To: From: STATE OF CALIFORNIA SACRAMENTO 14 Inter-Departmental Communication John ¥ Fisher Executive Officer ware Porammel Ottteur Koa. 1 Sacramento, California Subject: Department of Mental Hygiene “fens se “a ee * File No. Date: Seo aed 7 Protest of Examination Medical Deputy Directer — Department of Mental Hygiene Reference is made to the examination for Medical Deputy Director, Department of Mental Hygiene, given on April 29, 1947. I protest the general character of this examination and some specific questions. I have not had sufficient time to go into the examination $0 as to protest all the questions that are in question because I have been out of town and must go again before the ationten time for protest. eaghrye. I wish first to say that an attempt seems to have vee made to make this examination especially hard, and also thet im doing so, numerous multiple choice questions were given to which there were several answers just as appropriate as the answer keyed as correct. Along with the diffioulty of deciding a fine point between four or five different answers, the fact that the examination was five hours leng and- constant writing was necessary in order to complete it made it impossible to evaluate the various ideas that may have been in the examiner's mind with sufficient thoroughness to head up of what might have been considered by him to be the correct answer. With these et remarks items are mentioned as Penenee he A ‘am, thin face 1s no more an indieation of peptic i car then : om ¢ “oF . the other conditions mentioned in the aml-— tiple choice question. Many physicians and health officers — argae am the Tanpenaed incidence of reported diabetes mellitus being due to the recent discovery of previously mrecognized cases. In fact it has been definitely shown that during the first World War the incidence of diabetes mellitus definitely decreased in Germany because of the shortage of food, including sugar, and it increased later on after the war when the population could get the foods that they wanted. The consumption of sugar in large quantities has long been recognized as one 70910 3-47 10M SPO « GstaeeS STATE OF CALIFORNIA SACRAMENTO 14 Inter-Departmental Communication [~ : | John F, Fisher File.No. Page 2 ; Executive Officer . | To: ‘Mate Personnel Goard Date: 5547 Sacramento, California Subject: From: Department of Mental Hygiene of the important causes for numerous eases of diabetes mellitus. Aso, most of the specific diagnostic measures for diabetes mellitus were know 25 years ago. | : ion 2 aze The most important complication of primary epatia is stated to be epilepsy rather than paralysis. aa | : There is very serious doubt about the aceuracy of this _ gaestion. Paralysis complicating primary amentia is a very common con~ _ @itien. Our institutions for mental defectives have literally hundreds of these cases, They also have cases of epilepsy but the epileptic cases are in a large measure not primary but eecondary to birth injuries, infections, ete. S & | Que st se 18 _Aeoording to this question penicillin in large doses iatrodesed intrathecally does not produce convulsions, — oes etc, Wo The answer to this suanion bs in error. It is well known that penicillin given intrathecally in large doses will produce convulsions. In fact, there is an article in the dournal of the American Medical Asso~ ax elation, May 3, 1947, which confirms this and cites a case. I quote from this article. | =< | "The purpose of this article is to report a case of menin- gococcic meningitis in which the patient received (by error) a single mas~ sive dose of penicillin intrathecally and recovered after a series of — generalised convulsions." Also in this article it is stated that penicillin may produce convulsions when applied in sufficient concentration to the cerebral cortex. | ‘ 5 in the peve' ric ion. It is keyed that the sinetiremnenriobacren is nab a ihe aan adjunct in distinguishing epilepsy from other neurological conditions. | I claim that the electroencephalogram is a specific diagnostic adjunct. In fact, about the only thing for which the electroencephalogram * "Intrathecal Penicillin," by dames RK. Reuling, M. D., amd Charles renee | _* D. — ~ Page ‘16, Journal Ae a. Ae, May By ‘1947 | a on ee api le RN Og eT Ee Se Ts ES! toe aloe i Sai | el ere nreet aia oes ae arene ia ee earl tet nl To: From: =< od © @&®| 70910 3-47 10M SPO aéfitsnigo STATE OF CALIFORNIA SACRAMENTO 14 Inter-Departmental Communication John F. Fisher Eile No. page 3 Executive Officer | 2s. State Personnel Board Date: $=5=h7 Sacramento, Califomia Subject: Department of Mental Hygiene is a near specific diagnostic aid is epilepsy. It is used in all institutions for epilepsy because of this and it is regularly used to discover whether people have epileptic tendencies; whereas in muserous neurological condi- tions the electroencephalogram has absolutely no value. The word "speci fic® introduced in thie question would, of eourse, render the answer debatable because if this i# what the word was introduced for it is a tricky question intended to mislead neople who know how widely used the sloctrosnaephalagres is in the dlagosis of epllepsy. | juestion 99 7¢.121. The keyed answer to this question is in error, and I Urey that spechienlly all psychiatrists will agree with this. According to the snewer schizophrenia is determined by a specific genetic factor. It ia pretty well agreed that there 4s a hereditary element in the predisposition of many cases of schizophrenia. It is also agreed that there is nothing specific about thie. I believe that no one has claimed that it is a specific genetic factor. If the word "specific" were left out of this question an argument could be made for answering it "true," but there would still be authorities who would question the genetic element. | Phe question included under 113 and 117 does not seem to be a fair question. A correct answer to it surely does not show any knowledge of value or importance. Im this question one is asked to give the name of the right author to the title of certain articles in recent literature on psychosomatic medicine. | - The important point about psychosomatic medicine is to know medical opinions about it. The literature is enormous and whether or not one knows who wrote one of the hundreds of articles that have been written | ie a bit of useless informtion that very few people who are authorities on psychosomatic medicine would be able to give. - To: L From: i: nababeih “th i =< oO © & 70910 3-47 10M SPO ogi STATE OF CALIFORNIA SACRAMENTO 14 Inter-Departmental Communication John F, Fisher Eile No. page 4 Executive Officer ae | State Personnel Board Date: 5=5=h7 Sacramento, California Subject: Department of Mental Hygiene Some of the questions in the dietetic and nutritional section seem to apply to dietitians rather than to a nutritionist. 2 age 2), has a very debatable keyed anewer. The idea is what conduleh should be substituted for meat sandwiches when financial limitations or low market supplies preclude the furnishing of meat sand- wiches. The answer given is peanut butter sandwich. The answer which I believe many nutritionist would regard as correct would be egg sandwich. The nutritional qualities of eggs are more comparable to the nutritionsl qualities of meat than are those of peanut butter. This applies to the protein and fat content and to the vitamins. The nutri- tional qualities of peanut butter, seem to me, would be unfortunate if a person had to live on this type of meat substitute. The caloric value of peanut butter is high, but the fat content is twice that ef protein, which is not the case of any meat except pork. It is admitted that peanut butter is ¢heaper than eggs, but cheapness is not the only consideration in sandwiches. Of course, the argument can always be made that for one sand- wich it make 5 aeaAie difference what it contains. ion 3, page 24. The keyed answer for this is mumber three. t five is just as correct and perhaps more so. This insures a sabisfactory preten : winflu enced by Opinion as must be the case with the keyed answer. . The answer given here is that an open space : aren refrigerened eeieins is the most desirable thing in refrigeration, This is put above low temperature. It seems to me to be common sense knowledge that there can be no proper refrigeration without low temperature. — All the still air in the world will do no good unless we have this. The low temperature is therefore the proper answer for this question. a multiple choice question, could be answered by four of ne five possible methods given. The keyed answer, number 5, "a conference with the chef on the day ahead" semms to be the most incorrect method, because the chef is certainly not supposed to dictate what foods are to be served. His function is to cook it and he should be ready to do 30. To: LL From: