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report, which states that an annual intake of 900students is- required. The average recent pre-warfigure was 340, and even this has since fallen, far belowthe permitted war-time quota, to less than 300.Without some radical changes in existing arrangements,therefore, the needs of the public will not be met. Afar greater number of entrants to the dental professionmust somehow be secured; and in order to secure themit must be made more attractive in every way. At

present the dental surgeon is too often despised byhis medical colleagues because of his inferior educationand because dentistry is often considered more of abusiness and less of a profession than medicine itself.The obvious way to overcome this difficulty is tomake the standard of education higher, to provideremuneration based on quality and not quantity ofwork, and to make it clear that dentistry is but abranch of medicine. If this is achieved, a better typeof entrant, who can work on equal terms, professionaland financial, with other medical practitioners willcome forward.The separation of dentistry from medicine has led

to an unfortunate emphasis on its mechanical side.True, the mechanical side is of great importance.Fillings that do not stay in, and dentures that do notfit, are no good to anyone : but only too often generalprinciples of medicine are forfeited in the quest formechanical perfection. It is odd that, whereas theophthalmic surgeon who does refractions sends his

patient to the optician for spectacles, and the ortho-paedic surgeon sends his patient with an amputationto the limb-maker, the dental surgeon who removesthe teeth must himself fit the denture, which is nomore nor less than an artificial mechanical substitute.This fact of selling a piece of apparatus over thecounter is felt by many dental surgeons to be invidious.Furthermore, as Major-General HELLIWELL pointsout in his minority report,2 it is somewhat anomalousthat dental surgeons who find their greatest source ofincome in the extraction of teeth and the provisionof dentures should at the same time be expected topreserve the teeth in order to avoid these self-sameextractions and dentures. Actually, what is therein the fitting of dentures that demands special know-ledge of a medical type ? 1 It is of course a processrequiring skill, artistic sense, and manual dexterity :but surely it could be performed by someone who hashad special training in this particular work, and notnecessarily one with a knowledge of the fundamentalmedical sciences. If this work were delegated to thedenture-maker, working, if necessary, under the

supervision of the dental specialist, the emphasiswould at once come to lie on the preservation of theteeth by the latter and not on their replacement.The basic problem of the dental profession

might in the long run be solved, as the reportsuggests, by the employment of ancillary workersunder the supervision of a dental specialist. In NewZealand the school dental service is mainly staffedby so-called ’’ dental nurses," who after -two years’training carry out fillings, extractions, and prophy-laxis for school-children under the supervision of

qualified dental officers. In 1939, with 350 of thesedental nurses, the number of children under systematictreatment was 150,000. In this country during thewar 50 W.A.A.F. " hygienists

" have been employed2. Ibid, p. 49.

to undertake scaling and oral hygiene for the RoyalAir Force, thereby releasing dental surgeons for otherdental work. If this principle was further extendedand a medical qualification was deemed a necessityfor the dental specialist, his status would be greatlyenhanced. He would act as consultant, and wouldoperate in the more difficult type of case, but wouldhand over most of his patients to ancillaries whosework he would supervise. Admittedly, the difficultiesof reorganisation along these lines might be great,but they should not be insuperable when dentistrycan be concentrated in appropriate centres where thelabour can be divided among a group. A short State-subsidised course for ancillary workers, with sufficientremuneration at the end of the course, should attract

enough entrants to provide a comprehensive dentalservice for the whole country, children and adultsalike. The rapid fall in entry of students to the

profession could be stopped, and the dental specialist,working with other doctors, would not only find hisspecialty more attractive but also be better fittedto make use of the greater opportunities for researchthat are advocated in the report.

Annotations

STUDENT HEALTH

MANY young people working for university degreeshave narrow means after their fees have been paid; ,and this relative poverty is reflected in poor food, poorquarters, and neglect of the early stages of disease.Medical students have expressed their concern at theconditions under which their fellows live and the

Royal College of Physicians has now endorsed many oftheir recommendations in a report on Student Healthservices. Evidence submitted to the college " leaves nodoubt that there is a serious amount of sickness amonguniversity students and that there is almost a completeindifference by many university authorities to anymeasure of preventive medicine." The college hold thatthe universities must accept far greater responsibilityfor the health of their students.At Aberdeen University, where undergraduates have

the right to be medically examined if they wish, it hasbeen found that over half those coming for examinationare in need of medical or surgical treatment or adviceon minor abnormalities, especially remediable defectsof eyes and teeth. Many have mild psychological dis-abilities, and from other sources the committee learnedthat serious psychiatric disorders sometimes pass unrecog-nised and untreated for long periods. Sick-bays for

acutely ill students may be inadequate or. non-existent ;and students living in lodgings may be outside anyscheme for medical or nursing care, and may be soshort of funds that they hesitate to call in the doctor.Their food is often unsuitable, and they have to spendmoney on expensive snacks because no canteen is

provided for them. Even those who live in college maybe offered a diet which shows no sign of expert nutritionalplanning. Lodgings for students living out of collegeare usually inspected, by the university, but standardsof inspection vary, and the possible effects on healthare not seriously considered. In 1939 only 6 out of 31universities and university colleges had a compulsorymedical examination for students on entry, and only 41. Health and the Student. British Medical Students Association.

1944.2. Third Interim Report of the Social and Preventive Medicine

Committee of the Royal College of Physicians. January, 1946.The members of the committee are Prof. Alan Moncrieff(chairman), Lord Moran, P.R.C.P., Prof. M. Greenwood, F.R.S.,Prof. Arthur Ellis, Dr. H. E. A. Boldero, Dr. J. A. Charles,Dr. P. M. D’Arcy Hart, Prof. Aubrey Lewis, Dr. Janet Vaughan,Sir Allen Daley, Dr. J. E. Gordon, and Prof. J. M. Mackintosh.

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had a voluntary examination ; in 1943, 9 had compulsoryand 2 had voluntary examinations, while " other medicalservices "-but never at all complete-were available in 19.The college suggest that universities might have a

standard form of application, to be filled up by parents,and accompanied by a medical certificate. All studentsshould have a medical examination on entering theuniversity, arranged by the authorities in associationwith the university department of social medicine orthe staff of the local teaching hospital ; and this shouldinclude an X-ray examination of the chest. The exami-nation would not be made until-the student had alreadybeen accepted by the university, and no student wouldbe rejected on the results of examination unless he hadsome condition which needed temporary treatment orwhich would be harmful to others until remedied. Inthe case of other troubles, students would merely be toldof the schemes for treatment ; and these should certainlyinclude dental and ophthalmic care for students duringtheir time at the university. It should be possible todetect serious psychosis in entrants, and some form ofpsychological testing would provide useful material forresearch, since a student’s performance in the testscould be related to his subsequent achievements. Ifsome defect was found which put a university career outof the question the whole matter would have to bediscussed with the parents, student, family doctor, anduniversity authorities.

After the examination on entry, students should beexamined yearly. The college consider that everyresidential college or hostel should have a visiting nurse,a sick-bay, and a first-aid post. Medical schools, of course,might arrange for such services to be provided in hospital.The university should make sure that medical attentionis readily forthcoming to students in lodgings, but themethod of providing it will have to be settled when theNational Health Service has been established. Lodgingsshould be properly inspected by people with specialexperience " of the type possessed by the sanitaryinspector, health visitor, and trained social worker," andany of these people could be given additional trainingto fit them for the task. They would study the sanitation,furnishing, ventilation, and lighting of the rooms let tostudents, and the cooking and diet offered. In additionthe college hold that there should be university canteensand self-service cafeterias, managed by committees onwhich the students are represented. Profit, which shouldbe small, ought to be spent on improving the restaurants ;and a dietitian should advise on the choice of food andits cooking. A doctor appointed to supervise studenthealth should advise on habits of work and exercise. Itis to be hoped that universities will take to heart thistimely advice from an authoritative source.

COMFORT IN THE HOME

IN the last few years the Ministry of Works hasproduced an admirable series of "Post-war BuildingStudies." Most of these have dealt with the technicalaspects of construction, including modern principles inlighting and insulation; but the latest production-onthe heating and ventilation of dwellings 1-should com-mand the wider attention of doctors and the generalpublic. Under the chairmanship of Sir Alfred Egerton,a committee representing many interests-technical,industrial, and even housewifely-has reviewed thewhole question of comfort in the ordinary dwelling inthe light of modern knowledge and the practice in othercountries which are more advanced than ours. The

report is timely, not only because we are entering on themost tremendous housing programme of all history butalso because we are in this respect one of the mostbackward of civilised countries.

1. Post-war Building Studies. No. 19, Heating and Ventilation ofDwellings. H.M. Stationery Office. 1945. 2s. 6d.

The Egerton report deals first with domestic heatingas part of a national fuel policy. In 1938 there were inGreat Britain some 12.5 million dwellings with about3-7 persons to each. The quantity of coal used fordomestic space-heating, water-heating, and cookingservices was about 63 million tons, or 1 t tons per head.The poor insulation of our houses, and our reliance onthe charming but atmosphere-polluting and grosslywasteful open fire, means that the average efficiency ofdomestic heating is low, probably less than 25%. A com.

parison with the fuel consumption in other oountries,such as pre-war Germany and the United States, showsthat we get far too little comfort and service for ourmoney. Our main source of heat is coal, yet what wehave of this we waste on inefficient apparatus. Thewarmth of the British home is confined to a narrow andoften selfish circle around a single fireside. The rest ofthe living-space, though generous in area compared withmany countries, is so cold in winter as to be barelyhabitable. " It is possible," the report says, " to havetoo much comfort, for the body may then lose its powerof quick adaptation, which is an essential requirementof normal health." This danger cannot be serious inthe vast majority of British houses. The term " com-fort" is not defined in the report, but an ingeniousinstrument called the " eupatheoscope" records as a

single index the three most important factors in itscomposition-air temperature, air movement, and radia-tion from the surroundings-known as the " equivalenttemperature." The report suggests that most peoplefeel comfortable within the range of 62-66° F equivalenttemperature, when they are taking their ease ; and thata lower figure (say 50-55° F) is enough for the housewifein action. But is it enough for the young children whowill presumably be playing on the floor while she is

doing her housework This estimate of requirements for space-heating leads

the committee, logically enough, to consider the

desirability of background heating in a dwelling :"

Apart from the necessity of providing warmth to renderconditions in the home comfortable it is desirable to provideagainst excessive chilling of the structure of the house, whichcauses condensation of moisture on the walls, furnishings, andhousehold linen. Such condensation most frequently occurswhen the outside temperature and humidity rise suddenlyafter a spell of cold weather. It is probable that a consider-able amount of trouble may be avoided if the temperatureinside the house is prevented from falling below about 45-50° Fby providing a moderate degree of continuous warmth."That is what is meant by " background heating." The

urgent question is how it is to be secured. The standards

approved in the report presuppose background heatingthroughout the house, maintaining throughout thetwenty-four hours a minimum temperature of 4-50° F,with " topping up " to 6° F in the living-room when itis in use, and to various lower temperatures in kitchenand bedrooms according to needs. The possible com-binations of appliances, for which a maze of calculationshave been made, seem to boil down to these :

1. A closeable fire or semi-closed stove fitted with a con-vection jacket, supplying direct radiant heat and warm airto the living-room in which it is installed, and warm air, throughducts, to the bedrooms. The bedrooms would be topped upby gas or electric fires.

2. A small hot-water supply boiler providing backgroundheating for the whole house by means of hot-water radiators,with topping up by gas or electric fires.

3. Gas or electric convectors as the main agent for back-ground heating, with additional fires for topping up, withoutany solid fuel appliance.Thus far the emphasis rests on a method of heating

which provides continuous background warmth andintermittent topping up to comfort temperatures. Butthe issue is not so simple as that : there are at leasttwo more alternatives. One is to rely wholly on inter-mittent heating ; and another is to provide, like our