NATURE 



541 



THURSDAY, JULY i, 1920. 



Editorial and Publishing Offices: 



MACMILLAN gr CO., LTD., 



ST. MARTIN'S STREET, LONDON, W.C.2. 



Advertisements and business letters should be 



addressed to the Publishers. 



Editorial communications to the Editor. 



Telegraphic Address : PHUSIS, LONDON. 

 Telephone Number: GERRARD 8830. 



Medical Research and the Practitioner. 



IN the interim report ^ issued recently by the Con- 

 suhative Council on Medical and Allied 

 Services, under the chairmanship of Lord Dawson 

 of Penn, the proportion given to research is dis- 

 appointingly small. Perhaps this was inevitable. 

 The medical organisation suggested includes 

 effective laboratory equipment at every stage from 

 the domiciliarv work of the practitioner to the 

 conducting of prolonged researches by the Medical 

 Research Council; but the portions dealing with 

 research proper are very generalised. A docu- 

 ment like this should be a new charter for medi- 

 cine, and the scientific mind naturally expects to 

 see the scientific groundwork fully developed. For 

 increased and accelerated research is essential to 

 the continued expansion of scientific medicine. In 

 the report it is hoped 



"that the scheme of services which we suggest 

 would facilitate enquiry into the causes of disease 

 and the possible remedies. The facts which indi- 

 cated the need for such enquiry might, we think, 

 often be brought together in the first instance by 

 the medical practitioners in a given locality," 



It is difficult to justify the hesitating note of 

 these sentences. Medical practice bristles with 

 unsolved problems ; but usually the practitioner is 

 inadequately trained to discover them. Sir James 

 Mackenzie shows what a general practitioner can 

 do when he has the interest and the capacity to 

 train himself. The war has unveiled many gaps 

 in scientific medicine. Even the war reports of 

 the Medical Research Council, not to refer to the 

 many others, prove that the science of medicine 

 will not advance merely by a re-shuffling of the 

 medical army, but by greater intensity of research 

 and discovery. 



jVledicine has to face the fact that, for practical 



-•1 Ministry of Health Consultative Council on Medical and Allied 

 Services. Interim Report on the Kuture Provision of Medical and Allied 

 Services. Pp. 28. (London: H.M. Stationery Office, 1020.) Cmd. 693. 

 Price IT. net. 



NO. 2644, VOL. 105] 



purposes, it knows nothing about the cause of 

 measles, scarlet fever, mumps, influenza, rheu- 

 matic fever, cancer, or other forms of malignancy ; 

 nor is the knowledge of the causes of dead and 

 premature births more than elementary. These are 

 only a few illustrations taken from the Medical 

 Research Committee's fifth annual report. It is 

 reasonable to expect that, in a scheme that brings 

 the medical profession into a unity, the clotted 

 masses of problems facing the general practitioner 

 and scientific worker alike would be sketched with 

 precision and force. The report does add that 



"there are great and important opportunities for 

 research in preventive medicine, which at present 

 are scarcely dealt with by any organisation, and 

 mostly are not attempted by individuals. En- 

 couragement of research in the prevention of 

 disease should, we think, be developed, for the 

 materials are everywhere, and the results would 

 undoubtedly be valuable." 



From this the lay public would not readily 

 gather that the future value of the general prac- 

 titioner to the State depends on the development 

 of research in at least the following sciences : 

 biology, physiology, bio-chemistry, pathology, and 

 experimental therapeutics. To the raw materials 

 of such researches the various classes of medical 

 practitioners can contribute; but they have little 

 stimulus to do so unless they keep more closely 

 in the currents of the scientific work of the 

 schools. 



The report indicates that, for the purposes of 

 research into fundamental problems, "the pro- 

 fession would no doubt look to the Universities 

 and the Medical Research Council for guidance 

 and assistance." When we reflect that the medical 

 profession has to deal with sanatoria for tuber- 

 culosis, recuperative centres, hospitals for' curable 

 or incurable mental disease, institutions for the 

 feeble-minded, epileptic colonies, orthopaedic 

 centres, hospitals for infectious diseases, not to 

 mention general hospitals and the innumerable 

 fresh points emerging in eveny man's practice, 

 there is abundant occasion to look both for "guid- 

 ance and assistance." 



What we miss here is a compact and well- 

 loaded presentment of the case for research from 

 the general practitioner's point of view. At 

 present neither general practitioners nor consult- 

 ants have an adequate conviction that more and 

 more as time goes on the value of their work will 

 depend' on the capacity to understand and to 

 prevent the beginnings of disease, and that, with- 

 out effective training in research at some stage of 

 their career, they can make little headway in pre- 



