766 
adds still to unequalled conquests ; that “ integration” 
in medicine has at least begun. 
Why, then, should we turn from Sir George New- 
man’s remarkable document dissatisfied and oppressed ? 
It is not primarily the wealth of medical knowledge 
that is Sir George Newman’s theme, but the problem 
of student inheritance. It may be true that “the 
most after all that can be accomplished .. . is to 
provide him with the tools of learning in order that 
by experience he may become a reliable and effective 
workman.” It is true, if by “tools of learning” is 
meant something which, though vague, is positively 
and certainly immeasurably short of his ultimate 
attainment as a representative physician or surgeon, 
or an efficient general practitioner. In the most that 
can be accomplished is room for widely divergent ideals 
and attitudes. ‘‘ Science,” writes Dr. Bateson, “ is 
not a material to be bought round the corner by the 
dram, but the one permanent and indispensable light 
in which every action and eyery policy must be judged. 
. .. The splendid purpose which Science serves is 
the inculcation of principle and balance, not facts.” 
Is this sentiment, so ingrained in the outlook of the 
man of science who necessarily looks forwards and 
away from the already known, a safe approach to the 
discussion of the adventitious and the merely academic 
in the medical curriculum ? Over and over again it is 
borne in upon us that the medical student is the veriest 
beast of intellectual burden. The biologist writes 
threateningly that “‘if the medical man is not a biologist, 
he is nothing,” while it is admitted that “what is 
necessary is a widening of the basis, less imposition 
of details on the memory of the student, and an 
introduction to scientific thought and method.” In 
chemistry ‘“‘ the amount of detail imposed upon the 
student in didactic lectures is still perhaps too great.” 
Anatomy “ has been robbed of its heritage and reduced 
to the routine and detailed analysis of a scrapped 
machine, and the only goal has all too frequently been 
the examination test.” The past student of anatomy 
was “overburdened with a multiplicity of detail, 
wearied with bone classes and a hundred systematic 
lectures, and harassed by meticulous examinations 
for which he is driven to prepare himself by ‘ cram- 
ming.’” Even in medicine and surgery “ the student 
is overfed for his size.”” He attempts to learn, merely 
for examination purposes, much that is of little value, 
yet fails completely to master the simpler knowledge 
and manipulations which may fall to his lot frequently. 
How could it be otherwise when the prestige of famous 
schools depends upon pass lists and distinction lists, and 
not by any means upon the “ inculcation of principle 
and balance” which only life, ‘never overlooking a 
mistake or making the smallest allowance for ignor- 
NO. 2797, VOL. III] 
NATURE 

[JUNE 9, 1923 
ance,’ can test? Much as the fame of some of them 
deserves to be founded in the breadth and distinction 
and power to influence of their teachers, that is the 
case in scarcely one. “At present, in spite of the 
reasonableness, high competency and goodwill of the 
examiners, the system remains a shackle upon medical 
education.” 
Sir George Newman offers two remedies for this 
malady. The first is time and the natural order of — 
events, a necessary element, doubtless, in every 
advancement. The second is the acquisition of a 
more practical outlook throughout the training of the 
student. His science should be applied science. We 
wonder whether the historical and, as it were, develop- 
mental setting in which Sir George Newman has cast 
his study has not misled him there. Is the progress of 
medicine really an orderly progress as of one body? 
The point is sharpened by Prof. Halliburton, to whose 
views the memorandum gives assent. ‘‘I venture to 
think,” he says, “ that not infrequently the fault lies 
not with the physiological teacher, but with the hospital 
physician. . . . The physician, after an inadequate 
study of the science of physiology in the remote past, 
may have lost all touch and sympathy with the science 
of to-day, may have sunk into an easy empiricism, and 
may be content to cloak his ignorance by sneers at the 
application of scientific methods to practice.” Thought- 
ful students have themselves recognised (or suspected) 
that it was there the bottom fell out of their curriculum. 
They had been taught to expect too much from practice: 
had confused applied science with the application of 
scientific methods. Sir George Newman regards the 
antithesis between the practical man and the inquiring 
man as false. But it is not false. It lies at the root 
of all the present difficulties of medical education. 
The “clinical unit” system—a genuine device of 
integration—may do much to resolve it ; but confusion 
of thought in regard to it will prove the most dangerous 
obstacle to that great reform in medicine which now 
opens before us so hopefully. 

British Coal-Mining in the War Period. 
The British Coal-Mining Industry during the War. By 
Sir R. A. S. Redmayne. (Economic and Social 
History of the World War, British Series. Published 
on behalf of the Carnegie Endowment for Inter- 
national Peace.) Pp.xv+ 348. (Oxford : Clarendon 
Press; London: Oxford University Press, 1923.) 
tos. 6d. net. : 
IR RICHARD REDMAYNE is to be congratulated 
upon having produced a work of quite exceptional 
interest ; the history of the means by which the British 
coal supply, upon which our chances of victory so greatly 

