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THE DISASTER.I

I -OUR MEDICAL SERVICES.

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I OUR MEDICAL SERVICES. Sir Alfred -Nioiwi, at the dinner he gave to the Oddfellows la.st week at Swansea, made a powerful plea for the co-ordination of our medical services in so far as they affected mothers and children. As an illustration of the weakness inherent in the present fiys-j terns for thero is no systemâhe j pointed out how the child at school, tinder the care of the Board of Educa- tion oiffr?or, passed out of his jurisdic- tion when it became a question of home conditions; then it came into the pro- vince of tho municipal medical officer. The "borough member might have in- stanced o-th?r Absurdities of the clean- cuL divi?icnK of medical responsibilities tov,Ja.y. The need for co-ordination, is patent to those who study with sym- pathy tueh problems as these. In view ( of Sir Alfred Mond'-s speech, therefore, it is interesting to note that Dr. W. A. Brend, B.Sc., Iccturer on Forensic Medicine at CI taring Croas Hospital, calls for drastic alterations, in prin- ciple and administration, of our medical service, in tho course of an rtic1o he contributes to the June is?uc of The Nineteenth Century and After." Dr. Brend desire, as a first tRp towards an adequate system, the establishment under the State of a salarieci imedital service, including both consultant and geupral practitioners, which would ex- whirh woiij< i ex- tend to women and children, and would require to be co-ordina.ted with, if it did not actually absorb, tho present (Poor Law medical outdoor relief, and perhaps also the existing arrangements for the treatment of school children. At Manchester this week, a great conference of trade union approved society delegates called for the institu- tion of a State Medical Service. Noth- ing is more certain than that such a service is coming; whether we are quite prepared for it, whether we are ready to accept medical attention providod alto- gether by the State, is another matter. But, in view of tho decision at Man- chester, our readers may note the scileme outlined by Dr. Brend --not tho first-, but possess- ing novel and distinct features. He suggests the provision of a equipped oent rally-placed clinic for every town of 20,000 inhabitants, the number to bo increased in proportion to the population. Under such a scheme, therefore, Swansea wonid tavo six clinics. Each clinic will have a staff of from five to eight general praccv tioners, ono or two nurses, and such whole or part-time surgeons, oculists, and other specialists as were required. There should be a chief medical officer to each clinic, principal medical officers, and a central administrative staff in all large towns and counties. The sug- gestion of the writer is that after a given dateâand at least a year's fiotioo would bo necessaryâthe panels through- out the ooun try, should be de- clared closed. Every doctor should be allowed to detain all the persons ho already lias, and at the present capitation fees. But after the closure, instead of permitting any doctor to add his name to the panel list his service should only be recruited as occasion demanded, and by the ap- pointment of whole-time salaried medi- cal officers. At the same time tho clinic system would be gradually de- veloped, the use of the clinic being available for panel doctors as -well as for the salaried officers, and a begin-! ning would be made as far as circum- stances permitted of parcelling out the area into districts.

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