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"SPECIALISM IN MEDICINE."
THE PICRIC ACID TEST FOR SUGAR IN THE URINE. as obstetrician someone who wishes to practise alone. The division of duties at the Samaritan Free Hospital enables that hospital to concentrate its advantages as a school of abdominal surgery in a few hands. The importance of this to every special hospital was by Mr. Hutchinson in the prominently broughtto forward Address on Surgery the British Medical Association. He distinguished specialists from special hospitals, remarking that "it is quite possible that the latter may, when the staff is large in proportion to the number of beds, cease to offer the advantages as regards individual experience which they are designed to do." A special hospital which does not offer to its staff superior opportunities for practice, and to its patients superior treatment, is worse than useless.
and to elect
midwifery
I a.m. Sirs.
obedient servant. Portman-street, W., Aug. 20th, 1895. your
JOHN D.
MALCOLM.
483
excel. Take one of the simplest of specialties-dentistry. Few departments, if any, are easier to attain a knowledge of, yet what proportion of dental work falls to the lot of the general compared with the special practitioner2 There is a division of medicine in which, if in any, the general practitioner should equal the special. Yet in every town of adequate size specialists in midwifery are found. In the more difficult departments the specialisation is more accentuated. The advantage of specialism is that its practitioners have very much greater experience than the general practitioner, and even the general physician or surgeon. For one case of glaucoma, lupus, laryngeal tumour, or nasal polypus, &c., the general man sees, the special will see twenty or fifty or more. In the management of these he must attain to greater and General practitioners, as their more satisfactory knowledge. name implies, are intended to treat the generality of diseases ; those which are unusual, tedious, or refractory they would do well to refer to the specialist. T
Aug. 22nd, 1895.
THE PICRIC ACID TEST FOR SUGAR IN THE URINE.
::1m,
Sirs
yours
truly,
A SPECIALIST.
To the Editors of THE LANCET. MANCHESTER. SIRS,—In a review with which my book on " The Urine OUR OWN CORRESPONDENT.) (FROM was recently honoured in one of the quarterly medical journals, I am found fault with for not mentioning that ’Corporation and the Mersey and Irwell Joint Committee. boiling is required to bring out the red colouration on1’Iec the addition of a solution of picric acid and liquor potassas in IN THE LANCET of the 17th hist. the relations of urine containing sugar. Now, the fact is that if a solution tthe corporation to the joint committee are adverted of picric acid (about a third) be added, with an equal tto, and at the last meeting of the city council quantity of liquor potassas, to urine containing sugar a red-lAlderman Thompson, chairman of the Rivers Committee, dish colouration is produced in the cold. This is un- made some remarks on the same subject, saying that doubtedly intensified on boiling, the fluid assuming a claret’’ the time had arrived when Manchester ought to be colour, which passes on repose and cooling to a deep port- (on its dignity as regards the joint committee." The wine colour. What, however, is of more significance, theprecise 1 bearing of that expression in relation to the same results ensue in perfectly normal urine. The reaction pollution of the Irwell by Manchester sewage is not obvious. ] is more marked, however, in urine containing an abundance He ] alluded to the unpleasant position he had occupied in of uric acid. This test, then, is eminently fallacious, and presiding over that committee (being its vice-chairman) when ] should be discarded for either qualitative or quantitative the 1 Manchester effluent was being denounced, " but now that :Sir John Hibbert had been relieved of Parliamentary duties analysis of sugar in the urine. I am. Sirs. vours faithfullv.and , could take his place as chairman, he (the Alderman) D. CAMPBELL BLACK, M.D., The Manchester effluent was said could speak out." Protessor of Physiology in Anderson’s College to be bad, but he added that Sir Henry Roscoe, Medical School, Glasgow. Aug. 19th, 1895. in his report on twenty specimens of effluents from various places, described it as " slightly turbid, containing a little oxide of iron in suspension, and with a slightly tarry smell," AN IMPOSTOR. while against this the effluents from various residential places were said to have a "sewage smell" and a "putrescent To the Editors of THE LANCET. smell." This does not sound very dreadful, but it differs SIRS,-It has just come to my knowledge that an unknownmuch from the description current some little time since. person giving an address in Goswell-road, E.C., and writing ]He went on to say: ’Considering the amount of faecal under the name of Dr. G. R. Saunders, has put himself inr matter, market refuse, and refuse from dye-works and other communication with old St. Bartholomew’s men, stating that that had to be dealt with in Manchester, he thought places he has just returned from New Zealand in distress and asking were entitled to praise for the effluent rather than they for :pecuniary assistance. I am happy to state that my1blame." For the moment, perhaps, he did not bear in mind brother, Dr. G. R. Saunders, is now in New Zealand, andthat this is only in part a water-carriage town, and that that such an intimation is entirely untrue. I shall be glad tothe market refuse and a good part of that from dye-works hear from any of the victims of this person. are solid, and therefore do not go into the sewers. I am. Sirs. vour obedient servant, Some time must elapse before the sewage arrangements of FREDERICK W. SAUNDERS, M.B. Cantab. Manchester can be considered perfect, and the corporation Chieveley House, near Newbury, Berks, Aug. 20th, 1895. cannot at present feel quite happy when the matter is discussed in the joint committee, though great efforts are being made to push on the various works. In the meantime the "SPECIALISM IN MEDICINE." vice-chairman and his colleagues from the city council must be the victims of contending emotions-on the one side fired To the Editors of THE LANCET. with zeal for purity of effluent, and on the other tempted to SIRS,—Your correspondent," A General Practitioner," is, Ithink that even virtue may be carried to excess. The comthink, in error when he describes overcharging as if it were of this joint committee is somewhat complex, but position the monopoly of specialism. I fear that some general as of the interests involved. The County well as special practitioners are guilty of that crime, thoughfairly representative Councils of Lancashire and Cheshire send respectively eight perhaps a specialty lends itself more easily to theand three members, Manchester and Salford six and two, felony. In any case it is but a matter of degree in thewhile Bolton, Bury, Oldham, Rochdale, and Stockport send extent of criminality, and it is greatly to be regrettedone each. Sir John Hibbert, the chairman of the Lancathat practitioners, general and special, are to be foundshire is also chairman of the Mersey and Council, County lending themselves to such actions. The general practitionerIrwell and of the Ribble joint committees. is aggrieved if the specialist does not charge high fees, and P7trc7),ase of Chat Moss. unless he does assumes he seeks to take his patients out of An important addition to the property of the corporation his hands altogether. A solution of the question offers itself, viz., that it be no detriment to the specialist to take was announced at the last meeting of the council-viz., the moderate fees. And this is probably what will result, thatpurchase of Chat Moss, with an area of 2500 acres. The in all cases of difficulty and chronicity, whether amongcost, plus law and other charges, was £ 147,631 4s. 11d. the poorer or the richer classes, the specialist shouldThis is a large sum for it in these days of diminished land be consulted. To argue against specialism now is to argue values, but the longer the delay the higher the price would against civilisation. The specialist with .special piactice must be, so that without doubt the corporation has dune wisely in "
’
and to elect
midwifery
I a.m. Sirs.
obedient servant. Portman-street, W., Aug. 20th, 1895. your
JOHN D.
MALCOLM.
483
excel. Take one of the simplest of specialties-dentistry. Few departments, if any, are easier to attain a knowledge of, yet what proportion of dental work falls to the lot of the general compared with the special practitioner2 There is a division of medicine in which, if in any, the general practitioner should equal the special. Yet in every town of adequate size specialists in midwifery are found. In the more difficult departments the specialisation is more accentuated. The advantage of specialism is that its practitioners have very much greater experience than the general practitioner, and even the general physician or surgeon. For one case of glaucoma, lupus, laryngeal tumour, or nasal polypus, &c., the general man sees, the special will see twenty or fifty or more. In the management of these he must attain to greater and General practitioners, as their more satisfactory knowledge. name implies, are intended to treat the generality of diseases ; those which are unusual, tedious, or refractory they would do well to refer to the specialist. T
Aug. 22nd, 1895.
THE PICRIC ACID TEST FOR SUGAR IN THE URINE.
::1m,
Sirs
yours
truly,
A SPECIALIST.
To the Editors of THE LANCET. MANCHESTER. SIRS,—In a review with which my book on " The Urine OUR OWN CORRESPONDENT.) (FROM was recently honoured in one of the quarterly medical journals, I am found fault with for not mentioning that ’Corporation and the Mersey and Irwell Joint Committee. boiling is required to bring out the red colouration on1’Iec the addition of a solution of picric acid and liquor potassas in IN THE LANCET of the 17th hist. the relations of urine containing sugar. Now, the fact is that if a solution tthe corporation to the joint committee are adverted of picric acid (about a third) be added, with an equal tto, and at the last meeting of the city council quantity of liquor potassas, to urine containing sugar a red-lAlderman Thompson, chairman of the Rivers Committee, dish colouration is produced in the cold. This is un- made some remarks on the same subject, saying that doubtedly intensified on boiling, the fluid assuming a claret’’ the time had arrived when Manchester ought to be colour, which passes on repose and cooling to a deep port- (on its dignity as regards the joint committee." The wine colour. What, however, is of more significance, theprecise 1 bearing of that expression in relation to the same results ensue in perfectly normal urine. The reaction pollution of the Irwell by Manchester sewage is not obvious. ] is more marked, however, in urine containing an abundance He ] alluded to the unpleasant position he had occupied in of uric acid. This test, then, is eminently fallacious, and presiding over that committee (being its vice-chairman) when ] should be discarded for either qualitative or quantitative the 1 Manchester effluent was being denounced, " but now that :Sir John Hibbert had been relieved of Parliamentary duties analysis of sugar in the urine. I am. Sirs. vours faithfullv.and , could take his place as chairman, he (the Alderman) D. CAMPBELL BLACK, M.D., The Manchester effluent was said could speak out." Protessor of Physiology in Anderson’s College to be bad, but he added that Sir Henry Roscoe, Medical School, Glasgow. Aug. 19th, 1895. in his report on twenty specimens of effluents from various places, described it as " slightly turbid, containing a little oxide of iron in suspension, and with a slightly tarry smell," AN IMPOSTOR. while against this the effluents from various residential places were said to have a "sewage smell" and a "putrescent To the Editors of THE LANCET. smell." This does not sound very dreadful, but it differs SIRS,-It has just come to my knowledge that an unknownmuch from the description current some little time since. person giving an address in Goswell-road, E.C., and writing ]He went on to say: ’Considering the amount of faecal under the name of Dr. G. R. Saunders, has put himself inr matter, market refuse, and refuse from dye-works and other communication with old St. Bartholomew’s men, stating that that had to be dealt with in Manchester, he thought places he has just returned from New Zealand in distress and asking were entitled to praise for the effluent rather than they for :pecuniary assistance. I am happy to state that my1blame." For the moment, perhaps, he did not bear in mind brother, Dr. G. R. Saunders, is now in New Zealand, andthat this is only in part a water-carriage town, and that that such an intimation is entirely untrue. I shall be glad tothe market refuse and a good part of that from dye-works hear from any of the victims of this person. are solid, and therefore do not go into the sewers. I am. Sirs. vour obedient servant, Some time must elapse before the sewage arrangements of FREDERICK W. SAUNDERS, M.B. Cantab. Manchester can be considered perfect, and the corporation Chieveley House, near Newbury, Berks, Aug. 20th, 1895. cannot at present feel quite happy when the matter is discussed in the joint committee, though great efforts are being made to push on the various works. In the meantime the "SPECIALISM IN MEDICINE." vice-chairman and his colleagues from the city council must be the victims of contending emotions-on the one side fired To the Editors of THE LANCET. with zeal for purity of effluent, and on the other tempted to SIRS,—Your correspondent," A General Practitioner," is, Ithink that even virtue may be carried to excess. The comthink, in error when he describes overcharging as if it were of this joint committee is somewhat complex, but position the monopoly of specialism. I fear that some general as of the interests involved. The County well as special practitioners are guilty of that crime, thoughfairly representative Councils of Lancashire and Cheshire send respectively eight perhaps a specialty lends itself more easily to theand three members, Manchester and Salford six and two, felony. In any case it is but a matter of degree in thewhile Bolton, Bury, Oldham, Rochdale, and Stockport send extent of criminality, and it is greatly to be regrettedone each. Sir John Hibbert, the chairman of the Lancathat practitioners, general and special, are to be foundshire is also chairman of the Mersey and Council, County lending themselves to such actions. The general practitionerIrwell and of the Ribble joint committees. is aggrieved if the specialist does not charge high fees, and P7trc7),ase of Chat Moss. unless he does assumes he seeks to take his patients out of An important addition to the property of the corporation his hands altogether. A solution of the question offers itself, viz., that it be no detriment to the specialist to take was announced at the last meeting of the council-viz., the moderate fees. And this is probably what will result, thatpurchase of Chat Moss, with an area of 2500 acres. The in all cases of difficulty and chronicity, whether amongcost, plus law and other charges, was £ 147,631 4s. 11d. the poorer or the richer classes, the specialist shouldThis is a large sum for it in these days of diminished land be consulted. To argue against specialism now is to argue values, but the longer the delay the higher the price would against civilisation. The specialist with .special piactice must be, so that without doubt the corporation has dune wisely in "
’