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ESTIMATION OF BASAL METABOLIC RATE
323 be withheld from a midwife on the grounds that, in the remote possibility of her inducing anaesthesia, a fatal accident might follow, then it can be argued that anaesthetics should never be given, since deaths have been known to occur even when qualified doctors give them. The only rational course would be to arrange an investigation, in domiciliary practice, to compare the inhaler with the methods now in use. ’ A. FREEDMAN. Hendon, N.W.4. *** The college’s report is reviewed on p. 312.-ED. L.
business to hold any responsible position. A N..C. of marked personality can sometimes overbear even an experienced clinician, and I have seen gross errors of diagnosis made in this way : he is an expert technician, but should lean on the morbid physiologist, and is therefore an assistant rather than a principal. Finally, all laboratory workers-and consultants generally-are eccentrics who take up their specialised work because they enjoy it. The course in chemistry given to medical students is an excellent introduction, and it should not take long for an eccentric interested in medical chemistry to turn himself into a competent chemist-even though the average student fails to profit from that same course. Central Middlesex Hospital, GEORGE DISCOMBE.
PALLIATIVE SURGERY IN FACIAL PALSY
Sm,-Before surgeons embark too enthusiastically on attempts to alleviate facial paralysis by fascial slings or nerve operation they should clearly appreciate certain facts regarding this lesion. 1. Complete unilateral facial paralysis is not always disfiguring with the face at rest : indeed the side of the paralysis may only become apparent on facial
London, N.W.10.
ESTIMATION OF BASAL METABOLIC RATE you published an article by Dr. Bene in which he claimed that the B.M.R. could be calculated by multiplying the patient’s respiratory rate by his pulserate and expressing the figure thus obtained as an index " -e.g., normal pulse-rate (72) x normal respiration1296. The normal range is 1100-1500." rate (18) Some obvious criticisms of this paper sprang immediately to mind. (The figures for the R.P. index which follow are expressed as a percentage, taking 13-96 as normal.) 1. It is extremely improbable that so complicated a function could be expressed by so simple a formula, and previous methods such as those of Boothby and of Reid have, as Dr. Bene admits, proved completely fallacious. 2. Thyrotoxicosis is a disease of the whole body, but the parts of the body are unequally attacked. In different patients the assault is concentrated on different objectives. In some the most obvious results are mental, in others neurological, cardiac, respiratory, and so on. Neither the pulse-rate nor
SiR,-On Jan. 22
movement. 2. Some cases of facial palsy develop a disfiguring contracture of the paralysed side, a tendency which may be aggravated by the introduction of fascial slings. 3. Facial palsies whether from trauma or from Bell’s palsy either begin to recover within three or four weeks with a perfect restoration of function, or they may recover slowly by nerve regeneration. A very small proportion remain permanently paralysed. 4. Some recovery of movement following nerve regeneration first becomes evident three to nine months after the palsy, and improvement continues for a year or longer. 5. If operatious to " decompress " the facial nerve are to be advocated on the theory that the nerve is compressed, there are two rational alternatives : (a) one may either operate on all cases on the day the palsy rate bears any constant relationship to the develops, though this involves many unnecessary the respiratory of the disease or to the B.M.R. Thus one patient whose severity or the should be for (b) operation delayed operations ; records I have re-examined in the past week had obvious at least nine months after the palsy appears, that is clinical thyrotoxicosis and a B.M.R. of + 20-5 before thyroidecuntil sufficient time has elapsed to ensure that good tomy, but his respiration-rate at rest was 7 and his pulsenatural regeneration will not occur. Operations carried rate 82. After operation his B.M.R. was - 10, his respirationout within six months of the palsy appearing are therefore was 8, and his pulse-rate 68. By Dr. Bene’s method unreasonable, and reports of good results following rate the B.M.R. works out at - 56% before operation and 58% intervention at this period are meaningless. afterwards. 6. Perfect recovery of facial movement is impossible 3. Dr. Bene claims that his R.P. index corresponded with when regeneration of the nerve has to occur; the the B.M.R. in 67% of 43 patients- whose B.M.B. lay above inevitable mass movements can be observed for the + 15%, in 70% of 48 with a B.M.R. between + 15 and - 10%, rest of the patient’s life. There can therefore be no such " and in 70% of 9 patients with a B.M.R. of less than - 10%. thing as a perfect recovery " after nerve suture. But he does not explain what he means by correspondence " ; 7. There is room for further research on the natural can hardly mean that it is exact. Within what range does history of facial palsy to provide a clear background he he allow variation to occur without " correspondence being with which to compare alleged improvements in vitiated ? treatment. 4. He obtains his patients’ pulse and respiratory rates W. RITCHIE RUSSELL. Oxford. -
=
"
"
’
.
5 minutes’ rest. This is not long enough for the basal values to be attained. So short a period of rest may be sufficient for a few ; others require a little longer, and others again much longer. It follows from this that the figures for one patient are not comparable with those for another and that if his method is accurate for some it is bound to be inaccurate for others.
after
HOSPITAL BIOCHEMISTS SiB,—It appears from his letter of Feb. 5 that Dr. Taylor also regards the non-medical chemist (N.M.C.) as a technician ; so the point at issue is whether a technician or a medical consultant should be in charge of the routine laboratory. The investigation of a patient’s sickness starts at the bedside and may continue into the laboratory, and the task of the laboratory is to give the necessary clues to the clinician as quickly as possible. The choice of investigation is determined by the history and condition of the patient, and it is at this point that the medical qualification is desirable-it does not matter whether the laboratory consultant is called a chemical pathologist, clinical pathologist, biochemist, or physician for metabolic disease. I cannot too strongly condemn the idea that all tests must be completed before they are reviewed, for this leads straight to penny-in-the-slot pathology and a great increase in laboratory output, usually without corresponding benefit to the patient ; while the clinician is tempted to use laboratory tests to replace careful clinical observation. On the contrary, the results of onetest should be used to indicate whether further tests are desirable, and if so, which test is to be performed next. If the results are " coloured " by this procedure -i.e., falsified to agree with preconceived ideas-then the analyst is fundamentally dishonest and has no
only
truly
But. Sir, if despite these criticisms, Dr. Bene’s method should work, it would effect an important saving of time and money. If it should not, it is important that his statements should, lest they prove a stumbling-block, be refuted at the earliest possible moment, for unfortunately a refutation never quite catches a fallacy, I therefore however hot it may follow on its heels. examined the records of 100 B.M.R. determinations performed on 87 unselected patients by Miss E. M. Dean in this clinic. To give Dr. Bene’s method every chance I have allowed that the R.P. index corresponds with the B.M.R. when it lies within 10 % of it in either direction, which I think is rather generous. I found that among 59 patients with B.M.R.s above + 15% there were 11. (19%) agreements, among 37 with B.M.R.s between +15 % and - 10 % there were 3 (8 %) agreements, and among-unfortunately-only 4 with B.M.R.s below 10 % there was 1 agreement. The disagreement was often profound. For instance, in one instance the’B.M.R. was + 74% and the R.P. index - 22% and in another the B.M.R. was - 5% and the R.P. index + 46%. -
324 ’ It may be argued that my figures are comparable with those of Dr. Bene because
not strictly my patients
had been at rest for several hours and his for only five minutes. There is justice in this argument, but it weights the scales against Dr. Bene. As I have pointed out, his figures cannot be equally accurate because his data are not equally basal (and it is the basal metabolism he seeks to estimate). But supposing they were equally accurate, one would expect them to give figures higher than mine because his conditions are less basal. The fact that the R.P. index is in 60 % of my cases lower than the B.M.R. provides a final proof of my assertions that the two are completely unrelated to one another. RAYMOND GREENE. Thyroid Clinic, New End Hospital, London, N.W.3.
SIR,—There are four standard methods for estimating the basal metabolism, and these depend upon measuring: 1. 2. 3. 4.
The heat output. The oxygen consumption. The carbon-dioxide output. Both the oxygen consumption and the carbon-dioxide output. -
For many years now, formulae have been proposed for
translating simple bedside records into an approximate figure for the basal metabolism.’- These formulae, like Dr. Bene’s, are based on the fact that in thyrotoxicosis there may be tachycardia, an increased respiration-rate, and a rise in pulse pressure, whereas in hypothyroidism there may be the converse, and in normal people there The normal range of pulse-rate, may be more of these. respiration-rate, and pulse pressure is very wide, and, as they are not always greatly altered in thyrotoxicosis and in hypothyroidism, it is doubtful whether any of
the formulae can serve as a substitute for direct measurement of the basal metabolism. They may nevertheless have a certain clinical value : for example, the product of the pulse and respiration rates may well fall when thyrotoxicosis is reduced and rise when hypothyroidism is relieved. For basal metabolism, the range accepted as normal is wide. Indeed, the range accepted by Miss Lovell and Dr. Martin is different from my own, based on a study of some 2300 people of both sexes from the ages of three to eighty. This makes the interpretation of the basal rate at times not easy, and on occasions erroneous. Severe thyrotoxicosis or hypothyroidism may be easy to diagnose clinically, and in these cases the basal metabolism is usually well outside the normal range ; on the other hand, in the very mild cases, where assistance in the diagnosis may be most required, an isolated reading of the basal metabolism is of limited value.2 Observations on the variations in the basal metabolism can be made a most sensitive index of thyroid dysfunction if: 1. In the diagnosis of thyrotoxicosis, the basal rate is measured before and after twelve days of iodine medication. Only in thyrotoxicosis does iodine cause a significant alteration in the basal metabolism. 2. In the diagnosis of hypothyroidism the basal metabolism is measured before and after two to four weeks of thyroid -2 grains daily. Only in hypothyroidism does thyroid medication in such doses and over such a period cause a significant rise in the basal rate. Returning to Lovell and Martin’s criticism of Bene’s R.P. index, it appears possible that they may not have repeated quite accurately Bene’s observations. Bene counted the pulse and respirations after a rest of only five minutes, whereas basal conditions require a rest period of at least thirty minutes. As Lovell and Martin referred to 50 unselected cases from their records, no doubt the respirations and pulses were recorded under basal conditions. It is no criticism of Bene’s work that he chose arbitrarily a period of five, and not ten, twenty, or thirty minutes, for in seeking to make an intelligent guess at the basal metabolism, by a formula in no way related to heat output, it is not essential to comply with standard heat-output conditions. If he could devise the perfect formula by making certain observations while patients were standing on their heads, then all the more credit to Dr. Bene. ’
1. E.g., Read, J. M. J. Amer. med. Ass. 1922, 78, 1887. Gale, A.M., Gale, C. H. Lancet, 1931, i, 1287. Jenkins, R. L. Arch. intern. Med. 1932, 49, 188. 2. Robertson, J. D. Lancet, 1934, ii, 1076; Ann. Surg. 1949, 4, 3.
In summary -’Ithink it can be .said that the pulserespiration product after a five-minuter rest period may
well have
a certain clinical value, provided a correlation with the basal metabolism is not attempted. J. DOUGLAS ROBERTSON. Department of Clinical Investigation,
The London Clinic, W.1.
SENIORS AND JUNIORS have read with astonishment "Physician’s " SIR,—I letter in your last issue. He states that the assessing committees appointed to advise the regional hospital boards on the status of consultant staffs are instructed to relegate junior consultants to a new category of " senior hospital officer." Last June the Minister of Health announced that the Government accepted in principle the recommendations of the Spens Committee. There is no doubt that the creation of a new barrier between the training of a specialist and the realisation of specialist status is a complete denial of the principles enunciated by the Spens Committee on this matter. It is dreadful to think that a decision of such importance to so many specialists can be taken in camera, especially when that decision is a categorical contradiction of an ’
accepted principle. Perhaps " Physician " is misinformed ; but if he is not, then I hope this violation of principle will be actively resisted by such bodies as represent us. SECOND PHYSICIAN.
MEDICAL TECHNOLOGY IN BRITAIN AND AMERICA SIR,—Dr. Whitehead’s article in your issue of Jan. 15 has been read with great interest by medical- and scientific laboratory technicians throughout this country. Dr. Whitehead is to be congratulated upon his comprehensive survey of the position, particularly with reference to the training of those technicians who are eligible for membership of the Institute of Medical Laboratory ’
Technology. In discussing the work of technicians in anatomy and physiology and of those who are associated with science
suggests that the formation of independent association of these technicians might The majority of prove a satisfactory arrangement.
rather than medicine, he an
those concerned are of the same opinion, and I am sure that Dr. Whitehead will be glad to learn that such an organisation is in existence. It has for its object the preparation of the ground for the establishment of a professional institute for the education and registration of laboratory technicians not’ at present within the jurisdiction of the Institute of Medical Laboratory Technology, with which it will be in many ways comparable. During the interim period which must elapse before the institute can be fully established, an association, called for the time being the Science Technologists’ Association, has been set up and has the temporary use of an office at 151, Victoria - Street. London, S.W.I. These two organisations-the I.M.L.T. and the S.T.A. -are independent of each other, although there is an abundance of common interest ; and we are grateful to the I.M.L.T. for advice and practical assistance which have been freely given. Membership of the new institute will be restricted to the holders of certain certificates and/or diplomas, the exact details of which have not yet been finally settled, although the general scheme has been agreed upon and pilot and preliminary courses of study are in operation at Paddington Technical College, London, W.9, and The similar courses are contemplated elsewhere. educational requirements are as follows : Preliminary education should be at or approaching present school certificate or senior College of Preceptors certificate ’
’
standard in selected subjects, such as elementary mathematics, English, and general science. In special cases, other evidence of general education would be considered. The following technological courses are to be taken concurrently with general laboratory work in which the technician is normally engaged : (1) a 3-year course prior to a certificate examination ; and (2) a course lasting a further 2 years prior to a diploma examination. Candidates who have satisfactorily completed the courses and passed the.
business to hold any responsible position. A N..C. of marked personality can sometimes overbear even an experienced clinician, and I have seen gross errors of diagnosis made in this way : he is an expert technician, but should lean on the morbid physiologist, and is therefore an assistant rather than a principal. Finally, all laboratory workers-and consultants generally-are eccentrics who take up their specialised work because they enjoy it. The course in chemistry given to medical students is an excellent introduction, and it should not take long for an eccentric interested in medical chemistry to turn himself into a competent chemist-even though the average student fails to profit from that same course. Central Middlesex Hospital, GEORGE DISCOMBE.
PALLIATIVE SURGERY IN FACIAL PALSY
Sm,-Before surgeons embark too enthusiastically on attempts to alleviate facial paralysis by fascial slings or nerve operation they should clearly appreciate certain facts regarding this lesion. 1. Complete unilateral facial paralysis is not always disfiguring with the face at rest : indeed the side of the paralysis may only become apparent on facial
London, N.W.10.
ESTIMATION OF BASAL METABOLIC RATE you published an article by Dr. Bene in which he claimed that the B.M.R. could be calculated by multiplying the patient’s respiratory rate by his pulserate and expressing the figure thus obtained as an index " -e.g., normal pulse-rate (72) x normal respiration1296. The normal range is 1100-1500." rate (18) Some obvious criticisms of this paper sprang immediately to mind. (The figures for the R.P. index which follow are expressed as a percentage, taking 13-96 as normal.) 1. It is extremely improbable that so complicated a function could be expressed by so simple a formula, and previous methods such as those of Boothby and of Reid have, as Dr. Bene admits, proved completely fallacious. 2. Thyrotoxicosis is a disease of the whole body, but the parts of the body are unequally attacked. In different patients the assault is concentrated on different objectives. In some the most obvious results are mental, in others neurological, cardiac, respiratory, and so on. Neither the pulse-rate nor
SiR,-On Jan. 22
movement. 2. Some cases of facial palsy develop a disfiguring contracture of the paralysed side, a tendency which may be aggravated by the introduction of fascial slings. 3. Facial palsies whether from trauma or from Bell’s palsy either begin to recover within three or four weeks with a perfect restoration of function, or they may recover slowly by nerve regeneration. A very small proportion remain permanently paralysed. 4. Some recovery of movement following nerve regeneration first becomes evident three to nine months after the palsy, and improvement continues for a year or longer. 5. If operatious to " decompress " the facial nerve are to be advocated on the theory that the nerve is compressed, there are two rational alternatives : (a) one may either operate on all cases on the day the palsy rate bears any constant relationship to the develops, though this involves many unnecessary the respiratory of the disease or to the B.M.R. Thus one patient whose severity or the should be for (b) operation delayed operations ; records I have re-examined in the past week had obvious at least nine months after the palsy appears, that is clinical thyrotoxicosis and a B.M.R. of + 20-5 before thyroidecuntil sufficient time has elapsed to ensure that good tomy, but his respiration-rate at rest was 7 and his pulsenatural regeneration will not occur. Operations carried rate 82. After operation his B.M.R. was - 10, his respirationout within six months of the palsy appearing are therefore was 8, and his pulse-rate 68. By Dr. Bene’s method unreasonable, and reports of good results following rate the B.M.R. works out at - 56% before operation and 58% intervention at this period are meaningless. afterwards. 6. Perfect recovery of facial movement is impossible 3. Dr. Bene claims that his R.P. index corresponded with when regeneration of the nerve has to occur; the the B.M.R. in 67% of 43 patients- whose B.M.B. lay above inevitable mass movements can be observed for the + 15%, in 70% of 48 with a B.M.R. between + 15 and - 10%, rest of the patient’s life. There can therefore be no such " and in 70% of 9 patients with a B.M.R. of less than - 10%. thing as a perfect recovery " after nerve suture. But he does not explain what he means by correspondence " ; 7. There is room for further research on the natural can hardly mean that it is exact. Within what range does history of facial palsy to provide a clear background he he allow variation to occur without " correspondence being with which to compare alleged improvements in vitiated ? treatment. 4. He obtains his patients’ pulse and respiratory rates W. RITCHIE RUSSELL. Oxford. -
=
"
"
’
.
5 minutes’ rest. This is not long enough for the basal values to be attained. So short a period of rest may be sufficient for a few ; others require a little longer, and others again much longer. It follows from this that the figures for one patient are not comparable with those for another and that if his method is accurate for some it is bound to be inaccurate for others.
after
HOSPITAL BIOCHEMISTS SiB,—It appears from his letter of Feb. 5 that Dr. Taylor also regards the non-medical chemist (N.M.C.) as a technician ; so the point at issue is whether a technician or a medical consultant should be in charge of the routine laboratory. The investigation of a patient’s sickness starts at the bedside and may continue into the laboratory, and the task of the laboratory is to give the necessary clues to the clinician as quickly as possible. The choice of investigation is determined by the history and condition of the patient, and it is at this point that the medical qualification is desirable-it does not matter whether the laboratory consultant is called a chemical pathologist, clinical pathologist, biochemist, or physician for metabolic disease. I cannot too strongly condemn the idea that all tests must be completed before they are reviewed, for this leads straight to penny-in-the-slot pathology and a great increase in laboratory output, usually without corresponding benefit to the patient ; while the clinician is tempted to use laboratory tests to replace careful clinical observation. On the contrary, the results of onetest should be used to indicate whether further tests are desirable, and if so, which test is to be performed next. If the results are " coloured " by this procedure -i.e., falsified to agree with preconceived ideas-then the analyst is fundamentally dishonest and has no
only
truly
But. Sir, if despite these criticisms, Dr. Bene’s method should work, it would effect an important saving of time and money. If it should not, it is important that his statements should, lest they prove a stumbling-block, be refuted at the earliest possible moment, for unfortunately a refutation never quite catches a fallacy, I therefore however hot it may follow on its heels. examined the records of 100 B.M.R. determinations performed on 87 unselected patients by Miss E. M. Dean in this clinic. To give Dr. Bene’s method every chance I have allowed that the R.P. index corresponds with the B.M.R. when it lies within 10 % of it in either direction, which I think is rather generous. I found that among 59 patients with B.M.R.s above + 15% there were 11. (19%) agreements, among 37 with B.M.R.s between +15 % and - 10 % there were 3 (8 %) agreements, and among-unfortunately-only 4 with B.M.R.s below 10 % there was 1 agreement. The disagreement was often profound. For instance, in one instance the’B.M.R. was + 74% and the R.P. index - 22% and in another the B.M.R. was - 5% and the R.P. index + 46%. -
324 ’ It may be argued that my figures are comparable with those of Dr. Bene because
not strictly my patients
had been at rest for several hours and his for only five minutes. There is justice in this argument, but it weights the scales against Dr. Bene. As I have pointed out, his figures cannot be equally accurate because his data are not equally basal (and it is the basal metabolism he seeks to estimate). But supposing they were equally accurate, one would expect them to give figures higher than mine because his conditions are less basal. The fact that the R.P. index is in 60 % of my cases lower than the B.M.R. provides a final proof of my assertions that the two are completely unrelated to one another. RAYMOND GREENE. Thyroid Clinic, New End Hospital, London, N.W.3.
SIR,—There are four standard methods for estimating the basal metabolism, and these depend upon measuring: 1. 2. 3. 4.
The heat output. The oxygen consumption. The carbon-dioxide output. Both the oxygen consumption and the carbon-dioxide output. -
For many years now, formulae have been proposed for
translating simple bedside records into an approximate figure for the basal metabolism.’- These formulae, like Dr. Bene’s, are based on the fact that in thyrotoxicosis there may be tachycardia, an increased respiration-rate, and a rise in pulse pressure, whereas in hypothyroidism there may be the converse, and in normal people there The normal range of pulse-rate, may be more of these. respiration-rate, and pulse pressure is very wide, and, as they are not always greatly altered in thyrotoxicosis and in hypothyroidism, it is doubtful whether any of
the formulae can serve as a substitute for direct measurement of the basal metabolism. They may nevertheless have a certain clinical value : for example, the product of the pulse and respiration rates may well fall when thyrotoxicosis is reduced and rise when hypothyroidism is relieved. For basal metabolism, the range accepted as normal is wide. Indeed, the range accepted by Miss Lovell and Dr. Martin is different from my own, based on a study of some 2300 people of both sexes from the ages of three to eighty. This makes the interpretation of the basal rate at times not easy, and on occasions erroneous. Severe thyrotoxicosis or hypothyroidism may be easy to diagnose clinically, and in these cases the basal metabolism is usually well outside the normal range ; on the other hand, in the very mild cases, where assistance in the diagnosis may be most required, an isolated reading of the basal metabolism is of limited value.2 Observations on the variations in the basal metabolism can be made a most sensitive index of thyroid dysfunction if: 1. In the diagnosis of thyrotoxicosis, the basal rate is measured before and after twelve days of iodine medication. Only in thyrotoxicosis does iodine cause a significant alteration in the basal metabolism. 2. In the diagnosis of hypothyroidism the basal metabolism is measured before and after two to four weeks of thyroid -2 grains daily. Only in hypothyroidism does thyroid medication in such doses and over such a period cause a significant rise in the basal rate. Returning to Lovell and Martin’s criticism of Bene’s R.P. index, it appears possible that they may not have repeated quite accurately Bene’s observations. Bene counted the pulse and respirations after a rest of only five minutes, whereas basal conditions require a rest period of at least thirty minutes. As Lovell and Martin referred to 50 unselected cases from their records, no doubt the respirations and pulses were recorded under basal conditions. It is no criticism of Bene’s work that he chose arbitrarily a period of five, and not ten, twenty, or thirty minutes, for in seeking to make an intelligent guess at the basal metabolism, by a formula in no way related to heat output, it is not essential to comply with standard heat-output conditions. If he could devise the perfect formula by making certain observations while patients were standing on their heads, then all the more credit to Dr. Bene. ’
1. E.g., Read, J. M. J. Amer. med. Ass. 1922, 78, 1887. Gale, A.M., Gale, C. H. Lancet, 1931, i, 1287. Jenkins, R. L. Arch. intern. Med. 1932, 49, 188. 2. Robertson, J. D. Lancet, 1934, ii, 1076; Ann. Surg. 1949, 4, 3.
In summary -’Ithink it can be .said that the pulserespiration product after a five-minuter rest period may
well have
a certain clinical value, provided a correlation with the basal metabolism is not attempted. J. DOUGLAS ROBERTSON. Department of Clinical Investigation,
The London Clinic, W.1.
SENIORS AND JUNIORS have read with astonishment "Physician’s " SIR,—I letter in your last issue. He states that the assessing committees appointed to advise the regional hospital boards on the status of consultant staffs are instructed to relegate junior consultants to a new category of " senior hospital officer." Last June the Minister of Health announced that the Government accepted in principle the recommendations of the Spens Committee. There is no doubt that the creation of a new barrier between the training of a specialist and the realisation of specialist status is a complete denial of the principles enunciated by the Spens Committee on this matter. It is dreadful to think that a decision of such importance to so many specialists can be taken in camera, especially when that decision is a categorical contradiction of an ’
accepted principle. Perhaps " Physician " is misinformed ; but if he is not, then I hope this violation of principle will be actively resisted by such bodies as represent us. SECOND PHYSICIAN.
MEDICAL TECHNOLOGY IN BRITAIN AND AMERICA SIR,—Dr. Whitehead’s article in your issue of Jan. 15 has been read with great interest by medical- and scientific laboratory technicians throughout this country. Dr. Whitehead is to be congratulated upon his comprehensive survey of the position, particularly with reference to the training of those technicians who are eligible for membership of the Institute of Medical Laboratory ’
Technology. In discussing the work of technicians in anatomy and physiology and of those who are associated with science
suggests that the formation of independent association of these technicians might The majority of prove a satisfactory arrangement.
rather than medicine, he an
those concerned are of the same opinion, and I am sure that Dr. Whitehead will be glad to learn that such an organisation is in existence. It has for its object the preparation of the ground for the establishment of a professional institute for the education and registration of laboratory technicians not’ at present within the jurisdiction of the Institute of Medical Laboratory Technology, with which it will be in many ways comparable. During the interim period which must elapse before the institute can be fully established, an association, called for the time being the Science Technologists’ Association, has been set up and has the temporary use of an office at 151, Victoria - Street. London, S.W.I. These two organisations-the I.M.L.T. and the S.T.A. -are independent of each other, although there is an abundance of common interest ; and we are grateful to the I.M.L.T. for advice and practical assistance which have been freely given. Membership of the new institute will be restricted to the holders of certain certificates and/or diplomas, the exact details of which have not yet been finally settled, although the general scheme has been agreed upon and pilot and preliminary courses of study are in operation at Paddington Technical College, London, W.9, and The similar courses are contemplated elsewhere. educational requirements are as follows : Preliminary education should be at or approaching present school certificate or senior College of Preceptors certificate ’
’
standard in selected subjects, such as elementary mathematics, English, and general science. In special cases, other evidence of general education would be considered. The following technological courses are to be taken concurrently with general laboratory work in which the technician is normally engaged : (1) a 3-year course prior to a certificate examination ; and (2) a course lasting a further 2 years prior to a diploma examination. Candidates who have satisfactorily completed the courses and passed the.