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THE DENTISTS BILL
1128
diphtheria or whooping-cough. Tuberculosis was moderately prevalent, and receives considerable attention. The malaria situation has been much improved since B.D.T. came into general use: the morbidity-rate in 1936-46 varied from 266 to 574 per 1000 population ;
little
1947-50 it fell from
The vector of has been malaria, Anopheles culicifacies, virtually eradicated from the wet zone and the intermediate zone of the island as a result of the D.D.T. campaign. The fact that it has been found in the jungle, away from human habitation, probably means that it cannot be completely eradicated, and this may affect the malaria situation in the future. It is quite that the medical authorities of are a Ceylon making great and successful effort to cope with their many health problems. They have a long way still to go, but on traditional lines they will undoubtedly be successful. The people will be healthier, and they will continue rapidly to increase in numbers. The imminent problem of population pressure is only briefly mentioned in this report. A medical report alone cannot give a of complete picture public-health activity ; it is necessary to know also the agricultural potential- of the country and the developments proposed to exploit it, and other matters of economics and of education, because in these days of phenomenal medical progress the health and well-being of peoples depend as much on farmers and land as on doctors. It will soon be essential to increase food production and to limit the increase of
in
196 to 81.
evident
population. Health never has been, and certainly is not now, a purely medical problem ; but it is for the doctors to insist on the need for political and administrative action. In Ceylon, as elsewhere, the most difficult of human problems is still unsolved. THE DENTISTS BILL
Dentists Bill1 is that which proposes a three-year experiment in the use of ancillary dental workers in the National Health Service and the local-government dental services. These ancillaries would be trained, and then permitted to fill and extract teeth, under the supervision of qualified dentists. Presumably it is hoped that if the experiment succeeds the number of suitable recruits who come for training will go along way to solve the man-power problem in dentistry, This problem is not new and before the end of the war an interdepartmental committee, with Lord Teviot THE most
important
section of the
new
forward
as chairman, was already considering ways’in which it might be solved 2 ; but at that time only one member of the committee, the late Major-General Helliwell; advocated the training and employment of dental ancillaries. The introduction of the N.H.S. has made even more acute the shortage of dentists in relation to the demands on their services, and has contributed to the collapse’ of the school dental service. By contrast, the continuous development and progress, over the last thirty years, of the school dental service in New Zealand, where school-children’s teeth are cared for by dental nurses with two years’ special training in children’s dentistry, has suggested to many that this is the best way of staffing a children’s service. The new Bill is in fact the conseof the favourable report of an official mission of quence eminent dpntal surgeons from this country who went to New Zealand to see the scheme in operation there.3 Since then the New Zealand service has been examined at greater length by an American investigator, who published an equally favourable report under the 1. See Lancet, Dec. 8, 1951, p. 1092. 2. Report of Interdepartmental Committee on Dentistry. London, 1946. See Lancet, 1946, i, 240. 3. New Zealand School Dental Nurses : Report of United Kingdom Dental Mission. London, 1950. See Lancet, 1950, ii, 491; 1951, i, 155.
of the World Health Organisation this summer.4 The fact that the new Bill was prepared under a Labour Government and is being presented, apparently unaltered, by its Conservative successor suggests that lay public opinion, in so far as it has considered the problem, is fairly unanimous in believing that the use of ancillaries offers the only reasonable hope of resuscitating the school dental service. But, despite the favourable New Zealand reports, the dental profession in this country has not yet been entirely won over to the idea of the use of ancillaries, even in the relatively specialised field of children’s dentistry. Opponents of the Bill will say that its proposals undermine the " status " of the profession, by attacking its main bulwark, the Dentists Act of 1921, which restricts the practice of dentistry to registered dentists who have followed a prescribed course of training. To permit partly trained personnel to practise, it will be argued, must lead to dilution " of the profession, a lowering of standards of service, and a decline in the standing of the dental surgeon. Our own answer to this would be that by ensuring that the work of the ancillaries is as closely supervised by dentists as that of clinical students in the dental schools, sufficient protection would be given to the public. Nor.should the standing of the profession be compromised as long as the recognition given to the ancillaries is quite obviously not that of a member of the dental profession. Public opinion in New Zealand does not seem to respect the dental profession any less now that the children of that country get dental treatment mainly from school dental nurses ; nor does the profession feel that its standing or its interests require the abolition of the scheme. On the contrary, most dentists in New Zealand support the scheme, though they may criticise details of its working. They find that the generation who have had continuous dental treatment from the school dental nurses are much better dental patients in later life. Tha Bill also proposes to abolish the Dental Board and to transfer its powers, and those exercised over the dental profession by the General Medical Council, to a new General Dental Council. Though this proposal of autonomy will appear attractive to many dentists, we question whether it is in the true interest of the profession that it should be further detached from the general body of medicine. Progress would rather seem to lie in the direction of closer integration of dentistry within medicine, with the establishment of a common basic medical diplolna for all medical practitioners, dental surgeons included. In this system, dentistry would be a specialist aspect of surgery rather than a separate art practised by an autonomous body of practitioners. The Dentists Bill is surely, in this respect, a step in the wrong direction.
auspices
.
"
THE ADJUDICATOR APPOINTED THE former Minister of Health and Secretary of State for Scotland suggested that the proposed arbitration upon the proper size of the central pool from which the general practitioners are paid, should be left to a single° adjudicator, rather than to a court of arbitration. The General Medical Services Committee agreed to this course, and after discussion were assured that a judge of the High Court of Justice might be made the adjudicator, if the Lord Chancellor could make the services of one of the judges available. In a written answer6 the present Minister of Health has announced that he and the Secretary of State for Scotland have, with the concurrence of the Genera,l Medical Services
Committee, appointed as adjudicator Mr. Justice Danckwerts, a judge of the High Court of Justice
(chancery division). 4. Fulton, J. T. Experiment in Dental Care: Results of New Zealand’s use of School Dental Nurses. World Health Organisation. See Lancet, Sept. 15, 1951, p. 485. 5. Lancet, Aug. 11, 1951, p. 256. See 6. p. 1139.
diphtheria or whooping-cough. Tuberculosis was moderately prevalent, and receives considerable attention. The malaria situation has been much improved since B.D.T. came into general use: the morbidity-rate in 1936-46 varied from 266 to 574 per 1000 population ;
little
1947-50 it fell from
The vector of has been malaria, Anopheles culicifacies, virtually eradicated from the wet zone and the intermediate zone of the island as a result of the D.D.T. campaign. The fact that it has been found in the jungle, away from human habitation, probably means that it cannot be completely eradicated, and this may affect the malaria situation in the future. It is quite that the medical authorities of are a Ceylon making great and successful effort to cope with their many health problems. They have a long way still to go, but on traditional lines they will undoubtedly be successful. The people will be healthier, and they will continue rapidly to increase in numbers. The imminent problem of population pressure is only briefly mentioned in this report. A medical report alone cannot give a of complete picture public-health activity ; it is necessary to know also the agricultural potential- of the country and the developments proposed to exploit it, and other matters of economics and of education, because in these days of phenomenal medical progress the health and well-being of peoples depend as much on farmers and land as on doctors. It will soon be essential to increase food production and to limit the increase of
in
196 to 81.
evident
population. Health never has been, and certainly is not now, a purely medical problem ; but it is for the doctors to insist on the need for political and administrative action. In Ceylon, as elsewhere, the most difficult of human problems is still unsolved. THE DENTISTS BILL
Dentists Bill1 is that which proposes a three-year experiment in the use of ancillary dental workers in the National Health Service and the local-government dental services. These ancillaries would be trained, and then permitted to fill and extract teeth, under the supervision of qualified dentists. Presumably it is hoped that if the experiment succeeds the number of suitable recruits who come for training will go along way to solve the man-power problem in dentistry, This problem is not new and before the end of the war an interdepartmental committee, with Lord Teviot THE most
important
section of the
new
forward
as chairman, was already considering ways’in which it might be solved 2 ; but at that time only one member of the committee, the late Major-General Helliwell; advocated the training and employment of dental ancillaries. The introduction of the N.H.S. has made even more acute the shortage of dentists in relation to the demands on their services, and has contributed to the collapse’ of the school dental service. By contrast, the continuous development and progress, over the last thirty years, of the school dental service in New Zealand, where school-children’s teeth are cared for by dental nurses with two years’ special training in children’s dentistry, has suggested to many that this is the best way of staffing a children’s service. The new Bill is in fact the conseof the favourable report of an official mission of quence eminent dpntal surgeons from this country who went to New Zealand to see the scheme in operation there.3 Since then the New Zealand service has been examined at greater length by an American investigator, who published an equally favourable report under the 1. See Lancet, Dec. 8, 1951, p. 1092. 2. Report of Interdepartmental Committee on Dentistry. London, 1946. See Lancet, 1946, i, 240. 3. New Zealand School Dental Nurses : Report of United Kingdom Dental Mission. London, 1950. See Lancet, 1950, ii, 491; 1951, i, 155.
of the World Health Organisation this summer.4 The fact that the new Bill was prepared under a Labour Government and is being presented, apparently unaltered, by its Conservative successor suggests that lay public opinion, in so far as it has considered the problem, is fairly unanimous in believing that the use of ancillaries offers the only reasonable hope of resuscitating the school dental service. But, despite the favourable New Zealand reports, the dental profession in this country has not yet been entirely won over to the idea of the use of ancillaries, even in the relatively specialised field of children’s dentistry. Opponents of the Bill will say that its proposals undermine the " status " of the profession, by attacking its main bulwark, the Dentists Act of 1921, which restricts the practice of dentistry to registered dentists who have followed a prescribed course of training. To permit partly trained personnel to practise, it will be argued, must lead to dilution " of the profession, a lowering of standards of service, and a decline in the standing of the dental surgeon. Our own answer to this would be that by ensuring that the work of the ancillaries is as closely supervised by dentists as that of clinical students in the dental schools, sufficient protection would be given to the public. Nor.should the standing of the profession be compromised as long as the recognition given to the ancillaries is quite obviously not that of a member of the dental profession. Public opinion in New Zealand does not seem to respect the dental profession any less now that the children of that country get dental treatment mainly from school dental nurses ; nor does the profession feel that its standing or its interests require the abolition of the scheme. On the contrary, most dentists in New Zealand support the scheme, though they may criticise details of its working. They find that the generation who have had continuous dental treatment from the school dental nurses are much better dental patients in later life. Tha Bill also proposes to abolish the Dental Board and to transfer its powers, and those exercised over the dental profession by the General Medical Council, to a new General Dental Council. Though this proposal of autonomy will appear attractive to many dentists, we question whether it is in the true interest of the profession that it should be further detached from the general body of medicine. Progress would rather seem to lie in the direction of closer integration of dentistry within medicine, with the establishment of a common basic medical diplolna for all medical practitioners, dental surgeons included. In this system, dentistry would be a specialist aspect of surgery rather than a separate art practised by an autonomous body of practitioners. The Dentists Bill is surely, in this respect, a step in the wrong direction.
auspices
.
"
THE ADJUDICATOR APPOINTED THE former Minister of Health and Secretary of State for Scotland suggested that the proposed arbitration upon the proper size of the central pool from which the general practitioners are paid, should be left to a single° adjudicator, rather than to a court of arbitration. The General Medical Services Committee agreed to this course, and after discussion were assured that a judge of the High Court of Justice might be made the adjudicator, if the Lord Chancellor could make the services of one of the judges available. In a written answer6 the present Minister of Health has announced that he and the Secretary of State for Scotland have, with the concurrence of the Genera,l Medical Services
Committee, appointed as adjudicator Mr. Justice Danckwerts, a judge of the High Court of Justice
(chancery division). 4. Fulton, J. T. Experiment in Dental Care: Results of New Zealand’s use of School Dental Nurses. World Health Organisation. See Lancet, Sept. 15, 1951, p. 485. 5. Lancet, Aug. 11, 1951, p. 256. See 6. p. 1139.