1128

little diphtheria or whooping-cough. Tuberculosis was

moderately prevalent, and receives considerable attention.The malaria situation has been much improved sinceB.D.T. came into general use: the morbidity-rate in1936-46 varied from 266 to 574 per 1000 population ;in 1947-50 it fell from 196 to 81. The vector ofmalaria, Anopheles culicifacies, has been virtuallyeradicated from the wet zone and the intermediate zoneof the island as a result of the D.D.T. campaign. Thefact that it has been found in the jungle, away fromhuman habitation, probably means that it cannot be

completely eradicated, and this may affect the malariasituation in the future.

It is quite evident that the medical authorities of

Ceylon are making a great and successful effort to copewith their many health problems. They have a long waystill to go, but on traditional lines they will undoubtedlybe successful. The people will be healthier, and they willcontinue rapidly to increase in numbers. The imminent

problem of population pressure is only briefly mentionedin this report. A medical report alone cannot give acomplete picture of public-health activity ; it is necessaryto know also the agricultural potential- of the countryand the developments proposed to exploit it, and othermatters of economics and of education, because in thesedays of phenomenal medical progress the health andwell-being of peoples depend as much on farmers andland as on doctors. It will soon be essential toincrease food production and to limit the increase ofpopulation.Health never has been, and certainly is not now, a

purely medical problem ; but it is for the doctors toinsist on the need for political and administrative action.In Ceylon, as elsewhere, the most difficult of human

problems is still unsolved.

THE DENTISTS BILL

THE most important section of the new Dentists Bill 1is that which proposes a three-year experiment in theuse of ancillary dental workers in the National HealthService and the local-government dental services. Theseancillaries would be trained, and then permitted to filland extract teeth, under the supervision of qualifieddentists. Presumably it is hoped that if the experimentsucceeds the number of suitable recruits who comeforward for training will go along way to solve the

man-power problem in dentistry,This problem is not new and before the end of the

war an interdepartmental committee, with Lord Teviotas chairman, was already considering ways’in which itmight be solved 2 ; but at that time only one memberof the committee, the late Major-General Helliwell;advocated the training and employment of dentalancillaries. The introduction of the N.H.S. has madeeven more acute the shortage of dentists in relation tothe demands on their services, and has contributed to thecollapse’ of the school dental service. By contrast, thecontinuous development and progress, over the last thirtyyears, of the school dental service in New Zealand, whereschool-children’s teeth are cared for by dental nurseswith two years’ special training in children’s dentistry,has suggested to many that this is the best way of staffinga children’s service. The new Bill is in fact the conse-

quence of the favourable report of an official mission ofeminent dpntal surgeons from this country who went toNew Zealand to see the scheme in operation there.3Since then the New Zealand service has been examinedat greater length by an American investigator, whopublished an equally favourable report under the

1. See Lancet, Dec. 8, 1951, p. 1092.2. Report of Interdepartmental Committee on Dentistry. London,

1946. See Lancet, 1946, i, 240.3. New Zealand School Dental Nurses : Report of United Kingdom

Dental Mission. London, 1950. See Lancet, 1950, ii, 491;1951, i, 155.

auspices of the World Health Organisation thissummer.4 .

The fact that the new Bill was prepared under aLabour Government and is being presented, apparentlyunaltered, by its Conservative successor suggests thatlay public opinion, in so far as it has considered the

problem, is fairly unanimous in believing that the use ofancillaries offers the only reasonable hope of resuscitatingthe school dental service. But, despite the favourableNew Zealand reports, the dental profession in this countryhas not yet been entirely won over to the idea of the useof ancillaries, even in the relatively specialised field ofchildren’s dentistry. Opponents of the Bill will say thatits proposals undermine the " status " of the profession,by attacking its main bulwark, the Dentists Act of 1921,which restricts the practice of dentistry to registereddentists who have followed a prescribed course of

training. To permit partly trained personnel to practise,it will be argued, must lead to

" dilution " of the pro-fession, a lowering of standards of service, and a declinein the standing of the dental surgeon. Our own answerto this would be that by ensuring that the work of theancillaries is as closely supervised by dentists as that ofclinical students in the dental schools, sufficient pro-tection would be given to the public. Nor.should the

standing of the profession be compromised as long as therecognition given to the ancillaries is quite obviously notthat of a member of the dental profession. Publicopinion in New Zealand does not seem to respect thedental profession any less now that the children of thatcountry get dental treatment mainly from school dentalnurses ; nor does the profession feel that its standingor its interests require the abolition of the scheme. Onthe contrary, most dentists in New Zealand support thescheme, though they may criticise details of its working.They find that the generation who have had continuousdental treatment from the school dental nurses are muchbetter dental patients in later life.Tha Bill also proposes to abolish the Dental Board and

to transfer its powers, and those exercised over thedental profession by the General Medical Council, to anew General Dental Council. Though this proposal ofautonomy will appear attractive to many dentists, wequestion whether it is in the true interest of the professionthat it should be further detached from the general bodyof medicine. Progress would rather seem to lie in thedirection of closer integration of dentistry within medicine,with the establishment of a common basic medical

diplolna for all medical practitioners, dental surgeonsincluded. In this system, dentistry would be a specialistaspect of surgery rather than a separate art practisedby an autonomous body of practitioners. The DentistsBill is surely, in this respect, a step in the wrong direction.

THE ADJUDICATOR APPOINTEDTHE former Minister of Health and Secretary of State

for Scotland suggested that the proposed arbitrationupon the proper size of the central pool from which thegeneral practitioners are paid, should be left to a singleadjudicator, rather than to a court of arbitration. °

The General Medical Services Committee agreed to thiscourse, and after discussion were assured that a judgeof the High Court of Justice might be made the

adjudicator, if the Lord Chancellor could make theservices of one of the judges available. In a writtenanswer 6 the present Minister of Health has announcedthat he and the Secretary of State for Scotland have,with the concurrence of the Genera,l Medical ServicesCommittee, appointed as adjudicator Mr. JusticeDanckwerts, a judge of the High Court of Justice

(chancery division).4. Fulton, J. T. Experiment in Dental Care: Results of New

Zealand’s use of School Dental Nurses. World Health Organisa-tion. See Lancet, Sept. 15, 1951, p. 485.

5. Lancet, Aug. 11, 1951, p. 256.6. See p. 1139.