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prevention the medical practitioner must be educated in the fuller appreciation
and the real import of early symptoms, and also in drawing conclusions from the
nature of the illnesses which are observed in the group of patients for which he
is responsible. It would be easy to enlarge upon this theme, but I limit myself
to suggesting that consideration should be given to the following points:—
What is the most practical method which will ensure that persons will seek
medical treatment early, or that incipient disease will be recognised at an earlier
date than is now the case ?
Ought the principles of national insurance to be extended, and, if so, to what
extent, and how should the cost of such extended facilities be met ?
How can the poor, who are not now included in the Insurance scheme, be
brought into a scheme of national treatment and still remain free from the stigma
of pauperisation and free from risk of involvement in invidious distinctions ?
How can the activities, knowledge and experience of general practitioners
be best utilised in preventive work ?
How can existing institutions be adapted to help in the development of the
system ?
Is it necessary that the National Insurance Committee should accept responsibility
both for medical treatment and for sickness and disablement benefits ?
Can existing local authorities be vested with the power of providing national
treatment, and the medical profession, which is so intimately concerned in this
work, be given a share of the responsibility ?
Other suggestions could be introduced, but these appear to me to be of the
most pressing importance, and any practical scheme using existing machinery,
modified and extended as the circumstances seem to require, is the immediate
essential.
Any alteration in the matter of the treatment of the indigent poor which is
at the present time undertaken by the Poor Law Authorities, would appear to
me to be premature and undesirable until the details of future development have
been considered and decided upon. Variations, whatever they may be, should be
on lines which will ensure that they fit in the new programme. If they do not
radical change will again be necessary in the near future.
It has been suggested that the visitation of sick poor by the staff of the Medical
Officer of Health should be undertaken. This, I submit, would be a duty which
is outside the scope of the Medical Officer's functions. These are mainly administrative,
and even if the proposal were put into effect as a temporary measure there
would still be the sentimental objection which attaches to charitable relief, and
that objection would exist so long as an individual requiring relief is singled out
for special consideration. With the extension of national insurance it does not
seem an impracticable proposition to provide for the poor as well as for those
who are able to pay weekly contributions.
CLEANSING OF VERMINOUS SCHOOL CHILDREN.
The arrangement, which has existed for some years between the Corporation
and the London County Council under which the former undertook to cleanse
school children suffering from verminous infection, has been subjected to revision.
When first undertaken, the arrangement was confined to children residing in the
City and attending public elementary schools provided or maintained by the
London County Council. A subsequent extension provided similar facilities for
children not residing in the City but attending schools situated in the City.
At the request of the London County Council a further extension has now
been made to include in the arrangement, subject to certain limitations as regards
numbers, non-resident children attending schools outside the City area.
It will be seen, therefore, that the facilities of the Corporation's Disinfecting
Station at Golden Lane are available for the cleansing of any child attending
any public elementary school maintained or provided by the London County
Council, subject only to certain limitations as to numbers submitted.