134 
MAJORITY REPORT. 
ER ——— 
the estimate is admitted to be highly conjectural, resting mainly 
on the personal impression of members of the Regional Medical 
Staff of the Ministry who have had extensive experience of 
general practice. 
The great difficulty of forming even an approximate estimate 
of the cost of these particular services arises, first, from the lack 
of data of the extent of the real need of them, and, secondly, 
from the difficulty of devising adequate safeguards against un- 
necessary calls for second opinions. It is obvious that without 
such safeguards a large cost might be incurred without corre- 
sponding advantage. For these reasons, we recommend that the 
working of the arrangements for the provision of a domiciliary 
consultant service should be closely watched by the Central 
Department, particularly in the early stages, to ensure that the 
system is not resorted to by lax or negligent practitioners in 
cases where no real doubt arises in regard either to diagnosis or 
treatment. 
LABORATORY AIDS TO DIAGNOSIS. 
293. There appears to be a unanimous and strong desire for 
the provision of laboratory aids to diagnosis. Under this head 
are included :— 
(1) Microscopie, bacteriological, or chemical examina- 
tion of blood, fluids aspirated or otherwise obtained from the 
patient, such as cerebro-spinal, pleuritic and ascitic, urine, 
feces, sputum, vomit, pus, tumours and other tissues. 
(2) Tests of function, i.e., urea elimination, test meal. 
This list is exclusive of the examinations made for the 
preparation of autogenous vaccines, and of the examinations now 
undertaken by local authorities, i.e., examinations of diphtheria 
swabs, sputum for the tubercle bacillus, Widal reactions, and 
Wassermann reactions and other tests in connection with 
venereal disease. 
294. If a scheme were being prepared for the provision of 
services for the whole population, it might be worth while to go 
into questions of possible organisation of a scheme of laboratories 
that would be newly provided where not already available. But 
when considering provision for insured persons only, we under- 
stand that there is no reason to suppose that contracts could not 
be made with existing laboratories for doing all the work. 
EsTiMATE oF COST OF LABORATORY AIDS. 
295. As to cost, we understand that the estimates obtained 
from general practitioners of the prospective demand for such 
services have varied somewhat widely, and in some of them, 
sufficient account does not appear to have been taken of the 
considerable increase in the volume of work which would 
probably have to be undertaken, particularly if the service were 
associated with the provision of specialist clinical services. The 
ficures given converge towards about £5 per 1,000 insured per-