- Email: [email protected]
GASTROSCOPY
1361 We are informed that the British Postgraduate Medical School have invited Prof. W. W. C. Topley, F.R.S., to deliver the inaugural lecture. He has agreed to do so and the lecture will be delivered in +nA HntnTrm——T
am.
Sir-
vonrs
f>l,iil1fl111v.
A. H.
PROCTOR,
Secretary to the Memorial Committee.
June 1st.
GASTROSCOPY To the Editor
of
THE LANCET
SiR,-Your leading article of Nov. 20th led lively correspondence, and even at this late
to
a
date of the I was
I would like if I may to comment on some opinions expressed by Dr. Denys Jennings. amazed at his statement (p. 1278) that " Schindler finds that carcinoma of the stomach can be controlled by the office use of the gastroscope," for I cannot believe I ever wrote such nonsense. After I had recovered a little bit I read carefully the chapters on Early Diagnosis, and on Systematic Campaign against Gastric Cancer, in my book (pp. 237 and 258) to discover which sentence Dr. Jennings had in mind. But I found nothing. Let me say that I agree with him in many points. Against the opinion of such excellent men as Hurst, Faber, and Konjetzny, I most definitely believe that chronic gastritis has nothing to do with the aetiology of chronic gastro-duodenal ulcer, and even nothing to do with the origin of pernicious anaemia. I believe I have evidence in support of this opinion. On the other hand, I fully agree with the same authors that gastric carcinoma often develops on the soil of chronic gastritis. Not long ago I observed the case of a surgeon who had suffered for ten years from epigastric distress : no hydrochloric acid was found ; in the last three years a filling defect of the greater curvature developed and grew larger ; gastroscopy revealed a well-defined, not ulcerated, polypoid tumour in a completely atrophic mucosa ; operation and microscopic examination confirmed the gastroscopic diagnosis. Could a careful observer like Gutzeit have overlooked these frequent cases1 I do not believe so. I admit of course that there are cases of carcinoma that are found to be inoperable five days after the onset of the very first symptoms, and I have repeatedly mentioned them in my book. I agree with Dr. Jennings-and disagree with Dr. Hancock (p. 1403)-about the great value of clinical observation, even against the so-called evidence of the histologic examination. This refers not only to the connexion of ulcer and carcinoma but even to the histologic conception of chronic gastritis (see " Relationship of Histologic and Gastroscopic Findings in Diagnosis of Chronic Gastritis," Amer. J. digest. Dis. 1936, 3, 153), in which I evidently disagree with ...
Konjetzny. Dr. Jennings fears that the work of my adherents will start a gastroscopical gastritis racket." Here in America one calls " racket " a union to get personal advantages for its members by dishonest means, and it seems to have the same meaning in England since he writes of " fame and fortune." Probably he does not mean to attack me. But are we to suppose that men like Hurst, Konjetzny, and Katsch (whose important referat of Paris he evidently has not read), or such a noble statesman as Faber, should participate in a racket " ? Even a scientific adversary has to read only a few lines by Konjetzny to become convinced of his scientific integrity. The same is true of Gutzeit as well as of the other men mentioned. I believe, however, that Gutzeit has made a serious, dangerous mistake. In my book of 1923 I describe "
"
results obtained with my old rigid Has Dr. Jennings ever wondered why I should have given it up, and should have tried over long, very long, years to develop an entirely different instrument ?’? After 1922 I had no mishap myself. But I knew that such mishaps had occurred and could occur again at any moment, and that they did occur in the hands of inexperienced workers. I understood that the risk of them condemned this wonderful method of examination to remain a laboratory method ; I accepted Boas’s opinion. Dr. Jennings knows the final success. I realised that the optical qualities of the new instrument were not so good as those of the rigid one (see the chapter on General Optical Problems in my book). But what z? Certainly we could not return to was to be done ? the dangerous rigid instruments, but must develop a better optical system in the flexible gastroscope. This I have achieved with the construction of the
the
splendid gastroscope.
50° gastroscope. With full intention I omitted a discussion of the rigid instruments in my book ; I did not want to hurt Korbsch, who has such great merits. But now, when a man so experienced as Gutzeit advocates the rigid instrument because he himself has had no accident and because he is not able to see the broader aspect of the situation, I cannot be silent any longer. Here in the United States and in Canada, where very few Korbsch instruments are used, two deaths following the use of a Korbsch gastroscope have already occurred-one of them, together with another mishap, being reported by H. T. Thorlakson (Cccnad. med. Ass. J. 1937, 36, 345). I am, Sir, yours faithfully, RUDOLF SCHINDLER. new
Associate Professor of Medicine, the
University of Chicago.
MEDICAL EDUCATION IN INDIA
To the Editor
of
THE LANCET
SiR,-In his address at the annual meeting of the Manchester Medical Society on May 4th Sir Richard Needham made very appropriate suggestions about medical education in India (Lancet, May 21st, p. 1196). It remains to be seen whether the Indian Medical Council will pay heed and take complete control, not just by making an imperfect register but by taking adequate possession of all institutions. That means including the licentiates in the register along with the graduates as one unit without any distinction. The next step would be for the Council to set up one uniform standard of medical education, whether for licentiates or graduates, throughout all the presidencies and provinces. The licentiates are at present looked down upon for not possessing the university cachet ; but they are adequately trained and qualified in Western medicine to practise medicine, surgery, and midwifery, with the same responsibilities as those of the graduates. Improved facilities have made the licentiates of the last decade far better S. class ; the equipped than the old L.M. & examinations are not far from the graduate standard and the examiners are often the same for both. The licentiates have proved their metal in civil, military, and government hospitals, dispensaries, schools, and colleges ; the health of India cannot progress without their help. It is they who come in direct contact with the multimillions of the poor. I am, Sir, yours faithfully, F. TARAPORVALA, London, SAV., June 2nd.
Ex-President, All India Medical Licentiate Association.
am.
Sir-
vonrs
f>l,iil1fl111v.
A. H.
PROCTOR,
Secretary to the Memorial Committee.
June 1st.
GASTROSCOPY To the Editor
of
THE LANCET
SiR,-Your leading article of Nov. 20th led lively correspondence, and even at this late
to
a
date of the I was
I would like if I may to comment on some opinions expressed by Dr. Denys Jennings. amazed at his statement (p. 1278) that " Schindler finds that carcinoma of the stomach can be controlled by the office use of the gastroscope," for I cannot believe I ever wrote such nonsense. After I had recovered a little bit I read carefully the chapters on Early Diagnosis, and on Systematic Campaign against Gastric Cancer, in my book (pp. 237 and 258) to discover which sentence Dr. Jennings had in mind. But I found nothing. Let me say that I agree with him in many points. Against the opinion of such excellent men as Hurst, Faber, and Konjetzny, I most definitely believe that chronic gastritis has nothing to do with the aetiology of chronic gastro-duodenal ulcer, and even nothing to do with the origin of pernicious anaemia. I believe I have evidence in support of this opinion. On the other hand, I fully agree with the same authors that gastric carcinoma often develops on the soil of chronic gastritis. Not long ago I observed the case of a surgeon who had suffered for ten years from epigastric distress : no hydrochloric acid was found ; in the last three years a filling defect of the greater curvature developed and grew larger ; gastroscopy revealed a well-defined, not ulcerated, polypoid tumour in a completely atrophic mucosa ; operation and microscopic examination confirmed the gastroscopic diagnosis. Could a careful observer like Gutzeit have overlooked these frequent cases1 I do not believe so. I admit of course that there are cases of carcinoma that are found to be inoperable five days after the onset of the very first symptoms, and I have repeatedly mentioned them in my book. I agree with Dr. Jennings-and disagree with Dr. Hancock (p. 1403)-about the great value of clinical observation, even against the so-called evidence of the histologic examination. This refers not only to the connexion of ulcer and carcinoma but even to the histologic conception of chronic gastritis (see " Relationship of Histologic and Gastroscopic Findings in Diagnosis of Chronic Gastritis," Amer. J. digest. Dis. 1936, 3, 153), in which I evidently disagree with ...
Konjetzny. Dr. Jennings fears that the work of my adherents will start a gastroscopical gastritis racket." Here in America one calls " racket " a union to get personal advantages for its members by dishonest means, and it seems to have the same meaning in England since he writes of " fame and fortune." Probably he does not mean to attack me. But are we to suppose that men like Hurst, Konjetzny, and Katsch (whose important referat of Paris he evidently has not read), or such a noble statesman as Faber, should participate in a racket " ? Even a scientific adversary has to read only a few lines by Konjetzny to become convinced of his scientific integrity. The same is true of Gutzeit as well as of the other men mentioned. I believe, however, that Gutzeit has made a serious, dangerous mistake. In my book of 1923 I describe "
"
results obtained with my old rigid Has Dr. Jennings ever wondered why I should have given it up, and should have tried over long, very long, years to develop an entirely different instrument ?’? After 1922 I had no mishap myself. But I knew that such mishaps had occurred and could occur again at any moment, and that they did occur in the hands of inexperienced workers. I understood that the risk of them condemned this wonderful method of examination to remain a laboratory method ; I accepted Boas’s opinion. Dr. Jennings knows the final success. I realised that the optical qualities of the new instrument were not so good as those of the rigid one (see the chapter on General Optical Problems in my book). But what z? Certainly we could not return to was to be done ? the dangerous rigid instruments, but must develop a better optical system in the flexible gastroscope. This I have achieved with the construction of the
the
splendid gastroscope.
50° gastroscope. With full intention I omitted a discussion of the rigid instruments in my book ; I did not want to hurt Korbsch, who has such great merits. But now, when a man so experienced as Gutzeit advocates the rigid instrument because he himself has had no accident and because he is not able to see the broader aspect of the situation, I cannot be silent any longer. Here in the United States and in Canada, where very few Korbsch instruments are used, two deaths following the use of a Korbsch gastroscope have already occurred-one of them, together with another mishap, being reported by H. T. Thorlakson (Cccnad. med. Ass. J. 1937, 36, 345). I am, Sir, yours faithfully, RUDOLF SCHINDLER. new
Associate Professor of Medicine, the
University of Chicago.
MEDICAL EDUCATION IN INDIA
To the Editor
of
THE LANCET
SiR,-In his address at the annual meeting of the Manchester Medical Society on May 4th Sir Richard Needham made very appropriate suggestions about medical education in India (Lancet, May 21st, p. 1196). It remains to be seen whether the Indian Medical Council will pay heed and take complete control, not just by making an imperfect register but by taking adequate possession of all institutions. That means including the licentiates in the register along with the graduates as one unit without any distinction. The next step would be for the Council to set up one uniform standard of medical education, whether for licentiates or graduates, throughout all the presidencies and provinces. The licentiates are at present looked down upon for not possessing the university cachet ; but they are adequately trained and qualified in Western medicine to practise medicine, surgery, and midwifery, with the same responsibilities as those of the graduates. Improved facilities have made the licentiates of the last decade far better S. class ; the equipped than the old L.M. & examinations are not far from the graduate standard and the examiners are often the same for both. The licentiates have proved their metal in civil, military, and government hospitals, dispensaries, schools, and colleges ; the health of India cannot progress without their help. It is they who come in direct contact with the multimillions of the poor. I am, Sir, yours faithfully, F. TARAPORVALA, London, SAV., June 2nd.
Ex-President, All India Medical Licentiate Association.