junior consultants in the e.m.s

1341

His mother was a woman of 50. Her left

temporal muscle was definitely wasted, and the rightone was suspicious of wasting. The orbiculares oculiseemed to be somewhat weak and she was unableto blow out her cheeks. The sternomastoids as wellas other neck muscles and all forearm muscles werepoorly developed. There was slight but definite wast-ing in the lateral part of both thenar eminences, asconfirmed by Dr. Bailey. Five of her brothers andsisters had died. One was abroad. Five of her brothersand sisters, living in this country, were examined andall showed symptoms suspicious of dystrophiamyotonica.I also examined the mother, 85 years of age. Her

left thenar eminence was definitely wasted; the rightone was somewhat flat.From these examinations of the patient and his

relatives I think the diagnosis of dystrophia myotoniais justifiable. In 1939, however, Dr. A. S. Patersonand I published a paper on the identity of myotoniacongenita (Thomsen’s disease), dystrophia myotonica(myotonia atrophica) and paramyotonia (Brain, 1939,62, 198). We maintained that a distinction betweenthese three affections was not justified, and we sug-gested for all three the common name myotonia con-genita or Thomsen’s disease. In this sense I agreewith the diagnosis myotonia congenita for the case inwhich Guttman and Stokes observed good results withquinine therapy.

I am, Sir, yours faithfully,OTTO MAAS.

JUNIOR CONSULTANTS IN THE E.M.S.

SiR,-I should like strongly to protest at the treat-ment the junior consultants have received at thehands of the Ministry of Health. I have not done sobefore because I had hopes that this would be cor-rected, but as the ministry has taken about three weeksto reply to my numerous letters I have only nowlearnt that any more considerate attitude on theirpart is a forlorn hope.There are many others in the same boat and my own

case is, I think, typical. I have the M.D., the M.R.C.P.and the D.P.M. (all of London), I have spent five orsix years doing hospital work in psychiatry and duringthe last five years have practised it as a consultant.I am physician in charge of a department at onehospital of nearly 300 beds, assistant physician toanother and chief assistant to a teaching hospital.Having written some fifteen papers and two books onmy own subject and contributed to others I can claimto be a specialist in it. This would appear to be theopinion of the Ministry of Health, which sent me aform under the E.M.S. as a "Psychiatrist," but at asalary of f550 per annum. At that time, wheneveryone was expecting an air-raid on London at anymoment, I abandoned my practice and went as soonas I was called, but I pointed out to the ministrythat I had been appointed as a specialist-i.e., a

psychiatrist-but was being offered only the remunera-tion of a general practitioner. When a consultantleaves his practice he cannot leave it in some col-league’s hands but must abandon it to its fate,whereas the general practitioner goes on drawingsomething from his practice and does not need theextra remuneration, nor has he the terrific rents of theconsultant. Since the outbreak of war I have beenin constant communication with the ministry (or asconstant as one can be with someone who answers amonth after!) I have had no satisfaction except that"the Minister’s advisers see no reason to alter mystatus." My sector chief, the adviser himself, and

everyone except the ministry have stated that as aconsultant I should have the rank and remunerationof a specialist, but nothing appears to move theministry. In despair I tried the B.M.A., but althoughsympathetic the B.M.A. took nearly as long to answermy letters and was no more successful with theministry than I was. It seems to me that the B.M.A.has, like Frankenstein, created a monster which willdestroy it and unhappily also those who had hoped itwould protect them.Meanwhile, my rentals and insurance are more than

I am earning under the E.M.S. and although thelandlords are taking part payment on account I fearthat some day I shall have to meet the appalling debtI am being forced to accumulate.

I am, Sir, yours faithfully,Harley Street, W.I. A PSYCHIATRIST.

DOSAGE IN RADON THERAPY

SiR,-There is an increasing use of radon in radiumtherapy owing to present conditions. The followingdata may be of use to those who have not hithertobeen accustomed to adjust the length of exposure tothe declining strength of a source. This can be doneas shown in table 1, the assumption being that one

starts with just as much radon (millicuries) as hithertoone used radium (milligrammes). The " time tohalf value " for radon is taken as 3’86 days.

TABLE 1

Period of treatment Period of treatmentwith radium (days) with radon (days)

1 ...... 1.102 ...... 2.493 ...... 4.324 ...... 7.085 ...... 12-805.56 .... Infinite (lifetime)

For those who do not wish to prolong the periodof treatment the alternative is to start with a largernumber of millicuries of radon than one hitherto usedmilligrammes of radium. The data are given intable 2, the second column showing how the milli-grammes must be multiplied in order to give thenumber of millicuries having the dosage equivalencefor any specified period of exposure. With a sourcedeclining in strength, the average strength over anyspell of time can be calculated. Some may find ita useful quantity. Values have been calculated andtabulated in the third column of table 2.

TABLE 2

Period of treat- Mg. to be mul- Average strength (per-ment (days) tiplied by centage of originalstrength)1 .... 1.09 91.52.... 1.19 84-03.... 1.30 77-44.... 1-40 71.35 .... 1.52 66.06.... 1.64 61.17.... 1.76 57.08 .... 1-89 53-09 .... 2.02 49.5

10 .... 2.16 46.3

The reference throughout has been to equivalencein physical doses; it is well known that the biologicaleffect of a strong source acting for a short time isnot necessarily the same as the effect of a weak oneacting for a long time.

I am, Sir, yours faithfully,Barnato Joel Laboratories,

Middlesex Hospital, W.1.SIDNEY RUSS.