812

IMMUNISATION STATUS OF us CHILDREN AT THE TIME OF PERTUSSISINFECTION

THE LANCET, OCTOBER 25,1975

THE M.R.C.P. AND ENTRY TO WGHER SPECIALISTTRAINING IN PlEDIATRICS

the serious adverse effects of the pertussis vaccine, but thepresent advantages of the vaccine well outweigh thedisadvantages.

CultureStatus Total

Positive Negative-------

Patients aged over 5 ma.:Complete immunisation .. .. 7 19 26Incomplete immunisation ., 6 5 11No immunisation .. . , .. 5 21 26

Patients aged 3-5 mo.:Complete immunisation .. .. 3 2 5Imcomplete immunisation ., 7 4 11No immunisation .. .. .. 0 11 11

Patients aged under 3 mo.:No immunisation .. .. .. 11 18 29

39 80 119

Department of Psediatrics,University of Turku,

SF-20520 Turku 52, Finland.

Aurora Hospital andDepartment of Psediatrics,

University of Helsinki.

Tampere Communal Hospital,Department of Psediatrics,Tampere Central Hospital.

Department of Infectious Diseases,University of Turku.

Department of Peediatrics,University of Oulu.

TOIvo T. SALMIOLLI RUUSKANEN

RUTTA HUOVILA

ARJA OUTINENRAIMO ANTTILA

PENTTI HANNINEN

KAUKO KOUVALAINEN

SIR,-The Colleges have been reviewing the common part-nexamination for the M.R.C.P.(U.K.) diploma, which was intro­duced in October, 1972. On the whole we are pleased with theexamination and are satisfied that it is performing its functionas an entry examination to higher specialist training.

There is one point which is receiving special attention. TheJoint Committee on Higher Medical Training recommendsthat those intending to specialise in medicine should enterhigher specialist training four years after graduation andshould usually achieve their membership during general pro­fessional training. Our experience suggests that the entry ofpsediatricians into higher specialist training is delayed becauseof the difficulties they encounter at present in the commonpart-rr written examination. Candidates may now opt to be ex­amined in the orals and c1inicals in either general medicine orpediatrics. The written sections of the part-n examinationrequire a fair degree of experience in adult medicine andanalysis shows that candidates opting for peediatrics are at adisadvantage in the current written examination, particularlyin the data interpretation and projected material sections (eventhough some pediatric questions are included).

The Colleges have therefore agreed that a padiatric writtensection will be introduced as soon as possible in 1977. Thestandard of the examination will remain the same and somequestions will be common to both the peediatric and general­medicine options. Those candidates who have succeeded in themembership examination through the psediatric option shouldnot in any way be considered to be "specialists" without un­dergoing higher specialist training as laid down by the JointCommittee on Higher Medical Training.

Riihimiiki Regional Hospital,Riihimiiki, Finland.

SURGICAL TRAINING

SIR,-The letter from Professor B1andy and others (Oct. 4,p. 656) is important, for, as they point out, the British surgicalFellowships are now unique in being examinations taken at thebeginning of training whereas those of the other Fellowshipsand the American Boards are at the end of higher surgicaltraining.

Higher surgical training in Britain has been revolutionisedin the past few years with all the changes inherent in the nowrequired inspection and approval of centres for higher trainingin each surgical specialty. In basic or pre-F.R.C.S. training Ibelieve the British have shown great wisdom in retaining aprolonged training in surgery in general. In Edinburgh, forexample, in a 3-year rotation in basic surgical training, theyoung surgeon may meet five specialties of surgery, giving hima width of education that is unsurpassed. In North America,in contrast, training outside the chosen final specialty hasalmost been eliminated. I hope we will never follow this pat­tern. It is tempting to do SO, for the surgeon in some of thesecountries graduates to full practice at the age of 31 or 32whilst in this country on our old, disorganised pattern of train­ing our surgeons were only obtaining consultant posts at theage of 37 or 38. Our new pattern of training, longer thoughit is than in some countries, is likely to shorten training veryconsiderably and eventually men will be completing their sur­gical training at the age of 32 or 33-an average saving of 5years over the present system.

SCLEROSING PERITONITIS AND PRACTOLOLSIR,-You have published several reports of sclerosing

peritonitis as a complication of praetolol therapy. Wedescribe here a further case.

A 50-year-old farmer's wife had a hysterectomy for myomas in1971. She had postoperative pulmonary embolism but recoveredwell. From 1971 she had recurrent angina, and practolol(' Eraldin '), 1 tablet 2-3 times a day, was prescribed in Septem­ber, 1972. This drug was given regularly until August, 1974.As supplementary therapy long-acting glyceryl trinitrate wasprescribed, I tablet 2-3 times a day. From September, 1974,she had sporadic pain in the upper abdomen, vomiting, andmeteorism. Her diet was found not to have any effect on thesedisorders.

During the last days of March, 1975, heavy vomitingoccurred. The patient was admitted to hospital, and apleural" chafing" sound was discovered in the lungs. Onpalpation the abdomen was soft, but a large cystoid tumour,about 30 em in diameter, was palpable in the right umbilicalregion. X-ray revealed a partial intestinal obstruction.Contrast X-ray located it in the distal jejunum. On admis­sion, the results of laboratory tests were normal. Atlaparatomy on April 8 a sheath 2-3 mm thick was found tobe covering the organs in the abdominal cavity. Thetumour proved to be a bundle of intestine covered by thissheath. The intestine was freed from adhesions andplicated. Postoperative recovery was normal. Thespecimen taken from the sheath corresponded fully withthat described by Brown and his colleagues.' Nooculocutaneous symptoms were found in our patient.

S. SOIMAKALLIOK. VALLINMAKIH. LEHMUS.

1. Brown, P., Baddeley, H., Read, A. E., Davies, J. D., McGarry, J.Lancet, 1974, ii, 1477.

Central M.R.C.I'. (U.K.) Office,c/o Royal College of Physicians,11 51. Andrew's Place,l.ondon NWI 4LE

JOHN CROFTONPresident, Royal College of

Physicians of Edinburgh

FERGUSON ANDERSONPresident, Royal College of

Physicians and Surgeons of Glasgow

CYRIl. A. CLARKEPresident, Royal College of

Physicians of London