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An upward trend in psychosomatic illness mightbe inferred, Dr. HALLIDAY argues, if morbiditystatistics showed an increase both in the averageduration of incapacity and in the certificatedcauses known to cover psychosomatic illness, andif these increases were most marked in the youngerage-groups. Actually the Scottish data availablesince 1930 show marked increases of this kind

among insured persons certified as incapable ofwork. The number of " chronic " patients-i.e.,those on the sick list continuously throughout astatistical year, has increased by one-third ; andin the year 1935-36, the latest for which statisticshave been published, such " chronic " illnessesaccounted for more than one-half of the nineteenand three-quarter million days of incapacitatingsickness among the Scottish insured population.The chief increase has been in the conditions

covering psychosomatic disorders and in the

younger age-groups. Dr. HALLIDAY thinks the

ordinary methods of medical examination shouldbe modified to provide for the detection and treat-ment of underlying psychosomatic factors ; other-wise the extended provision of facilities for themechanistic treatment of symptoms may, byinducing fixation, increase the duration of in-validism. He quotes with approval Dr. MCKINLAY.’Sremark: " The efficiency of a service must

ultimately be judged by the standard of health ofthe people rather than by the nature and amountof the facilities available for its preservation."

Dr. WALKER, on the other hand, thinks Dr.HALLIDAY attributes greater relative importanceto psychosomatic factors in the rise in incapaci-tating sickness than can be justified by thestatistical evidence ; for there has been, he insists,2a definite rise in certificated causes of incapacitywhich are certainly of organic origin—e.g., tuber-culosis and injuries. To diminish incapacitatingsickness he would provide fuller facilities for earlydiagnosis, so that trivial conditions may be dis-tinguished from conditions which, though not

trivial, present initially trivial symptoms. Thereis need also for routine and periodical medicalexamination for adults as well as for children.He is convinced, however, that the psychic elementin disease is of great importance, and he concludesthat " the large volume of incapacitating illnessdue to or associated with states of anxiety can beprevented, not so much by psycho-analytic or

other psychotherapeutic methods of treatment,but by Christian sympathy and understanding anda re-awakening in the patient and his attendants ofthe spirit and faith of the Great Healer." In thisconclusion Dr. WALKER is in general agreementwith Dr. C. G. JuN&, who has stated 3 that amonghis patients over the age of 35 there was not onewhose problem in the last resort was not that offinding a religious outlook on life, and who con-cluded a congress of psychotherapy at Oxford inthe recent summer with the words : "It is aninsanity of the white man that he has lost thereligious order of life."

2 J. R. sanit. Inst. August, 1938.3 Modern Man in Search of a Soul, London, 1933.

4 See Lancet, August 6th, pp. 325, 336.

DENTAL AUTONOMY

SiR FRANCIS AcLAND thinks the time may havecome for the dental profession to be master in itsown house. He was opening the 35th session ofthe Dental Board of the United Kingdom, andwas recalling the steps which led up to the establish-ment of a separate dental council. The story beginswith the departmental committee which twentyyears ago inquired into the extent and gravity ofthe evils of dental practice by persons not properlyqualified. This committee, over which AcLANDhimself presided, came to the conclusion that thecontrol of the dental profession and the custodyof a register should be entrusted to a statutoryboard under the General Medical Council. SirDONALD MAcALiSTER had reminded the committeethat in 1878, when the first Act regulating dentalpractice was passed, dentistry was put under themedical council because there was no dental

profession ; this outside control was to him a stepin the evolution which he regarded as ultimatelyinevitable, namely, the establishment of a separatedental council. Sir FRANCIS ACLAND himself speaksof the Dental Board as it now exists as the kindof halfway house in which British people are

generally comfortable for some time.The action of the Dental Board is at present

limited in three directions. The board cannot directthe erasure of the name of a registered dentalpractitioner for professional misconduct or in

consequence of conviction in a court of law : itcan only report its findings to the General MedicalCouncil and leave them to act. Further, althoughrecruits to the profession are now almost withoutexception graduates or licentiates in’dental surgeryor dentistry, the G.M.C. still retain the power of

dealing with applications for registration as colonialor foreign dentists by persons holding qualificationsgranted elsewhere, and also the power to recogniseadditional qualifications granted after examination.The compilation of the register is in fact still underdivided control, and in the sphere of dental educa-tion there is also some division of function betweenthe two bodies. The G.M.C. retain the power to

question licensing bodies about courses of study andmethods of examining, to arrange for visitation ofexaminations, and to prohibit any attempt to imposerestrictions as to theories of dentistry on candidatesoffering themselves for examination. It is thereforethe General Medical Council and not the DentalBoard which influences the progress of dentaleducation by making recommendations with whichlicensing bodies find it necessary to comply-although the board spends much time and moneyon the award of bursaries, on raising the standardof teaching in dental schools, and on improvingtheir premises and equipment.Whether the time has now come for some

redistribution of functions between the medical anddental councils, Sir FRANCIS AcLAND did not regardit as for him to say ; he simply stated the problemfor the consideration of both bodies. But to state the

problem is enough. No one doubts the competenceof the Dental Board to manage its own affairs.