120 Journal of the Royal Society of Medicine Volume 87 February 1994 thirty-eight questionnaires were sent to trainees thought that the majority of consultants were not and 508 replies were received, making the response aware of the aims of training for the trainees in the rate 69%. Moreover, 131 questionnaires were sent to hospital part ofthe VTS. Contact between the course Vocational Training Scheme (VTS) course organizers organizer and consultant was poor, with no contact and 107 replies were received which made the in 20% and a single yearly contact in 44%. Many had response rate 82%. previously encountered problems with consultants in Professor Bouchier-Hayes gave a concise analysis relation to vocational training. of both parts of the research: of those hospital Overall only 23% were satisfied with the hospital trainees that responded 52% were women, 93% were training component of vocational training. on three-year rotations and 75% had, in fact, Professor Bouchier-Hayes summarized the con- worked in a general practice post. Further analysis clusions drawn from the questionnaires to the trainees revealed: and the course organizers and emphasized that the hospital component of training is characterized Hours worked The average number ofhours worked by: each week was 75 with 33 ofthose being spent on 'out (a) Ill-defined educational objectives of hours' work. The highest hours were found in (b) Teaching of limited value to general practices obstetrics, gynaecology and paediatrics. No one was (c) Teaching that is limited in amount working less than 40 h each week. (d) Little induction to posts and feedback were (e) Insufflcient assessment ofprogress Relevance ofexperience. Only 60% of trainees on performance satisfied that they obtained relevant experience in the (f) Poor access to half-day release management of chronic disease, in caring for the (g) Poor levels of communication between consultants dying and looking after elderly people. Only 40% were and course organizers satisfied with their experience in caring for people with physical handicap. Professor Bouchier-Hayes made some practical proposals for a change in the hospital content of the Availability of teaching Teaching was mainly training and provoked discussion. consultant teaching, lectures and seminars, and He said that there need to be changes made in the business ward round (76-88%). Skills teaching only balance between the hospital and general practice formed 59% and teaching ward rounds and audit phases of training. Alternative attachments such only 40%. as public health departments or FHSAs need to be considered. Furthermore, the quality of the hospital Induction to posts. An induction course was only experience and its relevance to general practice needs provided to 30% of doctors and many commented on to be improved. This needs to occur at three levels: the poor content. Accident and emergency, general national, regional, and local. medicine and paediatrics were the best at about 30%. At a national level organizations such as the JCPTGP, RCGP and GMSC must decide-how training Hospital post satisfaction. Overall 50% were needs to change and how its quality can be maintained. satisfied. The highest level found in psychiatry (75%) At a regional level advisers and postgraduate deans and the lowest in obstetrics (35%) and the care of the should be encouraged to develop new posts and to elderly (33%). ensure that teaching and learning takes place through a credible approval mechanism for individual Half-day release. Only 63% of trainees had access to posts. At a local level, this is where there is the half-day release during their current post. Of those greatest potential for improvement. Course organizers that had access 77% were expected to attend three- must be encouraged to take the lead in vocational quarters or more of the sessions but in reality only training and to improve their communication with 37% managed to attend. The reasons for non- hospital consultants to work on the content of the attendance were pressure of work (63%), no cover hospital posts. Consultants need to be more involved (47%), too immersed in work (20%) and lack ofsupport in local schemes. (9%). As the Journal is read not only by GPs but also many consultants, it would be interesting to have Assessment. Two-thirds of trainees were unhappy their comments, perhaps in the 'Letter to the Editor' with the level offeedback on their progress with 60% columns. expecting an end-point assessment. Peter Orton The replies from course organizers were even more Bashir Qureshi revealing ofthe inadequacies. The course organizers Section of General Practice

to see two of the chief allurements of that town, the Report of outing Summer outing to Portsmouth and RNH Haslar Naval Dockyard, including the wreck of the Mary of Section of the Rose, and the Royal Naval Hospital, Haslar. History of Medicine, 12 June 1993 RNH Haslar Dr Margaret Rule, a marine archaeologist, had Keywords: Margaret Rule; Mary Rose; been concerned with the location and recovery ofthe The Summer Outing of a boatload of members ofthe wreck of King Henry VIII's flagship The Mary Rose History ofMedicine Section, joined by a boarding-party from the 1960s; indeed it has been a case of the from the Osler Club of London, visited Portsmouth mutual rule of each queen over the other's kingdom Journal of the Royal Society of Medicine Volume 87 February 1994 121

(or, perhaps more politically correct, each king over pots were used. Following this, bandages smeared the other's queendom). In the summer of 1545 the with a bland ointment were applied to the wounds. Mary Rose set sail from Portsmouth harbour, where However, in the case of the Mary Rose the surgical she had been built in 1509, loaded with 700 men, one equipment was unopened. There were skeletons half crew and the other half soldiers (300 more than in the hold and apothecaries scales were found her normal complement), to attack the French fleet, on the upper deck. A contemporary letter was which lay near by. She capsized and King Henry discovered which referred to the knaves on board who watched the disaster from the shore. The possible would not obey orders and pull back the guns from reasons for the capsize will be referred to later. the ports after firing. Two days after the engagement The wreck was gradually covered with silt and in which the French were defeated an epidemic of disappeared entirely from view 100 years ago. The dysentery swept through the British fleet. From lower layers ofsilt created an anaerobic environment all this Sir James surmised that dysentery struck the which helped to preserve the remains ofthe wreck and crew of the Mary Rose while she set sail, leading the artefacts. The Mary Rose Trust was established to poor seamanship which, combined with the in 1979 and the wreck was salvaged in 1985, a fraught overloading of the complement on board and the manoeuvre witnessed by the television and the Prince possible ill-siting of the gun ports and heavy guns, of Wales. led to the ship's capsizing. A steel frame was constructed to straddle the wreck and cables were passed to the timbers of the Mary Mr J C Goddard (final year medical student The Rose, which was winched up and settled in a cradle. London Hospital Medical College Turner Street, There was one agonising moment when the framework London, UK, and Nora Schuster prize winner) then partially collapsed onto the wreck, but the stout gave us a paper on 'Naval surgery prior to 1805'. The timber resisted the threat to its integrity. The wreck Napoleonic Wars led to a considerable improvement was transferred to a berth at the dockside and has in the pay and conditions of naval surgeons, and they been sprayed with cool water for 20 h each day ever were even granted a uniform and sword in 1805, and since in order to maintain the condition of the wood. half pay between voyages; a painting of The Death Eventually it is planned to permeate the timbers with ofNelson depicts the surgeon in uniform for the first polyethylene glycol and allow them to dry out. time. They were also expected to furnish their own Objects recovered from the wreck included: the instrument chest, which had to be inspected by skeletons of 200 bodies, some with clothing, and the Royal College of Surgeons (prior to 1800 The 18 000 light objects, the location of which was Company of Surgeons) and then sealed before being precisely documented, and among which were leather taken aboard. Dr Goddard, who was taking final purses and clothing accessories, wooden and pewter examinations in Medicine, gave us some graphic (officer ware) eating utensils and bronze stewing pots, details taken from the journals of naval surgeons. wheat seeds, pepper-corns, the bones ofbeef and fish cut to standard sizes, the cod samples missing the Surgeon Rear Admiral A L Revell RN DA FFARCS most succulent cut, suggesting some entrepreneurial (Director Medical Services RN Hospital, Plymouth, filching, an oak leaf, glass vessels, the remains of UK) concluded the talks with a 'History ofthe Royal black rats and beetles and wooden fishing-tackle. Hospital, Haslar'. The architect Theodore Jacobsen Larger objects found included two large copper was commissioned to construct a naval hospital. cauldrons set in fire-boxes in the hold and in which He had already built The Foundling Hospital in the food was cooked, and several cannon. Bloomsbury, London, which Captain Coram was The barber-surgeon had two small cabins on the instrumental in procuring, and in 1753 the front wing lower deck, rooms without daylight and surrounded ofHaslar Hospital was opened. It still stands, said at by heavy cannon. Some 64 objects were recovered the time to be the largest brick building in Europe, from these rooms, including brass syringes with andthe bricks still show less weathering than do those changeable nozzles, probably for urethral irrigation, manufactured in this Century. The patients were ear scoops of bone, a bleeding bowl, razor blade conveyed from ship to the hospital in carriages, and handles, ointment vases, a surgeon's cap and a range some ofthe later rails can still be seen in the entrance of earthenware flagons or pots from the Rhineland, to the hospital. The land route from Gosport passed to be referred to later. It was suggested that a mallet over a wind-swept bridge referred to colloquially as also found might be used to tap repeatedly on the 'pneumonia bridge', and when an enterprising helmet of a soldier undergoing an operation as a kind merchant started to sell liquor on the route it was of distractional anaesthetic. said that patients tended to arrive not only with Regaled with information, we viewed the Mary Rose pneumonia but also drunk. herself before lunching in the Officers' Mess at As many ofthe patients were press-ganged seamen RNH Haslar. who wished to escape, a fence ofiron railings was made from the ward wings to St Luke's Church, and there After lunch we heard Surgeon Vice Admiral was even a sentry in charge of sewers mounted for Sir James Watt (Past President ofthe Royal Society the same precaution. We were informed that the of Medicine and late Medical Director-General RN) Press-gang Act had not yet been repealed. The nurses explain the mysteries of why the ship capsized were a rough lot and were wont to carry bladders full and the purpose of the pots in the Barber-Surgeon's of gin strapped to their stays into the wards, where cabin. The Salerneon tradition of treating wounds they did not confine their activities to orthodox duties was practised by the naval surgeons at the time, ofcomfort. However, John Howard, when he inspected in which wounds were cleaned and the surrounding the hospital in 1758, pronounced that all was well. skin shaved, the edges were abraided and foreign bodies removed before the wounds were salved After tea the visitors were shown around the with dilute wine, for which purpose the Rhineland eighteenth century buildings by Admiral Revell, 122 Journal of the Royal Society of Medicine Volume 87 February 1994

Captain Jenkinson RN and members ofthe staff. In of us thought that our President's naval and oceanic the charming Georgian Church of St Luke, which was expertise had temporarily deserted him. Not a bit of restored in 1963, we learned that the surgeon's it. The two walkers arrived intact and dry, fully patients sat on the right of the nave and the exercised and aglow, just in time to catch the ferry, physician's on the left. and only then did the clouds burst in a thunderous Under the aegis of our President, the day had been farewell to a delightful day. agreeably occupied by nautical matters but when we saw, at the conclusion, our leader and a colleague electing to walk back to the ferry and at the same time M A Smith we surveyed the dark clouds gathering above, many Council Member, History of Medicine Section

would have sufficed to kill a ship's crew or a company of soldiers'. Letters to the Editor ANDREW GASSON 6 De Walden Street London WlM 7PH, UK

Preference is given to the letters commenting on contributions published recently in the JRSM They should not exceed He/She 300 words and should be typed double-spaced. I refer to the letters from Sidney Kahn (May 1993 JRSM, Two hundred years of drug abuse p 309) and Geoffrey Ridgway (April 1992 JRSM, p 246). I think the resentment in connection with the use of he as Another well known Victorian who might have been a sex-neutral personal pronoun is felt by a minority of the mentioned in Golding's 'Two Hundred Years of Drug Abuse' population and the attempt to impose a neologism such as (May 1993 JRSM, p 282) is the novelist, Wilkie Collins. 'esh' on the majority would probably have the reverse effect The Moonstone (1868), possibly his most famous book, was ofthat intended. It would promote merriment at the expense written whilst he was taking opium to alleviate the symptoms of the minority. The solutions proposed s/he, h/she and esh of gout. In addition, the plot hinges round the central could be opposed on the ground that the first letters s or h character's somnambulistic hiding ofthe eponymous diamond and even the unaspirated e are sex orientated. I think a whilst unknowingly under the influence of the drug. better solution might be 'he using the neutral apostrophe In 1869, Collins wrote to note the possible omission of a letter and this could be used in writing. As in my opinion attempts to introduce a neologism in speech would not be successful I think it should My Doctor [Francis Carr Beard] is trying to break me of the habit of drinking laudanum. I am stabbed every night at ten with a sharp be accepted that those who feel very strongly about the pointed syringe which injects morphia under my skin - and gets me matter should use she where formerly he would have been a night's rest without any of the drawbacks of taking opium used to indicate either sex, whereas those who do not feel internally. IfI only persevere with this, I am told that I shall be able, 'inflamed' by the use of he should still employ it. I do not before long, gradually to diminish the quantity of morphia and the think the majority would resent the use of she by those who number of the nights stabbings - and so emancipate myself from thought it appropriate. I am sure no offence was ever opium altogether. intended by those using he to represent any person whose sex is not specified and perhaps we should be more tolerant in this matter. Alas, the treatment proved unsuccessful and towards C E QUIN 31 Prince Edwards Road, the end of his life Collins 'took more laudanum than Lewes, E Sussex BN7 1BL, UK

INTERNATIONAL SOCIETY FOR THE HISTORY OF MEDICINE

4-8 SEPTEMBER 1994 WaW GLASGOW, SCOTLAND

34TH INTERNATIONAL CONGRESS ON THE HISTORY OF MEDICINE Meeting Makers, S0 George St., Glasgow. GI iQE. UK. Tel: 041-553 1930