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DYEING THE Y CHROMOSOME
596 for the
damagecaused by the cannonball when it lands again. It is, however, more intellectually and technically challenging to keep a patient numb during the whole of her labour rather than just freeze her tail-end with a saddle or pudendal block for delivery. It gives the obstetrician a chance to use his forceps too ! Now the anaathetists are asking to be excused their boring duties in the operating-room so that they can strut about the tranquil, meditative, and preoxygenated atmosphere of the intensive-care unit. However, as Dr. Boliston has pointed out, intensive-care work will employ only a minute percentage of the anaesthetists in practice today. I admit that the administration of anaesthesia during lengthy operations can be tedious, and a scandalous waste of profound theoretical knowledge and technical skill if a physician anaesthetist is in constant attendance. This is especially relevant if a regional technique is being used for a superficial operation. The solution, which will
-
make many British anxsthetists recoil in horror, is of course the nurse anaesthetist. These people, after proper training, are much more than mere technicians. They easily master most general anaesthetic techniques and monitor patients a good deal more closely than, I dare say, most British anxsthetists do. Of course, nurse anxsthetists require close supervision by an anxsthetist who is readily available. Even so, the release from routine monitoring and maintenance of anaesthesia leaves him free to supervise two or even three operating-rooms quite comfortably. Nor is the safety of the patient jeopardised by this arrangement, since any unforeseen problems are likely to occur when the physician is in attendance, during induction, emergence, or repositioning, &c. It must be admitted that most of the problems which confront the practising anaathetist, though dangerous, are of a technical mundane, rather than exotic metabolic More often the anaesthetist is bothered by the nature. extremely obese patient or the " full stomach " than a case of myasthenia gravis or low pseudocholinesterase. The anaesthetist who handles problems in three operatingrooms
keeps
more
technically proficient and mentally
alert than his colleague who " sits " on his own cases. If this system is widely instituted, it would, of course, require a drastic reduction in the output of anxsthetists, and a consequent easing of the burden to the taxpayer (U.K.) or Blue Shield subscriber (U.S.). The anarsthetist would become a " rare bird ", but a more intellectually satisfied and respected one. Detroit, Michigan 48201.
THOMAS S. MORLEY.
DYEING THE Y CHROMOSOME
SiR,—We were interested in your leader on this subject (Feb. 6, p. 275). Since the reports of Zechand Pearson et al.2 we have been routinely examining leucocytes in blood-smears for the Y chromosome, using quinacrine dihydrochloride. We have found this method very useful in the investigation of intersex problems and in screening selected males (newborns, criminals, &c.) for Y-chromosome In abnormalities, particularly the XYY condition.a.4 cells obtained amniocentesis were addition, by accurately and rapidly sexed using the fluorescent technique for the Y chromosome followed by sex-chromatin testing using phase microscopy on the same slide.5 This test is most 1. 2.
3. 4.
Zech, L. Expl Cell Res. 1969, 58, 463. Pearson, P. L., Bobrow, M., Vosa, C. G. Nature, 1970, 226, 80. Conen, P. E., Lewin, P., Vakil, D. Am. J. hum. Genet. 1970, 22, 22a (abstr.). Lewin, P., Vakil, D., Conen, P. E. Ann. R. Coll. Physns Surg. Can. 1970, 4, 37 (abstr.).
5. Lewin, P., Conen, P. E. ibid. p. 60 (abstr.).
useful for those patients who have previously had children with severe X-linked disorders (haemophilia, Duchennetype muscular dystrophy), in whom it is necessary to know the sex of the unborn infant early and accurately, to determine whether therapeutic abortion is indicated. Hospital for Sick Children, Toronto 2, Canada.
P. K. LEWIN D. V. VAKIL P. E. CONEN.
THE PURSUIT OF PREFERMENT
Sm,-Many years ago you published an admirably short article on How to Apply for Medical Posts.1 I at once had this copied for the benefit of my juniors, and have been at pains to draw their attention to its availability. Now the companion piece, On the Art of being Interviewed (Jan. 16, p. 127), should shorten the odds against applicants who mark and digest it. Dr. Stewart declares his neutral point of observation. Mine, over a comparable period, after earlier experiences as the hare, has been as one of the hounds. Prospective hares can, therefore, be assured of the weight of all that Dr. Stewart has to say. He stresses the visit to the job beforehand. I can disclose that I have myself used this question as a means of displaying an unwanted applicant to the committee as one lacking in zeal. A further contribution to the insight of the applicant is that there are usually some half-dozen questioners. Each arrives with a series of rather brilliant and searching questions. One man opens the bowling, and the others see with dismay that he has stolen all their best questions. This is the candidate’s opportunity. One should, of course, avoid the well-worn B.B.C. " I’m so glad you asked me that question ", but the same bright appreciation of the quality of the discerning questioner can still be given in an admiring if less obvious way. This leads to another aim for the candidate. I spoke of the committee as the hounds, but the role is in the eye of the beholder. Who Pretender is and who is King, God bless us all, that’s quite another thing, and a candidate may persuade himself that the initiative is really his. This is his chance so to manoeuvre as imperceptibly to put the inquisitors at their This ease, to leave loose ends that they can take up. objective approach is, of course, the application of the principle of reciprocal inhibition to that anxiety which is the candidate’s enemy in all such seemingly unequal ordeals. There is lastly the final question. " We have decided to offer you the post, Dr. Chose-are you prepared to accept it ?" In the interests of economy, you have combined your visit to the job with your appearance for interview, but have thus discovered at the eleventh hour that this is no place for you. If you refuse bluntly, you may not be considered eligible for your expenses. This risk I avoided once by implying that the post and its attributes carried interesting and engaging possibilities, but that I hoped that the committee was prepared to spend a vast amount of money without which ... &c. They were not. Honour and expenses were both saved. Hellesdon Hospital, F. J. NAPIER. Norwich.
SiR,-At first I couldn’t believe it ! A special article On the Art of Being Interviewed. The system of management is obviously so power-structured that, after all the years of medical study, hospital, work, and striving, one has to be subjected to an interrogation by academic judges who appear to have no objective criteria. Doctors who are subjected to these interviews should be paid rather than 1.
Lancet, 1949, i, 34.
damagecaused by the cannonball when it lands again. It is, however, more intellectually and technically challenging to keep a patient numb during the whole of her labour rather than just freeze her tail-end with a saddle or pudendal block for delivery. It gives the obstetrician a chance to use his forceps too ! Now the anaathetists are asking to be excused their boring duties in the operating-room so that they can strut about the tranquil, meditative, and preoxygenated atmosphere of the intensive-care unit. However, as Dr. Boliston has pointed out, intensive-care work will employ only a minute percentage of the anaesthetists in practice today. I admit that the administration of anaesthesia during lengthy operations can be tedious, and a scandalous waste of profound theoretical knowledge and technical skill if a physician anaesthetist is in constant attendance. This is especially relevant if a regional technique is being used for a superficial operation. The solution, which will
-
make many British anxsthetists recoil in horror, is of course the nurse anaesthetist. These people, after proper training, are much more than mere technicians. They easily master most general anaesthetic techniques and monitor patients a good deal more closely than, I dare say, most British anxsthetists do. Of course, nurse anxsthetists require close supervision by an anxsthetist who is readily available. Even so, the release from routine monitoring and maintenance of anaesthesia leaves him free to supervise two or even three operating-rooms quite comfortably. Nor is the safety of the patient jeopardised by this arrangement, since any unforeseen problems are likely to occur when the physician is in attendance, during induction, emergence, or repositioning, &c. It must be admitted that most of the problems which confront the practising anaathetist, though dangerous, are of a technical mundane, rather than exotic metabolic More often the anaesthetist is bothered by the nature. extremely obese patient or the " full stomach " than a case of myasthenia gravis or low pseudocholinesterase. The anaesthetist who handles problems in three operatingrooms
keeps
more
technically proficient and mentally
alert than his colleague who " sits " on his own cases. If this system is widely instituted, it would, of course, require a drastic reduction in the output of anxsthetists, and a consequent easing of the burden to the taxpayer (U.K.) or Blue Shield subscriber (U.S.). The anarsthetist would become a " rare bird ", but a more intellectually satisfied and respected one. Detroit, Michigan 48201.
THOMAS S. MORLEY.
DYEING THE Y CHROMOSOME
SiR,—We were interested in your leader on this subject (Feb. 6, p. 275). Since the reports of Zechand Pearson et al.2 we have been routinely examining leucocytes in blood-smears for the Y chromosome, using quinacrine dihydrochloride. We have found this method very useful in the investigation of intersex problems and in screening selected males (newborns, criminals, &c.) for Y-chromosome In abnormalities, particularly the XYY condition.a.4 cells obtained amniocentesis were addition, by accurately and rapidly sexed using the fluorescent technique for the Y chromosome followed by sex-chromatin testing using phase microscopy on the same slide.5 This test is most 1. 2.
3. 4.
Zech, L. Expl Cell Res. 1969, 58, 463. Pearson, P. L., Bobrow, M., Vosa, C. G. Nature, 1970, 226, 80. Conen, P. E., Lewin, P., Vakil, D. Am. J. hum. Genet. 1970, 22, 22a (abstr.). Lewin, P., Vakil, D., Conen, P. E. Ann. R. Coll. Physns Surg. Can. 1970, 4, 37 (abstr.).
5. Lewin, P., Conen, P. E. ibid. p. 60 (abstr.).
useful for those patients who have previously had children with severe X-linked disorders (haemophilia, Duchennetype muscular dystrophy), in whom it is necessary to know the sex of the unborn infant early and accurately, to determine whether therapeutic abortion is indicated. Hospital for Sick Children, Toronto 2, Canada.
P. K. LEWIN D. V. VAKIL P. E. CONEN.
THE PURSUIT OF PREFERMENT
Sm,-Many years ago you published an admirably short article on How to Apply for Medical Posts.1 I at once had this copied for the benefit of my juniors, and have been at pains to draw their attention to its availability. Now the companion piece, On the Art of being Interviewed (Jan. 16, p. 127), should shorten the odds against applicants who mark and digest it. Dr. Stewart declares his neutral point of observation. Mine, over a comparable period, after earlier experiences as the hare, has been as one of the hounds. Prospective hares can, therefore, be assured of the weight of all that Dr. Stewart has to say. He stresses the visit to the job beforehand. I can disclose that I have myself used this question as a means of displaying an unwanted applicant to the committee as one lacking in zeal. A further contribution to the insight of the applicant is that there are usually some half-dozen questioners. Each arrives with a series of rather brilliant and searching questions. One man opens the bowling, and the others see with dismay that he has stolen all their best questions. This is the candidate’s opportunity. One should, of course, avoid the well-worn B.B.C. " I’m so glad you asked me that question ", but the same bright appreciation of the quality of the discerning questioner can still be given in an admiring if less obvious way. This leads to another aim for the candidate. I spoke of the committee as the hounds, but the role is in the eye of the beholder. Who Pretender is and who is King, God bless us all, that’s quite another thing, and a candidate may persuade himself that the initiative is really his. This is his chance so to manoeuvre as imperceptibly to put the inquisitors at their This ease, to leave loose ends that they can take up. objective approach is, of course, the application of the principle of reciprocal inhibition to that anxiety which is the candidate’s enemy in all such seemingly unequal ordeals. There is lastly the final question. " We have decided to offer you the post, Dr. Chose-are you prepared to accept it ?" In the interests of economy, you have combined your visit to the job with your appearance for interview, but have thus discovered at the eleventh hour that this is no place for you. If you refuse bluntly, you may not be considered eligible for your expenses. This risk I avoided once by implying that the post and its attributes carried interesting and engaging possibilities, but that I hoped that the committee was prepared to spend a vast amount of money without which ... &c. They were not. Honour and expenses were both saved. Hellesdon Hospital, F. J. NAPIER. Norwich.
SiR,-At first I couldn’t believe it ! A special article On the Art of Being Interviewed. The system of management is obviously so power-structured that, after all the years of medical study, hospital, work, and striving, one has to be subjected to an interrogation by academic judges who appear to have no objective criteria. Doctors who are subjected to these interviews should be paid rather than 1.
Lancet, 1949, i, 34.