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MODERN MEDICAL EDUCATION.
58 cent. of residue. In other words, bulk for bulk, normal ixces should contain, according to the above statement, eight and a half times more pigment than the fseces of this case. Unless, therefore, the iatty fseces were eight and a half times bulkier than the normal the output of pigment must have been less than normal. Does Dr. Cammidge suggest that they were so bulky as this ?‘! In the case I lately published their bulk was certainly nothing like so excessive. The statement with which I disagree therefore .remains .’ non-proven," and I still think it mistaken. On the other hand, the following supports my view. In THE LANCET of May 30th, 1903, p. 1497, will be found a very interesting paper by Dr. W. B. Cheadle on Acholia, defined as a condition of "absence of bile in the stools without jaundice or sign of obstruction to the biliary outflow from the duct5," therefore including all kinds of cases characterised by stools of this description. Analyses of the faeces in Dr. Cheadle’s cases had been made by Dr. W. H. Willcox. Dr. Cheadle said, "In all cases bile pigment is deficient and in extreme and typical cases, where the stools appear white, no trace of it can be found. Moreover, in the most marked cases analysed by Dr. Willcox the bile acids were entirely absent also." In one of the cases quoted (Case 2) the stools contained at one time 49’65 per cent. of fat, whilst " bile pigment and bile acids were entirely absent." It is to be observed, however, that this case recovered, so that its exact pathology remains doubtful. Again, there is Sir Lauder Brunton’s case quoted by Mr. Mayo Robson in his Hunterian lectures in 1904, in which Dr. Sidney Martin found only small quantities of unaltered biliverdin and only an indication of biliary acids"in the white motions. The fact probably is that the pale colour of the fseces, in cases such as have been discussed, depends partly on the excess of light-coloured fat present, partly, as Dr. Cammidge suggests, on the crystalline peculiarities of the fat, and partly on a The diminution in the output of the fecal pigment. exact part played by each of these factors is, no doubt, different in different cases. What the real explanation of this diminution in the pigment is cannot be now positively stated. It evidently occurs when abundant bile is entering the alimentary canal. Dr. J. T. Walker’s suggestion that defect of pancreatic secretion may have something to do with it is well worthy of attention. There is one thing which, at all events, I think that this discussion has brought out clearly (especially some curious facts mentioned by Mr. Watkins)-viz., that the whole subject of fsecal pigment is is need of re-investigation. When that is undertaken I hope that Dr. Walker’s theory will not be lost sight of. With apologies for the unavoidable length of this letter, I am, Sirs, yours faithfully, W. GORDON. Exeter, Dec. 30th, 1905.
VENTRAL FIXATION OF THE UTERUS
sort of an idea of one’s patient’s ailment before the administration of any drug-has little or no time to deal with the treatment of the particular case, and the student recognises this. He is also aware that the examiners at the colleges and the universities have an awkward habit of following up their examination-in-chief by the questionIAnd how would " As ward clerks this was common knowledge you treat it ? to us, and we applied the remedy by following our own, and other, house physicians on their morning rounds. We saw what was given, what happened or what did not happen, and we asked the reason. The house physician, being a man who was endeavouring to make the most of his time, welcomed the amateur censorship and found that the necessity for explanation implied a corresponding necessary cogitation before applying any of the pharmaceutical remedies of his calling. It the physician, on his rounds, saw fit to change the treatment, he was forced, if merely in justice to his house physician, to explain why he had done so to his class. So it arose that the house physician taught treatment. I am only a recently qualified general practitioner and therefore hasten to bow to the undoubted practical experience of L.S.A." Still I cannot agree that the Apothecaries’ Hall examinations demand a greater knowledge of drugs and their applications than the tests applied by other examining bodies. I have the M.R.C.S., L.R.C.P., and the B.S. and M.D. Lond. I have not taken the L.S.A. but I have successfully "coachedfor that diploma. I have held the usual appointments, including house physician at a great London hospital, and can therefore place myself on all fours with "L.S.A.’s" son. Yet I should be false were I to deny the enormous amount of practical treatment that I learnt in my various appointments. As a house physician I did not have to worry with blood counts and the like. They were the province of the clinical clerks. I was therefore free to apply myself simply and solely to treatment, and this 1 hold is one of the inestimable advantages of a house physicianship at a big hospital. In my turn I had my volunteer class of fifth years’ men and we argued and wrangled over treatment. I had to be sure of my facts ; I was always liable to the direct negative from one of my class"and it was never policy to attempt to bluff. Anything new was given a fair trial and dropped or continued according to results. I admit there is a class of men which considers that the ends of medical science are met when once the lesion is located with accuracy. But this class is small and learns wisdom later. The great bulk of students at the present time fully realise the importance of treatment and do their best to acquire some working knowledge. As to the house staff, how often has one heard the caution from one house physician to another who is filling his friend’s spare beds: " Don’t send me in any curiosities. Send me in something I can treat." Apologbing for a prolix and, I fear, egotistical 1 am, Sirs, yours faithfully, letter, GENERAL PRACTITIONER. Jan. lst, 1906. "
BY A NEW METHOD To the Editors of THE LANCET.
SIRS,—If Mr. W. G. Richardson will consult THE LANCET of Feb. 12th, 1898, p. 429, he will find the description of an operation almost identical with the one which he publishes in your columns last week, written by Mr. C. J. Bond of Leicester. This operation I have seen done many times with excellent results both at Leicester and at the Bradford I am, Sirs, yours faithfully, -Infirmary. J. PHILLIPS. Girlington, Bradford, Dec. 27th, 1905.
MODERN MEDICAL EDUCATION. To the Editors of THE LANCET. think " L.S.A."1 is hardly fair in his very SlRS,—I of modern medical teaching. condemnation .sweeping
Nowadays, certainly, the enormous amount of knowledge which can, and must, be obtained solely by clinical work under the guidance of a properly qualified teacher has tended to crowd out "treatment" from the systematic The courses of study pursued in the medical schools. medical registrar, hammering away at the methods by which disease is recognised and differentiatd-and " L.S.A." will himself admit that it ia as well to have some 1
THE
LANCET, Dec. 23rd, 1905, p. 1866.
THE BATTLE OF THE CLUBS. (FROM OUR SPECIAL COMMISSIONER.) Medical Scandal at 3-racclesfield.-Tocal Economic Conditions.-No Improvement for Three-quarters (If a Century.Medical Offioers paid 10d. per Member per Year.Contrcret Work at Less than a per TVee7i. OF all the deplorable descriptions of the degradation wrought in the ranks of the medical profession by club practice or the contract system the following account of the state of affairs at Macclesfield will probably iank among the worst. This town used to be a prosperous silk manufacturirg centre and some 75 years ago an individual called Fergusson started a burial club for the advantage of the operatives engaged in that trade. Any student of political economy knows what were the conditions of the workers in factories during the earlier half of the nineteenth century ; how the abuses then prevalent led up to the Chartist agitation, to the Peterloo massacre, and finally resulted in far-reaching and beneficent factory and sanitary legislation. It was on July 10th, 1831, that the Macclesfield General Burial Society was established and on Jan. llth, 1905, this society issued its seventyIt had 6115 third annual report and balance-sheet.
li’arthing
,
VENTRAL FIXATION OF THE UTERUS
sort of an idea of one’s patient’s ailment before the administration of any drug-has little or no time to deal with the treatment of the particular case, and the student recognises this. He is also aware that the examiners at the colleges and the universities have an awkward habit of following up their examination-in-chief by the questionIAnd how would " As ward clerks this was common knowledge you treat it ? to us, and we applied the remedy by following our own, and other, house physicians on their morning rounds. We saw what was given, what happened or what did not happen, and we asked the reason. The house physician, being a man who was endeavouring to make the most of his time, welcomed the amateur censorship and found that the necessity for explanation implied a corresponding necessary cogitation before applying any of the pharmaceutical remedies of his calling. It the physician, on his rounds, saw fit to change the treatment, he was forced, if merely in justice to his house physician, to explain why he had done so to his class. So it arose that the house physician taught treatment. I am only a recently qualified general practitioner and therefore hasten to bow to the undoubted practical experience of L.S.A." Still I cannot agree that the Apothecaries’ Hall examinations demand a greater knowledge of drugs and their applications than the tests applied by other examining bodies. I have the M.R.C.S., L.R.C.P., and the B.S. and M.D. Lond. I have not taken the L.S.A. but I have successfully "coachedfor that diploma. I have held the usual appointments, including house physician at a great London hospital, and can therefore place myself on all fours with "L.S.A.’s" son. Yet I should be false were I to deny the enormous amount of practical treatment that I learnt in my various appointments. As a house physician I did not have to worry with blood counts and the like. They were the province of the clinical clerks. I was therefore free to apply myself simply and solely to treatment, and this 1 hold is one of the inestimable advantages of a house physicianship at a big hospital. In my turn I had my volunteer class of fifth years’ men and we argued and wrangled over treatment. I had to be sure of my facts ; I was always liable to the direct negative from one of my class"and it was never policy to attempt to bluff. Anything new was given a fair trial and dropped or continued according to results. I admit there is a class of men which considers that the ends of medical science are met when once the lesion is located with accuracy. But this class is small and learns wisdom later. The great bulk of students at the present time fully realise the importance of treatment and do their best to acquire some working knowledge. As to the house staff, how often has one heard the caution from one house physician to another who is filling his friend’s spare beds: " Don’t send me in any curiosities. Send me in something I can treat." Apologbing for a prolix and, I fear, egotistical 1 am, Sirs, yours faithfully, letter, GENERAL PRACTITIONER. Jan. lst, 1906. "
BY A NEW METHOD To the Editors of THE LANCET.
SIRS,—If Mr. W. G. Richardson will consult THE LANCET of Feb. 12th, 1898, p. 429, he will find the description of an operation almost identical with the one which he publishes in your columns last week, written by Mr. C. J. Bond of Leicester. This operation I have seen done many times with excellent results both at Leicester and at the Bradford I am, Sirs, yours faithfully, -Infirmary. J. PHILLIPS. Girlington, Bradford, Dec. 27th, 1905.
MODERN MEDICAL EDUCATION. To the Editors of THE LANCET. think " L.S.A."1 is hardly fair in his very SlRS,—I of modern medical teaching. condemnation .sweeping
Nowadays, certainly, the enormous amount of knowledge which can, and must, be obtained solely by clinical work under the guidance of a properly qualified teacher has tended to crowd out "treatment" from the systematic The courses of study pursued in the medical schools. medical registrar, hammering away at the methods by which disease is recognised and differentiatd-and " L.S.A." will himself admit that it ia as well to have some 1
THE
LANCET, Dec. 23rd, 1905, p. 1866.
THE BATTLE OF THE CLUBS. (FROM OUR SPECIAL COMMISSIONER.) Medical Scandal at 3-racclesfield.-Tocal Economic Conditions.-No Improvement for Three-quarters (If a Century.Medical Offioers paid 10d. per Member per Year.Contrcret Work at Less than a per TVee7i. OF all the deplorable descriptions of the degradation wrought in the ranks of the medical profession by club practice or the contract system the following account of the state of affairs at Macclesfield will probably iank among the worst. This town used to be a prosperous silk manufacturirg centre and some 75 years ago an individual called Fergusson started a burial club for the advantage of the operatives engaged in that trade. Any student of political economy knows what were the conditions of the workers in factories during the earlier half of the nineteenth century ; how the abuses then prevalent led up to the Chartist agitation, to the Peterloo massacre, and finally resulted in far-reaching and beneficent factory and sanitary legislation. It was on July 10th, 1831, that the Macclesfield General Burial Society was established and on Jan. llth, 1905, this society issued its seventyIt had 6115 third annual report and balance-sheet.
li’arthing
,