crofts, and guardianshiphas become in some cases almost a matter of heredity,the present guardians having been in contact withpatients from their earliest days. In such instancesthe present guardians carry on a tradition of tolerance,patience, and skill which their grandparents firstlearnt. Very little objection is taken to the close

mixing of normal children with defective adults, amixing which in itself seems to arouse a sense of

responsibility in the children. Licence has proveduseful. The general consensus of opinion favours ashort period of institutional care, but several examplesare given of the process whereby children are trans-ferred to guardianship after lengthy preparation ofthe parents for the step. The fact that the patientdoes in suitable instances return home from time totime undoubtedly helps. The defectives who dobest are those who have had the advantage of

training in special schools or at welfare centres beforebeing boarded-out. The Commissioners stress the

necessity of more accommodation of an institutionalkind. A State institution is required for the speciallydifficult defective. Ascertainment is still far fromperfect. The higher grade defective is not suffi-

ciently marked out from the normal child at school.He goes out into the world, and only later comesunder the notice of the authorities. In view of theconsiderable use made of guardianship in Scot-land these cases might do well after they had beentransferred to special schools. It is noted that twoCommissioners of the English Board of Control havevisited some of the boarded-out cases and were

impressed by "the intelligence, culture, simplicity,and kindness " of the Scottish guardians. Surelysuch virtues are not peculiar to Northern Britain,but certain factors seem to work against a furtherextension of the practice. The high-grade defectivesare an asset to mental hospitals in terms of workgiven ; they help to bring down the cost per head.Boarding-out is a hazard. Many may feel that resi-dence under hospital conditions is to be preferred.But when the strain placed upon hospital accom-modation by serious psychotic cases is considered,and the durable results of the system in Scotlandare remembered, it would seem that boarding-outis likely to prove a developing mode of treatment.Though little mention is made of the boarding-out.of cases of chronic mental illness it is generally

agreed that this mode of dealing with certain patients rcould be expanded. It is not only a matter of bedsand accommodation. Nor is it only a case of givingmore opportunities for guardianship to suitable

people. Boarding-out is one of the main ways in .

which the public can recognise the common incidence !

of mental disorder and learn to overcome the repul-sion which cuts across the progress of psychiatry andthe humane treatment of the mentally afflicted.

INFECTIOUS DISEASE

IN ENGLAND AND WALES DURING THE WEEK ENDED

APRIL 13TH, 1935

2Voc6tMoM,s.—The following cases of infectiousdisease were notified during the week: Small-pox,0 ; scarlet fever, 2430 ; diphtheria, 1211 ; entericfever, 25 ; acute pneumonia (primary or influenzal),1429 ; puerperal fever, 53 ; puerperal pyrexia, 134;cerebro-spinal fever, 23 ; acute poliomyelitis, 3;encephalitis lethargica, 6 ; dysentery, 22 ; ophthalmianeonatorum, 92. No case of cholera, plague, or

typhus fever was notified during the week.The number of cases in the Infectious Hospitals of the

London County Council on April 20th was 3590, which included:Scarlet fever, 1107 ; diphtheria, 1540 ; measles, 22 ; whooping-cough, 368 ; puerperal fever, 18 mothers (plus 5 babies);encephalitis lethargica, 270 ; poliomyelitis, 2. At St. Margaret’sHospital there were 14 babies (plus 8 mothers) with ophthalmianeonatorum. ’

Deaths.-In 121 great towns, including London,there was no death from small-pox, 3 (1) from entericfever, 20 (0) from measles, 8 (2) from scarlet fever,28 (6) from whooping-cough, 45 (5) from diphtheria,43 (9) from diarrhoea and enteritis under two years,and 180 (24) from influenza. The figures in parenthesesare those for London itself.The number of influenzal deaths still remains almost stationary,

the reported deaths for the last few weeks (working backwards)being 180, 184, 181, 175, 145, 139, 83. This week these deathswere reported from 62 great towns, Manchester reporting 22,Blackburn 10, Portsmouth and Leeds each 7, Birmingham 6,Liverpool, Newcastle-on-Tyne, and Sheffield each 5, Bradford,Stoke-on-Trent, and Norwich each 4. (During the same weekGlasgow reported 8 deaths, Edinburgh 7.) Edmonton andEnfield each had 1 death from enteric fever. Four deaths frommeasles occurred at Cardiff. Leeds, Liverpool, and Sheffieldeach reported 3 deaths from diphtheria, no other large townmore than 2.

The number of stillbirths notified during the weekwas 251 (corresponding to a rate of 37 per 1000 totalbirths), including 33 in London.

ROYAL WEST SUSSEX HospITAL.-At the annualmeeting of the governors on April llth Sir OsmondBrock, chairman of the finance committee, said thatthis hospital was trying to arrange with all the othersin the district for a general appeal for a reductionin their rating assessment. The Bishop of Chichester,who presided, referred to the disappointing reply of thecounty council to a request for a grant of JE6400 towardsthe provision of a maternity home. The area served bythe hospital had seen steady building development andit was difficult to feel that the hospital should be expected.without assistance, to meet the needs of a populationmuch larger than the one for which it was provided.