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sectional interests to deviate him from his path. Thevoluntary hospitals should realise that they have a muchbetter bargaining power today than they will have in afew years time, when publicly controlled hospitals havehad a chance to develop.The present hospital service is far from perfect and

needs a drastic overhaul ; so it is to be hoped that thosewho negotiate on behalf of the medical profession andhospital interests generally will be successful within theframework of the white-paper proposals, in helping theMinister of Health to produce a National Health Service ’second to none, in which, incidentally, the conditions ofservice and remuneration for the medical professionand other hospital staff are such as to attract the mostsuitable personnel.

Hitchin. A. A. CUNNINGHAM.

GROUP MEDICINE AND PRIVATE PRACTICE

SIR,—We learnt our medicine in hospital (bed andoutpatients). This is ideal group medicine. Let usreproduce this for every 10,000 people throughout thecountry and unite to give this service, which will improveus by mutual example and precept.

This is incompatible with private practice and privateenterprise.. I began to study medicine after service in the lastwar. Next year (after 26 years) I hope to completethe payment of goodwill for my present practice. Thereis still a mortgage on the house. Even if I had to givethe goodwill of my practice I am ready to join such anIdeal Medical Service today.

UNUNITED.

DISCUSSING THE WHITE PAPER

SIR,—Halving attended discussions on the white-paper, called by the British Medical Association, in twovery different towns in England, I am impressed bycertain similarities.

1. Each was attended by a member of the highestcouncils of the BMA who to a large extent " managed "the meeting in spite of his protestations to the contrary.This tended to give the impression, rightly or wrongly,that the BMA has a policy which was fixed, and, it washoped, would be merely endorsed by the meeting, orthe questionary.

2. As was expected, the average age of the memberswas well over 45, and the motions passed were thoseof that age-group.

3. The question of buying and selling of practiceswas avoided, even when it had been raised. It seemsthat the unrepresented young doctors have had littlechance to discuss the matter, though I should imaginethat nearly all those who have never embarked on apractice in this way will wish to avoid doing so now. Andmany of those, like myself, who see a prospect of yearsof debt ahead of them, thanks to war service, mightwelcome a chance to receive even an incomplete com-pensation, in exchange for freedom from this anxiety,and work in a well-run health centre. There are ad-vantages in the cooperation and lack of competitionwhich have been appreciated in a military hospital,and which are often absent from general practice.

4. There was condemnation of health centres. Sostrong was the feeling of the older men that one wonderedwhat hidden motive lay behind it. It seems certainthat these centres are going to be established by theGovernment, and time could be spent more fruitfullyin making sure that they are as efficient as possible (ifthis is desired), rather than in destructive criticism of thewhole idea. The younger generation will probably staffthem very largely, after demobilisation, and it is they whoare debarred from making their suggestions just now.

5. The power to direct young practitioners was

strongly rejected. No-one likes being " posted," butsome means must be found of redistributing doctors,at least temporarily. Increased financial inducement-should play a part. Could not a young doctor be givena choice of vacancies, much as he at present has onlya limited choice of house appointments at any onetime ? This would be much preferable to a definiteposting, often given against his will, which is the stateof affairs apparently expected by these meetings.

6. There was a division of opinion about means ofremuneration, though agreement on the principle that

the income must have relation to services rendered.Can it be said that this principle is strictly adhered tounder the present system of buying practices ? Ofcourse there must be an increase of remuneration withage and experience.

7. Unfortunately the approach to each questionseemed to be from the point of view of the doctor ratherthan from that of the patient. Though the latter isbeing avoided in this letter, I feel that both points ofview must be fully considered if we wish to retain thepublic goodwill.

8. There was universal condemnation of the adminis-trative proposals of the white-paper, and in this .1 feelin complete agreement with BMA criticisms.

THIRTY-FOURTemp. Captain RAMC

PATHOLOGY AND THE NATIONAL HEALTHSERVICE

SIR,—Pathology, except tor a briet reterence to publichealth bacteriology and to " laboratory service," is notmentioned in the white-paper, and we feel it is time thatconstructive proposals regarding the position of patho-logists and the part which pathology ought to play inthe new medical service should be made by practisingpathologists. We have no mandate to speak for ourfellows or for any administrative authority, but we havereason to believe that our views accord with those ofthe majority of our colleagues.We believe that the closest coordination between the

two main branches of pathology-academic and applied-is essential to a satisfactory pathological service.Nothing should be allowed to split the component partsinto a number of watertight compartments.Academic pathology, mainly concerned with teaching

and research, will inevitably be centred in the medicaldepartments of the universities, and will, we suppose,be fully considered in the report of the InterdepartmentalCommittee. It would, however, be undesirable wereresearch and teaching to be confined to universitydepartments and research institutions. The efficiencyof laboratories chiefly concerned with routine work canbe ensured only if their staffs have opportunity forindependent investigations, and for benefiting by thestimulus that teaching offers. For this reason, thestaffing of hospital laboratories must be adequate enoughto afford the pathologists time to make use of theseopportunities as they arise.

It may prove expedient, at any rate for the time being,to place what is called public health bacteriology undera separate administration. Whilst we should regretthis, we believe that the detrimental effect on pathologyas a whole which such a schism would entail could bemitigated to a considerable extent if adequate coördina-tion with the rest of pathology could still be maintained.Clinical pathology is an important part of a generalhospital service and as such must be closely bound upwith the general scheme of hospital management. Buta brief consideration of the technical practices of clinicalpathology and public health bacteriology shows thatthey are so closely related as to make division unprofit-able.The cooperation of the two main branches of patho-.

logy may be seriously handicapped by being adminis-tered by three different organisations-university,ministry, and local or regional authority. The desiredcoordination of the parts into one whole, however, canbe achieved primarily by the pathologists themselves,provided that the scheme of administration is such as topermit this.Within the areas of the joint authority, as envisaged

in the white-paper, there should be pathological com-mittees capable of advising the joint authority on allpathological matters. These committees should berepresentative of all the laboratories in the area, andconstituted in a similar manner to those which arealready working satisfactorily in some of the defenceregions.The university departments of pathology should

retain their primary functions of teaching and research,and act as the training centres of sufficient pathologiststo supply the needs of the service. The professorsshould act as the friends and advisers of all pathologistsin their regions and, in some cases, as national advisers