SUPPLEMENT TO THE BRITISH MEDICAL JOURNAL

LONDON SATURD)AY JUNE 19 1954 CONIENTS Annual Meeting: Programme - -321 Medical Certificates for Service Men - 347 Agenda of Annual Representative Meeting 330 Patients Referred by Dentists for Penicillin Injections 347 Welfare Foods --340 A Comprehensive Service - 347 G.M.S. Committee --340 Central Consultants and Specialists Committee 348 Provisionally Registered House Officers - 341 Southem Branch Annual Meeting 349 Remuneration of Whole-time Medical and Dental Staff. N. L. Rowe, F.D.S.R.C.S., M.R.C.S., Reducing Waiting-time of Out-patients - 349 L.R.C.P. - -341 Correspondence 350 Major Accidents - -347 Association Notices- 352 British Medical Association ANNUAL MEETING-GLASGOW, JULY 1- 9, 1954

President-Elect: Emeritus Professor jr JOHN McNEE, D.S.O., M.D., D.Sc., LL.D., F.R.C.P., F.R.F.P.S. Joint General Secretaries: J. INGLIS CAMERON, M.B., Ch.B., F.R.F.P.S.; J. T. MCCUTCHEON, M.A., L.R.C.P., L.R.C.S., L.R.F.P.S. Science Secretary: J. BASIL RENNIE, M.D., F.R.C.P., F.R.F.P.S. Deputy Science Secretary: A. W. KAY, M.D., Ch.M., F.R.C.S.Ed. Executive Officer: G. A. PECK, B.Sc., British Medical Association, Glasgow Regional Office, 234, St. Vincent Street, Glasgow, C.2. PROGRAMME The 122nd Annual Meeting of the British Medical Associa- A full social programme is being arranged, including a tion will be held in Glasgow from Thursday, July 1, to Civic Reception on Tuesday evening, July 6, and a Univer- Friday, July 9, 1954, inclusive. sity Reception on Wednesday evening, July 7. There will On the evening of Wednesday, June 30, there will be a also be a dance on Friday evening, July 9. Cocktail Party for Representatives and their Ladies, arranged Several special functions have been arranged for ladies by the Glasgow Division. accompanying members, including visits to Lcch Lomond, The Annual Representative Meeting will begin on Thurs- Lake of Menteith and Stirling Castle, the Burns Country, day, July 1, and continue on Friday, Saturday, and Monday. and Edinburgh. Also included among these is an all-day July 2, 3, and 5: excursion to Loch Katrine and the Trossachs. The Representatives' Dinner and Ladies' Dinner will take The usual golf competitions will take place, and there will place on Thursday, July 1, followed by a dance. be an additional medal competition at Old Prestwick Golf The Overseas Luncheon has been arranged for Friday. Course on Thursday, July 8, for those not eligible for the July 2. Treasurer's Cup competition. On Sunday, July 4, an all-day cruise on the Firth of Clyde The Overseas Conference will be held on the afternoon of has been planned, and this will be followed in the evening Wednesday, July 7, followed by a reception given by the by a concert, specially arranged by the B.B.C. Over-seas League; there will also be an "At Home" for The Adjourned Annual General Meeting and President's over seas visitors given by the Empire Medical Advisory Address will take place in the Kelvin Hall on the evenin- Bureau on Thursday, July 8. of Monday, July 5, and the President's Reception, which The Reception Room for Registration will be open in the follows, will be held in the Bute Hall, at the University. Kelvin Hall on Monday, July 5, at 9 a.m. The Annual Scientific Meeting and associated functions Three Plenary Scientific Sessions have been arranged as occupy the period from Tuesday morning, July 6, to the follows: Tuesday, July 6, at 9.30 a.m., subject "The Prob- evening of Friday, July 9. lem of Sleep"; Wednesday, July 7, at 3 p.m., subject " Food The Official Religious Service will be held in Glasgow and Disease"; Thursday, July 8, at 9.15 a.m., subject "The Cathedral on the afternoon of Tuesday, July 6, and the Problem of Pulmonarv Tuberculosis To-day." Roman Catholic Service will be held at St. Andrew's Seventeen Scientific Sections have been arranged, the meet- Cathedral at the same time. ings to take place on Wednesday morning, July 7, Thursday The Annual Dinner of the Association will be held in afternoon, July 8, and Friday morning and afternoon, July 9 the Central Hotel on Thursday, July 8. (details are given below). 2578 322 JuNE 19, 1954 ANNUAL MEETING: PROGRAMME SUPPLEMENT TO THE BRITISH MEDICAL JOURNAL The Scientific Exhibition will be held in the Kelvin Hall, the world-famous Clyde shipyards. Thereafter, in more and will be open daily from July 5 to 9. Demonstrations open waters, the ship will sail through Largs Channel, will be given at fixed advertised times and a wide field of between the two islands-the Cumbraes-and round the medical interests will be covered. For details see page 326. southernmost point of the Island of Bute. Turning north, The Annual Exhibition of Pharmaceutical Products, it will go through the Kyles of Bute, and return to the Instruments, Appliances, and Medical Publications will also mainland at Wemyss Bay, passing Toward Point on the be housed in the Kelvin Hall. The Exhibition will be open way. from 9 a.m. to 6 p.m. from July 5 to 9 inclusive. For A special train will take visitors from Wemyss Bay back details of exhibitors see page 326. to the Central Station, Glasgow, for 6 p.m., in good time The Ladies' Club will be situated in the College Rooms. for the evening concert. University, and will be open throughout the Meeting. Lunch and afternoon tea will be provided on board ship. Inclusive ticket: 30s. Except for Representatives, for whom REGULATIONS REGARDING DRESS Cpecial arrangements are being made, early application is Academic Dress is to be worn at the President's Address, advisable. the President's Reception, the Official Religious Service, the HOTEL ACCOMMODATION Roman Catholic Service, the Civic Reception, and the Hotel accommodation in and around Glasgow is now University Reception. very fully booked up. Those who have difficulty in making Robes may be hired from Messrs. Ede and Ravenscroft, arrangements are advised to write direct to the Executive Ltd., 93, Chancery Lane, London, W.C.2, or, in the case of Officer, B.M.A. Glasgow Regional Office, 234, St. Vincent Glasgow graduates, from Messrs. Thomson, Son and Street, Glasgow, C.2, stating their exact requirements. Wright, Ltd., 173, St. Vincent Street, Glasgow, C.2. Early application is advised, as the supply of gowns is TRAVEL RESERVATIONS limited, and it is suggested that the gowns be sent to the Accommodation on trains and on aircraft between Lon- home address of the individual concerned. don and Glasgow during July is booked at a very early Evening Dress (Tails or Dinner Jacket), with Decorations, date. It is advisable to make reservations as soon as is to be worn at the President's Reception, Civic Reception, possible. University Reception, and Annual Dinner. Evening Dress without Decorations should be worn at the Representatives' ABERDEEN GRADUATES' DINNER Dinner, the Representatives' Dance, and the Dance in the 9. A dinner arranged by the Glasgow Aberdeen University Union on July Association will be held in the North British Hotel, Glas- REGISTRATION FEE gow. on Saturday, July 3, at 7.30 p.m. Tickets will be 25s. Members attending the Annual Meeting (other than (excluding wines). members of the Representative Body and overseas visitors) All Aberdeen graduates and their ladies attending the are required to pay a fee of one guinea towards the expenses Annual Represitative Meeting will be welcome. Those of the Meeting. The fee will be payable when members intending to be present should apply without any delay to register at the Reception Office. Mr. W. E. S. Thomson, 23, Thorn Drive, Bearsden, Glas- gow, for further information. TICKETS All tickets for functions up to Sunday, July 4, will be EDINBURGH GRADUATES' DINNER available for Representatives at the A.R.M. Inquiry Office The Edinburgh Graduates' Dinner will be held at the at the Bute Hall, University, on June 30, July 1, 2, and 3, Grosvenor Restaurant, 74, Gordon Street, Glasgow, on and for ladies at the Ladies' Club, the College Rooms, Saturday, July 3, at 7.30 for 8 p.m. It is hoped that all University. Edinburgh graduates and their ladies attending the Annual Tickets for all other functions after Sunday, July 4, will Representative Meeting will be able to be present. Tickets, be available from Monday, July 5, at the Reception Office, price 30s. each, inclusive of aperitifs, may be obtained from Kelvin Hall, or at the Ladies' Club. Dr. J. Cottrell, Flottergate House, Grimsby. BADGES GLASGOW GRADUATES' DINNER Members will not be admitted to Plenary Sessions, The Glasgow Graduates' Dinner will be held in the Scientific Sections, or Exhibitions unless wearing badges. Royal Faculty of Physicians and Surgeons of Glasgow, They should therefore visit the Reception Office, Kelvin 242, St. Vincent Street, Glasgow, C.2, on Saturday, July 3, Hall, on the first day of the Annual Meeting t`\ obtain at 7 for 7.30 p.m. The dinner is open to Glasgow graduates their handbook, badge, registration card, and tickets. and their ladies who are attending the Annual Representa- Officers of Scientific Sections and other office-holders tive Meeting. should inquire for special badges at the Reception Office. The cost is 30s. each, including aperitifs. Numbers are limited, and early application, with appropriate remittance. CAR PARKING should be made to Dr. J. C. Macarthur, Roadmeetings Windscreen labels may be obtained at the Reception House, Carluke, Lanarkshire. Offices, and members bringing their own cars are advised to use these labels to facilitate car parking. IRISH GRADUATES' LUNCHEON Members staying in hotels in the centre of the city may The Irish Graduates' Luncheon will be held at the Students' find it difficult to leave their cars overnight. Adjacent Union, University Avenue, Glasgow, on Wednesday, July 7, to the Central Hotel there is limited parking accommoda- at 1 p.m. at a cost of 7s. per person (excluding wine). This tion within the Central Station at a charge of 2s. for each luncheon is open to all Irish graduates and their ladies 12-hour period, night or day. attending the Annual Meeting, and those intending to be present are asked to notify in advance the manager of the THE ALL-DAY CRUISE ON THE FIRTH OF CLYDE Students' Union. No tickets will be issued, and payment An all-day trip down the Clyde on the largest and most will be made at the luncheon. luxurious of the Clyde Fleet, the turbine vessel Queen Mary II, has been arranged for Sunday, July 4, commencing WELSH DINNER at 10.15 a.m. The route to be followed is designed to The Welsh Dinner will be held at the Grosvenor Restaur- show visitors the scenic beauties of the Firth of Clyde. ant, Gordon Street, Glasgow, at 7.30 p.m. on Saturday, Leaving from the heart of Glasgow at Bridge Wharf, July 3. All Welsh representatives, Welsh graduates, and the first stretch of the river to the Tail of the Bank includes others with Welsh associations, accompanied by their ladies, 'SUPPLEMENT TO THE 323 JIJNE 19, 1954 ANNUAL MEETING: PROGRAMME ER:TISH MEDICAL JOURNAL will be welcome at this dinner. Tickets will be 30s. per head fessor MICHAEL BOYD (Manchester), Dr. WM. FERGUSON (exclusive of wines), and those wishing to attend are asked ANDERSON (Glasgow), Dr. O. T. BROWN (Dundee). to apply with remittance to Dr. W. F. Anderson, 40, New- Thursday, July 8.-2.30 p.m., Medical Treatment of lands Road, Glasgow, S.3, before June 26. Hypertension, Dr. GEOFFREY BOURNE (London), Dr. J. GIBSON GRAHAM (Glasgow), Dr. GAVIN SHAW (Glasgow). CHRISTIAN MEDICAL FELLOWSHIP ANNUAL Anticoagulants in Coronary Thrombosis, Dr. RAE GILCHRIST BREAKFAST (Edinburgh), Professor R. B. HUNTER (Dundee), Dr. A. BROWN (Glasgow). Anticoagulants in Thrombophlebitis, The Annual Breakfast of the Christian Medical Fellow- Dr. BODLEY SCOrr (London), Mr. R. S. MURLEY (London), ship will be held in the Students' Union, University Avenue, Mr. R. B. WRIGHT (Glasgow). Glasgow, on Wednesday, July 7, at 8.15 a.m. The chair- man will be Sir John McNee, and the speaker Mr. Howard Somervell. The proceedings will terminate at 9.15 a.m. SURGERY Those intending to be present are asked to notify the local Dr. J. C. Eaton, 19, Boclair Road, Bearsden, President: Sir HENEAGE OGILVIE, K.B.E., M.A., M.D., secretary, M.Ch., F.R.C.S. (London). Glasgow. Vice-Presidents: JOHN DUNBAR, M.B., F.R.F.P.S. (Glas- gow); Professor C. F. W. ILLINGWORTH, C.B.E., M.D., SCIENTIFIC MEETING Ch.M., F.R.C.S.Ed., F.R.F.P.S. (Glasgow); T. MURRAY PLENARY SESSIONS NEWTON, M.B., F.R.F.P.S. (Glasgow); Sir ARTHUR PORRITr, K.C.M.G., C.B.E., M.Ch., F.R.C.S., LL.D. (London). The Arena, The Kelvin Hall Hon. Secretaries: A. B. KERR, O.B.E., T.D., M.B., Tuesday, July 6, 9.30 am.: "The Problem of Sleep" F.R.F.P.S., F.R.C.S.Ed., 5, La Belle Place, Glasgow, C.3; Chairman: Professor Sir DAVID CAMPBELL (Aberdeen). IAN M. ORR, O.B.E., M.D., Ch.M., F.R.C.S.Ed., Brooklands, Speakers: Professor Sir GEOFFREY JEFFERSON (Man- Garstang, Preston, Lancs. chester), Professor D. M. DUNLOP (Edinburgh), Dr. J. 0. Official Reporters: Mr. R. S. MURLEY (July 7); Dr. G. W. McDONAGH (Stanley), Dr. A. H. DOUTHWAITE (London), HAYWARD (July 8). Dr. MACDONALD CR1TCHLEY (London). Sessions Zoology Lecture Theatre. Wednesday, July 7, 3 p.m.: "Food and Disease" Wednesday, July 7.-9.30 a.m., The Surgical Treatment Chairman: Dr. W. G. CLARK (Edinburgh). of Peptic Ulcer. Panel discussion: Mr. JOHN BRUCE (Edin- Speakers: Dr. C. METCALFE BROWN (Manchester), Dr. burgh), Mr. R. L. HOLT (Manchester), Professor C. F. W. JOAN TAYLOR (London), Dr. J. S. K. BoYD (London), ILLINGWORTH (Glasgow), Dr. F. AVERY JONES (London). Professor R. CRUICKSHANK (London), Mr. A. E. BURDETT Short Papers: The Effects of Pregnancy and the Menopause (London); Professor B. S. PLArr (London). on the Course of Peptic Ulcer, Mr. DOUGLAS H. CLARK (Glasgow); Cartilage Implants in Surgical Repair, Mr. Thursday, July 8, 9.15 a.m.: "The Problem of Pulmonary THOMAS GIBSON (Glasgow). Tuberculosis To-day " Thursday, July 8.-2.30 p.m. (Joint Meeting with the Chairman: Sir ANDREW DAVIDSON (Edinburgh). Section of Cardiology), Surgery in the Treatment of Mitral Speakers: Dr. PETER MCKINLAY (Edinburgh), Dr. A. B. Stenosis, Professor W. A. MACKEY (Glasgow), Dr. MAURICE SEMPLE (Liverpool), Dr. J. R. LANGMUIR (Glasgow), Dr. CAMPBELL (London), Dr. R. W. D. TURNER (Edinburgh), Mr. W. D. W. BROOKS (London), Mr. T. HOLMES SELLORS P. R. ALLISON (Leeds). Arterial Grafting, Mr. H. G. (London), Dr. R. R. TRAIL (London). EASTCOTr (London), Mr. W. P. CLELAND (London).

SCIENTIFIC SECTIONS OBSTETRICS AND GYNAECOLOGY President: Professor R. A. LENNIE, T.D., M.D., F.R.F.P.S., All sessions will be held in the University and details are F.R.C.O.G. (Glasgow). given of the lecture theatres where the sessions are to be Vice-Presidents: ROBERT M. CORBET, M.B., M.A.O., held. F.R.C.P.I., F.R.C.S.I., F.R.C.O.G. (Preston), DAVID W. MEDICINE CURRIE, M.D., Ch.M., F.R.C.S., F.R.C.O.G. (Leeds); President: G. E. BEAUMONT, D.M., F.R.C.P., D.P.H. W. F. T. HAULTAIN, O.B.E., M.C., B.A., M.B., F.R.C.P.Ed., (London). F.R.C.S.Ed., F.R.C.O.G. (Edinburgh); JOHN HEWIrr, M.B., Vice-Presidents: Professor S. ALSTIEAD, M.D., F.R.C.P., F.R.F.P.S., F.R.C.O.G. (Glasgow); Professor G. GORDON F.R.F.P.S. (Glasgow); Professor L. J. DAVIS, M.D., LENNON, M.B., Ch.M., F.R.C.O.G., M.M.S.A. (Bristol). F.R.C.P., F.R.C.P.Ed., F.R.F.P.S., F.R.S.Ed. (Glasgow); Hon. Secretaries: R. MURDOCH, T.D., M.B., M.R.C.O.G., Professor S. J. HARTFALL, T.D., M.D., B.Sc., F.R.C.P. 16, Lilybank Gardens, Glasgow, W.2; R. B. K. RICKFORD, (Leeds); W. R. SNODGRASS, M.A., M.D., B.Sc., F.R.F.P.S. M.D., F.R.C.S., F.R.C.O.G., St. Thomas's Hospital, London, (Glasgow). S.E.I. Hon. Secretaries: JOHN H. HUNT, D.M., M.R.C.P., Official Reporter: Mr. S. BENDER. 54, Sloane Street, London, S.W.1 ; E. G. OASTLER, T.D., M.A., M.B., Ch.B., F.R.C.P., F.R.F.P.S., 4, Woodside Ter- Sessions race, Glasgow, C.3. Botany Lecture Theatre. Official Reporter: Dr. T. PARKINSON. Wednesday, July 7.-9.30 a.m., Management of Labour in Contracted Pelvis, Dr. H. R. MAcLENNAN (Glasgow), Pro- Sessions fessor W. I. C. MORRIS (Manchester), Dr. J. BRUCE DEWAR Phy'siology Lecture Theatre. (Dumfries). Early Recognition of Cancer of the Uterus, Wednesday, July 7.-9.30 a.m., Management of Old Age Dr. R. M. CORBET (Preston), Professor G. GORDON LENNON in General Practice, Dr. TREVOR HOWELL (London). Pre- (Bristol), Professor H. C. McLAREN (Birmingham), Miss vention and Treatment of Respiratory Infection in Old Age, M. E. ArrwOOD (Birmingham). Sir GEOFFREY MARSHALL (London), Dr. NEVILLE OSWALD Thursday, July 8.-2.30 p.m., Indications for Induction (London), Dr. T. McEWAN (Glasgow). Treatment of Parkin- of Labour, Dr. R. A. TENNENT (Glasgow), Mr. MASLEN- sonism, Dr. H. G. GARLAND (Leeds), Dr. H. G. MILLER JONES (Wolverhampton), Mr. LESLIE PATRICK (Sheffield). (Newcastle-upon-Tyne). Treatment of Peripheral Vascular Endometriosis, Mr. LESLIE WILLIAMS (London), Dr. JOHN Disease in Old Age, Professor E. J. WAYNE (Glasgow), Pro- STURROCK (Edinburgh), Mr. W. HAWKSWORTH (Oxford). SUPPLEMENT TO THE 324 JUNE 19, 1954 ANNUAL MEETING: PROGRAMME BRITISH MEDICAL JOURNAL

,ANAESTHETICS Sessions President: JOHN GILLIES, C.V.O., M.C., F.R.C.S.Ed., Natural Philosophy Lecture Theatre (new building). M.R.C.P.Ed., F.F.A. R.C.S., D.A. (Edinburgh). Wednesday, July 7.-9.30 a.m., Recent Views on the Vice-Presidents: H. H. PINKERTON, M.B., F.R.F.P.S., Aetiology and Treatment of Marasmus: A General Survey F.F.A. R.C.S., D.A. (Glasgow); F. G. WOOD-SMITH, M.B., of the Problem. Professor J. M. SMELLIE (Birmingham); F.F.A. R.C.S., D.A. (London). The Social Aspects of Marasmus, Professor W. S. CRAIG Hon. Secretaries: W. AUKIN, M.R.C.S., L.R.C.P., D.A., (Leeds); Feeding Difficulties in Marasmus and their Cor- Wyncroft, 35, Gladhow Wood Road, Leeds, 8; I. M. rection, Professor R. W. B. ELLIS (Edinburgh); Renal CAMPBELL DEWAR, M.B., F.F.A. R.C.S., 57, Kelvinside Gar- Acidosis and Idiopathic Hypercalcaemia, Dr. REGINALD dens, Glasgow, N.W. LIGHTWOOD (London); Fibrocystic Disease of the Pancreas, Official Reporter: Dr. GEORGE ELLIS. Dr. R. A. SHANKS (Glasgow). Acute Haematogenous Osteitis: The Changing Picture, Mr. MArrHEW WHITE Session (Glasgow); The Diagnosis of Osteitis, Dr. G. A. NELIGAN (Newcastle); The Treatment of Osteitis, Mr. J. S. MASON Physiology Lecture Theatre. R. B. Friday, July 9.-2 p.m., Medico-Legal Hazards in Anaes- BROWN (Edinburgh); Osteitis in the Newborn, Mr. thesia, Professor W. W. MUSHIN (Cardiff), Mr. W. MAIR, B.L., ZACHARY (Sheffield); The Choice of Antibiotics in Osteitis, LL.B. (Glasgow). Occasional Papers: Hand Blood Flow Dr. 1. A. B. CATHIE (London). During Sleep, Dr. I. D. FERGUSON and Mr. A. PRINGLE, Thursday, July 8.-2.30 p.m., The Care and Management B.Sc. (Glasgow); Hand Blood Flow During Anaesthesia, of the Epileptic Child: Epilepsy as a Social Problem, Dr. Dr. A. C. FORRESTER (Glasgow); The Effects of Spontaneous J. ROMANES DAVIDSON (Bridge of Weir); Disturbances of and Artificial Pulmonary Ventilation on the Alveolar Car- Behaviour in Epileptic Children, Dr. DESMOND A. POND bon Dioxide Content in Man under Thiopentone Anaes- (London); The Medical Treatment of Epilepsy, Dr. J. P. M. thesia with Muscle Relaxant Drugs, Dr. R. P. HARBORD TIZARD (London); The Surgical Aspects of Epilepsy, Mr. (Leeds); Second Thoughts on Neonatal Anaesthesia, Dr. G. F. J. GILLINGHAM (Edinburgh). JACKSON REES (Liverpool). Filnm: The Circulatory Effects of Artificial Respiration, Dr. E. TRIER M0RCH (Chicago, DERMATOLOGY U.S.A.). President: BRIAN F. RUSSELL, M.D., F.R.C.P., D.P.H. CARDIOLOGY (London). President: J. H. WRIGHT, J.P., M.D., F.R.C.P.Ed., Vice-Presidents: F. F. HELLIER, O.B.E., M.A., M.D., F.R.F.P.S. (Glasgow). F.R.C.P. (Leeds); J. FERGUSON SMITH, M.A., M.D., Vice-Presidents: I. MACPHERSON, M.D., F.R.C.P. (Leeds); F.R.F.P.S. (Glasgow); JAMES SOMMERVILLE, M.B., ALBERT A. F. PEEL, M.A., D.M., F.R.F.P.S. (Glasgow); K. F.R.F.P.S. (Glasgow); H. J. WALLACE, M.A., M.D., SHIRLEY SMITH, M.D., B.Sc., F.R.C.P. (London). F.R.C.P. (London). Hon. Secretaries: G. J. AITKEN, M.B., B.Sc., F.R.F.P.S., Hon. Secretaries: A. GIRDWOOD FERGUSSON, M.D., 31, Kenmuir Avenue, North Mount Vernon, Glasgow, E.2; F.R.F.P.S., 3, Ashton Road, Glasgow, W.2; I. B. SNEDDON, C. J. GAVEY, M.D., F.R.C.P., 106, Harley Street, London, M.B., M.R.C.P., 4, Claremont Place, Sheffield, 10. W.1. Official Reporter: Dr. J. T. INGRAM. Official Reporter: Dr. G. W. HAYWARD. Session Sessions Dermatology Lecture Theatre. Zoology Lecture Theatre. Friday, July 9.-9.30 a.m., The Preventive Aspect of Thursday, July 8.-2.30 p.m. (Joint Meeting with the Dermatitis and Allied Disorders, Dr. F. F. HELLIER (Leeds), Section of Surgery), Surgery in the Treatment of Mitral Dr. G. A. HODGSON (Cardiff), Dr. C. N. D. CRUICKSHANK Stenosis, Professor W. A. MACKEY (Glasgow), Dr. MAURICE (Birmingham), Dr. E. COLLIER (Glasgow). Occasional CAMPBELL (London), Dr. R. W. D. TURNER (Edinburgh), Mr. Papers: Otitis Externa, Mr. C. A. KEOGH (London); Treat- P. R. ALLISON (Leeds). Arterial Grafting, Mr. H. G. ment of Haemangiomata, Dr. W. L. LISTER (Plymouth). EASTCOTT (London), Mr. W. P. CLELAND (London). 2.30 p.m., Demonstration of Clinical Cases. Physiology Lecture Theatre. Friday, July 9.-9.30 a.m., Coronary Artery Disease : (1) The Aetiology of Coronary Artery Disease, Professor J. B. FORENSIC MEDICINE DUGUID (Newcastle-upon-Tyne); (2) The Significance of President: Professor JOHN GLAISTER, M.D., D.Sc., Cholesterol in the Causation of Atheroma and Coronary F.R.F.P.S., F.R.S.Ed., Barrister-at-Law (Glasgow). Artery Disease, Dr. T. D. V. LAWRIE (Glasgow); (3) Electro- Vice-Presidents: FRANCIS E. CAMPS, M.D., D.T.M.&H. cardiography in Coronary Artery Disease, Dr. WILLIAM (London); Professor CYRIL J. POLSON, M.D., F.R.C.P., EVANS (London); (4) The Use of Oestrogens in the Treat- Barrister-at-Law (Leeds); R. DONALD TEARE, M.A., M.D., ment of Coronary Artery Disease, Dr. M. F. OLIVER (Edin- M.R.C.P. (London). burgh); (5) Treatment of Shock in Myocardial Infarction, Hon. Secretaries: GILBERT FORBES, M.D., B.Sc., Dr. K. SHIRLEY SMITH (London). F.R.C.S.Ed., F.R.F.P.S., Department of Forensic Medicine, The University, Sheffield, 10; J. A. IMRIE, M.D., CHILD HEALTH F.R.C.S.Ed., Police Headquarters, 21, St. Andrew's Street, Glasgow, C.l. President: Professor STANLEY G. GRAHAM, M.D., Dr. GILBERT FORBES. F.R.C.P.Ed., F.R.F.P.S. (Glasgow). Official Reporter: Vice-Presidents: P. R. EVANS, M.D., M.Sc., F.R.C.P. (London); Professor J. L. HENDERSON, M.D., F.R.C.P.Ed. Session (Dundee); BERNARD E. SCHLESINGER, O.B.E., M.D.. F.R.C.P. Chemistry Lecture Theatre. (London); MATrHEW WHITE, M.B., F.R.C.S.Ed., F.R.F.P.S. Friday, July 9.-2 p.m., Forensic Medicine in Relation (Glasgow). to the General Public, Professor D. J. A. KERR (Edin- Hon. Secretaries: J. H. HUTCHISON, O.B.E., M.D., burgh) and Mr. HECTOR MCKECHNIE, Q.C. (Edinburgh); F.R.C.P., F.R.F.P.S., 21, Victoria Park Gardens North, Forensic Psychiatry, Dr. J. C. M. MATHESON (London); Glasgow, W.1; A. P. NORMAN, M.B.E., M.D., M.R.C.P., Forensic Pathology, Professor CYRIL J. POLSON (Leeds), D.C.H., Institute of Child Health, the Hospital for Sick Police Surgeons Dr. J. A. IMRIE (Glasgow) and Dr. RALPH Children, Great Ormond Street, London, W.C.1. SUMMERS (London); Forensic Chemistry, Mr. MAGNUS Official Reporter: Dr. P. R. EVANS. HERD (Glasgow). SUPPLEMENT TO THE 325 JUNE 19, 19!4 ANNUAL MEETING: PROGRAMME BRITISH MEDICAL JOURNAL

MICROBIOLOGY AND PATHOLOGY OPHTHALMOLOGY President: Professor D. F. CAPPELL, M.D., F.R.F.P.S., President: Professor W. J. B. RIDDELL, M.D., F.R.F.P.S.. F.R.S.Ed. (Glasgow). F.R.S.Ed. (Glasgow). Vice-Presidents: Professor ROBERT CRUICKSHANK, M.D., Vice-Presidents: C. DEE SHAPLAND, M.B., M.R.C.P., F.R.C.P., D.P.H. (London); Professor J. W. HOWIE, M.D., F.R.C.S. (London); S. S. SUMNER, M.B., F.R.C.S.Ed. (Glasgow); Professor G. L. MONTGOMERY, M.D., Ph.D., (Preston). F.R.F.P.S. (Glasgow). Hon. Secretaries: R. LEISHMAN, M.D., 11, Sandyford Hon. Secretaries: H. E. HUTCHISON, M.D., Department Place, Glasgow, C.3; S. J. H. MILLER, M.D., F.R.C.S., of Pathology, Western Infirmary, Glasgow, W.1,; JOAN 21, Wimpole Street, London, W.1. TAYLOR, M.B., D.P.H., Central Public Health Laboratory, Official Repor-ter: Mr. S. J. H. MILLER. Colindale Avenue, London, N.W.9. Official Reporter: Dr. IAN TAYLOR. Sessions Ophthalmology Lecture Theatre. Friday, July 9.-9.30 a.m. (Joint Session with the Session Section of Occupational Health), The Employment of the Chemistry Lecture Theatre. Visually Handicapped, Dr. WILLIAM HUNTER (Glasgow), Wednesday, July 7.-9.30 a.m. (Joint Session with Section Dr. EDWIN GORDON MACKIE (Sheffield). Short Papers re- of Preventive Medicine and Infectious Diseases), Polio- lated to the same subject will also be read by Dr. JAMES H. myelitis: Recent Advances in Knowledge of the Virus, BELL (Glasgow), Dr. M. E. M. HERFORD (Slough) Dr. ALLAN P. GOFFE (London); Epidemiology, Dr. W. H. Eye Defects of School-leavers, Dr. ARCHIBALD R. MILLER BRADLEY (London); The Acute Case, with Special Reference (Glasgow) and Mr. JOHN T. STEWART (Glasgow). to Respiratory Failure, Dr. A. B. CHRISTIE (Liverpool). Friday, July 9.-2 p.m., Ocular Headache, Professor W. J. B. RIDDELL (Glasgow). Occasional Papers: Trachoma in Glasgow-Paper by the late Dr. S. SPENCE MEIGHAN to NEUROLOGY be read by Dr. D. CHRISTISON (Glasgow); Field Defects in President: MACDONALD CRITCHLEY, M.D., F.R.C.P. Disseminated Sclerosis, Dr. R. J. MCWILLIAM (Glasgow). (London). Vice-Presidents: WYLIE MCKISSOCK, O.B.E., M.S., ORTHOPAEDICS lF.R.C.S. (London); D. W. C. NORTHFIELD, M.S., F.R.C.S. President: Emeritus Professor Sir HARRY PLATT, M.D., (London); J. ERIC PATERSON, M.B., F.R.F.P.S. (Glasgow); M.S., F.R.C.S., F.A.C.S. (Manchester). JOHN D. SPILLANE, M.l., F.R.C.P. (Cardiff). Vice-Presidents: ROLAND BARNES, F.R.C.S., F.R.F.P.S. Hon. Secretaries: A. M. G. CAMPBELL, D.M., F.R.C.P., (Glasgow); H. E. HARDING, F.R.C.S. (London); JAMES 79, Pembroke Road, Bristol; J. S. M. ROBERTSON, M.B., PATRICK, M.B., F.R.C.S. (Glasgow); Professor GEORGE F.R.C.S., 23, Kingsborough Gardens, Glasgow, W.2. PERKINS, M.C., M.Ch., F.R.C.S. (London). Official Reporter: Dr. C. W. M. WHITTY. Hon. Secretaries: J. G. BONNIN, M.B., F.R.C.S., Central Middlesex Hospital, Park Royal, London, N.W.10; ATHOL R. PARKES, M.B., F.R.C.S.Ed., Western Infirmary, Glasgow, Session W.1. Botany Lecture Theatre. Official Reporter: Mr. J. G. BONNIN. Friday, July 9.-2 p.m., Symposium on Occupational Neurological Diseases. Pressure Neuropathy, Dr. H. G. Session GARLAND (Leeds); Metallic Poisons and the Nervous Chemistry Lecture Theatre. System, Dr. J. W. ALDREN TURNER (London); Damage to Friday, July 9.-9.30 a.m., Symposium on Poliomyelitis. the Nervous System from Gas Poisoning, Dr. R. S. ALLISON The Management of the Infectious Phase of Poliomyelitis, (Belfast); The New Insecticides and the Nervous System, Dr. T. ANDERSON (Glasgow); The Prevention of Deformity, Dr. A. M. G. CAMPBELL (Bristol). Cerebral Abscess, Mr. J. M. P. CLARK (Leeds); The Flail and Shortened Limb, Mr. J. E. PATERSON (Glasgow); Mr. W. S. LEWIN (Oxford). Mr. ROBERT ROAF (Liverpool). Occasional Papers: Treat- ment of Hallux Valgus by Arthrodesis, Mr. A. MAcDOUGALL (Glasgow); Penicillin Nerve Lesions, Mr. A. R. PARKES OCCUPATIONAL HEALTH (Glasgow). President: Professor THOMAS FERGUSON, C.B.E., M.D., PHYSICAL MEDICINE D.Sc., F.R.C.P.Ed., D.P.H., F.R.F.P.S. (Glasgow). Vice-Presidents: H. ALEXANDER, M.B., D.P.H. (London); President: W. S. TEGNER, B.M., B.Ch., F.R.C.P. (London). JOHN CRAW, M.B., F.R.F.P.S. (Whitehaven); J. J. O'DWYER, Vice-Presidents: P. BAUWENS, M.R.C.S., L.R.C.P. (Lon- C.B.E., M.D., D.P.H. (London). don); H. A. BURT, M.A., M.B., B.Ch., F.R.C.P. (London); Hon. Secretaries: GEO. BUCHANAN, B.L., L.R.F.P.S., DONALD WILSON, M.B., B.S., M.R.C.P. (Chichester). D.P.H., D.P.A., D.T.M.&H., D.I.H., 28, Langside Drive, Hon. Secretaries: A. C. BOYLE, M.D., M.R.C.P., Newlands, Glasgow, S.3: M. E. M. HERFORD, D.S.O., D.Phys.Med., Department of Physical Medicine, the M.C., M.B.E., M.B., D.P.H., Ferneham, Farnham Royal, Middlesex Hospital, W.1 ; T. N. FRASER, M.D., F.R.C.P., Bucks. F.R.F.P.S., 112, Southbrae Drive, Glasgow, W.3. Official Reporter: Mr. S. J. H. MILLER. Official Reporter: Dr. A. C. BOYLE. Session Session Zoology Lecture Theatre. Ophthalmology Lecture Theatre. Friday, July 9.-2 p.m., Recent Developments in Rehabi- Friday, Jutly 9.-9.30 a.m. (Joint Session with the litation, Group Captain C. J. S. O'MALLEY (London), Dr. Section of Ophthalmology). The Employment of the F. S. COOKSEY (London), Lieutenant-Colonel J. FRASER Visually Handicapped, Dr. WILLIAM HUNTER (Glasgow), (Inverness). Management of Degenerative Joint Disease, Dr. EDWIN GORDON MACKIE (Sheffield). Short papers re- Dr. H. A. BURT (London), Dr. LOGIE S. BAIN (Aberdeen), lated to the same subject will also be read by Dr. JAMES H. Dr. DONALD WILSON (Chichester). Electro-Diagnosis, Pro- BELL (Glasgow), Dr. M. E. M. HERFORD (Slough) fessor A. E. RITCHIE (St. Andrews), Dr. A. T. RICHARDSON -Eye Defects of School-leavers, Dr. ARCHIBALD R. MILLER (London), Squadron Leader C. B. WYNN PARRY (Farnham (Glasgow), and Mr. JOHN T. STEWART (Glasgow). Common). 326 JUNE 19, 1954 SUPPLEMENT TO THE ANNUAL MEETING: PROGRAMME BRITISH MEDICAL JOURNAL

PREVENTIVE MEDICINE AND INFECTIOUS Session DISEASES Natural Philosophy Lecture Theatre (new building). Presidenit: T. ANDERSON, M.D., F.R.C.P.Ed., F.R.F.P.S. Friday, July 9.-2 p.m., Carcinoma of Bladder, Mr. A. H. (Glasgow). JACOBS (Glasgow), Dr. G. W. BLOMFIELD (Sheffield). Leuk- Vice-Presidents: C. METCALFE BROWN, M.D., D.P.H., aemia, Dr. R. BODLEY SCOTT (London), Dr. A. A. CHARTERIS Barrister-at-Law (Manchester); S. C. GAWNE, M.D., B.S., (Glasgow), Dr. S. P. RAWSON (Glasgow). M.R.C.S., L.R.C.P., D.C.H., D.P.H., Barrister-at-Law (Liver- pool); STUART LAIDLAW, J.P., O.St.J., M.D., B.Sc., F.R.F.P.S., D.P.H., B.L., D.P.A. (Glasgow); LLYWELYN ROBERTS, M.D., SCIENTIFIC EXHIBITION M.R.C.P., D.P.H. (Sheffield). Kelvin Hall, July 5-9 Hon. Secretaries: JAMES H. LAWSON, M.D., D.P.H., The Exhibition will be open each day at 9 a.m. and will Ruchill Fever Hospital, Glasgow, N.W.; J. B. S. MORGAN, close on the first three days at 6 p.m. and on the last two M.B., B.Sc., M.R.C.S., D.P.H., County Health Department, at 5 p.m. County Offices, St. Mary's Gate, Derby. The following list gives brief details of the exhibit: Official Reporter: Dr. IAN TAYLOR. Royal Samaritan Hospital for Women and the Royal In- firmary, Glasgow. Diagnostic survey of the infertile Sessions marriage. Chemistry Lecture Theatre. Department of Ophthalmology, University of Glasgow. Wednesday, July 7.-9.30 a.m. (Joint Session with Section Eye changes in vascular disease with examples of clinical of Microbiology and Pathology), Poliomyelitis : Recent retinal photographs. Advances in Knowledge of the Virus, Dr. ALLAN P. GOFFE Scottish National Blood Transfusion Association, Edin- (London); Epidemiology, Dr. W. H. BRADLEY (London); burgh. Economical production in the laboratory of useful The Acute Case, with Special Reference to Respiratory plasma fractions and illustrations of their use. Failure, Dr. A. B. CHRISTIE (Liverpool). Department of Pharmacology and Therapeutics, Univer- Thursday, July 8.-2.30 p.m., The Epidemiology of Non- sity of Sheffield; National Centre of Radiotherapy, Shef- Infectious Diseases : The Epidemiological Method, Dr. J. N. field; Department of Medicine, University of Glasgow, MORRIS (London); The Epidemiology of Old Age, Dr. W. Royal Infirmary; and Department of Therapeutics, Uni- FERGUSON ANDERSON (Glasgow); The Epidemiological Ap- versity of Edinburgh. The role of radioactive iodine in proach to Obstetric Medicine, Dr. ANGUS M. THOMSON modern medicine. (Aberdeen); The Role of the Medical Officer of Health, Departments of Pathology and Surgery, Glasgow Royal Dr. JOHN RIDDELL (Edinburgh). Infirmary. Phaeochromocytosis-clinical aspects, diagnosis by adrenergic blocking drugs, treatment, and pathology, with special reference to malignancy. PSYCHIATRY Department of Anaesthesia, Glasgow Royal Infirmary. President: Professor T. FERGUSON RODGER, M.B., Hand plethysmography unit for use during surgical anaes- F.R.C.P.Ed. (Glasgow). thesia, with charts illustrating results. Vice-Presidents: MURIEL BARTON HALL, M.D., Ch.B. Department of Child Health, University of Glasgow, and (Liverpool); Professor ALEXANDER KENNEDY, M.D., F.R.C.P. Hospital for Sick Children, Glasgow. (1) Radioactive iodine (Newcastle-upon-Tyne); DAVID YELLOWLEES, M.B., Ch.B. studies in familial cretinism. (2) Chromatography, bio-assay, (Glasgow). and electrophoresis in the hormone treatment of nephrosis. Hon. Secretaries: T. C. N. GIBBENS, M.D., D.P.M., Insti- (3) Fibrocystic disease of the pancreas. tute of Psychiatry, Maudsley Hospital, Denmark Hill, Department of Health for Scotland. Statistical presen- London, S.E.5; HUNTER GILLIES, M.D., F.R.C.P.Ed., tation of certain topics within the interest of the department. D.P.M., Psychiatric Unit, Stobhill General Hospital, Glas- Rowett Research Institute, Bucksburn, Aberdeenshire. gow, N. The skeleton in lactation. Official Reporter: Professor A. KENNEDY. Department of Dermatology, Leeds General Infirmary. Some mycotic infections of the smooth skin and nails. Department of Child Health, University of Sheffield. Session Tuberculous meningitis. Natural Philosophy Lecture Theatre (new building). Nuffield Department of Clinical Medicine, Radcliffe In- Friday, July 9.-9.30 a.m., Depression: The Diagnosis of firmary, Oxford. The stomach in anaemia: (1) histology; Depression, Dr. W. MAYER-GROSS (Dumfries); The Risks of (2) studies on the intrinsic factor of Castle; and (3) estima- Suicide in States of Depression, Dr. E. STENGEL (London); tion of pepsin and uropepsinogen. The Treatment of Depression, Dr. I. R. C. BATCHELOR Nuffield Orthopaedic Centre, Oxford. (1) The aetio- (Edinburgh); The Rationale of Electrical Convulsion Treat- pathology of osteoarthritis of the hip. (2) Research on the ment, Dr. D. A. POND (London); Failures with Electrical clinical characteristics of scoliosis. Convulsion Treatment, Dr. J. L. CAMERON (Glasgow); The Departments of Medical Art, Neuroradiology, and Neuro- Effects of Depression on Industrial Efficiency, Dr. M. surgery, Manchester Royal Infirmary. The radiological MARKOWE (London); Depression in Relation to Crime, Dr. diagnosis of brain tumour. J. C. M. MATHESON (London). Crichton Royal Hospital, Dumfries. Demonstration of modern techniques in child psychiatry. Department of Psychological Research, Crichton Royal RADIOLOGY Hospital, Dumfries. Demonstration of psychometric testing. President: Professor B. W. WINDEYER, M.B., B.S., Department of Psychological Medicine, King's College F.R.C.S., F.F.R., D.M.R.E. (London). Medical School, Newcastle-upon-Tyne, and Biophysics Unit, Vice-Presidents: Professor ROBERT MCWHIRTER, Crichton Royal Hospital, Dumfries. Portable E.E.G. F.R.C.S.Ed., F.F.R., F.R.S.Ed. (Edinburgh); JOHN R. equipment. NUTrALL, M.D., F.F.R., D.M.R. (Leeds); S. D. Scorr PARK, The National Maternity Hospital, Dublin. Medical condi- M.B., Ch.B., D.M.R.E. (Glasgow). tions complicating pregnancy. Hon. Secretaries: DAVID STENHOUSE, M.B., F.R.F.P.S., Cancer Research Department, Royal Beatson Memorial F.F.R., D.M.R., X-ray Department, McAlpin Nursing Hospital, Glasgow. (1) Atmospheric pollution tests for Home, 121, Hill Street, Glasgow, C.3; J. J. STEVENSON, (a) arsenic, (b) benzpyrene, (c) radioactivity. (2) Analysis M.D., D.M.R., The Royal Cancer Hospital, Fulham Road, of tobacco smoke. (3) Liver cancer in animals. London, S.W.3. Urological Units, Victoria Infirmary, Glasgow, and Hair- Official Reporter: Dr. A. E. JONES. myres Hospital. Lanarkshire. (1) Prostatic obstruction. JUNE 19, 1954 ANNUAL SUPPLEMENT TO THE MEETING: PROGRAMME BRITISH MEDICAL JOURNAL 327 (2) Carcinoma of bladder. (3) Cases of aberrant ureter in 3 and 4.-Messrs. H. K. Lewis and Co. Ltd., 136, Gower Street. the female causing incontinence. W.C.1. Department of Pathology, Glasgow Royal Infirmary. The 5.-Messrs. Paines and Byrne Ltd.. Pabyrn Laboratories. Green- effect of A.C.T.H. and cortisone on repair of lesions induced ford, Middlesex. experimentally in animals for example, in peptic ulceration, 6.-Messrs. A. L. Simpkin and Co. Ltd., Hunter Road, hepatic cirrhosis, and quartz granuloma. Sheffield. 6. 7.-The Camden Chemical Co. Ltd., 61, Gray's Inn Road, Department of Pathology, Glasgow Royal Infirmary. London, W.C.1. Pituitary and adrenal changes in pathological conditions of 8.-The British Medical Association. man and animals. 10.-National Association for the Prevention of Tuberculosis, Royal Infirmary, Glasgow. Mitral disease. Pre-opera- Tavistock House. Tavistock Square, London, W.C.1. tion investigation, especially cardiac catheterization and 1i.-Family Doctor, B.M.A. House, Tavistock Square. London, auricular puncture. Comparison of operation findings with W.C.l1. pre-operation assessment. Post-operation assessment. 12.-Wright, Layman and Umney, 42-50, Southwark Street, Auricular biopsy findings. Pathological specimens show- S.E.1. ing complications of interest. 13.-Messrs. Airmed Ltd., East Industrial Estate, Harlow, Esseix. 14.-Oxford University Press, Press Road, Neasden, London, Department of Infectious Diseases, University of Glasgow. N.W.10. and Public Health Department, City of Glasgow. (1) 15.-Cambridge Instrument Co. Ltd., 13, Grosvenor Place. Statistics of the City of Glasgow for acute respiratory London, S.W.1. diseases during the last 25 years. (2) Results of bacterio- 16.-Roche Products Ltd., 15, Manchester Square, London, W.1- logical examination. (3) Results of virological examination. 17.-Messrs. May and Baker, Ltd., Dagenham, Essex. Department of Pathology, Western Infirmary, Glasgow. 18.-Messrs. Glaxo Laboratories Ltd., 963, Greenford Road, Studies on iron metabolism in man and experimental Greenford, Middlesex. I 19.-Messrs. S. H. Camp and Co. Ltd., 19, Hanover Square, animals, illustrated by colour photography. I Royal Army Medical College. Mite-borne (scrub) typhus. London. WI. 20.-Board of Registration of Medical Auxiliaries, Tavistock National Coal Board Medical Service. Research into the House North, Tavistock Square, London, W.C.1. physiological and psychological effects of work in hot and 21. Messrs. Eli Lilly and Co. Ltd., Basingstoke, Hants. humid atmospheres. 22.-Messrs. Menley and James, Ltd., Coldharbour Lane, S.E.5. The Royal Cancer Hospital, London. Demonstration of 23 and 24.-Messrs. Pfizer Ltd., 137-139, Sandgate Road, Folke- cancer of the breast. stone, Kent. St. Bartholomew's Hospital, London, and the Royal 25.-Messrs. Chas. F. Thackray Ltd., 10, Park Street, Leeds, 1. Cancer Hospital. Portal hypertension; distribution, effect 26.-Messrs. G. D. Searle and Co. Ltd., 17, Manchester Street, of different treatments on prognosis, liver function, blood W.1. 27.-E.M.I. Sales Service Ltd., Hayes, Middlesex. counts. 28.-The Ethicon Laboratories Bankhead Avenue, Rehabilitation Committee of B.M.A.; Ministry of Labour. Suture Ltd., Sighthill, Edinburgh, 11. Scope and facilities for rehabilitation. 29.-Messrs. Benger Laboratories Ltd., Holmes Chapel, Cheshire. Food Hygiene Laboratory of the Central Public Health 30.-British Oxygen Co. Ltd., Medical Division, Great West Laboratory, Colindale. Bacterial food-poisoning and other Road, Brentford, Middlesex. food-borne disease. 31.-Messrs. Duncan, Flockhart and Co. Ltd., 104, Holyrood The Wright-Fleming Institute of Microbiology, St. Mary's Road, Edinburgh, 8. Hospital, London. Demonstration of basic mechanisms of 32.-Messrs. Boots Pure Drug Co. Ltd., Station Street. immediate and delayed reactions and Nottingham. (pollen) (tuberculin) 33.-Messrs. Burroughs Wellcome and Co., 183-193, Euston their clinical significance. Road, London, N.W.1. British European Airways, with the Scottish Air Ambu- 34.-Distillers Company (Biochemicals) Ltd., Fleming Road. lance Scheme of the Department of Health for Scotland. Speke, Liverpool, 19. Medical aspects of the Highlands and Islands Air Ambu- 35.-The Crookes Laboratories Ltd., Gorset Road, Park Royal, lance Service. N.W.10. Royal Air Force, Directorate General of Medical Services. 36.-British Drug Houses Ltd., Graham Street, City Road, Recent advances in electrodiagnosis and electrotherapy. London, N.l. Royal Navy (Royal Naval Personnel Research Committee, 39.-Ciba Laboratories Ltd., Horsham, Sussex. and Director of 40.-Sandoz Products Ltd., 134, Wigmore Street, London, W.I. Naval Life Saving Committee, Victualling). 41.-Calmic Ltd., Crewe Hall, Crewe. Advances made since the 1939-45 war on survival at sea and 42.-Messrs. Smith and Nephew Ltd., Tewin Road, Welwyn cold- and foul-weather clothing. Garden City, Herts. 43.-Don S. Momand Ltd.. 58, Albany Street, N.W.1. SPECIAL EXHIBITIONS 44.-Lederle Laboratories Division, Cyanamid Products Ltd., Bush House, Aidwych, London, W.C.2. Kelvin Hall, July 5-9 45.-Messrs. Allen and Hanburys Ltd., Bethnal Green, London, Royal Faculty of Physicians and Surgeons of Glasgow. E.2. Glasgow in the history of medicine. 46.-Messrs. Parke, Davis and Co. Ltd., Staines Road, Hounslow, Pharmaceutical of Great Britain. Recent ad- Middlesex. Society 47.-Imperial Chemical (Pharmaceuticals) Ltd., Fulshaw Hall, vances in pharmaceutical science ; objects of historical Wilmslow, Manchester. interest. 48.-Messrs. Cow and Gate Ltd., Guildford, Surrey. Royal Photographic Society, Medical Group. One 49.-Westminster Bank Ltd., 41, Lothbury, London, E.C.I. hundred years of medical photography. 50.-Messrs. Reckitt and Colman Ltd., Dansom Lane, Hull. Ministry of Labour and National Service. The rehabili- 51.-London Hospital (Ligature Department) Ltd., London Hos- tation and resettlement of the disabled. pital, Whitechapel Road, London, E.1. 52.-Messrs. Butterworth and Co. (Publishers) Ltd., 88, Kings- way, London, W.C.2. EXHIBITION OF PHARMACEUTICAL PRODUCTS, 53.-Phillips Electrical Ltd., Century House, Shaftesbury Avenue, INSTRUMENTS, APPLIANCES, AND MEDICAL London, W.C.2. PUBLICATIONS 54.-Messrs. John Wyeth and Bro. Ltd., Clifton House, Euston W.C.I. Kelvin 5-9 9 a.m.-6 each Road, Hall, July (Open p.m. day) 55.-Energen Foods Co. Ltd.. Willesden, London, N.W.10. EXHIBITORS 56.-The Scholl Manufacturing Co. Ltd., 182-204, St. John Stand No. Street, London, E.C.1. 1.-Messrs. Down Bros. and Mayer and Phelps, Ltd., Chiron 57.-Medical Insurance Agency Ltd., B.M.A. House, Tavistock House, 32-34, New Cavendish Street, London, W.I. Square, W.C.1. 2.enito Urinary Manufacturing Co. Ltd., 28, Devonshire 58.-Messrs. Bayer Products Ltd., Africa House, Kingsway, Street, London, W 1. London, W.C.2. SUPPLEMENT TO THE 328 JUNE 19, 1954 ANNUAL MEETING: PROGRAMME BRITISH MEDICAL JOURNAL 59.-Lucozade Ltd., Great West Road, Brentford, Middlesex. Saturday, July 3 62.-Organon Laboratories Ltd., Brettenham House, Lancaster 9.00 a.m.-Annual Representative Meeting Inquiry Office open. Place, W.C.2. 9.00 a.m.-Council Meeting, Forehall, University. 63.-Messrs. C. L. Bencard Ltd., Minerva Road, London, 9.30 a.m.-Ladies' Club open. N.W.l0. 10.00 a.m.-Annual Representative Meeting. 64.-Messrs. Bailliere, Tindall and Cox, Ltd., 7 and 8, Henrietta 10.30 a.m. to 5.30 p.m.-L. All-day excursion to the Lake of Street, Covent Garden, London, W.C.2, Menteith and visit to Stirling Castle. Luncheon at 66.-Messrs John Smith and Son (Glasgow) Ltd., 26-30, Gibson the Lake of Menteith Hotel or the Lion and the Street, Hillhead, Glasgow, W.2. Unicorn, Thornhill. Tea at Stirling Castle (by kind 67.-Messrs. E. Hutchings and Co., Ltd., 18, Charterhouse invitation of the Stirling Branch and by kind per- Square, E.C.1. mission of Major J. G. D. Fanshawe and the Officers 68.-Messrs. E. and S. Livingstone Ltd., 16-17, Teviot Place, of the Regimental Headquarters and Depot, the Edinburgh, 1. Argyll and Sutherland Highlanders). (For 100.) 69.-Messrs. Edward Taylor Ltd., Monton, Eccles, Manchester. Ticket 12s. 6d. 76.-Messrs. Oxygenaire (London) Ltd., 8, Duke Street, Wigmore 7.30 p.m.-Aberdeen Graduates' Dinner, North British Hotel, Street, W.1. George Square, Glasgow, C.2. Ticket 25s., exclud- 77.-Matburn, Ltd., 25, Red Lion Street, W.C.l. ing wines. 78.-Remploy Ltd., Advertising Department, 25, Buckingham 7.30 p.m.-Edinburgh Graduates' Dinner, Grosvenor Restaur- Gate, London, S.W 1. ant, Gordon Street, Glasgow, C.I. Ticket 30s., in- 79.-Ortho Pharmaceuticals Ltd., Lane End, High Wycombe, cluding aperitifs. Bucks. 7.30 p.m.-Glasgow Graduates' Dinner, Royal Faculty of Physicians and Surgeons, 242, St. Vincent Street, Glasgow, C.2. Ticket 30s., including aperitifs. TIME-TABLE OF MEETINGS 7.30 p.m.-Welsh Dinner, Grosvenor Restaurant, Gordon Street, R.-Events available for members of Representative Body and Glasgow, C.1. Ticket 30s., excluding wines. Ladies accompanying them. 8.30 p.m.-R. Block Booking, " Half-past Eight " (Summer L.-Events primarily arranged for Ladies. Revue), Albambra Theatre, Wellington Street, U.-Events for all Members and Ladies accompanying them. Glasgow, C.2. (For 150.) Ticket 7s. 6d. *Academic Robes should be worn. Sunday, July 4 Wednesday, June 30 10.15 a.m. to 6.00 p.m.-All-day sail on the Firth of Clyde with 4.30 to 6.30 p.m.-Annual Representative Meeting Inquiry luncheon, afternoon tea, and return by train. In- Office open at Bute Hall, University. clusive ticket 30s. 4.30 to 6.30 p.m.-Ladies' Club open, the College Rooms, 8.30 to 10.15 p.m.-Concert, Kelvin Hall, Kelvingrove, specially University. arranged by the B.B.C. and to be broadcast on the 8.30 to 10.30 p.m.-R. Cocktail Party (by invitation of the Scottish Home Service from 9.15 to 10.15 p.m. Glasgow Division), Trades House, Glassford Street, Glasgow, C.l. Monday, July 5 9.00 a.m.-Annual Representative Meeting Inquiry Office open. 9.00 a.m.-Scientific Exhibition opens at the Kelvin Hall, Thursday, July 1 Kelvingrove. 9.00 a.m.-Annual Representative Meeting Inquiry Office open 9.00 a.m.-Exhibition of Pharmaceutical Products, Instruments, at Bute Hall, University. Appliances, and Medical Publications, opening by 9.00 a.m.-Ladies' Club open, the College Rooms, University. the President-Elect, Kelvin Hall, Kelvingrove. 10.00 a.m.-Annual Representative Meeting commences, Bute 9.00 a.m.-Reception Room for Registration opens at Kelvin Hall, University. Hall, Kelvingrove. 11.00 a.m.-Welcome by the Right Honourable the Lord 9.30 a.m.-Ladies' Club open. Provost of Glasgow to Annual Representative Meet- 9.30 a.m. to 5.00 p.m.-L. All-day excursion to the Kingdom ing. of Fife and visit to Falkland Palace. Coffee at the 2.00 to 5.30 p.m.-L. Excursion to Loch Lomond (afternoon Green Hotel, Kinross, Loch Leven, and luncheon at tea by kind invitation of Lady Colquhoun of Luss Auchtermuchty by kind invitation of Mrs. H. B. and Major-General A. P. D. Telfer-Smollet, Lord Muir and the Fife Branch. (For 60.) Inclusive Lieutenant of Dunbartonshire). (For 100.) Inclu- ticket, 12s. 6d. sive ticket, 6s. 10.00 a.m.-Annual Representative Meeting. 7.30 p.m.-R. Representatives' Dinner, Central Hotel, Gordon 11.00 a.m.-L. Notts Ladies' Challenge Cup Golf Competition Street, Glasgow, C.l. Ticket 25s., excluding wines. at Buchanan Castle Golf Club (non-golfers also 8.00 p.m.-L. Representatives' Ladies' Dinner, Central Hotel, invited). Gordon Street, Glasgow, C.l. Ticket 25s., including 12.30 p.m.-Annual General Meeting, Bute Hall, University. aperitifs. p.m.-Council Meeting, Forehall, University (at conclusion 9.30 p.m.-R. Representatives' Dance, Central Hotel, Gordon of Annual Representative Meeting). Street, Glasgow, C.l. Ticket 10s., including buffet. 5.00 p.m.-Medical Films, Kelvin Hall (first floor). 8.15 p.m.-U.* Adjourned Annual General Meeting and Presi- Friday, July 2 dent's Address, Kelvin Hall, Kelvingrove. (For 9.00 a.m.-Annual Representative Meeting Inquiry Office open. 1,100.) 9.30 a.m.-Ladies' Club open. 9.30 p.m. to 12 midnight.-U.* President's Reception. Bute 9.30 a.m.-Annual Representative Meeting. Hall, University. (For 1,100.) 9.30 a.m. to 6.00 p.m.-L. All-day excursion to the Trossachs, returning via Duchray Valley, including State Forest Tuesday, July 6 (Sail on Loch Katrine and luncheon by kind invita- 9.00 a.m.-Reception Room for Registration open. tion of Glasgow Corporation). (For 100.) Inclu- 9.00 a.m.-Scientific Exhibition open. sive ticket, 12s. 6d. 9.00 a.m.-Exhibition of Pharmaceutical Products, Instruments, 1.00 p.m.-Overseas Luncheon, Royal Faculty of Physicians Appliances, and Medical Publications open. and Surgeons. 242, St. Vincent Street, Glasgow, C.2. 9.30 a.m.-Ladies' Club open. 2.00 to 6.00 p.m.-L. Visit to Livingstone Memorial, Blantyre; 9.30 a.m. to 12 noon.-Scientific Plenary Session-" The Prob- Clyde Valley and Lanark (afternoon tea at Clydesdale lem of Sleep," Arena, Kelvin Hall. Hotel by kind invitation of the Lanarkshire 10.30 a.m. to 12.30 p.m.-L. Visit to the grounds of Eastwood Division). (For 40.) Inclusive ticket, 6s. Park, Renfrewshire, and coffee by kind invitation of 5.00 p.m.-Cocktail Party for Women Representatives and Viscountess Weir. (For 60.) Transport ticket, 2s. medical women accompanying Representatives, 2.30 p.m.-Robing for Religious Service, Royal Infirmary. Royal Faculty of Physicians and Surgeons, 242, St. 3.00 p.m.-U.* Official Religious Service, Glasgow Cathedral. Vincent Street, Glasgow, C.2 (by invitation of the 3.00 p.m.-U.* Roman Catholic Service, St. Andrew's Medical Women's Federation, Scottish Western Cathedral, Glasgow, followed by reception at St. Association). Enoch Hotel by the Archbishop of Glasgow. 8.00 to 10.00 p.m.-Reception and Demonstration by Director 5.00 p.m.-Reception by Royal Faculty of Physicians and and Staff at Glasgow Art Gallery, Kelvingrove. (For Surgeons, 242, St. Vincent Street, Glasgow, C.2. 600.) (Numbers limited.) SUPPLEMENT TO THE JUNE 19, 1954 ANNUAL MEETING: PROGRAMME BRITISH MEDICAL JOURNAL 329

8.00 p.m. to 12 midnight.-U.* Reception and Dance by invita- 9.00 a.m.-Exhibition of Pharmaceutical Products, Instruments, tion of the Right Honourable the Lord Provost of Appliances, and Medical Publications open. Glasgow and Magistrates at the City Chambers, 9.15 to 11.45 a.m.-Scientific Plenary Session-" The Problem George Square, Glasgow, C.2. (For 750.) of Pulmonary Tuberculosis To-day," Arena, Kelvin Hall. Wednesday, July 7 9.30 a.m.-Ladies' Club open. 9.30 a.m. to 5.30 p.m.-L. All-day excursion to Edinburgh. 8.15 aan.-Annual Breakfast of the Christian Medical Fellow- Visit to Castle, St. Giles' Cathedral, John Knox's ship, the Union, University Avenue, Glasgow. House, Holyrood Palace. Return via Forth Bridge 9.00 a.m.-Reception Room for Registration open. and 9.00 a.m.-Scientific Exhibition open. Linlithgow. (Luncheon by kind invitation of 9.00 a.m.-Exhibition of Pharmaceutical Products, Instruments, the Edinburgh Division. Tea by kind invitation of Appliances, and Medical Publications open. Mrs. David Band.) (For 60.) Inclusive ticket, 9.30 a.m.-Ladies' Club open. 12s. 6d. 10.00 9.30 a.m to 12.30 p.m.-Scientific Sections, University. a.m.-Treasurer's Cup Golf Competition and Medal Com- 10.00 a.m.-Leinster and Childe Cup Golf Competition at pctition at Old Prestwick Golf Club, Prestwick, Western Golf Club, Gailes, Ayrshire. Ayrshire. 10.00 a.m. to 5.00 p.m.-L. All-day excursion to Burns Country. 12.15 p.m.-University Meeting in the Bute Hall for the con- Morning coffee at the Dutch House by kind invita- ferring of honorary degrees. tion of the Ayrshire Division. Luncheon at the 2.30 to 5.30 p.m.-Scientific Sectionis, University. Burns Monument Hotel. Tea by kind invitation of 3.00 to 5.30 p.m.-U. Garden Party in the grounds of the Mrs. Kennedy, of Doonholm. (For 60.) Inclusive Glasgow Royal Mental Hospital, Gartnavel, 1055, ticket, 12s. 6d. Great Western Road, Glasgow, W.2, by invitation 1.00 p.m.-Irish Graduates' Luncheon, the Union, University of the Medical Superintendent and the Board of Avenue. 7s., excluding wines. Management. (For 200.) 2.00 to 3.00 p.m.-President and Party, Official Tour of 5.00 p.m.-" At Home " for Overseas Visitors given by the Scientific Exhibition. Empire Medical Advisory Bureau, Royal Faculty of 3.00 p.m.-Overseas Conference, Forehall, University. Annual Physicians and Surgeons, 242, St. Vincent Street, Report by the Secretary of the Overseas Committee, Glasgow, C.2. followed by general discussion. 7.30 p.m.-U. Annual Dinner, Central Hotel, Gordon Street, 3.00 to 5.30 p.m.-Scientific Pleniary Session-" Food and Glasgow, C.l. (For 350.) Ticket £2 10s., including Disease," Arena, Kelvin Hall. wines. 5.00 to 6.00 p.m.-Reception for Overseas visitors given by the Over-seas League, 3, Claremont Terrace, Glasgow, Friday, July 9 C.3. 9.00 a.m.-Reception Room for Registration open. 5.45 p.m.-Medical Films, Kelvin Hall (first floor). 9.00 a.m.-Scientific Exhibition open. 8.00 to 11.30 p.m.-U.* Reception and Dance in the Bute Hall 9.00 a.m.-Exhibition of Pharmaceutical Products, Instruments, by invitation of the University of Glasgow. (For Appliances, and Medical Publications open. 800.) 9.30 a.m.-Ladies' Club open (closes at 1 p.m.). 9.30 a.m. to 12.30 p.m. Scientific Sections, University. Thursday, July 8 2.00 to 5.00 p.m.-Scientific Sections, University. 9.00 a.m.-Reception Room for Registration open. 8.00 p.m. to 1.00 a.m.-U. Dance, the Union, University 9.00 a.m.-Scientific Exhibition open. Avenue, Glasgow. (For 350.) Ticket 15s.

Street map of Glasgow. SUPPLEMENT TO THE 330 JUNE 19, 1954 AGENDA OF A.R.M. BRITISH MEDICAL JOURNAL British Medical Association AGENDA OF ANNUAL REPRESENTATIVE MEETING, JULY 1, 2, 3, AND 5, 1954, IN THE BUTE HALL, UNIVERSITY, GLASGOW CHAIRMAN: Dr. S. WAND, Birmingham PRELIMINARY BUSINESS SCOTLAND Items 1 to 7 relate to preliminary business. 17. Motion by the Chairman of the Scottish Committee on behalf of the Council: That the Annual Report of REPORT OF AGENDA COMMITTEE Council under " Scotland" (Doc. A.R.M. 2, paras. 156-64) Grouping of AMotions and Amendments be received. 8. The Committee has arranged certain Motions and 18. Motion by the Chairman of the Scottish Committee: Amendments which cover substantially the same ground in That the Annual Report of Council under " Scotland " be groups and has selected in each group one Motion or approved. Amendment (marked with an asterisk *) on which it pro- PRIVATE PRACTICE poses that discussion should take place. The Representatives 19. Motion by the Chairman of the Private Practice of the Constituencies concerned have been informed of Committee on behalf of the Council: That the these proposals in accordance with Standing Order 21 (iii). Annual and Supplementary Reports of Council under " Private Practice" (Docs. A.R.M. 2, paras. 105-17, and Order of Businiess A.R.M. 3, paras. 226-31) be received. 9. The Committee recommends: Recommendation: (1) That the business under " Over- One-day Certificates to Miners: Bonus Shift Certificates seas" be taken at 11 a.m. on Saturday, July 3; 20. Motion by MORPETH: That the B.M.A. approach (2) That " Other Motions by Divisions and Branches," the Minister of Health concerning the issue of one-day if not previously dealt with, be considered as the first certificates to miners and requests him to institute negotia- business on Monday, July 5, after the Official Votes of tions with the Ministry of Fuel and Power with a view to Thanks; their complete abolition. (3) That, with these exceptions, the order of the business be as set out in the Agenda. Life Assurance: Fee for Ordinary Form 21. Motion by the Chairman of the Private Practice Com- STANDING ORDERS mittee: That para. 106 of the Annual Report of Council 10. Motion by the Chairman: That the Standing Orders be approved. (Doc. A.R.M. 5) as circulated with this Agenda be adopted 22. Amendment by SOUTH-EAST ESSEX: That the stand- as the Standing Orders of the Meeting. ard fee for medical examination and report for life assurance should be increased from one and a half guineas PRELIMINARY to a minimum of two guineas. I1. Motion by the Chairman of Council on behalf of the *23. Amendment by GREENWICH AND DEPTFORD: That Council: That the Annual and Supplementary Reports of this Annual Representative Meeting is of the opinion that Council under " Preliminary " (Docs. A.R.M. 2, paras. 1-17, the fee for life assurance examination should be increased and A.R.M. 3, paras. 190-3) be received. to £2 2s. 24. Amendment by HARROW: That this Meeting re- Election of Vice-Presidents affirms the resolution passed at the 1953 A.R.M.-namely, 12. Motion by the Chairman of Council: That, with effect that the fee for the ordinary form of life assurance exam- from the conclusion of his term of office as President, Mr. ination should be increased from £1 lls. 6d. to £2 2s. J. W. Tudor Thomas, M.D., M.S., D.Sc., F.R.C.S., be elected a Vice-President of the Association in recognition 25. Amendment by BOLTON: That the fees for medical of his valuable services to the Association. examinations or reports for life assurance purposes should 13. Motion by the Chairman of Council: That Mr. be a minimum of two guineas for a full examination and A. M. A. Moore, F.R.C.S., be elected a Vice-President of one guinea for a report without examination. the Association in recognition of his valuable services to the Association. Life Assuralnce-Attendance Reports 26. Motion by RUGBY and SOUTH WARWICKSHIRE: That Service Representatives on Council this Meeting is of opinion that there is no objection to the 14. Motion by the Chairman of Council: That the follow- issue of attendance reports (that is, reports, without medical ing be elected as reprcsentatives. of the R.A.M.C. and the examination, regarding persons proposing to take out life Medical Branch of the Royal Air Force on the Council for assurance policies), provided that: (i) a suitable form of the period 1954-7: Royal Army Medical Corps: Major- consent signed by the patient agreeing to such a report General J. C. A. Dowse, C.B., C.B.E., M.C.; Medical being issiued is forwarded by the company to the prac- Branch of the Royal Air Force: Air Vice-Marshal W. E. titioner for his retention; and (ii) a suitable fee is agreed Barnes, C.B.E. upon, depending on the complexity of the report required. Coat of Arms 15. Motion by the Chairman of Council: That the pro- Duration Certificates posed coat of arms, as designed by the College of Arms, be 27. Motion by the Chairman of the Private Practice Com- accepted as a gift to the Association from the members of mittee: That para. 108 of the Annual Report of Council Council. be approved. 28. Amendment by OXFORD: That this Meeting supports Remainder of Report under " Prelinminary" the motion concerning duration certificates, referred to 16. Motion by the Chairman of Council: That the re- Council at the A.R.M., 1953, and affirms that it should mainder of the Annual and Supplementary Reports of supersede the resolution of the A.R.M., 1937, reaffirmed in Council under "Preliminary" be approved. 1949. SUPPLEMENT TO THE JUNE 19, 1954 AGENDA OF A.R.M. BRITISH MEDICAL JOURNAL 331 29. Amendment by RUGBY and SOUTH WARWICKSHIRE: 37. Motion by the Chairman of the Constitution Com- That this Meeting is of the opinion that (1) a " duration mittee: That the Annual Report of Council under "Con- certificate" (that is, a medical report about the previous stitution of the Association" be approved. health and medical history of a person who has died shortly after having been accepted for life assurance, without prior to medical examination) could jeopardize, but could never be Access Parliamzent and Ministry of Health essential to, the claim to the assurance. (2) A practitioner 38. Motion by MARYLEBONE: That this Meeting draws should not, therefore, issue such a certificate unless all the attention to the fact that the Representative Body has no following conditions have been fulfilled: access to Parliament nor to the Minister of Health, either (a) The proposer dies within three years of taking out directly or through its Council, and requires that plans be the policy. presented at the next Annual Representative Meeting to (b) The original proposal, read and signed by the pro- correct this anomaly. poser, contained a clause authorizing the company to apply for, and the doctor to issue, a " duration certifi- ARBITRATION MACHINERY cate" in the event of early death. 39. on (c) The original proposal be produced for the prac- Motion by the Chairman of the Committee Arbi- titioner's inspection. tration Machinery on behalf of the Council: That the Annual and Supplementary Reports of Council under A certified copy a (d) photostat (or duplicate actually "Arbitration Machinery" (Docs. A.R.M. 2, para. 83, and the be to the for signed by proposer) supplied practitioner A.R.M. 3, para. 210) be received. his retention. 40. Motion by LIVERPOOL: That this Meeting also notes (e) The policy has been taken oilt prior to December 31, with satisfaction that the question of arbitration is to be 1954. raised again by the Staff Side in the near future. 30. Motion by NEWCASTLE-UPON-TYNE: That all indus- *41. Motion by WORCESTER AND BROMSGROVE: That trial insurance companies should require a medical certificate there should be the unilateral right to arbitration. from clients to the effect that he/she has been in good 42. Motion by WINCHESTER: That in view of the unsatis- health for two years prior to taking a policy. factory consultant award, Council be instructed to press urgently for the right of unilateral access to arbitration. Remainder of Report under "Private Practice" 31. Motion by the Chairman of the Private Practice Com- mittee: That the remainder of the Annual and Supple- 43. Motion by the Chairman of the Committee on Arbi- mentary Reports of Council under "Private Practice" be tration Machinery : That the Annual and Supplementary approved. Reports of Council under "Arbitration Machinery" be Medical Witnesses in Law Courts approved. 32. Motion by SWANSEA: That this Meeting, having con- sidered the case where a local single-handed general prac- HOSPITAL AND CONSULTANT SERVICES titioner was compelled, under a subpoena, to spend four days at the Assize Court recently held at a town 45 miles 44. Motion by the Chairman of the Central Consultants distant, the action in which his evidence was required not and Specialists Committee on behalf of the Council : That commencing until the third day of his attendance, and his the Annual and Supplementary Reports of Council under medical evidence not being taken until the fourth day, and " Hospital and Consultant Services " (Docs. A.R.M. 2, paras. realizing that similar occurrences are taking place all over 53-81, and A.R.M. 3, paras. 206-8) be received. the country, causing great hardship to doctors and patients alike, calls upon the Council of the British Medical Asso- ciation to approach the Lord Chancellor's department seek- Review of Consultant Organization ing a drastic change for the better in the present methods 45. Motion by the Chairman of the Central Consultants. witnesses. of summoning and hearing medical and Specialists Committee: That paras. 53 and 206 of the Fees for Services of Medical Practitioners Called in by Annual and Supplementary Reports of Council be approved. the Police 46. Amendment by WORCESTER AND BROMSGROVE: That in subparagraph (3) of para. 206, the last words should be OF WIGHT: That in those areas 33. Motion by ISLE amended to read "who are graded as consultants, senior where adequate remuneration is not being paid by the hospital medical officers, and G.P. 10(b)'s." police authorities for the services of medical practitioners, the Council be asked to take action with the Associations of Local Authorities to support local claims. Hospital Junior Staffing Remluneration of Members of Medical Boards 47. Motion by the Chairman of the Central Consultants, and paras. 34. Motion CITY OF EDINBURGH: That in the Specialists Committee: That 54 and 207 of by opinion the of the Representative Body the time has come for an in- Annual and Supplementary Reports of Council be crease in the remuneration of members of medical boards approved. under the various Ministries (for example, the Ministry of 48. Amendment by SWANSEA: That this Meeting de- Labour and National Service, and the Ministry of National plores the implied merger of the senior hospital medical Insurance and Pensions). officers with senior registrars in the senior medical officer grade, and it believes that the S.H.M.O. grade should Constitution of Private Practice Committee remain linked with the consultants and specialists group. 35. Motion by MARYLEBONE: That this Meeting instructs 49. Motion by CLEVELAND: That this Meeting urges that the the Council to form a plan whereby the Private Practice training of registrars in all specialties should be Committee shall be truly representative of private practice, a continuous and progressive process, and that a period of both general and consultant. not less than 12 months in a non-teaching hospital should be necessary to qualify for consultant status. 50. Motion by BRIGHTON AND MID-SUSSEX: That the CONSTITUTION OF THE ASSOCIATION Representative Body feels that the ratio of all grades of 36. Motion bv the Chairman of the Constitution Com- registrars to consultants' sessions should be equal in teaching mittee on behalf of the Council: That the Annual Report and non-teaching hospitals, and that both grades of these of Council under "Constitution of the Association" (Doc. registrars should interchange between these respective hos- A.R.M. 2, para. 155) be received. pitals. OF A.R.M. SUPPLEMENT TO THE 332 JUNE 19, 1954 AGENDA BRITISH MEDICAL JOURNAL

51. Motion by WORCESTER AND BROMSGROVE: That the *66. Amendment by AYRSHIRE: That the Annual Repre- Council be asked to investigate the possibility of arranging sentative Meeting insists that future negotiations on behalf suitable liaison between regional hospital boards, hospital of the consultants and specialists shall be conducted by management committees, and executive councils so that B.M.A. machinery. registrars who have failed to become consultants may find 67. Amendment by SOUTHPORT: That this Meeting recom- those vacancies in general practice where there is an oppor- mends that future negotiations for remuneration of the tunity to continue in the local hospital the specialist work profession should be conducted under the auspices of the for which they have been trained. B.M.A., which should insist on the right to arbitration. 68. Amendment by SOUTHAMPTON: That this Meeting Senior Registrars and Additional Conslultant Posts does not recognize the recent agreement on hospital medical 52. Motion by NORTH GLAMORGAN AND BRECKNOCK: That staffs' salaries as either adequate or just, and it urges the this Meeting is of opinion that the Minister should increase Association to take over negotiations and take every the number of part-time consultant posts in general medicine possible step to refer the problem to arbitration and to and surgery and in psychiatry. obtain for any future occasion the right of unilateral access to arbitration. Remuneration of Hospital Medical Staff 69. Amendment by CONSETT: That as the B.M.A. is criti- 53. Motion by the Chairman of the Central Consultants cized for not taking sufficient interest in the welfare of hos- pital medical staff and for not retaining full control and Specialists Committee: That paras. 58 and 208 of the of its Annual and Supplementary Reports of Council be approved. Consultants and Specialists Committee, so that the full nego- tiating power and machinery of the B.M.A. could be used, *54. Amendment by HEXHAM: That this Meeting is dis- this Meeting that an attempt should be satisfied with the recent consultants' award, and the reasons considers made to given therefor. reunite the various sections of the profession so that in any future negotiations there is a backing from the 55. Amendment by WORCESTER AND BROMSGROVE: That B.M.A. in toto. this Meeting is profoundly dissatisfied with the alteration 70. Amendment by CONSETT: That the in remuneration and the manner of the negotiations. B.M.A. take 56. Amendment by DARTFORD: That this Meeting de- over all negotiations on remuneration, conditions of service, plores the departure from Spens in the recently negotiated and the right to,arbitration for the profession as a whole. readjustment of salaries of hospital medical staff and 71. Amendment by NOrrINGHAMSHIRE: That the recent of hospital medical demands that acceptance of this interim settlement shall not agreement on the remuneration staff has prejudice the claim that further adjustments should be made led to a loss of confidence in the negotiators and to dissatis- which are in keeping with the recommendations of the Spens faction with the constitution of the Joint Committee, and therefore with the Staff Side of Whitley Council. It is Report. therefore resolved that the British Medical 57. Amendment by CONSETT: That the recent new Association agreement for remuneration of hospital medical and dental should become the negotiating body for all branches of the staff is not satisfactory. profession. 72. Amendment by SOUTHAMPTON: That, bearing in mind *58. Amendment by MANCHESTER: That this Meeting the limitations imposed on the Royal Colleges by their deplores the inadequacy of the recent agreement reached on charter, which restricts their medico-political activities, this the remuneration of hospital medical staffs, and urges that Meeting feels that a reorganization of the Joint Committee steps be taken to reopen this matter immediately, with a is essential and that the Consultants and Specialists Com- view to obtaining the implementation of the Spens Report mittee of the Association should have a greater part in all as applied to consultants and specialists and obtaining ade- future negotiations as representatives of the hospital medical quate betterment. In the event of disagreement the matter staff, and instructs Council to take urgent action to imple- should be referred to arbitration. ment this resolution. 59. Amendment by WORCESTER AND BROMSGROVE: That 73. Amendment by CONSETT: That the Central Consul- further negotiations be opened immediately to obtain a tants and Specialists Committee be renamed the Hospital figure which is consistent with the Spens recommendations. Medical Staff Committee and be a normal committee with- 60.,mendment by HEREFORD: That the Representative out autonomy and be composed of elected " " representatives Body is dissatisfied with the award of Committee B of from the Branches. the Medical Whitley Council for the remuneration of 74. Amendment by CONSETT: That the Regional Consul- hospital and consultant services, in that the recommenda- tants and Specialists Committees be abolished and that all tions of the Spens Report have not been implemented, and matters connected with hospital medical staff be dealt with directs the Council to insist that negotiations be reopened. through the normal channels-that is, Division and Branch 61. Amendment by HOLLAND: That the recent increase to the Representative Body and Council. in remuneration of hospital medical officers does not imple- 75. Amendment by MARYLEBONE: That in view of the ment or safeguard the Spens Report, and the Council is frustration experienced in the Whitley machinery, this requested to take such immediate action as is possible to Meeting advises the Central Consultants and Specialists secure an award in the terms of the Spens Report. Committee and the Joint Consultants Committee to with- 62. Amendment by SOUTHPORT: That this Meeting ex- draw from Whitley, and to arrange a direct approach to presses dissatisfaction both with the method of negotiation the Minister. and the result in relation to remuneration of hospital medical 76. Amendmentby WEST DENBIGH AND FLINT: That the staff, and urges that negotiationsbe reopened. S.H.M.O. remuneration should be raised forthwith to ap- proximate more nearly to that of consultant. 63. Amendment by WORCESTER AND BROMSGROVE: That 77. Amendment by SOUTH ESSEX: That the value of the a further attempt be made to make the present settlement emoluments of house officers should remain at£100. retrospective to the date of commencement of negotiations. 78. Amendment by WORCESTER AND BROMSGROVE: That 64. Amendment by CLEVELAND: That this Meeting, be- practitioners on the staffs of hospitals at present remun- ing dissatisfied with the outcome of the Whitlev negotia- erated on G.P. 10(b) rates should also receive an increase tions, wishes to take steps to review the whole of the in remuneration. negotiating machinery for consultants and specialists. 79. Motion by LIVERPOOL: That this Meeting en- 65. Amendment by SUNDERLAND: That this Meeting dorses the views expressed by the Council in its Supple- recommends that a negotiating committee be elected (repre- mentarv Report and notes with satisfaction that the Council sentative of all sections of the profession) to conduct all has reaffirmed its policy to adhere to the basis of remun- futuren neoatintion on the ubject of terms of service or eration as enunciated in the Spens Reports. It urges that remuneration of anv section of the profession. negotiations be continued and that the best actuarial and JUNE 19, 1954 AGENDA OF A.R.M. SUPPLEMENT TO THE BRITISH MEDICAL JOURNAL 333 legal advice be given to the negotiators, all of whom should 92. Motion by MANCHESTER: That this Meeting agrees be members of the Central Consultants and Specialists in general principle that ultimately a closely integrated Committee either by election or ex officio. national service should be planned; this is meanwhile not 80. Motion by WORCESTER AND BROMSGROVE: That in to prejudice the further development of any local approved view of the damaging restrictions which make it impossible geriatric service already established and such as exists in to have present on the Staff Side at meetings of Whitley Manchester. Committee " B " expert legal and actuarial advisers, in 93. Motion by WESTMINSTER AND HOLBORN: That this future it is essential that the Staff Side should have available Meeting is alarmed at the absence of any organization in all the facilities for special legal or other advice both prior some areas for ensuring prompt admission to hospital of to and during the conduct of negotiations. aged persons in need of full-time attention, and suggests 81. Motion by SUNDERLAND: That this Meeting re- that the early appointment of a doctor, able to assess the quests that Council seek the formation of a court of inquiry needs of each and authorized to arrange admission, is to determine the proper level of hospital staffs' remunera- essential. tion. 82. Motion by CITY OF EDINBURGH: That this Meeting Representation on Regional Boards and Hospital considers it to be prejudicial to the best interests of medical Management Committees teaching in this country that there should be such a large 94. Motion by DARTFORD: That this Meeting is of the discrepancy, accentuated by the recent agreement on opinion that medical members of regional hospital boards hospital staff remuneration, between the salaries of consul- and hospital management committees should be elected by tants paid by hospital boards and those employed full- their professional colleagues. time by the universities, particularly since both may be 95. Motion by READING: That every endeavour sho'uld carrying out similar duties in the same hospitals. It is urged be made to ensure that all hospital management committees that immediate steps be taken to improve the financial have general-practitioner representation. position of medical members of university teaching staffs. 96. Motion by READING: That each hospital in the area of a hospital management committee should be represented Contributions of B.M.A. to Negotiating Bodies on that committee by one member of its medical staff. 83. Motion by TORQUAY: That the contributions of the B.M.A. to the expenses of the Joint Consultants Committee Remainder of Report under "Hospital and Consultant and the Staff Side of Committee " B " of the Medical Services" Whitley Council should be directly proportional to the 97. Motion, by the Chairman of the Central Consultants representation of the B.M.A. on those Committees. and Specialists Committee: That the remainder of the Annual and Supplementary Reports of Council under Legal Actions Involving Hospital Authorities and Members "Hospital and Consultant Services" be approved. of their Medical Staffs 84. Motion by READING: That this Meeting deplores the Facilities for Hospital Staff to Attend Meetings of apparent change in the law by which a practitioner can Professional Body no longer successfully plead reasonable care and skill in 98. Motion by MARYLEBONE: That this Meeting requests defence, where he has made an error of judgment. the Council to urge regional hospital boards and boards of governors of hospitals to grant every facility to hospital Whole-time or Part-time Service medical staff for the purpose of attending the Annual Repre- 85. Motion by HARROW: That regional hospital boards sentative Meeting. should permit whole-time salaried consultants to become part-time when they so desire. Consultants and Specialists Defence Fund 86. Motion by WORCESTER AND BROMSGROVE: That 99. Motion by GLASGOW: That this Representative Body consultants, including medical superintendents in the Mental requests Council to take steps to ensure that an adequate Health Service, should be given the option of being on a Defence Fund is established by the consultants and part-time or a whole-time basis. specialists. S.H.M.O. Appointments Domiciliary Consultation Arrangements 100. Motion by GATESHEAD: That no further S.H.M.O. That 87. Motion by RUGBY and SOUTH WARWICKSHIRE: posts be established and that existing posts should be sub- this is of that the should not Meeting opinion diagnosis ject to biennial review with a view to upgrading. be disclosed on domiciliary consultation certificates. *88. Motion by RICHMOND: That facilities for domiciliary Grading of S.H.M.O.s visits under the'National Health Service be made available 101. Motion by WOOLWICH: That this Meeting draws to National Health Service patients in private nursing- attention to the complete lack of uniformity in different homes. regions, and sometimes within the same region, in the use 89. Motion by EAST YORKSHIRE: That where in view of the grade of S.H.M.O.. particularly in relation to and to of the shortage of hospital beds for chronic illness, many the detriment of the Tuberculosis Service; and that Council have to be admitted to for patients private nursing-homes be requested to treat the correction of this injustice as a social or domestic reasons, this Representative Body urges matter of priority, and to employ every means in the power should not be debarred such admission from that they by of the British Medical Association to ensure the grading as National Health the benefits of consultant services under the consultants of these S.H.M.O.s who are at present inappro- Service. priately and unfairly graded. 90. Motion by YORK: That it should be within the Junior Hospital Medical Staffs powers of the general practitioner in charge of a patient 102. Motion by DORSET: That this Meeting considers that confined in a private nursing-home to call in the aid of a the interests of the junior hospital medical staff do not have consultant anaesthetist under the domiciliary consultation adequate expression in the B.M.A. and that a standing arrangements of the National Health Service. committee should be set up to watch over these interests. Geriatric Units A ccommodation of Medical Superintenzdents outside the 91. Motion by LINCOLN: That this Meeting reaffirms its Hospital previous decision to recommend to the Minister the estab- 103. Motion by WORCESTER AND BROMSGROVE: That the lishment of geriatric units under the guidance of an experi- Council be asked to investigate the possibility of medical enced physician and expresses grave concern at the delay superintendents being given the opportunity to live outside in dealing with this urgent problem. the hospital if they so desire. 334 JUNE 19, 1954 AGENDA OF A.R.M. SUPPLEMENT TO THE BRITISH MEDICAL JOURNAL

Machinery for Appointmiient of Consultants and Registrars Reinmuneration of Whole-timize Industrial Medical Officers 104. Motion by SOUTH ESSEX: That this Meeting con- 115. Motion by the Chairman of the Occupational Health siders that at the appointment of registrars and consultants, Committee : That the following recommendation of the both the hospital management committee and the assessors Couincil be adopted: should have equal voting power, while the chairman should That the revised statement on remuneration of whole- retain a casting vote. time industrial medical officers, set out in Appendix IX 105. Motion by BRIGHTON AND MID-SUSSEX: That the to the Annual Report of Council, be approved. Representative Body considers that local group medical and lay committee members should have more say in the ap- Remainder of Report under "Occupational Health" pointment of consultant staff. 116. Motion by the Chairman of the Occupational Health A dmlinistration of Hospital Groups Committee on behalf of the Council : That the iemainder of the Annual and Supplementary Reports of Council under 106. Motion by DORSET: That this Meeting considers that "Occupational Health" be approved. the administration of hospital groups could be improved by occasionally appointing experienced doctors as secretaries ORGANIZATION to hospital management committees. 117. Motion by the Chairman of the Organization Com- Control of Hospital Managenment mittee on behalf of the Council: That the Annual Report of Council under " Organization" (Doc. A.R.M. 2, paras. 107. Motion by MID-CHESHIRE: That this Meeting would 141-54) be received. deprecate the return of hospital management from indepen- dent to municipal control. A utonomous Bodies 118. Motion by the Chairman of the Organization Com- Post-mortem Exaamniilations mittee: That the following recommendation of the Council 108. Motion by DEWSBURY: That it should be possible be adopted: for a practitioner to have a post-mortem performed by a That the autonomous powers of the General Medical consultant pathologist on any patient who was of particular Services Committee and the Centrt,l Consultants and clinical interest to the practitioner. The cost of such a Specialists Committee be renewed in respect of the year service could be borne by the research grant of the National 1954-5. Health Service. That the Representative Body looks to these coin- mittees to ensure (1) that no action be taken by either Rh Tests and Blood Grouping which may prejudice the interests of another part of the 109. Motion by BUCKINGHAMSHIRE: That when Rh tests profession without full prior consultation with the appro- and blood grouping are carried out, a card should be sup- priate interests, and (2) that their autonomous powers will plied suitable for preservation by the patient. be used so as to expedite and not delay the work of the Association. Visits to Patientts in London Fever Hospitals Election of "Ten" Members of Council 110. Motion by PADDINGTON: That the London fever hospitals should permit daily visits to patients in all suitable 119. Motion by the Chairman of the Organization Com- cases, except in special circumstances. mittee: That the following recommendation of the Council be adopted: OCCUPATIONAL HEALTH 1. That By-laW 49 be amended as follows: 111. Motion by the Chairman of the Occupational Health (i) By inserting the following new subparagraph: on of the Council: That the Annual and (2) For the purpose of electing the President, the Committee behalf Chairman, and the Deputy Chairman of the Representa- Supplementary Reports of Council under " Occupational tive Body, the Treasurer, and the members of the Health" (Docs. A.R.M. 2, paras. 84-7, and A.R.M. 3, paras. Council and of any Standing Committees required to 211-15), the Memorandum to the Ministry of Labour and be elected by the Representative Body votes shall be National Service on the Future of the Occupational Health recorded at such time and in such manner as the Repre- Services (Appendix III), the Memorandum on Medical Stan- sentative Meeting may decide. dards for Road, Rail, and Air Transport (Appendix IV), the (ii) By altering the numbering of the existing subpara- Memorandum on the National Insurance (Industrial Injuries) graphs (2)-(5) to (3)-(6) respectively and by adding at Act (Appendix V), and the Revised Statement on the the commencement of new subparagraph (3) the words Remuneration of Whole-time Industrial Medical Officers " Except as aforesaid." (Appendix IX) be received. 2. That By-law 53(c) be altered by the deletion of all words after "as to" in line 3 and the substitution therefor of the Medical Standards for Road, Rail, anid Air Transport following: 112. Motion by the Chairman of the Occupational Health "ten by Representatives of Constituencies and of Public Committee That para. 85 of the Annual Report of Council Health Service Members and Members of Council repre- submitted the Trans- senting the medical branches of the armed Forces, as to and the Memorandum to Ministry of a further two by the elected Representatives of Con- port (Appendix IV to the Annual Report) be approved. stituencies comprised in the Branches and Divisions in 113. Amendment by SOUTHAMPTON: That in the opinion Scotland, and as to a further one by the elected Repre- of the Meeting further consideration should be given to the sentatives of Constituencies comprised in the Branches information which should be disclosed on Form P.S.V. I5A and Divisions in Wales, including Monmouthshire." (application for licence to drive public service vehicles). The By-laws as amended would read: Duities of anid Ethical Rules for Indusirial Medical Officers 49. Voting 114. Motion by RUGBY and SOUTH WARWICKSHIRE: That (2) For the purpose of electing the President, the Chair- this Meeting urges Council to take further active steps to try man, and the Deputy Chairman of the Representative Body. a list of industrial medical the Treasurer, and the members of the Council and of any to compile comprehensive officers, Standing Committees required to be elected by the Repre- or, failing this, to circulate among all non-members of the sentative Body votes shall be recorded at such time and in Association a copy of "The Duties and Ethical Rules for such manner as the Representative Meeting may decide. Industrial Medical Officers," and also to publish them at (3) Except as aforesaid, voting shall be by show of hands, periodic (say three-yearly) intervals in the Supplement. unless before the vote is taken fifteen Representatives present JUNE 1954 SUPPLEMENT TO THE 1954 OF 19, AGENDA JUNE A.R.M. 19, A.R.M.~~ BRITISH-..... MEDICAL --.JOURNAL 335

request that the vote be taken by roll-call, in which event Salaries in the Public Health Service it shall (subject as hereinafter provided) be so taken. If, however, upon the Chairman proceeding to take the vote, a *127. Motion by CITY OF ABERDEEN, BANFF, MORAY AND vote by card is demanded by a majority of the Representa- NAIRN, and DUNDEE: That the disparity between remunera- tives present the vote shall be taken by card.... tion in the Public Health Service and that of the medical profession as a whole is a threat to the rest of the profession Council: Coinposition and contrary to It 53. . . public interest. is therefore the declared policy of the Association that remuneration in the Public (c) Thirteen (being persons who have been members of the Association for at least the period aforesaid), at the Repre- Health Service be brought into line with that of hospital sentative Meeting being elected as to ten by Representatives and general practice, and the Council is instructed to take of Constituencies and of Public Health Service Members and steps to implement this policy as a matter of urgency. Members of Council representing the medical branches of 128. Motion by GATESHEAD: That the whole structure the armed Forces, as to a further two by the elected Repre- of public health remuneration be reviewed, as it is still out sentatives of Constituencies comprised in the Branches and of line with that in other branches of the Service. Divisions in Scotland, and as to a further one by the elected 129. Motion by HARROW: That this Meeting considers Representatives of Constituencies comprised in the Branches that in view of the serious and Divisions in position developing with regard Wales, including Monmouthshire. to recruitment in the Public Health Service, steps be taken Membership of Divisions and Branches to reopen the question of salaries in that service. 120. Motion by the Chairman of the Organization Com- mittee: That para. 150 of the Annual Report of Council be Constitution of Public Health Committee approved. 130. Motion by LIVERPOOL: That this Meeting, while 121. Amendment by RUGBY and SOUTH WARWICKSHIRE: welcoming the Report of Council that the Industrial Court That this Meeting cannot accept Council's view that imple- Awards have been accepted by all local authorities, is of mentation of Minute 255 of the 1953 Annual Representative the opinion that the organization of the Public Health Com- Meeting would cause any material administrative difficulties, mittee is not sufficiently representative of the junior grades or to any would lead insuperable complications or anoma- of the Public Health Service; and that the matter be con- lies, and urges that the said Minute be implemented as sidered by the Constitution Committee. soon as possible. Scales of Fees for -Special Sessions Remainder of Report under " Organization" 131. Motion by NORTH NORTHUMBERLAND: That in the 122. Motion by the Chairman of the Organization Com- opinibn of this Meeting all scales of fees for special sessions mittee: That the remainder of the Annual Report of -for example, dental anaesthetics, etc.-should be imme- Council under " Organization " be approved. diately revised. B.M.A. Year Book REFORM OF THE NATIONAL HEALTH SERVICE 123. Motion by RUGBY and SOUTH WARWICKSHIRE: That 132. Motion by the Chairman of the Amending Acts Com- this Meeting considers that this publication is a very useful mittee on behalf of the Council: That the Annual and source of information on a variety of subjects, and urges Supplementary Reports of Council under "Reform of the that a free copy be issued to all members periodically National Health Service" (Does. A.R.M. 2, para. 82, and (though not necessarily every year). A.R.M. 3, para. 209) and the proposed scheme for the restoration of the right to buy and sell goodwill (Appendix PUBLIC HEALTH VIII) be received. Goodwill 124. Motion by the Chairman of the Public Health Com- 133. Motion by the Chairman of Council: That the mittee on behalf of the Council: That the Annual and following recommendation of the Council be adopted: Supplementary Reports of Council under " Public Health" (Docs. A.R.M. 2, paras. 88-98, and A.R.M. 3, paras. 216- That in view of (a) the practical difficulties of imple- 24), the Memorandum on the General Practitioner and the menting the proposed scheme for the right to buy and Health Visitor (Appendix VI), the Memorandum of Evi- sell goodwill, (b) the high capital outlay required by dence submitted by the Council to the Health Visitors' young practitioners to launch into practice, (c) the divided Working Party (Appendix X), the Memorandum of Evi- opinion in the profession as to the desire to introduce such a scheme, and dence submitted by the Council to the Working Party on (d) the known political resistance to the Training of District Nurses (Appendix XI), and the any such proposal, no further action be taken. Statement on the Memorandum submitted by the British 134. Amendment by LINCOLN: That the recommendation Veterinary Association to the Ministry of Agriculture and of the Council be varied to read: Fisheries on the subject of Meat Production and Control That no further action be taken regarding the scheme (Appendix XII) be received. for the restoration of the right to buy and sell goodwill, 125. Motion by the Chairman of the Public Health Com- contained in Appendix VIII of the Supplementary Report mittee: That the Annual and Supplementary Reports of of Council. Council under "Public Health " be approved. 135. Amendment by HARROW: That the principle of a Arbitration and the Public Health Service general practitioner owning and being able to dispose of the goodwill of his practice in any way he likes is 126. Motion by DARLINGTON: That this considers funda- Meeting mentally sound and proper, but that this Meeting defers that, the Council failed to obtain a having Whitley Court consideration of what action to take in regard to this prin- of Arbitration as mandated by the amended Mid-Herts reso- ciple until all Divisions have had an opportunity of studying lution passed at the 1953 A.R.M. the Council (Min. 83), Council's report on goodwill and of deciding what action be instructed to withdraw all members from the Public should be taken. Health Service if this court of arbitration has not been 136. Amendment by SOUTH-WEST ESSEX: That the obtained by December 31, 1954. scheme be referred back to the Council in order that it (Min. 83 of the was as follows: A.R.M., 1953, may consider arrangements whereby new entrants to prac- That this Meeting deplores the lack of a Whitley Court tice will have an opportunity of entering the Service either of Arbitration to which there should be a right of (1) by purchase of the goodwill of the practice, or (2) by appeal by unilateral reference and where the ruling selection by the Medical Practices Committee. should be binding on both parties, and instructs 137. Amendment by CHELSEA AND FULHAM: That the Council to take immediate and urgent action.) scheme for the reintroduction of buying and selling prac- SUPPLEMENT TO THE 336 JUNE 19, 1954 AGENDA OF A.R.M. BRITISH MEDICAL JOURNAL tices be referred back to Council for amendment and to and A.R.M. 3, paras. 194-205) and the Second Report devise regulations that will fully protect the financial posi- of the Working Party on the Danckwerts Award and the tion of new entrants. Small-list Practitioner (Appendix VII) be received. 138. Amendment by SOUTH STAFFORDSHIRE: That since the return of the right to buy and sell goodwill would The Danckwerts Award and thze Smnall-list Practitioner appear to present no insuperable difficulties, Council be in- 153. Motion by the Chairman of the General Medical structed as a matter of urgency to institute appropriate Services Committee: That paras. 21 and 196 of the Annual steps to try to regain this right. and Supplementary Reports of Council and Appendix VII- 139. Amendment by MARYLEBONE: That this Meeting Second Report of the Working Party on the Danckwerts commends the work of the Amending Acts Committee in Award and the Small-list Practitioner-be approved. its scheme for the restoration of the right to buy and sell 154. Amendment by CHELSEA AND FULHAM, KENSINGTON the goodwill of practices and instructs the Council to imple- AND HAMMERSMITH, and PADDINGTON: That account should ment the proposals. be taken of those practitioners who are under 60 years of 140. Amendment by BRIGHTON AND MID-SUSSEX: That age and also not in receipt of a fixed annual payment, who a referendum of the profession be taken as to the principle will now be worse off than they were under Danckwerts. of the return of the right to buy and sell goodwill. *141. Amendment by RICHMOND: That the return of the Admnissiont of Students to Medical Schools right to buy and sell goodwill being of such essential im- 155. Motion by HEXHAM: That this Meeting considers portance to the freedom of the profession, this Representa- that, in view of the saturation of certain branches of the tive Meeting requests that the considered opinion of the medical profession, the Minister should be impressed with profession should be ascertained by a plebiscite to be held the extreme urgency of the situation, in setting up at the before the next Annual Representative Meeting. earliest possible moment the working party proposed in 142. Amendment by MANCHESTER: That this Meeting section 24 of the Annual Report of Council. requests Council to take a postal vote of all general practi- 156. Motion by NEWCASTLE-UPON-TYNE: That in view of tioners on the question of the restoration of the sale of the serious consequences which would follow if the country goodwill of practices. became saturated with doctors, and pending the deliberations of the General Medical Services Committee on this prob- 143. Motion by AYRSHIRE and EAST KENT: That this lem, the Council should consider the advisability of taking Meeting considers that the restoration of the right to buy immediate steps to reduce the intake of students into medical and sell the goodwill of medical practices in the National schools. Health Service is impracticable. Change of Practice 157. Motion by KENSINGTON AND HAMMERSMITH: That MEDICAL FILMS this Meeting appreciates the efforts of the General Medical 144. Motion by the Chairman of the Film Committee Services Committee to facilitate the exchange of practices. on behalf of the Council: That the Annual Report of and urges it to continue to do all in its power to achieve Council under "Medical Films" (Doc. A.R.M. 2, para. this, since the inability to remove from some districts after 175) be received. years of hard work constitutes a grave hardship not only to 145. Motion by the Chairman of the Film Committee: the doctor but often even more so to his family, who suffer That the Annual Report of Council under " Medical Films" social and educational disabilities. be approved. Machiniery for Filling Practice Vacancies

" BRITISH MEDICAL JOURNAL" 158. Motion by WEST DENBIGH AND FLINT: That when vacancies in practices have to be filled, the appoint- 146. Motion by the Chairman of the Journal Committee ment should be made by the local executive council. on behalf of the Council: That the Annual Report of 159. Motion by HARROW: That advertised vacancies for Council under " British Medical Journal" (Doe. A.R.M. 2, practices on new estates or adjacent to existing built-up para. 118) be received. areas should not be advertised in the British Medical Journal 147. Motion by the Chairman of the Journal Committee: until the matter has been referred to the local Division of That the Annual Report of Council under " British Medical the Journal" be approved. B.M.A. for its views. B.M.J. Adlvertisements and Nationality of Applicants for Economy in Prescribing Appointnlents *160. Motion by ST. PANCRAS: That the Council, through the General Medical Services Committee, urges once again 148. Motion by CITY: That advertisements in the British the immediate introduction of stock orders for doctors' Medical Journal shall not contain any inquiry as to the surgeries. nationality of the applicant, except when the knowledge of 161. Motion by BUCKINGHAMSHIRE: That the Representa- certain languages is necessary for the treatment of patients. tive Body considers the introduction of Form E.C. lOA in England and Wales imperative within the next twelve "FAMILY DOCTOR" months. 149. Motion by the Chairman of the Family Doctor Com- 162. Motion by DARTFORD: That this Meeting deplores mittee on behalf of the Council: That the Annual Report the present regulations regarding the supply of drugs and of Council under " Family Doctor" (Doc. A.R.M. 2, para. dressings for ready use in the surgery and recommends the 119) be received. stopping of payment for ready use dressings and the intro- 150. Motion by the Chairman of the Family Doctor Com- duction of Form E.C. IOA. mittee: That the Annual Report of Council under "Family 163. Motion by BRIGHTON AND MID-SUSSEX: That to Doctor " be approved. bring about a substantial saving in prescribing costs, the 151. Motion by ISLE OF WIGHT: That this Meeting con- Council should continue to press for stock orders for gratulates the editorial staff of Family Doctor on the pre- doctors' surgeries in England and Wales. sentation of this publication. GENERAL MEDICAL SERVICES 164. Motion by WEST BROMWICH AND SMETHWICK: That 152. Motion by the Chairman of the General Medical it be referred to the Council to devise an alternative scheme Services Committee on behalf of the Council: That the whereby Form E.C. 1OA or an effective equivalent may be Annual and Supplementary Reports of Council under operated for the ordering of stock drugs and surgical "General Medical Services" (Docs. A.R.M. 2, paras. 18-49, requisites. JUNE 19, 1954 AGENDA OF A.R.M. BRITISHSUPPLEMENTMEDICAL TOJOURNALTHE 337 165. Motion by GATESHEAD: That no prescriptions for cussions with the Ministry with this in view should be cod-liver oil and malt be questioned by the Pricing Bureaus reopened with the minimum of delay. unless in excess of 4 lb. 179. Motion by ISLE OF ELY: That this Annual Repre- sentative Meeting resolves that the procedure in operation Dangerous Drugs Regulations in England and Wales with regard to Obstetric Lists under 166. Motion by the Chairman of the General Medical the National Health Service (Maternity Medical Services) Services Committee: That para. 31 of the Annual Report be abolished, and that the procedure at present followed in of Council be approved. Scotland and Northern Ireland be adopted in its place. * 167. Amendment by MANCHESTER: That this Meeting asks Council to press for the withdrawal of the circular G.P. Maternity Beds in Hospitals issued by the Ministry dealing with the issue of pethidine 180. Motion by BATH: That this Meeting urges that to midwives. regional hospital boards be instructed to refrain from 168. Amendment by CAMBRIDGE AND HUNTINGDON: That reducing the number of general-practitioner maternity beds representations be made to the Ministry of Health that in hospitals. midwifery practice will be made exceedingly difficult for Clintical Researcih Board general practitioners if midwives are not permitted to ad- 181. Motion by DORSET: That this Meeting considers that minister pethidine on the instruction of a general practi- a general practitioner should sit on the Clinical Research tioner unless the latter is present. Board as a right.

169. Amendment by RUGBY and SOUTH WARWICKSHIRE: Certification for Surgical Corsets That this Meeting is of opinion that pethidine should be 182. Motion by the Chairman of the General Medical administered only under the supervision of a doctor and Services Committee : That para. 48 of the Annual Report only with his agreement, but not necessarily in his presence, of Council be approved. and that the medical officer of health should not be allowed 183. Amendment by GATESHEAD: That every effort should to issue or to authorize the administration of pethidine be made to secure the abolition of the purchase tax on unless he personally accepts responsibility for the case. corsets. 170. Amendment by MID-CHESHIRE: That this Meeting 184. Amendment by RUGBY and SOUTH WARWICKSH1RE: protests at the wording of paragraph 31 of the Annual That this Meeting is of opinion that general practitioners Report of Council, and recommends that this be clarified. should not be required to issue certificates for surgical corsets solely for the purpose of obtaining exemption from Supply of Medicilles to Private Patients purchase tax. 171. Motion by MARYLEBONE: That this Meeting instructs Elimination of Inflation the Council to continue to press the Minister to take imme- 185. Motion by WORCESTER AND BROMSGROVE: That the diate steps to allow the issue of medicine on Form E.C. 10 Ministry be pressed again to have instructions printed on to private patients. the Medical Card requesting the patient to notify to the executive council any change of address. Accommodation in Surgeries and Waiting-rooms 172. Motion by CITY: That in order that single-handed Remainder of Report under "General Medical Services" practitioners may improve their surgery premises, a sum of 186. Motion by the Chairman of the General Medical money should be set aside from which a loan may be ob- Services Committee That the remainder of the Annual tained on the same conditions as appertains to group and Supplementary Reports of Council under " General practice. Medical Services " be approved. Emnployment of General Practitioners in Hospitals Disposal of Goodwill of Private Practice by N.H.S. 173. Motion by HEXHAM: That this Meeting views with Practitioner great concern any possible reduction in the remuneration of general practitioners working in hospitals. 187. Motion by BOURNEMOUTH: That any doctor who 174. Motion by WEST DENBIGH AND FLINT: That general purchases the goodwill or a share of the goodwill of a practitioners in hospital service should continue to receive private practice shall be entitled to sell the same even if he not less than £175 per annum per session. is engaged in National Health practice in the same area. 175. Motion by MID-CHESHIRE: That this Meeting urges Employment of Assistants the Council to expedite the payment to general practitioners in hospitals of the sum of £175 per annum. 188. Motion by GREENWICH AND DEPTFORD: That in the opinion of this Meeting any legislation regarding the taking Representation of Genieral Practitioners in Hospital or keeping of an assistant is a dangerous curtailment of A dministration liberty. The Representative Body therefore requests the 176. Motion by the Chairman of the General Medical Council to take active steps through the Medical Practices Services Committee: That para. 39 of the Annual Report Advisory Bureau to protect the interests of applicants and of Council be approved. inform them of the state of affairs in anx particular case. 177. Amendment bv RUGBY and SOUTH WARWICKSHIRE: That this Meeting strongly supports the General Medical Single-handed Practitioners with Excessive Lists Services Committee's view that the general-practitioner 189. Motion by LEWISHAM: That a principal with a list representatives on regional hospital boards should always in excess of the maximum allowed for single-handed practice, enjoy the confidence of their local colleagues, but views with having employed assistance for an aggregate period of two- deep dismay the Ministry's suggestion that the practitioner years, shall take a partner or have his list reduced to the best suited, in his colleagues' opinion, for the post might maximum for a single-handed practitioner. be (and in fact very often is) excluded solely " to preserve the geographical balance of the other members of the Practice Accommodation in Isolated Areas Board," and this Meeting urges that the general practitioners' 190. Motion by WESTMORLAND: That the Representative nominees should be accepted. Body invites the Council to review the difficulty experienced by practitioners in isolated areas in obtaining suitable prac- Maternity Medical Services: The Obstetric List tice accommodation, and that in appropriate cases the 178. Motion by DARTFORD: That this Meeting reaffirms Ministry be asked to give powers to executive councils to the opinion of the Representative Body of 1953 regarding provide such accommodation on payment of an appro- the abolition of the Obstetric List and recommends that dis- priate rental. SUPPLEMENT TO THE 338 JUNE 19, 1954 AGENDA OF A.R.M. BRITISH MEDICAL JOURNAL Certification Provision of Additional Voluntary Compensation Schleme 191. Motion by RUGBY and SOUTH WARWICKSHIRE: That 198. Motion by BUCKINGHAMSHIRE: That in view of the this Meeting considers that the present practice of requiring admitted inadequacies of the present superannuation scheme a full week's national insurance contribution for any portion this Meeting suggests the provision of an additional volun- of a week, for which a person (not otherwise exempt) is tary scheme sponsored by the Ministry, equal payments certified as fit for work, is unfair not only to the con- being made by the practitioner and the Government. tributors but also to the doctors, since it at times jeopardizes the doctor-patient relationship. This Meeting therefore MEDICAL ETHICS urges Council, in the interests of common justice, to raise 199. Motion by the Chairman of the Central Ethical Com- this matter with the Ministry, notwithstanding the slight mittee on behalf of the Council: That the Annual and administrative problem which the adoption of the proposed Supplementary Reports of Council under " Medical Ethics " alteration might involve. (Docs. A.R.M. 2, paras. 99-104, and A.R.M. 3, para. 225) Disclosure of Clinical Details to Local Medical Committees be received. 192. Motion by RUGBY and SOUTH WARWICKSHIRE: That Loan of Hospital Records to Government Departments this Meeting is dissatisfied with the "suggested procedure " of the Central Com- Supplement, August 1, 1953, p. 68) for dealing with 200. Motion by the Chairman Ethical (B.M.J. of the cases in which a practitioner who has been asked by an mittee: That the following recommendation Council executive council for clinical details of a patient (so that be adopted: it may be decided whether a preparation prescribed on That the following statement on the loan of hospital Form E.C. 10 was a food or a drug) finds that the patient records to Government departments be approved: refuses to give consent to such disclosure. Objections are (a) That medical records should be lent to the medical (a) that it would only be strictly ethical if the patient had officers employed by Government departments only consented to this specific arrangement, and (b) the onus of when written consent has been given by or on behalf obtaining the patient's written consent should be on the of the patient. executive council and not on the practitioner. (b) That the form of consent signed by or on behalf (The "suggested procedure " referred to is as follows of the patient should include a statement that the "The practitioner sends the details of the case to the patient agrees to his hospital records being made secretary of the local medical committee, who is, in most available to the medical board in order to assist them cases, himself a doctor, or to the chairman of the com- in determining the degree of disablement and whether mittee. The secretary or chairman, as the case may be, it is related to his industrial accident. discloses to his committee the clinical details which he (c) That wherever practicable, and particularly where receives, but withholds the name of the patient. The disclosure of information may have an adverse psy- committee, in informing the executive council of its find- chological effect upon the patient, the practitioner ings, suppresses these clinical details, but the council will, who compiled the record or, if he is not available, of course, be in possession of the name of the patient one nominated by the hospital authority for the pur- through their clerk. Thus the secretary or chairman of pose, should be consulted on the wisdom of disclos- the local medical committee is the only person who is in ing to the patient all of the confidential information a position to connect the patient by name with the clinical contained therein, at the same time taking the oppor- details, and the objection to the disclosure of medical tunity of reviewing the notes before they leave the information to lay members and officials of the executive hospital. council is avoided.") Remainder of Report unider "Medical Ethics" Valuation of Doctors' Houses 201. Motion by the Chairman of the Central Ethical Com- 193. Motion by YORK: That the present system of valua- mittee: That the remainder of the Annual and Supple- tion of the house of a doctor retiring from the National mentary Reports of Council under " Medical' Ethics " be Health Service is unsatisfactory, inasmuch as no consider- approved. ation is given by the valuer appointed for the purpose to FINANCE the special accommodation for patients provided at the doctor's house. 202. Motion by the Treasurer on behalf of the Council: That the Annual and Supplementary Reports of Council Londonm Local Medical Comnmittee and Approval of Trainers under " Finance" (Docs. A.R.M. 2, paras. 120-7, and 194. Motion, by PADDINGTON: That this Meeting resents A.R.M. 3, para. 232) and Appendix XIII and the Financial the persistent refusal of the Local Medical Committee for Statement for the year ending December 31, 1953 (Doc. London to arrange for appeals against the decision of A.R.M. 3A), be received. their subcommittee concerned with the approval of trainers, 203. Motion by the Treasurer: That the Annual and in spite of persistent representations made to it. Supplementary Reports of Council under " Finance " be approved. Postgraduate Instruction for General Practitioners Association Membership Subscription 195. Motion by PADDINGTON: That the regional boards 204. Motion by MARYLEBONE: That this Meeting notes should be encouraged to provide postgraduate instruction with satisfaction the greatly improved financial position of to practitioners in all areas, to equip the practitioner to the Association, which has resulted in part from the increase satisfy the requirements of the local medical committee. in subscription from four to six guineas in 1952, and instructs the Council to make plans for reducing the subscription to COMPENSATION AND SUPERANNUATION five guineas within two years. 196. Motion by the Chairman of the Compensation and 205. Motion by GATESHEAD: That an assurance be given Superannuation Committee on behalf of the Council: That that, as soon as financial circumstances of the Association the Annual Report of Council under " Compensation and permit, the question of reducing all membership subscrip- Superannuation" (Doc. A.R.M. 2, paras. 50-2), and the tions will be seriously considered. Memorandum on the Financial Position of Practitioners on 206. Motion by RUGBY and SOUTH WARWICKSHIRE: That Retirement (Appendix II) be received. this Meeting views with much concern the rather heavy fall 197. Motion by the Chairman of the Compensation and in membership since the increased subscription rate, and Superannuation Committee That the Annual Report of asks for a clear statement from Council regarding the prob- Council under " Compensation and Superannuation " be able future trends of the Association's finances, membership, approved. and subscription rates. SUPPLEA1ENT TO THE 339 JUNE 19, 1954 AGENDA OF A.R.M. BRITISH MEDICAL JOURNAL

207. Motion by RUGBY and SOUTH WARWICKSHIRE: That ARMED FORCES this Meeting urges the Council to investigate the desirability of having different subscription rates for " town " and 222. Motion by the Chairman of the Armed Forces Com- country" members. mittee on behalf of the Council: That the Annual Report 208. Motion by RUGBY and SOUTH WARWICKSHIRE: That of Council under "Armed Forces " (Doc. A.R.M. 2, para. it be referred to the Council to consider the possibility of 140) be received. reducing the B.M.A. subscription to half a guinea or even 223. Motion by the Chairman of the Armed Forces Com- less to members for the first 13 months after qualification. mittee: That the Annual Report of Council under " Armed Forces" be approved. Subscription Payable by Whole-time Salaried Menmbers 209. Motion by the Treasurer: That para. 127 of the WALES Annual Report of Council be approved. 224. Motion by the Chairman of the Welsh Committee *210. Amendment by HARROW: That this Meeting con- on behalf of the Council: That the Annual Report of siders that the reduced subscription of four guineas should Council under "Wales " (Doc. A.R.M. 2, para. 165) be be granted to all whole-time salaried members of the received. Association. 225. Motion by the Chairman of the Welsh Committee: 211. Amendment by PERTH: That this Meeting reiterates That the Annual Report of Council under "Wales" be its view that the reduced subscription of four guineas should approved. be granted to all whole-time salaried members of the OVERSEAS Association. 226. Motion by the Chairman of the Overseas Committee 212. Amendment by MID-CHESHIRE: That this Meeting That the Annual Report of regrets that Council did not see fit to accept the resolution on behalf of the Council: paid Council under " Overseas " (Doc. A.R.M. 2, paras. 166- of the A.R.M., 1953, regarding subscriptions to be 72) be received. bv members of the Association on full-time salaried service. 227. Motion by the Chairman of the Overseas Committee: That the Annual Report of Council under' Overseas" be approved. BUILDING 213. Motion by the Chairman of the Estates Committee EMPIRE MEDICAL ADVISORY BUREAU Report of on behalf of the Council: That the Annual 228. Motion by the Chairman of the Committee of Council under " Building" (Doc. A.R.M. 2, para. 128) be Management of the Empire Medical Advisory Bureau on received. behalf of the Council: That the Annual Report of Council 214. Motion by the Chairman of the Estates Committee: " " " " under Empire Medical A8visory Bureau (Doc. A.R.M. That the Annual Report of Council under Building be 2, para. 173) be received. approved. 229. Motion by the Chairman of the Committee of SCIENCE Management of the Empire Medical Advisory Bureau: 215. Motion by the Chairman of the Science Committee That the Annual Report of Council under " Empire Medical on' behalf of the Council: That the Annual and Supple- Advisory Bureau" be approved. mentary Reports of Council under " Science " (Docs. A.R.M. 2, paras. 129-34, and A.R.M. 3, paras. 233-8) be received. INTERNATIONAL MEDICAL VISITORS' BUREAU Postage otn Library Books 230. Motion by the Chairman of the Committee of 216. Motion by HUDDERSFIELD: That in the interests of Management of the International Medical Visitors' Bureau provincial practitioners, whose opportunities to enjoy the on behalf of the Council: That the Annual Report of facilities of B.M.A. House are limited, the Association Council under " International Medical Visitors' Bureau" return to the former system of paying outgoing postage on (Doc. A.R.M. 2, para. 174) be received. Library books and periodicals sent out on loan. 231. Motion by the Chairman of the Committee of Management of the International Medical Visitors' Bureau: Renmainider of Report under " Science" That the Annual Report of Council under " International 217. Motion by the Chairman of the Science Committee: Medical Visitors' Bureau" be approved. That the remainder of the Annual and Supplementary Reports of Council under " Science" be approved. MEDICAL BENEVOLENCE 232. Motion by the Chairman of the Charities Committee PUBLIC RELATIONS on behalf of the Council: That the Supplementary Report 218. Motion by the Chairman of the Public Relations of Council under " Medical Benevolence " (Doc. A.R.M. 3, Committee on behalf of the Council: That the Annual paras. 239-40) be received. Report of Council under "Public Relations" (Doc. A.R.M. 233. Motion by the Chairman of the Charities Com- 2. paras. 135-9) be received. mittee: That the Supplementary Report of Council under 219. Motion by the Chairman of the Public Relations "Medical Benevolence " be approved. Committee: That the Annual Report of Council under -'Public Relations" be approved. WORLD RELATIONS National Itnsuirance Conitributioni anid Health Service 234. Motion by the Chairman of the International Rela- tions Committee on behalf of the Council: That the Annual '20. Motion by PADDINGTON: That greater publicity and Supplementary Reports of Council under "World Re- should be given to the fact that the National Insurance lations" (Docs. A.R.M. 2, paras. 176-9, and A.R.M. 3, Scheme ceased in July, 1948, and that the present National paras. 241-3) be received. Insurance contribution is not used for financing the health 235. Motion by the Chairman of the International Rela- service, the finances being provided out of the general tions Committee: That the Annual and Supplementary revenue. Reports of Council under " World Relations " be approved. Public Relations Officer and Unfair Criticism of thle Profession OTHER ASSOCIATION ACTIVITIES 221. Motion by GREENWICH AND DEPTFORD: That the 236. Motion by the Chairman of Council: That the Council be instructed to ensure that the Public Relations Annual and Supplementary Reports of Council under Officer should take all steps to prevent unfair criticism of "Other Association Activities " (Docs. A.R.M. 2, paras. the medical profession passing unanswered. 180-9, and A.R.M. 3, paras. 244-51) be received. SUPPLEMENT TO THE 340 JUNE 19, 1954 AGENDA OF A.R.M. BRITISH MEDICAL JOURNAL 237. Motion by the Chairman of Council: That the Annual and Supplementary Reports of Council under WELFARE FOODS "Other Association Activities" be approved. CHANGES IN DISTRIBUTION Local food offices close at the end of June, but expectant OTHER MOTIONS BY DIVISIONS AND BRANCHES mothers and young children will be entitled as before to General Medical Council and Checking of Register their special issues of liquid milk, national dried milk, cod- 238. Motion by BOLTON: That this Meeting considers liver oil, orange juice, and vitamin tablets. Liquid milk that the Medical Act should be so amended as to ensure will still be distributed by dairymen. The other foods will that no medical practitioner may suffer the indignity of be distributed at welfare clinics or other convenient local the removal of his name from the Medical Register and health authority centre. Existing ration books will con- the implications thereof, by reason of his failure to respond tinue until the end of October to be used as proof of entitle- to a postal inquiry as to his whereabouts by the General ment, and therefore patients should be advised to keep their Medical Council. books carefully after rationing ends in July. For new 239. Motion by BRISTOL: That in the opinion of this applications, after ration books finish, mothers must write Meeting it seems doubtful whether the General Medical or call at the local office of the Ministry of Pensions and Council, in the process of checking the Register, is taking National Insurance or, in some places, the Ministry of sufficient precautions to ensure that doctors receive its com- Labour and National Service. munications. Considering the importance of this matter to every doctor, we are of the opinion that both questionary and reply should be sent by registered post. G.M.S. CONMITTEE Whole-time Salaried Service ASSISTANTS AND YOUNG PRACTITIONERS *240. Motion by SOUTH STAFFORDSHIRE: That this SUBCOMMITlTEE A.R.M. reaffirms that opposition to any form of full-time Elections will be held in July to appoint representatives of salaried general medical service is the policy of the British assistants and unestablished principals to the Assistants and Medical Association. Young Practitioners Subcommittee of the General Medical 241. Motion by HARROW: That this Meeting is totally Services Committee for the session 1954L-5. The newly against a whole-time salaried service for general practi- appointed Subcommittee will come into office on Septem- tioners. ber 1, 1954. 242. Motion by MARYLEBONE: That this Meeting, repre- For the purposes of election, England and Wales is divided sentative of all branches of the profession, expresses its into five regions: (1) South-west and Wales, (2) South-east, strong opposition to a full-tins State salaried service, and (3) North-west and Midlands, (4) North-east, and (5) London reaffirms the resolution passed in May, 1946, and again in and Home Counties. The General Medical Services Sub- July, 1953-" The medical profession is, in the public committee (Scotland) appoints two representatives for that interest, opposed to any form of service which leads directly country as a whole. or indirectly to the profession as a whole becoming full-time the or authorities." Each region is based upon a regional office of Associa- salaried servants of the State local tion and elects two direct representatives to the Subcom- mittee one assistant and one unestablished principal. The G.M.S. Committee appoints six of its members to serve on Televising of Advlertisements of Pharmaceutical Products the Subcommittee. One assistant and one unestablished 243. Motion by CITY OF EDINBURGH: That the televising principal from the Subcommittee are co-opted to the G.M.S. of advertisements for pharmaceutical products, either Committee. directly or indirectly by the science survey type of pro- The electorate and membership of the Subcommittee, apart gramme, would be prejudicial to the best interests of from the representatives of the G.M.S. Committee, are medical practice in this country. restricted to the following classes of practitioner (i) Assistants in general practice. Implementation of Resoluitions of Representative Body (ii) Practitioners engaged predominantly in general practice as 244. Motion by MANCHESTER: That this Meeting requests principals (including those in partnership) whose total gross that when a resolution is passed at a Representative Meet- professional income does not exceed £1,500 per annum. ing, the Division or Divisions concerned in moving the reso- lution be kept informed of the steps taken to implement Assistants the resolution. The electoral roll for assistants is compiled from the Association's records, and each eligible assistant should by Concessions to Doctors in " YelTow Band " Areas in London now have received a letter from the secretary of the Com- 245. Motion by PADDINGTON: That the concession of 20 mittee advising him that, unless he signifies to the contrary, minutes granted to vehicles for loading and unloading in his name will automatically be included in the new roll. yellow band areas in London should be extended to cover Any assistant who has not received such a letter but believes the car of a doctor visiting a patient in that area. himself to be eligible for inclusion in the roll should com- municate with the Secretary, B.M.A., House, Tavistock ELECTIONS Square, London, W.C.1, not later than Monday, June 28. 246. Elect: Chairman; Deputy Chairman; Treasurer; 10 Members of Council by R.B. as a whole; 2 Members of Unestablished Principals Council by Representatives of Scottish Constituencies; 1 Applications are invited from principals whose total gross Member of Council by Representatives of Constituencies in professional income does not exceed £1,500 and whose names Wales (including Monmouthshire); and Members of Stand- are not already included in the electoral roll. Such appli- ing Committees and of A.R.M. Agenda Committee. cations should be made not later than Monday, June 28, on the form set out below. MINUTES 247. Motion: That the Chairman be empowered, on behalf Nominations of the Meeting, provisionally to approve the Minutes of Electoral rolls will, as indicated above, be closed on this Meeting. June 28. On July 2 a copy of the revised roll for his area 248. Any other business. will be sent to each eligible assistant or unestablished princi- SUPPLEMENT TO THE JUNE 19, 1954 G.M.S. COMMITTEE BRITISH MEDICAL JOURNAL 341 pal, asking for the submission of nominations not later than JuLly 19. If there is a contest in any particular area, voting THE REMUNERATION OF WHOLE-TIME papers will then be issued. MEDICAL AND DENTAL STAFF For the use of uzestablished printcipals only- A REVIEW OF THE YEARS 1948-54 GENERAL MEDICAL SERVICES COMMITTEE BY ASSISTANTS AND YOUNG PRACTITIONERS SUBCOMMITTEE N. L. ROWE, F.D.S. R.C.S., M.R.C.S., L.R.C.P. UNESrABLISHED PRINCIPALS In a short while the seventh year of the National Health I...... begin, and in view of this fact and the recent (Block letters, please) Service will award to hospital medical staff, it behoves us all to examine of ...... with the greatest possible care the situation in which we find ourselves. The present time is a very critical one indeed for ...... I...... I....I...... the doctor or dental surgeon who by choice or force of hereby apply for inclusion in the electoral roll of unestablished principals circumstances finds himself to be a whole-time employee to accept I declare that I am engaged predominantly in general practice of the Government. Those who elected the induce- as a principal with a total gross professional income not exceed- ments offered by the Ministry of Health in 1948 to pursue a ing £1,500 per annum, specialist career in the Hospital Service should, in the light and I undertake to inform the Secretary of the Committee at of recent events, be in no doubt regarding their position, B.M.A. House of any change in my status which affects my and be able to decide for themselves whether or not the eligibility for membership of the electorate. promises made so long ago have to-day been honoured in full by the State. Many members of the whole-time medical Signed ...... and dental staff of this country's hospitals will have been Date ...... appointed after the early days of the Service, and it is pos- To be returned not later than first post on June 28, 1954. sible that they may not be entirely aware of the events preceding their entry or fully cognizant of the prospects which await them. It is hoped that this article will enable PROVISIONALLY REGISTERED HOUSE the present situation to be seen in a clear light and in its OFFICERS correct perspective. DELAYS IN OBTAINING APPOINTMENTS Origin of the National Health Service Newly qualified practitioners are facing difficulties and de- lays in obtaining approved pre-registration appointments. The foundation of the National Health Service was laid The Ministry of Labour and National Service has recently down by a National Government embracing all political submitted statistics to the Central Medical Recruitment parties, and there must be few indeed who do not approve Committee which show that 24%,b of provisionally registered of the basic principles underlying the institution of the house officers had not obtained their second house appoint- scheme. The provision of an efficient and economic Health ment by the tenth month after qualification, the implication Service for the people of this country is of vital importance being that they would not be available for National Service for everyone, and is a matter which should transcend party for at least 16 months. The position is causing concern politics. to the Central Medical Recruitment Committee. Unfortunately, the National Health Service Bill, which Among the many factors concerned in this problem it has became law in 1946, was introduced by the Socialist Govern- been suggested that delay is in part due to lack of co-ordina- ment, and the normal criticism of the Opposition inevitably tion between the time of the final examination in different resulted in the National Health Service becoming a powerful centres and the dates on which the majority of hospital factor in party politics; and, because of its strong appeal to vacancies occur. Although there seems to be substantially the masses of " something apparently for nothing," the more approved posts available than there are practitioners whole project became a vote-catching device of the first qualifying each year, great difficulty is being experienced in magnitude. This regrettable state of affairs has not been obtaining posts in general medicine and in midwifery, and confined to the Labour Government alone, and each party therefore congestion occurs at the end of the first six months. in turn has found itself committed, for reasons of political The difficulties are also probably increased because some expediency, to an enlfanit terrible whose prodigious financial deliberately await the more attractive vacancies. appetite has been the bane of existence to its impoverished guardians. The necessity for finding some means of assuag- Matters for Consideration ing the demands of this voracious offspring without ruining In 1952 the Ministry of Health issued a memorandum the community's financial resources has resulted in the appli- which foreshadowed possible difficulties and suggested means cation of very many " delaying tactics " in the settlement of dealing with them by co-operation between licensing of accounts. bodies, boards of governors, regional hospital boards, and hospital management committees. Among the points sub- Whitley Machinery mitted for consideration were whether delay could be obvi- During the second reading debate on the National Health ated without undue inconvenience to hospital authorities if Service Bill in May, 1946, Mr. Greenwood, replying for applications for pre-registration posts were advertised for or the Government, stated that it was Mr. Bevan's intention accepted from students who had not yet taken their qualify- to use " the familiar machinery of discussion and negotia- ing examinations; and whether any advantage would be tion with employees" before prescribing terms of service gained by setting up regional bureaux through which all or rates of remuneration. He went on to say: "What my applications for employment in pre-registration posts would right hon. friend [Mr. Aneurin Bevan] has in mind where pass. Also it was asked whether arrangements could be there is no machinery is to set up some machinery of the made, gradually if necessary, for the commencing date of Whitley Council type, behind which there may be provision more pre-registration appointments to coincide approxi- for agreed reference to arbitration." The Government's mately with the time at which the greatest number of proposals for Whitley machinery were sent to the B.M.A. students within the region qualify. in October, 1947, and included in these were the following The B.M.A. has approached the deans of medical schools statements: " It will suffice here to say that, while the in England, Scotland, and Wales to ask them about the posi- Government hopes that the normal working of Whitleyism tion in their areas and their observations on the practicability will minimize the necessity for arbitration, it is anxious to of the suggestions made in the Ministry's circular. accord f ullest rights to arbitration subject to the preser- SUPPLEMENT TO THE 342 JUNE 19, 1954 REMUNERATION OF WHOLE-TIME MEDICAL STAFF BRITISH MEDICAL JOURNAL vation of the Government's prerogatives. A code of con- marized for purposes of assessment of income tax under duct is unlikely to be arbitrable, but a siunple proposal for Schedule D in Table V of the National Income anid Ex- a change in wage or salary rates almost certainly is" (my pendituire of the United Kingdom, published by the Central italics). Statistical Office as follows : 1938, £105m.; 1946, £180m. Commenting upon this situation, the leading article of 1947, £200m.; 1948, £212m. the B.M.J. (1949, 2, 63) stated: " In May, 1948, the Minister From this it might be assumed that, allowing for some agreed that after the inception of the Service it would be increase in total numbers within the professions concerned, open to the profession to raise through Whitley machinery there had been approximately a 100% increase in remunera- the question of betterment. It was because of this that the tion, and that this factor would be taken into account when chairman of Council, Dr. H. Guy Dain, was able to per- the adjustments in " relation to the present value of money" suade the medical profession to enter the National Health were subsequently made. Service." A few specialists wrote for personal confirmation of the The Basis of Remuneration situation, a typical reply being: Two committees were set up under the chairmanship of " I am writing to confirm that the salary is provisional and Sir William Spens, the general practice committee subse- subject to review before March 31, 1949, in the light of recom- menidations made in the Spens Report. All changes in rates of quently issuing a report upon the remuneration of general salaries occasioned by this review will have retrospective effect practitioners; and the specialist committee some time later from July 5, 1948" (my italics). providing a report on the remuneration of consultants and specialists. Both reports were publicly accepted by the Review of Medical Staff Minister of Health, Mr. Aneurin Bevan, and the profession, Hospital as the basis of future remuneration. Unfortunately, owing During this period hospital staffs were " graded" by to the instability of social and economic conditions at that grading committees, and in the light of subsequent events time, the Spens Reports defined remuneration in terms of there can be little doubt that grave injustices occurred as the 1939 values of money, and stated those now well-known the result of the introduction by the Government of the words: "We leave to others the problem of the necessary grades of S.H.M.O. and S.H.D.O., which provided a ready adjustments to present-day values of money, but we desire means of obtaining consultant services, in many cases, at a to emphasize as strongly as possible that such adjustments rate of remuneration £1,000 below the equivalent maximum should have direct regard not only to estimates of the change of the consultant scale. The view of the Council of the in the value of money but to the increases which have in B.M.A. on this matter was expressed in their Supplementary fact taken place since 1939 in incomes both in the medical Report (Supplement, 1949, 1, 287), when it was stated: and other professions. In our judgment it is only if corre- " The committee feels that the creation of this grade, neces- sponding changes are made in the incomes of consultants sary as it may be for the appropriate classification of certain and specialists that the recruitment and status of the vari- transferred officers, is fraught with danger in that it might lead ous branches of specialist practice will be maintained." to the establishment of two grades of specialist, involving a process of dilution which would be most undesirable. It is It is important to realize that the betterment factor in the therefore insistent that the grade shall not be applied to practi- case of general practitioners had been determined by the tioners of consultant status, and had recommended to the Joint Government as long ago as 1946, and that this figure was Committee that the grade should be used only as a temporary imizposed by the Government but not agreed to by the pro- expedient, and that no future appointments should be made in fession when the Health Service began on the appointed this grade." day, July 5, 1948. Advertisements for appointments involving specialist duties in this grade were no longer accepted for insertion July, 1948-March, 1952 in the Jouirnal. Unfortunately, there are still to-day many Although the imposition of the 20% betterment factor very experienced physicians and surgeons graded as upon the general practitioners took place from the outset, S.H.M.O.s but performing consultant duties, thus providing hospital medical and dental staffs were left in ignorance of a pool of what must be considered as " cheap labour." the betterment factor which the Government intended to Internal strife was created at the registrar level by the impose upon them, and were obliged to exist upon rates of creation of an excessive number of posts which bore no pay which were 25% to 40% below the accepted minimum relationship to the ultimate consultant establishment, so that of the Spens scale in terms of 1939 monev values, whilst at considerable uncertainty for the future existed. the same time paying compulsory superannuation contri- Senior consultants were divided among themselves over butions. the question of merit awards, which were allotted secretly It was therefore necessary for the Ministry of Health to to a total of 340O of specialists. The whole basis of the invite specialists to participate in the National Health Ser- merit award system, and in particular the secrecy surround- vice upon a temporary basis, interim contracts being issued ing them, was the subject of much criticism. for this purpose, and these, inter alia, stated: Divided Within " The invitation to take part in the service on the basis of the remuneration and conditions now proposed is made for a limited Thus the Minister had been able to exploit the weaknesses period only in order to allow of review and the substitution of of human character by allowing the profession to sit in firm contracts on a permanent basis as soon as possible. The judgment upon themselves. A correspondent in the Supple- rates of remuneration, trave'ling expenses, etc., proposed in the ment (1949, 2, 192) aptly summarized the situation when invitation are provisional payments until the rates evolved from he wrote: "We may well ask ourselves, 'How could this the Spens Report are known." situation come about? ' It has come about because doc- Part-time specialists were more fortunate, since the Appen- tors have been, since the National Health Service was first dix contained provisional rates which in their case amounted mooted, woefully disunited and disorganized, pursuing selfish to £200 per annum per half-day. Many of the whole-time aims and sectional interests and failing to come together specialists thought that this could be taken to infer that 11 for their own protection. Thus wedges are being driven half-days or £2,200 per annum, a betterment factor of 47%, between various sections of the profession. If doctors do might be taken as a starting-point for negotiations regarding not now at this late hour organize and unite, then the the betterment factor to be applied to the Spens Report for outlook for the doctor and his family is black indeed. And Consultants and Specialists. the time is short." There will be few of the medical pro- Some support to this impression was given by the increases fession to-day employed in hospitals who would be inclined which had in fact taken place in the medical and other to cast the first stone at the writer of this shrewd comment professions since 1938. The professional earnings of doc- of almost five years ago, and, as he inferred, the time was tors, dentists, lawyers, artists, and journalists were sum- "later than you think." JUNE 19, 1954 REMUNERATION OF WHOLE-TIME MEDICAL STAFF BRITISHSUPPLEMENTMEDICAL TOJOURNALTtHF 343 machinery of Whitley had been exhausted, issues of Compulsory Arbitration remuneration remaining in dispute would go either to In the meanwhile the General Medical Services Com- arbitration or for inquiry and report by a committee. mittee had obtained the opinion of an expert economist, (d) That the model form of contract would be amended who came to the conclusion that the increase in middle- to make it clear that it was not subject to unilateral class budgets in 1948 was 85% over the pre-war figure. A modification. report on remuneration went to the Ministry on March 4, By signing a contract at this time a specialist was not 1949, and a deputation of members of the General Medical necessarily committing himself to an acceptance of 20%o Services Committee went to the Ministry on April 14 to as an adequate betterment factor, but acknowledging only discuss remuneration in the light of the report. An indica- that he was prepared to enter the scheme under the terms tion of the attitude to be adopted from that time hence- and conditions of service which had at that time been forward was given when the Ministry was asked whether, assured for him by the Joint Committee, his contract in the event of a dispute on remuneration, the profession's including the proviso that remuneration was subject to claims should be submitted through Whitley machinery and "the terms and conditions of service determined from finally, if necessary, to arbitration; the reply given was as time to time," knowing full well that further negotiations follows: " It must not be assumed without further discus- on the subject of remuneration were under consideration. sion that participation in the Whitley machinery necessarily In view of recent events, it is of some interest to note involves, in the event of disagreement, the right to resort the substance of a letter at this time (B.AM.J. Suipplenment, compulsorily to arbitration on all subjects." 1949, 2, 185) from the members of the S.W. Metropolitan Commenting upon this in a leading article entitled (Western) Regional Committee, one of the signatories to "Breach of Faith," the Journal (1949, 1, 762) observed that which is a member of the present Joint Committee. A the profession would be disturbed at the negative caution paragraph from the letter reads: " It has been noted also in the Ministry's reply. It added: "Without the right to that the Joint Committee has omitted to report 'regularly resort compulsorily to arbitration on a subject such as its proceedings to the Central Committee and finally acted remuneration the Whitley machinery may well be reduced without authority in agreeing with the Ministry to recom- to mere trifling, the correction of minor administrative mend the terms for the permanent contracts for hospital errors here and there and the removal of the occasional staffs, while discarding almost all the points of objection straw from the camel's back. It is difficult to see how any or modification which had been previously put forward by claims on which the two sides of the Whitley Council fail the Regional and Central Committees. Such behaviour to agree can be justly decided if, on the Government's does not inspire confidence in the Joint Committee- for the prerogative, resort to independent arbitration is denied. future conduct by it of the affairs of hospital staffs, even Indeed, not only the claim but justice itself would be if the staffs were prepared to waive their right to democratic denied." representation." It should also be recalled that the Chairman of Council The Danckwerts Award said at the Special Representative Meeting on May 28, 1948: A fundamental error of policy took place when it was "The Minister has agreed that when the Service starts on agreed to allow the general practitioners to press their claim July 5 we can immediately raise with the Whitley Council for betterment independently, since it was, as future events which will be set up to consider general practitioner proved, yet one more crack in the unity of the profession. remuneration, this matter of the betterment factor and the Every possible means to effect a peaceful settlement by implementation of the Spens Report. Tlherefore we are negotiation having been tried, the attitude of the Minister not bound to the present conditions as set out in the (Mr. Aneurin Bevan) may be observed from an extract of remuneration offer if we can prove to the Whitley Council his letter (B.M.J. Supplement, 1950, 1, 179) in reply to the that the amount is not the proper one." previous request for application of a 70% betterment factor in the light of a carefully assessed 85% increase in the Minister The Bettenment Factor cost of living. The letter concluded : "The is. clear that in the light of these figures no reasonable case In the meantime, the Joint Committee had been advising can be made for any increase in the total remuneration of consultants not to sign any contract with the Ministrv, general practitioners, nor any argument substantiated to which had issued its proposed terms and conditions of show that general practitioners as a group are inadequately service in March, 1949. The leading article (Journal, 1949, paid. Nor, in his view, could any claim be justified that 1, 486) concerning " Remuneration of Specialists " noted the any future alteration of remuneration at any later date Spens recommendations that increases in the medical and should be made retrospective, either to July, 1948, or to other professions were to be taken into account in calcu- the present day. This view rests upon the sheer merits of lating the betterment factor, and drew attention to the the case as revealed by the plain figures and facts as they Chorley Committee's proposals for remunerating higher stand." civil which had been the Govern- servants, just accepted by After a threat of mass withdrawal from the Service the ment. It was observed that: "The salaries of permanent bluff contained in this letter was the went secretaries and secretaries in Government called, dispute deputy Depart- to and the " sheer merits of the case as revealed ments have been increased by 50% above the salaries of arbitration, by the plain figures and facts as they stand" resulted in these officers in 1939. It is not unfair to assume from this the adjudication of Mr. Justice Danckwerts. The outcome that the Government 50% as a reasonable better- regards was that a betterment factor of was to the ment factor." 85% applied years 1948-50, and 100% to 1951. Contracts Signed The statistics for this inquiry were prepared by Professor In view of the long delay and the financial hardship R. G. D. Allen, who occupied the Chair of Statistics at suffered by hospital medical staffs, and that the Ministry London University. After a most detailed investigation, he was unlikely immediately to give any further concessions came to the conclusion that in 1952 the rise in the cost of by negotiation, the Committee and the Joint Committee living represented an increase of approximately 120% over decided to advise hospital staff to sign contracts. This the 1939 level. was, however, done only after certain very important safe- This complete vindication of the claims of the general guards had been obtained from the Minister: (a) That no practitioners badly rocked the complacency of the Govern- changes would be made in the terms and conditions of ment, which hastened, through the medium of the Chan- service without discussion in the appropriate part of the cellor of the Exchequer, to make a statement to the Whitley machinery, when established. (b) That remunera- following effect: tion was a subject suitable for arbitration. (c) That, save " I want to make it clear that the terms of reference of in exceptional cireumstances, and after the conciliation Mr. Justice Danckwerts's award were confined solely to SUPP;,EMENT TO THE 344 JuNE 19, 1954 REMUNERATION OF WHOLE-TIME MEDICAL STAFF BRITISH MEDICAL JOURNAL the question of the remuneration of general practitioners in would have looked into the earnings of part-time consul- the National Health Service, and his award has no wider tants." Sir Russell implied that this might have had application. In accepting the results of the adjudication, unfortunate results, but in the Supplement (May 22, p. 280) which was of an exceptional nature, the Government have concluded a letter with these words: " Can we not continue by no means adopted the view that similar adjustments in to put unity before sectional interest ? other fields should follow. In their view there is no justifi- cation for anv assumption that the appropriate standard of remuneration for the professional classes is a rate of 10000 Comparative Figures above that in force in 1939. They consider that remunera- The accompanying graph attempts to illustrate the past, tion should be determined in the light of all relevant present, and future position of a whole-time consultant circumstances." as from the appointed day in July, 1948, and to compare Whilst the Minister is entitled to take this view, if he this with the increase in the cost of living which has taken wishes, he is of course not infallible in law, and the proper place from the inception of the Health Service. course would seem to be to have pressed immediately for an adjudi- 40 cation concerning the betterment 35 factor to be applied to hospital medical staffs upon the sheer 30 merits of the case and not, under MINIMUM OF 25 -2 the circumstances, in relation to 1954 LEVEL 23 5_£10 the Danckwerts award. Whatever 20F the Minister's views, it would have ,5 been very difficult, having regard to the figures available from Pro- 10 fessor Allen's calculations, to have (COSTIINDEX=OF LIVING108 5- awarded a betterment factor very MINIMUM OF much below that of the general .1948 LEVEL 700 practitioner, particularly when we £182 look back to the Chorley report in MINIMUMOF -10 which the Government accepted SPENS £1500O £I62 1949 as justifying the application of 1939 LEVEL - 11.75 a betterment factor of 50%° to higher civil servants. -20 9 1950 1951 1952 1953 1954 1955 1956 At this juncture it should be re- Chart 194anship between cost-of-living index and remuneration of the membered that, although both the Chart showing relatio whole-time consultant, 1948-56. Danckwerts award and the scale for hospital staff imposed in 1949 but not put into effect The graph is based upon percentage variations between until 1950 were retrospective to July, 1948, the Govern- the official cost-of-living index and the relationship of ment had obtained four vears' services to a considerable the 1948 scale to the 1939 Spens scale. The position at extent upon credit in the case of general practitioners, and July, 1948, has been taken as the datum line of zero point two years' credit facilities of a similar nature in the case of in relation both to the salary minimum of £1,700 and to the hospital staff and in both instances these were free of cost-of-living index, which at that time stood at 108. The interest. In addition the money from superannuation con- Spens minimum of £1,500 is £200 below this point, and is tributions was not in circulation, or available to meet the therefore shown as a decrease or minus factor of 11.7%, day-to-day financial commitments of an impoverished which is equivalent to saying that the minimum of the hospital medical staff. 1948 scale is 13.3% above the Spens minimum. If the 1948 scale had been a true replica of the Spens Why no Inquiry ? scale with an even 13.3% increase throughout, the line Another two years' delay was no doubt imperative if the depicting salary would of course be the same as the 1948 Government was to recover from the situation brought salary scale datum line but it will be observed that this is about by the Danckwerts award, and subsequent events not the case, and that, although declining slightly initially have shown that this has indeed been the policy carried out and then closely approximating to a 13.3% increase, sub- in relation to the recent negotiations. Sir Russell Brain, sequent increments are inadequate and the line declines Chairman of the Staff Side of Committee " B " of the sharply so that at the maximum of the scale the betterment Medical Whitley Council, stated (Supplemnent, April 10, factor is only 10%' above the 1939 Spens level-this neces- p. 145) that if negotiations at this stage had broken down sarily having to be shown as a 2.9% decrease from the in the Whitley Council the Minister could fulfil his under- corresponding point on the datum line representing a level taking by referring all aspects of consultant remuneration 13.3% increase (£2,832) over the Spens maximum. to a committee of inquiry. In view of the indisputable As from April 1, 1954, the 1948 scale is shown as a merits of the case and the sound precedent created by the dotted line, the actual salary received rising abruptly in Danckwerts adjudication it is difficult to understand why accordance with the recent increase. The next point or this was not done immediately. The excuse offered was incremental date on the 1954 salary scale takes a downward that there was a danger that the findings could in effect direction, expressed as a percentage increase above the replace the Spens Report as the basis of consultant remun- equivalent point on the 1948 scale, and the percentage eration for the future. One is not aware that this has in relationship of the 1954 scale to the 1948 scale throughout fact been the effect of the Danckwerts award so far as the from the minimum to the maximum may be observed from general practitioners are concerned, and it is impossible the dotted line shown as a "back-projection" and con- to conceive that the basis upon which the profession entered tinuation of the 1954 salary line. the National Health Service would be jeopardized by a The situation arising from the imposition of the 1948 properly constituted legal body. scale may be seen by reference to Table I. The system of Referring to the possibility of such an inquiry into the tapering off, perhaps better described as " chiselling " off, remuneration of hospital medical staff, Sir Russell Brain remuneration at the upper end of the scale is particularly stated (Suipplemtienit, Mav 8. p. 228) that this " would not reprehensible in view of the relatively greater burden of have concerned itself with cost-of-living betterment but taxation which the higher-income groups are called upon JUNE 19, 1954 REMUNERATION OF WHOLE-TIME MEDICAL STAFF BRITISHSUPPLEMENTMEDICAL TOJOURNALTHE 345

TABLE I

%Increase Over 1948 Scale Less 6', 1948 Scale Plus 1939 Spens Scale Compulsory Personal /, Increase over 1939 Spens Scale of Grade Government Superannuation Taxable Income Remaining after Preceding Grade Superannuation8%, With Without Contribution and Deductions Contribution Government Government 8% Government 8% Contribution 8% Contribution Contribution Percentage Amount Consultant: Minimum, £1,700 .. .. £1,836 1888% 13 3, £1,598 6 5 £98 Maximum, £2,750 .. £2,970 22-4% 1000% £2,585 3-4 £85 Senior Registrar: Minimum, £1,000 £1,080 20% ! 1-11 £940 4-4 £40 Maximum, £1,300 .. £1,404 17% 8-3' £1,222 1-9 £22 Registrar: Minimum, £775 .. .. £837 19-5% 10 7% £728 4 £28 Maximur, £890 £960 20% 11-25%/ £837 4-6 £37 Senior,House Officer, £670 .. £723 20-5% 11-66% £630 5 £30 Example:-Consultant minimum, £1,836 (188',) -£136 (Government contribution)-£102 (personal contribution)=£1,598 (6 5% increase over Spens). TABLE II.-Remuneration of Whole-time Consultant

'/0 Adjustment of % Variation of Cost-of-living Total ' Salary Back Pay Due. Increase Salary to give Actuial Scale Index and ", Difference Required Subject to GradeGrade YearYear Spens1939 1948ofScale Scale1948 Increase13.3% LevelAboveof Adjustedfrom 13-3%Scale IncteaseJuly, 1948since BetweenScale andActual Increaseto Offsetin Incomefor YearTax Over 1939 Spens + =Above when Cost-of-living Cost of Living Applicable and 1939 Scale Scale - =Below Index= 108* Index Each Year Superannuation Minimum .. 1948 £1,500 13-3 £1,700 £1,700 Nil 108: Nil Nil £1,700 Nil First increment 1949 £1,625 12-3 £1,825 £1,841 -0-9 111: +2-8 3-7 £1,893 £68 Second ,, 1950 £1,750 11-5 £1,950 £1,983 -1-6 114: +5-5 7-1 £2,088 £138 Third ,, 1951 £1,825 13-5 £2,075 £2,067 +0-4 126: +16-6 16-2 £2,411 £336 Fourth , 1952 £1,950 14-0 £2,225 £2,209 +0-7 138: +27-7 27-0 £2,848 £623 Fifth 1,953 £2,075 14-4 £2,375 £2,351 +1-0 141: +30-5 29-5 £3,075 £526t(°of £701) Total, £l,691t * Ministrv of Lab-ur Gazette, Februiary, 1954, p. 64. t Remuneration from July, 1953, to March 31, 1954. Approximately equal to £750 net. Note: -Increments are due in July each vear. TABLE III.-Remuneration of the S.H.M.O. and the J.H.M.O.

Cost-of-living Index and % Salary which wotild have Back Pay Due. Subject to Grade Year 1948 Scale* Increase Since July, 1948, been Required to Offset Tax for Year Applicable when Index= 108 Increase in Cost of Living and Superannuation S.H.M.O.: First year 1948 £1,300 108 Nil £1,300 Nil Second ,, 1949 £1,350 111 2-8°/O £1,388 £38 Third ,, 1950 £1,400 114 555% £1,477 £77 Fourth ,, 1951 £1,450 126 166%°0 £1,691 £241 Fifth ,, 1952 £1,500. 138 27-7% £1,915 £415 Sixth year (9,112ths) 1953 £1,550 141 30 5/O £2,023 £355 (j of £473) £1,126 J.H.M.O.: First year 1948 £700 108 Nil £700 Nil Second,, 1949 £750 111 2-8% £771 £21 Third ,, 1950 £800 114 5 5° £844 £44 Fourth ,, 1951 £850 126 16 6% £991 £141 Fifth ,, 1952 £900 138 27.7% £1,149 £249 Sixth year (9,'12ths) 1953 £950 141 305%°O £1,240 £217 (j of £290) £672

* The gradesof S.H.M.O. and J.H.M.O. were not provided for in the Spens Report. There are therefore no 1939 equivalents. TABLE IV.-Remuneration of Senior Registrar, Registrar, and Senior House Officer

% 1948 Scale Cost-of-living Salary Back Pay Due. Year of 1939 1948 Increase Adjusted Index and % Required to Subject to Income Grade Serviceervo SSpens SScale Scaleof 1948Over to13-3%give July,Increase1948,Sincewhen IncreaseOffset in SuperannuationTax and for 1939 Scale Increase Index=108 Cost of Living Year Applicable Senior Registrar: First year .. .. Jan., 1951 £900 £1,000 11.1% £1,020 118 9% £1, 112 f£112 Second,, .. .. Jan., 1952 £1,000 £1,100 10 0% £1,133 133 23%' £1,382 £282 Third .. .. Jan., 1953 £1,100 £1,200 9-0% £1,246 139 28%' £1,595 l£395 * Fourth,, .. .. Jan., 1954 £1,200 £1,300 8-3% £1,360 141 30 5%y £1,775 £119 (3/12ths of I-_I £475) l£908 Registrar: First year .. .. Jan., 1952 £700 £775 10-7% £793 133 23% £975 £200 Second,, Jan., 1953 £800 £890 11-25% £906 139 28% £1,160 £270 £470 Senior house officer .. Jan., 1953 £600 £670 11-66%/ £689 139 28% £882 £2t2 * The Spens scale was based upon a total of three years' service in the grade of senior registrar. The fourth year has been calculated by adding a further £100 to the third year of the Spens remuneration. 346 JUNE 19, 1954 REMUNERATION OF WHOLE-TIME MEDICAL STAFF BRITISHSUPPLEMENTMEDICAL TOJOURNALTHE TABLE V. Remuneration of House Officer

Salary which would have Back Pay Due. Sbject Cost-of-living Index been Required to OF-set to Tax for Year and °' Since in Cost of Applicable and July,Increase1948, when Living,IncreaseLess Appropriate Superannuation. Index 108 Adjustment to Deduction (6l12ths of Annual for Residential Emoluments Amount in Each Period) House officer: First six months .. July, 1952 £350-£100=£250 138 277°/ £447 -£128 = £319 £34 10s. Second .. .. Jan., 1953 £400 -£100 =£300 141 30 5°0% £522-£130=£392 £46 Third .. .. July, 1953 £450 -£100 £350 141 30 5% £587-£130=£457 £53 10s. l£134

* The grades of house officer were not provided for in the Spens Report. There are therefore no 1939 equivalents. to bear to-day in comparison with 1939. This pattern of TABLE VIII.-Proposed Rates of Remuneration for Other Grades remuneration has been followed in an exaggerated form of Hospital Medical Staff Senior hospital medical officer . . £1,700 x £l O0-£2,2001 by the 1954 scale. Junior , ,,, ,.£900 x £75-£l,275 Bearing in mind the fact that the 1948 pay scale did not House Officer: First six months .. £455-£130=£325 Second . £530-£130= £400 become effective until 1950, thus securing two years' ser- Third ,, ...... £580-£130=£450 vices to a large extent on credit, and that no retrospective N.B.-No Spens equivalent exists for the above grades to which an approxi- pay has been given with the recent award, the extent of mate increase of 30% over the 1948 level has been applied. In the case of House Officers an increase to the rates for residential emoluments has been cheap labour obtained by the Government may be readily made so as to bring the charge up to a level commensurate with the increase envisaged. Add to this the underpayment of hospital staff, in the cost of living. particularly in the registrar grades, and it becomes im- Senior registrar .£1,350x£L100-£L1,650 Registrar . £1,05Qx £150-£l1,200 mediately apparent that the -whole scheme has been floated Senior house officer £900 to a considerable extent upon the finances not of the N.B.-The salaries for the above grades have been obtained by calculating Government but of the hospital medical staffs themselves. the ratio for the Spens minimum of the grade in relation to the Spens minimum of the Consultant grade--e.g., senior registrar, £900; consultant, £1,500= The back pay to which we are morally entitled is set out ratio 9/15ths or 3/Sths of proposed consultant's minimum of £2,250; equiva- comprehensively for all grades in Tables II, III, IV, and V. lent to £1,350 p.a. The inadequacy of the 1954 scale in relation to the 1948 scale at all points beyond July, 1951, is very obvious, and and principles of the Spens scale it is necessary to ensure it might be said that it is almost three years out of date. that the ratio of remuneration between the different grades The net effective increase of the 1954 maximum is only is maintained, and every effort has been made to ensure that 9.4% above the corrected maximum of the 1948 scale. this basis is preserved. It is also necessary to provide an An attempt has been made to construct a scale, increase of the maximum over the minimum of the scale accepting to that and a true increase in 1948 of 13.3% over the Spens scale equivalent recommended by the Spens Report, throughout the salary range, and applying to the corrected thus to avoid the tendency to "make up on the swings what has been lost on the roundabouts," a which salary figures thus obtained an increase of 30.5 % to offset technique the increase in the cost of living since 1948. In applying has already been exposed. A comparison between the Spens 1954 and the scale is a betterment factor of 30.5% to the 1948 scale was scale,, 1948 scale, scale, proposed (which shown in an imposed 13.3 % increase above the 1939 Spens scale), Table IX. thus making a total betterment of approximately 44% above TABLE IX pre-war levels, it is not intended to suggest either that this 1939 1948 1954 Proposed is necessarily an adequate figure or that an assumption has Spens Scale Scale Scale Scale been made to the effect that every increase in the cost of Minimum .. £1,500 £1,700 £2,100 £2,250 living should result automatically in the application of a First increment .. £t,625 £1,825 £2,225 £2,400 corresponding betterment factor. The intention is rather Second ,, . £1,750 £1,950 £2,350 £2,550 Third ,, .. £1,825 £2,075 £2,475 £2,700 to indicate that this is the absolute minimum betterment Fourth .. £1,950 £2,225 £2,600 £2,850 which could be considered in the light of all the relevant Fifth .. £2,075 £2,375 £2,725 £3,000 be seen in Tables Sixth ,, .. £2,200 £2,500 £2,850 £3,250 circumstances. The results may VI, Seventh ,, .. £2,375 £2,625 £2,975 £3,500 VII, and VIII. In order to preserve the essential structure Maximum .. £2,500 £2,750 £3,100 £3,750 % increase from TABL'R Vl.-1954 Salary Scale for Whole-time Consultant minimum to max- Adjusted to Compensate for 30.5% Increase in Cost of Liiving imum .. .. 661 618 47-6 661

1948 Scale Adjusted Adjusted Figure to to give 13-3% Level 30.5% Increase Provide Even and Increments of Tncrease Over Over Corrected Smooth The extent to which the 1954 scale has implemented the All Points on 1939 1948 Scale Progression of Spens recommendations and the real value of the recent Spens Scale Proposed Scale increase in salary may be observed in the figures in Table X. Minimum £1,700 £2,218 £2,250 These have been calculated in accordance with Mr. Butler's First .. El 841 £2.402 £2,400 Second .. £ 1983 £2,588 £2,550 Third .. £2,067 £2,697 £2,700 Fourth .. £2,209 £2,883 £2,850 TABLE X Fifth .. £2,351 f3£,068 £3,000 Sixth .. £2,493 £3,253 £3,250 Seventh .. £2,691 £3,500 £3,512 SalarySp-laryTax Net Superan- True Equivalent1938 Maximum £2,832 £3,696 £3,750 1954 nuation Net Net Income

This scale may therefore be expressed as £2,250 x £15O-£3,000 x £250 Senior Registrar: -£3,750. Minimum .. £1,100 £136 £964 £66 £898 £395 Maximum .. £1,400 £241 £1,159 £84 £1,075 £473 TABLE VII.-Whole-time Consultant in Receipt of Merit Award. S.H.M.O.: (All Merit Awards Plus 30% Increase) Minimum .. £1,500 £276 £1,224 £90 £1,134 £499 .. "A " award .. £3,750-- £3,250= £7,000 .. 4%/ of consultants Maximum £1,950 £434 £1,516 £117 £1,399 £615 "B " . . £3750-cn7 £1 95(=05,700 .. 10°% It Consultant: C" .. £3,750+£6J3-=4,400 .. 200% Minimum .. £2,100 £504 £1,596 £126 £1,470 £647 N.B.-Equivalent pre-wsr purchasing power of 1954 income of £5,000 p.a. Maximum .. £3,100 £1,074 £2,026 £186 £1,840 £809 for a married man with two children =£1,090. This is provided by a tax-free Plus " C" income of approximateiv £2,630 A consultant in receipt of the maximum merit award £216 £879 merit award will therefore tiot have the equivalent 1939 purchasing power £3,600 £1,386 £2,214 £1,998 of the minimum of the 1s39 Spens scale for consultants without a meritaward. JUNE 19, 1954 REMUNERATION OF WHOLE-TIME MEDICAL STAFF SUPPLEMENT TO THE BRITISH MEDICAL JOURNAL 347

statement on February 6, 1953, that the pound was then worth 44% of its 1938 value, and on the assumption that MAJOR ACCIDENTS the individual concerned is married, with two children. MOBILE HOSPITAL TEAMS Apart from the many anomalies of the merit award system, there is one feature which is not always fully Arrangements are being made for certain hospitals in all appreciated. The Spens Report laid down that 4% of areas to be ready to send mobile medical teams to the consultants were to receive an " A " award of £2,500, 10% scene of major civil accidents involving large numbers of a "B" award of £1,500, and 20% a "C" award of £500 casualties. It will be the function of the ambulance ser- per annum additional to the normal rate of remuneration. vice to call on the most appropriate hospital. The ambu- Since part-time consultants receive only a proportionate lance service will be kept informed by hospitals of the amount of the merit award dependent upon the number of number of beds remaining available for casualties. If it sessions they perform, the percentage quota may be ful- is necessary to call upon more distant "support" hospi- filled at a much smaller cost to the Exchequer by giving tals, the hospital medical officer in charge of a mobile team awards to part-time rather than whole-time consultants. will keep the ambulance service informed as to which of For example, of 100 consultants eligible for "C" awards the hospitals should receive casualties. Mobile teams from of £500 per annum only 20%, or a fifth, may receive them. hospitals will bring their own surgical and medical equip- If, therefore, 20 whole-time consultants receive awards the ment. amount involved is 20x£500 per annum=£10,000. If 20 The Ministry of Health has notified all local health part-time consultants receive the award, each performing authorities of these arrangements (circular 13/54). 2/llths, they each receive approximately £90 per annum as their proportion of the merit award at a total cost of £1,800. In both cases the 20% quota has been satisfied. MEDICAL Allowances for Whole-time Staff CERTIFICATES FOR SERVICE MIEN So much has been said concerning this subject that it will Medical certificates submitted by civilian medical practi- tioners men on suffice to repeat the recommendations of the Spens Report, for Service leave who are prevented by ill- which in assuming that whole-time specialists would be ness from reporting to their units on the date specified do not paid " any sums which represent expenses reasonably incur- always provide the information required by the Service red in the course of their work" which would not be liable authorities, and a certain amount of trouble is caused by this omission. The Service departments concerned expect to tax, specified such items as: ". . car expenses; certificates made out expenses of travel apart from the use of a car; the cost under these circumstances to state of renewal of instruments and other equipment; the cost specifically that the patient is unfit to travel: a statement that of books and journals, preparation of scientific papers, and the patient is unfit for duty is insufficient for Service subscriptions to professional societies ; printing, stationery, requirements. postage and telephone costs; expenses of attendance at national and international professional meetings; and the expenses of visiting hospitals and clinics at home and abroad, and entertaining visiting colleagues." PATIENTS REFERRED BY DENTISTS FOR PENICILLIN INJECTIONS The Future The Secretary of the British Dental Association has sent the Hospital medical and dental staff must now decide for following letter to his association's branches and sections themselves whether they are content to aim at a salary and to local dental committees: which will give them at the maximum of the consultant "The British Medical Association has told us that difficulties scale, aged about 45, a spendable income of £1,840 per have arisen in parts of the country where some dental practi- annum with an equivalent purchasing power of £809 in tioners have referred patients to doctors for penicillin injections. 1938, and whether in the light of all the facts this can be The doctor is sometimes placed in an awkward position in dental cases of this kind if he regarded as a proper implementation of the Spens Report decides that risks of sensitization and bacteriological resistance preclude the use of penicillin on in virtue of which the was to profession induced enter the a particular patient. The British Medical Association has accord- Service. The Whitley machinery at the present time has ingly asked that any dentist referring a patient to a doctor for broken down completely, and in view of the often-repeated this treatment should make his request to the doctor in writing assurances that the Minister would certainly agree to it, an and should not give any details to the patient. inquiry, based upon the Spens recommendations and the "The General Dental Services Committee agrees entirely with merits of the case and not the Danckwerts award, should the suggestion of the British Medical Association on this point, be instituted forthwith. It should also be made quite clear and it would appreciate it if you could take steps to give the matter all possible that an increase in pay is not being demanded, but that a publicity in your area." rectification of the unjust rates of remuneration imposed by the Government in 1950 (retrospective to 1948) is being sought, together with full back pay as compensation for the severe personal financial hardship endured for six years by the hospital full-time staffs of this country. This is not A COMPREHENSIVE SERVICE to say that the correct proportion of back pay should not be given to part-time consultants, but rather to emphasize The following letter has been sent to us by the recipient. that, since they have been able to offset the increase in "Dear Dr., living by increased fees to private patients, and to obtain "Please be as kind as give me cream for my leg also gauze preferential allowances, the financial draught has not been so severe. and lint. And I would like if you will come down and see it when you are coming this way. And please do me a One point above all stands out in the clearest possible favour, Dr., by telling me the names of the three horses you manner-unity is strength in the medical profession as it is think will come in on the Derby. elsewhere. As the B.M.J. has repeatedly pointed out, if we abandon Spens we abandon our birthright. The time "Yours sincerely, has come to close our ranks, demand as a united body an " Alice. impartial inquiry, and fight to the last ditch to ensure that "Please write the names of the horses down to my we get it. husband as he might not remember." SUPPLEMENT TO THE 348 JUNE 19, 1954 CONSULTANTS AND SPECIALISTS COMMITTEE BRITISH IVMEDICAL JOURNAL attention to previous resolutions that all S.H.M.O.s doing CENTRAL CONSULTANTS AND SPEUALISTS consultant work or who were in full charge of chest units should be given consultant status. Mr. STAVELEY GOUGH COMMITTEE pointed out that, so far as beds were concerned, it could not A PLEA FOR REVIEW OF JUNIOR HOSPITAL STAFF be decided from the fact that if a man had charge of 10 An all-day meeting of the Central Consultants and Special- beds or of 100 beds that he was a consultant or an S.H.M.O. ists Committee was held on June 10, with Dr. T. ROWLAND After some discussion the resolution of the Group was HIILL in the chair. A report on a number of detailed matters referred to the Joint Committee. was presented by the Executive. One of these concerned the method to be adopted in reviewing part-time contracts, Employment of Locumtenents During Annual Leave and in particular to the introduction of attendance registers It was reported that the South-western Regional Com- and to the opposition already voiced by the Central and mittee had expressed concern regarding the non-provision Joint Committees to the requirement to "clock in." The of consultant locumtenent cover during holiday periods. point was that the reassessment of part-time contracts on the Dr. L. S. POTTER, for the Medical Practices Advisory evidence of an attendance register would tend to reduce Bureau, said that, although the demand was likely to exceed consultant remuneration to a time basis. There were, how- the supply, there were quite a number of locumtenents ever, allegations that some part-time men were not putting available for this purpose. One of the metropolitan in the expected amount of time. regional boards kept a panel of locumtenents, and he did Mr. NORTHFIELD pointed out that, if some men were not not see why this idea should not be carried out in other putting in their full time, this might be due not to any regions. He himself would do his best to provide names for lack of conscientiousness on their part but to the fact that the panels. there was not enough work presenting itself to enable the It was agreed to inform other regional boards of the contract to be fulfilled. Mr. LAWRENCE ABEL suggested panel system. that any difficulties could be dealt with on the spot in a perfectly friendly manner, or, if necessary, by the local Remuneration of Hospital Medical Staff consultants committee; it was a domestic problem. The Committee had before it a number of communica- The CHAIRMAN said that with highly qualified professional tions from regional committees concerning the recent men measurement by time could never be more than a revision in remuneration. Mr. NICHOLSON-LAILEY, speaking broad criterion. for the South-western Region, said that it was their view The Committee reaffirmed its opposition to the principle that as an urgent matter the Joint Committee should obtain of "clocking in " and emphasized the importance of estab- calculations regarding the betterment factor. These calcula- lishing a closer and more understanding relationship be- tions should be made by economic experts of the highest tween a board's administrative officers and the consultants authority, and if they -proved to be materially in excess of in the region. Professor CLOAKE undertook to bring for- the recent awards a further claim in exact and definite ward a reasoned resolution on the subject at the next meet- terms should be made forthwith. ing of the Executive. It was also agreed that the cor- The CHAIRMAN pointed out that in the latest Bulletin respondence on the subject should be referred to the (Bulletin No. 3) all the considerations were set out. He Joint Committee. felt confident that this was the first time the actual facts The Expense Levy had been assembled in this manner. The CHAIRMAN, in reporting on the work of the Joint The representative of the South-eastern Metropolitan Committee, said that a small subcommittee had been ap- Regional Committee urged that the Staff Side of Committee pointed to work out the details of a scheme for the intro- " B " should press for the implementation of the Spens duction of an expense levy. The principle had been mooted report in respect of the payment of adequate allowances of having one levv to cover the expense of the whole of to cover professional expenses reasonably incurred by the consultants' organization. The Ministry had so far hospital medical staff in the performance of their duties, consistently refused to entertain a proposal for deduction and that in view of recent changes in income-tax assessment of contributions to an expense levy at source, but if neces- such allowances should be obtained both for whole-time sary a personal interview with the Minister would be sought. and for part-time consultants. It appeared from a rough calculation that no unreasonable It was agreed to forward the proposals to the Staff Side demand would be made upon the individual. of Committee "B."

Representation on Regional Hospital Boards Accessibility of Hospital Records Attention was called to a recent resolution of the Council Dr. COCHRANE SHANKS submitted the minutes of the agreeing in principle that names of suitable members of Medico-Legal Subcommittee. These included a statement the public health service should be included in the list of by the Law Society concerning the furnishing of medical doctors nominated by the Association for membership of reports on hospital patients to solicitors or other interested regional hospital boards, and the Liaison Committee had third parties. He said that the statement contained nothing suggested that the attention of Branches and Divisions be to which exception could be taken, and it made it abun- drawn to the desirability of such an inclusion. dantly clear that it rested solely within the discretion of the Some members of the Central Committee, however, member of the medical staff concerned to furnish a report pointed out the inadequacy of hospital medical staff repre- or not. There was no reference, however, in the statement sentation on the boards and the likelihood that this would to the furnishing of copies of hospital records, and his sub- be further reduced if seats were allocated for the representa- committee thought that attention should be drawn to the tion of other outside interests. It was agreed to refer the Minister's assurance that copies of hospital notes should matter back to the Liaison Committee for further con- not be allowed to leave the hospital without reference to sideration. the practitioner concerned. Grading of S.H.M.O.s The Tuberculosis and Diseases of the Chest Group Com- The Registrar Position mittee brought forward a resolutidn that the Staff Side of Resolutions from the Registrars Group Council were Committee " B " be urged to continue to press for a solution before the Committee calling attention to the need, when of the problem of securing for upgraded S.H.M.O.s a start- the remuneration of S.H.M.O.s was considered, for an ing salary at an appropriate point above the minimum of the appreciable increase in the remuneration of senior house consultant scale as permitted by the terms and conditions officers and a further increase for other grades of hospital of service. It was agreed that this should go forward to junior staff. The Group Council also submitted a report the Staff Side of Committee "B." The same Group drew of a discussion which they had held on the general position SUPPLEMENT TO THE JUNE 19, 1954 CONSULTANTS AND SPECIALISTS COMMITTEE BRITISH MEDICAL JOURNAL 349 of hospital junior staff with a request that it be forwarded to the Joint Committee and submitted for publication in SOUTHERN BRANCH ANNUAL MEETING the medical press. SUCCESSFUL GATHERING AT WINCHESTER Dr. R. M. FORRESTER said that the Registrars Group was far more concerned with future prospects than with present The Southern Branch of the B.M.A. held a successful and remuneration, but there were also some points on remunera- interesting annual meeting on June 4 and 5. The hosts this tion which they had specially in mind. They had hoped year were the Winchester Division, who arranged their annual that, when the Joint Committee and the Whitley Council charities ball for the night of June 4 to coincide with were pressing for an improvement for seniors, consideration the meeting. About 250 members and their ladies attended would also be given to the house officer, especially the house the ball, which was held in the beautiful Old Guildhall, officer after his pre-registration term. If hospitals wanted the proceeds going to the Council for the Care of Cripples. junior staff they must be prepared to pay a remuneration The following day the 78th annual meeting of the Branch which would compare favourably with what a young man was held in the Guildhall. Dr. A. Orley, of Guernsey, the could earn in general practice as an assistant and junior retiring president, invested the incoming president, Dr. partner. Particularly now that senior registrars were allowed C. B. S. Fuller (Winchester), with the presidential badge. to re-apply and continue for more than four years, there Dr. R. H. Balfour Barrow was reappointed honorary secre- should be a continuing increase of their remuneration up tary; Dr. J. C. Harland (Isle of Wight) was made president- to a figure more closely approximating to that of the con- elect. After a graciously expressed civic welcome by the sultant service. They were very disappointed that the gap Mayor of Winchester, Mrs. H. M. Charles, Dr. C. B. S. between the remuneration at the top of the senior registrar Fuller delivered the Winchester address on " The Antibiotics scale and that at the bottom of the consultant scale had not and Their Effect on the Changing Form of Disease." been narrowed. Dr. Forrester went on to speak of the general position. Demonstration of Physical Medicine He mentioned that recently for one consultant post in Before ending the meeting with a visit to the library of Bournemouth there were 128 applicants, and 108 of these Winchester College, members and their ladies saw a most were of less than consultant status. During recent years interesting demonstration in the Physical Medicine Depart- the Royal Colleges had turned out a large number of people ment of the Royal Hampshire County Hospital by Dr. with higher qualifications, and he thought the situation had Russell Grant. Dr. Grant pointed out how most of the got out of hand. When it was proposed to cut down the apparatus and installations, from wax baths and light and number of senior registrars from 1,400 to about 500 there heat apparatus to a hot pool, had been constructed at a was an outcry, and the final establishment was agreed at fraction of the usual cost by careful improvisation and 960 senior registrars. This was based partly on the idea planning. The demonstrations showed how function could that there must be competition for senior registrar posts. be restored by special training and surgical appliances, and He agreed that competition was necessary, but not to the by installing modifications and gadgets to enable disabled extent of that shown by Bournemouth. The Ministry said patients to cook and to run their homes. A well-knit organ- that there were about 150 consultant posts coming up each ization has been built up through various agencies in each year. But there were 240 senior registrars coming up each parish to ensure visiting, reading, and shopping for the year and only 150 consultant jobs for them, and the fol- homebound, infirm, and blind. lowing year the same thing would be repeated and worsened because of the numbers from the previous year who had perhaps taken research fellowships or lecturer posts, and hung on in the hope of a consultant appointment. The whole idea of the competition was wrongly worked out. REDUCING WAITING-TIME OF There were far tQo many senior registrars for too few OUT-PATIENTS prospective jobs. The Ministry had stated to the Joint MINISTER URGES APPOINTMENTS SYSTEM Committee that as from 1956 the numbers of consultants and S.H.M.O.s reaching retiring age each year would be Hospital authorities throughout England and Wales have higher than in the past few years, and that this would allow been asked by the Minister of Health, Mr. lain Macleod, for an increase in the number of men in training for the to review the working of out-patient departments so as to resultant vacancies-that is, from 960 to 1,080. This showed remove all reasonable causes of complaint. Matters which the Ministry to be completely out of touch with the position. he thinks call for- special attention are appointments sys- He believed that a perfectly honest mistake had been made. tems, punctuality of staff, and reception of patients. While A great many senior registrars were, in fact, doing consultant much public criticism may well arise from lack of an work for which they were not being paid. He hoped adequate appreciation of the difficulties involved, the that the statement on the subject which the Registrars complaints made have been so widespread as to suggest Group Council had formulated would be sent for the to Mr. Macleod that at a number of hospitals the sugges- information of the Joint Committee. tions previously made on this subject have either not been Professor G. I. STRACHAN, chairman of the subcommittee put into effect or are not being successfully applied.. The which has this matter in hand, said that clearly this and main points of criticism he cites are: (a) that patients called other cognate matters on the agenda relating to hospital for an appointment at a particular time frequently have to junior staffing could not be adequately discussed at that wait for an hour (and often much longer) before they are late stage of the Committee's meeting, and he proposed that seen by the doctor; (b) that the consultants in charge of these very important and complicated considerations should clinics are responsible for some of these delays by arriving be referred to his subcommittee, from which they would late; (c) that appointments systems are badly organized; again come forward to the main committee with re- and (d) that little attempt is made to explain to patients the commenda.tions. reason for delays, to win their confidence, or to consider This was seconded and agreed to. their comfort or needs. Suggestions for Improvement TRADE UNION MEMBERSHIIP The Minister suggests that regional boards and manage- The following is a list of local authorities which are under- ment committees should pay special attention to certain stood to require employees to be members of a trade union points. Appointments systems, he thinks, should not only or other organization: be universal but designed to ensure, as far as possible, that Metropolitan Borough Councils.-Fulham, Southwark. each patient is called for the time that he is expected to see Non-County Borough Councils.-Crewe. the doctor. The old practice of " multiple " or " block " Urban District Councils.-Houghton-le-Spring. bookings should be discontinued. The needs of parents 19, 1954 SUPPLEMENT TO THE 350 JuNE REDUCING WAITING-TIME OF OUT-PATIENTS BRITISH MEDICAL JOURNAL with small children at home and of patients coming from a service. This, in my opinion, is quite inaccurate and a distance by infrequent buses or train also clearly call for unjustified by anything said in Council during these separate consideration. It should be impressed upon con- debates.-I am, etc., sultants that the success of the appointments system depends Cambridge. ALEXR. BROWN. on their being present on time, and an administrative officer of adequate seniority should be made responsible for the History of the W.M.A. efficient running of the appointments system. The Minister urges that special care should be taken in SIR,-I was interested to read in the Supplementary selecting the staff responsible for receiving patients, and they Report of Council (Supplement, May 22, p. 247) a short should remember that patients are often anxious, bewildered, history of the World Medical Association, to which, how- or even frightened, and it is essential to attend to their needs ever, in the interests of historical accuracy, I should like and comfort. Much ill-informed criticism could be avoided to add a couple of footnotes. In 1939 the B.M.A. Council by the development of better relations with patients and had decided to dissociate itself entirely from the Association with the public at large. A helpful and kindly approach to Professionnelle Internationale des Medecins, and a resolu- out-patients by receptionists and other staff is only one tion to that effect was on the agenda of the Representative example of this. Much more could be done to interest the Body at Aberdeen in 1939. The Marylebone Division, at public in the work of the hospitals and the difficulties with a meeting before the Annual Meeting, took serious excep- which they have to contend, and in the steps being taken to tion to this and put forward a counter-resolution. I have overcome them. not the reference by me here, but it was the first resolution The Minister says that later he will call for a report discussed by the Representative Body in 1939, and a full has been report appears, I know, in the Supplement. I had the showing the extent to which waiting-time honour (and the temerity) of moving the Marylebone eliminated. Division's resolution and had to reply at the end of the The Consultants and Specialists Committee has asked its discussion to the then Chairman of Council, Sir Kaye Le Executive Committee to examine the question of waiting- Fleming, who denounced the Marylebone Division's views time in hospital out-patient departments, and to report. in the strongest terms. The Representative Body supported me, however, with a very large majority, and the B.M.A.'s association with the A.P.I.M. was thus continued-in spite Correspondence of the Council-throughout and after the last war. I well remember the conference at B.M.A. House in September, 1946, under the chairmanship of Sir Hugh Lett. Return of Goodwill Lord Horder and I were asked by the American Medical Association to attend it on their behalf as " observers," SIR,-I have read with interest the letters by Drs. E. C. for they were hesitant and sent no official representatives. Warner (Supplement, May 29, p. 290), A. V. Russell, and The French, Belgian, and Spanish delegates in particular J. 0. M. Rees (Supplement, June 12, p. 319) regarding the wanted to retain the old A.P.I.M., but during the conference goodwill issue and the action taken by Council at its March -thanks in the main to the tact of Dr. Routley, of Canada, and May meetings. I have re-read the minutes of the and Dr. Charles Hill-the atmosphere changed from early March meeting and find that the motion read as follows: suspicions to friendliness and co-operation. Lord Horder " That the scheme be presented to the Representative Body and I were therefore able to send a persuasive report to together with a statement of the advantages and disad- the American Medical Association, telling them (as was true) vantages appertaining to that scheme." It was decided that that without their co-operation the new W.M.A. would this statement should be drawn up by the Amending Acts be as ineffective as the late lamented League of Nations, Committee with the addition of cd-opted members. There but that with them it might well become something worth does not appear from the letters to be any dispute about while, useful not only to the medical profession all over or disagreement with this course. There is, however, some- the world, but to humanity at large-as, indeed, it is thing else which happened at the March meeting which they proving.-I am, etc., seemed to have ignored. The Chairman asked if it was the wish of the Council that the report of the Amending Gibraltar. R. SCOTT STEVENSON. Acts Committee should be submitted to the G.M.S. Com- '** An account of the discussion Mr. Scott Stevenson mittee and Private Practice Committee for their comments, refers to was published in the Supplement of July 29, 1939. and the Council agreed to this being done. Surely it is The Marylebone amendment, carried by a " considerable clear from this that it was in the mind of the chairman, majority," was as follows: in common with many other members of Council, that "That in view of the long association of the B.M.A. when at the May meeting the report was again placed on with the A.P.I.M., of the recognition by the Health Com- the Council agenda it would be open for Council to take mittee of the League of Nations of the A.P.I.M. as any action it might think fit. responsibly concerned with medico-social questions of high Many of us thought that it was the duty of Council, importance, and of the desirability, more especially in having considered the full report, to give a lead to the existing circumstances, of maintaining international contacts, Representative Body. Indeed, to fail to do so would, at the present juncture, the Association should continue I think, have amounted to a failure to carry out our proper to be represented as a constituent member at the Annual functions. We had been instructed to prepare a scheme for Conference of the A.P.I.M."-ED., B.M.J. the return of the right to buy and sell goodwill and present it to the Representative Body. We have done the first part, and the second will be fulfilled at Glasgow. But I venture Employment of Tuberculosis Visitors to assert that, if the Council, having examined the scheme SIR,-As in the first sentence of Miss Shiela D. Robinson's in its totality, had failed to pass its opinion upon its merits letter (Supplement, May 29, p. 290) my name is invoked, and feasibility, it would rightly have been accused of and the last paragraph invites the opinions of tuberculosis cowardice and shirking its duty. I think the scheme is the officers on certain modifications in training and qualifications best that can be prepared, and tribute should be paid to of tuberculosis visitors advocated by her, I beg to reply. the ingenuity of those who devoted so much time and although I believe the views of individuals cannot influ- energy to its preparation; but this does not make it a wise, ence future policy at all. My original letter (Journal, June feasible, or by any means acceptable one. This, however, 21, 1952, p. 1355) did not deal with training, but was written will be argued out at Glasgow. at a time when we in the chest clinic service locally were Dr. Rees draws the red herring of the full-time salaried engaged in a " rearguard action " against a serious threat to service across the trail. Quite unjustifiably he asserts that withdraw tuberculosis visitors from the chest clinics, to base there are members of Council who are in favour of such them in a distant guildhall, and to transform them-women SUPPLEMENT TO THE JUNE 19. 1954 CORRESPONDENCE BR;TISH MEDICAL JOURNAL 351 who had spent most of their professional life in tuberculosis method only gives an approximate comparison between -into the " all purpose " health visitor. departments doing the same type of work. If, in addition, Miss Robinson will know-her letter gives little clue-that the total number of films of each size used (calculated easily the future training and utilization of visitors is now being from stocks consumed) is divided by the number of inves- reviewed by a Working Party to which memoranda and tigations, a general indication is given as to whether oral evidence have been submitted by bodies such as the techniques are extensive or "economical." In the excellent Society of Medical Officers of Health, B.M.A., etc., and that memorandum on diagnostic radiology drawn up by the a report expressing its considered views will be issued in due Faculty of Radiologists, staffing of departments is assessed course. Her attempt to reopen the subject in your columns according to the number of "investigations" per annum. seems, therefore, belated if not futile. I hope I am right in This rough guide has been of some limited value in the assuming that the Working Party will have listened to evi- past. What advantage is there in changing to a mathe- dence from the British Tuberculosis Association or Joint matical system which superficially appears to be " scientific" Tuberculosis Council before its conclusions are reached on but which actually neglects variation in factors sufficient to the future of tuberculosis visitors. make a 100% error more probable than possible ? Responsible, with three colleagues, for the chest clinic and Most x-ray departments have difficulty, owing to short- ancillary work in an area of 375,000 (approximately) popu- age of staff, in coping with routine clerical duties. The lation size, I am more concerned that we should keep tuber- bureaucratic tendencies of the National Health Service add culosis visitors as essential members of the clinic's " team," further difficulties. Is this " unit " system a foretaste of the co-operating to that degree only obtainable by daily personal " costing" of each department which will shortly plague contact with the others and working under a common roof, us ? If so, we shall need far more clerks than radio- than with splitting hairs about their professional training graphers, unless slot machines and comptometers are requirements. The qualifications of visitors were laid down provided.-I am, etc., by Local Government Regulations (1930); these are change- Port Talbot, Glam. R. A. ROBERTS. able by legislation, and the Working Party's report may be the precursor of change. Remuneration of Hospital Medical Staff In to Miss Robinson's my view reply specific question, is SIR,-At the special meeting of the Central Consultants that a trained visitor (her certificate is equivalent to a D.P.H.) and Specialists Committee on April 28, 1954, to discuss the will usually fit into the chest clinic's team more smoothly statement by Sir Russell Brain on remuneration of than a nurse qualified S.R.N. and with the British Tubercu- hospital medical staff (Supplement, May 8, p. 228), Dr. D. P. Steven- losis Association's certificate, who may never before have son stated that since the publication of the new increases set foot in a tuberculous household, and will not as a rule there had been remarkably little correspondence on the sub- know much of, or have any bias towards, preventive and ject, a fact which might argue contentment or apathy. I social medicine. The late Sir R. Philip said that it was the have heard these words-" contentment or apathy chief job of a tuberculosis officer to prevent, not to treat, "-quoted on several occasions since then. This is a most irresponsible tuberculosis; were it translated into terms of the job of a statement to make at this time. visitor, his aphorism would still hold some truth. I dis- The negotiations have been conducted in secrecy. The agree that a may be " pre- newly qualified visitor without full facts are now revealed to us. vious only being Most of us experience" of tuberculosis. Here, each student here have received our first real information visitor in the form of spends about eight of her 50 weeks' training as a full- a bulletin five These facts time member of the chest clinic's staff. As she only days ago. require consider- well, receives able without some the of four digestion. Surely correspondence, know- benefit, perhaps doubtful, one-hour lectures ledge of the facts, such as has now been given to us, would on the official on (based syllabus) tuberculosis, and tutorials have been premature. I would suggest that a more guarded on special subjects-for example, the rationale of Mantoux- phraseology would be more appropriate and that potential testing, B.C.G. vaccination, mass miniature radiography, etc. boomerangs should be avoided.-I am, etc., It has been my happy experience to work occasionally with Kirkcaldy. WILLIAM DRUMMOND. visitors who had not the health visitor certificate, but were otherwise well trained in general and tuberculosis nursing. Emergency Admissions They accustomed themselves quickly to the new climate and conditions of the clinic, and proved of equal merit to their SIR,-Perhaps I am a little late regarding the question of health visitor certificate sisters. Bed Bureau, which was discussed by Dr. S. Stowe (Supple- In conclusion, I would voice an appeal that, whatever ment, May 1, p. 214) and Dr. R. S. V. Marshall (p. 215), change may be effected in the syllabus of training, it should following your medico-legal article (Journal, April 17, be on the side of simplification and pruning of what has p. 940), and later by Dr. H. Maitland Moir (Supplement, become an exotic growth, much of the theoretical instruc- May 15, p. 246) and Dr. Thomas M. Glaister (Supplement, tion and " cramming " involved being of little practical use May 29, p. 291). I can only say that in my area, the after qualification.-I am, etc., Plymouth Group, the Bureau is efficiency itself, twenty-four- Hull. R. HARDY. hour service, kind, and helpful.-I am, etc., Kingsbridge. T. H. STEELE_PERKINS. Radiology on Points SIR,-Dr. Anthony A. Vickers (Supplement, May 29, A Doctor Looks at Crime p. 291) and your previous correspondents have only touched SIR,-Dr. Oliver Gray's short monograph as he himself the fringe of the anomalies arising through assessing various describes it (Supplement, April 24, p. 179) deserves close radiological investigations on a points system. The yearly and careful study by all. With Dr. R. W. Cockshut totals have little meaning because of the marked variations (Supplement, May 8, p. 232) I agree that the subject-matter in many factors: the type of patient; the routine of is of great interest " not only for what it says but for what individual radiologists ; the demands of various specialists; it leaves unsaid," especially for those who are concerned the general facilities and stress of work in each department; with the moral and social welfare of our juvenile and and, probably most of all, in the interpretation of the adolescent population. The whole problem of the young " units " themselves. In the past each department has had offender requires thorough discussion. The probable under- a rough estimate of its own increasing work in the yearly lying causes and appropriate treatment must be studied totals of " investigations " or "examinations." To judge seriously and from all aspects, but above all we must study any further increase one must still use the older method. likely methods of prevention. Wise action taken at this If a comparison between different departments is neces- stage of their lives will often, in my view, act as a deter- sary, the numbers of the major investigations-barium meal, rent to adult crime. barium enema, I.V.P., etc.-give added information and In my opinion, as a family medical practitioner of many can make some allowance for specialized work. Even this years' standing and practising in an area with a large 352 JUNE 19, 1954 ASSOCIATION NOTICES SUPPLEMENT TO TIlE 352 JUNE 19, 1954 ASSOCIATION NOTICES~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~BRITISH MED:CAL JOURNAL juvenile population, the present attitude to authority, the lack of honesty, truthfulness, and especially responsibility JULY among certain sections of the juvenile population of to-day, 1 Thurs. Annual Representative Meeting (at Glasgow), can be remedied in the first place by the teaching of good 10 a.m. 2 Fri. Annual Representative Meeting (at Glasgow), moral principles from the home. The average adolescent 9.30 a.m. of to-day is a self-centred individual lacking in good 3 Sat. Council (at Glasgow), 9 a.m. manners and with a definite lowering of moral standards. 3 Sat. Annual Representative Meeting (at Glasgow), The reasons for this decline have resulted, in my opinion, 10 a.m. from the upheavals of war, housing difficulties, the present- 5 Mon. Annual Representative Meeting (at Glasgow), day speed of living, and the parents' willingness, almost 10 a.m. eagerness, for the responsibility of the children to be passed 5 Mon. Annual General Meeting (at Glasgow), 12.30 p.m. on to the State. 5 Mon Council (at Glasgow), at conclusion of A.R.M. of the 5 Mon. Adjourned Annual General Meeting and Presi- A very important factor in the limited outlook dent's Address (at Glasgow), 8.15 p.m. young adolescent of to-day is the lack of true religion and 14 Wed. Maritime Subcommittee, Private Practice Com- moral principles that are so sadly lacking in their homes. mittee, 2 p.m. (Date changed from July 21.) The teaching of these matters must commence in the home. 15 Thurs. Working Party Subcommittee, Joint Consultants The groundings given by the parents can then be exDanded Committee. Meeting with Ministry of Health during school years, but the first responsibility in this at 23, Savile Row, London, W., 2.30 p.m. direction is the parents. The study of juvenile delinquency 22 Thurs. General Medical Services Committee, 10.30 a.m. and of kindred subjects, as raised by Dr. Oliver Gray, is, I 22 Thurs. Central Ethical Committee, 2 p.m. consider, one of the most fascinating, interesting, and vital subjects within the sphere of social welfare.-I am, etc., Branch and Division Meetings to be Held Leeds. HARRY SUGAR01. CITY DIVISION.-(1) At B.M.A. House, Tavistock Square. W.C., Tuesday, June 22, 8.30 p.m., consideration of Agenda of Prescribing Costs A.R.M. (2) At Institute of Laryngology and Otology, Gray's SIR,-Mr. F. G. Fleming (Supplement, May 29, p. 291) Inn Road, W.C., Friday, June 25, 3.30 p.m., clinical meeting. suggests that I have overlooked the fact that the ls. lid. Mr. K. G. Rotter: " Otitis Media in Children and Infants." COVENTRY DIVISION.-Wednesday, June 23, 2.30 p.m. Visit paid to chemists for 24 tab. codein. co. includes Is. dis- to Cadbury Brothers Ltd., Bournville. pensing fee. Indeed, I have not. What puzzles me is why DORSET DIVISION.-At Antelope Hotel, Dorchester, Friday, putting 24 tablets in a cardboard box should be dignified June 25, 7.45 for 8 p.m., dinner; 9 p.m., annual general meeting. by the name of dispensing or attract a fee at all. When DUDLEY DIvIsIoN.-At Prestwood Sanatorium, Stourbridge, the pharmacist really does dispense, by all means let him Tuesday, June 22, 8.30 p.m., clinical meeting arranged by Dr. J. be paid the rate for the job, but a vast number of prescrip- Stevenson and staff and Dr. A. W. B. MacDonald. tions involve no dispensing at all, and are nothing more EAST SOMERSET DIvIsION.-At the Small Hall, Wells, Sunday, June 20, 3 p.m., annual general meeting. Consideration of than retail sales, with the sole difference that, instead of Annual Report of Council, etc. the medicament being asked for verbally, the name is EAST SUFFOLK DIvISION.-At East Suffolk and Ipswich Hospi- written on a piece of paper called a prescription form. tal, Tuesday, June 22, 8.30 p.m., annual general meeting; elec- The retail price of 24 tab. codein. co., in a cardboard tion of officers; consideration of Annual Report of Council, etc. box, is ls. 4d. Any doctor will, I am sure, find his chemist ENFIELD AND POTTERS BAR DIvIsIoN.-Thursday, June 24, summer social meeting. Members to meet at Blomfield Road, delighted to give him 10% discount on this. Presumably Paddington, at 3.15 p.m., for trip by motor barge on Regent's the Ministry could negotiate even better terms and get 15% Canal. or even 20%; thereby paying about Is. ld. instead of GLASGOW DIvISION.-At Institution of Engineers and Ship- Is. lId. Why don't they ?-I am, etc., builders in Scotland, 39, Elmbank Crescent, Glasgow, Wednes- W. EDWARDS. day, June 23, 8.30 p.m. Ashtead. Surrey. KENSINGTON AND HAMMERSMITH DIvISIoN.-At St. Charles's Hospital, Ladbroke Grove, W., Friday, June 25, 3.30 for 4 p.m., Keeping Clear of the Zebra clinical meeting. NORTH MIDDLESEX DIvISION.-Sunday, June 27, annual out- SIR,-From July 1, 1954, it will be an offence to stop a ing. Members to meet in the Lion House, Zoological Gardens, vehicle within 45 ft. of the approach side of a zebra cross- Regent's Park, N.W., at 10.30 a.m. Members wishing to join ing for setting down, picking up, loading, and unloading. the party are asked to communicate immediately with the There seem to be no exceptions, and if any hospital has a honorary secretary of the Division, Dr. Joan Chappell, 1, Wins- be ford Terrace, London, N.18. zebra crossing within this distance of its entrance it will NORWICH DIvISION.-At Norfolk and Norwich Hospital, Tues- necessary for them to take local action to get the crossing day, June 22, 8.30 p.m., annual meeting; election of officers; moved. Ambulances will, apparently, no longer be per- consideration of Annual Report of Council, etc. mitted to take up patients from places within these zones, OXFORD DIvIsION.-At Radcliffe Infirmary, Oxford, Wednes- and, of course, the regulation also applies to doctors' cars. day, June 23, 8.15 p.m., clinical meeting. The Order does not seem to have received much publicity, SALISBURY DIvISION.-At Salisbury Infirmary, Monday, June 21, 8.15 p.m., annual general meeting; election of officers, etc. and I am therefore writing to ask you to draw attention to SHEFFIELD DIvISION.--() At Sheffield University Medical the matter.-I am, etc., Library, Friday, June 18, 8.30 p.m., consideration of Annual London, S.W.10. R. KELSON FORD. Report of Council, etc. (2) At Royal Victoria Hotel, Sheffield, Friday, June 25, 12.30 p.m., annual luncheon to new medical graduands of Sheffield University. SOUTH MIDDLESEX DIVISION.-At Anchor Hotel, Shepperton, Association Notices Monday, June 21, 9 p.m., consideration of Agenda of A.R.M., etc. STRATFORD DIVISION.-At the Clinic, Katherine Road, Forest Gate, E., Thursday, June 24, 2.45 p.m., lecture by Dr. Philip Diary of Central Meetings Ellman, followed by clinical demonstrations, on the Diagnosis, JUNE Differential Diagnosis, and Treatment of Pulmonary Tuberculosis in Clinical Practice. 22 Tues. Psychological Medicine Group Committee, 2 p.m. TOWER HAMLETS DIvISION.-At Mile End Hospital, Bancroft 23 Wed. Accommodation Subcommittee, Estates Com- Road, E., Friday, June 25, 3 p.m., clinical meeting. Miss Gladys mittee, 12 noon. H. Dodds and Dr. S. D. " 23 Wed. Estates Committee, 2 p.m. Perchard: Gynaecology." 23 Wed. Executive Subcommittee, Joint Formulary Com- TUNBRIDGE WELLS DIvISION.-At Kent and Sussex Hospital, mittee (at Pharmaceutical Society, 17, Blooms- Tunbridge Wells, Wednesday, June 23, 8.30 p.m. Consideration bury Square, London, W.C.), 2 p.m. of Supplementary Annual Report of Council and Agenda of 23 Wed Geriatrics Joint Subcommittee, 2.15 p.m. A.R.M., etc. 24 Thurs. Guillebaud Evidence Steering Committee, 10 a.m. WESTMINSTER AND HOLBORN DIVISION.-At Westminster City 24 Thurs. Constitution Committee, 2 p.m. Chambers, Thursday, June 24, 8 p.m., annual general meeting. 24 Thurs. Journal Committee, 2 p.m. Consideration of A.R.M. Agenda; election of officers, etc.