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PNEUMOCONIOSIS IN BOILER SCALERS
453 Professional education, is self-education. The medical school must train in method and technique, and provide inspiration. The medical curriculum cannot be encyclopaedic. The particular facts learned, the particular skills acquired, are of less importance than the habit of inquiry, the ability to use the senses, the capacity for well-directed effort. It is futile and impossible for the medical curriculum to lay down sets of facts which all should know. Good students will learn important facts and principles because they continually recur. The medical curriculum cannot aim to produce physicians ready to practise ; it can at best so train students that practical experience, in the first instance as house officers, will in time make and equip them. It is indeed no paradox to assert that, though medicine can be learned, it cannot be taught. The medical school can at most hope to launch students with a momentum that will make them active learners throughout their professional life. Methods of teaching and the medical curriculum must be designed to make this task easier. GEORGE R. W. N. LUNTZ. Guy’s Hospital, London.
SIR,-Crofton and Diggle consider the symptoms observed after sulphaguanidine therapy to be due either to the direct toxicity of sulphaguanidine upon the organ-
or possibly to the original dysentery itself and in your annotation you seem to take the same view. Recent work by Najjar and Holt (J. Amer. med. Ass. 1943, 123, 683) suggests, however, another possibility with regard to the pathogenesis of such confusional states. These workers gave 9 subjects a synthetic diet entirely devoid of thiamine, and found that in the faeces of 4 of the subjects thiamine was still excreted in amounts ranging from 37 to 52 ag. per day. These amounts were reduced to zero within a wt-ek by giving 1-5 g. ofsuccinylsulphathiazole four-hourly; but thiamine reappeared again within a few days of discontinuing the treatment. They interpret these results by assuming biosynthesis of vitamin Bi by the intestinal organisms, and point to the important clinical implication of their findings in
ism,
sulphonamide therapy. It is therefore a possibility that the symptoms reported by Crofton and Diggle were due to an acute thiamine deficiency which was causing a syndrome of the Wernicke type. It is perhaps pertinent to note that Daft, Endicott PNEUMOCONIOSIS IN BOILER SCALERS and others (Proc. Soc. exp. Biol., IV. Y. 1943, 53, 130) have noted vitamin-E deficiency in rats, given succinylsulphaSIR,—In their paper of March 4 Todd and Rice refer thiazole in purified diets. to a previous publication of mine and credit me with a LCC Central Pathological
Laboratory, Epsom.
R. BENESCH.
SULPHONAMIDE-UREA MIXTURES SIR,-In your editorial of Jan. 8 you mention the divergent results obtained by various workers on the properties in vitro of urea-sulphonamide mixtures. We would like to add that the particular organism and set of experimental conditions chosen for the test entirely determine the nature of the results. Using Streptococcus pyogenes, no potentiation was found. In our work with Escherichia coli, the findings depended to a very large extent on the size of the inoculum, the smaller inocula being much more susceptible to the toxic effect of urea or sulphathiazole alone, but all inocula showing a potentiating effect of these substances in combination .(Proc. Soc. exp.Biol., N.Y. 1943, 54,107). The seeming discrepancy is resolved into a difference in experimental conditions, Kirby using small inocula and the -remaining workers large ones. For in-vitro work, small inocula often give misleading indications. The large inocula results with E. coli are well in accord with the clinical data. S. W. LEE. JEANNE A. EPSTEIN. Wallace Laboratories, E. J. FOLEY. New Brunswick, N.J.
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statement I never made. I have not found that these " patients look prematurely old and describe the cough as worse in the morning, ’ and this statement is not contained in my paper. In your annotation in the same issue (p. 317) you say, " referring to my third radiological type, it is not clear whether the diagnosis of fibrosis was made on clinical or on radiological data." It was made, of course, on radio’" logical evidence ; I would not venture to assert on clinical grounds alone that pulmonary fibrosis was present. The annotation continues, ," the relevant illustration shows a great increase in the normal linear markings possibly attributable to opaque dust in the bronchial,tubes." True, there is some increased striation to be seen on this film, but the chief feature is fibrosis ; examination of the original leaves no doubt on this point. Further, these words imply that the " normal linear markings " are caused by the bronchial tubes. Surely it is generally recognised that they are shadows of blood-vessels. How, therefore, can " opaque dust in the bronchial tubes." be responsible for an increase in " the normal linear markings ? " In any event, it is out of keeping with our present knowledge of pathology to attribute the abnormal radiological appearances of a pneumoconiosis to the mere deposition of foreign matter in the bronchial tubes. LASAR DUNNER. Cottingham, Nr. Hull.
THE MEDICAL CURRICULUM
SIR,-I should like
as a South African now to express a of view on the derived to some extent while at a
INSURANCE BENEFITS IN WARTIME
resident
in this country medical point curriculum London school of medicine. This is that medicine must be looked upon as a science, and the severest effort must be made to purify, extend and organise knowledge. If medicine is classified as an art, the practitioner is encouraged to proceed with a clear conscience on superficial or empirical lines ; if, on the other hand, he is acutely conscious of a responsibility to scientific spirit and method, he will almost inevitably endeavour to proceed more systematically in the accumulation of data, the framing of hypotheses, and the checking of results. Medical practice is essentially a matter of observation, inference, verification, generalisation. Though the experienced clinician may achieve a diagnosis so swiftly that he seems to be guided by something called " clinical instinct," we may be sure that the processes actually involved are observation, elimination of the irrelevant, inference-in other words, rapid induction. On the basis of a large experience, he simply selects more discriminatingly and decides more
quickly.
It would be a mistake to try to apply a rigid formula to the medical curriculum. Beyond obvious essentials, medicine can utilise various types of ability and training, and the medical faculties in British medical schools address their instruction to a miscellaneous student body. Schools, however, should aim to be sensible and comradely in discipline, flexible in curriculum, informal in method, and democratic in spirit.
SIR,—This letter is prompted by a desire to make known to medical and dental practitioners what attempts are being made to safeguard insurance benefits in the varying conditions of war at home and overseas. As directors of this society we feel that it is of vital impor-
that members and non-members alike should know of the beneficial concessions which it grants to the professions which it serves. Sickness and accident policies have always excluded claims caused or aggravated by war. This is a very wide clause and so unsatisfactory that this society now looks upon all claims not directly due to enemy action as covered by the ordinary conditions of the policy, while those directly due to enemy action are dealt with by an ance
ex-gratia payment. Ex-gratia payments
are made for incapacity due to enemy action, full benefit being paid for 13 weeks, with reduced benefit for a further 13 weeks and reconsideration thereafter. If the incapacity arises in the United Kingdom benefit begins at once, while if it arises overseas it commences from the date of embarkation for the United Kingdom. Those who hold deferred benefit policies are eligible for the same benefits if incapacity persists at the end of the deferred period, which is deemed to start on embarkation for the United Kingdom if the incapacity arises overseas. Service members at home are paid benefit for all incapacity not due to enemy action. In addition to this, although benefits in prewar times are restricted to the United Kingdom, except for small concessions on the
SIR,-Crofton and Diggle consider the symptoms observed after sulphaguanidine therapy to be due either to the direct toxicity of sulphaguanidine upon the organ-
or possibly to the original dysentery itself and in your annotation you seem to take the same view. Recent work by Najjar and Holt (J. Amer. med. Ass. 1943, 123, 683) suggests, however, another possibility with regard to the pathogenesis of such confusional states. These workers gave 9 subjects a synthetic diet entirely devoid of thiamine, and found that in the faeces of 4 of the subjects thiamine was still excreted in amounts ranging from 37 to 52 ag. per day. These amounts were reduced to zero within a wt-ek by giving 1-5 g. ofsuccinylsulphathiazole four-hourly; but thiamine reappeared again within a few days of discontinuing the treatment. They interpret these results by assuming biosynthesis of vitamin Bi by the intestinal organisms, and point to the important clinical implication of their findings in
ism,
sulphonamide therapy. It is therefore a possibility that the symptoms reported by Crofton and Diggle were due to an acute thiamine deficiency which was causing a syndrome of the Wernicke type. It is perhaps pertinent to note that Daft, Endicott PNEUMOCONIOSIS IN BOILER SCALERS and others (Proc. Soc. exp. Biol., IV. Y. 1943, 53, 130) have noted vitamin-E deficiency in rats, given succinylsulphaSIR,—In their paper of March 4 Todd and Rice refer thiazole in purified diets. to a previous publication of mine and credit me with a LCC Central Pathological
Laboratory, Epsom.
R. BENESCH.
SULPHONAMIDE-UREA MIXTURES SIR,-In your editorial of Jan. 8 you mention the divergent results obtained by various workers on the properties in vitro of urea-sulphonamide mixtures. We would like to add that the particular organism and set of experimental conditions chosen for the test entirely determine the nature of the results. Using Streptococcus pyogenes, no potentiation was found. In our work with Escherichia coli, the findings depended to a very large extent on the size of the inoculum, the smaller inocula being much more susceptible to the toxic effect of urea or sulphathiazole alone, but all inocula showing a potentiating effect of these substances in combination .(Proc. Soc. exp.Biol., N.Y. 1943, 54,107). The seeming discrepancy is resolved into a difference in experimental conditions, Kirby using small inocula and the -remaining workers large ones. For in-vitro work, small inocula often give misleading indications. The large inocula results with E. coli are well in accord with the clinical data. S. W. LEE. JEANNE A. EPSTEIN. Wallace Laboratories, E. J. FOLEY. New Brunswick, N.J.
-
statement I never made. I have not found that these " patients look prematurely old and describe the cough as worse in the morning, ’ and this statement is not contained in my paper. In your annotation in the same issue (p. 317) you say, " referring to my third radiological type, it is not clear whether the diagnosis of fibrosis was made on clinical or on radiological data." It was made, of course, on radio’" logical evidence ; I would not venture to assert on clinical grounds alone that pulmonary fibrosis was present. The annotation continues, ," the relevant illustration shows a great increase in the normal linear markings possibly attributable to opaque dust in the bronchial,tubes." True, there is some increased striation to be seen on this film, but the chief feature is fibrosis ; examination of the original leaves no doubt on this point. Further, these words imply that the " normal linear markings " are caused by the bronchial tubes. Surely it is generally recognised that they are shadows of blood-vessels. How, therefore, can " opaque dust in the bronchial tubes." be responsible for an increase in " the normal linear markings ? " In any event, it is out of keeping with our present knowledge of pathology to attribute the abnormal radiological appearances of a pneumoconiosis to the mere deposition of foreign matter in the bronchial tubes. LASAR DUNNER. Cottingham, Nr. Hull.
THE MEDICAL CURRICULUM
SIR,-I should like
as a South African now to express a of view on the derived to some extent while at a
INSURANCE BENEFITS IN WARTIME
resident
in this country medical point curriculum London school of medicine. This is that medicine must be looked upon as a science, and the severest effort must be made to purify, extend and organise knowledge. If medicine is classified as an art, the practitioner is encouraged to proceed with a clear conscience on superficial or empirical lines ; if, on the other hand, he is acutely conscious of a responsibility to scientific spirit and method, he will almost inevitably endeavour to proceed more systematically in the accumulation of data, the framing of hypotheses, and the checking of results. Medical practice is essentially a matter of observation, inference, verification, generalisation. Though the experienced clinician may achieve a diagnosis so swiftly that he seems to be guided by something called " clinical instinct," we may be sure that the processes actually involved are observation, elimination of the irrelevant, inference-in other words, rapid induction. On the basis of a large experience, he simply selects more discriminatingly and decides more
quickly.
It would be a mistake to try to apply a rigid formula to the medical curriculum. Beyond obvious essentials, medicine can utilise various types of ability and training, and the medical faculties in British medical schools address their instruction to a miscellaneous student body. Schools, however, should aim to be sensible and comradely in discipline, flexible in curriculum, informal in method, and democratic in spirit.
SIR,—This letter is prompted by a desire to make known to medical and dental practitioners what attempts are being made to safeguard insurance benefits in the varying conditions of war at home and overseas. As directors of this society we feel that it is of vital impor-
that members and non-members alike should know of the beneficial concessions which it grants to the professions which it serves. Sickness and accident policies have always excluded claims caused or aggravated by war. This is a very wide clause and so unsatisfactory that this society now looks upon all claims not directly due to enemy action as covered by the ordinary conditions of the policy, while those directly due to enemy action are dealt with by an ance
ex-gratia payment. Ex-gratia payments
are made for incapacity due to enemy action, full benefit being paid for 13 weeks, with reduced benefit for a further 13 weeks and reconsideration thereafter. If the incapacity arises in the United Kingdom benefit begins at once, while if it arises overseas it commences from the date of embarkation for the United Kingdom. Those who hold deferred benefit policies are eligible for the same benefits if incapacity persists at the end of the deferred period, which is deemed to start on embarkation for the United Kingdom if the incapacity arises overseas. Service members at home are paid benefit for all incapacity not due to enemy action. In addition to this, although benefits in prewar times are restricted to the United Kingdom, except for small concessions on the