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Public Health
749 Such elimination was in fact proved. coccus there." It is accepted that the normal intestinal flora is essential to health; and this flora is profoundly disturbed under the influence of chemotherapy and antibiotics. Intestinal disturbances, sometimes serious in children, often seem to occur during the period of relative sterility of the canal. Research on this problem might well lead to interesting and clinically useful conclusions. D. ASTLEY SANFORD. Royal lnnrma,ry, sunaeria-nd. -
DENTURES AND ANÆSTHESIA
Sm,—Are there not two simple ways of obtaining airtight fit for edentulous patients, which do not require special apparatus or expose dentures to risk of fracture ?P A swab of normal theatre size packed into each cheek around the airway or tube (unless the nasal air passage is ensured) will bring the face to a good round contour, over which a face mask fits well. A really large face-piece of the old conical, unmoulded type will sit " so far out on the face that the edentulous collapse is usually avoided, and a good fit is far more likely than with any of the patterns of small mask. Unfortunately these large masks are now difficult to buy. The principle of fitting the bony margin of the face is the same as Mr. Phillips is applying with his inhaler. "
London, E.11.
J. BARNARD.
CRISIS ON QUALIFICATION
SiR,-The annotation entitled The Prentice Practitioner in your issue of Oct. 23 has aroused considerable interest among some who hope shortly to be the object of the arrangements proposed by the Minister of Health. The writers of this letter are students of a London hospital who have had their medical studies interrupted by six or more years of war service and feel considerable concern over that part of their training which will begin as soon as
they qualify.
In the next twelve months a considerable number of ex-Service students will be finishing their undergraduate courses at the various medical schools and colleges ; and the following year this class of students will amount to about half the total qualifying. Still another year later the proportion will be even higher. The average age of ex-Service students on qualification is, or will be, about 30. It is realised that in a few years, although a small ex-Service element may remain because of conscription, the age will be considerably less. Owing to their age, this present group (a result ’of the recent war) has certain problems which deserve consideration when such schemes as the present one are worked out. Many of these students are married and have children ; and, although the Ministry of Education is paying maintenance grants to most of them, nearly all of them are suffering real financial hardship, as their gratuities and savingsare soon exhausted. On qualification these grants cease abruptly, so that, unless some measures are instigated in the immediate future, very few will be able to apply for house-appointments, which are a necessary part of medical training. The present rate of pay for house-appointments will almost entirely preclude those who have a family to feed, clothe, and educate from applying for such appointments. By the simple consideration of averages, the ex-Service group must contain a number of men of ability. Many, too, were trained for, and held positions of, considerable responsibility in various arms of the Services. Surely any such ability, training, and experience will have its uses in the profession. It will be regrettable if a certain number of men from sheer necessity short-circuit some aspects of their training and offer their services to the highest
bidder.
We feel most strongly that the salary for houseappointments should be uniform throughout the country and that there should be a definite scale, taking into
consideration such factors as age, and number of dependants. The Minister of Education has adopted a scale for students’ maintenance on these lines, and the
Services, too, pay their personnel in a similar manner. After house-appointments, those of us entering general practice will welcome the latest suggestion for further training under experienced general practitioners. With
to the salary mentioned by you and to which the Insurance Acts Committee has objected, we feel that this is not, in all conscience, too liberal. The principal will have, as you point out, fully qualified, enthusiastic assistance and all that this means to someone who must be feeling the effects of a life of unstinted labour. From the assistant’s point of view, he will almost certainly have to take temporary furnished accommodation for his family, which alone will cost him at least five guineas a week. (We know, we have had to pay it.) These are hard facts and not flights of fancy which we have put in this letter. We appreciate that it is easy to criticise and difficult to construct, but we hope that by raising these problems we may enable the highest standards in medicine to be maintained by ensuring that the newest mexnbers of the profession may follow the excellent paths which have been, and are being, laid down for them. J. M. BROWN W. A. BULLEN G. DOUGAN I. F. G. MCLANNAHAN J. F. TRUNCHION.
regard
RETURN TO PHILANTHROPY SiR,-In last week’s leading article, is the sharp antithesis between " the enthusiastic gatherings of the hospital contributory schemes of a decade ago" and the meetings of a regional board quite justified by the
structure of the new organisation ? The contact with the people is through the management committees rather than the regional board. Camberwell provides an example. Ten daysago the mayor presided over a large and representative gathering of voluntary workers in, and friends of, the three hospitals (formerly L.C.C.) of Dulwich, St. Francis, and St. Giles. Mr. Lesser, chairman of the Hospital Saving Association, accompanied by many of the local group secretaries, spoke in advocacy of the formation of the Camberwell Hospitals Fellowship, which was constituted by those present. The fellowship will be formed by various groups and friends of the hospitals. Patients will be the first group, under the guidance of the Vicar of Camberwell, who has been a patient. Librarians, who are already doing excellent work for the patients and other voluntary workers in various capacities, will elect their representatives to form, with representatives of the patients, the governing council of the fellowship. Thus there will be a representative organisation to which the management committee can render an account of their stewardship annually. As patients will have a preponderant voice it will represent the " consumer interest " which can only be found with much difficulty in other public-service
undertakings. C. E. A. BEDWELL Chairman,
Camberwell Hospitals Management Dulwich Hospital, London, S.E.22.
Committee.
Public Health Mobile Dental and Medical Units PROMPTED by the unsuitability of some of the existing temporary dental clinics, Kent County Council’s primaryeducation and welfare subcommittee has recommended that a mobile clinic should be provided for the school health service in country districts. The units, of which there are likely to be three, will be drawn in turn by a single " mechanical horse." The trailer portion will contain a waiting-room, surgery, and recovery room, and will have its own X-ray apparatus and electrical system. Where a mains supply is unobtainable, water will be drawn from built-in tanks. The Empire News (Oct. 24) reports that a travelling surgery will soon be operating in the rural district of New Earswick, Yorkshire. A caravan, drawn by a shooting-brake, will be partitioned into a reception room, a consulting-room, and two small dressing-rooms. The surgery is being sent out by the Rowntree Village Trust with the backing of the Ministry of Health ; and if it is successful further units of the same sort may be introduced.
DENTURES AND ANÆSTHESIA
Sm,—Are there not two simple ways of obtaining airtight fit for edentulous patients, which do not require special apparatus or expose dentures to risk of fracture ?P A swab of normal theatre size packed into each cheek around the airway or tube (unless the nasal air passage is ensured) will bring the face to a good round contour, over which a face mask fits well. A really large face-piece of the old conical, unmoulded type will sit " so far out on the face that the edentulous collapse is usually avoided, and a good fit is far more likely than with any of the patterns of small mask. Unfortunately these large masks are now difficult to buy. The principle of fitting the bony margin of the face is the same as Mr. Phillips is applying with his inhaler. "
London, E.11.
J. BARNARD.
CRISIS ON QUALIFICATION
SiR,-The annotation entitled The Prentice Practitioner in your issue of Oct. 23 has aroused considerable interest among some who hope shortly to be the object of the arrangements proposed by the Minister of Health. The writers of this letter are students of a London hospital who have had their medical studies interrupted by six or more years of war service and feel considerable concern over that part of their training which will begin as soon as
they qualify.
In the next twelve months a considerable number of ex-Service students will be finishing their undergraduate courses at the various medical schools and colleges ; and the following year this class of students will amount to about half the total qualifying. Still another year later the proportion will be even higher. The average age of ex-Service students on qualification is, or will be, about 30. It is realised that in a few years, although a small ex-Service element may remain because of conscription, the age will be considerably less. Owing to their age, this present group (a result ’of the recent war) has certain problems which deserve consideration when such schemes as the present one are worked out. Many of these students are married and have children ; and, although the Ministry of Education is paying maintenance grants to most of them, nearly all of them are suffering real financial hardship, as their gratuities and savingsare soon exhausted. On qualification these grants cease abruptly, so that, unless some measures are instigated in the immediate future, very few will be able to apply for house-appointments, which are a necessary part of medical training. The present rate of pay for house-appointments will almost entirely preclude those who have a family to feed, clothe, and educate from applying for such appointments. By the simple consideration of averages, the ex-Service group must contain a number of men of ability. Many, too, were trained for, and held positions of, considerable responsibility in various arms of the Services. Surely any such ability, training, and experience will have its uses in the profession. It will be regrettable if a certain number of men from sheer necessity short-circuit some aspects of their training and offer their services to the highest
bidder.
We feel most strongly that the salary for houseappointments should be uniform throughout the country and that there should be a definite scale, taking into
consideration such factors as age, and number of dependants. The Minister of Education has adopted a scale for students’ maintenance on these lines, and the
Services, too, pay their personnel in a similar manner. After house-appointments, those of us entering general practice will welcome the latest suggestion for further training under experienced general practitioners. With
to the salary mentioned by you and to which the Insurance Acts Committee has objected, we feel that this is not, in all conscience, too liberal. The principal will have, as you point out, fully qualified, enthusiastic assistance and all that this means to someone who must be feeling the effects of a life of unstinted labour. From the assistant’s point of view, he will almost certainly have to take temporary furnished accommodation for his family, which alone will cost him at least five guineas a week. (We know, we have had to pay it.) These are hard facts and not flights of fancy which we have put in this letter. We appreciate that it is easy to criticise and difficult to construct, but we hope that by raising these problems we may enable the highest standards in medicine to be maintained by ensuring that the newest mexnbers of the profession may follow the excellent paths which have been, and are being, laid down for them. J. M. BROWN W. A. BULLEN G. DOUGAN I. F. G. MCLANNAHAN J. F. TRUNCHION.
regard
RETURN TO PHILANTHROPY SiR,-In last week’s leading article, is the sharp antithesis between " the enthusiastic gatherings of the hospital contributory schemes of a decade ago" and the meetings of a regional board quite justified by the
structure of the new organisation ? The contact with the people is through the management committees rather than the regional board. Camberwell provides an example. Ten daysago the mayor presided over a large and representative gathering of voluntary workers in, and friends of, the three hospitals (formerly L.C.C.) of Dulwich, St. Francis, and St. Giles. Mr. Lesser, chairman of the Hospital Saving Association, accompanied by many of the local group secretaries, spoke in advocacy of the formation of the Camberwell Hospitals Fellowship, which was constituted by those present. The fellowship will be formed by various groups and friends of the hospitals. Patients will be the first group, under the guidance of the Vicar of Camberwell, who has been a patient. Librarians, who are already doing excellent work for the patients and other voluntary workers in various capacities, will elect their representatives to form, with representatives of the patients, the governing council of the fellowship. Thus there will be a representative organisation to which the management committee can render an account of their stewardship annually. As patients will have a preponderant voice it will represent the " consumer interest " which can only be found with much difficulty in other public-service
undertakings. C. E. A. BEDWELL Chairman,
Camberwell Hospitals Management Dulwich Hospital, London, S.E.22.
Committee.
Public Health Mobile Dental and Medical Units PROMPTED by the unsuitability of some of the existing temporary dental clinics, Kent County Council’s primaryeducation and welfare subcommittee has recommended that a mobile clinic should be provided for the school health service in country districts. The units, of which there are likely to be three, will be drawn in turn by a single " mechanical horse." The trailer portion will contain a waiting-room, surgery, and recovery room, and will have its own X-ray apparatus and electrical system. Where a mains supply is unobtainable, water will be drawn from built-in tanks. The Empire News (Oct. 24) reports that a travelling surgery will soon be operating in the rural district of New Earswick, Yorkshire. A caravan, drawn by a shooting-brake, will be partitioned into a reception room, a consulting-room, and two small dressing-rooms. The surgery is being sent out by the Rowntree Village Trust with the backing of the Ministry of Health ; and if it is successful further units of the same sort may be introduced.