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Government was beginning to respect, them for it.Dr. II. GUY DAIN (Birmingham), however, was sure

that things had changed : the Royal Commissionamounted to effective arbitration, he declared-butamid cries of dissent. The move to modify the council’srecommendation was defeated by 163 to 199.

An amendment frankly in favour of cooperationwith the Commission was then debated. Dr. A. H. HALL

(Brighton), president of the B.M.A., said that the effortsof Dr. Wand and others had narrowed the gap in the

dispute and he hoped that it could be narrowed stillfurther-but not, he was sure, without the aid of publicopinion, which should not be ignored in the meeting’sdecisions.

Dr. TALBOT ROGERS (Bromley) confessed that he hadhad serious doubts about the Royal Commission becauseof the probable delay in the appearance of its findingsand because of the difficulty of deploying the profession’sarguments before it. But these doubts had been com-pletely resolved. The doctors had got to give evidencesome time and Dr. Talbot Rogers hoped they wouldgive it soon. Dr. A. B. DAVIES (Walsall and Lichfield),who succeeded Dr. Talbot Rogers as chairman of theGeneral Medical Services Committee, said it was highlydesirable that the meeting’s decision should accordwith that of the Special Conference of Local MedicalCommittees held on the previous day (the conferencehad decided to defer until June a decision on the RoyalCommission and on withdrawal).

Prof. H. W. ROGERS (Belfast) said his division hadinstructed him to vote against cooperation, but hisown feeling was that to give evidence would providedoctors with a much better opportunity of having theirclaim heard. He thought it would be selfish, however,for some people who, like himself, were already gettingan adequate salary, to claim a penny more. Doctorsshould raise their eyes from the mire and bitternessand try to help the country as a whole.

Mr. T. HoLMES SELLO]tcz, chairman of the CentralConsultants and Specialists Committee, said his com-mittee had reversed a previous decision against coöpera-tion ; and the Joint Consultants and Specialists Com-mittee had asked its constituent bodies to prepareevidence.

Several speakers were concerned at the damagecooperation with the Royal Commission might do tothe public-health doctors. Dr. H. D. CHALKE (London)recalled a unanimous decision, at the last representativemeeting, to "stick together." Now the public-healthdoctors were in danger of being thrown to the wolves.

Finally, the meeting decided to accept the council’srecommendation without reservation or amendment.

WITHDRAWAL

Moving the council’s second recommendation—todefer a decision on withdrawal—Dr. WAND emphasisedthat a date on which a decision would be taken had been

deliberately omitted from the wording of the recom-mendation. It was a strong resolution : a date couldeasily be determined after cumsultations—or the break-down of consultations—when the Royal Commissionhad reported. Many amendments concerned withwithdrawal on the original agenda were not discussed ;but it was agreed to ask the Central Consultants andSpecialists Committee " to take active steps towardsa special levy in proportionate amount to help in thepresent remuneration crisis." And the B.M.A. councilwas asked to use all its efforts to increase the DefenceTrusts. If any of the representatives had a mind tocall for an immediate decision to withdraw, they keptit to themselves ; and the meeting quickly approvedthe council’s recommendation.

1. See Lancet, May 4, 1957, p. 927.

A LEGAL FIGHT?

Though the fire seemed to have gone out of the meeting,Dr. J. A. GORSKY (Westminster) struck quite a sparkwith his robust, plea for the institution of legal proceed-ings to establish whether the Spens reports constituteda legally implied contract. The surrender of rights bydoctors when they entered the National Health Servicemust, lie claimed, have some significance in law, andhe thought that the Spens report for the general practi.tioner constituted a legally valid contract. The professionshould ask the High Court for a declaratory judgmentto that effect.

Dr. W. N. LEAK (Mid-Cheshire) read to the meetingthe much-quoted paragraph 179 from the Ministry ofHealth Handbook for General Medical Practitioners.This paragraph, according to Dr. Gorsky, was admissiblein a court of law.

" Tho Central Pool is now calculated on the basis of theestimated net remuneration appropriate for general practi.tioners in 1939 (as recommended by the Spens Committeein 1946) together with a betterment factor taking account ofchanges in the value of money since that time. This amountis adjusted to take account of changes in the number ofgeneral practitiorierg participating in the Service, theirestimated remuneration from other sources, and the super-annuation contributions made by the Exchequer."

Dr. WAND said that Dr. Gorsky’s points had beenin the minds of the council in recent weeks. Eminentlegal opinion had been against going to court; but ifanother counsel were to be consulted and if he said thatthere was even a small reasonable chance of success,then it might be the thing to do. If legal advice wasagainst going to court, it would be foolish to do so. The

meeting was keen to see the prospects of legal actionexamined further, and Dr. Gorsky’s plan was referredto the council.

Public Health

Adolescents

AT the Royal Society of Health congress, held atFolkestone on April 30 to May 3, Mr. W. Emrys Davies,PH.D., described how, with the forthright spirit of ourtimes, he had challenged his teen-age pupils to uncoveranonymously the pattern of their private lives, and withthe trust and frankness of youth they had done so. Howfar the children of a comprehensive school on a largeManchester housing estate are typical of youngsters inthe rest of Britain is unknown, but there seems noreason to think that Wythenshawe’s are any better orany worse than their contemporaries elsewhere. Indeedit is popularly believed that children in the south ofEngland reach social maturation and sophisticationearlier than their northern brothers and sisters. Whetherthat is so or not, Dr. Davies’s findings at least point tothe broad trends in our social progress, and they are notwithout medical significance if we can bring ourselves toface realities.The home background of the youngsters was mainly

in social classes ill and IV, 82 % of the fathers beingskilled or partly skilled ; and the age-groups questionedwere the 131/c141/2 or the 141/2-151/2 cohorts. Mostgroups contained about 190 pupils, but some selectiveinquiries were much smaller. On that account many ofthe results should perhaps be viewed with reserve.

Dr. Davies asked his 131/2-141/2-year-olds how theyspent their spare time, and what were their majorinterests outside school. Physical activity in one formor another still held the interest of 60 % ; the other 40 %had already acquired the’ more sedentary pursuits ofBritish adult life today. Television and cinemas attractedboth sexes fairly equally, but while the rest of the girlswere starting to look for boy-friends, or occasionallyreading, their male contemporaries were consoling them-selves by making things with their hands. Readinganything more than comics featured little in their boy-hood lives. It was another year before the boys became

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more girl-conscious. At 14½-15½ years of age, 00% of’, boys and girls chose either companionship of the opposite

sex or mixed parties.It was found that a third of the 13½-14½ age-group

had nine or less hours’ sleep, and Dr. Davies suggestedthat this was too short a time for growing bodies andactive minds. Whether a child comes to terms withsleep requirements is the parents’ responsibility, but it isthe schoolmaster who gets the backwa,sh. Early to bedwas never a popular cry, and perhaps less so nowadayswhen the hypnotic television screen stirs up sex andviolence until nearly 11 P.M.There is evidence of early recourse to sedatives.

5% of the 131/2-141/2-year-old group admitted takingsedative drugs regularly, and another 36 % occasionally.If that is what happens with the odd bottle of pills inthe bathroom cupboard, what will happen when theflood tide of tranquillisers crosses the Atlantic ? i’ Ifsmoking can be regarded as a sedative, and not merelya display of teen-age bravado, nearly half of the boys anda fifth of the girls in the 14½-15½ group had acquireda taste for smoking, and indeed that taste might alreadyhave developed into a habit. So much for the progressof the campaign against lung cancer. Stimulation withalcohol had already started in the same age-group.Of a sample 33 boys and 32 girls, 41 % seldom hada drink, 32 % admitted occasional indulgence, 15%drank regularly, and 5 % did so both regularly andfrequently.Answers on personal hygiene were illuminating. 65 %

of the youngsters bathed only once a week. Hand-washingafter toilet was practised always by 34 °,, usually by55%, and seldom by 11%. Teeth-cleaning was dis-appointing : 39 % brushed their teeth either occasionallyor never, 35 % did so once a day, and only 25 % observeddid so night and morning ; 3 % of the girls did somore than twice a day. Sharing hair-combs was veryprevalent in both sexes, but communal life no doubtencourages the practice of borrowing items of personaltoilet.The answers to these questions may suggest fresh lines

of approach. We must recognise the earlier socialmaturation of our teenagers and realise that it is develop-ing unevenly. If heterosexual interests are being arousedearlier than in our own generation it is no use blindingourselves to the fact. Surely there is scope to play onthe vanities of awakening consciousness to get across thebasic points of personal hygiene and bodily health ; thisis no more than is done for the adult population by theadvertisers of cosmetics, deodorants, drugs, and fancyfoods. If grown-ups are most easily taught through themedium of strip-cartoons, eye-catching posters, slogans,and television, why should children be fed with lessexciting fare ? We are still a long way behind commercialpractice with our market research.

It would be equally unrealistic to assume thatyoungsters know all the answers. Dr. Davies provedthat they do not. Outline anatomy of the human bodywas only hazily understood by most of the 14½-15½age-group, and knowledge of basic physiology was evenscantier. In the 14½-15½ age-group 75 % of the boysand 94% of the girls registered a strong desire to learnmore about the development and functioning of thehuman body. No-one can blame them for their ignoranceof this subject, and by their answers they threw thechallenge squarely back to us.

Scotland in 1956

Provisional statistics for last year have been issued bythe Registrar-General for Scotland. 1 The birth-rate was18 per 1000 population, which was 0-5 above the ratefor 1955. The stillbirth-rate was 24 per 1000 live andstill births-1 less than that for 1955. The death-rate(120 per 1000 population) was the same as that for1955. The infant-mortality rate was 29 per 1000 livebirths, which was the lowest ever recorded ; and theneonatal-death rate was 19 per 1000—1 less than in1955. The death-rate from tuberculosis was 16 (respira-tory 14, non-respiratory 2) per 100,000 population.1. Quarterly return of the Registrar-General, Scotland, for the

quarter ended Dec. 21, 1956 ; also preliminary return for 1956.H.M. Stationery Office. Pp. 40. 2s. 6d.

A Primer in Public Health

Dr. A. K. Southwood, director-general of public healthin South Australia, has written a booklet 1 for theguidance of newly appointed medical oitlcers of health.It is in simple, at times breezy, language, and coversa wide field, with ample quotations from authors as

various as Percival Pott, Charles Dickens, and J. S. Mill.Some of the material has special application to SouthAustralia, and some of the rest will be familiar to anydoctor ; but the medical officer of health in this countrymay find the clear presentation useful in his activitiesin health education.

Infectious Diseases in England and Wales

* Not including late returns.

1. Southwood, A. It. The Bases of Public Health. Published by theDepartment of Public Health, Adelaide. 1957. Pp. 84.

Parliament

The National Health Service Contribution

As has already been announced, the Governmentproposes to introduce a Bill to institute a separateNational Health Service contribution and to double the10d. which is at present allocated to the service from thepresent joint National Insurance contribution. Sincethe proposals are an increase in amounts paid into theExchequer the Bill has to be founded on a Ways andMeans resolution, and in introducing this resolution onMay 1 Mr. J. ENOCH PowELL, financial secretary to theTreasury, pointed out that the National Health Serviceelement had always stood on a different footing from therest of the combined payment. Unlike the rest of thecontribution, it was paid from the Fund, where the restremained, into the Exchequer ; it did not constitute aqualification for receiving benefit ; and, finally, whereasthe rest of the combined payment was designed to meetthe whole cost of the insurance benefits, it was nevercontemplated that this element should represent morethan a fraction of the cost of the National Health Service.There had been a good deal of misunderstanding andmisapprehension as to the nature, the amount, and theeffect of the National Health Service element, and hethought it sensible that its entirely separate natureshould be formally and explicitly recognised. In hisreport in 1942 Lord Beveridge had written :

" There is no obvious reason, apart from a desire to keepthe insurance contribution as low as possible, why insuredpersons should be relieved of this burden wholly, in order thatthey may bear it as taxpayers. If importance attaches topreserving the contributory principle for cash benefit it attachesalso to contribution for medical treatment.... There appearsto be a case for including part of the cost of domiciliarytreatment in the insurance contribution." ’