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X RAY TREATMENT OF CANCER.
1224 be acquired by legislation, so that the situation should be clear to all the statutory bodies. There is also support for the reform to be found in the fact that degrees taken in special branches of medicine-i.e., M.D. (State Med.),M.D. (Trop. Med.),andM.D. (Psych. Med.)-are registered ; if the degrees why not the
Correspondence. " Audi alteram
partem."
THE QUESTION OF SPECIAL DIPLOMAS. To the Editor of THE LANCET. SIR,-From time to time vacancies are advertised
diplomas ? I am,
Sir,
yours
faithfully,
C. RUSSELL CORFIELD,
M.D. Brux.,
L.M.S.S.A. Lond., D.T.M. Liverp. Lincoln, June 14th, 1926.
in the columns of the medical journals, one of the conditions of candidature being the holding of one *** We have reason to believe the General Medical of the special diplomas. We learn that the D.P.H. is an extremely useful additional qualification, the Council is perfectly willing to register the special possession of which is indispensable to those who wish diplomas but little enthusiasm has been manifested to become school medical officers or medical officers by the statutory bodies issuing them to press for the of health. The D.T.M. is almost compulsory to new legislation which would be necessitated. The would-be officials of the Colonial Medical Services or D.P.H. is registrable by the Council whose ruling on workers in the tropics, special pay being promised to the cognate curriculum is therefore binding on the the holders of this extra qualification in many cases ; educational bodies concerned. Some of these might and it is useless to try for any tea- or rubber-estate object to loss of autonomy in the matter of special appointment without it. The possessors of the diplomas at present non-registrable. In regard to D.M.R.E. hold the fort as regards vacancies on the these the Council as the authority on medical ,electro-therapeutic or radiological staffs of our large education may pass resolutions but the examining hospitals and institutions, and the D.P.M. has become bodies are not bound by them.-ED. L. the sine qua non for all who propose to specialise in mental or nervous diseases and whose intention it is to get on the staffs of our large asylums. Diplomas X RAY TREATMENT OF CANCER. in tuberculosis diseases-i.e., D.T.D.-are now To the Editor of THE LANCET. expected of tuberculosis officers, and further special courses and qualifications are now being advanced for the SIR,-In leading article on the X Ray Treatment bacteriology and every other side line in medicine of Cancer in THE LANCET of June 12th, you were and surgery. kind enough to make some references to my recently The question now arises-why are these demands published book on " Radiotherapy in Relation to being made ? The answer is surely, that the holders General Medicine " (Oxford Medical Publications). of these special diplomas are recognised by the various One quotation is : " To British radiologists the treatauthorities as being more highly qualified or specialised ment of carcinoma of the womb is of little practical to hold certain posts than could be those medical importance, for they never see it." Your inadvertent men who are not so trained. This being a fact, how omission of the word early before carcinoma (see p. 97) is it that these qualifications with one exception-i.e., might perhaps lead readers to believe that radiothe D.P.H.-are not registrable. It does not appear therapeutists in this country take no interest in that those responsible for this oversight quite realise uterine cancer. The contrary is the case. We do our that it not only takes time and money, but an intensive best for the inoperable and the recurrent cases, of training and stiff examinations before these diplomas which, unfortunately, there is a plentiful supply. are obtained, and that they are only granted by Control of pain and haemorrhage is usually possible, recognised examining boards and universities. Why, and in some instances restoration to apparent health then, should these diplomas remain officially for a period measured in months and occasionally in I am, Sir, yours faithfully, unrecognised ? Who is responsible ? What antiquated years. machinery refuses to move ? It is quite time that F. HERNAMAN-JOHNSON. all qualifications legally gained by hard preparation Harley-street, June 12th, 1926. and after due examination should be registrable as 44 extra qualifications," providing the holders are already qualified to be admitted to the Medical
Register.
"TOXIC
..
-
-
.
-
.
-
-
I do not know of any actual hardship which has accrued to the holders of these special diplomas on application for posts owing to the fact that special diplomas cannot be registered, but it is clear that serious inconvenience may arise and probably has arisen. For example, a medical man when travelling applies for a vacancy and his personal statement of possessing a diploma is rightly not accepted, yet no one usually carries his diplomas about with him. The possession of a non-registrable special diploma may be supported by an entry in the Medical Directory, but absence of its registration in the Medical Register, the official roll of the profession, might make it necessary for an applicant to prove his identification and statements. Employers recognising the value of these special qualifications often demand them, even when not obliged to do so by the rules which govern the appointments, and are put to extra trouble and correspondence to ascertain that an applicant has the special training required, and this only because he is not registered as holding some diploma which he claims to possess. I can quite understand that new legislation is necessary to set this matter right, and it seems to me that the initiative might well come from the statutory bodies which grant the diplomas. A few weeks ago the Society of Apothecaries was told that the right to grant a registrable diploma in midwifery could only
MENINGEAL HÆMORRHAGE."
(SUBDURAL)
of THE LANCET. should like thank Dr. C. P. Symonds to SIR,-We for his comments in your issue of June ath and to submit the following observations in reply :In the first place we agree that the term " subarachnoid " is a more correct anatomical description than "subdural." Dr. Symonds’s suggestion that in one of our cases the blood came from a punctured vein has no application. All practitioners experienced in these matters will agree with us that there is no resemblance whatever between venous puncture blood and blood effusions such as the haemorrhages we have described. We accept Dr. Symonds’s evidence that a number of these hemorrhages are due to aneurysm, but in our opinion the present state of our knowledge of the subject does not justify the assumption that all owe.their origin to this condition. In our opinion the clinical histories of our cases and their response to treatment establish a strong argument in favour of a toxic origin. In our first case there were definite extra-meningeal signs of toxicity-viz., pleuropericardial friction and dilatation of the heart, which appear to us to be incompatible with a diagnosis of To the Editor
congenital
aneurysm.
In the other two cases, cerebro-spinal fever was present in the area and the mode of commencement
Correspondence. " Audi alteram
partem."
THE QUESTION OF SPECIAL DIPLOMAS. To the Editor of THE LANCET. SIR,-From time to time vacancies are advertised
diplomas ? I am,
Sir,
yours
faithfully,
C. RUSSELL CORFIELD,
M.D. Brux.,
L.M.S.S.A. Lond., D.T.M. Liverp. Lincoln, June 14th, 1926.
in the columns of the medical journals, one of the conditions of candidature being the holding of one *** We have reason to believe the General Medical of the special diplomas. We learn that the D.P.H. is an extremely useful additional qualification, the Council is perfectly willing to register the special possession of which is indispensable to those who wish diplomas but little enthusiasm has been manifested to become school medical officers or medical officers by the statutory bodies issuing them to press for the of health. The D.T.M. is almost compulsory to new legislation which would be necessitated. The would-be officials of the Colonial Medical Services or D.P.H. is registrable by the Council whose ruling on workers in the tropics, special pay being promised to the cognate curriculum is therefore binding on the the holders of this extra qualification in many cases ; educational bodies concerned. Some of these might and it is useless to try for any tea- or rubber-estate object to loss of autonomy in the matter of special appointment without it. The possessors of the diplomas at present non-registrable. In regard to D.M.R.E. hold the fort as regards vacancies on the these the Council as the authority on medical ,electro-therapeutic or radiological staffs of our large education may pass resolutions but the examining hospitals and institutions, and the D.P.M. has become bodies are not bound by them.-ED. L. the sine qua non for all who propose to specialise in mental or nervous diseases and whose intention it is to get on the staffs of our large asylums. Diplomas X RAY TREATMENT OF CANCER. in tuberculosis diseases-i.e., D.T.D.-are now To the Editor of THE LANCET. expected of tuberculosis officers, and further special courses and qualifications are now being advanced for the SIR,-In leading article on the X Ray Treatment bacteriology and every other side line in medicine of Cancer in THE LANCET of June 12th, you were and surgery. kind enough to make some references to my recently The question now arises-why are these demands published book on " Radiotherapy in Relation to being made ? The answer is surely, that the holders General Medicine " (Oxford Medical Publications). of these special diplomas are recognised by the various One quotation is : " To British radiologists the treatauthorities as being more highly qualified or specialised ment of carcinoma of the womb is of little practical to hold certain posts than could be those medical importance, for they never see it." Your inadvertent men who are not so trained. This being a fact, how omission of the word early before carcinoma (see p. 97) is it that these qualifications with one exception-i.e., might perhaps lead readers to believe that radiothe D.P.H.-are not registrable. It does not appear therapeutists in this country take no interest in that those responsible for this oversight quite realise uterine cancer. The contrary is the case. We do our that it not only takes time and money, but an intensive best for the inoperable and the recurrent cases, of training and stiff examinations before these diplomas which, unfortunately, there is a plentiful supply. are obtained, and that they are only granted by Control of pain and haemorrhage is usually possible, recognised examining boards and universities. Why, and in some instances restoration to apparent health then, should these diplomas remain officially for a period measured in months and occasionally in I am, Sir, yours faithfully, unrecognised ? Who is responsible ? What antiquated years. machinery refuses to move ? It is quite time that F. HERNAMAN-JOHNSON. all qualifications legally gained by hard preparation Harley-street, June 12th, 1926. and after due examination should be registrable as 44 extra qualifications," providing the holders are already qualified to be admitted to the Medical
Register.
"TOXIC
..
-
-
.
-
.
-
-
I do not know of any actual hardship which has accrued to the holders of these special diplomas on application for posts owing to the fact that special diplomas cannot be registered, but it is clear that serious inconvenience may arise and probably has arisen. For example, a medical man when travelling applies for a vacancy and his personal statement of possessing a diploma is rightly not accepted, yet no one usually carries his diplomas about with him. The possession of a non-registrable special diploma may be supported by an entry in the Medical Directory, but absence of its registration in the Medical Register, the official roll of the profession, might make it necessary for an applicant to prove his identification and statements. Employers recognising the value of these special qualifications often demand them, even when not obliged to do so by the rules which govern the appointments, and are put to extra trouble and correspondence to ascertain that an applicant has the special training required, and this only because he is not registered as holding some diploma which he claims to possess. I can quite understand that new legislation is necessary to set this matter right, and it seems to me that the initiative might well come from the statutory bodies which grant the diplomas. A few weeks ago the Society of Apothecaries was told that the right to grant a registrable diploma in midwifery could only
MENINGEAL HÆMORRHAGE."
(SUBDURAL)
of THE LANCET. should like thank Dr. C. P. Symonds to SIR,-We for his comments in your issue of June ath and to submit the following observations in reply :In the first place we agree that the term " subarachnoid " is a more correct anatomical description than "subdural." Dr. Symonds’s suggestion that in one of our cases the blood came from a punctured vein has no application. All practitioners experienced in these matters will agree with us that there is no resemblance whatever between venous puncture blood and blood effusions such as the haemorrhages we have described. We accept Dr. Symonds’s evidence that a number of these hemorrhages are due to aneurysm, but in our opinion the present state of our knowledge of the subject does not justify the assumption that all owe.their origin to this condition. In our opinion the clinical histories of our cases and their response to treatment establish a strong argument in favour of a toxic origin. In our first case there were definite extra-meningeal signs of toxicity-viz., pleuropericardial friction and dilatation of the heart, which appear to us to be incompatible with a diagnosis of To the Editor
congenital
aneurysm.
In the other two cases, cerebro-spinal fever was present in the area and the mode of commencement