1679THE MEDICAL PROFESSION AND THE NATIONAL INSURANCE ACT.

THE ANNUAL MEETING OF FELLOWS ANDMEMBERS OF THE ROYAL COLLEGE

OF SURGEONS OF ENGLAND.To the Edito’l’ of THE LANCET.

SIR,-In your issue of Nov. 30th last an account is givenof the exceptionally interesting proceedings at the annualmeeting of Fellows and Members at the Royal College ofSurgeons of England on Nov. 21st last. On p. 1533, firstcolumn, your account says, I I When the resolution was putto the meeting it was carried." May I point out that Mr.H. Nelson Hardy’s resolution was not carried, but the amend-ment proposed by Dr. W. G. Dickinson, which statedthat the meeting approved of the action of the Council ofthe Royal College of Surgeons so far as it has gone." " A

stinging satire 1I am. Sir. vours faithfullv.

SIDNEY C. LAWRENCE,Honorary Secretary, Society of Members of the Royal

12 College of Surgeons of England.1:1

Dec. 10th, 1912

* We much regret the slip by which the words " as

amended " were omitted after " resolution."-ED. L.

MALAGA AS A HEALTH RESORT.To the Editor of THE LANCET.

SIR,-In THE LANCET of Oct. 23rd, 1909, p. 1256, appeareda short note referring to the recommendation of Malaga as awinter resort by Mr. Staniforth, British Consul in that city.It is true that patients are sometimes sent to Malaga underthe impression that this place is an ideal resort for certainchest complaints. However bountiful Nature may havebeen in endowing Malaga with her best gifts, man hashardly done his share towards making it a suitable place ofresidence for invalids. Malaga consists of practically twoparts-the town with the port and, to the east, the suburb of’’ La Caleta." In the former part are two fine avenues, breath-ing spaces for the populace of the dirty and insanitary town.Off these two avenues one tumbles into uneven and uncleanstreets filled with a medley of people-the smart officer inloosely fitting uniform at one end of the scale, the grimyand persistent beggar at the other. Malaga streets androads are veritable traps for unwary feet. There are holesin the roadway and holes in the side walks. Stones arethrown down like rubbish into an ashpit and are left to be

trampled in by the traffic. Every sort of garbage seems- tofind its way into Malaga streets. Escaping eastward thetraveller suddenly comes upon two gateposts with the in-scription British Cemetery." This marks the beginningof the invalid quarter of Malaga, °° La Caleta." " It is rathera pretty spot, with trees and tombs extending up a hillside. English and German names only are seen upon thegravestones in the Protestant burial place. From this land-mark one passes along a dusty and uneven road through thesuburb. Here it is that invalids are recommended to stayand bask in the sun by the sea. The sun truly shines,but the seashore is cut off by a row of villas, while beyondthese there is a single line of railway within a foot or so ofthe water’s edge. An electric tramway runs along the roadin front of the villas, and on the other side of the road aresome picturesque houses, rising one above the other, on thesloping ground. A narrow roadway zigzags up the hill andleads to some fairly good pensions. It might be well for apatient to be perched up here, but the ascent is a severeeffort, and below one encounters an almost perpetual cloud ofdust which irritates the air passages. The Limonar is avilla-lined avenue at right angles to the main road of theCaleta. It is a pretty part, with beautifully planned gardensto each house. The effect, however, is spoilt by the stateof the roads which cross it. They are the dust-holesof the villas round the corner. Their condition shocks botheye and nose. One notices all over this district a dividingline between private enterprise and the general slackness ofthe public authorities. The most picturesque part of thissuburb is the " Miramar " further east. Here attempts havebeen made to lay out and develop the natural beauty of thehills. Some pretty villas with coloured tiled roofs have beenbuilt here, amidst a luxuriance of mimosa trees. One ofthese houses, belonging to a German doctor, is, I believe,run as a sanatorium. The climate of Malaga is equable,

mild, and exceptionally dry. The annual number of rainydays is 52 ; only 40 days in the year are cloudy, while 195are entirely cloudless. The north wind, ° Terral," is icilycold in winter, and when it is blowing the warmth-seekinginvalid has to keep indoors. Nature has given Malaga a fineclimate and natural beauty in luxuriant vegetation, but thedrawbacks to living here for the invalid are the utter neglectof cleanliness in the streets, the almost perpetual dust, andthe inefficiency of the drainage system. At the present timethere seems no prospect of improvement. Invalids are notwanted in Malaga. I am, Sir, yours faithfully,Nov. 30th, 1912. M.D.

THE MEDICAL PROFESSION AND THENATIONAL INSURANCE ACT.

To the Editor of THE LANCET.

SIR,-Almost every day fresh evidence comes to me of theserious injury inflicted on our cause by the want of a widelycirculated plain statement to the public of the reasons forour resistance to the injurious proposals made to us. Not

only does it prejudice our case directly by allowing anadverse public opinion to grow up-the natural product ofunanswered misrepresentation- but it indirectly endangers.our own morale through the depressing influence of such a,public opinion. A clear, concise pr6cis of our reasons,handed to the editor of every important newspaper in thecountry by a deputation of his own medical acquaintances,asking for a favourable leading article, could not fail torender yeoman service just now.

I am. Sir. vours faithfully.

I Exeter, Dec. 2nd, 1912. W. GORDON.

To the Editor of THE LANCET.

SIR,-The results of the past fortnight’s negotiations have-not materially affected the sacrifices which we are bound.now to accept finally if we consent to work the InsuranceAct on the principles irrevocably embodied in that Act and!its attached Regulations.

1. We must accept the insurance risk inherent in the-

acceptance of fixed pay for unknown and increasing work.On the consequences of this proposition, which to some ofus seems so illogical and suicidal, much has been written,.inour press ; but they will not deter anyone who, in thenatural desire to end our uncertainties by a definite agree-ment, is short-sighted enough to accept all the legal restric-tions of the great contract now offered to us. Incidentallythe cardinal principle of our determining the mode ofremuneration drops out.

2. We must accept a statutory legal obligation to attendall calls ; a condition absolutely novel to our profession, and,destructive of our freedom and of the proper relationsbetween patient and doctor. On this also volumes might be-written.

3. We must accept dependence on Insurance Committees as,our masters and paymasters, committees which, with 10 percent. of medical members added, still remain substantiallyour old masters the Friendly Societies, with the added power-of (1) enormously increased numbers, (2) State-aided finance,and (3) legal compulsion. on their side, confirmed and rati--fied by our formal acceptance of the position. Bang goesanother cardinal point.

4. We must accept the servitude of Regulations under-liability to legal penalties and legal obligations. These

Regulations, absolutely necessary under a panel system,however revolting- to our instincts, have the force of law, but,,unlike law, can be added to or altered or increased from.time to time by the Commissioners. Bureaucracy per-manently supersedes law so far as our liberties are-

concerned.5. We must accept the legal duty of attending committees,-

both insurance and medical, now and in all future time,which will be impossible for busy practitioners, who there--fore now give up definitely all practical safeguard to theirinterests for the future.

6. We busy practitioners must accept the liability tovexatious legal processes of complaint, costly both to ourtime and our pockets, by beneficiaries who will occupy theadvantageous position of being (a) unemployed because sick.and (b) possessed on their side of the legal assistance andpurse of the State. The existing power of free practitioners