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COINS, ORIFICES, &c.
1021 It would be most unwise to be dogmatic regarding these points, as a multiplicity of factors may influence the relationship between pregnancy and the disease.44 Nevertheless, attention should be directed to the adrenal cortex as a factor which may be more powerful than is realised. It would seem possible that the dual nature of the influence which the hypersecretion of these powerful hormones in pregnancy may exert on the disease may explain why the individual case may either deteriorate or improve, though the figures for the group as a whole show that the prognosis is not significantly altered. H. MORROW BROWN. Edinburgh. ANOMALIES OF SALARY
SIR,-I
must express the
concern
of the Institution of
Professional Civil Servants at the line taken in your
leading article last week. We have no desire at all to comment on your decision about the publication of Government advertisements. That is patently for you and it would be improper for us to offer an opinion. In the course of your decision, however, you do in fact, even though it may not be your intention, enter the lists against the Civil Service medical officer. The proposal by the Chancellor that the committee should consider both the structure of the Civil Service and the salaries is an issue that we are shortly to discuss with one of his officers. What neither the Chancellor nor you appear to appreciate is that the structure and salaries are two separate and distinct questions and not
tion and the Treasury, but we were told quite definitely and flatly by the Treasury spokesmen that they were not in a position to negotiate. They listened quite politely to what we had to say but they were certainly not negotiating; and indeed the Treasury officers were at pains to make it clear that they were not negotiating. We are seriously concerned at the effect of what is happening in the medical Civil Service. There is already an undermining of efficiency, which must necessarily result where a service is undermanned. May I assure you that officers throughout the medical Civil Service feel themselves to be very wrongly treated1 There would be no objection at all to a proposition that Sir Will Spens or the Spens Committees should in fact be asked to act as arbitrators or to be put in a position in which, say, Lord Chorley, was recently put in a consideration of the salary-scale of assistant secretaries-that is, his committee received evidence from the Association of First Division Civil Servants and from the Treasury and then gave its views as to what the salary-scale of assistant secretaries should be. The Government accepted the recommendations of the committee. There is a precisely similar set of circumstances vis-a-vis the Spens Committees, and it is on that basis that we should be very glad to see this issue referred to them for a decision ; and there is no reason, if the Government were prepared, that such an arrangement should not be put in hand forthwith. Institution of Professional Civil Servants, STANLEY MAYNE. Queen Anne’s Chambers, Broadway, London, S.W.1
one.
So far as salaries are concerned, Sir Will Spens in the two reports of his committees set out in clear and unmistakeable language -his views about the remuneration of people in the medical profession. He does not in terms deal with the salaried medical officer, but there is unlikely to be any dissent from the view that the salaried medical officer must have a salary which is in scale with the remuneration open to his fellows, calculated on a different basis. As you quite rightly point out, however, there is not a proper relation between the two, because even the standard and standing of the salaried medical profession will go down. In terms of a medical service, this seems to be an absurd state of affairs and one that ought not to be tolerated. It is our view, therefore, that there is no need for a new committee to adjudicate on what ought to be the salary of the medical officer but that Sir Will Spens, who has had all the advantages of previous research, is the best person to express a considered and authoritative view in this matter. The decision of a committee with Sir Will Spens would not, of course, be dissented from, but there seems to be something fundamentally wrong in any proposal that would place on a body totally different from that of the Spens Committees the work of determining the right level for a section of the salariat in the medical profession. On particular points that you make, may I offer the following comments ? You say that pressure is permissible when an individual employer does not apply some national scale. That, surely, is exactly what is happening here. There are only some 500 or 600 medical officers in the Civil Service. The vast bulk of the 40,000-50,000 medical people in the country are remunerated largely, if not wholly, from State funds through the National Health Service-that is to say, on scales which have been agreed by the Government. The claim that is being made for Civil Service medical officers is simply that these officers should be remunerated on the same basis as medical people in the National Health Service. You also say that pressure can probably be justified when it is brought to bear on an employer who refuses to negotiate through the channels laid down for the purpose. That is exactly what has happened in this case. There is a machinery of negotiation between the institu-
COINS, ORIFICES, &c.
SIR,-Now that Dr. Lloyd (May 13) has gone
a
long
way towards meeting your peripatetic correspondent’s request for a table relating the diameters of coins to the bodily orifices, I must point out the desperate need for a new table,drawn up by a panel of experts, correlating (1) degrees of dilatation of the full-term cervix, (2) fingers of the hand, and (3) coins of the realm. Consultants, nursing staff, and practitioners all use different terminologies and mensuration standards as the os dilates. A table like this would make a fine contribution to present-day obstetro-numismatics. And in view of the shrinking world, it might be as well to systematise the cervix in values of francs, marks, dollars, roubles, and others (at current rates of exchange, of
course). Cambridge.
A. S. PLAYFAIR. THE DEAF CHILD I was reading Mrs. and- Dr.
SIR,-Recently Ewing’s on Opportitnity and the Deaf Child (published in 1947) and found them saying that, when a child is deaf, dumb, and wordless, his intelligence is impoverished by the lack of language. In this they seem to me to overlook the imagination of the child. As a congenitally deaf person, I remember that, before I learnt to lip-read and to’speak, my mind was filled with imagination. Naturally my thoughts were in pictures, but so are those of all children before they are able to speak. The difference is that we deaf go on like this for a longer period-until we are taught to speak. I do not think that any parent
book
of a deaf-born child need fear that the mind of the child will remain blank until he achieves speech. May I at the same time comment on a conclusion reached by the Ewings after much experiment-namely, that a pure-tone audiometer is unsuitable for any child under five years of age, so long as he shows no sign of " hearing." A deaf-born child, they say, must be trained to listen-i.e., to learn to hear-before his hearing can be tested. This I believe to be very true. My hearing amounts to practically nothing ; yet, with a hearing-aid I am able to assimilate many sorts of sounds, to recognise some, and to locate them, although I am unable to
.
SIR,-I
must express the
concern
of the Institution of
Professional Civil Servants at the line taken in your
leading article last week. We have no desire at all to comment on your decision about the publication of Government advertisements. That is patently for you and it would be improper for us to offer an opinion. In the course of your decision, however, you do in fact, even though it may not be your intention, enter the lists against the Civil Service medical officer. The proposal by the Chancellor that the committee should consider both the structure of the Civil Service and the salaries is an issue that we are shortly to discuss with one of his officers. What neither the Chancellor nor you appear to appreciate is that the structure and salaries are two separate and distinct questions and not
tion and the Treasury, but we were told quite definitely and flatly by the Treasury spokesmen that they were not in a position to negotiate. They listened quite politely to what we had to say but they were certainly not negotiating; and indeed the Treasury officers were at pains to make it clear that they were not negotiating. We are seriously concerned at the effect of what is happening in the medical Civil Service. There is already an undermining of efficiency, which must necessarily result where a service is undermanned. May I assure you that officers throughout the medical Civil Service feel themselves to be very wrongly treated1 There would be no objection at all to a proposition that Sir Will Spens or the Spens Committees should in fact be asked to act as arbitrators or to be put in a position in which, say, Lord Chorley, was recently put in a consideration of the salary-scale of assistant secretaries-that is, his committee received evidence from the Association of First Division Civil Servants and from the Treasury and then gave its views as to what the salary-scale of assistant secretaries should be. The Government accepted the recommendations of the committee. There is a precisely similar set of circumstances vis-a-vis the Spens Committees, and it is on that basis that we should be very glad to see this issue referred to them for a decision ; and there is no reason, if the Government were prepared, that such an arrangement should not be put in hand forthwith. Institution of Professional Civil Servants, STANLEY MAYNE. Queen Anne’s Chambers, Broadway, London, S.W.1
one.
So far as salaries are concerned, Sir Will Spens in the two reports of his committees set out in clear and unmistakeable language -his views about the remuneration of people in the medical profession. He does not in terms deal with the salaried medical officer, but there is unlikely to be any dissent from the view that the salaried medical officer must have a salary which is in scale with the remuneration open to his fellows, calculated on a different basis. As you quite rightly point out, however, there is not a proper relation between the two, because even the standard and standing of the salaried medical profession will go down. In terms of a medical service, this seems to be an absurd state of affairs and one that ought not to be tolerated. It is our view, therefore, that there is no need for a new committee to adjudicate on what ought to be the salary of the medical officer but that Sir Will Spens, who has had all the advantages of previous research, is the best person to express a considered and authoritative view in this matter. The decision of a committee with Sir Will Spens would not, of course, be dissented from, but there seems to be something fundamentally wrong in any proposal that would place on a body totally different from that of the Spens Committees the work of determining the right level for a section of the salariat in the medical profession. On particular points that you make, may I offer the following comments ? You say that pressure is permissible when an individual employer does not apply some national scale. That, surely, is exactly what is happening here. There are only some 500 or 600 medical officers in the Civil Service. The vast bulk of the 40,000-50,000 medical people in the country are remunerated largely, if not wholly, from State funds through the National Health Service-that is to say, on scales which have been agreed by the Government. The claim that is being made for Civil Service medical officers is simply that these officers should be remunerated on the same basis as medical people in the National Health Service. You also say that pressure can probably be justified when it is brought to bear on an employer who refuses to negotiate through the channels laid down for the purpose. That is exactly what has happened in this case. There is a machinery of negotiation between the institu-
COINS, ORIFICES, &c.
SIR,-Now that Dr. Lloyd (May 13) has gone
a
long
way towards meeting your peripatetic correspondent’s request for a table relating the diameters of coins to the bodily orifices, I must point out the desperate need for a new table,drawn up by a panel of experts, correlating (1) degrees of dilatation of the full-term cervix, (2) fingers of the hand, and (3) coins of the realm. Consultants, nursing staff, and practitioners all use different terminologies and mensuration standards as the os dilates. A table like this would make a fine contribution to present-day obstetro-numismatics. And in view of the shrinking world, it might be as well to systematise the cervix in values of francs, marks, dollars, roubles, and others (at current rates of exchange, of
course). Cambridge.
A. S. PLAYFAIR. THE DEAF CHILD I was reading Mrs. and- Dr.
SIR,-Recently Ewing’s on Opportitnity and the Deaf Child (published in 1947) and found them saying that, when a child is deaf, dumb, and wordless, his intelligence is impoverished by the lack of language. In this they seem to me to overlook the imagination of the child. As a congenitally deaf person, I remember that, before I learnt to lip-read and to’speak, my mind was filled with imagination. Naturally my thoughts were in pictures, but so are those of all children before they are able to speak. The difference is that we deaf go on like this for a longer period-until we are taught to speak. I do not think that any parent
book
of a deaf-born child need fear that the mind of the child will remain blank until he achieves speech. May I at the same time comment on a conclusion reached by the Ewings after much experiment-namely, that a pure-tone audiometer is unsuitable for any child under five years of age, so long as he shows no sign of " hearing." A deaf-born child, they say, must be trained to listen-i.e., to learn to hear-before his hearing can be tested. This I believe to be very true. My hearing amounts to practically nothing ; yet, with a hearing-aid I am able to assimilate many sorts of sounds, to recognise some, and to locate them, although I am unable to
.