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BACILLARY DYSENTERY
547 " were intelligent men eager for cure, others were -which reads In a series of 1400 cases in which all allow cases were treated with sulphonamide in desire to themselves or others to severe potentially lacking help any help them, and the worst among them were properly des- drugs, the course of the disease was mild," gives a more accurate picture of the true state of affairs. I would cribed as mental defectives (p. 38). I have received letters from men whose good-will I have point out that although it may contain a " therapeutic no reason to doubt and must confess to disappointment as implication," it is none the less a statement of fact. I to their progress, although on discharge they seemed fit to agree that the point has no bearing on the theme of Lieut.-Colonel Scadding’s paper, but his statement about carry on their ordinary life. A minor illness or perhaps the mildness of bacillary dysentery in -Middle East.might some excitement causes a set-back and the subsequent diagnosis and treatment are not often on the lines of any well be quoted out of its context when the general subject of sulphonamide therapy in bacillary dysentery is under rational psychotherapy (p. 52). review. The renewal of a useful adaptability to social demands is A disjointed argument will lead nowhere, and so we the most difficult and unsatisfactory problem of treatment must I would like however to answer agree to differ. 53). (p. the final point raised by Lieut.-Colonel Scadding. It is I also studied predisposition, taking as my standard one of the regrets of my life that we did not know of the that " with my present knowledge I would, on psychoaction of sulphonamides in bacillary dysentery until our logical grounds, have rejected the man on enlistment, attention was drawn to it by the use of sulphaguanidine. with his previous history, as now known, placed before Far from holding the opinion he suggests, I have little me." A classification of 415 cases resulted as follows :— doubt that if we had made use of the preparations then Average service and sulphapyridine-the hisavailable-sulphanilamide Percentage of abroad in the whole tory of bacillary dysentery in those early days would have months been very different, and many valuable lives would have 1. Previous condition aggravated 12 19’5 been saved. by warfare ...... 2. Previous condition aggravatect by Fortunately, our difference of outlook on this question6-5 10 strain of army life .... will settle itself automatically. If, in the course of years 3. Previous condition apparently to come, and other than through the development of 10.1 2-7 unaltered’....
Some
.
..
..
..
4. No
predisposition ;
symptoms
followed actual warfare 5. No predisposition ; symptoms followed strain of army life.. 6. Weak herd instinct. [A euphemi sm for recognisable s elf-s eekir g ..
or
malingering.]
....
57-6
..
1-9
..
4-3
..
19
proved sulphonamide-resistant strains of organisms, bacillary dysentery again becomes a severe and killing
.
disease in a community which is comparable to the military population of Middle East and in which early
20-5
treatment with sulphonamides of all but the mildest cases is a routine measure, the honours go to Lieut.Colonel Scadding. If on the other hand it continues to be, as it is now, a non-killing and in fact a comparatively trivial disease, I have no doubt he will be prepared to admit that my observations and deductions have not been inaccurate. I am well content to await the verdict. J. S. K. BOYD. B.L.A.
4
The negative correlation between predisposition and length of service abroad confirms the general accuracy of my estimate of that quality, and I noted that the good average service of group 1 depended upon the presence of members of one diagnostic class (that-in which I place
’
G. F.) " who sometimes withstood with great endurance the strain of war." The numerical preponderance of group 4, with a record of service that would perhaps RESERVATION OF MEDICAL STUDENTS compare favourably with that of any other group of SIR,-I have been approached on several occasions by ex-Service men, is to be noted when one is faced with a students whose reservations have been cancelled medical condemnation of " war neurotics." general by the Ministry of Labour because they have failed in There are some favourable changes since these observations were made. Psychiatrists, in spite of one examination in the medical course. The most onerous effect of this procedure is seen in cases where a influential opposition, have excluded from the Army student has failed in the second MB examination at a numbers of men who would have come into groups 1, 2, university but has passed the equivalent examination of and 3, though many still slip through. Treatment, too, the English Conjoint Board, and upon the latter has progressed. The method of abreaction was, to has been accepted for his clinical training speak in meiosis, derided by the very best people in achievement at a London teaching hospital, and some months laterthose early days. Now it is a commonplace and freely in one instance after the student had completed 9 months used close to the battle front, though I am credibly informed that it is still occasionally obstructed in this clinical training to the satisfaction of the hospital been called up and forced to relinquish country by surviving obscurantists who prefer’kick-in- authorities-has all of I prospects qualification. as a think. clinician, the-pants therapy. Speaking The Minister, in reply to myself (Hansard, July 29, speedy treatment by abreaction will arrest the con1943), described his procedure as followssolidation of symptoms that used to occur so often, but " One of the conditions for the continued reservation of psychiatrists using this method are still too few ; for this and other reasons we may expect to be faced with a medical student is that he shall be periodically certified large numbers of men more or less affected by the by the responsible authority of the university or other emotional stresses and horrors of war. training establishment as making satisfactory progress in The ex-soldier with symptoms, or who has once his studies. This restriction is necessary not only for some suffered a relapse, is aware of his nervousness and finds general reasons but because the number of places for it a handicap in the open labour market. If he belongs medical students is limited and an unsatisfactory student to my group 4 he rightly attributes it to his war service ; is not only failing to qualify himself but is preventing add to this a sense of economic insecurity, whether in someone else from doing so." addition to or resulting from his condition, with a I Sir, that this is putting too high a premium suspicion that his symptoms are belittled, and many a uponsubmit, the result of one examination. There must be decent citizen is turned into a man with a grievance. few of us who have not failed at some part of the very It does not make sense to lay down as a first principle in arduous preparation for the medical profession. the handling of the nervous ex-soldier (who, let us-=bear I have repeatedly pointed out in such cases to Mr. in mind, has often fought bravely and long) that " in Bevin that the consequence of his regulations is to his own interest " (for so the argument goes) he should withhold from qualification a number of candidates for not receive a pension. the medical profession and thus invalidate the success MILLAIS CULPIN. London, W.I. of schemes for postwar reconstruction which depend so largely upon securing an adequate number of doctors to BACILLARY DYSENTERY work them. The demand is likely to be at least three SIR,—Lieut.-Colonel Scadding, replying on Sept. 9 to times as great as the present supply, and, in as much as the minimal period for training a doctor is, some six my letter of July 15, considers that his statement,the type of dysentery current (in Middle East) was mild," years, preparation for that demand should be put into was justified. Having carefully considered his com- operation now. E. GRAHAM-LITTLE. House of Commons. ments, I still think that my suggested amendment, *
’
-
-
Some
.
..
..
..
4. No
predisposition ;
symptoms
followed actual warfare 5. No predisposition ; symptoms followed strain of army life.. 6. Weak herd instinct. [A euphemi sm for recognisable s elf-s eekir g ..
or
malingering.]
....
57-6
..
1-9
..
4-3
..
19
proved sulphonamide-resistant strains of organisms, bacillary dysentery again becomes a severe and killing
.
disease in a community which is comparable to the military population of Middle East and in which early
20-5
treatment with sulphonamides of all but the mildest cases is a routine measure, the honours go to Lieut.Colonel Scadding. If on the other hand it continues to be, as it is now, a non-killing and in fact a comparatively trivial disease, I have no doubt he will be prepared to admit that my observations and deductions have not been inaccurate. I am well content to await the verdict. J. S. K. BOYD. B.L.A.
4
The negative correlation between predisposition and length of service abroad confirms the general accuracy of my estimate of that quality, and I noted that the good average service of group 1 depended upon the presence of members of one diagnostic class (that-in which I place
’
G. F.) " who sometimes withstood with great endurance the strain of war." The numerical preponderance of group 4, with a record of service that would perhaps RESERVATION OF MEDICAL STUDENTS compare favourably with that of any other group of SIR,-I have been approached on several occasions by ex-Service men, is to be noted when one is faced with a students whose reservations have been cancelled medical condemnation of " war neurotics." general by the Ministry of Labour because they have failed in There are some favourable changes since these observations were made. Psychiatrists, in spite of one examination in the medical course. The most onerous effect of this procedure is seen in cases where a influential opposition, have excluded from the Army student has failed in the second MB examination at a numbers of men who would have come into groups 1, 2, university but has passed the equivalent examination of and 3, though many still slip through. Treatment, too, the English Conjoint Board, and upon the latter has progressed. The method of abreaction was, to has been accepted for his clinical training speak in meiosis, derided by the very best people in achievement at a London teaching hospital, and some months laterthose early days. Now it is a commonplace and freely in one instance after the student had completed 9 months used close to the battle front, though I am credibly informed that it is still occasionally obstructed in this clinical training to the satisfaction of the hospital been called up and forced to relinquish country by surviving obscurantists who prefer’kick-in- authorities-has all of I prospects qualification. as a think. clinician, the-pants therapy. Speaking The Minister, in reply to myself (Hansard, July 29, speedy treatment by abreaction will arrest the con1943), described his procedure as followssolidation of symptoms that used to occur so often, but " One of the conditions for the continued reservation of psychiatrists using this method are still too few ; for this and other reasons we may expect to be faced with a medical student is that he shall be periodically certified large numbers of men more or less affected by the by the responsible authority of the university or other emotional stresses and horrors of war. training establishment as making satisfactory progress in The ex-soldier with symptoms, or who has once his studies. This restriction is necessary not only for some suffered a relapse, is aware of his nervousness and finds general reasons but because the number of places for it a handicap in the open labour market. If he belongs medical students is limited and an unsatisfactory student to my group 4 he rightly attributes it to his war service ; is not only failing to qualify himself but is preventing add to this a sense of economic insecurity, whether in someone else from doing so." addition to or resulting from his condition, with a I Sir, that this is putting too high a premium suspicion that his symptoms are belittled, and many a uponsubmit, the result of one examination. There must be decent citizen is turned into a man with a grievance. few of us who have not failed at some part of the very It does not make sense to lay down as a first principle in arduous preparation for the medical profession. the handling of the nervous ex-soldier (who, let us-=bear I have repeatedly pointed out in such cases to Mr. in mind, has often fought bravely and long) that " in Bevin that the consequence of his regulations is to his own interest " (for so the argument goes) he should withhold from qualification a number of candidates for not receive a pension. the medical profession and thus invalidate the success MILLAIS CULPIN. London, W.I. of schemes for postwar reconstruction which depend so largely upon securing an adequate number of doctors to BACILLARY DYSENTERY work them. The demand is likely to be at least three SIR,—Lieut.-Colonel Scadding, replying on Sept. 9 to times as great as the present supply, and, in as much as the minimal period for training a doctor is, some six my letter of July 15, considers that his statement,the type of dysentery current (in Middle East) was mild," years, preparation for that demand should be put into was justified. Having carefully considered his com- operation now. E. GRAHAM-LITTLE. House of Commons. ments, I still think that my suggested amendment, *
’
-
-