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THE REGISTRAR'S PLIGHT
115 which my assailant could not face.
Encouraged by this I put up a barrage to cover my daughter’s retreat to the other bank ; and a somewhat more accurate barrage from two small boys, who welcomed the opportunity with glee, did the same for your somewhat battered correspondent, now incapable of vision from his right eye. For a week to come I received solicitous inquiries The as to how I came by such a wonderful black eye. arm bruises being deeper were more slow in showing, but
Letters to the Editor
success
THE REGISTRAR’S PLIGHT
SiR,-The "registrar problem," discussed in your
leading article of June 24,
cannot easily be solved without either unfairness to the registrars or detriment to the hospital services. If the present number of registrars is maintained it is certain that many will be unable to impressive. I still do not know whether a swan can break a man’s obtain consultant posts, and it is hard to know how arm with a blow of his wing, but I am entirely convinced they can then be employed usefully and contentedly and tliat the bather should avoid the cock swan who is without wasting their special training. If, as seems cares. oppressed by family the number of is likely, registrar posts drastically reduced, * * * the hospital services will become less efficient. Much of The peripatetic first-aid examiner (July 1) was the very necessary work now being done by registrars unluckv in his viva candidates. I remember one cannot be done well by less experienced people, and a particular session because five successive examinees compensatory increase in the number of consultants does answered my question on the treatment of gastric haemorrhage by rattling out, parrot fashion, " oyster not seem likely at present. The eventual number of registrar posts will probably soup." This was at Birmingham, and as I was a Scot, I did not realise the intended answer was " ice to suck." be estimated by predicting the consultant vacancies I was pleased with this little misunderstanding, just as likely to be open in the future, with allowance for some I had been puzzled by the local delicacy which seemed to registrars who drop by the wayside and for others who cause so many bellyaches to be called " unfidum," will eventually go abroad or into the Armed Forces. translated as home fed ham." The smaller number of registrars so arrived at will Of course I related my examination experiences in the almost certainly be inadequate for the amount of work mess, never thinking it would appear in The Lancet years that is to be done. The gap could be at least partly later in an article on Hints to M.R.C.P. Candidates," but the story had changed slightly in the interval. The filled by taking on as registrars more postgraduate stu.scene was now an M.R.C.P. viva. The examiner asked dents from abroad, many of whom have hitherto been my question; the poor candidates recommended the discouraged by the difficulty of getting worth-while same soup. The examiner solved the conundrum by hospital appointments in this country. There are already discovering that the candidates had all attended a cram many such people in Britain, eager for work and expericlass run by a Scotsman where there had been a bit ence, and if the jobs were available there could be more. of difficulty over his accent. Most of them have commitments or prospects at home, The Times fourth leader the other day discussed the and few would likely remain to compete for consultant birth of jokes and anecdotes, and wondered where they started. I know where this one started, and I am still vacancies here. It is time for a planned policy of postgraduate medical proud of my child, although it is a bit of a changeling. * f * training, based on the needs of the world community and the contribution which this country in particular can As one of diverted diploma graduates,1 At present peripateticauy covering miles and, miles in make. The present trend, unfortunately, is to pander to the relentless brilliance of Africa, may I send this titbit the demand for multiple higher qualifications by organiof tropical hygiene ? sing longer and drier didactic lecture courses as preparaWe met several tsetse control posts in Portuguese tion for more and more complex examinations. As and the East Africa and some in Nyasaland procedure similar amenities are now available in the Dominions and We drove the car into was roughly the same in each. elsewhere, fewer students are likely in the future to come a sort of garage shed, with doors at both ends and a thing that might havebeen a fume cupboard at the to Britain for these inducements alone. It is not wholly side. The doors were shut and an African solemnly appreciated here that Britain’s greatest single attraction sprayed us here and there with aFlit’ gun-we formed to postgraduate students from less thickly populated the impression that tsetse only fly in a band 3-4 ft. from countries is the concentration of clinical material to be the ground. Then there was a pause for about 2 or 3 studied and the vast bulk of work to be done in British minutes, after which either the spraying was repeated or hospitals. If this asset can be used to the full in postthe door opened and we were freed. This interesting graduate teaching, Britain’s future as a world medical ritual took place several times ; we never knew whether will become much more certain. It is to be hoped centre In we were entering or leaving the infested area. that the final establishment of registrar posts is not set the was further still Nyasaland procedure simplified. The African in charge informed us that as it was after too low until this possibility has been thoroughly explored 6 P.M. their post had stopped work and we could go and a broad policy decided upon, to which the Ministry, the straight through. Evidently tsetses keep trade-union Royal colleges, and the universities could all contribute hours. to their mutual advantage. * !i! * D. B. STEWART. Aberdeen. After moving the patient into a better light I sat down "
"
_
Mackintoshes
-
to await what I expected would be a perfectly normal delivery. Nor did I have to wait long. Very soon the vertex peeped out shyly and was crowned ; then the head was completely delivered and it was fully extended immediately afterwards. The thorax followed quickly, and the legs were born and waved feebly in the air. Next there was half an hour of apparent inertia without further progress. There seemed to be some difficulty in delivering the aftercoming abdomen, and I began to get worried. I had never seen or read of such a thing before and did not know what to do. There was no obvious distress, so I refrained from interfering (apart from testing an occasional reflex) and allowed nature to take its course. And rightly, for suddenly the abdomen slipped out easily, and the dragon-fly promptly reversed its position and began to dry its wings. 1. See Lancet
1950, i, 934, 1019.
CEREBELLAR SYNDROME FOLLOWING SODIUM AMYTAL
SiR,—I was much interested in Dr. Bodman’s observations last week on cerebellar effects following administration of ’Sodium amytal,’ and would like to mention some observations of my own. These are recorded in my article on the anaesthesia of rabbits in the UFAW handbook on the Care and JYlanagement of Laboratory Animals (London, 1947)-an article that was written in 1944-45. Of rabbits anaesthetised with intravenous ’Nembutal’ (sodium iso-amytal) or ’Evipan ’ (hexobarbitone), a fairly large proportion showed some degree of nystagmus, often quite slight, but sometimes very marked indeed, with synchronous nystagmoid movements of the whisker or even of the whole head. On at least one occasion, -
Encouraged by this I put up a barrage to cover my daughter’s retreat to the other bank ; and a somewhat more accurate barrage from two small boys, who welcomed the opportunity with glee, did the same for your somewhat battered correspondent, now incapable of vision from his right eye. For a week to come I received solicitous inquiries The as to how I came by such a wonderful black eye. arm bruises being deeper were more slow in showing, but
Letters to the Editor
success
THE REGISTRAR’S PLIGHT
SiR,-The "registrar problem," discussed in your
leading article of June 24,
cannot easily be solved without either unfairness to the registrars or detriment to the hospital services. If the present number of registrars is maintained it is certain that many will be unable to impressive. I still do not know whether a swan can break a man’s obtain consultant posts, and it is hard to know how arm with a blow of his wing, but I am entirely convinced they can then be employed usefully and contentedly and tliat the bather should avoid the cock swan who is without wasting their special training. If, as seems cares. oppressed by family the number of is likely, registrar posts drastically reduced, * * * the hospital services will become less efficient. Much of The peripatetic first-aid examiner (July 1) was the very necessary work now being done by registrars unluckv in his viva candidates. I remember one cannot be done well by less experienced people, and a particular session because five successive examinees compensatory increase in the number of consultants does answered my question on the treatment of gastric haemorrhage by rattling out, parrot fashion, " oyster not seem likely at present. The eventual number of registrar posts will probably soup." This was at Birmingham, and as I was a Scot, I did not realise the intended answer was " ice to suck." be estimated by predicting the consultant vacancies I was pleased with this little misunderstanding, just as likely to be open in the future, with allowance for some I had been puzzled by the local delicacy which seemed to registrars who drop by the wayside and for others who cause so many bellyaches to be called " unfidum," will eventually go abroad or into the Armed Forces. translated as home fed ham." The smaller number of registrars so arrived at will Of course I related my examination experiences in the almost certainly be inadequate for the amount of work mess, never thinking it would appear in The Lancet years that is to be done. The gap could be at least partly later in an article on Hints to M.R.C.P. Candidates," but the story had changed slightly in the interval. The filled by taking on as registrars more postgraduate stu.scene was now an M.R.C.P. viva. The examiner asked dents from abroad, many of whom have hitherto been my question; the poor candidates recommended the discouraged by the difficulty of getting worth-while same soup. The examiner solved the conundrum by hospital appointments in this country. There are already discovering that the candidates had all attended a cram many such people in Britain, eager for work and expericlass run by a Scotsman where there had been a bit ence, and if the jobs were available there could be more. of difficulty over his accent. Most of them have commitments or prospects at home, The Times fourth leader the other day discussed the and few would likely remain to compete for consultant birth of jokes and anecdotes, and wondered where they started. I know where this one started, and I am still vacancies here. It is time for a planned policy of postgraduate medical proud of my child, although it is a bit of a changeling. * f * training, based on the needs of the world community and the contribution which this country in particular can As one of diverted diploma graduates,1 At present peripateticauy covering miles and, miles in make. The present trend, unfortunately, is to pander to the relentless brilliance of Africa, may I send this titbit the demand for multiple higher qualifications by organiof tropical hygiene ? sing longer and drier didactic lecture courses as preparaWe met several tsetse control posts in Portuguese tion for more and more complex examinations. As and the East Africa and some in Nyasaland procedure similar amenities are now available in the Dominions and We drove the car into was roughly the same in each. elsewhere, fewer students are likely in the future to come a sort of garage shed, with doors at both ends and a thing that might havebeen a fume cupboard at the to Britain for these inducements alone. It is not wholly side. The doors were shut and an African solemnly appreciated here that Britain’s greatest single attraction sprayed us here and there with aFlit’ gun-we formed to postgraduate students from less thickly populated the impression that tsetse only fly in a band 3-4 ft. from countries is the concentration of clinical material to be the ground. Then there was a pause for about 2 or 3 studied and the vast bulk of work to be done in British minutes, after which either the spraying was repeated or hospitals. If this asset can be used to the full in postthe door opened and we were freed. This interesting graduate teaching, Britain’s future as a world medical ritual took place several times ; we never knew whether will become much more certain. It is to be hoped centre In we were entering or leaving the infested area. that the final establishment of registrar posts is not set the was further still Nyasaland procedure simplified. The African in charge informed us that as it was after too low until this possibility has been thoroughly explored 6 P.M. their post had stopped work and we could go and a broad policy decided upon, to which the Ministry, the straight through. Evidently tsetses keep trade-union Royal colleges, and the universities could all contribute hours. to their mutual advantage. * !i! * D. B. STEWART. Aberdeen. After moving the patient into a better light I sat down "
"
_
Mackintoshes
-
to await what I expected would be a perfectly normal delivery. Nor did I have to wait long. Very soon the vertex peeped out shyly and was crowned ; then the head was completely delivered and it was fully extended immediately afterwards. The thorax followed quickly, and the legs were born and waved feebly in the air. Next there was half an hour of apparent inertia without further progress. There seemed to be some difficulty in delivering the aftercoming abdomen, and I began to get worried. I had never seen or read of such a thing before and did not know what to do. There was no obvious distress, so I refrained from interfering (apart from testing an occasional reflex) and allowed nature to take its course. And rightly, for suddenly the abdomen slipped out easily, and the dragon-fly promptly reversed its position and began to dry its wings. 1. See Lancet
1950, i, 934, 1019.
CEREBELLAR SYNDROME FOLLOWING SODIUM AMYTAL
SiR,—I was much interested in Dr. Bodman’s observations last week on cerebellar effects following administration of ’Sodium amytal,’ and would like to mention some observations of my own. These are recorded in my article on the anaesthesia of rabbits in the UFAW handbook on the Care and JYlanagement of Laboratory Animals (London, 1947)-an article that was written in 1944-45. Of rabbits anaesthetised with intravenous ’Nembutal’ (sodium iso-amytal) or ’Evipan ’ (hexobarbitone), a fairly large proportion showed some degree of nystagmus, often quite slight, but sometimes very marked indeed, with synchronous nystagmoid movements of the whisker or even of the whole head. On at least one occasion, -