No. 1/1942:

DEPARTMENT OF LOCAL GOVERNMENT AND PUBLIC HEALTH. THE PUBLIC ASSISTANCE (MEDICAL ASSISTANCE IN DISPENSARY DISTRICTS) ORDER, 1942.

DEPARTMENT OF LOCAL GOVERNMENT AND PUBLIC HEALTH. THE PUBLIC ASSISTANCE (MEDICAL ASSISTANCE IN DISPENSARY DISTRICTS) ORDER, 1942.

ARRANGEMENT OF ARTICLES.

1. Short title and commencement.

2. Definitions.

3. Issue of medical assistance tickets.

4. Cancellation of medical assistance tickets.

5. List of persons authorised to issue tickets.

6. Return of medical assistance tickets.

7. Appointment of wardens.

8. Forms of medical assistance tickets.

9. Period for which medical assistance tickets continue in force.

10. Midwifery cases.

11. Scale of fees of medical officer for attendance in his private capacity on persons unable to pay the usual fees.

12. Appointment of officers.

13. Prohibition of taking of fees or payments by officers of dispensary districts.

14. Summoning of extra professional assistance.

15. Duties of medical officer.

16. Duties of compounder of medicine.

17. Duties of midwife.

18. Heating of dispensaries.

19. Half-yearly statement of expenses.

20. List of contractors to be furnished to medical officers.

21. Notice of dispensary arrangements.

22. Notice board for each dispensary.

SCHEDULE.

DEPARTMENT OF LOCAL GOVERNMENT AND PUBLIC HEALTH.

THE PUBLIC ASSISTANCE ACT, 1939.

THE PUBLIC ASSISTANCE (MEDICAL ASSISTANCE IN DISPENSARY DISTRICTS) ORDER, 1942.

REGULATIONS

The Minister for Local Government and Public Health in exercise of the powers vested in him by the Public Assistance Act, 1939 , and the Local Government Act, 1941 , and of all other powers in this behalf enabling him does by this his Order make the following regulations, that is to say :—

1.—(1) This Order may be cited as the Public Assistance (Medical Assistance in Dispensary Districts) Order, 1942.

(2) This Order shall come into operation on the commencement of the Public Assistance Act, 1939 .

2. In this Order unless the context otherwise requires :— the expression "the Minister" means the Minister for Local Government and Public Health ; the expression "prescribed" means prescribed by the Minister.

3.—(1) Subject to the provisions of this Order every member of a public assistance authority and every person appointed under this Order to be a warden for a dispensary district and every assistance officer of a public assistance authority shall have power to afford medical assistance in a dispensary district to a person eligible therefor by the issue of a ticket (hereinafter referred to as "a medical assistance ticket") in such one of the forms prescribed by this Order as may be appropriate, addressed to the medical officer or to the midwife of the dispensary district (as the case may require) in which such person is resident.

(2) A person empowered to issue medical assistance tickets shall not delegate that power to others ; and shall not sign any such ticket in blank nor leave it to be filled up by any other person.

(3) A member of a public assistance authority shall not issue a medical assistance ticket in respect of a person who is not resident in the dispensary district in which such member resides.

(4) A warden shall not issue a medical assistance ticket addressed to the medical officer or midwife of any dispensary district other than that for which he is appointed to act as warden.

(5) An assistance officer shall not issue a medical assistance ticket addressed to the medical officer or midwife of any dispensary district which is not included in his assistance district.

4.—(1) A public assistance authority shall, in any case in which it is satisfied that a person to whom a medical assistance ticket has been issued, is not a person eligible for medical assistance, or is not a fit object for such assistance, cancel such ticket but shall thereupon notify, in writing, such person, the medical officer of the dispensary district concerned and the issuer of the ticket, of such cancellation.

(2) A person by whom a medical assistance ticket is issued shall, in any case in which he is satisfied that the person to whom the ticket was issued, is not a person eligible for medical assistance, or is not a fit object for such assistance, cancel such ticket but shall thereupon notify, in writing, such person and the medical officer of the dispensary district concerned of such cancellation.

5. The public assistance authority shall cause each medical officer of a dispensary district to be furnished with a list showing the names and residences of all persons from time to time entitled to issue medical assistance tickets in his district and shall cause such medical officer to be notified of any changes from time to time to be made therein.

6. Whenever any person ceases to be entitled to issue medical assistance tickets, the public assistance authority shall notify such person accordingly and secure the return of any unused forms of the tickets.

7.—(1) A public assistance authority shall for the purposes of this Order, from time to time appoint a sufficient number of persons, to be known as wardens, for each dispensary district of the public assistance district of such authority.

(2) A warden of a dispensary district of a public assistance district shall unless he dies, resigns, or is removed by the public assistance authority, or otherwise ceases to hold office, hold office for such period as the public assistance authority shall, at the time of appointment, determine.

8.—(1) A medical assistance ticket issued under this Order shall :—

(a) if medical assistance is to be given to the patient only at a dispensary of a dispensary district, be in the Form No. 1 in the Schedule to this Order ;

(b) if medical assistance is to be given at the home of the patient or elsewhere, be in the Form No. 2 in the Schedule to this Order ;

(c) if the case is a midwifery case in which the attendance of a midwife is required at the home of the patient, be in the Form No. 3 in the Schedule to this Order.

(2) The public assistance authority shall cause, medical assistance tickets to be bound up in check books with duplicate counterfoils, and to be printed in accordance with the prescribed directions.

9.—(1) Every medical assistance ticket shall continue in force until whichever of the following events shall first occur :—

(a) the cancellation of the ticket by the issuer or by the public assistance authority ;

(b) the cesser of the patient to attend at the dispensary, if the ticket issued is in the Form No. 1 in the Schedule to this Order ;

(c) the termination of the case, if the ticket issued is in the Form No. 2 or Form No. 3 in the Schedule to this Order ; or

(d) the expiration of three months from the date of issue of the ticket.

(2) For the purposes of this regulation a patient shall be deemed to have ceased to attend a dispensary if he has not attended thereat during a period of one month.

10.—(1) A visiting medical assistance ticket issued in the Form No. 2 in the Schedule to this Order, in a case of midwifery shall be deemed to cast on the medical officer of a dispensary district receiving it a full and undivided responsibility for the care of the case, notwithstanding the fact that a midwife is appointed for the service of the district, and the fact that the services of the midwife are available shall not be deemed to relieve the medical officer from such responsibility.

(2) For the purposes of this Order cases of abortion or miscarriage shall be deemed to be midwifery cases.

(3) The following provisions shall apply in all cases in which medical assistance is required by medical assistance ticket for women in labour :—

(i) the ticket should ordinarily be addressed to the midwife of the dispensary district ;

(ii) the ticket, if in the Form No. 2 in the Schedule to this Order shall be presented to the medical officer of the dispensary district, who shall register it and ascertain by visiting the patient that the case is one of natural labour ;

(iii) if it should appear on such visit that the case is likely to be attended with any difficulty or danger, the medical officer of the dispensary district shall take charge of the case himself, and may also requisition the services of the midwife of the dispensary district ; but if the medical officer is satisfied that the case is one of normal labour, he may place the midwife in attendance directing her that should anything abnormal or dangerous arise, she shall immediately call for his assistance ;

(iv) the ticket, if in the Form No. 3 in the Schedule to this Order, shall be presented to the midwife of the dispensary district, who shall duly and punctually attend thereon ;

(v) if in any case attended upon a ticket whether in the Form No. 2 or the Form No. 3 in the Schedule to this Order, the midwife of the dispensary district finds it necessary to call for the assistance of the medical officer of the dispensary district, and shall intimate, in writing, the same to him, the medical officer shall immediately take charge of the case.

11. For the purpose of enabling persons empowered by this Order to issue medical assistance tickets, to be in a better position to judge whether an applicant for medical assistance is a person eligible therefor, the public assistance authority may invite each medical officer of a dispensary district to furnish in writing, a scale of charges for attendance upon persons whose circumstances would not admit of their paying the usual fees of the medical officer in his private capacity, and a copy of every such scale of fees, if furnished to the authority, shall be supplied by the authority to each such person concerned. Any such scale of fees, furnished by a medical officer of a dispensary district shall be regarded as operative until withdrawn by such medical officer.

12.—(1) A public assistance authority shall appoint for the service of each dispensary district in its public assistance district such number of suitable persons to hold the following offices or any of them, as the Minister may direct :—

1. Medical officer ;

2. Midwife ;

3. Compounder of medicine ; and

4. Dispensary nurse.

(2) Unless and until the Minister shall otherwise direct, the number of medical officers, midwives, compounders of medicine and dispensary nurses to be appointed by a public assistance authority for the service of any dispensary district in its public assistance district shall be such number as shall have been directed to be appointed therefor immediately before the commencement of this Order.

13. An officer of a dispensary district shall not demand or receive any fee or payment for his services from any person entitled to medical assistance by virtue of the possession of a medical assistance ticket.

14.—(1) Whenever, in the course of his attendance upon dispensary patients, a case arises, which, in the opinion of the medical officer of a dispensary district necessitates his obtaining the assistance of another medical practitioner the medical officer may, on his own authority, summon the assistance of such other medical practitioner and shall thereupon report fully in writing the circumstances to the public assistance authority.

(2) If the public assistance authority on consideration of the report of the medical officer is satisfied that the employment by the medical officer of the dispensary district of such other medical practitioner as aforesaid, was necessary, the authority shall allow payment of a fee to such medical practitioner not exceeding the appropriate fee prescribed by the scale referred to in paragraph (3) hereof, either by way of refund to the medical officer, if such fee has been paid by him or otherwise.

(3) A public assistance authority shall, subject to the approval of the Minister, or the Minister may, in case of neglect or default by the authority, fix a scale of the fees to be allowed by the authority under this regulation, for the rendering of assistance by a medical practitioner, both in the day time and at night, and a copy of such scale shall be furnished by the authority to each medical officer of a dispensary district.

(4) Any dispute which shall arise as to whether the summoning of a medical practitioner by a medical officer was necessary or as to the amount of the fee payable to such medical practitioner under this regulation shall be determined by the Minister, whose decision shall be final and conclusive.

15.—(i) In this regulation references to a dispensary district shall in relation to a medical officer to whom a division of a dispensary district has been assigned be construed as a reference to such division.

(ii) The duties of every medical officer of a dispensary district shall be as follows, that is to say :—

(1) To attend punctually at each dispensary of the district under his charge, on such days and during such hours as the Minister may approve or direct, and to continue in attendance thereat during the fixed hours and, when necessary, for such further time as may be sufficient to permit of his discharging properly and carefully the duties devolving upon him as medical officer.

(2) To afford medical assistance and advice to any person resident in the district, either :—

(a) at a dispensary, if such person attends thereat and presents a medical assistance ticket therefor in the Form No. 1 in the Schedule to this Order ; or

(b) at the home of such person or elsewhere, as the case may require, if a medical assistance ticket is presented to him on behalf of such person in the Form No. 2 in the Schedule to this Order.

(3) To continue in attendance on any person by whom or on whose behalf a ticket has been presented to him as aforesaid, until his services are no longer required or the ticket ceases to be in force.

(4) If any patient, in the opinion of the medical officer, be an unfit object for medical assistance, forthwith to report the circumstances of the case to the issuer of the medical assistance ticket, with a view to the cancellation thereof and, if he thinks proper, also to the public assistance authority for its directions.

(5) In every case in which application shall be made to him for medical assistance, to require to be furnished with a medical assistance ticket signed by some person authorised to grant it, and not to afford medical assistance, except in case of urgency, before the ticket has been presented ; when such case of urgency occurs, to act at once on his own responsibility, but to require the applicant in such instances to procure the appropriate medical assistance ticket and present it as soon afterwards as possible.

(6) To give a written certificate under his hand to the public assistance authority, or the assistance officer when called upon to do so, of the state of health of any dispensary patient attended by him, and of such patient's fitness or unfitness to be removed to any district or other institution to which the authority is authorised to send persons eligible for assistance.

(7) To keep and duly enter up the medical assistance register in the Form No. 4 in the Schedule to this Order and when so required, to submit the same to any medical inspector of the Minister for examination.

(8) To file at the dispensary all medical assistance tickets received by him and to mark the number of the case in the medical assistance register on the face of each ticket, before filing it, and to preserve the same for a period of at least one year.

(9) To inspect at the end of each quarter of the year, the register of cases attended by the midwife of his dispensary district and to see that the same is properly entered up by her and to authenticate the same by his initials with the addition of the date of inspection.

(10) From time to time as may be necessary, but once at least in each quarter of the year at such time, if any, as the public assistance authority may appoint for the purpose, to transmit to the authority a requisition in duplicate, in the prescribed form, of the drugs, medicines, and medical and surgical appliances required by him.

(11) If no compounder of medicine is appointed,—

(a) carefully to compare and check the drugs, medicines and medical and surgical appliances received at the dispensary with the respective invoices relating thereto ;

(b) to take charge of and keep carefully and safely as far as lies in his power, all drugs, medicines, stores, and medical and surgical appliances provided by the public assistance authority for use in the dispensary ;

(c) to keep the poisonous drugs and medicines at the dispensary under lock and key in a press separate from the other drugs and medicines and to retain and be responsible for the possession of the key of such press ;

(d) to preserve the medical and surgical appliances of the dispensary in good order, and to keep a complete list of all appliances provided from time to time for dispensary use, and submit the list at the end of each half-year ending the 30th day of September and the 31st day of March, respectively, to the authorised officer of the public assistance authority for examination at the dispensary, and upon his resigning or otherwise ceasing to hold office, to hand over the appliances specified in such list to the authorised officer of the authority, who shall compare the same with such list and report any deficiencies or discrepancies therein to the authority.

(12) To send, to the public assistance authority for transmission to the analyst for analysis, according to the requirements of the Minister, samples of the drugs and medicines supplied to the dispensary in compliance with each requisition made by him, not later than fourteen days after the receipt thereof.

(13) To record in a book, to be kept for the purpose at each dispensary at which he attends, the time of his arrival and departure, on each of the days appointed for his attendance thereat.

(14) To report in writing to the public assistance authority any matter which he may deem it necessary to bring under the notice of the authority.

(15) Within twenty-one days after the expiration of each half-year ending on the 30th day of September and 31st day of March, respectively, to forward to the Minister and to the public assistance authority a return for each such half-year in the prescribed form.

(16) To make such returns appertaining to the duties of his office as may from time to time be required by the Minister, or by the public assistance authority.

(17) To report to the public assistance authority any defect in the quality or sort of the drugs, medicines and medical and surgical appliances supplied for the use of the dispensary district.

(18) To report to the public assistance authority or to the Minister any neglect or failure on the part of the compounder of medicine or the midwife or the dispensary nurse to discharge punctually and properly the duties appertaining to their offices.

(19) To occupy the dispensary residence (if any) provided for the dispensary district and to pay such reasonable rent in respect thereof as the public assistance authority, with the approval of the Minister, may determine.

(20) If no dispensary residence is provided, to reside in such central and convenient place within the dispensary district as the Minister shall approve, unless the Minister, on any exceptional and sufficient grounds, dispenses with this condition.

(21) To transact the duties and business of his dispensary district with due regard not only to efficiency but also to economy.

(22) To discharge, if so required, the duties of certifying surgeon under section 120 of the Factory and Workshops Act, 1901.

(23) To perform such other duties as shall be imposed upon him by statute or by any Order of the Minister for the time being in force or as may be assigned to him by the public assistance authority with the consent of the Minister.

16.—(i) In this Regulation references to a dispensary shall in relation to a compounder of medicine to whom a division of a dispensary district has been assigned be construed as a reference to the dispensary or dispensaries of such division and references to the medical officer of the district shall be construed as references to the medical officer of the dispensary district in charge of such division.

(ii) The duties of every compounder of medicine of a dispensary district shall be as follows, that is to say :—

(1) To attend at the dispensary on such days and at such fixed hours as the Minister may approve or direct, and to continue in attendance thereat for such time as may be sufficient to permit of his compounding the prescriptions of all the patients attended by the medical officer of the district.

(2) To attend at a dispensary at any time and compound the medicines prescribed by the medical officer of the district for any urgent case.

(3) To take charge of and keep carefully and safely as far as lies in his power, all drugs, medicines, stores and medical and surgical appliances provided by the public assistance authority for use in the dispensary.

(4) To report to the medical officer of the district any defect observed in the quality or sort of the drugs, medicines and appliances supplied for the use of the dispensary.

(5) To keep the poisonous drugs and medicines at the dispensary under lock and key in a press separate from the other drugs and medicines, and to retain and be responsible for the possession of the key of such press.

(6) To prepare and dispense skilfully and cautiously all prescriptions drawn up and ordered by the medical officer of the district and punctually to supply the medicines, when prepared to the persons authorised to receive them, and, when so required by the prescriptions, to express in writing, or by printed labels, the proper directions to accompany the medicines.

(7) To make such pharmaceutical preparations for use in dispensing medicines as he may be required to make from time to time, by the medical officer of the district.

(8) To keep in a suitable book for the purpose, to be provided by the public assistance authority, a record of all prescriptions so compounded, and of all medical and surgical appliances issued by him out of stock.

(9) To prepare, after consultation with the medical officer of the district and to submit for his signature, the necessary estimates and requisitions for drugs and medicines.

(10) To record in a book, to be kept for that purpose at each dispensary, the time of his arrival and departure and to submit such book at least once in each month to the medical officer of the district for examination.

(11) Carefully to compare and check the drugs and medicines and medical and surgical appliances received at the dispensary with the invoices relating thereto.

(12) To keep a complete list of all appliances provided from time to time for the use of a dispensary and to submit the list at the end of each half-year ending the 30th day of September and the 31st day of March, respectively, to the authorised officer of the public assistance authority for examination, and, upon his resigning or otherwise ceasing to hold office to hand over the appliances specified in such list to the authorised officer of the authority who shall compare the same with such list and report any deficiencies or discrepancies therein to the authority.

(13) To discharge such other duties as may from time to time be imposed upon him by any Order of the Minister for the time being in force or assigned to him by the public assistance authority.

17.—(i) In this Regulation references to a dispensary district shall, in relation to a midwife to whom a division of a dispensary district has been assigned, be construed as a reference to such division and references to the medical officer of the district shall be construed as references to the medical officer of the dispensary district in charge of such division.

(ii) The duties of every midwife of a dispensary district shall be as follows, that is to say :—

(1) To occupy the dispensary midwife's residence (if any) provided for the dispensary district and to pay such reasonable rent in respect thereof as the public assistance authority, with the approval of the Minister, may determine.

(2) If no dispensary midwife's residence is provided for the dispensary district, to reside in such central and convenient place in the district as the Minister shall from time to time approve.

(3) Duly and punctually to attend all cases of midwifery in the district which she shall be required by the medical officer of the district to attend, or in respect of which tickets in the Form No. 3 in the Schedule to this Order, have been presented to her ; and to continue in attendance on each such case until her services are no longer necessary.

(4) To summon in writing the medical officer of the district, in any case of midwifery upon which she is in attendance in which his assistance becomes necessary.

(5) On the termination of any midwifery case in which the assistance of the medical officer of the district has not been called for, to report the result to the medical officer of the district.

(6) To keep a register in the Form No. 5 in the Schedule to this Order of all cases attended by her, either on the order of the medical officer of the district, or on a ticket in the Form No. 3 in the Schedule to this Order, and to submit such register for inspection to any medical inspector of the Minister when so required and also to the medical officer of the district for his quarterly inspection, and also, if and when required by the public assistance authority, to submit the same through the medical officer of the district for examination by the authority.

(7) To observe and execute all lawful orders and directions of the medical officer of the district applicable to her office.

(8) To discharge such other duties as may be imposed upon her by any Order of the Minister for the time being in force or as may be assigned to her by the public assistance authority.

18. The public assistance authority shall make full and adequate provision for the heating of dispensary premises during such periods of the year, and on such days of the week as the medical officer in charge thereof may consider necessary for the proper preservation of the medicines and appliances and for the comfort of the patients.

19. Immediately after the completion of each half-year, ending on the 30th day of September and the 31st day of March, respectively, the public assistance authority shall cause to be furnished to the medical officer in charge of any dispensary of a dispensary district, a statement of all items of expenses incurred in respect of such dispensary which shall have been included in the half-year's accounts ; and such statement shall be made in such form as may be directed or approved by the Minister and shall be filed for reference at such dispensary.

20. The public assistance authority shall furnish, as soon as may be, to each medical officer of a dispensary district for his information and guidance in ordering supplies, particulars of the official contractors or other contractors from whom drugs and medicines and medical and surgical appliances are obtained by the authority and the prices thereof.

21. The public assistance authority shall cause to be prepared with respect to each dispensary of a dispensary district, a notice of the dispensary arrangements, and shall cause a copy of such notice to be posted at each such dispensary and at such other places in the district as may be necessary for the due notification of the dispensary arrangements.

22. district also cause a notice board showing the names and addresses of the officers of the dispensary district assigned thereto and the days and hours on and between which the dispensary shall be open, to be kept conspicuously painted and affixed to the exterior of each such dispensary.

SCHEDULE

FORM No. 1

Number in Register..................

TICKET FOR ATTENDANCE AT DISPENSARY.

.................. (1)

To Dr. ...................Medical Officer of.................... Dispensary District in the.................. Public Assistance District.

You are hereby directed to afford medical assistance and advice to.................. aged ...... residing at .............................., in the above-mentioned Dispensary District, who is by occupation a .......................

Dated this ............ day of ....................., 19......

Signed ................................

.........................................(2).

(1) Insert name of public assistance authority.

(2) Insert description, i.e., member of public assistance authority, or assistance officer, or warden, as the case may be.

FORM No. 2.

Number in Register..................

TICKET FOR ATTENDANCE AT THE PATIENT'S HOME.

................... (1)

To Dr. ................... Medical Officer of ................... Dispensary District in the .................. Public Assistance District.

You are hereby directed to visit and afford medical assistance and advice to .................... aged ........... residing at ......................., in the above-mentioned Dispensary District, who is by occupation a .......................

Dated this ............ day of ....................., 19 ......

Signed..........................................

.............................. (2).

FORM NO. 3.

Number in Register...............

TICKET FOR ATTENDANCE OF MIDWIFE AT THE PATIENT'S HOME.

........................ (1)

To ........................ Midwife of .......................... Dispensary District in the ......................... Public Assistance District.

You are hereby directed to visit at once..................... residing at ......................, in the above-mentioned Dispensary District, who is by occupation a ......................, and afford her the necessary attendance and nursing.

Dated this ............ day of ....................., 19......

Signed...............................

..................... (2).

(1) Insert name of public assistance authority.

(2) Insert description, i.e., member of public authority, assistance officer, or warden, as the case may be.

DIRECTIONS FOR PRINTING MEDICAL ASSISTANCE TICKETS.

Blank tickets for medical assistance are to be printed in the Forms Nos. 1, 2 and 3 and bound up in books with duplicate perforated counterfoils. The name of the medical officer and of the dispensary district and of the public assistance authority and its district should be printed on the tickets for each district, so as to reduce, as far as possible, the number of particulars to be written by the person filling up and issuing the tickets.

Form No. 1 which is the form of ticket to be issued for medical assistance to be given to the person attending at the dispensary, is to be printed in the black ink. Form No. 2 which is the form of ticket to be issued where it is necessary that the medical officer should visit the patient in his home, is, for the sake of distinction and convenience, to be printed in red ink.

On the back of the ticket, Form No. 1 the following memorandum is to be printed :—" A member of the public assistance authority, warden, or assistance officer, before issuing a ticket, shall exercise due diligence in ascertaining whether the applicant is a person eligible for medical assistance."

On the back of the ticket, Form No. 2 the following memorandum is to be printed :—" This ticket may be presented to the medical officer at the dispensary, within the hours of his attendance there ; or may be presented to him, or left for him at his residence ; or may be presented to him personally anywhere. The ticket should be presented as soon after it has been obtained as practicable, with such information as can be given regarding the nature of the case. A member of the public assistance authority, warden, or assistance officer, before issuing a ticket shall exercise due diligence in ascertaining whether the applicant is a person eligible for medical assistance. "

Tickets in the Form No. 3 are to be printed in purple ink and are to be used when the patient applies for the services of a midwife.

DIRECTIONS FOR FILLING UP MEDICAL ASSISTANCE TICKETS.

(To be printed on the first leaf of each check book).

The ticket and counterfoil are both to be filled up by the person authorised to issue the ticket ; the counterfoil to be retained by the person issuing the ticket, and the ticket to be detached from the book and given to the applicant, for presentation to the medical officer, or midwife, as the case may be.

Care should be taken in the issuing of the tickets accordingly ; and tickets should be issued to the medical officer in the Form No. 2 for visiting at the residence of the applicant, in cases of necessity only, and with all available information as to the nature of the case.

The ticket is to be issued for the dispensary district or division of the dispensary district in which the applicant is resident at the time ; and care should be taken to fill up the ticket and apprise the applicant accordingly as the medical officer of a dispensary district is only bound to attend a person eligible for medical assistance who is resident therein, and similarly the midwife.

The Christian name and surname of the applicant should be inserted in the ticket in full ; and such description of his place of abode (as, name of townland, and, where necessary, the parish also ; or in the case of cities and towns, the street, place, or row, etc., and number of house) should be given as will be sufficient for identification and for registration ; and with this object, the age and occupation of the applicant should also be stated wherever practicable. Any further observations which the issuer of the ticket may desire to make should be written on the front of the ticket.

A member of the public assistance authority, warden, or assistance officer, before issuing a ticket, shall exercise due diligence in ascertaining whether the applicant is a person entitled to gratuitous medical assistance.

FORM No. 4.

MEDICAL ASSISTANCE REGISTER.

.................... Public Assistance District.

.................... Dispensary District.

.................... Division.

DIRECTIONS FOR FILLING UP THE MEDICAL ASSISTANCE REGISTER.

(To be printed at the beginning of each book).

Column 1.—The series of numbers is to run from the beginning to the end of the year ; and a fresh series is to be commenced on the 1st January in each year, beginning with the first new case on or after that day. The same patient is not to have a second number, except in the event of the issue of a fresh ticket in which event he should, on its presentation, be registered again with a fresh number, as a new case, reference being also made, in the column for observations, to his previous number.

Columns 7 and 8.—The date of each attendance from the commencement to the termination of the case is to be entered in the appropriate columns.

An alphabetical index should form part of the Register.

Form No. 5.

REGISTER OF CASES ATTENDED BY MIDWIFE.

.............................. Public Assistance District.

.............................. Dispensary District.

.............................. Division.

Name of Midwife .................................

GIVEN under the Official Seal of the Minister for Local Government and Public Health this Twenty-third day of March, One Thousand Nine Hundred and Forty-two.

(Signed) SEÁN MacENTEE,

Minister for Local Government

and Public Health.

INSTRUCTIONAL MEMORANDUM.

A—LUNATICS.

1. The duty of examining dangerous lunatics is cast upon dispensary medical officers by section 10 of the Lunacy (Ireland) Act, 1867, as amended by section 14 of the Lunatic Asylums (Ireland) Act, 1875.

Under the provisions of section 10 of the first-mentioned Act, as amended by the Courts of Justice Act, 1924 , a Justice of the District Court or two Peace Commissioners before whom any person is brought, under circumstances denoting a derangement of mind, may call to their assistance—

(a) the medical officer of the dispensary district in which the Justice or Peace Commissioners shall be at the time when the lunatic is brought before them, or

(b) if there be more than one such medical officer, the nearest available medical officer of such district, or

(c) if there be no such medical officer available, then the nearest available medical officer of any neighbouring dispensary district—

to examine such person with a view to certifying whether he is a dangerous lunatic or dangerous idiot.

By section 14 of the Lunatic Asylums (Ireland) Act, 1875, as adapted by the Public Assistance Act, 1939 , the Justice or Peace Commissioners are authorised, if he or they think fit so to do, to make an order upon the public assistance authority for the public assistance district to which the person examined belongs, for payment of the expenses of such examination, including reasonable remuneration to the medical officer—such sum not to exceed in the whole £2.

2. It is the duty of a dispensary medical officer when called to the assistance of the Justice or Peace Commissioners to examine any person who may be brought before them under circumstances denoting derangement of mind, before certifying that the person is a dangerous lunatic or a dangerous idiot, to be fully satisfied of the fact after special personal inquiry into the case.

B.—REQUISITIONS FOR DRUGS, MEDICINES AND MEDICAL AND SURGICAL APPLIANCES.

The medical officer should make out his requisitions in strict accordance with the printed instructions on the form, and should only order such articles as, from his local knowledge, he has reason to think will be required.

Immediately on receipt of each consignment, the medical officer concerned shall carefully check the quantities with the invoice, weighing each drug and medicine, and shall note any excess or deficiency. The medical officer shall then personally select a few samples (three to six) and forward them to the Secretary of the Public Assistance Authority for transmission to the analyst, and shall mark on the invoice the items from which the selections have been made. The medical officer also shall see that the samples are carefully made up (sample bottles and corrugated paper for packing are included in the prescribed lists), and shall attach to each sample a label showing :—

(a) The name of the county.

(b) The name of the dispensary district.

(c) The name of the drug.

(d) The date of delivery of the drug by contractor at the dispensary.

(e) The name of the medical officer and date of forwarding sample to the analyst.

The Secretary to the Public Assistance Authority will provide the requisite supplies of suitable labels, and the medical officer should ascertain that the sample bottles are perfectly clean and dry, and he should use stoppered bottles for liquid acids and volatile drugs—the bottles to be entirely filled so as to prevent deterioration. Powders that are liable to chemical change owing to exposure should be sent in properly corked bottles. Sealing wax should not be used on the corks of the sample bottles. The analysts have been requested to note upon their certificates any failure to observe the above directions. The medical officer should at once call the attention of the Public Assistance Authority to any delay on the part of the contractor in forwarding the drugs, or the invoices, which latter should be despatched on the same day as the goods.

Medical officers should exercise their own discretion in selecting the samples, and shall be fully responsible for the judiciousness of the selection made on each occasion. The following are, however, the drugs and medicines found by experience to be most likely to be adulterated or deficient in strength :—Glycerinum pepsini, Hydrargyrum cum creta, Linimentum camphoræ, Liquor Hydrargryri perchloridi, Liquor iodi mitis, Liquor morphine hydrochloridi, Liquor strychninæ hydrochloridi, Oxymel scillæ, Spiritus Ætheris nitrosi, Spiritus Ammoniæ Aromaticus, Syrupus ferri iodidi, Syrupus ferri phosphatis cum quinina et strychnina, Unguentum Chrysarobini, Unguentum hydrargyri, Unguentum iodi denigrescens. Tinctures, Liquid Extracts, and Concentrated Liquors are frequently deficient in alcohol or in extractive.

The Department of Local Government and Public Health have ascertained that the quantities requisite for analytical purposes of the undermentioned drugs are :—

The medical officer, when he has duly checked the articles received with the invoice, shall fill in the certificate at D, and immediately transmit the " Original " requisition to the Secretary to the Public Assistance Authority, retaining the other copy in the dispensary.

Sera, and trusses, when urgently required, may be ordered by the medical officer direct from the contractor by letter or telegram, but in such cases a formal requisition in confirmation of the order must be subsequently submitted to the Public Assistance Authority in the usual manner.

In the event of a medical officer requiring to be supplied with any article not on the prescribed lists, a separate requisition must be made on a form which should follow the usual form as nearly as possible, and be dealt with in the same manner. The requisition should state the circumstances which are considered to render it necessary, the estimated cost of the article, and the reason why none of the articles on the prescribed lists is suitable to the case.

Such items as disinfectants, soap, water jugs and basins, towels, lamps, candles, lamp oil, for use in dispensaries should not be included in these requisitions, but should be obtained through the Public Assistance Authority in the same manner as the ordinary supplies for a district institution.