182 THE TEACHING OF ANATOMY
SIR,-As a gynaecologist I am concerned about the melancholic state- of undergraduate education in departments of anatomy of the United Kingdom, which Professor Sinclair has so vividly portrayed. May I suggest that some of us whose pleasure it is to use a scalpel from time to time might consider re-entering the anatomy school, whether it be preclinical or paraclinical, a little time before retirement ? Perhaps we could do this for one or two sessions a week. We could relax a little, learn a lot, and teach a little. When retirement day arrives a second career might await us in that we could, as doctors and as surgeons, teach medical students anatomy. It would be very unlikely that we would overload them with excessive detail, and by drawing on our clinical experience we might arouse interest. Women’s Hospital, ALAN M. SMITH. Wolverhampton WV1 4PW.
Effect of saralasin
on
lying
and
standing blood-pressure.
increased (see accompanying figure). The lying blood-pressure decreased, but not as much as the standing pressure. The infusion was stopped when the standing pressure was 100/60 mm. Hg, and both lying and standing pressure returned towards preinfusion levels over the next 55 minutes.
Surely screening programmes looking for angiotensin-lldependent hypertensives should exclude patients on vasodilating drugs for other reasons than the risk of hypotension -i.e., a hypotensive response’to saralasin in patients on drugs that stimulate the renin-angiotensin system may give false positives. Department of Medicine, Charing Cross Hospital Medical School, Fulham Palace Road, London W6 8RF.
GRAHAM A. MACGREGOR.
RAPID DIAGNOSIS OF VIRUS INFECTIONS
SIR,-We agree with Dr Banatvala and his colleagues p. 79) about the usefulness of the electron microscope in the diagnosis of certain virus infections in the
(July 12,
clinical virology laboratory. In addition to the direct examination of material obtained from skin lesions and fsces, we have found that electron microscopy has been extremely useful in a secondary role in the preliminary identification of viruses causing a cytopathic effect in tissue-culture-particularly in the diagnosis of viral infections of the eye, where we have been able to diagnose adenovirus, herpesvirus, and vaccinia-virusinfections. In the two latter groups we have usually been able to identify the virus group within 48 hours of receiving eye swabs. We have also been able to make preliminary identifications of influenza and parainfluenza viruses in cells inoculated with material from the respiratory tract. It is now standard practice in this laboratory to examine in the electron microscope by negative staining all cultures showing cytopathic effects and we have found that this leads to a considerable saving of time and expensive reagents. A note of caution we should like to add is that, because of the very high concentration of virus particles required to make a positive diagnosis, failure to observe particles does not indicate a negative diagnosis. Institute of
Virology,
University of Glasgow, Church Street, Glasgow G11 5JR. 1.
T. H. PENNINGTON E. A. C. FOLLETT M. C. TIMBURY.
Rennie, A. G. R., Cant, J. S., Foulds, W. S., Pennington, T. H., Timbury, M. C. Lancet, 1974, ii, 273.
MEDICAL COURSE AT THE OPEN UNIVERSITY I SIR,-May respond to the points raised on my paper (April 26, p. 965) ? In reply to Dr Fry (May 3, p. 1029) I do not agree that the principal argument in favour of a medical course at the Open University is a putative need for more doctors. My main arguments are that it would diversify entry to the medical profession, give a group of able, zealous, and currently frustrated men and women a chance of proving the selectors wrong, and hasten the introduction of some of the Open University’s techniques to medical education. While it is possible in theory that these objects could be achieved by modifications in the policy of the existing schools, I do not think that in practice this is likely to happen. The Open University has the additional advantage for the mature student wishing to study medicine that he would not have to commit himself at the outset, as is necessary at an orthodox school, to the irrevocable step of giving up his current livelihood. Dr Fry attributes incorrectly to me an estimate of two years as the likely duration of the part-time preclinical I envisaged this course for an Open University student. as an extreme, practicable perhaps for students who already held a PH.D. in a biological subject, the other extreme being a period of at least five years. I agree with Mr Potter (May 17, p. 1139) that for two reasons a medical course at the Open University might reduce the maldistribution of medical manpower. In the first place mature students would tend, I suspect, to stay put on graduation more frequently than do students straight from school, so a regionally based quota such as the Open University operates for its other courses, but on this occasion weighted towards the underdoctored areas, might prove effective. Secondly, the effect of age would inevitably tend to turn mature graduates in the direction of the less competitive fields with shorter trainings. I agree with Dr Conway (May 10, p. 1085) that entry would have to be controlled and would be smaller than the demand for places. I argued that an entry of 600 would provide around 300 graduates at relatively low cost, but the numbers of entrants would need to be adjusted in the light of experience of the actual rate of drop-out and the national medical-manpower requirements. Indeed, the comparative ease with which the numbers could be adjusted upwards or downwards would introduce a much needed additional degree of freedom into the current system. Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton SO9 4XY. 1.
Sinclair,
D.
Lancet, 1975, i, 875.
E. D. ACHESON.
SIR,-As a gynaecologist I am concerned about the melancholic state- of undergraduate education in departments of anatomy of the United Kingdom, which Professor Sinclair has so vividly portrayed. May I suggest that some of us whose pleasure it is to use a scalpel from time to time might consider re-entering the anatomy school, whether it be preclinical or paraclinical, a little time before retirement ? Perhaps we could do this for one or two sessions a week. We could relax a little, learn a lot, and teach a little. When retirement day arrives a second career might await us in that we could, as doctors and as surgeons, teach medical students anatomy. It would be very unlikely that we would overload them with excessive detail, and by drawing on our clinical experience we might arouse interest. Women’s Hospital, ALAN M. SMITH. Wolverhampton WV1 4PW.
Effect of saralasin
on
lying
and
standing blood-pressure.
increased (see accompanying figure). The lying blood-pressure decreased, but not as much as the standing pressure. The infusion was stopped when the standing pressure was 100/60 mm. Hg, and both lying and standing pressure returned towards preinfusion levels over the next 55 minutes.
Surely screening programmes looking for angiotensin-lldependent hypertensives should exclude patients on vasodilating drugs for other reasons than the risk of hypotension -i.e., a hypotensive response’to saralasin in patients on drugs that stimulate the renin-angiotensin system may give false positives. Department of Medicine, Charing Cross Hospital Medical School, Fulham Palace Road, London W6 8RF.
GRAHAM A. MACGREGOR.
RAPID DIAGNOSIS OF VIRUS INFECTIONS
SIR,-We agree with Dr Banatvala and his colleagues p. 79) about the usefulness of the electron microscope in the diagnosis of certain virus infections in the
(July 12,
clinical virology laboratory. In addition to the direct examination of material obtained from skin lesions and fsces, we have found that electron microscopy has been extremely useful in a secondary role in the preliminary identification of viruses causing a cytopathic effect in tissue-culture-particularly in the diagnosis of viral infections of the eye, where we have been able to diagnose adenovirus, herpesvirus, and vaccinia-virusinfections. In the two latter groups we have usually been able to identify the virus group within 48 hours of receiving eye swabs. We have also been able to make preliminary identifications of influenza and parainfluenza viruses in cells inoculated with material from the respiratory tract. It is now standard practice in this laboratory to examine in the electron microscope by negative staining all cultures showing cytopathic effects and we have found that this leads to a considerable saving of time and expensive reagents. A note of caution we should like to add is that, because of the very high concentration of virus particles required to make a positive diagnosis, failure to observe particles does not indicate a negative diagnosis. Institute of
Virology,
University of Glasgow, Church Street, Glasgow G11 5JR. 1.
T. H. PENNINGTON E. A. C. FOLLETT M. C. TIMBURY.
Rennie, A. G. R., Cant, J. S., Foulds, W. S., Pennington, T. H., Timbury, M. C. Lancet, 1974, ii, 273.
MEDICAL COURSE AT THE OPEN UNIVERSITY I SIR,-May respond to the points raised on my paper (April 26, p. 965) ? In reply to Dr Fry (May 3, p. 1029) I do not agree that the principal argument in favour of a medical course at the Open University is a putative need for more doctors. My main arguments are that it would diversify entry to the medical profession, give a group of able, zealous, and currently frustrated men and women a chance of proving the selectors wrong, and hasten the introduction of some of the Open University’s techniques to medical education. While it is possible in theory that these objects could be achieved by modifications in the policy of the existing schools, I do not think that in practice this is likely to happen. The Open University has the additional advantage for the mature student wishing to study medicine that he would not have to commit himself at the outset, as is necessary at an orthodox school, to the irrevocable step of giving up his current livelihood. Dr Fry attributes incorrectly to me an estimate of two years as the likely duration of the part-time preclinical I envisaged this course for an Open University student. as an extreme, practicable perhaps for students who already held a PH.D. in a biological subject, the other extreme being a period of at least five years. I agree with Mr Potter (May 17, p. 1139) that for two reasons a medical course at the Open University might reduce the maldistribution of medical manpower. In the first place mature students would tend, I suspect, to stay put on graduation more frequently than do students straight from school, so a regionally based quota such as the Open University operates for its other courses, but on this occasion weighted towards the underdoctored areas, might prove effective. Secondly, the effect of age would inevitably tend to turn mature graduates in the direction of the less competitive fields with shorter trainings. I agree with Dr Conway (May 10, p. 1085) that entry would have to be controlled and would be smaller than the demand for places. I argued that an entry of 600 would provide around 300 graduates at relatively low cost, but the numbers of entrants would need to be adjusted in the light of experience of the actual rate of drop-out and the national medical-manpower requirements. Indeed, the comparative ease with which the numbers could be adjusted upwards or downwards would introduce a much needed additional degree of freedom into the current system. Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton SO9 4XY. 1.
Sinclair,
D.
Lancet, 1975, i, 875.
E. D. ACHESON.
