SUPPLEMENT TO THE BRITISH MEDICAL JOURNAL LONDON SATURDAY MARCH 7 1953

CONTENTS

Occasional Conunent - - - - 59 Appointments to Scottish Health Services Council and The Constitution of the B.M.A.-II - - - - 60 Standing Advisory Committees 64

Floods------62 Irish Health Bill - - - - -64 The Association and Public Health - - - 62 Correspondence - - - -65

Occupational Health Committee - - - - 63 Association Notices ------6

OCCASIONAL COMMENT Association in which it described Representative Meetings as "a shambles-too many members discussing too many WINCHESTER ON THE R.B. resolutions," and recommended that the membership should That the spirit of reform is still alive in the Winchester be reduced to 200, " based on Branch representation." This Division is evident from the memorandum on the Represen- led to further discussions at Headquarters, culminating in tative Body of the Association published last week (Suipple- a report by the Council to the A.R.M. in 1949. This report, ment, February 28, p. 55). This will no doubt revive, as it referred to below, discussed the size of the agenda, but is intended to revive, discussion of certain problems which made no reference to the size of the meetings. The latter have received much careful study in recent years. The latest problem was re-examined by the Organization Committee Winchester proposals relate to the size and composition of during session 1950-1, but the Committee decided against the R.B. and to matters of procedure, especially the arrange- recommending any change, considering that attendance at ment of the agenda. the meetings was of " great educational value to the mem- bers concerned." The Problem of Size The Financial Aspect The original plan for the Representative Body, drawn Last session the Council, at the suggestion of its Finance up in 1902, provided for one representative to be elected Inquiry Committee, asked the Organization Committee to by each constituency, the total number of constituencies look at the matter again from the point of view of economy. not to exceed 300. To-day the relevant By-law, which dates On this occasion the Committee went so far as to recom- from 1911, entitles a constituency in the United Kingdom mend to the Council two alternative methods of reducing the with not less than 150 members to elect one additional number of representatives by altering the qualification for representative for every 100 members in excess of 50. Of additional representation of constituencies. The first plan necessity,' therefore, the R.B. has grown enormously in size was the one proposed by Gloucestershire in 1948-that a with the ever-increasing membership of the Association. constituency with not less than 200 members should have The number of representatives actually appointed by the an additional representative for every 150 in excess of 50. home constituencies was 210 in 1920, 278 in 1938, 360 in This would have reduced the R.B. to 350. The alternative 1947, and 425 in 1951. The possible number in 1953 is plan was that a constituency with not less than 250 448. members should have an additional representative for every Previous Discussions 150 in excess of 100. This would have brought about a In the autumn of 1947 the Organization Committee began reduction to 304. The Council rejected both proposals and to discuss the advisability of a reduction in size, and in reported to the R.B. at Dublin last July that it was satisfied April of the following year it advised the Council to recom- that the additional representation afforded under the exist- mend that the R.B. should approve a reduction to approxi- ing By-law "more than compensates for the expenditure mately 300 and should instruct the Council to submit pro- involved." Apparently the same satisfaction was felt by posals for bringing this about. It was argued in the the R.B., which rejected motions from Cornwall and Council that the governing considerations should be the Gloucestershire asking for reconsideration of the matter. effectiveness of the R.B. as a working body, and the limita- And now, nothing daunted, Winchester returns to the attack. tion imposed by the size of the Great Hall at B.M.A. House and the halls in provincial cities. Against this it was main- The Problem of Procedure tained that it was " a healthy thing that as many representa- The congestion of business at the Representative Meet- tives as possible should be appointed, for such people, when ings, and particularly at the special Meetings, became a they went back to their constituencies, were good disciples serious problem in the period of unusual medico-political of Association policy." The Council's decision was to refer activity when the proposals for the National Health Service the matter back to the Committee and later in the same were under discussion. In 1945 the Winchester Division year the R.B. itself rejected a motion from Gloucestershire proposed that, as a temporary measure " during the present advocating a decrease in its size. emergency," the bulk of the agenda should be dealt with by committees constituted ad hoc, which would sit simul- " A Shambles" taneously and report to plenary sessions of the R.B. This In August, 1948, the Winchester Division produced a proposal did not find favour, but in 1946 a Winchester comprehensive memorandum on the organization of the motion that a committee should be appointed to recommend 2511 60 MARCH 7, 1953 SUPPLEMENT TO THE OCCASIONAL COMMENT BRITISH MEDICAL JOURNAL " such alterations in procedure as would enable the bulk of example, one representative from each region." The present the agenda to receive adequate consideration" was referred Winchester memorandum asks for four members of the to the Agenda Committee. This Committee, which had no R.B. to be elected by the Central Consultants and Specialists dictatorial ambitions, advised that it should not be em- Committee, and varying numbers by certain other com- powered to compile " omnibus ' resolutions and to exclude mittees representing sectional interests. To judge from the motions covered by such resolutions from the agenda. It discussion at Dublin, this is likely to prove the most con- discussed, but did not advocate, the plan of resolutions from troversial of the new proposals, although there is already Divisions being filtered through a body composed of repre- provision for four public health service members to be sentatives of grouped Branch councils. Its only positive re- elected-not, as Winchester suggests, by the Public Health commendation was that its own membership (consisting of the Committee, but by the general body of the public health Chairman and Deputy Chairman of the R.B. and the Chair- service members of the Association. This is the sole excep- man of Council, with power to co-opt up to four chairmen tion to the rule of election by Divisions and Branches. of standing c6mmittees) should be altered by the addition Apart from any possible objection in principle (such as was ,of two members elected by the R.B. This was approved by voiced at Dublin) to an extension of sectional representation, the A.R.M. in 1946, and two years later the number of there may perhaps be differing views about the particular members so elected was increased to four. sections which might properly be included if any such scheme as is now proposed were to be adopted. And it "Starred " Motions may perhaps be questioned whether the present proposals would either provide the " balanced representation of all The 1948 Winchester memorandum recommended dis- sections of the profession" which Winchester desires, or "Cussion and co-ordination of Divisional resolutions at the remove the disadvantage-if, as Winchester suggests, it is a Branch level, and further co-ordination by a committee disadvantage-of the majority of the representatives being elected by the R.B. or by the Branches before transmission general practitioners. of the resolutions to the Agenda Committee. In the fol- Whatever decisions may be taken on these matters, this lowing year the Council reported on the problem to the small Division is to be admired for the ceaseless thought R.B. Its report discussed, among other matters, the plan which it gives to the improvement of the Association's of "starring" a selected motion in a group of similar organization and surely also for what is either the engaging motions on the same subject, the other motions in the modesty or the nice sense of humour displayed in its remark group being held to be covered by the one " starred." that it is "not entirely satisfied with the view that the Certain disadvantages of this plan, which had been tried activity of a Division increases in direct proportion to its in 1946, were suggested. A representative, for example, membership." might feel that the "starred" motion did not bring out the precise point made by his constituency in a " covered" motion. The Council made no definite recommendation, but the A.R.M. in 1949 approved a motion from Maryle- THE CONSTITUTION OF THE B.M.A. bone that representatives whose motions were "grouped" *or "held covered" should be given at least 48 hours' 1.-THE REPRESENTATIVE BODY notice in writing and be allowed an opportunity of discus- The first Annual Representative Meeting was held in 1903 sion at the meeting to decide on the proposer of the at Swansea during the Annual Meeting of the British Medi- " starred" motion. It also referred to the Council a cal Association, and it marked the emergence of the Associa- motion from Mid-Cheshire calling for the early institution tion from a long period of controversy as a truly democratic of a "steering committee " for the agenda at Representa- body. What constitutes a representative assembly is always tive Meetings. difficult to define. The line between a representative and a Recent Changes delegate can never be exactly drawn. The representative At the Southport meeting in 1950 a number of changes comes, as do members of the Representative Body year by -were introduced. First, four complete days-instead of year, instructed by his constituency concerning the princi- three and a half-were made available for the meeting, pal items on the agenda or at least the general line of which now begins on a Thursday morning and need not policy which is proposed; and yet he is at liberty, being conclude before the following Monday afternoon. Secondly, a representative and not a delegate, so to interpret his duties the time allowed to movers of motions and amendments was that if he finds the arguments on the other side so cogent, reduced. Thirdly, the procedure of the grouping and "star- or if new aspects of the problem come forward or new ring" of certain motions by the Agenda Committee was facts are revealed, and he feels that his decision would be incorporated in the Standing Orders. Despite these changes, endorsed by the members of his constituency, he may vote -the A.R.M. at Southport, owing to exceptional circum- contrary to his original instructions. That principle at stances, was unable to complete its business, and an least has always obtained in the Association, where, unlike adjourned meeting was held in London in September, when Parliaments, there are no parties with conflicting loyalties. -it was decided, on the recommendation of the Agenda Com- The representative is a trusted man, permitted to exercise -mittee, that representatives whose motions were grouped his discretion with regard to his instructions, not an auto- should be empowered to select a motion for discussion in maton registering a vote. Even if he is not sure that his place of the "starred " motion, or to agree a common form change of attitude on a particular question may be endorsed of motion. Other proposals approved were that the Chair- by his constituents, and follows the line of his own con- man should be empowered to take such steps as he deems victions, probably no one will reproach him, and what his necessary to prevent tedious repetition, and that the Agenda constituency may lose in one respect they gain in having a Committee should meet at intervals during the meeting to representative of independence of mind and judgment. In examine the progress made and to make any necessary any event, as representatives hold office only for one year, Tecommendations. Whether these variQus measures to faci- a constituency can change its representative in time for litate the conduct of business at Representative Meetings go another Annual Meeting. Unlike Parliamentary constitu- far enough is no doubt debatable. Winchester thinks they encies, it has not to await the lifetime of a Parliament. ,do not. The Representative Body is the governing organ of the Association. In this assembly policy is determined. The Representation of Sectional Interests Council is the central executive, charged with carrying out At the A.R.M. last year Winchester failed to secure that policy. Only in certain relatively minor, though not acceptance of a motion that in any future reorganization unimportant, fields can the Council act on its own. For of the constitution of the R.B. consideration should be example, the general and sectional meetings of the Associa- -given to providing for "direct election to the R.B. from tion and many other internal and domestic matters are in the regional consultants and specialists committees-for its sole charge. MARCH 7, 1953 CONSTITUTION OF THE SUPPLEMENT TO THE B.M.A. BRITISH MEDICAL JOURNAL 61 Composition of the Representative Body The first and principal business of the Annual Representa- tive Meeting is to consider the Annual Report of Council, The representatives are elected by the constituencies, which is published beforehand in ample time for considera- which are Divisions or groups of Divisions; members of tion by the Divisions, while a Supplementary Report covers Council also sit in the Representative Body, although their later events. It considers also the Financial Statement of voting rights, unless thev are also elected representatives, the Association. At least two months' notice is required are limited. There are 201 constituencies in Great Britain' from Divisions or Branches of any motion they may desire and Northern Ireland for the purpose of election to the to bring forward at an Annual Representative Meeting, or 14 Representative Body, and in addition each Division of the days' notice in the case of a Special Representative Meeting. Association overseas an independent constituency is and The Annual Report is a comprehensive document, recording entitled to return one representative. Great pains have been the work of the many committees, standing and special, taken to ensure a proper geographical representation. which assist the Council, and, although opportunity is given The number of members of the Representative Body from for motions on matters not covered by the report, these are Great Britain and Northern Ireland is 441 ; of 56 these, generally few and minor. A time limit is imposed on represent Scottish constituencies, 21 Welsh, and 13 Northern speakers, but can be extended. Ireland. Most of the constituencies consist of single Divi- sions, but sometimes two, and in one case (Aberdeen and Fifty Years of History Kincardine counties and the islands of Orkney and Shetland) three, are grouped together to form a constituency. Each As already stated, the first Annual Representative Meet- constituency elects one member, with an additional member ing was held at Swansea in 1903. Some of those who for every 100 members of the Association in excess of 50. attended that meeting are happily still with us, notably With the continual growth of the membership of the Alfred Cox, who on that occasion represented Consett and Association the result has been that some constituencies Gateshead, and who was to be Medical Secretary of the return a phalanx of representatives. One Division (Glas- Association for 20 years, and R. Langdon-Down, who put gow) is entitled to 11; three (the cities of Birmingham and in conspicuous service as chairman of the Central Ethical Edinburgh and the borough of Marylebone, in London) are Committee. Many whose names are still familiar in entitled to 10. But nearly half the constituencies return Association memories attended that first meeting-a future only one member, and of the remainder more than half Chairman of Council in J. A. Macdonald, then representa- return only two. The Branch area with the largest num- tive of West Somerset; a future Treasurer in N. Bishop ber of representatives is the Metropolitan Counties, with Harman, representative of Hampstead; a future Chairman 73, followed by Yorkshire, with 28, and Glasgow and the of the Representative Body in T. W. H. Garstang, of West of Scotland, with 25. There are also four representa- Cheshire. The number of representatives attending was tives specially elected by the public health service mem- 135, much smaller than the number of constituencies, the bers of the Association. This special representation was reverse of the position obtaining to-day. agreed upon a few years ago in order to ensure that the The first Chairman of the Representative Body was Sir public health service would have its mouthpiece in these Victor Horsley, a man who had already achieved world- assemblies, which might well not have happened had it wide fame as a physiologist, neurologist, rnd surgeon, and been left to the accident of the constituency vote. Over- who had plunged into the struggle for the reorganization seas Divisions, or Branches without Divisions, may return of the Association and the championship of the general nearly 70 representatives. Thus the total assembly of the practitioner with all the zeal of a youthful enthusiast. It was Representative Body may be more than 500, one-half he who at the meeting of the Association three years constituting a quorum. This forms a real problem in the earlier at Ipswich brought forward the motion to appoint matter of accommodation in the halls in which the meeting a committee to consider the constitution of the Association, is held, not excepting the Great Hall of the Association in and when after long drscussions it was hammered out in London, for the volume of documents with which each legal form and adopted at meetings in London in 1902 Sir representative is burdened necessitates a table as well as Victor Horsley was the obvious choice of what has now a chair. become a long succession of able chairmen. In spite of his radicalism and his strongly held opinions he had a pro- The Representative Body at Work found respect for constitutional practice, and this proved The Annual Representative Meeting is normally held at to be of the greatest value to the Association in the four the time of or just preceding the Annual Meeting of the critical years in which he-presided over the Representative Association, but there is provision for calling a Special Meetings. One curious circumstance marked his election Representative Meeting, either by the chairman of the to the chairmanship. After he had been chosen it was Representative Body on the requisition of the Council or discovered that he was not properly a member of the Repre- on the requisition of not less than 20 constituencies. At sentative Body at all, because the secretary of his con- times of crisis, such as the introduction of National Health stituency had inadvertently omitted to inform Headquarters Insurance in 1911-12 or of the National Health Service in of his election. The technical lapse was soon rectified. 1946-8, several Special Representative Meetings were sum- Another little circumstance attending the first Representa- moned (each of them, by the way, at the cost of some- tive Meeting is worth noting. On the second day of the thing like £1,000 to the Association, for the first-class meeting-it lasted a day and a half-a timid knock at the return fares of representatives are paid centrally) to make door conveyed a request from the Press-not the nationat specific decisions on policy. but the local Press-for permission to report some of the The Representative Body elects its own chairman and proceedings. The meeting discussed this matter at length, deputy chairman, also, on the recommendation of Council, and decided that the request could not be granted-a very the president of the Association, and it elects 16 members different attitude from that which obtains to-day, when, of Council, 10 of them being ordinary members and three thanks to the Public Relations Department, every facility Service members, elected by the representatives voting is afforded to the 40 or 50 pressmen who usually attend to together as a whole, together with two elected by repre- report the meeting extensively in all the principal journals sentatives of constituencies in Scotland, and one by repre- of the country. On some occasions the meeting has gone sentatives of constituencies in Wales. Both the Repre- into closed session, but on others it has discussed private sentative Body and the Council are carefully adjusted on matters in the presence of the Press, and a word to them the geographical model so as to ensure the representation has always secured their loyalty and co-operation. of different types of practice so far as these can be This short account does not pretend to be a history of linked with varying localities, and in fact, although apart the work of the Representative Body over the course of from the public health service there is no specific provi- 50 years, a period which has included two world wars and sion, every branch of medicine can be sure of having a two major revolutions in medical practice in this country. voice. But it can be said that the machine has worked well. 7, 1953 SUPPLEMENT TO THE 62 MARCH CONSTITUTION OF THE B.M.A. BRITISH MEDICAL JOURNAL During the few days into which the Annual Meeting has decided by both sides to refer the matter to arbitration. had to be compressed no professional or trade union con- The necessary action was now being taken to report the gress has shown such a capacity for hard work. The stand- matter to the Minister of Labour under the Industrial ing orders have been framed to secure the utmost fairness to Courts Act. Further, discussions were now going ahead all taking part in the debates. If there have been grievances, with Counsel regarding the preparation and presentation of these have arisen from the size of the meeting and the the claim. multiplicity of motions and amendments. Some effort has "Dual Appointments" been made lately to curb the diffuseness of debate which is The circulars (RHB (53) 11 and Ministry of Health 3/53) likely to follow when large numbers of constituencies send which deal with the recent agreement were-received. The forward amendments of similar intention but slightly membership of the Staff Side of the Advisory Committee, different phrasing. which had been the subject of discussion in the Central There has been much keen debate at Representative Meet- Consultants and Specialists Committee, was agreed. ings; oratory has often risen to a high level, the clash of opinion has been expected and welcomed. But the writer Superannuation of these notes has attended every Annual Meeting for more than 40 years, and, except for one or two instances at the Some comments by the Compensation and Superannua- beginning of the National Health Insurance controversy, he tion Committee on the Local Government Superannuation cannot recall any disagreeable incidents which have left a Bill were considered. The Bill itself was considered to mark in the mind. Exchanges on a personal level have be satisfactory, but it was emphasized that it would be been very few. In spite of the enormous volume of busi- important to watch any subsequent regulations. An assur- ness which has had to be carried through in a short time, ance had been given that the Association would be afforded the Representative Body has proved worthy of the pro- an opportunity of studying draft regulations before they fession it represents, a machine well poised and effective were laid before Parliament. for its purpose, and a model which other professional A summary of the extent to which local health authori- organizations have envied and sometimes imitated. ties were exercising their discretionary power under the Local Government Superannuation Act, 1937, whereby part- time service may be superannuable, was received. The dis- cretionary power did not appear to be widely used, and FIOODS the Committee decided to consider the matter further. Arrangements are being made to ensure that for the time Decentralization of Part III Services being doctors who have suffered as the result of the recent flood disaster will not suffer any loss of income from The Committee had on a previous occasion received a capitation payments and temporary-resident payments. The document prepared by the Society of Medical Officers of position will be reviewed from time to time. Health regarding the decentralization of Part III Services. It was agreed that this document set out the views of the Committee and should be recommended for acceptance by the Council of the Association. THE ASSOCIATION AND PUIBLIC HEALTH Therapeutic Abortion A meeting of the Public Health Committee of the Associa- tion was held on February 20, with Dr. H. K. CoWAN in It was reported to the Committee that a private Bill had the chair. Dr. C. Metcalfe Brovyn was warmly welcomed been introduced into the House of Commons to add a back after his illness, and the Committee also welcomed proviso to the appropriate section of the Offences Against a new member, Dr. J. S. G. Burnett. the Person Act, 1861 (which makes it a felony to administer It was reported that, with only five exceptions, where drugs or use instruments to procure abortion). The proviso appeals are pending, local authorities had accepted the is as follows: awards Nos. 2285 and 2321 of the Industrial Court. (a) No person shall be found guilty of an offence under this section unless it is proved that the act charged was not done in Appeals Machinery-Northern Ireland good faith for the purpose of preserving the life of the mother; (b) no registered medical practitioner who acts with the concur- A report was made on the present position regarding the ring opinion of a second registered medical practitioner shall be approach already made to the Northern Ireland Govern- found guilty of an offence under this section unless it is proved ment in connexion with the need for an adequate appeals that the act charged was not done in good faith for the purpose machinery in Northern Ireland, and particular reference was of preventing injury to the mother in body or health. made to the present disagreement regarding certain divi- LEIGH TAYLOR Messrs. Dr. METCALFE BROWN referred to the statement issued to sional medical officers. Mr. (of the Press by the British Medical Association on the subject Hempsons, solicitors to the Association) attended the Com- of therapeutic abortion. With regard to the proviso before mittee and explained the variations in the legal position the Committee, he spoke of the difficulty of proving " good as between Northern Ireland and the rest of the United faith." If subclause (a) were passed it might just as well a be made Kingdom. It was agreed that further approach be said that anybody was entitled to carry out therapeutic to the Northern Ireland Government. abortion. Council The CHA1RMAN pointed out that the Act of 1861 referred Whitley to unlawful abortion, thereby implying that.abortion under In the wider field of arbitration it was reported that the given conditions might be carried out lawfully. Dr. General Whitley Council, at a meeting during the following METCALFE BROWN moved that the Committee inform the week, would be giving further consideration to the establish- Central Ethical Committee that in its view subclause (a) ment of a court of arbitration within the existing machinery. was objectionable. This was agreed. In the event of the Staff Side failing to reach a satisfactory After considerable discussion on subclause (b) the Com- agreement with the Management Side, alternative action mittee agreed that its views were fully expressed in the would have to be taken. statement already issued by the Association, which reads as follows: "The general question whether it is right to Assistant Medical Officer Arbitration perform therapeutic abortion (that is, abortion carried out The CHAIRMAN gave a full report of the discussions in for the purpose of saving the life of a mother or of connexion with the claim for the revision of the salary preventing injury to her health) involves important non- scale for assistant medical officers. The Staff and Manage- medical considerations outside the province of the Associa- ment Sides had failed to reach agreement and it had been tion, and on which, therefore, we are not called to comment. MARCH 7, 1953 ASSOCIATION AND SUPPLEMENT TO THE PUBLIC I-IEALTH BRIrISH MEDICAL JOURNAL 63 There is considerable uncertainty, however, regarding the Integration of Training for Diplomas present legal position. If, as is sometimes believed, thera- peutic abortion is in fact permissible under the existing law, At a previous meeting the Committee appointed a sub- it is highly desirable that the legal position should be committee to consider the integration of the training for the made clear. The question whether or not to perform a diplomas in industrial health and in public health and the therapeutic abortion in any particular case-within the possibility of a part-time course spread over two or three limitations imposed by the law-must be left to the decision years in place of the one-year full-time course for the D.I.H. of the doctor concerned. The Association would always The conclusion reached was that there was no objection to advise that a doctor proposing to carry out therapeutic even more integration of the two courses than exists at abortion should seek a second opinion from a professional present, since a necessary proportion of the knowledge is colleague." common to both. It was mentioned that the London School of Hygiene and Tropical Medicine had gone some consider- Other Business able way towards achieving this integration in a teaching A number of other matters, including Home' Office experiment with a selected group of students. The evidence, Circular No. 258/52 on child care, the resettlement in however, was insufficient at present for the subcommittee industry of tuberculous persons, and the care of mothers to recommend a complete amalgamation of the two and babies during the lying-in period, were considered by courses. It was generally agreed that a part-time course the Committee. for the D.I.H., spread over a period of two or three years, was both desirable and practicable. The full Committee agreed to submit these views to the PUBLIC HEALTH SERVICE DEFENCE TRUST Council. Purpose of the Trust Fund Medical Examination of Public Transport Drivers The Committee, sitting as the Trustees of the Public Two members of Council, Mr. D. S. Pracy and Dr. R. Health Service Defence Trust, considered the question of Forbes, attended during a discussion in the Committee on contributing from the Trust Fund towards the legal costs the medical examination of public transport drivers. The involved in the presentation of cases for arbitration. These Committee was concerned with the possibility of drivers cases might involve a single medical officer, a section, or suffering from diabetic coma or some other condition which the whole of the public health service. impaired their mental state, imperilling the safety of the The view was expressed that the Trust Fund was origin- travelling public. ally intended to assist members in difficulties or suffering Dr. FORBES pointed out that there were two matters in- hardship which resulted from their adhesion to B.M.A. volved in this subject. One was the policy with regard policy. It was agreed, however, that under the constitution to more frequent examination of drivers of transport of of the Trust it was clear that the Trustees had wide powers any kind, and the other was the ethical question of what and it was entirely proper to use the funds available for the doctor should do when he became aware that his patient, arbitration purposes. a driver of a vehicle, was suffering from some condition The present position regarding the other Trusts-General which might be a serious danger to the public. The Medical Services Defence Trust and Hospital Medical Staffs B.M.A. had said that information gained from the patient Defence Trust-was explained. It was agreed that, with- in confidence must not be disclosed except by consent or out prejudice to the future, the Trust should pay the legal by statutory authority.' costs of the arbitration on the assistant medical officer A subcommittee was set up to prepare, with all urgency, claim, and also of a pending case of arbitration under the a report on the whole subject. Included on the sub- Industrial Courts Act concerning an individual medical committee will be medical officers closely concerned with officer regarding whose status there is a difference of view transport questions. The question of the extent of the refer- between the two sides of Committee C. ence was considered. It was suggested that it might be extended to drivers of motor-cars in general, but it was agreed to limit it in the first place to drivers of passenger transport. OCCUPATIONAL HEALTH COMMITTEE Ethical Rules for Industrial Medical Officers THE FUTURE OF OCCUPATIONAL HEALTH A document which had been submitted by the Association SERVICES of Industrial Medical Officers at an earlier meeting, entitled A meeting of the Occupational Health Committee of the " Notes for the Guidance of Industrial Medical Officers," Association was held on February 18, with Dr. J. A. L. had been considered by the Central Ethical Committee, VAUGHAN JONES in the chair. It was announced that Dr. which had expressed anxiety regarding the apparent desire J. M. Rogan had accepted the Committee's invitation to of industrial medical officers to undertake the continued serve as a co-opted member, and that the Public Health, treatment in minor or trivial cases without the consent Central Consultants and Specialists, and Private Practice of the general practitioner. At a later meeting they had Committees, and the Dermatologists Group Committee had considered the view of the Association of Industrial Medical appointed representatives for the current session. Officers that there was no longer any necessity for them The Committee devoted itself to the study of a draft to be singled out as a section of the profession requiring memorandum intended for the Ministry of Labour and special ethical rules. In reply to this the Central Ethical National Service on the future of occupational health Committee had said that there was no intention to single services. It had been learned that the Social Insurance and them out or to suppose that they were more likely than any- Industrial Welfare Committee of the Trades Union Congress one else to transgress the accepted code of ethics, but there was anxious to have informal discussion on the develop- were ethical rules for other sections of the profession, and ment of a comprehensive occupational health service. A the rules were of great value when questions were raised or joint meeting had been held at which a preliminary ex- complaints lodged. It regarded the retention of the present change of views had taken place. rules as highly desirable. After the draft memorandum had been discussed for 'The policy of the Associatiorn in this respect was reaffirmed some time in the Occupational Health Committee, and at the Annual Representative Meeting last year: " That it is a in the had been agreed practitioner's obligation to observe strictly the rule of profes- various amendments phraseology sional secrecy by refraining from disclosing voluntarily without the to, it was found necessary for the memorandum to be consent of the patient (save with statutory sanction) to any third referred back to the Planning Subcommittee for reconsider- party information which he has learned in his professional rela- ation of certain essential points. tionship with the patient." 64 MARCH 7, 1953 OCCUPATIONAL HEALTH SUPPLEMENT TO THE COMMITTEE BRITISH MEDICAL JOURNAL A long discussion took place in the Occupational Health Advisory Commnittee: Mr. J. Hall, Western General Hospital, Committee on this subject, and various points were made Edinburgh, Dr. I. M. Macleod, general practitioner, Inverness, and by representatives of the Association of Industrial Medical Mr. G. D. Stewart, retail pharmacist, Edinburgh, have been re- Officers. One of them pointed out that whereas under the appointed. Standing Advisory Committee on Hospital anid Specialist Services: Dr. J. T. Curran, Superintendent, Lennox first of the rules an industrial medical officer giving advice Castle Mental Deficiency Institution. Mr. J. Mackenzie, male or treatment at the place of employment must inform the mental nurse, Craig Dunain Mental Hospital, Inverness, has been employee's doctor of the material facts, yet in an establish- reappointed. Standing Advisory Comnmittee on Local Authority ment in which there was no medical officer but there was Services: Dr. I. B. K. MacGregor, general practitioner, Kilmarn- a nurse she might carry out some necessary treatment with- ock, and Mr. W. J. M. Kean, chairman, Public Health Committee, out being under any compulsion immediately to ring up Edinburgh. Mr. R. P. Ligertwood, chairman, Public Health Com- the patient's doctor. The member who raised this point mittee, Aberdeen, has been reappointed. Standing Advisory thought the matter was one to be considered on grounds of Committee on General Practitioner Services: Mr. G. G. C. Bain, chairman, Aberdeen Executive Council, and Mr. M. B. Jackson, common sense and convenient practice. Another argument ophthalmic optician, Dunfermline, have been reappointed. Stand- put forward was that the ethical considerations originally ing Advisory Committee on Health Services in the Highlands and advanced did not carry the weight they formerly did, now Islands: Dr. C. S. Sandeman, general practitioner, Durness. Mr. that the National Health Service was in being. This argu- J. S. Banks, chairman, Caithness Executive Council, and Mr. J. ment was answered by a statement that ethical considera- McNaughton, Argyll County Council, have been reappointed. tions between doctors were unaffected by the existence of a National Health Service.- Another point made in the discussion was that there were part-time industrial medical officers who might use their position to attract patients on IRISH HEALTH BILL to their lists, and the ethical rules were essential to prevent this from happening. One member expressed the view that CHANGES FROM WHITE PAPER if some instructions were given to general practitioners The Government of Eire has recently published the text of when they took over an industrial appointment a consider- its Health Bill. An explanatory memorandum issued with able part of the difficulty would be overcome. the Bill says that its main object is to give to local health It was agreed that the document under consideration authorities the power and the duty to provide the improved should go back to the Association of Industrial Medical and extended health services outlined in the White Paper Officers for study and revision in the light of the comments published in July, 1952 (Supplement, August 9, 1952, p. 92). made by the Central Ethical and Occupational Health The explanatory memorandum also states that suggestions Committees. made by several bodies particularly interested in the develop- ment of health services for modifications of the White Paper proposals have been taken into consideration in drafting the Bill. The White Paper proposals were rejected by the Irish APPOINTMENTS TO SCOlTISH HEALTH Medical Association as unacceptable (Supplement, Novem- SERVICES COUNCIL AND STANDING ber 15, 1952, p. 193). ADVISORY COMMHlTEES New Features The Secretary of State for Scotland has appointed the Important changes from the White Paper are confined following eight- new members to the Scottish Health Services to new definitions of the income groups eligible for free Council in place of those who retired on December 31, 1952. treatment. They affect mostly what was described in the Dr. W. Mackie, Group Medical Superin.endent, Perth Royal In- White Paper as the "middle income class." It has been firmary Group, until December 31, 1953; Dr. W. Boyd, Medical decided that only the lower income group (previously known Superintendent, Stratheden Mental Hospital; Dr. C. W. Clayson, as the public assistance group) should have free general- physician-in-charge, Lochmaben Sanatorium ; Dr. J. G. M. practitioner, maternity, hospital, and specialist treatment. Hamilton, physician, Edinburgh; Professor J. L. Henderson, Pro- This proposal does not alter the existing position. The fessor of Paediatrics, St. Andrews University; Councillor Mrs. middle income classes are defined in the Bill as (a) persons M. S. Ewart, chairman of the Health Committee of Hamilton Town Council; Mr. J. South, ex-chairman, Northern Regional insured under the Social Welfare Act, 1952, (b) adult per- Hospital Board; and Mr. W. R. Tattersall. dental practitioner, sons whose yearly means (including the means of certain Perth, have been appointed members of the Council until members of the family) are less than £600, (c) adult persons December 31, 1955. whose yearly means (including those of certain members of the family) are derived wholly or mainly from farming Reappointments and the valuation of whose farms is £50 or less, together The following members have been reappointed until December with (d) other persons who, in the opinion of the health 31, 1953: Dr. I. D. Grant, general practitioner, Glasgow; Mr. authority, would be unable without undue hardship to pro- W. W. Galbraith, surgeon, Glasgow; Miss E. W. Himsworth, vide institutional and specialist services for themselves or County Nursing Superintendent, Midlothian and Peebles; and Dr. and their David McCall, secretary, Pharmaceutical Society (Scottish their dependants. These groups, dependants, may Department). have free institutional and specialist services (but not general-practitioner or maternity services) as determined Standing Advisory Committees by the local health authorities. At the same time, local authorities will have discretion to impose a charge on groups The Secretary of State has also appointed the following (a}-(c) not exceeding two guineas a week for institutional members to the Standing Advisory Committees. services. A higher charge may be made for the persons Standing Medical Advisory Committee: Dr. D. P. Cuthbertson, specified in group (d). Director, Rowett Research Institute, Aberdeen, has been re- appointed. Standing Dental Advisory Committee: Mr. J. F. Maternity Services Henderson, dental practitioner, Motherwell, and Mr. D. MacGregor, chairman, Scottish Committee of the British Dental The White Paper proposed that maternity services should Association. Mr. G. K. MacLennan, dental practitioner, Edin- be free to all. In the Bill free services are restricted to the burgh, has been reappointed. Standing Nursing and Midwifery lower income groups and those in the middle income group Advisory Committee: Miss M. Fraser, Supervisor of Midwives who are unable to pay. Otherwise maternity services of for Lanarkshire; Miss F. E. Kaye, Matron, Aberdeen Royal all kinds-specialist and general practitioner-will be ob- Infirmary; and Miss C. Macdonald, Matron, Craig Dunain Men- income and above the tal Hospital, Inverness. Professor W. L. Burgess, Department tained by the middle groups by pay- of Public Health and Social Medicine, St. Andrews University. ment of £1 per annum. These contributions will be payable and Miss M. C. N. Lamb, Education Officer, Royal College of to the local health authority, and regulations will govern Nursing, have been reappointed. Standing Pharmaceuitical the conditions of their payment. SUPPLEMENT TO THE 65 MARCH 7, 1953 IRISH HEALTH BILL BRITISH MEDICAL JOURNAL Schoolchildren medical services in the Colony during the last 25 years, in which activities trained Africans have played an increas- Special arrangements are made in the Bill for free ingly important part. Whilst casual visitors to the Colony specialist and institutional treatment for all pupils in the disparity between the productive farm national schools in respect of defects found at school are impressed by for lands of European settlements and the soil-eroded areas of health examinations. Arrangements are also made certain native reserves, no competent authority has ever cripples and mental defectives. A service at child welfare advocated that the solution of the food problems of the clinics and similar institutions will be available, free, for Africans -lay in interfering with the successful farming of children up to 6 years of age. the former. The Kenya Branch is anxious that the pro- The local health authorities will be responsible for the fession should become acquainted with these facts, lest in a administration of all services. There is no provision in the desire to help the Africans of Kenya some of its members Bill for any central medical advisory council. might misinterpret events and hinder a return to orderly progress on which alone the health of all communities, but especially that of the African, depends. Correspondence It should be recognized that, with possible rare exceptions, Mau Mau has had no support from members of any tribe in Kenya except the Wa-Kikuyu.-I am, etc., Mau Mau Nairobi. R. HowiTT WISEMAN, SIR,-The annual general meeting of the Kenya Branch Hon. Secretary, Kenya Branch. of the Association was held in Nairobi on January 30, six days after the murder of Dr. Esmee Ruck, whose obituary Cost of Prescribing notice appeared in the Journal of February 28, p. 513. The SIR,-If everyone taking a prescription to the chemist's meeting expressed the wish that the profession should be would bring along a clean medicine bottle, Britain would acquainted with the wanton attacks which have been made save £lm. a year. At present National Health Service and of the continuing threat to life in Kenya. Although patients lose roughly one-half of the 100,000,000 handed to cognizance had been taken of subversive movements for them each twelve months; and, as householder, pharmacist, some years, it was only in September, 1952, that it became and taxpayer, need I say how much I deplore the loss of clear that a considerable section of the Kikuyu tribe had, the £lm. which this wastage means to all of us ?-I am, etc., perhaps largely by coercion, taken an illegal pagan oath Nottingham. MARY A. BURR. which forced dedication to the perpetration of murder and other felonies with the object of expelling British settlers Admission of Acutely IlI Patients to Hospital who held that the improve- and those loyal leading Africans 7, lot lay in co-operation with the Government. SIR,-Like Dr. A. Harbour (Supplement, February ment of their I to read week by week that 80% to is openly anti-Christian. The causes and p. 37), am irritated The movement to the Emergency Bed Service are controlling forces behind the movement, known as the 90% of applications to hospital. Also, like Dr. Harbour, I have Mau Mau, are sub judice, but it would appear to have taken admitted " learned long ago the type of case that it is useless to try root because some African "intelligentsia have been en- analysis of the couraged to believe that their prosperity lay in expelling to get admitted. I entirely agree with his A G.P. has to learn to withstand the reproachful the British and seizing political power by force. situation. looks of the district nurse as she gallantly struggles to pre- The Kenya Branch put forward in 1947-8 the case for a problem. vent pressure sores developing in some elderly, comatose, Royal Commission to inquire into the population bronchopneumonic, doubly incontinent, and with perhaps The Kenya representative at the Annual Meeting at Cam- I no longer trouble the bridge in 1948 pleaded for support for the proposal and only a senile husband to tend her. E.B.S. with such cases. subsequently the Council of the British Medical Associa- question. tion recommended it to the Colonial Office. The Govern- Dr. Harbour might well have raised a further to recommend the What kind of case does occupy the beds of medical wards ? ment then in office, however, declined principle, if any, is used in the selection of such appointment of a Commission. It will thus be seen that What Branch has been actively concerned with the cases ? From my own experience, certainly not that of the Kenya need. My own feeling-and I should be glad to problem of providing sufficient food for an increasing popu- greatest this is the primary need of be proved wrong-is that cases have roughly the follow- lation. On the human level those cases of medical or thera- of the Branch are devoting ing priority. First are the Colony. Many members of urgency in the out-patient to medical work primarily on behalf peutic interest seen on grounds their professional lives are similar cases from general practi- and the present disturbances are a great dis- department; second of Africans, and very much the last, are those to us all. Casualty figures of those murdered tioners; third, pathetic, appointment desperate, all-too-common cases of serious illness in the by Mau Mau up to January 31, 1953, are Wa-Kikuyu 134, am, other Africans 37, Europeans 8, Asians 2. These numbers elderly with inadequate facilities for home care.-I may appear small, but in the affected areas loyal Africans etc., are on the alert against surprise attacks from their neigh- London, S.W. 14. J. H. S. HOPKINS. bours, whilst the murdered include some of the most loyal of Registrars and progressive chiefs, headmen, teachers, and pastors. Position Europeans have been attacked at night, those chosen being SIR,-I should be grateful if you would allow me to the apparently vulnerable from their situation. No dis- correct a serious error in your report of a statement I made crimination in the choice of victims is made unless it is to at the Central Consultants Committee on February 12 choose those who are elderly or who are held in especial (Supplement, February 21, p. 46). esteem by Africans whom they have befriended. Dr. Esmee My figures for senior registrars who are now in their Ruck was not the first member of our profession to be fourth or subsequent years referred only to two metro- attacked. Commander Meiklejohn and his wife, Dr. politan, two provincial, and one Scottish region. In these Meiklejohn, were similarly attacked by a gang using the five regions alone we are aware of about 110 senior regis- usual sharp and heavy knives. Both were left for dead, trars in this unenviable position. We believe that when up- but, although Commander Meiklejohn subsequently died, to-date figures from all the regions are known there will be Dr. Meiklejohn survives after sustaining severe mutilating at least 300 senior registrars in the same position. It is wounds. Farmers and others in affected areas have been left difficult to see how the Ministry of Health can remain with no recourse but to arm against all possible assailants, complacent about the future of such a large group of highly for those propagating the crimes include trusted servants, so trained men.-I am, etc., little have we correctly understood African psychology. R. M. FORRESTER, Great strides have been made in the development of the Manchester. Late Chairman, Registrars' Group. SUPPLEMENT TO THE 66 MARCH 7, 1953 ASSOCIATION NOTICES BRITISH MEDICAL JOURNAL Public Health Servce Members Association Notices Two members of Council are nominated and elected by members of th% Association employed in the public health service as defined in By-law 1 (3). Candidates must be members of the ELECTION OF MEMBERS OF COUNCIL public health service as so defined. that nomination of candidates for Notice is hereby given One Woman Member election as members of Council, 1953-4, (a) by the follow- elected health service One woman member of Council is nominated and ing Divisions and Branches, (b) by public members of the Association. mnembers, and (c) by women members, must be forwarded by women in writing so as to reach me not later than Saturday, April 4, Nominations 1953. The nominations must be on the prescribed forms, copies Forty Members by Branches in Great Briain and Northern of which can be obtained on application to me. In the case Ireland of the 40 members to be elected by Divisions and Branches, No*. of Members the nomination may be by a Division or Division-Branch as of Council to be such, or by not fewer than three members of any Branch in Elected by the group. A notice will be published by the Council in the Group England and Wales Grotup British Medical Journal Supplement on April 18, 1953, of 1. North of England Branch; Tees-side Branch 2 the candidates nominated. Where contests occur, voting 2. East Yorkshire Branch: Yorkshire Branch 3 duly nominated candi- Branch papers containing the names of all 3. North Lancashire and Westmorland dates will be issued on April 25, 1953, from the Head Office, 4. Divisions in Cheshire: Birkenhead and Square, London, Wirral; Chester; Crewe; Hyde; Maccles- British Medical Association, Tavistock field and East Cheshire; Mid-Cheshire; W.C.1, to each member in the Group, or to the public health Stockport; Wallasey .. service members, or to women members. A notice will be 5. Lancashire Divisions of Merseyside Branch: published by the Council in the Supplement of 'May 16, Liverpool, St. Helens, Southport, Warring- 1953, giving the results of the elections where there have ton; Isle of Man Branch been contests. A. MACRAE, 6. Lancashire Divisions of South Lancashire and East Cheshire Branch: Ashton-under- Secretary. Lyne; Bolton; Bury; Leigh; Manchester; Oldham; Rochdale; Salford; Wigan I Diary of Central Meetings 7. Derbyshire Branch; Nottinghamshire Branch; Leicester MARCH Branch; Lincolnshire 11 Wed. General Practice Review Committee (adjourned and Rutland Branch .. l meeting), 11 a.m. 8. Midland Branch .. 13 Fri. Consulting Pathologists Group Committee, 9. Staffordshire Branch; Worcester and 2.30 p.m. Hereford Branch .. 17 Tues. Subcommittee re Occupational Dermatitis, Occu- 10. Berks, Bucks, and Oxford Branch; North- pational Health Committee, 2 p.m. amptonshire Branch .. 18 Wed. Council, 10 a.m. Branch; Norfolk Branch; 18 Wed. Charities Committee, 1.15 p.m. 11. Cambs and Hunts 19 Thurs. G.M.S. Committee, 10.30 a.m. Suffolk Branch .. 19 Thurs. Radiologists Group Committee, 2 p.m. 12. Divisions of Metropolitan Counties Branch 1 in Middlesex .. .. Branch and Division Meetings to be Held Division .. 13. Marylebone ALDERSHOT AND BASINGSTOKE DIVISION.-At Village Hall, 14. Tower Hamlets Division; City Division; discuss a South-west Essex Rotherwick, Wednesday, March 11, 9 p.m., meeting to Stratford Division; proposal to alter the area of the Division. Division .. .. BURTON-ON-TRENT DIVISIoN.-At Burton Golf Club, Ashby 15. Hampstead Division; St. Pancras Division: Road, Tuesday, March 10, 7.45 p.m., dinner, followed by lecture Westminster and Holborn Division by Dr. Melville D. Mackenzie: " International Medical Work." 16. Kensington and Hammersmith Division: CROYDON DIVISION.-At 43, Wellesley Road, W. Croydon, Paddington Division; Chelsea and Fulham Tuesday, March 10, 8.30 p.m., general meeting. Illustrated Division .. .. address by Dr. Philip ElIman: " Cancer of the Lung-Problems Greenwich and Dept- in Diagnosis and Differential Diagnosis." 17. Camberwell Division; EAST KENT DIvisioN.-At Chez Laurie Restaurant, Thanet ford Division; Lambeth and Southwark Way, Herne Bay, Thursday, March 12, 7.30 p.m., dinner; Division; Lewisham Division; Woolwich 8.45 p.m., meeting. Dr. J. M. Lipscomb: " Heart Trouble." Division; Wandsworth Division HENDON DIvISION.-At Hendon Hall Hotel, London, N.W.- 18. Hertfordshire Branch; Essex Branch; Bed- Tuesday, March 10, 8.45 p.m., clinical meeting. Dr. Donald fordshire Branch .. Teare: " Abortion." 19. Surrey Branch .. 2 KESTEVEN DIVisION.-At White Hart Hotel, Sleaford, Thursday, March 12, 7.15 for 7.30 p.m., dinner; 9 p.m., address by Dr. C. 20. Kent Branch .. .. " of the .. Worster-Drought: Recognition of Early Organic Disease 21. Sussex Branch .. Nervous System." 22. Southern Branch: Dorset and West Hants LEEDS DIVISION.-At Medical School, Leeds, Wednesday, Branch .. .. March 11. 8.15 p.m., meeting. Lecture by Dr. Ffrangcon 23. Bath, Bristol, and Somerset Branch; Roberts: " The Impact of Scientific Medicine on the Struggle for Gloucestershire Branch; Wiltshire Branch Existence." Branch 1 MACCLESFIELD AND EAST CHESHIRE DIVISION.-At Royal Oak 24. South-western Monday, March 9, 8.30 p.m., 25. North Wales Branch; Shropshire and Hotel, Alderley Edge, Cheshire, medical Mid-Wales Branch .. meeting. Discussion on Cohen Report, followed by Branch films. 26. South Wales and Monmouthshire MANCHESTER DiVISION.-At Manchester Royal Infirmary. Oxford Road, Manchester, Thursday, March 12, 5.30 p.m., Scotland special meeting. Dr. E. E. Claxton (Assistant Secretary, B.M.A.): 27. Aberdeen Branch; Dundee Branch; "Current Problems in the Hospital Field." Northern Counties of Scotland Branch; ST. PANCRAS DIVISION.-At Old Library, B.M.A. House, Perth Branch .. I Tavistock Square, W.C., Tuesday, March 10, 8.30 p.m., meeting. " Geriatrics." 28. Edinburgh and South-east of Scotland Lord Amulree: Street. Salis- Branch; Fife Branch I SALISaBuRY DiviSION.-At Church House, Crane bury, Tuesday, March 10, 8.15 p.m., meeting. B.M.A. Lecture 29. Glasgow and West of Scotland Branch " End of I by Mr. T. Holmes Sellors: Disorders of the Lower (Glasgow Division) .. the Oesophagus" (illustrated with lantern slides). 30. Glasgow and West of Scotland Branch SCARBOROUGH DIVISION.-At Scarborough Hospital, Thursday. (County Divisions); Border Counties March 12, 8.30 p.m., meeting. Mr. A. J. Wrigley: " Changes that Branch; Stirling Branch 2 have Occurred in Obstetrics in the Past 25 Years and the Lessons to be Learned from Them." Northerni Ireland TuNBRIDGE WELLS DIvIsiON.-At Pembury Hospital, Wednes- 31. Northern Ireland Branch 2 day, March 11, 8.30 p.m., clinical meeting.