SUPPLEMENT TO THE

BRITISH MEDICAL JOURNAL

LONDON SATURDAY DECEMBER 15 1951

CONTENTSHealth Centres in Hospitals. Maurice Mitman, M.D., Judge Appointed to Adjudicate 263

F.R.C.P. 261 Heard at Headquarters 263College of General Practice 262 General Medical Council -264Doctors' Telephone Centre -262 Correspondence 266Coal Board Salaries Up -263 Association Notices-268

HEALTH CENTRES IN HOSPITALS*BY

MAURICE MITMAN, M.D., FJIC.P.

There is no immediate prospect of new health centresbeing built, though there is a possibility of spurioushealth centres being set up in existing unsatisfactoryplaces.

I would suggest that health centres should be set upin hospitals-in existing out-patient departments, or inenlarged out-patient departments, or even in new out-patient departments, but in hospitals. I am convincedthat this is immediately practicable in many instances.It wotild do four important things:

(1) It would integrate the general practitioner with thehospital service.

(2) It would improve his status.(3) lt would provide him immediately with many of his

requirements, such as accommodation for group practice,ancillary services, and secretarial help.

(4) It would integrate two important branches of theN.H.S.

Out-patient departments are here, and are very littleused at night. It is therefore practicable to use themfor evening sessions, and in many instances they wouldbe immediately available. Accommodation and equip-ment would be available, as well as nurses, secretaries,telephone operators, laboratory technicians, radio-graphers, pharmacists, porters, and supervisory staff.The organization and the administration would bethere: it might be-it would be-necessary to extendthe department and increase the staff, but it is easierand cheaper to extend than to set up an entirely neworganization of the same type. Some hospitals arealready committed to the extension of their out-patientdepartment. Where this is being done its possible useas a health centre should be envisaged. On the other*A speech delivered before the Kent Branch of the B.M.A.

hand there may actually be spare accommodation ina hospital with large waiting-halls which are no longerrequired because of the introduction of an appointmentsystem.

Ancillary ServicesEven if this arrangement means no greater volume of

pathological, radiological, and physiotherapeutic ser-vices, general practitioners would get them directlyinstead of having to submit their requests throughseveral channels. This must result in economy and willultimately allow more work to be done. The economywill be in the time of the patient, the consultant, thehospital staff, and the secretarial staff, and the resultwould be diversion of staff to the general practitionerwithout an increase in numbers.

Moreover, there might be an actual economy in therequest for ancillary services. At present, for patientsadmitted to hospital for investigation, it is often thehouse officer or registrar who orders the investigationin preparation for his chief. In my view an experiencedG.P. investigating such a case in an out-patient depart-ment is more competent to decide what investigationsneed be done, and is more reasonable and more econo-mical in his requests than a recently qualified houseofficer.

If ever health centres are built there will be a replica-tion not only of buildings, equipment, and staff, but ofservices. It is likely that investigations conducted in ahealth centre may prove unacceptable to consultantsadmitting patients to hospital and they would berepeated. Here the investigations are conducted forthe consultant and the general practitioner by the samestaff.

If this proposal works, consider the enormouseconomy in building, equipment, and staff. Apart frombeing easier and cheaper to extend than to set upde novo, the staff of a hospital are likely to be moreefficient, the quality of the work done is likely tobe better, there would be supervision that is

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impossible in a health centre, the equipment would bebetter, and a wider range of investigations could beundertaken at the direct request of the general practi-tioner.

Moreover, the convenience to the patient would bebetter served. Facilities for investigations and ancillaryservices after working hours are badly needed to allowpatients to remain at work pending investigation.

I need not labour the advantages to be gained by theeasy access of the G.P. to the consultant-who indeedwould be his colleague.

Co-ordination of ServicesThe scheme would bring into closer co-operation two

important divisions of the National Health Service-thelocal health authority responsible for the health centreand the regional hospital board or board of governors.In so far as G.P.s are servants of the third division-the executive council-there would be a link with thistoo.

Lastly, if the G.P. gains entry to the hospital he willtake his place by the side of his specialist colleague.Immediately his status will rise and his integration intothe hospital service will be automatic. Once the G.P.is in the out-patient department many of his require-ments will be met, including a G.P. bed. Moreover,the services of a trainee G.P. or house officer who wantsto become a G.P. would incidentally be available fornight calls. One of the reliefs the G.P. has the rightto expect in middle life is the relief from night calls,which should be undertaken by the young.

I believe that, with the G.P. in hospital as well as inthe patient's home, the life of the G.P. will be one ofthe most interesting and most valuable in medicine.General practice will become the choice of many of therecently qualified. The " surgery " will be taken outof the home of the G.P. and this will relieve his wife ofmany of her drudgeries.

COLLEGE OF GENERAL PRACTICEMORE EVIDENCE COLLECTED

Addressing the St. Marylebone Division of the B.M.A. onNovember 12, Dr. J. H. HUNT referred to suggestions sentby general practitioners to him and Dr. F. M. Rose afterthe publication of their letter in the medical press (seeJournal, October 12, p. 908). They hoped to collect stillmore evidence from Divisional meetings of the B.M.A.,from the Royal Colleges, the Society of Apothecaries, thePostgraduate Federation, and from the Academy of GeneralPractice in the U.S.A. What they had obtained so far indi-cated that many general practitioners felt there were at leastnine ways in which they could be helped by a college oracademy of general practice. He thought that " academy "might be the most suitable title in harmony with theAcademy of their American colleagues. The nine pointswhich he went on to discuss were as follows:

Leadership and Guidance(1) The college would provide an academic headquarters,

run by practitioners for practitioners, which could speakauthoritatively for general practice, both within the profes-sion and outside it. It must be academic and educational,not political; and it must supplement the work of theRoyal Colleges and the B.M.A. rather than compete withthem in any way.

(2) Such a college or academy would provide for generalpractice some sort of recognized leadership, which had beenlacking for so long.

(3) It would be able to follow a planned and agreed policyabout many matters concerned with general practice,co-ordinating and assisting the work of the many differentcommittees trying to help practitioners now.

(4) It would have a say in undergraduate medical training.(5) Postgraduate teaching, even more than undergraduate

teaching, could be helped considerably by such a college,which could act as a forum for exchange of views. andsponsor lectures and discussions and perhaps exchanges ofvisits with colleagues overseas.

(6) Research in general practice: the encouragement, guid-ance, and publication of ideas that occurred to general prac-titioners would be a major responsibility of such a collegeor academy, together with the collection of clinical data andstatistics and the publication of surveys.

(7) The college would act as a repository for the traditionsand ethics of general practice-traditions which seemed fastto be dying out.

(8) It could improve the status and prestige of practitioners.(9) Such a body might later on be able to improve the

quality of general practice, to set a high standard and seekto maintain it, perhaps with a higher diploma (obtained byelection or examination, or both). Dr. Hunt felt that sucha body should prove its worth for several years before sucha diploma was considered.

* DOCTORS' TELEPHONE CENTREGLASGOW SCHEME

The Glasgow Local Medical Committee opened on Decem-ber 1 a telephone message centre, BEL 1212, with day andnight attendance. It allows doctors with automatic tele-phones in the Glasgow area to leave their houses un-attended. Before going out the doctor telephones to thecentre and leaves with the clerk there details of his depu-tizing arrangements for the time he will be away; or hemay give a telephone number where he will be personallyavailable. When a patient telephones to a doctor's houseand obtains no reply he may now ring BEL 1212, and hewill be told who is acting for his own doctor for urgentcases. He then makes direct contact with the deputy'shouse.

It is expected that the greatest use will be made of thecentre on the doctor's half-holiday and at week-ends ; thenormal Post Office diversion will continue to be used forholiday times. Doctors with manual telephones will notuse the centre.The centre is accommodated and staffed free of charge

by the Scottish Western Regional Hospital Board. Allexpenses connected with the administration and the hireof the telephones from the Post Office are met from thefunds of the Glasgow Local Medical Committee, whichis financed by a voluntary levy from general practitioners.

Consultants can use the service on the same terms, andalso doctors in the area of the Glasgow automatic telephonesystem who are not on the list of the executive council forGlasgow. Before using the service they should apply tothe Glasgow Local Medical Committee at 257, West GeorgeStreet, Glasgow, C.2.

Administrative DetailsThere are at present three lines obtainable by dialling BEL 1212,

and a fourth line, BEL 1211, used only by doctors ringing thecentre to advise their arrangements.Near this telephone there is a filing cabinet containing a card

for each general practitioner on the list of the executive councilfor Glasgow, and for each consultant and general practitioneroutside the city who has said he will use the centre. Eachcard bears the name and address (or addresses) and telephonenumber (or numbers) of the doctor, with a note of his partner(s)

262 DEc. 15, 1951 HEALTH CENTRES IN HOSPITALS

Dec. 15, 1951 DOCTORS' TELEPHONE CENTRE SUPPLEMENT To THe .263BRITISH MEDICAL JOURNAL

and any " standing " deputizing arrangement he may haveprev-iously intimated to the committee. If he is a member of agroup which operates a rota for off-duty time, this is stated.The doctor must telephone to the centre before leaving his

house unattended, and the clerk then removes his card, marks theappropriate deputy or notes the telephone number at whichthe doctor may be found and the expected time of his return,and places the card in a small file beside the telephones.When ani inquiry is received the clerk can say in a few seconds

whether the doctor is indeed off duty and give the necessaryinformation, or can tell the inquirer that he has no informationabout the doctor in question and advise him to try again, in casehe has been ringing a wrong number. By this system it ishoped to avoid the transference to a deputy of calls intended fora doctor whose telephone is attended, with subsequent irritationto both practitioners.When the doctor returns home he notifies the centre accord-

ingly, and his card is replaced in the filing cabinet.The record of doctors will be kept up to date, and new and

altered deputizing arrangements will be noted as they are inti-mated to the committee. This will reduce the time spent on thetelephone by the doctor when notifying the centre of his pro-posed zbsence, and increase the volume of traffic which can behandled with the available number of lines.

COAL BOARD SALARIES UPThe National Coal Board, after discussion and in agreementwith the B.M.A., has decided to introduce increased rates ofpay for full-time medical officers employed by the Board.The new salary ranges, which take effect from December 1,are as follows:

Medical officers-i.e., colliety, group, and area medical officers:£1,250 to £1,900.

Divisional medical officers (except South-eastern Division):£1,700 to £2,300, with provision for salaries up to £2,500 inexceptional circumstances.

JUDGE APPOINTED TO ADJUDICATEMr. Justice Danckwerts hasaccepted an invitation of theLord Chancellor to act asadjudicator on the remunera-tion of general practitioners.Announcing this in Parlia-ment on December 6, theMinister of Health, Mr.Crookshank, added, " It willbe for him to determinewith the parties to theadjudication whether theevidence should be madepublic."

Mr. Justice Danckwerts,who is aged 64, was calledto the Bar in 1913, and has

rl10"and Fr) l been a judge of the HighCourt in the Chancery Divi-

sion since 1949. From 1941 to 1949 he was Junior Counselto the Treasury and Board of Trade in Chancery matters andJunior Counsel to the Attorney-General in Charity matters.

The Ministry of Health has prepared a new leaflet (SDK) to

explain superannUation to people who leave National HealthService employment. Copies have been issued to employers in the

National Health Service to give them a ready means of answer-

ing similar questions from employees It is not intended thatcopies shall be automatically given to everyone who leaves theService, but the Ministry has suggested that copies should beplaced on notice boards and in staff common rooms, and thatany officer who may be leaving the Service should be able to

borrow a copy

Heard at Headquarters

Distinguished ServiceA member of the B.M.A. with a distinguished record ofservice to the profession is Dr. Charles Frier of Granthnm.On November 22 membersof the Kes.even Divisiongave him a complimentaryluncheon and presented himwith a pair of silver candle-sticks. Dr. Frier, who isaged 83, qualified in 1892and became a member of ~.the B.M.A. in 1900. Forover 30 years he has beena member of the Representa-tive Body; he has also beena member of the Conferenceof Local Medical and PanelCommittees since its in-auguration. A member ofthe Midland Branch Councilsince 1914, he became thefirst president of the Lincolnshire Branch when it wasformed in 1932, and he has also been honorary secretaryand chairman of the Kesteven Division.

Complinmentary LuncheonAt the luncheon given in honour of Dr. Frier, Dr. R. E.

Crockatt, chairman of the Lincolnshire Branch, welcomedtheir chief guest as one to whom they had always lookedfor guidance in affairs of state and of the medical world.Dr. L. S. Potter, representing B.M.A. Headquarters, bore aletter of congratulation from the Chairman of Council, andreflected the opinion of many when he said that there hadnever been a stauncher friend of the B.M.A. than Dr. Frier.Dr. J. H. C. Clarke, M.O.H. of Kesteven, also paid tributeto his long and valued services to the profession and tothe Association. Dr. J. R. Munro then presented the candle-sticks to him, and the company drank to Dr. Frier's goodhealth. Dr. Frler in response said he was very much touchedby all that had been said; and he then reviewed some of thechanges in practice during the first half of the century, speak-ing particularly of contract practice, with which he had beenintimately associated over many years. He said he had beenreferred to as a specialist, which was not true unless as ageneral practitioner he could regard himself as a specialistin general medicine. It was often said that the consultantknew more and more about less and less. He had faith andhope that in spite of the modern trends the converse wouildnever be said about general practitioners. He concluded bythanking the assembled company for the honour they haddone him and for the beautiful gift they had fotund fit tobestow upon him.

No Fooling Her

Mr. Basil Henriques, who presides over an East Endjuvenile court, told a London audience the other day that hehad before him a smallish girl about whose mental state hewas uncertain. He turned to an officer and asked, "Is thisan M.D. case ? " whereupon the gir! herself piped up, " No,sir, I'm not mentally deficient, I'm educationally subnormal."

Are Doctors Really Necessary ?

When a doctor visited a child the other day he waspresented with the note reproduced below. Apparently theauthor of the note was not present, but in the course of along and varied career he had been a male nurse."This patient, aged 9 years, has had diarrhoea from Sunday

p.m. and has expelled large numbers of threadworms. Couldthe patient possibly have tabs. butolan for tbe latter and S-succidine tabs. for the diarrhoea and kaolin pulv."

GENERAL MED

GENERAL MEDICAL COUNCILMEDICAL DISCIPLINARY COMMITTEE

The second session of the Medical Disciplinary Com-mittee, set up under the Medical Act, 1950, opened in Lon-don on November 28 under the chairmanship of ProfessorDAVID CAMPBELL. The programme of business containedfour applications for the restoration of names to the Registerand complaints against thirteen practitioners.

RestorationsThe Committee, after hearing the applicants in public and

perusing the testimonials submitted, instructed the Registrarto restore to the Register the names of Donald GordonCoutts and Michael Ansel Wiseman. It was unable toaccede to an application by Stewart Quarterman Servante.An application was made by Mr. Illtyd Gwyn Williams,

of Barry, Glam., whose name was erased from the Registerat the November, 1950, session of the Committee. A petitionwas presented on Mr. Williams's behalf containing 14,997signatures which had been collected in Barry in eight daysand represented various sections of the population, includingclergymen and ministers, nurses and pharmacists, andorganized workers. It was stated that the organization ofthe petition was entirely spontaneous and that the applicanthad had nothing to do with it. Testimonials to Mr.Williams's character were also read from prominent localpersons, and two members of Parliament gave evidence in hisfavour.

Notwithstanding this, however, the Committee found itselfunable to direct the Registiar to restore Mr. Williams'sname:

Adultery During Professional RelationshipThe Committee considered the case of Arthur James Daly,

registered as of BM/FTLC, London, who appeared on thecharge that he had committed adultery with Agnes Halliday,a married woman, of which adultery he had been foundguilty by d'ecree of the Divorce Division dated December 11,1950, and made absolute on January 23, 1951, in the caseof Halliday v. Halliday and Daly, in which he was the co-respondent, and that he stood in professional relationshipwith the said Agnes Halliday at all material times.

Mr. Gerald Howard, K.C., M.P., presented the facts tothe Committee, and Dr. Daly was defended by Mr. LeighTaylor, of Hempsons, on behalf of the Medical DefenceUnion.

Mr. Howard said that, quite briefly, the history of the matterwas that Mr. and Mrs. Halliday were married in 1941, and livedat Nelson, Lancashire. In the early part of 1947 Dr. Daly boughta practice in that town. Mrs. Halliday became a patient of hisin the early part of that year, and in June, 1947, when she wasoperated on for appendicitis, he made arrangements for theoperation. He treated her later in that year and at various timesin the early part of 1948, and in July, 1948, with the cominginto operation of the National Health Service Act, both she andher husband went on Dr. Daly's list. In April, 1950, he wasresponsible for sending her for some form of x-ray examination.There was no doubt also that during these years there was socialintercourse between Dr. Daly and Mr, and Mrs. Halliday, anda certain number of social visits were paid to each other's houses.Adultery took place in July, 1950, at a hotel in London.

Dr. Daly's defence was that the first professional attendancewas quite casual. Atter this he was introduced to her sociallyand friendship developed with both her and her husband. Theylived in a comparatively small industrial town and in their ownlittle circle they met frequently. It was contended on his behalf,therefore, that the adultery grew out of social relationship andwas not infamous conduct in a professional respect.

Mr. Howard suggested that it was straining the meaning ofterms to claim that, because the two relationships, professionaland social, existed side by side, therefore adultery must not bedescribed as professional misconduct on the ground that althoughthe lady was a patient she was a friend as well.

Evidence was given by Mr. Halliday in support of the com-plaint, and Dr. Daly gave evidence on his own behalf and wassupported by Mrs. Halliday and by certain evidence as to

)ICAL COUNCIL SUPPLEMENT1 To TIl

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character. It was stated that Dr. Daly and Mrs. Hallidiy wereliving together and wished to marry, but the doctor's wife hadnot instituted divorce proceedings.

The Committee found the facts proved, judged Dr. Dalyto have been guilty of infamous conduct in a professionalrespect, and instructed the Registrar to erase his name fromthe Medical Register. The decision is subject to appeal.

Charges of CanvassingThe Committee next considered the case of Adam Wensley,

registered as of London Road, Retford, Nottinghamshire,against whom it was alleged that he had canvassed thepatients of Dr. Kool Want, of Retford, with a view to induc-ing them to become patients of his for the purpose of the

National Health Service Act, 1946. Dr. Wensley appearedand was legally represented by Mr. Leigh Taylor, ofHempsons, solicitors, on behalf of the Medical DefenceUnion. The complainants were the Medical ProtectionSociety, represented by Mr. Norman Richards, counsel.instructed by Le Brasseur and Oakley.

Eleven charges were set out, but one was withdrawn becausethe witness was not present and a statutory declaration wasdeemed inadmissible. In each of the cases the allegation was thesame-namely, that Dr. Wensley had canvassed certain personswith a view to inducing them to transfer themselves, and in somecases their families, from the National Health Service list of Dr.Kool Want, his former partner, to his own. About ten witnesses,all of them Dr. Kool Want's patients, went into the box andtold a similar story, that they had called at the partnership surgeryor that Dr. Wensley had called upon them, and had said that ifthey wished to remain under his care they should take the neces-

sary action with regard to their cards. One witness said thatshe understood that Dr. Kool Want was giving up practice.

After the evidence of these witnesses Mr. Leigh Taylor submittedthat in respect of five of the ten charges, according to the evidencegiven by the witnesses, he had no case to answer. In certain ofthese cases Dr. Wensley was alleged to have said, " If you wantme to carry on attending you, you will have to let me have yourcard." His submission was that that was no evidence of canvass-ing; it was simply the statement of a fact, and there was noinducement offered to transfer. He had merely told these peoplewhat they had to do, on the dissolution of the partnership, ifthey and their families wished to remain as his patients. Noattempt was made to persuade them to change their doctor. Inone of the cases the witness called at the surgery and was toldby Dr. Wensley that the doctors were parting, and that if hewanted him to go on treating him he should let him have hiscard, but if he did not so want him, he need not do anything; theclear option was offered, and there was no inducement.Mr. Norman Richards, on behalf of the complainants, said that

Dr. Wensley had stated to the various witnesses that if they wantedto have him as their doctor they must let him have their cards;there could not be a clearer case of canvassing.

The Committee went in camera to consider these submis-sions and afterwards the Chairman announced that in twoof the five cases mentioned by Mr. Taylor they had foundthat Dr. Wensley had not been guilty of infamous conductin a professional respect. The other charges remained tobe argued.

The Case for the RespondentDr. Adam Wensley, in the witness stand, said that he was

a Pole, born in 1904. He was mobilized on the outbreak ofhostilities, and went with sections of the Polish army toRumania and afterwards to France. When France fell hecame to England and served with the Polish army here. In1942 he went to the Polish School of Medicine at EdinburghUniversity and qualified M.B., Ch.B. in 1946. He servedin a hospital appointment until 1949 and was then invitedinto partnership with Dr. Kool Want, an Indian, at Retford.The partnership was begun in February, 1950, but no partner-ship agreement was ever signed.

Dr. Want at that time was a sick man, suffering from myo-cardial failure, and Dr. Wensley at first did most of the work ofthe partnership. On May 11, 1951, he received a letter fromDr. Want's solicitors giving a month's notice of termination ofthe partnership. Apart from one incident there had been nodisagreement between the parties, and the notice came to hinm as

264 DEc. 15, 1951

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a complete surprise. Meanwhile he had bought a house inRetford, with Dr. Want's knowledge. At the time the partnershipended Dr. Want had a National Health Service list of about3.000 and he had one of about 200. All the patients were treatedas patients of the partnership.He then decided to open his own practice in Retford and

obtained the approval of the executive council. The premises heultimately obtained were away from Dr. Want's, on the otherside of the main centre of the town. Asked what steps werewaken to make known to patients the dissolution of the partner-ship, he said that the news spread quickly through the small-town; he informed his own patients. A lot of Dr. Want's patientsasked him what they should do about changing their card. At notime did he invite or encourage anyone to come over to him, nor,did he ever intentionally suggest that Dr. Want was too ill tocarry on practice. In the month following the dissolution ofpartnership about 500 patients-in the main those whom he hadbecn treating, or members of their families-changed over to him.He said that some of the witnesses had misapprehended his words.-He denied having said the things they attributed to him. Forinstatlce, one of the witnesses had said that he had spoken of his" panel "; it was a word he never used.Asked in cross-examination whether all the witnesses were lying,

hle said that the story they had told was a complete fabrication-a lie, Only when patients asked him how they should proceedto transfer did he tell them what to do with their cards.

Mr. Leigh Taylor, in the course of a final speech on behalfof the respondent, commented on the fact that the aggrievedperson (Dr. Want) had not been called as a witness. It wouldhave been interesting to have heard more about this partnership.

Mr. Norman Richards said that it was not just a question ofpartnership. The charges were in respect of canvassing, and theonly people who could give evidence as to canvassing were those-who were canvassed.

After the Committee had considered the case in camera,the Chairman announced that it had found that none of thefacts alleged against Dr. Wensley in the charge had beenproved to its satisfaction. It had accordingfy judged thathe had not been guilty of infamqps conduct in a professionalTespect in regard to any of the facts mentioned. That com-pleted the case.

Alleged Adultery During Professional RelationshipThe Committee considered a charge against Griffith John

Griffiths, F.R.C.S., registered as of De Parys Avenue, Bed-ford, who appeared on the charge that he had committed.adultery with Gertrude Evelyne Hills, a married woman, of'which adultery he had been found guilty by the decree of theDivorce Division of the High Court of Justice dated Febru-ary 2, 1950, and made absolute on March 23, 1950, in thecase of Hills v. Hills and Griffiths, in which he was the co-

respondent, and that he had stood in professional relationshipwith the said Gertrude Evelyne Hills at the material times.

Mr. Griffiths was represented by Mr. Leigh Taylor, of Hemp-sons, solicitors, on behalf of the Medifal Defence Union. Thefacts were placed before the Committee by Mr. Gerald Howard,K.C., M.P., on behalf of the Council's solicitors, Messrs. Water-house and Co.

Mr. Howard said that the adultery in this case continued from1935 to 1942. Mr. Griffiths, who at the beginning of that time'was in general practice in Bedford, first attended Mrs. Hillsor her child in a professional capacity in 1935, and familiaritydeveloped. Evidence in support of the charge was given byMrs. Hills...Mr. Griffiths, in the witness box, said that he deeply andsincerely regretted this conduct, and added that long before anydivorce proceedings were undertaken he had made a clean breastof it to l.s wife, who had forgiven him.The Committee found that the facts alleged against him in the

charge had been proved to its satisfaction, and then asked whetherthere was any p'ea in mitigation or evidence as to character.

Sir Gordon Gordon-Taylor said t'.at he had known Mr.Griffiths, who was formerly his house-surgeon, for about 20 years.He was very much respected and everybody spoke well of him.He had the greatest regard for him, alike for his personality andfor his keenness and ability as a surgical specialist. He was amember of the Council of the Section of Proctology of the RoyalSociety of Medicine.Mr. Edward Naggier Graham, F.R.C.S., of Bedford, also said

that he had known Mr. Griffiths for 20 years. He was a verylikeable type of man, kind to his patients, and held in highesteem in the surgical world.

Mr. Leigh Taylor, after putting in other testimonials, said thatthis adultery, which had ceased nine years ago and for which Mr.Griffiths had suffered deeply, was one lamentable lapse in anotherwise most honourable career. For fifLeen years Mr. Griflithshad lived in the shadow of these proceedings, and in 1949, whenhe was beginning to think that the past was forgotten, the divorceproceedings relating to incidents so long ago were started.

After the Committee had deliberated in camnera the Chair-man announced that it had judged Mr. Griffiths to have beenguilty of infamous conduct in a professional respect in rela-tion to the facts set out in the charge, but it had not seenfit to direct the Registrar to erase his name from the Register,and this closed the case.

Cases Arising from ConvictionsThe Committee considered the case of Henry Charles

Coutts Hackney, registered as of Kelvedon Common, Brent-wood, who appeared on the charge that in July last he wasconvicted at the Central Criminal Court on an indictmentthat he had conspired with other persons to cheat anddefraud by false pretences and that with intent to defraudhe had obtained from one Jack Lawrence Wood £100, andhad been ordered to be imprisoned for nine months. Theconviction was admitted, and particulars were given of someprevious convictions. In May, 1944, his name had beenerased from the Register and was restored in December, 1950.A solicitor gave evidence for Dr. Hackney, whom he hadknown for' more than 20 years. He had never heard a wordagainst his professional reputation, but he was foolish insome other matters. He had been misled and had got intobad company. The Committee instructed the Registrar toerase the name from the Register.The case next considered was that of Patrick Joseph

Conlin, registered as of Mardy, Ferndale, Glamorgan, againstwhom it was alleged that in September, 1950, he had beenconvicted at Chesterfield of being in charge of a motor-carwhile under the influence of drink. It was stated that therehad been previous convictions for similar offences, and hisname was erased from the Register in 1942, but restored in1945. The Committee decided to give Dr. Conlin one furtheropportunity, and postponed judgment until November, 1952,when he will be required to appear with testimonials.The Committee considered the case of William Allan,

registered as of Burnley Road, Sowerby Bridge, Yorkshire,who appeared on the charge that he had been convicted on

April 12, 1951, at Todmorden of driving a motor-car whileunder the influence of drink. Thqe had been previous con-victions for similar offences and Dr. Allan had appearedbefore the General Medical Council in 1946, when judgmentwas postponed. There were various subsequent adjourn-ments of the case in view of the fact that Dr. Allan was inhospital receiving treatment. It was stated that he was now

again receiving treatment, which was having satisfactoryresults. Dr. Allan said that he had mastered his tendency toalcoholism, and only broke down on the occasion whichled to this last conviction owing to overwork. The Chairmansaid that this was not the first time that Dr. Allan hadappeared before them, and the Committee took a seriousview of such cases. To give him one more opportunity theywould postpone judgment until November, 1952, when hewould be required to appear with testimonials.The next case was that of Patrick Kennedy, registered as

of East Dulwich Road, London, S.E., who appeared on thecharge that he had been convicted at Birmingham in 1949and at Bow Street in 1951 of being drunk. It was stated thatDr. Kennedy was before the General Medical Council in1941 after similar convictions and judgment was postponeduntil 1943, when the Council did not see fit to erase his name.The Chairman said that here again they would give thedoctor a further opportunity and postpone judgment untilNovember, 1952.The last case was that of Hugh McNicholl, registered as of

High Road, Mottingham, who appeared on the charge thathe had been convicted at the Maidstone quarter sessions inMarch, 1951, of being in charge of a motor vehicle whileunder the influence of drink and had been ordered to be

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266 DEc. 15, 1951 GENERAL MEDICAL COUNCIL SUPPLEMENT To TwIlBRITISH MEDICAL JOURNAL

imprisoned for six calendar months and disqualified fromholding a driving licence for seven years. It was stated thatthere had been similar convictions in 1939 and 1942, andan inquiry before the General Medical Council in November,1942, when judgment was postponed until November, 1943,and then it was decided not to erase the name. Testimonialsas to Dr. McNicholl's high character in his profession wereread from Mr. E. Hesketh Roberts, F.R.C.S., and others. lnthe witness box Dr. McNicholl said that at the time of thisoccurrence he was suffering severely from influenza, and infact had just installed a locumtenent (who also gave evidence)in his practice to take over until his recovery. He had takenvery little alcohol, and was prepared to give an undertakingnot to take any. In this case also the Committee postponedjudgment until November, 1952, when Dr. McNicholl wouldbe required to appear and furnish testimonials from his pro-fessional brethren or others.

Correspondence

Discipline in the N.H.S.SIR,-You have once again raised the matter of disciplinary

action against doctors (Journal, November 24, p. 1267). Itseems to me that there is a fundamental principle involvedhere of the widest application. The tribunal before whichcases are brought has not the power of life and death, butit has the power of something not very far from it-thepower to prevent a doctor from earning his living. It hasalso the power to inflict heavy fines.The independence of the judiciary from the executive is

the strongest safeguard of liberty we possess. Destroy thatindependence and dictatorship is at hand. Yet here we havea body, the tribunal, existing side by side with the judiciary.wielding similar powers, but lacking entirely in the proce-

dures and safeguards which represent the accumulated legalwisdom of centuries. Such a dilution can only result in a

weakening of the judiciary, with disastrous possibilities. Ifthe machinery set up by the Minister of Health is acceptedas a precedent, what is to prevent other Ministries setting upsimilar machinery ? The Ministry of Food might set tupa tribunal to deal with offences against food regulations, theMinistry of Fuel one to deal with offences against fuelregulations. These are not exact parallels but they are near

enough.The Ministries are at present sufficiently powerful in all

conscience. Add to their powers to regulate the details ofour daily lives the power to supplant the courts of law, andthe liberty of the citizen, already lopped and pruned, willbe cut off at the root.-I am, etc.,

Peebles. W. A. S. THOM.

Deplorable InterferenceSIR,-This is a serious letter of protest on behalf of the

medical staff of the Torbay Hospital in connexion with thedecision of the South-western Regional Board to take overthe septic beds for the housing of tuberculous cases. Thesewards consist of seven or eight beds in three rooms, in a

block off a main corridor, a few yards from the children'sward and maternity block.The Torbay Hospital, an acute area hospital of some 170

beds, was considered during a survey in 1947 as being toosmall in all departments for the demands made on it. We onthe staff know only too well how true this is, in common,I am sure, with similar conditions in most busy hospitals.The demands on our beds have been increasing yearly andeven more so since the appointment of new specialists, allof whom would like a bed here and there.

It is at serious business to lose the septic block, for itmeans that the infected, unpleasant, noisy, and otherwiseexceptional cases from any departments will not be able tobe isolated. The local public have been told this by the Press

and there is much indignation. Through the Fellowship forFreedom in Medicine the matter has also been- raised inthe national press.

Alternative accommodation for these tuberculous caseswas swept aside on various pretexts, and it seems that themain object of the planners was to save expense-anotherexample of cheapening medicine, using the word in bothsenses; a deplorable interference which we have to waste-time fighting; a senseless bureaucratic ordering about, inignorance of local affairs, to fit some prearranged pattern.

So far the difficulties confronting the matron, the protestsof the medical staff and management, and the indignant presshave had no visible effect: the decision to deprive thehiospital and the public of these precious beds still exists. Itmight be helpfuil if similar problems threatening otherhospitals were ventilated in your correspondence columns.-I am, etc.,Torquay. W. ETHERINGTON-WILSON.

Government Committee on General PracticeSIR, l am perturbed at the apparently short-sighted recep-

tion, as reported in your columns, given by the Conferenceof Local Medical Committees (Suppletnent, November 10,p. 197) and the members of Council (Supplement, Novem-ber 17, p. 209) in regard to the evidence to be given beforethe Government Committee on General Practice.The questionary circulated by this Government committee

is a tricky document. Most of the questions are of the" Have you stopped beating your wife yet ? " variety.Nevertheless, there is little doubt that the report, if everpublished, will be the guiding star for future administratorsof general practice for many years to come.

General practitioners hope that the B.M.A. is capable ofrising to the occasion with more success than in 1948. Theproposal that the B.M.A. should co-operate with the numer-ous other medical bodies who are at present quietly andbusily submitting evidence on their own, by submitting aunified report, appears to me to be sound and statesmanlike.Your report that Council "decided to let the matter go

on for the time being" is a fair reflection on the present-day attitude of the B.M.A. towards general practice. Itrust that other G.P.s will watch carefully all future state-ments made regarding the submission of evidence to thiscommittee.-I am, etc.,

Batley. Yorks. JAMFS A. WARD.

Civil Service DoctorsSIR,-The unanimous verdict of the medical press on the

Howitt report may be summarized in the words of theMedical Officer of November 24 (p. 208): " If ever a com-mittee has miscalculated the law of supply and demand inrelation to material that should be of the best quality, hereis the example of it." My purpose in adding my smallcontribution to the clamour is to stress how urgent is theneed for action and to indicate the type of action required.Urgency is indicated because of danger to the Government

doctors, to the profession as a whole, and to the country. Itmight be said that men who have waited three and a halfyears for their increases can wait a little longer, and thata man should be able to live on a provincial maximum of£1,625. But Government doctors with pre-war salaries of£1,150 or £1,200 naturally entered into commitme~nts whichthey can no longer meet, and some of -them already havesubstantial overdrafts. The danger to other members of theprofession is not only that the Howitt proposals "-willobviously be used as a focal point for an attack on therenmuneration of consultants and general practitioners " (andon that of university staffs, local-government doctors, etc.),but also that these proposals, unless vigorously resisted, willenable the Treasury to carry out the policy of divide andconquer. For example, it does not take much imaginationto see that, if the consultants take no interest in the welfareof the doctors in the Ministry of Health, the latter might inretaliation suggest to their political head that a substantial

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DEC.15,1951CORRESPONDENCE BRITISHUPPLEMELNT TO14 26

saving could be achieved by reducing distinction awards. Asituation in which 25 doctors have left the Ministry' of Healthwithin three years, and in which the Ministry and Depart-ment of Health have advertised vacancies in England andScotland respectively but have been unable to fill them, ismanifestly dangerous to the country, and might be disastrousin the event of war or of a major epidemic; and to fillresponsible posts with doctors of inferior quality wouldbe akin to sabotage.The B.M.A. and the appropriate Civil Service associations

submitted a claim for increased remuneration of Governmentdoctors in 1949. The then Chancellor declined to negotiate,but in 1950-faced with a complete ban on advertisements-he adopted the stalling device of seeking the opinions of acommittee of his own nominees; and that committee, whichwas in no sense an arbitration tribunal, has now given itsadvice. I understand that at the beginning of Novemberthe Chancellor was informed in writing that negotiations onthe 1949 claim had not yet taken place. Since then onemonth has already elapsed.

I suggest, Sir, that if negotiations have not made sub-stantial progress before the next meeting of the Council ofthe Association, the Council should forthwith impose a banon advertisements for all medical posts in Governmentemployment, full-time or part-time, permanent or temporary.Such drastic action will not only ensure more rapid con-sideration of the claim, it will also avert the very realdanger of responsible posts being filled by third-raters.-Iam, etc.,

GOVERNMENT M.O.

History at a GlanceSIR,-Since the initiation of the National Health Service

I have felt the need of a condensed previous history of mypatients. For the past two and a half years I have beenusing a rubber stamp which fits into the upper right-handcorner of the record envelopes, Forms E.C. 5 and 6. Thestamp measures 2 in. by I in. and is set out as follows:

Pert/ Mea/SF/MumGM /CP/Dip/Glas .........Blood . ..

.. .... .... ... .........

The following diseases are thus represented: pertussis,measles, scarlet fever, mumps, german measles, chicken-pox,diphtheria. Form O.S.C.1, if issued, is entered against" Glas," and the entries against " Blood " are the Rh factorand other blood groups. The free space beneath is left forother important illnesses relevant to the patient's history.If the patient has had, or develops, a disease shown on thestamp, that disease is crossed out.The use of this stamp rules out the necessity of going

through all the patient's records in search of previous history.I can turn to the back of the envelope and see at a glancewhat I want to know. I suggest that something similarcould be incorporated in future issues of Forms E.C. 5and 6.-I am, etc,

Bristol. P. S. SINCLAIR.

Payment of Dispensing Doctors

SIR,-At this time, when so many aspects of general prac-tice are under review, may I plead the cause of that hard-worked individual, the dispensing doctor ?Few rural practices will support a secretary-dispenser, and

for the vast majority the system whereby prescriptions aredispensed against Forms E.C.10, which are then sorted andsent to the pricing bureau, is far too time-consuming. Ifthe doctor dispenses on a capitation fee, there will often beoccasions when he wishes to provide a drug which does notfigure on the arbitrary list of "specially expensive drugs "

but which will absorb his dispensing fees for many patientsfor several years at one stroke. It is surely asking too muchof the doctor to make him undertake the extra burden ofdispensing, with the prospect of being actually out of pocketon this part of his work.

The remedy is simple. Let it be recognized that in certainareas, where the services of a retail pharmacist are not avail-able, the doctor undertakes to dispense for his patients. Forthis service he should receive a small capitation fee of, say,2s. 6d. per annum. Let him obtain his stock of drugs eitherfrom the manufacturers or from wholesale chemists free-possibly on special order forms provided by the executivecouncils-and let these order forms, duly certified by thedoctor, be presented by the suppliers for payment. In thisway no doctor need worry about a prospective loss in hisdispensary account; fluctuations in drug costs will not affectmethoes of payment; and prescribing costs will be moreeasily checked by executive councils.-I am, etc.,

Newbury, Berks. JoHN RICHARDS.

Off SchoolSIR,-1 would like to draw your attention to a practice

which is becoming increasingly prevalent in my area andwhich I feel is unnecessarily wasting the valuab!e time ofthe general practitioners-namely, the increasing demand ofschool-masters for a medical certificate when a child is awayfrom school for even a short time. Previously, when a childhad a minor upset necessitating a short absence from schoola note from the mother to the school was consideredadequate. Now not a small proportion of the childrenwho attend my surgery do so only for a medical certificate.

Cotuld not general practitioners in areas where this prac-tice is frequent combine in refusing to give certificates toschoolchildren, thus allowing ourselves to devote more timeto the children whose mothers need our advice as doctors ?-I am, etc.,

London, S.E.16. JOSEPH ARMSTRONG.

Compulsory RetirementSIR,-Reference theletters appearing in the Supplement on

this subject, I wish to support the views expressed. As onewho has been hit financially in two world wars, I haveendeavoured to find employment on medical boards, but findG.P.s with maximum panel practices preferred to retireddoctors. I appeal to the B.M.A. to take up the plight ofretired doctors.-I am, etc.,

Southport. S. THEO. BEccs.

POINTS FROM LETTERSTracing Patients

Dr. D. LEIGH (Wantage, Berks) w,rites: Drs. D. M. Bladon andC. S. Shepherd complain bitterly of the purging of their lists(Supplement, November 24, p. 231). I should like to say (hat Iconsider the executive council's action definitely in the bestinterest ot the Coventry doctors. Dr. Bladon admits that the oldpractices are much harder hit than the new ones. This is thecrux of the matter. New doctors have to do something activelyfor practically every patient that signs on. Their lists are com-posed very largely of living patients that are or have been recentlyin need of care. The older a practice gets, the more patientswill there be on the list that have been missed by the councilwhen they should have been removed. One can assert that, as ageneral rule, the younger the practice the more work is done per1,000 patients on the list. It is utterly immoral that old-establishedpractices with huge numbers of defunct patients should keep thecapitation rate down for the active young practices....

Declining Capitation FeeDr. DENIS P. FITZGERALD (London, E.10) writes: May I

endorse whole-heartedly the opinions expressed by Dr. P. P.Slater (Suipplement, November 24. p. 231) ? I think the medicalprofession, particularly the general practitioner, has been morethan disgracefully treated by an incompetent body of administra-tors, even though I have had the good fortune of being appointedto a practice under the N.H.S Why cannot we have leaderswith the spirit of women like Dr. Slater ? Surely our professionmust have a few thousand with her point of view, and must this" vicious exploitation," as she so aptly puts it, go on and onwith an occasional irate practitioner writing a letter in theSupplement when the spirit moves him ?

DEc. 15, 1951 CORRE-'

260 DEC. 15, 1951 ASSOCIATION NOTICES SUPPLEMENYT TO TIHEBRITISri MEDICAL JOURNAL

H.M. Forces Appointments

ROYAL NAVYActing Interim Surgeon Lieutenant-Commander T. C. Barras

has been transferred to the Permanent List of the R.N., in therank of Acting Interim Surgeon Lieutenant-Commander.Acting Interim Surgeon Lieuteniant-Commander (Emergency)

J. P. Griffiths to be Surgeon Lieutenant-Commander (Emergency).

ARMYMajor-General K. A. M. Tomory, C.B., O.B.E., K.H.P., late

R.A.M.C., has retired on retired pay.Brigadier (Tenporary Major-General) A. J. Beveridge, O.B.E.,

M.C., K.H.P., late R.A.M.C., to be Major-General.Brigadier F. K Escritt, O.B.E., late R.A.M.C., has been

appointed a Deputy Director, Medical Services, and has beengranted the temporary rank of Major-General.

Colonel F. C. Hilton-Sergeant, late R.A.M.C., to be Brigadier.Colonels W. C. MacKinnon and T. H. Twigg, late R.A.M.C.,

have retired on retired pay.Colonel J. W. Hyatt, late R.A.M.C., having completed four

year's in the rank, is retained on the Active List supernumerary toestablishnent.

Lieutenant-Colonels A. N. B. Odbert, O.B.E., and S. W. KArundel, from R.A.M.C.. to be Colonels.

HIOUSEHOLD CAVALRYR.H.G.-Surgeon Major H. A. Ledgard to be Surgeon

Lieutenant-Colonel.

ROYAL ARNMY MEDICAL CORPSLieutenant-Colonel W. II. Hargreaves, O.B.E., has been

seconded under the Foreign Office.Majors K. P. Brown, M.B.E., and J. C. Watts, M.C., to be

Lieutenant-Colonels.Majo. F. McKibbin, O.B.E. (Retired and Re-employed), has

reverted to retired pay and has been restored to the rank ofColonel on ceasing to be re-employed.Major A. R. Laing, from Short Service Commission, to be

Major.Captain M. G. Jackson-Smyth to b. Major.Short Service Commission, Type " B."-Major W. S. Angus has

etired, receiving a gratuity.Short Service (Specialist) Comlnission.-Major D. G. Milne has

retired, having received a gratuity. Captain M. M. Munro to beMajor.

Short Service Commissions.-Captains C. A. G. Duffy, L. F.Jeffcoat, T.D., P. K. Murphy, and V. 0. G. Smyth to be Majors.

REGULAR ARMY RESERVE OF OFFICERSMajor-General 0. W. McSheehy, C.B., D.S.O., O.B.E., late

R.A.M.C., having attained the age limit of liability to recall, hasceased to belong to the Reserve of Officers.

Colonels (Honorary Brigadiers) E. M. Townsend, M.C., G. S.Douglas, A. R. Oram, O.B.E., MI.C., and J. S. K. Boyd, O.B.E.,late R.A.M.C., having attained the age limit of liability to recall,have ceased to belong to the Reserve of Officers.

Colonel T. H. Sarsfield, O.B.E., late R.A.M.C., having attainedthe age limit of liability to recall, has ceased to belong to theReserve of Officers.

ROYAL ARMY MEDICAL CORPSMajor (Honorary Colonel) B. E. Schlesinger, O.B.E., having

attained the age limit of liability to recall, has ceased to belongto the Reserve of Officers.Major (Honorary Lieutenant-Colonel) I. Buchanan, having

attained the age limit of liability to recall, has ceased-to belongto the Reserve of Officers.Major (Honorary Lieutenant-Colonel) J. W. Crofton has ceased

to belong to the Reserve of Officers.Majors I. C. Thomson and E. W. Vincent have ceased to belong

to the Reserve of Officers.Captain (War. Substantive Lieutenant-Colonel) J. C. McGrath,

M.C., having attained the age limit of liability to recall, hasceased to belong to the Reserve of Officers, and has been grantedthe honorary rank of Colonel.

Captain (Honorary Major) C. G. O'Driscoll has ceased tobelong to the Reserve of Officers.Captain J. H. T. Challis, having attained the age limit of liability

to recall, has ceased to belong to the Reserve of Officers, and hasbeen granted the honorary rank of Major.

COLONIAL MEDICAL SERVICEThe following appointments have been announced: M. A. Byer.

M.B., Ch.B., M.P.H., Medical Officer, Grade B. Health Depart-ment, Trinidad; F. G. Domaingue, M.B., B.S., D.T.M.&H., D.A.,Specialist (Anaesthetist), Mauritius; M. A. Fawkes, M.B., D.P.H.,Venereal Diseases Specialist, 'Trinidad; E. F. B. Forster, M.B.,Ch.B., Alienist Specialist, Gold Coast; S. C. Kuo, M.B., B.S.M.P.H., Medical Officer, Hong Koiig: R. F. Payne, M.R.C.S.,

L.R.C.P., Medical Officer, Fiji; J. G. Grounds, M.B., Ch.B., andD. O'Keefe, F.R.C.S., Medical Officers, Kenya; D. M. Cassidy,M.B., Ch.B., and P. G. W. A. Lommerse. M.B., Ch.B.. MedicalOfficers, Tanganyikn; P. I. Franks, M.R.C S., L.R.C.P., D.O.M.S.,Medical @fficer, Federation of Malaya; W. A. S. George, M.B.,Ch.B., Medical Officer, British Honduras; J. D. Macgregor,M.B., Ch.B., Medical Officer, Sierra Leone; C. J. Berry, M.B.,Ch.B., Temporary Medical Officer (Pathologist), Nigeria; MissK. M. Ellis, M.B., Medical Officer, Nigeria; J. A. Mahoney,M.R.C.S., L.R.C.P., Medical Officer, Gambia: K. M. Mehta,M.B., B.Ch., Surgeon, North Borneo.

Association NoticesDiary of Central Meetings

DECEMBER14 Fri. Ophthalmic Qualifications Committee, I p.m.14 Fri. Ophthalmic Group Committee, 2 p.m.14 Fri. Public Health Committee, 2 p.m.18 Tues. Building Committee, 2 p.m.18 Tues. Join, Committee of B.M.A. with Pharmaceutical

Society, 2.15 p.m.19 Wed. Education Conference Subcommittee, Inter-

national Relations Committee, 11.15 a.m.19 Wed. Film Committee, 2 p.m.20 Thurs. General Medical Services Committee, 11 a.m.20 Thurs. Evidence Conimittee on Marriage and Divoorce,

2 p.m.JANUARY

2 Wed. Private Practice Committee, 2 p.m.3 Thurs. Evidence Committee on Marriage and Divorce,

2 p.m.7 Mon. Armed Forces Committee, 2 p.m.16 Wed. General Practice Review Committee, 11 a.m.22 Tues. Staff Side of Committee C, 10 a.m.22 Tues. Whitley Committee C (at 1, Richmond Terrace,

Whitehall, S.W.), 12 noon.

FEBRUARY6 Wed. General Practice Review Committee, 11 a.m.

Branch and Division Meetings to be HeldSUTHERLAND DIvISION.-At Sutherland Arms Hotel, Lairg,

Wednesday, December 19, 6 p.m., B.M.A. Lecture by ProfessorStanley Alstead: " The Medical Knowledge of William Shake-speare." A dinner will follow.

Meetings of Branches and DivisionsWEST BROMWICH AND SMETHWICK DIVISION

At the Annual General Meeting of the Division, held onNovember 18, the following officers were elected for the 1951-2session: chairman, Dr. G. J. Garratt; deputy chairman, Dr. E.Condon; hon. secretary and treasurer, Dr. C. E. Matthews;Asst. hon. secretary and treasurer, Dr. L. T. H. Mills; representa-tive on the Representative Body,-sDr. D. Saklatvala; representativeorfAhe Branch Council, Dr. L. T. H. Mills; Executive and EthicalCommittee, Dr. Clyde McKenzie, Dr. J. H. Mitchell, Dr. A. M.Stevens, Mr. W. E. Wimberger.On vacating the chair and installing the new chairman, Mlr.

W. E. Wimberger thanked the members for the support they hadgiven him during his year of office, during which he thought theyhad achieved a very useful year's work. He expressed his wishesto Dr. Garratt for a happy year as chairman of the Division.

In reply, Dr. Garratt expressed his thanks and appreciation tothe Division for electing him chairman, an office which he woulddo his utmost to fill with efficiency and dignity. He thankedMr. Wimberger for his services during the year. Mr. Wimbergersuitably replied.The chairman also expressed, on behalf of the Division, thanks

to the retiring hon. secretary, Dr. Lewis, and the assistant hon.secretary, Dr. Mills, for their work during the year. He alsoexpressed, on behalf of the Division, congratulations and goodwishes to Dr. Lewis on his new appointment, to which Dr. Lewisr-eplied.

HOLLAND DiV'ISIONA meeting of the Division was held at Spalding on November

2. There was a very good attendance, and after supper themeeting was addressed on " Backache " by Mr. H. E. Harding(Dean of Westminster Hospital Medical School). He stressedthe importance of real team-work between general practitionersand consultants in the investigation and subsequent treatment ofthis common and often intractable complaint. He kept hisaudience keenly attentive until a late hour. On the motion ofthe chairman, Dr G. Walker, he was most cordially thankedfor his address and for his kindness in journeying from Londonto deliver it.

Pubished by the Proprietors, the British Medical Association, Tavistock Square. London. W.C.1, and printed by Fisher, Knight &-Co., Ltd.,The Gainsborough Press, St. Albans. Printed in Great Britain. Entered as Second Class at New York. U.S.A., Post Office.