S.I. No. 38/1934 - Boards of Guardians (Officers) Order, 1938 The Dispensary (Rules and Regulations) Order, 1934.

STATUTORY RULES AND ORDERS. 1934. No. 38.GENERAL RULES FOR THE GOVERNMENT OF DISPENSARY DISTRICTS AND THE PERFORMANCE OF VACCINATION ENTITLEDTOGETHER WITH AN INSTRUCTIONAL MEMORANDUM.

INDEX OF CONTENTS OF DISPENSARY RULES.

DEPARTMENT OF LOCAL GOVERNMENT AND PUBLIC HEALTH.

The Minister for Local Government and Public Health in exercise of the powers vested in him by the Poor Relief (Ireland) Act, 1851, the Vaccination (Ireland) Acts, as adapted by the Adaptation (Vaccination (Ireland) Acts) Order, 1925, the Local Government (Temporary Provisions) Acts, 1923 and 1924, and of every county scheme confirmed or amended by or in pursuance of the said last mentioned Acts, and of all other powers in this behalf enabling him does by this his Order make the following rules and regulations for the government of dispensary districts and for the guidance and control of every board entrusted with the administration of the relief of the poor in any county or county borough under any such county scheme, and of every board of assistance for a poor law union and the several officers to be appointed in connection with dispensary districts, and does also make the regulations hereinafter appearing relating to vaccination in the several dispensary districts, that is to say:—

Title.

ARTICLE 1.—This Order may be cited as the Dispensary and Vaccination (Rules and Regulations) Order, 1934, and shall come into operation on the date hereof.

Revocation of previous orders.

ARTICLE 2. —From and after the coming into operation of this Order the following Orders shall be revoked, but such revocation shall not affect the validity of any proceedings taken or matter or thing done thereunder, or remaining to be taken or done in continuation of steps already duly taken or done thereunder, that is to say: —

(1) The Orders made by the Local Government Board for Ireland bearing date respectively the 24th day of February, 1899, the 23rd day of March, 1901, the 20th day of December, 1905, and the 19th day of May, 1919, which regulate the government of dispensary districts in poor law unions, and the performance of vaccination therein.

(2) The Orders made by the Minister for Local Government and the Minister for Local Government and Public Health Health entitled respectively the Dispensary (County Boards of Health) Rules and Regulations, 1923, and the Dispensary (Boards of Health) (Amendment) Order, 1925.

Interpretation.

ARTICLE 3. —The Interpretation Act, 1889, applies to the interpreation of this Order in like manner as it applies to the interpretation of an Act of the Oireachtas passed before the 1st day of January, 1924.

Definitions.

ARTICLE 4. —In this Order unless the context otherwise requires: —

the expression "the Minister" means the Minister for Local Government and Public Health;

the expression "county scheme" means a scheme confirmed or amended by or in pursuance of the Local Government (Temporary Provisions) Acts, 1923 and 1924;

the expression "board of assistance" means the board to which is entrusted under a county scheme the administration of the relief of the poor in any county or county borough, and includes a board of assistance established by the Local Government (Dublin) (Amendment) Act, 1931 ;

the word "prescribed" means prescribed by the Minister. the expression "vaccination authority" means as the case may be the council of a county borough or urban district, or board of health to whom the powers and duties of boards of guardians under the Vaccination (Ireland) Acts have been transferred by section 9 of the Local Government (Temporary Provisions) Act, 1923 , as amended by the Local Government Acts, 1925 and 1927, and includes a board of assistance established by the Local Government (Dublin) (Amendment) Act, 1931 .

the expression "official contractor" means an official contractor under the Local Authorities (Combined Purchasing) Act, 1925 ;

the word "secretary" includes the Clerk of a Union.

the expression "assistance officer" includes a relieving officer.

Wardens.

ARTICLE 5.—(1) Immediately after each election of a board of assistance, the board may appoint a sufficient number of wardens for the district electoral divisions of each dispensary district, who in addition to the members of the board, and the assistance officers of the board shall be empowered to issue medical relief tickets.

Issue of medical relief tickets.

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

Secretary's duties.

Return of authorised medical relief tickets.

ARTICLE 6.—The secretary of the board of assistance shall, as soon as may be after each election of the members of the board, make a return in the Form A, No. l , in this Order, to the Minister, of the names and addresses of the members of the board of assistance, and of the assistance officers, and wardens authorised to issue medical relief tickets in each dispensary district; and in like manner, on the election of a person to fill a casual vacancy in the membership of a board of assistance or on any appointment by the board of a warden to fill any vacancy, the secretary shall make a return to the Minister, in the Form A, No. 2, in this Order, and shall on his election, send to each member, a notice in the Form B, No. 1, and shall, on his appointment, send to each warden a notice in the Form B, No. 2, in this Order.

Secretary duties. (continued).

Particulars of same to be furnished to dispensary officers.

ARTICLE 7.—Immediately upon the completion of the list of members, wardens, and assistance officers as aforesaid, the secretary of the board of assistance shall furnish each medical officer of a dispensary district with a copy thereof, according to the Form C in this Order, giving the names and residences of all persons entitled to issue tickets for medical relief in his district, that is to say, of the members of the board of assistance, 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 such medical officer from time to time of any changes, from death or otherwise, of members or of assistance officers, or wardens, in his district.

Secretary's duties (continued).

Form N to be posted at dispensary and throughout district.

ARTICLE 8.—(1) The secretary of a board of assistance shall prepare with respect to each dispensary district a notice of the dispensary arrangements in the Form N in this Order, and shall cause a copy of such notice to be posted at each dispensary in the dispensary district, and at such other places in the district as may be necessary for the due notification of the dispensary arrangements

Form O to be kept at dispensary.

(2) The secretary shall also cause a notice board showing the particulars specified in the Form O in this Order, to be kept conspicuously painted and affixed to the exterior of each dispensary in the dispensary district.

Secretary's duties (continued).

Cessor of office of Issuers of medical relief tickets.

ARTICLE 9.—Whenever any person ceases to be a member of a board of assistance, or a warden or an assistance officer, the secretary of the board shall transmit to such person a notice in the Form D in this Order, and shall take steps to secure the return to the board of any unused forms of the tickets for medical relief which had been issued to such person in the medical relief ticket check books (Forms E1, E 2, and E 3, in this Order).

Appointment of additional wardens.

ARTICLE 10.—A board of assistance 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.

Voting: Casting vote of chairman.

ARTICLE 11.—Subject to the provisions of each county scheme every question under the Poor Relief (Ireland) Act, 1851, at any meeting of a board of assistance shall be determined by a majority of the votes of the members present thereat and voting on the question, but in case of equality of votes the chairman of the meeting shall have a second or casting vote.

Proceedings of board of assistance.

ARTICLE 12.—(1) At the first ordinary meeting of a board of assistance in each month, or as soon thereafter as conveniently may be (or more frequently if the board so arrange), the following business shall be conducted:—

Examination of registers.

(i) The board shall examine the medical relief registers and midwife's register of cases attended of any dispensary district which they may have specifically required to be submitted to them for examination, and shall cause any directions given by them with regard to persons to whom entries on such registers relate to be recorded and authenticated in the several columns of the returns.

Consideration of medical officers' reports.

(ii) The board shall receive and consider the monthly reports (Form F1) of the medical officers of the several dispensary districts, and any reports made to them in writing by such medical officers, and shall give any necessary directions thereon, and record the same on their minutes.

Consider requisitions

(2) A board of assistance, as occasion may arise:—

(i) shall receive and consider any requisition of a medical officer of a dispensary district for medicines and medical and surgical appliances, and shall give the necessary directions thereon to the secretary of the board.

Examine Form L.

(ii) shall examine the copy of the medical officer's return (Form L), in respect of each dispensary district laid before them half-yearly in pursuance of the direction hereinafter contained.

Examine expenses of dispensary districts.

(iii) shall examine at least once in each half-year, ending on the 30th day of September and the 31st day of March, respectively, 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.

Conveyance of records.

(iv) shall make due and adequate arrangements for the speedy conveyance to and from the place of meeting of the board of any medical officer's books and records which they have required to be submitted to them for examination, and shall provide the necessary waterproof boxes or wrappers for the safe transit of such documents.

Vaccination reports.

(v) shall, if a vaccination authority, on receiving from the medical officer a report in the Form H in this Order, cause the same to lie on the table of the board-room for inspection, for a period of twenty-eight days.

Medical relief tickets.

ARTICLE 13.—(1) Every ticket for medical relief issued under Section

9 of the Poor Relief (Ireland) Act, 1851, shall:—

Issue.

(a if medical relief is to be given only at the dispensary of a dispensary district, be in the Form E 1 in this Order:

(b) if medical relief is to be given at the home of the poor person requiring relief or elsewhere, be in the Form E 2 in this Order;

(c) if the case is a midwifery case in which the attendance of a midwife is required at the home of the patient, be in the Form E 3 in this Order.

Continuance in force.

(2) Every ticket for medical relief shall continue in force:—

(a) until it is withdrawn by the issuer or by the board of assistance under Section 9 of the Poor Relief (Ireland) Act, 1851; or

(b) until the patient ceases to attend the dispensary, if the ticket issued is in the Form E 1 in this Order; or

(c) until the termination of the case if the ticket issued is in the Form E 2 or Form E 3 in this Order.

Midwifery cases.

Form E 2. Duty of medical officer.

ARTICLE 14.—(1) A visiting ticket issued in the Form E. 2 in this Order, in a case of midwifery shall be deemed to cast on the medical officer of a dispensary district receiving it a full and undivided responsibility for the care of the case notwithstanding the fact that a midwife is officially employed in the district, and the fact that the services of the midwife are available shall not be deemed to relieve the medical officer from such responsibility.

Procedure.

(2) The following course shall be adopted in all cases in which dispensary relief is required by ticket for women in labour:

(i) The ticket may be addressed either to the medical officer or to the midwife, at the option of the patient;

(ii) 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;

(iii) 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 the medical officer is satisfied that the case is one of natural labour, he may place the midwife in attendance, directing her that should anything out of the course of nature, or dangerous, arise, she shall immediately call for his assistance;

(iv) the ticket, if in the Form E 3 in this Order, shall be presented to the midwife, who shall duly and punctually attend thereon;

(v) 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, in writing, the same to him, the medical officer shall immediately take charge of the case;

(vi) cases of abortion and miscarriage shall be regarded as midwifery cases.

Cancellation of tickets.

ARTICLE 15.—(1) Any member of a board of assistance, 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 Poor Relief (Ireland) Act, 1851, be at liberty, and is hereby empowered to withdraw such ticket, provided always that immediate notification of such withdrawal shall be given by him in writing to the medical officer, the board of assistance, and the person on whose behalf the ticket was issued.

Scale of fees for poor persons.

(2) For the purpose of enabling members of a board of assistance, wardens, and assistance officers to be in a better position to judge whether an applicant for medical relief is a " poor person " as aforesaid, the board of assistance may invite each medical officer of a dispensary district to furnish in writing, a scale of charges for attendance upon persons whose circumstances would not admit of their paying the doctor's usual fees, and a copy of every such scale of fees, if furnished to the board of assistance, 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 furnished by a medical officer of a dispensary district shall be regarded as operative until withdrawn by such medical officer.

Appointment of officers for dispensary districts.

ARTICLE 16.—A board of assistance shall, from time to time, appoint such officers as may be directed by 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.

Duties to be performed in person.

ARTICLE 17.—Every officer of a dispensary district shall, save where otherwise authorised by this Order or by the board of assistance, with the special permission of the Minister first had and obtained, perform his duties in person and shall not entrust the performance of the same to a deputy.

Appointment of officers.

ARTICLE 18.—The appointment of every officer to be appointed for a dispensary district in pursuance of any Order of the Minister shall, as soon as the same shall have been made, be reported to the Minister by the secretary of the board of assistance, who shall, without delay, furnish on the form approved by the Minister, such particulars in regard to the appointment as the Minister may require. A supply of such forms shall be kept in stock by the secretary to enable him to report the appointments of the several dispensary officers.

Employment of temporary officers.

ARTICLE 19.—(1) If an officer of a dispensary district to whom this Article applies be temporarily incapacitated, by illness or other cause, from performing his duties or shall die or resign his office, the assistance officer acting for the district shall thereupon employ a duly qualified person temporarily to perform the duties of the office of such officer pending the next following meeting of the board of assistance to whom he shall report in writing, the circumstances of the case and the name of the person temporarily employed by him; and if the necessity still exists the board shall either continue such employment or make such other arrangements as may be necessary for the discharge of the duties of the office of such officer during his temporary incapacity or until an appointment is duly made to the vacant office, as the case may be; and for the time during which such person shall be temporarily employed, he shall perform all the duties of the office which he is temporarily employed to perform, and shall duly enter up such of the books of the dispensary as are required to be entered up as part of such duties, for such time before any remuneration that may be approved of or directed by the Minister be paid to him.

(2) An officer to whom this article applies who becomes temporarily incapacitated by illness or other cause from performing his duties shall communicate immediately with the assistance officer of the dispensary district and shall, if possible, recommend a suitable and duly qualified person to perform his duties during such temporary incapacity which person shall, if practicable, be employed temporarily by the assistance officer for the purposes of this Article.

Residence of temporary officers.

(3) So far as practicable, the person to be employed temporarily for the purposes of this Article shall be a person who will reside in the dispensary district during the period for which he shall be employed.

Remuneration of temporary officer.

(4) A board of assistance shall pay to a person temporarily employed under this Article, such reasonable remuneration as the Minister shall approve or direct.

(5) This Article shall apply to a medical officer, a compounder of medicine, a midwife and a dispensary nurse of a dispensary district.

Extra professional assistance.

ARTICLE 20.— (1) Whenever, in the course of his attendance upon dispensary patients, a case arises which, in the opinion of the medical officer of a dispensary district necessitates his obtaining the assistance of another medical practitioner, the medical officer may, on his own authority, summon the assistance of such other medical practitioner and shall thereupon report fully in writing, the circumstances to the board of assistance at their next following meeting.

Payment.

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

Scale of fees.

Extra professional assistance

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

Determination of disputes as to remuneration.

(4) Any dispute which shall arise as to whether the summoning of a medical practitioner by a medical officer was necessary or as to the amount of the fee payable to such medical practitioner under this Article shall be determined by the Minister, whose decision shall be final and conclusive, and the Minister may, if he finds that the summoning of such medical practitioner was not necessary, and, if the fee payable to the medical practitioner has been paid to him out of the funds of the board, authorise the board to deduct the amount of such fee from the salary of the medical officer.

Salaries of officers.

ARTICLE 21.—(1) A board of assistance shall pay to each paid officer, permanent or temporary, duly authorised and appointed for the service of a dispensary district, such salary or remuneration as the Minister may from time to time approve or direct.

Payment.

(2) The salary of each paid officer, duly appointed for the service of a dispensary district, shall be payable by the board of assistance 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, and no longer, subject to the provisions of this Order or, any direction to the contrary given by the Minister under Section 11 of the Local Authorities (Officers and Employees) Act, 1926 , in regard to the remuneration of any officer who has been suspended thereunder.

Vaccination fees.

(3) The sum due to each medical officer for vaccination or revaccination 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.

Dispensary officers' vacation.

ARTICLE 22.—(1) A board of assistance shall allow to each medical officer of a dispensary district an annual vacation of four weeks and may, with the consent of the Minister first had and obtained, allow to any other officer of a dispensary district an annual vacation not exceeding four weeks.

Employment and remuneration of substitute

(2) A board of assistance shall in the case of a medical officer of a dispensary district and may in the case of any other officer of a dispensary district if the Minister so approves appoint a duly qualified person to perform temporarily the duties of such officer during the absence of that officer on vacation under this Article.

(3) A medical officer shall not relinquish the discharge of his duties under this Article unless and until he submits an application to the Board of assistance nominating a duly qualified practitioner who undertakes to perform the duties of temporary medical officer at a rate of remuneration to be stated, nor until the Minister expresses his approval of the arrangements made.

(4) A board of assistance shall pay to any person temporarily employed to perform the duties of an officer of a dispensary district under this Article, such remuneration as the Minister shall approve or direct.

Special leave to dispensary officers.

ARTICLE 23.—(1) A board of assistance may, with the consent of the Minister, first had and obtained, and subject to such terms and conditions as the Minister may approve, grant special leave of absence to an officer of a dispensary district for a period or periods not exceeding, in the aggregate, three months in any period of three consecutive years for the purpose of enabling such officer to undertake a special course of study which will better fit him for the discharge of the duties of his office.

(2) A board of assistance may, if the Minister so approves, appoint a person temporarily to perform the duties of any officer of a dispensary district during his absence on special leave, granted to him under this Article.

Tenure of office.

ARTICLE 24.—(1) Every officer appointed to or holding any office under the Poor Relief (Ireland) Act, 1851, shall, subject to the provisions of Section 11 of the Local Authorities (Officers and Employees) Act, 1926 , continue to hold the same until he shall die, or resign, or be removed by the Minister, or be proved to be insane by evidence which the Minister shall deem sufficient.

Suspension.

(2) Where a board of assistance in pursuance of Section 11 of the Local Authorities (Officers and Employees) Act, 1926 , suspend from duty any officer appointed to or holding any office under the Poor Relief (Ireland) Act, 1851, the board shall forthwith report such suspension together with the cause thereof to the Minister.

Sick leave.

ARTICLE 25.—Sick leave may be granted by a board of assistance to any officer of a dispensary district, subject to the following general conditions:—

(i) Continuous sick leave on full salary shall not be granted by the board for any period longer than six months.

(ii) At the expiration of such six months, if still unfit for duty, the officer may be allowed by the board salary at not more than half his ordinary rate of salary, and that for a further period not exceeding six months.

(iii) After twelve months' continuous sick leave no officer shall be paid by the board any salary, but the officer may, in special circumstances, with the consent of the Minister, be permitted by the board to continue in office without salary for a further period not exceeding six months, upon the expiration of which time, if unable to resume duty, the officer shall be called upon by the board to resign his office.

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

(v) Prolonged sick leave, allowed under the conditions specified in paragraphs (i) to (iv) above, shall be granted by the board only in a case where a reasonable hope is entertained of the officer being able to resume the discharge of his duties.

Duties of medical officer.

ARTICLE 26.—The duties of every medical officer of a dispensary district shall be as follows, that is to say:—

(1) He shall attend punctually at the dispensary or dispensaries of the district or division of a district under his charge, on such days and during 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 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.

(2) He shall duly 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 assistance, 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.

(3) He shall file at the dispensary all medical relief tickets received by him and shall mark the number of the case in the register (Form F in this Order) on the face of each ticket, before filing it and shall preserve the same for a period of at least two years.

(4) 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 assistance 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 assistance 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 shall be considered as no longer under treatment.

(5) 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 authorised 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.

(6) 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.

(7) He shall give a written certificate under his hand to the board of assistance, 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 institution maintained by the board or to which the board is authorised to send persons eligible for relief.

(8) He shall keep and duly enter up the medical relief register in the Form F in this Order or in such other form as may be prescribed, and all other registers and records which may from time to time be prescribed and shall, when so specifically required by the board of assistance, submit all or any of the same to the board for examination, and shall, when so required, submit all or any of the same for inspection by any Medical Inspector of the Minister.

(9) He shall furnish to the board of assistance at the end of each month a return in the Form F 1 in this Order of the number of poor persons to whom medical relief shall have been afforded by him.

(10) He shall inspect monthly the register of cases attended by the midwife of his dispensary district and shall see that the same is properly entered up by her and shall authenticate the same by his initials.

(11) He shall, from time to time as may be necessary, but once at least in each quarter of the year at such time, if any, as the board of assistance may appoint for the purpose, transmit to the secretary of the board a requisition in duplicate in the form (Form M) in this Order or in such other form as may, from time to time, be prescribed, of the medicines and the medical and surgical appliances required by him.

(12) He shall, if no compounder of medicine is appointed, carefully compare and check the medicines and the medical and surgical appliances received at the dispensary with the respective invoices relating thereto.

(13) He shall, if no compounder of medicine is appointed, take charge of and keep carefully and safely, as far as lies in his power, all drugs, medicines, stores and medical and surgical appliances provided by the board of assistance for use in the dispensary.

(14) He shall, if no compounder of medicine is appointed, keep the poisonous medicines at the dispensary under lock and key in a press separate from the other medicines and shall retain and be responsible for the possession of the key of such press.

(15) He shall, as soon as reasonably may be, send to the secretary of the board of assistance for transmission to the analyst 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.

(16) He shall keep a report-book with the pages numbered consecutively in the Form I in this Order 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.

(17) He shall report in writing to the board of assistance, any matter which he may deem it necessary to bring under the notice of the board.

(18) 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 in this Order, and also as directed on the said form with such variations as may from time to time be prescribed by the Minister.

(19) He shall make such return appertaining to the duties of the office as may be from time to time required by the Minister, or by the board of assistance.

(20) He shall, if no compounder of medicine is employed, preserve the medical and surgical appliances of the dispensary in good order, and shall also keep a complete list of all appliances provided from time to time for dispensary use, and submit the list at the end of each half-year ending the 30th day of September and the 31st day of March, respectively, to the secretary of the board of assistance for examination, and shall, upon his resigning or otherwise ceasing to hold office, hand over the appliances specified in such list to the secretary of the board, who shall compare the same with such list and report any deficiencies or discrepancies therein to the board.

(21) He shall report to the board of assistance, or to the Minister, any neglect or failure on the part of the compounder of medicine or the midwife or the dispensary nurse to discharge punctually and properly the duties appertaining to their offices.

(22) He shall reside in such central and convenient place within the dispensary district as the Minister shall approve, unless the Minister, on any exceptional and sufficient grounds, dispenses with this condition.

(23) He shall, if so required, discharge the duties of certifying surgeon under Section 120 of the Factory and Workshops Act, 1901, and also perform any other duties imposed on him by statute, or assigned to him by the Minister.

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

(25) He shall occupy the dispensary residence (if any) provided for the dispensary district under the Dispensary Houses (Ireland) Act, 1879, and shall pay such reasonable rent in respect thereof as the board of assistance, with the approval of the Minister, may determine.

Vaccination.

ARTICLE 27.—The duties in relation to vaccination of:—

(a) the medical officer of a dispensary district of the Dublin, Balrothery and Rathdown Unions; and

(b) the medical officer of health of a dispensary district situate elsewhere,

shall be as follows, that is to say:—

(1) 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 vaccination of all persons who may come to him for the purpose, and shall continue in attendance thereat during the fixed hours and for such further time as may be necessary for that purpose.

(2) 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 time 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 Form G in this Order, of all cases of successful vaccination 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 any cases which he may have duly entered in the register of vaccination which he is required to keep in pursuance of Section 7 of the Vaccination (Ireland) Act, 1863.

(3) 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.

(4) He shall make 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, not less frequently than once in each half-year in the Form H in this Order.

(5) He shall keep the vaccination register open at all reasonable times to inspection by any member of the vaccination authority.

(6) He shall give to any person making application therefor a copy certified under his hand of any entry or entries in the vaccination register, which is not, or are not, required to be made in the register of vaccination which he is required to keep in pursuance of Section 7 of the Vaccination (Ireland) Act, 1963, on payment of the fee of two shillings for each certificate, which shall include a fee for any such search made by him.

(7) 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 in this Order, 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.

(8) The re-vaccination of persons applying for the purpose shall be limited by the following conditions:—

(1) 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.

(2) 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.

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

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

Duties of compounder.

ARTICLE 28.—The duties of every compounder of medicine of a dispensary district shall be as follows, that is to say:—

(1) 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 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 of the district.

(2) He shall further attend at a dispensary of the district or division of the district in his charge at any time and compound the medicines prescribed by the medical officer for any urgent case.

(3) He shall take charge of and keep carefully and safely as far as lies in his power, all drugs, medicines, stores, and medical and surgical appliances provided by the board of assistance for use in the dispensary or dispensaries of the district or division of the district in his charge.

(4) He shall keep the poisonous medicines at the dispensary or dispensaries of the district or division of the district in his charge under lock and key ina press separate from the other medicines, and shall retain and be responsible for the possession of the key of such press.

(5) He shall prepare and dispense skilfully and cautiously all prescriptions drawn up and ordered by a medical officer of the district or division of the district in his charge, and shall punctually supply the medicines, when prepared, to the persons authorised 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.

(6) He shall make such pharmaceutical preparations for use in dispensing medicines as he may be required to make from time to time, by a medical officer of the district or division of the district in his charge.

(7) He shall keep in a suitable book for the purpose to be provided by the secretary of the board of assistance, a record of all prescriptions so compounded, and of all medical and surgical appliances issued by him out of stock.

(8) He shall prepare, after consultation with the medical officer or officers of the district or division of the district in his charge and submit for his or their signature, the necessary estimates and requisitions for medicines.

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

(10) He shall carefully compare and check the medicines and medical and surgical appliances received at the dispensary or dispensaries with the invoices relating thereto.

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

(12) He shall discharge such other duties as from time to time may be assigned to him by the board of assistance with the consent of the Minister.

Duties of midwife.

ARTICLE 29.—-The duties of every midwife of a dispensary district shall be as follows, that is to say:—

(1) She shall reside in such convenient place in the district as the Minister shall from time to time approve or direct.

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

(3) 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.

(4) 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.

(5) She shall keep a register in the Form K in this Order or in such other form as may be prescribed of all cases attended by her either on the order of the medical officer or on ticket in the Form E 3 in this Order, in a suitable book for the purpose to be provided by the secretary of the board of assistance, and shall submit this register monthly to the medical officer for inspection by him and shall also, if and when required by the board, submit the same through the medical officer for examination by the board.

(6) The midwife is hereby 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.

Dispensary premises.

ARTICLE 30.—The board of assistance shall take care that all the dispensary premises, provided, by them 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.

Supply of stationery.

ARTICLE 31.—The board of assistance 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 of the Minister and all other requisites for the use of each officer of a dispensary district; and shall also cause to be provided a sufficient number of check-books of medical relief tickets in the Forms E 1, E 2, and E 3, in this Order, and cause a sufficient supply of such check-books to be furnished to each member of the board and to each assistance officer and warden.

Half-yearly statement of expenses.

ARTICLE 32.—Immediately after the completion of each half-year, ending on the 30th day of September and the 31st day of March, respectively, the board of assistance 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 of the district.

Contracts.

Medicines and Medical and surgical a appliances.

ARTICLE 33.—(1) A contract for the supply of drugs, medicines and medical and surgical appliances for the use of a dispensary, entered into by a board of assistance with a person other than an official contractor shall be in the prescribed form; and the person so contracting shall be required to enter with two sureties who may be approved by the board, into a bond in the prescribed form, in such penal sum as the board shall think fit, conditioned for the due performance of the contract.

(2) No contract shall be entered into by a board of assistance for such supply as aforesaid with a person other than an official contractor, unless such person has submitted a tender for such contract in the prescribed form.

(3) Every contract entered into by a board of assistance for such supply as aforesaid, with a person other than an official contractor, shall be entered into for the period from the lst April in one year to the 31st March in the next following year.

(4) Save as otherwise provided by this Order, the regulations made by the Minister for the time being in force, relating to contracts to be made by a board of assistance shall apply for the purposes of this Article in relation to every contract entered into with a person other than an official contractor.

Recoupment

ARTICLE 34.—The following conditions shall govern the recoupment from the Local Taxation Account under Section 58 of the Local Government (Ireland) Act, 1898, of expenditure incurred by a board of assistance for medicines and medical and surgical appliances, that is to say:—

(1) Supplies shall be purchased either from an official contractor or from a contractor approved of by the Minister whose prices of supply are not greater than those of an official contractor.

(2) Expenditure upon any medicine or medical or surgical appliances, not specified in the prescribed lists, shall not be reckoned for recoupment.

(3) A certificate by a county analyst or other analyst recognised by the Minister shall be obtained certifying that such analyst has examined samples of drugs from the various institutions and dispensaries of the board of assistance, which certificate shall indicate any departure from any prescribed standard for any such drug.

(4) Supplies shall not, after warning by the Minister, continue to be obtained from an official contractor or other contractor who has been shown to have supplied drugs or other articles not of the prescribed standard or medical and surgical appliances not of good quality.

(5) Expenditure in any institution or dispensary which the Minister, after due inquiry, declares to be excessive, having regard to the nature and number of the cases treated thereat shall not to such extent as the Minister shall determine, be reckoned for recoupment.

List of official contractors to be furnished to medical officers.

ARTICLE 35.—The secretary of a board of assistance shall furnish, as soon as may be, to each medical officer of a dispensary district for his information and guidance in ordering supplies, particulars of the official contractors or other contractors from whom medicines and medical and surgical appliances are obtained by the board and the prices thereof.

FORMS REFERRED TO IN THIS ORDER.

FORM A. No. 1.

Return of Members of the Board, of Wardens and Assistance (Relieving) Officers authorised to issue Medical Relief Tickets in the above-named Dispensary District.

(1) Insert name of Board of Assistance.

FORM A, No. 2.

(1) Insert name of Board of Assistance

FORM B, No. 1.

Notice to be given by the Secretary of a Board of Assistance to each Member of the Board after election.

(1) Insert name of board of Assistance.

..................(¹)

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

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.

FORM B, No. 2.

Notice to be given to a Warden on his election by a Board of Assistance.

(1) Insert name of Board of Assistance.

SIR,—Notice is hereby given to you that you have been elected by the above Board to be a Warden, and you are, therefore, authorized to issue Tickets for the Medical Relief of persons resident in the above Dispensary District.

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.

FORM C.

(1) Insert name of Board of Assistance.

List of Members of the above Board, and of the Assistance (Relieving Officers and Wardens acting for each Electoral Division included in the above Dispensary District, and authorized to issue Medical Relief Tickets therein.

FORM D.

Notice to be transmitted by Secretary of Board of Assistance to a Member of the Board, or Warden, on the expiration of his term of office, in case he be not re-elected.

(1) Insert name of Board of Assistance.

SIR,—I am directed by the above Board to inform 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 Poor Relief (Ireland ) Act, 1851, 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 above Board 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.

(1) Insert name of Board of Assistance

Notice to be transmitted by Secretary to an Assistance Officer on the expiration of his term of office.

SIR,—I am directed by the above Board to inform you that your power to issue Tickets for Medical Relief in the . . . . . . . . . . . . . . . . . Dispensary District, in pursuance of the provisions of the Poor Relief (Ireland) Act, 1851, 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 above Board, for the use of the persons authorized to issue such tickets, any blank forms of Medical Relief Tickets in the Chock Books, Forms E 1, E 2, and E 3, which now remain in your hands unused.

DIRECTIONS FOR PRINTING MEDICAL RELIEF TICKETS.

Blank Tickets for Medical Relief are to be printed in the Forms E 1 and E 2 in counterparts, and bound up in books; and the name of the Medical Officer, and of the Dispensary District and Board of Assistance should 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 be 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 Assistance, 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 Assistance, 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 in the 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.

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 authorized 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 apprise 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, etc., 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 Assistance, 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.

(1) Insert name of Board of Assistance.

..................(¹)

MEDICAL RELIEF REGISTER.

(2) Insert name of County, Public Assistance District or Union, as the case may be.

........................Dispensary District, in the....................................(²)

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 ago 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.—This Column is intended for any particulars, directions or explanation as to any case which the Medical Officer or the Chairman of the Board of Assistance 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) should be bound up with the Register to serve as an index.

FORM F 1.

(1) Insert name of Board of Assistance.

.....................(¹)

(2) Insert name of County, Public Assistance District or Union, as the case may be.

RETURN OF PATIENTS ATTENDED BY MEDICAL OFFICER DURING MONTH ENDED.................19

(1) Insert name of Board of Assistance.

(2) Insert name of County, Public Assistance District or Union, as the case may be.

FORM G.

VACCINATION REGISTER.

......................... (¹)

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

REGISTER OF CASES OF SUCCESSFUL VACCINATION AND RE-VACCINATION.

1) Insert name of County Borough, Urban District, County Health District or Union, as the case may be.

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 the 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 in 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 Vaccination (Ireland) Act, 1858, of the NUMBER OF PERSONS SUCCESSFULLY VACCINATED by him.

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 Public Health, and that I duly inspected the result of the vaccination at the times required by the Regulations of the said Minister, and that I have entered all the required particulars in the Vaccination Register.

FORM I.

MEDICAL OFFICER'S REPORT BOOK.

(1) Insert name of County Borough, Urban District, County Health District or Union, as the case may be

(1) Insert name of Board of Assistance

FORM K.

(1) Insert name of Assistance.

MEDICAL OFFICER'S RETURN—FORM L.

For half-year ended ...................19 .....

This Return should be prepared in triplicate within 21 days of 31st March or 30th September, as the case may be. One copy should then be sent to the Secretary of the Board of Assistance, the second to the Department of Local Government and Public Health, Custom House, Dublin, and the third copy retained by the Medical Officer.

9. Statistics of diseases caused by infection during each month of the half-year:

__________

(II.)—MEDICAL CHARITIES.

__________

FORM L.

(1) Insert name of Board of Assistance.

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

__________

(III)—PUBLIC HEALTH ACTS.

__________

FORM L.

*State here the District (County Health District or Urban District) in which the Dispensary District is situate. If the Dispensary District is situate partly in the Urban District and partly in the County Health District a separate form for each should be furnished under the Public Health Acts.

FORM M.

ESTIMATE AND REQUISITION FOR MEDICINES, &c.

FORM M.—Estimate of Medicines, etc., required.

(1) Insert name of Board of Assistance.

(1) Insert name of Board of Assistance.

(A) I certify that the quantities stated in Column 5 are required to be ordered for use in the

_______________________________________________________________

(B) M ................................................... please supply the quantities named in Column 5 of the above form.

Approved by............................................................ ........................................................ this............................................................ .......day of...............................................19....

Requisition forwarded to Contractor, this ..................................... day of

..................................19......

FORM N.

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

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

(1) Insert name of Board of Assistance.

....................................Dispensary District, consisting of the District Electoral Divisions of .................................................. in the (2) ...........................................

(2) Insert name of County, Public Assistance District or Union as the case may be.

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

(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.)

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

Midwife M ........................................... of ............................................... (her place of residence to be stated).

Compounder of Medicines, Mr.................................................... of ..............................................

The services of the Medical Officer and of the Midwife are available free for poor persons.

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.

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.

Visiting Tickets for the services of the Midwife may be left at her residence or may be presented to her personally elsewhere. They should be presented as early in the day as possible.

The Medical Officer or the Midwife is not bound, except in case of emergency, to afford Medical Relief to any poor person without a Ticket, but Vaccination is performed without a Ticket being required.

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

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

Notice is also given that, in pursuance of the provisions of the Vaccination (Ireland) Act, 1858, 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.

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.

FORM O.

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

(1) Insert name of Board of Assistance.

Open on *................................. from ......................... o'clock 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 Assistance for the purpose.

FORM P.

(1) Insert name of Board of Assistance.

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

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

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

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.

FORM P 1

(1) Insert name of Board of Assistance.

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

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

Medical Officer's Report of all Children born in the above Dispensary District and entered in previous Returns, Form P, as not having been vaccinated, who have been successfully vaccinated during the quarter.

Given under the Official Seal of the Minister for Local Government and Public Health, this Nineteenth day of March, in the Year of Our Lord, One Thousand Nine Hundred and Thirty-four.

(Signed), SEAN T. O CEALLAIGH,

Minister for Local Government and Public Health.

DISPENSARY OFFICERS.

The Qualifications required for Dispensary Officers are:—

MEDICAL OFFICER—Every person of either sex to be appointed to serve as Medical Officer of a Dispensary District:—

(a) Shall be a Medical Practitioner registered in the Medical Register of Saorstát Eireann;

(b) Shall hold a Certificate of Proficiency in Vaccination recognised by the Minister.

(c) Shall be duly qualified for at least twelve months, except in the case of a person temporarily appointed.

COMPOUNDER OF MEDICINE—Every person of either sex to be appointed to serve as Compounder of Medicine of a Dispensary District:—

(a) Shall have obtained a licence of the Apothecaries' Hall, Dublin, or a Certificate of qualification as a Pharmaceutical Chemist from the Pharmaceutical Society of Saorstát Eireann.

(b) Shall have reached the age of 21 years.

MIDWIFE—Every person to be appointed to serve as a Midwife of a Dispensary District:—

(a) 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.

(b) Shall have reached the age of 21 years.

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

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

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

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

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

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 Justice or Peace Commissioners are authorized, if he or they think fit so to do, to make an order upon the Public Assistance Authority for the area 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 Justice or Peace Commissioners to examine any person who may be brought before them under circumstances denoting derangement of mind, before certifying that the person is a dangerous lunatic or a dangerous idiot, to be fully satisfied of the fact after special personal inquiry into the case; 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.

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 District Mental Hospital, under the provisions of the Act 30 and 31 Vic., c. 118, s. 10.

2. STATEMENT OF PARTICULARS OF CASE

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

B.—VACCINATION.

VACCINATION ACTS.

Vaccination Acts.

3. The "Vaccination Acts" comprise the Acts—

the principal provisions of which are the following: —

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

Vaccination districts and attendance of medical officer.

(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 revaccinated.

(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 and Public Health 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 vaccinated within three months after birth.

(a) The parents and guardians of every child born after the 15th 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 I.—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 2 of article 27 of the dispensary regulations instead of entering it in the vaccination register which is prescribed by Section 7 of the Act 26 and 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.

Transmission to medical officers of list of births and deaths.

(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.)

(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 payment 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., c. 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 District Justice. (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.)

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, chickenpox 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 Department of Local Government and Public Health.

(5) Each requisition to the Vaccine Branch for glycerinated 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 Branch.

(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. The contents of one tube of lymph should not be used on more than one child.

(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 Department of Local Government and Public Health.

(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 Director of the Vaccine Branch, 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 Director of the Vaccine Branch, Department of Local Government and Public Health, University College, Earlsfort Terrace, Dublin.

(15) Applications for supplies of the lymph should be made direct to the Director of the Vaccine Branch 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:—

TEACHERS OF VACCINATION.

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

(1) Dr. Colman Mansfield Saunders, 24 Fitzwilliam Square, Dublin.

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

(3) Professor J. M. O'Donovan, University College, Cork.

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 Department of Local Government and Public Health.

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 Assistance 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 institution.

(c) The name of the drug.

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

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

The Secretary of the Board of Assistance will provide the requisite supplies of suitable labels, and the medical officer should ascertain that the sample bottles are perfectly clean and dry, and he should use stoppered bottles for liquid acids and volatile drugs—the bottles to be entirely filled so as to prevent deterioration. Powders that are liable to chemical change owing to exposure should be sent in properly corked bottles. Sealing wax should not be used on the corks of the sample bottles. The analysts have been requested to note upon their certificates any failure to observe the above directions. The medical officer should at once call the attention of the Board of Assistance 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 camphoræ, Liquor Hydrargyri perchloridi, Liquor morphine hydrochloridi, Liquor strychninæ hydrochloridi, Oxymel scillæ Pepsinum, Pulvis glycyrrhizæ 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 Department of Local Government and Public Health have ascertained that the quantities requisite for analytical purposes of the undermentioned drugs are:—

The medical officer, when he has duly checked the articles received with the invoice, shall fill in the certificate at D, and immediately transmit the " Original " requisition to the Secretary of the Board of Assistance, 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 Assistance in the usual manner.

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

Such items as disinfectants, soap, water jugs and basins, towels, lamps, candles, lamp oil, for use in dispensaries should not be included in these requisitions, but should be obtained through the Board of Assistance 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 Assistance 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 Assistance.

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 Assistance.