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THE L.C.C. HOSPITAL SERVICE

THE hospital service of the London County Councilprovides opportunities for valuable experience formedical graduates who intend to be general practi-tioners or consultants, as well as for those who intendto make the public health service their career. Underthe operation of the Local Government Act, 1929,the L.C.C. is responsible for the management of75 hospitals (excluding mental hospitals)-namely,28 general hospitals, including one for children,10 hospitals and institutions for the chronic sick,2 convalescent hospitals for general cases, 2 hospitalsfor sane epileptics, 16 fever and other infectionshospitals, 10 tuberculosis hospitals, including four forchildren, 5 special hospitals and convalescent homesfor children, and 2 venereal disease hospitals.Medical superintendents of the hospitals, who are

expected to be experienced hospital administrators,receive £900 to £1650 a year, corresponding to hos-pitals varying in accommodation from 160 to 1300patients. In addition, medical superintendents areprovided with an unfurnished house or quarters, withpayment by the Council of local and water rates.The subordinate staff is classified thus :

Scale ofGrade. annual salary.

In addition all these officers are provided withboard, lodging, and washing. All the positionsmentioned involve full-time duties, and it is a

condition of service that such officers shall not under-take any other paid employment. The staffingprovides, where necessary, for house physicians orhouse surgeons, remunerated at the rate of £120 ayear, with residence, and for clinical assistants, whoare non-resident and receive £150 a year, with mealswhen on duty. These officers are not employed ina whole-time capacity and are granted adequateleisure for study.Deputy medical superintendents and senior

assistant medical officers who occupy unfurnishedhouses or quarters (married quarters) in the hospitalsare paid the following salaries in lieu of those setout above. The unfurnished houses or quarters areprovided free of charge, the Council also payingall local and water rates :-

Scale ofGrade. annual salarv.

Vacancies in the higher grades are filled, as far as possible, by promotion from the existing staff. All full-time medical staff are allowed liberal annualleave with pay, and full pay during sickness for areasonable period. For subordinate staff, the extentand fluidity of the hospital service provides uniqueopportunities for a variety of experience, and facilitiesexist for specialisation and for officers to follow coursesof study outside the service with a view to improvingtheir professional qualifications.During the past year 174 vacancies have been

filled, including 1 position as medical superintendent,17 as senior assistant medical officers, 105 as assistantmedical officers, and 51 as house surgeons, housephysicians, or clinical assistants. During the yearalso a large number-more than 200-of part-timeconsultants and specialists were employed in thevarious units and groups of these hospitals. Theseappointments, which vary from 1 to 7 sessions a week, f

include physicians, surgeons, obstetricians and gynmco-logists, anaesthetists, psediatrists, neurologists, ortho-paedists, radiologists, dermatologists, ophthalmologists,urologists, and ear, nose, and throat specialists.

In addition, other part-time consultants andspecialists were employed for special purposes-e.g., venereal diseases specialists, plastic and thoracicsurgeons, &c.-and the services were available of atuberculosis officer at each general hospital having atuberculosis ward.

Post-graduate facilities.-These are as follow :-HAMMERSMITH HOSPITAL : In connexion with the

British Postgraduate Medical School, of which a

full account is given on pp. 487 and 488.ST. ALFEGE’S HOSPITAL: Facilities are afforded

to the Final Fellowship Class of Guy’s Hospital toexamine selected cases. The demonstration is under-taken by. a surgical tutor of the class.

ST. ANDREW’S HOSPITAL: Consultant surgeonholds weekly classes for two periods of about 10 weeksprevious to Final F.R.C.S. examinations.

ST. JAMES’ HOSPITAL: The South-West LondonPost-Graduate Association has its headquarters atthis hospital where three sessions of lectures are

given annually-Autumn, Lent, and Summer.Instruction is given, in collaboration with the Fellow-ship of Medicine, in orthopædic surgery and specialanaesthesia for plastic surgery.

Post-graduate courses.-Courses of instruction in

hospital administration for candidates for the Diplomain Public Health are held at the NORTH-WESTERNHOSPITAL and at the BROOK HOSPITAL.

Special units.-There are the following specialdepartments for the treatment of various diseases inthe hospitals :-

* The thoracic surgery unit will be transferred to St. MaryAbbots probably on Oct. 1st, 1936.

Undergraduate facilities.-The following generalhospitals are affiliated to medical schools for thepurpose of clinical teaching :-

Obstetric instruction.-In’ addition, undergraduatesfrom seven medical schools are accepted as students

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for instruction in obstetrics at the following generalhospitals :-

RESIDENT STUDENTS

NON-RESIDENT STUDENTS

St. Alfege’s Hospital .. Guy’s.

The fever hospitals provide facilities for under-graduate instruction in infectious disease.

Small-pox.—Provision is also made for demonstra-tions in the diagnosis and treatment of small-poxfor both under-graduate and post-graduate students.

Recognition for examinations.-The majority of thegeneral hospitals are recognised for qualification forcandidature in branch 1 of the University of LondonM.D. Examination. Ten of the general hospitals arerecognised by the British College of Obstetricians andGynaecologists for candidature for their Diplomaand membership.

PRISON MEDICAL SERVICE

Whole-time appointments.-At the larger prisonsthe medical-officerships are full-time appointments,and at certain establishments deputy medical officersare appointed to assist in the work. Whole-timemedical officers are in two classes : medical officers,class II., £525 a year proceeding by annual incre-ments of £25 to 800 a year (the commencing salaryfor those holding the diploma of psychological medi-cine being £575 per annum) ; medical officers, class I.,£800 a year proceeding by annual increments of£30 to £1000 a year. Unfurnished quarters are

provided or an allowance in lieu is made. Theposts are pensionable. The initial appointment isto the class II. grade with prospects of promotionto the higher rank. Of the whole-time Prison MedicalService 16 are class II. and 12 are class I. Promotionsfrom class II. to the rank of medical officer, class I.,are made as vacancies occur. Three of the seniormedical officers receive an additional allowance of£50 per annum, and at certain prisons, medicalofficers receive fees for giving evidence in thecriminal courts. Candidates must be fully qualifiedand registered. Preference is given to those whohave held house appointments, have had experiencein mental diseases and psychological methods, andare between the ages of 25 and 35 years.

Part-time appointments.-The medical-officershipsof the smaller prisons, where the work is insufficientto occupy a man’s whole time, are usually filled bylocal practitioners, who combine the prison workwith their own practice. The salary paid for suchpart-time work varies according to the extent ofthe duties required. Such appointments may beterminated with notice at any time, and the holdersare not entitled to pension.

Further particulars can be obtained from the

secretary, Prison Commission, Home Office, London,S.W.I.

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WOMEN’S MEDICAL SERVICE FOR INDIA

AMONG careers open to medical women abroad theWomen’s Medical Service for India deserves honour-able mention. Admission is made by selection inIndia and England, preference being given to thosewith Indian experience. The Service is open to fullyqualified medical women of British or Indiannationality, and with the present amount of Govern-ment subsidy the number of full medical officers islimited to 44. There are six to ten temporary officers,and in addition there is a training reserve of aboutfourteen recently qualified women holding degrees inmedicine, of Indian universities. Medical womenproceeding to India to join the Women’s MedicalService receive a sufficient sum for a first-class

passage to India. On landing they are postedto one of the larger women’s hospitals to gain Indianexperience and to learn the language. For a furtherperiod they are appointed to act temporarily formedical women on furlough. They are then definitelyappointed to the charge of hospitals. Private practiceis allowed, provided it does not interfere with officialduties. The only exception is in administrativeor educational posts, when an allowance in lieu ofpractice is given. The amount obtained from practicevaries according to the station, but in most cases itforms a fair addition to the salary, varying from 2150to £1000 a year.

Excellent opportunities for surgery, gynaecology,and midwifery are found in the Women’s MedicalService. Opportunities are likely to open in the futurein connexion with maternity and child welfare.Doctors in charge of hospitals have ample scopefor administration and their duties always includesome teaching of Indian nurses and dispensers,as well as training young medical women as housesurgeons and physicians. Teaching posts at MedicalColleges and Schools for Women form about one-third of the total sanctioned posts in the Service.The cost of living in India is much higher than

formerly, but it should be possible for a medicalwoman (with house provided) to meet actual house-hold expenses for about Rs.300 per mensem, leavingthe remainder of her salary for dress and personalexpenses. To this must be added the necessarysaving to meet additional expense for furlough andleave spent in the hills.

Rates of pay are as follows :—

* Given to officers of European domicile.t At rupee value Is. 6d.

Furnished quarters are provided, representing anadditional Rs.150 per mensem or an allowance isgiven instead.

Leave on average pay is earned at the rate of 2/llthsof the period spent on duty.

Study-leave is granted to the extent of 12 monthsin the total service and will not be granted more thantwice in the course of an officer’s service. Duringstudy-leave an officer draws half average pay, with astudy allowance at the rate of 12s. a day duringthe course of study. Officers of European domicileare entitled to four free return first-class passages froma port in India to a port outside India in their wholeservice. The first passage is not granted until afterthe expiry of four years’ approved service, and there-after passages may be granted at intervals of not lessthan four years. There is a Provident Fund to whichmembers of the Service contribute 10 per cent.of their pay. The Service contributes another 10per eent., which accumulates at interest and is repaidon retirement.

Admission to the Service is made by selection inIndia and England-preference being given to thosewith Indian experience. Vacancies are few, usuallythree or four only in each year. Candidates in theUnited Kingdom should apply to the Hon. Secretary,United Kingdom Branch of the Countess of Dufferin’sFund, care of India Office, Whitehall, London.Candidates in India should apply to the Chief MedicalOfficer, Women’s Medical Service, Dufferin Office,Red Cross Building, New Delhi. Information aboutthe Service can also be obtained from the MedicalAdviser to the United Kingdom Dufferin Fund,c/o The High Commissioner for India, India House,Aldwych, London, W.C.2, who can be seen there byappointment.