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THE COLLEGE OF SURGEONS, DUBLIN.
658 formation of a new examining board, whether under Government auspices or otherwise, and protested warmly against any system of centralisation which would deprive Dublin of the medical schools. In conclusion, Mr. Macnamara threw out the following suggestions for the General Medical Council when legislating upon medical education :H First,-Let no pupil be permitted, unless under special circumstances, to seek his licence in any other division of the empire than that in which he was educated. Should any special circumstances arise to render it desirable that he should resort elsewhere for his licence, let him state such circumstances to the Branch Medical Council for his division of the kingdom, and let them issue to such corporation, if they think fit, a liceat ad examination, without which it shall be illegal for them to do so, and for an infringement of which regulation the offending corporation shall be reported in the proper quarter, and the party who has thus wrongfully received its licence shall not be entitled to have it placed upon the Register. " Second, Let all the corporations keep a list of such candidates as they have found it necessary to remit back to their studies, and let copies of such lists be forwarded with the least possible delay to all the other corporations. " Third,-Every registered candidate should be made acquainted with the cause of his rejection; he should not be allowed to present himself anywhere for examination within a period of six months from his former rejection, nor without producing satisfactory evidence of having devoted his attention to that subject upon which he had pre-
tributable to nosocomial causes, it ought then to be ascer. tained whether there was any undue prevalence of zymotic disease at the time, or in the locality from which those patients were drawn.* To continue, however. Mr. Callender, in reference to the material operated on, proceeds to show that one class of patients-viz., those coming from country districts to St. Bartholomew’s Hospital, forms an exceptional group. Coniparing the results of amputations on this class of patients with those recorded by Sir James Simpson, he endeavours to prove that country patients recover in St. Bartholomew’s Hospital after amputations as well as country patients in private practice. The remarkable difference in the mortality after operations performed on country patients, as compared with the mortality after all amputations in St. Bartholomew’s, is, he thinks, quite conformable to what we know regarding the different values of lives in large cities as compared with those in less populous places. In the next part of his paper Mr. Callender discusses the results of amputations in country hospitals, giving the number of beds in the different infirmaries, and showing that the relative mortality after amputation was not in any direct ratio to the size of the hospital. He then institutes some comparisons between similar hospitals in the same or similar localities, with the view of indicating the wide differences which exist between them as regards their death-rates. The influence of special and personal causes as determining the results is dwelt upon in relation to severe railway accidents, multiple injuries, &c. Mr. Callender concludes by saying that " If we take 157 returns of 139 cases in private country practice, which returns give the experience of practitioners each of whom has operated, on an average, in 8 cases, and which are in marked contrast with the 217 returns of 779 cases, with an average of only 3 cases to each return, and in which not one single death is recorded,-if we take, I repeat, the 157 returns we have the following figures :-
viously failed.
secure in a more efficient manner the out of third suggestion, the rejected candidate this carrying should not be permitted to have back his certificates from the College in which he had lodged them until his term of "
probation
all Amputations. 1 in 5’7 died; or 17’5 per cent. 1 in 5’8 died; or 17 ,, 1 in 5.8 died; or 17’1 ,,
Morality after
Country hospitals, Country cases in London, Country private practice, ..
Fourth,-To
had
expired." SCARLET
FEVER.’
WE have more than once directed attention to the epidemic of scarlet fever in London, which now for the fifth week in succession has carried off more than 200 persons, and is evidently advancing rather than receding in its proelsewhere ?" gress. The Registrar-General’s Quarterly Return shows that, not in London only, but all over the country, the disease is raging with greater or less severity. Scarcely a THE COLLEGE OF SURGEONS, DUBLIN. , district out of those for which the notes" of the registrars are given-and these unfortunately represent only a section ON Monday, October 25th, the opening address for the of the returns for the whole country-but gives tidings session was delivered in the theatre of the Royal College of either of fatal cases or of attacks whose results will only be Surgeons of Ireland, by Professor Rawdon Macnamara, in the Return for December. In Croydon subPresident of the College. After taking a rapid survey of apparent district scarlet fever caused 32 out of 343 deaths; in Dartthe medical horizon, the lecturer proceeded to combat the 8 out of 82; in Shoreham, 7 out of 33; in Alton, Hants, notion entertained in some quarters that systematic lectures ford, 22 out of 85; in St. Mary, Reading, 29 out of 89; in West are superfluous, and urged the advantages both to students 23 out of 49; in West Ham, 39 out of 259; in and medical science of there being so many active minds Wycombe, 4 out of 30; in Road, Frome, 2 out of 10; in Egloshayle, constantly engaged in the direction of medical study. Mr. Shrewsbury St. Mary, 17 out of 109; in Oldbury, West Macnamara urged the students not to imagine that their 39 out of 140; in Sedgley, Dudley, 22 out of 211; Bromwich, youth was a bar to distinction, and quoted numerous his- in Holy Trinity, Coventry, 36 out of 125; in North-East Lintorical instances of renown achieved in early years to decoln, 6 out of 33; in Barton, Glauford Brigg, 6 out of 59; monstrate the fallacy of the argument. Turning to the in Ilkeston, 45 out of 114; in Belper, 7 out of 69; in Lever, question of professional examinations, the lecturer took Bolton, 27 out of 85; in Whitworth, Rochdale, 25 out of 75; credit to the College of Surgeons for not having reduced in Clitheroe, 14 out of 68; in Blackburn, 86 out of 477; in the standard of their tests, although they found that Irish Kirkham, 9 out of 45; in Dalton, 12 out of 102; in Horsstudents occasionally sought the sister countries for a quali- forth, 9 out of 47; in Darton, 14 out of 40; in Drypool, 14 fication after being rejected in Dublin. He deprecated the out of 81; in Hornsea, Skirlaugh, 8 out of 22; in Scarborough, 42 out of 183; in Hutton Bushell, 8 out of 21 ; in * Mr. Callender since this article has been in type has been kind enough to 13 out of 32 ; in Tanfield, IS out of 71; in Chesterforward us a copy of the paper read by him before the Medico-Chirurgical Lythe, 23 out of 132; in Winlaton, 14 out of 91; in North le-street, we have not asbut had tables. We have to his time yet Society, analyse certained, however, thnt no conditions outside St. Bartholomew’s Hospital Shields, 20 out of 105; in Whitehaven, 10 out of 69; in were recognised as influencing the results. In 1856 and 1863 respectively Coleford, 25 out of 62; in Llangafelach, 8 out 81 ; in Swanthere were five and eight consecutively fatal cases, but the deaths were due remembered that scarlet a and not to variety of causes, to any one more signally than the rest. Mr. sea, 77 out of 266. It needs to be Callender has kindly informed us that, whilst thigh amputations are very fever in its most fatal epidemic year, 1863, cause only 65 fatal in a given year, leg amputations recover well, and the reverse ; and he out of every 1000 deaths throughout the whole of England, cites in corroboration of this statement the death-rates after leg and thigh in order to understand the significance of proportions such amputations for disease in 1857. If the hospital condition affected the cases, as we have instanced above. t ought to tell in one set as much as in the ether. No one can fail to notice how closely these experiences agree. Is this a mere coincidence? Is it not rather the common-sense truth about this question of the death-rate after amputations performed on country people here and
"
I’,
tributable to nosocomial causes, it ought then to be ascer. tained whether there was any undue prevalence of zymotic disease at the time, or in the locality from which those patients were drawn.* To continue, however. Mr. Callender, in reference to the material operated on, proceeds to show that one class of patients-viz., those coming from country districts to St. Bartholomew’s Hospital, forms an exceptional group. Coniparing the results of amputations on this class of patients with those recorded by Sir James Simpson, he endeavours to prove that country patients recover in St. Bartholomew’s Hospital after amputations as well as country patients in private practice. The remarkable difference in the mortality after operations performed on country patients, as compared with the mortality after all amputations in St. Bartholomew’s, is, he thinks, quite conformable to what we know regarding the different values of lives in large cities as compared with those in less populous places. In the next part of his paper Mr. Callender discusses the results of amputations in country hospitals, giving the number of beds in the different infirmaries, and showing that the relative mortality after amputation was not in any direct ratio to the size of the hospital. He then institutes some comparisons between similar hospitals in the same or similar localities, with the view of indicating the wide differences which exist between them as regards their death-rates. The influence of special and personal causes as determining the results is dwelt upon in relation to severe railway accidents, multiple injuries, &c. Mr. Callender concludes by saying that " If we take 157 returns of 139 cases in private country practice, which returns give the experience of practitioners each of whom has operated, on an average, in 8 cases, and which are in marked contrast with the 217 returns of 779 cases, with an average of only 3 cases to each return, and in which not one single death is recorded,-if we take, I repeat, the 157 returns we have the following figures :-
viously failed.
secure in a more efficient manner the out of third suggestion, the rejected candidate this carrying should not be permitted to have back his certificates from the College in which he had lodged them until his term of "
probation
all Amputations. 1 in 5’7 died; or 17’5 per cent. 1 in 5’8 died; or 17 ,, 1 in 5.8 died; or 17’1 ,,
Morality after
Country hospitals, Country cases in London, Country private practice, ..
Fourth,-To
had
expired." SCARLET
FEVER.’
WE have more than once directed attention to the epidemic of scarlet fever in London, which now for the fifth week in succession has carried off more than 200 persons, and is evidently advancing rather than receding in its proelsewhere ?" gress. The Registrar-General’s Quarterly Return shows that, not in London only, but all over the country, the disease is raging with greater or less severity. Scarcely a THE COLLEGE OF SURGEONS, DUBLIN. , district out of those for which the notes" of the registrars are given-and these unfortunately represent only a section ON Monday, October 25th, the opening address for the of the returns for the whole country-but gives tidings session was delivered in the theatre of the Royal College of either of fatal cases or of attacks whose results will only be Surgeons of Ireland, by Professor Rawdon Macnamara, in the Return for December. In Croydon subPresident of the College. After taking a rapid survey of apparent district scarlet fever caused 32 out of 343 deaths; in Dartthe medical horizon, the lecturer proceeded to combat the 8 out of 82; in Shoreham, 7 out of 33; in Alton, Hants, notion entertained in some quarters that systematic lectures ford, 22 out of 85; in St. Mary, Reading, 29 out of 89; in West are superfluous, and urged the advantages both to students 23 out of 49; in West Ham, 39 out of 259; in and medical science of there being so many active minds Wycombe, 4 out of 30; in Road, Frome, 2 out of 10; in Egloshayle, constantly engaged in the direction of medical study. Mr. Shrewsbury St. Mary, 17 out of 109; in Oldbury, West Macnamara urged the students not to imagine that their 39 out of 140; in Sedgley, Dudley, 22 out of 211; Bromwich, youth was a bar to distinction, and quoted numerous his- in Holy Trinity, Coventry, 36 out of 125; in North-East Lintorical instances of renown achieved in early years to decoln, 6 out of 33; in Barton, Glauford Brigg, 6 out of 59; monstrate the fallacy of the argument. Turning to the in Ilkeston, 45 out of 114; in Belper, 7 out of 69; in Lever, question of professional examinations, the lecturer took Bolton, 27 out of 85; in Whitworth, Rochdale, 25 out of 75; credit to the College of Surgeons for not having reduced in Clitheroe, 14 out of 68; in Blackburn, 86 out of 477; in the standard of their tests, although they found that Irish Kirkham, 9 out of 45; in Dalton, 12 out of 102; in Horsstudents occasionally sought the sister countries for a quali- forth, 9 out of 47; in Darton, 14 out of 40; in Drypool, 14 fication after being rejected in Dublin. He deprecated the out of 81; in Hornsea, Skirlaugh, 8 out of 22; in Scarborough, 42 out of 183; in Hutton Bushell, 8 out of 21 ; in * Mr. Callender since this article has been in type has been kind enough to 13 out of 32 ; in Tanfield, IS out of 71; in Chesterforward us a copy of the paper read by him before the Medico-Chirurgical Lythe, 23 out of 132; in Winlaton, 14 out of 91; in North le-street, we have not asbut had tables. We have to his time yet Society, analyse certained, however, thnt no conditions outside St. Bartholomew’s Hospital Shields, 20 out of 105; in Whitehaven, 10 out of 69; in were recognised as influencing the results. In 1856 and 1863 respectively Coleford, 25 out of 62; in Llangafelach, 8 out 81 ; in Swanthere were five and eight consecutively fatal cases, but the deaths were due remembered that scarlet a and not to variety of causes, to any one more signally than the rest. Mr. sea, 77 out of 266. It needs to be Callender has kindly informed us that, whilst thigh amputations are very fever in its most fatal epidemic year, 1863, cause only 65 fatal in a given year, leg amputations recover well, and the reverse ; and he out of every 1000 deaths throughout the whole of England, cites in corroboration of this statement the death-rates after leg and thigh in order to understand the significance of proportions such amputations for disease in 1857. If the hospital condition affected the cases, as we have instanced above. t ought to tell in one set as much as in the ether. No one can fail to notice how closely these experiences agree. Is this a mere coincidence? Is it not rather the common-sense truth about this question of the death-rate after amputations performed on country people here and
"
I’,