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THE HEALTH AND CONDITIONS OF WORK OF MEDICAL STUDENTS.
1063 The born surgeon, though he probably would be the first to take advantage of this kind of instruction, can look after himself, for he can pick up what he wants anywhere ; but there are not enough born surgeons to go round, and the more ordinary man must be taught the craft of surgery in exactly the same way as a carpenter or stone cutter is taught his particular craft, by learning the use of hisoftools under In one branch a good instructor. medicine, dentistry, the necessity of high-class craftsmanship is well understood, and ingenious methods have been devised to teach the student the use of his hands. Dissecting would form a useful link between fundamental craftsmanship and operating first on the dead
THE HEALTH AND CONDITIONS OF WORK OF MEDICAL STUDENTS. To the Editor of THE LANCET.
SIR,-Mr. Corner cannot, I think, have paid me the compliment of reading my paper, for he entirely misinterprets its purpose. As Mr. Corner seems under a misapprehension with regard to the object of my address, which was to consider the health and mortality, not the careers, of medical students, I cannot but be doubtful
as
to
whether the papers that he cites, his own and one by Sir Squire Sprigge, would have helped me materially. When I wrote asking for information on my subject, then on the living. We are not naturally accurate, we make ourselves the Dean of St. Thomas’s Hospital did not mention A painter, if Mr. Corner’s paper, which Mr. Corner tells me was accurate because necessity drives us. he is an artist, will always try to express himself published in the St. Thomas’s Hospital Gazette. The before he knows anything of the craft of painting ; Dean of St. George’s Hospital similarly did not refer he will force himself to learn to draw and paint, me to Sir Squire Sprigge’s contribution regarding because he finds out the necessity. Perhaps my only St. George’s students. Clearly these authorities, who valid excuse for daring to write this letter is that I were in a better position than I was to be familiar with have practised and instructed in two callings, both of the articles referred to-St. Thomas’s Hospital Gazette which, for their fullest expression, require such infinite is little read outside St. Thomas’s-did not regard labour from the apprentice. them as being pertinent to my inquiry. I am, Sir, yours
faithfully,
I am, Sir, yours faithfully, E. GRAHAM LITTLE.
HENRY TONKS. Slade School of Fine Art, University College, Gower-street, W.C., Nov. 11th, 1929.
BROWN
v.
WHITE BREAD.
To the Editor of THE LANCET. SIR,-Hartwell and Mottram found that their mice "
did not do well on an Essex " diet, that is, a diet based on one which Dr. A. B. Hill found to be an average one for Essex agricultural labourers and their families. Miss Brad and I have been inbreeding a stock of mice for six years and we have found the mice do very well and breed very well on an Essex diet. Our diet consists of meat, 5-8 ; potatoes, .
28-2 ; greens or peas or beans, 6-2 ; cheese, 0-8 ; tangerine, 2-8; sugar, 5-4; rolled oats, 0-8; milk, 8-3; white bread, 41-7. The food is got as cooked for our canteen lunch and is crumbled, shredded, and mixed together, and then minced. No water is added. We have come to regard this diet as excellent for producing fine-looking and well-breeding mice, better than what we call our "Alild" diet, three
I
THE DIAGNOSIS OF LARYNGEAL CANCER. To the Editor of THE LANCET.
SIR,-Mr. Layton has evaded my question as to why my cases illustrated by lantern slides of microscopical sections " afforded a strong argument against
biopsies." erroneous
The cases illustrated the correction of clinical diagnoses by means of the microscopical examination of portions of tissue removed for the purpose. The assurance afforded by the unmistakable evidence of the microscope led to the prompt adoption of energetic treatment and the preservation of lives which would otherwise have been lost. Mr. Layton may have justification for his objection to microscopical biopsies, but surely not founded on these cases. I am, Sir, yours faithfully, JAMES DUNDAS-GRANT.
inevitably
and raw green stuff. kinds I am, Sir, vours faithfully. tbhEof grain -’-
AVERTIN ANÆSTHESIA.
LEONARD HILL.
INTERPRETATION OF FERTILITY TESTS. To the Editor of THE LANCET. SiB,—May I make two observations
upon the
excellent article in your Clinical Interpretation Series by Mr. Kenneth Walker last week. Incompatibility or relative fertility is often due to lack of sexual orgasm in the female with a certain male partner. Women respond with varying intensity to different males, and consequently there is a variation in quantity and quality of their sexual secretions during intercourse. This also explains why a woman will often infect one man with gonorrhoea and not others. In other words she suffers from a type of impotency.
The second point is of great medico-legal importance, particularly in cases of disputed paternity. Mr. Walker quotes the numerical calculations of spermatozoa by Comber and Sanders, and points out that conception very rarely took place when the figure was below 60 million. I would suggest some other factor was operating. Bearing in mind that usually only one spermatozoon penetrates an ovum, and that simply spraying the vulva with semen has caused pregnancy, I at least would hesitate to give a negative reply unless I found 60 million in a specimen. T
anr)
Cir
-x7,niipQ
f",1t.’hf"lhr
M. W. BROWDY.
To the Editor
of
THE LANCET.
Sin,—I hope you will allow me to draw attention to some errors and omissions in your report of my paper on Avertin (THE LANCET, Nov. 9th, p. 979). Firstly, when speaking of the strengths of the solutions used I tried to make it clear that it is the manufacturers who now recommend a 2’5 per cent. in preference to a 3 per cent. solution on the grounds that absorption from a 2-5 per cent solution is more even and gradual but that I preferred the stronger solution for children as the smaller quantity of fluid to be injected is more readily retained by them. Secondly, the sentence beginning " fatal cases " misrepresents me, for only one death occurred in my series of 106 administrations, and I gave reasons for my belief that avertin was
not
responsible.
The omissions are more serious; no mention is made of the importance of testing the solution for impurities before injection, although this was emphasised. Again, no mention is made of the need for care in dosage, although a considerable part of my paper was devoted to the discussion of this essential ; the result is that I am reported as saying that avertin is " a safe means of induction," whereas my statement was that it is safe if used in the doses recommended by Prof. Eichholtz. I am, Sir, yours faithfully, FRANCIS SHIPWAY.
THE HEALTH AND CONDITIONS OF WORK OF MEDICAL STUDENTS. To the Editor of THE LANCET.
SIR,-Mr. Corner cannot, I think, have paid me the compliment of reading my paper, for he entirely misinterprets its purpose. As Mr. Corner seems under a misapprehension with regard to the object of my address, which was to consider the health and mortality, not the careers, of medical students, I cannot but be doubtful
as
to
whether the papers that he cites, his own and one by Sir Squire Sprigge, would have helped me materially. When I wrote asking for information on my subject, then on the living. We are not naturally accurate, we make ourselves the Dean of St. Thomas’s Hospital did not mention A painter, if Mr. Corner’s paper, which Mr. Corner tells me was accurate because necessity drives us. he is an artist, will always try to express himself published in the St. Thomas’s Hospital Gazette. The before he knows anything of the craft of painting ; Dean of St. George’s Hospital similarly did not refer he will force himself to learn to draw and paint, me to Sir Squire Sprigge’s contribution regarding because he finds out the necessity. Perhaps my only St. George’s students. Clearly these authorities, who valid excuse for daring to write this letter is that I were in a better position than I was to be familiar with have practised and instructed in two callings, both of the articles referred to-St. Thomas’s Hospital Gazette which, for their fullest expression, require such infinite is little read outside St. Thomas’s-did not regard labour from the apprentice. them as being pertinent to my inquiry. I am, Sir, yours
faithfully,
I am, Sir, yours faithfully, E. GRAHAM LITTLE.
HENRY TONKS. Slade School of Fine Art, University College, Gower-street, W.C., Nov. 11th, 1929.
BROWN
v.
WHITE BREAD.
To the Editor of THE LANCET. SIR,-Hartwell and Mottram found that their mice "
did not do well on an Essex " diet, that is, a diet based on one which Dr. A. B. Hill found to be an average one for Essex agricultural labourers and their families. Miss Brad and I have been inbreeding a stock of mice for six years and we have found the mice do very well and breed very well on an Essex diet. Our diet consists of meat, 5-8 ; potatoes, .
28-2 ; greens or peas or beans, 6-2 ; cheese, 0-8 ; tangerine, 2-8; sugar, 5-4; rolled oats, 0-8; milk, 8-3; white bread, 41-7. The food is got as cooked for our canteen lunch and is crumbled, shredded, and mixed together, and then minced. No water is added. We have come to regard this diet as excellent for producing fine-looking and well-breeding mice, better than what we call our "Alild" diet, three
I
THE DIAGNOSIS OF LARYNGEAL CANCER. To the Editor of THE LANCET.
SIR,-Mr. Layton has evaded my question as to why my cases illustrated by lantern slides of microscopical sections " afforded a strong argument against
biopsies." erroneous
The cases illustrated the correction of clinical diagnoses by means of the microscopical examination of portions of tissue removed for the purpose. The assurance afforded by the unmistakable evidence of the microscope led to the prompt adoption of energetic treatment and the preservation of lives which would otherwise have been lost. Mr. Layton may have justification for his objection to microscopical biopsies, but surely not founded on these cases. I am, Sir, yours faithfully, JAMES DUNDAS-GRANT.
inevitably
and raw green stuff. kinds I am, Sir, vours faithfully. tbhEof grain -’-
AVERTIN ANÆSTHESIA.
LEONARD HILL.
INTERPRETATION OF FERTILITY TESTS. To the Editor of THE LANCET. SiB,—May I make two observations
upon the
excellent article in your Clinical Interpretation Series by Mr. Kenneth Walker last week. Incompatibility or relative fertility is often due to lack of sexual orgasm in the female with a certain male partner. Women respond with varying intensity to different males, and consequently there is a variation in quantity and quality of their sexual secretions during intercourse. This also explains why a woman will often infect one man with gonorrhoea and not others. In other words she suffers from a type of impotency.
The second point is of great medico-legal importance, particularly in cases of disputed paternity. Mr. Walker quotes the numerical calculations of spermatozoa by Comber and Sanders, and points out that conception very rarely took place when the figure was below 60 million. I would suggest some other factor was operating. Bearing in mind that usually only one spermatozoon penetrates an ovum, and that simply spraying the vulva with semen has caused pregnancy, I at least would hesitate to give a negative reply unless I found 60 million in a specimen. T
anr)
Cir
-x7,niipQ
f",1t.’hf"lhr
M. W. BROWDY.
To the Editor
of
THE LANCET.
Sin,—I hope you will allow me to draw attention to some errors and omissions in your report of my paper on Avertin (THE LANCET, Nov. 9th, p. 979). Firstly, when speaking of the strengths of the solutions used I tried to make it clear that it is the manufacturers who now recommend a 2’5 per cent. in preference to a 3 per cent. solution on the grounds that absorption from a 2-5 per cent solution is more even and gradual but that I preferred the stronger solution for children as the smaller quantity of fluid to be injected is more readily retained by them. Secondly, the sentence beginning " fatal cases " misrepresents me, for only one death occurred in my series of 106 administrations, and I gave reasons for my belief that avertin was
not
responsible.
The omissions are more serious; no mention is made of the importance of testing the solution for impurities before injection, although this was emphasised. Again, no mention is made of the need for care in dosage, although a considerable part of my paper was devoted to the discussion of this essential ; the result is that I am reported as saying that avertin is " a safe means of induction," whereas my statement was that it is safe if used in the doses recommended by Prof. Eichholtz. I am, Sir, yours faithfully, FRANCIS SHIPWAY.