UNQUALIFIED RADIOLOGY

1244

CORRESPONDENCE To the Editor

of

SiR,-In October, by your

THE LANCET courteous

permission,

I

able to make an appeal to your readers for contributions towards our Christmas gift fund. I do not wish to labour the distress which unfortunately exists, for it is well known to all. The response to my appeal to date is 126 4s., a sum far short of what we need. I am confident that it will be the desire of the profession that we should distribute gifts to each of the 650 beneficiaries on our books. May I ask once was

for a generous response and as soon as possible, so that when we sit down to our comfortable dinners we may know that some comfort and pleasure has been given to our own poor people. Donations should be sent to the hon. treasurer, Royal Medical Benevolent more

Fund, 11, Chandos-street, London, W.l. I

am,

Sir,

yours

faithfully, THOS.

Nov. 26th.

BARLOW,

President, Royal Medical Benevolent Fund.

FITNESS FOR PUBLIC SERVICE To the L’ditor

oJ

a stipulation that they should receive no salary during absence from duty caused by tuberculosis. This plan,however, might be difficult in operation and lead to disputes. My own feeling is that the best solution to the present problem would be, in the words of your previous correspondents, the use of "clinical judgment, instead of rule-of-thumb

be

A CHRISTMAS APPEAL

THE LANCET

Sn:,—I was much interested in the letter in your last issue from two sanatorium medical officers, and in support of their plea would like to record my own

experience. Four years ago I was treated for pulmonary tuberculosis by artificial pneumothorax plus division of adhesions by cautery and diathermy ; the disease was arrested and two years ago the pneumothorax fillings were discontinued. Since then-and indeed for most of the first two years-I have been at work, and I have no physical signs other than those of fibrosis. Yet I find it quite impossible to obtain work with a public authority. I was elected to a post under the local authorities of a large city, but was immediately dismissed after I had told the medical examiner my history-though he could find only the signs of fibrosis. When I suggested that I should not join the superannuation scheme I was told that this was impossible, since it was of statutory significance." It is certainly of great personal significance to any medical man who is an arrested case of tuberculosis that, with a very few exceptions, the only career open to him is that which is least suitable to "

him-namely, general practice. But if we look at this question, as we should, from the point of view of the State, is the present state of affairs the most beneficial possible ? Quite apart from the fact that many patients gain experience of tuberculosis during the period of their treatment and are especially qualified to work as tuberculosis officers, &c., as was permitted until a short time ago, we must consider the question, Is the State going to benefit if ,

,

.

this class of doctor is forced to take up work more likely to cause a breakdown-because the work suited to him from the point of view of regular hours and minimum amount of night work is now closed tohim? If it is true, as your correspondents say, that " this fund is a retiring and not a sickness benefit fund," it would surely be advantageous to the public authority if the persons receiving pensions were to die as soon as possible after ceasing work. The " first-class life " would be a disadvantage from the public point of view. But is not sickness benefit usually included in If it is, an alternative to the increase these schemes of contributions from ex-tuberculous patients would

reiection."

I

am.

Sir.

vours

faithfullv, "

Nov. 26th.

Ex-A.P."

UNQUALIFIED RADIOLOGY

of THE LANCET SIR,—The time has surely come when steps should be taken to prevent the use of X ray apparatus by those whose capabilities are inadequate. The present legal position is that anyone may purchase and use equipment which is, as is well known, a potential source of danger both to patient and to operator. Thus it is possible for any individual to employ X rays for diagnostic and therapeutic purposes without having the necessary anatomical, pathological, and medical knowledge. Can it be right that a radiographer (however skilled he may be as a technical worker), a chemist, or an engineer should be legally empowered to express an opinion as to the evidence of a pathological process or to expose a patient to a beam of X rays for It is of course recognised that purpose of treatment members of the Society of Radiographers undertake that they will not interpret radiograms and that they will not carry out radiation therapy except under the strict supervision of a qualified medical practitioner, but there are may quasi-radiographers who are not members of this society and who therefore are not bound by such an undertaking. Radiographic interpretation and the determination of X ray dosage call for very skilled judgment, but it is suggested that such is not among the attributes of many who succumb to incautiously phrased advertisements which infer that efficient radiological practice requires nothing more than the acquisition and opera. tion of a piece of apparatus. The remedy appears to lie in the hands of the general members of the medical profession. The assistance afforded to them by radiology may be immense, but only when they will recognise that the whole subject is one requiring endless study, subsequent to a thorough training in general medicine, with especial reference to pathology and physics. We are, Sir, yours faithfully, To the Editor

G. SHEARER, President of the British Institute of Radiology.

J. DUNCAN WHITE, Chairman of the medical committee of the Institute. Welbeck-street, W., Nov. 26th.

MIDWIFERY IN GENERAL PRACTICE

To the Editor

of THE LANCET SIR,—As a rural practitioner who has practised midwifery single-handed for over forty years let me say how deeply interested I was in reading Dr. Dale Logan’s contribution in your issue of Nov. 17th (p. 1141). It deserves to be printed in letters of gold. I feel sure every word he sayswill be welcomed and believed to be true by every general practitioner who has engaged in midwifery these past thirty years or so. Dr. Logan is quite right when he says that press publicity, plus our local authorities and obstetric experts, have done their best to frighten general practitioners from doing any midwifery at all. All the blame for puerperal morbidity and mortality was