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A DUAL RADIOLOGICAL FELLOWSHIP
1234 of the U.S. Public Health Service and the American Society of Clinical Pathologists (1934-35) was no happier. The Wassermann techniques employed in these studies yielded widely discrepant results and in only three of nine flocculation tests under investigation were the results reliable enough to warrant further trial. It has long been known that even in the hands of experts the results obtained with all these tests vary widely. Dr. Eagle, having justified by comparative figures his contention that the diagnostic tests as now performed in many laboratories are inadequate, is not without constructive suggestions. One is the refinement of the tests, though he admits that their sensitivity can be little, if at all, increased beyond the level already attained-well over 95 per cent. positive reactions in untreated syphilitic patients-in some of the newer flocculation methods or in an ice-box Wassermann reaction with a highly sensitised antigen. Improvement could still be effected in the provision of a wider margin of safety in the preparation and adjustment of the reagents and in minimising the personal element of interpretation in reading the results. More important, however, is his plea for a more critical attitude on the part of the individual laboratory to the calibre of its own performance. In some laboratories " outmoded procedures, such as water-bath fixation, are employed ; in others poor results are obtained, even with an approved technique, owing to an insufficiently trained personnel. Dr. Eagle regards ice-box fixation as essential for the satisfactory performance of the Wassermann test; in this country most laboratories use the method, recommended in a report to the Medical Research Council in 1929 by E. J. Wyler,2 of fixation for half an hour at room temperature followed by half an hour in the water-bath at 37° C. A serological report on a patient with suspected syphilis, whether before, during, or after treatment may have such a profound effect on the health and happiness that questions of technique should not be left unsettled. Another conference to evaluate the newer modifications of the complement-fixation and flocculation tests is surely overdue. Methods will have to be discussed afresh, after an unbiased survey of recent advances ; and the routine laboratories adopting the one recommended should at least have opportunity of checking their technique from time to time with that practised in a reliable control laboratory. Some would go further and maintain that laboratories where Wassermann and similar tests are performed should be subject to
periodical inspection by
an
expert.
A DUAL RADIOLOGICAL FELLOWSHIP
AT its recent meeting in Belfast the British Association of Radiologists came to a decision that should do much to improve the status of radiologists. When the Association was founded four years ago foundation members were admitted to the fellowship by thesis, but it was not long before examinations were established, and the first of these was held last year. The next step was to recognise that radiology has two distinct branches-therapy and diagnosis-and it candidates for the was originally proposed that fellowship should take examinations in both subjects and reach an honours standard in one of them. This plan, however, has now been abandoned, and there will henceforth be separate examinations in radiotherapy and in radiodiagnosis, success in either 2 Spec. Rep. Ser. med.
Res. Coun., Lond.
1929, No.
129.
of which will confer the title of fellow. Both examinations will include sections on medicine, surgery, and pathology, and it is hoped that bodies granting higher qualifications in these subjects will cooperate by appointing associate examiners. Candidates who already hold such higher qualifications will be exempt from the relevant part of the examination, but must possess a diploma in radiology and must present a thesis on some aspect of either diagnosis or therapy. One beneficial effect of a special examination in radiotherapy should be to facilitate the choice by hospital authorities of medical officers competent to take charge of this department and to control the use of the radium provided by the Radium Commission. In their last report the Commission commented on the difficulty of obtaining well-trained radiotherapists, and made various suggestions for improvement in their status. It is now generally agreed that X ray and radium therapy cannot be divorced, and that a full knowledge of both, as well as of the physics of irradiation, is needed by those who undertake responsibility for the treatment of patients by such potent agents. But the most important side of the radiotherapist’s work is clinical, and extensive experience, particularly in the treatment of malignant disease, is also essential if this work is to be done well. Such experience can be obtained only in special hospitals, or in large general ones where cases treated by these methods amount to many hundreds in a year. The radiotherapist of the future, after obtaining a diploma in radiology, will clearly have to embark on a course of training as exacting as that required for any other specialty. If he then passes an examination of a standard high enough to ensure theoretical as well as practical competence he will be entitled to a status equal to that of any member of the staff, though the nature of his work demands a full-time appointment on a salaried basis. TROPIC OR TROPHIC? SOME of those who read the note by Dr. van Wagenen and Dr. Morse appearing on p. 1220 will dismiss its opening word, gonadot1"ophic, as a printer’s But they will be wrong ; for the form that error. yesterday was only a .commonplace spelling mistake bids fair to prevail to-morrow. In a book published last year Prof. Burn1 contended that in endocrinological usage the termination tropic is less suitable than trophic and recommended that henceforth gonadotrophie, thyrotrophic, adrenotrophic, &c., should replace the current form. Tropic means " turning towards," whereas tropic means " nourishing " ; and ultimately it must be left to biologists to decide which of these more accurately describes the action of a hormone. In favour of the change it is argued that the thyroid-stimulating hormone, for example, does not turn towards the thyroid any more than it turns towards all the other glands and tissues ; but when, on its travels round the circulation, it reaches the thyroid it proceeds to nourish that particular gland in some way necessary to its growth-excess or deficiency of such nourishment making it hypertrophic or hypotrophic. The conception of a thyrotropic hormone is, moreover, inconsistent with the familiar conception of geotropic or heliotropic growth by plants ; for it is the hormone that turns to the gland, not the gland to the hormone. Some oppose the alteration on the ground that better terms will have to be devised when more is known about these substances ; but as an interim improvement it is 1 Burn, J. H., Biological Standardisation, Oxford, 1937.
periodical inspection by
an
expert.
A DUAL RADIOLOGICAL FELLOWSHIP
AT its recent meeting in Belfast the British Association of Radiologists came to a decision that should do much to improve the status of radiologists. When the Association was founded four years ago foundation members were admitted to the fellowship by thesis, but it was not long before examinations were established, and the first of these was held last year. The next step was to recognise that radiology has two distinct branches-therapy and diagnosis-and it candidates for the was originally proposed that fellowship should take examinations in both subjects and reach an honours standard in one of them. This plan, however, has now been abandoned, and there will henceforth be separate examinations in radiotherapy and in radiodiagnosis, success in either 2 Spec. Rep. Ser. med.
Res. Coun., Lond.
1929, No.
129.
of which will confer the title of fellow. Both examinations will include sections on medicine, surgery, and pathology, and it is hoped that bodies granting higher qualifications in these subjects will cooperate by appointing associate examiners. Candidates who already hold such higher qualifications will be exempt from the relevant part of the examination, but must possess a diploma in radiology and must present a thesis on some aspect of either diagnosis or therapy. One beneficial effect of a special examination in radiotherapy should be to facilitate the choice by hospital authorities of medical officers competent to take charge of this department and to control the use of the radium provided by the Radium Commission. In their last report the Commission commented on the difficulty of obtaining well-trained radiotherapists, and made various suggestions for improvement in their status. It is now generally agreed that X ray and radium therapy cannot be divorced, and that a full knowledge of both, as well as of the physics of irradiation, is needed by those who undertake responsibility for the treatment of patients by such potent agents. But the most important side of the radiotherapist’s work is clinical, and extensive experience, particularly in the treatment of malignant disease, is also essential if this work is to be done well. Such experience can be obtained only in special hospitals, or in large general ones where cases treated by these methods amount to many hundreds in a year. The radiotherapist of the future, after obtaining a diploma in radiology, will clearly have to embark on a course of training as exacting as that required for any other specialty. If he then passes an examination of a standard high enough to ensure theoretical as well as practical competence he will be entitled to a status equal to that of any member of the staff, though the nature of his work demands a full-time appointment on a salaried basis. TROPIC OR TROPHIC? SOME of those who read the note by Dr. van Wagenen and Dr. Morse appearing on p. 1220 will dismiss its opening word, gonadot1"ophic, as a printer’s But they will be wrong ; for the form that error. yesterday was only a .commonplace spelling mistake bids fair to prevail to-morrow. In a book published last year Prof. Burn1 contended that in endocrinological usage the termination tropic is less suitable than trophic and recommended that henceforth gonadotrophie, thyrotrophic, adrenotrophic, &c., should replace the current form. Tropic means " turning towards," whereas tropic means " nourishing " ; and ultimately it must be left to biologists to decide which of these more accurately describes the action of a hormone. In favour of the change it is argued that the thyroid-stimulating hormone, for example, does not turn towards the thyroid any more than it turns towards all the other glands and tissues ; but when, on its travels round the circulation, it reaches the thyroid it proceeds to nourish that particular gland in some way necessary to its growth-excess or deficiency of such nourishment making it hypertrophic or hypotrophic. The conception of a thyrotropic hormone is, moreover, inconsistent with the familiar conception of geotropic or heliotropic growth by plants ; for it is the hormone that turns to the gland, not the gland to the hormone. Some oppose the alteration on the ground that better terms will have to be devised when more is known about these substances ; but as an interim improvement it is 1 Burn, J. H., Biological Standardisation, Oxford, 1937.