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SELECTION OF STUDENTS AT CROWDED MEDICAL SCHOOLS.
192
judgment in particular cases. In this country these intermediate medical subjects at University College, operations are usually performed under general anaes- although admission to University College does not confer thesia, but it appears from the paper by Mr. W. Morris, any presumptive right to admission to .the Hospital. which is also to be found in this number, that all adult Eight of the 12 places allotted to women will be filled on cases are now operated on at the Mayo Clinic by disthe nomination of the authorities of University College section under local anaesthesia. His description of the and the remaining four will be thrown open to comtechnique there adopted will be useful to those who petitive examination. The resolution limiting the wish to try it here. number of women students to 12 does not come into force until October, 1922, leaving an interval during -
SUPPURATING
MYOMA
UTERI.
THE subject of suppuration in uterine fibroids is discussed by Dr. J. W. Nixon,l who reports a case in a woman, aged 20, suffering from gonorrhoeal endometritis, which occurred in the surgical clinic of Dr. John B. The Deaver at the Lankenau Hospital, Philadelphia. rarity of this complication is shown by the fact that this was the first example of the kind among 1200 operations for uterine fibroids performed by that surgeon. It is true that some authorities estimate the frequency of suppuration in fibroids as high as 5 per cent. (A. Martin) or even 15 per cent. (Cullingworth), but Dr. Nixon attributes this to an inaccurate classification, which includes necrosis, gangrene, and other forms of degeneration. Although a fibroid may become infected at any time, infection is most likely to take place during the most active period of sexual life-namely, from the twenty-fifth to the fortyfifth year. The date of suppuration after the first appearance of the tumour varies from 2 years, as in Dr. Nixon’s case, to 10, 20, or even 40 years. In order of frequency, the factors leading to infection of a fibroid are pregnancy, surgical and obstetrical trauma, direct extension of infection from endometritis in the interstitial variety, torsion of the pedicle, especially in the cases of the subserous fibroid, chemical irritation by ergot or other drugs intended to contract the uterus, and mechanical irritation by X rays and radium. There is no type of organism peculiar to suppurating fibroids, but Dr. Nixon’s case is the first example on record in which gonococci have been found. The symptoms are not distinctive except that the pain, which has hitherto been dull and dragging, is likely to assume a stabbing In some cases there may be a rapid character. increase in size of the tumour, accompanied by local tenderness, fever, night sweats, and possibly A high a discharge of pus from the vagina. leucocytosis is also suggestive. The prognosis is grave owing to the complications liable to ensue as well as to the debilitated state of the patient at the time of the operation. The mortality has been variously estimated from 27 per cent. (Kelly and Cullen) to 70 per cent. (Berger). Early operation is essential, hysterectomy, total or subtotal, being indicated. In Dr. Nixon’s case, in which subtotal hysterectomy was performed by Dr. Deaver, the uterus presented five myomata, the largest of which contained irregular ragged cavities .full of thick greenish pus, smears from which showed a
which it may be
expected that the non-selected students will obtain admission to some other hospital admitting women students. The entry of men students to the Medical School is also restricted by the size of the Hospital. At the present the School is only able to admit for the full course men who have completed their preliminary and intermediate studies at University College and a certain number of selected men from Oxford and Cambridge. The total number of students admitted in any one year cannot exceed 80 and it is interesting to compare the method of selection with that adopted by the University of Minnesota, which, as we learn from Dr. Norman Walker’s report cited elsewhere, can also only admit 80 entrants annually. The following is the method adopted at Minnesota, which, in all its details, could not be followed in this country with success :The Dean of the Medical Faculty had 400 inquiries from those who proposed to enter last autumn. By a strict scrutiny of the educational qualifications of the applicants, he reduced it to below 200. The answers were then considered to the schedule of inquiry sent out to those concerned with the candidate’s earlier education and examination, including a report on personal appearance, manner with associates, initiative, ambition, industry, tact, use of oral and of written English. The Dean by this means reduced the numbers to something like 150. But still this did not get down to 80, and they then applied mental tests, and a series of examinations on the Binet method were applied to the residue. At the end of the first year unsuitable students are again weeded out, and advised either to give up medicine or to find some other place to study it in, their places being filled by students from schools which have as yet no clinical facilities and only give the first and second year’s instruction in medicine. Popular schools all have to adopt some kind of entrance filter and are evidently within their rights in selecting the material likely to benefit most fully from the educational facilities provided. The contrivance of the filter will, however, leave ample room for the tact and discretion of the authorities.
H.R.H. the Prince of Wales has announced his intention of being present at the Hunterian festival dinner of the Royal College of Surgeons of England to be held on Feb. 14th, when he will receive his diploma as Honorary Fellow.
THE appointment is announced of Mr. S. P. Vivian, a Assistant Secretary in the Ministry of Health Principal Gram-negative intracellular diplococcus. The patient and Registrar-General, to be Registrar-General Deputy left the hospital in good condition 27 days after the in succession to Sir Bernard Mallet, K.C.B. operation. -
SELECTION OF STUDENTS AT CROWDED MEDICAL SCHOOLS. AT a recent meeting of the General Committee of University College Hospital the following resolution was passed regarding the admission of women students to the Medical School :-
FOUR lectures on Communicable Diseases will be delivered by Sir Robert Armstrong-Jones at Gresham College, Basinghall-street, London, E.C., on Jan. 25th and the three following days, at 6 P.M. Admission is free.
That during the session 1922-23 and in subsequent sessions the number of women students to be admitted to the Hospital and Medical School be limited to 12. We understand that the circumstances in which this decision was taken were substantially these. The School Committee felt that there was an actual danger of the school becoming swamped by women students, and that if an undue proportion of women students were admitted there would be considerable risk of men students being driven away from the Medical School. It was recognised that the decision would entail some hardship upon women now taking their preliminary and
GREAT NORTHERN CENTRAL HOSPITAL.-At a special meeting of the governors of the Royal Chest Hospital, City-road, held at the Mansion House on Jan. 17th, the scheme, noted last week, for the amalgamation of this hospital with the Great Northern Central Hospital, Holloway-road, was approved. The latter hospital is to provide a number of beds allocated to diseases of the heart and lungs at least equal to those given up by the Royal Chest Hospital, and a block is to be named the Royal Chest Hospital block. The City-road premises are to remain open until such time as building becomes practicable, when the in-patient block and the nurses’ home will be disposed of ; the out-patient and X ray departments will be retained. It is stated that proper provision will be made for the medical and lay staffs of the Chest Hospital.
1
Journal of the American Medical Association, Dec. 15th, 1920.
AMALGAMATION
OF
ROYAL CHEST HOSPITAL
WITH
judgment in particular cases. In this country these intermediate medical subjects at University College, operations are usually performed under general anaes- although admission to University College does not confer thesia, but it appears from the paper by Mr. W. Morris, any presumptive right to admission to .the Hospital. which is also to be found in this number, that all adult Eight of the 12 places allotted to women will be filled on cases are now operated on at the Mayo Clinic by disthe nomination of the authorities of University College section under local anaesthesia. His description of the and the remaining four will be thrown open to comtechnique there adopted will be useful to those who petitive examination. The resolution limiting the wish to try it here. number of women students to 12 does not come into force until October, 1922, leaving an interval during -
SUPPURATING
MYOMA
UTERI.
THE subject of suppuration in uterine fibroids is discussed by Dr. J. W. Nixon,l who reports a case in a woman, aged 20, suffering from gonorrhoeal endometritis, which occurred in the surgical clinic of Dr. John B. The Deaver at the Lankenau Hospital, Philadelphia. rarity of this complication is shown by the fact that this was the first example of the kind among 1200 operations for uterine fibroids performed by that surgeon. It is true that some authorities estimate the frequency of suppuration in fibroids as high as 5 per cent. (A. Martin) or even 15 per cent. (Cullingworth), but Dr. Nixon attributes this to an inaccurate classification, which includes necrosis, gangrene, and other forms of degeneration. Although a fibroid may become infected at any time, infection is most likely to take place during the most active period of sexual life-namely, from the twenty-fifth to the fortyfifth year. The date of suppuration after the first appearance of the tumour varies from 2 years, as in Dr. Nixon’s case, to 10, 20, or even 40 years. In order of frequency, the factors leading to infection of a fibroid are pregnancy, surgical and obstetrical trauma, direct extension of infection from endometritis in the interstitial variety, torsion of the pedicle, especially in the cases of the subserous fibroid, chemical irritation by ergot or other drugs intended to contract the uterus, and mechanical irritation by X rays and radium. There is no type of organism peculiar to suppurating fibroids, but Dr. Nixon’s case is the first example on record in which gonococci have been found. The symptoms are not distinctive except that the pain, which has hitherto been dull and dragging, is likely to assume a stabbing In some cases there may be a rapid character. increase in size of the tumour, accompanied by local tenderness, fever, night sweats, and possibly A high a discharge of pus from the vagina. leucocytosis is also suggestive. The prognosis is grave owing to the complications liable to ensue as well as to the debilitated state of the patient at the time of the operation. The mortality has been variously estimated from 27 per cent. (Kelly and Cullen) to 70 per cent. (Berger). Early operation is essential, hysterectomy, total or subtotal, being indicated. In Dr. Nixon’s case, in which subtotal hysterectomy was performed by Dr. Deaver, the uterus presented five myomata, the largest of which contained irregular ragged cavities .full of thick greenish pus, smears from which showed a
which it may be
expected that the non-selected students will obtain admission to some other hospital admitting women students. The entry of men students to the Medical School is also restricted by the size of the Hospital. At the present the School is only able to admit for the full course men who have completed their preliminary and intermediate studies at University College and a certain number of selected men from Oxford and Cambridge. The total number of students admitted in any one year cannot exceed 80 and it is interesting to compare the method of selection with that adopted by the University of Minnesota, which, as we learn from Dr. Norman Walker’s report cited elsewhere, can also only admit 80 entrants annually. The following is the method adopted at Minnesota, which, in all its details, could not be followed in this country with success :The Dean of the Medical Faculty had 400 inquiries from those who proposed to enter last autumn. By a strict scrutiny of the educational qualifications of the applicants, he reduced it to below 200. The answers were then considered to the schedule of inquiry sent out to those concerned with the candidate’s earlier education and examination, including a report on personal appearance, manner with associates, initiative, ambition, industry, tact, use of oral and of written English. The Dean by this means reduced the numbers to something like 150. But still this did not get down to 80, and they then applied mental tests, and a series of examinations on the Binet method were applied to the residue. At the end of the first year unsuitable students are again weeded out, and advised either to give up medicine or to find some other place to study it in, their places being filled by students from schools which have as yet no clinical facilities and only give the first and second year’s instruction in medicine. Popular schools all have to adopt some kind of entrance filter and are evidently within their rights in selecting the material likely to benefit most fully from the educational facilities provided. The contrivance of the filter will, however, leave ample room for the tact and discretion of the authorities.
H.R.H. the Prince of Wales has announced his intention of being present at the Hunterian festival dinner of the Royal College of Surgeons of England to be held on Feb. 14th, when he will receive his diploma as Honorary Fellow.
THE appointment is announced of Mr. S. P. Vivian, a Assistant Secretary in the Ministry of Health Principal Gram-negative intracellular diplococcus. The patient and Registrar-General, to be Registrar-General Deputy left the hospital in good condition 27 days after the in succession to Sir Bernard Mallet, K.C.B. operation. -
SELECTION OF STUDENTS AT CROWDED MEDICAL SCHOOLS. AT a recent meeting of the General Committee of University College Hospital the following resolution was passed regarding the admission of women students to the Medical School :-
FOUR lectures on Communicable Diseases will be delivered by Sir Robert Armstrong-Jones at Gresham College, Basinghall-street, London, E.C., on Jan. 25th and the three following days, at 6 P.M. Admission is free.
That during the session 1922-23 and in subsequent sessions the number of women students to be admitted to the Hospital and Medical School be limited to 12. We understand that the circumstances in which this decision was taken were substantially these. The School Committee felt that there was an actual danger of the school becoming swamped by women students, and that if an undue proportion of women students were admitted there would be considerable risk of men students being driven away from the Medical School. It was recognised that the decision would entail some hardship upon women now taking their preliminary and
GREAT NORTHERN CENTRAL HOSPITAL.-At a special meeting of the governors of the Royal Chest Hospital, City-road, held at the Mansion House on Jan. 17th, the scheme, noted last week, for the amalgamation of this hospital with the Great Northern Central Hospital, Holloway-road, was approved. The latter hospital is to provide a number of beds allocated to diseases of the heart and lungs at least equal to those given up by the Royal Chest Hospital, and a block is to be named the Royal Chest Hospital block. The City-road premises are to remain open until such time as building becomes practicable, when the in-patient block and the nurses’ home will be disposed of ; the out-patient and X ray departments will be retained. It is stated that proper provision will be made for the medical and lay staffs of the Chest Hospital.
1
Journal of the American Medical Association, Dec. 15th, 1920.
AMALGAMATION
OF
ROYAL CHEST HOSPITAL
WITH