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There are about 4000 doctors in practice and 2000nurses. Under the Japanese, medicine was almost theonly profession open to the bright young man. The

teaching was rigid and authoritarian and the litigiouscustoms of the country made it difficult for him to adoptmany of the modern methods of treatment.

The medical school of the National (formerly Imperial)University is now largely staffed by men who havespent some time in the United States, and betterstandards of work are spreading through the island.Some 365 health stations, each serving a population ofabout 30,000, have been built, nearly all since the war.These are neat, simple, one-storev, concrete buildings

Fig. 2-The younger of these two

sisters shows the hair-changes of

protein-deficiency not amounting to

kwashiorkor.

with a staff of 1 or 2

doctors, 2 to 4 nurses,a sanitary inspector,and a clerk. In themornings clinics are

held for patients whocannot afford, or donot choose, privatedoctors. Patientsare assessed at howmuch they can affordto pay, but treatmentand drugs can be

given free of charge.The afternoons are

spent in public-healthwork, includingclinics for maternityand child welfare,school health, immu-nisation, and thetreatment t of ftrachoma. Post-

graduate trainingin preventive

medicine, organised by the provincial health administra-tion with the help of the World Health Organisation,UNICEF, and other bodies, is improving the amountand quality of the work done. Till now, except at theUniversity Hospital in Taipei, the work of the hospitalshas been below that of the health stations. In view ofthe economic problems of the country it is perhaps aswell that for the present the greatest effort should beconcentrated on preventive medicine and medicaleducation.

Malaria has practically disappeared since the W.H.O.team first began to show how D.D.T. could be used.

Despite what American and British textbooks say,schistosomiasis does not exist. If only we knew whyit did not exist here, whereas it does in all the neighbouringcountries, we might be able to control its transmission.Tuberculosis and syphilis are common, leprosy unusual.Ankylostomiasis and amcebiasis are common, ascariasisuniversal. Poliomyelitis, until recently unrecognised, isnow beginning to occur in small localised epidemics inchildren under 5, just as it has in most tropical islandssince the war. When I first came to Taiwan I did notexpect to find much delinquency and psychoneuroses,but the familiar Occidental pattern of psychosomaticdisorders and mental ill health seem to be in evi-dence. Aribonavinosis and vitamin-A deficiencies are

common in school-children, and the child of 10-18months often gets too little protein for his needs (fig. 2).How the coolie and the farm-labourer do their work andmaintain their weight and strength is a mystery to me.As elsewhere, the women vary in beauty, but both menand women have beautifully modelled legs. The towns-man is slight and narrow-chested, but the farmer andthe manual worker have fine, strong bodies. Childrenare made much of and are always welcome ; they behavemuch as children do elsewhere but schools are pretty

restrictive and remind me of the classrooms of anothereducational era.The Taiwanese are not a martial race, and they dislike

the idea of being involved in a civil war which stillappears to be someone else’s problem, though it hasbeen said that the one thing they might fight for wouldbe to help the mainlanders back to the mainland.

Politics apart, the years to come will have problemsenough in store, for rising numbers on so densely popu-lated an island may soon produce violent economic

changes. But the Taiwanese can accept an impossiblesituation cheerfully, and meantime he takes the greatestpleasure in sharing with you the good things of Formosa-good food, good company, and a wonderful countryside.

Before Our Time

BRITISH DOCTORS AT PADUA

UNIVERSITY *

ANDRA BOSATRAM.D. Padua

* Based on an address given during the visit to Padua lastyear of the Visiting Association of Throat and EarSurgeons of Great Britain.

EVEN before the foundation of its university in 1222,Padua was recognised as a centre of international culture ;and between the 13th and 18th centuries it attractedstudents from many countries, including some distin-guished British doctors.

According to ancient customs, many of which stillpersist in some British and American universities, thestudents elected each year a rector, who was given greatauthority and prestige, not only over them, but alsowith the civil and religious authority of the city. Atfirst there was only one rector but later the studentswere grouped into " nations," each of which elected arector of its own. These nations became the basic unitof university administration. A document of 1228mentions the English as belonging, with the Frenchand Normans to the nation of Langue d’oeil. Later

they joined the " German" nation which included

Flemings, Scandinavians, and Poles. The number of

English students apparently increased rapidly, and in1331 they formed, with the Scots, a nation of their own.The Scots, however, liked to be kept distinct from theEnglish, to such a point that in 1534 they joined withanother nation, and did not re-join the English till 1602.

In 1399 the faculties of arts, medicine, and naturalphilosophy were separated from the older faculty of lawand given autonomous status. Anatomical research wasauthorised by the religious and civil authorities ; andAlexander Benedetti, a professor of the university,discussed in a treatise the problem of the constructionof an anatomy theatre. These developments drew moreBritish students and doctors to Padua. The first impor-tant group of which we have news arrived from Oxfordin the second half of the 15th century, led by JohnTiptoft, Earl of Worcester, and it included students oflaw and medicine. Though many of these remained forsome years, for others Padua was only a station of theirperegrinatio academica.Among these student visitors the first important

medical figure we meet is John Chambers. A priest anda master of arts of Oxford, he came to Padua in the lastyears of the 15th century to study medicine. After hereturned to England, he became personal physician toHenry VIII. He collaborated with Linacre in foundingthe Royal College of Physicians of London and, as

counsellor of the king, he shared in the medical organisa-tion of England. At the end of his life Chambers waswarden of Merton College, Oxford.

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Thomas Linacre himself came to Italy in 1488, withWilliam of Selling whose pupil he had been at Oxford.After visiting Florence, he moved to Padua to studymedicine, and took his degree in 1492. Besides theanatomist Benedetti, his masters at Padua includedNicolo Leoniceno, a famous Greek scholar; and he wasalso a friend of the great editor, Aldo Manuzio. When hereturned to England he lectured at Oxford and Cam-bridge ; he became a personal physician to Henry VIII ;and he was also tutor to Princess Mary. Yet he stillfound time to edit the first English translations of Galen.Somewhere about the year 1540 another student of

medicine who has achieved fame came to Padua—:7o/Caius. He was the faithful pupil of Giovan Battista daMonte, who was the first teacher to bring students intothe hospital wards, so as to talk to the patients and tostudy their illnesses. Caius, in proof of his devotion andesteem for his master, quoted him immediately afterGalen in the titles of his books.Thomas Phayer, also came to Padua, but it is not

known whether he studied medicine or law, but he laterpractised both professions. He was the author of thefirst English treatise on paediatrics and of the firsttranslation of Virgil’s Aeneid.

Between 1521 and 1525, as part of his peregrination,John Clement visited Padua. He, too, was a physicianto Henry VIII, he translated Greek classics, and hemarried the daughter of Sir Thomas More. EdwardJorden, who took his medical degree at Padua towardsthe end of the 16th century, was the author of the firstEnglish psychiatric study, which includes the case-

history of a woman with laryngeal spasm of hystericalorigin.And now, at the end of this glorious century, we meet

William Harvey, who’ came to Padua to study underFabricius d’Acquapendente, in the new anatomy theatre,the first in the world, which had been built in 1595. Nearby, from a roughly made professorial chair, erected in theopen to satisfy the numerous students, Galileo Galileidemonstrated his universal laws. Harvey received hisdegree on April 25, 1602, from the hands of a Palatinecount, Sigismondo Capodolista ; for he was not a Catholicand the Venetian Republic had obtained leave thatnon-catholic students should receive their degrees fromsome Paduan counts of imperial title rather than fromthe bishop.

Fabricius, who had deeply studied the venous system,had probably a big influence on Harvey’s work on thecirculation. Moreover, both the idea of the circulation,and the term itself, were known before this work wasdone. But Harvey’s achievement was to demonstratethe phenomenon, both qualitatively and quantitatively,so that his inquiry into the circulation of the blood canbe regarded as the first really modern work in experi-mental physiology. In his method we can properlyrecognise Galileo’s teaching ; for Galileo was the fatherof experimental research and exercised a profoundinfluence also in medicine, which he had studied as ayoung man. * * *

Those I have named here are only the most eminentfigures of this period. How numerous were their lessfamous colleagues is shown by the fact that the roll ofthe Royal College of Physicians between 1502 and 1671includes at least 57 men who had taken their degrees atPadua. To these we must add the greater number ofstudents who frequented this university for a brief time ;and equally we must take note of the continuous exchangeof news and ideas so fervid among the scholars of thatepoch-a reciprocal influence evident, for example, inthe support which Ramazzini, of this university, gave toSydenham’s theories of the genius epidemicus. Our

meeting today prolongs the community of spirit andculture which is the solid basis of friendship betweenour countries.

Public Health

Random Reflections "

" I thought it might be useful to try to convey some-thing of my. own faith in the value of our work andmy confidence in our future," said Dr. Charles Whitein his presidential address to the Society of MedicalOfficers of Health on Sept. 22. It is, he thinks, nogood complaining that the curative services attract mostattention : " of course they do and will continue todo so." He hoped that those engaged in the treatmentof disease would become more generous in their ack.

nowledgement of public-health work and more anxiousto cooperate in it. For their part, those engaged inpublic health should be generous in acknowledging theachievements of curative medicine but should at the sametime have faith in themselves, in the value of what theyhave done, and in the possibility of doing even greaterthings.

Medical officers of health had been heard to complainthat the National Health Service Act had left them onlyenvironmental hygiene and epidemiology ; but such acomplaint, he felt, implied too narrow a view of themeaning of these words :

" Environmental hygiene in its restricted sense has beenlimited to the hygiene of man’s physical surroundings. Itis a branch of public-health work which I think some medicalofficers of health have in recent years tended to hand overto non-medical staff or to other departments of the localauthority, but I agree with Sir William Savage that medicalofficers should retain a close interest and association with it.In the first place their medical training and experience hasdeveloped their powers of observation and their capacity toweigh the relative importance of the conditions they observe.They expect to have to use their discretion in prescribingtreatment and not to be bound by hard and fast rules andstandards which are so beloved by the lay staff. In the second

place it has been my experience that sanitary inspectorswelcome the interest of the medical officer of health in theirwork and the opportunity of discussing their problems withhim. They realise that the M.o.H. cannot be as familiar asthey are with all the detail of the practical work in which theyare engaged day by day, but they know that he understandsthe underlying principles and can bring a trained mind to theconsideration of such principles in particular cases. I think

sanitary inspectors generally are quite happy to be membersof a team of which the M.o.H. is captain, but if the M.o.H.does not play then they not unnaturally want to be

independent." .

But environmental hygiene meant much more than thephysical surroundings which affect health; it includedthe personal and social relationships which can have aprofound effect on the individual, and thus not only onhis mental but on his physical health. As regards mentalill health, there was scope for much more preventivework at all ages, which in his opinion could be developedonly by the public-health service, in cooperation withgeneral practitioners and certain voluntary organisations.The tendency had been to regard epidemiology as the

study only of communicable diseases ; but Dr. Whitethought the M.o.H. should accept J. N. Morris’s broaderdefinition of epidemiology as " the study of health anddisease of populations in relation to their environmentand ways of living."

In discussing the advances that the M.O.H. might makeinto new territory with the aid of allies, Dr. Whitenumbered among those allies the voluntary societies.In one respect these had a great advantage over officialbodies : they could take action in individual cases, sofar as their funds permit, without committing themselvesto similar action in all the similar cases that mightpresent themselves ; and this made it easier for them todo pioneer work on a small scale. Many people were stillanxious to give personal service to those in misfortuneor distress, but on the other hand it’was nowadays farharder to collect money for charitable purposes.

" While