- Email: [email protected]
COMMISSIONS IN THE R.A.M.C.
735
ANNOTATIONS COMMISSIONS IN THE R.A.M.C.
WE learn that the supply of medical officers for the regular army is now being maintained at a rate which should soon make up the shortage experienced for some years after the war. Since 1934, when the recommendations of the Warren Fisher Committee were adopted, 195 short-service commissions have been given. Of this number 182 qualified in home medical schools and 13 in the Dominions. Resident civil hospital appointments were held by 152 officers before or after receiving a commission. This high proportion is the result of seconding young officers to complete or to take up house appointments after being gazetted into the Royal Army Medical Corps. Since 1935 junior officers with special qualifications or who have experience beyond the average in branches of medicine may be particular graded for special employment in the subject of their choice and while so employed receive additional pay. Up to date 49 have been graded as follows : surgeons 19, anaesthetists 10, gynaecologists 6, physicians 5, "
"
pathologists 3, otologists 2, ophthalmologists 2, dermatologists 2. The next entry for the corps takes place on May 1st. SIX YEARS WASTED
THE appointment of the Interdepartmental Committee on the Nursing Services has led to a revival of interest in the final report of THE LANCET Commission on Nursing. Now that many bodies deeply concerned at the shortage are preparing evidence for submission to the committee we receive almost daily tributes, direct and indirect, to the wisdom of the proposals made therein. The consensus of opinion is that if these had been more generally implemented the supply of candidates would by now have been adequate to the increasing need. This view was set1 out with cogency and precision in a contemporary last week. " The standard work on reform of the nursing profession is THE LANCET Commission’s report (1932),a work of such excellence that though it is somewhat old it will never become obsolete. Had THE LANCET recommendations been adopted in full, the nursing profession would have been placed on a basis from which it would have developed automatically and the necessity for the Interdepartmental Committee would not have arisen. The ’ The College of Nursing memorandum * says : recommendations put forward by THE LANCET Commission became unnecessary as the position was remedied automatically by the economic world crisis.’ We are inclined to put this somewhat differently by saying that the crisis in relieving by force of circumstance the acute shortage of nurses which led to THE LANCET Commission, gave a temporary excuse for not accepting its recommendations. The crisis fortunately has passed and the troubles of the nursing profession have returned and some permanent settlement of them is now
imperative."
Our contemporary proceeds to comment on the training of a health visitor and to protest against one of the suggestions made by the College of Nursing in their evidence-that the health visitor’s two years’ training might be taken as a pre-nursing course to 1 Med. Offr., March 19th, 1938, p. 116. Memorandum relating to conditions in the nursing profession for submission to the Interdepartmental Committee on the Nursing Services. 1938. Pp. 43. Is. 6d. (Obtainable from the Secretary of the College, la, Henrietta-street, *
London, W.I.)
fill the gap between school and hospital. Medical officers of health give good reasons for objecting to this sequence of professional education. They contend that the special kind of training required by the health visitor cannot be appreciated by those without considerable experience of life and would only be confusing to a young girl who knows nothing of the social troubles of humanity and how to react to them. It would indeed be small gain if the gap were filled at the expense of the balanced outlook which is more essential than ever before in those who go into the homes of the people to teach them the art of
healthy living.
FIBIGER’S TUMOUR OF THE
RAT’S
STOMACH
significance of Fibiger’s contribution to the cancer problem 1 is generally held to lie in his demonstration of an extraneous cause, the parasitic worm Gogylo7zema neoplasticum, in the stomachs of rats affected with gastric cancer, and in the provision of an experimental method for reproducing this lesion by feeding rats with that parasite. The history of his discovery and the difficulties which he met with and overcame are related by Hadfield and Garrod2 who describe it as one of the most extraordinary stories in the whole of pathology. Another chapter in this story has lately been added by Cramer.33 From it we realise that the mystery deepens while the interest it evokes becomes in some ways greater, in others less. It is less because doubt has arisen whether Fibiger’s tumours were in fact malignant carcinomata. The question was first raised by Bullock and Rohdenburg4 and more recently by Passey 5 and, as Cramer points out, the only conclusive evidence to be found in support of malignant change refers to one mouse from which Fibiger succeeded in transplanting one of his alleged carcinomata through four generations. The lesions in the lungs described as metastases may very well have been squamous metaplasia of bronchial mucosa due, as Passey, Leese, and Knox6 have pointed out, to a diet deficient in vitamin A. Fibiger repeatedly stated in his writings that his animals were kept on a diet composed exclusively of white bread and water. This would have contained little or no’ vitamin A and a subsidiary problem, which Cramer discusses, is how these rats managed to live long enough to get the lesion. In interpreting Fibiger’s accounts of the tumours, however, it has to be remembered that he clearly described two distinctive conditions, a benign hyperplasia and a malignant type of growth, and that he was an experienced observer. It might then seem to be a simple matter to settle this doubt by repeating Fibiger’s experiments. It appears that no one has attempted this with mice, and that Passey has been unable to obtain any but benign lesions in rats, although he fed his animals with the Gongylonema neoplasticum in combination with a diet of white bread and water, Even so the and with a vitamin-A deficient diet. he and not lesions obtained were slight benign THE
1 Fibiger, J.,
Z.
Krebsforsch. 1913, 13, 217 ; 1914, 14, 295 ;
1920, 17, 1. 2
Hadfield, G., and Garrod, L. P., Recent Advances in Pathology, London, 1934, p. 55. 3 Cramer, W., Amer. J. Cancer, 1937, 31, 537. 4 Bullock, F. D., and Rohdenburg, G. L., J. Cancer Res. 1918, 3, 227. 5 Passey, R. D., Annual Report of the Yorkshire Council of British Empire Cancer Campaign, 1934, p. 9 ; 1935, p. 8. 6 Passey, R. D., Leese, A., and Knox, J. C., J. Path. Bact. 1936, 42, 425.
ANNOTATIONS COMMISSIONS IN THE R.A.M.C.
WE learn that the supply of medical officers for the regular army is now being maintained at a rate which should soon make up the shortage experienced for some years after the war. Since 1934, when the recommendations of the Warren Fisher Committee were adopted, 195 short-service commissions have been given. Of this number 182 qualified in home medical schools and 13 in the Dominions. Resident civil hospital appointments were held by 152 officers before or after receiving a commission. This high proportion is the result of seconding young officers to complete or to take up house appointments after being gazetted into the Royal Army Medical Corps. Since 1935 junior officers with special qualifications or who have experience beyond the average in branches of medicine may be particular graded for special employment in the subject of their choice and while so employed receive additional pay. Up to date 49 have been graded as follows : surgeons 19, anaesthetists 10, gynaecologists 6, physicians 5, "
"
pathologists 3, otologists 2, ophthalmologists 2, dermatologists 2. The next entry for the corps takes place on May 1st. SIX YEARS WASTED
THE appointment of the Interdepartmental Committee on the Nursing Services has led to a revival of interest in the final report of THE LANCET Commission on Nursing. Now that many bodies deeply concerned at the shortage are preparing evidence for submission to the committee we receive almost daily tributes, direct and indirect, to the wisdom of the proposals made therein. The consensus of opinion is that if these had been more generally implemented the supply of candidates would by now have been adequate to the increasing need. This view was set1 out with cogency and precision in a contemporary last week. " The standard work on reform of the nursing profession is THE LANCET Commission’s report (1932),a work of such excellence that though it is somewhat old it will never become obsolete. Had THE LANCET recommendations been adopted in full, the nursing profession would have been placed on a basis from which it would have developed automatically and the necessity for the Interdepartmental Committee would not have arisen. The ’ The College of Nursing memorandum * says : recommendations put forward by THE LANCET Commission became unnecessary as the position was remedied automatically by the economic world crisis.’ We are inclined to put this somewhat differently by saying that the crisis in relieving by force of circumstance the acute shortage of nurses which led to THE LANCET Commission, gave a temporary excuse for not accepting its recommendations. The crisis fortunately has passed and the troubles of the nursing profession have returned and some permanent settlement of them is now
imperative."
Our contemporary proceeds to comment on the training of a health visitor and to protest against one of the suggestions made by the College of Nursing in their evidence-that the health visitor’s two years’ training might be taken as a pre-nursing course to 1 Med. Offr., March 19th, 1938, p. 116. Memorandum relating to conditions in the nursing profession for submission to the Interdepartmental Committee on the Nursing Services. 1938. Pp. 43. Is. 6d. (Obtainable from the Secretary of the College, la, Henrietta-street, *
London, W.I.)
fill the gap between school and hospital. Medical officers of health give good reasons for objecting to this sequence of professional education. They contend that the special kind of training required by the health visitor cannot be appreciated by those without considerable experience of life and would only be confusing to a young girl who knows nothing of the social troubles of humanity and how to react to them. It would indeed be small gain if the gap were filled at the expense of the balanced outlook which is more essential than ever before in those who go into the homes of the people to teach them the art of
healthy living.
FIBIGER’S TUMOUR OF THE
RAT’S
STOMACH
significance of Fibiger’s contribution to the cancer problem 1 is generally held to lie in his demonstration of an extraneous cause, the parasitic worm Gogylo7zema neoplasticum, in the stomachs of rats affected with gastric cancer, and in the provision of an experimental method for reproducing this lesion by feeding rats with that parasite. The history of his discovery and the difficulties which he met with and overcame are related by Hadfield and Garrod2 who describe it as one of the most extraordinary stories in the whole of pathology. Another chapter in this story has lately been added by Cramer.33 From it we realise that the mystery deepens while the interest it evokes becomes in some ways greater, in others less. It is less because doubt has arisen whether Fibiger’s tumours were in fact malignant carcinomata. The question was first raised by Bullock and Rohdenburg4 and more recently by Passey 5 and, as Cramer points out, the only conclusive evidence to be found in support of malignant change refers to one mouse from which Fibiger succeeded in transplanting one of his alleged carcinomata through four generations. The lesions in the lungs described as metastases may very well have been squamous metaplasia of bronchial mucosa due, as Passey, Leese, and Knox6 have pointed out, to a diet deficient in vitamin A. Fibiger repeatedly stated in his writings that his animals were kept on a diet composed exclusively of white bread and water. This would have contained little or no’ vitamin A and a subsidiary problem, which Cramer discusses, is how these rats managed to live long enough to get the lesion. In interpreting Fibiger’s accounts of the tumours, however, it has to be remembered that he clearly described two distinctive conditions, a benign hyperplasia and a malignant type of growth, and that he was an experienced observer. It might then seem to be a simple matter to settle this doubt by repeating Fibiger’s experiments. It appears that no one has attempted this with mice, and that Passey has been unable to obtain any but benign lesions in rats, although he fed his animals with the Gongylonema neoplasticum in combination with a diet of white bread and water, Even so the and with a vitamin-A deficient diet. he and not lesions obtained were slight benign THE
1 Fibiger, J.,
Z.
Krebsforsch. 1913, 13, 217 ; 1914, 14, 295 ;
1920, 17, 1. 2
Hadfield, G., and Garrod, L. P., Recent Advances in Pathology, London, 1934, p. 55. 3 Cramer, W., Amer. J. Cancer, 1937, 31, 537. 4 Bullock, F. D., and Rohdenburg, G. L., J. Cancer Res. 1918, 3, 227. 5 Passey, R. D., Annual Report of the Yorkshire Council of British Empire Cancer Campaign, 1934, p. 9 ; 1935, p. 8. 6 Passey, R. D., Leese, A., and Knox, J. C., J. Path. Bact. 1936, 42, 425.