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officer of health of a small borough may have clinicalwork to do as well. The more junior posts includesome with partly or entirely administrative responsi-bility, but most of them are clinical. There are oppor-tunities for promotion in some specialist clinical fieldssuch as tuberculosis and venereal diseases ; but in thematernity and child welfare and school medical branchespromotion usually means at least partial diversion toadministrative work. The changes which may followthe. introduction of a comprehensive national healthservice cannot be forecast with certainty, but it seemslikely that they will tend to bring the clinic services atpresent provided by local authorities into much closerassociation with general practice and the hospitalservices. The maternity service would naturally beassociated with the obstetric service -of hospitals, andschool medical and infant welfare work with paediatrics.In this way those engaged in the clinic work would notbe restricted as they may be now to the examinationof children, mostly healthy, or to the antenatal andpostnatal supervision of women whose confinements areattended by others. The tuberculosis and venerealdiseases services must be closely interlocked with the’preventive services, as must the other clinic services,but in future they are likely to form a part of the nationalhospital service rather than to be run as a separateorganisation. Thus it seems likely that there will soonbe better opportunities in clinical preventive work, andthose undertaking it will not have to turn to adminis-tration in -order to secure advancement. The whole-time public health medical officer will be an adminis-trator familiar with clinical preventive work, and ableto organise field investigations-for instance, on nutri-tion. There will also probably be many more openingsfor medical administrators in the hospital services.

The mode of entry to the service will probably be notas in the past through the clinical side, but throughassistant administrative posts concerned with controlof infectious diseases and organisation of clinic services.Thus there will be far less likelihood of medical officerswho have taken postgraduate qualifications in publichealth devoting the rest of their professional lives toclinical work in a limited field. The very fact thatthose who undertake clinical preventive work will alsobe engaged in curative work will bring the adminis-trative medical officer responsible for the organisationof clinic services into far closer contact with his pro-fessional colleagues.

The possession of a diploma in public health or - itsequivalent is necessary for anyone now appointed asMOH ; this diploma is not necessary for those engagedin clinic work, though many possess it. In future,officers appointed to junior whole-time public healthposts will need this background of training for the pre-ventive and administrative work in which they will beengaged. The curriculum for the diploma is now underreview, and it is probable that the revised course willprovide a basic training in preventive work suitable forall, with opportunity for the later study of specialbranches.

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LONDON COUNTY COUNCIL HOSPITALSTHE hospitals service of the London County Council

provides special facilities for undergraduate instruction,and opportunities for experience for medical graduateswho intend either to be general practitioners or consul-tants, or to enter the LCC Public Health and HospitalService. At the beginning of the war, the service con-tained 97 hospitals with beds for 71,694 patients. The97 hospitals consist of 44 general hospitals, 32 specialhospitals and 21 mental hospitals and institutions forthe mentally defective ; 32 of the hospitals were includedin the Emergency Hospital Scheme.

Treatment is provided in these hospitals for all kindsof acute and’chronic illnesses, including fevers, tuber-culosis, mental and nervous disorders.

’ HOSPITALS BRANCH

Medical superintendents of the hospitals, who areexpected to be experienced hospital administrators,receive 28 50 to JS1650 a year, in hospitals with accommo-dation for from 160 to 1300 patients. In addition,medical superintendents are provided with an unfurnishedhouse or quarters with payment by the Council of localand water rates.

The other full-time medical staff are’ classified as:Grade ..4nn"<<LZ salary (basic)

Deputy medical superintendent, class I 650&mdash;50&mdash;800Deputy medical superintendent, class II 600&mdash;B30&mdash;B750Deputy medical superintendent, class III 550&mdash;25&mdash;650Deputy medical superintendent, class IV 500&mdash;B25&mdash;600Senior resident surgeon, physician, or ob-

stetrician, and senior assistant medicalofficer &pound;500&mdash;&pound;25&mdash;&pound;600

Assistant medical officer, class I .. &pound;350&mdash;&pound;25&mdash;&pound;425Assistant medical officer, class II .. i2250Senior house officers ;P,200House-physicians and house-surgeons .. B120

These officers are provided with board, lodging, andwashing. Clinical assistants, who are non-resident,receive 2150 a year with meals when on duty. Vacanciesin the higher grades are filled as far as possible by pro-motion from the existing staff. In addition, a largenumber of part-time consultants and specialists are

employed in the various hospitals, as well as some whole-time non-resident specialists at a salary of 21250-250-21500. In addition to the basic salary ’ratesquoted above, medical staff receiving salaries notexceeding :E1500 a year (including emoluments), incommon with other professional grades of staff, draw acost-of-living allowance.A central histological laboratory and an antitoxin

establishment, as well as seven group laboratories ofthe pathological service, serve a number of hospitals.Attached to the group laboratories are subsidiarylaboratories situated in the various hospitals. Normally- a medical staff of 27 is attached to these laboratories,’but some of them are at present working at otherlaboratories under the EMS.

TEACHING FACILITIES

Since the war began, courses in fever hospital adminis-tration for the diploma in public health have beensuspended ; other postgraduate facilities have remainedas they were. The British Postgraduate Medical Schoolis at the Council’s Hammersmith Hospital.

Patients under treatment in the Council’s hospitalshave not been much reduced in number, and increaseduse is being made of them for teaching purposes.Arrangements have been made whereby maternitystudents have had training and experience in thematernity departments of the Council’s general hospitals.The fever hospitals also provide for undergraduateinstruction, and, when patients are available, for demon-strations in the diagnosis and treatment, of smallpox forboth undergraduate and postgraduate students. Studentsare resident during their course of instruction in some ofthe fever hospitals. ,

Most of the general hospitals are recognised trainingcentres for candidates for the University of London MDexamination ; 18 of them for the diploma and member-ship of the Royal College of Obstetricians and Gyneeco-logists and for the nnal’ FRCS examination and thediploma in anaesthetics. Service at Queen Mary’sHospital for Children, Carshalton, and at St. JamesHospital is recognised by the Royal Colleges of Physiciansand Surgeons as a part qualification for the diploma inchild health.

THE MENTAL HOSPITALS SERVICETHE public mental hospitals in England and Wales

are the responsibility of the local authorities. Apartfrom those hospitals administered by the London CountyCouncil, there are 65 hospitals under the control ofcounty councils, and 26 hospitals under the control ofcounty borough councils. The hospitals vary in sizefrom the small borough mental hospitals with about400 beds to the large county mental hospitals with over2000 beds.

Assistant medical officers are paid in accordance withthe scale laid down by the Askwith agreement : ;B850rising by annual increments of 225 to ;f;450 per annum,with emoluments which must include board, lodging,laundry, and attendance. In addition, those medicalofficers who possess a diploma in psychological medicinereceive a further &pound;50 per annum. Suitable provision ismade for the accommodation of married assistantmedical officers. In the higher posts of deputy medicalsuperintendent and medical superintendent no uniformscale of salaries is laid down, and these vary betweenthe different hospitals. In addition to salary, emolumentsare provided which usually consist of a house, furnished

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or unfurnished, fuel and light. Permanent medicalappointments are in all cases established posts withinthe meaning of the Asylums Officers’ SuperannuationAct, 1909.Posts at these hospitals offer medical officers scope

for initiative and promotion. Very few new appoint-ments have been made during the war, and medicalstaffs have been much curtailed. There should be goodopenings in these immediate post-war years.The mental health services of the LCC are responsible

for a large medical service, vacancies in which arenQrmally advertised at short intervals. No new per-manent appointments are being made at present ;indeed the staffs of the various hospitals have beenreduced as a war measure. An applicant enters theservice as assistant medical officer at a salary of &pound;470 ayear, rising by annual increments of j625 to fit570.Salaries are graded through the various ranks to fi1450paid to superintendents of large hospitals ; a super-intendent is also provided with an unfurnished house onthe hospital premises. Assistant medical officers may berequired to live in the institution which they are servingand to pay fixed rates for board, lodging, and washing.Officers contribute to a superannuation fund. They arerequired to take a diploma in psychological medicinewithin three years of entering the service and the diplomacarries with it a payment, in addition to salary, of 250a year. Promotion is reasonably rapid for men. Themental health services are actively concerned in theEMS. Three hospitals are used entirely as emergencyhospitals and at three others there is an emergencyhospital section. Treatment is provided for all types ofacute, medical, and surgical cases, and the hospitals arestaffed and equipped to give specialised treatment. Themedical staff for these hospitals is drawn mainly fromthe emergency medical service. -

MINES MEDICAL SERVICE, THE Mines Medical Service now consists of eightregional mines medical officers, with a chief minesmedical officer and a deputy at headquarters.The white-paper on coal proposed the establishment

of this service " with a view particularly to checkingwastage of labour." Thus much of the work of themedical staff is concerned with applications -for releasefrpm the industry on medical grounds. Before themedical service was founded all such applicants weresent by the Ministry of Labour for independent medicalexamination. The functions of the service have beentwofold: to relieve the workman of such examination,if the medical evidence put forward by him was suffici-ently conclusive ; and in doubtful cases where inde-pendent medical examination is necessary, to secure ahigh standard of examination. These services havebeen of value both to the workmen individually and inhelping to check unwarranted wastage of labour. Butit has always been realised that these activities, essentialas they are at present, are not constructive, except inthat they lead to better medical or surgical treatmentof the patients concerned. From the start the medicalofficers have been enjoined to devote all the timepossible to professional activities at the mines and inconnexion with the hospitals, rehabilitation centres, andother institutions to which the miners go for treatment.Professional work at the mines themselves is increasingin volume. Medical officers have charge of the first-aidand ambulance arrangements both below and aboveground ; they study the working conditions in relationto the miners’ health, and are getting a wide first-handexperience of the coal-mining community at work.Special attention is being given, and will be givenincreasingly, to a practical study of the causes of theso-called industrial diseases, and to measures for pre-venting or alleviating them. The field to be covered iswide, and previous work and experience have alreadyshown that there are no easy roads to speedy improve-ment ; but it is hoped to improve conditions graduallyby concentrating on particular difficulties and problems.Several studies of this kind are already in hand. Theuse of morphine for the first-aid treatment of cases ofpainful injury underground has proved beneficial. Alarge number of cases have been treated with goodresults, the drug easing the patient and lessening the shock.The conditions governing the use of the drug at mines

are strictly enforced. Various industrial hazards, suchas dermatitis, epidermophytosis, Weil’s disease, andoccupational diseases such as the " beats " and pneumo-coniosis, are continuously studied. The medical serviceis looking forward to the time when the whole of itsenergies can be concentrated on constructive work of thiskind, and in the meantime will devote to it all the timethat can be spared from dealing with the temporaryproblems and difficulties arising out of the war.

PRISONSAT the larger prisons whole-time officers are appointed,

sometimes with deputy medical officers to assist them.Unfurnished quarters are provided or an allowance madein aid of rent. Posts are pensionable and promotionsare made as vacancies occur. Candidates with a

diploma in psychological medicine receive &pound;50 perannum more on appointment than candidates withoutthis qualification, and are given preference providedthey also have good all-round general experience. Atthe smaller prisons no whole-time officers are employed ;local practitioners are usually appointed as part-timeofficers. Further particulars can be obtained from thePrison Commissioners, Kensington Mansions, TrebovirRoad, London, SW5.

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Services Abroad

INDIAN MEDICAL SERVICERECRUITMENT to the Indian Medical Service, which is

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designed primarily to meet the needs of the Indian Army,was modified by the war, and officers have been appointedto emergency commissions in the military branch for theduration of the war, in the East. The method of recruit-ment of men medical officers, other than those of Indianor Dominions origin, has been altered and those wishingto be appointed are required to join the Royal ArmyMedical Corps first. After a course of instruction theycan apply to be posted to the Indian establishment, andare then given an opportunity to transfer to the IndianMedical Service. Officers selected for transfer will begiven preference when applying for permanent commis-sions in the Indian Medical Service, if these are grantedagain now the war is over. The upper age-limit forEuropean emergency commissioned officers on appoint-ment is at present 45.

Officers on appointment to the IMS are eligible for thegrant of antedates, which are reckoned in assessingservice for seniority and promotion, in respect of speci-fied higher medical qualifications (six months or a year)or approved whole-time hospital appointments (maxi-mum a year). The antedating in these cases is limitedto a total period of 1 t years. Antedating equivalent tohalf the period spent in practice, less the period grantedin respect of hospital appointments, is also allowed up toa maximum of 5 years. All previous full-pay commis-sioned service with the Armed Forces as a medical officeralso counts towards rank and seniority on transfer.

Qualified officers selected for specialist posts are

granted appropriate temporary rank with the pay andallowances of the appointment. Passages to India arenot granted to wives and families ; but if, at the end of ,his service, an emergency commissioned officer elects toreside in India, he can be allowed the cost of transport ofhimself and his family to the place where he wishes to live.The pay of a European lieutenant in India is &pound;585

yearly, and of a captain on promotion &pound;750; on hisrelease an emergency commissioned officer receives aminimum gratuity of Rs. 2000 if his date of registrationas a doctor was before Jan. 1, 1940, or Rs. 1000 ifregistered on or after that date, provided he completes ayear of service ; he gets an addition of a month’s pay foreach further year of Army service. If invalided out fora disability due to service he receives disability retired-pay appropriate to his rank and degree of disablement,which for Europeans is as for officers of the RAMC. Ifhe dies as a result of military service during the war,provision is made for his widow and children.Women medical officers are appointed direct for service

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with the Indian Medical Service by the Secretary ofState for India under conditions similar to the above,and a number have already been appointed from theUnited Kingdom. Full information regarding theseappointments and those available for Indian medical