411 Numbers starting study and registering.* * The numbers shown as starting study are taken from the Medical Students’ Register up to 1938 ; and since then from returns made by the medical schools to the General Medical Council. Both forms of notification are incomplete for certain years. Starting with 1953, the figure is based on the annual examina- tion returns and covers the calendar year instead of the academic year as formerly. in 1954, 4542 (2222 fully registered and 2320 provisionally registered) ; and in 1955, 5310 (2992 fully registered and 2318 provisionally registered). The 1954 and 1955 totals include, of course, a considerable proportion of those provisionally registered in the previous year. The number obtaining provisional and full registration in 1953 was much lower than in the preceding five years. This is attributable to two things : (1) some people who would normally have registered in 1953 took special steps to obtain registration before the end of 1952 in order to avoid the preregistration year ; ; and (2) the lengthening of the curriculum at certain Scottish universities has meant that fewer than usual qualified and became provisionally registered in 1953. The striking increase in the number of newly registered doctors in 1952 (4493 as against 3075 in 1951) was largely due to the addition of 1452 names to the Commonwealth List in 1952 (as compared with 471 in 1951). Number of fully registered doctors on the Medical Register. The Defence Services Royal Naval Medical Service The Medical Service of the Royal Navy affords, to medical practitioners who are attracted by the prospect of sea service and work with the Royal Navy, a wide opportunity to practise their profession in an attractive environment. A background of naval tradition naturally permeates the Royal Naval Hospitals and Naval Training Establishments, as well as Her Majesty’s ships. Officers serving on the permanent list are encouraged to specialise in all branches of medicine, and they are given full facilities to obtain higher qualifications. Courses of post- graduate study are carried out not only in naval hospitals but also at civilian teaching centres. There is a wide variety of subjects comprised in the title " naval medicine," and it might often be claimed that certain of these subjects are unique. They include aviation medicine, the physiology of diving, the physical aspects of service afloat and ashore, commando service, tropical diseases, and last, but by no means least, industrial hygiene. Furthermore, a naval medical officer is no longer concerned with the care of the sailor alone, but must also have up-to-date knowledge of the diseases of women and children so that he may attend the needs of the W.R.N.S., members of the Q.A.R.N.N.S., Naval v.A.D.s, and the wives and children of Servicemen and Admiralty personnel serving abroad. The Royal Naval Medical Service offers a life career with service on the active list up to 55 for all officers, to 57 for surgeon captains, and to 60 years of age for surgeon rear-admirals. Provision is made in the regu- lations for counting previous experience, both service and professional. All previous commissioned service as a medical officer in one of the Armed Forces is allowed to count in full, and all non-medical commissioned service is allowed to count as to half. Civilian hospital experi- ence, and also experience of a special nature in private RATES OF PAY OF MEDICAL OFFICERS IN THE ROYAL NAVAL MEDICAL SERVICE (i) The married rates shown apply to officers over 25 years cf age only. (ii) When not accommodated or messed the following additional allowances are paid to single officers’ : Up to surgeon lieutenant-commander .... . 4z288 Surgeon commander and surgeon captain under 6 years .............8343 Surgeon captain over 6 years k398 Surgeon rear-admiral and surgeon vice-admiral £ I53 (iii) In similar circumstances, married officers receive an additional allowance of :E8S per annum. (iv) Married officers whose families are provided with official quarters or whose families accompany them abroad, have their marriage allowance reduced by 54 per annum.
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Numbers starting study and registering.** The numbers shown as starting study are taken from the Medical
Students’ Register up to 1938 ; and since then from returnsmade by the medical schools to the General Medical Council.Both forms of notification are incomplete for certain years.Starting with 1953, the figure is based on the annual examina-tion returns and covers the calendar year instead of the academicyear as formerly.
in 1954, 4542 (2222 fully registered and 2320 provisionallyregistered) ; and in 1955, 5310 (2992 fully registeredand 2318 provisionally registered). The 1954 and 1955totals include, of course, a considerable proportion ofthose provisionally registered in the previous year.The number obtaining provisional and full registration
in 1953 was much lower than in the preceding five years.This is attributable to two things : (1) some people whowould normally have registered in 1953 took special stepsto obtain registration before the end of 1952 in order toavoid the preregistration year ; ; and (2) the lengtheningof the curriculum at certain Scottish universities has meantthat fewer than usual qualified and became provisionallyregistered in 1953. The striking increase in the number ofnewly registered doctors in 1952 (4493 as against 3075 in1951) was largely due to the addition of 1452 names to theCommonwealth List in 1952 (as compared with 471 in 1951).
Number of fully registered doctors on the Medical Register.
The Defence Services
Royal Naval Medical ServiceThe Medical Service of the Royal Navy affords, to
medical practitioners who are attracted by the prospectof sea service and work with the Royal Navy, a wideopportunity to practise their profession in an attractiveenvironment. A background of naval tradition naturallypermeates the Royal Naval Hospitals and Naval TrainingEstablishments, as well as Her Majesty’s ships. Officersserving on the permanent list are encouraged to specialisein all branches of medicine, and they are given fullfacilities to obtain higher qualifications. Courses of post-graduate study are carried out not only in naval hospitalsbut also at civilian teaching centres. There is a widevariety of subjects comprised in the title " navalmedicine," and it might often be claimed that certainof these subjects are unique. They include aviationmedicine, the physiology of diving, the physical aspectsof service afloat and ashore, commando service, tropicaldiseases, and last, but by no means least, industrialhygiene. Furthermore, a naval medical officer is nolonger concerned with the care of the sailor alone, butmust also have up-to-date knowledge of the diseases ofwomen and children so that he may attend the needs ofthe W.R.N.S., members of the Q.A.R.N.N.S., Naval v.A.D.s,and the wives and children of Servicemen and Admiraltypersonnel serving abroad.The Royal Naval Medical Service offers a life career
with service on the active list up to 55 for all officers, to57 for surgeon captains, and to 60 years of age forsurgeon rear-admirals. Provision is made in the regu-lations for counting previous experience, both serviceand professional. All previous commissioned service as amedical officer in one of the Armed Forces is allowed tocount in full, and all non-medical commissioned serviceis allowed to count as to half. Civilian hospital experi-ence, and also experience of a special nature in private
RATES OF PAY OF MEDICAL OFFICERS IN THE ROYAL NAVAL
MEDICAL SERVICE
(i) The married rates shown apply to officers over 25 years cfage only.
(ii) When not accommodated or messed the following additionalallowances are paid to single officers’ :
Up to surgeon lieutenant-commander .... . 4z288Surgeon commander and surgeon captain under
6 years .............8343Surgeon captain over 6 years k398Surgeon rear-admiral and surgeon vice-admiral £ I53
(iii) In similar circumstances, married officers receive an additionalallowance of :E8S per annum.
(iv) Married officers whose families are provided with officialquarters or whose families accompany them abroad, have theirmarriage allowance reduced by 54 per annum.
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practice which is recognised by the Medical Director-General as warranting additional seniority, may beallowed to count up to a limit of seven years in all.The additional seniority will be reckoned as service for
pay and promotion but not for retired pay or gratuity.Leave is granted to officers at the following scales : inthe United Kingdom, 42 days a year ; when appointed toH.M. Ships on general service, at the rate of 3 days amonth ; when on foreign service, 14 days local leave ayear with a further 2 days for each month abroad onreturn to the United Kingdom.Entry in the first place is for a short-service com-
mission of either three or four years which may beextended. During this time application may be madefor transfer to the permanent list. Medical practi-tioners who undertake their National Service in the RoyalNavy are also eligible to apply to transfer to the per-manent list. The normal career for a medical officerprovides for promotion to the full rank of surgeonlieutenant after one year’s service, and to surgeonlieutenant-commander after a further seven years’service. Surgeon lieutenant-commanders are promotedto surgeon commander by selection at about their ]5thyear of total service and surgeon commanders are
promoted by selection to surgeon captain about their23rd year of total service. Subsequent promotion tosurgeon rear-admiral is by selection.
Rates of pay are shown in the accompanying table.Medical officers are also eligible for allowances, in additionto the basic rates of pay, on the same scale and underthe same conditions as for other officers of equivalentrank. These include travelling expenses, subsistenceallowance, and passages for wives and families. Officerswho transfer to permanent commissions after a minimumof one year’s service will be paid a permanent commissiongrant of 21500 (taxable).The maximum rates of retired pay are payable to
officers who complete certain specified periods of service.In addition to retired pay, a terminal grant of three timesthe annual amount of retired pay is payable to officerswho have completed not less than 20 years’ service. Thefollowing rates are the maximum rates payable on
Officers allowed to withdraw, who are ineligible forretired pay, will be eligible to receive gratnities as follows :
After 3 years full pay (short) service.... 450 (tax free)After 4 years full pay (short) service.... 600 (tax free)After 10 years’ full-pay (permanent) service ...81000For each complete year in excess of 10 years :8150Maximum total gratuity ...... 2350
Further information may be obtained from theMedical Department, Admiralty, Queen Anne’s Mansions,St. James’s Park, London, S.W.I.
ROYAL NAVAL DENTAL SERVICE
Dental officers are entered for Naval service under similarconditions to those applying to medical officers. Information
concerning conditions of service can be obtained from theMedical Department of the Navy, Queen Anne’s Mansions,St. James’s Park, London, S.W.I.
Royal Army Medical CorpsThere is, at the moment, a limited requirement for
trained specialists, particularly ophthalmologists, oto-laryngologists, and radiologists. In the main, however,the R.A.M.C. seeks applications from young recentlyqualified practitioners.- Vo-.specM Career66% of medical officers will be employed on general-
practitioner duties. After attending the junior officers’course at the Royal Army Medical College, they starttheir career as regimental medical officers where theybecome conversant with the soldier and his environment,the objects of the Army, and the requirements from its
medical service in peace and war. They will, later, serveoverseas where, as a regimental medical officer or incharge of a reception station or small hospital, they willbe able to study the causation, prevention, and treat-ment of tropical diseases, the effects of climate, &c.On their return, they attend the senior officers’ course;the first 21/2 months are spent in study at the RoyalArmy Medical College, Millbank, and the next 3 monthsin a special postgraduate course at a London teachinghospital. At this stage officers may opt to remain atgeneral medical duties or take up field training or juniorstaff appointments. For the more senior ranks therequirements are a sound background of clinical and
preventive medicine to meet their advanced responsi-bilities in the administration of the Army Medical Servicesin peace and war.
specialist CoreerSpecialists are, subject to professional proficiency,
employed on specialist duties up to the rank of colonel.Thereafter they may serve in this rank up to the retiringage of 57 or may be selected for promotion to brigadiereither in a specialist or non-specialist capacity. Theprocess of selection for specialist training is carried outafter the junior officers’ course, those applicants who aremost successful in the course examination being accepted.Those accepted are provided with excellent opportunitiesto obtain higher qualifications and specialist experience.Postgraduate Training
There are liberal arrangements for specialists and non-specialists to undergo postgraduate training throughouttheir career.
- employment after RetirementAll suitable medical officers (specialist or non-specialist)
may be employed up to the age of 65 in appointmentsspecially set aside for retired officers. Non-specialistsare employed on general practitioner or medical adminis-trative duties and specialists on specialist duties.Conditions of Service ,
As conditions of service greatly affect a wife, marriedpractitioners considering an army career are advisedthat their wives should discuss these conditions witharmy wives who have served at home and overseas.The overseas tour is of 3 years’ duration. Families
of officers aged 25 or over can, in the case of most over-seas stations, accompany the officer by sea or air. Localallowances are paid in certain overseas areas where thecost of living is greater than in the United Kingdom.Schools are normally available locally, and in the caseof those with children between 11 and 18 years left inthe United Kingdom a tax-free education allowance ofup to ;S75 per year is paid if they attend boarding-school, or 226 a year if they attend day school and areplaced in the care of a guardian. In addition specialair flights, sometimes free and sometimes at reducedrates, are available to bring school-children to jointheir parents for the holidays. The facilities for sportand leave travel vary but are usually very good.A home to7.cr, spent in U.K. or North-West Europe,
lasts at the moment 4-5 years. As a rule there is no
difficulty in obtaining family accommodation or arrang-ing schools. The education allowance referred to aboveis, however, subject to income-tax in the case of thoseserving in U.K., but not in North-West Europe.
It is the Army policy that all ranks should be givensome months’ warning of an impending move. Thisis done as much as possible but cannot always beachieved-for example, the posting of an officer afterthe senior officers’ course may be influenced by his
performance on the course and cannot be decided before-hand, and emergencies may necessitate a sudden chainof appointments and reliefs.For those over 25 years of age, travel of families from
duty station to duty station is, subject to certain condi-tions, at public expense. If serving on a commission of3 years or over refund of furniture and removal expensesis payable and disturbance allowance of either jE40 or
jE20, depending on the type of accommodation occupied,is issuable to cover incidental expenses for such moves.providing the period of duty at the new station is for atleast 6 months. Furniture of those over 25 years ofage, and serving for 3 years or more, who go overseaswith their families, may, subject to certain conditionsbe stored at public expense. Family accommodation
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provided by the government is at a reasonable rent-furnished accommodation for a major is, for example,£ 100 per year.The comradeship of the Army extends to wives and
children, but the wives of those interested will find outabout this and the advantages and disadvantages ofan army life far better from other army wives.
Conditions of CommissioningThe normal maximum age is 33 but allowance is
made for those who have previously held commissionedrank in H.M. Forces on full pay. An antedate, countingtowards pay and promotion may be allowed for 2 yearsspent in civilian practice or hospitals. An additionalperiod of up to 5 years may be allowed for specialistappointments held. An allowance is also made forprevious commissioned service on full pay. This antedatecounts towards the " reckonable service " mentionedbelow.
Promotion and PayDetails are given in the accompanying table. In
addition the following are payable :On appointment to a permanent commission, a taxable grant of
B1600.An initial outfit allowance (in addition to certain free issues of
clothing) so that officers may provide themselves with the authorisedscale of uniform without expense to themselves.
Junior specialist pay.... ’..&bgr;73 per yearSenior specialist pay .......8219 per yearQualification pay (for Staff Collegegraduates) ........ 63tol27peryear
PROMOTION AND RATES OF PAY OF R.A.M.C. MEDICAL OFFICERS
The marriage allowance for officers aged 25 or over is k55 ayear less when family accommodation is provided or the familyaccompanies the husband at an overseas station..
Retired Pay, &c.For less than 20 years’ qualifying service, there is a
tax-free gratuity rising from .S1000 at 10 years’ serviceto 22800 at 19 years’ service.Pensions are payable as follows on retirement at the
ages and with the reckonable service stated :
êIJajor k625 for 22 years’ reckonable service at 53 years,plus lump-sum grant of ;81875.
Lieut.-colonel 800 for 24 years’ reckonable service at 55 years,plus lump-sum grant of .82400.
Colonel .....81000 for 26 years’ reckonable service at 57years, plus lump-sum grant of ;83000.
Brigadier 91150 for 28 years’ reckonable service at 59 years,plus lump-sum grant of ;83450.
’.lajor-general ...81400 for 30 years’ reckon able service at 60 years,plus lump-sum grant of ;84200.
Lieut.-general ...81600 for 30 years’ reckonable service, on
completion of appointment, ;84800.
Deductions are made in the case of an officer whosereckonable service is less than stated above or whoretired voluntarily 2 or more years before his compulsoryretiring age.
Retired-officer AppointmentsThese may be held from the date of retirement until
the age of 65. The annual salary ranks from £ 880 to.EL107, in addition to pension.Further information may be obtained from the
Assistant Director-General, The War Office (A.M.D.2),London, S.W.I.
ROYAL ARMY DENTAL CORPS
Registered dental surgeons of British nationality or citizensof the Irish Republic who are liable for service under theNational Service Act may apply for short-service commissionsfor not less than 3 years on the active list, with a reserveliability up to 8 years from the date of their appointment. Those(both men and women) who are not liable for service may applyfor short-service commissions for varying periods of between2 and 8 years on the active list. An antedate of senioritycounting towards increments of pay and time promotion maybe granted for postgraduate civil professional experience upto a maximum of 7 years in the case of recognised specialistappointments and a variable period, at the discretion of theDirector Army Dental Service, for other appointments orcivilian practice ; previous commissioned service in theArmed Forces is also taken into consideration. A tax-free
gratuity is payable (200 after 2 years, E375 after 3 years,and ;!Ò125 for each year’s satisfactory completed service over3 years). Officers or dental surgeons (male) may be appointedto permanent commissions direct or at any time during theshort-service or National-Service engagement. Until further
notice, those so appointed will be paid a special grant of;!Ò1250 (taxable) after one year’s satisfactory service as dentalofficers. The period of their short-service commissions willreckon towards ultimate retired pay and service gratuity,but will not entitle them to short-service gratuities. Dental
surgeons who are eligible to apply may obtain full particularsand application forms from the Under-Secretary of State,The War office (A.M.D.6), London, S.W.I.
Royal Air Force Medical BranchThe Royal Air Force offers commissions to fully
registered men and women practitioners who are Britishsubjects or citizens of the Irish Republic and are belowthe age of 33, although candidates above that age willbe considered. Apart from the treatment of R.A.F.personnel and their families, medical practice in theRoyal Air Force brings medical officers into close contactwith flying and the problems of aviation medicine.Suitable male medical officers may be selected for trainingas pilots for duties as flying personnel medical officers.There are openings in all the main clinical specialties,aviation medicine and physiology, hygiene, and indus-trial medicine. Medical officers may serve at R.A.F.units of all types, including hospitals, in Great Britain,Germany, the Middle East, and the Far East.Appointment is usually to short-service commissions
in the first instance, but exceptionally suitable candi-dates may be granted permanent commissions on firstappointment. Candidates may apply for commissionsduring their period of provisional registration, but willnot be appointed until they are fully registered. Medicalofficers serving on short-service or National-Servicecommissions may apply at any time for appointmentto permanent commissions. Short-service officers mayelect to serve initially for 3, 4, or 5 years on the activelist. The period originally chosen may be extended tocomplete any period of years up to a maximum of 8years at the discretion of the Air Council. On completionof their active-list service on a short-service commissionofficers are required to serve for 4 years in the RoyalAir Force Reserve of Officers. Candidates for permanentcommissions must be able to complete at least the 20years’ service necessary to qualify for retired pay.Antedates, which count towards pay, seniority, and timepromotion, will be granted to short-service and permanentofficers for the full period of previous commissionedservice on full pay as medical officer in the Armed Forcesor the Indian Medical Service ; for half the periodof any other previous commissioned service on fullpay in the Armed Forces ; and, under present regula-tions, up to a maximum of 7 years for civil experiencein recognised professional appointments after fullregistration, on the following basis :
(a) General practice.-Up to two years.(b) Hospital experience
(i) First four years (less any period for which antedate isgiven under (a) above).-In full.
(ii) Any later experience other than in a specialist post.half.
(iii) Experience in a recognised specialist post.-In full.Officers will normally be commissioned in the rank
of flying-officer with promotion to flight-lieutenant after
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RATES OF PAY OF NON-SPECIALIST MEDICAL OFFICERS IN THE
ROYAL AIR FORCE MEDICAL BRANCH
(a) The rates shown include the minimum rates of basic pay foreach rank. Increments of pay are given in the ranks of flight-lieutenant to group-captain inclusive, normally at two-year intervals.
(b) The total income is based on the assumption that :, (i) Single officers are not accommodated in a military mess,
nor receiving rations in kind.(ii) Married officers are not accommodated in Government quar-ters or Government hired accommodation, are over 25 yearsof age, and are not receiving rations in kind. (The marriageallowance for short-service and permanent-commission officersunder 25 is 56s. per week.)
(c) If accommodated in a military officers’ mess, single officersreceive accommodation and rations in kind, but their annual totalcash income is reduced by :S289 up to squadron-leader, by 398for air commodore, and by 9453 for air vice-marshal and air marshal.
(d) Specialists in the R.A.F. are granted antedates of senioritywhich count toward promotion and increments of pay.
one year’s reckonable service. Promotion to squadron-leader is after 8 years’ total reckonable service, andpromotion to wing-commander and the ranks above isby selection. Medical officers whose reckonable serviceon entry is one year or more, will be promoted to theappropriate higher rank with retrospective effect tothe date of commissioning, immediately they completethe short introductory course which follows appoint-ment to a commission. Rates of pay for non-specialistmedical officers are shown in the accompanying table.Officers selected for R.A.F. specialist appointments will,under present regulations, be granted an additionalantedate of 2 years in the rank of flight-lieutenant orsquadron-leader, and, if subsequently promoted towing-commander, a further year. A tax-free gratuity,at the rate of £ 200 a year for each year of satisfactoryactive-list service, is payable to short-service officerson transfer to the reserve. Arrangements exist topreserve their rights under the National Health Service(Superannuation) Regulations, 1950. Until further notice,a grant of .81500, subject to income-tax, will be madeafter one year’s satisfactory commissioned service in themedical branch to officers appointed to a permanentcommission. A permanent commission earns retired payand other benefits after completion of service. Permanentofficers may be allowed up to one year’s study leave, on fullpay and allowances, to take approved postgraduatecourses, and there are arrangements for specialist and non-specialist officers to attend periodical refresher courses.They can have a full career as clinical specialists andmay earn accelerated promotion for professional or
scientific distinction. Moreover, medical officers servingin non-specialist appointments but having experienceor aptitude in a clinical specialty may be given theopportunity of employment in the specialty with theobject of qualifying as R.A.F. specialists. Furtherinformation may be obtained from the Under-Secretaryof State, Air Ministry, M.A.1(P), 2-8 Richmond Terrace,Whitehall, S.W.1 (Trafalgar 8811, ext. 6674).
ROYAL AIR FORCE DENTAL BRANCH
Commissions are available in the Royal Air Force DentalBranch to candidates of either sex who possess a degree orlicence in dental surgery of a British university or licensingboard, and who are registered under the Dental Act in forcein the United Kingdom. Dental officers in the Royal AirForce have plenty of scope for all the aspects of dentistryin a branch which trains its own technicians and maintainsits own laboratories under senior dental officers. Dentalofficers serving on short-service or National-Service com-missions may apply at any time for appointment to permanentcommissions. The length of the period on a short-servicecommission and the period required in the reserve on its
completion is the same as for medical officers. Similarly,
dental surgeons may be granted permanent commissionsif they can complete at least 20 years’ service qualifyingfor retired pay. Previous commissioned service counts forantedate of seniority rank on appointment, and terms ofpromotion the same as for medical officers, while antedatesfor civil experience in a recognised professional appointmentare given on the following basis, subject to a maximum ante-date of 7 years for such experience : first 4 years, in full;any later experience, in half. Candidates who hold specialistappointments may be allowed to have their civil experienceassessed on a different basis, but within the same maximumof 7 years. A tax-free gratuity, at the rate of 9170 a year foreach year of satisfactory active-list service, is payable toshort-service officers on transfer to the reserve. Dentalofficers appointed to permanent commissions are encouragedto pursue their studies in postgraduate research and may beallowed up to seven months’ study leave on full pay andallowances to take approved postgraduate courses. Untilfurther notice, a grant of 1:1250, subject to income-tax, willbe made after one year’s satisfactory commissioned servicein the dental branch, to officers appointed to permanentcommissions. Short-service or permanent-commission officerswho have the appropriate higher qualifications and the requisiteexperience may be recommended for specialist appointments,which also attract the additional antedates given to specialistmedical officers. Further information may be had fromthe Under-Secretary of State, Air Ministry, M.A. 6,2-8, Richmond Terrace, Whitehall, S.W.1 (Trafalgar 8811,ext. 6669).
Health Services at Home
PUBLIC HEALTH
Tms year the public-health services are celebratingthe centenary of the foundation of the Society of MedicalOfficers of Health. Today, after over a hundred yearsof evolution, public health ranks next in size andimportance to the general-practitioner and hospitalservices and offers a satisfying career to the young doctorwho is keen to work for the welfare of the communityas well as for the individual.
’
Part ill of the National Health Service Act of 1947enlarged the scope of the personal health services.Under this Act the councils of counties and countyboroughs were designated " local health authorities,"and it was made their duty to provide clinics and otherservices for mothers and children, domiciliary midwifery,health-visiting, home-nursing, immunisation and vaccina-tion, ambulances, and domestic-help services. Mostof these services have grown rapidly, particularly theambulance, home-nursing, and domestic-help services,and their importance to the community is great. TheAct gave these authorities wide powers to start schemesfor the prevention of disease and the care and after-care of sick persons. The responsibility for the administra-tion of all these services falls on the medical officer ofhealth ; in most counties and county boroughs he isalso the principal school medical officer and is thus ableto coordinate the preventive health services to cover
children of all ages. In some areas further coordinationhas been secured by placing the authority’s social welfareservices also under the medical officer of health.
In environmental hygiene the duties of the medicalofficer of health are comparatively unchanged. Theseare the oldest of his responsibilities, but in contrast tothe early days, when the medical officer of health waspersonally concerned with the execution of many sanitaryduties, health departments are now organised to freehim from much of the detailed work, which is performedby trained lay officers, or even transferred to the careof other departments, as in the case of water-supply andsewage disposal. Naturally, the extent of this devolutionof responsibility varies widely, and in rural areas problemsof water-supply and sanitation are still a major con-
cern of the medical officer of health. The supervision ofhousing conditions is also a responsibility of the healthdepartment. All this work remains under the generalcontrol of the medical officer of health, and he mustsupervise the purity of water-supplies even though theirproduction is not his concern. Though less concernedwith detailed work, supervision must be far wider thanthat exercised by his predecessor of a hundred years ago.
