How upper-class diseases, cholera and sexual infections put doctors of yesteryear to test

There was a time when doctors' days were spent dealing with outbreaks of cholera in lunatic asylums and contemplating whether people with mental health problems should be sterilised.

Now the changing face of medical practice has been laid bare with the publication of exam papers dating back more than 100 years, revealing the clinical conundrums which have faced medics in decades past.

The papers, published by the Royal College of Physicians of Edinburgh (RCPE), cover medical problems which bear little relevance to life in Scotland now, such as cholera and scarlet fever.

But they are also revealing of problems which persist, such as sexually transmitted diseases.

The RCPE has published the exam papers to mark 150 years of overseeing the medical examination of doctors - an area where Scotland continues to lead the rest of the world.

Over the years, doctors from more than 80 countries have travelled to Edinburgh to take the Member of the Royal College of Physicians postgraduate medical exam for those wanting to train as specialists.

More than 3,000 candidates sat the exam through the RCPE in the last year alone.

The collection of more than 300 historical papers published on the college's website reveals some interesting insights into what was distracting medics in years gone by.

A paper from 1899 asked candidates to detail how they would examine a child in the case of a suspected infanticide.

A year later, a public health exam asked doctors to describe how to disinfect "a room which has been occupied by a case of scarlet fever in an upper-class house".

Another issue perplexing medics at the start of the last century was cholera.

In 1906, candidates were asked what preventive measures they would adopt in the case of cholera breaking out in a town, barracks, lunatic asylum or on board a ship.

Dr Neil Dewhurst, RCPE president, said a lot of the papers highlighted the changes in public health from the days when infectious diseases were common.

These included the problem of conditions such as syphilis, which has seen a comeback in recent years.The exam papers also reveal some interesting attitudes - and language - related to mental health.

One question asks doctors: "What results might be expected were sterilisation of mental defectives legalised?"

Dr Dewhurst said: "As people with genetic disorders live to older years, to reproductive age, these are areas we feel apprehensive about confronting, but they are still with us."

And the issue of antibiotic resistance was already troubling doctors back in the 1950s.

Dr Brian Keighley, chairman of the British Medical Association in Scotland, said: "These exam papers highlight how medicine has developed over the past 150 years.

"It is largely down to the determination and innovation of our doctors that many of the illnesses of the past can now be cured and even prevented.

"It also shows how important it is for doctors to have time to develop their skills and knowledge throughout their careers to ensure that patients continue to receive high standards of care."