LETTER TO THE MEDICAL WORLD Charles Wortham Brook

SEPTEMBER 10th, 1943

I should like to make some comments on the excellent Editorial appearing in the Medical World of August 27th.

It is interesting to learn that the President of the Pharmaceutical Council should suggest that in any new service the arrangements for dispensing should continue as at present.

One of the most obvious deficiencies of the present N.H.I. system is that after prescriptions have been written, they have to be taken long distances frequently at great inconvenience to a chemist’s shop which the patient or messenger may find closed, or may receive an instruction that the medicines are to be collected some hours later, for usually the pharmacist is not as considerate to his customers as the doctor is to his patients. Furthermore, the majority of retail chemists with whom I have conversed, frankly admit that their N.H.I. dispensing is a troublesome but unavoidable sideline, for to decline it would mean the loss of much of their other trade.

In a Health Centre it would be possible for the full-time salaried pharmacist to play a role of great importance, for he would not only be competent to become the business manager of the centre, but he could perform the invaluable duty of laboratory technician to the centre and as such could carry out for the general practitioners attached to the centre, routine investigation which would not require the attention or opinion of a clinical pathologist.

With regard to your criticisms of a scheme for a School Dental Service outlined by Miss Sclare, L.D.S., I consider that from an organisational standpoint your attitude is justified with one important exception and that is that you have failed to appreciate that operative dentistry for children should be a very distinct speciality. The majority of dentists if asked for their views will tell you that, they either like or detest treating children, and undoubtedly it is work for which women dentists are especially well suited, but unfortunately there are far too few of them.

This brings me to the point that it is essential that the dental profession will have to be drastically reorganised if the teeth of the nation are to be conserved.

In the first place it is my firm belief that the Dental Act of 1921 was a double-edged weapon for while it undoubtedly put a stop to quackery and flagrant advertising by the unscrupulous yet it created a monopoly which has led to an inevitable shortage of new entrants to the dental profession. The one surprising thing about it is that dentists have not exploited the position to greater advantage to themselves and have been content to accept an inferior status.

Secondly, for the very obvious purpose of restricting new entrants to dentistry the curriculum for dental students has been absurdly over­loaded and thus has been made unnecessarily expensive. Next time any reader has to have a particularly painful filling done by a newly-qualified man, let him take courage and consolation in his agony that at least the operator knows all about the dentition of a hake!

Much of the dental student’s time is spent at the work-bench, although the majority of them will vow that after qualifying they will never make another set of dentures but will leave this work to the more skilled and experienced dental mechanics. For goodness sake let us be logical. The aural surgeon does not make or fit “hearing aids.” The ophthalmic surgeon does not make or fit spectacles. Why should the, dental surgeon make or fit dentures?

The obvious solution is therefore for the dentist to confine himself to dental surgery, leaving prosthetics to a new class of qualified dental auxiliary— the denticians, who could be recruited from dental mechanics and from the ranks of skilled precision workers in which this country abounds.

But I admit that if the existing N.H.I. dental arrangements are allowed to continue, such a proposition as I have advanced is impossible, for the very simple reason that at the present time in an N.H.I, dental practice it is the prosthetic work that pays. A dentist may spend as much time by the chair doing one difficult filling for which he is paid 7s. 6d. plus a war bonus, but less the cost of materials and the wear and tear of his expensive apparatus, as he may take with all the steps necessary for the completion of a full upper and lower set of dentures for which he is paid £5 10s. plus a war bonus but less the cost of materials and manufacture, but which leaves him with a very much greater margin of profit than conservation work. Frankly, one cannot blame dentists for clearing mouths under existing conditions but in a salaried service this temptation will cease and there will be no obstacles to the appointment of full-time denticians.

By the way, sir, can you or any reader inform me how these new dental repair shops which are springing up like mushrooms are able to evade the Dental Act. It is rumoured that the customers take their own. impressions. Fortunately I am not adentulous. If I were, I think I should go to one of these shops to satisfy my curiosity.

Earlier on I stated that ophthalmic surgeons do not make or fit spectacles, but they all seem to be willing to do refractions, which is not surgery but a branch of physics and which is generally better done by qualified opticians who should have their own officially recognised register.

Taking into consideration all these, matters that I have raised it would appear that a good deal more thinking has got to be done before we can contemplate anything like a completely satisfactorily unified and co-rdinated National Medical Service.

What do you think?

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