860

discharged laterally instead of in the central furrow.The Chinaccridce are represented in the Atlantic byChimaer-a monstrosn but there are two other species.The anterior fin-spine of the Chimaera is movable andhas a row of denticles on each side of the posterioraspect ; when at rest these lie on the anterior marginof the fin in two grooves lined with the venom-producingepithelium. The poison is very virulent and thechimaeras are dreaded by fishermen since the wounds aredangerous, sometimes even fatal. _

THE LCC ON THE WHITE-PAPERON Dec. 19 the London County Council- decided to

send the Minister of Health its observations on theproposed National Health Service. These assume thatthe Council would be the " joint authority " for London.which would prepare the area plan, administer all thepublicly provided hospitals, and make contracts withthe voluntary hospitals for services within the plan.

The Council disapproves of the proposal for directExchequer payments to voluntary hospitals, and thesuggestion that these payments could perhaps be

pooled, because " such an arrangement might tend toencourage the collective organisation of the voluntaryhospitals in a body separate from, and independent of,the municipal hospitals." If the Government never-theless decide to pay voluntary hospitals directly, thepayments to each hospital " should be related solely tothe particular service rendered."The Council also raises the question whether national

insurance will confer on each individual the right todemand free treatment at any hospital or clinic whichcan admit him. What limits must be set to the freechoice of consultant and of hospital ? Many peopleliving outside the county boundary, and their doctors,have more faith in the hospitals of London than inhospitals nearer home.

"

Special contractual arrangements will therefore be neededfor many years for out-county patients, as the joint authoritiesconcerned will probably be unable for some time to come toprovide accommodation for the 40% of out-county patientshitherto using the central voluntary hospitals in London-andit may be that some out-county authorities will always preferto send certain of their patients to London. The question willtherefore arise whether the out-county authorities should makedirect arrangements with individual London-voluntary hos-pitals or whether, as would appear preferable, the Councilshould do it on their behalf and charge them. The lattermethod would seem to follow the line indicated in the white-paper. This will apply particularly to cases requiring special-ised treatment-e.g., to cancer cases needing radiotherapy.As mentioned later, a similar problem is involved in thevenereal disease scheme. A small committee containingrepresentatives of the Council and of the hospital authoritiesin the metropolitan area could usefully consider broad ques-tions of policy relating to hospital problems in the ’ catchment’area of the London voluntary hospitals. A lead as to theareas from which hospitals should draw their patients will nodoubt be given in the report of the hospital surveyors. In theabsence of collaboration, individual authorities might havean undue share of London beds."On the subject of general practice, the Council says

that " apart from the need for a new trend in under-graduate medical education, what has held back thedevelopment of a health ’ service and provided insteada service for sickness is that most doctors have had toomany patients. The work of getting them better hasleft insufficient time to go into why they were ill andwhat they should do to prevent a recurrence of theillness." If the health centre idea is to be a success,the premises must be really suitable and not makeshift.

" If the dual system under which general practitioners willbe engaged partly in group practice and partly in privatepractice is to be permitted, steps should be taken to ensure thatpatients using the public service are not at a disadvantagecompared with private patients."The Council wants to see one fully integrated health

service for the county, planned and controlled byitself, but it favours delegation to the metropolitanboroughs of (a) the maternity and child welfare work(non-institutional) which they now undertake, (b) theadministration of tuberculosis dispensaries, and (c)

epidemiological inquiries,’’ subject to a closer link with theCouncil’s laboratory services and its fever hospitals."

Early revision of the laws relating to lunacy andmental deficiency is recommended so that detailedproposals may be made for including mental healthservices in the comprehensive scheme.The figures given in an appendix to the white-paper

are thought to understate the probable cost of a com-prehensive service. The Council holds that local authori-ties administering health services should receive a shareof the money derived from national insurance contri-butions, and that after allowing for this share, not lessthan half their net expenditure- on these services shouldcome from the Exchequer. Special financial assistanceneeded by any local authority with low resources shouldbe the subject of a separate financing grant whichshould not be related to individual services.

" Unit grants of fixed annual amount per bed are inappro-priate for a continuously expanding hospital service. The

grant from the Government should be a uniform percentage ofthe whole expenditure by local authorities on all branchesof the new health service, including standard payments ’ tovoluntary hospitals and administrative costs, to ensure, interalia, that the cost of the expanding service may be reasonablyshared by central and local funds at every stage of the growingburden."

The Council, while remarking that " the originalconception of large authorities for all medical purposeswould have been much easier to administer," welcomesthe proposals as a considerable advance -towards theestablishment of a full health service for the people,which can, over a period of years, be built up, im-proved and developed. It hopes that the scheme willbe ready before demobilisation takes place. " Thereturning men and women from the Forces would thenfeel that something had been done to provide a betterEngland. The returning doctor who had been called .

up before he had settled iri practice could be offereda post in the new service and would not be called uponto find capital to purchase a practice." There is,however, a grave shortage of administrative staff capableof tackling a problem of this magnitude, and " it mightbe advisable, therefore, to operate the scheme in stages."Meanwhile the Council asks that it should be included

as a party to any negotiations between the Ministerof Health and the voluntary hospitals and the medicalprofession on matters likely to throw financial obliga-tions on it. ,

BARCLAY’S GEESE

WE have been asked to recall " Barclay’s witticism aboutthe geese," mentioned in our columns- last week (Lancet,Dec. 23, p. 828).

Dr. John Barclay, famous for his lectures on anatomy,delivered at Edinburgh at the beginning of the nineteenthcentury, spoke, to his class as follows :

’

" Gentlemen, while carrying on your work in the dissecting-’ *

room, beware of making anatomical discoveries ; and aboveall beware of rushing with them into print. Our-precursorshave left us little to discover. You may, perhaps, fall inwith a supernumerary muscle or tendon, a slight deviationor extra branchlet of an artery, or, perhaps, -a minute straytwig of a nerve-that will be all. But beware ! Publishthe fact, and ten chances to one you will have it shown thatyou have been forestalled long ago. Anatomy may belikened to a harvest-field. First come the reapers, who,entering upon the untrodden ground, cut down great storeof corn from all sides of them. These are the early anatomistsof modern Europe, such as Vesalius, Fallopius, Malpighi,and Harvey. Then come the gleaners, who gather up earsenough from the bare ridges to make a few loaves of bread.Such were the anatomists of last century-Valsalva, Cotun-nius, Haller, Winslow, Vicq d’Azyr, Camper, Hunter, andthe two Monros. Last of all come the geese, who still con-trive to pick up a few grains scattered here and there amongthe stubble, and waddle home in the evening, poor things,cackling with joy because of their success. Gentlemen, weare the geese." ,

Colonel J. W. VANREENEN, OBE, FRCSE, IMS, has beenappointed honorary physician to the King in succession toColonel R. V. Martin.