09/11/1923: Government Of Dispensary Districts


Ministry of Local Government. ____________________________ GENERAL RULES FOR THEAND THE PERFORMANCE OF VACCINATION, ENTITLED THE DISPENSARY (COUNTY BOARDS OF HEALTH) RULES AND REGULATIONS, 1923, TOGETHER WITH AN INSTRUCTIONAL MEMORANDUM.

INDEX OF CONTENTS.

OF

DISPENSARY RULES.

Article

Page

BONDS OF CONTRACTORS:

I.

Drug Contracts... ... ...

37

25

II.

Contracts for Medical and Surgical Appliances... ... ... ...

37

26

SECRETARY'S DUTIES:

I

To furnish Minister for Local Government at prescribed times with the names and addresses of the Members of the Board of Health and Wardens of the County (Form A, Nos. 1 and 2)...

4

7

II

To send at time of appointment notices to Members of the Board of Health and Wardens (Form B, Nos. 1 and 2)...

4

7

III.

To notify at prescribed times the Medical Officers of the names and addresses of the Members of the Board of Health, Wardens, and Relieving Officers, Form C... ... ... ...

5

7

IV.

To publish the prescribed notices of Dispensary arrangements, Form N, and cause notice boards to be kept affixed to the Dispensaries, Form O...

6

8

V.

To transmit a notice, Form D, in due course, to any person ceasing to be a Member of the Board of Health, Warden, or Relieving Officer

7

9

VI.

To keep in stock a supply of forms of queries for Dispensary Officers, and to report appointments without delay...

15

12

VII.

To furnish each Medical Officer with the half-yearly Account of the expenses of his District... ... ...

35

25

VIII.

To see that Bonds of contractors for medicines and medical and surgical appliances are duly executed ... ...

37

26

DISPENSARIES:

I.

Should be maintained in good order and condition, and kept properly heated...

32

25

II.

Water jugs, towels, lamp oil, disinfectants, should be supplied... ...

72

FEES:

I.

Medical Officers shall not demand or accept any fee from persons entitled to Dispensary relief... ... ...

17

14

II.

Each Medical Officer may be invited to state in writing his usual scale of fees...

9

9

III.

Deduction from Medical Officer's salary in respect of fees for extra professional assistance. Conditions as regards reference of disputes about claims to Minister for Local Government. Review of payment by Auditors...

23

21

IV.

Board of Health may adopt a scale of fees for extra professional assistance

25

22

V.

Amount of fee which a Medical Officer is entitled to be paid for each vaccination or re-vaccination performed by him ...

63

FORMS:

I.

Board of Health to provide the necessary forms and stationery... ... ...

33

25

II.

Prescribed forms, arranged alphabetically, A to P... ... ... ...

37-59

BOARD OF HEALTH:

I.

Voting of Board of Health on questions under the Medical Charities Act...

10

10

II.

Business under Medical Charities Act to be conducted at meetings of Board of Health... ... ... ..

11-12

10

III.

To appoint Dispensary Officers and cause vacancies to be reported to the Minister for Local Government...

13

11

IV.

To use and adopt the prescribed forms of bonds for contractors of medicines and medical and surgical appliances...

37

26

LUNATICS:

Summary of Lunacy Laws dealing with the duties and remuneration of Medical Officers... ... ... ...

58

MEDICINE AND SURGICAL APPLIANCES:

I.

Safe custody of poisonous medicines...

34

25

II.

Prescribed lists of drugs and medical and surgical appliances, conditions of recoupment, and annual contracts...

38

25

III.

Estimates and requisitions instructions—

71

OFFICERS:

I.

Appointments vested in Board of Health, who shall cause vacancies to be reported to the Minister for Local Government. Transfer of Officers...

13

11

II.

Notices of appointments... ...

14

11

III.

Mode of election—appointments to be reported to the Minister for Local Government... ... ...

15

12

IV.

Qualifications of Medical Officers, permanent and temporary... ...

16

12

also

68-70

V.

Duties of Medical Officers... ...

17

13

VI.

Duties of Medical Officers in midwifery cases... ... ... ...

22

20

VII.

Qualifications of Compounders of Medicine... ... ... ...

18

17

VIII.

Duties of Compounders of Medicine...

19

18

IX.

Qualifications and duties of Midwives

20-22

19

X.

Medical Officer's powers to summon extra professional assistance. Fees and payments in respect of such services and conditions as regards reference of disputes about claims to the Minister for Local Government... ...

30

24

XI.

Incapacity of Medical Officer to discharge his duties owing to illness or other cause, employment of substitute, duties and residence of temporary Medical Officer... ... ...

24

21

XII.

Remuneration of temporary Medical Officers... ... ... ...

25

22

XIII.

Salaries of Medical Officers—deductions

26

22

XIV.

Death or resignation of Medical Officer, provision for discharge of duties...

27

23

XV.

Medical Officers. Conditions as regards sick leave... ... ...

28

23

XVI.

Salaries, remuneration, and vaccination fees. Dates and conditions of payments by Board of Health...

29-30

23-24

XVII.

Annual vacations shall be allowed, and substitutes remunerated... ...

30

24

XVIII.

Continuance in office... ...

31

24

XIX.

Suspension and removal from office...

31

24

TICKETS:

I.

Members of Board of Health, Wardens, and Relieving Officers authorised to issue, and shall not delegate the power to others, nor sign tickets in blank...

3

7

II.

Issuer may withdraw... ...

9

9

III.

Continuance of tickets in force       17,

par. ii.

13

IV.

Directions for the printing and filling up of tickets... ... ...

45

VACCINATION:

I.

Summary of Vaccination Acts dealing with the duties and remuneration of Medical Officers... ... ... ...

60

II.

Instructions for Vaccinators... ...

64

III.

Authorized Teachers and course of Instruction in vaccination... ...

68

IV.

Amount of fee which may be charged by authorized teachers to a student for instruction, examination, and certificate in vaccination ... ...

70

WARDENS:

I.

Board of Health after each election may appoint a sufficient number of Wardens... ... ...

3

7

II.

Board of Health may fill up vacancies amongst the Wardens, and may, with consent of Minister for Local Government, add to the number of Wardens in any Dispensary District... ...

8

9

MINISTRY OF LOCAL GOVERNMENT.

To each County Board of Health established by a County Scheme in pursuance of the Local Government (Temporary Provisions) Act, 1923 ; to the Secretary of each such County Board of Health; to the Officers of Dispensary Districts in a County or County Borough to which a County Scheme relates; and to all whom it may concern:

IN exercise of the powers vested in me by the Poor Relief (Ireland) Act, 1851, and the Vaccination (Ireland) Act, 1858, as adapted by the Adaptation of Enactments Act, 1922 , and as modified by every County Scheme prepared under or in accordance with the Local Government (Temporary Provisions) Act, 1923 , and of all powers in this behalf enabling me, I, the Minister for Local Government, do by this my Order make the following general rules and regulations for the government of each dispensary district situate in a County or County Borough to which a County Scheme relates, and for the guidance and control of County Boards of Health and the several officers to be appointed in connection therewith respectively.

ARTICLE l.—This Order may be cited as the Dispensary (County Boards of Health) Rules and Regulations, 1923.

ARTICLE 2.—In this Order unless the context otherwise requires.

The expression "the Minister" means the Minister for Local Government.

The expression "County Scheme" means a scheme prepared under or in accordance with the Local Government (Temporary Provisions) Act, 1923 .

The expression "Board of Health" means a County Board of Health established by a County Scheme prepared under or in accordance with the Local Government (Temporary Provisions) Act, 1923 .

The expression "county institution" means any institution which a Board of Health is empowered to provide and maintain under a County Scheme.

The expression "county hospital" includes a district hospital.

The expression "vaccination authority" means the council of a county borough or the council of an urban or rural district as the case may be.

The expression "county" includes a county borough.

ARTICLE 3.—Immediately after each election of a Board of Health, the Board of Health may appoint a sufficient number of wardens for the electoral divisions of each dispensary district, who in addition to the members of the Board of Health and the assistance officers, shall be empowered to issue medical relief tickets. Persons empowered to issue tickets for medical relief shall not delegate that power to others; and such tickets shall not be signed in blank and left to be filled up by other persons.

ARTICLE 4.—The Secretary of the Board of Health shall thereupon make a return in the form A, No. 1, annexed to this Order, to the Minister, of the names and addresses of the members of the Board of Health, assistance officers, and wardens authorized to issue medical relief tickets in each dispensary district; and in like manner, on any appointment by the Board of Health of a warden to fill any vacancy, the Secretary shall make a return to the Minister, in the form A, No. 2, annexed to this Order, and shall,on his election, send to each member a notice in the annexed form B, No. 1, and shall, on his appointment, send to each warden a notice in the annexed form B, No. 2.

ARTICLE 5.—Immediately upon the completion of the list of members, wardens, and assistance officers as aforesaid, the Secretary of the Board of Health shall furnish each medical officer with a copy thereof, according to the annexed form C, giving the names and residences of all persons entitled to give tickets for medical relief in his district, that is to say, of the members of the Board of Health, and of every assistance officer and warden acting as such for any electoral division included in such district. And the Secretary shall in like manner notify, from time to time, any changes, from death or otherwise, of members, assistance officers, or wardens, in any districts, to the respective medical officers thereof.

ARTICLE 6.—The Secretary of the Board of Health shall also prepare a notice specifying the persons and their residences to whom application may be made for tickets for medical relief, the situation of the dispensary or dispensary stations in the district, the days and hours of attendance at each, the name and residence of the medical officer, and the compounder of medicine, and the midwife, the days and hours when the medical officer will attend at each of the places within such dispensary district appointed by the Board of Health for the purpose of vaccination, and such other particulars of the dispensary arrangements as may be necessary to afford due facility for obtaining medical relief and vaccination where requisite. Such notice shall be in the form N, annexed to this Order; and a copy shall be posted at each dispensary in the district and at such other places in the district as may be necessary for the due notification of the dispensary arrangements. The Secretary shall also cause a notice board, in the form O, to be kept conspicuously painted and affixed on the exterior of each dispensary in the district, showing the days and hours of attendance of the medical officer, his name and place of residence, and the names and addresses of the compounder of medicine and the midwife.

ARTICLE 7.—Whenever any person ceases to be a member of the Board of Health, or a warden, or an assistance officer, the Secretary of the Board of Health shall transmit to him a notice in the form D hereto annexed, apprising him of the cessation of his power to issue tickets for medical relief and requiring him to return to the Board of Health any forms of the tickets for medical relief, which had been issued to him in the medical relief ticket check books (forms E 1, E 2, and E 3 hereinafter mentioned) and which may not have been used.

ARTICLE 8.—The Board of Health may, from time to time fill up any vacancies which may occur amongst the wardens of a dispensary district, and may also, from time to time, when found necessary, with the consent of the Minister, add to the number of wardens in any dispensary district.

ARTICLE 9.—Any member of a Board of Health, warden, or assistance officer who has issued a ticket for medical relief shall, on being furnished with additional trustworthy information showing that the sick person for whom the ticket was issued is not a "poor person" within the meaning of the Medical Charities Act, be at liberty, and is hereby empowered to withdraw such ticket, provided always that immediate notification of such withdrawal is given by him in writing to the medical officer, the Board of Health, and the person on whose behalf the ticket was issued.

In order to enable members of a Board of Health, wardens, and assistance officers to be in a better position to judge whether an applicant for medical relief is a "poor person," the Board of Health may invite each of their medical officers to furnish in writing a scale of charges for attendance upon persons whose circumstances would not admit of their paying the doctor's usual fees, and a copy of every such scale of fees, if furnished to the Board of Health, shall be supplied by the Secretary to each member of the Board, and to each of the wardens and assistance officers connected with the medical officer's district. Any such scale of fees shall be regarded as operative until withdrawn by the medical officer.

ARTICLE 10.—Subject to the provisions of each County Scheme every question under the Poor Relief (Ireland) Act, 1851, at any meeting of the Board of Health shall be determined by a majority of the votes of the members present thereat and voting on the question.

ARTICLE 11.—The Board of Health shall examine and consider any reports made and entered by the medical officer in his report-book (form I) since the last meeting of the Board of Health, and give the necessary directions thereon, and record the same on their minutes. The Board of Health shall, as occasion shall arise, receive and consider the medical officer's requisition for the medicines and the medical and surgical appliances required, and shall give the necessary directions thereon to the Secretary. Such requisition shall be in such form as may from time to time be prescribed by the Minister instead of the form M annexed to these rules.

ARTICLE 12.—At the first ordinary meeting of the Board of Health in each month, or as soon thereafter as conveniently may be (or more frequently if the Board of Health so arrange) the following business shall be conducted:—

i. The Board of Health shall examine the register of persons to whom medical relief shall have been afforded since the last examination of the book; such register to be in the form F, annexed to this Order, and to be duly entered up by the medical officer of the dispensary district and produced for the inspection of the Board of Health.

ii. They may give directions regarding all persons so relieved as aforesaid, in pursuance of their powers under the 9th section of the Poor Relief (Ireland) Act, 1851; and such directions shall be recorded and authenticated in the several columns of the register, in the manner pointed out in the Farm F hereunto annexed.

iii. They shall examine the copy of the medical officer's return (form L) laid before them half-yearly in pursuance of the direction hereinafter contained.

iv. They shall examine at least once in each quarter the accounts of expenses incurred for the several dispensaries, and shall consider especially the expenditure for medicines—having regard to the number of patients under treatment.

v. They shall make due and adequate arrangements for the speedy conveyance to and from the place of meeting of the Board of Health of the medical officer's books and records, and shall provide the necessary waterproof boxes or wrappers for the safe transit of such documents.

vi. They shall, on receiving from the medical officer a report in the form H, cause same to lie on the table of the board-room for inspection for a period of twenty-eight days.

ARTICLE 13.—(1) The Board of Health shall from time to time appoint such officers as may be directed by sealed order of the Minister for the service of each dispensary district; and shall upon the occurrence of any vacancy, cause the same to be reported to the Minister, and proceed to a new appointment.

(2) The Board of Health may, upon the occurrence of a vacancy in any office of a dispensary district, without any advertisement giving notice of the appointment, appoint the person to fill such office, by transferring thereto, with the consent of the Minister, a permanent officer in the service of the Board, provided always that notice in writing of the proposal to make such transfer shall have been given and entered on the minutes at a meeting of the Board of Health one fortnight at least preceding the meeting at which the transfer is to be made and that the Secretary of the Board shall within seven days after such entry have forwarded a copy of the same to each member of the Board of Health.

ARTICLE 14.—No appointment of any dispensary officer directed to be appointed in pursuance of any order issued under the seal of the Minister, shall be made unless notice that such appointment will be made shall have been given and entered on the minutes of the Board of Health at a meeting one fortnight at least preceding the meeting at which the appointment is to be made, and unless an advertisement giving notice of such appointment shall, by the direction of the Board of Health, entered on their minutes, be published in some public newspaper circulating in the district at least ten days before the day on which such appointment is to be made.

ARTICLE 15.—Every officer to be appointed for a dispensary district in pursuance of any order under the seal of the Minister shall be appointed by a majority of the Board of Health present, and voting at any meeting, in the manner directed in article 10; and every such appointment shall, as soon as the same shall have been made, be reported to the Minister by the Secretary of the Board of Health, who shall, without delay, forward the prescribed query form, duly filled up and signed. A supply of query forms shall be kept in stock by the Secretary to enable him to report the appointments of the several dispensary officers.

MEDICAL OFFICER.

ARTICLE 16.—Every person of either sex to be appointed by any Board of Health to serve as medical officer of a dispensary district shall have the qualifications hereinafter set forth, that is to say—

i. Such person shall be registered under the Medical Acts, provided that in the case of a person registered before the 30th day of June, 1887, it shall be necessary that such person be qualified by law to practise both medicine and surgery in Ireland, and shall have obtained a diploma, certificate of a degree, licence, or other instrument granted by some body in Saorstát Eireann, Great Britain or Northern Ireland authorised by law to grand such diploma, certificate, licence, or instrument, testifying to his or her medical or surgical, or medical and surgical, qualification or qualifications, and that such person shall also have obtained a certificate, granted by some board, court of examiners, or other body or licensing corporation authorised by law to grant such certificate, certifying that he or she possesses a competent knowledge of midwifery.

ii. Such person shall have obtained a certificate of proficiency in vaccination given under such conditions as the Minister may from time to time approve by some person authorised to give such certificates and recognised by the Minister, and by whom such person shall have been duly instructed and examined in the practice of vaccination. Provided always that such certificate shall not be required to have been obtained by any person who has on the first day of May, 1906, the other qualifications prescribed by this article.

iii. Such person shall have reached the age of twenty-one years.

ARTICLE 17.—The duties of every medical officer of a dispensary district shall be as follows, that is to say:—

i. He shall attend at the dispensary or dispensaries of the district or division of a district under his charge, on such days and at such hours as the Minister may approve or direct, for the purpose of affording medical relief to any poor person applying for the same and presenting a ticket as hereinafter provided, and for the vaccination of all persons who may come to him for the purpose, and shall 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.

ii. He shall duly and punctually attend, either at the dispensary or at the home of the party on whose behalf application is made or elsewhere, as the case may require, and shall give his advice and assistance and supply all necessary medicines, including the use of surgical appliances, to every poor person in the district, or portion thereof under his charge, whom—by a ticket, signed by a member of the Board of Health, or by an assistance officer or warden, acting for any electoral division included in such district—he shall be directed to attend as medical officer; and he shall continue his attendance until such attendance is no longer required, or until the ticket be withdrawn or cancelled. Such tickets shall be in the form E 1, annexed to this Order, when medical relief is directed to be given at the dispensary only, and in the form E 2, annexed to this Order, when medical relief is directed to be given at the home of the patient or elsewhere; and all such tickets received by the medical officer shall be filed by him at the dispensary—the number of the case in the register (form F, annexed to this Order) being marked by him on the face of each ticket, before filing it— and shall be preserved for a period of at least two years. A ticket for medical relief continues in force (a) until it is withdrawn by the issuer or cancelled by the Board of Health in pursuance of section 9 of the Medical Charities Act, or (b) until the patient ceases to present himself at the dispensary in the case of a ticket in the form E 1, or (c) until the termination of the case, if the ticket be a visiting ticket in the form E 2, in which case the medical officer is bound to continue his attendance so long as it is requisite. If any patient, in the opinion of the medical officer, be an unfit object for medical relief, he shall forthwith report the circumstances of the case to the issuer of the ticket, and also to the Board of Health at their next ordinary meeting for their directions; and in respect of cases of cessation of attendance by a patient at the dispensary, the Board of Health may prescribe a period (of at least a month) for the guidance of the medical officer, during which if a patient ceases to attend he should be considered as no longer under treatment.

iii. In every case in which application shall be made to him for medical relief, other than vaccination, he shall require to be furnished with a ticket signed by some person authorized to grant it, and shall not afford medicine or medical appliances except in urgent cases, before the ticket has been presented; when such cases occur, the medical officer may act at once on his own responsibility, but he should require the applicants in such instances to procure tickets and present them as soon afterwards as possible.

iii. (a). He shall not demand or accept any fee or payment of any kind for his services from any person entitled to dispensary relief whom he shall be directed by a medical relief ticket to afford medicine and advice to or to attend.

iv. He shall give a written certificate under his hand to the Board of Health, 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 county hospital, as the case may be.

v. He shall keep and duly enter up the medical relief register according to the form F, hereunto annexed, and all other registers and records which may from time to time be prescribed by the Minister, and submit the same to the Board of Health at their first ordinary meeting in each month, or at such other times as the Board of Health may appoint.

vi. He shall, from time to time as may be necessary, but not less frequently than once in three months, transmit to the Secretary of the Board of Health a requisition in duplicate in such form as may from time to time be prescribed by the Minister, of the medicines and the medical and surgical appliances required.

vii. He shall carefully compare and check the medicines and the medical and surgical appliances received at the dispensary with the respective invoices relating thereto, but where a compounder of medicine is employed this duty shall be discharged, so far as regards the medicines, by the compounder of medicine.

viii. He shall as soon as reasonably may be, send to the Secretary of the Board of Health for analysis, according to the requirements of the Minister, samples of the medicines supplied to the dispensary in compliance with each requisition made by him.

ix. He shall vaccinate, in the prescribed manner, all persons who may come to him for that purpose at the dispensary or dispensaries, and shall do and perform all such other acts and things as may be necessary for the purpose of causing such vaccination to be successfully terminated; and shall attend at such convenient places within each vaccination district formed by the vaccination authority, at the times fixed and approved by them, for the purpose of vaccinating all persons who may come to him or whom he may be requested to vaccinate, being fit subjects for vaccination; and he shall keep and duly enter up a register, in the annexed form G, of all cases of successful vaccinations performed by him as medical officer of the dispensary district; and submit the same to the vaccination authority at each ordinary meeting or as soon thereafter as conveniently may be. Provided however, that in any case where the medical officer of the dispensary district is also the registrar of births and deaths for the district, it shall not be necessary for him to insert in the said vaccination register form G any cases which he may have duly entered in the register of vaccination which he is required to keep in pursuance of the 7th section of the Vaccination Act of 1863.

x. He shall inspect every person vaccinated by him on the eighth day after the operation of vaccination has been performed, and also on such other days as may be necessary. The report which he is required by the Vaccination Act of 1858 to make to the vaccination authority of all persons successfully vaccinated by him, shall be made by him not less frequently than once in each half-year in the form H, hereunto annexed, and the register (form G), referred to therein, shall be open at all reasonable times to inspection by any member of the vaccination authority.

xi. He shall forward to the vaccination authority on the 31st day of March, 30th day of June, 30th day of September, and 31st day of December in each year, a report in the form P, hereunto annexed, containing a complete list of the names of all children registered as born in the district, who are over three months of age, and who do not appear to have been vaccinated.

xii. The re-vaccination of persons applying for the purpose shall be limited by the following conditions:—

1st. That the marks of the primary vaccination are not, in the opinion of the medical officer, sufficiently numerous, distinct, and typical to afford the necessary protection against small-pox

2nd. That the person, although well vaccinated primarily, has attained the age of ten years, or, if there be an immediate danger of small-pox, the age of seven years.

3rd. That the person has not before been successfully re-vaccinated.

4th. That there are no circumstances present which would render the operation undesirable.

xiii. He shall submit to the Board of Health at their first ordinary meeting each month, or at such other times as the Board of Health may appoint, or as circumstances may render necessary, his report-book (form I), in which he shall enter the time of his arrival at and departure from the dispensary, or dispensaries, of the district, on each of the days, appointed for his attendance thereat, and also any matter which he may deem it necessary to bring under the notice of the Board of Health who will take into their consideration any entry which shall have been made therein since the previous examination of the book.

xiv. If there be within his district a bridewell or house of correction which he is required by the 15th section of the Poor Relief (Ireland) Act, 1851, to attend, he shall submit to the Board of Health not less frequently than once in each quarter, in the form K, hereunto annexed, an account of any medicines supplied to prisoners and inmates in such bridewell or house of correction.

xv. He shall, within twenty-one days after the expiration of each half year ending the 30th day of September and 31st day of March, respectively, forward to the Minister a return for each such half-year in the form L to these rules annexed, and also as directed on the said form with such variations as may from time to time be prescribed by the Minister. Such return shall be laid before the Board of Health, or other authority, at their next ordinary meeting.

xvi. In the event of the occurrence of cases of any infectious disease in the district under his charge, he shall address a report of the facts to the Minister, so as to enable him to call upon the sanitary authority, without delay, to make such special provision as may be necessary to prevent or mitigate the evil.

xvii. He shall make such returns appertaining to the duties of the office as may be from time to time required by the Minister, or by the Board of Health. He shall preserve the instruments and appliances placed in his custody in good order, and shall also keep a complete list of all instruments provided for dispensary use, and submit the list periodically to the Secretary of the Board of Health for examination. In the event of his resigning or ceasing to hold office, the instruments specified on such list shall be handed over to the Secretary of the Board of Health.

xviii. He shall report to the Board of Health, or to the Minister, any neglect or failure on the part of the compounder of medicine or the midwife to discharge punctually and properly the duties appertaining to their offices.

xix. He shall reside in a central and convenient place within the dispensary district, unless the Minister, on any exceptional and sufficient grounds, dispense with this condition.

xx. He shall, if so required, discharge the duties of certifying surgeon under section 71 of the Factory and Workshop Act, 1878, and also perform any other duties imposed on him by statute, or assigned to him by the Minister.

xxi. He shall transact the duties and business of his dispensary district with due regard not only to efficiency but also to economy.

xxii. He shall occupy the dispensary residence (if any) provided for the dispensary district under the Dispensary Houses (Ireland) Act, 1889, and shall pay such reasonable rent in respect thereof as the Board of Health, with the approval of the Minister, may determine.

COMPOUNDER OF MEDICINE.

ARTICLE 18.—Every person of either sex to be appointed by any Board of Health to serve as a compounder of medicine of a dispensary district shall have the qualifications hereinafter set forth, that is to say:—

i. Such person shall have obtained the licence of the Apothecaries' Hall, Dublin, or of the Society of Apothecaries, London, or a certificate of competency to compound medical prescriptions from the Pharmaceutical Society of Saorstát Eireann, Great Britain or of Northern Ireland, or shall be a compounder of medicine duly qualified in accordance with the Army Regulations, who at the date of his discharge from the army has been so registered and has before such date performed the duties of a compounder of medicine for not less than four years.

ii. Such person shall have reached the age of twenty-one years.

ARTICLE 19.—The duties of every compounder of medicine of a dispensary district shall be as follows, that is to say:—

i. He shall attend at the dispensary or dispensaries of the district on such days and at such fixed hours as the Minister may approve or direct, and shall continue in attendance thereat for such times as may be sufficient to permit of his compounding the prescriptions of all the patients attended by the medical officer or medical officers.

ii. He shall further attend at the dispensary at any time and compound the medicines prescribed by the medical officer for any urgent case.

iii. He shall take charge of and keep carefully and safely, as far as lies in his power, all drugs, medicines, and stores provided by the Board of Health for use in the dispensary.

iv. He shall prepare and dispense skilfully and cautiously all prescriptions drawn up and ordered by the medical officer or medical officers, and shall punctually supply the medicines, when prepared, to the persons authorized to receive them, and shall, when so required by the prescriptions, express in writing, or by printed labels, the proper directions to accompany the medicines.

v. He shall make such pharmaceutical preparations for use in dispensing medicines as he may be required to make from time to time by the medical officer, or medical officers.

vi. He shall keep a record of all prescriptions so compounded, and of all medical and surgical appliances issued by him out of stock to dispensary patients, and a suitable book for the purpose shall be provided by the Secretary of the Board of Health.

vii. He shall prepare, after consultation with the medical officer, and submit for his signature, the necessary estimates and requisitions for medicines.

viii. He shall record in a book, to be kept for that purpose at each dispensary, the time of his arrival and departure, and shall submit each book at least once in each month to the medical officer, to be transmitted through him to the Board of Health for examination.

ix. He shall carefully compare and check the medicines received at the dispensary with the invoices relating thereto, and shall discharge such other duties as from time to time may be assigned to him by the Board of Health with the consent of the Minister.

MIDWIFE.

ARTICLE 20.—Every person to be appointed by any Board of Health to serve as a midwife of a dispensary district shall have the qualifications hereinafter set forth, that is to say:—

i. Such person shall be certified under the Midwives (Ireland) Act, 1918, otherwise than in pursuance of clause (e) of sub-section (1) of section 2 of the said Act.

ii. Such person shall have reached the age of twenty-one years.

ARTICLE 21.—The duties of every midwife of a dispensary district shall be as follows, that is to say:—

i. She shall reside in a convenient place in the district, within easy access of the medical officer.

ii. She shall observe and execute all lawful orders and directions of the medical officer applicable to her office.

iii. She shall duly and punctually attend all cases of midwifery in the dispensary district in which medical relief tickets are issued, and shall continue in attendance on each patient until her services are no longer necessary.

iv. On the termination of those cases in which the assistance of the medical officer has not been called for, the midwife shall report the result to the medical officer.

v. She shall keep a register of all cases attended by her either on the order of the medical officer or on ticket form E 3, and a suitable book for the purpose shall be provided by the Secretary of the Board of Health. This register shall be submitted monthly through the medical officer to the Board of Health for examination.

vi. The midwife is prohibited, under penalty of dismissal from accepting a fee for her services from any patient in the dispensary district who has obtained a medical relief visiting ticket, or who is entitled to medical relief under the Poor Relief (Ireland) Act, 1851.

ARTICLE 22.—A visiting ticket issued in the Form E 2 in a case of midwifery shall cast on the medical officer receiving it a full and undivided responsibility, notwithstanding the fact that a midwife is officially employed in the district. The services of the midwife shall not relieve the medical officer from his responsibility, but are placed at his disposal for the purpose of enabling him to relieve himself from the necessity of attendance in cases of natural labour in which no difficulty exists.

The following course shall be adopted in all cases in which dispensary relief is required by ticket for women in labour.

The ticket may be addressed either to the medical officer or to the midwife, at the option of the patient.

The ticket, if in the Form E 2, shall be presented to the medical officer, who shall register it and ascertain by visiting the patient that the case is one of natural labour.

If it should appear on such visit that the case is likely to be attended with any difficulty or danger, the medical officer shall take charge of the case himself, and may also requisition the services of the midwife; but if he is satisfied that the case is one of natural labour, it will only be necessary for him to place the midwife in attendance, directing her that should any thing out of the course of nature, or dangerous, arise, she is immediately to call for his assistance.

The ticket, if in the form E 3, shall be presented to the midwife, who shall duly and punctually attend thereon.

If in any case attended upon a ticket (form E 2 or Form E 3) the midwife finds it necessary to call for the assistance of the medical officer, and should intimate the same to him, he must immediately take charge of the case. Cases of abortion and miscarriage are to be regarded as midwifery cases.

ARTICLE 23.—Whenever, in the course of his attendance upon dispensary patients, a case arises which in the opinion of the medical officer necessitates his obtaining the assistance of another medical practitioner, the medical officer may, on his own authority, summon the requisite extra professional assistance, and shall report fully the circumstances to the Board of Health at their next following meeting. If the Board of Health are not satisfied that the extra assistance was necessary they may, pending the reference of the matter to the Minister, decline to repay the medical officer the consultant's fee, if the fee has been paid by him, or deduct the amount from the medical officer's salary if the fee has been paid otherwise. The matter shall be forthwith referred to the Minister, whose decision shall be final and binding on all parties. Payments made by the Board of Health for extra services under this article shall be subject to review by the auditor appointed by the Minister.

ARTICLE 24.—If the medical officer be temporarily incapacitated, by illness or other cause, from performing his duties, he shall immediately communicate with the assistance officer of the district, and shall, if possible, recommend a medical practitioner qualified as provided in article 16 of this Order, to perform his duties during such temporary incapacity; and the assistance officer shall thereupon make the necessary arrangements for the discharge of the duties of medical officer pending the meeting of the Board of Health to whom he shall report the circumstances of the case and the name of the temporary substitute employed; and if the necessity still exists the Board of Health shall either continue such employment or make such other arrangements as they shall deem fit for the discharge of the medical officer's duties during his temporary incapacity; and for the time during which such temporary substitute shall act as medical officer, he shall perform all the duties of the medical officer, and shall duly enter up the books of the dispensary for such time before any remuneration that may be agreed upon and sanctioned by the Minister be paid to him. The services of a medical practitioner, who would reside in the dispensary district while acting as temporary medical officer, should be secured whenever practicable.

ARTICLE 25.—The Board of Health shall pay to the medical practitioner employed temporarily to discharge the duties of the medical officer, as aforesaid, such reasonable remuneration for his services as the Minister shall approve or direct. The Board of Health shall, with the approval of the Minister, adopt a scale of fees to be allowed for extra professional assistance rendered in the day time and at night, and a copy of such scale shall be furnished to each medical officer of the County.

ARTICLE 26.—The Board of Health shall not make any deduction from the salary of the medical officer in respect of any payment made by them under article 23 of this Order, unless with the approval of the Minister had and obtained.

ARTICLE 27.—In case of the death or resignation of a medical officer, provision shall, in like manner as provided in article 24, be made by the assistance officer and the Board of Health for the performance of the duties of medical officer by a person duly qualified in accordance with article 16, until the appointment of a medical officer shall have been duly made, in accordance with articles 14 and 15 of this Order.

ARTICLE 28.—Sick leave granted by the Board of Health with the approval of the Minister, to a medical officer, shall be subject to the following general conditions:—

i. Continuous sick leave on full salary shall not be granted for any period longer than six months. At the expiration of such six months, if the officer is still unfit for duty, he may be allowed salary at not more than half the ordinary rate, and that for a further period not exceeding six months. After twelve months' continuous sick leave no officer shall be paid any salary, but he may, in special circumstances, with the consent of the Minister, be permitted to retain his position without salary for a further period not exceeding six months, upon the expiration of which time, if unable to resume duty, he shall submit his resignation to the Board of Health.

ii. Cases of repeated, but not continuous, sick leave amounting in the aggregate to upwards of twelve months during any period of eighteen months shall be reported specially to the Minister, who shall decide what, if any, payment should be made in respect of salary during sick leave.

iii. Prolonged sick leave, allowed under the conditions specified in paragraphs i. and ii. above, shall only be granted in a case where a reasonable hope is entertained of the officer's being able to resume the discharge of his duties.

BOARD OF HEALTH.

ARTICLE 29.—The Board of Health shall pay to each paid officer, permanent or temporary, duly authorized and appointed for the service of a dispensary district, such salary or remuneration as the Minister may from time to time approve or direct. The sum due to each medical officer for vaccination or re-vaccination shall be payable by the Vaccination Authority on the expiration of twenty-eight days from the receipt by them of the report of the numbers vaccinated.

ARTICLE 30.—The salary of each paid officer duly appointed for the service of a dispensary district shall be payable by the Board of Health quarterly (that is to say, to the 31st March, 30th June, 30th September, and 31st December, respectively, in each year), and proportionately for any part of a quarter for which he may have acted; and his salary shall be payable up to the day on which he ceases to hold his office or employment, and no longer, but no officer having been suspended by the Board of Health in pursuance of article 36, and who shall, without the previous removal of such suspension, be dismissed by the Minister, shall be entitled to any salary from the date of such suspension. Each medical officer shall be allowed an annual vacation, of four weeks, and the Board of Health shall pay to the medical practitioner employed temporarily to discharge the duties of the medical officer for that period, such reasonable remuneration for his services as the Minister shall approve or direct. The medical officer shall not relinquish the discharge of his duties until he submits an application to the Board of Health nominating a duly qualified practitioner who undertakes to perform the duties of temporary medical officer at a rate of remuneration to be stated, and until the Minister expresses his approval of the arrangement made.

ARTICLE 31.—Every officer appointed to or holding any office under the Poor Relief (Ireland) Act, 1851, shall, subject to the provisions of article 36 of this Order, continue to hold the same until he die, or resign, or be removed by the Minister, or be proved to be insane by evidence which the Minister shall deem sufficient.

ARTICLE 32.—The Board of Health shall take care that the premises provided in pursuance of the 8th section of the said Act of 1851 shall be maintained in good order and condition, and that full and adequate provision is made for having fires regularly maintained in them during such periods of the year, and on such days of the week as the medical officer may consider necessary for the proper preservation of the medicines and the comfort of the patients.

ARTICLE 33.—The Board of Health shall from time to time as may be necessary, cause to be provided a sufficient supply of books, stationery, and forms prescribed by this or any other Order under the seal of the Minister and all other requisities for the use of each medical officer; and shall also cause a sufficient number of check-books of medical relief tickets, according to the annexed forms E 1, E 2, and E 3, to be provided, and cause a sufficient supply of such check-books to be furnished to each Member of the Board of Health, and to each assistance officer and warden.

ARTICLE 34.—The poisonous medicines shall be kept under lock and key, separate from the other medicines, and the medical officer, or the compounder (if employed), shall retain and be responsible for the possession of the key of the poison press.

ARTICLE 35.— Immediately after the completion of each half-year, the Board of Health shall cause their Secretary to furnish to the medical officer of each dispensary district a statement of all items of expenses incurred for the district 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 the dispensary.

ARTICLE 36.—The Board of Health may, at their discretion, on sufficient grounds, suspend from duty any officer appointed to or holding any office under the Poor Relief (Ireland) Act, 1851, and shall forthwith report such suspension, together with the cause thereof, to the Minister; and if the Minister shall remove the suspension, such officer shall remain and discharge the duties appertaining to the office; but if the Minister, after due inquiry, decide not to remove the suspension, the Minister may dismiss such officer.

DRUGS.

ARTICLE 37.—In making contracts for the supply of drugs, medicines, and medical and surgical appliances for the use of a dispensary the Board of Heath shall adopt and make use only of the form of contract hereinafter set forth; and the person or persons so contracting shall be required to enter, with two sureties who may be approved by the Board of Health, into a bond, according to the form of bond annexed to the said form of contract, in such penal sum as the Board of Health shall think fit, conditioned for the due performance of the contract. The Secretary of the Board of Health shall see that the bond is duly executed and shall record the fact on the minutes of proceedings of the Board of Health for the information of the Minister.

FORM OF CONTRACT FOR SUPPLIES OF MEDICINES TO BE DELIVERED FROM THE

DAY OF   TO THE   DAY OF

MEMORANDUM OF AGREEMENT made the    day of    , one thousand nine hundred and       BETWEEN    of the one part, and the    COUNTY BOARD OF HEALTH OF the other part. It is hereby agreed by and between the said parties hereto, and the said    to     in consideration of the payments to

be made to     as hereinafter mentioned, hereby contract with the    County Board of Health, that the said    shall from the   day of     until the    day of     next, inclusive (which period is hereinafter referred to as "the said term") supply and deliver, free of all expense of carriage or delivery, at such place or places in the said County, at such times, and in such manner as the said County Board of Health, or their Secretary, or other officer of the said County Board of Health duly authorised by them, shall from time to time direct, such of the articles enumerated in the list of medicines prescribed by the Minister for Local Government, and such other drugs and medicines as shall be from time to time required by the said County Board of Health, in such quantities as shall from time to time be required by the said County Board of Health—the articles enumerated in the said prescribed list to be supplied or delivered at such rates or prices as in the said lists are set forth, and such other drugs and medicines not included in the said list to be supplied and delivered at the current wholesale prices of such other drugs and medicines; subject, nevertheless, in every case to the provisions as to abatement hereinafter contained, and provided that all such articles, drugs, and medicines as are measured by weight shall be measured by avoirdupois weight.

And they, the said County Board of Health, do hereby agree that in case the said     shall well and truly serve, supply, and deliver the articles aforesaid, and such other drugs and medicines as aforesaid, upon the terms and in manner aforesaid, according to this agreement, they, the said County Board of Health shall pay the said    within   days after each and every such delivery during the said term, at the rates and prices aforesaid, for such quantity of the said articles and such other drugs and medicines as shall have been ordered, served, supplied, and delivered during the said term, and of which a bill of particulars shall have been sent with and at the time of the delivery of the said articles, and such other drugs and medicines. PROVIDED ALWAYS, and it is hereby expressly declared and agreed, and particularly by and on the part of the said     that in the case of every payment agreed to be made to the said     as aforesaid, they, the said County Board of Health shall be entitled to have and make an abatement or deduction therefrom at and after the rate of    per centum on the total amount set forth in the said bill of particulars as the amount payable in respect of the said articles at the rates or prices set forth in the said prescribed list. PROVIDED further, and it is hereby further expressly declared and agreed, and particularly by and on the part of the said that the said County Board of Health or the medical officer of any dispensary district in the said County shall be at liberty at any time to submit and refer a sample or samples of any of such articles or such other drugs and medicines as shall or may from time to time be supplied or delivered under the provisions hereof to the analyst of the county or borough in which the county home or hospital or dispensary is situated, or to such other analyst as the Minister for Local Government may direct, whose decision in relation thereto it is hereby agreed shall be final and conclusive upon the parties hereto respectively. And it is hereby further expressly agreed, and particularly by and on the part of the said , that in case any of the said articles or such other drugs and medicines shall or may be found and decided by such analyst as aforesaid not to be in every respect of good quality, or not to be of the quality and sort contracted for, or not to be in exact conformity with the standards and formularies of the latest edition of the British Pharmacopœia and with the standards for pharmacopœial preparations prescribed by the Minister for Local Government, then and in every such case they, the said County Board of Health, or their Secretary, or other officer duly authorised by them, shall be at liberty to return the said article or such other drug or medicine or the unused portion thereof at the expense of the said

or give notice for the same to be sent for and fetched away by the said and also to require the said to send a fresh supply of the said article or such other drug or medicine of the same quantity and quality as contracted for, and the said shall forthwith, on being so required, send a fresh supply of the said article or such other drug or medicine of the same quantity and quality contracted for, and in lieu of the article, drug, or medicine so first supplied, whether or not any part of the article, drug or medicine so first supplied may have been used. And it is hereby further expressly agreed, and particularly by and on the part of the said that in case such articles, or such other drugs and medicines, as are hereby contracted for, or any of them, shall not be duly served, supplied, and delivered by the said when and as directed by the said County Board of Health, or their Secretary, or other officer duly authorized by them, or in case such articles, or such other drugs and medicines, or any of them, shall or may be found and decided by such analyst as aforesaid not to be in every respect of good quality, or not to be of the quality and sort contracted for, or not to be in exact conformity with the standards and formularies of the latest edition of the British Pharmacopœia and with the standards for pharmacopœial preparations laid down by the Minister for Local Government, or in case such articles, or such other drugs or medicines, or any of them, shall be deficient in the weight, size, measure, or quantity stated and charged for in such bill of particulars, or if the same shall be delivered without such bill of particulars, they, the said County Board of Health, or their Secretary, or other officer so authorized by them, shall be at liberty to return the said articles or such other drugs or medicines or the unused portion or portions thereof at the expense of the said or give notice for the same to be sent for and fetched away by the said and that in every such case the said County Board of Health, or their Secretary, or other officer authorized by them, as aforesaid, may purchase a fresh supply of such articles, or of such other articles in lieu thereof, or of such other drugs and medicines as the said County Board of Health, or their Secretary, or other officer so authorized as aforesaid, shall think fit, or employ any other person or persons to furnish a fresh supply of such first-mentioned articles or of such other articles in lieu thereof, or of such other drugs and medicines, as aforesaid, in such a manner as may be required during the said term or any part of such term in the place of the saidAnd it is hereby further agreed that in case such first-mentioned articles, and such other drugs and medicines, shall not be duly served, supplied, and delivered in such quantities as shall from time to time be required by the said County Board of Health, then and in every such case, and as often as it shall so happen, the said County Board of Health, or their Secretary, or other officer so authorized as aforesaid, may purchase from any person or persons other than the said such a supply of the said first-mentioned articles and drugs and medicines as shall be necessary to complete the quantity required, or to purchase and provide such quantity or quantities or any other articles, drugs, and medicines, directed by the said County Board of Health to be used instead of the said first-mentioned articles, and drugs and medicines as shall be considered necessary by the said County Board of Health to supply such deficiency, and that in any and every such cases the said shall bear and make good all charges and expenses of such articles, drugs and medicines so to be provided, over and above the price or sum which would have been payable to the said under this agreement in respect of the said articles, drugs, and medicines, if they had been duly served, supplied, and delivered by the said. And also that the said County Board of Health may retain and apply any sum of money which may be due to the said under and by virtue of this agreement, at the time of any failure in the performance hereof, to the payment of such charges and expenses as the said County Board of Health may incur or be put to by reason thereof. And that, notwithstanding any agreement hereinbefore contained for making good the articles, drugs, and medicines which shall not be served, supplied and delivered according to the terms hereinbefore agreed on and in pursuance of this contract, the said County Board of Health may put in suit the bond to be given for the performance of this contract, of even date herewith, against the said and sureties, or either of them.

And it is hereby further agreed that it shall be lawful for the said County Board of Health, on the direction or with the consent of the Minister for Local Government, at any time during the said term to terminate this agreement by giving days' notice in writing of the termination of the agreement, such notice to be delivered to the said or left at usual place of abode or of carrying on business, and, such notice having been so left or delivered, this present contract or agreement shall in all respects cease and determine on the expiration of the said period named in such notice, anything herein contained to the contrary thereof in anywise notwithstanding.

And it is hereby further agreed by and between the parties hereto in manner following, that is to say, the said do hereby agree with the said County Board of Health to supply free of charge, save as hereinafter provided, all packages, hampers, jars, bottles, and other vessels in which drugs and medicines are contained, and to take back such packages, hampers, jars, bottles and vessels, when empty, and pay all reasonable packing and transit expenses incurred in respect of the return of such empties, and to take all risk of breakage in transit, and they, the said County Board of Health, hereby agree with the said to pay the said for all such packages, hampers, jars, bottles, and other vessels as aforesaid as are not returned by the said County Board of Health to the said within six months from the date at which the same containing drugs or medicines shall have been delivered to the said County Board of Health, such payment to be made in accordance with the list of prices submitted with tender by the said

As WITNESS the seal of the said County Board of Health, and the hand of the said the day and year first hereinbefore written.

[Bond.]

KNOW ALL MEN by these presents, that We are jointly and severally held and firmly bound to the County Board of Health in the sum of of good and lawful money of Saorstát Eireann, to be paid to the said County Board of Health or their certain attorney, successors, or assigns, for which payment to be well and faithfully made, we bind ourselves jointly, and each of us bindeth himself severally, our and each and every of our heirs, executors, and administrators, and every of them, firmly by these presents. Sealed with our seals, and dated this day of, in the year of our Lord one thousand nine hundred and

WHEREAS, by a certain contract or agreement, bearing even date with this obligation, and made between the above-bounden of the one part, and the above-named County Board of Health of the other part, the said has contracted with the said County Board of Health aforesaid, to serve, supply, and deliver, free of all expense, at in the said County, from the day of to the day of then next inclusive, such quantity of the several articles, drugs, and medicines therein specified as shall be required, of such quality, at such times, and after the rate and price, and subject, to the terms, provisions, and stipulations, as in the said contract or agreement are particularly mentioned and set forth, and as on reference thereto will more fully appear.

NOW THE CONDITION of this obligation is such, that if the above-bounden executors or administrators, do and shall well and truly perform, fulfil, and keep all and every the covenants, clauses, provisos, terms, and stipulations, in the said recited contract or agreement mentioned or contained, and on and their part to be observed, performed, fulfilled and kept according to the true purport, intent, and meaning thereof, then this bond or obligation shall be void, or else shall be and remain in full force and virtue.

Signed, sealed and delivered by the above-bounden

}

[Seal]

[Seal]

in presence of

[Seal]

Form of Contract and Bond for supplies of Medical and

Surgical Appliances, to be delivered from

the

day of

to the

day

of

MEMORANDUM OF AGREEMENT, made the

day of

one thousand nine hundred and

BETWEEN of the one part, and the

COUNTY BOARD OF HEALTH of the other part.

It is hereby agreed by and between the parties hereto, and the said do in consideration of the payments to be made to as hereinafter mentioned hereby contract with the County Board of Health, that the said shall from the day of until the day of next, inclusive (which period is hereinafter referred to as "the said term") supply and deliver free of all expense of carriage or delivery, at such place or places in the said County, at such times, and in such manner as the said County Board of Health, or their Secretary, or other officer of the said County Board of Health duly, authorized by them, shall from time to time direct, the articles enumerated in the list of medical and surgical appliances prescribed by the Minister for Local Government in such quantities as shall from time to time be required by the said County Board of Health—the same to be delivered at such rates or prices as in the said lists are set forth; subject, nevertheless, to the provisions as to abatement hereinafter contained.

And they, the said County Board of Health aforesaid, do hereby agree that in case the said shall well and truly serve, supply and deliver the articles aforesaid, upon the terms and in manner aforesaid, according to this agreement, they, the said County Board of Health shall pay the said within days after each and every such delivery during the said term, at the rates and prices aforesaid for such quantity of the said articles as shall have been ordered, served, supplied, and delivered, during the said term, and of which a bill of particulars shall have been sent with and at the time of the delivery of the said articles.

PROVIDED ALWAYS, and it is hereby expressly declared and agreed, and particularly by and on the part of the said that in the case of every payment agreed to be made to the said as aforesaid, they, the said County Board of Health shall be entitled to have and make an abatement or deduction therefrom at and after the rate of per centum on the total amount set forth in the said bill of particulars as the amount payable at the rates or prices set forth in the said prescribed list. PROVIDED FURTHER, and it is hereby expressly declared and agreed, and particularly by and on the part of the said that in case any such article or articles as shall or may from time to time be supplied or delivered under the provisions hereof, shall not be considered by the said County Board of Health or by the medical officer of the county institution or of a dispensary district, in every respect of good quality, and of the quality and sort contracted for, or in case such article or articles, or any of them, shall be deficient in the weight, size, measure, or quantity stated and charged for in such bill of particulars, or if the same shall be delivered without such bill of particulars, they the said County Board of Health, or their Secretary, or other officer so authorized by them, shall be at liberty to return the same at the expense of the said or give notice for the same to be sent for and fetched away by the said; and that in every such case the said County Board of Health, or their Secretary, or other officer so authorized by them, as aforesaid, may purchase a fresh supply of such articles, or of such other articles in lieu thereof, as the said County Board of Health, or their Secretary, or other officer so authorized as aforesaid, shall think fit, or employ any other person or persons to furnish a fresh supply of such first-mentioned articles or of such other articles in lieu thereof, as aforesaid, in such a manner as may be required during the said term, or any part of such term, in the place of the said And it is hereby further agreed that in case such first-mentioned articles shall not be duly served, supplied, and delivered in such quantities as shall from time to time be required by the said County Board of Health, then and in every such case, and as often as it shall so happen, the said County Board of Health, or their Secretary, or other officer so authorized as aforesaid, may purchase from any person or persons other than the said such a supply of the said first-mentioned articles as shall be necessary to complete the quantity required, or to purchase and provide such quantity or quantities of any other article or articles directed by the said County Board of Health to be used instead of the said first-mentioned articles, as shall be considered necessary by the said County Board of Health to supply such deficiency, and that in any and every of such cases the said shall bear and make good all charges and expenses of such articles so to be provided, over and above the price or sum which would have been payable under this agreement to the said in respect of the said articles if they had been duly served, supplied, and delivered by the said AND ALSO that the said County Board of Health may retain and apply any sum of money which may be due to the said under and by virtue of this agreement, at the time of any failure in the performance hereof, to the payment of such charges and expenses as the said County Board of Health may incur or be put to by reason thereof. And that, notwithstanding the agreement hereinbefore contained for making good the articles which shall not be served, supplied, and delivered according to the terms hereinbefore agreed on and in pursuance of this contract, the said County Board of Health may put in suit the bond to be given for the peformance of this contract, of even date herewith, against the said and

sureties, or either of them.

And it is hereby further agreed that it shall be lawful for the said County Board of Health, on the direction or with the consent of the Minister for Local Government, at any time during the said term to terminate this agreement by giving days' notice in writing of the termination of the agreement, such notice to be delivered to the said

or left at usual place of abode or of carrying on business, and, such notice having been so left or delivered, this present contract or agreement shall in all respects cease and determine on the expiration of the period named in such notice, anything herein contained to the contrary thereof in anywise notwithstanding.

As WITNESS the seal of the said County Board Board of Health, and the hand of the said

the day and year first hereinbefore written.

[Bond.]

KNOW ALL MEN by these presents, that We are jointly and severally held and firmly bound to the County Board of Health in the sum of of good and lawful money of Saorstát Eireann, to be paid to the said County Board of Health, or their certain attorney, successors, or assigns, for which payment to be well and faithfully made, we bind ourselves jointly, and each of us bindeth himself severally, our and each and every of our heirs, executors, and administrators, and every of them, firmly by these presents. Sealed with our seals, and dated this day of in the year of our Lord one thousand nine hundred and

WHEREAS, by a certain contract or agreement, bearing even date with this obligation, and made between the above-bounden of the one part, and the above-named County Board of Health of the other part, the said hath contracted with the said County Board of Health aforesaid, to serve, supply, and deliver, free of all expense, at in the said County, from the day of to the day of then next inclusive, such quantity of the several articles therein specified as shall be required, of such quality, at such times, and after the rate and price, and subject to the terms, provisions, and stipulations as in the said contract or agreement are particularly mentioned and set forth, and as on reference thereto will more fully appear.

NOW THE CONDITION of this Obligation is such that if the above-bounden executors or administrators, do and shall well and truly perform, fulfil, and keep all and every the covenants, clauses, provisoes, terms, and stipulations in the said recited contract or agreement mentioned or contained, and on and their part to be observed, performed, fulfilled, and kept according to the true purport, intent, and meaning thereof, then this bond or obligation shall be void, or else shall be and remain in full force and virtue.

Signed, sealed and delivered by the above-bounden

}

[Seal.]

[Seal.]

in presence of

[Seal.]

ARTICLE. 38.—(i.) The Minister will publish at the commencement of each year—

(a) A form of tender containing a list of authorized drugs and other requisites, together with a statement of the price specified for each article therein mentioned:

(b) A form of tender containing a list of medical and surgical appliances and requisites, together with a statement of the price specified for each article therein mentioned:

and the said forms, lists, and prices are in this order referred to respectively as the prescribed forms, the prescribed lists, and the prescribed prices.

(ii.) Every tender shall be in such one of the prescribed forms as is applicable to the case, and persons tendering shall state in the space provided therefor the percentage of abatement which they will be prepared to give from the gross cost of the articles purchased during the year, calculated at the prescribed prices.

(ii. A.) Recoupment from the Local Taxation (Saorstát Eireann) Account will not be allowed in any case where the Board of Health accepts a tender other than the lowest tender received by them for the supply of drugs or other articles contained in the prescribed lists unless the Minister, on application being made to him by the Board of Health for that purpose, approve of the acceptance of such tender.

(iii.) Recoupment from the Local Taxation (Saorstát Eireann) Account will only be allowed upon drugs and other articles contained in the prescribed lists.

(iv.) Recoupment from the Local Taxation (Saorstát Eireann) Account will only be allowed where the contractors for the supply of medicines, or of medical and surgical appliances, are either recognised manufacturers or recognised dealers who keep in stock a full assortment of the articles on the prescribed list to which the contract in each case refers.

(v.) Recoupment will not be sanctioned until the Board of Health obtain a certificate from the county or other analyst recognised by the Minister that he has examined samples of drugs from the County Institution and the various dispensaries of the County. When there has been any departure from the required standard, special attention must be called to the fact in the certificate.

(vi.) In the event of the Board of Health, after warning by the Minister, retaining the services of a contractor who has been shown to have supplied drugs or other articles not of the required standard, or medical or surgical appliances not of good quality, the Minister may refuse to recoup any portion of the expenditure incurred for medicines or medical or surgical appliances supplied by such contractor.

(vii.) Where the Minister after due inquiry, is of opinion that the expenditure for medicines or medical or surgical appliances in any County Institution or dispensary is excessive, having regard to the nature of the cases and the number of persons treated, he may refuse recoupment upon any portion of the expenditure which has been declared by him to be excessive.

(viii.) Contracts for medicines and medical and surgical appliances shall be entered into annually, from 1st of April in each year to the 31st of March in the following year, and a copy of the accepted tender shall be furnished without delay (or at least within fourteen days) by the Secretary of the Board of Health to each medical officer for his information and guidance in ordering supplies.

FORMS REFERRED TO IN THIS ORDER.

FORM A, No. 1.

—County.

—Dispensary District.

Return of members of the County Board of Health, Wardens, and Assistance Officers authorised to issue Medical Relief Tickets in the above-named County and Dispensary District.

Name of Dispensary District.

Members of the County Board of Health.

Wardens elected by the County Board of Health and Assistance Officer or Officers acting for any Electoral Division within the Dispensary District.

Name.

Residence.

Name of the Electoral Division in which Residence is situated.

Name.

Residence.

Name of the Electoral Division in which Residence is situated.

Signature,

Secretary of ___________

County Board of Health.

Date, ___________ of ____________ 1

FORM A, No. 2.

______________ County.

_________________ Dispensary District.

Return of [Member of County Board of Health or Warden] to supply a vacancy in the list of persons authorized to issue Medical Relief Tickets in the above-named Dispensary District.

Name of Member.

Name of Warden.

Residence (stating also the name of the Electoral Division in which it is situated.)

Signature,

Secretary of _____________ County Board of Health.

Date. __________ of __________ 1

FORM B, No. 1.

Notice to be given by the Secretary of the County Board of Health to each Member of the County Board of Health after election.

—COUNTY.

SIR, —Notice is hereby given to you that in pursuance of the powers conferred by your office as Member of the County Board of Health you are authorized to issue Medical Relief Tickets in every Dispensary District of the County.

Check Books containing Tickets for Medical Relief, in the prescribed Forms, are enclosed herewith; [or if the person has been previously appointed and supplied] can be obtained from me from time to time when those already issued to you have been used.

Signed this day of 1

Secretary of ___________ County Board of Health.

To

of

FORM B, No. 2.

Notice to be given to any Warden on his election by the County Board of Health.

_________________ COUNTY

_____________ DISPENSARY DISTRICT.

SIR,—Notice is hereby given to you that you have been elected by the — County Board of Health to be a Warden, and you are, therefore, authorized to issue medical relief tickets.

Check Books containing Tickets for Medical Relief, in the prescribed Forms, are enclosed herewith; [or if the person has been already supplied] can be obtained from me from time to time when those already issued to you have been used.

Signed this

day of

1

Secretary of _________ County Board of Health.

To

of

FORM C.

___________________ County.

_________________ Dispensary District.

List of members of the County Board of Health, and of the Assistance Officers and Wardens acting for each Electoral Division included in such District, and authorized to issue medical relief tickets.

Member of County Board of Health.

Assistance Officers acting for any Electoral Division in the District.

Wardens acting for any Electoral Division in the District.

Name.

Residence.

Name.

Residence.

Name.

Residence.

Signature,

Secretary of ______

County Board of Health.

To

Date,

_____ of

_________ 1

Medical Officer

of ___________ Dispensary District.

FORM D.

Notice to be transmitted by Secretary of County Board of Health to a member of the Board, or Warden, on the expiration of his Term of Office, in case he be not re-elected.

___________ COUNTY.

________________ DISPENSARY DISTRICT.

_________ of ________ , 1___________ .

SIR,—I am directed by the ___________ County Board of Health to apprize you that the period for which you were appointed a [Member of the Board or Warden, as case may be], having expired, your power to issue Tickets for Medical Relief, in pursuance of the provisions of the Medical Charities Act, has ceased; and the Medical Officer of the District is not authorized by the Act to afford medical relief upon any tickets hereafter issued by you, unless and until you shall be reappointed. And you are requested to be good enough to return to the County Board of Health, for the use of the persons authorized to issue such tickets, any blank forms of medical relief tickets in the Check Books, Farms E 1, E 2, and E 3, which now remain in your hands unused.

By Order of the County Board of Health,

To ___________

__________ Secretary.

____________________

Notice to be transmitted by Secretary to an Assistance Officer, on the expiration of his Term of Office.

_________________ COUNTY.

_________ DISPENSARY DISTRICT.

____________ of _________ , 1 ____ .

SIR,—I am directed by the __________ County Board of Health to apprize you that your power to issue tickets for medical relief in the ______ Dispensary District, in pursuance of the provisions of the Medical Charities Act, has ceased; and the medical officer of the District is not authorized by the Act to afford medical relief upon any tickets hereafter issued by you. And you are requested to be good enough to return to the County Board of Health, for the use of the persons authorised to issue such tickets, any blank forms of medical relief tickets in the Check Books, Forms E 1, E 2, and E 3, which now remain in your hands unused.

By Order of the County Board of Health,

To _____________________

_____________ Secretary.

FORMS E. 1, 2, and 3.—MEDICAL RELIEF TICKET CHECK BOOKS.

FORM E 1.

/images/en.si.1923.0951.0001.jpg

FORM E 1.

TICKET FOR ATTENDANCE AT DISPENSARY.

TICKET FOR ATTENDANCE AT DISPENSARY.

____________

____________

To Dr. , Medical Officer of

To Dr. , Medical Officer of

Dispensary District in County.

Dispensary District in County.

SIR,

SIR,

You are hereby directed to afford Medical Advice and any necessary Medicine to , aged ,

You are hereby directed to afford Medical Advice and any necessary Medicine to , aged ,

residing at , in the above Dispensary District, who is by occupation a

residing at , in the above Dispensary District, who is by occupation a

Dated this day of 1 .

Dated this day of 1 .

(Signed),

(Signed),

Member of County Board of Health Assistance Officer, or Warden, as the case may be.

Member of County Board of Health Assistance Officer, or Warden, as the case may be.

FORM E 2.

/images/en.si.1923.0951.0002.jpg

FORM E 2.

____________

____________

TICKET FOR ATTENDANCE AT THE PATIENT'S HOME.

TICKET FOR ATTENDANCE AT THE PATIENT'S HOME.

To Dr. Medical Officer of

To Dr. Medical Officer of

Dispensary District in County.

Dispensary District in County.

SIR,

SIR,

You are hereby directed to visit and afford Medical

You are hereby directed to visit and afford Medical

Advice and any necessary Medicine to

Advice and any necessary Medicine to

aged , residing at , in the above Dispensary District, who is by occupation a

aged , residing at , in the above Dispensary District, who is by occupation a

Dated this day of 1 .

Dated this day of 1 .

(Signed),

(Signed),

Member of County Board of Health, Assistance Officer, or Warden, as the case may be.

Member of County Board of Health, Assistance Officer, or Warden, as the case may be.

SEE THE BACK OF THIS TICKET FOR INSTRUCTION AS TO PRESENTING IT.

FORM E 3.

/images/en.si.1923.0951.0003.jpg

FORM E 3.

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

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

____________

____________

To Midwife of

To Midwife of

Dispensary District in County.

Dispensary District in County.

MADAM,

MADAM,

You are hereby directed to visit at once

You are hereby directed to visit at once

, residing at

, residing at

in the above Dispensary District, who is by occupation

in the above Dispensary District, who is by occupation

a , and afford her the necessary

a , and afford her the necessary

attendance and nursing.

attendance and nursing.

Dated this day of 1 .

Dated this day of 1 .

(Signed),

(Signed),

Member of County Board of Health, Assistance Officer, or Warden, as the case may be.

Member of County Board of Health, Assistance Officer, or Warden, as the case may be.

DIRECTIONS FOR PRINTING MEDICAL RELIEF TICKETS.

Blank tickets for medical relief are to be printed in the Forms E 1 and E2 in counterparts, and bound up in books; and the name of the medical officer, and of the dispensary district and County, can be printed in 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 E 1, which is the form of ticket to be issued for medical relief to he given on the party attending at the dispensary, is to be printed in black ink. Form E 2, which is the form of ticket to be issued where it is necessary that the medical officers should visit the patient at his home, is, for the sake of distinction and convenience, to be printed in red ink.

On the back of the ticket, Form E 1, the following memorandum is to be printed:—"A member of the Board of Health, warden, or assistance officer, before issuing a ticket, shall exercise due diligence in ascertaining whether the applicant is a `poor person' and entitled to gratuitous medical relief. "

On the back of the ticket, Form E 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 Board of Health, warden, or assistance officer, before issuing a ticket, shall .exercise due diligence in ascertaining whether the applicant is a `poor person' and entitled to gratuitous medical relief."

Tickets Form E 3 are to be printed also in counterparts in purple ink, and bound in books, and are to be used when the patient applies for the services of a midwife.

On the back of the ticket, Form E 3, the following memorandum is to be printed:—"The result of the case is to be recorded by the midwife hereon and the ticket given by her to the medical officer for registration. "

___________________________________________________________________

___________________________________________________________________

___________________________________________________________________

" Signature _____________________________

" Date _______________________

Directions for filling up medical relief tickets.—(To be printed on the first leaf of each check book).

The ticket and counterpart are both to be filled up by the person authorised to issue the ticket; one part to be retained by the person issuing the ticket and the other 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 E 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 in which the applicant is resident at the time; and care should be taken to fill up the ticket and apprize the applicant accordingly, as the medical officer of each dispensary district is only bound to attend " any poor person 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, &c., and number of house) should be given as will be sufficient for identification and for registration; and with this view, the age and occupation of the applicant should also be stated wherever practicable. Any further observation which the grantor of the ticket may desire to make should be written on the front of the ticket.

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

FORM F.

MEDICAL RELIEF REGISTER.

________ Dispensary District, in the

____________________ County.

Number of Case.

Date of presentation of Ticket.

Name of Patient.

Residence of Patient.

Age.

Disease.

Dates of Attendances.

Prescriptions and Treatment at Dates in preceding Columns.

Result:— (As Relieved, Cured Died, Ticket Cancelled by Country Board of Health, &c.)

Observations.

At Dispensary.

At Patient's Home.

Col. 1

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

Directions for filling up the medical relief 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 a second or subsequent illness, or in the case of a dispensary ticket of absence from the dispensary for a period of one month, in which event he should, on presentation of a fresh ticket, be registered again with a fresh number, as a new case, reference being also made, in the column for observations, to his previous number.

Column 2.—The date on which the ticket is presented to the medical officer is to be inserted in column 2.

Columns 3, 4, 5, and 6.—The Christian name and surname of the patient are to be inserted in full in column 3; the residence of the patient in column 4; the age of the patient, as well as can be ascertained, in column 5; and the disease for which the patient is treated in column 6.

Columns 7 and 8.—The date of each attendance from the commencement to the termination of the case is to be entered in these columns; if the attendance is at the dispensary, in column 7; if at the patient's home, in column 8.

Column 9.—Should contain a record of the treatment of each case. The date of each attendance, as entered in column 7 or 8, should be entered in this column also; with a description of the prescription or treatment at each date. If in any case the attendances and prescriptions should be too numerous to admit of their all being entered in the space provided for the purpose, a new entry of the case may be made at a subsequent page of the book, but not with a new number, a reference being made in the first entry to the page of the book at which the case is continued.

Column 10.—Is to contain a statement of the result of the case, as " Relieved," " Cured," " Died," " No further attendance at the Dispensary, " " Ticket withdrawn by issuer, " " Ticket Cancelled by County Board of Health, " and in the latter event the date of the meeting at which the ticket was cancelled should be entered, and the chairman of the day should place his signature or initials against the entry.

Column 11.—This column is intended for any other particulars, directions, or explanation as to any case which the medical officer or the chairman of the County Board of Health may think it desirable to insert.

A sufficient number of leaves (with the letters of the alphabet marked on spaces cut at the outer edge) is bound up with the register to serve as an index.

FORM G.

VACCINATION REGISTER.

County of ________________

Rural or Urban District ________________

District of ________________

Register of Cases of Successful Vaccination and

Re-vaccination.

No.

Name of Person Successfully Vaccinated.

Name of Person Successfully Re-Vaccinated.

Age at time of Vaccination.

Date of first Vaccination.

Residence at time of Vaccination.

If a child, Name and Residence of Father, Mother, or Person in charge.

Number of entry of child's Birth in the Register of Births.

Signature of Medical Officer and Date of Entry.

Instructions for Vaccination Register:—(To be printed at the beginning of each Book.)

The series of numbers in column 1 is to run from the beginning to the end of the year, and a fresh series of numbers is to be commenced on the 1st January in each year.

The column for number of entry of child's birth, in the register of births, need not be filled up unless the medical officer is also registrar of births and deaths, nor is cases where the person vaccinated was born before the 1st January, 1864.

The register of vaccination is to be laid before the vaccination authority at their first ordinary meeting in each month, or at such other times as they may appoint.

FORM H.

FORM OF REPORT OF THE MEDICAL OFFICER in pursuance of Section 3 of the Act 21 and 22 Vic., c. 64, of the NUMBER OF PERSONS SUCCESSFULLY VACCINATED by him.

________________ County or County Borough.

________________ Dispensary District.

________________ Urban or Rural District.

I hereby certify that I have, between the dates _________ and __________ , successfully vaccinated at the Dispensary and Vaccination Stations, ________________ persons; that I have in each case performed the operation in the manner prescribed by the Minister for Local Government, and that I duly inspected the result of the vaccination at the times required by the regulations of the Minister for Local Government, and that I have entered all the required particulars in the Vaccination Register.

(Signature) ________________

Medical Officer ________________ of Dispensary District.

Date, ________________ , 1  .

FORM I.

MEDICAL OFFICER'S REPORT BOOK.

________________ County.

________________ Dispensary District.

Date.

Time of arrival at the Dispensary.

Time of Departure from the Dispensary.

Report on any Matter requiring Attention from the County Board of Health.

FORM K

BRIDEWELL ACCOUNT.

________________ County.

________________ Dispensary District.

Medical Officer's Account of Medicines supplied to Prisoners and Inmates in __________ Bridewell [or House of Corroction, as the case may be], in the above Dispensary District, under §15 of 14 & 15 Vic., c. 68.

Number of Prisoners and Inmates attended by Medical Officer of Dispensary.

Medicines supplied.

Quantities thereof.

Date of Supply of Medicines.

Dates of Medical Officer's Attendance

Males.

Females.

Total.

Column 1.

2.

3.

4.

5.

________________ County.

________________ Dispensary District.

MEDICAL OFFICER'S RETURN.—FORM L.

Half-year ended the ________ 19 ___________ .

(I.)—STATISTICAL RETURN.

The dates to which this return should be made up are the 31st March and 30th September in each year.

NOTE.—The return should be forwarded to the Minister for Local Government as soon as possible after the end of the half-year (at least within twenty-one days), and a copy of the Statistical and Medical Charities (omitting the columns and replies to queries relating to vaccination) portions should be transmitted by the medical officer for submission to the County Board of Health at their next following meeting, and similarly, a copy of the Public Health portion, including a copy of the Statistical portion relating to vaccination, and of the replies to queries relating vaccination, for submission to the district council or councils, or council of a county borough concerned.

/images/en.si.1923.0951.0004.jpg

NOTE—Article 17 (XV.), ante, p. 17, directs that the Medical Officer's Return shall be in the Form L. with such variations as may from time to time be prescribed by the Minister for Local Government. The form prescribed from time to time will be furnished as required.

Signature,

Date,

Medical Officer.

(II.) —MEDICAL CHARITIES AND VACCINATION.

FORM L.

County.

Dispensary District.

Medical Officer's Return for the Half-year ended

the

19

.

QUESTIONS TO BE ANSWERED BY THE MEDICAL OFFICER,

ANSWERS

Medicines.

1. Have you any complaints to make as to the quality of the drugs or the manner in which they are supplied?

2. Are the medicines neatly packed and promptly delivered by the contractor, and the invoices received in good time? ... ... ... ... ...

3. Have you weighed the drugs on delivery and found them correct? ... ... ... ...

Vaccination.

1. Have you had any failures with the lymph procured from the Secretary of the Vaccine Department of the Ministry of Local Government, Dublin? ...

2. In performing primary vaccination at the dispensary and vaccination stations, do you follow the instructions of the Minister for Local Government by seeking to produce four typical vesicles? ... ...

3. Are the Dispensary arrangements and provisions as to vaccination duly notified by public notices (form N) posted in the district in accordance with article 6 of the dispensary rules, or in what manner? ...

4. Has there been any increase or diminution of primary vaccination as compared with the previous year?

5. Is the amount of vaccination performed in proportion to the population? ... ... ...

6. If not state the probable cause, or causes, of any diminution? ... ... ... ... ...

7. Have the reports (form P) been duly made and transmitted to the vaccination authority? ... ...

MEDICAL CHARITIES—continued.

QUESTIONS TO BE ANSWERED BY THE MEDICAL OFFICER,

ANSWERS.

Vaccination.— con.

[Report (form P) should be furnished four times a year—namely, for quarters ending 31st March, 30th June, 30th September, and 31st December, and not later than twenty-one days from the end of each quarter.]

8. How many defaulters were returned in:

(a) Report for 1st quarter of half-year.

(b) Report for 2nd quarter of half-year.

Dispensary Arrangements.

1. Is a notice board or inscription (form O) affixed on the exterior of each dispensary, in accordance with article 6 of the dispensary rules, and does such notice contain the particulars directed to be so affixed, and is it kept in a legible state? ... ... ... ...

2. Are the dispensary buildings suitable, in good order, and kept clean and does the caretaker perform her duties satisfactorily? ... ... ... ...

3. Is full and adequate provision made for having fires regularly maintained in the consulting and waiting-rooms? ... ... ... ... ...

Midwife.

1. Does the midwife perform her duties satisfactorily, and are her services requisitioned by the poor of the district?

General Observations.

[Any further observations which the Medical Officer may desire to make can be added here.]

Signature,

______________________________

Medical Officer.

Date,____________________

(III.) —PUBLIC HEALTH.

FORM L.

_________________ County.

_________________________Urban or Rural District.

______________________________ Dispensary District.

Medical Officer's Return for the Half-year ended ................................19................

QUESTIONS TO BE ANSWERED BY THE MEDICAL OFFICER,

ANSWERS.

________________

________________

1. Name and Address of each sanitary sub-officer acting within the dispensary district. ... ...

2. Are you satisfied that each sanitary sub-officer carefully inspects the district with a view of discovering nuisances, and that he reports such nuisances when necessary? ... ... ... ... ...

3. How many reports has he made to you during the half-year? ... ... ... ... ...

4. How many sanitary reports have been made by you during the half-year? ... ... ... ...

5. Have the nuisances reported been abated? ...

6. Have you, by inspection of your district, kept yourself informed of the conditions injurious to health existing therein, and regularly reported the same to the sanitary authority? ... ... ... ...

7. Is the district in good sanitary condition? If not, state the principal defects and requirements:—

Water Supply, ... ... ... ...

Sewerage, ... ... ... ... ...

Nuisances, ... ... ... ... ...

Dairies, Cowsheds, and Milkshops, ... ...

Factories and Workshops, ... ... ...

Common Lodging Houses, ... ... ...

Domestic scavenging

}

Urban Districts.

Housing of working classes

Other matters, ... ... ... ...

8. Have you reported to the sanitary authority these defects and the measures which you consider should be adopted for the improvement or protection of the public health in your district? ... ... ...

9. In the event of an outbreak of any infectious disease having occurred in the district during the half-year, state the number of cases, the probable source of infection, the steps taken to prevent the spread of the disease, whether you have furnished the report required by article 17, paragraph XVI., of the dispensary rules. (The answer to this question should not be confined to the medical officer's dispensary practice.)

10. General observations as to any matters affecting the public health of the district, e.g., the condition of the houses in regard to ventilation, lighting, cleanliness, and general sanitation.

Signature__________________

Medical Officer

___________________________

___________________________

}

Address.

Date,_________________________________

[NOTE.—A copy of this Return should be kept at the Dispensary for reference.)

FORM M.*

ESTIMATE AND REQUISITION FOR MEDICINES, &c.

FORM M.—Estimate of Medicines, &c., required.

____________County.

______________ Dispensary District.

No. of Article as given in Prescribed Lists.

Name of Article as given in Prescribed Lists.

Prescribed Prices.

Quantity remaining on Hand.

Quantity now required.

(Signature),

__________________________ Medical Officer.

Approved of this

day of

1 .

(Signature),

_______________________ Presiding Chairman.

(Signature),

____________________ Secretary.

* NOTE.—Article 11, directs that the medical officer's requisition shall be in such form as may from time to time be prescribed by the Minister for Local Government instead of this form M. The form prescribed from time to time will be furnished as required.

FORM N.

NOTICE FOR POSTING UP AT EACH DISPENSARY AND OTHER PLACES IN DISPENSARY DISTRICTS.

___________ COUNTY.

__________ DISPENSARY DISTRICT, consisting of the Electoral Divisions

of __________ in the above County.

[It is desirable that such description, by parishes or otherwise, should be given of the district as will enable the poor to understand what localities are included in it.]

Dispensary situate at (a sufficient description of the locality to be given).

Times of attendance of the medical officer at the dispensary every from o'clock to o'clock. Tickets for medical relief on attendance of the party at the dispensary must be presented at the dispensary within the hours and on the days here named.

Medical Officer, Dr. ____________ , of __________ (his place of residence to be stated).

Visiting Tickets, for the attendance of the Medical Officer at the patient's home, may be presented to the Medical Officer, at the Dispensary, or may be presented to him, or left for him at his residence, or may be presented to him personally anywhere.

Tickets presented at the Dispensary should be presented between the hours above-named, and Tickets presented at the Medical Officer's residence or elsewhere should be presented as early in the day as possible.

The following are the persons authorized to issue Tickets for Medical Relief in the above District:

Members of the County Board of Health: (state names and places of residences.) Wardens: (state names and places of residence.) Assistance Officers: (state names and places of residence).

The Medical Officer is not bound to attend or afford Medical Relief to any poor person without a ticket. But Vaccination is performed without a Ticket being required.

Compounder of Medicine, Mr. , of ________________ .

Midwife, Mrs. ________________ , of ________________ .

Notice is also given that, in pursuance of the provisions of the Act to make further provision for the practice of Vaccination in Ireland (21 and 22 Vic., cap. 64), the above-named Dispensary District has been divided into the undermentioned Districts, for the purpose of Vaccination, and that the Medical Officer of the said Dispensary District will attend on the days and hours and at the places hereunder mentioned, for the purpose of Vaccinating, gratuitously, all persons who may come to him for that purpose, or whom he may be requested to Vaccinate, being fit subjects for Vaccination.

Name of Vaccination District.

Name of Electoral Division or Divisions comprised in Vaccination District.

Places within the Vaccination District at which the Medical Officer will attend.

Days and Hours of Attendance.

Vaccination will also be performed gratuitously at the Dispensary as heretofore, on any of the Dispensary days, during the hours of attendance of the Medical Officer at the Dispensary.

Every person undergoing Vaccination should attend, or be brought, for examination of the Arm upon the same day of the week following the day on which such person had been vaccinated, and on such other days as the Medical Officer may direct in order to ensure the successful issue of the case.

Secretary

of ______________ County Board of Health.

FORM O.

FORM FOR A BOARD OR INSCRIPTION TO BE CONSPICUOUSLY PLACED ON THE EXTERIOR OF EACH DISPENSARY.

_________________ DISPENSARY.

Open on*

from

to

o'clock.

Vaccination gratis.

Medical Officer, Dr. or Surgeon (his name), of (his residence).

Compounder of Medicine, Mr. __________ , of ___________ .

Midwife, Mrs. ____________ , of _______________.

* Name the several days of the week determined upon by the Board of Health for the purpose.

FORM P.

____________ County or (County Borough)

____________ Dispensary District.

____________ Rural or Urban District.

Medical Officer's Report of all Children born in the District ,and over three months of age, who do not appear to have been vaccinated.

Number on Register.

Name of Child.

Date of Birth.

Name of Residence of Parent or Person having the Care, Nurture, or Custody of the Child.

Date being Notice under the 8th Section of the Vaccination Amendment Act, 1879, was given.

Observations.

NOTE.—In any case in which the medical officer may be aware of the reason why the child has not been vaccinated, he should state it in the column for observations; and in any case in which a certificate has been given that the child is not in a fit state for vaccination, or is insusceptible of the vaccine disease, the fact should be stated.

Given under my Seal of Office, this Ninth day of November, in the Year of Our Lord One Thousand Nine Hundred and Twenty-three.

(Signed), SEAMUS DE BÚR A,

Minister for Local Government.

II.

INSTRUCTIONAL MEMORANDUM.

A.—LUNATICS.

Examination of Lunatics.

1. The duty of examining dangerous lunatics is cast upon dispensary medical officers by the Acts 14 & 15 Vic., c. 68 (Medical Charities Act); 30 & 31 Vic., c. 118; and 38 & 39 Vic., c. 67.

Under the provisions of the 10th section of 30 & 31 Vic., c. 118, the two justices of the peace* 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 justices* 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.

Fee payable to Medical Officer.

By section 14 of 38 & 39 Vic., c. 67, as modified by the Local Government (Temporary Provisions) Act, 1923 , the two justices* are authorized, if they think fit so to do, to make an order upon the County Board of Health 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.

Personal inquiry necessary

2. It is the duty of a dispensary medical officer when called to the assistance of the justices* 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; and it is important that a copy of the following forms of certificate and statement of particulars should be filled up by the examining medical officer in every appropriate case after Such inquiry as above referred to—

*NOTE—By the District Justices (Temporary Provisions) Act, 1923 , which is in force for one calendar year from the passing thereof, viz., the 27th March, 1923, these powers of Justices are exercisable by a District Justice or (where appointed) by a Peace Commissioner (of sections 3 and 4 of that Act).

Form of certificate

Forms to be filled up by the physician or surgeon who has personally examined the lunatic:—

1. MEDICAL CERTIFICATE.

I certify that , whom I visited on day of ,and into whose case I specially and personally inquired, is now a dangerous Lunatic, and I am of opinion, from the nature of his malady, that he is a fit subject for speedy admission into Mental Hospital, under the provisions of the Acts 30 and 31 vic., c. 118, s. 10.

Date,

Signature of Physician or Surgeon

Residence,

2. STATEMENT OF PARTICULARS OF CASE.

Species of Insanity.

Probable cause of Derangement.

Prominent Symptoms.

Whether affected with Bodily Disease.

Whether Idiotic or Epileptic.

Facts indicating that the Patient is a Dangerous Lunatic.

I hereby certify that this form is filled up correctly, to the best of my opinion and belief.

Date

Signature of Physician or Surgeon,

B.—VACCINATION.

VACCINATION ACTS.

Vaccination Acts.

3. The "Vaccination Acts" comprise the Acts—

21 & 22 Vic., c. 64 (1858),

26 & 27 Vic., c. 52 (1863),

31 & 32 Vic., c. 87 (1868),

42 & 43 Vic., c. 70 (1879),

the principal provisions of which are the following:—

NOTE—It is provided by section 9, of the Local Government (Temporary Provisions) Act, 1923 , that when the board of guardians of any union is abolished by any County Scheme the powers and duties of such board under the Vaccination (Ireland) Acts in any County Borough, or Urban or Rural District forming part of such union shall be transferred to the Council of such County Borough, or Urban or Rural District.

Vaccination districts and attendance of medical officer.

(i.) Division into districts, and duty of medical officers.

(a.) The vaccination authority shall divide each dispensary district into vaccination districts, and shall require the medical officer of the district to attend at some convenient place within each vaccination district at certain specified times to vaccinate all persons who may come to him for that purpose, and who are fit subjects for vaccination. (Section 1, 21 & 22 Vic., c. 64.)

NOTE.—With regard to the particular periods of the year for attendance at the vaccination stations it is important that they should be fixed by the Vaccination Authority (after consultation with the medical officer if necessary) that they should be at intervals of not more than three months, and that they should be duly notified in the form N, as prescribed by the dispensary regulations:—

Medical officers to report number of persons successfully vaccinated or re-vaccinated.

(b.) The medical officer is to make a report to the vaccination authority from time to time of persons successfully vaccinated or re-vaccinated by him in each year, to be made in such form and contain such particulars as the Minister for Local Government shall direct, and to be recorded by the vaccination authority on their minutes. (Section 3 of 21 & 22 Vic., c. 64, and section 6 of 42 & 43 Vic., c. 70.)

(ii.) Compulsory Vaccination.

Children to be vaccinated within three months after birth.

(a.) The parents and guardians of every child born after the l5th August, 1879, or the persons having the care and nurture of such child are bound within three months, or as soon afterwards as may be practicable, to take the child to the dispensary for vaccination, unless it shall have been previously vaccinated by some duly qualified medical practitioner, and the vaccination duly certified. (Section 3 of 42 & 43 Vic., c. 70.)

Inspection after vaccination.

(b.) On the same day of the week following the day on which the child has been vaccinated, the child shall be again taken to the medical officer by whom the operation has been performed, in order that he may ascertain by inspection the result of the operation. (Section 4 of 42 & 43 Vic., c. 70.)

Penalty for neglect.

(c.) A penalty not exceeding 20s. for neglecting to take a child to be vaccinated or to be inspected after vaccination is imposed by Section 7 of 42 and 43 Vic., c. 70.

(iii.) Certificates.

Certificate of successful vaccination to be given to parents or guardians and duplicate to be transmitted to registrar.

(a.) A certificate of successful vaccination in a prescribed form is to be delivered by the medical officer (or practitioner), who shall have performed the operation to the father or the mother of the child, or to the person having the care or custody of the child. A duplicate of this certificate is to be transmitted by the medical officer (or practitioner):—

(1.) to the registrar of births and deaths of the district within which the birth was registered;

(2.) but if after due inquiry such district is not known to the medical officer (or practitioner), or if the birth of the child has not been registered, the duplicate is to be transmitted to the registrar of the district in which the operation was performed. (Section 5 of 42 and 43 Vic., c. 70. )

Penalty.

[A penalty of 20s. is imposed by section 8 of 42 and 43 Vic.; c. 70, on the medical officer or practitioner who fails to perform this duty.]

Same cases not to be entered in Register prescribed by Vaccination Acts and that prescribed by Dispensary Regulations.

NOTE 1.—If the medical officer of any dispensary district is also the registrar of births and deaths of that district, it shall be sufficient for him to sign one certificate to be delivered to the father or mother or other person as aforesaid, and to register the fact of such vaccination in the manner provided by section 7 of 26 and 27 Vic., c. 52.

2. When a medical officer of a district is also the registrar of births and deaths of such district, it is his duty when he vaccinates a person whose birth has been registered in another district to forward a certificate of successful vaccination to the registrar of the district in which the birth was registered, and it will be necessary for him to enter the case in the vaccination register, form G, which he is required to keep by clause ix. of article 17 of the dispensary regulations instead of entering it in the vaccination register which is prescribed by section 7 of the Act 26 & 27 Vic., cap. 52.

Certificate of unfitness for vaccination.

(b.) If a medical officer or practitioner is of opinion that any child is not in a fit and proper state to be successfully vaccinated, he may deliver a certificate to that effect, in a form prescribed, to the father or mother or the person having the care or custody of such child. This certificate is to remain in force for two months, and fresh certificates to the same effect may be given if necessary (Section 4 of 26 and 27 Vic:, cap. 52.)

Certificate of insusceptibility of vaccine disease.

(c.) If any medical practitioner is of opinion that any child who has been vaccinated by him is insusceptible of the vaccine disease, he shall deliver to the father or mother or person having the care of such child a certificate to that effect in a prescribed form. (Section 6 of 26 and 27 Vic., cap. 52.)

Register of successful vaccination to be kept.

(iv.) Duties of Registrar of Births and Deaths.

(a). He is to keep a register of cases of successful vaccination (section 7 of 26 and 27 Vic., c. 52), the certificates of which have been transmitted to him by any medical practitioner. (Section 5 of 42 and 43 Vic., c. 70.)

The penalty for omitting to' register vaccination is 20s. (Section 10, 26 and 27 Vic., c. 52.)

Notice to parent and others of the requirements of vaccination.

(b.) He is to give notice of the requirements of vaccination in a prescribed form to the father or mother or person having the care of a child who has not been certified to him as having been vaccinated within three months after the birth thereof.

(Section 8 of 26 and 27 Vic., cap. 52; Section 3 of 42 and 43 Vic., cap. 70.)

NOTE.—In prosecution of defaulters it will not be necessary to prove that the notice was received by the defendant. (Section 9 of 42 and 43 Vic., cap. 70).

Transmission to medical officers of list of births and deaths.

(c.) Every registrar for any place who is not the dispensary medical officer of the district is to transmit once at least in every month to each dispensary medical officer whose district is wholly or partially comprised in such place a return of all births and of all deaths of infants under 12 months of age, which have since the date of the last return been registered by such registrar as having occurred in the district of the dispensary medical officer to whom the return is sent. (Section 11 of 42 and 43 Vic., c. 70.)

NOTE.—Medical officers who are not registrars of births and deaths will thus be enabled to make out the quarterly returns of vaccination defaulters (form P) to the Vaccination Authority.

Rate of pavement for successful cases of vaccination.

(v.) Miscellaneous provisions.

(a.) The medical officer is entitled to be paid two shillings for every person successfully vaccinated or re-vaccinated by him within his dispensary district, provided he has made the required report (form H. of the dispensary regulations) to the vaccination authority. (Section 6 of 42 and 43 Vic., e. 70).

The vaccination authority may direct proceedings and remunerate medical officers.

(b.) The vaccination authority shall direct proceedings to be instituted for the purpose of enforcing obedience to the provisions of the Vaccination Acts. The medical officer of any dispensary district who may be required by the vaccination authority to attend such proceedings, shall be entitled to receive, in addition to his actual expenses, such sum, not exceeding one guinea for each day's attendance required and given, as the Court shall certify; these expenses, and all other expenses incurred in the prosecution, which the Court is of opinion should be allowed, are to be ascertained and certified by the justices of the peace* or one of them. (Section 10 of 42 and 43 Vic., c. 70.)

Penalty upon persons inoculating with small-pox.

(c.) The practice of inoculation with small-pox virus (or the attempt to inoculate with such virus), is made punishable by six months' imprisonment. (Section 4 of 31 and 32 Vic., c. 87.)

* See Note under heading of Lunatics.

INSTRUCTIONS FOR VACCINATORS.

(1) In all ordinary cases of primary vaccination the vaccinator must aim at producing four separate good-sized vesicles not less than three-quarters of an inch from one another. The total area of vesication resulting from the vaccination should not be less than half a square inch.

(2) Except so far as any immediate danger of smallpox may require he should vaccinate only subjects who are in good health. As regards infants, he should ascertain that there is not any febrile state, nor any irritation of the bowels, nor any unhealthy state of skin; especially no chafing or eczema behind the ears, or in the groin, or elsewhere in folds of skin. He should not, except of necessity, vaccinate in cases where there has been recent exposure to the infection of measles or scarlatina, nor when erysipelas is prevailing in or about the place of residence.

(3) The vaccinator must keep in good condition the lancets or other instruments which he uses for vaccinating, and he must not use them for any other purpose whatever. When he vaccinates he must cleanse and sterilize the instruments after one operation before proceeding to another.

(4) All vaccinations should be performed with glycerinated calf lymph supplied by the Local Government Department.

(5) Each requisition to the Vaccine Department for glycerianted calf lymph should be limited to the quantity estimated as being required by the vaccinator within a period of seven days.

(6) On receiving the supply of lymph the tubes should, until required for actual use, be stored by the vaccinator in a cool, dark place, such as the iron safe provided for the registration records, or the tubes should be placed in a room or apartment without a fire and protected from any appreciable changes of temperature. The supply should be used within seven days of its receipt, and any tubes remaining over for a longer period than a week should not be used for vaccinations, but instead should be returned to the Vaccine Department.

(7) The glycerinated calf lymph should never be carried about by the vaccinator in his pocket. as even the heat of the body is injurious to the active properties of lymph.

(8) When once the vaccinator has unsealed a tube of glycerinated calf lymph he must never attempt to keep any part of its contents for the purpose of vaccination on a future occasion.

(9) Under no circumstances should the mouth be applied directly to the tube in which the lymph is contained for the purpose of expelling the lymph. An artificial blower should be used for this purpose. The lymph may be blown out of the capillary tube on to a clean lancet or directly on to the infant's arm.

(10) Vaccination should at every stage be carried out with aseptic precautions. These should include:—1st—the washing of operator's hands; 2nd—the cleansing of the surface of the skin before vaccination, by washing it well with plain soap and sterilized water, afterwards rubbing the part with absorbent cotton steeped in rectified or methylated spirit, and then drying it with a piece of clean absorbent cotton or a sterilized towel—a germicide should not be used; and care should be taken in making the incision or scratches not to draw blood; 3rd—carefully washing the tubes with sterilized water before opening them to obtain vaccine; 4th—the use of sterilized instruments; 5th—the protection of the vaccinated surface against extraneous infection by applying an aseptic pad after the performance of the operation, which pad should be kept in position until the eighth day; and 6th—by washing the vesicles with sterilized water, on inspection of the results, and then dusting them with boric powder and applying an aseptic vaccination pad, which should be removed in four days, and the part dusted with boric powder until the crusts fall off.

Advice as to the precautions to be taken in this respect until the crusts have fallen off and the arm has healed should always be given to the person having the custody of the child.

(11) The vaccinator should scrupulously observe in his inspection every sign which may test the efficiency and purity of the lymph. He should note any case wherein the vaccine vesicle is unduly hastened or otherwise irregular in its development, or wherein any undue local irritation arises; and if similar results ensue in other cases vaccinated with the same lymph he should desist at once from employing it.

(12) If vaccination with active calf lymph fails, the infant should be vaccinated with calf lymph taken from a fresh supply. In the event of a second failure, the facts should be reported to the Local Government Department.

(13) Should a few tubes from any individual supply of lymph prove inert or otherwise defective the vaccinator should forthwith discontinue the use of that supply and report the facts to the Secretary of the Vaccine Department, sending him back the unused tubes.

(14) The vaccinator should keep a careful record of his vaccinations and the source of the lymph used. The results form respecting each supply of lymph should be filled up and returned by the vaccinator within three weeks to the Secretary of the Vaccine Department.

(15) Applications for supplies of the lymph should be made direct to the Secretary of the Vaccine Department and should state the number of infants and adults to be vaccinated, and the name of the institution or the Dispensary District, as the case may be; supplies will be furnished whenever required, and a Medical Officer should, therefore, keep as small a quantity as possible in stock.

Letters of application for lymph should be addressed as follows:—

The Secretary,

Local Government Vaccine Department,

52 Waterloo Road,

Dublin.

Ministry of Local Government,

Dublin,

January, 1923.

TEACHERS OF VACCINATION.

The authorised teachers of vaccination in Saorstát Eireann whose certificates of proficiency will be accepted by the Minister for Local Government are:—

(1) Dr. Montgomery, Secretary of the Vaccine Department, 52 Waterloo Road, Dublin.

(2) Dr. Michael McDonough, Medical Officer, Galway.

The requirement in regard to proficiency in vaccination applies to temporary as well as permanent Medical Officers, and when nominating a temporary substitute, if such substitute has taken out his Diplomas subsequent to 1st May, 1906, a Medical Officer should be careful to ascertain that he is fully qualified, as otherwise difficulty might arise upon the temporary appointment being reported to the Local Government Department.

COURSE OF INSTRUCTION IN VACCINATION.

The course of instruction in vaccination given by the authorised teachers extends over a period of at least six weeks. Six attendances are required from each student, and four of the attendances must be given in consecutive weeks. Before a certificate of proficiency is granted the student must pass an examination in the subject of the lectures delivered by the teacher during the course of instruction, and must also show practical knowledge and skill in the performance of the operation of vaccination.

The programme of instruction is carried out under the following headings:—

1. The history of Jenner's discovery of vaccination with all particulars on the subject.

2. The Vaccination Laws.

3. Small-pox with special reference to the value of vaccination and re-vaccination in preventing or modifying the disease.

4. Statistics showing the importance of the four insertions of lymph in vaccination.

5. Practical demonstration of the various stages of the vaccine vesicle.

6. Instructions on the methods of vaccinating and dressing the patient's arms after vaccination and on the eighth and subsequent days.

7. The methods of sterilizing the patients' arms. Instructions to pupils how to vaccinate and permitting them to perform operations under personal supervision.

8. Explanations of the different vaccination instruments and vaccine blowers, and methods of sterilizing them.

A fee of £1 1s. 0d. may be charged by an authorised teacher to each student for the course of instruction, examination, and certificate.

D.— REQUISITIONS FOR 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.

Supplies of medicine must be ordered not less frequently than once in three months, in such quantities as shall be estimated to suffice for that period.

Immediately on receipt of each quarterly consignment, the Medical Officer concerned shall carefully check the quantities with the invoice, weighing each drug, 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 Board of Health 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 or County Hospital.

(c) The name of the Drug.

(d) The date of delivery of the drug by Contractor at the Dispensary or Hospital.

(e) The name of the Medical Officer and date of forwarding sample to the Analyst.

The Secretary of the Board of Health will provide the requisite supplies of suitable labels, and the Medical Officer should ascertain that the sample bottles are perfectly clean and dry, and be 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 Board of Health 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 found by experience to be most likely to be adulterated or deficient in strength:—Glycerinum pepsini, Hydrargyrum cum creta Linimentum camphora, Liquor Hydrargyri per chloridi, Liquor morphine hydrochloridi, Liquor strychninæ hydrochloridi, Oxymel scillaæ Pepsinum, Pulvis glycyrrhizaæ compositus, Spiritus Ætheris nitrosi, Spiritus Ammoniæ Aromaticus, Syrupus ferri iodidi, Syrupus ferri phosphatis cum quinina et strychnina, Unguentum Chrysarobini, Unguentum hydrargyri. Tinctures, Liquid Extracts, and Concentrated Liquors are frequently deficient in alcohol or in extractive.

The Ministry of Local Government have ascertained that the quantities requisite for analytical purposes of the undermentioned drugs are:—

Tinctures, Spirits, Liquors, Wines, Liniments, Syrups, Fixed Oils, Turpentine

4

ounces.

Liquid mineral acids, Chloroform, and Æther

2

"

Liquid extracts and Concentrated Liquors

3

"

Inorganic salts, Potasii tartras acidus, Linum contusum........

1

ounce

Iodides, Bromides, Hard extracts, Glycerinum pepsini, Organic Acids, and Powders..

½

"

Pepsinum

¼

"

Essential Oils for qualitative examination

2

drachms.

Essential Oils for quantitative examination

1

ounce.

Alkaloids for qualitative examination...

1

drachm.

Alkaloids for quantitative examination.

3

drachms.

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 of the Board of Health, retaining the other copy in the Dispensary.

Leeches, Serums, 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 Board of Health 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 one of the articles on the Prescribed Lists arm 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 Board of Health in the same manner as the ordinary supplies for a county institution.

The Medical Officer shall preserve the instruments and appliances placed in his custody in good order, and shall also keep a complete list of all instruments provided for Dispensary use, and submit the list periodically to the Secretary of the Board of Health for examination. In the event of his resigning or ceasing to hold office, the instruments specified on such list shall be handed over to the Secretary of the Board of Health.

The Medical Officer shall transact the duties and business of his Dispensary District with due regard not only to efficiency, but also to economy. In case any article or articles supplied shall be considered by the Medical Officer not to be in every respect of good quality, and of the quality and sort contracted for, he shall report the facts at once to the Board of Health.