- Email: [email protected]
THE MEMBERS OF THE ROYAL COLLEGE OF SURGEONS OF ENGLAND.
1006
INSTRUCTION IN SMALL-POX.
THE MEMBERS OF THE ROYAL COLLEGE OF SURGEONS OF ENGLAND.
To the Editor
of THE LANCET. SIR,—The Metropolitan Asylums Board heartily congratulated in having arranged
of THE LANCET. a special SIR,—The annual meeting of Fellows and Members course of instruction in the diagnosis and treatment will soon take place. The same resolutions will be of small-pox. The treatment of small-pox, of course, passed, the same answers given in different form ; is a minor matter for most practitioners of medicine, all of which concerns management, a trifling claim, but there is probably no disease in the whole range of and a refusal. trifling medicine where diagnosis is a more vital matter This letter is to plead that the College, Fellows and so far at least as the safety of the community is Members should put on a higher plane the demands concerned. It is well known amongst all who have and refusals. The Council should cease to act as had to deal with the control of small-pox how large if they were only an examining body to grant surgical a part is played in- the spread of the disease by errors diplomas, and cease to resist all claims to professional in diagnosis, and this deficiency is largely accounted distinction by their Members ; the gift of twoFellowfor by the fact that so many practitioners have had each year is no stimulus to special work. Memships little, if any, practical instruction in the subject. bers should claim recognition of skill in their proSuch a course as has now been arranged by the fession, and not only of ability to assist in the internal Board, as announced in your issue last week, will be economy of the College. of a great value to those who attend it, but the pity No examination ever created a genius (I heard is that attendance on such a course is not made the late Prof. Huxley speak on this subject). The compulsory on all medical students before qualifying. College can easily encourage good work, and make it It is a curious anomaly, a survival, no doubt, of a possible for a Member to become a Fellow other bygone age, that whilst every student must take out a than by the method of examination, which comes special course of instruction in vaccination, which easy to a class of brain that is not the most useful now plays only a comparatively subsidiary part in in the world. A Fellow has knowledge, but he is not the effectivecontrol of small-pox, the subject of the a surgeon, a Member may not have such always diagnosis of small-pox, which is the keystone of technical learning, and he may have failed to absorb modern methods of control, is largely left to look after text-book information, yet many Members are firstI am, Sir, yours faithfully, itself. class surgeons and diagnosticians. It is here that C. KILLICK MILLARD, the College takes up the position " you cannot enter Medical Officer of Health. the honours list of our profession unless you go to school again and cram "-a procedure that is Health Offlee, Grey Friars, Leicester, May 6th, 1929. often impossible, and waste of time. The body of * ** The Deputy Clerk to the Metropolitan Asylums Fellows should not be a scientific " pocket borough," Board informs us that the holding by the Board of with a high commercial value attached to their courses of instruction in small-pox is not a new honours examinations. departure. The lack of sufficient clinical material I am, Sir, yours faithfully, has, however, rendered it impracticable to organise - courses for some considerable time past, though it W. B. COSENS, M.R.C.S. M.R.O.S. has been possible, from time to time, for parties of 1929. Chelsea, S.W., May Oakley-street, 1st, medical students attending fever courses at the Board’s hospitals, to attend single demonstrations at the small-pox hospitals.-ED. L. is to be
To the Editor
BLOOD
FLOGGING IN SOUTHERN RHODESIA.
STANDARDS.
To the Editor
of THE LANCET. vigorous defence
of the SIR,—Dr. Goodhart’s Haldane instrument and of the makers thereof is based on a misconception of my remarks, for which I fear the brevity of my phraseology is somewhat responsible. I did not mean to imply that there was necessarily an error in the standardisation of different Government medical officers in Southern Rhodesia specimens of Haldane’s apparatus, but that there was are controlled by a Medical Director, and all of them a variation in the hæmoglobin value as estimated by He sanctions flogging. At different methods and observers. I hasten to assure come under his decrees. the gaols there is a book which has to be signed by Dr. Goodhart that when specimens from the same the Government Medical Officer certifying that the patient are estimated by such an experienced observer prisoner is physically fit to undergo punishment, the as himself, it would not be possible to question the certificate being manifestly designed to protect the accuracy of his comparative tests on the same flogger as well as the flogged. The term " boys " is, apparatus. This, however, is not alwavs what of course, misleading-it means adults from 17 to 70 happens. Observers who do not do much blood work of age. A punishment may be described as are, in my view, hampered by the tint of methods years ., cuts with the cane" and this, to the ordinary where the colour is red. This always contains proporEnglishman with scholastic experience, sounds inno- tions of blue and yellow. By taking a monochromatic cent enough. It is not so. The prisoner is stripped reading through green glass this error is reduced to a naked and is then fastened with straps to the triangle considerable extent. which stands in the prison yard. The " cuts " are In regard to Haldane’s colour-scale I have found administered with a long, stout cane upon the bare the personal error of different observers to vary within buttocks. The cane wielded with two arms by a rather wide limits. By using Tallquist’s scale in the muscular person can, and does, inflict cruel punish- manner I suggested errors in dilution of the blood are ment. Not only must the Government Medical also avoided. For these reasons I consider it preferable Officer certify to the fitness of the prisoner, he must to Haldane’s or other dilution methods for use in also be present at, and witness to, the flogging. This general practice or in cases where the blood of the is a degrading and revolting duty for one medical patient cannot always be estimated by the same officer to impose upon a colleague, and not calculated observer. to exalt the professional status of the practitioner of I am, Sir, yours faithfully, medicine.-I am, Sir, yours faithfully, A. KNYVETT GORDON. R. F. RAND, M.D. 1929. Hartley, Southern Rhodesia, April 8th, Bedford-square, W.C., May 3rd, 1929. To the Editor
of THE LANCET. SIR,—Under the existing Government of Southern Rhodesia, adult natives may, by law, be flogged. The law, in authorising flogging, shelters itself behind medicine, and medicine sanctions the practice.
INSTRUCTION IN SMALL-POX.
THE MEMBERS OF THE ROYAL COLLEGE OF SURGEONS OF ENGLAND.
To the Editor
of THE LANCET. SIR,—The Metropolitan Asylums Board heartily congratulated in having arranged
of THE LANCET. a special SIR,—The annual meeting of Fellows and Members course of instruction in the diagnosis and treatment will soon take place. The same resolutions will be of small-pox. The treatment of small-pox, of course, passed, the same answers given in different form ; is a minor matter for most practitioners of medicine, all of which concerns management, a trifling claim, but there is probably no disease in the whole range of and a refusal. trifling medicine where diagnosis is a more vital matter This letter is to plead that the College, Fellows and so far at least as the safety of the community is Members should put on a higher plane the demands concerned. It is well known amongst all who have and refusals. The Council should cease to act as had to deal with the control of small-pox how large if they were only an examining body to grant surgical a part is played in- the spread of the disease by errors diplomas, and cease to resist all claims to professional in diagnosis, and this deficiency is largely accounted distinction by their Members ; the gift of twoFellowfor by the fact that so many practitioners have had each year is no stimulus to special work. Memships little, if any, practical instruction in the subject. bers should claim recognition of skill in their proSuch a course as has now been arranged by the fession, and not only of ability to assist in the internal Board, as announced in your issue last week, will be economy of the College. of a great value to those who attend it, but the pity No examination ever created a genius (I heard is that attendance on such a course is not made the late Prof. Huxley speak on this subject). The compulsory on all medical students before qualifying. College can easily encourage good work, and make it It is a curious anomaly, a survival, no doubt, of a possible for a Member to become a Fellow other bygone age, that whilst every student must take out a than by the method of examination, which comes special course of instruction in vaccination, which easy to a class of brain that is not the most useful now plays only a comparatively subsidiary part in in the world. A Fellow has knowledge, but he is not the effectivecontrol of small-pox, the subject of the a surgeon, a Member may not have such always diagnosis of small-pox, which is the keystone of technical learning, and he may have failed to absorb modern methods of control, is largely left to look after text-book information, yet many Members are firstI am, Sir, yours faithfully, itself. class surgeons and diagnosticians. It is here that C. KILLICK MILLARD, the College takes up the position " you cannot enter Medical Officer of Health. the honours list of our profession unless you go to school again and cram "-a procedure that is Health Offlee, Grey Friars, Leicester, May 6th, 1929. often impossible, and waste of time. The body of * ** The Deputy Clerk to the Metropolitan Asylums Fellows should not be a scientific " pocket borough," Board informs us that the holding by the Board of with a high commercial value attached to their courses of instruction in small-pox is not a new honours examinations. departure. The lack of sufficient clinical material I am, Sir, yours faithfully, has, however, rendered it impracticable to organise - courses for some considerable time past, though it W. B. COSENS, M.R.C.S. M.R.O.S. has been possible, from time to time, for parties of 1929. Chelsea, S.W., May Oakley-street, 1st, medical students attending fever courses at the Board’s hospitals, to attend single demonstrations at the small-pox hospitals.-ED. L. is to be
To the Editor
BLOOD
FLOGGING IN SOUTHERN RHODESIA.
STANDARDS.
To the Editor
of THE LANCET. vigorous defence
of the SIR,—Dr. Goodhart’s Haldane instrument and of the makers thereof is based on a misconception of my remarks, for which I fear the brevity of my phraseology is somewhat responsible. I did not mean to imply that there was necessarily an error in the standardisation of different Government medical officers in Southern Rhodesia specimens of Haldane’s apparatus, but that there was are controlled by a Medical Director, and all of them a variation in the hæmoglobin value as estimated by He sanctions flogging. At different methods and observers. I hasten to assure come under his decrees. the gaols there is a book which has to be signed by Dr. Goodhart that when specimens from the same the Government Medical Officer certifying that the patient are estimated by such an experienced observer prisoner is physically fit to undergo punishment, the as himself, it would not be possible to question the certificate being manifestly designed to protect the accuracy of his comparative tests on the same flogger as well as the flogged. The term " boys " is, apparatus. This, however, is not alwavs what of course, misleading-it means adults from 17 to 70 happens. Observers who do not do much blood work of age. A punishment may be described as are, in my view, hampered by the tint of methods years ., cuts with the cane" and this, to the ordinary where the colour is red. This always contains proporEnglishman with scholastic experience, sounds inno- tions of blue and yellow. By taking a monochromatic cent enough. It is not so. The prisoner is stripped reading through green glass this error is reduced to a naked and is then fastened with straps to the triangle considerable extent. which stands in the prison yard. The " cuts " are In regard to Haldane’s colour-scale I have found administered with a long, stout cane upon the bare the personal error of different observers to vary within buttocks. The cane wielded with two arms by a rather wide limits. By using Tallquist’s scale in the muscular person can, and does, inflict cruel punish- manner I suggested errors in dilution of the blood are ment. Not only must the Government Medical also avoided. For these reasons I consider it preferable Officer certify to the fitness of the prisoner, he must to Haldane’s or other dilution methods for use in also be present at, and witness to, the flogging. This general practice or in cases where the blood of the is a degrading and revolting duty for one medical patient cannot always be estimated by the same officer to impose upon a colleague, and not calculated observer. to exalt the professional status of the practitioner of I am, Sir, yours faithfully, medicine.-I am, Sir, yours faithfully, A. KNYVETT GORDON. R. F. RAND, M.D. 1929. Hartley, Southern Rhodesia, April 8th, Bedford-square, W.C., May 3rd, 1929. To the Editor
of THE LANCET. SIR,—Under the existing Government of Southern Rhodesia, adult natives may, by law, be flogged. The law, in authorising flogging, shelters itself behind medicine, and medicine sanctions the practice.