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THE COST OF STATE MEDICAL SERVICE
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! E are, it seems, now committed to a Ministry of Ilealth, with all the paraphernalia of commandeered hotels and highly paid officials, clerks, male, female, and flappers, appertaining. With it must come also the reform of the Panel system, which has certainly given no satisfaction to the patient; nor, as it would now seem, to the doctor. The probable result is that, perhaps not immediately, but sooner or later, medical and surgical treatment will be provided for everyone
AUTOMATICALLY CONTROLLED, AND USED BY THE R.A.F.: THE L.B. TYPE AERO-CAMERA.
by the State; and the doctor, instead of being, as hitherto, the friend of the family, will be trans- formed into a State official. This will, doubtless, be good fun for the doctor, who will henceforth be assured of a living wage for the rest of his life, after passing a few not very arduous examinations in his youth. He will thus be set free to devote himself to research, or to such other branch of the ars medica as may appeal to him, without the carking care perpetually before his eyes of having to earn his daily bread some- how, even if it be only by humouring the imaginary complaints of his richer patients. In this way, science may possibly benefit–although this is not quite certain; some of the best work in it having been done under the compulsion of hunger. But who is going to pay for it all ? The answer to this, as to all similar questions under our present system of government, is doubtless ” the State,” by which is always meant the taxable part of the community. The next question is, how much is it going to cost us ? An article by the Medical Officer of the City of London and the Secretary of the London Panel Committee in a recent number of the British Medical Journal gives us some inkling into this. It is true that the authors carefully guard them- selves in a supplementary note against the sup- position that it, or its figures, are in any way official; but as they have both of them been in- timately concerned with the working of the Panel system in the very heart of the Empire, it may be presumed that their views are fairly representative of those of the majority of their colleagues who have come into the Panel system. As no Govern- ment scheme could hope to work without the cordial co-operation of these last, it may further be guessed that if and when the official scheme is produced, it will bear a strong family likeness to that foreshadowed in the columns of our con- temporary.
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Now the article in question contemplates the establishment of what it calls clinics in every part of England and Wales. Why Scotland and Ireland are left out of the account, is not said; but possibly this is out of respect for the possibility of some further experiment in Home Rule or I)evolution.
In this larger portion of the United Kingdom, however, no town or village or rural district is considered to be too thinly populated to have dumped in its midst a clinic, which seems to be what our forefathers would have called a dispensary. To this clinic, a certain number, if not all, of the doctors in the neighbourhood – including, apparently, dentists-will be affiliated, and here they will be compelled to give attend- ance daily. The equipment of the clinic will, of course, be dependent on the thickness of the population in its neighbourhood; and while the larger clinics will be equipped with X-ray ap- paratus, operating-rooms, and all the scientific luxuries of a field hospital, the smaller ones will, apparently, not rise beyond the ordinary ” surgery,” or doctor’s shop of the General Practi- ticner. But
Dr.Howarth and Dr. Richmond contemplate
also a whole hierarchy of graduated clinics rising one above the other according to a regular system, so that the village clinic would have above it the dis- trict clinic, and the dis- trict clinic the County Hospital. until an even more august institu- tion was reached, to which the patient might in turn be transferred. They go so far in the other direction as to suggest ” travelling clinics ” for sparsely populated rural districts, which might or might not be motor-vans fitted up like some of the machines which we have lately seen at the Front. In the books of the clinic, however, every member of the community, great or small, will be regis- tered; and he or she will have the right of treatment there unless he prefers to go to a doctor outside, and to pay him in the usual way. What contribu- tion he is to make in return is not very dis- tinctly stated; but as the authors base their calculations on a figure of 13s. a head
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for the whole population, it is evident that this amount will have to be provided either by the patients or by the State. As, under the present Insurance Acts, the maximum payment by the insured amounts to 5d. per week, it is evident that this last would have to be exacted from the whole population or found by the State from other sources. Now, this figure works out, according to Dr. Howarth and Dr. Richmond, at £23,725,500oo per year, and it really matters very little to anyone whether we shall have to pay it in the shape of weekly contributions in the shape of stamps, or by additions to the income-tax, which is beginning to extend its grip over the poorer as well as the richer classes of the people. But will it remain at that figure ? No one who has had any experience of State management during the war can think so for a moment; and the authors’ own figures them- selves contradict the supposition. They show that in London and the provinces some 28,000 hospital beds are maintained at a cost of £2,855,230, or say £xoo apiece, and that, lumping in institutions like those for tuberculosis and other complaints requiring special treatment, they make up at present 3o9,ooo beds in all. These alone would therefore cost more than £3o,ooo,ooo, and, with the wastefulness attach- ing to all State management, and the great exten- sion of the system foreshadowed, this amount would probably be doubled. Would the balance be raised by loan ? We like not the security.-S. L.
PHOTOGRAPHY WHILE IN FLIGHT: THE AUTOMATICALLY CONTROLLED L.B. TYPE AERO-CAMERA IN USE. The L.B. Type Amo-Camera, invented by Mr. Colin M. Williamano, who is well known inthe cinemato- graph industry, was used by the Royal Air Force dmlng the war, to obtain records of the more- ments and tactic of the enemy. It is automatically contrlled, both for exposure and plate-chmane. The power necessary for carryin out the.s operations is supplied by the small propeller attached to the camera: the actlon of the propeller turnino under the influence of the wind velocity cause the plates to change mechaulcally within teo seconds after each exposure has been made. Mr. Williamson is alo the designer of the automatic film aero-camera, which is capable of making as many as 250 exposurs with one loading.