such as can suitably be dealt with therein, some cases in an early stage of the disease are admitted which should preferably be treated in a residential institution under the Association's scheme. As the Guardians are aware, whilst the Association are not under an obligation to provide residential treatment for particular individuals, or for cases for which the approved accommodation provided under their scheme is not suitable, it rests with the Association to consider applications for residential treatment from any persons suffering from tuberculosis who are resident in Wales and Monmouthshire and for whom suitable accommodation under their approved scheme is available. Such applications are considered on the recommendation, in the first instance, of the Tuberculosis Physician, and it is, therefore, desirable that, when application for admission to a Poor Law Institution is made in respect of a person who appears to the Medical Officer of the Institution to require treatment for which the Association have facilities, and particularly in cases in a stage of tuberculosis which affords a reasonable prospect of arrest of the disease, the Tuberculosis Physician should be requested to examine the patient, either before admission to the Institution, or, if there are reasons for immediate admission, as soon as possible after admission has taken place, with a view to his considering whether the case is one in which he should make a recommendation for resi dential treatment to the Association. I am, Sir, Your obedient Servant, H. W. F. FRANCIS, The Clerk to the Guardians. Circular 634. MINISTRY OF HEALTH, Whitehall, S. W. 1. 17th November, 1925. INTERNATIONAL AGREEMENT FOR THE TREATMENT OF SEAMEN SUFFERING FROM VENEREAL DISEASE. SIR, 1. I am directed by the Minister of Health to state that an International Agreement relating to the treatment of venereal diseases amongst seamen has recently been ratified by His Majesty on behalf of Great Britain and Northern Ireland. Under this agreement the contracting parties undertake that facilities shall be available, at each of their chief sea and river ports, for the gratuitous treatment of merchant seamen, without distinction of nationality; and such facilities are to include out-patient treatment, in-patient treatment when the Medical Officer of the Treatment Centre considers it to be necessary, and sufficient medical supplies to carry out necessary treatment during the voyage to the next port of call. The agreement also requires that each patient shall be supplied with a card for the purpose of providing a brief record of the diagnosis of the patient's case, the treatment given and the treatment to be followed during the course of the voyage. 2. It will be appreciated that, apart from the provision of medical supplies to carry out treatment during the voyage to the next port of call, the necessary arrangements are already in force in this country, and the Minister will be prepared to approve the supply to a seaman patient for the purpose of his treatment during the voyage to the next port of call, of such drugs, dressings and appliances as the Medical Officer of the Treatment Centre considers necessary, and as, in his opinion, can safely be used by the patient himself. Among the drugs the following may be mentioned:-Potassium permanganate, Sandal-wood oil, Copaiba and Cubebs in capsules or mixture, Calomel ointment, Mercurial pills and Mercurial ointment for inunction. Where the existing agreement with the Authorities of the Hospital at which the Treatment Centre has been established provides for the actual cost of drugs, dressings and appliances being defrayed by the local authority, no modification of the agreement will be required. In other cases, the Minister will be prepared to consider proposals for any necessary amendment of the agreement. 3. The Minister would also be prepared to approve the gratuitous supply to ships' doctors of approved arsenobenzol compounds by the Local Authorities of the home ports from which ships carrying doctors sail, provided that the doctors possess one or other of the qualifications set out in the Circular letter issued by the Local Government Board on the 29th August, 1916. It will not, however, be practicable, as in the case of other medical practitioners, for a ship's doctor to ask for a supply on Form V.2 for the treatment of a particular patient, and arrangements should be made for the supply, on application, of the number of doses which may reasonably be required, having regard to the probable number of cases of syphilis to be treated and the length of the voyage. Before a supply for a subsequent voyage is issued to a ship's doctor, a return should be obtained as to the number of persons treated on the previous voyage and the total number of doses administered. The attention of the doctor should be drawn to the necessity of storing the ampoules in a cool place. It is 4. As the Council are aware, a form of card (Form V. 15) is already in use for the purpose of providing a brief record of the diagnosis of a seaman's case and of the treatment given. requested that in future, when it is necessary to provide a seaman with a further card, the revised form (Form V. 44) may be issued to him. This form has been designed on an international model, and the abbreviations used differ from those employed in Form V.15 The abbreviations which are not explained in the form are as follows: B indicates Gonorrhea (Blennorrhagia). S C Syphilis. A copy of Form V. 44 is enclosed, and further copies can be obtained on application to this Department, but Form V.15 should continue to be used in the case of patients, other than seamen, who remove from one area to another. 5. A list of Treatment Centres in the chief ports throughout the world, which has been prepared by the British Social Hygiene Council, is enclosed, and it is requested that information as to the address of the Treatment Centre and the hours of the Clinics at the port to which the seaman is proceeding may be given to the patient. It will be seen from the list that charges are made to seamen for treatment in some countries which have not yet adhered to the International Agreement. 6. A copy of a Circular Letter which has been addressed to Port and Riparian Sanitary Authorities is enclosed for information, and it is requested that the Local Authority will make arrangements for a supply to the Port or Riparian Authority of the notices referred to in that Circular Letter. A copy of this Circular has been sent to the Authorities of approved Treatment Centres. I am, Sir, The Clerk of the Council, or the Town Clerk. Your obedient Servant, Af. Fraclachen Assistant Secretary. CIRCULAR 636. (England and Wales.) MINISTRY OF HEALTH, Sir, WHITEHALL, S. W. 1, 20TH NOVEMBER, 1925. I AM directed by the Minister of Health to refer to the Circular Letter which was sent to Local Authorities in May 1922 (see Appendix (A)), in which it was stated that it would be for Local Authorities to make such arrangements for the maintenance of local services as might be thought to be required in the event of need arising The events of recent years have shown that an industrial dispute may be so extended as to interfere seriously with communications, the conveyance of food and of other necessities. the supply of light and power and the health and means of livelihood of the population at large. While it is desirable that Government authorities, whether central or local, should keep aloof from any industrial dispute so far as it affects only the employers and the employed in the industry concerned, it is essential that other members of the community should be protected from the dangers and inconveniences of such a situation as is here indicated. This protection can best be supplied by decentralised organisation designed to secure the maintenance of services essential to the well-being of the community. Should such an emergency occur it is to their Local Authorities that the people will naturally turn for help in the difficulties which they may have to meet, and in order that any action initiated locally may harmonise with the national measures which the Government consider it desirable to take they think it necessary now to communicate to Local Authorities the following outline of the organisation which would be brought into operation by the Government to deal with essential services which are not purely local in character. This outline will, if it be necessary, be supplemented by further details in a later communication. By "emergency is meant a state of affairs necessitating the issue of a Proclamation under the Emergency Powers Act, 1920, as a preliminary to the issue of Regulations 'for securing the essentials of life to the country." The organisation which the Government propose is designed to supplement and to assist in an emergency the normal methods of communication, supply and distribution and to give to all those who can help an opportunity of doing so in the manner most required. It is not intended that the Government should substitute new machinery for that ordinarily existing to meet the essential needs of the community. 1. A Minister will in such an emergency act as Civil Commissioner on behalf of the Government in each of ten Divisions covering the whole of England and Wales. He will be assisted by a staff consisting mainly of representatives of the Departments of Government concerned and dealing with the following subjects: Transport; Food; Postal Services; Coal. It will be the duty of the Civil Commissioner and his staff during the emergency to keep in touch with the Local Authorities in each Division and to be available for consultation by them; and he will be empowered if necessary to give decisions on behalf of the Government. The towns in which Civil Commissioners will be stationed and the general outlines of the areas of the Divisions for which they will act are set out in Appendix (B). The Officers who will act as the Chief Assistants to the Civil Commissioners and those who will act as Technical Representatives for the services mentioned have been appointed, and these Officers will, as requisite, put themselves in touch with representatives of Local Authorities, and provide them with such information as may be practicable in regard to details of the organisation. 2. Each Division is divided into suitable areas for administering essential national services and, if considered necessary, for recruiting volunteers for those purposes. In each area there will on an emergency be a local Food Officer, a local Road Officer and a Haulage Committee and a Coal Emergency Officer, besides representatives (where required) for other essential services. There will also be a Chairman selected by the Government to convene and preside over a Volunteer Service Committee in each area for the recruitment of volunteers to assist in maintaining essential national services. In any town in which the Chairman of the Committee might consider it necessary to open a recruiting centre, it is earnestly hoped that it would be found practicable for the Local Authority concerned to combine with him in making the centre available for recruiting both for national and for local purposes, allocating by arrangement volunteers to local and national services in accordance with their qualifications and the needs of the occasion. Local Authorities are not expected to take any action so far as national services are concerned, unless and until approached by the Chairman. 3. On an emergency arising reliance will be placed to the utmost extent upon normal channels for the supply and distribution of food, and to this end the Divisional Food Representative upon the Civil Commissioner's staff will arrange for consultation with the principal traders as to the stocks of essential food stuffs in their possession or in transit. In the event of any shortage or delay in the supply of essential food-stuffs to the Division, the Food Representative will be in possession of information as to alternative sources of supply and the means to make them available. Local distribution and local shortages not affecting national supplies will ordinarily be dealt with by the local Food Officer. 4. Road Transport will be dealt with on similar lines. The Road Commissioner upon the Civil Commissioner's staff will be assisted by Road Officers and Haulage Committees in each of the areas comprised in the Division, who will endeavour by voluntary arrangement to promote the economical use of existing vehicles and where necessary the diversion of vehicles from less to more important services. Road Commissioners and Road Officers will be furnished with powers to this end should the exercise of such powers prove necessary. 5. In an emergency full directions will be sent as to the supply and distribution of coal. These directions may, if necessary, limit the supply of coal obtainable |