TRAINING OF GENERAL PHYSICIANS

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208 TRAINING OF GENERAL PHYSICIANS AT a comitia held on Tan. 31 the Royal College of Physicians of London approved the following report from its council :- Criteria for Consultants.-The council considered the criteria for consultants which had already been approved by the three Royal Colleges : 1. Consultants must have received their training at an approved hospital. Each college shall approve hospitals as suitable for training in its own branch of the profession and recognition shall be granted by the standing joint committee on the nomination of the individual college concerned. 2. Consultants shall have a minimum of five years’ approved training and experience after .qualification. 3. Consultants must hold an approved higher degree or diploma. 4. To be approved as a consultant, a candidate must hold or have held a recognised appointment to a hospital. 5. Consultants must not engage in general practice. The council approved them in principle as applying to general physicians, but pointed out that training might be undertaken at more than one hospital. They also agreed that the consultant should have a minimum of five years’ approved training and experience after quali- fication. This should be held to mean five years after registration. The council agreed that the M.R.c.P. examination should continue to be a test of the candi- date’s knowledge of general medicine. It was thought that it should not be taken earlier than one year after registration. Training of Physicians in General Medicine.-The council agreed that it was essential that the required training for general physicians should be as elastic as possible within the general framework already agreed upon. They agreed that the following minima should be expected: 1. Candidates should hold a resident appointment in an approved general hospital for at least one year after registration. During six months of this period, the post held should be that of house-physician. The remaining six months should be spent in another junior medical appointment such as house-surgeon, house-physician in a special hospital, or resident in one of the special departments. 2. Candidates should hold a clinical appointment such as that of registrar or chief assistant for at least two years in an approved general hospital. During this time, he should be encouraged to undertake research work or to hold some additional appointment such as a demonstratorship in a department of physiology, anatomy, pathology, or biochemistry. 3. Candidates should spend at least one year in research or travel or in some non-clinical subject, such as physiology, anatomy, pathology, or biochemistry. 4. No rigid requirements should be laid down for the remaining period of training. A general physician should have some knowledge of the work of special hospitals such as sanatoria, children’s hospitals, mental hospitals, &c., and appointments in such hospitals should be recognised. A period of six months spent in general practice might be allowed to count as part of the five years’ training. The council agreed that there should be no rigid order for holding these appointments, and they emphasised that the times suggested were minimal and not maximal.. PHYSIOTHERAPY AT HOME DISTRICT nurses, especially Queen’s nurses, have a high reputation for ability and skill, and like all people who are good at their job they are always finding ways of doing it even better. In Liverpool the Queen Victoria District Nursing Association is adding a mobile physiotherapy unit to its resources, so that paralysed or other patients unable to attend hospital outpatient departments, yet needing massage, ultraviolet light, infra-red ray, or other forms of light or electrical treatment, can receive them in the warmth and comfort of their own homes. This, the first unit of the kind to be provided by a city in connexion with its district nursing service, was launched by the Lord Mayor of Liverpool, on Jan. 15, from the Central Home of the association. If it proves a success other units will be put on the road. The association is affiliated to the Queen’s Institute of District Nursing, and is staffed entirely by Queen’s nurses. Medicine and the Law Abortion for Probable Defects in the Child THE suggestion has lately been made in America that when a woman contracts rubella in the early months of pregnancy abortion should be induced to prevent the birth of a defective child. This raises an interesting legal point. One cannot get away from the fact that abortion is a statutory felony under the Offences against the Person Act, 1861. It is thereby declared to be a felony if (1) a woman with child unlawfully takes a drug or uses an instrument to procure her own miscarriage, or (2) any- body else unlawfully gives her a drug or uses an instru- ment for that purpose. The fact that the woman desires to terminate her pregnancy is, as Macnaghten, J. told the jury in R. v. Bourne in July, 1938, quite irrele- vant. It was held in R. v. Sockett (1872) that the woman herself can be convicted of " being present, aiding and abetting " if she consents to the administering of the drug or to the use of the instrument. The word " unlaw- fully " is, of course, all-important. It was not, it is understood, included in the original indictment of Mr. Bourne ; the judge at trial allowed the indictment to be amended by its inclusion. In 1929 the Infant Life (Preservation) Act introduced an amendment of " the law with regard to the destruction of children at or before birth " ; in the interests of distraught mothers it created the new statutory offence of " child destruc- tion." There was an important proviso-" no person shall be guilty of an offence under this section unless it is proved that the act which caused the death of the child was not done in good faith for the purpose only of preserv- ing the life of the mother." This, it was apparently thought by the judge in the Bourne case, did no more than state the common law under which the termination of a pregnancy is justified if bona fide undertaken to save the mother’s life. Such an operation, Macnaghfen, J. considered, in effect would be lawfully and not unlaw- fully performed and therefore would be outside the Act of 1861. The acquittal of Mr. Bourne, satisfactory and proper as it was, prevented the Court of Criminal Appeal (and possibly also the House of Lords) from reviewing the law of abortion. It may be that the report, when it comes, of Lord Simon’s inquiry into population will give fresh impetus to a re-examination of the law. Meanwhile we have it established by Mr. Justice Macnaghten’s summing-up to the jury that the burden is on the prosecution to prove beyond reasonable doubt that the surgeon did not operate in good faith to preserve the mother’s life, and, further, that those words " for the purpose only of preserving the life of the mother " are to be construed " reasonably." They do not mean that he operates because the mother’s life is in instant danger. They protect the surgeon if continuing preg- nancy would mean that the " patient became a physical and mental wreck." What would have made the patient a physical and mental wreck in the Bourne case was largely, it may be, presumed, the fact that her child would have been a living reminder of the shameful violence with which the mother had been treated. If a woman can be assured that her child is certain to be born with some terrible deficiency, it might well have the same effect on her mind. We are here in that field of law where borderline cases are to be expected and where everything depends on the view taken by a jury of the facts of a particular case. All one can say is that the termination of a pregnancy is still prima facie a felony, but that juries are often sympathetic. THE Central Medical War Committee announces that the following have resumed civilian practice :- Mr. ARTHUR F. M. BARRON, F.R.C.S.E., 8, Bright’s Crescent, Edin. burgh, 9. Mr. J. 1. MuNRO BLACK, F.R.C.S., 87, Jesmond Road, Newcastle- upon-Tyne, 2. Dr. JAMES FLIND, D.P.M., 115, Harley Street, London, W.1. Mr. A. WALLIS KENDALL, M.S., F.R.C.S., King’s College Hospital, Denmark Hill, London, S.E.5. Dr. EMANuEL MILLER, 79, Harley Street, W.1. Mr. D. C. RACKER, F.R.C.S.E., M.R.C.O.G., 26, St. John Street, Manchester. Mr. A. RADCLIFFE, F.R.C.S., 15, Wimpole Street, W.l.

Transcript of TRAINING OF GENERAL PHYSICIANS

Page 1: TRAINING OF GENERAL PHYSICIANS

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TRAINING OF GENERAL PHYSICIANSAT a comitia held on Tan. 31 the Royal College of

Physicians of London approved the following reportfrom its council :-

Criteria for Consultants.-The council considered thecriteria for consultants which had already been approvedby the three Royal Colleges :1. Consultants must have received their training at an

approved hospital. Each college shall approve hospitalsas suitable for training in its own branch of the professionand recognition shall be granted by the standing jointcommittee on the nomination of the individual collegeconcerned.

2. Consultants shall have a minimum of five years’ approvedtraining and experience after .qualification.

3. Consultants must hold an approved higher degree or diploma.4. To be approved as a consultant, a candidate must hold or

have held a recognised appointment to a hospital.5. Consultants must not engage in general practice.The council approved them in principle as applying to

general physicians, but pointed out that training mightbe undertaken at more than one hospital. They also

agreed that the consultant should have a minimum offive years’ approved training and experience after quali-fication. This should be held to mean five years afterregistration. The council agreed that the M.R.c.P.

examination should continue to be a test of the candi-date’s knowledge of general medicine. It was thoughtthat it should not be taken earlier than one year afterregistration.

Training of Physicians in General Medicine.-Thecouncil agreed that it was essential that the requiredtraining for general physicians should be as elastic aspossible within the general framework already agreed upon.They agreed that the following minima should be expected:1. Candidates should hold a resident appointment in an

approved general hospital for at least one year after

registration. During six months of this period, the postheld should be that of house-physician. The remainingsix months should be spent in another junior medicalappointment such as house-surgeon, house-physician ina special hospital, or resident in one of the specialdepartments.

2. Candidates should hold a clinical appointment such as thatof registrar or chief assistant for at least two years in anapproved general hospital. During this time, he shouldbe encouraged to undertake research work or to holdsome additional appointment such as a demonstratorshipin a department of physiology, anatomy, pathology, orbiochemistry.

3. Candidates should spend at least one year in research ortravel or in some non-clinical subject, such as physiology,anatomy, pathology, or biochemistry.

4. No rigid requirements should be laid down for the remainingperiod of training. A general physician should havesome knowledge of the work of special hospitals such assanatoria, children’s hospitals, mental hospitals, &c., and

appointments in such hospitals should be recognised.A period of six months spent in general practice might beallowed to count as part of the five years’ training.

The council agreed that there should be no rigid orderfor holding these appointments, and they emphasisedthat the times suggested were minimal and not maximal..

PHYSIOTHERAPY AT HOME

DISTRICT nurses, especially Queen’s nurses, have a highreputation for ability and skill, and like all people who aregood at their job they are always finding ways of doing iteven better. In Liverpool the Queen Victoria District

Nursing Association is adding a mobile physiotherapy unit toits resources, so that paralysed or other patients unable toattend hospital outpatient departments, yet needing massage,ultraviolet light, infra-red ray, or other forms of light orelectrical treatment, can receive them in the warmth andcomfort of their own homes. This, the first unit of the kindto be provided by a city in connexion with its district nursingservice, was launched by the Lord Mayor of Liverpool, onJan. 15, from the Central Home of the association. If it

proves a success other units will be put on the road. Theassociation is affiliated to the Queen’s Institute of DistrictNursing, and is staffed entirely by Queen’s nurses.

Medicine and the Law

Abortion for Probable Defects in the Child

THE suggestion has lately been made in America thatwhen a woman contracts rubella in the early months ofpregnancy abortion should be induced to prevent thebirth of a defective child. This raises an interestinglegal point.One cannot get away from the fact that abortion is

a statutory felony under the Offences against the PersonAct, 1861. It is thereby declared to be a felony if (1) awoman with child unlawfully takes a drug or uses aninstrument to procure her own miscarriage, or (2) any-body else unlawfully gives her a drug or uses an instru-ment for that purpose. The fact that the womandesires to terminate her pregnancy is, as Macnaghten, J.told the jury in R. v. Bourne in July, 1938, quite irrele-vant. It was held in R. v. Sockett (1872) that the womanherself can be convicted of " being present, aiding andabetting " if she consents to the administering of thedrug or to the use of the instrument. The word " unlaw-fully " is, of course, all-important. It was not, it isunderstood, included in the original indictment ofMr. Bourne ; the judge at trial allowed the indictmentto be amended by its inclusion. In 1929 the InfantLife (Preservation) Act introduced an amendment of" the law with regard to the destruction of children ator before birth " ; in the interests of distraught mothersit created the new statutory offence of " child destruc-tion." There was an important proviso-" no personshall be guilty of an offence under this section unless it isproved that the act which caused the death of the childwas not done in good faith for the purpose only of preserv-ing the life of the mother." This, it was apparentlythought by the judge in the Bourne case, did no morethan state the common law under which the terminationof a pregnancy is justified if bona fide undertaken tosave the mother’s life. Such an operation, Macnaghfen,J. considered, in effect would be lawfully and not unlaw-fully performed and therefore would be outside the Actof 1861. The acquittal of Mr. Bourne, satisfactory andproper as it was, prevented the Court of Criminal Appeal(and possibly also the House of Lords) from reviewingthe law of abortion. It may be that the report, whenit comes, of Lord Simon’s inquiry into population willgive fresh impetus to a re-examination of the law.Meanwhile we have it established by Mr. JusticeMacnaghten’s summing-up to the jury that the burdenis on the prosecution to prove beyond reasonable doubtthat the surgeon did not operate in good faith to preservethe mother’s life, and, further, that those words " forthe purpose only of preserving the life of the mother

"

are to be construed " reasonably." They do not meanthat he operates because the mother’s life is in instantdanger. They protect the surgeon if continuing preg-nancy would mean that the " patient became a physicaland mental wreck." What would have made the patienta physical and mental wreck in the Bourne case waslargely, it may be, presumed, the fact that her childwould have been a living reminder of the shamefulviolence with which the mother had been treated. Ifa woman can be assured that her child is certain tobe born with some terrible deficiency, it might wellhave the same effect on her mind.We are here in that field of law where borderline cases

are to be expected and where everything depends on theview taken by a jury of the facts of a particular case.All one can say is that the termination of a pregnancy isstill prima facie a felony, but that juries are oftensympathetic.

THE Central Medical War Committee announces that thefollowing have resumed civilian practice :-

Mr. ARTHUR F. M. BARRON, F.R.C.S.E., 8, Bright’s Crescent, Edin.burgh, 9.

Mr. J. 1. MuNRO BLACK, F.R.C.S., 87, Jesmond Road, Newcastle-upon-Tyne, 2.

Dr. JAMES FLIND, D.P.M., 115, Harley Street, London, W.1.Mr. A. WALLIS KENDALL, M.S., F.R.C.S., King’s College Hospital,Denmark Hill, London, S.E.5.

Dr. EMANuEL MILLER, 79, Harley Street, W.1.Mr. D. C. RACKER, F.R.C.S.E., M.R.C.O.G., 26, St. John Street,

Manchester.Mr. A. RADCLIFFE, F.R.C.S., 15, Wimpole Street, W.l.