THE L.C.C. HOSPITAL SERVICE

537 THE L.C.C. HOSPITAL SERVICE of the London County Council for valuable experience for medical graduates who intend to be general practitioners or consultants, as well as for those who intend to make the public health service their career. Under the operation of the Local Government Act, 1929, the L.C.C. is responsible for the management of 75 hospitals (excluding mental hospitals)-namely, 28 general hospitals, including one for children, 10 hospitals and institutions for the chronic sick, 2 convalescent hospitals for general cases, 2 hospitals for sane epileptics, 16 fever and other infections hospitals, 10 tuberculosis hospitals, including four for children, 5 special hospitals and convalescent homes for children, and 2 venereal disease hospitals. Medical superintendents of the hospitals, who are expected to be experienced hospital administrators, receive £900 to £1650 a year, corresponding to hospitals varying in accommodation from 160 to 1300 patients. In addition,medical superintendents are provided with an unfurnished house or quarters, with payment by the Council of local and water rates. The subordinate staff is classified thus :

THE

hospital service

provides opportunities

Scale of annual salary.

Grade.

include physicians, surgeons, obstetricians and gynmcologists, anaesthetists, psediatrists, neurologists, orthopaedists, radiologists, dermatologists, ophthalmologists, urologists, and ear, nose, and throat specialists. In

addition,

specialists

other

part-time

consultants

and

employed for special purposesdiseases specialists, plastic and thoracic

were

e.g., venereal surgeons, &c.-and

the services were available of tuberculosis officer at each general hospital having tuberculosis ward.

a a

Post-graduate facilities.-These are as follow :HAMMERSMITH HOSPITAL : In connexion with the British Postgraduate Medical School, of which a full account is given on pp. 487 and 488. ST. ALFEGE’S HOSPITAL: Facilities are afforded to the Final Fellowship Class of Guy’s Hospital to examine selected cases. The demonstration is undertaken by. a surgical tutor of the class. ST. ANDREW’S HOSPITAL: Consultant surgeon holds weekly classes for two periods of about 10 weeks previous to Final F.R.C.S. examinations. ST. JAMES’ HOSPITAL: The South-West London Post-Graduate Association has its headquarters at this hospital where three sessions of lectures are

annually-Autumn, Lent, and Summer. Instruction is given, in collaboration with the Fellowship of Medicine, in orthopædic surgery and special anaesthesia for plastic surgery. Post-graduate courses.-Courses of instruction in hospital administration for candidates for the Diploma in Public Health are held at the NORTH-WESTERN HOSPITAL and at the BROOK HOSPITAL. given

Special units.-There are the following special departments for the treatment of various diseases in In addition all these officers are provided with board, lodging, and washing. All the positions mentioned involve full-time duties, and it is a condition of service that such officers shall not undertake any other paid employment. The staffing provides, where necessary, for house physicians or house surgeons, remunerated at the rate of £120 a year, with residence, and for clinical assistants, who are non-resident and receive £150 a year, with meals when on duty. These officers are not employed in a whole-time capacity and are granted adequate leisure for study. Deputy medical superintendents and senior assistant medical officers who occupy unfurnished houses or quarters (married quarters) in the hospitals are paid the following salaries in lieu of those set out above. The unfurnished houses or quarters are provided free of charge, the Council also paying all local and water rates :-

the hospitals

:-

Scale of Grade.

annual salarv. * The thoracic surgery unit will be transferred to St. Abbots probably on Oct. 1st, 1936.

Undergraduate

Mary

facilities.-The following general

to medical schools for the :teaching purpose All full-time medical staff are allowed liberal annual leave with pay, and full pay during sickness for a reasonable period. For subordinate staff, the extent and fluidity of the hospital service provides unique opportunities for a variety of experience, and facilities exist for specialisation and for officers to follow courses of study outside the service with a view to improving their professional qualifications. During the past year 174 vacancies have been filled, including 1 position as medical superintendent, 17 as senior assistant medical officers, 105 as assistant medical officers, and 51 as house surgeons, house physicians, or clinical assistants. During the year also a large number-more than 200-of part-time consultants and specialists were employed in the Obstetric instruction.-In’addition, undergraduates various units and groups of these hospitals. These f seven medical schools are accepted as students appointments, which vary from 1 to 7 sessions a week,from Vacancies in the

far

filled, higher grades possible, by promotion from the existing staff. are

as

affiliated ashospitalsofare clinical

538 for instruction in obstetrics at the

hospitals :-

following general

RESIDENT STUDENTS

passage to India. On landing they are posted to one of the larger women’s hospitals to gain Indian experience and to learn the language. For a further period they are appointed to act temporarily for medical women on furlough. They are then definitely appointed to the charge of hospitals. Private practice is allowed, provided it does not interfere with official The only exception is in administrative duties.

educational posts, when an allowance in lieu of practice is given. The amount obtained from practice varies according to the station, but in most cases it forms a fair addition to the salary, varying from 2150 or

NON-RESIDENT STUDENTS

St. Alfege’s Hospital

..

Guy’s.

The fever hospitals provide facilities for undergraduate instruction in infectious disease. Small-pox.—Provision is also made for demonstrations in the diagnosis and treatment of small-pox for both under-graduate and post-graduate students. Recognition for examinations.-The majority of the general hospitals are recognised for qualification for candidature in branch 1 of the University of London M.D. Examination. Ten of the general hospitals are recognised by the British College of Obstetricians and Gynaecologists for candidature for their Diploma and membership.

PRISON MEDICAL SERVICE Whole-time appointments.-At the larger prisons the medical-officerships are full-time appointments, and at certain establishments deputy medical officers are appointed to assist in the work. Whole-time medical officers are in two classes : medical officers, class II., £525 a year proceeding by annual increments of £25 to 800 a year (the commencing salary for those holding the diploma of psychological medicine being £575 per annum) ; medical officers, class I., £800 a year proceeding by annual increments of £30 to £1000 a year. Unfurnished quarters are provided or an allowance in lieu is made. The posts are pensionable. The initial appointment is to the class II. grade with prospects of promotion to the higher rank. Of the whole-time Prison Medical Service 16 are class II. and 12 are class I. Promotions from class II. to the rank of medical officer, class I., are made as vacancies occur. Three of the senior medical officers receive an additional allowance of £50 per annum, and at certain prisons, medical officers receive fees for giving evidence in the criminal courts. Candidates must be fully qualified and registered. Preference is given to those who have held house appointments, have had experience in mental diseases and psychological methods, and are between the ages of 25 and 35 years. Part-time appointments.-The medical-officerships of the smaller prisons, where the work is insufficient to occupy a man’s whole time, are usually filled by local practitioners, who combine the prison work with their own practice. The salary paid for such part-time work varies according to the extent of the duties required. Such appointments may be terminated with notice at any time, and the holders are not entitled to pension. Further particulars can be obtained from the secretary, Prison Commission, Home Office, London,

S.W.I.

______________

WOMEN’S MEDICAL SERVICE FOR INDIA AMONG careers open to medical women abroad the Women’s Medical Service for India deserves honourable mention. Admission is made by selection in India and England, preference being given to those with Indian experience. The Service is open to fully qualified medical women of British or Indian nationality, and with the present amount of Government subsidy the number of full medical officers is limited to 44. There are six to ten temporary officers, and in addition there is a training reserve of about fourteen recently qualified women holding degrees in medicine, of Indian universities. Medical women proceeding to India to join the Women’s Medical Service receive a sufficient sum for a first-class

to £1000 a year. Excellent opportunities for surgery, gynaecology, and midwifery are found in the Women’s Medical Service. Opportunities are likely to open in the future in connexion with maternity and child welfare. Doctors in charge of hospitals have ample scope for administration and their duties always include some teaching of Indian nurses and dispensers, as well as training young medical women as house surgeons and physicians. Teaching posts at Medical Colleges and Schools for Women form about onethird of the total sanctioned posts in the Service. The cost of living in India is much higher than formerly, but it should be possible for a medical woman (with house provided) to meet actual household expenses for about Rs.300 per mensem, leaving the remainder of her salary for dress and personal To this must be added the necessary expenses. saving to meet additional expense for furlough and leave spent in the hills. Rates of pay are as follows :—

* Given to officers of European domicile. t At rupee value Is. 6d.

Furnished quarters are provided, representing an additional Rs.150 per mensem or an allowance is given instead. Leave on average pay is earned at the rate of 2/llths of the period spent on duty. Study-leave is granted to the extent of 12 months in the total service and will not be granted more than twice in the course of an officer’s service. During study-leave an officer draws half average pay, with a study allowance at the rate of 12s. a day during the course of study. Officers of European domicile are entitled to four free return first-class passages from a port in India to a port outside India in their whole service. The first passage is not granted until after the expiry of four years’ approved service, and thereafter passages may be granted at intervals of not less than four years. There is a Provident Fund to which members of the Service contribute 10 per cent. of their pay. The Service contributes another 10 per eent., which accumulates at interest and is repaid on retirement. Admission to the Service is made by selection in India and England-preference being given to those with Indian experience. Vacancies are few, usually three or four only in each year. Candidates in the United Kingdom should apply to the Hon. Secretary, United Kingdom Branch of the Countess of Dufferin’s Fund, care of India Office, Whitehall, London. Candidates in India should apply to the Chief Medical Officer, Women’s Medical Service, Dufferin Office, Red Cross Building, New Delhi. Information about the Service can also be obtained from the Medical Adviser to the United Kingdom Dufferin Fund, c/o The High Commissioner for India, India House, Aldwych, London, W.C.2, who can be seen there by

appointment.