58
Journal of the Royal Society of Medicine Volume 84 January 1991
5 Nordqvist P, Dhuner K-G, Stenberg K, Orndahl G. Myxoedema coma and CO2-retention. Acta Med Scand 1960;166:189-94 6 Zwillich CW, Pierson DJ, Hofeldt FD, Lufkin EG, Weil JV. Ventilatory control in myxedema and hypothyroidism. N Engl J Med 1975;292:662-5 7 Norton PG, Dunn EV. Snoring as a risk factor for disease: an epidemiological survey. BMJ 1985;291:630-2 8 Gledhill RF. Snoring as the presenting feature of hypothyroidism. Postgrad Med J 1990;66:788-9
Osler's robes I am loathe to question the accuracy of Professor Charles Fletcher (May 1990 JRSM, p 342), that master of communication, but he is probably more familiar with the academic habits of the 'other place'. The robes that Osler bought in 1904 were those of a doctor of philosophy (DPhil) which would be conferred honoris causa during the annual BMA meeting. This degree was also conferred honoris causa on Sir Walter Fletcher during Viscount Cave's 1926 Encaenia. The Oxford University has never conferred a PhD degree. Osler attended the All Soul's luncheon but not the Vice Chancellor's reception, so he would only have worn the robes for about three hours, unless as fancy dress, like the shirt dance in his Christ Church surplice. As Regius Professor of Medicine the degree of Doctor of Medicine (DM) was conferred upon him by Decree and as a resident doctor he required three styles of academic dress for different formal occasions. The full dress scarlet robe, the scarlet cloak or convocation habit and the undressed black gown. It is believed that the late Dr F G Hobson's DM robes which are still in Oxford originally belonged to Sir Henry Acland and from him passed on to Sir William Osler. As Dr Fletcher recalls Osler's DPhii robes were cobbled at the request of Lord Brain, into those of a DM, substituting scarlet silk sleeves and facings for the neutral grey silk of the DPhil robe. As I understand it, Dr Fletcher with the agreement of Dr Brain gave this garment to the Governing Body of Green College, so that it could be available for any Oxford DM member of the College attending a ceremony when full dress robes were required. Instead it is in a glass case in the hall of 13 Norham Gardens, like a relic of a saint and with the same degree of authenticity. In the posthumous portrait of Sir William Osler, painted by Mr Kenneth Tryon, for the people of Dundas, Ontario, now in their Town Hall, it was this DM robe that he painted. The people of Dundas are rightly proud of Sir William Osler and it would be pleasant if Dr Fletcher, supported by Dr Brain, could persuade Green College to give these robes to the people ofDundas. They could actually see and possibly touch an academic garment that had once belonged to their most distinguished son. The DM robes formerly belonging to Dr F G Hobson and believed to have been owned by Sir William Osler, might then be bequeathed either to the Friends of 13 Norham Gardens or the Lady Osler Trustees. A H T ROBB-SMITH
Chaucers House, Woodstock, Oxfordshire OX7 lSP
Immunology of the tonsils Your correspondents Soothill and Donovan (July 1990 JRSM, p 478) may be interested in the following. In the 1950s and 1960s medical opinion in Rhodesia generally accepted that the reason for so few African tonsillectomies was that African children were not prone to tonsillitis. In a country where Europeans and Africans were attended separately this was not hard to confirm, but the reason for it was elusive. As a general practitioner unskilled in research methods' I looked for help to confirm my preliminary conclusion that "cow milk, which African children did not have, induced tonsillitis. This was rejected as absurd. My first introduction to a possible food allergy led to prophylactic management with antihistamine for recurrent tonsillitis in European children. The frequency between antibiotic requirement did seem to decrease. In 1967, by joining Rhodesia Railways, I had access to about 5000 medical records at Salisbury (now Harari). These were filed in families and for tonsillitis or tonsillectomy there was a distinctly familial trend. An incidental observation was an apparent association in these families with coronary artery disease. A deficiency of copies of ECG reports prevented follow-up. I found no help when I returned to UK in 1969 until I met Dr David Freed, MD, lecturer in Immunology in Manchester'. He introduced me to Dr Thornton Crouch, who, in South Africa, had come to similar conclusions, including both tonsillitis and coronary artery disease2. Coleford Allergy Clinic A H HODSON The Marshes, Coleford Gloucestershire GL16 8BD
References 1 Freed DLJ. Health hazards of milk. London: Bailliere
Tindal, 1983 2 Austin C. The cow and the coronary. New York: IExposition Press, 1979
Three dimensional thallium-technetium scans We read with interest the paper by Jenkins et al. on scans and surgery for primary hyperparathyroidism (July 1990 JRSM, p427). It suggests that this use of scintigraphy has proved of benefit to both the surgeon and the patient by reducing unnecessary dissection,.resulting in a substantial decrease in operating times, which may justify its routine use in the elderly population prior to surgery. The results do not mention a decrease in total operating time, merely a decrease in the time taken to find and remove the abnormal parathyroid gland initially. As the authors still attempt to identify all parathyroid glands, how does the ability to identify the abnormal gland early in the dissection, result in less dissection and a faster operating time? The results are not from a randomized comparison but from those patients who had routine preoperative scintigraphy over a 24-month period when compared to the parathyroid exploration results for the previous 12 months in patients who did not have preoperative scintigraphy. Several factors
Journal of the Royal Society of Medicine Volume 84 January 1991
5 Nordqvist P, Dhuner K-G, Stenberg K, Orndahl G. Myxoedema coma and CO2-retention. Acta Med Scand 1960;166:189-94 6 Zwillich CW, Pierson DJ, Hofeldt FD, Lufkin EG, Weil JV. Ventilatory control in myxedema and hypothyroidism. N Engl J Med 1975;292:662-5 7 Norton PG, Dunn EV. Snoring as a risk factor for disease: an epidemiological survey. BMJ 1985;291:630-2 8 Gledhill RF. Snoring as the presenting feature of hypothyroidism. Postgrad Med J 1990;66:788-9
Osler's robes I am loathe to question the accuracy of Professor Charles Fletcher (May 1990 JRSM, p 342), that master of communication, but he is probably more familiar with the academic habits of the 'other place'. The robes that Osler bought in 1904 were those of a doctor of philosophy (DPhil) which would be conferred honoris causa during the annual BMA meeting. This degree was also conferred honoris causa on Sir Walter Fletcher during Viscount Cave's 1926 Encaenia. The Oxford University has never conferred a PhD degree. Osler attended the All Soul's luncheon but not the Vice Chancellor's reception, so he would only have worn the robes for about three hours, unless as fancy dress, like the shirt dance in his Christ Church surplice. As Regius Professor of Medicine the degree of Doctor of Medicine (DM) was conferred upon him by Decree and as a resident doctor he required three styles of academic dress for different formal occasions. The full dress scarlet robe, the scarlet cloak or convocation habit and the undressed black gown. It is believed that the late Dr F G Hobson's DM robes which are still in Oxford originally belonged to Sir Henry Acland and from him passed on to Sir William Osler. As Dr Fletcher recalls Osler's DPhii robes were cobbled at the request of Lord Brain, into those of a DM, substituting scarlet silk sleeves and facings for the neutral grey silk of the DPhil robe. As I understand it, Dr Fletcher with the agreement of Dr Brain gave this garment to the Governing Body of Green College, so that it could be available for any Oxford DM member of the College attending a ceremony when full dress robes were required. Instead it is in a glass case in the hall of 13 Norham Gardens, like a relic of a saint and with the same degree of authenticity. In the posthumous portrait of Sir William Osler, painted by Mr Kenneth Tryon, for the people of Dundas, Ontario, now in their Town Hall, it was this DM robe that he painted. The people of Dundas are rightly proud of Sir William Osler and it would be pleasant if Dr Fletcher, supported by Dr Brain, could persuade Green College to give these robes to the people ofDundas. They could actually see and possibly touch an academic garment that had once belonged to their most distinguished son. The DM robes formerly belonging to Dr F G Hobson and believed to have been owned by Sir William Osler, might then be bequeathed either to the Friends of 13 Norham Gardens or the Lady Osler Trustees. A H T ROBB-SMITH
Chaucers House, Woodstock, Oxfordshire OX7 lSP
Immunology of the tonsils Your correspondents Soothill and Donovan (July 1990 JRSM, p 478) may be interested in the following. In the 1950s and 1960s medical opinion in Rhodesia generally accepted that the reason for so few African tonsillectomies was that African children were not prone to tonsillitis. In a country where Europeans and Africans were attended separately this was not hard to confirm, but the reason for it was elusive. As a general practitioner unskilled in research methods' I looked for help to confirm my preliminary conclusion that "cow milk, which African children did not have, induced tonsillitis. This was rejected as absurd. My first introduction to a possible food allergy led to prophylactic management with antihistamine for recurrent tonsillitis in European children. The frequency between antibiotic requirement did seem to decrease. In 1967, by joining Rhodesia Railways, I had access to about 5000 medical records at Salisbury (now Harari). These were filed in families and for tonsillitis or tonsillectomy there was a distinctly familial trend. An incidental observation was an apparent association in these families with coronary artery disease. A deficiency of copies of ECG reports prevented follow-up. I found no help when I returned to UK in 1969 until I met Dr David Freed, MD, lecturer in Immunology in Manchester'. He introduced me to Dr Thornton Crouch, who, in South Africa, had come to similar conclusions, including both tonsillitis and coronary artery disease2. Coleford Allergy Clinic A H HODSON The Marshes, Coleford Gloucestershire GL16 8BD
References 1 Freed DLJ. Health hazards of milk. London: Bailliere
Tindal, 1983 2 Austin C. The cow and the coronary. New York: IExposition Press, 1979
Three dimensional thallium-technetium scans We read with interest the paper by Jenkins et al. on scans and surgery for primary hyperparathyroidism (July 1990 JRSM, p427). It suggests that this use of scintigraphy has proved of benefit to both the surgeon and the patient by reducing unnecessary dissection,.resulting in a substantial decrease in operating times, which may justify its routine use in the elderly population prior to surgery. The results do not mention a decrease in total operating time, merely a decrease in the time taken to find and remove the abnormal parathyroid gland initially. As the authors still attempt to identify all parathyroid glands, how does the ability to identify the abnormal gland early in the dissection, result in less dissection and a faster operating time? The results are not from a randomized comparison but from those patients who had routine preoperative scintigraphy over a 24-month period when compared to the parathyroid exploration results for the previous 12 months in patients who did not have preoperative scintigraphy. Several factors
