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The Defence Services

SINCE the beginning of the war the Central Medical WarCommittee has been responsible for the supply of alldoctors for the defence services, and the Central DentalWar Committee for the supply of dental surgeons.

Royal Naval Medical ServiceThe usual regulations governing entry of medical and

dental officers to the Royal Naval Medical Service weresuspended during the war and the only medical officersbeing admitted are those granted temporary commissionsin the Royal Naval Volunteer Reserve. Candidates forentry must have had at least 6 months’ experience in ahouse appointment. Some vacancies will be filled byselection of officers from among those who have served inthe RNVR during the war. A small number of womenmedical officers are serving as surgeon lieutenants RNVRand one as surgeon lieutenant-commander RNVR (at-Medical Department, Admiralty).

Candidates for the Royal Naval Dental Service mustbe registered under the Medical or Dental Acts and mustalso have a registrable qualification in dental surgery.The method of entry is similar to that for medicalofficers.

Royal Army Medical CorpsNo direct applications for regular commissions in the

RAMC have been invited since the outbreak of war upto the present. All war-time appointments were toemergency commissions for the duration of the war ;but medical officers, after serving as emergency com-missioned officers for one year on full pay, now have anopportunity of applying for a regular short-servicecommission under conditions set out in Army CouncilInstructions, which are available for all officers to seein the office of the formation with which they are serving.Recently qualified doctors wishing to be appointed toan emergency commission should apply to the secretaryof the Central Medical War Committee, at BMA House ;or if resident in Scotland to the Scottish Central MedicalWar Committee, 7, Drumsheugh Gardens, Edinburgh 3.Applicants should have held an appointment either ashouse surgeon or house physician for six months.Women medical practitioners are needed for appoint-

ment to commissions in the Women’s Forces for employ-ment with the RAMC. They are required mainly forgeneral medical duties with the ATS. A number havebeen selected for specialist duties. Women must beunder 46 and fit for general service. Applications.mustbe made through the Central Medical War Committee.Applicants should have held an appointment either ashouse surgeon or house physician.ARMY DENTAL CORPS

As in the RAMC, no direct applications for regularcommissions in the Army Dental Corps have been invitedsince the outbreak of war. All war-time appoint-ments were to emergency commissions for the durationof the war; but dental officers, after serving as emergencycommissioned officers for one year on full pay, now havean opportunity of applying for a regular short-servicecommission. Recently qualified dental surgeons wish-ing to be appointed to emergency commissions shouldnotify the secretary of the Central Dental War Committee,at 13, Hill Street, London, Wl, or, in Scotland,the secretary of the Scottish Central Dental War Com-mittee, c/o the Department of Health for Scotland,Edinburgh 1.Women dental surgeons are eligible for appointment

to commissions in the Women’s Forces for employmentwith the Army Dental Corps. Thy are employed ondental duties with the ATS, and must be under 46 andfit for general service. Applications must be made tothe secretary of the Central Dental War Committee.

Royal Air Force Medical BranchCommissioins in the medical branch of the RAF are

now given only to those appointed to the Royal Air ForceVolunteer Reserve for the duration of the war. Short-service and permanent commissions are in abeyance buta limited number of permanent commissions are beinggranted.

Newly qualified medical officers are considered forservice in the medical branch of the Royal Air Forceafter having completed a six months’ house appointmentin a civil hospital. No appointments to commissions aremade direct by the Air Ministry; candidates mustregister with the Central Medical War Committee, whichallocates doctors for interview and medical examinationat the Medical Directorate, Air Ministry. Entry ofdoctors to commissions is normally in the rank offlying officer (corresponding to lieutenant in theRAMC) and promotion to flight lieutenant is automatic,after one year’s service provided recommendation forthe rank is satisfactory. There are from time to timea limited number of vacancies open to doctors holdingspecialist qualifications, and in selected cases a higherrank on entry is given. Medical officers on entry aregiven a short course of instruction at the Medical

Training Dep6t and on completion of the course

become available for posting. Such postings may beto -operational units, training units, recruiting centres,general hospitals, or station -hospitals. In addition toordinary general medical work, there are the importantbranches of aviation medicine and general preventivemedicine and hygiene. Medical officers are encouragedto make a special study of these.

There are now 106 women medical officers commissionedfor duty with the RAF as medical officers. They aremainly employed in thd care of WAAF personnel.

There is a separate dental branch of the RAF, anddental officers are not appointed to the medical branch.During the war dental officers have been appointedthrough the Central Dental War Committee, which hasbeen organised by the British Dental Association.Entry into regular service has been suspended and allaccepted candidates are at present commissioned in theRAF Volunteer Reserve for the duration of the war.There are 21 women dental officers now serving.

Health Services at Home

EMERGENCY MEDICAL SERVICE

HAVING done the work for which it was established, theEMS is beginning to close ; students in coming yearswill no longer take part in this service as a matter ofcourse before joining the Forces With the ending of theEuropean war the stream of casualties reaching EMShospitals abruptly ceased, and the only wounded arrivingnow are those long-term cases sent home by sea. Servicesick frpm home and abroad are still treated by the EMS.Looking back, it is clear that we have learned muchfrom the scheme. The first lesson-an odd one forEngland-was that it is sometimes possible to betoo ready for things. When war broke out the schemewas already planned to take the strain which after-wards fell on it in 1940. In London the strengthof the big metropolitan hospitals was early deployedinto the sectors, and in the provincial cities thesame principle was followed, in the belief that everyindustrial centre would soon become the focus of airassault. There was nothing wrong with this prophecyexcept the timing, and it was some months beforethe disorganised hospital and specialist services of thecountry could be adjusted afresh to the needs of themoment. When the blitz finally arrived, however, itwas relatively easy to return to the planned pattern,modified on lines suggested by the experience of morethan a year of war, and the principles proved to be sound.Air-raid casualties were sent out of the danger areasas soon as they could be moved, and casualties fromoverseas came to the big country hospitals-many ofthem situated in the borrowed wards of mental hospitals-which had been opened to receive them. The EMSalso founded some fine hutted hospitals, and addedhutted wards to many of the hospitals which were givingthe service hospitality. Now these host-hospitals aregradually taking back their beds, and some of them arethe gainers of new blocks.What parts of the emergency structure will survive

in the future medical services of the country it is notyet possible to say. The sector plan has shown howmuch is gained when a group of hospitals worktogether as a unit. The consultant service, under which

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specialists have regularly visited every hospital in theirown group, has proved outstandingly valuable ; it hasmeant, among other things, that a patient is under the eyeof one expert from start to finish of his treatment, whetherhe stays in one hospital or is moved to some other in thegroup. The special units-for head and spinal injuries,plastic cases, burns, fractures, thoracic injuries, eyelesions, and other conditions-have demonstrated afreshthat individual skills are used to best advantage in ateam. It would be unfortunate for medicine and forthe public if its special units were to disappear with theEMS, even though some types of them must becomeobsolete as the supply of cases diminishes.EMS hospitals, like others, have suffered from lack

of staff, particularly of domestic and nursing staff.Unlike the Fighting Forces the EMS has also lackedmedical staff. Despite these handicaps the service hasdone notable work, and will be remembered as a well-considered plan successfully carried, out.

INDUSTRIAL MEDICAL SERVICESTHE stimulus which war gave to industry has brought

industrial medicine actively into the service of thecountry, for output depends on the health and wellbeingof the workers. Moreover, the service will continue togrow in peace-time, for its value is being demonstratedyear by year.

Factories.-Of the departments supervising industrialhealth the oldest is the Factory Department, formerlyof the Home Office, since 1940 of the Ministry of Labourand National Service. This department administers theFactory Act with its regulations on accident and sicknessprevention, hours of work, amenities, first-aid andambulance rooms, and canteens. It is staffed by 14whole-time medical inspectors of factories who investi-gate conditions of work in factories ; they are stationedin London, Bristol, Birmingham, Sheffield, Manchester,Liverpool, Leeds, Glasgow, and Wolverhampton. Underthem nearly -2000 general practitioners giye part-timeservice as factory surgeons, examining all young entrantsinto industry, and periodically all those engaged indangerous processes, and they issue certificates under theWorkmen’s Compensation Act for scheduled industrialdiseases.Coal-mines.-The mines medical service,’ described

below, is responsible for the health of miners.Pneumoconiosis.-The silicosis and asbestosis medical

board consists of 11 whole-time doctors, stationed inSwansea, Cardiff, Stoke-on-Trent, Manchester, andSheffield. They have special experience of chestdiseases, and issue compensation certificates to workerswho develop silicosis or asbestosis ; they also examineworkers in industries liable to produce these conditions.A separate board consisting of three doctors was set upin Manchester in 1941 to supervise cotton-workers whodevelop byssinosis, and to issue compensation certificates.All workmen’s compensation schemes come under thedirection of the Home Office.

Factory medical officers.-Before the war the practiceof appointing whole-time or part-time works’ medicalofficers was not universal ; there were only about 50whole-time and part-time medical officers in factoriesthroughout England, Wales, and Scotland. But partlyas a result of the Factories (Medical and Welfare Ser-vices) Order, 1940, made by the Minister of Labour andNational Service, there has been a considerable increasein the number of works’ doctors. This order states thatthe occupier of a factory at which any work for theCrown is being done may be required by the chiefinspector of factories to appoint doctors, nurses, and’welfare supervisors, to look after the workers. At theend of 1943, there were 176 full-time and 750 part-timemedical officers in Great Britain, .and presumably thenumbers have increased since then. Some of these areworking in Royal Ordnance factories, under the Ministryof Supply.Many of these war-time appointments are likely to

become permanent now the war is over, since employerswho experience the benefit of a well-run medical servicein a factory rarely abolish it. Unfortunately most ofthe workpeople in this country are employed in smallfactories to which no doctors have been appointed. Ifa comprehensive medical service is introduced, theindustrial medical services will presumably be incor-

porated in it, and it may be possible to appoint medicalofficers to groups of such factories. At present works’doctors hold appointments mainly in the larger factoriesand are paid by the employers. Such a doctor appears tosome of the workers as the employer’s man, and theyare apt to distrust his opinions in consequence. Undera comprehensive medical service it should be possible toarrange that the doctor is employed by the State orsome other neutral body. ,

Medical officers of factories who are interested insocial problems have wide opportunities for their study,and can also undertake the teaching of health andhygiene. They can strengthen the bonds between thefactory service and the general medical and hospitalservices, treat accidents, reduce the chances of sepsis,follow up serious cases, and ensure that patients allreturn to work in the shortest time compatible withadequate treatment and rehabilitation. By reducingthe loss of working-time they have done valuable war-work.The Association of Industrial Medical Officers was

formed some years before the war by doctors interestedin the various aspects of industrial health. Brancheshave been established in various parts of the country.Information about the association may be obtained fromthe secretary, Cadby Hall, Kensington, London, W14.The new British Journal .of Industrial Medicine issponsored by the AIMO in conjunction with the BritishMedical Association.

Postgraduate training iii: industrial work is as yetpoorly developed, but week-end courses are providedfrom time to time at London, Birmingham, Manchester,Sheffield, Leeds, and Bristol. Research on factoryenvironment is carried out by the Industrial HealthResearch Board of the- Medical Research Council. Thecouncil has appointed a director of medical research,and established a research department at the LondonHospital.

PUBLIC HEALTHTHERE has been steady expansion in the field of public

health since the first medical officer of health wasappointed nearly a hundred years ago. In the earlydays the duties of the MOH were largely concerned withsanitation, especially such matters as the safety ofwater-supplies and sewage disposal. The work of thepioneers in this field led to the general acceptance andapplication of standards ; as a result, the need, fordetailed medical supervision of environmental hygienehas been reduced, though in some rural areas there isstill much to be done. The medical officer must nowretain general control and supervision of the work, buthe largely delegates it to sanitary inspectors, healthvisitors, and others. So long as the general controlremains with the medical officer trained in public healththere can be only good in this.

Control of infectious diseases was one of the firstfunctions of a medical officer of health ; at one time theisolation of such patients was held to be of primaryimportance. Now the emphasis is more upon theprovision of specialised treatment, so that larger hospitalswith specialist clinicians in charge have developed.The MOH is now much more concerned with activeprophylactic measures, such as diphtheria immunisation,though he is still often called on to advise on the diag-nosis in cases of doubt, and still deals with the homefollow-up and epidemic control.During the last thirty years the emphasis in public

health has turned gradually towards preventive clinicalwork, particularly in the maternity and child welfareand school medical services--so much so that there arenow in the public health service many more doctorsengaged on clinical duties than on administrative workor the control of environmental hygiene. The tuber-culosis service, -developed largely since the last war,covers both preventive and curative clinical work, andhas led to growing provision for institutional treatment.Over the same period the treatment of venereal diseaseshas developed. Since 1930 counties and county boroughshave enlarged their general hospital services in institu-tions taken over from the Boards of Guardians. TheMOH thus has an interest in general hospital adminis-tration also.

In general, senior posts in public health are nowalmost entirely administrative, though the medical