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work, and they believe that it should be treated in close,relation to the family and work situation. In Amsterdampatients are only sent to hospital as a last resort, and thisstep is regarded as an admission of failure by the mentalhealth service. It is never their first choice as it notinfrequently is in Great Britain today.

"

The mental health service is therefore closely concernedwith factory and labour conditions. The service believesthat work placement, aided by regular home super-vision, is often the best way of retaining these patientsas productive members of society. It also runs foursheltered workshops where patients can be reconditionedfor work while their problems are under care. Greatstress is placed on the home as the basis of the normalfamily. The Dutch contend that only in the home is itpossible to cooperate with the family. If the patient isout when a member of the service calls, the visit is asvaluable, because the relatives are helped to gain a betterunderstanding of the patient’s difficulties.An excellent relationship has been built up with the

police, who are encouraged to report significant antisocialbehaviour to the service. This procedure is often moreconducive to a permanent solution than a prosecution inthe courts. The service also advises the judiciary inmore serious charges.

, In Amsterdam the work of the service is carried outin teams. Each district has a full-time psychiatrist whois helped by social workers. During their postgraduatetraining all psychiatrists are seconded for six monthsfrom the university clinic to the preventive mentalhealth service to gain a practical understanding of socialand industrial conditions.

Although much of their work is done in the home orfactory medical department, the doctors of the servicehave access to first-class diagnostic facilities for psycho-logical and laboratory tests. For this purpose the

patient visits the central clinic. There is also an excellentuniversity psychiatric clinic with 200 beds which is anactive teaching and research centre. Close liaisonis maintained between the university clinic and theservice.About 40% of all adult psychiatric patients referred

to the mental health service are never admitted to

hospital, and respond with varying success to handlingin the home and factory. Where institutional treatmentis essential, arrangements are made for the patients carein a mental hospital. On his discharge the service resumessupervision and resettlement at work. Owing to theexcellence of the service, superintendents of mental

hospitals are said sometimes to discharge their patientstoo early, no doubt a fault on the right side.

RESULTS

Comparisons between one country and another arenotoriously difficult. Is Amsterdam, which has beendeveloping a first-class mental health service for 20 years,mentally healthier than London where the emphasis hasbeen on the provision of outpatient facilities and hospitalbeds ?,The suicide-rate, which is one recognised index, sug-

gests that the Dutch system is more effective. InAmsterdam suicides in 1951 were 7.3 per 100,000. InGreater London they were 11-7 per 100,000, or 60%higher. Again in 1950 Amsterdam had 330 people per100,000 in mental institutions, while London and theHome Counties had 412 per 100,000. In Amsterdam

0-1% of the population are admitted to mental hospitalsannually against 0-32% in London and the Home Counties.The ratio of hospital admissions for Greater London isthus three times as great as that for Amsterdam.

There are better ways of spending public money thanbuilding more mental hospitals, and the Dutch experiencedeserves careful study and adaptation to the needs of thiscountry. Perhaps once again prevention will prove

better, and cheaper; than cure.

GENERAL MEDICAL COUNCILIN a presidential address at the opening of the council’s188th session on May 25, Sir David Campbell observedthat of the 110 practitioners who had qualified in thiscountry and had been fully registered after obtainingthe requisite experience in house-officer appointments,under the terms of the Medical Act, 1950, 88 had obtainedtheir certificates of experience on the basis of six monthsspent in medicine and six months spent in surgery;the others had combined surgery or medicine with

midwifery.Since the beginning of last year it had been necessary

for practitioners holding recognised overseas Common-wealth and other diplomas who wished to obtain full

registration in this country to furnish the council withevidence that they had had such house-officer experienceas was required of applicants from the United Kingdom,or other experience not less extensive. In this period,721 overseas Commonwealth applicants had been fullyregistered. 250 of these practitioners qualified inAustralia, 213 in South Africa, 101 in India, 59 in NewZealand, 31 in Canada, 26 in Pakistan, 19 in Ceylon, and22 in other parts of the Commonwealth. A further2 practitioners holding recognised degrees granted inBurma had been fully registered in the Foreign List. Inaddition provisional registration had been granted to74 Commonwealth practitioners, 20 of whom sub-

sequently obtained full registration by service in the

hospitals in this country ; while temporary registrationunder section 8 of the Medical Practitioners andPharmacists Act, 1947, had been granted to 456 practi-tioners from Commonwealth or foreign countries, noteligible for full or provisional registration, who werethus enabled to take up postgraduate employment inour hospitals. Most of this group qualified in foreign zcountries, including 144 in Europe, 42 in America, and23 in Egypt. The great majority of overseas applicantsfor temporary, provisional or full registration came tothese shores to undertake postgraduate study ; andthese figures illustrated the great part that Britain wasplaying as a centre of higher medical education.During the session members of the council would be

asked to consider the appointment of a new specialcommittee on legislation to examine afresh the questionof consolidating the Medical Acts.The Executive Committee had resolved that the degrees

of the University of Agra should be recognised in respectof the Agra Medical College, of the University of Delhi inrespect of the Lady Hardinge Medical College, of the

University of the Punjab, in respect- of the AmritsarMedical College, and of the University of Gauhati in

respect of the Assam Medical College.The President said that in his address last November

he expressed the concern of the Disciplinary Committeesat the emergence of certain professional misdemeanoursin connection with the National Health Service whichhad kept recurring during the past few years, and ontheir advice issued a warning. He had since learned thatthis warning had ,been interpreted in some quarters asindicating that these misdemeanours were widespreadand as a reflection on the high general ethical standardof the profession in Great Britain. This was neitherintended nor implied. The Minister of Health, whenasked in the House of Commons on Jan. 21 what stepshe had taken since this statement was made, said :"I I have taken no steps since the statement made by thePresident of the-General Medical Council, but it is fair to saythat perhaps the right interpretation has not been put onwhat was said. As I. understand, it was a warning that theGeneral Medical Council quite rightly take a grave view oflaxity in these måttérs; and ’w1is’ hot an allegation thatfraudulent praptices or conduct were at all widespread."That reply, the President concluded, put the matter inits proper perspective. ’" ’ ,:B::,,’