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TUBERCULOSIS NOTIFICATION
1251
placental hormones,2 but I believe these are only one important factor. Toxemia results from the interplay of various factorsextrinsic (diet), intrinsic (hypertensive, renal), hormonal, mechanical, and infective-which lead to vasospasm and infarction. I have described8 the pre-infarct and post-infarct stages of toxaemia, and postpartum pre-eclampsia is, I believe, a normal part of the latter stage. K. D. SALZMANN. TUBERCULOSIS NOTIFICATION SIR,-Ydu quote (Nov. 5, p. 1036) from the Registry General’s commentary the official figure for tuberculosis notifications in 1949 as 50,000 and for 1958 as 30,000. On paper this looks very good and in fact would be good if 1958 were a true figure. You have previously published from me evidence that when the number of attested (tuberculintested) cattle increased, human tuberculosis also increased, and this applies to both pulmonary and non-pulmonary tuberculosis. On Oct. 1 this year the whole of Great Britain was declared free of cattle tuberculosis so that during 1949-58 eradication of cattle tuberculosis was in its final stages. Also during this period I suspect that the official figure was not correct. I remember a report from Hampshire of pulmonary and non-pulmonary tuberculosis in the same house: neither case had been officially notified. I suggest these are not isolated cases.
My opportunity of finding such evidence in a smallish veterinary practice is limited, but I will hazard that if all the individuals with tuberculosis were enumerated the 30,000 would be
verv near
100,000.
L. PITCHER. WORKING WIVES—AND THEIR CHILDREN
review of the subsequent careers of the Oxford women medical graduates, and the findings are somewhat disturbing. 75 of the 93 women, who graduated between 1941 and 1950, have married. Of these 75 married women, 32 (43%) are practising between half and full time; 15 (20%) are practising less, and usually much less than half-time and the majority of these are anxious to spend more time in medicine; 6 (8%) are not practising and have no desire to resume, while 22 (29%) are not practising but are very anxious so to do on a part-time basis. Accordingly about half of these married women seek, but are unable, to continue the career for which they trained. It would take too long to set out all the factors which cause this situation, and although it is true that lack of domestic help, income-tax laws, and the husband’s occupation all play their part, yet the principal factor is the unwillingness of hospital authorities, medical officers of health, and general practitioners, to accept women in half-time posts. Unless the Ministry of Health can induce a change of heart on this point, it would be wiser, from the point of view of the nation’s economy, if the admission of women to medicine were severely restricted, as the male wastage is so much less. On the other hand, they arrange things better in many European countries, where married medical women have no difficulty in obtaining satisfactory posts on a part-time basis. The situation with regard to those who graduated prior to 1940 is rather different as a far higher proportion have remained single, for as one of them wrote " my generation of medical women were brought up neither to receive nor expect to receive any special consideration because we were women. The present generation takes it for granted
SIR,-I have almost completed
2. 3.
Saizmann, Salzmann,
a
K. D. Lancet, 1955, ii, 953. K. D. Aetiology and Arrest of Pre-eclamptic Toxæmia with Ambulant Treatment. London, 1960. Early
that medical domestic ".
practice
can
be
arranged around the life
My advice, based on this study, to the woman medical student who wished to combine medical practice and matrimony would be a variant of that given by the oracle of Bouverie Street, " Don’t get married until you have established yourself in medicine, marry a doctor and obtain long leave, but don’t resign your post while having a baby, and thereafter only work half to three-quarters time; alternatively go abroad to a country (there are several) where domestic help is plentiful ". But Cupid is notoriously deaf to sage advice. The Radcliffe Infirmary, Oxford.
A. H. T. ROBB-SMITH.
MODERN CLINICAL BIOCHEMISTRY
SIR,-As head of a department which produces biochemists I should like to comment on the recent letters by Dr. Hendry (Oct. 29, Nov. 19), Dr. Woolf (Nov. 12), and others. At the present time the demand for biochemists with science degrees greatly exceeds the supply. Of the various possible sources of employment the National Health Service offers a reasonably good financial inducement to the young scientist, but in my experience it is exceedingly difficult to persuade science graduates to accept posts in hospital biochemical laboratories. One of the things which deters them from entering the hospital service is the feeling that they will be regarded by their medical colleagues not as professional scientists and university graduates but rather as subordinates in the iritellectual, economic, social, and professional category of technicians and medical auxiliaries. That these fears are not without justification is very beautifully illustrated in the unfortunate letter of Dr. Osborn (Nov. 5). It is true that science graduates express fewer misgivings about entering the biochemical laboratory of a large teaching hospital where they are under the control of a professional biochemist as head of a department, but it is becoming increasingly difficult to persuade them to work in the smaller hospitals where all the laboratory services are grouped under a non-biochemical pathologist. One disturbing result of this attitude is that the best science graduates tend to shun hospital employment-it is very rare for a first-class honours man to enter a hospital laboratory. The consequent flow of a number of the less able graduates to the hospitals is apt to give the medical staff a less favourable impression of the usefulness of scientists in their midst than they might otherwise gain. And so the vicious cycle begins. There is no doubt that the best training for a hospital biochemist is an honours science degree in biochemistry supplemented by a medical qualification; but such a training is lengthy and only a few students (about two per year in Glasgow) are willing to face it. The basis of the biochemist’s training must be chemical whereas that of the pathologist must be medical, but the biochemist at the end of his training must be able to discuss problems of mutual interest for the patient’s welfare with his pathological colleagues as an equal and not as a subordinate and he must have direct access to the clinician in charge of the patient. This is not merely a matter of professional prideit is the only way to encourage the ablest biochemists to enter, and to remain in, hospital work. It may be administratively untidy to have the biochemical laboratory of a hospital separate from the pathological laboratory which covers morbid anatomy, bacterio-
placental hormones,2 but I believe these are only one important factor. Toxemia results from the interplay of various factorsextrinsic (diet), intrinsic (hypertensive, renal), hormonal, mechanical, and infective-which lead to vasospasm and infarction. I have described8 the pre-infarct and post-infarct stages of toxaemia, and postpartum pre-eclampsia is, I believe, a normal part of the latter stage. K. D. SALZMANN. TUBERCULOSIS NOTIFICATION SIR,-Ydu quote (Nov. 5, p. 1036) from the Registry General’s commentary the official figure for tuberculosis notifications in 1949 as 50,000 and for 1958 as 30,000. On paper this looks very good and in fact would be good if 1958 were a true figure. You have previously published from me evidence that when the number of attested (tuberculintested) cattle increased, human tuberculosis also increased, and this applies to both pulmonary and non-pulmonary tuberculosis. On Oct. 1 this year the whole of Great Britain was declared free of cattle tuberculosis so that during 1949-58 eradication of cattle tuberculosis was in its final stages. Also during this period I suspect that the official figure was not correct. I remember a report from Hampshire of pulmonary and non-pulmonary tuberculosis in the same house: neither case had been officially notified. I suggest these are not isolated cases.
My opportunity of finding such evidence in a smallish veterinary practice is limited, but I will hazard that if all the individuals with tuberculosis were enumerated the 30,000 would be
verv near
100,000.
L. PITCHER. WORKING WIVES—AND THEIR CHILDREN
review of the subsequent careers of the Oxford women medical graduates, and the findings are somewhat disturbing. 75 of the 93 women, who graduated between 1941 and 1950, have married. Of these 75 married women, 32 (43%) are practising between half and full time; 15 (20%) are practising less, and usually much less than half-time and the majority of these are anxious to spend more time in medicine; 6 (8%) are not practising and have no desire to resume, while 22 (29%) are not practising but are very anxious so to do on a part-time basis. Accordingly about half of these married women seek, but are unable, to continue the career for which they trained. It would take too long to set out all the factors which cause this situation, and although it is true that lack of domestic help, income-tax laws, and the husband’s occupation all play their part, yet the principal factor is the unwillingness of hospital authorities, medical officers of health, and general practitioners, to accept women in half-time posts. Unless the Ministry of Health can induce a change of heart on this point, it would be wiser, from the point of view of the nation’s economy, if the admission of women to medicine were severely restricted, as the male wastage is so much less. On the other hand, they arrange things better in many European countries, where married medical women have no difficulty in obtaining satisfactory posts on a part-time basis. The situation with regard to those who graduated prior to 1940 is rather different as a far higher proportion have remained single, for as one of them wrote " my generation of medical women were brought up neither to receive nor expect to receive any special consideration because we were women. The present generation takes it for granted
SIR,-I have almost completed
2. 3.
Saizmann, Salzmann,
a
K. D. Lancet, 1955, ii, 953. K. D. Aetiology and Arrest of Pre-eclamptic Toxæmia with Ambulant Treatment. London, 1960. Early
that medical domestic ".
practice
can
be
arranged around the life
My advice, based on this study, to the woman medical student who wished to combine medical practice and matrimony would be a variant of that given by the oracle of Bouverie Street, " Don’t get married until you have established yourself in medicine, marry a doctor and obtain long leave, but don’t resign your post while having a baby, and thereafter only work half to three-quarters time; alternatively go abroad to a country (there are several) where domestic help is plentiful ". But Cupid is notoriously deaf to sage advice. The Radcliffe Infirmary, Oxford.
A. H. T. ROBB-SMITH.
MODERN CLINICAL BIOCHEMISTRY
SIR,-As head of a department which produces biochemists I should like to comment on the recent letters by Dr. Hendry (Oct. 29, Nov. 19), Dr. Woolf (Nov. 12), and others. At the present time the demand for biochemists with science degrees greatly exceeds the supply. Of the various possible sources of employment the National Health Service offers a reasonably good financial inducement to the young scientist, but in my experience it is exceedingly difficult to persuade science graduates to accept posts in hospital biochemical laboratories. One of the things which deters them from entering the hospital service is the feeling that they will be regarded by their medical colleagues not as professional scientists and university graduates but rather as subordinates in the iritellectual, economic, social, and professional category of technicians and medical auxiliaries. That these fears are not without justification is very beautifully illustrated in the unfortunate letter of Dr. Osborn (Nov. 5). It is true that science graduates express fewer misgivings about entering the biochemical laboratory of a large teaching hospital where they are under the control of a professional biochemist as head of a department, but it is becoming increasingly difficult to persuade them to work in the smaller hospitals where all the laboratory services are grouped under a non-biochemical pathologist. One disturbing result of this attitude is that the best science graduates tend to shun hospital employment-it is very rare for a first-class honours man to enter a hospital laboratory. The consequent flow of a number of the less able graduates to the hospitals is apt to give the medical staff a less favourable impression of the usefulness of scientists in their midst than they might otherwise gain. And so the vicious cycle begins. There is no doubt that the best training for a hospital biochemist is an honours science degree in biochemistry supplemented by a medical qualification; but such a training is lengthy and only a few students (about two per year in Glasgow) are willing to face it. The basis of the biochemist’s training must be chemical whereas that of the pathologist must be medical, but the biochemist at the end of his training must be able to discuss problems of mutual interest for the patient’s welfare with his pathological colleagues as an equal and not as a subordinate and he must have direct access to the clinician in charge of the patient. This is not merely a matter of professional prideit is the only way to encourage the ablest biochemists to enter, and to remain in, hospital work. It may be administratively untidy to have the biochemical laboratory of a hospital separate from the pathological laboratory which covers morbid anatomy, bacterio-