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Within the large psediatric units a child psychiatric unitwould be an advantage. This could economically bo of eightto twelve beds. The sister in charge should have had previouspsychiatric experience with children. In addition to the

consultant and resident medical staff, the part-time services ofa clinical psychologist, and a psychiatric social worker will beneeded. Where treatment is undertaken provision will haveto be made for this in staffing the department. The wholeunit working under the direction of a consultant psediatricpsychiatrist should form a part of the paediatric service.

Education and RecreationThe happiness of children in hospital can be materially

influenced by the opportunities they have for occupation.The use of education in hospital, not only to preventillness from interfering with educational progress, but alsoto keep children happy, should be recognised, and aliaison established with local education authorities.Provision should also be made for recreation and forplay.

Branch Outpatient and Casualty DepartmentsThese should be set up both in areas of scattered pop-

ulation and in city areas to meet the needs of thepopulation and to avoid the necessity of small units.Such branch outpatient departments should be staffedfrom the main paediatric unit, and thus be able to callupon the special facilities of these units.

Infectious DiseasesThe care of children suffering from infectious diseases

should be included in the general paediatric services forthe care of children in hospital. The Ministry of Healthhas stated (R.H.B. 48. 1) : " It is of the utmost importancethat hospitals or wards for infectious diseases should beclosely associated with paediatric departments, since somany of the patients are children and the problems aresimilar." This the committee fully endorses and considersthat when a vacancy occurs on the staff of an existinginfectious disease hospital, a paediatrician should beappointed. In every paediatric unit isolation accommoda-tion is essential, and as large units are developed a blockshould be included for infectious fevers.

Infants in Maternity UnitsThe committee has already stated that all maternity

hospitals and departments should have paediatricians onthe staff and they should undertake full responsibilityfor the care of the newborn.

In the larger units the services of a paediatric registrar areadvisable and the obstetric house-surgeons should be directlyresponsible for the infants to the paediatric registrar andconsultant. Every maternity hospital should be linked witha children’s hospital or children’s department of a generalhospital and thus be able to call upon the special facilities ofthe psediatric unit.

The Family DoctorPsediatric units should have the closest relationship

with family doctors, who should be encouraged to followtheir children while in hospital. The proper follow-upof hospital admissions may thus be promoted after theyreturn home from hospital, and the paediatric unit canperform an educative function.Where pædiatric beds are under the care of family doctors

it is important that the pædiatric services should be used andthat a paediatrician should advise on planning as well aspolicy, taking control, for example, when there is an outbreakof infection.

The Local Health AuthorityAll paediatric units should have the closest cooperation

with these authorities, particularly the maternity andchild-welfare and school health services, and should pro-vide facilities for the postgraduate tuition of clinic doctorsand health visitors. Through this coöperation the properfollow-up of patients may also be assisted after theirdischarge from hospital.

Regional Hospital BoardsIn each region there should be a paediatric committee

to advise the regional board upon questions of planningand policy for the care of children.

DISCUSSIONS ON ROYAL COMMISSION

ON Tuesday the Special Conference of Local MedicalCommittees decided to take no decision on the matterof the profession’s cooperation with the Royal Com-mission and to defer the question until the annualconference in June. The chairman of the GeneralMedical Services Committee, Dr. A. B. DAVIES, saidthat his committee had decided, by 24 votes to 22, atan emergency meeting held immediately before theconference, to put a new recommendation to the con-ference-namely, " that in view of the latest develop-ments evidence should now be given to the Royal Com-mission and a decision on withdrawal of services deferred."This decision had been taken after consideration ofa letter of April 26 from the Minister of Health to Dr.Solomon Wand, chairman of the council of theBritish Medical Association. Confirming what he hadsaid in a talk with Dr. Wand, the Minister declaredin his letter that there would be full consultationwith the profession before implementation of anyof the Royal Commission’s findings and " that suchconsultation could of course include any mattersrelevant to the report or the present dispute."Referring to Dr. Wand’s fear of some inconsistencybetween the terms of reference of the Royal Commissionand the public statements issued by its chairman,the Minister’s letter said that the public statementswhich had been issued could certainly be regarded ashaving full validity. On the position of public-healthmedical officers, the Minister repeated his previousassurance that any settlement for others, following theCommission’s report, could not fail to be taken intoaccount in considering the position of these doctors,and any claim through the normal machinery would ofnecessity be considered in the light of the report and ofany settlement that followed it. Giving the conferencehis interpretation of this letter, Dr. WAND pointed outthat the Minister had included the present disputein the matters for consultation after the Commission’sreport, and that the broadened terms of reference hadbeen confirmed. The issue was now " evidence or fight."If the conference accepted the new recommendationof the G.M.S. Committee, the intervening period wouldbe used to regain unity and strengthen the financesof the Trust, so that action could be taken if laterconsultations broke down.

Many members of the conference were uneasy at

taking a hurried decision before they had had a chanceto assess how the Minister’s letter and the latest state-ments by the chairman of the Royal Commission hadanected the situation. Dr. TALBOT ROGERS, on theother hand, urged the conference to make an immediatedecision. His own doubts about the Royal Commissionhad been resolved and he found it unthinkable that theCommission should go on hearing evidence without havingthe doctors’ case put before it. Dr. 1. D. GRANT warnedthe conference that to cooperate with the Commissionwas tacitly to accept unilateral dictation. Were doctorsto be servants of the Government or equal partnersin the National Health Service ? Proposing an amend-ment to defer decision until the annual conference inJune, Dr. FRANK GRAY remarked that until 9 o’clockthat morning the policy of the G.M.S. Committee hadbeen finm. Now, with almost indecent haste, it hadreversed that policy by the smallest possible majority.Dr. J. A. PRIDHAM also pleaded for more time to considerthe latest developments, and when it came to a vote theconference agreed with him. The conference also decidedthat a decision on withdrawal be deferred, and that the" interim offer of 5% should be accepted without

prejudice."During a discussion on the mechanism of withdrawal

from the National Health Service, a proposal that the

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withdrawal should be total and not phased was defeated ;and the conference supported the view that in theevent of progressive withdrawal no practitioner shouldbe asked to resign unless 80% of resignatiolls had beencollected from the area, in which he had been included.The special representative meeting of the B.M.A.

held last Wednesday will be reported in our next issue.

Central Consultants and Specialists CommitteeAt its meeting on Tuesday the committee decided to

recommend cooperation with the Royal Commission.

THE LONDON HOSPITAL RESEARCH

BUILDING

FROM its endowment funds the London Hospital hasspent E200,000 on a new research building in AshfieldStreet, Whitechapel, which will accommodate the researchunits of the hospital and thus make space in the mainhospital for clinical laboratories. The new building,which was officially opened last Wednesday, contains :The Hospital Physics UnitChief Physicist : L. A. W. KEMP, PH.D.The London Hospital Physics Laboratory came into being

in 1943 but for eight years was concerned almost entirely withradiotherapy physics. In 1951 it became responsible to aspecial physics subcommittee, and was made accessible toall departments. Since that time, it has done work for manydepartments, including the medical unit and the cancer

research, dental, cardiac, eleetro-encephalographic, oph-thalmic, and diagnostic X-ray departments, as well as severalof the research groups working in the medical college. Inthe field of radiation physics it has come to be known for itsspecialisation in precision dosimetry.The Hospital Instrument WorkshopChief Technician : E. PENFOLD.

This workshop has grown out of the initial steps taken tomeet the instrument-making needs of the physics laboratory.In 1951 a full-time instrument-maker was appointed, butthe needs of the laboratory grew rapidly, and it was foundthat an increasing number of other research departmentsalso required access to first-class instrument-makers. The

building of the new research block has therefore been made theoccasion for creating the research instrument workshop.administratively separate from the physics laboratory andstaffed by five instrument-makers (with a storekeeper),provided with 5 lathes, 2 milling-machines, 4 power clrills,and a surface grinder, together with a guillotine, bendingmachine, various presses, and welding and spraying equip-ment. The workshop is also equipped, to fl more modestdegree. for electronic work.

Department for Research in Industrial MedicineDirector: DONALD HUNTER, F.R.C.P.

This department (Medical Research (’ouncil) was formedin June, 1943, and its staff includes physicians, chemists,physicists, and technicians. Its aim is to study diseases ofoccupation and their prevention. These include (1) acuteand chronic poisoning by metals and chemical substances,(2) industrial cancer, and (3) the effects of physical agentssuch as vibratory tools. Field studies are undertaken any-where in Great Britain and have been made. for example,into fluorosis in an aluminium foundry at .Fort William,silicosis among Cornish tin-miners, and chronic cadmium

poisoning on Merseyside.In the new building there are organic and inorganic

chemistry laboratories, a laboratory for radioactive isotopes,a physics laboratory, and a histology laboratory. In theanimal-house a dosing-chamber has been built by the staffof the department in which animals can be treated withdust and fume under controlled conditions resembling thoseof a factory. ,

Venereal Diseases LaboratoryDirector : 1. N. ORPWOOD PRICE, M.R.C.H.

This laboratory (Medical Research Council) is a conjointlaboratory established in 1956 by fusion of the LondonHospital Whitechapel Clinic and the M.ILC’. Venereal Diseases

Reference Laboratories. The amalgamation of the twolaboratories has made it possible to achieve a much greateroutput of work without any increase in staff, which consistsof the director, two serologists. eleven technicians, and theusual ancillarv personnel.

Social Medicine Research Unit

Director: J. N. MORRIS, tv.ti.c.r.

This unit of the .Medical Research Council was founded in1948. and transferred to The London in January, 1956. Ithas a staff of about twelve—medical, statistical, sociological,and clerical. In addition, it enjoys much help from the staffof the hospital and from others. Depending on the nature ofthe problem, studies are made on a national or local scale,and though the unit’s principal method is that of the fieldsurvey, clinical and other methods are used as required.At present it is completing studies on infant mortality;

is actively engaged on several inquiries into the causes ofcoronary thrombosis in middle-aged men; and is planning tomove into the field of mental disease and the relations ofsocial to hereditary factors. Studies are also being made ofthe working of various parts of the health and social services.The advances in the treatment of mental disease mean thatmany patients are discharged home after a relatively shortstay in hospital. and the unit is trying also to assess the needsof such patients in the hope of helping to reduce the con-siderable relapse and readmission rates. In another inquirythe results of teaching and non-teaching hospitals in dealingwith certain " emergencies ’ are being compared. An inten-sive study has also been started of the problems of The LondonHospital itself.

The Dental Research Laboratories

The new dental research department, which consists of fourcompactly designed laboratories and a small photographicdarkroom, will provide much-needed space for the expansionof research already being carried out on dental disease bymembers of the staffs of the dental department and dentalschool. An experimental study of the influence of defectivenutrition on the incidence of dental decay is being undertakenby the department of’ children’s dentistry.

Cancer Research DepartmentDirector: M. H. SALAMAN. M.D.

This department was founded in 1930, and transferred tothe Medical College in 1948. It is largely maintained by ablock grant from the British Empire Cancer Campaign. Itconsists, at present, of six graduate and six technical staff.Members of the department have worked for the most part intwo fields (1) chemical carcinogenesis, and (2 the action oftumours on the enzymes of the host. Its new, compact,and well-equipped laboratories will, it is hoped, enable thedepartment to extend its work.

Department of Experimental SurgeryDirector : Prof. VICTOR W. Dix, F.B.c.s.

This department has been designed in two parts in orderto make it possible for work with radioactive isotopes to bedone safely. The part at present allotted to isotope workconsists of a large laboratory, a small animal-room, and a dog-room, and these rooms are completely isolated from the restof the department. The space allotted to ordinary experi-mental surgery consists of an operating-theatre, two labora-tories, a dog-room, two small animal-rooms, and a larger roomwhich is to be used for X-ray work and also as an additionaloperating-theatre. It is hoped that it will be possible to doevery sort of experimental work in the department exceptpossibly surgical experiments in which long-term survival isnecessary. Later it may be possible to make arrangements tokeep animals elsewhere for such experiments.

CLINICAL GENETICS RESEARCH UNITTHE Medical Research Council have established this

new research unit, under the directorship of Dr. J. A.Fraser Roberts, at the Institute of Child Health, TheHospital for Sick Children, Great Ormond Street,London, W.C.I. The research to be undertaken willinclude the investigation of congenital malformationsand hereditary abnormalities and diseases and studiesof the role of inheritance in common diseases.