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"ST. ANDREWS UNIVERSITY MEDICAL SCHOOL."
975 of instruction in bacteriology a necessary item in tho education of the medical student. The practical value of such knowledge in its relation to modern surgery, and the intimate connexion which exists between the science’of bacteriology and a rational hygiene, are beyond question, and have, moreover, been convincingly stated, both in your recent leading article on this subject and since by several of your correspondents. Perhaps in no branch of medical work is the value of a practical acquaintance with the technique of bacteriology more apparent than in the routine practice of a large fever hospital. Not only is such knowledge often of great assistance in the diagnosis and treatment of various forms of throat illness, but in many instancesthe allocation of a doubtful case is determined solely by the result of a bacteriological examination. It is, at times, of undoubted importance to the inmates of an institution for infectious diseases that the medical officer. should have had special experience in the work. The value of this experience is rapidly becoming recognised by the, various committees to whom is relegated the management of the fever hospitals, and in filling,up a vacancy on the staff ofmedical officers in the fever service (of whom there are about. fifty in London alone) I have known the election to haveultimately turned upon the possession of this important qualification. This is only as it should be, and, for my part" I fully sympathise with Dr. Washbourn in his desire to see the preliminaries settled without delay which shall ensure that every student shall have received practical instruction ism bacteriology before he is turned out to practise his profes-sion. I am, Sirs, yours faithfully, course
Correspondence. "
Audi alteram
partem."
"THE REGISTRAR-GENERAL AND DEATH CERTIFICATES." To the Editors of THE LANCET. SIRS,-Will you oblige me with space for a brief reply to Dr. H. Cyril Goodman’s letter, under the above heading,
which
in THE LANCET of
Sept. 26th ? Permit me whatever has been committed in this office with respect to the matter in question. Your correspondent, in common with other registered medical practitioners, has, doubtless, received a copy of the last edition of the Nomenclature of Diseases, recently published by the Royal College of Physicians of London. If Dr. Goodman will refer to the note on page 335 and also to page 343 of that book he will see that in the opinion of the College nonmalignant as well as malignant growths are unavoidably associated under the head "sarcoma." My object in asking the assistance of my medical brethren in these circumstances is to determine what proportion of the fatal cases of sarcoma are, in the judgment of the medical attendants, non-malignant in their nature. The information when obtained will be published in abstract in the reports of the RegistrarGeneral.-I am, Sirs, yours truly, JOHN TATHAM. General Register Office, Somerset House, Sept. 28th, 1896.
appeared
to assure Dr. Goodman that
no error
F. FOORD CAIGER. South-Western Fever Hospital, Stockwell, Sept. 29th, 1896.
To the Editors of THE LANCET.
SIRS,-I have read Dr. Goodman’s letter in THE LANCET of Sept. 26th with interest, as I also have been favoured a notice from the General Register Office similar to the received by him. I am asked " whether a sarcoma of the hip-bone, whose duration was one year and which caused death by exhaustion," was of a malignant nature. With this I also received another notice asking what was the cause of the septicaemia " in the case of a patient whose death was certified as being due primarily to ulcerative endocarditis secondarily to septicaemia. This second example is sufficiently absurd and does not seem to admit of much explanation. Some reason for the anxiety of the Registrar-General’s office for information about the malignancy of sarcoma may be found in the small print at the top of page 335 of the Official Nomenclature of Diseases issued by the Royal of Physicians of London. We find it here stated that College " in certain cases malignant and non-malignant growths are unavoidably associated under one head, as, for instance, under sarcoma." We are later given a classification of true cancer or carcinoma, which is apparently the only kind of tumour all of whose varieties are recognised as being malignant. We are unfortunately not given the points of differential diagnosis between the malignant and nonmalignant forms of sarcoma in this valuable work, nor, indeed, is it included in its scope ; nor are we told to whom we are indebted for this somewhat remarkable classification, as Mr. Hulke and Mr. Marcus Beck, who were originally appointed for this part of the work, died before its completion. Perhaps Dr. Payne, who edited it, may be able to enlighten us as to what is meant by a non-malignant sarcoma. That the officials of the Registrar-General’s office are guided in these matters by the official nomenclature of the Royal College of Physicians of London is, I believe, a fact, and we may thus explain their notice to Dr. Goodman and myself and perhaps to others. But even with this learned authority before us we may be permitted some degree of surprise at a request for information about the malignancy of a sarcoma which killed the unfortunate patient by exhaustion in one year from the time of onset. I may say that neither of my cases occurred in the institution with which I am now connected. In each case there was a complete post-mortem I am, Sirs, yours truly, examination. ARTHUR T. WHITE, M.R.C.S. Eng., L.R.C.P. Lond. Claybury Asylum, Essex, Sept. 26th, 1896.
with one
" BACTERIOLOGY AND THE MEDICAL CURRICULUM." To t7te Editors of THE LANCET. SIRS,-You have done good service in calling the attention of the profession to the extreme desirability of making
"ST. ANDREWS UNIVERSITY MEDICAL SCHOOL." To the Editors of THE LANCET. SIRS,-With reference to the letters under the abovet heading, from Dr. Buist of Dundee, and Dr. J. Bs which appeared in Tnn LANCET of Sept. 12th. and 19th, I beg to state that I presume Dr. Buist is well aware that under the 1862 ordinances St. Andrews University is authorised to give one complete annus medicus. It may be that under these 1862 ordinances the recently instituted lectures on Anatomy and Materia Medica. But this is doubtful may not qualify for graduation. has yet- to be determined, and cannot be settled? by the mere ipse dixit of any such self-constituted judges This is also of the less importance, as as Dr. Buist. it is not necessary that either of those subjects should be taken during the first year, and long before the termination of the first annus medicus medical education at St. Andrews will be placed upon an entirely satisfactory basis. Intending students need have no hesitation in joining the medical classes at St. Andrews University; their interests will be we!I cared for and safeguarded.-I am, Sirs, yours obediently, GEORGE W. BALFOUR, Member of the University Court of St. Andrews. 28th, 1896 Edinburgh, Sept. 28th, 1896.
Pettigrew,
"INQUESTS
AND
POST-MORTEM
EXAMINATIONS." To the Editors of THE LANCET. SIRS,-Re "Inquests and Post-mortem Examinations,T’ "Police Surgeon"would be wise to refuse to give any information as to the result of his examination until he is in the witness-box. On the printed subpoena I get it says, ’’ and make a post-mortem examination of the body, with am analysis, and report thereon at the said inquest." No coroner can demand any information unless you are in the witnessbox and have been "sworn." I am, Sirs, yours truly, A. PAGET STEAVENSON. West Bromwich, Sept. 25th, 1896. -
To the Editors of THE LANCET. SIRS,—I read with much interest the letter of "A PoliceSurgeon" in THE LANCET of Sept. 26th, and it gives me an opportunity of bringing to your notice the too frequent unfair, if not illegal, treatment of house surgeons concerned in coroners’ inquests and asking the opinion of your readers the subject. As everyone knows, resident medical officers.
aIon
Correspondence. "
Audi alteram
partem."
"THE REGISTRAR-GENERAL AND DEATH CERTIFICATES." To the Editors of THE LANCET. SIRS,-Will you oblige me with space for a brief reply to Dr. H. Cyril Goodman’s letter, under the above heading,
which
in THE LANCET of
Sept. 26th ? Permit me whatever has been committed in this office with respect to the matter in question. Your correspondent, in common with other registered medical practitioners, has, doubtless, received a copy of the last edition of the Nomenclature of Diseases, recently published by the Royal College of Physicians of London. If Dr. Goodman will refer to the note on page 335 and also to page 343 of that book he will see that in the opinion of the College nonmalignant as well as malignant growths are unavoidably associated under the head "sarcoma." My object in asking the assistance of my medical brethren in these circumstances is to determine what proportion of the fatal cases of sarcoma are, in the judgment of the medical attendants, non-malignant in their nature. The information when obtained will be published in abstract in the reports of the RegistrarGeneral.-I am, Sirs, yours truly, JOHN TATHAM. General Register Office, Somerset House, Sept. 28th, 1896.
appeared
to assure Dr. Goodman that
no error
F. FOORD CAIGER. South-Western Fever Hospital, Stockwell, Sept. 29th, 1896.
To the Editors of THE LANCET.
SIRS,-I have read Dr. Goodman’s letter in THE LANCET of Sept. 26th with interest, as I also have been favoured a notice from the General Register Office similar to the received by him. I am asked " whether a sarcoma of the hip-bone, whose duration was one year and which caused death by exhaustion," was of a malignant nature. With this I also received another notice asking what was the cause of the septicaemia " in the case of a patient whose death was certified as being due primarily to ulcerative endocarditis secondarily to septicaemia. This second example is sufficiently absurd and does not seem to admit of much explanation. Some reason for the anxiety of the Registrar-General’s office for information about the malignancy of sarcoma may be found in the small print at the top of page 335 of the Official Nomenclature of Diseases issued by the Royal of Physicians of London. We find it here stated that College " in certain cases malignant and non-malignant growths are unavoidably associated under one head, as, for instance, under sarcoma." We are later given a classification of true cancer or carcinoma, which is apparently the only kind of tumour all of whose varieties are recognised as being malignant. We are unfortunately not given the points of differential diagnosis between the malignant and nonmalignant forms of sarcoma in this valuable work, nor, indeed, is it included in its scope ; nor are we told to whom we are indebted for this somewhat remarkable classification, as Mr. Hulke and Mr. Marcus Beck, who were originally appointed for this part of the work, died before its completion. Perhaps Dr. Payne, who edited it, may be able to enlighten us as to what is meant by a non-malignant sarcoma. That the officials of the Registrar-General’s office are guided in these matters by the official nomenclature of the Royal College of Physicians of London is, I believe, a fact, and we may thus explain their notice to Dr. Goodman and myself and perhaps to others. But even with this learned authority before us we may be permitted some degree of surprise at a request for information about the malignancy of a sarcoma which killed the unfortunate patient by exhaustion in one year from the time of onset. I may say that neither of my cases occurred in the institution with which I am now connected. In each case there was a complete post-mortem I am, Sirs, yours truly, examination. ARTHUR T. WHITE, M.R.C.S. Eng., L.R.C.P. Lond. Claybury Asylum, Essex, Sept. 26th, 1896.
with one
" BACTERIOLOGY AND THE MEDICAL CURRICULUM." To t7te Editors of THE LANCET. SIRS,-You have done good service in calling the attention of the profession to the extreme desirability of making
"ST. ANDREWS UNIVERSITY MEDICAL SCHOOL." To the Editors of THE LANCET. SIRS,-With reference to the letters under the abovet heading, from Dr. Buist of Dundee, and Dr. J. Bs which appeared in Tnn LANCET of Sept. 12th. and 19th, I beg to state that I presume Dr. Buist is well aware that under the 1862 ordinances St. Andrews University is authorised to give one complete annus medicus. It may be that under these 1862 ordinances the recently instituted lectures on Anatomy and Materia Medica. But this is doubtful may not qualify for graduation. has yet- to be determined, and cannot be settled? by the mere ipse dixit of any such self-constituted judges This is also of the less importance, as as Dr. Buist. it is not necessary that either of those subjects should be taken during the first year, and long before the termination of the first annus medicus medical education at St. Andrews will be placed upon an entirely satisfactory basis. Intending students need have no hesitation in joining the medical classes at St. Andrews University; their interests will be we!I cared for and safeguarded.-I am, Sirs, yours obediently, GEORGE W. BALFOUR, Member of the University Court of St. Andrews. 28th, 1896 Edinburgh, Sept. 28th, 1896.
Pettigrew,
"INQUESTS
AND
POST-MORTEM
EXAMINATIONS." To the Editors of THE LANCET. SIRS,-Re "Inquests and Post-mortem Examinations,T’ "Police Surgeon"would be wise to refuse to give any information as to the result of his examination until he is in the witness-box. On the printed subpoena I get it says, ’’ and make a post-mortem examination of the body, with am analysis, and report thereon at the said inquest." No coroner can demand any information unless you are in the witnessbox and have been "sworn." I am, Sirs, yours truly, A. PAGET STEAVENSON. West Bromwich, Sept. 25th, 1896. -
To the Editors of THE LANCET. SIRS,—I read with much interest the letter of "A PoliceSurgeon" in THE LANCET of Sept. 26th, and it gives me an opportunity of bringing to your notice the too frequent unfair, if not illegal, treatment of house surgeons concerned in coroners’ inquests and asking the opinion of your readers the subject. As everyone knows, resident medical officers.
aIon