688

farm could be accounted for in this way. One can onlyconclude that the regulations relating to these sub-stances were inadequate to protect this man from poison-ing which might have resulted in his death.

I thank Dr. J. Liddell, consultant clinical pathologist, Guy’sHospital, Dr. R. G. Huntsman, consultant pathologist, St. Thomas’sHospital, Dr. K. Jones, medical director Fisons Pest Control, andDr. W. S. S. Laddell, Chemical Defence Experimental Establish-ment, for their advice and encouragement. I am grateful to thedepartment of pathology, Peterborough Memorial Hospital, forperforming the cholinesterase estimations, and to the inspector,Ministry of Agriculture at Huntingdon, for his invaluablecooperation.

Occasional Book

WHEN THE KNAVE EXPLOITS THE FOOLIN Washington, D.C., sixty years ago, a product with the

remarkable name of Cuforhedake Brune-Fude’ came underthe scrutiny of the Law. The charge was not murder of theEnglish tongue but misleading labelling. The prosecution,the first under the Pure Food and Drugs Act of 1906, wassuccessful, and the manufacturer had to part with 0-035%of an estimated$2 million profit. The spectacular success ofsimilar products and the often protracted events leading totheir demise is the material for a fascinating account ofquackery in 20th-century America.1 Professor Young sets hisstudy against a background of a nation eager to exploit to thefull the potential of mass advertising yet, paradoxically, justbeginning to reap the benefits of scientific medicine. In anearlier book, The Toadstool Millionaires, the author left off atthe passing of the 1906 Act. Had this piece of legislation beensuccessful, no sequel would have been required.

It is not easy consistently to distinguish the nostrum andfolk remedy from the more acceptable self-medications, butthere can be little doubt that " quack " is the right descriptionfor the products which the author puts up for ridicule-1 %sulphuric acid (for headaches, measles, consumption) and amixture of turpentine, ammonia, and raw eggs (a real cure-all)are but two examples. Manufacturers worked on the grandestscale. Professor Young cites one estimate of total annual salesas$2000 million, and by the time the last page is reached onealmost believes it.$26 million was spent in one year on a

single product-a subtle blend of vitamins, minerals, lucerne,parsley, and watercress. The enforcement agencies, the Foodand Drug Administration and Federal Trade Commission,had some notable successes but seem to have been inadequatelyequipped to tackle their enormous task. They found a usefulally in the American Medical Association, one of whose staffdevoted his working-life to the defeat of quackery, consultingAlice in Wonderland each time before passing judgment onsome particularly fanciful claim.

It is all good social history, a blend of scholarship andjournalism, yet something is missing. The paradox is therefor all to see-for example, years after Banting had discoveredinsulin a mixture of saltpetre and vinegar was being success-fully promoted as a cure for diabetes. Yet to the nature of thisgullibility-the " perennial proneness

" is the author’s term-Professor Young devotes but one short chapter. Is quackerymerely the offspring of ignorance ? If it is, can education alonehelp to remove it ? How could any health-education agency,however well intentioned and endowed, hope to have competedwith the State senator from Louisiana whose travelling show,including chorus girls and the Marx brothers, cost himhalf a million dollars and grossed him six times that sumin safes ?

PATER NOSTRUM

1. The Medical Messiahs. By JAMES HARVEY YOUNG, professor of history,Emory University, Princeton. New Jersey: Princeton UniversityPress. London: Oxford University Press. 1967. Pp. 460. S9. 85s. 6d.

Medical Education

COMMON PART-I

MEMBERSHIP EXAMINATION

OF ROYAL COLLEGES OF PHYSICIANS

AT the request of the fellows of the Royal Colleges ofPhysicians of Edinburgh and London and of the RoyalCollege of Physicians and Surgeons of Glasgow, a com-mittee was appointed to consider the establishment of acommon part I to their membership examinations. Therecommendations of this committee have now been

accepted by each of the three colleges, and arrangementsare being made to hold a common part-l membershipexamination starting in October. The ultimate aim of thecolleges is to discourage candidates from acquiring themembership of more than one college by examination, andauthority has been given for the committee to continuediscussions with this in view.The common examination will take the form of a

multiple-choice question paper, corrected and analysed bycomputer. A Joint Examination Board of the three collegeshas been set up. This Board will be responsible for theexamination, for the setting of the papers, and for theircorrection and analysis. They will recommend pass liststo the colleges, each of which will retain responsibility forits own pass list. Detailed regulations have been drawn upand will shortly be published.The announcement of this joint plan adds:

" If youngdoctors are to be actively discouraged from seeking theMembership of more than one of the Royal Colleges byexamination, it follows that the Profession and AdvisoryAppointment Committees should accept the membershipof the three Colleges as of equal standing and that Mem-bership of one College should suffice-on this the Collegesthemselves are already agreed. The Presidents of thethree Colleges hope that, in making consultant appoint-ments, Advisory Appointment Committees will, in future,pay more attention to the training that an applicant hasreceived before and after his admission as a Member of oneof the Colleges, than to the actual examination which hehas passed."

In England Now

A Running Commentary by Peripatetic CorrespondentsTHE proliferation of scientific journals, like that of motor-

cars, is so alarming that unless its rate is checked a jam mustinevitably supervene. A disciplinarian like Mrs. Castle isneeded to bring the scientific communication problem undersome kind of control. Any such control will be resented byscientists, who are by temperament individualists, but in thelong run they will recognise the necessity for restraint. Thereshould be a general limit on scientific writing: nobody shouldbe allowed to publish more than four papers a year, only oneof which can be a review. The penalty for publishing virtuallythe same paper twice should be suspension from publicationprivileges for a period of 1-10 years. In the case of extremeoffenders a life-sentence could be imposed. Writing fewerpapers would, as Dr. Johnson remarked of the prospect ofhanging, concentrate the mind wonderfully. There is, un-fortunately, no instrument like the breathalyser which mightallow objective assessment of the fitness of any person to

write papers; but a stricter editorial policy would, as in driving-tests, assure a reasonable standard of performance. And itshould be much more difficult to obtain a licence to start a new

journal than to open a new public-house.