574. 



NATURE 



[July 8, 1920 



The teachers of medicine, surgery, gynaecology, 

 etc., used to be men practising their profession 

 who gave up a certain amount of time to teaching 

 medical students. Such men could bring to their 

 teaching the ripe experience gained not only in 

 the hospital wards, but also in contact with private 

 patients ; and, in addition to teaching the science 

 and practice of medicine, were supposed to be able 

 to convey to the student something of the subtle 

 art popularly known as the "bedside manner," 

 which is sometimes reputed to be more useful to 

 the practitioner than either knowledge or skill. 

 But it has long been felt that such teachers. In the 

 course of their Individual careers, would become 

 more and more strongly tempted to neglect teach- 

 ing and research as the demands of their practices 

 became more insistent, and that It was only the 

 exceptional man who would be sufficiently inter- 

 ested In investigation and teaching to make the 

 financial and social sacrifice which the cultivation 

 of his scientific interests would inevitably entail. 



British medicine, both now and in the past, has 

 been extraordinarily fortunate in such " excep- 

 tional " physicians and surgeons, who have de- 

 liberately set aside part of their time for scientific 

 research and teaching. But for their zeal, this 

 country could not have acquired or maintained 

 Its deservedly high reputation for clinical research. 

 Nevertheless, the fact has to be faced that In some 

 of the hospitals attached to our schools of medicine 

 no real research of any kind Is being carried on, 

 and the clinical teaching Is of the most perfunctory 

 order. The obvious remedy for this disastrous ten- 

 dency is to appoint selected men to Investigate the 

 problems of medicine and surgery and to direct 

 the education of students, who will devote the 

 whole of their time to this work, as the professors 

 of anatomy, physiology, pathology, and phar- 

 macology do at present. Such a development has, 

 In fact, become Inevitable, for now that a real 

 science of medicine Is beginning to emerge the 

 investigation of Its difficult problems and the direc- 

 tion of the students' training demand the whole 

 time and energy of specially selected men with the 

 necessary technical training and self-denying devo- 

 tion to science to cope with such tasks. 



This system has been tried In America with most 

 encouraging results. Acting on the advice of 

 Sir George Newman, the Board of Education last 

 autumn agreed to provide financial help to enable 

 certain medical schools to Introduce the system of 

 full-time teachers of medicine and surgery In 

 England. Of the Institutions that availed them- 

 selves of this offer, the University College Hospital 

 NO. 2645, VOL. 105] 



Medical School was the only one which adopted 

 a really whole-time system ; and it was this con- 

 sideration that focussed the Interest of the Rocke- 

 feller Foundation upon the Gower Street School, 

 for in America the Rockefeller Foundation has 

 played a large part in encouraging the adoption of 

 the whole-time professorships of medicine and 

 surgery. Another factor that played some part in 

 determining its selection was the fact that 

 University College had made provision in its 

 Institutes of Physiology and Pharmacology for the 

 adequate training of students in those subjects, so 

 as to equip them to make the best use of the new 

 facilities for clinical study In the medical school ; 

 and further that Prof. Starling had agreed to hand 

 over to the department of anatomy the sub-de- 

 partment of histology, which Is vitally Important 

 for the full development of teaching and research 

 in anatomy. 



The great development in the science of 

 anatomy during the last thirty years has been due 

 mainly to the use of the microscope for the Inves- 

 tigation of the structure of the body and for the 

 study of embryology. British anatomy has been 

 hampered by the lack of the facilities for teaching 

 these vital parts of the subject, and has suffered 

 enormously from the lack of stimulating daily 

 contact with them. In other countries, and especi- 

 ally In America, the cultivation of histology 

 and embryology has not only made anatomy one 

 of the most active branches of medical study and 

 research, but also brought the work of the 

 department Into close touch with physiology, bio- 

 chemistry, and pathology, to the mutual benefit of 

 all these subjects, and especially to the student 

 who has to Integrate the Information acquired in 

 the different departments. It was the radical re- 

 forms effected In the teaching of anatomy by the 

 late Prof. Franklin Mall at the Johns Hopkins 

 Medical School in 1893 that played the chief part 

 In starting the great revolution in medical educa- 

 tion in America. The stimulating influence of the 

 abolition of the methods of medieval scholasticism 

 in anatomy and the return to the study of Nature 

 and to the use of experiment brought about a 

 closer co-operation with other departments and a 

 general quickening of the students' Interest in the 

 real science of medicine. 



The effects of these developments spread to 

 other American schools, and the Rockefeller Foun- 

 dation came to their help and contributed part of 

 the cost of the vital reforms. In 1914 It helped 

 the Washington University at St. Louis to build 

 a new medical school and hospital, with full-time 



