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against its utility—rather the reverse—and it would indeed be a pity if for
any reason it were dropped.
We have continued to act as medical referees for the Ministry of Pensions.
This work is necessarily of a somewhat thankless and uncongenial
nature. It differs from ordinary medical practice in that the doctor has not
only to consider the interests of the patients, but he has also to endeavour
to see that the State is not defrauded. Under such circumstances, it is
inevitable that occasional unpleasantness should arise, while the time occupied
in such duties is considerably greater than would be the case in dealing with
a similar number of patients of the non-pensioner class, and the number of
forms and reports to be completed is considerable. However, it is difficult to
see how else the work could be carried out, and the fact that the men are
under an obligation to attend at regular intervals secures an amount of supervision
over them which might otherwise be impossible. The actual treatment
of pensioners, other than institutional, is still conducted by Insurance Practitioners
in the main. As is well known, the Ministry of Health holds
strongly that as little treatment as possible should be given in the Dispensary,
and almost all insured patients, whether ex-service men or not, are now
referred back to their panel doctors. In spite of that fact, there remains a
considerable residue comprised of uninsured adults and children whom we
treat systematically.
Neither myself nor my colleague, Dr. Hamilton, as a result of our observations
when resident officers in institutions, has been favourably impressed
with the various methods of vaccine or serum treatment used in Pulmonary
Tuberculosis, and we have in the main relied on the usual non-specific reme
dies; but in the summer of the past year we felt compelled to give a trial
to Professor Dreyer's "defatted antigen," both because of the good results
claimed for it, and also because several patients who had read of it in the
lay press were extremely anxious to receive a course. We decided to limit
its use to certain classes of cases which came under one of the headings
tabulated below, and it was also explained to every one that the method
was only in the experimental stage and that we could not from personal
experience guarantee results.
1. Those whose condition was obviously deteriorating and who were
urgently clamorous to be given a trial.
2. Those who showed a good resistance but in whom the disease was
extensive and in whom with careful dosage at least no harm would
probably ensue.
3. Surgical cases.
The number selected was small, some being treated in their own homes, and
every effort was made to secure ample observation on the day following the