CIRCULARS. ficate from the Medical Officer of the fact of his having duly vaccinated and inspected all the persons who have been registered as vaccinated within the period to which the certificate applies. This will save a considerable amount of labour to the Medical Officer, while, at the same time, as the Vaccination Register is required by Art. 21, x., to be open at all reasonable times to inspection by members of the Board of Guardians and the Dispensary Committee, there will be ample opportu nity for examining the register as to individual cases. 5. Form I (Medical Officer's Report Book) has been slightly modified, and is intended to contain a record of the Medical Officer's attendances at the dispensary, and of any matter which he may think it necessary to bring under the notice of the Committee. 6. Form L (Medical Officer's Quarterly Return) has been very slightly altered, and it will be seen by Art. 21, xiv., that he is to forward it to the Commissioners immediately after the close of the quarter, and to lay a copy of it before the Committee at their next ordinary meeting. This course will prevent the inconvenience which has sometimes arisen from delaying the return until it had been submitted to the Committee, while the Committee will have the information before them at as early a period as under the former regulation. 7. In regard to the Estimate for Medicines, serious inconvenience has sometimes arisen, where, owing to irregular meetings on the part of the Committee, the Medical Officer has been unable to obtain their approval of the estimate before forwarding it to the Board of Guardians; an alteration has therefore been made in the regulation in this respect. The new regulation (Art. 21, vi.,) while it maintains the existing practice, as a general rule, of forwarding the estimate to the Board of Guardians through the Committee, authorizes the Medical Officer in cases of urgency to forward his estimate direct to the Board of Guardians. 8. With a view to the more effectual carrying out of the provisions of the Compulsory Vacci- CIRCULARS. By order of the Commissioners, To the Clerk of each Union. No. 2.-EXTRACTS from CIRCULAR of INSTRUCTIONS to MEDICAL OFFICERS of DISPENSARIES, dated 22nd December, 1853. 4. The Commissioners desire further to point out, as already intimated in the Instructions issued on a former occasion, that a Ticket for Medical Relief continues in force until it is cancelled by the Committee, in pursuance of the proviso in § 9 of the Act, or as long as the patient continues to present himself at the Dispensary, in the case of a Ticket in the Form E 1, or until the termination of the case, if the Ticket be a Visiting Ticket in the Form E 2 ; and in the latter case, the Medical Officer is bound to continue his attendance in pursuance of a Visiting Ticket until such attendance is no longer required. If the Medical Officer have reason to believe any case to be an unfit one for the continuance of medical relief, it is competent to him at any time to report the circumstances of the case to the Committee for their directions; and with the view of enabling the Medical Officer to discharge any patient from the books [in cases of cessation of attendance at the Dispensary], it may CIRCULARS. be necessary for the Committee to adopt some rule or instruction for his guidance in this respect, in cases where the patient ceases to attend for a given period, without being discharged as cured, and without his case being recorded accordingly. In some instances, it seems to have been considered that if a person has not presented himself at the Dispensary for a fortnight, and in some cases for a period as short as ten days, he should be considered as no longer under treatment; but the Commissioners are disposed to think that this period is too short; and they have addressed the Dispensary Committee accordingly. 5. A difficulty also arises in reference to the filling up of column 14a of the Medical Relief Register, headed "Result (as relieved, cured, died, &c.),” where the patient ceases to attend at the Dispensary without apprizing the Medical Officer. In the case of patients attended by the Medical Officer at their own homes, he will be able readily to record the result of a case which he so attends to its termination. With respect to patients attended at the Dispensary, in case of uncertainty as to the result after their last attendance there, and where the Medical Officer is not enabled to record their cure, or other ascertained result, he should enter in column 14a of the Register, the words "no further appearance," after the date of last attendance, or make some similar entry according to the facts of the case." No. 3.-EXTRACTS from CIRCULAR of INSTRUC- 5. It has been represented to the Commissioners that in some cases Committees of Management have not held their ordinary meetings regularly, owing to the want of attendance of what they deemed a sufficient number of Members to constitute a Column 10 in the new Form. a meeting; and the Commissioners have received CIRCULARS. inquiries as to the number of Members that may constitute a quorum or a meeting of the Committee. In the absence of any provision on this point in the Act, the Commissioners have expressed their opinion in reply to inquiries on the subject, that inasmuch as the Act does not declare any number of members of the Committee to be a quorum, they consider that two members will constitute a valid meeting of the Committee, and be competent to discharge the ordinary business; but that one Member could not, in the opinion of the Commissioners, examine and sign the Register of Cases of Medical Relief, and discharge the duty devolved on the Committee under §9 of the Act. 8. The Commissioners request the special attention of the Committee to the following passage in the accompanying Instructions to Medical Officers: "A Ticket for Medical Relief continues in force until it is cancelled by the Committee, in pursuance of the proviso in § 9 of the Act, or as long as the patient continues to present himself at the Dispensary, in the case of a Ticket in the Form E 1, or until the termination of the case, if the Ticket be a Visiting Ticket in the Form E 2; and in the latter case, the Medical Officer is bound to continue his attendance in pursuance of a Visiting Ticket, until such attendance is no longer required. If the Medical Officer have reason to believe any case to be an unfit one for the continuance of medical relief, it is competent to him at any time to report the circumstances of the case to the Committee for their directions; and with the view of enabling the Medical Officer to discharge any patient from the books [in cases of cessation of attendance at the Dispensary], it may be necessary for the Committee to adopt some rule or instruction for his guidance in this respect, in cases where the patient ceases to attend for a given period, without being discharged as cured, and without his case being recorded accordingly. In some instances, it seems to have been considered that if a person has not presented himself at the Dispensary for a fortnight, and in some cases for a period as short as ten days, he should be considered as no longer under treatment; but the Commissioners are disposed to think that this period is too short." CIRCULARS. No. 4.-MEDICAL RELIEF given without TICKETS -CIRCULAR to DISPENSARY MEDICAL OFFICERS -3rd September, 1869. Poor Law Commission Office, Dublin, 3rd September, 1869. SIR,-The attention of the Commissioners for administering the Laws for Relief of the Poor in Ireland has been drawn to the irregular manner in which medical relief has been dispensed in some Dispensary Districts, and the imperfect way in which the Register of cases relieved has been kept by some of the Medical Officers. In the Districts referred to a practice appears to have prevailed of affording medical treatment to sick persons without requiring them to procure and present tickets from any of the several persons authorized to give them. In some of these instances the Medical Officer registers the case, and in others the case is altogether omitted from the Dispensary records. Where the Medical Officer has adopted the latter course, the returns furnished to the Commissioners from the Registers have not correctly represented the number of persons who had obtained relief under the Medical Charities Act, and in both classes of cases the medicines belonging to the union have been improperly made use of, there being no authority to dispense those medicines without a ticket. The Commissioners think it right, therefore, to point out specially to each Dispensary Medical Officer, that the practice of giving medical relief without the production of a ticket signed by a person duly entitled to give tickets for medical relief under the Medical Charities Act is irregular, and not authorized by the provisions of that Act. Cases of urgency may occur in which the delay necessary to obtain a ticket might be of serious consequence, and in cases which are of this description the Medical Officer will act at once on his own responsibility; but in such instances he ought to require the applicants to procure tickets, and present them as soon afterwards as possible. |