F.W. Tunnicliffe
1901 The Lancet  
434 the service, its regulations and requirements, to which you draw attention in the leading article in THE LANCET of Feb. 2nd, p. 338-tbe Royal Army Medical Corps may rest thankful for the lines on which this inquiry has been carried out, for the impartiality shown, and for the conclusions arrived at. Tersely put it may be said that the defects brought to light touching the well-being of the sick and wounded range themselves under imperfections in the organisation of the corps and deficiency
more » ... f materials, the exigencies of war and the absence of sufficient transport; and, in respect to the first, quite preventable, it is abundantly clear that the responsibility rests with the sections of the War Office concerned with the points in question. And when we note the nature of the defects shown in the field under the pressure of military operations we recognise how closely they fit in with the known imperfections under which the corps laboured during peace and from which those having practical experience feared the results which have followed. A corps reduced to a numerical strength not even sufficient for peace requirements, with, so far as our officers were concerned, a paper reserve, deprived of all stimulus towards personal efficiency and professional progress, with deficient material to work with and practically no opportunities for practising during peace the demands of war, necessarily was unable to meet the onerous burden of a large war, yet showed the value of its component parts and the ability and energy of the majority of its personnel as, when supplemented by a strong civil contingent of officers and men and by private help, allowed the Commission to conclude that it cannot be properly said that the medical and hospital arrangements have broken down ; there has been nothing in the nature of a scandal with regard to the care of the sick and wounded, no general or wide-spread neglect of patients or indifference to their sufferings, and all witnesses of experience in other wars are practically unanimous in the view that taking it all in all in no campaign have the sick and wounded been so well looked after as they have been in this." One bubble which has been pricked is the asserted existence of an army reserve of medical men in the auxiliary forces or otherwise, and another, apparently relied on by the military coterie, is the hitherto asserted competency of the civil section adequately to take the place of a trained army medical staff. To enter further into details would occupy too much of your valuable space. Suffice it to say, that the business-hke recommendations of the Commission even better emphasise the defects elucidated than the narration of the work undertaken ; while on the three main points of the desirability of the conditions of service being such as to draw good professional men and ensure the maintenance of their qualifications at a high level, advancement for merit rather than by seniority for the upper ranks, and the production of good sanitarians in the Royal Army Medical Corps, they do but repeat the recommendations of the Crimean inquiry, and so land us exactly where we then were, with the whole of the sad experience then culled and the good intentions then formulated wasted and annulled in the interval by those to whom the well-being and efficiency of the medical section of army work was entrusted. In point of fact, the nation is again asked to do in 1901 what it was asked to do in 1858, what with the best intentions it proposed to do, but which it utterly failed to bring to good effect through its negligence to watch over the acts of its officials ; and the pressing present question is, Will it do any better now and in the future 7 The Commission merely indicate the lines along which progress should run and suggest another committeedepartmental or otherwise-to formulate the necessary details, and hence its accomplished work is but the primary step in the scheme to be evolved. It is apparent that the composition of this committee is all important, as with it rest the power of laying down the measures essential towards giving due effect to the recommendations made or, on the other hand, frustrating the attempt now again made to evolve an efficient medical corps capable of doing the highly important duties entrusted to it-duties now clearly placed before the public and after this committee has drawn up a course of action calculated to effect the objects desired it will rest with the War Minister to embody this outcome in a royal warrant or otherwise. And this third step satisfactorily accomplished the crux of the scheme, the pivot on which the entire previous labours will turn for good or evil results, will be arrived at as embodied in the questions: What guarantee have we that the decisions arrived at will be respected and not whittled away or ignored as in the past ? 7 Where resides the power capable of giving full effect to them 7 The unfortunate position of the Royal Army Medical Corps is that it is dependent for good working on so many sections of the War Office, any one or all of which may adversely influence it; and what is wanted is an emancipation of the corps from these trammels so that it may be free to perfect itself in accordance with its known wants from a professional standpoint and on a business basis. Clearly, much remains to be done before a successful issue is arrived at. I am. Sirs, vours faithfully. To tluJEdito'l's of THE LANCET. SIRS,-Since the publication of our last notel upon this subject we have continued our work in this direction, and have been able to demonstrate the presence of selenium in brewing sugar and beer, the only source of which is the impure sulphuric acid used in the manufacture of the sugar. The brewing sugar in addition to selenium contained arsenic. We may say incidentally that this sugar was not manufactured by the firm implicated in the recent epidemic. The beer we examined we obtained through the kindness of Sir Lauder Brunton, and it was one which was undoubtedly concerned in the beer-poisoning epidemic. We are at present occupied in the quantitative estimation of the selenium in both these substances. With regard to the pharmacological action of selenious acid the recent results obtained by 0. Modica are of especial interest in this connexion. This observer, while confirming the results of Czapek and Weil3 concerning the similarity of arsenious and selenious acid with regard to acute poisoning, points out that the symptoms of chronic poisoning which they produce are not by any means so similar. For instance, whilst wasting in animals chronically poisoned by arsenic practically never occurs, in chronic selenious acid' poisoning it is never absent. Further, in animalstolerance to continued small doses of arsenic is easily obtained. This is not so in the case of selenious acid. THE ADAPTABILITY OF CLOVER'S INHALER. ' To the Editors of THE LANCET. E SiBS,—This well-known inhaler has, with slight modifica-; tions, held its own for many years in the administration of , ether and when fitted with a tap at the free end of the bag 1 is frequently used for giving nitrous oxide prior to etherisation. It does not appear to be generally known that a Clover's inhaler without the bag is safe and effective for administration of chloroform or of mixtures of chloroform and ether. (Chloroform pure or in a mixture must never be i given with the bag on, as this is practically a closed method, -and to give chloroform by such a method is simply tempting r Providence.) Within the last few years McArdle has drawn r attention to the utility of this method in giving Tait's mixture, which consists of chloroform one part and ether t two parts, for gynaecological work. With slight modifica-L tions in the method of administration, I find it equally useful , for administration of chloroform alone and other mixtures of chloroform and ether. The following mixtures are of service :- ' The chloroform and ether are best kept in separate bottles 1
doi:10.1016/s0140-6736(01)71048-3 fatcat:ul4lqduw7fguthjayoq5j6mtxu