- Email: [email protected]
THE PROPOSED TEACHING UNIVERSITY AND THE MEDICAL CORPORATIONS.
THE NOTIFICATION OF PHTHISIS
686
defeated by only one vote, to include phthisis Post, is beginning to attract public attention, and we are among the notifiable diseases. The Bollington Local Board afraid that Mr. VAcnEE’s letter in answer to that article hardly is, we believe, not the only sanitary authority in Cheshire places the matter in its light light. To pronounce that and the counties surrounding it which has taken the sugges- "consumption is infectious through the excretions of the tion of the county council into serious consideration, and patient, like typhoid fever or cholera,"is, we think, perhaps some of them have, we learn, gone so far as to approach the hardly a desirable way of explaining the position to the Local Government Board for sanction to include phthisis public. It is certainly true that pulmonary tuberculosis is as a disease notifiable under the provisions of the Infectious probably communicable mainly by means of sputa, and Diseases (Notification) Act, 1889. It does not, however, intestinal tuberculosis by the excreta, but nevertheless we appear that there is by any means unanimity of opinion are hardly prepared to regard a tuberculous motion in quite among the advocates of notification as to what course is to the same light as "rice-water " evacuations. Although we be adopted as regards the cases of phthisis so notified, nor is speak in this way we fully recognise the importance of much it quite clear whether it is the intention of any of these good work which is being done with regard to limiting the authorities to embrace tuberculous affections of organs other spread of phthisis, and more especially do we think which
was
than the lungs in their operations. As far as we can learn there is a tendency among the sanitary authorities who advocate
notification to divide themselves into two camps, the one proposing only to interefere after the death of a patient from phthisis, the other animated with a desire to class the disease as "infectious," and apparently to deal with it in thee same manner as other infectious diseases. We must confess we have as yet seen no detailed account of what the supporters of this proposal have in view; but if phthisis is to be definitely scheduled as an infectious disease in our statute book it would certainly appear that it will become--at any rate, in process of time-amenable to all the provisions as regards infectious diseases in the Public Health Acts. If this be so, it is hardly possible to contemplate the result without some misgivings. Let us take, for instance, the case of a conscientious young man just about to enter life, and who is considered by his medical adviser to be manifesting the signs and symptoms of phthisis. The case
his
is in due
course
a
becomes in is in the and early death, to the public health. More
notified, and the patient
destined to
eyes leper, eyes of the community a than this, he would, if own
an
danger our supposition
be correct, be in
constant dread of the Public Health Act, 1875, and the Infectious Disease (Prevention) Act, 1890 ; his chances of would have vanished for ever, and the insurance societies would refuse to consider his proposal. If, too,
that the recent
of Dr. NiVEN in sending round house in Oldham leaflets setting
practice
every year to each forth how best to minimise is likely to be productive of
the
good
risks results.
of
infection The ques.
tion, however, is rather whether the energy proposed to be devoted to notification, &c , might not-at any rate, at present-be expended in a more profitable manner by a more rigid control of the conditions under which our milk supplies are secreted, drawn and stored, and by educating the public as to the influence which overcrowding, darkness, dampness, want of to the
ventilation, &c., are believed to have in predisposing disease ; in fact to impress up)n them the point that
susceptibility of important a factor as
a person to phthisis is at any rate as the exposure to infection. Our object has, however, rather been to utter a note of warning against any too precipitate scheduling of phthisis as an infectious disease, without adequate realisation of the issues involved,
the
regard as to what effect such a course might have creating on the part of the public a bias against the notification, not only of phthisis, but even of the more directly infectious diseases. At any rate, we think that the question may be very well postponed until the members of the Royal and
a
due
in
Commission
on
Tuberculosis have issued their report.
marriage
his removal to some isolation hospital was not insisted upon, and he was allowed, with the constant accompaniment of
disinfectant, to travel for the benefit of his health, he would, nevertheless, feel bound to a
spittoon provided
with
a
notify his leprous
condition to all hotel-keepers in order that disinfection of his room might be properly carried out. Add to this the by no means impossible circumstance that
the
diagnosis
was erroneous or
that the
patient
recovers-at
any rate, for a time-and we have some faint indication of the result of dealing with phthisis as an infectious disease within the meaning of the sanitary Acts. Possibly, in order to obviate erroneous diagnosis, it might be held to be a sine
of notification that the existence of the bacillus of tubercle should be demonstrated ; but, under the present conditions of medical education, we are obviously here face Errors of diagnosis in to face with an impracticability. dealing with infectious diseases such as scarlet fever, &c , are naturally to be deplored ; but the consequences would be but small as compared with the same error in dealing with phthisis. This question of the notification of phthisis is one which, if we may judge from a leading article in the Morning
qua non
Annotations. 11
Ne quid nimix.1’
THE PROPOSED TEACHING UNIVERSITY AND THE MEDICAL CORPORATIONS. ON Monday and Tuesday next respectively the Fellows and Members of the Royal College of Surgeonc, and on Monday the Fellows of the Royal College of Physicians, are summoned to consider the position of the Royal Colleges with regard to the proposals suggested by the Commissioners appointed to consider the Draft Charter for the proposed Gresham University in London. The Commissioners have taken in the widest possible sense their mandate "to consider, and, if you think fit, alter, amend, and extend, the proposed Charter ...... so as to form and report to us a scheme for the establishment under charter of an Efficient Teaching University for London." In the first place, they have recommended that the changes suggested by them should be effected, not by charter, but by legislative authority and by the appointment of a Commission with statutory powers. On the views of this Statutoiy y Commission will depend, so far as the proposed University is
THE INTERNATIONAL MEDICAL CONGRESS.
concerned, the position and relations of every institution and teacher who is connected, however remotely, with higher education in the metropolis. This Commission is "to receive the assents of the various persons and bodies, other than the Crown, the Convocation, the Faculties, and the Academic Council, who are to nominate to seats upon the Senate." Of the sixty-five senators, two will be appointed by the Royal two by the Royal College of Surgeons, by the Society of Apothecaries. The Senate will obviously be too large a body for any concerted action, and its work will be mainly performed by committees. The corporations, therefore, are sure of a substantial representation on any committee of medicine which can be formed from the members of the proposed Senate. The time has come when the Royal Colleges will have to admit the existence of the Society of Apothecaries. We have always protested against the blindness of the two corporations in ignoring the fact that there was a third licensing authority doing vigorous work, and we hope that, under the auspices of a Metropolitan University, a scheme for a more or less complete fusion of medical examinations and a reconcilicg of interests may take place. The University is recommended to enter into arrangements with the corporations for conducting in common certain parts of the examination for degrees ; and
College of Physicians,
and
one
687
ments will be invited ; (2) at the garden party to be held in the of the Quirinal, when invitations will be limited to 3000. Another and most attractive feature of the Congress will be theEsposizione Internazionale di Medicina e d’ Igiene,’ which, as already noted in THE LANCET, will be held not only in the gran serra,’ the ground floor and certain of the upper floors of the Fine Art Exhibition buildings, but in the space just cleared beside the Eldorado and in the vast locale behind the said buildings themselves. The success of theEsposizione’ will, it is asserted, far exceed all expectations. The exhibitors will number over 500, while many claims for permission to exhibit have had reluctantly to be disallowed because there is no more room available (non vi e Piic spazio disponibile). The of the and also most the majority ’Espositori,’ important as to wares and articles placed en evidence, are the Germans. The committee has completed the arrangements formerly mentioned for the electric illumination of theEsposizione,’ as the grand jury must hold its sittings in the evening so as to leave time for its members to assist at the Congress during the day. Acknowledgment may here be made of the engineers, Signors Bentivegna and Berlenda, to whose skill and energy, seconded by an admirable personnel, the arrangements are due. Among the exhibits those of the Central Committee of the Italian Red Cross will be peculiarly attractive. They will include a mountain hospital fully equipped and also a com-
grounds
suppose, will at once determine these bodies in accepting the seats offered to them on the Senate. It is, however, necessary to point out that the Academic Council pletely appointed sanitary flotilla and floating ambulance for of sixteen, which will practically be elected by the teachers, service on the great rivers and lakes of Europe. An elaborate will be the effective and determining body in the University. specimen of an ambulance train will further be on view. In To this body will be entrusted the duty of regulating- addition to these the exhibits of the Knights of Malta will subject to the ordinances of the University-the teaching, have special interest, representing as they do for the first examinations, and discipline of the University, and of time, certain useful innovations in the va2teriel for the care determining what teachers shall be recognised as university and cure of the wounded in war. " teachers, and to what faculties they shall be assigned. It is quite clear, therefore, that, whilst the professional corporaFLUSHING AND BLUSHING. tions are asked to send representatives to the Senate who AT first sight there is not much difference between flushing may discuss and, to a certain extent, guide the simplification and blushing, and, as far as the actual mechanism is conof the existing system of examinations, the teachers from the schools will form the real authority by electing the Academic cerned, this is true enough. The difference lies in the cause rather than in the character of the heightened colour. A Council, and it behoves each medical school to see that its interests are not sacrificed by this council of whom only blush is always the outcome of mental emotion ; the outward expression either of shame, shyness, or modesty. Flushing ’three out of sixteen will represent the faculty of Medicine. arises independently of mental emotion and may be a symptom of a large number of morbid conditions of which THE INTERNATIONAL MEDICAL CONGRESS. the reflex flushing after meals from dyspepsia is one of the DATING from Rome the lltli inst., our own correspondent most common and familiar, while that which constitutes part writes:—"For those who anticipate an inconveniently of the pre-convulsive aura of epileptics is the most important. crowded gathering it must be reassuring to find that such is Blushing is usually confined to the sides of the neck and face, not the forecast of the central committee, who have now especially the cheeks, and this localisation has been explained added to the facilities already available for intending ’Con- by the part being always exposed ; but this is not all, as gressisti’ quite another set of conditions, enabling persons otherwise our hands would also blush, and Darwin suggests outside the profession to appear at the sittings. According to that the redness is determined to the face by the amount of 3"oolló1nuniqué just received from the Segreteria Generale,’ attention which has been directed to the face throughBut blushing is by no the committee have resolved that, besides the physicians out innumerable generations. and surgeons and graduates in cognate sciences,all those means confined to the face, and in many cases extends persons who take an interest in the works of the Congress to the chest and shoulders, and even the whole body has itself’ will, on payment of 25 francs, be entitled to a mem- been known to redden under violent mental emotion. While ber’s ticket with all the privileges it implies, including par- the blush of shame in anyone and the blush of shyness in ticipation in the proceedings of the sections. The ladies of the child or of modesty in the young girl may be considered the ’Congressisti’ (so runs the communique) and the grown- a normal expression of the emotions, there are many inup members of their families will have to be introduced by a dividuals in whom blushing has become so easily excited and ’Congressista’to obtain their special ticket (price 10 francs). frequent as not only to introduce into their existence a All those, it continues, who are furnished with the said positive discomfort, but to render them actually unfit for tickets will be empowered to assist at the meetings, and at the business and social conduct of life, and blushing the fetes held in honour of the members proper. To these becomes a positive disease. There is no doubt that selftatter entertainments, however, exceptions will be made in at consciousness plays an important part in the production and least two instances : (1) At the banquet given by their perpetuation of this unpleasant manifestation, and, moreMajesties King Humbert and Queen Margaret at the Palace over, that the actual reddening of the skin is only one of of the Quirinal, when only the corps diploniatique accredited a series of symptoms which may accompany or precede the to the Court, the President and Vice-presidents of the blushing, mental confusion, a feeling of helplessness, palpitaCongress, and those officially representing foreign govern - tion, inability to speak and hanging down of the head, casting
this,
we
686
defeated by only one vote, to include phthisis Post, is beginning to attract public attention, and we are among the notifiable diseases. The Bollington Local Board afraid that Mr. VAcnEE’s letter in answer to that article hardly is, we believe, not the only sanitary authority in Cheshire places the matter in its light light. To pronounce that and the counties surrounding it which has taken the sugges- "consumption is infectious through the excretions of the tion of the county council into serious consideration, and patient, like typhoid fever or cholera,"is, we think, perhaps some of them have, we learn, gone so far as to approach the hardly a desirable way of explaining the position to the Local Government Board for sanction to include phthisis public. It is certainly true that pulmonary tuberculosis is as a disease notifiable under the provisions of the Infectious probably communicable mainly by means of sputa, and Diseases (Notification) Act, 1889. It does not, however, intestinal tuberculosis by the excreta, but nevertheless we appear that there is by any means unanimity of opinion are hardly prepared to regard a tuberculous motion in quite among the advocates of notification as to what course is to the same light as "rice-water " evacuations. Although we be adopted as regards the cases of phthisis so notified, nor is speak in this way we fully recognise the importance of much it quite clear whether it is the intention of any of these good work which is being done with regard to limiting the authorities to embrace tuberculous affections of organs other spread of phthisis, and more especially do we think which
was
than the lungs in their operations. As far as we can learn there is a tendency among the sanitary authorities who advocate
notification to divide themselves into two camps, the one proposing only to interefere after the death of a patient from phthisis, the other animated with a desire to class the disease as "infectious," and apparently to deal with it in thee same manner as other infectious diseases. We must confess we have as yet seen no detailed account of what the supporters of this proposal have in view; but if phthisis is to be definitely scheduled as an infectious disease in our statute book it would certainly appear that it will become--at any rate, in process of time-amenable to all the provisions as regards infectious diseases in the Public Health Acts. If this be so, it is hardly possible to contemplate the result without some misgivings. Let us take, for instance, the case of a conscientious young man just about to enter life, and who is considered by his medical adviser to be manifesting the signs and symptoms of phthisis. The case
his
is in due
course
a
becomes in is in the and early death, to the public health. More
notified, and the patient
destined to
eyes leper, eyes of the community a than this, he would, if own
an
danger our supposition
be correct, be in
constant dread of the Public Health Act, 1875, and the Infectious Disease (Prevention) Act, 1890 ; his chances of would have vanished for ever, and the insurance societies would refuse to consider his proposal. If, too,
that the recent
of Dr. NiVEN in sending round house in Oldham leaflets setting
practice
every year to each forth how best to minimise is likely to be productive of
the
good
risks results.
of
infection The ques.
tion, however, is rather whether the energy proposed to be devoted to notification, &c , might not-at any rate, at present-be expended in a more profitable manner by a more rigid control of the conditions under which our milk supplies are secreted, drawn and stored, and by educating the public as to the influence which overcrowding, darkness, dampness, want of to the
ventilation, &c., are believed to have in predisposing disease ; in fact to impress up)n them the point that
susceptibility of important a factor as
a person to phthisis is at any rate as the exposure to infection. Our object has, however, rather been to utter a note of warning against any too precipitate scheduling of phthisis as an infectious disease, without adequate realisation of the issues involved,
the
regard as to what effect such a course might have creating on the part of the public a bias against the notification, not only of phthisis, but even of the more directly infectious diseases. At any rate, we think that the question may be very well postponed until the members of the Royal and
a
due
in
Commission
on
Tuberculosis have issued their report.
marriage
his removal to some isolation hospital was not insisted upon, and he was allowed, with the constant accompaniment of
disinfectant, to travel for the benefit of his health, he would, nevertheless, feel bound to a
spittoon provided
with
a
notify his leprous
condition to all hotel-keepers in order that disinfection of his room might be properly carried out. Add to this the by no means impossible circumstance that
the
diagnosis
was erroneous or
that the
patient
recovers-at
any rate, for a time-and we have some faint indication of the result of dealing with phthisis as an infectious disease within the meaning of the sanitary Acts. Possibly, in order to obviate erroneous diagnosis, it might be held to be a sine
of notification that the existence of the bacillus of tubercle should be demonstrated ; but, under the present conditions of medical education, we are obviously here face Errors of diagnosis in to face with an impracticability. dealing with infectious diseases such as scarlet fever, &c , are naturally to be deplored ; but the consequences would be but small as compared with the same error in dealing with phthisis. This question of the notification of phthisis is one which, if we may judge from a leading article in the Morning
qua non
Annotations. 11
Ne quid nimix.1’
THE PROPOSED TEACHING UNIVERSITY AND THE MEDICAL CORPORATIONS. ON Monday and Tuesday next respectively the Fellows and Members of the Royal College of Surgeonc, and on Monday the Fellows of the Royal College of Physicians, are summoned to consider the position of the Royal Colleges with regard to the proposals suggested by the Commissioners appointed to consider the Draft Charter for the proposed Gresham University in London. The Commissioners have taken in the widest possible sense their mandate "to consider, and, if you think fit, alter, amend, and extend, the proposed Charter ...... so as to form and report to us a scheme for the establishment under charter of an Efficient Teaching University for London." In the first place, they have recommended that the changes suggested by them should be effected, not by charter, but by legislative authority and by the appointment of a Commission with statutory powers. On the views of this Statutoiy y Commission will depend, so far as the proposed University is
THE INTERNATIONAL MEDICAL CONGRESS.
concerned, the position and relations of every institution and teacher who is connected, however remotely, with higher education in the metropolis. This Commission is "to receive the assents of the various persons and bodies, other than the Crown, the Convocation, the Faculties, and the Academic Council, who are to nominate to seats upon the Senate." Of the sixty-five senators, two will be appointed by the Royal two by the Royal College of Surgeons, by the Society of Apothecaries. The Senate will obviously be too large a body for any concerted action, and its work will be mainly performed by committees. The corporations, therefore, are sure of a substantial representation on any committee of medicine which can be formed from the members of the proposed Senate. The time has come when the Royal Colleges will have to admit the existence of the Society of Apothecaries. We have always protested against the blindness of the two corporations in ignoring the fact that there was a third licensing authority doing vigorous work, and we hope that, under the auspices of a Metropolitan University, a scheme for a more or less complete fusion of medical examinations and a reconcilicg of interests may take place. The University is recommended to enter into arrangements with the corporations for conducting in common certain parts of the examination for degrees ; and
College of Physicians,
and
one
687
ments will be invited ; (2) at the garden party to be held in the of the Quirinal, when invitations will be limited to 3000. Another and most attractive feature of the Congress will be theEsposizione Internazionale di Medicina e d’ Igiene,’ which, as already noted in THE LANCET, will be held not only in the gran serra,’ the ground floor and certain of the upper floors of the Fine Art Exhibition buildings, but in the space just cleared beside the Eldorado and in the vast locale behind the said buildings themselves. The success of theEsposizione’ will, it is asserted, far exceed all expectations. The exhibitors will number over 500, while many claims for permission to exhibit have had reluctantly to be disallowed because there is no more room available (non vi e Piic spazio disponibile). The of the and also most the majority ’Espositori,’ important as to wares and articles placed en evidence, are the Germans. The committee has completed the arrangements formerly mentioned for the electric illumination of theEsposizione,’ as the grand jury must hold its sittings in the evening so as to leave time for its members to assist at the Congress during the day. Acknowledgment may here be made of the engineers, Signors Bentivegna and Berlenda, to whose skill and energy, seconded by an admirable personnel, the arrangements are due. Among the exhibits those of the Central Committee of the Italian Red Cross will be peculiarly attractive. They will include a mountain hospital fully equipped and also a com-
grounds
suppose, will at once determine these bodies in accepting the seats offered to them on the Senate. It is, however, necessary to point out that the Academic Council pletely appointed sanitary flotilla and floating ambulance for of sixteen, which will practically be elected by the teachers, service on the great rivers and lakes of Europe. An elaborate will be the effective and determining body in the University. specimen of an ambulance train will further be on view. In To this body will be entrusted the duty of regulating- addition to these the exhibits of the Knights of Malta will subject to the ordinances of the University-the teaching, have special interest, representing as they do for the first examinations, and discipline of the University, and of time, certain useful innovations in the va2teriel for the care determining what teachers shall be recognised as university and cure of the wounded in war. " teachers, and to what faculties they shall be assigned. It is quite clear, therefore, that, whilst the professional corporaFLUSHING AND BLUSHING. tions are asked to send representatives to the Senate who AT first sight there is not much difference between flushing may discuss and, to a certain extent, guide the simplification and blushing, and, as far as the actual mechanism is conof the existing system of examinations, the teachers from the schools will form the real authority by electing the Academic cerned, this is true enough. The difference lies in the cause rather than in the character of the heightened colour. A Council, and it behoves each medical school to see that its interests are not sacrificed by this council of whom only blush is always the outcome of mental emotion ; the outward expression either of shame, shyness, or modesty. Flushing ’three out of sixteen will represent the faculty of Medicine. arises independently of mental emotion and may be a symptom of a large number of morbid conditions of which THE INTERNATIONAL MEDICAL CONGRESS. the reflex flushing after meals from dyspepsia is one of the DATING from Rome the lltli inst., our own correspondent most common and familiar, while that which constitutes part writes:—"For those who anticipate an inconveniently of the pre-convulsive aura of epileptics is the most important. crowded gathering it must be reassuring to find that such is Blushing is usually confined to the sides of the neck and face, not the forecast of the central committee, who have now especially the cheeks, and this localisation has been explained added to the facilities already available for intending ’Con- by the part being always exposed ; but this is not all, as gressisti’ quite another set of conditions, enabling persons otherwise our hands would also blush, and Darwin suggests outside the profession to appear at the sittings. According to that the redness is determined to the face by the amount of 3"oolló1nuniqué just received from the Segreteria Generale,’ attention which has been directed to the face throughBut blushing is by no the committee have resolved that, besides the physicians out innumerable generations. and surgeons and graduates in cognate sciences,all those means confined to the face, and in many cases extends persons who take an interest in the works of the Congress to the chest and shoulders, and even the whole body has itself’ will, on payment of 25 francs, be entitled to a mem- been known to redden under violent mental emotion. While ber’s ticket with all the privileges it implies, including par- the blush of shame in anyone and the blush of shyness in ticipation in the proceedings of the sections. The ladies of the child or of modesty in the young girl may be considered the ’Congressisti’ (so runs the communique) and the grown- a normal expression of the emotions, there are many inup members of their families will have to be introduced by a dividuals in whom blushing has become so easily excited and ’Congressista’to obtain their special ticket (price 10 francs). frequent as not only to introduce into their existence a All those, it continues, who are furnished with the said positive discomfort, but to render them actually unfit for tickets will be empowered to assist at the meetings, and at the business and social conduct of life, and blushing the fetes held in honour of the members proper. To these becomes a positive disease. There is no doubt that selftatter entertainments, however, exceptions will be made in at consciousness plays an important part in the production and least two instances : (1) At the banquet given by their perpetuation of this unpleasant manifestation, and, moreMajesties King Humbert and Queen Margaret at the Palace over, that the actual reddening of the skin is only one of of the Quirinal, when only the corps diploniatique accredited a series of symptoms which may accompany or precede the to the Court, the President and Vice-presidents of the blushing, mental confusion, a feeling of helplessness, palpitaCongress, and those officially representing foreign govern - tion, inability to speak and hanging down of the head, casting
this,
we