323

M.D. examination; 18 of them for the final F.R.C.S.

examination and the diploma in anaesthetics, and anumber for the diploma and membership of the RoyalCollege of Obstetricians and Gynaecologists. Seven generalhospitals and Queen Mary’s Hospital for Children, Car-shalton, are partially recognised for the diploma in childhealth by the Royal Colleges of Physicians and Surgeons.

MENTAL HOSPITALS SERVICE

THE public mental hospitals in England and Wales ’ are the responsibility of the local authorities. Apart 3from those hospitals administered by the London County fCouncil, there are 65 hospitals under the control ofcounty councils, and 26 hospitals under the control ofcounty borough councils. The hospitals vary in size ’

from the small borough mental hospitals with about400 beds to the large county mental hospitals with over,2000 beds. ’

According to the interim revision of the Askwithmemorandum published this year, assistant medicalofficers to mental hospitals receive a minimum com-mencing salary of ;$;455, rising by annual increments of925 to £555 yearly, with emoluments which must include ’

board, lodging, laundry, and attendance. In addition,those medical officers who possess a diploma in psycho-logical medicine receive a further £50 per annum.Suitable provision is made for the accommodation ofmarried assistant medical officers. In the higher posts ofdeputy medical superintendent and medical superinten-dent no uniform scale of salaries is laid down, and thesevary between the different hospitals. In addition tosalary, emoluments are provided which usually consistof a house, furnished or unfurnished, fuel, and light.Permanent medical appointments are in all cases estab-lished posts within the meaning of the Asylums Officers’Superannuation Act, 1909.Posts at these hospitals offer medical officers scope

for initiative and promotion. Very few new appoint-ments were made during the war, and medical staffshave been much curtailed. There should be good openingsin these immediate post-war years.The mental health services of the L.C.C. are responsible

for a large medical service, vacancies in which are

advertised from time to time. An applicant entersthe service as assistant medical officer at a salaryof £575 a year, rising by annual increments of 25 to£675. Salaries are graded through the various ranks to£1600, plus a cost-of-living bonus of £90 (£72 to £82 forwomen), paid to superintendents of large hospitals; a super-intendent is also provided with an unfurnished house onthe hospital premises. Assistant medical officers may berequired to live in the institution which they are servingand to pay fixed rates for board, lodging, and laundry.Officers contribute to a superannuation fund. They arerequired to take a diploma in psychological medicinewithin three years of entering the service and the diplomacarries -with it a payment, in addition to salary, of £50a year. Promotion is reasonably rapid for men.

MINES MEDICAL SERVICE

THE Mines Medical Service now consists of eightregional mines medical officers, with a chief minesmedical officer and a deputy at headquarters.The white-paper on coal proposed the establishment

of this service "with a view particularly to checkingwastage of labour." Thus much of the work of themedical staff is concerned with applications for releasefrom the industry on medical grounds. Before themedical service was founded all such applicants weresent by the Ministry of Labour for independent medicalexamination. The functions of the service have beentwofold: to relieve the workman of such examination,if the medical evidence put forward by him was suffi-ciently conclusive ; and in doubtful cases where inde-pendent medical examination is necessary, to secure ahigh standard of examination. These services havebeen of value both to the workmen individually and inhelping to check unwarranted wastage of labour. Butit has always been realised that these activities, essentialas they are at present, are not constructive, except inthat they lead to better medical or surgical treatmentof the patients concerned. From the start the medicalofficers have been enjoined to devote all the time

possible to professional activities at the mines and inconnexion with the hospitals, rehabilitation centres, andother institutions to which the miners go for treatment.Professional work at the mines themselves is increasingin volume. Medical officers have charge of the first-aidand ambulance arrangements both below and aboveground ; they study the working conditions in relationto the miners’ health, and are getting a wide first-handexperience of the coal-mining community at work.Special attention is being given, and will be givenincreasingly, to a practical study of the causes of theso-called industrial diseases, and to measures for pre-venting or alleviating them. The field to be covered iswide, and previous work and experience have alreadyshown that there are no easy roads to speedy improve-ment ; but it is hoped to improve conditions graduallyby concentrating on particular difficulties and problems.Several studies of this kind are already in hand. Theuse of morphine for the first-aid treatment of cases ofpainful injury underground has proved beneficial. A

large number of cases have been treated with goodresults, the drug easing the patient and lessening theshock. The conditions governing the use of the drug atmines are strictly enforced. Various industrial hazards,such as dermatitis, epidermophytosis, Weil’s disease, andoccupational diseases such as the " beats " and pneumo-coniosis, are continuously studied. The medical officershave also prepared the way for the establishment ofmedical treatment centres at collieries, and for theappointment of State-registered nurses to work in them.The regional mines medical officers will assist in theselection of nurses and will guide and generally advisethem at the treatment centres in the early days of theirappointment. The medical service is looking forwardto the time when the whole of its energies can be con-centrated on constructive work of this kind, and in themeantime will devote to it all the time that can be sparedfrom dealing with the temporary problems and difficultiesstill arising out of the war.

PRISONS

AT the larger prisons whole-time officers are appointed,sometimes with deputy medical officers to assist them.Unfurnished quarters are provided or an allowance madein aid of rent. Posts are pensionable and promotionsare made as vacancies occur. Candidates with a

diploma in psychological medicine receive .S50 perannum more on appointment than candidates withoutthis qualification, and are given preference providedthey also have good all-round general experience. Atthe smaller prisons no whole-time officers are employed ;local practitioners are usually appointed as part-timeofficers. Further particulars can be obtained from thePrison Commissioners, Horseferry House, ThorneyStreet, Westminster, London, S.W.l.

STATE BOARDING-SCHOOLS.—In the past local educationauthorities have been concerned with boarding-schools mainlyto provide for handicapped children and those healthy childrenwho are unable to attend day-schools. Under the EducationAct of 1944 local authorities must see that boarding educa-tion is open to all children for whom these authoritiesand the parents consider it desirable. This has beencarried a step further in a Ministry of Education circular(no. 120, H.M. Stationery Office, Id.). It explains theexisting resources in county and voluntary, and in direct-grant schools, and mentions the arrangement already reachedwhereby local authorities may support pupils at independentschools outside the State system of education. It is hopedthat these arrangements will be increasingly employed andthat the independent schools will be willing to reserve moreplaces for children educated at the public expense. TheMinister is now to assemble a small committee to collectprecise information of the boarding places in all types of schoolsavailable for the use of education authorities (apart fromthose earmarked for local purposes). At the same time thecommittee will work out a procedure by which the pooledvacancies can be sought by individual local authorities andcan be fairly allocated. Local education authorities willbe responsible for the selection of pupils and, where necessary,for payment of appropriate expenses under an approvedincome scale. The aim is to develop speedily boarding educa-tion for all suitable pupils.