184 T G Parks duodenum, bones and teeth. Gastrointest Radiol 1976;1: 22 Nakamura Y, Lathrop M, Leppert M et al. Localisation of 67-80. the genetic defect in familial adenomatous polyposis within 20 Bussey HJR, Veale AMO, Morson BC. Genetics of gas- a small region of chromosome 5. Am J Hum Genet 1988; trointestinal polyposis. Gastroenterology 1978;74:1325-30. 43:638-44. 21 Bodmer WJ, Bailey CJ, Bodmer J et al. Localisation of the gene for familial adenomatous polyposis on Chromosome 5. Nature 1987;328:614-16.

The foliowing papers were also presented at the Sir Hugh Lockhart-Mummery Memorial Meeting

B Creamer MD FRCP The combined medical and surgical management of Crohn's disease W W Slack MCh FRCS Historical Aspects of Serjeant-Surgeon to The Queen B T Jackson MS FRCS Lyn Lockhart-Mummery: an appreciation Instructions to Authors Authors submitting original scientific papers for publication in the Annals should consult 'Uniform requirements for manuscripts submitted to biomedical journals' produced by the International Committee of Medical Journal Editors and published in the British Medical Journal, 6th February 1988, 401-56. These are designed to save time and expense and to enable authors to resubmit papers to other journals without extensive alterations. Only manuscripts which conform to this, the Vancouver style, will be considered. The text of observational and experimental articles is usually-but not necessarily-divided into sections with the headings Introduction, Methods, Results and Discussion. 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- ;~~~~~ 34 Reports and Comments

GUIDELINE TRAINING PROGRAMME FOR HIGHER SURGICAL TRAINEE IN GENERAL SURGERY WORKING IN A DISTRICT GENERAL HOSPITAL C D Collins MA ChM FRCS

Taunton and Somerset Hospital

Introduction If possible the supervised independent operating session In some DGHs, surgical trainees are simply used as 'pairs of should take place during the day after the firm's night on duty surgical hands' and the workload on the clinical surgical team is so that the recommendations of CEPOD might be met and so heavy that no time is allowed for the niceties of training; in more emergencies be operated on during the day with consul- others, there are insufficient resources for the trainee to tant involvement, rather than at night. undertake independent clinical work with appropriate super- A guideline programme for a Higher Surgical Trainee such as vision. Whilst clinical experience is the most important compo- this, taken in conjunction with that appropriate for the nent of surgical training in a DGH, it is only of real value if Consultant General Surgeon, will provide a basis for the appropriately supervised or monitored and if time is devoted to allocation of resources for general surgical firms in a DGH. discussion and learning from it. The problem is to achieve the Two consultants sharing a registrar and SHO will require eight balance for both consultant and trainee between pure service staffed operating lists and six staffed outpatient clinic suites. commitment and the learning process. This can only be done if sessional time is made available for education and if the importance of training is recognised by both the consultant Discussion surgeons, management and the trainees. In order to achieve this Currently the facilities available to surgical trainees vary consi- balance it is necessary to devise a programme which allows time derably from hospital to hospital. In some there is no oppor- for these commitments and is so arranged that consultants can, tunity for independent operating with consultant supervision and do, get together regularly with each other and with all the close at hand, whilst in other hospitals there are extra operating surgical trainees for organised structured teaching and discus- lists available and considerable pressure to use the trainees as sion sessions. Impetus to such organisation has been given by independent surgical labour to achieve a high operative turn- the CEPOD Report (1) and, more recently, the White Paper over. In this instance it might be appropriate if more consul- under the heading of 'Audit' (2). tants were appointed and the workload of the trainee was tailored to the guideline programme from which he could gain a Guideline Programme for Higher Surgical Trainee balanced training benefit. Formal training in the past has been geared to the FRCS The Royal College of Surgeons is now proposing a guideline examination and therefore is mostly focussed on the senior programme for a Consultant General Surgeon (3) in which one house officer. The College monitors the training potential of notional half-day is devoted to postgraduate activities and District General Hospitals through the quinquennial reviews medical audit. This is regarded as a fixed commitment to be and the Final FRCS examination itself has resulted in many undertaken by the consultant on a regular basis. This half-day College Tutors setting up in-house Fellowship tutorials and provides the opportunity for formal mortality and morbidity ward rounds. Currently the post-Fellowship trainee has largely meetings, surgical unit audit and clinico-pathological confer- been left to fend for himself. Perhaps the inter-Collegiate ences in addition to teaching ward rounds and tutorials. Specialty examination will provide the necessary stimulus to the On the basis of this consultant programme it is possible to formal organisation of teaching at this level. devise a guideline programme for a higher surgical trainee Good postgraduate training in the DGH has two require- working in a DGH for a team of two consultants. ments. The first is extensive, appropriately supervised surgical 1-Operating list shared with each consultant = 2 NHDs experience, and the second is the time and commitment from 1-Outpatient clinic with each consultant = 2 NHDs the consultants to provide the right opportunities for formal 1-Ward round with each consultant = 2 NHDs discussion, learning and teaching. It is hoped that the lead that 1-Operating list supervised by each the College has provided through its reports from the consultant =2 NHDs Commission on Surgical Services (4,5), its Audit Guidelines 1-Half-day for teaching, interdisciplinary and CEPOD, and the opportunities presented by the White meetings and medical audit = 1 NHD Paper will encourage consultants to adapt their working pro- 1-Study/Special Interest session = 1 NHD gramme to that recommended recently by the College and to develop the culture in their surgical unit which gives prime Total = 10 importance to educational activities. These changes will require the Government, the Department of Health and the tiers of NHD = Notional Half Day, which is equivalent to a period Health Authority Managers to honour their commitment to of 3.5 hours. consultant expansion (6) in order to maintain the surgical 35 service at its current level, particularly in understaffed State for Health, Wales, Northern Ireland and Districts. It is only by consultants and management accepting Scotland-London HMSO 1989. that postgraduate education of all surgical staff is of major 3 Model Job Description for Consultant Posts in General importance and worthy of the investment of both time and Surgery: RCS. February 1990. resource that the quality of surgical service and of surgical 4 General Surgical Manpower within the United Kingdom. training can be improved in District General Hospitals. Report of the Commission on the Provision of Surgical Services of the Royal College of Surgeons of England. June 1986. 5 Report of the Working Party on the Composition ofa Surgical References Team-General Surgery, Orthopaedic and Otolaryngology. I Report of the Confidential Enquiry into Peri-Operative Report of the Commission on the Provision of Surgical Services Deaths: Buck N, Devlin H B, and Lunn J N. Nuffield of the Royal College of Surgeons of England. January 1988. Provincial Hospital Trust. December 1987. 6 Hospital Medical Staffing-"Achieving a Balance-a Plan for 2 Working for Patients-Caring for the 1990s: Secretary of Action": DHSS. October 1987.

THE CAMBRIDGE AUDIT SYSTEM MEETING workload, case-mix, severity of illness at presentation and January 26 1990 variations in reporting complications as well as surgical exper- tise. It was striking that the discussion concentrated on the The theme of the Cambridge Audit System Meeting, held on interpretation of the data rather than on the technical aspects of January 26 1990, was 'Three years experience of surgical audit its retrieval. Another presentation costing the workload of a by microcomputer'. surgical unit highlighted the value of combining costing and Data entry using the Cambridge System was usually per- audit to provide information for resource management. formed by the medical secretaries who attended the meeting The overall impression was that the Cambridge Audit System and commented favourably on the system. Both entry and was user friendly, increased secretarial job satisfaction, and was recall was easy and became part of the unit's routine with no able to provide data which could improve the quality of care, increase in their workload. Automatic outpatient letters and resource management, teaching and communication. Further discharge summaries could be generated, thereby saving time meetings are being arranged and I can recommend attendance. which would otherwise be spent on taking dictation or audio- D S Burkitt chM typing. Telephone enquiries from patients and general practi- tioners could be answered easily without recourse to the case notes. Secretarial work became more interesting because the secretary was able to follow the patients' progress from the time JOINT CONFERENCE ON CLINICAL MANAGEMENT AND of referral, through their admission, to the subsequent follow- MEDICAL RECORDS up. Junior staff also benefit from the programme; dictating A Joint Conference on Clinical Management and Medical repetitive discharge summaries is unnecessary and valid data is Records was held at the Royal College of Surgeons on March 1 easily generated for audit meetings and log books. The general 1990. The meeting was held jointly with the Association of practitioners appreciate the prompt discharge summaries pro- Health Care Information and Medical Records Officers, Royal duced. College of Physicians, Royal College of Obstetricians and Inaccuracies inherent in the current system of coding-Inter- Gynaecologists, College of Anaesthetists, Royal College of national Classification of Diseases (ICD)-may be reduced by Psychiatrists, Royal College of Nursing and the Department of medical staff selecting the correct diagnosis from a list of Health. The meeting debated the requirements of medical diagnoses and the associated ICD code. Manually this is time- records both for the clinical management of patients and for consuming but the process is easily performed by the audit. Cambridge Audit System. It uses a biaxial system based on 87 In the morning there were presentations from each of the terms defining an organ or site and 140 terms defining a Royal Colleges about the requirements of medical records in condition. The combination of these is checked against a their specialty. In the afternoon some of the more general issues database of 'real' diagnoses and if it is valid, the diagnosis and relating to medical records were addressed. Miss Monica Burns its associated ICD code is entered. of the Department of Health discussed medical records and The ability to compare data from different centres is vital. A their value for resource management. Mr Trevor Tyrrell microcomputer, as opposed to a multi-user mainframe reviewed the current state of the art of clinical coding and Mrs computer, is able to provide a higher degree of confidentiality Diana Brahams reviewed the problems of confidentiality, but there can be a problem with incompatibility and the particularly as they applied to medical records and the changing transmission of confidential data via a telephone line. The use circumstances in the UK. Finally, Mr David Dunn from the of a system which generates data in a standard way enables Royal College of Surgeons addressed the problems of infor- comparisons to be made easily without the need for machine mation technology and demonstrated how the microcomputer compatibility. This was demonstrated admirably at the end of system could be used for clinical audit. In particular, Mr Dunn the meeting. The data on 22 497 patients admitted to four showed that the case mix was crucial to the outcome of surgery. centres, Brighton, Cambridge, Plymouth and Stoke, was The meeting was well attended by approximately 200 people, retrieved and the outcome of two procedures, herniorrhaphy including clinicians and medical records officers. This was and appendicectomy, was compared in detail. It became clear another successful venture for the College in the multi- that any comparison between the centres has to take into disciplinary approach to clinical practice. account factors such as age structure of the population, the H Brendan Devlin 36

NOTICE remain confidential at all times, and (b) that regular medical Although Fellows of the College of Anaesthetists will audit covering the work of each medical team takes place, in cease to receive the Annals after the May 1990 issue (see which every doctor is enabled and encouraged to participate. Editorial, January 1990, Vol 72.1.1), the option to Each LMAC should be chaired by a senior clinician who should continue receiving the journal is offered to all Fellows of be nominated by the medical staff. the College of Anaesthetists for an extra £20.00 on their The majority of Colleges have already prepared detailed yearly subscription. guidelines about the practice of medical audit in their special- A form is included with this issue of the Annals for ties, and require evidence of audit in considering the recogni- completion and return to the Records Office by those tion of training posts and programmes. Such statements should wishing to take up this offer. be read in conjunction with this general advice. AU Coliege Members and Fellows are strongly advised to ensure that the medical staff in their hospital takes the initiative in ensuring that a satisfactory medical audit struc- CONFERENCE OF MEDICAL ROYAL COLLEGES AND ture is developed locally. THEIR FACULTIES IN THE UK NIH CONSENSUS PANEL ISSUES REPORT Health Circular on Medical Audit A National Institutes of Health (NIH) consensus development Medical Audit is defined in Working Paper 6 of the White statement on 'Oral Complications of Cancer Therapies: Paper-'Working for Patients'-as 'the systematic, critical Diagnosis, Prevention, and Treatment' may be obtained from analysis of the quality of medical care, including the procedures the NIH Office of Medical Applications of Research (OMAR), used for diagnosis and treatment, the use of resources, and the National Institutes of Health, Building 1, Room 259, Bethesda, resulting outcome and quality of life for the patient.' Maryland 20892, USA. The Department of Health intends to issue a Health Circular The report was prepared by a panel of experts who con- which will outline the arrangements which Health Authorities sidered scientific evidence presented at a Consensus are required to make to ensure that a framework and adequate Development Conference at NIH. It contains recommenda- support for medical audit is in place by April, 1991. tions and conclusions concerning oral complications of cancer The Health Circular states 'This is to support the practice therapies. of medical audit, based on guidelines issued by the Royal At NIH, consensus conferences bring together dentists, Colleges to their respective specialties.' researchers, practising physicians, representatives of public In most Districts, medical audit will be based on a Local interest groups, consumers, and others to carry out scientific Medical Audit Committee, which will ensure (a) that the results assessments of drugs, devices, and procedures in an effort to of medical audit in respect of individual patients and doctors evaluate their safety and effectiveness. 37 College and Faculty Reports and Notices

MEETINGS OF COUNCIL COUNCIL VISIT TO ABERYSTWYTH

At an Ordinary Meeting of Council held on February 15 1990 The President and Council will meet with Fellows in Wales on with Mr Terence English, President, in the Chair, Dr Dhia the occasion of a Council Visit to Aberystwyth to be held on the Al-Musawi was awarded the Hallett Prize for his performance afternoon of Friday, June 29 1990. The programme will in the Primary FRCS Examination held in Baghdad in include a Scientific Meeting to be held at the Old College. Full November 1987. details are available from the Secretary of the College. Mr David Evans delivered a motion of condolence paying tribute to the life of the late Harold Clifford Edwards, Vice-President of the College 1968-69. The President drew Council's attention to the award of CBE COUNCIL VISIT TO BRISTOL to Mr D R Sweetnam, Professor Michael Rosen and Professor The Council of the College will visit Bristol on Friday, E Rhys Davies. November 9 1990. A meeting will be held at Bristol Royal Diplomas of Fellowship were granted to candidates in Infirmary, with presentations on surgical topics and audit, a accordance with the Report of the Court of Examiners dated debate and two Hunterian Lectures by local surgeons. 24 1989. (See page 38) and to: AKHTAR, Khurshid November registration forms will be available from the (Karachi), DRIVER, Ian Kenneth (London), KERR, Philip Full details and Secretary's Office from Simon Scott (Bristol), MAGEE, Timothy Raymond (Bristol), July. REYES, Richard John (London). Council noted the appointment of Dr Nina Wedderburn as Academic Dean of the Hunterian Institute. SPECIALTY EXAMINATION IN ORTHOPAEDIC SURGERY an Meeting of Council held on 8 March 1990 At Ordinary Royal Rollege of Surgeons of Edinburgh The Gilbert Blane Medal was awarded to Surgeon Commander Royal College of Surgeons of England D Baker. J Royal College of Physicians and Surgeons of Glasgow Professor N Crawford was appointed the Bernhard Baron College of Surgeons in Ireland Lecturer for 1990. Royal Crawford Jamieson was appointed the John Kinmonth The first Intercollegiate Specialty Examination in Orthopaedic Lecturer for 1990. Surgery will be held in Edinburgh on Monday and Tuesday, November 12-13 1990. Applications must be supported by written evidence that candidates hold the Surgical Fellowship of one of the Royal Colleges of Surgeons of Great Britain or Ireland or an equiva- lent Diploma and that they have completed three years of training in centres recognised by the Specialist Advisory Committee in Orthopaedic Surgery for training at Registrar or Senior Registrar level. At least one year of this period must be AND at Senior Registrar or equivalent level in Great Britain or ANNUAL MEETING OF FELLOWS MEMBERS oral Oxford, September 20-21 1990 Ireland. The Examination will consist of clinical and components and will contain a significant element of the Basic The Annual Meeting of Fellows and Members will be Sciences related to Orthopaedic Surgery. held at the Academic Centre, John Radcliffe Hospital, Regulations and application forms are available from the Oxford starting at 9 am on Thursday, September 20 1990 Secretariat, Intercollegiate Specialty Boards, 10 Hill Square, and closing after the morning session on Friday, Edinburgh EH8 9DR. Closing date for receipt of applications is September 21. The programme includes scientific sympo- Friday, September 28 1990. Fee: £230. sia and there will be a Hunterian Lecture by Professor Richard Kerr FRCS on 'Is the brain an immunologically privileged site?', and a debate on the motion 'This House Strongly Supports the Government Initiative on REGISTRARS AND SENIOR REGISTRARS Screening for Breast Cancer'. The Annual General Meeting will also form part of the A major conference for Registrars and Senior Registrars in all programme; Fellows wishing to submit motions for disciplines on 'Audit and Quality Assurance in Surgery' will be consideration at the meeting should do so, in writing, to held at the Royal College of Surgeons of England, 35-43 the Secretary, Royal College of Surgeons of England, 35- Lincoln's Inn Fields, London WC2A 3PN on Tuesday, July 24 43 Lincoln's Inn Fields, London WC2A 3PN, by 1990. September 10 1990. With lead presentation by Dr Alexandra Giraud from the The full programme and registration form are inserted Assistance Publique des Hopitaux de Paris, and presentations separately into this issue of the Annals, and additional from Registrars and Senior Registrars from various disciplines. copies may be obtained from the Secretary's Office at the For further details and a registration form, contact the College. College's Department of External Affairs: Tel 071 405 3474, ext 4172. 38 REPORT, dated November 24 1989, of the COURT OF DONNELLAN, Imelda Mary (Liverpool) EXAMINERS' EDEN, Christopher Geoffrey (London) FROST, Neil Andrew (Sheffield) The Court of Examiners reports to the Council that at the GRAHAM, Michael David (Cambridge) recent Final Examination for the Fellowship 31 candidates GRIFFITH, John Philip (Nottingham) presented themselves for the Examination in Ophthalmology, 9 HARRIES, Simon Anthony (London) of whom acquitted themselves satisfactorily; and 46 candidates HALL, Nigel Ruthven (Oxford) presented themselves for the Examination in Otolaryngology, HODGES, Andrew Michael (Birmingham) 11 of whom acquitted themselves satisfactorily; and 354 candi- HOLLINGWORTH, James (Liverpool) dates presented themselves for the Examination in General HUMPHREY, Gillian Mary Surgery, 102 of whom acquitted themselves satisfactorily. Elizabeth (Manchester) Of the successful candidates, Khurshid Akhtar, Paul Joseph JAMES, Peter John (Nottingham) Curley, Ian Kenneth Driver, Philip Simon Scott Kerr, KITCHEN, Neil David (Cambridge) Timothy Raymond Magee, Edwin Charles Nankivell, Marc LAUFFER, Gideon Louis (London) Rabinov, Richard John Reyes, Henrik Alex Steinbrecher, P. *LLOYD, Ian Christopher (London) Chandramani Sundaram, and Vijeyasingam s/o Rajasingam, LONSDALE, Robert John (London) have not yet complied with the regulations. MARKS, David Simon (London) The following are the names of the 111 candidates who are *MATTHEWS, Timothy David (London) therefore entitled, subject to the approval of the Council, to the SASSOON, Elaine Moira (London) Diploma of Fellow:- SEN, Aruni (Calcutta) WAHEDNA, Yasmin (Karachi) tWILSON, Paul Stephen (Birmingham) AGHA, Arif Humayun (Punjab) PARAMESWARAN, Sandrasekeram (Sri Lanka) AL-GHORAB, Mohamad (Damascus) SELWYN, Julian Ralph Merriman (London) AMEYE, Filip (Ghent) LEWIS, Wyn Griffith (Wales) *BACON, Annette Susan (Cambridge) EL RABAA, Saleem Mohamed tBIRCHALL, Martin Anthony (Cambridge) Ahmed (Cairo) BRIGGS, Timothy Paul (London) BABBAR, Surinder Kumar (Middlesex) CHAWDHERY, Muhammad Zafar (Dundee) SINGH, Kewal (Delhi) COHEN, Nicholas Paul (Birmingham) AHMED, Abdul Qayyum (Punjab) DEARDON, David John (Soton) ERDMANN, Matthias Walter Hans (Witwatersrand) EDWARDS, Allen Thomas (Wales) BOUGHDADY, Ilhamy Saad *ELLERTON, Christine Rachel (Leeds) Iskander (Ain Shams) ESBERGER, Demas Alexander (London) COURTNEY, Parul (Dublin) FLOWERS, Mark Jonathan (London) HACKNEY, Roger Graham (Birmingham) GREVITT, Michael Paul (London) HAPUARACHCHI, Joseph Sarath tHABASHI, Sherif (London) Antony (Colombo) HARVEY, Peter Thomas (Dundee) HEMAN-ACKAH, Christopher *HYKIN, Philip George (London) Asuaquarm (Ghana) IYER, Kishore Ramakrishna (Madras) tROGERS, Michael John Christopher (London) ADAM, Ian James (London) SARATH KUMARA, Kollure *ALLAN, Bruce Duncan Samuel (Cambridge) Appuhamilage (Peradeniya) ANSON, Kenneth Mark (London) BROWNE, Thomas Francis (N. U.I.) ARMSTRONG, Alison Louise (Sheffield) tPHILLIPS, David Esmond (London) BARRY, Matthew John (London) tPRINSLEY, Peter Richard (Sheffield) BLEWITT, Neil (Leeds) RAMESH, Subramanian (Madras) BOWYER, Gavin William (Oxford) tRYAN, Rowena Marion (Dublin) BROOKE, Nicholas Simon (Oxford) BARLOW, Ian William (Bristol) BROWELL, David Andrew (Newcastle) BHAGAT, Kaushik-Kumar, BROWSE, Dominic James (London) Baloobhai () CARLSON, Gordon Lawrence (Manchester) tBURTON, Martin James (Oxford) KHAN, Tahir Anis Shafi (Punjab) *FONSEKA, Hewafonsekage Charith KITSON, Jonathan Lane (London) Nilran (Colombo) MUIR, Gordon Hugh (.Glasgow) tLEIGHTON, Susanna Elizabeth NOBLE, Jeremy Guy (London) Jane (London) PARIKH, Aashish Madhusudan (Gujarat) NICHOLSON, George (London) PATEL, Rajan Kumar (Wales) NUR, Nasser Ali (Karachi) PULLAN, Rupert Derek (Oxford) *PITTS, John Francis Armstrong (Glasgow) RANABOLDO, Charles Jean (Soton) REINBACH, Diana Helen (London) ROYSTON, Simon Lester (Manchester) CASEY, Adrian Thomas Carlos SLATOR, Rona Caroline (London) Hickman (London) MORRIS, Sean Bryan (London) CHISSELL, Hugh Richard (London) NANCHAHAL, Jagdeep (London) tCOX, Graham John (London) NARAYAN, Deepak (Madras) DE SOUZA, Anthony Charles (Nottingham) PETERSON, David Charles (London) 39 PHILLIPSON, Andrew Peter (Liverpool) DENTON G W L FRCS POPERT, Richard John Mackay Research Fellow, Department of Surgery, University Hospital, Peter (London) Nottingham. RADLEY, Simon (Birmingham) EISENKRAFT J B FFARCS RAYNER, Simeon Sharratt (London) Professor of Anesthesiology and Director of Anesthesia SHAW, Christopher John (Oxford) Research, Mount Sinai School of Medicine, City University of tSHERMAN, Ian Walter (Soton) New York, USA. SINHA, Joydeep (Manchester) STOODLEY, Neil Gordon (Oxford) FERGUSSON C FRCS VARTY, Kevin (Oxford) Consultant in Traumatic and Orthopaedic Surgery, West VON SCHOENBERG, Marcelle Berkshire Health Authority. Alpheda Maria (London) FLANNIGAN G M FRCS WALLER, David Andrew (Nottingham) Consultant in Urology, Bradford Health Authority. WARD, David Anthony (London) WARREN, Hugh Walter (London) HART N B FRCS WILLSON, Peter David (London) Consultant in Plastic Surgery, Hull Health Authority. HIGGS J M FRCS Consultant Surgeon, Mid-Glamorgan Health Authority, * In Ophthalmology Princess of Wales Hospital, Bridgend. t In Otolaryngology HOCKEY M S FRCS Consultant in Accident and Emergency, Scunthorpe Health Authority. DEATHS HOLDEN D FRCS The Annals reports with regret the deaths of the following Consultant Urologist, Macclesfield Health Authority. Fellows and Diplomates: HOUGHTON P W J FRCS AUKIN Wolf FFARCS Consultant General Surgeon, Torbay Health Authority COHEN Solly Morris FRCS CONNOR Ronald Edward FRCS INGOLDBY C J H FRCS CURTIN Muriel Flavien FFARCS Consultant in General Surgery, Wakefield Health Authority. CURTIS John Bryant FRCS JACKSON I FCAnaes DINSDALE Tom FFARCS Consultant Anaesthetist, York District Hospital. DOYLE Richard Webster FRCS GABE Joel FRCS JAFFRAY D C FRCS GARDINER Ralph Harrison FRCS Consultant Orthopaedic Surgeon and Assistant Director of GRANAT Arnold Harvey FFARCS Clinical Studies, West Midlands RHA. HART Roland Jessup FRCS JONES J R FRCS McCAUL Ian Reay FRCS Consultant in Traumatic and Orthopaedic Surgery, East PRICE Bernard Henry MBE FRCS Berkshire Health Authority. SHEA Leonard Thomas FFARCS SINCLAIR Charles Gordon FRCS KIRWAN L A FRCS SQUIRE Christopher Michael FRCS Board certified by the American Board of Plastic Surgery. MADARIKAN B A FRCS Consultant Paediatric Surgeon, Department of Surgery, University College Hospital, Ibadan, Nigeria. APPOINTMENTS OF FELLOWS TO CONSULTANT AND SIMILAR POSTS MARKS P FRCS Consultant Neurosurgeon, Auckland Hospital, University of ALTMAN B FRCS FACS New Zealand. Director of the Department of Surgery, White Plains Hospital Auckland, Center, White Plains, New York, USA. MITCHELL M D FFARCS Consultant Anaesthetist, South Western Regional Health BRISTOL J B FRCS Authority, Cornwall and Isles of Scilly Health Authority. Consultant General Surgeon, Cheltenham Health Authority. NELSON M E FRCS CHADWICK D A FFARCS Consultant Ophthalmologist, Royal Hallamshire and Clinical Professor of Anesthesiology, Vanderbilt University Children's Hospitals, Sheffield. School of Medicine, and Director of Ambulatory Anesthesia, Vanderbilt University Hospital, Nashville, Tennessee. NELSON R J FRCS Consultant Neurosurgeon, Frenchay Health Authority. CHAFFE A G FFA Consultant Anaesthetist, Doncaster Royal Infirmary (Trent NEWMAN L H FCAnaes RHA). Consultant Anaesthetist, Broadgreen Hospital, Liverpool.

CROWTHER J FRCS NORTON A C FFARCS Consultant in Otolaryngology, Victoria Infirmary, Greater Consultant Anaesthetist, South Lincolnshire Health Authority, Glasgow Health Board, Glasgow. Pilgrim Hospital, Boston. 40 O'DWYER T P FRCS GIFTS Consultant Otolaryngologist for the Dublin area. RESPONSE TO COLLEGE APPEAL: 25 December-24 OAKLAND C D H FRCS February 1989 Consultant in Accident and Emergency, Frenchay Health During the past few weeks the following gifts have been Authority. received/promised: PALMER J H FRCS Gifts available for the general funds of the College and its Consultant in Plastic Surgery, Bradford Health Authority. Hunterian Institute PENFOLD N FCAnaes 2 Covenants and 16 Annual Payments totalling ...... £35 941 Consultant Anaesthetist to the West Suffolk Health Authority. 6 Legacies and 3 Further Bequests totalling ...... £...41 992 Donations over £500 totalling ...... £...... £ 8 500 RUDICK J FRCS Donations under £500 totalling ...... £...... 2 593 Chairman, Department of Surgery, Doctors Hospital, New York, USA. Gifts designated for special purposes within the College and its SMITH D FFARCS Hunterian Institute Consultant Anaesthetist, Western Infirmary, Glasgow. From the Welton Foundation the second payment of 3 pro- mised payments to the Department of Pharmacology TERRY T R FRCS ...... £...... £ 0000 Consultant in Urology to the Leicestershire Health Authority. From the Charles Wolfson Charitable Trust the second of 3 THOMPSON H H FRCS promised annual payments to support Professor Piper's Consultant Surgeon, Lister Hospital, Stevenage, Herts. research ...... £ 5 000

SIR ALEXANDER McCORMICK TRAVELLING JACKSONIAN PRIZE FELLOWSHIP The Council invite submission of dissertations for the 1990 Applications are invited by the Council for the fourth award of award of the Jacksonian Prize which consists of the sum of £250 the Sir Alexander McCormick Travelling Fellowship to further and a bronze medal. specialist clinical training or research in a chosen field in The Prize is open to Fellows and Members of the College, Australia and to cement surgical relations between England and Fellows in Dental Surgery. Dissertations compiled by more and Australia. A parallel award is to be made by the Royal than one applicant may be accepted if submitted by an eligible Australasian College of Surgeons. diplomate of the College. Applicants must be Surgical Fellows of the Royal College of Dissertations must be related to a practical subject in surgery Surgeons of England and hold a University or NHS post at but a specific topic is not prescribed. In order to ensure that his either Lecturer or Senior Registrar level. or her subject will be within the scope of the regulations each The value of the Fellowship is £5 000 tenable for one year intending candidate must notify the Secretary of the subject and would normally be available to go towards the following: proposed not less than six calendar months before the closing (a) travelling expenses (including expenses of family travel date for receipt of the dissertation, supplying a synopsis of not where relevant) and living allowances where not provided; more than 500 words. Four copies of each dissertation are (b) support for the Department(s) in which the applicant is required, at least one of which must be bound, and must reach working; and the Secretary of the College, 35-43 Lincoln's Inn Fields, (c) travel to meetings or other Departments within the host London WC2A 3PN, not later than 4.00 pm on December 31 country. 1990. Applications must reach the Secretary of the College, 35-43 Intending candidates should obtain further information Lincoln's Inn Fields, London WC2A 3PN not later than from the Secretary of the College. September 30 1990 and must include the following: (i) curriculum vitae; (ii) proposals for visit to be made during tenure of Fellowship (preferably over a period of one year with the visit commenc- ETHICON FOUNDATION FUND ing after January 1 1991) Applications are invited for grants from the Ethicon (iii) particulars of applicant's emoluments available in centre Foundation Fund, which was established by the generosity of in Australia and of any additional support applied for; Ethicon Limited for the purpose of promoting international (iv) Names and addresses of two referees, one of whom goodwill in surgery by providing financial assistance to Fellows should be the Head of Department in which the applicant is who are travelling abroad for research or training purposes. working, the other the head of the host Department. Applications are adjudicated upon by an Advisory Board Short-listed candidates will be interviewed at the College in which meets twice yearly. The Board favours applications November. which demonstrate that applicants are using their initiative to 41 obtain experience above and beyond that which they would December 1 for the January meeting, and not later than May 1 derive from a routine exchange or secondment to an overseas for the June meeting. centre. On occasions, grants may be made to senior applicants who may be visiting an overseas centre to teach rather than H J WINDSOR PRIZE 1990 learn. It does not, in general, favour grants to enable an Applications are invited for the next award of the H J Windsor applicant to attend a meeting or conference overseas, neither Prize established in 1976 by the late Dr H J Windsor KSG CBE does it favour grants to support the travel of an applicant's FRCS of Brisbane, Australia. family. Applications will only be considered from those who are Preference will be given on this occasion to a young Fellow of Fellows of the Royal College of Surgeons of England. the Royal College of Surgeons of England proposing to under- Successful candidates will be asked to submit a report on return take a research or educational project in Australia. from their visit. Applications should reach the Secretary of the Royal College Applications must include the following (6 copies of each): of Surgeons of England by July 31 1990 and should include a (a) A letter of application, to include details of the nature, brief curriculum vitae, an outline of the research or educational purpose, and date of proposed visit. project envisaged, and supporting letters from a consultant in (b) Curriculum vitae, including a list of publications. Australia and the person in Britain under whom the work is to (c) A letter of support from the head of department or be carried out. consultant under whom the applicant is working at present. The value of the prize is £250, to which it may be possible to (d) A financial statement showing (i) expenses to be add a supplementary travel grant. incurred, with special reference to the cost of travel, (ii) Please quote reference (RHED/ac) on application. financial resources already available, and (iii) other grants or fellowships being sought. (e) Please state where you saw the fund advertised. NEW YEAR'S HONOURS LIST, 1990 Applications for the next meeting should be sent to the Further to our announcement on page 27 of the March issue of Secretary of the Royal College of Surgeons of England, 35/43 the Bulletin it has been drawn to our attention that Edward Lincoln's Inn Fields, London WC2A 3PN, not later than Samuel BROADWAY FDSRCS has been awarded the OBE.

Other Notices

Liverpool Conference on the Severely Injured Lower Orthopaedics and Fractures for the Final FRCS Limb Norwich, September 21-22 1990 Medical June 7-8 1990 A two-day, non-residential, full-time course to be held at the Liverpool Institution, Norfolk & Norwich Institute for Medical Education. Course This conference is jointly organised by The Department of Organiser Mr J K Tucker. Fee £70. Further details from the Trauma and Orthopaedic Surgery at the The University of Course Secretary, Mrs I Oswick, Norfolk & Norwich Hospital, Liverpool and the Mersey Regional Plastic Surgery and Burns Brunswick Road, Norwich NRI 3SR. Centre. It has as its aim the improvement of joint management of such injuries by involved specialties in this country, and a national and international forum of speakers have been invited. AO Course Participation is limited to 100 delegates and is open to consul- Nottingham tant staff and trainees alike in all specialties involved with such September 4-7 1990 patients. This is a practical and theoretical course on fracture fixation, Further details and application forms may be obtained from including hands on workshop experience. It will be held at the Mr C Tulloch FRCS Department of Trauma and Orthopaedic Queen's Medical Centre, University Hospital, Nottingham. Surgery, University of Liverpool, or Mr A Roger Green FRCS Further information from Mr C L Colton, Consultant Mersey Regional Plastic Surgery and Burns Centre, Whiston Orthopaedic Surgeon, Queen's Medical Centre, University Hospital, Prescot, Merseyside L35 5DR. Tel: 051-426 1600 Hospital, Nottingham NG7 2UH. Tel: Nottingham 421421, (ext: 262) ext 43279.

2nd Congress of the European Association of MEDICAL AID FOR POLAND FUND Video-Surgery Surgical instruments and medical equipment of all kinds are September 6-8 1990 urgently needed in Polish hospitals. If you can help, please To be held at the Torino Esposizioni Congress Center. Further contact: Medical Aid for Poland Fund, 16 Warwick Road, details from Professor A Gaetini, General Co-ordinator, Torino London SW5 9VD. Tel: (071) 373 5464. Esposizioni, Corso Massimo D'Azeglio, 15-10126 Torino. 42 British Trauma Society: Third Annual Meeting Protheses Totales de Hanche sans Ciment Birmingham, October 5-6 1990 6-8 December 1990, Lyons, France. The meeting will consist of presentation of papers and a round Evaluation of total hip replacement without cement-overview table discussion on trauma care. Membership of the Society is of five years' results and new perspectives. Official language: open to all specialties who have an interest in trauma care. French. Further details from: Professor L P Fischer, Pavillon Further details from Mr S K Hardy, Hon Secretary, T, Hopital Edouard Herriot, Place d'Arsonval, 69437 Lyon Tottering Brook House, Saccary Lane, Mellor, Blackburn, Cedex 03. Tel: 010 33 73 34 47 09/10. Lancs. BBl 9DW.

Advanced Courses in Plastic Surgery 4(4) Genital Loire Valley Ultrasound Bicycle Tour deformities, trunk reconstruction, decubitus 23-29 September 1990 ulcers 25-26 June 1990 (Edinburgh, Scotland). and The course is aimed at consultants and trainees in plastic surgery, to whom places will initially be offered. Other medical Alaska 90-Cruise the Inland Passage graduates are encouraged to apply, and will be offered any remaining places. The content is at an advanced level. 6-13 July 1990 Further details from British Association of Plastic Surgeons, Details ofboth the above tours available from: Medical Seminars 35-43 Lincoln's Inn Field, London WC2a 3PN. Tel: 071-831 International, Inc., 9800 D Topanga Canyon Blvd, Suite 232, 5161/2 Fax 071-831 4041. Chatsworth, CA 91311 Tel: (818) 700-9821.

Advanced Courses in Plastic Surgery 4(5) Facial North-West Regional Final Fellowship Courses trauma, facial palsy October 1-2 1990 (Cambridge) Autumn Course 1990: 10-28 September North Manchester Post-Graduate Medical Centre, Manchester. The above course is aimed at consultants and trainees in plastic Three week course for those sitting the Examination imme- surgery, to whom places will initially be offered. Other medical diately following. Cost £475. Details from Mrs P.C. Mallinson, graduates are encouraged to apply, and will be offered any Administrator, North Manchester Post-Graduate Medical remaining places. The content is at an advanced level. Centre, The Red House, Delaunays Road, Crumpsall, Further details from British Association of Plastic Surgeons, Manchester M8 6RH. Tel: 061 795 4567. 35-43 Lincoln's Inn Fields, London WC2A 3PN. Tel: 071-831 5161/2 Fax: 071-831 4041. Sixth Annual Paediatric Urology Course The Institute of Laryngology and Otology. 27-28 September 1990, Cambridge. Current Approaches to Rhinosinusitis: Medical An advanced course under the auspices of the British and Surgical Management Association of Urological Surgeons for Senior Registrars in Urology and Paediatric Surgery and Registrars in Urology. October 8-10 1990 Details from Mr Robert Whitaker, Department of Urology, An international faculty including Dr David Kennedy, John Addenbrooke's Hospital, Cambridge CB2 2QQ. Hopkins University, USA and Dr Heinz Stammberger, University ENT Hospital, Graz, Austria. Course organisers V J Lund and I S Mackay. For further details contact Cheryl Overington, Courses Medical History Tours Organiser, The Institute of Laryngology and Otology, 330/332 How well do you know the Hunterian Museum? Have you Gray's Inn Road, London WC1X 8EE. Tel: 071-837 8855 ext visited the old St Thomas' operating theatre? Who grows the 4218. ingredients of vincristine? The answers to these questions and many more can be found from 'Medical History Tours'. For details of full or half-day tours and special arrangements for Microsurgery Courses conferences and meetings, please contact Sue Weir, 64 Roupell May 14-18 1990 Street, London SEI 8SS. Tel: 071 928 0765. July 16-19 1990 November 5-9 1990 The above courses will be held at the Cambridge Microsurgery Laboratory. Full details can be obtained from the Course Request for Annals for Romania Secretary, Department of Neurosurgery, Addenbrooke's Dr Badea Cristian, Str Agriselor 12, 2200 Brasov, Romania, is Hospital, Hills Road, Cambridge CB2 2QQ. Tel: 0223 245151 anxious to receive copies of the Annals. Is anyone willing to ext 2302. send on their journals after reading them? 43 COLLEGE DIARY

MAY 1990 Monday 18 Primary FDS Examination begins Thursday 3 Friday 22 Joseph Toynbee Lecture by Dr D E Brackmann on 'The Forty-third Anniversary of the Faculty of Dental Surgery Surgical Treatment of Vertigo' at The Royal Society of FDS Ceremony of Presentation of Diplomates (am) Medicine, Wimpole Street, London (5.30 pm) Charles Tomes Lecture by Professor J J Murray PhD MChD Monday 7 FDSRCS on 'Child Dental Health 1890-1990' (2.15 pm) BANK HOLIDAY-COLLEGE CLOSED Annual Meeting of Faculty of Dental Surgery (pm) Friday 11 FDS Anniversary Dinner (pm) FDS Board Election Monday 14 Primary FRCS Examination begins JULY 1990 Monday 21 First Membership Examination begins Tuesday 3 FCAnaes (Part III) Examination begins AO Course begins Monday 28 Thursday S BANK HOLIDAY-COLLEGE CLOSED Election to Council Tuesday 29 Wednesday 11 Final FDS Examination begins Ceremony of Presentation of Diplomates (2.00 pm) College Dinner (6.45 pm for 7.15 pm) JUNE 1990 Thursday 19 ODTS Day Monday Tuesday 24 DO Examination begins Meeting for Registrars and Senior Registrars on Audit and Monday 11 Quality Assurance DLO (Part 1) Examination begins FCAnaes (Part 1) Examination begins Revision Course (Anatomy/Physiology/Pathology) for AUGUST 1990 Surgeons begins Wednesday 13 MUSEUMS AND LIBRARY CLOSED THIS MONTH College Dinner (7.00 pm for 7.30 pm) Friday 24 Thursday 14 COLLEGE CLOSED DLO Part II begins Monday 27 Reception for Accredited Fellows (6.30 pm) BANK HOLIDAY 44 General information

College address for correspondence charged, but this can vary, depending upon the complexity of Royal College of Surgeons of England, Lincoln's Inn Fields, the search and the databases used. Searches of the older London WC2A 3PN (tel: 071-405 3474). Cables and tele- literature can also be made, but in all cases enquirers are messages: Collsurg, WC2, London. Facsimile 071-831 9438, recommended to discuss their requirements with the Library Telex 936573 RCSENG. staff. Where requests for searches are made in writing it would be helpful to receive full details of the subject of the search, to Officers of the College know whether clinical or research papers are required, and if Secretary of the College and of the Trustees of the Hunterian there are any date or language restrictions. Photocopies of Collection: R H E Duffett MA papers retrieved by searches can be supplied if required. Senior Assistant Secretary and Secretary of the Joint Lists of books added to the Library are published from time Committee for Higher Surgical Training: W Webber MA to time and may be obtained by writing to the Librarian. Finance Secretary: N Garland MA FCA IPFA The Hunterian Museum (Conservator: Professor J L Turk, Examinations Secretary and Secretary of the Examining Board George Qvist Curator: Miss E Allen) and The Odontological in England: J S West LLB Museum (Hon. Curator: Dr B K B Berkowitz, Osman Hill Secretary for External Affairs, Secretary of Joint Meeting of Curator: Dr C Grigson) are open each weekday from 10am to Surgical Colleges and of the Board of Surgical Specialties: 5pm. They are closed on Saturdays and during August and on C Duncan BA Bank Holidays and on other days when the College is closed. Secretary of the Hunterian Institute: L F Blythe BA The Welicome Museums ofAnatomy and Pathology are open Secretary of the College of Anaesthetists and of the Joint during normal working hours Mondays to Fridays only and are Committee for Higher Training of Anaesthetists: S N Alan LLB closed during August, and on Bank Holidays, and on other BBA days when the College is closed. Secretary of the Faculty of Dental Surgery and of the Joint Committee for Higher Training in Dentistry: A C de Looze MA Down House Assistant Secretary (Administration): M P Coomer BSc CHSM Down House, Downe, Kent BR6 7JT (tel: Farnborough Appeals Director: P I A B Baker FBIM MICFM 59119). The home of C le Darwin in the possession and Hunterian Institute under care of the Colle . com^.e Open daily The Hunterian Institute coordinates the teaching and research from 1 pm to 6 pm 4- .dmiIhC{5* 3AiiY &x&pt activities of the Departments of Anatomy, Pathology, Pharma- Mondays and Fridays.t Clod "T. and on cology, Physiology and Surgical Sciences, and Biochemistry Christmas Eve, Christm Da and Boxing Day. Open on Bank with the Research Departments of the College (Dental Science, Holiday Mondays (except a; above-). Admission £1.50 for Anaesthetics, Ophthalmology and Physics in relation to adults, 75p for pensioners and 3Op for children. Taxis and Surgery). The Wellcome Museums, together with the courses buses (146) from Bromley Noith or South stations or taxi from run by the College, including craft workshops and advanced Orpington. Enquiries should be addtessed tmthe Custodian. courses for Consultants, also come under the aegis of the Hunterian Institute. Nuffield College: residential accommodation Master: Professor Sir Stanley Peart FRCP FRS Subject to availability rooms may be booked for long or short periods, including some rooms for married couples. Enquiries Examinations to the Residence Officer (ext 2000). All enquiries relating to Examinations of the Colleges and the Faculty should be addressed to the Examinations Secretary. College facilities for functions and conferences College facilities All enquiries to the Facilities Co-ordinator (ext 2001). These include a common room for Fellows of the Colleges and Subscription Dinners Faculty and a cafeteria open for luncheon on weekdays to anyone having occasion to visit the College. These are held on the first or second Wednesday in certain months of the year. All Fellows and Members and other The Library and Museums diplomates of the Colleges and the Faculty are eligible to The Library (Librarian: I F Lyle ALA; Sub-Librarian: F K attend, with their guests. Details are available from Mr M Sherwood BSc ALA MI Inf Sci) iS open each weekday from 10am to Graddon, Facilities Co-ordinator (ext 2001) at the College, to 6pm and is closed on Saturdays, Bank Holidays, throughout whom all enquiries should be addressed. Tickets £22, including the month of August, and on other days when the College is drinks at reception and wine at dinner. closed. It is a reference collection of both current and historical material with a stock of over 160,000 books, periodicals and Hunterian and Arris and Gale lectures pamphlets. Nearly 600 current periodical titles are received and Fellows and Members wishing to apply to give a Hunterian or in addition there are about 3,500 non-current periodical sets Arris and Gale Lecture are advised to obtain the regulations dating from the seventeenth century. The Library is parti- from the Secretary. Applications are invited by advertisement cularly rich in the literature of surgery and all its specialities in the medical journals in September each year. including anaesthesia and oral surgery, and of anatomy, physio- logy and general pathology. There are also large collections of Examinership manuscripts, autograph letters, engraved portraits and photo- Vacancies are advertised as follows: graphs. Court of Examiners (Final Membership and Fellowship)- All the collection is available for inspection in the Library. College and Faculty Bulletin, BMJ and Lancet, March and Items are not lent to individuals, but books, periodicals and September. pamphlets less than fifty years old are lent to other medical Primary Fellowship and surgical diplomas-BMJ and libraries. Photocopies can be supplied at a cost of 10p per sheet Lancet, February. plus postage, subject to copyright restrictions and to the College of Anaesthetists-College and Faculty Bulletin, condition of the original. November. Literature searches can be undertaken using MEDLINE and Faculty of Dental Surgery-BD7, third Tuesday in Novem- other databases, for which a fee of £10.00 per search is normally ber.