934 THE NATIONAL INSURANCE ACT.

THE LANCET.

LONDON : SATURDAY, APRIL 6, 1912.

The National Insurance Act.TIME runs on and the medical profession still remains

in a regrettable condition of uncertainty as to what

are the prospects of professional life for a large sectionof our constituent body under the working of the

National Insurance Act. As we reported a fortnightago the British Medical Association have made certain

nominations to the Advisory Committee, which is coöpera-ting with the Insurance Commissioners to arrange the

regulations under which the Act shall be worked; but

the nominees of the British Medical Association are

pledged to withdraw their assistance if the regulations donot comply with the strongly expressed requisition of the

medical profession, whose well-known form needs no further

repetition. Surely the time is getting close when we

should learn that the Insurance Commissioners are willingto frame regulations in accordance with the demands

of the profession ; surely some public announcement shouldsoon be made of what has been done. If matters are

going smoothly it would relieve much apprehension to know

this ; if the discussions have so far not been harmonious

it might be extremely useful to allow any difficulty to beventilated. We know perfectly well that the persons

engaged in carrying on a delicate series of negotiationsdread nothing more than publicity while they are

making up their minds, but we have recently in generalpolitical affairs, as well as in medical affairs, had

examples of the misunderstandings and actual damagewhich may result from a too anxious concealment of

information from the public. If the regulations which

the Insurance Commissioners intend to promulgate are

such that they cannot be accepted by the medical profession,the withholding of medical benefit seems to be the course

that will be adopted by them; and in readiness for this I

the British Medical Association is devising a scheme for anational medical service, the design being of course to

resist the continuance, under some dominance of the

cooperative clubs, of the evils which, notably during thelast 20 years, have been rampant in club practice.

Ever since we published "The Battle of the Clubs the

eyes of the medical profession have been open to the mani-fold evils which can creep into contract practice. Armed

with this information the late Dr. J. G. GLOVER, who for

many years was one of the Direct Representatives of the

profession upon the General Medical Council, approachedthe Friendly Societies, with the leave of the Council, the

hope being that fall advantage would be taken of any desireto put the relations of those bodies with the medical pro-fession upon a better footing. Dr. GLOVER’S intervention,

however, proved of no avail, though he was widely trusted

and affectionately regarded by both sides. The abuses

remained unaltered. The Friendly Societies are, and alwayshave been, most valuable agencies for the promotion of thriftand order among their masses of members, and they relied

upon their honourable record in refusing to reconsider theunfair treatment of their medical officers. A National.

Insurance Act is now the law of the land which may per-

petuate, and must risk perpetuating, known abuses. All the

good things, and they are not a few, which could be saidfor the Act have been said in our pages, partly by ourselvesand partly by Dr. W. A. BREND, but the measure cannot be-

acquiesced in by the medical profession while the medical

position is so unprotected. The particular peril of the

situation before us is that the Insurance Commissioners,

finding that they have failed to meet the united demands

of the medical profession in any adequate manner,.

may attempt to place the organisation of medical benefits.

in the hands of the old-time masters of contract.

practice. The position consequently gives rise to serious.

apprehensions in the profession, and against any such

action on the part of the Insurance Commissioners-

it may be necessary to organise an alternative scheme of

public medical service and to support it with subscriptions’in aid of those who will suffer by their adherence to the

right professional view. We hope sincerely that no such

painful struggle lies before us. The author of the measure

has by this time recognised the error which he made in not

obtaining proper information from medical sources before

introducing his scheme to Parliament. Warned by this-

mistake the Commissioners ought to be ready to frame regula-tions to which the medical profession can give adherence.And they must know that if they fail to do this the medical

profession will not work under the old conditions of contract

practice. Medical men have said this in congress ; theyhave said it individually; their attitude has been endorsed by,the universities and corporations whence they obtain their

statutory right to practise; and it is idle to expect from thema change of front.

Psychiatry in England : its PresentState and its Outlook.

To a few of its most devoted students, who have long beenaware of the difficulties under which it labours, psychiatry inEngland is a subject that calls urgently for reform. Whether

this opinion is shared by the majority of alienists does notfor the moment concern us ; it is sufficient that those who

have the interests of psychiatry at heart can no longer regardthe situation with complacency. No one who has had th&

privilege of working in the neurological and psychiatricschools of the continent will, we suppose, be inclined ta

deny that English psychiatry does not at present enjoy therethat reputation which it might, and is not accorded that

honoured place which is so freely acknowledged by ourcontinental oonfreres for other branches of English medicalscience. At congresses on psychiatry and allied mattersEnglish representatives have, as a rule, been few and farbetween. There is held in Munich in autumn a post-graduate.course (Fortbildung) specially for the clinical and patho-logical study of the subject, a course which is valued so