The majority of the medical profession in Great Britain is engaged in either whole-time or part-time service for the state or for local authorities. Of the 24,000 medical practitioners in England and Wales, some 5,000 are engaged as poor-law doctors, some 4,000 or 5,000 in the public-health service, possibly 500 in the lunacy service, some 1,300 in the school medical service, and smaller numbers in various other forms of medical service for the state. This is exclusive of the general practitioners who undertake contract work under the National Insurance Act, and who cannot fall far short of three-fourths of the total membership of the profession. It should be noted that many doctors hold several appointments.
The state has, quite apart from National Insurance, given a rapidly increasing amount of medical assistance to the public.
1. Under the Poor Law, every destitute person is entitled to gratuitous medical attendance, at home or in an institution, and after a fashion has received this during the last century.
2. The institutional treatment of lunacy has grown to an extent which permits the treatment in an asylum of every certified lunatic.
3. The treatment at the expense of the state of feeble-minded persons is rapidly increasing.
4. Public health authorities provide institutional, and to a limited extent domiciliary, treatment of infectious diseases, this treatment being given, as in the preceding cases, in nearly every instance gratuitously.
5. To some extent prior to, and to an increased extent since, the passing of the National Insurance Act, sanatoriums and hospitals for the treatment of tuberculosis are provided by the public health authorities, the central government contributing to the local authority undertaking this duty one-half of all approved expenditure on these institutions, on tuberculosis clinics, and of the expenses incurred in the domiciliary nursing and supervision of tuberculosis patients.
6. Similarly the central government pays one-half of the approved expenditure incurred by local authorities or in certain cases by voluntary agencies in assistance given in aid of maternity and child welfare, e.g., in the provision of midwives, of consultant doctors, of lying-in homes and hospitals, of beds for præpartum treatment, of convalescent homes for mothers or their children, of infant consultations and clinics, etc.
7. In regard to venereal diseases the central government has gone still further. It has made it obligatory on the larger local authorities to provide facilities for pathological diagnosis, and for the treatment of patients suffering from these diseases irrespective of any residential or financial limitations. Arseno-benzol preparations are given gratuitously to medical practitioners, as also laboratory assistance in diagnosis. To ensure the success of the local arrangements the central government pays three-fourths of their total cost; and have passed an act which prohibits the treatment of venereal diseases by any unqualified person, as also the advertisement or sale of any remedies for these diseases.
8. Many public health authorities provide gratuitous assistance to medical practitioners in the bacteriological diagnosis of tuberculosis, enteric fever, diphtheria, etc. Recently Wasserman tests and searches for gonococci and spirochaetes have been added. In 1914 plans for further development, including the provision of complete clinical laboratories for the gratuitous use of practitioners had been planned, and the necessary grant had been obtained from Parliament; but the war led to the plans remaining in abeyance. At the same time government grants in aid of nursing, and of the provision of consultants and referees for insured patients were passed, but were similarly held in abeyance.