751

November for Middlesex county hospitals. His recom-mendations (table D) are for net earnings and (unlikethe figures in the report) for 1946. The 1939 percentagesare taken from Professor Bradford Hill’s tables and arefor all ages.

Sir Ernest concludes by saying that " there should beopportunity for every doctor to reach n 200 by the ageof 40 and nothing to prevent him reaching the higherranges before that age."

Special ArticlesROYAL COLLEGE OF SURGEONS

NATIONAL HEALTH SERVICE

AT a meeting of fellows on May 8, Sir ALFRED WEBB-JOHNSON, the president, reported resolutions by thecouncil of the college on the National Health ServiceBill. The council, he said, concurs with the observationsof the Negotiating Committee on the proposed serviceand gives the committee its full support. It also makesthe following observations :(a) The Negotiating Committee is urged to press for

the direct and independent representation of themedical profession on whatever statutory bodiesmay be set up to administer the service.

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(b) The council reaffirms its opinion (recorded on

Feb. 27) that " State ownership of the hospitalsis in no way essential to the successful administra-tion of a National Health Service." .

(e) While approving of the principle of unified controlof hospitals other than teaching hospitals by regionalboards of satisfactory composition, the councilviews with apprehension the appropriation of trustfunds.

(d) The council does not agree that the power to retainexisting endowments and accept funds should beconfined to teaching hospitals.

(e) The institution of health centres should be experi-mental in the first instance.

The council is opposed to the principle of a whole-time salaried service.

(g) The council agrees with the Negotiating Committeethat " control " is unnecessary and undesirablein regard to the distribution of doctors. An adequatedistribution can be effected without any change ofsystem other than the offering of extra inducements sin the case of unattractive districts. -

(h) The present system of sale and purchase of thegoodwill of general practices should not be interferedwith ; but if the sale of practices is made illegal orotherwise rendered- ineffective, adequate compensa-tion should be paid.

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(i) The restrictions which it is proposed to place on theprovision and use of private accommodation inhospitals are considered undesirable. ’ Hospitalservices should be so planned as to provide for allclasses of the community, and no regulationsshould be introduced which would discourageprivate patients from going to hospital for treat-ment, or discourage specia1ists from advising themto do so. In general, the fees payable by privatepatients should be fixed by the medical professionwithout interference by outside authorities, exceptthat, when accommodation is provided at speciallyreduced rates for persons of -moderate means, it isreasonable to lay down a maximum charge forprofessional services.

The PRESIDENT said that the whole scheme shouldbe considered on its merits, and not as a political issue.The profession’s task now was to obtain such amendmentsas were considered necessary.

Mr. T. B. LAYTON suggested that there had beentoo much opposition to the Bill as a whole ; many of itsterms had been foreseen for the last 30 years. Althoughsome clauses might be disputed, two of the proposedreforms were undoubtedly timely: these were the

withdrawal of domiciliary treatment from approvedsocieties and the removal of hospitals from the local politi-cal system. Some of the issues on which the professionwas criticising the Bill should, he considered, be debatedand decided after the Bill was enacted : e most of thepoints were not suitable for inclusion in an Act, wherethey would have a degree of permanence which wouldhamper subsequent amendment. It was wrong, he

thought, to insist on the right to buy and sell practices ;this custom was not seemly in the public’s eyes, and inrecent years displeasing aspects had developed, whichwould eventually have compelled the profession to takeaction.The PRESIDENT agreed that the Bill was bold and

statesmanlike; in particular, the institution of regionalbodies which are to have full authority would be animportant advance. But there were many points for

adjustment.Mr. WILFRID ADAMS suggested that national health

should be safeguarded by a medical advisory committee.Is this Bill, he asked, emanating from leaders of theprofession ? ‘ He considered that the operation of the

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National Health Insurance Act and of the tuberculosisservice indicated the Government’s incapacity to organisethe medical service ; and he suggested that the professionshould offer an alternative plan to that advanced in theBill. The present Bill should be an interim measure ;and the Government should be guided by the professionin deciding the form of the more revolutionary changes,the introduction of which should be deferred.

Mr. DICKSON WRIGHT defended the sale and purchaseof practices, which, he said, was a guarantee of goodfaith by doctors. The effect of the Bill, he said, wouldbe to foster not only utility hospitals but also utilitydoctors.A motion by Mr. LAYTON that the council’s resolutions

and its action in supporting the Negotiating Committeeshould be approved was carried unanimously.

Medicine and the Law

ReinstatementA MEDICAL officer was appointed to the staff of Whipps

Cross Hospital in 1932, and in 1939 was drawing hismaximum salary of oB450 per annum. On August 31,1939, he’ resigned to join the R.A.M.C., which he didon the following day. About a month before he wasdemobilised he wrote to the hospital concerning hisreturn but he did not fill in a reinstatement form. Hewas informed that there was a vacancy for a temporaryappointment at the hospital and on the advice of themedical superintendent he applied for and obtainedthis appointment which carried a salary of oB350 a year.This was about a month before he was demobilised.In view of his previous service with the West Hamborough council he applied by letter for his previoussalary and for his appointment to be permanent. Hereceived the reply, however, that as he had resigned in1939 and had withdrawn his superannuation contribu-tions the council did not propose to take any action inthe matter. He appealed against this decision andthe matter was referred to the Reinstatement Com-mittee. The committee, after hearing counsel represent-ing the medical officer, made an order that the WestHam borough council was to make available for himemployment at Whipps Cross Hospital from Sept. 1,1945, at a salary of j6450 a year, plus cost-of-living bonus,on terms not less favourable to him than those whichwould have been applicable to him had he not becomea person to whom the Act applied.The practitioner was assisted and represented by the

London and Counties Medical Protection Society.

Sir Howard Florey, F.R.s., is visiting Paris and Lyonsunder the auspices of the British Council from May 18 to 25.He is to receive an honorary degree at Lyons, where he willlecture on penicillin and allied subjects.