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THE GENERAL MEDICAL COUNCIL AND PRELIMINARY EXAMINATIONS.
1734 alike-in the number of their letters and in the number of their syllables, and do they not both begin with a V ?7 In conclusion let me propose that with due consideration and respect we consign to unfathomable volcanic depths our poor old "cell"" with its walls and its non-living "contents," its supposed mechanical contrivances, its physical properties, and its dead and dying protoplasm, and let us look forward in hopeful confidence to the coming century and the gradual rise of living bioplasm, that lives and moves and forms and dies, and to the time not far off when the human mind shall be freed from its artificial fetters long imposed; and in accord with reason, shall demand its vital supremacy and acknowledge its transcendant position in the life world, which in times of comparative darkness as regards natural knowledge was accorded to it by tradition, contemplation, and thoughta position which by the advance of new knowledge and research will become for ever certain and secure. Let the human mind accept its great responsibilities and no longer bow to the reckless efforts to intimidate it and perplex its judgment with wordy sophisms forged to force it to believe that man is but one of the innumerable forms derived from the overwhelming vastness of lifeless matter, of which he sees around him and can study and know but an infinitesimal portion-man said to be one with the mechanisms he designs and makes-man asserted to be but one of the infinite poweri-ess helpless outcomes of the material universe and passive immutable blind law1 I am, Sirs, yours faithfully, LIONEL S. BEALE. Dec. 3rd, 1898. * * This correspondence must now cease.-ED. L.
For five weeks immediately preceding his death the patient was under close observation in this hospital and I am convinced that during this period and up to Oct. 8th his symptoms differed in no way from those of an ordinary healthy child convalescing from a mild attack of scarlet fever. The patient’s urine had never to my knowledge been tested for sugar previously to the morning of Oct. 8th ; the specific gravity had, however, been taken on several occasions and had never exceeded 1025. I am, Sirs, yours faithfully, T. O’NEILL ROE, M.B. Lond., Resident Medical Officer, Nottingham City Isolation Hospital.
THE GENERAL MEDICAL COUNCIL AND PRELIMINARY EXAMINATIONS.
To the Editors of THE LANCET. SiRS,—I am instructed to send you the following table which was drawn up in this office from the returns supplied to the Medical Council by the various examining boards, including those for the Navy, Army, and Indian Medical Services, and submitted to the Education Committee when preparing the report quoted in Mr. Eve’s letter to your journal of Dec. 17th. By an oversight in drafting the returns were described in the first lines of the paragraph quoted as if they came from the examining boards for the medical services only. These lines should read as follows : "During the years 1892-1898 returns have been made to the Council on behalf of the examining boards, including those for the Navy, Army, and Indian Medical Services, regarding those candidates who showed deficiency in general education." The- necessary correction will be made in the "A CASE OF DEATH FROM DIABETES report before it is issued to the public. It will be observed that the summary of the statistics given MELLITUS IN WHICH THAT DISEASE in the remainder of the paragraph, and the conclusions drawn GAVE NO PREMONITORY therefrom in the following paragraph of the report are in accordance with the figures in the table submitted to the SYMPTOMS." Education Committee. To the Editors of THE LANCET. I am, Sirs, yours faithfully, SIRS,-The following case, bearing a close resemblance to H. E. E. ALLEN, ALLEN, the one recorded by Dr. T. Wilson Parry in THE LAXCET Dec. 21st, 1898. Registrar of the General Medical Council. The of Nov. 26th, 1898, came recently under my notice. showing the Numbers of candidates reported as having a delicate-looking boy, aged eight years, was Table patient, been JJefieient in General Ed2cccc.tioa rdth the Preliminary admitted to the Nottingham City Isolation Hospital on Eaeaminations passed by them during the 1ears 1892-1898. mild from a attack of scarlet Sept. 3rd, 1898, suffering fever. On Oct. 5th the patient who up to that time had progressed very favourably complained of headache and nausea. His urine on examination showed a specific gravity of 1025 and a faint trace of albumin. During the next two days the patient expressed himself as feeling quite well, though the slight albuminuria still remained. At 2 A.M. on Oct. 8th the patient woke suddenly from a sound sleep and commenced to scream with acute abdominal pain. As he was very constipated olive oil and simple enemata were given and a small, bard, dry motion was passed. The patient seemed much exhausted after this action of the bowels and aromatic spirit of ammonia was given as a restorative. Shortly afterwards the pain in the abdomen was relieved and the patient went quietly to sleep. At 7.30 A.M. he woke and passed a large motion of the same character as before. This was immediately followed by a sudden general collapse. At 8 A.M. the patient’s condition was as follows : he was lying on his back semi-conscious; he could be roused when spoken to sharply but his answers were unintelligible; his face was pinched and drawn and there was much cyanosis of his lips and ears ; his eyes were wide open, the pupils were dilated equally and reacted very slightly to ’light; his pulse could scarcely be felt at the wrist and his extremities were very cold ; his heart sounds were weak140 per minute; there were no murmurs; his respirations were slow, deep, and sighing, but nothing abnormal could be detected by examination of the chest. Examination of the urine gave the following result: the colour was pale, reaction was acid, the specific gravity was 1040, with a trace of albumin and a very large quantity of sugar. The coma gradually deepened and the patient died at 1 P.M. on Oct. 9th, thirty-five hours after the onset of the first
symptom.
The chief interest in this case, as in the one recorded by Dr. Parry, lies in the sudden onset of fatal symptoms. The boy’s parents stated that previously to the attack of scarlet fever he had always been a very healthy child and that he had certainly not had any of the usual symptoms of diabetes.
"
Examinations not
now on
the Council’s list.
The original letter from the War Office calling attention to deficiencies in preliminary education appears in the Executive Committee’s minutes for February, 1891. In 1893 seven persons were reported by the India Office (particulars not given). Also in 1893 one candidate, whose name could not be traced in the Students’ Register, was reported by the
1735
Conjoint Board of the Colleges of Physicians and Surgeons added anything but beneficial. Then "M.O.H." proof Ireland. In 1896 one Army candidate, name not given, poses to erect at a cost of some Z200 a heated greenhouse or In 1897 one Army candidate glasshouse. One point seems to be entirely omitted and that was reported for bad spelling. was reported for bad spelling. is, as I before tried to emphasise, the essentials of these Alpine resorts-viz., intense dryness of the air, absence of wind, an intense cold dryness, brilliant hot sunshine, and INFANTILE INSUSCEPTIBILITY TO lastly, the automatic expansion constantly going on of the lung under the atmospheric conditions such as cause the VACCINATION. barometer to stand at from 24 in. to 23 in., and I still mainTo the Editors of THE LANOET. tain that none of these conditions are in any way present or SIRS,—It may be assumed to be generally accepted that can be produced in England at any time of the year. Either there are several different causes which lead to the declara- the necessity for treatment under these conditions is a com" tion that an infant is " insusceptible to vaccination ; well- plete error or the method of building sanatoria in England known statistics such as those of Dr. Cory seem to show is a mistake. Certainly the methods or theories in the treatthat vaccination performed thrice unsuccessfully by no ment in England or in the high Alps in no way resemble The conditions are, and must be, entirely means implies an actual insusceptibility to vaccinia and no each other. doubt in a large majority of cases returned as " in- different. I write as regards the cure-the permanent cure susceptible"the vaccinator has been at fault either by in many cases-of pulmonary tuberculosis, and I do really scratching too minute an area of skin or by using inactive believe that the establishment in England of such sanat,oria, lymph, or, as has often been found, the mothers have pre- though leading to possible improvement at the time owing to vented the success of the operation by purposely washing or the greatly improved hygienic conditions and surroundings’, otherwise interfering with the "places" immediately the will never in the same or even in more than a very miner vaccination has been completed. It will probably be degree lead to the arrest and cure of pulmonary tuberagreed, however, that if such causes of failure are set aside culosis. there is a small residuum of cases truly insusceptible in the I would add that the suggested cost of the glass erection sense that vaccination of infants properly performed with suggested by "M.O.H." would more than pay for two efficient lymph on three occasions with intervals of a few seasons in the high Alps and he seems also to miss one of weeks or months between them has failed altogether; and the chief points, and that is that the air in his "house’" most vaccinators would recognise a degree of partial in- would be of necessity breathed and rebreathed. It is lik& susceptibility where out of several insertions of efficient applying a dirty dressing to a wound and it is only by vaccine over a considerable area made on each of two or being in the absolutely open air-not in rooms with even more occasions at most a single small vesicle has resulted. the windows open-that the same air is never breathed twiceThe purpose of my letter is to inquire of those who have over The healthy lung may not actually suffer from inhaling had large experience of vaccination whetlier any information the air over more than once-though it can certainly do can be furnished of the relation, if any, between such truly it no good-but to the diseased lung the air breathed should insusceptible or partially insusceptible infants and the con- be absolutely pure and this can only be obtained out of doors dition as to vaccination or variolation of the parents- and not inside any building. I would finish by adding that particularly of the mothers. In the case of an infant born to Dr. Lionel Beale’s description of the weather-four days oi, a mother actually ,uffering from small-pox there are recorded damp fog and wet and wind-more than fully confirms what instances in which the infant, vaccinated on several occa- I say about the impracticability of really carrying out thesions with efficient lymph and remaining exposed to variola, true "open-air"treatment of tuberculosis in England. I has developed neither vaccinia nor variola. This appears to think I may say that unless it has been seen in its entirety be the extreme case of true insusceptibility dependent on the as carried out here and in other high health resorts it is maternal condition. Are there known comparable instances impossible to appreciate one-tenth of its benefits or the in which an infant has been born to a mother actually suffer- advantages to be derived from it or the actual methods’ I am, Sirs, yours faithfully, ing from vaccinia and has proved insusceptible to vaccina- employed. A. G. P. GIPPS. tions properly performed with efficient lymph ? And, going GiPPS. Arosa, Dec. 14th, 1898. further back, what has been the condition as to insusceptibility or partial insusceptibility of infants born to mothers who have suffered from variola or vaccinia before but not " COPYRIGHT IN PRESCRIPTIONS." long antecedent to parturition? And, again, how long after To the Editors of THE LANCET. birth does this insusceptibility last ? Beyond two cases recently under my observation of infants SlR3,—You were good enough to publish a letter f om me whose mothers had been successfully revaccinated shortly on the above in which I advocated a subject some time before commencement of pregnancy and who, after several scheme which would limit the ago1 use of prescriptions to the vaccinations with lymph perfectly efficient and active when purposes for which they were intended, by granting copyused in other cases both before and after these failures, right in them to their authors. By this means it would be presented in one case no reaction and in the other a single easy to prevent a prescription written for a particular person small vesicle on the second time of vaccinating, I am unable at a particular time and in particular circumstances from to contribute any facts upon the subject. But the matter abuse by being made up over and over again for an indefinite has considerable interest and in Gloucester, Middlesbrough, time and used at times and in manners and perhaps even by and other places where no doubt there has lately been a con- other persons which were never contemplated by the siderable number of mothers vaccinated during pregnancy physician who was the author of the prescription. It is so or having small-pox during or immediately antecedent to clear to my mind that the author of a prescription should pregnancy there may have been several opportunities of have control to such an extent of the way that it is applied observing what, if any, has been the degree of insuscepti- that I feel sure that such an arrangement as I suggest must bility of their infants to vaccination. be brought about sooner or later, both as a matter of bare I am, Sirs, your faithfully, justice to medical men and also as conducive to the public G. P. P. SHUTER. SHUTER. Chiswick-lane, W., Dec. 9th, 1898. welfare. A case that strongly enforces the desirability of such a scheme being carried out has lately come to my knowledge and is as follows :"THE ’OPEN-AIR’ TREATMENT OF An inquest was held on Dec. 14th by Mr. Troutbeck, the coroner for Westminster, on the body of a lady, aged about TUBERCULOSIS." fifty years. The jury returned a verdict of "Accidental death To the Editors of THE LANCET. from an overdose of chloral hydrate." The following facts SiRS,—When my letter on the"open-air"" treatment of were given in evidence. The deceased had bought on tuberculosis was inserted in your issue of Nov. 26th, that Dec. 9th a 12 oz. bottle of a solution (syrup?) of chloral, conletter was written in London. This is dated from Arosa, at taining 80 grains to the ounce, at one of the so-called a height of over 6000 ft. in Switzerland. My letter has cooperative stores. This bottle was obtained by means of a, called forth a few remarks, one or two of which I should like prescription that had been written for the deceased’s to notice. I think Dr. Lionel Beale exactly hits it off when husband who had died five years previously. His widow (the he says that life to be spent Iin the contemplated sheds subject of the present inquest) had had it made up frequently in many parts of England in such weather as we have 1 THE LANCET, July 16th, 1898. lately enjoyed, would not be happy," and he might have
For five weeks immediately preceding his death the patient was under close observation in this hospital and I am convinced that during this period and up to Oct. 8th his symptoms differed in no way from those of an ordinary healthy child convalescing from a mild attack of scarlet fever. The patient’s urine had never to my knowledge been tested for sugar previously to the morning of Oct. 8th ; the specific gravity had, however, been taken on several occasions and had never exceeded 1025. I am, Sirs, yours faithfully, T. O’NEILL ROE, M.B. Lond., Resident Medical Officer, Nottingham City Isolation Hospital.
THE GENERAL MEDICAL COUNCIL AND PRELIMINARY EXAMINATIONS.
To the Editors of THE LANCET. SiRS,—I am instructed to send you the following table which was drawn up in this office from the returns supplied to the Medical Council by the various examining boards, including those for the Navy, Army, and Indian Medical Services, and submitted to the Education Committee when preparing the report quoted in Mr. Eve’s letter to your journal of Dec. 17th. By an oversight in drafting the returns were described in the first lines of the paragraph quoted as if they came from the examining boards for the medical services only. These lines should read as follows : "During the years 1892-1898 returns have been made to the Council on behalf of the examining boards, including those for the Navy, Army, and Indian Medical Services, regarding those candidates who showed deficiency in general education." The- necessary correction will be made in the "A CASE OF DEATH FROM DIABETES report before it is issued to the public. It will be observed that the summary of the statistics given MELLITUS IN WHICH THAT DISEASE in the remainder of the paragraph, and the conclusions drawn GAVE NO PREMONITORY therefrom in the following paragraph of the report are in accordance with the figures in the table submitted to the SYMPTOMS." Education Committee. To the Editors of THE LANCET. I am, Sirs, yours faithfully, SIRS,-The following case, bearing a close resemblance to H. E. E. ALLEN, ALLEN, the one recorded by Dr. T. Wilson Parry in THE LAXCET Dec. 21st, 1898. Registrar of the General Medical Council. The of Nov. 26th, 1898, came recently under my notice. showing the Numbers of candidates reported as having a delicate-looking boy, aged eight years, was Table patient, been JJefieient in General Ed2cccc.tioa rdth the Preliminary admitted to the Nottingham City Isolation Hospital on Eaeaminations passed by them during the 1ears 1892-1898. mild from a attack of scarlet Sept. 3rd, 1898, suffering fever. On Oct. 5th the patient who up to that time had progressed very favourably complained of headache and nausea. His urine on examination showed a specific gravity of 1025 and a faint trace of albumin. During the next two days the patient expressed himself as feeling quite well, though the slight albuminuria still remained. At 2 A.M. on Oct. 8th the patient woke suddenly from a sound sleep and commenced to scream with acute abdominal pain. As he was very constipated olive oil and simple enemata were given and a small, bard, dry motion was passed. The patient seemed much exhausted after this action of the bowels and aromatic spirit of ammonia was given as a restorative. Shortly afterwards the pain in the abdomen was relieved and the patient went quietly to sleep. At 7.30 A.M. he woke and passed a large motion of the same character as before. This was immediately followed by a sudden general collapse. At 8 A.M. the patient’s condition was as follows : he was lying on his back semi-conscious; he could be roused when spoken to sharply but his answers were unintelligible; his face was pinched and drawn and there was much cyanosis of his lips and ears ; his eyes were wide open, the pupils were dilated equally and reacted very slightly to ’light; his pulse could scarcely be felt at the wrist and his extremities were very cold ; his heart sounds were weak140 per minute; there were no murmurs; his respirations were slow, deep, and sighing, but nothing abnormal could be detected by examination of the chest. Examination of the urine gave the following result: the colour was pale, reaction was acid, the specific gravity was 1040, with a trace of albumin and a very large quantity of sugar. The coma gradually deepened and the patient died at 1 P.M. on Oct. 9th, thirty-five hours after the onset of the first
symptom.
The chief interest in this case, as in the one recorded by Dr. Parry, lies in the sudden onset of fatal symptoms. The boy’s parents stated that previously to the attack of scarlet fever he had always been a very healthy child and that he had certainly not had any of the usual symptoms of diabetes.
"
Examinations not
now on
the Council’s list.
The original letter from the War Office calling attention to deficiencies in preliminary education appears in the Executive Committee’s minutes for February, 1891. In 1893 seven persons were reported by the India Office (particulars not given). Also in 1893 one candidate, whose name could not be traced in the Students’ Register, was reported by the
1735
Conjoint Board of the Colleges of Physicians and Surgeons added anything but beneficial. Then "M.O.H." proof Ireland. In 1896 one Army candidate, name not given, poses to erect at a cost of some Z200 a heated greenhouse or In 1897 one Army candidate glasshouse. One point seems to be entirely omitted and that was reported for bad spelling. was reported for bad spelling. is, as I before tried to emphasise, the essentials of these Alpine resorts-viz., intense dryness of the air, absence of wind, an intense cold dryness, brilliant hot sunshine, and INFANTILE INSUSCEPTIBILITY TO lastly, the automatic expansion constantly going on of the lung under the atmospheric conditions such as cause the VACCINATION. barometer to stand at from 24 in. to 23 in., and I still mainTo the Editors of THE LANOET. tain that none of these conditions are in any way present or SIRS,—It may be assumed to be generally accepted that can be produced in England at any time of the year. Either there are several different causes which lead to the declara- the necessity for treatment under these conditions is a com" tion that an infant is " insusceptible to vaccination ; well- plete error or the method of building sanatoria in England known statistics such as those of Dr. Cory seem to show is a mistake. Certainly the methods or theories in the treatthat vaccination performed thrice unsuccessfully by no ment in England or in the high Alps in no way resemble The conditions are, and must be, entirely means implies an actual insusceptibility to vaccinia and no each other. doubt in a large majority of cases returned as " in- different. I write as regards the cure-the permanent cure susceptible"the vaccinator has been at fault either by in many cases-of pulmonary tuberculosis, and I do really scratching too minute an area of skin or by using inactive believe that the establishment in England of such sanat,oria, lymph, or, as has often been found, the mothers have pre- though leading to possible improvement at the time owing to vented the success of the operation by purposely washing or the greatly improved hygienic conditions and surroundings’, otherwise interfering with the "places" immediately the will never in the same or even in more than a very miner vaccination has been completed. It will probably be degree lead to the arrest and cure of pulmonary tuberagreed, however, that if such causes of failure are set aside culosis. there is a small residuum of cases truly insusceptible in the I would add that the suggested cost of the glass erection sense that vaccination of infants properly performed with suggested by "M.O.H." would more than pay for two efficient lymph on three occasions with intervals of a few seasons in the high Alps and he seems also to miss one of weeks or months between them has failed altogether; and the chief points, and that is that the air in his "house’" most vaccinators would recognise a degree of partial in- would be of necessity breathed and rebreathed. It is lik& susceptibility where out of several insertions of efficient applying a dirty dressing to a wound and it is only by vaccine over a considerable area made on each of two or being in the absolutely open air-not in rooms with even more occasions at most a single small vesicle has resulted. the windows open-that the same air is never breathed twiceThe purpose of my letter is to inquire of those who have over The healthy lung may not actually suffer from inhaling had large experience of vaccination whetlier any information the air over more than once-though it can certainly do can be furnished of the relation, if any, between such truly it no good-but to the diseased lung the air breathed should insusceptible or partially insusceptible infants and the con- be absolutely pure and this can only be obtained out of doors dition as to vaccination or variolation of the parents- and not inside any building. I would finish by adding that particularly of the mothers. In the case of an infant born to Dr. Lionel Beale’s description of the weather-four days oi, a mother actually ,uffering from small-pox there are recorded damp fog and wet and wind-more than fully confirms what instances in which the infant, vaccinated on several occa- I say about the impracticability of really carrying out thesions with efficient lymph and remaining exposed to variola, true "open-air"treatment of tuberculosis in England. I has developed neither vaccinia nor variola. This appears to think I may say that unless it has been seen in its entirety be the extreme case of true insusceptibility dependent on the as carried out here and in other high health resorts it is maternal condition. Are there known comparable instances impossible to appreciate one-tenth of its benefits or the in which an infant has been born to a mother actually suffer- advantages to be derived from it or the actual methods’ I am, Sirs, yours faithfully, ing from vaccinia and has proved insusceptible to vaccina- employed. A. G. P. GIPPS. tions properly performed with efficient lymph ? And, going GiPPS. Arosa, Dec. 14th, 1898. further back, what has been the condition as to insusceptibility or partial insusceptibility of infants born to mothers who have suffered from variola or vaccinia before but not " COPYRIGHT IN PRESCRIPTIONS." long antecedent to parturition? And, again, how long after To the Editors of THE LANCET. birth does this insusceptibility last ? Beyond two cases recently under my observation of infants SlR3,—You were good enough to publish a letter f om me whose mothers had been successfully revaccinated shortly on the above in which I advocated a subject some time before commencement of pregnancy and who, after several scheme which would limit the ago1 use of prescriptions to the vaccinations with lymph perfectly efficient and active when purposes for which they were intended, by granting copyused in other cases both before and after these failures, right in them to their authors. By this means it would be presented in one case no reaction and in the other a single easy to prevent a prescription written for a particular person small vesicle on the second time of vaccinating, I am unable at a particular time and in particular circumstances from to contribute any facts upon the subject. But the matter abuse by being made up over and over again for an indefinite has considerable interest and in Gloucester, Middlesbrough, time and used at times and in manners and perhaps even by and other places where no doubt there has lately been a con- other persons which were never contemplated by the siderable number of mothers vaccinated during pregnancy physician who was the author of the prescription. It is so or having small-pox during or immediately antecedent to clear to my mind that the author of a prescription should pregnancy there may have been several opportunities of have control to such an extent of the way that it is applied observing what, if any, has been the degree of insuscepti- that I feel sure that such an arrangement as I suggest must bility of their infants to vaccination. be brought about sooner or later, both as a matter of bare I am, Sirs, your faithfully, justice to medical men and also as conducive to the public G. P. P. SHUTER. SHUTER. Chiswick-lane, W., Dec. 9th, 1898. welfare. A case that strongly enforces the desirability of such a scheme being carried out has lately come to my knowledge and is as follows :"THE ’OPEN-AIR’ TREATMENT OF An inquest was held on Dec. 14th by Mr. Troutbeck, the coroner for Westminster, on the body of a lady, aged about TUBERCULOSIS." fifty years. The jury returned a verdict of "Accidental death To the Editors of THE LANCET. from an overdose of chloral hydrate." The following facts SiRS,—When my letter on the"open-air"" treatment of were given in evidence. The deceased had bought on tuberculosis was inserted in your issue of Nov. 26th, that Dec. 9th a 12 oz. bottle of a solution (syrup?) of chloral, conletter was written in London. This is dated from Arosa, at taining 80 grains to the ounce, at one of the so-called a height of over 6000 ft. in Switzerland. My letter has cooperative stores. This bottle was obtained by means of a, called forth a few remarks, one or two of which I should like prescription that had been written for the deceased’s to notice. I think Dr. Lionel Beale exactly hits it off when husband who had died five years previously. His widow (the he says that life to be spent Iin the contemplated sheds subject of the present inquest) had had it made up frequently in many parts of England in such weather as we have 1 THE LANCET, July 16th, 1898. lately enjoyed, would not be happy," and he might have