Brit. J. vener. Dis. (1970) 46, 162 Br J Vener Dis: first published as 10.1136/sti.46.2.162 on 1 April 1970. Downloaded from A diploma in venereology C. D. ALERGANT University of Liverpool Great Britain is probably the only major country in the training of venereologists, whereby doctors who the world where venereology is recognized and prac- had received a minimum of 130 hours' instruction tised as a distinct and separate specialty. Yet this was at a recognized clinic could be granted a certificate of not always the case. When Sir Jonathan Hutchinson, proficiency. In the 1930s many local authorities in- whose triad of Hutchinson's teeth, interstitial kera- sisted on the possession of such a certificate as a titis, and 8th nerve deafness is indelibly imprinted in condition of appQintment. the world literature, was appointed venereologist to With the establishment of the National Health the London Lock Hospital a century ago, he also held Service the clinics ceased to be the responsibility of appointments of dermatologist to another hospital, the local authority and the certificate lost its raison and ophthalmologist to yet another, to say nothing of d'etre, but there was still a steady demand for certifi- being physician to the City of London Chest Hos- cates from overseas graduates. Liverpool was one of pital and general surgeon to the London and Metro- the few centres continuing to provide any form of politan Hospitals. postgraduate training in venereology, and the Univer- Venereology as a specialty in its own right was a sity of Liverpool continued to grant certificates in copyright. much later development and occurred only in the venereology up to 1967. present century. The starting point was the report This then was the position 2 years ago, when it was of the Royal Commission in 1916 which recommended decided to approach the Faculty of Medicine of the the establishment of a nationwide network of local University of Liverpool with a proposal for an in- authority clinics for the free treatment of venereal tensive full-time course leading to a Diploma in disease. The appointment of full-time physicians to Venereology. Liverpool is a great port with an take charge of the larger clinics in the 1920s meant abundance of clinical material and a long tradition of http://sti.bmj.com/ that for the first time a doctor who wished to specia- postgraduate teaching. The importance of post- lize in venereology could earn a living without the graduate training, the attraction of a Diploma, and need to combine his work with some other specialty the absence of anything comparable elsewhere, were such as dermatology. The same decade also wit- all put forward to the Medical Faculty, and although nessed the foundation of the Medical Society for the objections and opposition were expected, the pro- Study of Venereal Diseases and the British Journal of posals were enthusiastically received by both the Venereal Diseases. Faculty of Medicine and the Senate. In 1967 the on September 24, 2021 by guest. Protected It was, however, the establishment of the National University of Liverpool became the first University Health Service in 1948 that resulted in the complete in Great Britain and, we believe, in Europe, to offer a emancipation of venereology and its final divorce Course and to award a Diploma in Venereology. from any other specialty. From the beginning Two full-time courses lasting for 3 months are venereology was recognized as a separate discipline held each year commencing in January and April, and venereologists were accorded the same rights, re- examinations being held in March and June. The sponsibilities, and privileges as consultants in other regulations provide that, before admission to the branches of medicine, and equally (if not more) im- Diploma examination, candidates shall be required to portant the same salary scale. attend approved courses of instruction in the Univer- In the 1920s most of those appointed to work in sity in the following subjects: Anatomy and Physi- the new clinics had gained experience in venereology ology; Pathology; Bacteriology; Serology; Clinical in the Armed Services during the first world war. By Venereology; Pharmacology and Therapeutics; Vital the end of the decade this source of supply began to Statistics and Epidemiology. dry up and there was a growing shortage of doctors The course is limited to a maximum of sixteen with experience in venereology to staff the two hun- students, and for purposes of clinical instruction they dred or so clinics throughout the country. In an are divided into four groups which rotate every 3 attempt to remedy this situation and to improve weeks. Each day the students attend in groups of standards, an Act of 1930 made some provision for three or four for clinical instruction, and they also A diploma in venereology 163 Br J Vener Dis: first published as 10.1136/sti.46.2.162 on 1 April 1970. Downloaded from are given the opportunity to gain experience in the final pass list. Successful candidates are entitled to simpler laboratory techniques, such as the staining use the qualification Dip. Ven. and examination of smears for gonococci and dark- The failure rate has varied between 10 and 30 per ground examination for Treponema pallidum. As cent. Candidates who fail the examination may sit their experience increases they are encouraged to again on payment of the appropriate fee without examine and write up cases themselves under the attending further lectures. supervision of the consultant in charge. From time Judged by the first 2 years' experience, the courses to time patients showing features of special interest can be regarded as extremely successful, and those are asked to attend for demonstration and discussion. to be held in 1970 are fully booked. Students have Twenty beds are available and regular ward rounds come from many parts of the world, including India, are conducted by the consultants in charge. Iraq, Jordan, Kenya, Libya, Nigeria, Pakistan, Singa- Systematic instruction in the principles and pore, and Thailand, as well as from Germany and practice of venereology is imparted by a series of the United Kingdom. Candidates need not have had twice weekly lectures throughout the 12 weeks' previous experience in venereology but a working course. An extensive collection of colour trans- knowledge of English is essential parencies is available to illustrate these lectures. It is not claimed that the course turns a tyro into a Instruction is not limited to clinical and systematic consultant venereologist in 3 months, but it provides venereology. The students are constantly reminded a sound basic training in the specialty of a kind not of the relationship between venereology and other previously attempted. Those who receive their branches of medicine, and in the earlier part of the "bit of paper" after their 3 months' hard labour course they attend lectures on anatomy and physi- have earned it, but there is no substitute for ology, bacteriology, serology, pathology, and pharma- experience. cology, which are tailored to their requirements and THE UNIVERSITY OF LIVERPOOL copyright. delivered by members ofthe appropriate departments. Diploma in Venereology During the same period groups of students visit the PAPER I laboratories for lecture demonstrations in both March 1969: THREE hours bacteriology and serology. Later in the course the Answer all questions students attend lectures on those clinical sub- 1. Discuss the differential diagnosis of ulceration of the jects most closely related to venereology-derma- penis. 2. tology, gynaecology, ophthalmology, and cardiology. How would you investigate a complaint of vaginal http://sti.bmj.com/ Clinical instruction in both dermatology and gynae- discharge in a young married woman? cology is also given in the hospital out-patient depart- 3. Describe the clinical features of Gonococcal Proctitis. ments. Discuss its diagnosis and treatment. 4. Write notes on the following: Instruction continues without a break for 12 weeks (a) Charcot joints and the examination, which takes place in the final (b) Gonococcal ophthalmia week of the course, consists of two 3-hour papers (c) Pediculosis pubis followed later in the week by a viva voce examination. (d) The treatment of vulval warts. on September 24, 2021 by guest. Protected Each paper consists offive questions all of which have 5. Describe the clinical features of Lymphogranuloma to be answered by the candidate. The pass mark is Venereum in the male. Discuss briefly both diagnosis and 50 per cent.: there are no grades. The first paper is treatment. devoted to clinical and systematic venereology, and PAPER II as March 1969 : THREE hours the second, generally regarded by the students the Answer all questions more difficult, is more theoretical and is designed to 1. Describe the pathological changes which occur in the test background knowledge of such subjects as brain and its coverings in Dementia Paralytica (G.P.I.). anatomy, pathology, bacteriology, serology, and What changes may be found in the C.S.F. in this con. pharmacology. Specimen papers are appended. dition? The oral examination is conducted by three ex- 2. Describe the lymphatic drainage of the external geni. aminers from the University of Liverpool, and one talia in the female, and its relationship to the clinical from another University. Each candidate spends 10 manifestations of venereal disease. minutes with each of two pairs of examiners. There 3. Discuss the cultural requirements of N. gonorrhoeae but and how it may be differentiated from other Neisseria. is no "clinical" examination, candidates may be 4. Discuss the role of the corticosteroids in venereology. shown pathological specimens, x-rays, and micro- What side effects may follow their prolonged use? scopic specimens, which they will be asked to identify 5. Define (a) sensitivity; (b) specificity, as applied to and discuss.