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THE CURRICULUM
501 work for local health authorities-i.e., immunisation and vaccination-the proceeds will not count towards
pension, nor will they earn him an independent pension from the local authority. This refusal to reckon in all remuneration from every branch of the national service suggests a complete misunderstanding of the general and is apparently decided practitioner’s worth and work, upon only to facilitate the work of accountants along familiar lines. The fact that the Ministry refuses to recognise that there is any shadow of impropriety in treating general practitioners in this manner is of particularly illofomen the and assuredly threatens the smooth operation The Medical Practitioners Union is not new service. represented upon the Negotiating Committee, nor does it usually see eye to eye with the British Medical Association, but it certainly looks as if it may be forced to urge upon its members an attitude not very different from that of the latter body, although for different reasons. No-one wants to see doctors on strike ; but if we general practitioners are to be deliberately treated as of less account than administrative officials in Whitehall and elsewhere, and if even reasonable representations are to be turned down as those above mentioned have been, then the strike is bound to come and the very best that can be hoped for is an unhappy and therefore inefficient service. GORDON WARD Sevenoaks. Vice-President, Medical Practitioners Union. OVERSEAS APPLICATIONS FOR APPOINTMENTS
SiR,-My Lancet comes direct, without forwarding either in the United Kingdom or in India. The issue of Jan. 18 arrived on March 1. In the advertisement columns of that issue are listed 172 appointments for which a last date of application is stated. The distribution of these dates is interesting : "immediately," " at once," " forthwith " or "as soon as possible Between Jan. 20 and Jan. 31 Feb. 1 and Feb. 10 " Feb. 11 and Feb. 20 ,, Feb. 21 and Feb. 28 " March 1 and March 10 " March 11 and March 20 " March 21 and March 31 "
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45 61 39 12 6 5 2 2
172
Thus only 4 of these 172 advertisements could have been answered in time by doctors serving in India. I did not wish to apply for any of these posts, and can therefore write without personal bitterness. But so long as these remain typical figures I hope you will not allow it to be suggested in your pages that doctors serving in the Forces overseas are given a fair opportunity to apply for jobs.
India.
MAJOR,
R.A.M.C.
ASCORBIC-ACID METABOLISM OF BANTU SOLDIERS SiR,—Ihave read the paper by Professor Kekwick, Dr. Wright, and Dr. Raper (March 29) with some interest since just ten years ago R. E. Bernstein and I produced " a study of the vitamin-C nutrition of healthy Europeans, Bantu mine recruits, and subscorbutic Bantu subjects " in the South African Journal of .Medical Science (1937, 2, 37). Our conclusions were substantially the same, as the following summary indicates. 1. On a vitamin-C-restricted diet the hourly and daily excretion of vitamin C by Europeans, who ordinarily took large amounts of the vitamin, was much higher than that of healthy Bantu mine recruits. 2. On giving test doses of ascorbic acid the Europeans studied showed an immediately accelerated excretion, and within the following 24 hours eliminated the greater proportion of the added vitamin ; the Bantus gave no such response as their tissues retained the added vitamin. This indicated that the Bantu was far less saturated than the European. 3. The highest degree of unsatiiration was found in subscorbutic subjects, judging both from their daily excretion and from their response to added vitamin C. 4.
The
bodily
store could be saturated in the
healthy
Bantu by addition of vitamin C in large amounts to his diet. 5. It was concluded that the difference between the bodily saturation of European and Bantu and the greater liability
of the latter to scorbutic conditions depends on difference in dietary intake of vitamin C and not to any physiological peculiarity in the Bantu. Our investigation was less extensive than that of Professor Kekwick and his colleagues, for in those days it was difficult and expensive to get ascorbic acid in South Africa. We noted, however, in general conformity with their results, that one apparently healthy Bantu mineworker required nearly 3 g. of ascorbic acid to increase his excretion to a level comparable to that of Europeans. J. S. WEINER. Department of Human Anatomy, Oxford. ’
SERVICE MEDICINE
SiB,—In his letter of April 5 " R.A.F. Medical Officer
"
states that a Service medical officer should be an officer first and a doctor second. Fortunately, he implies that this is necessary only in preventive medicine. I repeat, fortunately, for if this dogma is adhered to in treatment the result is deplorable. It leads to such abuses as the patient having to " parade " sick irrespective of his condition ; the patient lying " to attention" in bed whilst the C.O. of the hospital does his round ; and to attempts to over-rule clinical decisions by superior rank. Such things happened but very rarely in the war-time medical service of the R.A.F., but they are the results of medical officers being officers first and doctors second. If he is not to betray the Hippocratic oath a medical officer must always be a doctor first and an officer second ; and in my experience the personnel were best handled by those who followed this principle. Ex-R.A.F.V.R. MEDICAL OFFICER. THE CURRICULUM to congratulate Professor Zuckerman hasten SiR,-I and his colleagues in the University of Birmingham for having adopted so boldly a scheme for the reintegration of anatomy and physiology (March 29, p. 395). It is a policy which we in this university favour, strongly, though for the time being we are testing it, not in the whole preclinical curriculum, but in one or two of its sections-i.e., special senses and neurology. We shall watch with interest the Birmingham scheme in the hope that we also shall be able to adopt one on similar lines. It is perhaps worth recalling that the principle involved finds favour with the General Medical Council and is expressed in the latest recommendations as to professional education by the phrase " . throughout the period of preclinical studies every effort should be made to secure close correlation between Anatomy and
Physiology." Two points
of criticism of the Birmingham scheme to my mind; and doubtless these will be met if, in the light of experience, they prove to be well founded. The load of dissection allotted to the first term appears to be very heavy, coming as it does at a time when students are introduced to a new subject involving a complicated and difficult terminology ; and one would have thought in general that they are more fitted to undertake a more intensive burden of dissection at a somewhat later stage of the curriculum, possibly in the second or third terms. This excessive load probably arises from what would be my second criticism, that to a course of the type envisaged six terms rather than five should have been allotted. The additional term would permit a more leisured approach to the highly important subjects of anatomy and physiology, and would provide more time for greater development of lectures and lecture demonstrations in the coordinating series. Apart from these minor criticisms I feel sure that medical educationists throughout the country will await with interest further news of the results of the Birmingham scheme. Medical School, King’s College, R. B. GREEN. Newcastle-upon-Tyne. come
March the
Voluntary Hospitals Emergency Bed by a joint committee of the King Edward’s Hospital Fund and the Voluntary Hospitals Committee, dealt with 1541 cases on behalf of doctors and hospitals. This is an increase of 90%over March, 1946, and brings the total for the first quarter of 1947 to 4265. During
Service, which is
run
pension, nor will they earn him an independent pension from the local authority. This refusal to reckon in all remuneration from every branch of the national service suggests a complete misunderstanding of the general and is apparently decided practitioner’s worth and work, upon only to facilitate the work of accountants along familiar lines. The fact that the Ministry refuses to recognise that there is any shadow of impropriety in treating general practitioners in this manner is of particularly illofomen the and assuredly threatens the smooth operation The Medical Practitioners Union is not new service. represented upon the Negotiating Committee, nor does it usually see eye to eye with the British Medical Association, but it certainly looks as if it may be forced to urge upon its members an attitude not very different from that of the latter body, although for different reasons. No-one wants to see doctors on strike ; but if we general practitioners are to be deliberately treated as of less account than administrative officials in Whitehall and elsewhere, and if even reasonable representations are to be turned down as those above mentioned have been, then the strike is bound to come and the very best that can be hoped for is an unhappy and therefore inefficient service. GORDON WARD Sevenoaks. Vice-President, Medical Practitioners Union. OVERSEAS APPLICATIONS FOR APPOINTMENTS
SiR,-My Lancet comes direct, without forwarding either in the United Kingdom or in India. The issue of Jan. 18 arrived on March 1. In the advertisement columns of that issue are listed 172 appointments for which a last date of application is stated. The distribution of these dates is interesting : "immediately," " at once," " forthwith " or "as soon as possible Between Jan. 20 and Jan. 31 Feb. 1 and Feb. 10 " Feb. 11 and Feb. 20 ,, Feb. 21 and Feb. 28 " March 1 and March 10 " March 11 and March 20 " March 21 and March 31 "
......
..
......
......
......
......
......
45 61 39 12 6 5 2 2
172
Thus only 4 of these 172 advertisements could have been answered in time by doctors serving in India. I did not wish to apply for any of these posts, and can therefore write without personal bitterness. But so long as these remain typical figures I hope you will not allow it to be suggested in your pages that doctors serving in the Forces overseas are given a fair opportunity to apply for jobs.
India.
MAJOR,
R.A.M.C.
ASCORBIC-ACID METABOLISM OF BANTU SOLDIERS SiR,—Ihave read the paper by Professor Kekwick, Dr. Wright, and Dr. Raper (March 29) with some interest since just ten years ago R. E. Bernstein and I produced " a study of the vitamin-C nutrition of healthy Europeans, Bantu mine recruits, and subscorbutic Bantu subjects " in the South African Journal of .Medical Science (1937, 2, 37). Our conclusions were substantially the same, as the following summary indicates. 1. On a vitamin-C-restricted diet the hourly and daily excretion of vitamin C by Europeans, who ordinarily took large amounts of the vitamin, was much higher than that of healthy Bantu mine recruits. 2. On giving test doses of ascorbic acid the Europeans studied showed an immediately accelerated excretion, and within the following 24 hours eliminated the greater proportion of the added vitamin ; the Bantus gave no such response as their tissues retained the added vitamin. This indicated that the Bantu was far less saturated than the European. 3. The highest degree of unsatiiration was found in subscorbutic subjects, judging both from their daily excretion and from their response to added vitamin C. 4.
The
bodily
store could be saturated in the
healthy
Bantu by addition of vitamin C in large amounts to his diet. 5. It was concluded that the difference between the bodily saturation of European and Bantu and the greater liability
of the latter to scorbutic conditions depends on difference in dietary intake of vitamin C and not to any physiological peculiarity in the Bantu. Our investigation was less extensive than that of Professor Kekwick and his colleagues, for in those days it was difficult and expensive to get ascorbic acid in South Africa. We noted, however, in general conformity with their results, that one apparently healthy Bantu mineworker required nearly 3 g. of ascorbic acid to increase his excretion to a level comparable to that of Europeans. J. S. WEINER. Department of Human Anatomy, Oxford. ’
SERVICE MEDICINE
SiB,—In his letter of April 5 " R.A.F. Medical Officer
"
states that a Service medical officer should be an officer first and a doctor second. Fortunately, he implies that this is necessary only in preventive medicine. I repeat, fortunately, for if this dogma is adhered to in treatment the result is deplorable. It leads to such abuses as the patient having to " parade " sick irrespective of his condition ; the patient lying " to attention" in bed whilst the C.O. of the hospital does his round ; and to attempts to over-rule clinical decisions by superior rank. Such things happened but very rarely in the war-time medical service of the R.A.F., but they are the results of medical officers being officers first and doctors second. If he is not to betray the Hippocratic oath a medical officer must always be a doctor first and an officer second ; and in my experience the personnel were best handled by those who followed this principle. Ex-R.A.F.V.R. MEDICAL OFFICER. THE CURRICULUM to congratulate Professor Zuckerman hasten SiR,-I and his colleagues in the University of Birmingham for having adopted so boldly a scheme for the reintegration of anatomy and physiology (March 29, p. 395). It is a policy which we in this university favour, strongly, though for the time being we are testing it, not in the whole preclinical curriculum, but in one or two of its sections-i.e., special senses and neurology. We shall watch with interest the Birmingham scheme in the hope that we also shall be able to adopt one on similar lines. It is perhaps worth recalling that the principle involved finds favour with the General Medical Council and is expressed in the latest recommendations as to professional education by the phrase " . throughout the period of preclinical studies every effort should be made to secure close correlation between Anatomy and
Physiology." Two points
of criticism of the Birmingham scheme to my mind; and doubtless these will be met if, in the light of experience, they prove to be well founded. The load of dissection allotted to the first term appears to be very heavy, coming as it does at a time when students are introduced to a new subject involving a complicated and difficult terminology ; and one would have thought in general that they are more fitted to undertake a more intensive burden of dissection at a somewhat later stage of the curriculum, possibly in the second or third terms. This excessive load probably arises from what would be my second criticism, that to a course of the type envisaged six terms rather than five should have been allotted. The additional term would permit a more leisured approach to the highly important subjects of anatomy and physiology, and would provide more time for greater development of lectures and lecture demonstrations in the coordinating series. Apart from these minor criticisms I feel sure that medical educationists throughout the country will await with interest further news of the results of the Birmingham scheme. Medical School, King’s College, R. B. GREEN. Newcastle-upon-Tyne. come
March the
Voluntary Hospitals Emergency Bed by a joint committee of the King Edward’s Hospital Fund and the Voluntary Hospitals Committee, dealt with 1541 cases on behalf of doctors and hospitals. This is an increase of 90%over March, 1946, and brings the total for the first quarter of 1947 to 4265. During
Service, which is
run