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(b) The salary of a practitioner appointed as a part-timemedical officer of health shall be x of the appropriate salary,

II

according to population for a whole-time medical officer ofhealth, plus one quarter of x or one quarter of 11 - x

II 11whichever is the less, where x represents the number of

half-days per week, or their equivalent, devoted to the

appointment.6. Combined Appointments.-(a) Where a doctor acts as

medical,officer of health to more than one authority he shallreceive a salary-scale not less than E120 above the appropriatescale in section 5(a) indicated by the total population ofthe combined districts for which he is medical officer ofhealth.

(b) Where a combined appointment is part-time paragraph(b) of’section 5 shall apply.

(c) In Scotland, where a county medical officer of healthis also school medical officer for the county and for one ormore large burghs, the population of which is not includedin the, population of the administrative county, he shall receivea salary-scale not less than the appropriate salary-scale insection 5(a) above indicated by the total population of theadministrative county and large burgh(s).

7., Divisional or Area Medical Officers.—These are medicalofficers -appointed by local health authorities for divisionaladministration of the health services (including the schoolmedical service). They fall into two classes :

(a) divisional medical officers acting also as county districtmedical officers of health. The salary-scale shall be that

appropriate in section 5 according to population of thedivision or area, or population of the county district(s) forwhich he is acting as medical officer of health, whichever isthe greater :

(b) divisional medical officers not also acting as countydistrict medical officers of health. The salary scale shall bethat appropriate in section 2, according to population of thedivision or area.

8. Specialists.—Where a whole-time medical officer in anyof the above sections is employed partly by a regional hospitalboard and partly by a local authority, his total remunerationshall be the whole-time remuneration recognised by the

regional hospital board for the type of work undertaken forthem, or the salary-scale appropriate to his position in thelocal authority, whichever is the higher.

FURTHER PROPOSALS

Special Awards.—The subcommittee proposes that aproportion of medical officers of outstanding professionaleminence in the public--health service should receive asa special award payment in excess of the remunerationprovided for in the scales. Such awards should be madeon the recommendation of a specially appointed com-mittee mainly professional in character, includingmembers of the medical profession, representatives ofthe universities, the Medical Research Council, the

Ministry of Health, and the associations of local authori-ties. Such awards would be made in recognition of

professional merit and scientific work done for theadvancement of public health. They would be personalin character, and once made would continue to be receivedby the medical officer so long as he remained in thepublic-health service. a

Other Conditions.—It is proposed that medical officers-holding appointments in the County of London shallreceive £120 per annum in addition to their scale salaries,and that those holding appointments outside the areaof the county but within the Metropolitan police areashall receive an, additional 190 per annum. Among theother conditions laid down are that the scales shall

operate from July 5, 1948 ; that there shall be nodifferentiation on account of sex ; that for teachingduties additional remuneration shall be payable ; andthat all grades shall be given at least 6 weeks’ holidaya year, including public holidays. The report also namesconditions to govern allowances during absence throughillness.

Advisory Committee.-The subcommittee calls for theappointment of an advisory committee to consider :

1. Any case in which an authority proposes to employan officer on conditions not in accordance with these scalesand conditions.

2. Any difficulties in the application of the scales andconditions.3. Recommendations by the committee which is to considerspecial awards.The subcommittee observes, however, that all referencesto the advisory committee might go to the Whitleymachinery, once this is set up.

HEALTH CENTRES

THE Central Health Services Council has appointed acommittee to consider and make recommendations onthe lines along which health centres should be developedunder section 21 of the National Health Service Act.The members are :

F. MESSER, M.P. (chairman) ; F. J. BALLARD, G. 0. BARBER,M.B., A. BEAUCHAMP, M.B., D. CAMERON, M.R.C.S., Sir ERNESTROCK CARLING, F.R.C.S., Sir ALLEN DALEY, F.R.C.P.,L. FINDLAY, M.D., Captain S. H. HAMPSON, Miss M. E. HOLLING-WORTH, S.R.N., R. H. HENRIKSEN, M.P.S., R. D. LAWRENCE,F.R.C.P., Prof. J. M. MACKINTOSH, F.R.C.P., Prof. R. H. PARRY,F.R.C.P., A. TALBOT ROGERS, M.B. (vice-chairman), MissBLANCHE SHENTON, S.R.N., Mrs. DOROTHY THURTLE.

The secretary is Miss E. G. Long, of the Ministry ofHealth. The committee held its first meeting on Jan. 18.

COMPREHENSIVE CENTRE FOR LONDON

The first new centre to be -approved by the Ministerof Health under the National Health Service Act is to bebuilt on the Woodberry Downs estate, Stoke Newington,at an estimated cost of £187,275, excluding equipment.Construction, starting next month, is due for completionin two years.The centre is to serve an area with a growing popula-

tion, which is likely to number eventually some 18,000;but it is expected that people from other districts willalso attend. It will provide general-practitioner anddental services, antenatal and postnatal clinics,, a child-welfare clinic, a school treatment centre, and otherservices, possibly including a foot clinic. Each of the

principal departments has a separate entrance. Therewill be rooms for specialists.The central entrance leads to a small waiting-hall with

record office and inquiry counter, nurses’ room, and lavatories.Corridors lead off to six suites of rooms for medical prac-titioners. Each suite has a waiting-room, consulting-room,examination room and dressing cubicle, and exit lobby. Alsoon the ground-floor. is a small isolation ward with exit foreasy removal of patients by ambulance.A staircase leads to the first floor, where there is a bedroom,

bathroom, and lavatory for the doctor on night duty, and acommon-room with small service kitchen for general use bythe medical staff. On the same floor are a small drug store;a clinical side-room ; an eye room with dark-room, store,and orthoptic room opening from it ; a duty-room ; and astore-room. The centre of the first floor in this part of thebuilding provides a waiting-hall with record office andinquiry counter. A corridor leads to two dental surgerieswith recovery-room between and a dental workshop. A

minor-operations room with dressings-room, sterilising-room,and recovery-room are also in this part of the building.The school health unit has a waiting-hall, a room for

dealing with minor ailments, a consulting-room, a nurse’sroom, and a record office-all on the ground-floor. Imme-

diately above are two dental surgeries, with recovery-roomand two dental workshbps, and an eye-room with dark-room,store, and orthoptic room.The child-welfare unit has a toddlers’ room, milk-room,

and store. A corridor leads to a lecture hall with platformand a demonstration kitchen attached. Off the hall is asuite comprising an undressing space, an interview-room for

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health visitors with test-feed room attached, a weighing-room,and waiting-space for patients.The antenatal unit shares a waiting-hall with the child-

welfare unit. Interviewing-rooms for health visitors andmidwives, an advisory room with undressing cubicles and

urine-testing accommodation, and a doctor’s consulting-roomare provided. On the first floor an ultraviolet-light roomand an X-ray room will be available to all units.The remedial-exercise and child-guidance unit consists of

a play-room and rooms for a psychiatrist, a psychiatricsocial worker, and an educational psychologist. There is

also an office and a room fororthopaedic and remedial exer-

cises, with an undressing-roomattached.To the east of the centre a

! day-nursery is to be built. There: will be a lock-up garage for! each doctor.

At a press conference last. week, Mr. A. REGINALD STAMP,

chairman of the health com-

mittee of the London CountyCouncil (which, as the localhealth authority, is respon-sible for centres in London),explained that the first aim wasto provide one centre in eachof the nine health-service unitsof the county; and the Minister

had agreed to this in principle. It might be possible toprovide some by modification and extension of existingcentres, such as those at Finsbury and Bermondsey,which were not comprehensive; and already the councilwas on the way to acquiring sites for 40 new centres.The eventual aim was to have 162 centres-one forevery 20,000 of the population, this number comprisingtwo neighbourhood units each with 10,000. The Ministryhad instructed the council to rent accommodation todoctors in the new centre at an " uneconomic rent."

Disabilities

22. MYASTHENIA GRAVIS

My myasthenia started early in 1925, when I was 18.For several months it consisted of double-vision and

fatigue. This did not worry me unduly, for I was anart-student at the time, and it seemed likely that thesesymptoms were the result of eye-strain and the longhours of standing at my easel. An ophthalmic surgeontold me that there was muscular incoordination of theeyes, and prescribed glasses with a prism.

Soon, however, more alarming’ symptoms began.The first occurred when, I was ironing a dress andsuddenly found that I could not hold up my head ; it

kept drooping forward. Then my knees started to giveway under me at odd times, especially after running,and often on dismounting from mv bicycle. My eyelidswould droop uncontrollably when I was tired-far morethan in ordinary sleepiness-and after painting fora while my arm would drop to my side. And so it waswith all forms of muscular exertion ; my movements,whatever they happened to be, would start to flag, andI would have to stop and rest. After a short while I wouldfeel my strength returning and be able to carry on.This flagging of strength is difficult to describe." Weakness " was not the impression it gave me. Itwas more like a cutting-off of my movements from

my mind. I felt that my muscles were perfectly strongyet I could not make them respond to my will-justas in a nightmare one becomes rooted to the spot in anemergency.

By this time I was badly frightened, but I tried hardto swallow my fear and fight the symptoms, becauseI hated the thought of leaving the art-school. I was

working for a diploma at the time, and loved my work.Being the only child of rather over-anxious parents,I revelled in the freedom of art-school life. And aboveall I was unofficially engaged to a medical student.I was very much in love, and we could often meet fora meal. Nevertheless, I had to give in and stay at home.My parents became alarmed, and I was sent to aneminent neurologist.

This was a horrible experience. He examined methoroughly but could find no physical signs ; and I,being at the best of times a nervous and imaginativecreature, and by now scared out of my wits, made a verybad impression on him. He declared me to be sufferingfrom hysteria, and asked me what was on my mind.When I answered, truthfully, that nothing was, exceptanxiety over my symptoms, he replied, " My dear child,I am not a perfect fool ... ," and showed me out.At that time the disease was fluctuating in an extra-

ordinary way. Soon after my twentieth birthday I was,at my worst, as bad as I have ever been subsequently;yet on some of my better days I was practically normal.I began to notice that the relapses always occurredabout a week before my menstrual period was due,and that I improved again just before or after the periodstarted. At my worst I could not turn over or sit upin bed without help, chew my food, or keep my eyesproperly open or my mouth shut. Even speaking becamedifficult, for my tongue ’and vocal cords at these timeswere as useless as the rest of me. At this stage, however,these relapses were infrequent and always ceased

surprisingly suddenly.That was in 1926, and the next year was a nightmare.

My trouble was still believed to be functional, and one" cure " after another was tried, including a course ofpsycho-analysis. I was in despair, for, deep down,I could never quite believe that my symptoms werepurely hysterical. By the summer of 1927 the completelyhelpless phases came round almost every month, and atmy best all I could do was to walk a hundred yards or sowith a stick, leaning on somebody’s arm. I was sometimesdriven to a cinema, theatre, or concert-but inquirieshad always to be made regarding the number of stairson the way to my seat, and these expeditions were fraughtwith anxiety. I was helped with dressing and undressing,assisted or carried upstairs, and washed in a kneelingposition in the bath.

My parents were wonderfully patient with me, butI was alway haunted by the feeling that I was expected,sooner or later, to " pull myself together," and I knewthat I couldn’t. Yet for some reason I was bitterlyashamed of my condition. I was always trying to pretend