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THE LANCET.

LONDON: SATURDAY, NOVEMBER 20, 1915.

Medical Students and the War.THERE is no doubt that Lord DERBY’S pronounce-

ment with regard to the duty of medical studentsat the present time will place many of the youngmen who have decided during the past three yearsto embrace the profession of medicine in a verydifficult position. The views of those who hold

that the adequate supply of medical men shouldbe maintained by retaining students at theirmedical studies have been put before LordDERBY in an authoritative and responsiblemanner, and his answer has been uncompro-

mising. The Director-General of the Army MedicalService has now formally signified to the GeneralMedical Council, through whom the informationhas bean given to all whom it may concern, thathe is in agreement with Lord DERBY’S opinion,which, as has been already stated more than once inthese columns, is that the first-, second-, and third-year students should accept combatant commis-sions. The question of distinctive treatment forthese young men, admittedly of the very brand

- required as officers, has been thoroughly threshedout by correspondence in the medical and layjournals, by discussions at the Central MedicalWar Committee, and by interviews between LordDERBY and persons of the highest position in mattersof medical education. The Central Medical War

Committee, in explaining to the Director- General ofRecruiting the manner in which local war com-mittees had been working, achieved gratifying recog-nition as the agency for organising the medical pro-fession with regard to military services, and theyhave represented to Lord DERBY that in two waysthe activities of which he is the official head have

come into relation with their work. First, medical

practitioners have been approached to take com-

batant commissions. This was done in error, andall practitioners who have received the recruitingappeal directed to unstarred men can fall back

upon the War Emergency Committee of the

locality, or, if in their neighbourhood no suchbody exists, can bring the matter to the notice ofthe Central Medical War Committee. Secondly,the question of the enlistment of students comeswithin the sphere of the Central Medical War

Committee, and the problem of dealing with thejunior student was felt to be one upon whichguidance was required. Lord DERBY has signifiedto the Committee, as he had previously done else-where, that his opinion is unalterable. The juniorstudents, he holds, should join the army in a

combatant capacity.

Yet another repetition of this opinion was givenby Lord DERBY in response to a joint deputationof representatives from the Royal College of

Physicians of London, the Royal College of

Surgeons of England, the University of London,and the deans of the London schools of medicine.Lord DERBY took up the broad position that theneed of the country for a fully officered army inall its branches must take precedence of any need,however soundly anticipated, that the countrymay later feel through the shortage of medicalmen. It seems to us in face of the anxious attentionwhich the plight of our junior medical studentshas aroused, and the repeated decision of theauthorities upon the matter, that further debateupon it is unlikely to be fruitful, but we publish inanother column a letter from Professor A. E.

SHIPLEY, the Master of Christ’s College, Cambridge,which puts out the arguments for retaining medicalstudents at their studies until they are definitelyuseful at their professional subjects. Those argu-ments are admittedly strong. The medical student isa peculiar person; engaged upon studies which whencomplete will make of him a particularly valuablecitizen, he cannot be withdrawn from those studieswithout sacrificing much more time than he appearsto be surrendering. If he is stopped suddenlywhile engaged in the preliminary courses of thecurriculum he must inevitably lose not only theperiod for which he is at the war, but muchof the period, antecedent to the war, which hehas already employed in medical work; for

scientific education even in its elementary stagescannot be dropped for an indefinite time withoutentailing the necessity of complete recommence-ment. Again, the shortage of medical men,

undoubtedly implied in what will largely amountto the withdrawal from pupillage of the juniormedical students of our schools, may be a

more serious matter at this juncture than anyfalling off in the supply of students in normaltimes. The war must have its effect uponthe population of the country. There will be

returned to us a great many men who in one formor another will require medical or surgical help,while the value of young life will be so high thatthe care of the infant, of the expectant mother,and, we might add, of children at the school age willhave a particular value. By as much as the systemof medical inspection of the State school childrensuffers now by the temporary loss of medical

officers, by so much will greater effort be requiredin this direction in the near future. The medical

man, into whom the student of to-day would haveshortly been transformed, will be sadly wanted.

If we accept Lord DERBY’s broad view of the

situation, we trust that it may yet be possibleto use medical students who have put their

earlier classes and examinations behind them insome semi-medical capacity with the army. These

students, who are generally called third-yearstudents but who often enjoy greater seniority ,might well be made into surgeon-probationers,

1150

when their services would be of direct use inthe Royal. Army Medical Corps, and what theysaw while on service would help them in theirfuture professional studies The enlistment ofstudents by a careful group system might accom-plish something useful. Under Lord DERBY’Sscheme of enlistment by groups the young manwho is called up receives a fortnight’s notice,and this can be extended for reasons given. Can

it be accepted by the authorities as a validreason for the delay of a student to join the armyas a combatant officer that a medical examinationis impending ? In many cases the passing of

such an examination would render the student auseful adherent to the Royal Army Medical Corps,at any rate in some subordinate capacity, so thatthe slight delay would act in a doubly effectivemanner. For almost immediately the student wouldbecome useful to the country in the present crisis,and he would be in a far more favourable positionto obtain his qualifications the moment peace con-ditions re-existed, and then his assistance will behighly valuable to the country.

Laudanum.SOON after the last session of the Executive ICommittee of the General Medical Council we had

occasion to refer to the communications from

His Majesty’s Coroner for the City of London andBorough of Southwark to the Lord President ofthe Privy Council connected with the sale of

laudanum. It will be remembered that owing toan increase in the strength of tincture of opiumin the British Pharmacopoeia this article auto-

matically became included in that part of the

Schedule of Poisons in which the sale is safe-

guarded by all possible restrictions. It hadbeen urged that these restrictions in the case oflaudanum were vexatious and unnecessary, thatthis article was frequently sold in small quantitiesfor domestic purposes; and it was also said thatthere were many regular customers who habituallypurchased larger amounts who would resent anyinterference with their liberty of action, and who,further, might be in some danger if supplied withtincture of opium of the new strength without duewarning. The Council of the Pharmaceutical Societyendeavoured to afford guidance to dispensingchemists by recommending that " when laudanumis asked for the 1914 preparation should be suppliedand the poison-book signed, but where the 1898 pre-paration is demanded great care should be taken tolabel it accordingly, and the attention of the pur-chaser should be called to the fact that it is the1898 preparation." The matter was referred by thePrivy Council to the General Medical Council, andit has been under the consideration of the Pharma-

copoeia Committee. The Council adopted the reportof the Pharmacopoeia Committee, taking it as thebasis of a reply to the Lord President of the

Privy Council, who wished to know " whether thesociety is acting properly in assisting the sale of

any preparation of opium that does not complywith the requirements of the new edition of theBritish Pharmacopoeia." 1No one can complain of the judicious tone of

the report of the Pharmacopoeia Committee. It is

suggested that the form of the recommendation

published by the Pharmaceutical Society has givenrise to misapprehension, and that the latter part ofthe recommendation might be taken as conveying topersons who desired to obtain "laudanum" without

signing the "poison-book " information which couldhelp them to effect their purpose. The sting of thissuggestion is removed on remembering that it is

regarded as a misapprehension as to intentionand effect. The Pharmacopoeia Committee does

not say that the recommendation of the Pharma-ceutical Society is intended to assist the sale

of two distinct preparations called laudanum,but only that it has been worded so as to be

open to this inference. It is quite instructiveto note the manner in which the question hasbeen dealt with in the alternative form of recom-mendation drafted by the Pharmacopoeia Committee.By comparing the two it will be seen that the

Pharmaceutical Society was firstly concerned withinstructing the vendor how he should act when thelaudanum of 1898 was demanded, and his actions sofar as the recommendation is concerned are actionstaken to safeguard his own position in the eye ofthe law rather than to protect the purchaser. The

Pharmacopoeia Committee has approached the sub-ject from a different point of view, and while notignoring the duties of the dispenser, it concernsitself mainly with the responsibilities of the pur-chaser. The two sets of recommendations should

be carefully compared to realise with what littlevariance in verbiage a totally different complexionis put upon the sale of laudanum. The recom-

mendation of the Pharmacopoeia Committee runsas follows:-When tincture of opium or laudanum is asked for, no

preparation other than that described under these names inthe British Pharmacopoeia, 1914, may be supplied, and thepoison-book must be signed by the purchaser. When atincture of different strength or composition is expresslydemanded, the prescriber or applicant must indicate clearlythe formula for the special preparation he requires.

This wording, while it in no way hampers thesale of an article demanded, throws all responsi-bility upon the purchaser, who must be quite clearabout his requirements without any assistance orexplanation on the part of the vendor. There canbe no suggestion that the laudanum of 1898 hasbeen substituted for the laudanum of the British

Pharmacopoeia, or that the explanation afforded bythe dispenser as to the difference in strength mighthave been accompanied by any hint that the formeris safer on account of its smaller proportion ofmorphine or easier to purchase since the poison-book need not be signed at the completion ofthe transaction. Such inferences might, no doubterroneously, have been drawn from the wording ofthe recommendation of the Pharmaceutical Society.

1 See report of the Proceedings of the General Medical Council, p. 1147.