ANNALS of THE ROYAL COLLEGE of England

Volume 65 January-November 1983

Editor A J Harding Rains MS FRCS

Assistant Editor R M Kirk MS FRCS

Associate Editors Derek Seel FDSRCS DOrthRCS Faculty of Dental Surgery

J E Riding MD FFARCS Faculty of Anaesthetists

Executive Editor R E Horton MBE MS FRCS

Published by The Royal College of Surgeons of England in conjunction with the Journal Department of the British Medical Association, B.M.A. House, Tavistock Square, London, WClH 9JR CONTENTS Volume 65 January-November 1983

Page Editorial I Scientific Articles Limb preservation in the treatment of bone tumours Rodney Sweetnam 3 A time-saving but effective approach to the follow-up ofpatients after curative surgery for carcinoma of the large bowel Alexander P Ross 8 Percentage malignant involvement: a new concept in staging of breast cancer A Cuschieri, A D Irving, A 3 Robertson, J Clark and R A B Wood 11 'Out this nettle . . .' Peter W Thompson 14 An open comparison between routine and self-administered postoperative pain relief Peter 3 Slattery, Michael Harmer, Michael Rosen and Michael D Vickers 18 Angiography as an index of healing in experimental laparotomy wounds and colonic anastomoses David J Leaper 20 The effect of wall mechanical properties on patency of arterial grafts Iain G Kidson 24 Wound infection after cholecystectomy: a case for routine prophylaxis Richard S Stubbs 30 Rectocolectomy with anal conservation in inflammatory colitis A M Deane and I R Celestin 32 latrogenic spinal accessory nerve palsy Richard J King and Geraldo Motta 35 Subcutaneous bupivacaine for postoperative analgesia after herniorrhaphy K Hashemi and M D Middleton 38 Plain bupivacaine 0.50o: A preliminary evaluation as a spinal anaesthetic agent David W Ryan, Angus K Pridie and Paul F Copeland 40 Superficial acupuncture in the relief of chronic low back pain A J R MacDonald, K D Macrae, B R Master and A. P.Rubin 44 Prolonged access to the venuous system using the Hickman right atrial catheter G Sagor, P Mitchemere, J. Layfield, H G Prentice and R M Kirk 47 Aspects of treatment at the Zhejiang Medical College, China Shu rou Peng, Man Kwong rue, Vi Jeng and Jian Chen 50 Aging attitudes to home accidents John Watkins, Angela Perry and Richard Eiser 52 Thomas's splint with adjustable ring B N Muddu 55 Solo surgeon R. Bhattacharyya 57 Selecting surgical chairmen or Playing golf with matchsticks Harris B Shumacker 59 British Association of Clinical Anatomists 61, 198, 333 Some changing aspects of primary hyperparathyroidism Edward T Bainbrige and Anthony D Barnes 67 Factors influencing wound complications: a clinical and experimental study Timothy E Bucknall 71 Streptococcus milleri and surgical sepsis John C Tresadern, Roger J Farrand and Miles H Irving 78 Are systemic prophylactic antibiotics necessary for burns? M J Timmons 80 Op-site skin closure: a comparison with subcuticular and interrupted sutures G W Watson, C J Anders and J R Glover 83 Vein grafts for arterial repair: an experimental study of the histological development of the intima John K McGeachie, Francis J Prendergast and Peter J Morris 85 A modified Gritti-Stokes amputation: its place in the management of peripheral vascular disease C J M Beacock, J Doran, B R Hopkinson and G S Makin 90 Awareness during anaesthesia: a review J L Breckenridge and A R Aitkenhead 93 Long-term efficacy of surgical cordotomy in intractable non-malignant pain T M Jack and J W Lloyd 97 Ethamsylate in vaginal surgery under lumbar epidural anaesthesia G B Smith, R J Eltringham and J J Nightingale 103 Abdominal tuberculosis a disease revived N V Addison 105 The functional and morphological effects of duodeno-gastric reflux and their relation to peptic ulceration WEG Thomas 112 Gastric partitioning for morbid obesity D L Morris, J R Lee and R M Baddeley 117 A common bile duct sound: an aid to sphincterotomy Laurence F Tinckler 119 Anterior horseshoe fistula A P R Aluwihare 121 Stripping branchial fistulae J HNeame 123 Simple renal cysts in children A F Azmy and P G Ransely 124 The management of pyonephrosis G S M Harrison 126 Immunobiological determinants in organ transplantation Charles Marks 139 The role of surgery of the thymus for myasthenia gravis Clayton L N Robinson 145 The microflora of the oesophagus Aylwyn Mannell, Mary Plant and Julius Frolich 152 Presentation and prognosis of malignant tumours of the thyroid gland in the West Riding of Yorkshire C K Yeung and N V Addison 155 Is the undeniably palpable liver ever normal? D N L Ralphs, G Venn, 0 Khan, J C Palmer, D E Cameron and M Hobsley 159 The future of inhalation anasthesia E M Papper 161 A combination of subcuticular suture and sterile Micropore tape compared with conventional interrupted sutures for skin closure M Taube, R J Porter and P H Lord 164 The use of a new suture material (Polydioxanone) in the biliary tract Ronald W Hoile 168 A simple stoma wafer cutter Martin Clifton 172 Urodynamic investigation in a district general hospital A R de Bolla and D G Arkell 173 Experience with the 'Triple Test' in pancreatic disease H H Thompson, C L Brown, R S Murray, D L Wingate and H D Ritchie 176 A prospective study of radionuclide biliary scanning in acute pancreatitis 7 P Neoptolemos, D P Fossard and 7 M Berry 180 The transduodenal per-ampullary approach to common bile duct calculi A E Carter 183 Proximal gastric vagotomy: a district general hospital experience J J Wood, J M Ryan and C J Anders 185 The anatomical relationship between the retropancreatic part of the bile duct and the main pancreatic duct P M Dawson and T G Allen-Mersh 188 A proposed new method for the treatment of dry mouth N J Marks and B 7 Roberts 191 British urology 1982 W Keith reates 194 Microvascular free jejunal transfer reconstruction following pharyngolaryngectomy 7 P Birchall, M Hattab, K Pearman, D B Mathias and M 7 M Black 209 Observations on the activity of the renin-angiotensin-aldosterone (RAA) system after low volume colloid resuscitation for burn injury R W Griffiths, J G B Millar, J. Albano and P G Shakespeare 212 A simple, safe, surgical technique for closing the persistent ductus arteriosus in the preterm neonate A J Gunning 216 Meckel's Diverticulum: to look or not to look: to resect or not to resect A Lang-Stevenson 218 A study of colovesical fistulae in a district hospital Peter D Morrison and N V Addison 221 Day case inguinal hernia repair under local anaesthetic P A Baskerville and P E M Jarrett 224 The direct perfusion of surgical wounds with local anaesthetic solution: an approach to postoperative pain? D F M Thomas, W G Lambert and K Lloyd Williams 226 The fate of the below knee amputee Linda de Cossart, P Randall, P Tuner and R W Marcuson 230 The treatment of recurrent pulmonary embolism: experience with the Kimray Greenfield vena cava filter John H Scurr, Paul E M Jarrett and Christopher Wastell 233 A comparison of skin grafting and healing by granulation, following axillary excision for hidradenitis suppurativa Wyn P Morgan, Keith G Harding and Leslie E Hughes 235 Haemorrhoids treated by cryotherapy: a critical analysis J A Southam 237 Traumatic transection of the thoracic trAchea S P L Travis and G T Layer 240 An information leaflet for surgical patients T D Bunker 242 The surgery of malrotation and midgut volvulus: a nine year experience in neonates George H Welch, Amir F Azmy, and Mark A Ziervogel 244 Surgical operation rates: a twelve year experience in Stockton on Tees D S Quill, H. B. Devlin, c uA Plant, Katherine R Denham, R A McNay and D Morris 248 Problems of the medical staffing of intensive care units in British district general hospitals D G Price 254 Surgical wound management with adhesive polyurethane membrane: a preferred method for usage Laurence Tinckler 257 Problems with the use of Op-Site sutureless closures in orthopaedic procedures Timothy D Bunker 260 Right hemicolectomy: use of GIA stapler A K Ladha 263 A useful eye sign in the apparently unconscious patient David L Cain 265 The Falklands war: Army Field Surgical experience D S Jackson, C G Batty, J7 M Ryan and W S P McGregor 281 Delayed urinary fistula from high velocity missile injury to the ureter Nicholas E Cetti 286 Current thinking on the mnanagement of primary carcinoma of the breast M Baum 289 Epiglottopexy: a new surgical technique to prevent intractable aspiration G B Brookes and P McKelvie 293 Management of pancreatic trauma A Henarejos, D M Cohen and A R Moosa 297 Treatment of thyroid carcinoma in 107 cases D C C Bartolo, P H Kay and C H Talbot 301 Emergency surgery for stab wounds to the heart I J Reece and K G Davidson 304 Changing fashions in the surgery of aortic aneurysms G S Makin 308 Unoperated Abdominal Aortic Aneurysm: Presentation and Natural History E M Walker, B R Hopkinson and G S Makin 311 Second laparotomy following 'curative' resection for colorectal cancer H J Lewi, D C Carter, J G Ratcliffe and C S McArdle 314 Anaesthesia for laparoscopy: alfentanil and fentanyl compared B Kay, A T Cohen, F Shaw and T E Healy 316 Transtracheal ventilation in oral surgery P R Layman 318 The introduction of pulmonary artery pressure and cardiac output measurements in a district general hospital Howard S Smith 321 Identification of accessory bile ducts at cholecystectomy G B Hopkinson, D A K Woodward and N Prasad 323 Knotted drainage tube: practical points in its prevention Gillian E Mobb, M H Lewis and D P Goodwin 325 Abdominal drainage following cholecystectomy: high, low, or no suction? T T McCormack, P D Abel and C D Collins 326 Removal of common bile duct stones after emergency drainage of the gall bladder E M Walker and D H Rose 329 Needle aspiration in the treatment of pancreatic pseudocyst in childhood R Windle, D Finlay and J P Neoptolemos 331 The use of pedicled transplants of sigmoid or other parts of the intestinal tract for vaginal construction J C Goligher 353 Invasive breast cancer the tip of an iceberg C Jf Cahill, N M Gibbs, P. S. Boulter, M J Brient and J L Price 356 Reconstruction of the oesophagus Ronald Belsey 360 The restoration of laryngeal competence by polytetrafluoroethylene paste after oesophageal surgery A F Higgins, R F Gray and R M Kirk 365 Post-thoracotomy pain relief: combined use of cryoprobe and morphine infusion techniques I A Orr, D J M Keenan, J W Dundee, C C Patterson and A A Greenfield 366 Regional anaesthesia in elective hand surgery Christopher J Slack and Bernard S Sylvester 370 Airway management in the transfer of the unconscious patient Neville Robinson and Kenneth G A Macleod 372 Undergraduate students' experience in 'peripheral' and 'teaching' hospitals compared Richard E Wakeford 374 Manual dilatation of the anus and elastic band ligature: an effective short stay alternative to formal haemor- rhoidectomy for prolapsing haemorrhoids Henry C Umpleby and David C Britton 378 The efficacy of face masks Mahesh Shah, Paul Crompton and M D A Vickers 380 Towards an efficient retractor handle: an ergonomic study Stephen Brearley and Hilary Watson 382 Ureteric obstruction after dacron vascular replacement John Meyrick Thomas, Neil J McC Mortensen and Chistopher R Bayliss 385 The effect of cephradine prophylaxis on wound infection after arteral surgery through a groin incision John F Chester, Colin M Fergusson and Anthony D. B Chant 389 Post operative care: the role of the high dependency unit D L Crosby and G A D Rees 391 Minor burn injuries in children: inpatient versus outpatient treatment? Godfrey A La Ferla, Alasdair H B Fyfe and Ian K Drainer 394 Delayed rupture of the spleen can masquerade as appendicitis W B Campbell 396 Topical antiseptics in addition to peroperative antibiotics in preventing post-appendicectomy wound infections R B Galland, Teresa Karlowski, Caroline J Midwood, M V Madden and H. Carmalt 397 The place of antibiotics in preventing wound infection after clean operations in an Indian hospital: a prospec- tive randomised controlled clinical trial S Nundy and K Ramachandran 400 Peritoneal drainage following cholecystectomy: a controlled trial C Ragoonanan, D L Crosby, W P Morgan and B I Rees 403 The hip cast-brace for hip prosthesis instability Hugh D Stewart 404 A proposed simple classification of musculo-skeletal pain F F Casale 407 The arterial tourniquet I R Fletcher and T E J Healy 409 History of Medicine Bleeding and cupping J L Turk and Elizabeth Allen 128 El Zahrawi (936-1013 AD), the father of operative surgery Ismail A Nabri 132 Some Portraits of Sir Thomas Spencer Wells (1818-1897) V A J Swain 201 Ernest William Hey Groves and his contributions to orthopaedic surgery Anthony H C Ratclif 203 Campbell De Morgan and his Spots E M Rosser 266 The History and evolution of surgical instruments. III Handles. John Kirkup 269 Sir Benjamin Brodie, Bt. (1783- 1863) Mary Wharton 418 On the history of scrotal cancer H A Waldron 420 Comment 63, 135, 207, 274, 347, 423 2 Editorial trends in paper size, publishing and advertising. In terms of the growing number of original papers arriving on the desk cost effectiveness the size has to change to the almost of the editor, as encouragement was given to Fellows and ubiquitous A4 size, but it is realised that this change will non-Fellows to submit articles based upon their own distress those who already have neat rows of bound copies practice, either as aspects of diagnosis or as aspects of stacked in book shelves with appropriate spacing. For treatment. Because of the popularity of this forum of readers interested in keeping the volumes in order, special communication between the authors and the readers, and binders will be available for purchase from the BMAjournals the introduction of a comment section, it has not been department. The style ofprinting has not changed, and those possible to accept articles based on only one or two case who value the relationships of medicine and surgery will be reports. However, the editor will be presenting on trial those pleased to learn that Baskerville type with its serifs will reports which have a lesson to teach that is salutary (ofwhich continue to be used. Baskerville, the Birmingham japanner the literal sense is that it is conducive to health promoting whose hobby was to develop a legible type for printing, was recovery, or counteracting a deleterious influence). contemporary with the Birmingham medical scene at the In formulating an editorial policy one is always aware of time of the Lunar Society, Erasmus Darwin, William the interminable conflict between the merits ofarticles based Withering (of digitalis fame) and the Hunters. One of the upon proper scientific and numerate studies and those which books he produced in his new type was that by William appear to be virtually anecdotal. Many will agree with T. S. Hunter on the gravid uterus. Symbolism and relationships Eliot that 'there is, it seems to us, at best only a limited value continue in respect of the cover; the white on red cover in the knowledge derived from experience', but others might (recalling the barber's pole, or the cross of St. George) is observe that it is indeed those with little experience who are changed to topical 'Para red' which has a hint of the long loudest in their condemnation of the anecdotal reference, and intimate association of the Royal College with military and will cite the thalidomide, and the more recent Oprim, surgery now manifest in the three service Professors ofArmy, revelations to support the value of lessons based on Navy and Air Force Surgery. Readers are reminded that the correspondence notifying a single clinical experience. Are we College Arms are supported by two of the military surgeons to be completely dominated by an utterance of Lord Kelvin? present at the siege of Troy, Podalirius and Machaon. Finally the reader will note that there has been a change to In the course of its life which began in July 1947 the a new printer and that there is a new executive editor, both Annals has seen several changes in the type of papers being based in Bristol. In reporting this the Annals wishes to accepted and published. Originally the Annals confined itself pay a special tribute to Dr Donald Crowther, the retiring to publishing the lectures given in the postgraduate courses executive editor. With him the Annals has enjoyed over ten and the eponymous lectures, particularly the statutory happy and reformative years. How many authors have found Hunterian and the Arris and Gale lectures ofwhich it has the to their delight that the finished article has turned out in first right ofpublication. Several years ago, by a positive and phrase and style to bejust that much better than the one they painless act of parturition, the Annals gave birth to a submitted? Dr Crowther has put in countless hours of separate publication of selected College lectures under the sustained work of a high standard on behalf of the Annals title of 'Current Surgical Practice' (Arnold) of which there and the College and has loyally gone 'the extra mile' in are now three volumes. The void was filled immediately from helping to launch successfully the new Annals of 1983.

After this editorial was written the Annals heard with the deepest regret of the untimely death of the President of the College. So many of the changes being seen in the Annals were matters that were dear to him and it was in his own inimitable way that he interpreted the ideas and wishes of the Fellows up and down the country with regard to the development of the Annals in the years to come. Limb preservation in the treatment of bone tumours 7 peritoneal cavity with 4 or 5 inches (10-12 5cm) of tele- References scopic movement limited proximally by the ala of the sacrum I Gordon-Taylor G. On malignant disease in the region of the or stump of the ilium. After the operation the patient lies in hip. J R Coll Surg Edinb 1959;5:1-21. bed with the leg on pillows without traction. Pain is 2 Taylor G. On the treatment offractures oflong bones. J R Army surprisingly mild and even static quadriceps contractions are Med Corps 1917;29:493-7. possible within 48 hours or so. Walking with crutches 3 Riches E. The Gordon-Taylor tradition in the surgery ofcancer. Ann R Coll Surg Eng 1967;42:71-92. commences with wound healing. After about 6 months two 4 Gordon-Taylor G, Eiles P. Interinnomino-abdominal amputa- sticks are sufficient, or sometimes only one. tion. Br J Surg 1935;22:671-95. 5 Wiles P. The surgery of the osteoarthritic hip. Br J Surg 1958;45:488-97. 6 Cade S. Osteogenic sarcoma: a study based on 133 patients. J R Conclusion Coll Surg Edinb 1955; 1: 79- 111. These in outline are some of the advances in the surgical 7 Sweetnam RD, and Ross K. Surgical treatment of pulmonary metastases. J Bone Joint Surg (Br) 1967;49:74-79. treatment of bone tumours. Regrettably, amputation must 8 Burrows HJ. Major prosthetic replacement of bone: lessons still be necessary for probably the majority of our patients. I learnt in seventeen years.J BoneJoint Surg (Br) 1968;50:225-6. like to think that the great surgeon whom we are here to 9 Merle d'Aubigne R, Dejounay JP. Diaphyso-epiphysial re- honour would be delighted to feel that surgery remains in the section for bone tumours at the knee. J Bone Joint Surg (Br) forefront of treatment. Earlier lecturers who knew him well 1958;40:385-95. have spoken with eloquence from personal knowledge of his 10 Steel HH. Partial or complete resection of the hemipelvis. J personal courage, his extreme courtesy, his generosity and Bone Joint Surg (Am) 1978;60:719-30. astonishing energy. I wish that I too had known him in this 11 Eneking WF, Dunham WK. Resection and reconstruction of way. Those that follow, however, must do their utmost to see primary neoplasms involving the innominate bone. J Bone Joint a Surg (Am) 1978;60:731-46. that his kindness and dedication are not merely memory of 12 Zatsepin ST. Conservative operations for pelvic bone tumours. the past. A memorial lecture must not only look back but, in International Orthopaedics 1981;4:259-68. his own words, 'provide an inspiration for those who work for 13 Hiki Y, Mankin HJ. Radical resection and allograft replace- similar causes . . .'. We all work for such a cause and are here ment in the treatment of bone tumours. Nippon Seikeigeka to keep alive not only the memory of the man but all that he Gakkai Zasshi Journal of the Japanese Orthopaedic Associa- stood for. tion) 1980;54:50-74.

The Annals, March 1983 vol. 65 No 2. Contents of the forthcoming issue will include papers on: wound healing, surgical sepsis, skin closure, and prophylactic antibiotics in burns: Gastrointestinal surgery-proximal gastric vagotomy, duodenogastric reflux in relation to peptic ulceration, gastric partitioning for morbid obesity, the 'triple test' in pancreatic disease, the anatomy of the pancreatic and bile ducts, and biliary sphincterotomy: Anaesthesia awareness during anaesthesia, ethamsylate for haematemesis under lumbar epidural anaesthesia: also cordotomy for intractable pain, a treatment for dry mouth, and abdominal tuberculosis. Percentage malignant involvement in staging of breast cancer 13 by tumour to test the hypothesis of a critical point in the lesion and lymph node involvement based on selective biopsy. relationship between primary tumour burden and breast AmJ Surg 1972;124:158-64. bulk beyond which spread outside the confines of the breast 7 Hoopes BF, McGraw AB. The Halstead radical mastectomy: five year results in 246 consecutive operations at the same clinic. occurs and the prognostic outcome deteriorates. Our results Surgery 1942; 12:892-905. to date indicate a true positive correlation between per- 8 Kunath CA. Problem of cancer of the breast: radical mastec- centage neoplastic involvement of the breast and both tomy in 90 cases. Arch Surg 1940;41:66-78. pathological tumour size and incidence of axillary lymph 9 Pathology Working Group-Breast Cancer Task Force. node metastases. The percentage neoplastic involvement was Standardised management of breast specimens. Am J Clin significantly higher in patients who subsequently died of the Pathol 1973;60:789-98. disease or developed overt dissemination of their disease. It 10 Fisher ER, Gregorio RM, Fisher B. The pathology of invasive should be possible to estimate the percentage neoplastic breast carcinoma: a syllabus derived from findings of the involvement ofthe breast by computed mammography using National Surgical Adjuvant Breast Project. Cancer 1975;36: 1-85. the mediolateral and craniocaudal views, and this aspect is 11 Anderson MR, Hamlin I, Stanton MD. The relative sig- currently being investigated in this hospital. nificance of prognostic factors in breast carcinoma. Br J Cancer 1971 ;25:646f-56. 12 Say CC; Donegan WL. Invasive carcinoma of the breast: References prognostic significance of tumour size and involved axillary I Cutler SJ, Myers MH. Clinical classification of extent of disease lymph nodes. Cancer 1974;34:468-71. in cancer of the breast. J Natl Cancer Inst 1967;39:193-207. 13 Fisher B, Slack NH, Bross IDJ, et al. Cancer of the breast: size of 2 Champion HR, Wallace IW, Prescott RJ. Histology in breast neoplasm and prognosis. Cancer 1969;24:1071-80. cancer prognosis. Br J Cancer 1972;26: 129-38. 14 Cutler SJ, Zippin C, Asire AJ. The prognostic significance of 3 Fisher ER. Pathology of breast cancer. In: McGuire WL, ed. palpable lymph nodes in cancer of the breast. Cancer Breast cancer; advances in research and treatment. Edinburgh, 1969;23:243-50. London, New York: Churchill Livingstone, 1977:43-123. 15 Silverberg SG. Staging in therapy of cancer of the breast. Am J 4 Eggers C, de Cholnoky T, Jessup DS. Cancer of the breast. Ann Clin Pathol 1975;64:756-63. Surg 1941;113:321-40. 16 Fisher B, Slack NH. Number of lymph nodes examined and the 5 Brightmore TG, Greening WP, Hamlin I. An analysis ofclinical prognosis of breast carcinoma. Surg Gynecol Obstet and histopathological features in 101 cases of carcinoma of the 1970; 131:79-88. breast in women under 35 years of age. Br J Cancer 17 Cammoun H, Contesso G, Rouesse J. Les adenocarcinomes 1 970;24:644-69. cylindromateaux de sein. Anatomie Pathologique (Paris) 6 Johnstone FR. Carcinoma of breast: influence ofsize of primary 1972; 17:143-54.

Sir James Paget writes about the continuous assessment and examination of a surgeon by his colleagues. An extract from an address on February 8th, 1885 on the occasion of presentation of prizes to the Army Medical School at Netley Hospital: 'In our profession, most of us have to spend our lives in competitive examinations; various in method, but in- evitable, and, if we make good use of them, very useful to ourselves and to many others. If I may speak of the civil department of our profession, and of the life I have spent in it, in positions which many have envied, I must say that I have never been long unconscious of being under examination. My rivals have included many of my best and most accomplished friends; and my examiners have been the members of my profession, many of whom have been as able to judge me as the members of any board to which you will be submitted will be able to judge of you. I can well remember how, in the beginning of my professional life, I felt when in consultation with my seniors; with men of more experience than myself, with wider knowledge, and with a just respect for their own opinions and the accepted beliefs of that time. Every consultation was an examination, on the results of which my progress, my promotion as you would say, might depend. And this was true, not only in private practice, but even more in the position which is so much competed for, that of surgeon to a large hospital. There, every opinion, every operation, was watched by a crowd ofobservant men, by colleagues and pupils, most ofthem able and willing tojudge as strictly as they would judge of written papers. It was my privilege to promote, at St. Bartholomew's Hospital, a system which I think should be adopted at all such institutions. On an appointed day in each week all patients who may need important operations, and can properly be moved, are brought into the theatre and there examined by members of the surgical staf, each of whom in succession then states and explains to the students assembled, often in great numbers, his opinion as to the nature and proper treatment of each case. Have you ever submitted to a more serious test of your knowledge than this? Is it not like your own clinical examinations, only more severe? Memories and letters of Sir James Paget Longman, 1901. An open comparison between routine and self-administered postoperative pain relief 19 basis of pethidine 100 mg being equivalent to buprenorphine is clear that analgesia would not be improved merely by 0.3 mg, meptazinol 240 mg, morphine 10mg, papaveretum prescribing larger amounts of drug since the patients were 15 mg, and pentazocine 60 mg (4,8). actually given much less drug than would have been auth- The two groups of patients were closely similar in all orised by the 'pethidine 100mg 4-hourly p.r.n.' routine respects except for a marked difference in the average employed at present. It is therefore not just a matter of amount ofanalgesic administered. Patients permitted to take under-prescribing but of a genuine difficulty in matching analgesic on demand consumed almost twice as much drug dose to requirement. It is hard to see how nurses, given the as was given by nursing staff to the other group. constraints of their education and the staffing levels Linear analogue scores given for pain and nausea by available, could be encouraged to be more liberal with patients in both groups are presented in Table II. Pain scores analgesics and yet maintain safety. From this point of view at least, therefore, the patients TABLE II Assessment of analgesia after 24h entering the on-demand trials are achieving much greater pain relief without any adverse consequences. Since this Self-administered Staff-administered comparison could not be blind and the clinicians had analgesics (n = 39) analgesics (n = 20) freedom to prescribe analgesics with different durations of action only a rough estimation can be offered concerning Linear analogue 38.9 + 4.1 56.3 + 5.3* relative drug amounts. score for pain (mean + SEM) We wish to express our gratitude to Mrs M Davies, Miss P James, Linear analogue 26.4 + 5.6 15.4 + 5.4 and MrsJ Webster for their nursing assistance and to Miss D Forbes score for nausea for her secretarial help. (mean + SEM) References *p < 0.05, Mann Whitney 'u' test I Secher PH. Objective measurement of pain. Anesthesiology 1968; 1:209-10. 2 ScottJS. Obstetric analgesia. AmJ Obstet Gynec 1970;6:959-78. 3 Chakravarty W, Tucker W, Rosen M, Vickers MD. Comparison given by patients receiving staff-administered analgesics of buprenorphine and pethidine given intravenously on demand were significantly higher than by those able to take anal- to relieve postoperative pain. Br Med J 1979;ii:895-7. gesic on demand. The mean linear analogue score for nausea 4 Slattery PJ, Harmer M, Rosen M, Vickers MD. Intravenous was lower in the group receiving staff-administered anal- meptazinol for postoperative analgesia. Br J Anes gesics, but this difference was not significant. We noted a 1981 ;53:927-31. tendency to routine administration of antiemetics by the 5 Robinson JO, Rosen M, Evans JM, Revill SI? David H, Rees nurses when giving analgesics. GAD. Self-administered intravenous and intramuscular peth- idine. Anaesthesia 1980;35:763-70. Discussion 6 Revill SI, RobinsonJO, Rosen M, Hogg MIJ. The reliability ofa linear analogue for evaluating pain. Anaesthesia 1976;31: 1191-8. The significantly higher pain scores reported by the patients 7 Evans JM, Rosen M, MacCarthy J, Hogg MIJ. Apparatus for receiving staff-administered analgesics were associated with a patient-controlled adminstration of intravenous narcotics during smaller mean dose of analgesic over 24 h (350 mg of peth- labour. Lancet 1976;1:17-18. idine or equivalent compared with 633 mg). It is well known 8 Jaffe JH, Martin WR. Narcotic analgesics and antagonists. In: that nurses have difficulty in deciding upon an adequate but Goodman LS, Gilman A, eds. The pharmacological basis of safe amount of analgesia after operation on a 'p.r.n.' basis. It therapeutics, 6th ed. New York: Macmillan, 1980:494-534.

The Master of the Fishmongers' Company looks back at Mr. Paget's kindness to him when he was the son of a poor clergyman. One of the earliest friendships that he made in practice came back to him after many years. In 1885, at a dinner of the Fishmongers' Company, he proposed the health of Mr. Beckwith, the Prime Warden. Mr. Beckwith, in his reply, told this story that many years ago a boy, the son of a poor clergyman, was living in London, and was ill. He did not know to what doctor to go, and consulted his landlady. She said she did not know much about such people, but she had heard there was a young doctor, a young Mr. Paget at St. Bartholomew's Hospital, who was clever, and would probably see him without taking a fee. He went to this young Mr. Paget, who certainly seemed clever, and anyway cured him. And when he offered to pay, Mr. Paget said no-he sometimes did not take fees from clergymen, and might also decline to do so from their sons. 'But', said Mr. Beckwith, 'I never thought I should come to be one day Master of the Fishmongers' Company, and to thank SirJames Paget for proposing my health.' Memories and letters of Sir James Paget Longman, 190 1. Wound infection after cholecystectomy 31 coli, 8 with Staphylococcus aureus, 2 with Staph. albus, 1 with antibiotic regimen is hazardous in any respect. Bacterial mixed Staph. albus and Bacteroides, and the last was a resistance has certainly not been a problem. Pseudomonas septicaemia. The task of making a judgment on this issue is not a difficult one. To reiterate, the facts are these: cholecyst- Discussion ectomy carries a 15-25% risk of wound infection. This can Wound infection after cholecystectomy is a commoner occur- be reduced to 3-5% by using an antibiotic regimen, which rence than is often appreciated. This review and others has no known disadvantages. Though it is possible to identify confirm that the risks are of the order of 15-25% (1-4). a high-risk group, it is not possible to identify a truly low-risk While not all these infections are serious, they uniformly add group. Clearly, unless prophylactic antibiotics can be shown to the patient's discomfort. There is overwhelming evidence to carry significant disadvantages they should be given to all from prospective, randomised, controlled trials that this patients undergoing cholecystectomy. incidence can be reduced to 3-5% with prophylactic anti- biotics (1-4). I wish to thank the consultant surgeons at the West Middlesex Several authors believe that they can distinguish high-risk Hospital, Mr D E Bolt, Mr I J Cour-Palais, Mr J A Fleming, and from low-risk groups before surgery. They have advocated Mr P H Pattisson, for allowing me to conduct this study of their using prophylactic antibiotics only in high-risk patients patients. (1,5,6). Any one of the following features is believed to References confer high risk upon the patient: age over 70 years; I Chetlin SH, Elliott DW. Pre-operative antibiotics in biliary emergency surgery; obstructive jaundice; exploration of the surgery. Arch Surg 1973;107:319-22. common bile duct. 2 Stone HH, Hooper CA, Kolb LD, Geheber CE, Dawkins EJ. In the present study 18% (26/143) of those who did not Antibiotic prophylaxis in gastric, biliary, and colonic surgery. receive antibiotics developed a wound infection or septi- Ann Surg 1976;184:443-50. caemia. In those with one or more of the above risk factors 3 Keighley MRB, Drysdale RB, Quoraishi AH, Burdon DW, this incidence was 24% (12/49) and in those without a single Alexander-WilliamsJ. Antibiotics in biliary disease: the relative risk factor the rate was 15% (14/94). It is clear that while it is importance of antibiotic concentrations in the bile and serum. possible to a it not Gut 1976; 17:495-500. identify high-risk group, is possible to 4 Strachan CJL, Black J, Powis SJA, et al. Prophylactic use of identify a truly low-risk group. cephazolin against wound sepsis after cholecystectomy. Brit Strachan et al. (4) have established the efficacy of a single Med J 1977;i: 1254-6. preoperative dose of cephazolin 1.0 g in reducing wound 5 Sandusky WR. Use of prophylactic antibiotics in surgical infection following cholecystectomy from 16.9% to 3.2%. It patients. Surg Clin North Am 1980;60:83-92. is almost certainly necessary to extend this regimen if a T 6 Keighley MRB. Micro-organisms in the bile: a preventable tube is inserted because of the continuing potential con- cause of sepsis after biliary surgery. Ann R Coll Surg Engl tamination from the skin and bile. There is no evidence 1977;59:328-34. whatsoever to show that a single-dose or even a 3-dose

Following his transfer to Edinburgh Lister found the conversion ofhis house surgeons and nurses to the principles ofantisepsis a slow process at a time when 3 out of 4 patients having amputation through the thigh died of spreading infection. He received unexpected support for his work following a visit from Dr. Saxtorph. Dr. Saxtorph, Professor of Surgery in the University of Copenhagen, had paid a visit to Lister at Glasgow in the previous year. He had been impressed by reading Lister's reports upon compound fracture. He was more impressed by what he saw. He saw wounds heal without devastating inflammation. He stayed a considerable time with Lister, watching every detail of the thoughtful practice. He was also a firm believer in Pasteur's germ theory. Thus equipped he returned to Copenhagen. At the end of a year he, too, had wrought a miracle in his surgical wards. In July, 1870, he wrote to Lister the following letter:- "MY DEAR SIR, It is now a year since I left Glasgow, where I had the opportunity ofseeing how the antiseptic treatment of wounds is to be carried out. Every surgeon who has seen the remarkable results of this treatment must feel it his duty to imitate you, and dress the wounds after your principles. I therefore, as soon as I came home, adopted your method, and have used it now continually since that time; and I am happy to say that, although I have not generally succeeded in obtaining complete primary union" (i.e., healing of severed tissues directly by conjunction ofcut surfaces without gaping), "still, the treatment has proved in other respects extremely satisfactory.... Formerly there used to be every year several cases of death caused by hospital diseases, especially by pyaemia, sometimes arising from the most trivial injuries. Now, I have had the satisfaction that not a single case of pyaemia has occurred since I came home last year, which result is certainly owing to the introduction of your antiseptic treatment. But it must be clear to any surgeon who has adopted your method that unless you take the greatest precautions in every dressing until the wound is either healed or filled up with granulations, you will never see the excellent effects of this treatment. It certainly takes much longer time, and demands much greater precautions, than any other dressing; but the reward is certain, and it is a satisfaction to know that the good result of many operations almost entirely depends upon your dressing of the wound.... All the compound fractures which I had to deal with last year, some ofthem very severe ones, have healed without the least suppuration in the fracture itself, and the consolidation did not take much longer time than in a simple fracture. All the amputations of this year have recovered. There has certainly been some suppuration, but it never became profuse, and I never observed any putrefaction. I feel so much indebted to you for what I have learnt in seeing you employ the antiseptic dressing that I thought it my duty to let you know how things went on in my hospital practice; and I am happy to say that I have never tried any innovation which answered so admirably as this treatment of wounds. "Believe me, my dear Sir, ever yours, "SAXTORPH." from Lord Lister by G. T. Wrench Published by T. Fisher Unwin A ~~COLLEGEX

UBULLETIN IJOHN HUNTER 1728 1793

Supplement to the Annals of the Royal College of Surgeons of England

January 1983 Volume 65 No 1

Contents IFC College diary College and Faculty news I Death of Sir Alan Parks PRCS I Meeting of Council I Meeting of the Board of Faculty of Dental Surgery I Meeting of Board of Faculty of Anaesthetists 2 Annual Meeting of Fellows and Members, 1982 4 Admission to Honorary Fellowship of the College 5 Ceremony of Presentation of Diplomates 6 Joint Meeting of RCS, RACS and ASGBI, 6th-8th April 1983 6 Council visit to Cardiff, Wednesday 9th February 1983 6 College Dinners 7 College Evening 7 Course in Basic Medical Sciences for Dentists 7 Falklands Campaign Honours 7 Announcements 7 Mr Frank Glassow 7 Donations to the College 7 Bernard Sunley Fellowships 7 Porritt Fellowship 7 Lionel Colledge Memorial Fellowship in Otolaryngology 7 Jacksonian Prize, 1983 7 H J Windsor Prize, 1983 8 Report of the Board of Examiners for the Fellowship in the Faculty of Anaesthetists, 23rd July 1982 IBC Notice to contributors IBC Notices Tuesday 15 DOrth (Part II) examination begins College diary Thursday 17-Friday 18 Symposium on the medical aspects of the Falkland Islands Campaign (see IBC) January Friday 18 Saturday I Basic Medical Sciences lectures and demonstrations for C(LLEGE CLOSED Anaesthetists end Monday 3 Alonday 21 BANK HOLIDAY COLLEGE CLOSED Regional Meeting in Basingstoke Conservation of the anal sphincter Friday 7 Introductory course in Clinical Anaesthesia begins Holiday Lecture for Young People Professor H Ellis The sixth Course of lectures and demonstrations in Basic Medical Sciences former and medicine (3 p.m.) begins .Mionday 10 Wednesday 23 DO examination begins John Keats Memorial Lecture Professor W Walsh The Keat- W1'ednesday 12 sian paradox: the hectic and the healthy (5 p.m.) Ceremony of Presentation of Diplomates (1 1.30 a.m.) Friday 25 College Dinner (7.30p.m.) Introductory course in Clinical Anaesthesia ends Thursday 13 Monday 28 Quarterly Council (2p.m.) DMRT examination begins Final FFA examination begins .londay 17 March final LDS (Part I) examination begins Tuesday I sday 18 Primary FFA examination begins g papers issued for election of Fellows in the Faculty to the Wednesday 2 of Faculty of Anaesthetists Animal Care Course on small animal anaesthesia y for nomination of general dental practitioners for co- Election of Fellows in the Faculty to the Board of Faculty of n to the Board of Faculty of Dental Surgery Anaesthetists y19 Thursday 3 Committee for Higher Training of Anaesthetists Otolaryngology Lecture Mr D A W Edwards The oeso- phagus (5.30 p.m.) rd of Faculty of Dental Surgery (2.15 p.m.) Friday 4 unterian Lecture Professor P F Bradley The cryosurgery of Residential course in General, Oral and Dental Surgery ends bone in the maxillo-facial region (5 p.m.) Tuesday 8 Tuesday 25 Hunterian Lecture- Professor D E Neal A study ofpelvic nerve Final LDS (Part III) examination begins function (5 p.m.) (at St. Mark's Hospital) 4'ednesday 26 [Wednesday 9 Hunterian Trustees (2.30 p.m.) College Dinner (7.30 p.m.) Thursday 27 Thursday 10 Primary Fellowship examination begins Ordinary Council (2p.m.) Friday 11 February Regional Meeting in Bath Tuesday I Hunterian Lecture Professor P M Yeoman-Traction injuries Wood-Jones Medal Lecture-Mr H V Crock The blood supply of the brachial plexus (in Bath) to bones and the spinal cord (7 p.m.) (at the Royal Society of Medicine) Saturday 12 Last day for application for Annual Anaesthetics Examinerships Surgery course begins 'ednesday 2 Alonday 14 Meeting of Members in General Dental Surgery (4.30p.m.) Last day for application for Annual Examinerships Faculty of Dental Surgery Evening for General Dental First Membership examination begins Practitioners Aesthetics in restorative dentistry (6p.m.) Wednesday 16 Thursday 3 FACULTY OF ANAESTHETISTS ANNIVERSARY Board of Faculty of Anaesthetists (1 1 a.m.) Otolaryngology Lecture-Mr A W Morrison Meniere's Anniversary Forum Low flow and closed anaesthetic systems Disease (5.30 p.m.) Frederic Hewitt Lecture Dr J E Riding Still more to learn Monday 7 (3 p.m.) College Evening Cancer of the oesophagus (6 p.m.) Annual Meeting Intercollegiate Basic Sciences Course for Oncologists begins Anniversary Dinner DOrth (Part I) examination begins Hunterian Lecture-Professor Lindsay Symon Physiological Wednesday 9 aspects of intracranial aneurysm surgery (5 p.m.) Council vist to Cardif: Friday 18 Hunterian Lecture Professor D K Whittaker Mechanisms of Faculty of Dental Surgery Clinical Study Day Three score tissue destruction and healing following cryosurgery years .... and then? A new dimension, another problem College Dinner Wednesday 23 (see page 3) Hunterian Lecture Professor A D Barnes The changing face Friday 11 of parathyroid surgery (5 p.m.) Intercollegiate Basic Sciences Course for Oncologists ends Thursday 24 Monday 14 Victor Bonney Prize Lecture-The impact of laser microsurgery JOHN HUNTER born 1728 on gynaecology and presentation of the Prize to Mr J A Arris and Gale Lecture Mr P MJohnson-Degeneration of the Jordan (at the RCOG)-(time to be announced). cochlear nerve after exposure to neomycin sulphate (4.30 p.m.) Saturday 26 (at the Institute of Laryngology and Otology) Hunterian Banquet (7.45 p.m.) Vacancies on the Court of Examiners advertised Residential course in General, Oral and Dental Surgery begins Tuesday 29 DMRD examination begins Date of Council Election announced I

College and Faculty news

Death of Sir Alan Parks PRCS Fellows and other diplomates will have shared Council's profound regret on learning of the death ofthe President, Sir Alan Parks, on 3rd November 1982. The funeral was held privately at Dunwich in Suffolk and flowers, and a message of sympathy to Lady Parks and her family, were sent on behalf of Council, the Boards of Faculty, the Fellows and the staff of the College. A Service of Thanksgiving for Sir Alan's life and work will be held at the Church of St Clement Danes, in the Strand, London, on lWednesday 12th January at 4.30 p.m. Tickets will not be required and all who wish to attend will be most welcome.

Meeting of Council Dr RV WN'alker was appointed Charles Tomes Lecturer for 1984 and his lecture will be delivered on Friday 15th June 1984. At a Quarterly Meeting of the Council held on 14th October 1982 with the President, Sir Alan Parks, in the Chair Council learned Professor Al Darling CBE was appointed Webb-Johnson with deep regret of the deaths of Professor John Kinmonth Lecturer for the period 1982-84 and DrJE McAuley was appointed (Member of Council since 1977) and Mr Norman Tanner, FRCS Menzies Campbell Lecturer for the period 1982-84. The dates of their lectures will be advertised in due course. (past Mcmber of Council). A motion ofcondolence was passed with The resignation of Mr Peter Barton as a Member of the Board deep regret on the death of Sir Geoffrey Keynes, past Member of Council, Honorary Medallist and Honorary Librarian of the was noted with regret. The election of a Fellow in Dental Surgery-to this vacancy will take on Friday 6th May 1983. College. The deaths were also reported of Mr Charles Manning place (past MIember of the Court of Examiners), Dr Preston, A Wade and Dr Loyal Davis (Honorary Fellows) and Mr Harry Litchfield, Patron and past Solicitor of the College. Dr John Marshall, BSe PhD of the Institute of Ophthalmology has been appointed as Edridge-Green Lecturer for 1983. The award of the Burghard Fellowship in Surgical Science to Mr Meeting of Board of Faculty of Anaesthetists R A Greatorex, FRCS of Addenbrooke's Hospital, Cambridge was At a meeting of the Board of Faculty held on 20th Octo announced. with Professor Donald Campbell, Dean, in the Chair Mr Sta Marks and Spencer F'ellowships have been awarded to Mr C J Kelley, FRCS and Mr M Forrest for research in College Alan was appointed as the first full-time Secretary of the Fa departments. succeeding Mr R S Johnson-Gilbert, Secretary of the College w has acted also as Faculty Secretary since 1958. The following were appointed Royal College of Surgeons Surg- A resolution of condolence was passed on the death of Dr H H ical Tutors for three years in the first instance: NORTH WVEST THAMES REGION Pinkerton, Faculty Medallist and past Member of the Board. The resolution was moved by Professor Sir Gordon Robson and AVorthwick Park: Mr J Lewis, FRCS to succeed Mr A Elton seconded by Professor A A Spence. BedJord: Mr R L E Foley, FRCS to succeed Mr A G Beedon Dr J M Beasley, FFARACS of Birmingham was elected to the SOUTH EAST THAMES REGION Fellowship ad eundem. King's College Hospital: Mr H E Berry, FRCS to succeed Mr E R Howard Fcllowship Prizes were awarded to Dr S J Sperring and Dr A J SOUTH WN'EST THANIES REGION Walmslev, and a Nuffield Prize was awarded to Dr M K Sekar. Diplomas of Fellowship were granted in accordance with the pass Crawley: Mr S Janxrin, FRCS to succeed Mr J Neely NORTH WN`ESTERN REGION list which appears in this Bulletin. The Board noted executive action taken by the Dcan in granting Diplomas of Fellowship to Dr UniWersfty Hospital of South Alanchester: Mr F J Weighill, FRCS (New appointment) Song Aik Keh and Dr Martin Alan Johnson on 8th July 1982. WVALES The first Ceremony for the Presentation of Faculty Diplomates will be held on 15th June 1983. Rhyl: Mr M J S Hubbard, FRCS to succeed Mr 0 M Jonathan. The Board resolved that, with effect from January 1985, the Faculty's Fellowship examination structure should take the form of Meeting of the Board of Faculty of Dental Surgery a Part I examination, whose entry requirements will be the same as At a meeting of the Board of Faculty of Dental Surgery held on for the present Primary examination, followed by a combined Friday 15th October 1982 the following were admitted as MCOjbasic sciences viva, followed by a Final examination that will Examiners: include clinical measurement. Fellowship in Dental Surgery The following were appointed to serve as Faculty representatives Medicine and Surgery: Dr SG Elkington FRCP, Dr A McDonald on regional postgraduate and other committees: FRCP, Mr JPS Cochrane FRCS, Dr PR Salmon FRCP. Dr XN' R MacRae SE Scotland Dr C R Dundas NE Scotland Licence in Dental Surgery Dr S M Lyons CPME N Ireland Dental Section: Mr R Haskell FDSRCS. The following were appointed as Faculty Tutors: Surgical Section: Mr ME Bailey FRCS, Mr BJ Britton FRCS NORTHERN REGION Neewcastle: Dr S P Moffett in succession to Dr K Clarke .Membership in General Dental Surgery TRENT REGION Mr KF Marshall MGDSRCS Barnsley: Dr M Longan in succession to Dr D E Lee Doncaster: Dr B Milne in succession to Dr I H Taylor Certificates of Accreditation in Oral Surgery and Oral Medicine SE THAMES REGION were awarded to Mr Anthony David Giles FDSRCS, Mr Zohair Hastings: Dr F S Plumpton in succession to Dr A M Haines Haidar FDSRCS, Mr Derrick Ian Russell FDSRCS, Mr Richard Peter OXFORD REGION WNard-Booth FDSRCS. Aylesbury: Dr R B Plummer in succession to Dr C G Bird Mr WG Cross (Master of the Worshipful Company of Barbers), Certificates of Accreditation of completion of higher training Dr JW McLean OBE (President-Elect of the British Dental were granted to the following Fellows in the Faculty: Association) and Dr RV Walker (Professor of Surgery & Chairman NORTHERN REGION of Division of Oral Surgery of the University of Texas) were elected Dr Timothy John Digger, FFARCS Eng to the Fellowship in Dental Surgery. Dr Nila Ghosh, FFARCS Eng Mr WVG Cross will be admitted to the Fellowship in Dental YORKSHIRE REGION Surgery at the Faculty's Annual Meeting on Friday 17thJune 1983. Dr Philip John Bickford Smith, FFARCS Eng Dr JW McLean and Dr RV Walker will be admitted to the Dr Marjorie Elise Haw, FFARCS Eng Fellowship in Dental Surgery at the Faculty's Annual Meeting on Dr Ruth Eleanor Hills, FFARCS Eng Friday 15thJune 1984. Dr Christopher Anthony Wadon, FFARCS Eng 2 TRENT REGION 'Wc have vigorously pursued our policy of taking College Dr Robert Ellis, FFARCS Eng activities out of Lincoln's Inn Fields and have had many meetings Dr Ian Ronald Fletcher, FFARCS Eng throughout the breadth of the land. It is our aim to increase this Dr Rowan Nigel Francis, FFARCS Eng activity even more and, during the coming year, we will be holding Dr Philip Neil Ogden, FFARCS Eng mectings in WNolverhampton, Bath, Basingstoke, Manchester and Dr Robert William Stevens, FFARCS Eng Bristol. One of the College's functions is to facilitate communication Dr Eddward Amin WN'elchew, FFARCS Eng between Fellows, whether these be scientific, social or concerning Dr Paul Vincent WN!oodsford, FFARCS Eng policy. WVe try and incorporate all three in our meetings. A not EAST ANGLIA REGION unimportant mode of communication is the College journal. The Dr Diana Gillian Beeby, FFARCS Eng Annals will soon be appearing in a new format. The main part will Dr Roger Maitland Kipling, FFARCS Eng be scientific; there will be a separate insert related to College NORTH-WN'EST THAMES REGION domestic affairs. We hope that the Annals will become part of our Dr Helen Askitopoulou, FFARCS Eng national surgical heritage to an even greater degree than at present. Dr Nicholas Graham Jeffs, FFARCS Eng 'It is probable that, by the time this article is in print, the Dr Peter Alister Knappett, FFARCS Eng Examination Hall in Queen Square will have been sold. No-one Dr John Kirkwood Gillman Wells, FFARCS Eng likes to sell property, but the cost of maintenance and upkeep has NORTH-EAST THAMES REGION become a financial burden which we could not shoulder forever. Dr Barbara Bridget Alison Duncan, FFARCS Eng The need for separate examination facilities is declining and we are Dr Ian Gordon James, FFARCS Eng anxious to have most parts of the examination in the more Dr Alistair Graeme Marshall, FFARCS Eng hospitable atmosphere of the College itself. The capital raised by Dr Diana Margaret Susan Terry, FFARCS Eng, FFARCS Ire the sale will be spent on upgrading the College buildings. The SOUTH-EAST THAMES REGION lecture thcatres are being refurbished and we are planning to Dr Katherine Mary Collins, FFARCS Eng provide improved facilities for Fellows and Examiners, who may be Dr Gillian Heather Hackett, FFARCS Eng visiting the College, so that they can meet together and discuss Dr John Edwin Hammond, FFARCS Eng matters of common interest in an agreeable environment. The Christopher Raymond Hasbury, FFARCS Eng rooms in Nuffield College are also being refurbished in the first Iichael McDermot Twohig, FFARCS Eng major overhaul since the residence was built in 1954. The success of H-WNEST THAMES REGION providing better facilitics depends on them being used to a degree n James Ferris, FFARCS Eng, FFARCS Ire which justifies the expense of maintaining and staffing them. Edwin Stevens, FFARCS Eng 'You will all know the situation in which the Institute of Basic X REGION Medical Sciences was placed by the withdrawal of/J- million a year d Henry Read, FFARCS Eng by the University of London. The katabolic phase is virtually over; RD REGION now we have to redesign and provide support for an even more mela Scott Laurie, FFARCS Eng effective teaching and research establishment. We are planning T MIDLANDS REGION what will be known as the Hunterian Institute and it will be an r Roger Andre Botha, FFARCS Eng integral part of the College itself rather than a separate organism in Dr Vera Hilda Daya, FFARCS Eng our midst. Its activities will be under the general supervision of MERSEY REGION Professor Sir Gordon Robson who has been designated Master of Dr Angela D Murray, FFARCS Eng the Hunterian Institute. The overall decisions on College teaching Dr David Martin West, FFARCS Eng will be under the aegis of Mr Alan Apley, Chairman of the Courses NORTH-WESTERN REGION and Lectureships Committee. It is an important element in our Dr Peter Ashford, FFARCS Eng plan to make our teaching and research more relevant to and more Dr Petcr Michael Burridge, FFARCS Eng accessible to our Fellows in all disciplines. Dr Keith William Nightingale, FFARCS Eng 'The battle of the Falkland Islands was, thankfully, brief. We are Dr Pattabiraman Venkataraman, FFARCS Eng, FFARCS Ire particularly proud of the part played by the Medical Services in this WNALES campaign. As always happens, some good comes even out of war, Dr WVayne James, FFARCS Eng and the medical and surgical lessons learned have been most Dr Geoffrey Andrew Wenham, FFARCS Eng valuable. In conjunction with the Royal Society of Medicine and ABERDEEN the three Services, we are hoping to hold a two day symposium on DrJudith Susan Blaiklock, FFARCS Eng the Falklands campaign in February 1983. We count on your EDINBURGH support to make this a success. Dr Fiona Elizabeth Rallcy, FFARCS Eng 'Perhaps the event with the greatest medico-political content has GLASGOW been the publication of the Select Committee, chaired by Mrs Dr Richard Henry Kendal Marsh, FFARCS Eng Renee Short. I will not go into it now because we are to have a full- Dr David Weatherill, FFARCS Eng scale discussion at this meeting, held for the first time in Nott- ingham. We are delighted to be here and most grateful for all the arrangements that our Fellows have made for us. 'In conclusion, I would like to say that I hope you can see that Annual Meeting of Fellows and Members, 1982 the College is not standing still. The economic, social and scientific The Annual Meeting of Fellows and Members was held at the changes taking place do. not allow us to do so. I trust that the Queen's Medical Centre, Nottingham on Thursday 30th Septem- decisions made by Council, some of them very difficult, are in a ber, 1982 with the President, Sir Alan Parks, in the Chair. In direction which most of you would approve.' addition to Members of Council and the two Boards of Faculty, the meeting was attended by 59 College Fellows, 4 Fellows in Dental Address by the Dean of the Faculty of Surgery, 12 Fellows in the Faculty of Anaesthetists, 3 Members and Anaesthetists, Professor Donald Campbell one Member of the Faculty of Anaesthetists. (The address from the Dean that hitherto would have been delivered at the meeting was on this occasion circulated in printed Honorary Fellowship form) Dr David C Sabistonjr was introduced and a citation was delivered 'In June 1982 Dr J F Nunn completed his term as Dean. His by Professor Ivan Johnston. Dr Sabiston, having signed the Roll, eminence as a teacher and research worker ofinternational repute is was thereupon admitted to the Honorary Fellowship. of course well known and he applied the same energetic drive, enthusiasm and attention to detail to his overall duties as Dean. Dr Address by the President Nunn inaugurated what seems likely to become an annual event, (The address from the President that hitherto would have been the Conference of Faculty Tutors. The first such meeting in York in delivered at the meeting was on this occasion circulated in printed 1981 was considered by all an outstanding success, as was the form). second in Bristol in July of this year which, with minor modifica- 'It has been an interesting year perhaps a little too interesting. tions, followed the same pattern. These occasions have provided an One item which can give only pleasure to us all was the knighthood invaluable opportunity for Tutors to discuss with members of the conferred upon Gordon Robson in the Birthday Honours List. Sir Board the problems that affect the discharge of their important Gordon is a past Dean of the Faculty ofAnaesthetists and past Vice- duties on behalf of the Faculty at hospital level throughout the President of the College. United Kingdom. Moreover, the members of the principal Board Committees are given the opportunity to explain the current work 'That expansion of consultant numbers and reduction of the of the Faculty in an informal atmosphere, topics such as the changes registrar pool be pursued with the utmost urgency.' in the Fellowship examinations, manpower problems and so on 'Mr President, I am grateful for the opportunity of proposing this being prominent. The content of the programme is largely deter- motion to the Annual Meeting of Fellows and Members. This mined by the Faculty Tutors themselves, thus ensuring that the College is, of course, primarily concerned with the promotion of Board is kept alive to the needs and concerns of anaesthetists high standards both in surgical practice and in surgical training and throughout the country. it is clear that the way in which surgical units are staffed has an 'At an international level, Dr Nunn also was the instigator of a important influence on both of these. very significant innovation. In 1980 in London, and at Auckland, 'N'hen I received the notice of the meeting I thought for a long NZ, this year there took place meetings of the English-speaking time about whether it would be appropriate for me, as a fairly Faculties, Colleges and Boards of Anaesthesia. Matters of common recently admitted Fellow, to submit a motion. My chief fear was interest in the educational field, such as reciprocity ofqualifications, that the only peoplc who would submit motions would be those who were fully discussed. These meetings have been invaluable for all in have distinctly negative views about the current manpower prob- fostering understanding and future collaboration between respec- lem and that the mecting would, therefore, have no opportunity to tive national bodies in our specialty. Future meetings are likely to make any sort of positive statement. I am pleased that that fear has be convened at intervals of two to three years. not been realised but I do feel a trifle lonely as the only Fellow who 'Matters of training and education have occupied a good deal of has submitted a motion at all. I hope that the meeting won't hold it the Board's time throughout the year. An exploratory working against me. group has been set up to look into current practice with regard to 'This motion was written before the appearance of the College's training in Intensive Care and the suitability of the many and Second Report on Surgical Manpower and the Career Structure. various units throughout the country to conduct such training at Had I been able to see that report earlier the motion might well different levels. Another new enterprise is the Standing Committee have been "that this meeting endorses the second report". The on Obstetrical Anaesthesia and Analgesia. With representatives report seems to me a very perceptive one and one which approaches from the Royal College of Obstetricians and Gynaecologists as well solutions to the manpower problem in a way which I think should as the Faculty, this committee is examining areas ofcollaboration in be acceptable to most surgeons. I would draw your attention to the training schemes and also to consider ways and means of sharing first paragraph of the report: "The College reaffirms its commit- information ofjoint concern on hospital visits. ment to a modest expansion of the consultant and senior regis 'The Faculty continues to participate in the important work of grades followed by a substantial reduction of the registrar grad the Joint Committee for Higher Training of Anaesthetists in its is in this sense that I lay this motion before you today. oversight and regulation of Senior Registrar training programmes. 'It seems to me that any solution to the problem needs It is becoming clear that in its constant concern with maintaining three requirements. Firstly, it needs to provide the best the highest standards of training this body is firming up its practice service to patients; this after all is what running a Health Ser with regard to the content of some of these programmes while still all about. Secondly, it needs to balance the number of d endeavouring to retain the maximum flexibility in interpretation of coming out of medical school and the number of career posts whi training regulations. will ultimately be available to them. And thirdly, it needs to protect 'Fellows have no doubt been anxiously awaiting the outcome of the conditions of service of both the present and the future the Board's lengthy deliberations on the restructuring of the generations of consultants. It is my contention that each of these Fellowship examinations. This vital matter has of necessity goals can be met by an increase in the consultant establishment and occupied a large proportion of the Board's time over the past three a reduction in the number ofjunior doctors. I should like to enlarge years and must soon be resolved. A further complication however in on each of these points. First of all, as far as balancing the career an already complex situation may arise if, as a result of the decision structure is concerned, I am not saying, as some juniors have quite to sell Examination Hall at an early date there is a need to find unjustly becn accused of saying, that a consultant post must be alternative accommodation, particularly for the clinical element of created for each junior wherever he may be. In other words, if there the second part examination as it now stands, and in any re- are so many surgical registrars, that many consultant posts in structured form. As a matter of great urgency possible solutions are surgery have to bc crcated for them. This would clearly be a currently being examined. ludicrous way to run a Health Service. But at the present time there 'The forthcoming Faculty elections will see the retiral of four are almost 3000 pre-registration house officers in this country, long-serving Board members Drs Nunn, Howat and Enderby and virtually all of whom are British graduates, yet only some 2200 Professor Thornton. Their unstinting service to the Faculty and career posts become available annually. Unless the career structure specialty deserves our warmest appreciation as it represents a is balanced it seems that up to a third ofjunior doctors may never considerable sacrifice in time and effort which does not lessen as the secure any career post whatsoever. years go on. Earlier this year too Professor James Parkhouse 'Turning now to the consultants, there have been very great fears resigned, after long and valuable service on the Board, to take up that reform will mean consultants clerking their own patients, the post of Dean of Postgraduate Medicine at Newcastle. We wish putting up their own drips, sleeping in the hospital when on call him all success and at the same time welcome his successor, Dr and operating on emergencies at 4 o'clock in the morning. If this Bruce Scott of Edinburgh, who was elected in March 1982. were likely to happen consultants would have very real grounds for 'Fellows in the Faculty must take great pleasure in the recent fear but I am certain that it will not happen. I am certain primarily honour of a Knighthood bestowed on Professor J G Robson in the because consultants will not do it. Anyone who supposes that Queen's Birthday Honours List. His admirable contributions to the consultants could be forced to work under such circumstances Faculty, the College and the medical profession at large have been grossly underestimates the power of the consultant body; but it will appropriately recognised. not in any case bc necessary. Very substantial improvement in 'Furthermore, the College is in the process of reorganising its staffing ratios can be made whilst still maintaining enough junior scientific and research departments to form the new Hunterian staff to provide 24-hour emergency cover. There is no question that Institute and the onerous task of its direction falls to Sir Gordon as consultants work very hard. It would plainly be ridiculous to reduce the first Master of the Institute. the numbers of supporting juniors and expect consultants to carry 'It is gratifying to report that due to the generosity of Mr G on as before. What will happen if consultant numbers are expanded Hickman Phillips the Faculty has received the gift of a magnificent is that the patient load of each consultant will be reduced. chest which belonged to Henry Hill Hickman. This was accom- Consultants will have fewer beds, fewer operating sessions and fewer panied by a framed copy of a portrait of the pioneer of inhalational out-paticnt clinics but they will be able to supervise their in-patients anaesthesia. The Faculty possesses few memorabilia of the early more closely, operate on more of them themselves and follow them days of anaesthesia and these gifts are particularly welcome.' up personally in the out-patient department. I wish to emphasise this point because it seems to have received insufficient attention in Faculty of Dental Surgery the manpower debate to date. New consultant appointments in The addrcss that the Dean, Professor Paul Bramley, delivered to the future will differ from those in the past. Until now new consultant Annual Meeting of the Faculty was circulated for this meeting. It posts have been created to cover an unmet service need and so to was published in the November issue of the Annals, vol 64, no 6, pp develop the service. As a result they have been very expensive. In 435 6. the future new consultant posts will be created primarily to share in existing work. While this will undoubtedly require additional funds Medical Manpower and the Career Structure the sums involved should be less than those required for new posts Mr Stephen Brearley, Fellow, proposed the motion and made the formerly. speech which follows: 'This brings me on to the quality of service. At present there are twice as many junior doctors as consultants working in hospitals. Other Fellows spoke in support of the main proposals in the Assuming, as seems reasonable, that juniors and consultants work College Report but emphasised the need to maintain proper about as hard as each other this must mean that currently two standards. The President asked that particulars of unfilled consul- thirds of the work is being done by juniors. Some surveys have in tant posts should be brought to his notice. fact suggested that the proportion may be as high as 80°,. No less Replying to the debate, Mr Innes Williams expressed gratifica- an authority than the President of this College is on record as saying tion at the considerable degree ofunanimity that had been achieved that, although tremendous advances have been made in recent time between the views of senior and junior grades. He reminded the in the rangc and quality of major surgery, the standard of minor meeting that the College was concerned with all grades and all surgery remains as low as it ever was. This is a direct result of the specialties, within which the ratios would vary, and also with delegation of minor surgical procedures to junior, sometimes very providing training for doctors from overseas. Professor Slaney junior, surgeons. Consultants do not have time to do the hernias, reported the present ratios of consultant and training grades and the piles, the varicose veins themselves, often do not have time to anticipated that it would take at least ten years to achieve the levels supervise their juniors doing them and may not have time even to recommended in the College's First Manpower Report. Both train those juniors as thoroughly as they would like. An increase in Reports had stressed the importance of the surgical team and this the proportion of consultants in hospitals, leading to an increase in had been dealc with further at some length in the Second Report. the proportion of operations performed by consultants, could not This first step would be to try and aim at a team composed of two but lead to an improvement in standards. consultants, one registrar, one senior house officer and two preregis- 'It is clear therefore that a fundamental change in staffing ratios is tration housemen. This in itself would produce a substantial necessary. There have however been two recent developments in reduction in junior staff. The problem could be helped further if the the manpower debate which, if implemented, would help to soften DHSS would agree to allow some of the registrar training posts to the blow to those consultants who are worried at the prospect of be occupied by sponsored overseas trainees and if the 200 senior having inadequate junior support. The first of these is the recent set registrars in training were further considered, the levels of junior of proposals from the CCHMS, which consultant general surgeons staffing should be adequate. will by now have seen and been able to vote on. The essence of these Professor M J Joshi, Fellow emphasised the role that overseas proposals is that as well as a controlled expansion of the consultant graduates could fulfil in making up the shortfall at registrar level, to grade, registrar posts should be reviewed and those not required to mutual benefit. Such trainees should be carefully selected, should raimi a sufficient number of future consultants should be down- not form part of the UK career structure, and should return to their ed to SHO level. Entry to the registrar grade would then occur own countries which needed to benefit from the skills they had he attainment ofa Fellowship. I have some reservations about acquired. r oposals. I am not certain that they would lead to adequate ant expansion and there is a risk that we should substitute umbers of time-expired SHOs for the existing time-expired ADMISSION TO HONORARY FELLOWSHIP ars. It would be necessary to limit the amount of time a OF THE COLLEGE or could spend in the SHO grade in any one specialty. The roposals do however have the very desirable effect of introducing a Dr David C Sabiston Jr 'gate' at a fairly early stage in a doctor's career. Those doctors who On the occasion of the Annual Meeting of Fellows and Members at fail to get a registrar post in the specialty of their choice in their late Nottingham on 30th September 1982, Dr David C Sabiston Jr was twenties would know that they were not going to become consul- admitted to the Honorary Fellowship of the College. The citation tants in that specialty and would be able to re-deploy elsewhere. was delivered by Professor Ivan Johnston as follows: This would be a far less painful process than it is for those doctors 'Mr President, Members of Council, it is my great pleasure and who fail to secure a senior registrar post in the middle thirties, who privilege to present to you Dr David C Sabiston, Chairman of the often have extensive domestic responsibilities and for whom re- Department of Surgery at Duke University, Durham, North deployment is exceedingly difficult. Carolina, for admission to the Honorary Fellowship. 'The second development is the appearance of a set of proposals 'David Sabiston was born in Onslow County, North Carolina. from the British Postgraduate Medical Federation. In essence it is He graduated from the University of North Carolina at Chapel Hill suggested that employing authorities should ensure that at any one before moving north for medical studies at the Johns Hopkins time one-third of their registrar posts were occupied by overseas Hospital, Baltimore. At the same time, our President, Sir Alan trainees who had indicated that they did not intend to seek a Parks, crossed the Atlantic to become a medical student at Hopkins permanent career in Britain. Specific posts would not be identified and the first of the many links was forged, which brings us to this and there would have to be a fair distribution between teaching and ceremony today. non-teaching centres. There are a number of potential problems 'David Sabiston came under the strong and important influence over the implementation of such a scheme but it is difficult to see of Dr Alfred Blalock, one of our Honorary Fellows, and was soon how satisfactory training can be offered in this country to foreign making rapid progress in a surgical career under Dr Blalock's graduates without such an arrangement and the scheme would guidance. In 1949 he became the Harvey Cushing Fellow in enable the continuation of 50o more registrar posts than there Surgery and was soon an Assistant Professor at the Hopkins. His could be without it. early academic potential was recognised by a career research award 'In summary, therefore, it is clear that an increase in consultant from the National Institutes of Health. A Fulbright Scholarship numbers and a reduction in the registrar pool is desirable as a later brought him to work at the Nuffield Department of Surgery at means ofimproving the quality of the service and giving reasonable the University of Oxford with Professor Philip Allison and also at career prospects to doctors in training. Such a change could not Great Ormond Street Children's Hospital. The links with this only protect the conditions of service of existing and future country were strengthened enormously by the whole family at that consultants but would lead to a very desirable reduction in each time. consultant's patient load. The Royal College of Surgeons has 'Dr Sabiston was one of a very remarkable group of Dr Blalock's committed itself to making changes along these lines and it is in chief residents and associates who are now amongst the best known support of that policy that I urge you to support the motion.' names in American surgery, many becoming Chairmen of Univer- Responding to Mr Brearley, the President advised the meeting sity Departments throughout the United States. It was not expected, that it was principally for financial reasons that the increase in therefore, in 1964 that Dr Sabiston should have the opportunity to consultant numbers that had already been approved had not been return South to his beloved North Carolina and become the third implemented. Mr G Foster, Fellow, past President of the Associa- Chairman of the Department of Surgery on the beautiful pine tion of Surgeons in Training, reported that the Association had in forested campus at Duke and it is there that he has made his major general endorsed the Report's conclusions but was anxious to contribution to world surgery. maintain opportunities for adequate training at registrar level and 'Dr Sabiston was trained in cardiothoracic surgery having been proper consultant job content. involved with Dr Blalock in the first Blalock-Taussig blue baby Mr F D Skidmore, Fellow, urged the meeting to re-affirm operations. He has made significant contributions to the earlier and commitment to the National Health Service while encouraging the more accurate diagnosis of pulmonary embolism and his studies in development of private health care; lack of investment in the past, experimental cardiac defects and the clinical correction of congeni- and consequent shortage of operating and other facilities, was now tal heart lesions in children are well known. However, he has a factor in limiting expansion of the consultant grade. He ad- remained a general surgeon in a very remarkable fashion with vocated regional organisation of registrar training and flexibility in publications in abdominal surgery while at the same time being at the number of beds per consultant linked to developments in out the frontiers of development in a highly technical and specialised patient care and short-stay beds. field such as cardiac surgery. 5 'The department at Duke is large with seven divisions and the life 'Now I do want to emphasise to you that not only have you of the department revolves round Saturday morning grand rounds. obtained today a professional qualification, you have joined the The Chief is invariably present, sometimes having returned un- College and that is an important and gladsome thing to have done expectedly from an overnight journey. The general surgical grand and I want to spend some of my time saying a little of what I think rounds are followed by cardiothoracic rounds over both of which Dr that means. I think one can distinguish three major functions and Sabiston presides with the same authority, knowledge and quiet so, if as a mere physician I can put it that way, I am making bold to effectiveness. speak for Colleges in general because I really do believe that the 'He has many interests in operative surgery, but the teaching and things which unite them are infinitely more important and more training of his juniors are one of his joys. He is known as a kindly lasting than things which may happen from time to time to and effective teacher with a strong sense of the historical integrating differentiate them. They are obviously differentiated on a craft basis the contributions of our predecessors with modern thought and and over and above the different crafts which we pursue, we are development. after all members of a great and learned profession and that is a 'The name of Sabiston is synonymous with excellence in journals more important thing than the particular branch of it in which we and textbooks as Editor of Annals of Surgery and the controlling happen to practise. Now I think there are three key words; the first influence in one of the most famous American undergraduate of these is maintenance, the second is the future and the third is surgical texts with its physiological emphasis. His name is a byword social. Now the main function of the Colleges was never better in both undergraduate and postgraduate surgical education. expressed in my view than by your own President, Sir Alan Parks, 'He has brought a young Department of Surgery, opened in the two years or so ago at a meeting in Manchester. He said that the thirties, to a peak of eminence today and has received many real function and the main function of the Colleges is to ensure the personal awards and honours the list is very long but his early maintenance ofstandards of professional practice in the interests ofthe Presidency of the Society of University Surgeons and his Presidency patients and I underline that phrase. Now that really is the essence of the American Surgical Association probably have given him the of the College role. I need scarcely remind you that one of the ways greatest pleasure. He has also held important office in the American in which the Colleges discharge their responsibility is by holding College of Surgeons and he has been Chairman of the American examinations and I think the Fellowship examination is similar, in Board of Surgery. He maintains his links with his colleagues in this type and in the stage of a professional career at which you take it, to country by his active membership of the British Society of Cardio- the Membership of the Royal College of Physicians, and that means thoracic Surgeons. that in George Pickering's words it is a very hard examination at a 'The main love of his life is undoubtedly his love offamily and it is relatively young and tender stage in training. We certainly ke a pleasure to have Agnes Sabiston and her mother, Mrs Barden, emphasising in our College, and I imagine, Mr President, that with us today and it is a pity that their three charming daughters do the same, that the Diploma of Fellowship is not to indica could not also be here. Their lovely home in Durham is a haven of you are already an accomplished specialised surgeon, but th peace and delightful Southern hospitality. Following his home, his have demonstrated, and perhaps even more than demonst institution provides him with his greatest satisfaction and he devotes your fitness to proceed in your case to higher surgical trainin_ a lot of time and effort to his Department and teaching hospital. He 'Now I would like to turn to the future and say that the Colle enjoys gardening and has a keen interest in American history. His have an important role in looking ahead as well as in maintaining beloved North Carolina with its ocean beaches and Appalachian present standards, which is in itselfquite difficult in these days when mountains is his vacation land. we have rail strikes, and even worse in my view so-called industrial 'To his colleagues, patients and students, David Sabiston is a action, even within hospitals. One of the sophistries which causes warm, friendly, unassuming person with a delightful sense of me particular indignation is to hear the phrase "our action will not humour, tending to divert attention from himself to others. The harm the patients". Anyone who says that just has to face the mantle of his beloved chief, Alfred Blalock, fell firmly on David question, well what on earth were you doing to help the patients if Sabiston and has influenced him in many of his attitudes and stopping doing it will not harm them. It seems utterly un- activities. It is therefore not unexpected that so far five of his forgiveable. Now let's look to the future with optimism and associates at Duke have been invited to become Chairman of confidence and I think one thing that can help us to do that is to Surgery Departments in Universities throughout the United States. consider what the practice of medicine and the practice of surgery His Department and laboratories at Duke are now a sought-after was like in the past. We all know the sad fate ofCharles II; between place by Fellows of our College wishing to spend an elective year in his illness and his doctors he really suffered much. But I would like a training programme in the United States. to give two other examples which by extrapolation can be made 'Mr President, it gives me the greatest pleasure to present David hopeful and with which you may perhaps not be so familiar. The Sabiston, member of the Board of Regents of our sister College in first ofthese relates to George II and his wife Queen Caroline and in the United States, for the conferment of the Honorary Fellowship.' her last illness, which is described in the memoirs of Hervey, she obviously suffered from some form of obstruction of the bowel and CEREMONY OF PRESENTATION OF DIPLOMATES had a fistula and ultimately, of course, died in great agony from a condition from which any competent modern surgeon could have Address Sir Black saved her. George II was not a sensitive man (if he saw anyone by Douglas reading he became extremely cross and his wife was not allowed At a ceremony held on 7th July 1982, new diplomates of the College even to possess a book; his only redeeming feature in that context were presented to the President. After the formal ceremony, the was that he supported Handel and really liked music) but he was so following address was delivered by Sir Douglas Black, President of depressed and distressed by this illness that he said to his wife "I will the Royal College of Physicians: never marry again, I will take mistresses" and as far as I under- 'Mr President, My Lords, Ladies and Gentlemen. I began this stand, in both these promises he was faithful. The second ill- morning by speaking for three quarters of an hour to the Institute of ustration is the answer to a puzzle which may not in fact ever have Petroleum on health hazards in the changing oil industry. I must at puzzled you. But certainly I sometimes wonder why it was that once give you assurance that I have no wish to beat that record and Louis XIV was not succeeded by a son or even by a grandson, but a that I will not let it go to my head. Now I very much welcome the great-great-grandson, in the somewhat unpromising shape of Louis lead which you gave me just now that my remarks should be XV, and there is in fact a reason for this. The physician to the concentrated on those who obtained a Diploma and particularly French Royal House was a man of great authority and distinction perhaps the Diploma of Fellowship because I would, before known as Fagon and Louis XIV owed his survival not only to his addressing them, wish to congratulate all Fellows who have own splendid constitution but also because he was the only member obtained Diplomas this day, but it really would be presumptuous of of the Royal household who could tell Fagon that he was not going me to address advice, observations even, to those who have to take his advice. Fagon successfully eliminated all intermediate obtained the Fellowship on an Honorary or an ad eundem basis. generations and that is the answer to that particular puzzle. Even if the advice were good, it would be coming a little late and in 'Now I would like on my third heading to emphasise that you any case, they have proved that they do not need it. So now let me have joined not only a professional organisation but also a social address particularly those who have obtained the Diploma of organisation and I hope from time to time you will augment the Fellowship, and first of all, I have watched with diminishing purely professional aspects of being Fellows, Members and apprehension and growing confidence, the way in which they Licentiates of the College by taking part in the social activities of mounted those three steps diagonally and descended them again in the College as well. That is the best opportunity not only to meet the course of receiving their Diplomas. It looked to me like an old friends ofsome years standing, but also to make new ones and it assault course that had been designed by an under-employed is a very important supplement to the purely professional activities orthopaedic surgeon, if you can imagine such a phenomenon. of any College. 'Now finally, I would like to say what a great pleasure and The programme for Wednesday, 6th April, will take place at the honour it has been for me to be here today and again I will College. In the morning there will be papers by Professor Bertram concentrate my greetings and congratulations on the new Fellows. Cohen, FDSRCS FRCPath on 'John Hunter's application of It has been an added delight for us to see your wives and very science to surgery' and by Professor Roy Calne, FRS on 'Scientific occasionally to hear your families, although I notice that they have research in surgery today'. These will be followed by an explanation gone quiet now. Mr President, thank you once again for doing me of the concept of the Hunterian Institute, which is being created to the honour of asking me to deliver this address. I have been trying embrace all the scientific activities conducted at the College, and all my life to deliver a formal address and I now despair of ever brief statements on research in progress in the Institute. The succeeding.' afternoon programme will consist of a series of papers by distin- guished speakers under the general heading 'The New Biology and A vote of thanks to Sir Douglas was proposed by Mr H H G Clinical Management of Malignancy', concluding at 5 p.m. with Eastcott, Vice-President, who spoke as follows: the presentation of the Lister Medal for 1981 and delivery of the 'M,Ir Prcsident, My Lord, Ladies and Gentlemen, every so often Lister Oration, entitled 'The Skeptical Chirurgeon', by Professor in the south-east corner of Regent's Park, there occurs a remarkable John Goligher. The day will end with a reception, to which guests phenomenon. When I get home on the evening of the happening may be invited, in the Wellcome Museum of the History of my wife says (for we live in that part of Marylebone) "My dear, the Medicine at the Science Museum in South Kensington. Physicians were running today". By this she means not an organised The meeting on 7th and 8th April will be held at Imperial jog or sponsored marathon; they do not come past in little shorts or College. This will be the Annual Meeting of the Association of in track suits. They pass by our gate in their familiar hundreds, lots Surgeons but will be open to other Fellows of the College. of old friends among them, correctly attired for such an occasion in A comprehensive programme including all three days will be dark suits, from the consulting rooms down in Harley Street, or available in January. Fellows of the English College who do not from the Underground Station across the road, already reaching receive a copy by virtue of also being Fellows of the Association are into their inside pockets as they scurry northwards. You, Mr invited to obtain one from the Deputy Secretary of the College, to Prcsident, know what they are up to, for you are one of them. So whom all registrations for the Wednesday must be addressed. docs Sir Douglas, for this is the way that such a distinguished Fellows of the RACS (unless resident in Britain) should register physician is elected to the highest office in his profession; not as we through that College, which is also making travel and accommo- do here, in Vatican style, with everything but the coloured smoke, dation arrangements. Other Fellows of the English College resident by each Fellow of the College coming in person to vote for the in Australasia may wish to enquire of the RACS travel agents he wants for the new President. whether they can take advantage of these arrangements; the address n after he was installed, I would often see him in the early is Venture Holidays, 30 Collins Street, Melbourne 3000. gs, a tall lean figure, pensively walking in the Park, filled vho knows what concerns for the day ahead in his College. Sir glas, how I longed to greet you, to be able to make myself own to you as a neighbour and one of your humblest Licentiates. But it was easy to see that you needed those undisturbed moments, so I kept quiet. Besides, one of your predecessors, many years ago at Council visit to Cardiff, Wednesday 9th February a dinner party, had quietly and kindly let me know that there was 1983 no formal place for Licentiates in that fine building of yours (and it Members of Council have been invited to visit Cardiff on 9th was far too late for an attempt at the Membership). Let me hasten February when, in addition to meeting the Advisers on Surgical to say, however, that many and often since have been the happy Training and College Surgical Tutors in Wales, they will take part occasions for visits there, to your most friendly College. in the following programme which is open to all interested 'From your address this morning, and from your past achieve- practitioners: ments, we know why the Fellows ran to such good effect. Before I At the [lFelsh National School of Medicine: move our College's vote of thanks, Mr President, ladies and 2.30-4.30 p.m. Programm' of surgical papers, co-ordinated by gentlemen, you may like to hear the outcome of my researches in Professor L E Hughes, FRCS Manchester and elsewhere, on the personal and professional record 5 p.m. Hunterian Lecture by Professor D K Whittaker, FDSRCS of our gracious speaker to the Diplomates today. on 'Mechanisms of tissue destruction and healing following 'Coming from the East of Scotland, where words are few and the cryosurgery' best jokes are told with a straight face, such wit can easily be missed. At the Park Hotel: For example, to the colleague who professed in a conversation with 7 for 7.30 p.m. Subscription dinner open to diplomates of the Sir Douglas to be a "born-again Englishman", the quiet reply was College and Faculties and their guests. Dress informal. Tickets, that he was "lacking in ambition" like the headmaster who tells price £16 inclusive of wines, may be obtained from the Deputy us that our children could do better. Secretary of the College not later than 25th January. 'An enviable quality that he shows is his strength and economy of thought. He is able to reduce the most complex diagnostic problem, or a scientific or political one too, for that matter, to its bare essentials almost instantly. His skill as an administrator is legendary. 'He is a brave and direct man. A great deal of his experimental College Dinners work was carried out on himself. He and Professor Malcolm Milne Subscription dinners will be held on Wednesdays, 12th January, took a special diet of attrition so as to reduce their body potassium 9th March and 13th July 1983. All Fellows and other diplomates of to the point of extreme muscular weakness and the appearance of the College and its Faculties are eligible to attend and to invite ECG changes. Dr Geoffrey Wade relates how, as senior registrar, he personal guests. The time is 7.15 for 7.30 p.m., dress informal, and passed a vascular catheter into the left renal vein of the President of the ticket price inclusive of sherry and wines remains £16. Tickets his College, thereby setting up a record that is likely to stand. may be obtained from the Catering Supervisor at the College up to 'NMr President, I cannot finish without referring to the Black ten days before the event. Report on inequalities in medical care and their social aspects. This The guest speaker at the January dinner will be Surgeon Vice- crucial, compassionate book, difficult to obtain, is now out in Admiral Sir James Watt, KBE FRCS, President of the Royal Penguin. We must all be sure to read it now. Society of Medicine and formerly Medical Director-General of the 'There is much more that should be said, but too little time. Mr Royal Navy. He will give an illustrated talk entitled 'The Surgeon President, My Lord, Ladies and Gentlemen, it is an honour and a to the Mary Rose'. privilege to move this Vote of Thanks to Sir Douglas Black for his In March the speaker will by Mr Michael Wood, FRCS who is fine address to our Diplomates today.' Director-General ofthe African Medical and Research Foundation, which provides the African flying doctor service. The speaker for July will be announced in the next issue of this of RACS and 6th-8th Bulletin. Joint Meeting RCS, ASGBI, On Thursday, 9th June there will be a Soiree at the Royal April 1983 Academy Summer Exhibition open to diplomates of all the medical A Joint Meeting of the Royal College of Surgeons and Royal Royal Colleges and their guests. Details will be announced in the Australasian College of Surgeons with the Association of Surgeons March issue of the Bulletin or may be obtained from the Deputy of Great Britain and Ireland is to be held in London in April 1983. Secretary of the College. 7 College Evening Bernard Sunley Fellowships A College Evening (advanced discussion group for Fellows of the The Bernard Sunley Charitable Foundation has generously re- College) on 'Cancer of the Oesophagus' will be held on Monday 7th newed its support ofsurgical research in the College by offering two February 1983 at 6 p.m. under the Chairmanship of Professor research fellowships, each of [20,000 a year (including expenses) Harold Ellis DM MCh FRCS. The programme will be as follows: tenable over the next three years. The Fellowships will be tenable 6.00 The place of radical surgery Mr BA Ross (Norfolk & only in one of the departments in the College. Detailed conditions Norwich Hospital) for the awards had not been determined at the time of going to 6.30 The place of radiotherapy-Mr RJ Earlam (The London press, but Fellows interested in applying should request further Hospital) information immediately from the Master of the Hunterian 7.00 The place of intubation Dr M Atkinson (University Hos- Institute at the College. pital, Nottingham) 7.30 Buffet Supper Porritt Fellowship 8.30-9.30 Discussion The Winthrop Foundation is funding a fellowship in honour of The fee of £10.00 includes buffet supper. Cash bar available. Lord Porritt to encourage study of sports medicine and sporting Applications for tickets (accompanied by cheque) to Miss LEM injuries and has invited the College to assist in its administration. Napper, Surgical Training Office, by Friday 4th February 1983. This will be an annual award of [5000 for which the detailed conditions and mode ofapplication will be announced in the March Course in Basic Medical Sciences for Dentists issue of this Bulletin. An intensive course of study in the basic medical sciences for dentists, intended for candidates preparing for the Primary FDS examination, will be held at the Institute of Basic Medical Sciences Lionel Colledge Memorial Fellowship in starting in March 1983. The course will commence with four Otolaryngology separate days (8th and 22nd March and 5th and 19th April) of The next award or awards of the above Fellowship will be made for lectures and tutorials combined with a programme of reading and the year commencing 1st July, 1983. The maximum award to any written work. The fundamentals of the subjects will be covered to one Fellow will be [2500. provide the background necessary for the full-time section of the The following conditions are laid down by the Trust: course (16th May to 10th June inclusive) in which there will be a 1. Applicants must be United Kingdom born Fellows of the Roya programme oflectures, demonstrations and tutorial classes covering College of Surgeons of England aged between 25 and 35 yea_ topographical anatomy with histology and embryology, special the closing date for receipt of applications who are dental anatomy and histology, general pathology and micro- trainees or recently appointed consultants, or ofsimilar stat biology, applied physiology with pharmacology and biochemistry. otolaryngology. Applicants are expected to have a higher initial standard of 2. The subject of the award is head and neck surgery with knowledge than that required for the longer courses (8 weeks full- emphasis on laryngology. time) also held by the Institute and the course will involve a 3. The Fellowship is tenable for a period ofstudy or research in the considerable amount of personal revision. The inclusive fee will be continent of North America. [450. Application forms are available from The Secretary, Applications for the award or awards for 1983-84 must reach the Institute of Basic Medical Sciences, Royal College of Surgeons of Deputy Secretary of the Royal College of Surgeons of England, England, 35-43 Lincoln's Inn Fields, London WC2A 3PN. 35/43 Lincoln's Inn Fields, London WC2A 3PN not later than 8th (Telephone 01-405 3474 ext: 43). The closing date for applications April, 1983 and must include the following: is 1st March 1983. (a) Name, qualifications and brief curriculum vitae, including present appointment; Falklands Campaign Honours (b) Proposals for the tour or visit to be made during the tenure of The following Fellows and Members of the College received awards the Fellowship; arising from the Falklands Campaign: (c) Letters ofsupport from the applicant's present consultant (or, if CBE already a consultant, the name ofan independent referee in the Colonel Bruce Christopher McDERMOTT, FRCS United Kingdom) and the head(s) of the department(s) to be OBE visited; Surg Lt Cdr (A/Surg Cdr) Richard Tadeusz JOLLY, MRCS (d) A statement of the expenses to be incurred and of available MBE financial resources. FRCS Short-listed applicants may be required to attend for interview in Lt Cdr Philip James SHOULER, London, in which case necessary travelling expenses will be Announcements reimbursed. Mr D R Sweetnam, FRCS has been appointed as Orthopaedic Surgeon to Her Majesty the Queen. Jacksonian Prize, 1983 Dr J Vane, formerly Professor of Experimental Pharmacology in The Council invite submissions for the 1983 award of the the Institute ofBasic Medical Sciences, has been awarded the Nobel Jacksonian Prize, the value of which is [250; the prizeman also Prize for Medicine. receives a bronze medal. Professor Ralf Dahrendorf, Honorary Fellow, has been awarded The regulations were amended with effect from the 1980 award an Honorary KBE. so that dissertations, which must be related to a practical subject in surgery, are no longer to be submitted anonymously; the maximum Mr Frank Glassow length is now 35,000 words. The Annals apologises for an error in recording the Hunterian The Prize is open to Fellows and Members ofthe College, Fellows Frank as in Dental Surgery and Fellows in the Faculty of Anaesthetists. Professorship of Mr Glassow (erroneously listed Philip). Intending candidates should obtain further information from the Secretary of the College, who must be notified of the subject Donations to the College proposed not less than six calendar months before the closing date During the past few weeks the following generous donations have for receipt of dissertations, which is 31 December 1983. been received: A note about this distinguished award appeared in the Annals for Two covenants or promised annual donations totalling [1,100. November 1976 (p. 496). The prize-winning essays are perma- Fifteen legacies totalling [73,474. nently displayed in the College Library. Gifts of [500 and over totalling [3,450. Gifts under [500 totalling [1,803. H J Windsor Prize, 1983 Special gifts Applications are invited for the seventh award of the H J Windsor Donations in memory of the late Professor Kinmonth to be added to Prize established in 1976 by the late Dr H J Windsor, KSG CBE his Research Fund [241 FRCS of Brisbane, Australia. Four-year deposited covenant [1 25pa + tax in memory of the late Preference will be given on this occasion to a young Australasian Professor Kinmonth to be added to his Research Fund [714 surgeon proposing to undertake a research or educational project in Donation to support the Department of Pharmacology [15,000. the United Kingdom. Applications should reach the Deputy 8 Scerctary of thc College by 31st March 1983 and should include a brief curriculum vitae, an outline of the research or educational project envisaged, and supporting letters from a consultant in Australia and the person in the United Kingdom under whom the work is to be carried out. TFlhe value of the prize is £250, to which it may be possible to add a supplementary travel grant.

REPORT OF THE BOARD OF EXAMINERS FOR THE FELLOWSHIP IN THE FACULTY OF ANAESTHETISTS, 23rd July 1982

At the recent Final Examination for the Fellowship in the Faculty §COUPE, Susan Margaret (Dundee). of Anaesthetists, 412 candidates presented themselves for the DAVIES, Christopher Paul (Liverpool). Examination, 112 of whorn acquitted themselves satisfactorily. §DAVIES, Patricia Anne (Newcastle). Tlhe following are the names of the 112 candidates who are DICKSON, Graeme Robert (Melbourne). enititled to the Diploma of Fellow in the Faculty of Anaesthetists: EASTLEY, Roger James (Wales). N\ATKINS-PITCHFORD, John Michael MRCS (St Thomas'). HARRIS, Richard William (KCH). ABBOTT, Michael Anthony Sean MRCS (St Mara's). HENDERSON, Andrew Michael ( 1UCH). DIXON, John MRCS (Royal Free). LILLEY, Jean-Pierre (Birmingham). MIORGAN, Bernard Allan NIRCS (St George's). §LOWRIE, Angela (Nottingham). FARRUGIA, Paul David NIRCS (Westminster). MATHER, Stephen Peter (Dundee). RYLAH, Lindsey Thomas Alan MRCS (Wftestminster). NORLEY, Ian (St Mary's). RILEY, Bernard MRCS (St George's). PAYNE, Martin Richard (Bristol). BRISTONW, Aubrey Stretton Edward MRCS (Guy's). PERNDT, Haydn Keith Stevenson (Sydney). §KARUNARATNE, Nirmalee Marie MRCS (Sri Lanka). PITHER, Charles Edward (St Thomas'). \IANG, Kuo Pieng MIRCS (Ceylon). RAJENDRAM, Selvadurai (Ceylon). KRI, Manmohan Singh FRCS (NVewcastle). REILLY, Charles Stewart (Glasgow). I'l1, Mohamed Esmat Abdalla (Ain Shams). RITCHIE, Peter Andrew (KCH) EIKH, Murtaza El Hussan (Kashmir). ROSE, David John Anthony (Liverpool). O LLOCK, Ashley Neil (Otago). §SAMUEL, Mary Evangeline Thangavadivoo (Singapore). _IkNDON, Sat Paul (India). SIMPSON, David Alexander (Bart's). §ILLANGAKOON, Sabitadevi Maya Senanayake (Ceylon). §THORNBERRY, Elizabeth Anne (KCH). §KH.\NNA, Palvinder (India). ULYETT, Ian (Sheffield). M1ILLER, Richard Ignatius (Mlalta). YATES, David William (Southampton). MISHRA, Pitabas (Utkal). ALGIE, Thomas Alexander (Glasgow). RODRIGO, Muhandiramge Raveendranath Chandrakumar BOLSIN, Stephen Nicholas Cluley (UCH). (Ceylon). CHURCH, John (Bristol). THORPE, Peter Michael §CLARK, Colette (Glasgow). V'IJAYARATNAM, Sinnadurai (Madras). COLEMAN, Peter (Liverpool). Y'OGANATHAN, Selvarajah (Ceylon). CONROY, Philip Thomas (Alanchester). KH.\LIL, Hany Ramzy Ilias (Cairo). DAY, Alfred Charles (Auckland). §RAoxNI ANTONY, Karivelithara (Kerala). §GREBENIK, Catherine Rachael (Leeds). §KENT, Jennifer (St Mary's). GREENHOUGH, Stephen George (Manchester). ODURA-DOMINAH, Asamoah (.Newcastle). HIRSCH, Nicholas Paul (Guy's). §KUSHI MO, Olusola Temitayo (Ibadan). HOLLIS, John Nicholas (The London). §SARMA, Veena HOPKINS, Colin Stirton (Liverpool). BION, Julian Fleetwood (Charing Cross). §JONES, Janet Elizabeth (Liverpool). GIBBONS, John Joseph Patrick (Galway). LOGAN, Michael Robert (Edinburgh). HOFMANN, Francis Peter (Sydney). LOWE, David Martin (W'ales). HUSAIN, Arif (Nagpur). MACKIE, Adam Mitchell (The London). MOSKOVITS, Paul Emeric (Adelaide). §MAHENDRAN, Bhanumati (Sri Lanka). NARAYNSINGH, Aroon ([Vest Indies). MARTIN, John (Glasgow). ROBINSON, Peter Neville (Otago). §MOBLEY, Katharine Anne (St Mary's). §ALQUISI, Najlaa Khalil Salman (Baghdad). MURRAY, Stannard (Aberdeen). GU.NTLETT, Ian Sidney (The London). §NEWBEGIN, Hilary Eileen (St Mary's). KLINCK, John Rutherford (Mc.Gill). O'CONNOR, Michael (Bristol). KULKARNI, Vivekanand (Banalore). PELTON, Christopher Ian (Middlesex). KUTARSKI, Andrew Anthony (St Mary's). ROBERTS, Frederick Leighton (Bristol). LAVIES, Nicholas George (Bristol). SCOTT, Ralph Platt Fisher (Edinburgh). M\acKENZIE, Neil (Edinburgh). SPERRING, StevenJeffrey (Guy's). §NANDANWAR, Chetana (Mlanchester). STRAHAN, Samuel Keith (Manchester). O'LEARY, Patrick Thomas Gerard (Galway). TAN, Kok Hin (Malaya). ROBERTSON, James Alexander (Leeds). §TAYLOR, Valerie Margaret (Glasgow). SENGUPTA, Prasun (Bart's). §TWEED, Carol Suzanne (Bristol). §SMITH, Christina Margaret (Birmingham). NVALMSLEY, Anthony John (The London). §ABERCROMBIE, Eileen Gibson Neish (Glasgow). §WARNER, Jennifer Anne (St Mary's). ALSTON, Robin Peter (Glasgow). WVILSON, Colin Moffat (Glasgow). §ANNAN, FionaJane (Edinburgh). WN'OODCOCK, Thomas Edward (Charing Cross). ARCHER, Peter Laurence (Leeds). §WN'RIGHT, Margaret Mary (Dundee). §CARR, Caroline Anne (St Mary's). CARTER, Michael Ivor (W+eestminster). §Woman Notice to contributors

Authors intending to submit original scientific papers for publi- Illustrations including tables cation in the Annals are strongly advised to consult "Uniform The number of illustrations including tables should not be more requirements for manuscripts submitted to biomedical journals" than 10 for Hunterian Lectures etc and not more than 6 for other produced by the International Committee of Medical Journal scientific articles. Editors and published in the British Medical Journal 12th June 1982, 284, 1766- 1770. To save time and expense the Annals normally will only consider manuscripts which conform to this Colour illustrations style. Colour illustrations can be published only at the author's own The modifications and requirements that are special to the expense, which may be considerable. Annals are as follows: Arrows and symbols Title page Transfers or stencils should be used for arrows or other symbols The International Committee recommends that the title page indicating particular points in photomicrographs etc. A pencil or should contain the 'first name, middle initial and last name of each pen should not be used for this purpose. Alternatively the symbols author'. WVe recognise, however, that this may not be the form in may be written on a sheet of tracing paper covering the which the author would wish his name to appear in print. We photograph. suggest, therefore, that authors should give their name first in the required form followed in parenthesis by the form in which they wish it to be published, if this is different (eg Augustus B Jones (A Radiograph prints Burton Jones)). Original radiographs should not be submitted but should be The appointment of each author at the time of performance of the photographed and reduced. It is up to the author to make sure that work reported should be given. If he has since moved on, his new the prints (especially those of X-rays of bones) are of sufficiently X appointment should be given in a footnote. good quality to ensure reproduction without loss of essential detAj Text Original line drawings Two copies of the text should be submitted whenever possible. The Original line drawings, graphs, etc will be accepted in place c author should always retain a copy for consultation and comparison photographs of them, and indeed will often give better results. All with the proof. illustrations will be returned to the author after his article has been published. Length of text Articles based on Hunterian, Arris and Gale and other eponymous Scale lectures, also reviews, should not exceed 4000 words. Other articles The Annals will not insist on internal scale markers being included should not exceed 2000 words. in all photomicrographs. In their absence, however, the degree of magnification should be stated in the legend whenever possible; if Number of references the photomicrograph has to be reduced for publication, the No more than 25 references are accepted. magnification will be adjusted accordingly.

Notices

Advanced course in plastic surgery Course in orthopaedics The eleventh meeting of this course will be held on 28th and 29th The 67th course in orthopaedics (suitable for Final FRCS March 1983 in Manchester. The subject will be 'Head and neck candidates) will be held at the Rowley Bristow Orthopaedic cancer.' This course is aimed at consultants and senior registrars in Hospital, Pyrford, Surrey on Saturday and Sunday 12th/13th and plastic surgery, but other medical graduates are encouraged to 26th/27th March and 9th/ 1Oth April 1983. Further particulars may apply. Further details from Helen Hicks, British Postgraduate be obtained from the Course Secretary, Rowley Bristow Medical Federation, 33 Millman Street, London WC1N 3EO. Orthopaedic Hospital, Pyrford, Surrey (Telephone: Byfleet 41141 (Telephone 01-831 6222, extension 16.) ext. 205). The selection date for applications is 20th January 1983. Final Fellowship course, Birmingham An intensive postgraduate course in surgery, suitable for Final FRCS candidates, will be held at Dudley Road Hospital, Birmingham B18 7QH and at general and specialist hospitals in the Royal College of Surgeons in Ireland-Bicentenary Birmingham area from 14th to 25th March 1983, course fee: £325. In February 1984 the Royal College of Surgeons in Ireland will be Accommodation available at a nearby hotel at an additional celebrating its Bicentenary, and a Bicentenary Committee has been charge. Those interested may obtain further details and application formed under the chairmanship of Mr Francis A Duff, Past form from the Postgraduate Secretary, Dudley Road Hospital, President of the College. Birmingham B 18 7QH. (Tel. 021-554-3801 ext. 4489.) Various scientific events of the College and its Faculties have been planned over the months from February to November 1984, Falkland Islands symposium including an Open International Symposium on 'Surgical Educa- A symposium to discuss the medical experiences of the three armed tion' during the Charter Day Meeting from 9th to 11 th February, a services during the Falkland Islands Campaign is to take place at Symposium on 'Operative Repair of Urinary Incontinence in the the College on 17th and 18th February 1983. The programme is Female' at the Rotunda Hospital on the 8th and 9th March, a being arranged in conjunction with the services by the United Surgical Scientific Meeting in conjunction with the Surgical Services Section of the Royal Society of Medicine. Further details Research Society and the Association of Surgeons of Great Britain are available from the Sections Officer, Royal Society of Medicine, and Ireland from 12th to 14th September, and the Annual Meeting 1 Wimpole Street, London W1M 8AE, with whom those intending of the Society of Cardiovascular and Thoracic Surgeons of Great to be present are requested to register in advance. Britain and Ireland on the 27th and 28th of September. College address for correspondence subject bibliographies) can be supplied where detailed discussion is Roxal College of Surgeons of England, Lincoln's Inn Fields, possible between the enquirer and the staff of the Library. In other London WC2A 3PN. Telephone 01-405 3474. Cables and tele- cases the Library will offer advice on how best to obtain the messages: Collsurg, WVC2, London. information required. Photocopying, which is chargeable, can be undertaken.

Officers of the College Lists of books added to the Library appear from time to time as supplements to the Bulletin. Secretarv of the College, the Faculty of Dental Surgery, the T rustees of the Hunterian Collection, and theJoint Committees for Higher Surgical Training and for Higher Training in Dentistry: Museums R S Johnson-Gilbert, OBE MA The Hunterian Museum (George Qvist Curator: Miss E Allen) is Chief Accountant: R J Townsend, FCCA open each weekday from 10 a.m. to 5 p.m. Closed on Saturdays and Deputy Secretarv: Miss Hazel Child, BA during August and on Bank Holidays. The Wellcome Museums of Appeal Secretary: R N Hickling, BA Anatomy and Pathology (Conservators: Professors R M H Secretary, Faculty of Anaesthetists and Joint Committee on NIcMlinn and J L Turk) are open during normal working hours Higher Training in Anaesthesia: S N Alan, LLB BBA Niondays to Fridays only and are closed during August and on Assistant Secrctaries: Hardy Cooke (Personnel Officer), Bank Holidays. NV Webber, MA (Surgical Training) Records Officer: H G Paull, ACIS MBIM Down House Administrative Assistant to the Faculty of Dental Surgery: Miss Down House, Downe, Kent, BR6 7JT (Telephone 66-59119). Hon. P A Clarke Curator: Sir Hedley Atkins KBE FRCS. The home of Charles Darwin in the possession and under care of the College. Visitors Institute of Basic most welcome. Open daily from 1 p.m. to 6 p.m. (no admission after Medical Sciences 5.30 p.m.) except Mondays and Fridays. Closed during February The Institute is a Joint Faculty of the College and the British and on Christmas Eve, Christmas Day, and Boxing Day. Open on Postgraduate Medical Federation and comprises the teaching Bank Holiday Mondays (except as above). Admission 70p for and research activities of the Departments of Anatomy, Path- adults, 20p for children. Taxis and buses (146) from Bromley North ology, Pharmacology, Physiology and Surgical Sciences, and or South stations or taxi from Orpington. Enquiries should be ichemistrm addressed to the Custodian, P A Titheradge. int Secretaries: R S Johnson-Gilbert, OBE MA MI E Coops, MIA LLB Nuffield College facilities Assistant Secrctary: C Duncan, BA Accommodation: subject to availability rooms may be booked for long or short periods, including some rooms for married couples. Hunterian Institute Enquiries to the Bursar. The Hunterian Institute has been formed to combine and co- ordinate the teaching and research activities of the Departments of College facilities for functions and conferences the Institute of Basic Medical Sciences and the Research Depart- All enquiries to the Deputy Secretary. ments of the College (Dental Science, Anaesthetics and Ophthalmology). Subscription Dinners Master: Professor Sir Gordon Robson, CBE FRCS FFARCS These are held on the first or second Wednesday in certain months Secretary: R S Johnson-Gilbert, OBE MA of the year. All Fellows and Members and other diplomates of the Examinations College and its Faculties are eligible to attend, with their guests. Details are available from the Catering Supervisor at the College, to All enquires relating to Examinations of the College and its whom all enquiries should be addressed. Faculties should be addressed to the Examinations Secretary, C J Lambert, MIA at Examination Hall, 8-11 Queen Square, London Hunterian and Arris and Gale Lectures XVC IN 3AS (Telephonie 0 1-83 7 5892). Fellows and Members wishing to apply to give a Hunterian or Arris College facilities and Gale Lecture are advised to obtain the regulations from the Secretary. Applications are invited by advertisement in the medical These include a common room for Fellows of the College and journals in March each year. Applicants are asked to submit 35 Faculties and a cafeteria open for coffee, lunch and tea on weekdays copies of a synopsis of approximately 500 words describing the to anyone having occasion to visit the College. subject of the proposed lecture. The degree of originality should be indicated. Work carried out under a superior must be shown to The Library have the latter's approval before being submitted. No special form The Library (Librarian: Eustace Cornelius MIA ALA) is open each of application needs to be completed. weekday from 10a.m. to 6p.m. Closed on Saturdays and during August and on Bank Holidays. It is a reference library whose stock Examinerships comprises some 160,000 bound volumes of periodicals, pamphlets, Vacancies are advertised as follows: and books and it receives some current are 600 periodicals. There Court of Examiners (Final Membership and Fellowship) RCS large collections of manuscripts, autograph letters, engraved por- and Bulletin, March and September. traits, photographs. The Library is particularly rich in its Primary Fellowship and surgical diplomas BM_J and Lancet, collection of the literature of surgery and its specialties, including NMarch. anaestlhesia and oral surgery, and of anatomy, physiology, and Faculty of Dental Surgery-BDJ, third Tuesday in November. general pathology. Faculty of Anaesthetists RCS Bulletin, November. All the collection is available for consultation in the Library. Although items are not lent to individuals, books, pamphlets, and Letters periodicals less than 50 years old are lent to other medical libraries; It is not proposed to include letters from Fellows or Members in the older material can be supplied in photocopy. A MEDLINE College and Faculty Bulletin. Comments or enquiries relating to items terminal has been installed and searches can be processed at a cost included in the Bulletin should be addressed to the Secretary who of f10.00 per search. Information on specific subjects (including will, where appropriate, refer them to the relevant Committee.

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