68 



NiTURli 



[September 26, 1918 



dmirable contribution to " Recon- 

 the fruit of his official surveys of 

 te and future needs of the English 



ion of the community to the doctor 

 The latter is no longer merely a 

 private craftsman dealing with private clients. 

 Befon the war called the main body of practi- 

 s into war service, the State as such claimed 

 whole-time or part-time service of some 

 _>o,ooo of them, and imposed heavy civic responsi- 

 bilities upon the rest. The doctors were called to 

 a wider ministry than heretofore; the State by 

 implication musl needs concern itself with the 

 question of seeing thai they were fitted to serve 

 it. In the words of the paper, "medicine has 

 become a quasi-public profession ; . . . the citizen, 

 as legislator and as taxpayer no less than as 

 patient, is interested in the maintenance of a high 

 standard of medical education. . . . The common- 

 wealth does not require two standards of medical 

 man All medical education should be funda- 

 mentally one and the same in regard to basis, 

 technique, and spirit." Sir George Newman with- 

 out hesitation pronounces that there is only one 

 education which will meet the requirements*of the 

 nation; "in a word, it is a university education 

 in medicine. And the foundation of such an 

 education is science." 



lie is well aware that the present five years' 

 curriculum is overloaded : but it can be lightened 

 to some extent when all secondary schools teach 

 science efficiently. The student would not, as 

 now, begin his medical course ignorant of the 

 essential propaedeutic of chemistry, physics, and 

 biology. If the elements of these were already 

 familiar to him, the university professors of the 

 first-year stage might limit themselves to senior 

 courses on the medical bearings of these subjects. 

 \n.itomy and physiology, now taught to an ever- 

 increasing degree in the true scientific spirit, 

 should be more closely related with clinical medi- 

 cine and surgery. The laboratory and the 

 demonstration-lecture must displace the "syste- 

 matic" lecture. Pharmacology, from which 

 "materia medica " and pharmacy may now be 

 seven d, should link up physiology with clinical 

 thei t] itics, and have its laboratories and special 

 stalls. Therapeutics should constitute a distinct 

 Orient, in direct relation with the hospital 

 ward tienl room. Pathology, which has 



of late "come to its own," must all over the 

 country havi its hospital "institute," under its 

 own professoi and assistants, and be worked as 

 an indispensab e factor in ward-work, and planned 

 on the basis ol " lather than "specimens." 



It is in the 1 i ijects and in preventive 



medicine thai Engl fiools are most defective. 



The English system I i medicine too much as 



an art, too little as ., ience. It gives small 



chance for the study of prophylaxis or of incipient 



disease; its ward-cases an the "finished 



le." It is ill organised, for its professors are 



part-time men, whose- bread-winning work is 



-ate practice, not their tea in . As an 



. 2SS2. VOL. I02] 



eminent physician has said : " llarlcy Street is the 

 grave of the clinical teacher." "A man cannot 

 serve two masters," says Sir George Newman. 

 "That is the predicament of the clinical teacher 

 in England. And there is only one solution. He 

 must be paid as a teacher." This means, as has 

 been pointed out authoritatively by many who 

 have a rigbl to speak, the establishment and en- 

 dowment of whole-time professors of the "final 

 subjects, medicine, surgery, and obstetrics, each 

 with his "unit" of wards, laboratories, and 

 stall, co-ordinated, freed from the compulsion 

 of outside practice, bound to devote him- 

 Self not only to teaching, but also to re- 

 search. "The need of English medicine above 

 all others at the present time is the opportunity 

 for the cultivation of the laboratory method and 

 the scientific spirit." For preventive medicine 

 the like is required; the ordinary practitioner need 

 not be a professional or specialist medical officer 

 of health, but he must know enough to articulate 

 his own work with the State services that touch 

 it at innumerable points; and he must interfuse 

 prevention with all his curing.. Hence, in his 

 training, it is the interest of the nation to ensure 

 that the purpose and spirit of preventive medicine 

 should pervade the entire curriculum — for all the 

 branches and departments of the latter need its 

 inspiration. The General Medical Council last 

 May took the first step along this patli of pro- 

 gress. 



"The Place of Research in Medical Si 

 is the subject of a moving chapter, in which the 

 verdict of the London University Commission 

 (1913) is cited as an aphorism : "It is a necessary 

 condition of the work of university teachers that 

 they should be systematically engaged in original 

 work," with the pithy comment that "he only is 

 the great teacher who is inspired by the spirit of 

 discov cry. " 



The- urgent need for organised and efficient 

 "post-graduate" instruction, to enable the prac- 

 titioner to supplement his general knowledge by 

 specialities, and to keep himself abreast, by peri- 

 odic sludv at the fountain-heads, of modern ad- 

 vances, is eloquently expounded, not for the first 

 time. Hut it has been brought home with new 

 insistence by the pressure of recent experience, 

 flic men ol the medical services Army, Navy, 

 Indian, Colonial — clamour for such opportunities; 

 graduates from the Overseas Dominions, from 

 the United States, and from the Allied countries, 

 arc asking lor the chance to study in Britain 

 rather than in Ciermanv or Austria. Are we ready 

 for them in London, in England? Sir deorge 

 New man sets forth what is still lacking in our 

 equipment, ami the list of shortcomings is not 

 small. Ilie cost in money will be considerable: 

 we have the men; we require the organisation. 

 Hut the President of the Hoard of Education and 

 "both Houses of Parliament " are told frankly 

 that "it would handsomely repay thi- State to 

 encourage and to aid " a regular system of post- 

 graduate study, "so rapid and profound are the 

 advances in medicine." 



