34

some 2000 in mental-deficiency institutions have beensterilised ; this is not done for eugenic reasons, but

simply to make it possible for them to live in societywithout being a burden to themselves or others. Boththese processes have logical justification. Whether theyare morally or socially justifiable is another matter,on which I do not feel competent to pronounce.

CONCLUSIONS

Putting aside the questions of sterilisation and castra-tion, I fee] that Herstedvester is the most brilliant answerto the problem of human wickedness which has yet beendevised. To take the scum of the prison populationand to cure half of them is something I had regarded asimpossible. As Dr. Sturup says, it is not a matter of

making criminal psychopaths into normal people, butof making them into nice psychopaths who are capableof adapting themselves to ordinary life.

Herstedvester is something I believe we should copy.But it is wrong to expect the courts to diagnose psycho-pathy. The proper place for diagnosis is in the prisonpsychiatric clinic. But once transfer to the psycho-pathic prison takes place, -the sentence should becomeindeterminate, for the possibilites of cure are entirelydependent on the prisoner having to work his passage.The conversion of an absolute to an indeterminatesentence is a serious matter, and it must be rememberedit is as much for the good of society as for the prisoner;certification should perhaps therefore be done by a

High Court judge, with the full criminal and medicalevidence before him.The old conception of the criminal lunatic is one we

ought to get rid of at the earliest possible moment. Any-one charged with a crime who is in fact suffering from apsychosis should not be sentenced but certified andtreated in an ordinary mental hospital. Criminal psycho-paths should be sentenced in the ordinary way, diagnosedin prison, after careful and if necessary prolongedobservation, and then transferred to a psychopathicprison on an indeterminate sentence, there to remainuntil (if ever) they are fit to return to society. Wemust face the fact that, with our present knowledge,a certain proportion of criminal psychopaths are com-pletely incurable ; for the benefit of society, they mustbe segregated indefinitely. But if it is possible toreclaim and convert into useful citizens something likehalf of the worst recidivists-and Herstedvester shows

that it is-then it is our plain duty to get on with thejob as quickly as possible.

Valuable though the work of criminal reclaiming is,the social significance of Herstedvester is much more

profound. For here we have the first successful attemptat the scientific treatment of human wickedness. Out-

patient psychiatric treatment of the really viciouscriminal is almost always a failure, since the will toreform is as a rule completely absent. In Herstedvester,i is possible to develop the will to reform, since it is theonly route of return to the outside world. Above all,in such a place, the codification of scientific knowledgeabout psychopathy can begin. Acquaintance betweenthe psychopath and the psychiatrist has in the pastoften been nodding only. For the psychopath spurnsthe doctor, and seldom gets into the mental hospital.In those psychopaths whom society has decided mustbe withdrawn from circulation, we have a clinical poolin which we shall certainly catch fish with jewels in theirmouths.

REFERENCES

Stürup, G. K., et al. (1948) Danish Psychiatry. Lectures tothe Danish Society of Psychiatry. Copenhagen : SchønbergskeForlag.

Stürup, G. K. Treatment of Criminal Psychopaths. Report on theEighth Congress of Scandinavian Psychiatrists.

Wulff, H., Sand, K. (1945) Acta chir. scand. 92, 470.

HOW TO APPLY FOR MEDICAL POSTS

No amount of good advice can increase the numberof successful candidates for medical posts, because thereis only a limited number of jobs. Nevertheless, there aremany unsuccessful applicants who feel frustrated becausethey do not feel they have made the best of their attempts,and those starting to apply for jobs are often uncertainof the best way of making their applications or conductingtheir interview. It is to these people that this article isaddressed. The greater the efficiency of applications andinterviews the more likely is it that the most suitablecandidate will be elected. The advice given here appliesin the main to posts at outside hospitals, for the juniorappointments at teaching hospitals are made by staffwho know the candidate already.The three stages in obtaining an appointment are :

(1) choosing a likely post, (2) composing a suitable

application, and (3) interviewing the appointmentscommittee.

THE CHOICE

The candidate is wise to ponder carefully over theadvertisements in the medical press and restrict hischoice to a few carefully selected posts. Do not apply forjobs you don’t want, because candidates who turn up forinterview and then decide they do not want the postare causing unnecessary work for appointments com-mittees. Do not apply for a post " just to have a crackat it " when you have hardly any chance of success-it has a demoralising effect on a candidate to be turneddown frequently. Choose a job that you really want andthat you feel adequately equipped to perform.

It is a good idea to try and find out a little more abouta post before you apply. You may have friends whohave worked at the hospital concerned or known thechief with whom you will work ; from them you may gethelpful inside information. With a senior post it is

quite justifiable to try and arrange a visit to thehospital and so meet the people you would work withand see the conditions and equipment of the department.Because of the " no canvassing " clause in advertise-ments many people are afraid to go near the hospitalbefore the interview, though it is a perfectly reasonablething to do.

THE APPLICATIONTHE APPLICATION .

It is worth taking a lot of trouble to set out theapplication systematically, and to have it neatly typedand attractively presented. Remember that short listsare made from a large number of applications, and ifgood points are poorly presented they may easily beoverlooked. Further, a slovenly application may givean impression of a slovenly applicant. Therefore thesmall expense of good paper and professional typing isworth while. Fresh typing looks much better thancarbon copies or cyclostyled printing, and avoids givingthe impression that the candidate is always applyingfor jobs. Here is an example of a systematic arrangementof a candidate’s particulars.The first page thus :

35

The second page thus :Sir,I have the honour to apply for the post of registrar to the

cardiological department at St. Job’s. My particulars are asfollows :JVcttM John Edward Smith.-4ge: 30.Nationality : English.place and Date of Berth London. June 1, 1918.Early E<!M<xtM<Mt.’ :

St. Quinidine’s School and Galen’s College, Oxbridge.Medical School :

St. Richard’s Hospital.State: :

Married, with one child.Academic Qualifications : :

B.Sc. lst class honours.......... 1941M.A., Oxbridge ............ 1941L.R.C.P., M.R.C.S., England 1942M.R.C.P., England .......... 1945M.D., Oxbridge ............ 1946

Academic Distinctimas :The Darwin Biology Prize (St. Quinidine’s) ... 1936Entrance Scholarship, Galen’s C011ege, Oxbridge .. 1937The Osler Medal for Clinical Medicine.. 1940

appointments at St. Richard’s Hospital :Clinical assistant to surgical outpatients 1942Demonstrator; pathological department .... 1942House-physician to Sir Bernard Bronchus.... 1943Junior registrar to cardiological department.... 1944

Military Sen’&Icirc;ce: :1945-46 R.M.O. to The Marylebone Highlanders.1946-48 Graded specialist attached to 693 General Hospital.Demobilised 1948 with rank of major.

Other Experience : :Teaching.-I was demonstrator in anatomy for six months,

Oxbridge, 1941. I have two years’ experience of teaching andlecturing in elementary cardiology, 1944 and 1945.

Tropical Disffl8eB.-I had considerable experience of tropicaldiseases in Burma and North Africa during my army service.

LaMtrtMtes.&mdash;I speak fluent Spanish and have a working knowledgeof French.Learned Societies :

Fellow of the Royal Society of Medicine (memberof the cardiological section) ...... 1945

Member of the British Medical Association.... 1942Secretary to St. Richard’s Medical Society.... 1943-44

Publications : -

A Case of Struve’s Disease. St. Richard’s Hospital Journal, 1943.Genetic Studies in Heart Diseases. Journal of Cardiac Genetics,

1947.Prolonged Circulation Time in Albinos. Pl’Oceedings of the

211ackeneie Society, 1948.Referees :

Sir Bernard Bronchus, o.B.E., F.R.C.P., senior physician, St.Richard’s Hospital.

Victor Valve, Esq., M.D., The Coronary Club, Heart Street, W.1.

With more senior posts a covering letter is oftenwritten, or the introduction on the second page is

expanded to describe any reasons why the applicantfeels he is specially suitable for the post. Many foreigndoctors enclose with their application a long, boring,and irrclevant life-story including all their hardships andinjustices. This cuts no ice.

TestimonialsIn this example referees have been given, and

therefore no testimonials are enclosed with the applica-tion. This practice is increasing steadily, and there isno doubt it is much more satisfactory than the oldtestimonial system. ,

The orthodox testimonial with its standardised phrasesabout " loyal and agreeable colleague and " consci-entiously recommend him for any post usually carrieslittle weight even if signed by a well-known name. Thereason is that when a junior doctor asks his chief for atestimonial he expects as a natural right a glut of super-latives, and nearly always he gets it. A few men try towrite honest testimonials, but it is very hard to write ajust and true opinion of a doctor if that opinion is to behanded to the subject himself. Consequently, a conven-tion has developed that every testimonial must be loadedwith praise whatever the merits of its owner. Testi-monials for that reason have become increasingly insin-cere and stereotyped and are treated with increasingdisregard. Referees, on the other hand, can be writtento and asked for a confidential report on a man, andtheir statements are much more revealing. If theadvertisement for a post requires testimonials and/orreferees, the candidate is wise to choose referees whetheror not he sends testimonials as well. Before a candidate

chooses a person as a referee he should obtain his

permission to use his name for that purpose.THE INTERVIEW

First, clothes. No committee consciously takes muchnotice of clothes, but it is advisable to look reasonablyneat and clean and not to convey an impression oicasualness-it cannot do harm to take a little trouble,and it may do good. Nevertheless don’t " dress up,"putting on clothes you never wear normally-a man whoonly wears a hard collar for interviews looks stiff andstarched, and ill at ease, like a confirmation candidate ora choirboy. ’

Secondly, be natural. A candidate who tries to "

putover " a planned impression reeks of insincerity. Do nottry to think during each answer exactly what impressionit will make. If somebody is obviously trying to becharming or to be confident, it is astonishing howunattractive he is. Your own natural self is almost

always more attractive than the. self you think thecommittee want you to be.

Don’t be on your guard. Those interviewing you wantto find out how good you are, not how bad you are. Theywant to get you talking naturally and often find it hardto start the ball rolling. (Some of those interviewingyou ask questions merely to show the other members ofthe committee that they are awake or that they havesome special bit of knowledge ; so do not look resentfulif an occasional rather silly question is asked.)Some common openings are : " Tell us briefly about

your previous experience and education." " Are youinterested in any special branch of medicine or surgery "" What plans have you got for the future and whatposition do you finally hope to reach ? " " What makesyou feel that you are a suitable person to fill this post "The answers to these questions are often already in

front of the board on the copies of the candidate’ appli-cation, but the board may wish to refresh their memoriesand usually find the spoken word gives a clearer impres-sion than the written word. It is therefore unwise fora candidate to say " I think you already have thosedetails in front of you." Before the interview it issensible for a candidate to become clear in his own. mindwhat his interests, ambitions, and capabilities are, sothat he can answer the above-mentioned questions. Itis unwise to prepare a set speech for an answer, becausea prepared reply has a lack of spontaneity which makes itmuch less compelling than extempore speech.When speaking at the interview, do not look at the

floor or the ceiling, but look one of your interrogatorsstraight in the eye. It is hard for a shy candidate to dothis, but he must-manage it somehow. It is often difficultto decide which particular member of the interviewing -*

committee to look at. The following suggestions may behelpful. When in doubt address yourself to the chairman ‘In general look at the person who asked you the question,but if you feel you have focused on one individual toolong, turn to the chairman or to the member who seemsmost interested in what you are saying. If you have hada preliminary interview with a medical selection com-mittee, when you have a second interview with the laycommittee address yourself to the lay members of thatcommittee, and avoid unduly technical expressions.Many candidates make a bad impression at an interviewbecause they look unfriendly ; in fact they look cross,suspicious, or aggressive. This may be their way ofconcealing either shyness or nervousness, but committeesinterpret it sometimes as’ meaning that the man will beabrupt or intimidating to patients. Hence, be friendlywith committees and don’t look at them as one looksat an opponent in the boxing-ring.While you are waiting outside with other applicants

for the post, passing those interminable cigarette-smoking moments before you are called, do not discuss

36

the post and the impending interview with the othercandidates. It will only increase your apprehension andprobably convince you that all the others are better thanyourself. It is better to be silent or to chatter nervouslyabout general topics.

’

Lastly, remember that the average committee is a gooddeal more discerning than you think. There are storiesof incompetent candidates bluffing their way into highpositions, but they are mostly untrue. Inarticulate and

inadequate as a candidate’s behaviour at an interviewmay be, the committee will probably make due allowancefor it and form a shrewd idea of the personality andpotentialities that lie in the background. PROTEUS.

Disabilities

. 20. CORONARY THROMBOSISIT was on a grey, dull, Sunday morning at 7.30, three

years ago, that it hit me ; and hitting is riot a bad

description. I was 48, and in the last twenty years Ihad not had a single day in bed. Two months before,I had woken early in the morning with pain in the frontof the chest, behind the second and third costal cartilages ;it lasted about ten minutes. This was something newto me and I consulted one of my local colleagues, avery good doctor. The result of an exhaustive overhaulwas completely negative: " Can’t find a thing thematter, old boy ; probably some indigestion ; ;’ cutdown the smoking," and so on.

In the last five years my job as a G.P. surgeon had notbeen too easy : the house had a direct hit; the familywere evacuated five hundred miles away ; the practicehad just vanished ; and there were lots of worries,financial and domestic. Still, between periods of beingfrightened to death or bored stiff I had a happy enoughtime ; a long operating session on the ghastly bomb orshell injuries would be followed by a day with the HomeGuard, tearing over the downs and initiating them inthe use of the Vickers machine-gun. Just my privatearmy. What fun it was and what an antidote.To revert to that Sunday morning: the pain was severe,

. very, centring on the middle of the chest over the secondand third costal cartilages ; it did not radiate downthe arms. It was a gnawing, screwing pain-as if some-one was applying a vice behind the sternum ; and it

gradually got worse. I was alone ; my general factotumhad not yet arrived. I got out of bed and walked

up and down, but it was no use ; any drugs were down-stairs and I could not, or would not, go and get them."Besides," I thought, " can do nothing": and as

I had never taken anything except aspirin and alkalisifl my life and was going to die in any case, why bother ? ‘But I wished it would hurry up ; "and why shouldI go out this way when I missed the bombs and shellsin this war and got away with the Salient and theSomme in the last one " All these thoughts passedthrough my mind. I hugged the side of the bed, andthen I must have passed out, for the next thing Iremember was seeing my old factotum with the morningtea. She took one look and grabbed the telephone.My partner arrived and pushed some morphine intome, a big dose. I had never had morphine beforewhat a joy and relief ! In the meantime I had sweatedright through a large woollen dressing-gown.

Afterwards I had a vague notion of being trundleddown into an ambulance in a canvas carrying stretcher.That evening the nearest consultant, first-class at his

job, arrived from twenty miles away and gave the

gravest prognosis to my partner : " he will probablybe dead by the morning." (I have no doubt that at thetime he was perfectly justifies ; but since then he andI have often laughed about it.) I gathered later that mypulse was all over the place, with a systolic blood-pressurewell under 80, and terrific left-ventricle dilation, the

apex-beat being somewhere near the backbone. Butall the pain had gone and I was comfortable. I had more

morphine again that night, for which I was very grateful.The next day a very distinguished general consulting

physician arrived from London (thank God there arestill some left) ; and quite properly, I think, he also tooka grave view. I was in no pain but had the most frightfulflatulence-fore and aft, chiefly fore. I was nursed

sitting up and watched my epigastrium fluttering withsickening cardiac irregularities. Another annoyancewas my tongue ; it was red and clean from tip to base,but very sore. The pulse was still nobody’s -business,and an electrocardiogram done that day indicated a largeblock in the left coronary artery. My memory of the firstweek is rather vague ; I was having morphine andhypnotics at night and digitaline gr. 1/so" three times aday. The days passed in a dreamy haze broken only bythe confounded flatulence. After using the bedpan twiceI flatly refused to have anything more to do with itand insisted on being lifted out and assisted to thecommode. This created an uproar, as strict ordershad been given that I was not to be moved at all for atleast a month. " Well," I said, " if I am going to dieI am going to die on the commode and be damned toeveryone ; don’t tell me that there is less cardiac strainon the bedpan-it just isn’t true." I got my own wayand still lived. One other annoying thing : I had to becatheterised several times because I simply could noturinate lying down. It took me a week to learn thetrick, and I advise everyone over 50 to practise it.

I was seven weeks in bed and have nothing but praisefor my nurses. It didn’t take long to find that the artof nursing is simply knowing how to nurse, not adoptingthe attitude of a half-qualified doctor. It was the little

things that mattered, and in these I was highly served.My appetite was poor but that did not worry me, andI started to smoke cigarettes after the first three weeks.Extrasystoles were a nuisance, and I took rather a

morbid interest in the slow rise of my systolic blood-pressure, which gradually crept up to over the 100 mark.I read all the literature of coronary thrombosis I could

lay my hands on, from Tom Lewis downwards, and wasneither enlightened nor amused. " Heavens," I said, " weknow nothing about it apart from post-mortem appear-ances," and so I turned to P. G. Wodehouse. I got up inthe eighth week and went out convalescent in the ninth.

One’s mental outlook at this stage seemed completelyto overshadow the physical disability. All the gloomy,prognostications came to my mind : " Oh yes, oldSo-and-So had a c.T., you know. He’s finished for

keeps-such a pity. He was doing first-class work andwas just on the top of the wave, and now he’s retiredto an old lighthouse and just does some quiet prawning,"or " he’s gone to the Ministry of Pensions." Multiplysuch statements by ten and that is how one felt.

I found there were three physical disabilities-insomnia,flatulence, and inability to walk any distance withoutpain in the legs. The first two could be coped with, butthe cramp in the calves was an infernal nuisance. Itwas not a claudication ; the pain was centred over thetubercle of the scaphoid of both feet. I simply could notmake it out, for my muscles were quite well developed.Curiously enough I had no dyspnaea and no precordialpain, and my extrasystoles had gone ; but the pain inthe feet and calves went on. I drove the car 200 milesat a sitting without any effort, but as soon as I got outand set my feet to the ground it all started again. Thiswent on for two months without a let-up. I was gettingquite worried about it when suddenly on getting out ofbed one morning it vanished and has never come backagain. That just made all the difference and my remain-ing month of convalescence was straightforward. Duringthese months I took no drugs except -occasionallya mild hypnotic. I carried a ’Tubonic’ ampoule of