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CHARING CROSS HOSPITAL INSTITUTE OF PATHOLOGY.
260 THYROID GLAND AND CALCIUM THERAPY To the Editor of THE LANCET. your issue of Jan. 9th appears a letter from Dr. D. C. Nasmyth which raises a point of great clinical importance-namely, the advisability of administering thyroid substance to individuals suffering from chilblains. Dr. Nasmyth contends that any benefit which results from such treatment is due to the contained parathyroid element, and that, in her experience, the " administration of thyroid often causes chilblains where they have not previously existed." There is, I think, ample evidence that the salts of calcium are of great value in the treatment of chilblains, and the work of Groves and Vines showed that the parathyroid apparatus and the calcium metabolism of the body stand in close relationship. In the experiments of MacCallum and Voegtlin on the effects of calcium salts on tetany, they showed that both in animals and human beings the administration of lime salts caused the symptoms to disappear. The exhibition of calcium salts in the treatment of chilblains dates back to days before the r6le of the parathyroids was understood. It is now, in conjunction with parathyroid substance, an accepted method of treating this troublesome, if somewhat petty, complaint. That many sufferers from chilblains are also hypo-parathyroideics is probable ; it is also likely that some of these individuals are lacking an adequate supply of thyroid secretion, and they would therefore benefit by thyroid feeding. The whole question of the inter-relationship of the thyroid and parathyroid apparatus is still so undecided that, clinically, it is only possible to pick out the outstanding symptoms in an individual case and prescribe accordingly. I do not see any good grounds for objecting to the dual prescription of thyroid and parathyroid in a given case, so long as the symptoms support such a prescription. I cannot personally recall any patients who have developed chilblains for the first time after taking thyroid substance ; but it is not improbable that this might occur in what may be called " potential " sufferers, if their calcium elimination was briskly stimulated. I am, Sir, yours faithfully, IVO GEIKIE COBB. Queen Anne-street, W., Jan. 12th, 1926.
THE SPECIAL DIPLOMAS OF THE ROYAL COLLEGE OF SURGEONS OF ENGLAND.
SiR,—In
To
the
Editor
of THE
LANCET.
SIR,-The younger generation can now obtain diplomas in otology, ophthalmology, and other subjects at the Royal College of Surgeons of England as an evidence of their competence to practise these branches of their profession as specialists." This is a step in the right direction, but to senior men it may seem hard that, after years of hard work, they should be without such a special diploma unless they pass the necessary examination. Many men hesitate, lest failure should occur to prejudice them in the eyes of their patients. They feel that such an examination would be at the hands of their contemporaries, possibly even of their juniors, and that differences of personal opinion might hazard their success. Would it not be an expedient and graceful act if the Royal College could see its way to granting its special diplomas to those who have been practising their specialties for, say, 25 years ? Of course, on payment of the necessary fee. "
I am, Sir, yours faithfully, F.R.C.S. AND SPECIALIST OF THIRTY YEARS STANDING.
Jan. 22and, 1926.
** * Our correspondent, whose position as a specialist no strengthening, puts forward a view that must command sympathy, but we believe that the College would decline the responsibility suggested.
requires
The task of discrimination would be too difficult because there are no standards on which the withholding the diploma without examination from claimants to the position of specialist could be justified, at any rate, in the eyes of the disappointed. And injustice might be done unwittingly.-ED. L.
Obituary.
IRIS FOX, M.D. LOND. WK deeply regret to record the death of Dr. Iris She pricked her finger at an Fox from septicaemia,. autopsy on an accident case on Christmas Eve and this was followed by severe local infection, which it was hoped for several weeks would not become generalised. Her death occurred on Jan. 21st. CHARING CROSS HOSPITAL INSTITUTE OF Iris Fox was the youngest daughter of Dr. R. Fortescue Fox and was born at Strathpeffer Spa, of PATHOLOGY. the sixth medical generation in direct line of the Fox To the Editor of THE LANCET. She was educated at Queen’s College, Harleyfamily. SIR,—In your issue of Nov. 22nd, 1924 (p. 1102), street, and the Mount School, York, and then studied you published details of a scheme under which the for two year’s at the Slade School of Art before Hospital for Epilepsy and Paralysis placed its entering the London School of Medicine for Women pathological facilities at the disposal of general with a scholarship. After qualifying in 1915 she held practitioners in the neighbourhood, for the benefit a series of resident appointments at the Royal Northern of those patients who could not pay private fees, the South-Western Fever Hospital, and the and in the same issue (p. 1097) a letter signed by Hospital, South London Hospital for Women. Towards the the pathologists of three London hospitals, of whom end of the war she spent some months at Samoens, Dr. Alfred Piney was one, protesting against the in French in charge of women and children Savoy, hospital’s policy. Their argument was carried on sinistrées, sent there by the Friends’ War Victims’ by Dr. J. A. Murray, President of the Pathological Committee. In 1918 she became medical registrar at Section of the Royal Society of Medicine, and you the Royal Free Hospital before definitely taking up were good enough to publish a reply from the hospital the pathological work which was to become her chief on Dec. 6th (p. 1206). interest in medicine. After 18 months as second A circular dated Nov. 1st, 1925, from Charing Cross assistant pathologist at St. Mary’s Hospital and a Hospital Institute of Pathology has reached me, from further year as assistant pathologist at the Swansea which it appears that this hospital’s scheme, which General Dr. Iris Fox was appointed senior Hospital, was criticised a year before, has been in the main assistant pathologist at the Royal Free Hospital, which adopted by the Institute. In an accompanying carried with it the assistant directorship of pathological schedule of fees the statement is made that Dr. Alfred studies in the London School of Medicine for Women. Piney (one of the signatories of the above-mentioned Just before doing so she took the M.D. Lond. with and I venture to ask, letter) will sign all reports, as the special subject, and worked for through your columns, if Dr. Piney will state what pathology some months on endocrine glands in relation to has influenced him during the past 12 months to mental at the Maudsley Hospital, under disorder, change his views, and whether his present opinions the guidance of Sir Frederick Mott. Her time at are shared by his co-signatories. the Royal Free Hospital was largely spent in I am, Sir, yours faithfully, organising an efficient bacteriological department, H. W. BURLEIGH, what remained being devoted to a study of the Secretary and General Superintendent, Hospital for Epilepsy and Paralysis. Jan. 25th, 1926. streptococci, especially in relation to infective arthritis,
THE SPECIAL DIPLOMAS OF THE ROYAL COLLEGE OF SURGEONS OF ENGLAND.
SiR,—In
To
the
Editor
of THE
LANCET.
SIR,-The younger generation can now obtain diplomas in otology, ophthalmology, and other subjects at the Royal College of Surgeons of England as an evidence of their competence to practise these branches of their profession as specialists." This is a step in the right direction, but to senior men it may seem hard that, after years of hard work, they should be without such a special diploma unless they pass the necessary examination. Many men hesitate, lest failure should occur to prejudice them in the eyes of their patients. They feel that such an examination would be at the hands of their contemporaries, possibly even of their juniors, and that differences of personal opinion might hazard their success. Would it not be an expedient and graceful act if the Royal College could see its way to granting its special diplomas to those who have been practising their specialties for, say, 25 years ? Of course, on payment of the necessary fee. "
I am, Sir, yours faithfully, F.R.C.S. AND SPECIALIST OF THIRTY YEARS STANDING.
Jan. 22and, 1926.
** * Our correspondent, whose position as a specialist no strengthening, puts forward a view that must command sympathy, but we believe that the College would decline the responsibility suggested.
requires
The task of discrimination would be too difficult because there are no standards on which the withholding the diploma without examination from claimants to the position of specialist could be justified, at any rate, in the eyes of the disappointed. And injustice might be done unwittingly.-ED. L.
Obituary.
IRIS FOX, M.D. LOND. WK deeply regret to record the death of Dr. Iris She pricked her finger at an Fox from septicaemia,. autopsy on an accident case on Christmas Eve and this was followed by severe local infection, which it was hoped for several weeks would not become generalised. Her death occurred on Jan. 21st. CHARING CROSS HOSPITAL INSTITUTE OF Iris Fox was the youngest daughter of Dr. R. Fortescue Fox and was born at Strathpeffer Spa, of PATHOLOGY. the sixth medical generation in direct line of the Fox To the Editor of THE LANCET. She was educated at Queen’s College, Harleyfamily. SIR,—In your issue of Nov. 22nd, 1924 (p. 1102), street, and the Mount School, York, and then studied you published details of a scheme under which the for two year’s at the Slade School of Art before Hospital for Epilepsy and Paralysis placed its entering the London School of Medicine for Women pathological facilities at the disposal of general with a scholarship. After qualifying in 1915 she held practitioners in the neighbourhood, for the benefit a series of resident appointments at the Royal Northern of those patients who could not pay private fees, the South-Western Fever Hospital, and the and in the same issue (p. 1097) a letter signed by Hospital, South London Hospital for Women. Towards the the pathologists of three London hospitals, of whom end of the war she spent some months at Samoens, Dr. Alfred Piney was one, protesting against the in French in charge of women and children Savoy, hospital’s policy. Their argument was carried on sinistrées, sent there by the Friends’ War Victims’ by Dr. J. A. Murray, President of the Pathological Committee. In 1918 she became medical registrar at Section of the Royal Society of Medicine, and you the Royal Free Hospital before definitely taking up were good enough to publish a reply from the hospital the pathological work which was to become her chief on Dec. 6th (p. 1206). interest in medicine. After 18 months as second A circular dated Nov. 1st, 1925, from Charing Cross assistant pathologist at St. Mary’s Hospital and a Hospital Institute of Pathology has reached me, from further year as assistant pathologist at the Swansea which it appears that this hospital’s scheme, which General Dr. Iris Fox was appointed senior Hospital, was criticised a year before, has been in the main assistant pathologist at the Royal Free Hospital, which adopted by the Institute. In an accompanying carried with it the assistant directorship of pathological schedule of fees the statement is made that Dr. Alfred studies in the London School of Medicine for Women. Piney (one of the signatories of the above-mentioned Just before doing so she took the M.D. Lond. with and I venture to ask, letter) will sign all reports, as the special subject, and worked for through your columns, if Dr. Piney will state what pathology some months on endocrine glands in relation to has influenced him during the past 12 months to mental at the Maudsley Hospital, under disorder, change his views, and whether his present opinions the guidance of Sir Frederick Mott. Her time at are shared by his co-signatories. the Royal Free Hospital was largely spent in I am, Sir, yours faithfully, organising an efficient bacteriological department, H. W. BURLEIGH, what remained being devoted to a study of the Secretary and General Superintendent, Hospital for Epilepsy and Paralysis. Jan. 25th, 1926. streptococci, especially in relation to infective arthritis,