1013

Annotations

THE TERMS AND CONDITIONS

ON Tuesday the Ministry of Health issued the termsand conditions of service which are to be the basis ofcontracts for hospital and dental staff. It asks that assoon as possible hospital boards and managementcommittees should tell the doctors concerned what duties

they want them to perform as from July 5 next. Wherenew contracts cannot be arranged by that date, the exist-ing interim contracts will be extended for a further

specified period. ’

The terms and conditions have not been widelyaltered since the draft which we published substantiallyon March 19. Nevertheless there are changes in termino-logy that give a rather different picture of the service.The word " specialist " disappears, and the full-blownspecialist is now described as a consultant. The senior

hospital medical officer stands revealed as a seniormember of the service, to be appointed (like the con-sultant) by a hospital board and not (like the registrar)by a management committee. The title of S.H.M.O. isused for convenience in defining the grade, and for

purposes of official documents : but " it need not be

adopted as a title describing individual officers holdingthe posts in this grade, and boards are free to use what-ever terminology may be preferred, e.g., an anaesthetistholding a post in the S.H.M.O. grade might be given thetitle of ’ anaesthetist,’ a consultant in the same field

being called a consultant anaesthetist ’." The form ofcontract proposed for consultants and s.H.M.o.s is thesame, and " until the service has been further developedboards may find it necessary to invite some s.H.M.o.sto undertake domiciliary consultations

" for which theywill receive the same fees as consultants. All this isrational, and probably in the best interest, eventually,of the service. But it will be some time before the largebody of men and women who are engaged in specialistwork adjust themselves to the delayed discovery thatthe recommendations of the Spens Committee applyonly to the relatively small group now designatedconsultants and to juniors in training.The term " trainee specialist

"

(grades 3, 2, and 1) iswithdrawn in favour of " junior registrar," " regis-trar," and " senior registrar," and arrangements are

suggested by which hospital boards shall proceedimmediately with the grading of registrars.

" Holders of registrar posts supernumerary to establish-ment are expected, as soon as possible, to seek posts withina hospital’s normal establishment if they need further

hospital posts in order to gain experience. To minimisehardship during the transitional period, however, boardsof governors and hospital management committees mayretain men of accepted ability holding class 111 posts underthe scheme for postgraduate education of ex-Service officers,for a further period of six months in ’ supernumerary ’ postsafter the termination of their current appointment in caseswhere the latter is due to end on or before Sept. 30, 1949."

Particulars are given of the circumstances in which part-time registrar posts may be held. These will commanda maximum of nine-elevenths of the whole-time salaryappropriate to the person concerned.The memorandum accompanying the Ministry’s docu-

ment affords many valuable explanations and some side-lights. On the subject of medical superintendents it saysthat " the objective of boards should be to reduce to aminimum the time given by medical staff to administra-tive duties, and to enable them to devote their energiesto clinical work in their appropriate grade." No periodof tenure is to be specified in the contract of any hospitaldoctor except registrars, house-officers, and certaintypes of clinical assistant. The Ministry emphasises thatcalculation of the number of notional half-days worked

by part-timers must be based on the time that would betaken by an average practitioner to perform the duties,and not on the time taken by the particular practitioner.It expresses the hope that engagement of a locum willvery seldom be necessary, all practitioners being expectedto deputise for absent colleagues when necessary, evenif this occasionally involves interchange between hos-pitals. Boards may allow consultants extended leave ofabsence (without pay) to enable them to take up teachingposts in Colonial universities, provided they undertaketo return to the hospital service as soon as they comeback.

" The period of leave granted for this purpose should inno case exceed three years. At the end of such leave theboard should offer the consultant a new post (not necessarilythe one he held before his absence) or help him to find apost with another board."

The intention is that as far as possible the whole ofthe new terms of service should be applied with effectfrom July 5, 1948, and the boards are advised how tointerpret this principle in various kinds of case. Wehope thatthe Ministry will in this light reconsider a strange rulingin its memorandum of May 27 on appeals by practitionersfor a review of their grading. This seems to say that a

practitioner will be penalised financially if his successfulapplication happens to be heard after rather than beforeJuly 5.

THE SCHOOLMEN

NOT many, perhaps, of those who attended the

symposium of the Society for General Microbiology onthe nature of the bacterial surface realised that they werereviving a pleasant old thirteenth century custom. Didnot Doctor Perspicuus and Doctor Profundus, footsoreand thirsty, converge on the Sorbonne from Oxford andPavia and Valladolid, and there discuss the overcrowdingof angels on a needle-point ? It is surely not mucheasier to elucidate the physical properties of beings sosmall as bacteria as of those so remote as seraphim.Since approach in a no. 14 bus gives less opportunityfor studious reflection than a stroll from one medieval

university to another the organisers of this symposiumhad printed a series of essays by the speakers so thatno undue time should be wasted in mere factual explana-tion. Seldom has so much wisdom been packed into80 pages, and we trust that they will be reprinted in theJournal of General Microbiology. Already the bacterialsurface, some 15 square microns, has been divided

among the specialists and our attention was centred onthose who discussed the properties of the flagellum. Isthis an active organ of locomotion or a shred of capsularsubstance trailed behind a bacterium spinning like acorkscrew ? Pijper, whose heretical advocacy of thesecond view has already been discussed in these columns,lproduced one further argument : that Salmonella typhimoves just as well when its flagella have been removedby violent shaking.2 Our only doubt lies in the possi-bility of being sure that no flagella remain after thistreatment. But, true to tradition, the disputants madeno converts and reached no conclusion. Prof. A. A.Miles expounded the prolegomena like a schoolman born,and we realised what had been lost when logic left thecurriculum south of the Tweed. All the brightest youngmen know about statistical significance, but their paperssuggest that they are sometimes hazy about major andminor premisses.The form and function of a dinner fork are fairly

obviously associated. Their relation in S. typhi is dimlyvisible to those who took part in this symposium. To themedical profession as a whole it would matter little if thisorganism were shaped like .E or swam like CaptainWebb.

1. Annotation, Lancet, 1948, ii, 860.2. Pijper, A. Science, 1949, 109, 379.