ANNOTATIONS

ANNOTATIONS

zravTa peL

The medical student who is said to have translated our heading
into " everyone has a discharge " would hardly have been "sent up
for good " in any well regulated school, for the true meaning is that
everything is in a state of flux. It offers us a suitable heading -for
some reflections on the. future of the profession. Far reaching
changes are being ventilated in the press and it seems to be certain
that after the war things cannot go on as they have in the past.
Some are wholeheartedly in favour of a state controlled medical
profession, both practitioners and hospitals, while others view the
prospect of state control with dismay.

There are at least two sides to the question; first, the general
public and secondly the profession; while the latter can be sub-
divided into consultants, public health officers and general practi-
tioners. From the public view-point we think that the medical
services-hitherto provided have on the whole worked well, and from
the practitioner's point of view, fairly well. It has often been said
that no medical practitioner need starve, but most of those consul-
tants who have started their careers without private means have
had a very uphill struggle in the beginning. And few medical men
manage to save enough to leave a fortune to their descendants. In
favour of state control. at first sight there would seem to be much
to be said from the view-point of the general practitioner: regular
working- hours, a regular holiday, a guaranteed-income and a pension
on retirement. The scheme for pooling the medical resources of
any district, so that no one is out of bed at confinements every night
in the week, sounds well, but it rather overlooks the wishes of the
-patient, who may have asked Dr. X to attend her, and may not
wish at-the last moment to be put off with the services of Dr. Y.
One of the bugbears of state control is the inevitable beaurocracy
and the red tape which it entails.
The ophthalmologist is in rather a special position. Most of his

work comes to his consulting room. As a rule he does not deal in
parts of the body outside his own sphere; should he find evidence
of general disease he usually communicates with the patients'
medical attendant or suggests a physician or specialist as the case
may be. So far we have been thinking of the more opulent types
of patient. Those less well-off have also to be considered. Hitherto
vast numbers of the poorer elements of the population have obtained
their glasses through the sight-testing opticians. When it is a
simple case of refraction or of presbyopia there is no reason to doubt
that a large proportion of these are provided with suitable lenses.

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ANNOTATIONS5

As ophthalmologists it is our obvious duty to press for a proper
ophthalmic service for all classes of the community by qualified
medical practitioners with ophthalmic training who should receive
an adequate fee for their work. ,A revision and extension of the
National Ophthalmic Treatment Board would seem to be the ideal
solution of our part of the problem.
We view with alarm the prospect of state control of the voluntary

hospitals and we think that free choice of doctor must be accorded
to the patient for the success of any scheme of re-organization of
the health services. And, lastly, a similar freedom should be meted
out to the medical practitioner. May we not agree with that great
Scottish physician who, in one of his prefaces, said'he thought, with
Adam Smith, that a'mediciner should be as free to exercise his
gifts as an architect-or a mole catcher ?

A Singular Error

Madame de Stael's well known epithet vulgaire, applied to the
writings of Jane Austen, was a blow which staggered lovers of
the Hampshiie novelist's books until some one suggestedihat the
adjective in this case meant "commonplace" rather than "low."
Thence onwvards everything was comfortable. Our own comfort is
often disturbed round about the beginning of each month by the
fear that we have missed some dreadful howler in reading the
proofs: Could a graph of our feelings be constructed it would show
a regular rise and fall each month over a good many years with
occasional excrescences above the common level where we have
blundered more than usual. We regret to have to -record that this
happened in our October number, where, on page 436, occur the
words "There is little or no data." We understand that this slip-
shod construction is increasingly common in physical literature.
That such a monstrous error should be prevalent is indeed a flaw in
a centuries-long system of classical education.' There is, however, no
reason to despair, all will be well when the new Education Act is'
passed'and we may look forward with confidence to the time when,
in the words' of our erudite Minister of Education, the boy well
grounded in Latin-will "take" (not only) "the internal combustion
engine (but also the whole range of phYsics) " in his stride."

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