The value of the Glasgow coma scale is definite and widely accepted. It is a help in teaching a difficult subject, in mutual understanding in a few words, and in comparison of cases. It uses accurate and practical observations. It is the best method of measuring the state of consciousness, provided observation of the diameter and light reaction of the pupils is added It avoids what Jamieson and Yelland feared in 1968. "It is tragic if the wardmaid assesses deterioration by recognizing that a patient is not as bright now as earlier while trained staff await the development of the next stage in their preconceived, rigid scale of deterioration."