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of area of early infraclavicular infiltration ; area of primaryinfiltration well defined ; no sign of secondary deposits ; no

further calcification of small infraclavicular focus on rightside. No abnormal calcification in region of kidneys or ofarteries of abdomen.No tubercle bacilli were found in a concentrated 24-hour

specimen of urine.Similar toxic symptoms have been met with fairly

often in other cases, and the earliest symptom hasinvariably been thirst, followed by nausea and vomiting.Reduction or cessation of treatment causes a retrogressionof symptoms. In 9 cases there was no rise in serum-calcium but often a rise in inorganic phosphorus notrelated to symptoms or to clinical improvement. Noother case showed a raised blood-urea. Erythrocyte-sedimentation rates were apparently not significant.The rather stormy course of this patient is a warning

of the dangers of this form of therapy. Thirst is appar-ently often present in patients receiving massive dosesof calciferol. Though not necessitating a reduction indosage, this symptom is, I suggest, an indication thatthe limit of tolerance is being approached, and possiblythat the optimal dosage is being administered. I wish toemphasise the necessity of medical supervision of casesof lupus vulgaris on this form of therapy.

I am indebted to Dr. M. Sloan Smith for permission toDublish this note.

Victoria Infirmary, Glasgow. R. WORKMAN CARSLAW.

ANALGESIA IN LABOUR

SiB,—In accordance with the views expressed byDr. John Elam in your issue of April 26, an experiencedanaesthetist upon the staff of the Municipal GeneralHospital, interested in the relief of pain in labour,visits the Croydon Obstetric Unit twice weekly to super-vise and encourage the staff in the administration ofanalgesia in labour, and to inspect frequently gas-and-air apparatus so as to correct small mechanical defectswhich may otherwise lead to bad results. Minnitt’sgas and air, Chassar Moir’s attachment, and Trilene’will be used according to the special needs of each case.A pamphlet is to be issued to expectant mothers

describing what steps will be taken to relieve pain inlabour and explaining the correct use of the apparatusand at which stage of labour it will be used. A Minnitt’smachine will be demonstrated in the antenatal clinic forexpectant mothers to familiarise themselves with the useof the machine. By these methods it is hoped that theelement of apprehension, which appears to play a largepart in the pain experienced in labour, will be allayed,and that analgesia will be used to the best advantage.

I agree with Dr. Elam that the relief of pain duringconfinement is a primary duty of those conductinglabour, and it is incumbent upon us to use to the fullrecent advances in the relief of pain in labour so thatconfinement will not be the nightmare of former days.

This letter is endorsed by the M.O.H. of Croydon,Dr. Oscar Holden.

A. F. CLIFTSenior Obstetrical Officer, Croydon County Borough.

EX-SERVICE ADMINISTRATORS

SIR,-That only " Enmeshed " (April 26) has com-mented on " Burma Star’s " letter (Feb. 15) must bedue, I think, to the number of ex-Service doctors whoserved in India and Burma still feeling exhausted aftertheir struggles with the regular Army and I.M.S. adminis-trators during the recent war. All of us who were outthere know what the position was. But we are only asmall percentage of those on the Medical Register, andin any event have practically no voice in the appointmentof administrators in the National Health Service.The ex-regulars will honestly be able to say they

have had administrative experience. Unfortunately,however, they have had no training in administration,and adopted that task either because of the easier promotionand higher rank obtainable or because of lack of clinicalability, or both. The good medically qualified adminis-trator is rare, since he requires the same qualities asa good clinician and usually prefers the latter role.

CHARPOY BASHER.

Parliament

ON THE FLOOR OF THE HOUSE

THE National Health Service Bill for Scotland passedits final committee stage and third reading in the Houselast week. It is expected that the service in Scotland willbegin, as in England, on April 1 next year. There hasbeen more socialisation of medicine in Scotland than inEngland, and the debate had a different emphasis forthat reason. Some of the Conservative opposition wasforced into a curious contradictory attitude. Lady Grant,for instance-and she speaks pleasantly and graciouslyat all times-put forward the view that " we support theBill in principle " but there was in it " much of evil."Sir William Darling, however, had no doubts. For himthe Bill was just a piece of bureaucratic machinery.The organisation of the health service, he held, was theduty not of the Government but of

"

every single citizenin Scotland "-a kind of William Morris anarchic utopia.Colonel Walter Elliot was critical, but when defendinghimself against what he thought was an unfair chargeof speaking too long he asked " Does anybody suggest...that we have not cooperated to the utmost with theMinister in bringing forward his measure ? " Thisbalance between opposition and support was a delicateone. There was practically no raging tearing oppositionbecause Scotland has already great experience of schemesallied to the National Health Service. During the war,when Scotland was a single region under the civil defenceplans, the medical organisation of the E.M.S. there wasmore thorough and complete than in England and Wales.And then there is the medical service in the Highlandsand Islands to which Mr. Buchanan, joint under-secretary,paid a high tribute. It was, he said, a service which"for devotion, self sacrifice, and capacity" is far aheadof anything connected with private practice. Indeedprivate practice in the Highlands and Islands could notexist if it were not for the State subsidy.

Mr. Buchanan, in winding up the debate, spokewithout a brief or even notes and made the speech ofthe day. Not only has he the eloquence of long practicein the House, he has the eloquence of a detached andintimate knowledge of his subject. He knows the panelsystem and the other systems of medical practice, andhe spoke of them with a fluent understanding whichcontrasted not only with the approach of his opponentsbut of some of his supporters. The present arrangementshe dubbed " a higgledy-piggled system that no-one

who knew anything at all about it would defend forfive minutes." Mr. Buchanan’s remarks ranged fromprovision for medical research, which is to be increased, tothe need for dental treatment and the free treatmentof wife and child. As for free choice of doctor, it existed" as a great deal of by-play, but not in reality.". Adoctor in a great working-class district is chosen fortwo reasons. One is his availability at the particularmoment at which his service is needed, the second is hisproximity to his prospective patient’s home. Much ofthe success of the scheme, Mr. Buchanan thought, woulddepend on the humanity of the Secretary of State andhis officials and the vigilance of the House of Commons.

It is too early yet to estimate the political effect ofthe Budget. Resentment against the tobacco tax in theHouse is considerable but is balanced by reflections onincome-tax reductions. Not enough was said about thepolicy behind the Budget and how our dollar resourcesare being used. The revolt of the Ministry of Foodrepresentatives at the high prices in the internationalwheat agreement is significant. There we were using ourpower as one of the largest import markets of the world,and it is time we did. MEDICUS, M.P.

FROM THE PRESS GALLERY

Summer Fuel Restrictions

In the House of Commons on April 24 Mr. E. SmNWELL,Minister of Fuel and Power, announced the details ofthe Government’s plan for saving fuel during the summer.A complete statutory prohibition on the use of space-heating in industrial and commercial premises wouldbe imposed from May 5, when the new Order wouldcome into force, until the end of October. Provision

617

would be made for the heating of premises in whichnight work was being done in May, September, andOctober.The new Order would also impose a ban upon the use

of electricity for space-heating in residential premisesuntil the end of September, subject to relaxation onlywhere a medical certificate was given. No statutoryrestriction would be imposed upon the use of solid fuelin residential premises, because it was already limitedby supply restrictions ; and, unless people observed equalrestraint in its use for space-heating in the summer,they would only have to pay for it later on.The Government, Mr. Shinwell continued, asked all

domestic consumers of gas and electricity to aim atsaving 25% of the amounts they consumed during thecomparable period last year-that figure, of course, toinclude the savings made by the discontinuance of theuse of gas and electric fires. The Government relied onnon-industrial and commercial consumers to makesacrifices at least equal to those asked for from domesticconsumers.

Replying to questions, Mr. Shinwell said he wasconsidering the need for space-heating in places wherethere were young children-say under two years of age-and he believed that such cases might come within thecategory of the relaxation which was to be based on theproduction of a medical certificate. It was not possibleto state with absolute accuracy what was likely to bethe saving which would result from these new restrictions,but Mr. Shinwell thought that it might be between2 and 21/2 million tons.

QUESTION TIMEFood Prices

In reply to a Parliamentary question on the cost ofstaple foods, Mr. JOHN STRACHEY, the Minister of Food,last week issued the following table.

Note.-The subsidy for beef and mutton is the average for all typesof carcass meat.

Our Calories

Mr. W. ELLIOT asked the Minister of Food what was thecalorie intake per head of the population for the latest monthfor which a dietary survey was available ; and what werethe figures for the nearest corresponding date of a yearago.-Mr. STBAOHEY replied : The latest figure we haveis for December last. It is based on a small but repre-sentative sample of working-class families and covers onlyfood eaten in the home, and not school, or any other mealstaken out of the home. The figure is 2300 calories, whichcompares with an average of 2390 in December, 1945.

Silicosis Boards

Mr. 1). J. WILLIAMS asked the Minister of National Insurancethe number of applications for certificates received by theSilicosis Medical Board from coalminers in South Wales andthe numbers who were certified totally and partially disabledfor the first quarters of 1946 and 1947, respectively.-Mr.JAr2FS GRIFFITHS replied : During January to March, lastyear, 2312 applications were received and 2424 cases weredealt with by the medical board, of which 1230 were certifiedto be suffering from pneumoconiosis. The correspondingfigures for this year are applications received 1520, cases

dealt with 2545, of which 840 were certified.-Mr. WILLIAMS :When will the Minister be able to give some reason for thisremarkable and welcome decrease in the number of appli-cants ?-Mr. GRIFFITHS : I am having a special inquirymade. The reduction is very substantial and I hope to beable to indicate that there is a turn of the tide and that weare beginning to conquer this dread disease.

Mr. WILLIAMS asked the Minister what steps he was takingto strengthen the staff of the board in South Wales.-Mr.GRIFFITHS replied : At the beginning of this year 6 newappointments were made, 2 of them to fill vacancies causedby resignation. There are now 15 doctors attached to- theboard in South Wales as compared with 11 a year ago and 8two years ago.

Priority Motor-cars for DoctorsMr. C. N. SHAWCROSS asked the Minister of Supply whether

he was aware that the efforts of the motor industry to givepreference in the delivery of motor-cars required by doctorshad proved ineffective, and that many doctors urgently inneed of motor-cars for their professional duties were unableto obtain them ; and if he would consider, with the industry,enforcing a scheme of covenants similar to the scheme pro-hibiting resale of motor-cars within 12 months, wherebymotor dealers were obliged to give priority of delivery tosuch doctors.-Mr. J. WILMOT: No, Sir. The motor industryis honouring its undertaking to give preference to the deliveryof cars required by doctors, while having regard to the claimsof the other priority users, nurses, and midwives.. Mr. SnAWCROSS : Is the Minister aware that the supply

of motor-cars for doctors came from the dealers and not fromthe manufacturers, and will he not arrange that dealersenter into covenants with the manufacturers to give priorityto doctors in need of cars ?-Mr. WIL1YIOT : I have not hadany complaints about this, but I will certainly take it upwith the industry. -

Mr. SHAWCROSS further asked the Minister if he was awarethat in regard to midwives and district nurses there was ascheme in force between the Ministry of Health and theindustry which worked very well, but there was no suchscheme for doctors. No further reply was given.

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Public Health

Local-government Areas ReviewedIN their first annual report 1 the Local Government

Boundary Commission discuss matters of principleaffecting their task, which is to make all local-govern-ment authorities effective and convenient units. Theyaim at considering the most urgent cases first, andalready 15 areas (some of them very large) have beenreviewed, this process having required no less than191 conferences with local authorities in their own areas.Preliminary decisions on all cases of real urgency will, it ishoped, be made before the end of May.Any proposal for extending the territory of a

particular local authority inevitably concerns one or

more of its neighbours, who must therefore be consulted.The size of the commission’s undertaking is indicated bythe fact that 37 counties (out of 61) and 80 countyboroughs (out of 83) have asked for boundary adjust-ments. In addition 44 other local-government unitswould like to see themselves turned into 33 new countyboroughs. Attractive as is the one-tier system of localgovernment to those who participate in it, the fullrealisation of the county boroughs’ proposals wouldreduce the population and rateable value of the admini-strative counties by 26 % and 251/2 % respectively.

1. H.M. Stationery Office. Pp. 20. 4d.