SUPPLEMENT TO THE

BRITISH MEDICAL JOURNAL LONDON SATURDAY JUNE 18 1949

THE SECRETARY REPORTS MINISTRY'S TERMS FOR HOSPITAL STAFFS The Joint Committee considers that the following provision should be included in Paragraph 14 and embodied in the contract as part The terms and conditions of service of hospital medical and of the terms of service: dental staff, and the Ministry's explanatory memorandum In conformity with the assurance given by the Minister of Health (Supplement, June 11, p. 314), represent the limit to which the that existing hospital staffs would be taken over at the appointed Joint Committee has been able to secure concessions by day, and that after the review of the specialist services boards will negotiation. offer new appointments to their staffs either in their existing During the next few weeks consultants and specialists will or in other hospitals, security of tenure of the number of sessions have an opportunity of discussing the terms at meetings. of specialists rendering part-time service shall be maintained. A number of the more important issues are discussed below, Where the number of sessions performed by a specialist at any one including a comparison between the representations made by hospital is substantially curtailed through no fault of the specialist, the Joint Committee and the reactions of the Ministry as the regional hospital board (or board of governors either directly or in conjunction with the regional hospital board) shall be respon- embodied in the final terms of service. sible for providing alternative sessions in another hospital in the region. Where the board is unable to do so the Minister shall Senior Hospital Medical Officers assume responsibility for offering a suitable alternative post under The Joint Committee has expressed the view that no proper another board. The same procedure shall apply to new entrants. distinction can be drawn between junior specialists and full Medical superintendents and senior hospital medical officers should specialists. A practitioner is either a specialist or not, and it have the same security of tenure in their appointments as specialists. is a matte#for regret that the Ministry should have suggested The Ministry proposals do not go as far as those put forward to Review Committees that so-called junior specialists should above. In effect they provide that, where a consultant considers be graded as senior hospital medical officers. The Joint Com- that his appointment has been unfairly terminated by a board, mittee therefore asked that a system of appeal should be estab- he shall be entitled to send a full statement of the facts to lished by which a practitioner not satisfied with his grading the Minister, who will obtain the written views of the board can secure a review of his assessment by a committee other concerned and put the case before a professional committee than the one which made the first assessment. Further, the (consisting of representatives of the Ministry. and of the pro- Joint Committee sought an assurance that no specialist sub- &fession, under the chairmansl)ipof the Chief Medical Officer) sequently appointed would be graded as a senior hospital for its advice. The committee will have discretion to inter- medical officer and that no additional appointments would be view both parties if it thinks fit. In the light of its advice made to this grade except in such limited field as may be agreed the Minister may confirm the termination of services or direct between the Ministry and the Joint Committee.- reinstatement, or arrange some third solution agreeable to the The Ministry proposes that senior practitioners performing parties concerned, such as re-employment in a different post. clinical duties who are not of consultant status and are not Although it is envisaged that this procedure will be com- registrars be appointed to the senior hospital medical officer pleted before the board's decision is put into effect, the grade, but that the term need not be adopted as a title describing machinery of dismissal with its implied stigma is put into individual officers holding the posts in this grade. Boards are free operation before the consultant has had an opportunity of to use whatever terminology is preferred-e.g., an anaesthetist stating his case to the appeal body. holding a post in the senior hospital medical officer grade might The terms a " include paragraph to the effect that, where be given the title of anaesthetist"-a specialist in the same a of in the " change organization hospital and specialist services field being called a consultant anaesthetist." involves displacement or serious disturbance of a part-time On the question of appeal, the Ministry has agreed that consultant's services, the board has a moral obligation to aggrieved practitioners shall have a right of appeal to the " render the greatest possible assistance " to the consultant to Review Committee, the committee being enlarged for the pur- obtain work in another pose by the addition of two members-one nominated by the comparable hospital. appropriate Royal College, and one drawn from the Review Committee of an adjoining hospital region. Medical Superintendents The Joint Committee considers that rates of remuneration Security of Tenure for medical superintendents should not be prejudiced by The Joint Committee has sought to secure adequate safe- considerations of policy on what should be the appropriate guards for consultants and specialists holding appointments in .form of hospital administration in the future. Therefore the the hospital service and has put forward the following proposals remuneration attached to hospital appointments in the field of on security of tenure. medical administration should be appropriate to the status and of a medical Where the appropriate committee of a board proposes to recom- qualifications practitioner. mend to the board the termination of a specialist's contract, the board, The Joint Committee accordingly recommended: before considering the matter, should refer it to a central professional (i) that where a medical superintendent is classified as a specialist committee for examination, the board being directed thereafter to he should be remunerated as a specialist whatever the proportion of proceed or not to proceed with the termination of the contract of the time spent on administration; practitioner in question in the light of the findings of the central (ii) that a medical superintendent not classified as a specialist professional comnmittee. < should be on a salary scale of £1,500 to £2,500, according to the The central professional comnmittee should consist of the Chief size and character of the hospital and the duties involved. Medical Officer of the Ministry as chairman, two registered medical The Ministry proposes that a medical superintendent be paid practitioners selected by him, and three specialists nominated ad hoc a of a by the Joint Committee. The chairman should not have a casting salary consisting fraction of the whole salary of vote. a consultant or senior hospital medical officer according to his An aggrieved specialist should have the right to appear personally grading in respect of the time given to clinical work and before the oentral professional committee, and to have the assistance a fraction of the appropriate rate for hospital administra- of a professional colleague if he so desires. tive staff for the time given to administrative work. 2317 332 JUNE THE SUPPLEMET 10o THE 18, 1949 SECRETARY REPORTS BRITISH MEDICAL JOURNAL

The Ministry has, however, conceded the point that when a Clinical Consultants Engaged in Teaching whole-time officer is engaged almost wholly on clinical work, (Document, and gives only a small proportion of time to administrative paragraph 9) duties, his appropriate clinical remuneration shall not be The University Grants Committee in making grants to uni- affected. versities will have regard to the following salary rates (oper- Part-time Consultant Appointments ating from April 1, 1949) for holders of whole-time clinical In general, the Ministry has accepted the Joint Com- posts in medical and dental schools: mittee's proposals for calculating the remuneration of part-time Professors: Within the range of £2,250 to £2,750. specialists, and in the explanatory memorandum points out Lecturers: £600 to a maximum within the range of £1,500 to that boards are expected to make a pre-contract assessment of £2,000 (or £2,500 for posts carrying special responsibility). the duties attached to the post in terms of the time which Readers: Within the range of £1,500 to £2,000 (or £2,500 for should be taken by an average practitioner to perform the posts carrying special responsibility). duties. There will therefore be no need for consultants to Boards will pay no remuneration whatsoever to holders of " clock in and out." these posts or to clinical professors, heads of university depart- It is recognized that consultants engaged in teaching duties ments, etc., who devote a large part of their time to university will require more time in undertaking a session than a non- work. (In cases of doubt the university or school should be teacher, and this factor will be taken into account in assessing asked whether they regard the clinical teacher as coming under the number of notional half-days. Arrangements will be made paragraph 9 (1) or 9 (2) of the Terms of Service.) These for the pre-contract assessment to be reviewed from time to officers will hold honorary unpaid appointments with the board time. and will thereby be eligible for distinction awards. Where an Part-time Registrars award is granted, the board will pay over to the university or medical or dental school the value of the award (or, in the case Part-time appointments in the registrar grades will be calcu- of holders of part-time teaching appointments, the appropriate lated on a number of notional half-days. proportion of the value) so that the university or school may This is a new point which did not appear in the provisional include this in the remuneration they pay to the teachers. This terms. remuneration is not superannuable under the National Health Maximum Remuneration for Part-time Appointments Service Superannuation Scheme. It is proposed that the maximum remuneration for part-time The Joint Committee considers these proposals to be inade- specialists shall be 91/11 of the whole-time remuneration appro- quate, and have urged that discussions on a national level priate to the officer concerned and for registrars 9/11 of the should be held as soon as possible. whole-time salary. Exceptional Consultations Determination of Salaries Payable from July 5, 1948 The Joint Committee has urged that payments for exceptional The salaries of consultants, payable from July 5, 1948, will consultations should be on a sessional basis at the rate appro- be the salary which the officer would have been receiving on priate to the seniority of the specialist concerned-i.e., at the that date had the proposed system of remuneration been in same rate as for the specialists' contractual duties. But the operation since the date on which he first accepted a hospital Ministry has adhered to its original proposal that payment staff appointment with full clinical responsibility. should be at the rate of 5 guineas a visit, any operative work It is stated that there must have been no break of service, being included. but the Ministry has agreed with the Joint Committee's con- Domiciliary Consultations tention that war service or national service on call-up will not The Ministry has agreed to the Joint Committee's suggestion constitute a break for this purpose. that the title " domiliciary visit " should be changed to " domi- In the case of senior hospital medical officers, boards have ciliary consultation." This change is important because it makes discretion to decide at which point in the salary scale existing a distinction between consultations at the request of a general staff should start provided that the starting salary shall in no practitioner and domiciliary visits for the purpose of routine case be higher than that-which the officer would receive were treatment such as are carried out by tuberculosis officers. his position on the scale determined by age alone. Officers The Joint Committee considered that whole-time specialists who were transferred under Section 68 of the National Health should not in principle undertake domiciliary consultations Service Act and who, immediately before July 5, 1948, were except (a) where there is no part-time specialist available or receiving salaries better than those now introduced will be (b) where the character of the specialty is such as to necessitate entitled to receive their previous salary scale and conditions of the attendance of a whole-time specialist. The Ministry pro- service on a personal basis for so long as they remain in the poses that whole-time officers should undertake domiciliary same appointment, or another appointment of the same or work but that their liability in this field should be clearly defined greater responsibility, as the one they held at the appointed day. and limited and should not be additional to normal whole-time commitments but part of them. Whole-time specialists will not Car Allowance receive additional payments for domiciliary consultations. The The terms of service provide for domiciliary consultations to be Joint Committee made a number of recommenda- undertaken by senior hospital medical officers. tions for improvement of the travelling allowances. These The Ministry has not given effect to the Joint Committee's recommendations are not reflected in the final terms. proposal for an increase in the travelling and subsistence allow- ances or for the removal of the ceiling of remuneration for Are the Terms Acceptable ? domiciliary consultations, but specialists undertaking this work Only the more important points in the final terms have been are given the option of having the maximum calculated as referred to above, and the comparisons drawn between the 200 gtuineas in any one quarter or 800 guineas in any one year. recommendations of the Joint Committee and the Ministry's Clinical final terms are not a substitute for the two documents pub- Consultants Teaching Medical Students lished last week. The task before consultants and specialists The Joint Committee has pressed for a national agreement is clear. It is for each individually to decide whether the for the payment of clinical teaching to be negotiated and pro- terms are sufficiently acceptable to justify consultants and mulgated before contracts are offered. The Ministry proposes specialists signing the permanent contracts offered to them. The that whole-time clinical consultants engaged in teaching shall Joint Committee is seeking the views of its constituent bodies hold honorary unpaid appointments with the appropriate hos- on this issue and will meet on July 5 to decide the character pital board and shall receive from the board appropriate of the advice to be given to the profession. The Central expenses for hospital work. They will also be eligible for dis- Consultants and Specialists Committee, before expressing its tinction awards. Part-time specialists who teach will be view, will have before it the opinions of the various regional remunerated by hospital boards (including distinction awards committees. In the meantime, specialists are again advised not and expenses) in addition to any remuneration they may receive to sign permanent contracts until the Central Committee has from the university or teaching school for teaching duties. met and expressed its view. JUNE 18, 1949 NATIONAL HEALTH SERVICE' SUPPLEMENT TO THE 333 JUNE 18, 1949 NATIONAL HEALTH SERVICE~~~~~~~~~~~~~~~-BRITISH MEDICAL JOURNAL National Health Service

FACTORY MEDICAL SERVICES hospital, one of whom should be of the specialty of the practi- tioner whose grading is under review. Factory inspectors have recently investigated the medical ser- vices in different kinds of factories in Britain for the Ministry Further Appeal of Labour. The inquiry was carried out on the suggestion of a subcommittee of the Industrial Health Advisory Practitioners whose appeals were considered by a reviewing Committee. committee identical with the committee which first graded them The inquiry shows that out of 243,769 factories in Britain will be given a further fortnight in which to lodge an appeal, 4,499 have definite arrangements for some kind of medical so that it can be referred to the enlarged committee. services other than statutory examinations of young persons. General medical supervision is provided in 2,525 factories, Limitation of Appeals supervision of first-aid and ambulance-room services in 2,511, The Ministry has cancelled the proviso that remuneration and in 2,274 factories particular groups of workers-e.g., those at a higher rate as a consequence of any regrading on appeal subject to special health risks-are given a periodical medical shall be applicable from the date of regrading only, and not examination. retrospectively, where the regrading is completed after July 5 A periodical medical examination of all workers is given at next. Instead, no appeal lodged with a'regional hospital board the factory in 229 instances, and at the doctor's'surgery in 18. or board of governors after July 4, 1949, or more than 14 days New entrants and applicants are examined in 1,558 factories, after the notification of grading to the practitioner, whichever and at the doctor's surgery in 225. At 1,159 factories there is is the later, will be considered. Any practitioner whose appeal provision at the factory for examining workers returning after is out of time, and who subsequently obtains a consultant post illness, and at 141 at the doctor's surgery. upon the recommendation of an advisory appointments com- mittee constituted under the National Health Service (Appoint- Group Medical Services rntent of Specialists) Regulations, 1948, will not be able to The inquiry shows that there appear to be only three schemes claim retrospective adjustment of salary at the higher rate from of group medical services for small independent factories as July 5, 1948. distinct from factories run by large or closely associated con- cerns. These are at the trading estates at Slough, Bridgend, and Hillington. The Slough scheme covers 113 factories, of which HOSPITAL EYE SERVICE 33 employ fewer than 26 workers; the Bridgend scheme covers The Minister has decided that reversible frames and frosted 39 factories, of which 15 employ fewer than 26 workers; and and Chevasse lenses may be supplied under the National the Hillington scheme covers 126 factories, of which 69 employ Health Service without charge to thW patient. Laminated safety fewer than 26 workers:. lenses may be supplied under the Service, but the patient is normally required to contribute part of the cost. Extra Supervision Glasses may be repaired, except when the damage is due to Inspectors were asked whether in their districts there are carelessness, free of charge under the hospital eye service. any industries which predominantly stand out as having This condition applies also to those glasses for which the factories with arrangements for medical supervision beyond patient has contributed part of the cost. legally compulsory medical examinations. Most of the replies were'negative, but it seems that the following did fall into that category: dockyards and other factories occupied by the Admiralty, Royal Ordnance factories, the aircraft industry, HOSPITAL BUDGETS shipbuilding, iron and steel manufacture, the metal tube BEDS NOT TO BE CLOSED at factories occu- industry, the chemical industry (particularly The Minister of Health has sent a letter to hospital boards pied by Imperial Chemical Industries), the tobacco and cigarette in the closing industry, electric cable and large electrical manufacturing emphasizing that economies should not result cotton of beds or the reduction of other services essential to the undertakings, and spinning. care and welfare of patients. In certain special cases it may Factory Doctors be necessary to provide for expenditure on development now in hand involving the opening of additional beds, recruitment Whole-time service is given by 53 doctors who hold appoint- of staff, and the provision of other essential services which ments as "appointed factory doctors," and 586 who are not in the view of the boards are required in the interests of " appointed factory doctors." Of appointed factory doctors the patients. doing part-time work, 94 do a substantial amount (more than The Minister relies on the boards in preparing revised esti- 12 hours a week on the average), 245 between three and mates to exercise close financial vigilance and to budget only 12 hours a week, and 1,397 three hours a week or less; for services which they are satisfied must be brought into of those not appointed factory doctors, the numbers are operation during the current financial year. Estimates should respectively 111, 406, and 584. be based on the assumption that existing services are to be maintained; they should provide for developments in progress, opening unstaffed beds, and allow for recommended wage REVIEW COMMrffEES increases. Enlarged to Hear Appeals WJhen review committees of regional boards hear appeals from FUND practitioners who disagree with. their grading they will be HOSPITAL ENDOWMENTS enlarged by the addition of two members-one nominated by The Minister has made regulations (S.I. No. 482, 1949) which the appropriate Royal College accord'ing to the specialty of the provide that, after the discharge out of the Hospital Endow- practitioner, and one drawn from the review committee of an ments Fund of certain liabilities transferred to the Minister of adjoining hospital region. This decision is a result of discussions Health by the N.H.S. Act, 1946, the balance of the fund will between the Ministry and the Joint Committee. Similarly, the be apportioned between regional hospital boards and hospital Ministry requests that boards of governors will arrange that management committees by reference to the number of beds when cases are reconsidered the committee which originally in the hospitals which they control. The income of the fund reviewed them shall be enlarged by the addition of two members is to be distributed to the boards and committees proportion- drawn from the medical staff committee of another teaching ately to their shares. 334 JUNE 18, 1949 SUPPLEMENT TO THE ELECTION TO COUNCIL BRITISH MEDICAL JOURNAL

0

Existing Jroup[ngy

ELECTION TO COUNCIL GROUPING OF BRANCHES AND DIVISIONS The Council's recommended plan for the grouping of Branches and Wales. In the Lancashire and Cheshire and Isle of and Divisions for the election of 37 members to Council was Man group a line on the map shows a suggested subdivi- published in the Supplement of May 28 (p. 293). These maps sion, but it will rest with the Lancashire and Cheshire Branch illustrate the grouping as it is at present, and as it is proposed. to suggest the precise areas (Supplementary Annual Report of The figures in white show the number of members to be elected; Council). the figures in black the approximate number of electors. The The existing grouping for the direct election of four members proposed changes are shown on separate maps for England to Council by members of the Branches in Scotland is retained. SUPPLEMENT TO THE JUNE 1I8, 1949 ELECTION TO COUNCIL BRITISH MEDICAL JOURNAL 335

-ISLE ~OF WIGHT

E N G LAN DAND WALES Proposed c7r0u0g

Under the proposal submitted by the Council the representatives constituencies. Under the proposed new plan the Northern in the Representative Body of the constituencies in Scotland Ireland Branch will elect two members to Council by the direct will elect two members to Council in substitution for the exist- method. ing arrangement under which Groups N and 0, and P and Q, Consequent on the increase in the number of members to be respectively elect one nember each. The groups in Scotland directly elected to Council, the procedure under which the are shown on the map lettered as they are at present. Similarly, representatives in the Representative Body of constituencies in the representatives of Welsh constituencies will continue to England elect eight members to Council will be discontinued. elect one member to Council. Further, the number of members of Council to be elected by At present Northern Ireland elects two members to Council, the Representative Body as a whole will be increased fro.:n one by the direct method and one by the representatives of eight to ten. 336 JuNE 18, 1949 GENERAL MEDICAL SUPPLEMENT TO THE SERVICES COMMITTEE BRITISH MEDICAL JOURNAL now been graded senior hospital medical officers. It-had now GENERAL MEDICAL SERVICES COMMIITEE been agreed that in future no appointment of senior hospital Questions of remuneration and of Whitley machinery and medical officer should be made except in a very limited field, arbitration occupied the early part of the meeting on June 2, and the definition of that field was being prepared at the moment. which was reported in the Supplement of June 11 (p. 328). The assessment of payment for temporary residents was then The committee decided, in view of the widespread dissatis- considered. The Remuneration Subcommittee had found that faction' throughout the country, to ask for a proper appeal the old method of adjustment as between one area and, another machinery consisting of a committee none of whose members no longer justified the labour involved, and recommended that were concerned with the original assessment.% a direct payment be made in respect of every temporary resi- dent, the charge-a direct one on the central fund-to be 15s. General Practitioners on Staffs of Cottage Hospitals for each ordinary "temporary," and, provisionally, 2s. 6d. for An important matter was brought before the committee by each resident in a convalescent home. Dr. Howie Wood, who produced a form of contract with a The total amount paid out for temporary residents in England cottage hospital in the course of which it was stated that in so and Wales during the first quarter of the present year was far as a general practitioner provided general medical services £62,298, and for Scotland something like £10,000. A member to a patient on his own domiciliary list he was already remuner- said that in Blackpool during the same period the number was ated for the work he did in hospital, and in order to provide 4,256, so that evidently a considerable sum of money was remuneration for hospital wdrk done for other doctors' patients involved. Discussion took place on the definition of " temporary the hospital management committee had set up a staff fund resident" and of " treatment." Was the giving of a certificate equal to £25 per occupied bed. This was for assisting at opera- "treatment"? Dr. Jope said that any person who resided tions and writing up case notes for patients other than the within an area for a period exceeding 24 hours should be practitioner's own. The sum mentioned was considered to be -regarded as a temporary resident; if the residence was for less inadequate in itself and also in comparison with the payment than that time the case would constitute an emergency. of general practitioners attending convalescent homes. There The matter was referred again to the Remuneration Sub- was an implication in the contract that attendance at the committee for action along the lines of the discussion. surgeon's behest was part of the general practitioner's duty. The committee was fully in sympathy with the protest made, Foreign Visitors and noted this question as one to be dealt with as soon as the present negotiations on remuneration were concluded. Asked whether any steps had been taken to secure safeguards concerning foreign visitors who benefited from the Service during their stay in this country, Dr. Wand, the chairman, Partnerships and the Inducements Fund explained that the Ministry's view was that, while at any particu- Dr. Katharine Harrower asked the committee to express the lar moment a certain number of foreign visitors might be in opinion that, in the case of partners, inducement payments this country participating in the benefits of the Service, it was should be directly related to the work done and not modified probable that a corresponding number of British people were by any relationship existing between the partners. She instanced abroad, and were therefore outside the responsibility of the a case in which a husband and wife were in partnership with a practitioner on whose list they were. It was also pointed out third practitioner, and the Ministry assessed the husband and that it was much easier to get on the list than off the list. wife together as representing 1+ x, whereas the third practi- It was reported that Professor Bradford Hill had agreed to tioner represented 1 x. It was a very short step from this to undertake a statistical inquiry for one full year as from Oct. 1 the cutting down of payments in any partnership, say of father into the work done by general practitioners. Professor Hill had and son. at first expressed himself as doubtful concerning the value of D;r. Harrower was asked to prepare a short memorandum the inquiry if it involved a comparison with pre-war N.H.I. on this subject so that the maiter could be pursued with the figures covering less than half the population. He had been Ministry. informed that the purpose of the inquiry was to discover how Other Business much work practitioners were now doing and to assess the case A report was made on a number of matters' which had been for improvement of remuneration on the basis of the number discussed with the Ministry of Health. These included the of iten4 of service rendered. He had consented to undertake treatment of merchant seamen, mileage payments for maternity the task on the understanding that comparisons with the earlier cases, emergency caims where calls were frivolous or unjustified, period could not be justified. and the question of telephone charges. With regard to this last The chairman said that the Ministry realized the importance it was mentioned that the Scottish Department had stated that of the.problem of inflation of doctors' lists, particularly the it was prepared to make some contribution when charges were cumulative effect of inflation when patients had gone on to excessive. lists in two different areas, and a careful check would be made It was reported that a deputation had been received from the in areas where this was known to occur. It had been promised National Conference of Friendly Societies to discuss the quest that the possibility of a central register in line with the census tion of the issue of medical certificates of incapacity to volun- to be taken in 1951 would be looked into. tary members of the societies who were not entitled to sickness benefit under the National Insurance Act. These people had Position of General-Practitioner Specialists to ask their doctors for private certificates. Many doctors gave, Dr. Talbot Rogers, in presenting the minutes of a sub- them gratuitously, but it was a hardship when the persons committee which has been considering the position of general- concerned were required to pay a fee, for the weekly payments practitioner specialists, said that the results of the reviewing were often only a matter of a few shillings. boards were far worse than he had expected. To all intents The committee viewed the request sympathetically, and was and purposes hardly any general practitioners had been placed of opinion that in such circumstances doctors should not charge in the ranks of sefialists. Not only th;, but quite a,large for a pro forma certificate. proportion of the younger people, and some of the older ones, who were doing only specialist work and were regarded by their colleagues in hospital as specialists, and in most cases would in TRADE UNION MEMBERSHIP private practice be recognized as such, had been classified as The following is a list of local authorities which are under- senior hospital medical officers. stood to require employees to be members of a trade union The Secretary (Dr. Charles Hill) said that the Joint Com- or other organization: mittee under Sir Lionel Whitby's chairmanship had been press- Metropotitan Borough Councils.-Fulham, Hackney, Poplar. ing for a proper appeal machinery. The standards of grading varied enormously in different areas, and trouble was blowing Non-County Borough Councils.-Dartford, Wallsend. up all over the country, not only with regard to general- Urban District Councils.-Denton, Droylsden, Houghton-le- practitioner specialists but with regard to provincial hospital Spring, Huyton-with-Roby, Redditch (restricted to new appoint- officers, who had always been regarded as specialists and had ments), Tyldesley. JUNE 18, 1949 SCOTTISH G.M.S. SUBCOMMITTEE BRITISHSUPPLEMENTMEDICAL 1O0JOURNALTHE 337

SCOT1,SI G.M.S. SUBCOMMITTEE WHITLEY, MACHINERY AND PUBLIC A proposal to introduce in Scotland the Formulary recently HEALTH SALARIES announced by Mr. Bevan as applying to England and Wales A meeting of the Public Health Committee of the Association was considered by the General Medical Services Subcommittee was held on June 3, Dr. James Fenton presiding. An explana- (Scotland) at a meeting at B.M.A. House, Edinburgh, on tion was given of the position with regard to Whitley machinery May 26. Dr. W. M. Knox presided. and arbitration, similar to that which had been made on the The Department of Health for Scotland pointed out that if previous day to the General Medical Services Committee the committee approved of the Department's issuing the (SupplenieBt, June 11. p. 328). Under Clause 12 of the amend- Forinulary to practitioners in Scotland they would also send ing Bill it appeared that resort to arbitration was possible only out an accompanying letter explaining the position. with the consent of the Minister. Other types of procedure The opinion was expressed that practitioners already made regarding suitable means of settlement were discussed. The use of their own formulae and it would be to the advantage chairman said that a close watch was being kept on the situa- of the profession to use the national one. It was not so much tion from every aspect-that of public health officers as well as a question of whether the Formulary should be used but rather general practitioners and consultants and specialists. N hether it should be issued. The covering letter made it The committee considered a letter which had been received abundantly clear that there was no intention of introducing from a county medical officer of health suggesting that the compulsion. Association itself should make known to individual members The opinion was also expressed that the introduction of the of local authorities the relevant details of the present dispute Formnulary would lead to a general deterioration of the high with local authorities' associations concerning salaries. This standard of prescribing which existed in Scotland and to some correspondent had found that some members of local authori- lazy-mindedness. ties thought they were acting in good faith in advertising posts The committee agreed to the Department's proposal to issue (in the local press, the medical journals being closed to them) the Formulary together with the covering note. at a higher salary than had hitherto obtained. The view of the committee, however, was that it could not approach individual Filling Vacancies members of local authorities, and that it was the duty of each After discussion the subcommittee indicated its readiness to medical officer of health to explain the position to his council take part in a meeting with representatives of the Department or committee, as, indeed, had been done in the case of the of Health and the Scottish Association of Executive Councils correspondent concerned. suggested by the latter body with a view to reducing to a It was reported that a communication had been addressed to minimum the delay which is taking place in connexion with the professors of public health at all teaching centres with a the filling of vacancies on the medical list of an executive view to making the Association's policy known to all successful council on the death or retirement of a practitioner. It was D.P.H. candidates. Replies had been received from most of decided to transmit to the Department of Health a suggestion the professors testifying their full agreement with the B.M.A. that the joint meeting, if held, might take into consideration policy and in some cases giving names of candidates so that that where in the filling of a vacancy the local medical com- the Association could communicate direct with them. mittee, executive council, and'the Medical Practices Committee Active steps were also being taken to counter any demand by are in agreement, in the interests of a general speeding up, local authorities to employ general practitioners on a sessional there should be no appeal to the Secretary of State. Where basis for the purpose of undertaking duties normally carried out there was difference of opinion in any of these bodies, however, by a whole-time medical officer. When it came to the notice of should be allowable. the head office that a local authority was contemplating such a appeals step, the local Division was informed and requested to advise practitioners in the area against the acceptance of such employ- Other Business ment. In the Metropolitan Counties Branch a special appeal The committee received a report on discussions with repre- had been addressed to all general practitioners, and a letter sen.atives of Scottish Local Authorities on the question of on this subject had also been sent to all local units of the which services are covered by the fees payable to general -Association throughout the country. practi.oners under the National Health scheme. The sub- committee decided to take up with the Department of Health Fees for Part-time Work the position of general practitioners under the Service in The secretary of the committee (Dr. Kelynack) gave a verbal respect of the domiciliary treatment of venereal diseases. report of a meeting with representatives of local authorities' The committee rejected a proposal by the Department of associations at the Ministry of Health on May 31 concerning Health and the pharmacists that, in future, prescription forms the minimum fees to be paid for part-time work. She said that should be in duplicate or triplicate.' It was admitted that the it was the first time that all these various matters had been pharmacists had made out a case for the keeping of a record assembled in one document. General agreement had been for their own purposes, but the view was taken that the time reached on the minimum fees as recommended by the Associa- was inopportune to ask the practitioner to undertake what is tion for certain services. It was not possible to give a full not for his purposes an essential duty. report as negotiations were still continuing, a further meeting having been arranged for June 20. Constitution of Committee The committee expressed its satisfaction with the interim report. In connexion with the constitution of the General Medical It was -eported that on May 4 a meeting of the Askwith Services Subcommittee (Scotland) it was decided to recom- Advisory Committee which had been called could not proceed mend to the parent committee that in future each local medical because the County Councils Association, supported by the committee in Scotland'should have at least one representative Urban and Rural District Councils Associations, had refused on the subcommittee. On a vote it was agreed that the to take part on the ground that the action of the B.M.A. in Scottish representatives on the Central General Medical Ser- refusing public health authority advertisements implied a vices Committee should continue to be appointed on an area repudiation of the Askwith Agreement. The Association of basis and not by the General Medical Services (Scotland) Municipal Corporations and the London County Council were Subcommittee. represented, and the absence of representatives of the other bodies was generally regarded as highly discourteous. The matter had been reported to the Minister by the independent chairman of the Advisory Committee. Dangerous Drugs Act: Withdrawal of Authority It was reported from the Society of Medical Officers of Health The Home Office announces that Dr. Alexander Watt (Peterhead) that the council of that body had considered the basis upon is no longer authorized to be in possession-of or to prescribe those which public health service members should contribute to the drugs to which the Dangerous Drugs Regulations apply. funds of the British Medical Guild. The society considered 338 JUNE 18, 1949 WHITLEY MACHINERY AND PUBLIC HEALTH SALARIES SUPPLEMENT TO THE BRITISH MEDICAL JOURNAL

that a levy should be made on the basis of Lx for those with obligations which were quite unacceptable. This matter has been salaries of £1,500 and over, by Ly for those with salaries of satisfactorily adjusted by the Branch with the minimum of guidance between £1,000 and £1,500, and £z for those with salaries of from headquarters. The Branch arranged a conference of secretaries under and that the of the appropriate contribu- of Divisions in the county to meet the Commissioner,-who has agreed £1,000, question to correct the impression caused, by a further letter in a form agreed tions to be made should be considered by the General Purposes by the Branch. Committee of the society, when recommendations would be sent The Prison Commission, with the help of the Ministry of Health, to the Association. is attempting to form local panels of general practitioners who may be called upon to certify persons on remand where the mental con- dition and need for detention are in question. A fee is offered which is quite inadequate and at variance with Association policy. Clearly ROLE OF THE DIVISIONS IN THE MEDICO- the use of local machinery is necessary in order to warn doctors POLITICAL WORK OF THE ASSOCIATION requested to accept these terms that by so doing they will prejudice the outcome of central negotiations. The Organization Committee has prepar-ed the following Thus memorandum: the Divisions have a two-way function in local political activity. They may take the initiative when questions arise The Association has been described as a federation of local locally in the first instance, calling on the branch or Head- medical societies, each having its own administration and rules. quarters for help, if need be; or they may act as a link between Each local unit has autonomy within the limits imposed by the centre and periphery and inform members where individual articles and by-laws of the Association, but is linked to others action or co-operation is required. and with the central executive. In another sphere, closely related to medical politics, the The Division provides the means for carrying out locally the role of the Division is very important. This is in promoting main objects of the Association-the promotion of the medical and maintaining good relations between the local profession and allied sciences and the maintenance of the honour and on the one hand and local government, local institutions, and interests of the profession. It is to the Division that the indi- the lay public on the other. The B.M.A. is now generally vidual member should look for help and advice and for the accepted as the representative body of the medical profession, opportunity of meeting his colleagues. but this has not happened fortuitously, and if this position is The activities of Divisions can be grouped under four heads to be maintained in local communities constant vigilance and scientific, social, medico-political, and ethical. During the past action by the Division will be necessary. Good public relations decade, but chiefly since the end of the war, most Divisions have are a necessary condition of success in the medico-political been preoccupied with medical politics, and the proportion of field and are by no means limited to organized press publicity. meetings held to discuss political matters has been unduly high, The second factor likely to affect the part played by Divisions often at the expense of scientific meetings. It is to be hoped in medical politics is the establishment of special negotiating that the balance will be restored, because experience shows that machinery for general practitioners and consultants. Com- scientific and social occasions attract as a rule larger attendances, mittees are now established with autonomy in their respective and that where the main activity of the Division is political its fields, linked to the Association centrally but with no corre- work tends to pass into the hands of the few who are interested, sponding link between local organizations. The argument that with harmful effect both to the Division and to the Association this situation is not new and that the General Medical Services as a whole. Committee is only the Insurance Acts Committee under another Nevertheless, it is important that the Division should continue name is unconvincing. A new situation has arisen through to foster interest and to take part in medico-political work. the introduction of a 100% service and through the establish- Only by this means can the individual member be given the ment of similar machinery to represent consultants and opportunity of criticizing, and through his representative on specialists. The G.M.S. Committee and the Central Consultants the Representative Body of shaping, the policy of the Committee are empowered to act independently in all questions Association. affecting practitioners taking part in the Health Service. Under The Representative Body is the parliament of the Association. these circumstances it would seem at first sight that, in a large Once every year it meets to review in detail all the manifold part of the medico-political field, the local units of the Asso- activities of the many committees which, on behalf of the ciation must stand aside in order to avoid the dangers of divided Council, watch over the interests of the profession. It is the. counsels and duplication of responsibility. Closer examinationt responsibility of the Division executive, not only to provide of the position shows, however, that for the Division it is a the occasion for discussion of the Council's annual report, but change rather than an abdication of function. to make every member of the Division feel that his co- operation is needed in order that his representative may attend Link in the Profession the Annual Meeting with full knowledge of the views of those Though there is usually cross-representation between the he represents. local medical committees and regional consultants committees, Two changes likely to affect the position of the Division in making them nominally representative of the whole profession relation to medico-political work have followed the introduction in their areas, these areas are so different and the main interests of 100% service and the co-ordination of the hospital, public of the two committees so divergent that in fact they are as health, and general medical services in a single administrative separate and distinct as the right and left hands of the medical structure under the National Health Service Act. In the first body-politic. It is for the Division to form the link and to place more emphasis is placed on negotiation at a national the field preserve the unity of the profession locally. The Division, level, of local negotiation in which the Division or because its area is designed to enable members to meet, can Branch could conduct its own affairs being correspondingly attain a much closer contact between its members and its narrowed. Secondly, special machinery has been extended or executive than a county or regional committee can have with devised to deal with terms and conditions of service in the its constituents. In the latter case the relationship is purely three main fields of practice. formal, and, once the committee has been elected, formation of policy must remain mainly in the hands of the executive. Local Action In the Division, on the other hand, there is opportunity for While it is true that the field of local political work has been free criticism and discussion. narrowed, much remains. In all questions affe..ting private Some Divisions, in order to increase facilities for discussion, practice or services outside the scope of the Act it is still the have formed still smaller units-study groups-and there are responsibility of the Division to secure the implementation of clearly advantages in arranging Division areas so that members Association policy in its area. A review of the work of the can meet without having to travel long distances. The pro- Private Practice Committee in recent months will show many posal that the areas of Divisions and Branches should be examples of questions which can be best dealt with by local revised to conform to the areas of executive councils or regional units within centrally determined policy. Two instances will hospital boards should be resisted. suffice to illustrate this point. Fortunately for the sake of the unity of the profession The Commissioner of Police for a northern county recently circu- the members of local medical committees and regional con- larized former police surgeons and others and attempted to impose sultants committees are usually leading members of the JUNE 18, 1949 ROLE OF DIVISIONS IN THE MEDICO-POLITICAL WORK BRtITISHSUPPLEMENTMEDICAL TOJOURNAL. 339 profession in their areas and as such often hold office in their Divisions; thus there can be a two-way exchange of informa- tion, and co-operation is assured. Passive acceptance of this Questions Answered situation, however, is not enough, and an important aim of the Division should be to secure that the Association is adequately represented on these committees. Emergency Fee Another important aspect of the work of the Division in the Q.- 1 was summoned by the local police to appear at the medico-political field is the education and introduction to station to identify a girl brought to them with loss of memory." medical politics of the younger members, many of whom feel I went and identified the patient and took her home. As for that their interests are not fully understood by their senior payment, the officer in charge of the station said that, since I colleagues in established practice. The L.M.C. is remote from was a National Health Service doctor, no " certificate" could the assistant, and the consultants committee is far removed be issued to me and that I therefore would receive no payment from the hospital resident, but both should feel that they can from the police. Is this kind of activity part of my duty under speak and vote at Division meetings and that their views are the N.H.S. ? If not, to whom do I apply for remuneration? welcome. Those who are interested in political work can A.-Where a is aspire to of the executive or office in the practitioner asked to attend a patient as a membership Division result of an accident or other emergency he is entitled to claim as a first step towards membership of one of the representative an from the committees or the of the emergency fee executive council if the patient is not Representative Body Association. on his list. The only exception is where a fee under the Road Clearly the role of the Division in providing a meeting- Traffic Act-can ground for doctors in all branches of be claimed. The police are responsible for a practice and a common fee only where an examination or report is undertaken at their forum for the expression of medico-political opinion will be, request. if anything, more important in the future than in the past. Dental Haemorrhages Q.-During the past few weeks I have been palled out on HEARD AT HEADQUARTERS several occasions to arrest haemorrhage after dental extractions. On whom does this responsibility lie-the dentist or the doctor ? A.-The arrest of dental haemorrhage is the responsibility-of the dental surgeon who undertook the extraction. When the Silent Eloquence dentist is not immediately available the patient often calls upon Many people have eipressed themselves forcibly from time his normal medical attendant. In the Ministry's view this ser- to time about the new Health Act, but hardly to the extent of vice forms part of the practitioner's normal obligations to his the deaf and dumb speaker of whom Sir Allen Daley spoke the patients, but the Association is disputing this interpretation and other day. In explaining the Act to a company of deaf and is pressing for an appropriate fee to be paid when the general dumb he dislocated three of his fingers. practitioner is called out.

B.M.A. Films Patient on Public List A feature of the recent Conference of Honorary Secretaries Q.-A few weeks ago I received a request to visit a patient was a film show. The Association is aiming to becomne, through who, although actually on my register of insured persons-, had its film library and bureau, the primary authority on medical some time previously moved to a district in which 1 have not films in this country. It is not merely a question of bringing undertaken to visit State patients. 1 explained this on the together films which have a medical interest, but of developing phone, and was informed that the patient was aware of this, a method of presenting medical subjects. To that end a script but was anxious that I should continue to attend the family as is being prepared by the Film Committee for a specimen film private patients. I visited the patient for several days. I am for potential film producers illustrating how best such a film aware that I should be at liberty to refuse to visit the patient may be made. A viewing-room at Headquarters, a B.M.A. film and instruct them to call in a doctor who attends State patients caption for attachment to Association films, and arrangements in their particular district, but am I at liberty to charge a visiting with a film laboratory for the titling, editing, and conversion of fee, notwithstanding the fact that they were at the time on my films are other activities on foot. list of State patients ? A.-As the patient concerned is included on your public list Not for Nothing you are debarred by the regulations from receiving any fee in respect of medical attendance An ophthalmic medical practitioner tells us that he has or treatment given. received the following letter about one of his patients: "I understand you examined my daughter's eyes, well I am not satisfied with the report you gave her, do you know much about eyes as you say she has one lazy eye, do you not know of a HONG KONG AND CHIINA BRANCH cure for such an eye, if you do not, I will have to take my The Branch has about 175 members, of whom about 6/7 are daughter to one who does know, and will a4tempt to put it in Hong Kong and the rest in China. Seventeen meetings right, and I will see that we dont pay national insurance for have been held in Hong Kong since the war, at which mem- nothing." bers have read papers, films have been shown, and laboratory One Mosquito and clinical demonstrations have been arranged. The Branch owns a library in the centre of the town and has recently One would like to have the comments of a Ross Institute purchased some 50 new books. investigator on a statement made by Lord Winster, the late Each month the honorary secretary, Dr. D. W. Gould, makes Governor of Cyprus, at a Meeting of the Royal Empire Society. a pr6cis of the proceedings of the Branch Council, which is Lord Winster painted an idyllic picture of Cyprus (in every circulated to all members both in Hong Kong and China, and respect except the political) and referred in particular to its he includes with it information on any matters of general immunity from malaria. The island has been scourged by interest which have arisen during the month. malaria for generations, and there used to be districts where The Branch Council is active and effective. Forty-five mem- malaria affected the entire population. But now the place has bers of the Branch in Hong Kong are Chinese, and the Branch been cleaned up and not a case remains, as Drs. Shelley and co-operates closely with the Hong Kong Branch of the Chinese Aziz recorded recently in this Journal. Lord Winster then said Medical Association. that during his governorship an investigator came out from the Most of the members in China itself are medical missionaries. Ross Institute to see what had been done about the malaria- It appears that the Communists are allowing medical mission- carrying mosquito, and he was able to find only one on the aries to continue their work in the areas so far conquered, whole island. "And I am absolutely certain," added his provided the missionaries confine themselves to mnedicine and lordship, " that he brought it out with him!" abstain from religious or political activity. 340 JUNE 1949 ANNUAL MEETING: THE SUPPLEMENT TO rHE 18, SECTIONS BRITISH MEDICAL JOURNAL British Medical Association ONE HUNDRED AND SEVENTEENTH ANNUAL MEETING, HARROGATE, JUNE 24 TO JULY 1, 1949 President-Elect: C. W. CURTIS BAIN, M.C., D.M., F.R.C.P., Senior Physician, Harrogate General Hospital. Local General Secretary: D. D. PAYNE, M.D., D.P.H.) B M A. Office, Royal Baths, Harrogate. Executive Officer: G. A. PECK, B.Sc. J B O Local Sciencc Secretary: J. V. WILSON, M.D., M.R.C.P., Department of. Pathology, Harrogate General Hospital. PROGRAMME SCIENTIFIC SECTIONS Assessinig Disproportion. To be opened jointly by Professor The following Sections will meet on Four Days: CHASSAR MOIR (Oxford) and Dr. J. BLAIR HARTLEY (Man- MEDICINE chester), followed by Miss MEAVE KENNY (London) and Dr. S. President: Professor R. E. TUNBRIDGE, O.B.E., M.Sc., M.D., JOSEPHS (Newcastle-upon-Tyne). F.R.C.P. (Leeds). Thursday, June 30 (Combined Meeting with Section of Dermatology).-10 a.m., Discussion: Pruritus Vulvae. To be Vice-Presidents: Profesvor H. W. FULLERTON, M.D., F.R.C.P. opened (Aberdeen); R. R. BOMFORD, D.M., F.R.C.P. (London); Pro- by Professor T. N. A. JEFFCOATE (Liverpool) and Dr. fessor A. P. THOMSON, M.C., M.D., F.R.C.P. (Birmingham). G. A. GRANT PETERKIN (Edinburgh), followed by Dr. ELIZABETH Hon. Secretaries: T. G. REAH, M.D., M.R.C.P., 4, Spring HUNT (London) and Dr. C. J. MACKINLAY (Glasgow). Grove, Harrogate; J. L. LOVIBOND, M.D., F.R.C.P., 81, Harley Friday, July 1.-1O a.m., Discussion: Functional Uterine Street, W.1. Haemorrhage. To be opened by Mr. V. B. GREEN-ARMYTAGE Official Reporter: Dr. K. M. A. PERRY. (London), followed by Dr. P. M. F. BISHOP (London) and Meeting-place: Harrogate Hydro. Dr. T. N. MAcGREGOR (Edinburgh). Tuesday, June 28.-10 a.m., Discussioni: Diabetes Mellitus. To be opened by Dr. R. D. LAWRENCE (London), followed by PATHOLOGY AND BACTERIOLOGY Professor R. E. TUNBRIDGE (Leeds), Insulin and Diet; Mr. President: Professor R. J. V. PULVYERTAFT, O.B.E., M.D., H. H. FOURACRE BARNS (London) and Dr. CHARLES ROLLAND F.R.C.P. (London). (Edinburgh), Pregnancy Aspects; Mr. D. A. HALL, Ph.D. Vice-Presidents: Professor T. F. HEWER, M.D., F.R.C.P. (Leeds), Rapid Blood Sugar Estimations: Dr. R. G. PALEY (Bristol); J. G. GREENFIELD, M.D., F.R.C.P. (London); A. H. T. (Leeds), Skin Complications of Insulin Injections; and Dr. ROBB-SMITH, M.D., M.R.C.P. (Oxford). A. J. BALLANTYNE (Glasgow), Ocular Complications. Dr. E. P. Hon. Secretaries: J. V. WILSON, M.D., M.R.C.P., Harrogate JOSLIN (Boston, U.S.A.) will be present and take part in the General Hospital, Harrogate; Professor H. A. MAGNUS, M.D., discussion. Department of Pathology, King's College Hospital, Denmark Wednesday, June 29 (Combined Meeting with Section of Hill, S.E.5. Surgery).-10 a.m., Discussion: Treatment of Peptic Ulcers. Official Reporter: Professor ROBERT CRUICKSHANK. To be introduced and summarized by Sir HENRY COHEN (Liver- Meeting-place: Grand Hotel. pool). Opening paper by the late Mr. A. HEDLEY VISICK Tuesday, June 28.-9.45 a.m., Opening of Pathological (York) to be read by Dr. C. N. PULVERTAFr (York), followed Museurm, Royal Bath Hospital, Cornwall Road, by Professor by Dr. RICHARD DOLL (London), Sociological Aspects; and M. J. STEWART, LL.D., F.R.C.P., F.R.F.P.S., F.F.R. (Leeds). Mr. A. D. BEATTIE (Leicester), Surgical Aspect. 10 a.m., Discussion: The Laboratory Diagnosis and Prevention Thursday, June 30.-10 a.m., Papers: (1) Streptomycin, by of Whooping-cough. To be opened by Professor R. CRUICK- Dr. GEOFFREY MARSHALL (London); (2) Radioactive Substances SHANK (London), followed by Dr. W. C. COCKBURN (London), in Clinical Medicine, by Dr. RUSSELL FRASER (London); (3) and Dr. D. G. EVANS (Manchester). 12 noon, Discussion. Anticoagulants, by Professor H. W. FULLERTON (Aberdeen). The Care and Treatment of Labcratory Animals, To be Friday, July 1.-I0 a.m., Discussion: Cirrhosis of the Liver. opened by Dr. JEAN VINTNER (Technical Secretary, U.F.A.W.). To be opened by Dr. N. II. MARTIN (London), Aetiology and followed by Professor A. N. WORDEN (Chief Biochenmist to Pathology, followed by Dr. N. H. K. HAGGIE (London). the Animal Health Trust). Alcohol in Cirrhosis; Mr. J. E. RICHARDSON (London), Surgical Wednesday, June 29 (Combined Meeting with Section of Aspects; and Dr. E. R. CULLINAN (London), Clinical Aspects Tropical Medicine).-10 a.m., Discussion: Fat Metabolism and Summary. Paper: Salicylate Therapy in Acute Rheuma- and the Strue Syndrome. To be opened jointly by Professor tism, by Dr. G. WATKINSON (Leeds). A. C. FRAZER (Birmingham) and Dr. DOUGLAS BLACK (Man- Thursday, June 30, and Friday, July I.-2.30 p.m., Royal chester), followed by Dr. K. D. KEELE (London) and Dr. Bath Hospital. Demonstration: The Role of Surgery in A. W. D. LEISHMAN (Sheffield). During the discussionSir PHILIP Rheumatism. " Movement is Life " (Lucas-Championniere). MANSON-BAHR will show lantern slides illustrating the lesions OBSTETRICS AND GYNAECOLOGY of the tongue iA strue. Thursday, June 30.-10 a.m., Discussion: Chemotherapy in President: Professor A. M. CLAYE, M.D., F.R.C.S., the Treatment of Malignant Disease. To be opened by Pro- F.R.C.O.G. (Leeds). fessor E. C. DODDS (London), followed by Sir STANFORD CADE Vice-Presidents: GLADYS KAY, M.D. (Harrogate); Professor (London), Professor A. HADDOW (London), and Professor F. T. N. A. JEFFCOATE, M.D., F.R.C.S.Ed., F.R.C.O.G. (Liver- DICKENS (London). pool); ARNOLD L. WALKER, M.B., F.R.C.S., F.R.C.O.G. Friday, July J.-10 a.m., Papers: (1) The Pathological (London). Anatomy of Hypersensitivity Reactions in Man, by Professor Hon. Secretaries: C. RUTHERFORD MORISON, M.D., HILDING BERGSTRAND (Stockholm), (2) Temporal Arthritis, by M.R.C.O.G., 2, Lancaster Road, Harrogate; Miss JOSEPHINE Dr. C. V. HARRISON (London), (3) Vascular Changes in Diabetes, BARNES, D.M., F.R.C.S., M.R.C.P., M.R.C.O.G., 7, Wimpole with Particular Reference to Retinal and Renal Changes, by Dr. Street, W.1. N. ASHTION (London). Official Reporter: Dr. D. GORDON LENNON. Meeting-place: Prince of Wales Hotel. RADIOLOGY Tuesday, June 28.-I 0 a.m., Discussion: Breech Presentation President: J. L. A. GROUT, F.R.C.S.Ed., D.M.R.E., F.F.R. and its Management. To be opened by Mr. R. NEWTON (Man- (Sheffield). chester), followed by Mr. C. M. MARSHALL (Liverpool), Mr. Vice-Presidents: C. G. HITCHCOCK, M.R.C.S., L.R.C.P. B. L. JEAFFRESON (Leeds), and Dr. J. LOVSET (Norway). (Harrogate); J. ALEX. THOMSON, M.B., Ch.B., D.M.R.E. Wednesday, June 29 (Combined Meeting with Section of (Harrogate); Professor BRIAN W. WINDEYER, F.R.C.S.Ed., Radiology).-10 fa.m., Discussion: The Value of X-ray in D.M.R.E., F.F.R. (London). SUPPLEMLNT TO THE JUNE 18, 1949 ANNUAL MEETING: THE SECTIONS BRIristi MEDICAL JOURNAL 341

Hon. Secretaries: C. N. M.B., B.Ch., D.M.R.E., PULVERTAFT, The following Sections will meet on Two Days: York County Hospital, York; JOHN R. NUTTALL, M.D., F.F.R., D.M.R., Radium Department, General. Infirmary, Leeds. ANAESTHETICS Official Reporter: Mr. COOPER. President: Professor R. R. MACINTOSH, D.M., F.R.C.S.Ed., Tuesday, June 28. Meeting-place: Queen Hotel (Therapeutic D.A. (Oxford). Meeting). 10 a.m., Discussion: The Scope and Limitation Vice-Presidents: B. L. S. MURTAGH, M.B., Ch.B., of Radiotherapy. To be opened jointly by Dr. J. S. FULTON F.F.A. R.C.S., D.A. (Birmingham); H. B. WILSON, M.B., (Liverpool) and Dr. CHESTER WILLIAMS (Bradford). Ch.B., D.P.H., F.F.A. R.C.S., D.A. (Aberdeen); GEOFFREY Wedniesday, Jun?e 29. Meetinig-place: Prince of Wales Hotel ORGANE, M.D., F.F.A. R.C.S., D.A. (London). (Combined Meeting with Section of Obstetrics and Gynaeco- Hon. Secretaries: W. M. JONES, M.B., B.S., D.A., 4, South logy).-10 a.m., Discuission: The Value of X-ray in Assessing Drive, Harrogate; J. ALFRED LEE, M.R.C.S., L.R.C.P., Disproportion. To be opened jointly by Professor CHASSAR F.F.A. R.C.S., D.A., 73, King's Road, Westcliff-on-Sea. MOIR (Oxford) and Dr. J. BLAIR HARTLEY (Manchester), fol- Official Reporter: Dr. W. W. MUSHIN. lowed by Miss MEAVE KENNY (London) and Dr. S. JOSEPHS Meeting-place: Queen Hotel. (Newcastle-upon-Tyne). Wednesday, June 29.-10 a.m., Discussiont: Post-operative Wednesday, June .29. Meeting-place: Prince of Wales Hotel Pulmonary Complications. To be opened jointly by Dr. (Therapeutic Meeting).-I0 a.m., Discussion: Radiotherapy in H. J. V. MORTON (Uxbridge) and Dr. E. M. BUZZARD (Oxford). Spondylitis Ankylopoietica and Osteoarthritis. To be opened followed by Mr. DONALD BARLOW (London), Dr. DONALD by Dr. E. L. GWENDOLEN HILTON (London), followed by Dr. TEARE (London), and Dr. JOAN MILLAR (Newcastle-upon-Tyne). MARGARET D. SNELLING (London) and Dr. L. JANET MALLENDER Thiursday, June 30-10 a.m., Disclussion: Dental Anaesthesia. (Leeds). To be opened by Dr. W. S. MCCONNELL (London), followed Thursday, Junie 30. Meeting-place: Majestic Hotel (Com- by Dr. STEPHEN COFFIN (London) and Dr. FREDA BANNISTER bined Meeting with Section of Cardiology).-I0 a.m., Discus- (Chester). 11.15 a.m., Discussioni: The Use of Continuous sioni: Angiocardiography. To be opened jointly by Dr. Caudal and Peridural Analgesia in Obstetrics, Surgery, and FRANCES GARDNER (London), Interpretation of Normal Angio- Therapeutics. To be opened by Dr. ROBERT A. HINGSON cardiograms; of those seen in Cases of Cyanotic Heart Disease, (Johns Hopkins, Baltimore). (Note.-This discussion may be and in Aortitis and Aortic Aneurysm; and Dr. J. WILKIE continued at 2.30 p.m.) (Sheffield), Technical Considerations; Demonstration of Angio- cardiograms. Followed by Dr. K. D. KEELE (London), Angio- ANATOMY AND PHYSIOLOGY cardiograms in Acyanotic Heart Disease; Dr. T. H. HILLS Presidenit. Professor JOHN KIRK, M.B., Ch.B., F.R.C.S.Ed. (London), Angiocardiograms in Cyanotic Heart Disease; and (London). Dr. F. JACKSON (London), Present Trends in North American Vice-Presidents: Professor A. HEMINGWAY, M.Sc., M.B., Clinics. Ch.B. (Leeds); Professor FRANCIS DAVIES, M.D. (Sheffield); Friday, July 1. Meeting-place: Queen Hotel (Diagnostic Professor C. MCLAREN WEST, M.C., M.B., B.Ch. (Cardiff). Meeting).-10 a.m., Discussion: Radiology of Joints. To be Hon. Secretaries: E. J. FIELD, M.D., M.S., Department of Dr. E. DUFF by Dr. opened by GRAY (Manchester), followed Anatomy, University of Bristol; R. J. SCOTHORNE, B.Sc., M.B.. P. H. WHITAKER (Liverpool) and Dr. J. B. KING (Edinburgh). Ch.B., Anatomy Department, School of Medicine, Leeds, 2. SURGERY Official Reporters: Professor A. HEMINGWAY and Dr. E. J. FIELD. Presidenit: T. V. PEARCE, M.D., F.R.C.S. (Harrogate). Nate: On Tuesday, June 28, Physiology and Anatomy will Vice-Presidents: H. HAMILTON STEWART, F.R.C.S. (Brad- meet as separate Sections, but there will be a united meeting ford); IAN J. FRASER, D.S.O., O.B.E., F.R.C.S. (Belfast); Sir on Wednesday, June 29. CECIL P. G. WAKELEY, F.R.C.S., F.R.A.C.S., F.R.S.Ed. (London). Phlysiology-Tuesday, Jun?e 28. Meeting-place :Cairn Hydro. Hon. Secretaries: GORDON N. F.R.C.S., BAILEY, M.A., M.B., -10 a.m., Sytmtposiuim on the Control of Activity in the Gastro- 2, Lancaster Road, Harrogate; RODNEY SMITH, M.S., F.R.C.S., intestinal Tract. Spcakers: Professor R. A. GREGORY (Liver- 6, Devonshire Place, W.1. pool), Motility of the Small Intestine in Relation to Feeding; Official Reporter: Professor IAN AIRD. Dr. A. A. HARPER (Manchester), The Control of Gastric and Tuesday, June 28. Meeting-place: Majestic Hotel.-10 a.m., Pancreatic Secretion; Dr. R. E. DAVIES (Sheffield), Secretory Discussion: Prostatic Obstruction. To be opened by Mr. Mechanisms and Their Control; Dr. J. N. HUNT (London), H. HAMILTON STEWART (Bradford), followed by Mr. WILSON Studies of Gastric Motility. HEY (Manchester), Mr. ASHTON MILLER (Bristol), and Mr. JoHN Anatonmy-Tuesday, June 28. Meeting-place: Prince of SWINNEY (Newcastle-upon-Tyne). Wales Hotel.-I0 a.m., Symposium on Muscle Structure and Wednesday, June 29 (Combined Meeting with Section of Function. Speakers: Professor W. E. LE GROS CLARK (Oxford). Medicine). Meeting-place: Harrogate Hydro.-lO a.m., Discus- The Vascularization of Muscle, with Special Reference to sian: Treatment of Peptic Ulcers. To be introduced and sum-' Ischaemic Necrosis and Reparative Processes; Dr. R. BARER marized by Sir HENRY COHEN (Liverpool). Opening Paper by (Oxford), The Organization of the Muscle Fibre; Dr. R. E. M. the late Mr. A. HEDLEY VISICK (York) to be read by Dr. C. N. BOWDEN (London), Some Aspects of Denervation and Re- PULVERTAFT (York), followed by Dr. RICHARD DOLL (London), innervation of Human Voluntary Muscle; Mr. W. F. FLOYD Sociological Aspects; and Mr. A. D. BEAT-IE (Leicester), (London), Clinical Value of Electro-myographic Studies; and Surgical Aspect. Professor W. T. ASTBURY (Leeds), The Muscle as a Molecular Thursday, June 30 (Combined Meeting with Section of Neuro- Machine. logy and Psychiatry). Meeting-place: Majestic Hotel.-I0 a.m., Wednesday, Juine 29. Meeting-place: Cairn Hydro.-10 a.m., Discussion: The and Sequelae Qf Treatment, After-Treatment, Symposiurm on the Anatomy and Physiology of the Skin. Closed Injuries to the Head. To be opened by Professor Speakers: Professor H-I. BARCROFT (London), Factors Regulating NORMAN MCOMISH Dorr (Edinburgh), followed by Dr. W. Blood Flow in the Skin; Dr. C. A. KEELE (London), The Con- RITCHIE RUSSELL (Oxford), Rehabilitation after Head Injury; trol of Sweating: Dr. R. E. BILLINGHAM (Birmingham), The and Dr. E. STENGEL (Chichester), Psychiatric Aspects of Head Anatomical Basis of Epidermal Pigmentation in Man; and Injury. 2.30 p.m., Occasional Paper: The Mechanism of Speech Dr. G. WEDDELL (Oxford), The Pattern of Cutaneous and the Repair of a Cleft Palate, by Mr. MICHAEL OLDFIELD Innervation. (Leeds), illustrated by coloured film and drawings. Friday, July 1. Meeting-place: Majestic Hotel.-10 a.m., CARDIOLOGY Discussion: Pain in the Right Iliac Fossa. To be opened by Pr-esident: Sir JOHN PARKINSON, M.D., F.R.C.P. (London). Dr. A. FULLERTON (Batley), followed by Professor D. CHAMBER- Vice-Presidents: JOHN R. H. TOWERS, M.D., F.R.C.P. LAIN (Leeds), Mr. R. K. BowEs (London), and Mr. G. H. (Leeds); Professor J. CRIGHTON BRAMWELL, M.D., F.R.C.P. MACNAB (London). (Manchester); D. EVAN BEDFORD, M.D., F.R.C.P. (London). Thursday, June 30, and Friday, Jiuly L.-2.30 p.m., Royal Hon. Secretaries: D. R. CAMERON, M.D., M.R.C.P., 14. Bath Hospital. Demonstration: The Role of Surgery in Clifton, York; GRAHAM W. HAYWARD, M.D., F.R.C.P., Rheumatism. " Movement is Life" (Lucas-Championniere). St. Bartholomew's Hospital, E.C.1. SUPPLEMENT TO THE 342 JUNE 18, 1949 ANNUAL MEETING: THE SECTIONS BRITISH MEDICAL JOURNAL Official Reporter: Dr. PAUL WOOD. Hon. Secretaries: JAMES VALENTINE, M.B., Ch.B., D.P.M., Meeting-place: Majestic Hotel. Scalebor Park, Burley-in-Wharfedale, near Leeds, Yorks: Thursdav, Ju(ne 30 (Combined Meeting with Section of HELEN E. DIMSDALE, -M.D., F.R.C.P., 41, Devonshire Street, Radiology).-I0 a.m., Discussion: Angiocardiography. To be Portland Place, London, W.I. opened jointly by Dr. FRANCES GARDNER (London), Interpreta- Official Reporters: Dr. W. RITCHIE RUSSELL (June 30 only) tion of Normal Angiocardiograms; of those seen in Cases of and Dr. PURDON MARTIN. Cyanotic Heart Disease, and in Aortitis and Aortic Aneurysm; Meeting-place: Majestic Hotel. and Dr. J. WILKIE (Sheffield), Technical Considerations: Wednesday, June 29.-I0 a.m., Discussion: Intractable Pain. Demonstration of Angiocardiograms. Followed by Dr. K. D. To be opened jointly by Dr. J. PURDON MARTIN (London) and KEELE (London), Angiocardiograms in Acyanotic Heart Dis- Mr. WYLIE MCKISSOCK (London), followed by Dr. E. B. ease; Dr. T. H. HILLS (London), Angiocardiograms in Cyanotic STRAUSS (London), Psychiatric' Aspect; and Dr. ANDREW Heart Disease: and Dr. F. JACKSON (London), Present Trends WILSON (London), Pharmacological Aspect. in North American Clinics. Thzursday, June 30 (Combined Meeting with Section of Friday, July L.-IO a.m., Simulation of Heart Disease by Surgery).-I0 a.m., Discussion: The Treatment, After- Other Conditions. To be opened by Dr. RAE GILCHRIST (Edin- Treatment, and Sequelae of Closed Injuries to the Head. burgh), followed by (a) Simulation by Pulmonary Conditions, To be opened by Professor NORMAN MCOMISH DoTT (Edin- by Dr. J. CLIFFORD HOYLE (London); (b) Simulation by Gastro- burgh), followed by Dr. W. RITCHIE RUSSELL (Oxford), Re- intestinal Conditions, by Dr. S. W. PATTERSON (Ruthin Castle); habilitation after Head Injury; and Dr. E. STENGEL (London), (c) Simulation by Psychoneuroses, by Dr. WILLIAM PHILLIPS Psychiatric Aspects of Head Injury. (Cardiff). 12 noon, Discussion: The Treatment of Obstinate Heart Failure. To be opened by Dr. D. EVAN BEDFORD OCCUPATIONAL HEALTH (London). President: Professor R. E. LANE, M.D., F.R.C.P. CHILD HEALTH (Manchester). President: Professor C. W. VINING, M.D., F.R.C.P., D.P.H. Vice-Presidents: Professor G. P. CROWDEN, O.B.E., D.Sc., (Leeds). M.R.C.P. (London); F. S. COOKSEY, O.B.E., M.D., D.Phys.M. Vice-Presidents: Professor R. S. ILLINGWORTH, M.D., (London); W. BLOOD, M.R.C.S., L.R.C.P., D.I.H. (London). F.R.C.P., D.P.H., D.C.H. (Sheffield); A. A. E. NEWTH, M.B., Han. Secretaries: CHARLES CRESDEE, M.R.C.S.. Wits End, B.S., D.P.H. (Nottingham); Professor W. S. M. CRAIG, M.D., Fixby Road, Huddersfield; R. S. F. SCHILLING, M.D., D.P.H., F.R.C.P.Ed., F.R.S.Ed. (Leeds). Department of Occupational Health, University of Manchester. Hon. Secretaries: L. J. PROSSER, M.B., Ch.B., D.C.H., 11, Manchester, 13. Ripon Road, Harrogate; T. COLVER, M.D., M.R.C.P., 4, Clare- Official Reporter: Dr. R. S. F. SCHILLING. mont Place, Sheffield, 10. Meeting-place: Majestic Hotel. Official Reporter: Professor W. S. CRAIG. Wednesday, June 29-10 a.m., Discuission: The Development Meeting-place: Grand Hotel. of a Comprehensive Medical Service for Industry. To be Wednesday, June 29.-10 a.m., Discussion: Common Feed- opened by Dr. DONALD STEWART (Birmingham), followed by ing Difficulties in Infancy. To be opened by Professor R. S. Dr. STUART LAIDLAW (Glasgow) and Dr. N. J. COCHRAN (Burton- ILLINGWORTH (Sheffield), followed by Dr. FRANCES CHARLOTTE upon-Trent). NAISH (York), Dr. STANLEY G. GRAHAM (Glasgow), and Dr. Thursday, June 30.-10 a.m., Discussion: Tuberculosis and JEAN MACKINTOSH (Birmingham). Discussion: Domiciliary Occupation. (1) Tuberculosis in the Boot and Shoe Trade, Care of the Premature Child. To be opened by Dr. F. J. W. by Dr. ALICE STEWART (Harrow-on-the-Hill); (2) Mass Radio- MILLER (Newcastle-upon-Tyne). graphy in Industry, by Dr. W. POINTON DICK (Denham); Thursday, June 30 (Combined Meeting with Section of Pre- (3) Rehabilitation and Resettlement, by Dr. F. R. G. HEAF ventive Medicine).-I0 a.m., Discussion: Behaviour Difficulties (London). in Childhood. To be opened by Dr. MILDRED CREAK (London), OPHTHALMOLOGY followed by Professor C. W. VINING (Leeds) and Dr. President: JAMES FISON, M.D. (Harrogate). W. S. MACDONALD (Leeds). 3 p.m., Demonstration of Cases and Vice-Presidents: JOHN MARSHALL, M.C., M.B., Ch.B., Radiographs of Tuberculosis in Childhood, at Scotton Banks D.O.M.S. (Glasgow); N. P. R. GALLOWAY, M.B., Ch.B., D.O. Sanatorium, by Dr. VINCENT RYAN (Knaresborough). (Nottingham); A. B. Nurr, M.B., B.S. (Sheffield). Hon. Secretaries: JANE A. M. SHEPHERD, M.B., Ch.B., DERMATOLOGY D.O.M.S., 39, Harlow Oval, Harrogate; P. D. TREVOR-ROPER, President: J. T. INGRAM, M.D., F.R.C.P. (Leeds). M.B., B.Ch., F.R.C.S., D.O.M.S., 126, Harley Street, W.I. Vice-Presidenzts: BiuAN F. RUSSELL, M.D., M.R.C.P., D.P.H. Official Reporter: Mr. J. H. DOGGART. (London); P. B. MUMFORD, M.D., F.R.C.P. (Manchester); Meeting-place: Masonic Hall, Harrogate. GEOFFREY HODGSON, M.B.E., M.D. (Cardiff). Thursday, June 30.-10 a.m., Discussion: Ophthalmology in Hon. Secretaries: S. T. ANNING, M.D., M.R.C.P., 5a, Shaw Relation to Diseases of the Skin. To be opened by Mr. I. H. Lane, Leeds, 6; H. J. WALLACE, M.D., M.R.C.P., 80, Harley DOGGART (London), followed by Dr. ALICE CARLTON (Oxford) Street, W.1. and Dr. I. B. SNEDDON (Sheffield). Aftemoon, Occasional Official Reporter: Dr. J. T. INGRAM. Papers: (1) Scleromalacia Perforans, by Mr. H. V. INGRAM Thursday, June 30. Meeting-place: Prince of Wales Hotel (Newcastle-upon-Tyne); (2) Angiomatosis Retinae, by Mr. (Combined Meeting with Section of Obstetrics and Gynaeco- A. G. CROSS (London); (3) Watery Eye, by Mr. JOHN MARSHALL logy).-I0 a.m., Discussion: Pruritus Vulvae. To be opened (Glasgow). by Professor T. N. A. JEFFCOATE (Liverpool) and Dr. G. A. Friday, July 1.L0 a.m., Occasional Papers: (1) Toxo- GRANT PETERKIN (Edinburgh), followed by Dr. ELIZABETH HUNT plasmosis, by Mr. A. B. Nurr (Sheffield); (2) Practical Oph- (London). thalmology in Spain and Holland in 1948, by Mr. JOHN FOSTER Friday, July 1. Meeting-place: Majestic Hotel.-I0 a.m., (Leeds). Discussion: Psoriasis. To be opened by Dr. H. W. BARBER ORTHOPAEDICS (London), followed by Dr. BRIAN F. RUSSELL (London) and President: R. BROOMHEAD, M.B., F.R.C.S. (Leeds). Dr. J. H. TWISTON DAVIES (Manchester). Occasioinal Paper: Vice-Presidents: C. GORDON IRWiN, M.B., F.R.C.S.Ed. The Uses and Abuses of Chemotherapy in Dermatology, by (Newcastle-upon-Tyne); H. JACKSON BURROWS, M.D., F.R.C.S., Dr. F. F. HELLIER (Leeds). 2.30 p.m., Clinical Meeting at F.R.A.C.S. (London); F. W. HOLDSWORTH, M.B., M.Ch., Royal Bath Hospital. F.R.C.S. (Sheffield). Hon. Secretaries: IAN LAWSON DICK, M.B., Ch.M., NEUROLOGY AND PSYCHIATRY F.R.C.S.Ed., 2, Walmer Villas. Manningham Lane, Bradford; President: W. RUSSELL BRAIN, D.M., F.R.C.P. (London). J. P. CAMPBELL, M.B., Ch.B., F.R.C.S.Ed., 1, Tavistock Avenue, Vice-Presidents: W. R. HENDERSON, O.B.E., M.B., Ch.B., Mapperley Park, Nottingham. F.R.C.S. (Leeds); DAVID ROBERTSON, M.D. (York); R. G. Official Reporter: Mr. NORMAN CAPENER. GORDON, M.D., F.R.C.P.Ed. (Bath), Meeting-place: Majestic Hotel. SUPPLEMENT TO THE 343 JUNE 18, 1949 ANNUAL MEETING: THE SECTIONS BRITISH MEDICAL JOURNAL

Tuesday, June 28.-I0 a.m., Discussions: (1) Closed Fractures Official Reporter: Mr. COOPER. of the Shaft of the Radius and Ulna. To be opened by Meeting-place: Majestic Hotel. Mr. E. MERVYN EVANS (Birmingham), followed by Mr. F. W. Tuesday, June 28.-10 a.m., Discussion: (1) Rheumatoid HOLDSWORTH (Sheffield) and Mr. IAN LAWSON DICK (Bradford). Arthritis in the Young. To be opened by Dr. B. E. SCHLESINGER 11.30 a.m., (2) Upper Limb Pain due to Lesions of the Thoracic (London), followed by Professor W. S. M. CRAIG (Leeds) and Outlet. To be opened by Professor LAMBERT ROGERS (Cardiff). Dr. DONALD WILSON (Bognor Regis). (2) Clinical Lecture- Wednesday, June 29 (Combined Meeting with Section of Demonstration. To be opened by Sir HENRY COHEN (Liver- Rheumatology).-I0 a.m., (1) The Structure and Functions of pool), followed by Dr. L. C. HILL (Bath). the Synovial Membrane, by Professor D. V. DAVIES (London): Wednesday, June 29 (Combined Meeting with Section of followed by The Varieties of Pathological Reactions Encoun- Orthopaedics).-I0 a.m., (1) The Structure and Functions of tered in Human Synovial Tissues; by Dr. D. H. COLLINS (Leeds). the Synovial Membrane, by Professor D. V. DAVIES (London); (2) Partial Denervation of the Hip-Joint in Osteoarthritis, illus- followed by The Varieties of Pathological Reactions Encoun- trated by film, by Mr. H. PETTY (Leeds); followed by Indica- tered in Human Synovial Tissues, by Dr. D. H. COLLINS (Leeds). tions for Vitallium Mould Arthroplasty of the Hip and Survey (2)-Partial Denervation of. the Hip-joint in Osteoarthritis, illus- of End-results, by Mr. R. BROOMHEAD (Leeds). (3) Physical trated by film, by Mr. H. PETTY (Leeds); followed by Indica- Treatment of Arthritis. To be opened by Dr. H. F. TURNEY tions for Vitallium Mould Arthroplasty of the Hip and Survey (London). of End-results, by Mr. R. BROOMHEAD (Leeds). (3) Physical Thursday, June 30, and Friday, July 1. 2.30 p.m., Royal Treatment of Arthritis. To be opened by Dr. H. F. TURNEY Bath Hospital. Demonstration: The Role of Surgery in (London). Rheumatism. "Movement is Life" (Lucas-Championniere). Thursday, June 30, and Friday, July 1.-2.30 p.m., Royal Bath Hospital. Demonstration: The Role of Surgery in Rheumatism. " Movement is Life " (Lucas Championniere). OTO-RHINO-LARYNGOLOGY 3.30 p.m., Report on Proceedings of International Congress of President: A. B. PAVEY SMITH, M.C., M.B., F.R.C.S. Rheumatology at New York, by Dr. G. D. KERSLEY (Bath). (Harrogate). Vice-Presidents: W. I. DAGGErr, M.B., B.Ch., F.R.C.S. TROPICAL MEDICINE (London); R. GARNETT PASSE, F.R.C.S., D.L.O. (London); GEORGE SEED, M.B., Ch.B., F.R.C.S., D.L.O. (Leeds). President: G. W. M. FINDLAY, C.B.E., M.D., F.R.C.P. Hon. Secretaries: J. E. REES, M.R.C.S., L.R.C.P., D.L.O., (London). 10, York Place, Harrogate; H. S. SHARP, M.B., B.Ch., F.R.C.S., Vice-Presidents: Professor B. G. MAEGRAITH, M.B.. B.S.. 149, Harley Street, W.I. (Liverpool); Colonel H. E. SHORrr, C.I.E., M.D., D.T.M., Official Reporter: Mr. NORMAN JORY. I.M.S. (Ret.) (London); J. BALFOUR KIRK, C.M.G., F.R.C.P., Meeting-place: Caim Hydro. D.P.H., D.T.M.&H. (London). Thursday, June 30.-10 a.m., Discussion: Nasal Allergy. To Hon. Secretaries: B. CLIVF NICHOLSON, M.D., M.R.C.P., be opened by Mr. R. R. SIMPSON (Hull), followed by Pro- D.P.H., 24, Swan Road, Harrogate; CLEMENT C. CHESTERMAN, fessor R. B. HUNTER (Dundee), Mr. J. GERRIE (Aberdeen), Dr. O.B.E., M.D., M.R.C.P., D.T.M.&H., 7, Parsifal Road, N.W.6. N. SOUTHWELL (London), and Dr. H. H. MOLL (Leeds). Official Reporters: Dr. F. HAWKING and Dr. DOUGLAS BLACK. Friday, July 1.-I a.m., Discussion: Acute Respiratory Meeting-place: Grand Hote!. Obstruction in Infants and Young Children.. To be opened Tuesday, June 28.-tO a.m., Discussion: Tropical Diseases by Mr. G. E. ARCHER (Manchester), followed by Dr. MARY J. as Aftermath of War. To be opened by Air Vice-Marshal WILMERS (London), Mr. J. H. OTTY (Bradford), and Dr. E. C. T. C. ST. C. MORTON (R.A.F.), followed by Dr. A. R. D. ADAMS BENN (Leeds). (Liverpool), Dr. J. P. CAPLAN (London), Sir GORDON COVELL (London), Professor G. J. STEFANOPOULO (Pasteur Institute, PREVENTIVE MEDICINE Paris), and Dr. F. HAWKING (London). During the discussion slides President: Professor R. H. PARRY, M.D., F.R.C.P., D.P.H. Professor H. E. SHORTT (London) will show lantern depicting the exoerythrocytic cycle of the malarian parasite. (Bristol). of Vice-Presidents: D. D. D.P.H. (Harrogate); Wednesday, June 29 (Combined Meeting with Section PAYNE, M.D., and Discussion: Fat C. FRASER BROCKINGTON, M.A., M.D., D.P.H. (Wakefield); Pathology Bacteriology).-10 a.m., R. H. H. JOLLY, M.D., D.P.H. (Wolverhampton). Metabolism and the Sprue Syndrome. To be opened jointly by Professor A. C. FRAZER (Birmingham) and Dr. DOUGLAS Hon. Secretaries: HUGH 0. M. Ch.B., D.P.H., BRYANT, M.B., followed Dr. K. D. KEELE Health Harrogate; H. J. BLACK (Manchester), by (London) Department, Municipal Offices, and Dr. A. W. D. LEISHMAN TRENCHARD, M.B., Ch.B., M.R.C.P., Chest Clinic, 53, Green- (Sheffield). hill Crescent, Harrow, Middlesex. Official Reporter: Dr. G. HAMILTON HOGBEN. Meeting-place: Grand Hotel. Thursday, Junie 30 (Combined Meeting with Section of Child HOTEL AND LODGING ACCOMMODATION Health).-10 a.m., Discussion: Behaviour Difficulties in Child- Accommodation in Harrogate during the time of the B.M.A. hood. To be opened by Dr. MILDRED CREAK (London), fol- Annual Meeting is now extremely limited, and members who lowed by Professor C. W. VINING (Leeds), Dr. H. C. CAMEROCN have not made their reservations should do so at once. (For (London), Dr. A. A. E. NEWTH (Nottingham), and Dr. W. S. list of hotels, see Suipplement, April 23, p. 243.) MACDONALD (Leeds). and Friday, July 1-10 aim., Discussion: Marriage Preg- REGULATIONS REGARDING DRESS nancy in Relation to Tuberculosis. To be opened by Dr. F. A. H. SIMMONDS (South Mimms), followed by Dr. R. C. Robes with hoods are to be worn at : the Official Religious COHEN (Braintree) and Dr. JEAN HALLUM (Birmingham). Occa- Service, Tuesday, June 28. at 3 p.m.; the President's Address, sional Paper: Recent Developments in Influenza, by Dr. C. H. Tuesday, June 28, at 8.30 p.m.; the President's Reception, ANDREWES (Hampstead). Tuesday, June 28, at 9.30 p.m.; the Mayor's Reception, Wednesday, June 29, at 8.30 p.m.; the Roman Catholic Service, Thursday, June 30, at 3 p.m. RHEUMATOLOGY Robes may be hired from Messrs. Ede and Ravenscroft, Ltd., Presidenit: W. YEOMAN. M.D. (Harrogate). 93, Chancery Lane, W.C.2, and should be sent direct to the Vice-Presidents: G. NORMAN MYERS, M.Sc., M.D., F.R.C.P hotel or other accommodation in which the hirer is resident (Cambridge); G. D. KERSLEY, M.D., F.R.C.P. (Bath); H. F. and not to the Reception Office. TURNEY, D.M., M.R.C.P. (London). Evening Dress (Tails or Dinner Jacket) with Decorations is Hon. Secretaries: D. N. Ross, M.D., F.R.F.P.S., Royal Bath to be worn at the President's Reception, Civic Reception, and Hospital, Harrogate; DORIS M. BAKER, M.D., M.R.C.P., 9, Annual Dinner. Dress is optional for the Representatives' Upper Wimpole Street, W.l. Dinner. SUIPMEMEP4T TO THE 344 JUNE 18, 1949- ANNUAL MEETING ARRANGEMENTS BRITISH MEDICAL JOURNAL

REGISTRATION FEE AT ANNUAL MEETINGS of being at the Reception Office, Sun Pavilion, Valley Gardens, by 9.45 a.m. on the first day of their attendance at the Annual The expenditure arising in connexion with the Annual Meet- Meeting in order to register and obtain their handbook, badge, ings has in the past been met from a guarantee fund raised by registration card, and tickets. the local profession, supplemented by a grant from the Council Officers of Scientific Sections should inquire for special of the Association. The Council considers that the time has badges at the Reception Office. come when the proportion of the expenses falling upon the local profession should be minimized. With this object in v.ew the Council, while continuing the central grant, has decided LUNCHEON RESERVATIONS that members attending the Annual Meeting (other than mem- Non-resident members attending the Scientific Sections are bers of the Representative Body and overseas visitors) should invited to write to the hotel concerned, if they wish to reserve be asked to pay a fee of one guinea towards the expenses of their luncheon in advance. Luncheon reservations may also the meeting. The fee of one guinea will be payable when be made at the hotel before 10.30 a.m. on the day in question. members register at the Reception Office, Sun Pavilion. Harrogate. SPORTS FACILITIES OFFICIAL RELIGIOUS SERVICE The Official Religious Service will be held in St. Peter's Gclf.-All particulars about the Golf Competitions may be Church. Harrogate, on Tuesday, June 28, and the sermon will obtained from the Golf Secretary, Reception Office, Sun be given by His Grace the Archbishop of York. The service Pavilion, Valley Gardens, and from the Ladies' Golf Secretary, will be broadcast in the Northern Programme, and the church Ladies' Club, Prospect Hotel. is likely to be full. It has therefore been decided to issue tickets Other Sports.-Facilities for tennis, putting, miniature golf, fcr the Procession, for which academic dress is required. It bowls, r-ding, and boating are also available. will then be possible to ascertain how many seats will be avail- Bridge.-Arrangements have also been made for bridge to able for wives and friends. Application for tickets, which will be played at the Stray Bridge Club, 11, South Park Road, at admit to the robing-room at the Royal Hall, can be made on certain times. the enclosed form. The tickets themselves will be issued at the CAR PARKS Reception Office, Sun Pavilion, from 2 p.m. on Monday, and Representatives will be able Windscreen labels can be obtained by members at the June 27. Members of Council Reception Office, Sun Pavilion, Valley Gardens. to obtain their tickets for robing at the A.R.M. Inquiry Office, Hotel Car from Friday, June 24. Should the number of By kind permission of the Director, the Grand Royal Hall, the use members members intending to take part in the procession be less than Park, Cornwall Road, will be available for of the seating accommodation at the church, additional tickets for atcending the Reception Office and Exhibition. be issued on Tuesday morning in Municipal car parks are available at: Harlow Moor Drive, admission to the church will Valley Drive, Princes Square, Railway Station, " Belvedere,'> crder of application. Those receiving them must be in their Hall. seats by 2.30 p.m. Those taking part in the procession should Victoria Avenue, and the Royal reach the Royal Hall by 2 p.m., as all the congregation must be seated before the broadcast begins at 3 p.m. EXCURSION PROGRAMME Excursions to places of interest in the neighbourhood of TIME-TABLE OF MEETING Harrogate are likely to prove a great attraction to the doctors Key Arrangements and their wives attending the Annual Meeting. R.-events available for members of Representative Body and Ladies for transport and refreshments have already had to be made accompanying them. and the numbers fixed for each excursion. In order to avoid L.-events primarily arranged for Ladies. disappointment those wishing to take part in any of the excur- U.-events for all Members and Ladies accompanying them. sions* should therefore fill in the enclosed form and send it, *-Academic Robes should be worn. 'with the appropriate payment, to the Executive Officer, B.M.A. Office, Royal Baths, Harrogate, Yorks. Cheques should be Friday, June 24 made payable to "The British Medical Association " and 9.00 a.m.-A.R.M. Inquiry Office open-Royal Hall. crossed. Excursions 6, 24, and 27 are fully booked. 9.30 a.m.-Ladies' Club open for registration-Prospect Hotel. Applications will be acknowledged at once, but the reserved 10.00 a.m.-Annual Representative Meeting-Royal Hall. tickets will be collected at the Reception Office, Sun Pavilion. 11.00 a.m.-Civic Welcome to Representatives-Royal Hall. Harrogate, at any time after 2 p.m. on Monday, June 27, except L. Orchestra and coffee-Lounge Hall, Royal Baths. in the case of Representatives and Members of Council, whose 12.30 for 1.00 p.m.-Lunch to Overseas B.M.A. Representatives- tickets will be issued at the A.R.M. Inquiry Office, Royal Hall, Queen Hotel. 2.30 to 5.30 p.m.-L. Excursion to Harewood Park and Gardens Harrogate. between June 24 and 27. (by gracious permission of H.R.H. the Princess Royal and the Earl of Harewood). Ticket 6s., including tea. TICKETS 5.30 to 6.15 p.m.-R. Tour of Royal Baths. Tickets for functions other than excursions may not be 8.00 to 10.00 p.m.-R. Coach tour to Brimham Rocks. Ticket 5s. reserved in advance but will be obtained at the Reception R. Coach tour to Fewston and Moors. Ticket 4s. Office, Sun Pavilion, Valley Gardens, at the time of the meeting, R. Theatre. as in former years. June 25 Tickets for entertainments and receptions to be held on Saturday, Tutesday and Wednesday will be issued at the Reception Office 9.00 a.m.-A.R.M. Inquiry Office open-Royal Hall. 9.30 a.m.-Annual Representative Meeting-Royal Hall. from Monday, June 27, at 2 p.m. Hotel. on Thursday and Friday will not be 9.30 a.m.-Ladies' Club open-Prospect Tickets for functions 11.00 a.m.-L. Orchestra and coffee-Lounge Hall, Royal Baths. obtainable before Wednesday morning. 2.00 to 5.30 p.m.-L. Excursion to Ripon and Fountains Abbey. Note: Representatives and Members of Council should apply Ticket 10s., including tea. at the A.R.M. Inquiry Office, Royal Hall, for tickets up to L. Excursion to Aldborough (by kind permission of Wednesday evening. Lady Lawson Tancred). Ticket 8s. 6d., including tea. Tickets for Ladies' Functions will be issued at the Ladies' 5.30 to 6.15 p.m.-R. Tour of Royal Baths. Club. Prospect Hotel, from Friday, June 24. 6.00 p.m.-Press Cocktail Party-Fountain Court, Royal Baths. 7.00 for 7.30 p.m.-Glasgow Graduate's Dinner-Hotel Majestic. BADGES 8.00 to 10.00 p.m.-R. Coach tour to Ripley Castle (by kind per- mission of Sir William and Lady Ingilby). Ticket 2s. 6d. Members will not be admitted to the Scientific Sections R. Coach tour to Plompton Rocks and Spofforth Castle. unless wearing hadges. Thev should therefore make a point Ticket 3s. 6d. *The short morning and evening excursions may also be booked at R. Dancing. the time of the meeting at Harrogate. R. Theatre. SUPPLEMENT TQ T4HE JUNE 18, 1949 TIME-TABLE OF MEETING BRITISH MEDICAL JOURNAL 345

10.00 a.m.-U. Childe and Leinster Cup Golf Competition-Oak- Sunday, June 26 dale Golf Course. R. Church Services. 10.00 a.m. to 12.45 p.m.-L. Visit. to Knaresborough Market. 10.00 a.m.-R. Tour of Royal Batihs. Ticket 3s. 6d., including coffee. R. Golf. 10.30 a.m. to 6.00 p.m.-L. Visit to Fountains Abbey and Ripon R. Tennis. (Tea by kind invitation of the Mayor and Corporation). 10.30 a.m. to 6.30 p.m.-R. Excursion to Rievaulx Abbey and Ticket 13s., including lunch and tea. Byland Abbey. Ticket 22s., including lunch and tea. 10.30 a.m. to 6.00 p.m.-L. Visit to York (tea by kind invitation of R. Excursion to Richmond and Wensleydale. Ticket the Lord Mayor and Corporation). Ticket 13s., including 20s., including lunch and tea. lunch and tea. 2.00 to 5.30 p.m.-R. Excursion to Burnsall and Appletreewick. 11.00 a.m.-L. Tour of Royal Baths. Ticket 10s., including tea. Orchestra and coffee-Lounge Hall, Royal Baths. R. Excursion to Ripon and Fountains Abbey. Ticket 2.00 to 6.00 p.m.-U. .Visit to Ripon (tea by kind invitation of the 10s., including tea. Mayor and Corporation). Ticket 5s. 8.00 p.m.-Operatic Celebrity Concert-Royal flall. 2.00 to 6.00 p.m.-U. Visit to York (tea by kind invitation of the Lord Mayor and Corporation). Ticket 7s. 6d. Monday, June 27 2.00 to 6.00 p.m.-U. Excursion to Byland Abbey and Coxwold. Ticket 12s., including tea. 9.00 a.m.-Council Meeting-Council Room, Municipal Offices. 2.00 to 6.00 p.m.-U. Excursion to Haworth (Bronte Country> 9.00 a.m.-A.R.M. Inquiry Office open-Royal Hall. (tea by kind invitation of Drs. J. E. Baird, M. P. Fitz- 9.30 a.m.-Ladies' Club open-Prospect Hotel. gerald, and W. J. McCracken). Ticket 10s. 10.00 a.m.-Annual Representative Meeting-Royal Hall. 2.30 p.m.-Overseas Conference-Council Room, Municipal Offices. 10.00 a.m. to 12.45 p.m.-L. Visit to Templenewsam. Ticket 5.30 p.m.-U. Tour of Royal Baths. 7s. 6d., including coffee. 5.30 p.m.-Empire Medical Advisory Bureau Cocktail Party for 10.00 a.m. to 6.00 p.m.-L. Visit to York. Ticket 16s., including Overseas and Foreign Delegates-Lounge Hall, Royal lunch and tea. Baths. 11.00 a.m.-L. Tour of Royal Baths. 8.30 p.m.-.U*. Civic Reception-Royal Hall. L. Orchestra and coffee-Lounge Hall, Royal Baths. 2.00 p.m.-Reception Room open for registration-Sun Pavilion, Valley Gardens. 2.00 to 5.30 p.m.-L. Excursion to Ilkley and Bolton Abbey. Thursday, June 30 Ticket 10s., including tea. 9.00 a.m.-Reception Room open-Sun Pavilion, Valley Gardens. 5.30 to 6.15 p.m.-L. Tour of Royal Baths. 9.00 a.m.-Exhibition open-Sun Pavilion, Valley Gardens. 7.00 for 7.30 p.m.-R. Representatives' Dinner-Grand Hotel. 9.30 a.m.-Ladies' Club open-Prospect Hotel. Ticket 10s. 6d., excluding wine. 9.30 a.m.-Pathological Museum open-Royal Bath Hospital, Corn- 9.00 p.m.-U. Annual General Meeting-Grand Hotel Ballroom. wall Road. 10.00 a.m.-Scientific Sections. Tuesday, June 28 10.00 a.m.-Treasurer's Cup Golf Competition-Pannal Golf opening of Exhibition by President-Sun Course. 9.00 a.m.-Official 10.00 a.m. to 12.30 p.m.-L. Visit to Ripon Market. Ticket 5s. 6d., Pavilion, Valley Gardens. coffee. open registrations-Sun Pavilion, including 9.00 a.m.-Reception Room for 11.00 a.m.-L. Orchestra and coffee-Lounge Hall, Royal Baths. Valley Gardens. 1.00 p.m.-Irish Graduates' Lunch-Granby Hotel. 9.30 a.m. to 12 noon.-Annual Representative Meeting-Royal Ticket 9s. Hall (if still in session). 2.00 to 5.30 p.m.-U. Visit to Templenewsam. 6d., open-Prospect Hotel. including tea. 9.30 a.m.-Ladies' Club U. Visit to Harewood Park and Gardens (by gracious 9.45 a.m.-Opening of Pathological Museum by Professor M. J. H.R.H. the Princess and the Earl Stewart, LL.D., F.R.C.P., F.R.F.P.S., F.F.R., at Royal permission of Royal Bath Hospital (Laboratory), Cornwall Road. of Harewood). Ticket 6s., including tea. U. Visit to Fountains Abbey and Ripon (by kind per- 9.30 a.m. to 1.00 p.m.-L. Visit to Listers Mills, Manningham, Ticket permission of the Directors). Ticket mission of Commander and Lady Doris Vyner). Bradford (by kind 10s., including tea. 7s. 6d. Bath Sections. 2.30 p.m.-U. Demonstration and tour-Royal Hospital, 10.00 a.m.-Scientific Cornwall Road (limited to 50). 10.00 a.m. to 12.45 p.m.-L. Visit to Ripley Castle (by kind per- 3.00 p.m.- *. Benediction in St. Robert's Church, Robert Street. mission of Sir William and Lady Ingilby). Ticket 2s. 6d. The Sermon will be preached by the Right Rev. H. J. 11.00 a.m.-L. Orchestra and coffee-Lounge Hall, Royal Baths. Poskitt, M.A., D.D., Bishop of Leeds. 2.00 p.m.-Members will robe in Royal Hall for official Religious to Service, and procession will be formed. 4.00 p.m.-U. Division Garden Party-Hotel Majestic (limited 2.30 p.m.-Procession leaves Royal Hall for St. Peter's Church. 500). 5.00 p.m.-U. B.M.A. Films-Grand Hotel Ballroom. 3.00 p.m.-U*. Official Religious Service, St. Peter's Church. The to service will be conducted by the Vicar of St. Peter's 7.30 for 8.00 p.m.-Annual Dinner-Hotel Majestic (limited 420). Church, and the Sermon will be given by His Grace the Ticket 35s., including wines. Archbishop of York. It will be broadcast in the B.B.C. Theatre. Northern Programme. Bridge. 3.15 to 5.30 p.m.-L. Coach tour to Fewston and Washburndale. Friday, Jutly 1 Ticket 7s. 6d., including tea. 8.30 a.m.-Annual Breakfast of the Medical Prayer Union-Harro- 5.00 p.m.-U. B.M.A. Films-Grand Hotel Ballroom. gate Hydro (limited to 100). 5.30 to 6.15 p.m.-U. Tour of Royal Baths. 9.00 a.m.-Reception Room open-Sun Pavilion, Valley Gardens. 5.45 p.m.-British Council Reception for Overseas and Foreign 9.00 a.m.-Exhibition open-Sun Pavilion, Valley Gardens. Delegates-Queen Hotel. 9.30 a.m.-Ladies Club open-Prospect Hotel. 6.00 p.m.-Medical Women's Federation Sherry Party-Fountain 9.30 a.m.-Pathological Museum open-Royal Bath Hospital, Corn- Court, Royal Baths. Open to all Medical Women (by wall Road. invitation of Harrogate Members of M.W.F.). 10.00 a.m.-Scientific Sections. 8.30 p.m.-U*. Adjourned Annual General Meeting and 11.00 a.m.-Tour of Royal Baths. President's Address-Royal Hall (limited to 1,300). Orchestra and coffee-Lounge Hall, Royal Baths. 9.30 p.m.-U*. President's Reception-Lounge Hall, Royal Baths 2.00 to 6.00 p.m.-U. Visit to York. Ticket 10s., including tea. (limited to 600). U. Coach tour to Brimham Rocks. Ticket 8s. 6d., including tea. Wednesday, June 29 2.30 p.m.-Demonstration and tour-Royal Bath Hospital, Corn- 9.00 a.m.-Council Meeting-Council Room, Municipal Offices. wall Road (limited to 50). 9.00 a.m.-Reception Room open-Sun Pavilion, Valley Gardens. 5.30 to 6.15 p.m.-U. Tour of Royal Baths. 9.00 a.m.-Exhibition open-Sun Pavilion, Valley Gardens. 8.30 p.m.-Popular Lecture by " The Radio Doctor "-Royal Hall. 9.30 a.m.-Ladies' Club open-Prospect Hotel. 9.30 a.m.-Pathological Museum open-Royal Bath Hospital, Corn- wall Road. 10.00 am-Scientific Sections. The address of the Paddington Group Hospital Management 10.00 a.m.-L. Notts Ladies' Challenge Cup Golf Competition- Committee is now: Paddington Hospital, 285, Harrow Road, Starbeck Golf Course. London, W.9. SUPPLEMENT TO THE 346 JUNE 18, 1949 ANNUAL REPRESENTATIVE MEETING BRITISH MEDICAL JOURNAL

BRITISH MEDICAL ASSOCIATION Routine Medical Examination of Nurses Motion by DERBY: That Council be instructed to press for ANNUAL REPRESENTATIVE MEETING the payment of fees to practitioners engaged in the routine MOTIONS AND AMENDMENTS FROM DIVISIONS medical examination of nurses. AND BRANCHES Midwives Act-Fees for Attendances and Post-natal CONSULTANTS AND SPECIALISTS Examinations Domiciliary Visits in Nursing-homes Amendment by DERBY: That the period during which claims that the for fees under the Midwives Act may be submitted be extended Motion by BRISTOL: That this meeting regrets to six months. Minister of Health has set up regulations which make a patient in a nursing-home both private and Service at the same time, and demands that this anomaly be resolved by allowing for all lInstitutional Maternity Services N.H.S. patients in nursing-homes either domiciliary visits by Motion by NORWICH: That this meeting urges that steps be specialists or the charging of fees by their general practitioners. taken to ensure that local authorities may run institutional Motion by CITY OF EDINBURGH: That the recommendation maternity services independently of the regional hospital boards, of the committee in relation to domiciliary visits in nursing- to which general practitioners shall have access. homes (para. 71 of Annual Report) should be extended to include all urgent medical or surgical or other cases. Position of the School Medical Officer Motion by BRISTOL: That a school medical officer should Economy in Hospital Management send any child he considers to need hospital treatment to the Motion by MID-ESSEX DIVISION: That economy in hospital family doctor; he should not, except in case of urgency, send management be effected, first, by a reduction in the adminis- the child to any particular hospital or to any particular con- trative costs. sultant, the choice of which is the proper province of the family Domiciliary Consultations doctor in conjunction with the parents. Motion by CHELSEA AND FULHAM: That a list of specialists willing to undertake domiciliary consultations should be circu- MEDICAL ETHICS lated to general practitioners without further delay. Motion by KENSINGTON AND HAMMERSMITH: That the Proposed Terms antd Conditions of Service of Hospital pamphlet on Medical Ethics be issued not only to those newly Medical Staff qualified practitioners, but also to all overseas practitioners who have arrived into the country during the last ten years, and also Motion by CLEVELAND: That all grades of practitioners be be made available to all others who wish to apply for it. paid in retrospect when final terms are agreed and that a no detriment clause be added. ORGANIZATION Selection of Specialists Constitution of Central Council of the Association Motion by SOUTH-WEST WALES: That this meeting instructs Amendment by GLOUCESTERSHIRE: That Section 124 of the Council to take immediate steps to urge the Minister of Council's Annual Report and Section (viii) of Appendix IV Health so to amend the Acts or regulations that regional grading to that Report be referred back to Council for further -committees shall by statute consult the medical practitioners of consideration. all classes, general practitioner or otherwise, on the merits of Amendment by BOURNEMOUrH: That the proposals for the individual applicants for grading. reconstitution of the Council be referred back for further Motion by SOUTH-WEST WALES: That this meeting instructs consideration. the Council to take immediate steps to urge the Minister of Amendment by BRADFORD: That instead of 10 members of Health so to amend the Act that specialists dissatisfied by the Council being elected by the Representative Body and 37 direct -decisions of regional grading committees may have the right of as proposed by the Council, 47 should be elected direct and -appeal to independent appeal tribunals. none by the Representative Body. Motion by CLEVELAND: That this meeting strongly refutes Amendment by BOURNEMOUTH: That the Representative Body the suggestion contained in the Regional Hospital Board's approve the principle that the number of members of Council circular (49) 70 that the profession has agreed that in the case directly elected by members in the Branches and Divisions of of regrading on appeal it will be satisfied that payment at the the Association in Great Britain and Northern Ireland should higher grade shall be applied from the date of regrading only. be increased, provided that in so doing the number of members of Council elected by the Representative Body is not diminished. PRIVATE PRACTICE Amendment by WINCHESTER: That the Representative Body Allowances to Medical Witnesses in Criminal Cases approve the principle that the number of members of Council Motion by SOUTH-EAST ESSEX: That (with reference to directly elected by members in the Branches and Divisions of para. 83 of the Annual Report of Council), in the opinion of the Association in Great Britain and Northern Ireland should be this meeting, regulations under which maximum allowances are increased; that members should be elected by reconstituted quoted, but not minimum, lead to inequalities of remuneration Branches, and should be responsible to their Branch. for similar services and are most unsatisfactory; and that the Amendment by WINCHESTER: That the number of members Council be pressed to approach the Home Office with a view to of Council elected by Branches in Great Britain and Northern a fixed scale of fees being laid down. Ireland should be increased from 37 to 53. Amendment by BURY: That the number of members of the Fees for First-aid Lectures Council elected by Branches should not be fewer than 42, and Motion by MARYLEBONE: That with reference to para. 85 of that these 42 or more be distributed among groups according Council's Report the attention of the British Red Cross Society, to membership and strength. the St. John Ambulance Association, and the Home Office be called to Minute 89 passed at the A.R.M. at Cambridge regard- Grouping for Direct Election of 37 Meembers of Council ing fees for first-aid lectures and examinations, etc. Amendment by EAST YORKSHIRE: That the Representative Body gives provisional approval to the plan submitted by the Reports to Insurance Companies Council for the grouping for election of 37 members of Council, Motion by GATESHEAD: That this meeting reaffirms the but refers the matter for further consideration by the Council, resolution of the A.R.M., 1937, with regard to the payment for in order that anomalies in the grouping may be reviewed. reports to insurance companies furnished after the death of Amendment by BOURNEMOUTH: That the Dorset and West patients who have been accepted for insurance without medical Hants Branch be grouped with the Wiltshire, Somerset, and examination. Gloucestershire Branches. SUPPLEMENT TO THE 347 JUNE 18, 1949 ANNUAL REPRESENTATIVE MEETING BRIrISH MEDICAL JOURNAL

Election of Members of Council by Representative Body Regional Organization Amendment by WINCHESTER: That the direct election of Motion by Winchester: That the primary duty of each members by the Representative Body should be discontinued. Regional Secretary shall be to his Region. He shall pay regular Instead, Council may co-opt up to six members of the Associa- visits to Divisions and be available, in liaison with Divisional tion who are of proved experience and knowledge in the medico- Secretaries, for consultation with and visits to individual mem- political field, and not representing any given area; and that bers; but he shall have access to all central committees. the chairmen of the Scottish, Welsh, and Northern Ireland Committees should be members of the Council. of Autonomous Bodies Amendment by PLYMOUTH: That only eight members of Position Council be elected by the Representative Body as a whole. Motion by BOURNEMOUTH: That the Council be asked to appoint a special committee to consider and report on the situa- Members Ex-officio of the Council tion created by the formation of autonomous bodies within the Association and their relationship to the Representative Body. Motion: That the following Recommendation of the Council Amendment by BROMLEY: That so long as the General be adopted: That the following cease to be members, ex- Medical Services Committee and the Central Consultants and officio, of the Council: (a) Immediate Past-Chairman of Repre- Specialists Committee are autonomous, the Representative Body sentative Body; (b) Deputy Chairman -of Representative Body; can no longer be considered to be the Body that formulates the and (c) Immediate Past-Treasurer. policy of the B.M.A. Amendment by WINCHESTER: That the recommendation be That this situation strikes at the whole structure of the adopted, subject to the addition of the following words: Association, and that steps should be taken to remedy it. "President-Elect and the Immediate Past-President." Motion by BURY: That the term of membership of the ex-officio members of Council be limited to three years. Organization of the Association in the Dominions, Colonies, and Dependencies Overseas Members of Council Motion by MARYLEBONE AND PLYMOUTH: That a Special Com- Amendment by WINCHESTER: That the number of members mittee be appointed to consider the B.M.A. Overseas organiza- elected by Branches of the Association not in Great Britain or tion, including the Dominions, Colonies, and Dependencies, and Northern Ireland should be reduced from eight to one-viz., to ascertain the feelings of all sections of their medical practi- the chairman of the Colonies and Dependencies Committee. tioners and others interested. Service Members on the Council Quorum of Representative Meetings Amendment by WINCHESTER: That the present arrangement Motion by READING: That this meeting considers that the under which three members of the Council are elected to repre- quorun of the Representative Body should be reduced fronr sent respectively the Royal Naval Medical Service, the Army one-half to one-quarter of the members elected to attend. Medical Service, and the Royal Air Force Medical Service be discontinued, and that the chairman of the Armed Forces Duties of Representatives Committee be a mnember of the Council. Motion by LoTHLNS: That this meeting, being aware of the Representation of Public Health Service on the Council confusion which exists as to the duties of a representative, affirms its belief that representatives should be guided by Divi- Amendment by WINCHESTER: That the existing arrangement sional,opinion, but at the same time should be free to make under which two members of Council are elected by Public decisions in the light of debates, and requests the Council to Health Service members be discontinued, and that the chair- make this clear in the Annual Handbook. man of the Public Health Committee be a member of the Council. Expenses of Representatives Attending Representative Meetings Representation of Women Members on the Council Motion by SOUTHAMPTON: That in the event of the Council's Amendment by WINCHESTER: That the present arrangement recommendation in para. 116 of the Annual Report of Council under which women members of the Association elect one being carried (re subscription), the expenses of Representa- member to the Council be discontinued. tives attending Representative Meetings be defrayed by the Association. The "Six-year Rule" Recogtti*ion of Outstanding Services Amendment by DERBY: That membership to the Council for Motion by GREENWICH AND DEPTFORD: That this meeting those members elected by Group Branches or Divisions should recommends that the Council consider ways in which Divisions be for a period of three years. could honour members who have rendered outstanding services on their behalf. Agenda of Representative Meetings, NAnONAL FORMULARY Motion by MARYLEBONE: That with reference to para. 205 Motion by HENDON: That the Representative Body is of of the Council's report Representatives whose motions and is " opinion that, while a National Formulary desirable, early amendments have been grouped" or "held covered" shall steps should be taken to improve the contents and scope of be given at least 48 hours' notice in writing, and on the day of the existing National Formulary so that it will prove to be of the Representative Meeting shall be given the opportunity to real value to those engaged in the science and art of medicine meet for discussion in an adjacent room to decide on the and to the public at large. proposer of motion, who would be allowed to speak to 10 minutes and reply for 10 minutes, other speakers being limited to 5 minutes. No resolution "grouped" or "held covered" AMENDING BILL should be taken until one hour after the meeting starts. Motion by HENDON: That in the opinion of the Representa- Motion by WINCHESTER: That Divisions shall submit their tive Body the Minister of Health is primarily guilty of a breach resolutions initially to Branch Councils, who, whilst having no of faith in failing to redeem his promise to provide Compulsory power of veto, shall discuss these, correlate them, and forward Arbitration for the ultimate settlement of any dispute relating to an Agenda Committee of the Representative Body. Not- to the remuneration of public practitioners, and secondly of withstanding this, a Division shall always retain the power of introducing an amending Bill without affording the representa- forwarding a resolution direct to the Representative Body if tives of the profession a prior opportunity to peruse and dissatisfied with the action of the Branch Council. comment on its provisions. Motion by MID-CHEsHItE: Tat the Representatives of the Motion by BRIGHTON: That this meeting is of opinion that A.R.M. strongly urge the early institution of a " steering com- arbitration provided for in the amending Bill should be under- mittee " for the agenda at Representative Meetings. Whitley Council, and not as set out in Section 12 of the Bill. 348 JUNE 1949 ANNUAL REPRESENTATIVE MEETING SUPPLEMENT TO THE 18, BRITISH MEDICAL JOURNAL

Motion by CLEVELAND: That the profession insist on the right GENERAL PRACTITIONERS AND HOSPITAL WORK to arbitrate from the findings of the Whitley Council. 4 Motion by BRIGHTON: That this meeting registers its pro- Motion by MID-CHESHIRE: That this meeting protest strongly found dissatisfaction at the Minister's breach of faith in not against the steady exclusion of general practitioners from work honouring his undertaking to consult the medical profession in hospitals. before presenting the amnending Bill to Parliament. Motion by EAST HERTS: That the apparent policy of the regional boards to eliminate general practitioners from hospital LAY CONTROL OF MEDICINE work is to be deprecated. Motion by BISHOP AUCKLAND: That this meeting views with great alarm the threatened lay control of Medicine and recom- DECISIONS OF MEDICAL PRACTICES COMMITTEE mends that appropriate action be taken. Motion by LIVERPOOL: That wherever the decision of the medical practices committee differs from that of the local REMUNERATION OF GENERAL PRACTITIONERS executive committee, the medical practices committee should furnish in writing to the said executive committee the reasons Motion by BRIGHTON: In view of the failure of the Minister for its decision. to give a satisfactory reply to the profession's reasoned case for an increase in remuneration, based upon the betterment EMERGENCY DISPENSING factor, the Council be instructed to ask local medical com- Motion by WEMBLEY: That this meeting considers that the mittees to invite general practitioners to place their resignations payment of 2s. 6d. per 100 patients for emergency dispensing is at the disposal of such committees, unless terms acceptable to ludicrous and quite inadequate; that steps should be taken the majority of the profession are received before Sept. 30, 1949. immediately in England and Wales to adopt the procedure Motion by CAMBERWELL: That subject to the receipt of extra E.C.1OA as in Scotland. grants from the Treasury, this Meeting agrees that the capita- tion fee for the first 1,000 patients should be raised. MEDICAL ADVISORY COMMrIrEES Motion by WEMBLEY: That this Meeting considers that the amount of the capitation fee is not equitable throughout the Motion by NEWCASTLE-UPON TYNE : That as medical repre- country and should be made uniform irrespective of area and sentation on boards and committees of the National Health irrespective of other payments such as mileage and dispensing. Service is inadequate, the Association be instructed to press for Motion by CLEVELAND: That this meeting wishes strongly to either direct representation of appropriate sections of the pro- support any action the Council should decide to take under fession on these boards and committees or that medical para. 178 of the Report of Council. practitioners be appointed to boards and committees after consultation and in agreement with such sections of the TEMPORARY RESIDENTS profession. Motion by HEXHAM : That the fee of 15s. for attending resi- A B.M.A. CAR BADGE dents is totally inadequate and compares unfavourably with the Motion by HENDON: That the Representative Body compli- pre-1938 P.A.C. remuneration. As this especially affects ments the Council on the design of a car badge prepared in doctors practising in seaside and holiday resorts where the response to the appropriate resolution last year and restates patients only call in medical aid in cases of severe disability, its view that the badge should be made available forthwith to it is considered that the fee for temporary residents should be members of the Association. not less than one guinea. Motion by CITY: That this meeting considers the sign Doctor " on motor-cars is now unnecessary and undesirable. BASIC SALARIES Motion by HENDON: That the Council be instructed to repre- MEDICAL OFFICERS OF APPROVED SCHOOLS sent to the Ministry of Health that all basic salaries granted by executive councils should be a primary charge on the central Motion by NEWCASTLE-UPON-TYNE: That this meeting con- pool. siders that the rate of salary offered to medical officers of approved schools is totally inadequate considering the nature VACCINATION AND IMMUNIZATION and amount of work entailed and that this present arrangetnent Motion by HENDON: That this meeting is definitely of opinion should not be accepted. that immunization and vaccination should fall outside the scope of the contract for public practitioners and be made the subject DOCTORS' CARS of separate remuneration both for the services and the reports involved. Motion by NEWCASTLE-UPON-TYNE: That this meeting is not satisfied that the profession receives a sufficient measure of PROVISION OF MEDICINES AND APPLIANCES FOR PRIVATE priority in the delivery of new cars. PATIENTS Motion by HENDON: That disappointment and resentment be SALARIES IN THE PUBLIC HEALTH SERVICE expressed by the Representative Body at the failure of the Motion by WEMBLEY: That this meeting considers that the Minister to include in the amending Bill provision for the attention of the profession as a whole should be drawn to the free supply of medicines and scheduled appliances to private undesirability of medical practitioners accepting service with patients. local authorities on a sessional basis which would tend to enable such authorities to carry out their public health work and thus GENERAL PRACTITIONERS AND SPECIAL DEPARTMENTS ignore the British Medical Association's conditions of service OF HOSPITALS for whole-time public health officers. Motion by EAST HERTS: That the maintenance of patho- logical and radiological facilities for general practitioners with- out the intervention of a consultant in a hospital out-patient MEMBERSHIP SUBSCRIPTION department is essential. Amendment by CARDIFF: That the subscription of medical officers in the public health service who receive no income tax MEDICAL SERVICES COMMITTEE PROCEDURE allowances in respect thereof should remain as at present. Motion by SouTH ESSEX: That this meeting requests Council Motion by HENDON: That the Council be urged to make to introduce a scheme whereby a member can commute his early representations to the Minister to have the regulations annual subscription to a lump sum life subscription. relating to the procedure of the medical services committees amended to bring them into line with those applicable to Northern Ireland, whereby a defendant doctor appearing ENTRIES -IN TELEPHONE DIRECTORIES before a medical service cotnmittee may have, if he so desires, Amendment by CLEVELAND: That this meeting does not agree the services of a paid advocate or solicitor. with para. 119 of the report since the addition of the specialty 349 JUNE 18, 1949 ANNUAL REPRESENTATIVE MEETING BRITISHSUPPLEMENTMEDICAL JOURNALTO THE is the only method of distinction where names are similar, as occurs in this area. PRACTICE OF ORTHOPTICS MEDICAL PRACTITIONERS HANDBOOK The Council of the Faculty of Ophthalmologists has issued a Motion by HENDON: That this meeting urges the Council to memorandum on orthoptics. The report was orginally drafted take steps for the preparation and early issue of a Newly by the Orthoptic Board and has been modified by the Council Qualified Practitioners Handbook. of the Faculty. It has been sent to the Ministry of Health and the British Optical Association. APATHY OF THE PROFESSION The memorandum, here slightly abridged, begins by distin- Motion by BRIGHTON: That the Annual Representative Meet- guishing two classes of people doing orthoptic work. ing views with profound regret the apparent apathy in the (1) Orthoptists, who are medical auxiliaries and hold the profession, and instructs the Council to use the editorials of Diploma of the Orthoptic Board (D.B.O.). Their training and the British Medical Jouirnal as much as possible to rouse mem- work are under the direction of recognized medically qualified bers of the profession to realize their responsibilities in the ophthalmologists. outcome of the present conflict. The course of training occupies two years (full-time) and is carried out in orthoptic schools recognized by the Orthoptic MEMBER OF U.S. ARMY AIR FORCE MEDICAL CORPS Board. Holders of the diploma are entitled to practise orthop- Motion by Metropolitan Counties Branch: That all members tics, but they must abide by the ethical rules of the British of the United States Army Air Force Medical Corps be elected Orthoptic Board, which forbid those who hold the diploma to honorary members of the Association for the term of their prescribe glasses or to treat cases other than those referred to service in the United Kingdom. them by recognized ophthalmologists. These orthoptists work in orthoptic departments of ophthalmic hospitals, in ophthalmic PAYMENT OF MILEAGE TO MEMBERS ATTENDING MEETINGS departments of general hospitals, at school ophthalmic clinics, or Motion by LANARKSHIRE: That it be remitted to the Council in private practice. They are mostly women. There are about to consider the question of introducing the payment of mileage 241 orthoptists holding the D.B.O. practising in this country. at the usually accepted rates to members attending B.M.A. The examination for the diploma was started in 1935. committees of Divisions and Branches and also certain central (2) Ophthaltic opticians who have special knowledge of committees where the payment of a mileage grant could be orthoptics are for the most part those who hold the Diploma regarded as both appropriate and equitable. of Orthoptics (D.Orth.), which is granted by the. British Optical Association (B.O.A.). Their training and work are not under HEALTH CENTRES the direction of the medical profession. Motion by HENDON: That the Representative Body is of The examination for the D.Orth. is open to members of the opinion that a doctor practising in and from a health centre B.O.A. or to holders of any qualification in refraction or should not be obliged to enter into partnership with any or all optometry approved by the Council of the B.O.A. There is, of his colleagues who may be similarly placed. no prescribed course for the D.Orth., but nearly all those who Motion by CITY: That this meeting whilst approving in take the examination study at either the' Refraction " Hospital " principle the idea of health centres views with alarm the atti- London or at the Manchester College of Technology. (They tude of local health authorities in attempting to obtain the usually attend only once a week for a year.) These optician- acquiescence of local practitioners in the establishment of such orthoptists work for large firms of opticians, or on their own,, centres without definite terms of service being previously laid in which case orthoptics is usually a sideline, their main work. down and calls upon the Council to open immediate discussions being refraction. There are about 250 ophthalmic opticians in with the Minister of Health. this country who hold this diploma. The examination for the OTHER MOTIONS BY DIVISIONS AND BRANCHES D.Orth. started in 1939. Motion by TORQUAY: Believing that decisions backed by the At present there is a shortage of orthoptists, partly because Association as a whole must carry greater weight with the fewer were trained during the war, and partly because of the Minister and with the public than decisions of individual groups increased demand for orthoptic work. More students are now and with a view to maintaining the unity of the profession, an being trained. When the school ophthalmic clinics come under opportunity should be given to the Groups to correlate their the Hospital Service more orthoptists will probably be required. views one dwith another and with the policy of the Association It is estimated that some 600 orthoptists will soon be needed as a whole before any decisions on policy are made known to in the final Ophthalmic Service. The memorandum assumes the Minister or the Press. that the staff of all National Health Ophthalmic Clinics will Motion by TORQUAY: That, in' order that the Association consist of one or more of the following: ophthalmic surgeon, should become a potent instrument in obtaining satisfaction, the refractionist, orthoptist, and dispensing optician. ' Council should bend all their energies in the coming year to The limited practical training available for the candidates for arming the Association with the necessary power to enforce the D.Orth. has been considered. The amount of properly their demands. selected clinical material available for teaching is negligible Motion by BRADFORD: That in the opinion of this meeting the compared with what is available through the orthoptic schools only organization which can protect the interests of the general attached to hospitals. Optician-orthoptists are handicapped in practitioner is one holding the certificate of the Registrar of their work by lack of opportunity of association with ophthal' Friendly Societies. mic surgeons. The authors of the memorandum consider that, Motion by BROMLEY: That the meetings of the Representa- since the ophthalmic surgeon is ultimately responsible for the tive Body should be recorded verbatim as in Hansard, and patient, if holders of the D.Orth. are to be employed in the should be available for reference. Health Service as orthoptists they should be so only after they Motion by LANARKSHIRE: That in view of the introduction have had the opportunity of working with ophthalmic surgeons of the National Health Service and the possibility of war in' and of undergoing a course of training in the recognized the future, the miterests of practitioners called for service with orthoptic school of a hospi:al. the Forces be safeguarded by the following measures: (a) Where service pay is less than the net income, earned under the National Health Service, the difference to be made up from the total sum available for payment of practitioners under the National Health Service. DOMICILIARY SPECIALIST SERVICES (b) That on return from service, a practitioner's income be main- taimed for a period of eighteen months at the gross rate earned prior A woman confined in a private maternity home may be visited to service. by an obstetrician or her baby by a paediatrician under the domiciliary specialist service in an emergency. The Minister Correction has decided that such cases fall within the scope of the specialist In the form of contract for whole-time consultants or S.H.M.O.s domiciliary service when specialist attention is needed and when (Supplement, June 11, p. 320) the Ministry mistakenly. included an' medical considerations make it impossible for the patient to be. asteris1: after the words " their temporary absence.". - removed to hospital. SUPPLEMENT TO THE 350 JUNE 18, 1949 CORRESPONDENCE BRITIS.i MEDICAL JOURNAL voice that the strongest protest be made to the Ministry in order that this arrant piece of injustice may be removed at the Correspondence earliest opportunity. It is high time that the Minister was told with no uncertain voice that "what is sauce for the gander is Trainee Specialists sauce for the goose."-I am, etc., Poole, Dorset. A. ARNAUD REID. SIR,-YOu have had a number of letters recently regarding the proposed terms of service for trainee specialists, but we Terms for Consultants should like the views described below to be given some further publicity. SIR,-I believe the comments on the proposed terms of We are concerned that in the proposed terms of service no service for hospital staffs (Supplement, March 19, p. 147) are allowance has been made for seniority lost due to service with misleading in regard to superannuation. They suggest that the H.M. Forces. We understand that the Spens Committee was employer's 8% contribution is to be deducted from. a betterment guided, among other principles, by the principle that placing factor of 20%-in other words, that it may be considered as on the scale should have regard to age. The committee's report a part of the employee's remuneration, as it is a payment made was accepted in principle by the Ministry of Health, but in the on his behalf. This is not so. Also it is clear that super- proposed terms of the Ministry of Health no allowance has annuation and betterment are separate problems: it is unfor- been made for the ex-Service trainee specialist who, after one tunate that they have arisen simultaneously. to six years in the Services and at a considerably older age, The employer's 8% superannuation contribution is not made will receive a salary appropriate to a much younger person on behalf of the employee: it is made by the employer, and qualified for a short time-e.g., a Class II post holder will he receives benefit from it. It gives him the right to retire receive £700 on the Spens scale (£775 on the Ministry of Health an employee who, though he has given long and faithful service, scale). This is thought by the Spens Committee to be adequate has ceased to be useful through old age or infirmity. The for a person aged 26. This salary spells dire hardship for an pension avoids hard feelings and recriminations. Similarly the ex-Service trainee of, say, the age of 30, for which age the employer, by having paid superannuation contributions, can Spens Conmittee regard £1,100 as being essential to avoid feel that he has honourably discharged his responsibilities to hardship. the widow and family of a deceased employee. Where there To avoid serious injustice we submit that in arriving at the is no scheme to which he can contribute the employer himself appropriate salary on this scale for trainee specialists allow- has an obligation to provide a pension for his ex-employee. ance should be made for the number of years served in H.M. Of course the employee also has a duty to provide for his Forces. This principle has already been conceded in the case old age and for his family in event of infirmity or death. of specialists, where the conditions are exactly comparable. The Responsibility in this matter of pension is divided between scales are fair to the newly qualified trainee, they are fair to employer and employee. The fact is recognized and regular- the specialists, they must also be fair to the ex-Service trainee ized in superannuation schemes. specialist. Your suggestion is tantamount to supposing that, if a man Since July 5, 1948, many ex-Service registrars have had their earning £1,080 p.a. entered a (si.nilar) superannuation scheme, posts converted into a permanent hospital appointment. We his salary would be reduced by £80 p.a. to cover the employer's submit that all holders of registrarships held under the further- contribution. education scheme should qualify for retrospective payment to There are only two explhnations of the proposed ternis July 5, 1948. either the remuneration is being reduced to meet the Govern- We appreciate that it would be difficult for individual hos- ment's superannuation contribution, or the Minister is offering pitals to meet all these requirements out of their present esti- us a betterment factor of 11 %.-I am, etc., mates. We submit, therefore, that central action on the part Preston. J. A. CARR. of the Ministry of Health should be taken in all these individual cases until the situation has rectified itself. We are, etc., Specialist Grading J. G. HOWELLS. P. SAINSBURY. SIR,-The main line of demarcation in the grading of J. T. HUTCHINSON. R. F. HOBSON. specialists should be between (1) men whose income is solely D. V. MARTIN. E. J. ANTHONY. derived from consultant practice, and (2) men whose income is D. S. MACPHAIL. partly derived from general practice, although also engaged in some specialty. The first group could be divided into two SIR,-I have been waiting for some time for a protest to categories, giving the following classification be made in your columns about the remuneration for trainee 1. Staf] Specialist.-Doing consultant work only: holding a post- specialists which has been proposed by the Minister. I appear graduate qualification; having been in consultant practice at least to have waited so far in vain. five years. The salary proposed by the Spens Committee for a Grade III 2. Associate Specialist.-Doing consultant work only; holding a trainee specialist was £600 p.a. (living out). Mr. Bevan pro- postgraduate qualification; liaving been in consultant practice less poses that this should now be £670 p.a.-an increase, even when than five years. Automatic promotion to staff specialist after the Government superannuation contribution has been added, completing five years of consultant practice. of only about 20.5%,, to allow for the betterment factor. At 3. Senior Hospital Medical Officer.-Engaged in general practice not a time when Ministry of Labour figures show that the average but doing some specialist work; postgraduate qualification or more than he did in 1939 the essential; promotion to associate specialist when he fulfils the wage-earner is getting 120% necessary criteria. young trainee specialist is to get 20.5% more than the Sperns Report said he should have got in that year. In other words, The remuneration of the first two groups should be at a the working-class betterment factor is to be 120 or more ; the considerably higher level than for the S.H.M.O. group, as the betterment factor of a registrar is to be 20.5. This makes com- latter can rely chiefly or partly on income from general practice. plete nonsense of the Spens Report. Precise definitions such as the above should be agreed with Furthermore, while it is bad enough for the overworked the Ministry before appeals are due to be heard by the Appeals general practitioner to get only 34% gross, it is still worse for Committees.-I am, etc., the registrar, often with a wife and family to support. The B'ackpool. R. E. HORSFALL. latter gets a betterment of only 20.5% net and is far nearer the subsistence level. Many of these people, whose only sin SIR,-Mr. R. L. Newell (Proceedings of Council, Supplement, is that they love their work and wish to take a higher qualifica- May 21, p. 283) stated that grading committees decided entirely tion in it, are living on the verge of bankruptcy, with an ever- on the basis of a man's qualifications. My personal experience increasing overdraft to distract them from their work. refutes his assertion and supports the views and wamings put So far, however, the British Medical Association has done forward by the Secretary (Supplement, May 14, p. 269) with absolutely nothing to remedy this state of affairs and to remove regard to the senior hospital medical officer grade. this gross injustice, or if action has been taken it has been done I am over 12 years qualified, and in January last I filled up a behind closed doors. Let us therefore demand with a united form sent to me for specialist grading. Having heard Aothing SUPPLEMENT TO THE 351 JUNE 18, 1949 CORRESPONDENCE BRITISH MEDICAL JOURNAL meanwhile, I recently obtained a personal interview with my decided to seek the -ruling of a High Court judge on the'proper regional board and was then told that, of the people who by construction of the "Costs in Criminal Cases Act, 1908," and postgraduate degrees, experience, etc., were of specialist stan- the " Witnesses Allowances Regulations, 1948," on the follow- dard, not more than 50%/ would be graded full specialist, and ing grounds. of the people of assistant specialist standard the majority would Subject to the regulations, there may be allowed such sums be graded as senior hospital officers. Furthermore, at this as 'appear to the court reasonably sufficient to compensate the interview I was enlightened as to the reason for this policy: witness for the expenses, trouble, or lass of time properly the object was to save money by down-grading as many people incurred in or incidental to the' giving of evidence. It is the as possible. duty of the Taxing Officer to " ascertain the amount " of costs When I tried to find out, at the interview and subsequently, which the court has directed to be paid out of public funds. who or what body had the privilege of deciding my grading In the ordinary way the Taxing Officer ascertains the amount and future I was met by a smoke-screen. The decisions are without reference to the court, and he has been guided by the apparently being carried out in secrecy behind closed doors. instructions contained in the Home Office circular. Accord- The secrecy is not quite complete, because some people in a ingly, the refusal by a Taxing Officer of an appropriate position to " work behind the scenes " or " in the know " have allowance to a hospital doctor who was salaried and lost no already been told that they will be graded full specialists.-I remuneration by attending court, on the grounds that such an am, etc., allowance conflicted with the directions in the Home Office M.D., M.R.C.P. circular, was recently challenged, and it was contended that the Disparity in Incomes particular witness had not been compensated for trouble or SIR,-I enclose a cutting from the Sunday Express of loss of time which attendance at court necessarily involved. April 17 quoting figures for the West Ham area which, if An application for the reconsideration of the fees to be correct, should be more forcibly brought to the notice of the allowed in this case and for a ruling on the principle to be public. Analysis reveals the following average incomes during applied was heard by Mr. Justice Devlin in Chambers. It the first nine months of the Health Service : Doctors, £736; was argued that paragraph 5 of the Home Office circular was dentists, £2,942; chemists, £2,413. tco narrow, as, if the doctor had been an ordinary general Such figures show a sorry state of affairs the G.P.-the practitioner, he would have incurred the expense of having to very hub of the Service-finds himself the poor man of the employ the services of another doctor to attend to his patients show. His more fortunate colleagues can "shut shop" and' during the time he was absent at court, or, if he did not adopt forget their patients and customers during their leisure hours, this course, he would have to see his patients in time which he and feel satisfied that they receive payment for what they have might otherwise have devoted to leisure. actually done during working hours. Mr. Justice Devlin agreed with this contention and stated Fundamentally, the medical practitioner should be the that he would direct the Clerk of Assize that the directions in highest paid of the professions in the Service. His training is paragraph 5 of the Home Office circular (re professional-witness longer and more exacting, and he carries by far the greatest fees to salaried officers) were too narrow, and the-mere fact responsibility. Unfortunately he has had no business experi- that a practising doctor does not lose income is not sufficient ence and now finds himself sadly lacking in the fight for to reduce him to the status of an ordinary witness. He further financial existence, without which he cannot hope to maintain stated that it was for the Clerk of Assize to assess what amount his professional dignity.-I am, etc., should be paid for the trouble and loss of time. Wallasey, Cheshire. THOS. H. H. GREEN. It is suggested, therefore, that salaried doctors who find them- selves in a similar position of having been refused a profes- Allowances for Professional Witnesses sional-witness allowance in accordance with the scale described in the Witnesses Allowances Regulations, 1948, should argue SIR,-There will be many of your readers who have been tLe point whenever it arises, and should appeal to the judge annoyed to find that they are not eligible for payment of a or chairman of the court if the Taxing Officer refuses the professional-witness aIlow?ince for attending the Criminal appropriate allowance, making use of the opinion expressed Courts to give professional evidence in accordance with the by Mr. Justice Devlin as described above. scales recently defined in the Witnesses Allowances Regulations, This legal ruling will be brought to the notice of the Home 1948 (Statutory Instrument No. 1909 (L.23)), as published in the Office, and it is hoped that the offending paragraph in the Supplement, Sept. 25, 1948 (p. 129). circular will be revised.-I am, ets., The reason for this refusal by the Courts to pay such witness ALISTAIR FRENCH, fees is that the Home Office issued a circular on Aug. 26, 1948, Secretary, The Medical Protection Society. to all Clerks of the Peace, Clerks of Assize, and Clerks to Justices, giving guidance in the implementation of the Witnesses Allowances Regulations which came into operation on Sept. 13, Letter from a Division Chairman 1948. This circular stated that professional witnesses' allow- SIR,-The letter (Supplement, April 30, p. 253) deploring ances should not be paid to salaried officers who did not lose the poor attendances at B.M.A. meetings suggests: "The fourth remuneration by reason of attending court, with the result that explanation, and the most reasonable, was that a condition of professional-witness fees have been refused to many doctors complete and profound apathy pervaded the bulk of the working in whole-tinie salaried posts (in hospitals and other doctors." But it fails to consider the causes of the apathy. public health services, etc.), to their great indignation. What are they? My Society was concerned about this position and took In my opinion tlpe apathy is due to the belief that whatever Counsel's opinion with regard to the validity of the Home Office resolutions may be passed at the meeting, or in London, no circular, which, unlike the regulations, had not statutory force. appreciable alteration would be effected. And again why? To Counsel advised that paragraphs 2 and 5 of the Home Office go back only a short period, it had been said that there were circular appeared to be conflicting. not enough' doctors to work the health service, yet when aboiit The Home Office appear to concede in paragraph 2 that a half voted in its favour the other half were officially advised witness specifically called in, because of his expert and pro- to join. Why? Because those at Headquarters knew that, fessional,qualification, may be given an appropriate allowance. whatever a local practitioner had signed, few would hesitate In paragraph 5 they exclude salaried officers without giving to break their word if it were to their financial advantage to do *any indication that the court ought to take into consideration so. One practitioner could not trust another local practitioner whether or not the giving of evidence may fairly be regarded to keep his word and not to take advantage of him. as incidental to the officer's ordinary duties, and whether Put shortly, there is a complete lack of confidence. We trouble or loss of time has been occasioned. have been told that ballots were secret to avoid victimization.' The Society made representation to the Home Office request- If a cause is worth while it is worth being made a victim in ing that the circular should be revised, but was informed that an endeavour to uphold it. Did the early Christian martyrs the Home Secretary would not be prepared to depart from the complain there was no secret ballot? statement in his circular that professional-witness allowances The lack of confidence is engendered by lack of truth and should not be paid to salaried officers. It was accordingly experience of the way the Protection of Practices Scheme was SUPPLEMENT TO THE 352 JUNE 18, 1949 CORRESPONDENCE BRITISH MEDICAL JOURNAL not kept. Privately it was reported that one practitioner in I refer to the dignity of and respect for the general practitioner, Kent had acquired over 400 panel patients from an absentee and for this reason I am distressed at the provision not permit- practitioner; yet he did not pay into the scheme a single shilling ting him to order an arch support, an abdominal belt, and for private cases. Are we really going to believe he had none? some other simple things for his patients, but must direct the But in the official report these facts were not published, nor patient to the hospital. was his name. Yet public morality is formed by public opinion. There are other restrictions of the general practitioner's The number of unethical and immoral acts that are passed by activities which I think are not in the interests of doctor or is prodigious. patient. No facilities have been granted him to have simple Let us face it, there is no faith, for professional, like public, pathological and x-ray examinations done at his request with- morality is at a low ebb. Until this is altered, there will be out the intervention of the hospital physician or surgeon. I am apathy. As Sir Stafford Cripps has said, this is more a moral sure it is all wrong and an insult to a branch of the brofession than an economic crisis. I am, etc., which in Germany produced Koch and here gave us Sir James Pettswood, Kent. G. C. MILNER. Mackenzie, to mention only two names. The importance of the general practitioner-the title of an Senior Hospital Medical Officer article I wrote for the West London Medical Journal, a copy SIR,-The letter from " Mens Sara" (Supplement, April 30, of which I sent to the Minister of Health-must be recognized p. 260) raises very important points to all young members of the if a really satisfactory medical service is our aim. The general profession on the specialist side-that is, the point of grading, practitioner, as I suggested in a memorandum submitted to the status, and tenure of a post. In the past, when experience was conference of universities and Royal Colleges met to consider adequate, one obtained an appointment, and if one's ability alterations in the students' medical curriculum, must be was worthy the post was permanent. Such is my own lot as trained to play his part.-I am, etc., radiologist to two hospitals, where I have handled the work Lcndcn, W.8. HAROLD H. SANGUINETTI. with commendation, and salary increment, since appointment. Now the grade of senior hospital medical officer, which did Health Centres ntot exist when one entered the Service, is brought forward as SIR, There has been much discussion over the establishment a blind alley with meagre salary increments and no visible of so-called health centres under the National Health scheme. chance of rapid upgrading. The alternative, non-acceptance, I recall that, when the introduction of a National Health Ser- means unemployment-or country-wide " touting" with no vice was advocated, much play was made with the advantages settled domicile. which would accrue from the pursuit and practice of preventive At a recent meeting it was stated that nobody could be medicine. We were told that under such a scheme the general accepted as a specialist without two points: (a) Five years' practitioner would be encouraged to spend much of his time in experience in the specialty, and (b) attaining the age oQ 32- educating the people in the preVention of illness and in the this despite provision for a specialist below 32 in the proposals. attainment of positive [sic] health. In what directions have We were infcrined that thc' e were basic grading tenets. they been so encouraged, what new efforts in the prevention of In my own case I have nine months to wait. Whilst it would disease have been initiated ? I have heard of none. be aggravating, in view of a dentist's age not being applicable On the contrary, local authorities are being enjoined-and but only ability being the arbiter, it is more than this owing some are planning to erect polyclinics for the treatment of to the strong likelihood that such grading may persist after disease. In one of the larger Midland towns plans are afoot one has officially "qualified"; and the amount of -responsi- for the erection of so-called health centres which are designed bility demanded remain constant. Such grading may attach to replace the surgeries now provided by the general practi- to the post and affect future holders. tioners. In other words, not health centres but centres for The B.M.A. should demand endorsement of a resolution ill-health are being envisaged. The disadvantages of such passed at the meeting which I mentioned. It was to the effect centralization are too obvious to need elaboration. that all gradings of senior hospital medical officer should be My own conception of a health centre-by no means original subject by legislation to yearly review, with a view to the earliest -is that it is a place devoted, among other things, to: possible upgrading, and that the ranking should not be used (a) The education of the public in all matters relating to the health as a means of employing cheap specialized labour. The point and well-being of a community-for example, food, housing is vital. At present the seniors are not involved. Apart from (including lighting and ventilation), clothing, exercise, work and to-day's junior ranks being to-morrow's seniors, once this is fatigue, mental and physical rehabilitation. established its future revocation will be nearly impossible. The (b) Child and mother welfare. slogan should be, as with the T.U.C., " The rate for the job "- (c) Mental health. especially when one has no other consulting income.-I am, etc., (d) The prevention and treatment of endemic diseases, whether BELOW AGE. communicable or not-e.g., rheumatism, syphilis, tuberculosis, polio- myelitis, diphtheria, and the like. SIR,-I am gravely disturbed by the letter from Dr. Stephen (e) The prevention and control of epidemic disease. Krauss (Supplement, May 7, p. 266) on the above topic. His (f) Demography. point of view is all the more alarming as "quite a number (g) Research. of colleagues . . . hold these views." In my submission the For a large town only one such centre would be necessary. suggestion that senior hospital officers should be made eligible It should have a central location, be of first-class architectural for distinction awards is completely defeatist in its approach, design, and should exhibit the highest available standards of and is moreover foredoomed to failure. construction, hygiene, and aesthetics; in fact, it should be a It appears clear that a considerable number of hospital centre of which the community could be as proud as of the medical officers who have in the past been regarded as town hall, and might form part of a civic centre. specialists by their colleagues are in danger of being placed in But such a grand design has been allowed to give place to Wiis grading. Surely they should not fight for better remunera- numerous little treatment centres which will afford the public tion within this grading, but for the right of a really effective no greater speed or efficiency of treatment except in one or two appeal against the decision of the Assessment Committee.- directions-e.g., x rays and minor surgery. It remains to be I am, etc., seen whether, indeed, general practitioners will avail themselves Birmingham. F. A. BLEADEN. of these centres, as they will be free to employ them or not as the convenience of their practices directs. It is not unlikely Importance of the G.P. that some of these buildings may come to be white elephants SIR, It is well that general practitioners should insist on erected and -run most uneconomically to the greater glory of adequate remuneration, for the labourer should be worthy of no one, except perhaps of the nephelococcygeans who plan them. his hire-should be, although the present form of payment There is another consideration: is it expedient that a local or hardly encourages the development of the best kind of service. regional public body should acquire a vested interest in ill- But there are other matters even more important than pay health ? This will undoubtedly occur if working space in these which demand consideration by the profession and the public. treatment centres is rented to general practitioners, much in SUPPLEMENT TO THE JUNE 18, 1949 CORRESPONDENCE BRITISH MEDICAL JOURNAL 353 the same way as landlords in Harley Street have come to Even in the latter case the original appointment is made demand increasingly exorbitant rentals of specialists. Caveat principally to one hospital, and visits from time to time to emptor! I am, etc., other institutions are of a nature subsidiary to the principal Elton, Notts. V. L. FERGUSON. appointment. Should that principal appointment cease to exist, could the specialist concerned still be deemed to be in the To Stop Frivolous Calls e:nploy of the hospital board ? And could he be transferred to another hospital in the service of the board ? It is my SIR,-May I make a suggestion to cut down the cost of the suggestion he could not. It is my further suggestion N.H.S. ? My idea is that each patient should get free of that that such subsidiary duties which arose by virtue of his holding the charge from his local executive council a book of, say, 20 principal appointment would no longer be open to him, and tickets to last a certain period, say six months. Each ticket that they would thereupon require to be carried out by some would represent a service from his doctor, and would be other specialist still in the employ of the board. Of course collected by the doctor at each visit or consultation. At the end of each month these tickets would be returned by the much would depend upon the exact nature of the contract which the "displaced" specialist had entered into in the first practitioner to the local executive council. If the patient place. exceeds his quota of tickets then he can purchase more at a nominal fee, say Is. each. By this means no doctor can be Take as an example the pos of surgeon to the (fictitious) Town of accused of making money out of the scheme and it will stop Nod Hospital. That is the appointment which a particular man is frivolous calls on the doctor's time. I am, etc., assumed to hold. Incidental to this, and because he holds it, he also visits once a week a small cottage hospital near by. The board Hove, Sussex. PAUL E. R. KIRBY. decides to close the Town of Nod Hospital and make' it into a purely orthopaedic centre, appointing to it an orthopaedic surgeon Transfer of Specialists from somewhere else. The general surgeon finds his services are dispensed with, for there are no longer any general surgical beds SIR,-On so many occasions has the Minister of Health there. broken faith with the professions undertaking service under Several points arise. First, what is his future position at the small the Health Act that it is somewhat unusual to find him for cottage hospital near by ? He had never actually been appointed to once attempting to keep it. What is rather disturbing, however, it as a surgeon, his single weekly session there being regarded merely is to find that in order to maintain this faith the Minister finds as part of his duties at the main hospital, and being consequential it necessary to break the law. upon his holding that appointment. That, however, is the least The Ministry of Health has informed hospital boards (we important point. Suppose that, in accordance with the Minister's recent are told) that the Minister has a moral obligation for seeing directive to lhospital boards, the board offers that specialist an appointment as that displaced members of hospital staffs are given, as far as is surgeon at the City of Blanktown Hospital (also fictitious), would practicable, the opportunity of undertaking similar duties else- such an offer be intra vires the rcgional board, or would the board wshere. Quite apart from the fact that it, being a moral obliga- have to advertise a vacancy on the staff of the City of Blanktown tion, must be somewhat outside the Minister's usual line of Hospital and then hope that the surgeon in question would be country, a perusal of the regulations (which have all the force selected to fill it ? Could the difficulty be got over by the board's of law) dealing with the making of hospital appointments effecting a union between the two hospitals at Nod and Blanktown reveals that no appointment of a specialist may be made except and regarding them thereafter as one hospital simply divided into two parts, one consisting of the "general " the in accordance with those regulations. Statutory Instrument and the other of "orthopaedic " part of the same hospital ? No. 1948, sets -out the manner by which all specialist 1416, It rmight be argued that such a union would validate the tranlsfer para. appointments shall be made, and 8 thereof lays it down on the grounds that the specialist was merely changing the venue of that in no other manner may such appointments be made. his department within the same single administrative unit-the same Now it would seem that the Minister, putting himself above hospital, now departmentally divided but still administratively a the law which he himself has made by virtue of the powers single hospital. But while such an argument might well validate vested in him under the Act, has informed hospital boards that the transfer in these circumstances it is extremely difficult to find they should make appointments in a manner other than that gr-ounds to validate the transfer of a specialist to an altogether prescribed by the regulations-viz., merely by finding alterna- different hospital simply in order that he should suffer no hardship because his former office had ceased to exist. The Minister's desire to tive employment for those whose jobs cease to exist for any prevent hardship is one thing. Compliance with the law is another. reason. I suggest that he does not possess the authority to issue such a directive, the terms of which aim to override the provi- To put a man on to the staff of a hospital of which staff he sions of the regulations already laid before Parliament, and I is not at present a mernber must surely be interpreted as "filling suggest further that no hospital board has any power to act a vacancy," even if that vacancy is being specially created for contrary to those regulations, no matter what its master may the express purpose of being filled by that particular man. If direct it to do. this be accepted as a reasonable argument then the regulations The regulations clearly state that they will apply ' on the cited above must apply in every such case, and it therefore occasion of each vacancy in an office, which for this purpose become ultra vires any regional board to carry out the under- includes a new office which the board propose to fill." If a taking given by the Minister regarding the re-employment of specialist's services are dispensed with because the office which displaced specialists. For the Minister's undertaking to be he has formerly held ceases to exist he is indeed unfortunate, possible some amendment becomes necessary to the regulations and it would appear that the Minister really wishes to prevent concerned. Failing this amendment the suggestion is offered any such injustice or hardship from arising, but it is equally that any appointments made not in accordance with the terms clear that no hospital board possesses the authority to appoint of the regulations will be invalid, liable to be set aside by the that specialist to another office without going through the courts; and, moreover, any remuneration paid out by way of procedure laid down in the regulations cited above, which means salaries in respect of such appointments might even be regarded advertising the vacancy and setting up the appointments advisory as the wrongful application of public money. committee, etc. Any appointment made other than in the It is indeed unfair that a specialist be dispensed with because manner prescribed is liable to be declared invalid in the courts of some matter of policy affecting the office which he holds and and set aside. may have held for many years, but it is more important that a At present every specialist appointment in the country exists constant vigilance be maintained to see that both the Minister under a certain title. The sudden imposition of common and his stooges on regional boards and other committees carry ownership of hospitals has not implied necessarily an inter- out their duties under the Act and administer it strictly in changeability or transferability of the incumbents of specific accordance with its provisions and the provisions of the regula- appointments. The physician in charge of cardiac department tions and orders made under it. It may well be that I am in in Hospital X, engaged for that purpose and under that title, error in my interpretation of the regulations in question, but it is not necessarily bound to render services in other hospitals appears to me that, before accepting the Minister's general offer under the same regional board, although there have been of alternative appointment "wherever practicable," the B.M.A. recently some appointments which have stipulated that the should take advice as to whether it is within the authority of incumbent's services may be required from time to time in other regional boards to act on this Ministerial directive, and if my institutions under the board's control. own suggestions are correct then the sooner an amendment to SUPPLEMENT TO THE 354 JUNE 18, 1949 CORRESPONDENCE BRITISH MEDICAL JOUKNAL the regulations to cover such cases is made the better it will be Several cases were shown and the disease was discussed in detail. Mr. C. Gordon Irwin then delivered an entertaining and instructive for all concerned. I do not think the question is just academic. lecture on his recent American tour. -I am, etc., The second meeting, on March 10, consisted in a demonstration by Penzance, Ccrnwall. GEOFFREY MYERS. Mr. J. D. Rose of excellent lantern slides and cases dealing wIt[i various forms of ulceration and gangrene. This was followed by a lecture on "Medical and Veterinary Science " by Mr. W. Lyle POINTS FROM LETTERS Stewart, who dealt in some detail with the condition of swayback in Supply of Glasses sheep and other dietary deficiencies, as well as some infective dis- orders of common interest to the medical profession and veterinary Mr. S. BLACK, Director, Information Bureau, Association of surgeons. Optical Practitioners, writes: I think Dr. Coke Harvey's letter The last meeting was held on Ma-ch 31, and over 200 doctors and (Supplement, May 7, p. 267) on the difficulty of Mr. X in getting his students were present. The whole evening was devoted to a dis- spectacles repaired requires some explanation. The N.H.S. regula- cussion of obstetrical problems and was arranged by Professor tions demand that a re-examination of the eyes is necessary before E. Farquhar Murray. Mr. Stabler gave an interesting and practical a repair can be carried out if more than two years have elapsed account of what to do until the arrival of the flying squad. Dr. The reason for this regulation is to discourage William Hunter showed a film in support of his description of the since the last test. care of the perineum during labour, and Mr. Linton Snaith dis- patients from allowing too long to elapse between examinations and cussed threatened abortion and described the experiences in the past because it is cheaper in many cases to supply a new frame rather few years at the Newcastle General Hospital. Professor E. Farquhar than to patch up an old frame after several years' use. Mr. X Murray discussed the present position of midwifery. The meeting had four alternative ways open to him to obtain an examination of ended with a description by Mr. Harvey Evers of the third stage of his eyes. Through the Health Service he could have consulted an labour and its complications, and was made particularly interesting ophthalmic medical practitioner, or an ophthalmic optician; or he by the many historical references. could have had his eyes examined at an eye hospital; or lastly he could visit an ophthalmologist privately. Apparently Mr. X took CHELSEA AND FULHAM DIVISION the last course, and therefore he was not entitled to obtain free A meeting of the Chelsea and Fulham Division was held on Service spectacles cannot be supplied to a private May 20, with the Kensington and Hammersmith, Westminster and spectacles. Health Holborn, and Wandsworth Divisions as guests. The chairman, prescription. If a patient brings a private prescription and insists Dr. R. Kelson Ford, introduced Dr. Ronald Gibson, Hon. Secretary on having spectacles through the scheme, the optician has to inform of Winchester Division. him that his only way to do this is to have his eyes examined through Dr. Gibson said that Winchester felt strongly that now as never the Health Service, when any necessary spectacles can be supplied. before there must be a strong B.M.A. with every part of it closely knit to the other. After looking into the constitution of the B.M.A. Comparative Incomes it was decided to draw up a memorandum for submission to other to see the apparent apathy Divisions, and when suggestions and revisions were received on the A. C. E. writes: It is indeed surprising memorandum their own views had been "sunk" to agree with those of the profession to the cavalier treatment it is receiving from the of the majority. Minister. . I am one of the " haves " with a gross income of over After the majority views had been received a revised memorandum £3,000, but I really wonder how some of our colleagues are managing had been issued; from this a further revised memorandum had been to pay overheads, let alone live. I was very shocked recently to see made, and it was decided that the subject was so important that a our local executive council's position for the first nine months of special representative meeting should be called. The main points the N.H.S. Translated into yearly averages it is as follows, in round for discussion were the Secretariat and Representative Body (the two doctor, £1,600; units which link up the Council with the periphery), and the figures of payments: Average gross payments per Constitution of Council. per dentist, £4,550; per optician, £3,200; per chemist, £3,000. My The present Council, which consisted of one-third of its members dental and optician friends tell me they feel the net income to be directly representing the Divisions and two-thirds not directly 50% of gross income, making £2,275 and £1,600, respectively, while representing the Divisions, was not considered democratic. It was two chemists were unwilling to pass an opinion as they said over- thought that the correct proportion was at least two-thirds to be heads were covered by other lines. Assuming a doctor's overheads directly represented and one-third not directly represented. to be 33- %, the average net income is just over £1,050. . I read It was felt that the Secretariat were able and very hard-working May-20 that " Mr. Bevan's aim is to give the men but were not sufficiently in contact with the periphery. The in a daily paper of Secretariat must go out to the periphery and not wait in Head- average efficient dentist a net income of not less than £1,788 per quarters for people to come up and contact them. Winchester annum," so that surely in fairness the average efficient doctor should suggested that these Regional Secretaries should be free from as be worth at least £2,000 per annum net, and this should be tied to much committee work as possible so as to have time to meet the average number of patients per doctor. . Incidentally, in individual members. many areas the capitation fee was less than 17s. last year, and it is Something must be done to strengthen the Representative Body surely time we demanded, not asked for, 30s. per head at least for and make more effective the discussion of resolutions which came the first 2,200 patients and 20s. for any others up to a maximum before it. The Winchester scheme, which had had a reasonable amount of support, was that the Divisions should first of all put up of 3,500. their resolutions to Branch Councils, and they should go from the Branch to an Agenda Committee. Winchester suggested that the Divisions should submit their resolutions, and if not satisfied with Association Notices the action of the Branch Council could retain the power to send them direct to the Representative Body, the object being to strengthen the B.M.A. and bring each unit as near as possible. .Diary of Central Meetings Dr. L. Potter, Assistant Secretary, B.M.A., said that it had been for many years the policy of the Council to decentralize so far JUNE as possible, and a great deal of controversy had gone on as to 21 Tues. Conference of Anaesthetists Group, 2 p.m. whether a Secretary should be resident in a Region. He was of the 21 Tues. World Medical Association-Ladies' Committee, opinion that he wouW be of far more use if he were in close contact 4.30 p.m. with work at Headquarters. All Secretaries had access to all Com- JULY mittees, but even so it was difficult to keep abreast of the manifold 7 Thurs. Joint Committee on Association of the General acivities. Regional offices were being set up. Practitioner with Hospitals, 2 p.m. Dr. Gorsky emphasized that he was in sympathy with the reorgan- 7 Thurs. Radiologists Group Committee, 2 p.m. ization of the whole organization, but that Dr. Gibson's idea of strengthening the B.M.A. was to revolutionize the Representative Branch and Division Meetings to be Held Body. Dr. C. Watney Roe asked the meeina to bear in mind the instruc- OXFORD DIvIsIoN.-Wednesday, June 22, Visit to the Atomic tions given to their representatives on March 18 to press for at least Energy Research Establishment, Harwell. two-thirds direct representation on the Council and the cessation of ROCHDALE DIvISION.-At Rochdale Infirmary, Sunday, Junie 19, elections by the R.B. Now that the Council were also Trustees of 6 p.m., annual general meeting. Consideration of Annual Repoi-t the British Medical Guild. this was doubly important. of Council; election of officers for 1949-50; instruction of Represen- The chairman, Dr. Ford, suggested that an age limit for tative to A.R.M. (Meeting adjourned from June 10.) membership might be imposed. SuRREY BRANCH.-At Town Hall, Castlefield Road, Reigate, Wed- Dr. Milligan. chairman of Westminster Division, proposed a vote nesday, June 22, 2.30 p.m. Annual meeting. Presidential address of thanks to Dr. Gibson. by Dr. L. J. Barford: " Towards a Better Understanding of Rheumatism." Visits to Redhill Adrodrome, Fuller's Earth Union WANDSWORTH DIVISION Works, Redhill, and Mullard's Radio Research Works, Redhill. At the annual meeting of the Wandsworth Division, held on May 31, the following appointments were made for the vear 1949-50: Meetings of Branches and Divisions chairman. Dr. H. Alexancder: vice-chairman, Dr. D. W. Jackman: NORTH OF ENGLAND BRANCH hon. treasurer, Dr. R. J. Saunders; hon. secretary, Dr. T. J. Lee; A spring course of scientific meetings was held at the Royal assistant hon. secretaries, Dr. C. J. Grosch and Dr. G. R. Boyes; Victoria Infirmary, Newcastle-upon-Tyne, during February and representatives to A.R.M., Dr. Alexander, Dr. G. R. Boyes, Dr. March. Grosch, and Dr. T. J. ILee: reoresentatives on Brarsch Council. Dr The first meeting, held on Feb. 24, was well attended and consisted Cornick, Dr. Jackman. Dr. D. Billig, Dr. J. G. H. McNabb, and the in a demonstration by Dr. C. N. Armstrong on Simmonds's disease. hon. secretaries ex officio.