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THORACIC SURGICAL SERVICE
801
health., These two papers, based on clinical and environmental observations, together with the work done during
hospitals
intervening years on the radio-opaque dusts in general, have put the diagnosis of industrial lung diseases and other pulmonary lesions on a firmer basis. The more widely the work becomes known the less often will welders and other workers who inhale radio-opaque dusts be diagnosed and treated for miliary tuberculosis or silicosis on the X-ray findings alone.
there should be
the
‘
LIVE
TO
LEARN
EACH of the 25 men and women whom Sir James Marchant has asked to relate What Life Has Taught Me1 has carried away a different lesson from the school-room ; for, as Dean Inge points out, life teaches us what we Miss Margaret Bondfield, for are capable of learning. instance, has learnt that to be tolerant of others gives us a chance to do a job of work whole-heartedly, and Bertrand Russell, though he recognises the cruelty of our world, believes firmly in respect for the individual, which he defines as a reluctance to inflict humiliation. Lord Horder admits that he is glad to have attended life’s school, for the system of education has appealed to his logical sense ; there have been neither rewards nor punishments-only consequences. Above all he has learnt that living is worth while. Miss Margery Fry reminds us that most of us will live longer than we are meant to, and suggests that an alertness to detect life in the individual instead of accepting it in the mass will help us to make good use of our extended span. Mr. E. V. Knox, as befits the editor of Punch, records with satisfaction that the people of this country value their sense of humour more than wisdom. The Rev. C. C. Martindale, in a tutorial on the lessons of illness, urges the invalid to be patient with doctors, who are amazingly nice when tamed. Sir William Beach Thomas, who is grateful for his own early knowledge of the deep country, fears that the townsman often has no interest that warms life. " I speak truth;" Montaigne wrote, " not so much as I would, but as much as I dare, and I dare a little the Most of the contributors have more as I grow older." -the bravest have given us the dared with best reading.
should be adopted as the main centres, which would then help to staff small units in the undergraduate teaching hospitals. Some patients now have to wait two or three years for admission to existing centres ; service cannot match the need, undue disturbance of present arrangements, particularly for minor operations.
and because the
new
no
" What is urgently necessary at the moment is to prevent the outcropping, without reference to the general plan, of so-called centres staffed by practitioners who decide to take up ’ chest surgery, when their circumstances neither enable them to serve a proper apprenticeship nor offer them the prospect of an amount of work sufficient to make them competent."
One of the first tasks of units, as they are set up, will be teams ; and the surgeons for these must first be well grounded in general surgery. " The work cannot be carried out efficiently by the surgeons or nurses who engage in it as a temporary occupation or who are directed to it when they happen not to be doing something else." The society is convinced that the principal surgeon of each unit should eventually devote himself exclusively to his specialty ; he should remain a clinician in active practice ; and his.emoluments should not be so low as to persuade him that his appointment is simply a stepping-stone to a higher administrative post. This conclusion will be warmly echoed by most clinicians. to train further
MORE
LIGHT
ON THE SOUTH "APE-MEN
AFRICAN
"
IN the year that has elapsed since Prof. W. E. Le Gros F.R.s., lectured at the Zoological Societyon the remains of the fossil ape-like creatures (Australopithecinse) discovered by Dr. R. Broom, F.R.s., near Johannesburg, many more remains of the same creatures have been found by Dr. Broom at Sterkfontein. These new discoveries, which were discussed and illustrated by Prof. Le Gros Clark2 at the Linnean Society on April 22, are very abundant and include at least five more skulls (some
Clark,
unusually complete), limb-bones, including a practically complete os innominatum, and several maxillae and mandibles, both mature and immature.
Their state in some cases preservation is extraordinarily perfect, so that minute foramina and delicate sutures in the skull can be accurately defined. The new material appears to provide emphatic conTHORACIC SURGICAL SERVICE of some of the main conclusions drawn from firmation THE organisation of hospitals ’in regions promises the discovered fossils, which, though quite previously particular benefit to the rarer and more complex special- extensive, were by no means so perfect. The hominid ties. As long ago as 1944 the Society of Thoracic Surgeons the remains features discovered displayed by newly issued a memorandum in which they argued for a regional are in many respects very impressive. This is particularly service based on - well-equipped and well-staffed units the case with the contour of the supraorbital and frontal whose work should comprehend the surgery of both of the skull, the very low position of the occipital region tuberculous and non-tuberculous diseases of the chest : the torus, disposition of the orbits, the construction of the " members of the society are unanimous in strongly tympanic region, the shape of the dental arcade, the the treatment of of surgical deprecating any separation wear of the teeth, the relatively small canine (which pulmonary tuberculosis from that of other chest diseases." evidently became worn down flat to the level of the This is’reiterated in a new edition of the memorandum.2 adjacent teeth, even in comparatively young individuals), The way is now open to planning by regions ; and, and the forward position of the occipital condyles. This thanks mainly to the coming union of local-authority last feature, which is particularly significant, appears and other hospitals, it should be possible to end the to be consistent in all the skull bases now available for unnatural estrangement of the two branches of chest study. Of the limb bones, the os innominatum is the surgery. The society hopes to see at least one primary most remarkable. In the shape of the ilium it corresponds thoracic centre set up in each of the hospital regions. very closely with that of man and shows none of the This centre, with perhaps 50-100 beds, should be in, characters whereby that of the anthropoid apes is or closely associated with, the teaching hospital; and distinguished so sharply from the human pelvis.3 It this should at least contain a unit of 15-25 -beds for the inference already drawn from a study of the confirms undergraduate instruction. In most regions secondary skull femur, and talus-that the Australopithecine base, units will be needed, while in some regions tertiary units, stood and walked in approximately human fashioii. for minor operations, may be found necessary. The The additional evidence assembled by Dr. Broom will memorandum urges that in London the special chest
Montaigne;
1. London: Odhams. 1948. Pp. 310. 10s. 6d. 2. Society of Thoracic Surgeons of Great Britain and Ireland : Memorandum on the Provision of a National Thoracic Surgical Service. March, 1948.
of
clearly
have
an
important bearing
1. Lancet, 1947, i, 837. 2. Nature, Lond. 1948, 161, 667. 3. Broom, R., Robinson, J. T. Ibid,
on
the
systematic
1947, 160, 430.
health., These two papers, based on clinical and environmental observations, together with the work done during
hospitals
intervening years on the radio-opaque dusts in general, have put the diagnosis of industrial lung diseases and other pulmonary lesions on a firmer basis. The more widely the work becomes known the less often will welders and other workers who inhale radio-opaque dusts be diagnosed and treated for miliary tuberculosis or silicosis on the X-ray findings alone.
there should be
the
‘
LIVE
TO
LEARN
EACH of the 25 men and women whom Sir James Marchant has asked to relate What Life Has Taught Me1 has carried away a different lesson from the school-room ; for, as Dean Inge points out, life teaches us what we Miss Margaret Bondfield, for are capable of learning. instance, has learnt that to be tolerant of others gives us a chance to do a job of work whole-heartedly, and Bertrand Russell, though he recognises the cruelty of our world, believes firmly in respect for the individual, which he defines as a reluctance to inflict humiliation. Lord Horder admits that he is glad to have attended life’s school, for the system of education has appealed to his logical sense ; there have been neither rewards nor punishments-only consequences. Above all he has learnt that living is worth while. Miss Margery Fry reminds us that most of us will live longer than we are meant to, and suggests that an alertness to detect life in the individual instead of accepting it in the mass will help us to make good use of our extended span. Mr. E. V. Knox, as befits the editor of Punch, records with satisfaction that the people of this country value their sense of humour more than wisdom. The Rev. C. C. Martindale, in a tutorial on the lessons of illness, urges the invalid to be patient with doctors, who are amazingly nice when tamed. Sir William Beach Thomas, who is grateful for his own early knowledge of the deep country, fears that the townsman often has no interest that warms life. " I speak truth;" Montaigne wrote, " not so much as I would, but as much as I dare, and I dare a little the Most of the contributors have more as I grow older." -the bravest have given us the dared with best reading.
should be adopted as the main centres, which would then help to staff small units in the undergraduate teaching hospitals. Some patients now have to wait two or three years for admission to existing centres ; service cannot match the need, undue disturbance of present arrangements, particularly for minor operations.
and because the
new
no
" What is urgently necessary at the moment is to prevent the outcropping, without reference to the general plan, of so-called centres staffed by practitioners who decide to take up ’ chest surgery, when their circumstances neither enable them to serve a proper apprenticeship nor offer them the prospect of an amount of work sufficient to make them competent."
One of the first tasks of units, as they are set up, will be teams ; and the surgeons for these must first be well grounded in general surgery. " The work cannot be carried out efficiently by the surgeons or nurses who engage in it as a temporary occupation or who are directed to it when they happen not to be doing something else." The society is convinced that the principal surgeon of each unit should eventually devote himself exclusively to his specialty ; he should remain a clinician in active practice ; and his.emoluments should not be so low as to persuade him that his appointment is simply a stepping-stone to a higher administrative post. This conclusion will be warmly echoed by most clinicians. to train further
MORE
LIGHT
ON THE SOUTH "APE-MEN
AFRICAN
"
IN the year that has elapsed since Prof. W. E. Le Gros F.R.s., lectured at the Zoological Societyon the remains of the fossil ape-like creatures (Australopithecinse) discovered by Dr. R. Broom, F.R.s., near Johannesburg, many more remains of the same creatures have been found by Dr. Broom at Sterkfontein. These new discoveries, which were discussed and illustrated by Prof. Le Gros Clark2 at the Linnean Society on April 22, are very abundant and include at least five more skulls (some
Clark,
unusually complete), limb-bones, including a practically complete os innominatum, and several maxillae and mandibles, both mature and immature.
Their state in some cases preservation is extraordinarily perfect, so that minute foramina and delicate sutures in the skull can be accurately defined. The new material appears to provide emphatic conTHORACIC SURGICAL SERVICE of some of the main conclusions drawn from firmation THE organisation of hospitals ’in regions promises the discovered fossils, which, though quite previously particular benefit to the rarer and more complex special- extensive, were by no means so perfect. The hominid ties. As long ago as 1944 the Society of Thoracic Surgeons the remains features discovered displayed by newly issued a memorandum in which they argued for a regional are in many respects very impressive. This is particularly service based on - well-equipped and well-staffed units the case with the contour of the supraorbital and frontal whose work should comprehend the surgery of both of the skull, the very low position of the occipital region tuberculous and non-tuberculous diseases of the chest : the torus, disposition of the orbits, the construction of the " members of the society are unanimous in strongly tympanic region, the shape of the dental arcade, the the treatment of of surgical deprecating any separation wear of the teeth, the relatively small canine (which pulmonary tuberculosis from that of other chest diseases." evidently became worn down flat to the level of the This is’reiterated in a new edition of the memorandum.2 adjacent teeth, even in comparatively young individuals), The way is now open to planning by regions ; and, and the forward position of the occipital condyles. This thanks mainly to the coming union of local-authority last feature, which is particularly significant, appears and other hospitals, it should be possible to end the to be consistent in all the skull bases now available for unnatural estrangement of the two branches of chest study. Of the limb bones, the os innominatum is the surgery. The society hopes to see at least one primary most remarkable. In the shape of the ilium it corresponds thoracic centre set up in each of the hospital regions. very closely with that of man and shows none of the This centre, with perhaps 50-100 beds, should be in, characters whereby that of the anthropoid apes is or closely associated with, the teaching hospital; and distinguished so sharply from the human pelvis.3 It this should at least contain a unit of 15-25 -beds for the inference already drawn from a study of the confirms undergraduate instruction. In most regions secondary skull femur, and talus-that the Australopithecine base, units will be needed, while in some regions tertiary units, stood and walked in approximately human fashioii. for minor operations, may be found necessary. The The additional evidence assembled by Dr. Broom will memorandum urges that in London the special chest
Montaigne;
1. London: Odhams. 1948. Pp. 310. 10s. 6d. 2. Society of Thoracic Surgeons of Great Britain and Ireland : Memorandum on the Provision of a National Thoracic Surgical Service. March, 1948.
of
clearly
have
an
important bearing
1. Lancet, 1947, i, 837. 2. Nature, Lond. 1948, 161, 667. 3. Broom, R., Robinson, J. T. Ibid,
on
the
systematic
1947, 160, 430.