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Horse) severely wounded, two men of the 1-2nd Gurkhaskilled and two slightly wounded, two followers killed (onedied of wounds) and three severely wounded. One Britishofficer (Captain A. M. Hutchins), one Indian officer, fivenon-commissioned officers and men, and 47 followers died ofdisease. Four British officers, seven British warrant andnon-commissioned officers, and 224 Indian troops were

invalided, and 477 sick followers had also to be invalidedand returned to their depots or other stations.

Honorary Physicians to Government Hospitals.A resolution published in the current United Prminces

Gazette states that the Lieutenant-Governor is desirous of

appointing private medical practitioners as honorary phy-sicians and surgeons of Government hospitals. He directsthat if suitable medical practitioners are ready to take up theappointments as honorary physicians and surgeons they shallbe appointed at the Government hospitals at Allahabad,Benares, Bareilly, Cawnpore, and Meerut. These appoint-ments will be in the first instance for three years, and at theend of that period it will be decided whether the system hasbeen sufficiently successful to justify its continuation or

extension.Noises in Calcutta.

A special subcommittee of the Calcutta corporation is con-sidering the means of removing the noise of municipal carts,and it is understood that a prize for the design of a vehiclewith noiseless wheels will be offered in due course.

A Golf Chmpion.Last month Major A. Chalmers, I.M.S., won the golf

championship of Southern India for the second time insuccession. His opponent was 2 up on the first round inthe afternoon. Chalmers at once wiped off this advantageagainst him, and was 3 up at the turn for the second round,eventually winning by 3 up and 2 to play.June 7th.

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Obituary.WILLIAM MURRELL, M.D. BRUX,, F.R.C.P. LoND.,

SENIOR PHYSICIAN TO, AND LECTURER ON MEDICINE AT,WESTNIINSTER HOSPITAL.

Dr. William Murrell, whose death we recorded last week,was born on Nov. 26th, 1853. His father was WilliamKenrick Murrell, M.A., barrister-at-law. He was educated’at Murray’s School, Wimbledon, and University College,London, and thence passed on to University College Hospital.He qualified L.S.A. in 1874 and obtained the diplomas ofM. R. C. S. Eng. and L. R. C. P. Lond. in the following year.In 1877 he became a Member of the Royal College of

Physicians and was elected Fellow in 1883. He took theM.D. degree at Brussels in 1879.

Dr. Murrell shortly after qualification became demon-strator of physiology in the Medical School of Uni-

versity College Hospital, and held the Sharpey Physio-logical Scholarship. He was always keenly interestedin pharmacology and was much influenced by Dr. SidneyRinger, whom he helped in some of his researches. Hisearliest independent publication was on Nitroglycerine asa Remedy for Angina Pectoris," which was written in 1880.About this time he joined the staff of the Westminster

Hospital Medical School as teacher of histology, and soonafterwards was appointed medical registrar at the hospital.In 1886 he was elected assistant physician, and in 1896 phy-sician. He was devoted to his work in the wards, and his deathwas without doubt hastened by his persistence in returningto hospital labours in spite of ill-health and against the adviceof his friends. For several months before his death he hadsuffered with heart disease; and in the spring of this yeardropsy supervened and he was obliged to go away. As

soon, however, as his health had slightly improved hereturned to the hospital, with the result that there was asecond breakdown, followed by death on June 28th at hishome in Welbeck-street after a week’s confinement to bed.

Dr. Murrell was a prolific writer, chiefly on subjects con-nected with therapeutics and pharmacology, and his easy,fluent style and clear expression gained many readers. His bestknown books are A Manual of Pharmacology and Therapeu-tics," "What to do in Cases of Poisoning," the demand for

which was so great that it ran through ten editions, and’’ Masso-Therapeutics. or Massage as a Mode of Treatment,

"

which was translated into German, French, and Russian.Besides these books he wrote a large number of papersfor the medical journals and- societies, and also dida certain amount of medical journalistic work, throughthe medium of which he was largely instrumental in

exposing the scandalous massage establishments whichat one time flourished in the West-end of London.At the time of his death Dr. Murrell, in addition to his

appointments at Westminster Hospital, was a member of theFaculty of Medicine in the University of London, and anexaminer to the Civil Service Commission and to the Universityof Aberdeen. He had formerly held examinerships in materiamedica at the Universities of Edinburgh and Glasgow andat the Royal College of Physicians of London. In 1881 hewas elected a laureate of the Academy of Medicine of Paris,and in 1887 he was one of the vice-presidents of the Inter-national Medical Congress held at Washington. For someyears he was on the medical staff of the Paddington GreenChildren’s Hospital, where he became senior physician.

THE NATIONAL INSURANCE ACT.

AN OPEN LETTER FROM MR. LLOYD GEORGE.

The Chancellor of the Exchequer has addressed thefollowing letter to a medical correspondent :-

11. Downing-street, London, S.V’., July 9th, 1912.DEAR SIR,-In reply to your letter. I fully appreciate the anxiety

which you and many other members of the profession feel as to thepresent position with respect to the Insurance Act. Such anxiety isonly natural when those engaged in any calling are faced with such agreat change in the conditions of work with which they are familiar asthe Insurance Act must inevitably produce in the case of the medicalprofession. At the same time a great deal of the uneasiness at present feltby some members of your profession rests, I am sure. on miaunder-standing of the position, and I shall be glad if, by this letter, I can dosomething to clear matters up.In the first place I am surprised to learn that there is an impression

in some quarters that the Government are not desirous of coming toterms with the doctors. This is entirely wrong. We have never

wavered in our belief that the cordial cooperation of the medical pro-fession is necessary in order that the best results may be obtained fromthe Insurance Act, and we are prepared to do all in our power tosecure that cooperation. The only practical question is whether that

cooperation can be secured by anything that it is in our power to do.Although public opinion will be most desirous that we should come toterms, it certainly would not countenance acceptance of every demandthat might be made, and the same is true of Parliament.Looking through the points originally put forward by the British

Medical Association 12 months ago, it seems to me that substantiallyonly two remain outstanding. The others have, I think, been in themain conceded, although in some cases adjustment may be desired inthe framing of regulations, on which there should be little difficulty incoming to an agreement.The two chief points that seem to me to be outstanding are the

question of remuneration and the question of the income limit. As

regards the subject of remuneration I have said-and I repeat-that,the Government are prepared, as part of a general settlement, to recom-mend Parliament to increase the amount available for remuneration ofthose doctors who take part in the formation of panels. It is true thatI have had to make clear that I did not expect to be able to meet thedemands put forward by the British Medical Association for 88. 6d. perhead exclusive of drugs and of a long list of extras. I feel sure, how-ever, that this demand was put forward without fully realising what itmeant. In private practice doctors know the amount they receive fromthose they actually attend, and they find it difficult to realise whatwould be the effect on their income if they were paid a fixed sum perhead per annum in respect of a large section of the population whetherthey actually attended them or not. I hope that the inquiry whichSir William Plender is now carrying out will serve to remove thiscause of misunderstanding once and for all.As to the income limit everything depends on what the demand of

the profession on this point really means. The Government, supportedby Parliament, held that this question must be settled locally, in orderthat due regard may be had to local conditions, and the Act is soframed accordingly. But, even if it were legal, the Government couldnot agree to the proposal that any powers conferred on the InsuranceCommissioners should be exercised to coerce the Insurance Committeesin the exercise of the discretion secured to them by the Act in thisrespect. So far as I can ascertain, no responsible political leader oneither side has been prepared to support such a proposal.

I hope that, as I have suggested to the British Medical Association,the forthcoming Representative Meeting will appoint a committeewith authority to negotiate with me in a practical spirit. I am con-vinced that it will be a misfortune both for the country and, if youwill allow me to say so, not less for members of your profession, if weare unable to come to terms. I still believe that the most satisfactoryway of working the medical service under existing conditions will be bythe system of free choice of doctor by patients, with the various safe-guards for the profession which were inserted in the Act at the requestof the British Medical Association. If unfortunately this is foundimpracticable, I do not doubt that the insured will be able to obtainmedical attendance, either under other arrangements made byInsurance Committees or by arrangements which they themselves willmake by means of the money supplied from the Insurance Funds. But

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I am convinced that if we were driven to this way of doing things itwould not be so satisfactory from the public point of view, and it wouldcertainly be less remunerative and in every respect less advantageous tothe profession than the arrangements that we can make if we come toterms.

"- I am, &c.,- -

(Signed) D. LLOYD GEORGE. IADMINISTRATION OF SANATORIUM BENEFIT.

The English Insurance Commissioners, after consultationwith the Local Government Board, have just issued a

memorandum (No. 112) for the guidance of Insurance Com-mittees in commencing the administration of sanatoriumbenefit under the Act. The memorandum states that for thetime being this benefit is confined to the treatment of tuber-culosis among insured persons recommended by InsuranceCommittees. Treatment for purposes of sanatoriumbenefit may be given (a) in sanatoria, hospitals, or

other residential institutions, or (b) at tuberculosis dis-

pensaries (i.e., local centres for expert diagnosis and

treatment), or other non-residential institutions, or in thepatient’s home. The duty of the Insurance Committees is,not themselves to provide institutions, but to make arrange-ments with suitable persons or local authorities for this

purpose to the satisfaction of the Commissioners. The Act

lays down that sanatorium benefit shall be available toinsured persons from July 15th ; but the memorandumexplains that in most districts the full system of dis-

pensaries, sanatoria, &c., which is in contemplation will notbe available until some time after the commencement ofthe Act. Since this is evident, the Insurance Committeesare instructed that, where and so far as the complete systemoutlined in the memorandum is not available, they mustmake temporary arrangements at the outset. To enable thecommittees to provide sanatorium benefit during the sixmonths before the Act comes into full operation each com-mittee will be credited with a sum equivalent to about.ELI. 5s. per 1000 of the total population of its area. The

majority of cases will have to be treated in dispensaries orat home, and even dispensaries cannot be in working orderfor some time to come. It is suggested that in those dis-tricts where a tuberculosis officer has not been appointed themedical officer of health should, with the consent of thecounty or county borough council, act temporarily as theexpert adviser of the committee in dealing with individualapplications for sanatorium benefit. Where a patient is

waiting for admission to a sanatorium or hospital, treat-ment in a dispensary or home treatment by a privatepractitioner is recommended. The memorandum states inthis connexion that arrangements for treatment by privatepractitioners may be made in various ways ; for instance,where this course is found more convenient, the patient maybe authorised to obtain from his own medical attendant suchtreatment as may have been sanctioned in his case by theInsurance Committee, to be provided at the cost of the fundsof the Committee. The Insurance Commissioners and theLocal Government Board concur in the belief that it isdesirable that domiciliary treatment of cases of tuberculosisunder the Act should be carried out so far as practicable bygeneral practitioners acting in consultation with the localtuberculosis officers or other approved advisers.

NATIONAL MEDICAL UNION.A general meeting of the National Medical Union was

held on July 4th at the Onward Buildings, Deansgate, Man-chester, Mr. G. A. Wright, the President of the Union, beingin the chair.The report of the General Committee, which had been

circulated to the members, was taken as read, and the reso-lutions arising therefrom were debated.Mr. C. R. 0. Garrard (Salford), Mr. J. J. Bell (Bradford,

Yorks). and others spoke in laudatory terms of the stand takenby the Union in guarding the interests of the profession andin getting the British Medical Association to take up thefirmer attitude which it has recently adopted," and it wasunanimously resolved to carry on the militant work of theUnion in watching the interests of the profession, and instrengthening the British Medical Association in its deter-mined opposition to the National Insurance Act as at presentframed." "

The meeting agreed that Mr. J. E. O’Sullivan, of Liver-pool, a general practitioner, and a firm supporter of the

policy of the Union, should be recommended as the third

Representative of Lancashire and Cheshire on the Councilof the British Medical Association.The following resolution was carried unanimously :-That the medical members of the Advisory Committee should at once

resign their positions, as it was both useless and undignified to continuein office.

It was pointed out in this connexion that the pourparlerswith the Chancellor of the Exchequer displayed his completeignorance of medical practice, and that the negotiations werequite illusory.A resolution was carried with acclamation to the effect

that-

This Union considers the action of the Chancellor of the Exchequerin suggesting an inquisitorial investigation into the books of privatepractitioners is a piece of unparalleled impertinence, and calls on allmembers of the Union to refuse to have their books examined by anyservant of the Government.

Another resolution which was passed expressed the con-viction that it was anomalous that medical officers of healthshould be asked, or consent to allow themselves, to beelected on Local Insurance Committees. In this connexionit was mentioned that at a meeting of medical officers ofhealth held in London recently it was proposed by Mr.Smith Whitaker that these officers, with the aid of

assistants, should work the Act, but they refused to entertainany such proposal.

Dr. Reynolds thanked the members of the Union fortheir support in the recent Council election, and stated thathe would not give way one iota in his opposition to the Actas it stands, and would unremittingly carry out thedetermined wishes of the profession.The meeting desired, in view of the recent utterances of

the Chancellor of the Exchequer and other members of theGovernment, to indicate to the Government, and to thepublic generally, the determined attitude of the medicalprofession in their decision to take no part in the workingof the National Insurance Act until it is amended in accord-ance with their first demands, and for the benefit of thepeople whom it is supposed to serve. It was pointed outin the report presented to the meeting that a money pay-ment in lieu of medical benefits not being an adequatereturn for the promises contained in the Act, the Governmentwill break their contract with the insured if they pursuethis policy, while it will remain with the employers oflabour and the insured to deal with those who have made

promises which it is impossible to fulfil.

Medical News.EXAMINING BOARD IN ENGLAND BY THE ROYAL

COLLEGES OF PHYSICIANS OF LONDON AND SURGEONS OFENGLAND.-At the Second Professional Examination in

Anatomy and Physiology, held on June 27th and 28th andJuly lst and 2nd, 98 candidates presented themselves, ofwhom 48 were approved and 50 were referred. The followingare the names of the successful candidates :-

John Gordon Ackland, William Guy Embleton Allen, and JohnAndrew, St. Bartholomew’s Hospital; Arthur Lawrence Anthony,Guy’s Hospital; James Dorrington Bangay, St. Bartholomew’sHospital; Percival Cheal and Hugh Collins, London Hospital;Eleyathamby Coomaraswamy, Ceylon Medical College andMiddlesex Hospital; Edmund Sheppard Cuthbert, St. Bartholo-mew’s Hospital; Ernest Ivon Davies, University College, Cardiff;George Stanley Deane, London Hospital; Lionel Basil de Kretser,Ceylon Medical College and Middlesex Hospital; Stanley ErnestYork Elliott, St. Mary’s Hospital; Cuthbert Lindsay Emmerson,St. Bartholomew’s Hospital; Moustafa Fahmy, Cairo and LondonHospital; Luis Hernando Garces and William Tudor Gwynne-Jones, London Hospital ; George Harris Haines, UniversityCollege; Douglas Noel Hardcastle, St. Mary’s Hospital; LancelotHorsley, Guy’s Hospital; Gerald Patrick Kidd, St. Thomas’s Hos-pital ; Noel Sigismund Koch, St. Bartholomew’s Hospital;Gajanan Chintaman Kusumbeker, L.M. & S. Bombay, BombayUniversity and University College; Gerald Struan Marshall,Charing Cross Hospital; Archibald Daniel Marston, Guy’sHospital; Donald Samuel Eccles Milligan and William HubertMilligan, St. Thomas’s Hospital; Elizabeth Morse, London Schoolof Medicine for Women ; Alfred William North, Birmingham Uni-versity ; Thomas Owen, Cambridge University and St. Bartholo-mew’s Hospital; Cuthbert Felix Oliver Pandithesekere, CeyloilMedical College and Middlesex Hospital; Maurice Pearson, Guy’sHospital; Vishwanath Damodar Phatak, Bombay University andMiddlesex Hospital; Isabel Quanbrough, L.M. & S. Bombay,Bombay University and Royal Free Hospital; Charles HarleyFavory, Cambridge University and St. Bartholomew’s Fospital;John Godfrey Bradley Smith, St. Bartholomew’s Hospital;