Sir,
Re: A response to European working time directive and surgical training. An open letter to the Presidents of the Surgical Royal Colleges and Programme Directors of Higher Surgical Training.
Response from D. Rowley, Director of Education, Royal College of Surgeons of Edinburgh.
Surg J R Coll Surg Edinb Irel. 2004;2:5; 297-298
It is always valuable for a President to be protected by his Director of Education but I would simply like to reiterate that throughout negotiations about EWTD, the Colleges and the Specialty Associations have been vociferous in indicating it is simply impossible to train surgeons in a shorter number of hours per week and in a shorter number of years as suggested by Modernising Medical Careers combined with the significant problems relating to the new consultant contract and attitudes towards time for training.
Professor Rowley is entirely correct in indicating the problem is multi-factorial but our Lords and Masters are insistent that in the United Kingdom we must follow the European Working Time Directive. However, it is also true that we are making significant progress with regards methods of training and structuring it in such a way that true competence will be assessed and that the standards which this College has strived to maintain for nearly 500 years will be maintained and enhanced.
Yours faithfully,
Mr J. A. R. Smith President, the Royal College of Surgeons of Edinburgh Scotland, UK
Sir,
Re: Syme and his amputation Surg J R Coll Surg Edinb Irel., 2: 2004; 91-98
As an orthopaedic surgeon who occasionally performs Syme’s amputation, I found Dr Malcom-Smith’s historical article fascinating. However, I wonder if he is aware that the Dr Wilson, one of Syme’s patients to whom he refers to, recorded his own vivid account of the procedure. Dr Wilson was twenty-four years old at the time and had trained as a surgeon and attended Syme’s lectures. He was a Chemistry lecturer and became Professor of Technology at Edinburgh University and Director of the Industrial Museum of Scotland.
On his death, his sister Jessie published a memoir in 1860, mainly using his correspondence. His diseased foot is dealt with in detail as is his treatment under Syme who, having decided to amputate, gave him a week to put his affairs in order. The operation was carried out at his home in January 1843 and Jessie recounts:
‘During the operation’, George says, ‘in spite of the pain it occasioned, my senses were preternaturally acute. I watched all that the surgeons did with a fascinated intensity. Of the agony it occasioned, I will say nothing. Suffering so great as I underwent cannot be expressed in words, and thus fortunately cannot be recalled. The particular pangs are now forgotten; but the black whirlwind of emotion, the horror of great darkness, and the sense of desertion by God and man, bordering close upon despair, which swept through my mind and overwhelmed my heart, I can never forget, however gladly I would do so.’
Dr Wilson’s experience understandably led to an interest-in anaesthetic use and among his many publications are included: On the specific gravity of chloroform, and its superiority, when pure, as an anaesthetic. Edinburgh Monthly Journal of Medical Science 1848.
Anaesthetics in surgery, from a patient’s point of view. Simpsons Obstetric Memoirs vol.2.
REFERENCES
1. Wilson JA. Memoir of George Wilson Edinburgh:
Edmonston and Douglas, 1860 and London and Cambridge: Macmillan Co., 1860.
Yours sincereley,
B. D. Todd Stepping Hill Hospital Cheshire, UK
Sir,
Re: Syme and his amputation Surg J R Coll Surg Edinb Irel., 2: 2004; 91-98
I am intrigued by the account of the amputation on George Wilson in 1843 as personal accounts of patients in the preanaesthetic days of operative surgery are rarely recorded. It is interesting to note that George Wilson refused anything to mitigate the agony of operation though of course, for example, alcohol and morphia preparations were widely used in other contexts. Entries in the Ward Journals of that time do not contain any reference to the use of sedation (or stimulants) before operation suggesting that, if ever used, it was not common practice.
Dr Wilson graduated MD in 1839 and must have been aware what it was like to undergo an operation. Following his experience it is of no surprise, therefore, that his career as a chemist led him to be interested in anaesthetics.
Yours sincerely,
N. A. Malcolm-Smith Department of Anaesthetics Critical Care and Pain Medicine Royal Infirmary of Edinburgh Edinburgh, Scotland