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partly upon the quantity of antibiotics with which thediscs are impregnated. The fact that certain labora-tories obtain equal zones of inhibition by this methoddoes not necessarily imply that the organisms are equallysensitive to therapeutically possible concentrations of theantibiotics concerned.Bernhard Baron Research Laboratories,Queen Charlotte’s Maternity Hospital,

London, W.6. ’. . CALMAN.R. M.CALMAN.Bernhard Baron Research Laboratories,Queen Charlotte’s Maternity Hospital,

London, W.6.

Parliament

The Bill in Committee

IN the motion on the Money Resolution to the NationalHealth Service Bill on April 3, Mr. GEOFFREY BINGsaid that the money resolution authorised the collectionof new charges and provided for the money to be paidto the Treasury. Yet under clause 6 of the Bill, it seemedto him that the Government proposed to pay some ofthese moneys to the hospital boards instead of into theTreasury. Mr. ANEURIN BEVAN asked if a regionalhospital board was entitled to use any receipts fromcharges made for, say, abdominal belts to be set offagainst the rest of their expenditures. Mr. H. F. C.OROOKSHANK replied that the present intention was thatcash recovered through the appliances account will bepaid into the Exchequer and will not be set off by thehospital boards. Mr. BEVAN construed this as meaningthat we were starting off the year with a severely con-tracted hospital service or would need a supplementaryestimate. Charges on appliances " will not assist thehospital authorities at all, but would automatically goto make up the 40 million for the general practitioners."

. A TIME-LIMIT

The House then went into committee, and Mr. H. A.MARQUAND moved an amendment limiting the operationof the Bill to April 1, 1954. If the Bill was being intro-duced to reduce Government expenditure in an emergencysurely we must look forward to a time when the emergencywould be over. He had chosen 1954 as...the time-limitbecause it would give the nation an opportunity to holda grand inquest on the N.H.S. after six years’ experience.Mr. ENOCH PowELL objected on the grounds that

patients might be tempted by such a proviso to hold backfrom getting treatment in the hope that they mightescape the charge. Mr. F. MESSER supported the amend-ment because he believed that if the N.H.S. was to be asuccess it must be comprehensive. The two years wouldgive us an opportunity to see where other economies

could be made. We must be clear, he said, whether thepurpose of the Bill was to act as a deterrent or to savemoney. He did not believe people went to hospital forfun. It might be inevitable, because the nation camefirst, that we were for the moment unable to give treat-ment to all who needed it, but if so let us limit theperiod. Mr. ARTHUR BLENKINSOP declared that if thecharges were intended to be permanent this was a changeof principle and not of detail. He reminded the com-mittee that, so far from being extravagant, we spend afar smaller proportion of our national income on healththan does the United States. Mr. HORACE KING pointedout that the clause gave the Minister power to makeregulations far beyond any of the charges he proposedat present. A Bill which conferred such wide powersshould surely be limited to two years.Mr. CROOKSHANK pointed out that though the Act of

1951 which dealt with appliances, including dentures andspectacles, had a time-limit, the Act of 1949, which tookpower to impose a charge for prescriptions on the generalpractitioners’ patients, had no limit. Because this newBill also dealt with prescriptions the Government haddecided it was reasonable that no limitation of timeshould appear in this Bill either. In reply to the questionwhether that meant the charges were permanent hewould remind the committee that they could by Order inCouncil vary the charges or direct that they should atany time cease to exist. He did not see why anyoneshould assume from this Bill that the charges wereintended to be permanent. We found ourselves in agreat national emergency, and this Bill was one of the

means by which we were trying to rectify the homesector of the emergency. The amendment was lost by276 votes to 263.

EXEMPTION OF OUTPATIENTS

Dr. EDITH SUMMERSKILL moved an amendment toexempt the hospital outpatient from the charge on drugsand medicines. The position of the outpatient, she held,was entirely different from that of the ordinary patient.She agreed that the drug bill was out of control, and thatmany people were enjoying too expensive prescriptions,but that was not the fault of the outpatient. Mr. ENOCHPOWELL held that excessive pressure on the generalpractitioners’ surgeries and on the outpatient depart-ments of our hospitals hung together and must be dealtwith together. But he felt that one of the big questionsraised by the Bill was the chronic sick. He thoughtthe right way to answer the problem was not by classi-fying the sickness of the patient or the resorts to whichhe went for treatment, but by concentrating on efficientmachinery for relieving need. Miss JENNIE LEE thoughtthe charges would be a temptation to sympatheticdoctors to overprescribe to save their patients’ money.She pointed out that if a prescription cost less than Is.a poor patient would be unable to reclaim the money.Miss PATRICIA HoRNSBY-SMiTH said that the Govern-ment felt that if a charge was to be made for prescriptionsit was not fair to exempt people who got their medicinefrom an outpatient department. There was the furtherdifficulty that some hospitals did not have a dispensingservice. If prescriptions in outpatient departmentswere free, pressure on hospitals would increase. Theaverage cost of a prescription was 3s. 8d. The I s.prescription was only a moderate proportion of this cost.She emphasised that if a patient thought his medicinecost less than Is. he was free to buy it outside thehealth service. Less than 1 in every 100 prescriptionscost less than Is. and most of those cost between 10d.and 11d. The amendment was rejected by 281 votesto 269.

Hospital Finance in the Newcastle RegionIn the House of Commons on April 1, Miss IRENE

WARD pointed out that though Newcastle upon TyneRegional Hospital Board served a population of 2,911,922,or approximately 6-64 % of the total population of

England and Wales, the money, running costs andcapital, allotted to the hospital service in the Newcastleregion for 1951-52 was £11,266,000 for regional hospitalboard hospitals and £1,156,567 for the teaching hospitals.That was approximately 5-1 % of the £243 millionallotted to the hospital service of the whole of Englandand Wales. Newcastle region was therefore gettingabout 23% less than its proper share. Whatever mightbe the reasons, good or bad, which before July, 1948,left some parts of the country with a good hospitalservice and other parts with a bad one, there could beno justification in the National Health Service formaintaining grossly different standards. On the popula-tion basis, and with the country’s present expenditureon the hospital service, Miss Ward contended that theNewcastle region should be getting, about £16 millionper annum instead of £12,422,000. She was gratefulto the Minister for the supplementary allocations,amounting in all to £150,000, made from the under-spending of other regions, but she felt the Newcastleregion’s basic allocation should be adjusted.

Miss PATRICIA HoItNSSY-SMITII, parliamentarysecretary to the Ministry of Health, pointed out that thelargest part of the gross sum allocated to regional hos-pital boards was used for revenue and maintenance anda smaller part for capital expenditure. The revenue formaintaining existing resources for staffing, wages,laundry, food, and the like within a hospital must berelated to the existing hospital resources and not to thepopulation. If there were not the nursing staff andthe hospitals grants for maintenance could not be

expected. Miss Ward’s claim for B16 million wasunrealistic in relation to the number of hospitals inthe Newcastle Regional Hospital Board’s area. Thisyear’s allocation of £12,359,000 to the board includedan amount for developments and improvements whichwas the second highest in the country. Also in that

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allocation was an additional .c200,000 which wouldenable the region to refrain from closing four maternityhospitals with 63 beds, and an infectious-diseases hospitalwith 30 beds, and would give the board a chance toopen the greater proportion of 546 beds many of whichwere for tuberculous patients. The amount availablefor capital investment programmes was severely limitedat present. For 1950-51 the Newcastle Regional HospitalBoard received £738,000, which included an additionalallocation of £224,000; in 1951-52, with the programmedrastically curtailed, they would receive a basic allow-ance of £384,000. The Newcastle region had 6 % of thestaffed beds in England and Wales, and the share ofcapital allocation given to them this year would be6.8% of the capital available for regional boards.

a QUESTION TIMECancer of the Lung

Mr. WILLIAM SHEPHERD asked the Minister of Health ifhe was aware that the arsenic content of English cigaretteshad been found to range twice as high as that of Americancigarettes and 25 times as high as that of Turkish andRhodesian cigarettes ; and whether, in view of the fact thatthere were grounds for the belief that this arsenic contentmight be the cause of the increasing incidence of cancer of thelung, he would regulate the entry into the country of tobaccohaving an unnecessarily high-arsenic content.-Miss PATRICIAHoRNSBY-SMITH replied : The Minister is aware that a

small-scale study showed these proportions, but I understandthe amounts were very small and varied widely in the sametypes of cigarettes. Also the Minister is advised that arsenicin tobacco smoke is not established as a likely cause of cancerof the lung, and that the great bulk of the tobacco used inBritish cigarettes comes from the countries mentioned inthe question.

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Replying to a further question Miss Hornsby-Smith statedthat international lung cancer statistics gave no indicationthat arsenic in cigarettes caused cancer, though one Turkishhospital had reported a high incidence of lung cancer.

Cancer PublicityMr. SHEPHERD asked the Minister if he had given con-

sideration to the desirability of education in the cancer field ;and what conclusions he had reached.-Miss HORNSBY-SMITH

replied : The Central Health Services Council have advisedme that it is undesirable at the present time for any cancerpublicity to be carried out by any central Government

organisation direct to the general public. The Minister ofHealth’s Cancer and Radiotherapy Standing Advisory Com-mittee are considering the merits of local schemes of cancereducation.

Dr. BARNETT STROSS: Will the hon. lady bear in mindthat the type of advice she has been given is in the mindsof many people wrong and that the public have a right toknow what dangers they face ? The more we know aboutit the better for all.

Mr. JoHN HYND : Can the hon. lady indicate how muchof the increase in deaths attributable to cancer is due to the

improvement in diagnosis ?Miss HoRNSBY-SMiTH : I would agree that there has been

_ a: considerable improvement in diagnosis in the early stagesof the incidence of cancer and that has substantially con-tributed to the increased figures. Taking the best medicaladvice at our disposal we do not think it is advisable toincrease public alarm. We are, however, using all endeavoursby the education of general practitioners in early diagnosisto encourage all possible methods of ascertaining the incidenceof this disease.

General PractitionersIn answer to a question Mr. H. F. C. CROOKSHANK said that

at Jan. 1, 1952, the number of general practitioners in GreatBritain receiving payment from the National Health Servicewas 20,859. Mr. KING: Is the Minister aware that his answermeans that the Danckwerts award proposes to increase theincome of doctors by 1:10 per week with 1:30 a week backmoney ?

Mr. KING further asked the Minister what sum of money waspaid in 1951, under the National Health Service, to generalpractitioners in Great Britain.-Mr. CROOKSHANK replied :Figures for the calendar year are not available, but for theyear ending March 31, 1951, the total amount payable togeneral medical practitioners in Great Britain for work doneunder the National Health Service is estimated to have been£51,644,000. Mr. KING: Is the Minister aware that his

answer indicates that the average income of the generalpractitioner from the National Health Service is £50 per weekand, while nobody would object to making up the moneyreceived by rural doctors and those with small lists, thereseems no justification for the amount proposed under theDanckwerts award ? ‘?

Accommodation for Permanent InvalidsMr. J. ENOCH POWELL asked the Minister how many

institutions existed under his control specifically for theaccommodation of permanent invalids in early and middlelife ; and what was the capacity of these institutions.—MissHORNSBY-SMITH replied : Two separate establishments with54 beds are now in process of conversion to this use. Fiveother special sections of larger hospitals provide 109 beds.and three more units with 72 beds are in various stages ofpreparation. The number of hospital patients in this groupis not large-possibly between 400 and 500 spread throughoutthe whole country.

Public Health

Yellow-fever InoculationsIN accordance with an international agreement, the

Government of the United Kingdom can insist on theinternational recognition of yellow-fever inoculationsperformed in this country only if : (a) they are done ata centre or by a medical practitioner specificallyauthorised by them for that purpose ; (b) the certificateis given on one of the international forms speciallysupplied to such centres or practitioners; and (e) a vaccineapproved by W.H.O. is used for the inoculation. Thecentres and others so authorised have to be notified tothe World Health Organisation, and the names are

published by W.H.O. to all countries so that theauthenticity of the certificates may be verified.

Authority to give yellow-fever inoculations is givenonly when the Ministry of Health is satisfied that specialstorage facilities for the vaccine are available and thatthe vaccinators are conversant with the necessarytechnique.

Certificates that do not comply with the above con-ditions will probably not be accepted by foreign healthauthorities ; and their holders may be put to greattrouble and inconvenience, and even be subject toisolation.A list of places at which yellow-fever inoculation can

be obtained free of charge will be found on the backofthe notice to travellers which is issued with all renewalsof passports ; and this list can be obtained from travelagencies or the Ministry of Health.

Scotland’s HealthThe best of Scotland’s health news for 1951 lis that for

the third year in succession there has been a substan-tial drop in the death-rate from respiratory tuberculosis,which now stands at 37 per 100,000 of the population(1884 deaths) as against 66 in 1948 (3415 deaths).The incidence, as measured by notification of new cases,also continues to fall, though not so rapidly. But this is

largely because the problem is being tackled at an earlierstage, and because the aim is to eliminate the diseaseand not merely reduce the death-rate. Even with thishandicap the provisional notification-rate for 1951 is 154(representing 7875 new notifications) as against 1M(8653 new notifications) in 1949.

Outside tuberculosis the year is described as " static."

The common infectious diseases remained at a low level,the health of the school-children was well maintained.and the infant-mortality rate-37 deaths per 1000 livebirths-was the lowest yet recorded. The crude death-rate rose slightly, but as the increase was in the higherage-groups, and was largely due to influenza and respiratory diseases, it is held to be more a reflection of thesevere weather in the early part of the year than of anydeterioration in the general health of the nation.The Scottish Health Services Council, whose report is

included with that of the Department of Health, hall,for some time been studying the increased number ofdeaths due to heart-disease among people under 60 and

1. Reports of the Department of Health for Scotland and Scotti,’jHealth Services Council, 1951. H.M. Stationery Office. 1952.Pp. 124. 3s. 6d.