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rheostats and switches and protected by a guard rail isbuilt in the form of a modified commutator with two

plain slip rings upon which four brushes bear, those forthe commutator being adjustable laterally and angularly. Itis driven by means of a quarter horse power semi-inclosedelectric motor, a flexible coupling being interposed, and thespeed is regulated by a rheostat. The free end is fitted totake flexible shafts for surgical instruments, vibrators, &c.The reverser dispenses with the interrupter of the oldinduction coil and has the very distinct advantages that itworks without sparking, contains no mercury to "sicken,"and no expensive platinum contacts to burn. The con-denser may be charged from one to 200 times per second,giving with the resonance coils anything up to 1000 sparksper second between the terminals of the coil. The con-densers are situated in a cupboard (not shown in the

picture) beneath the upper part of the apparatus andconsist of two or more steel vessels fitted with a terminal.The lid carries two folded aluminium plates kept in positionby glass insulated uprights fixed to a false bottom in the cellin such a way as to make short circuits an impossibility.The dielectric is only a minute fraction of a millimetre inthickness, being represented by a film of aluminium hydroxideformed electrolytically on the surface of the aluminium

plates. The electrolyte is a special alkaline solution. The

capacity is enormously increased by adopting such an ex-tremely thin separating dielectric. It exceeds for each con-denser 100 microfarads at a charging potential of 110 voltsand 50 periods and will discharge on a 100-volt circuit at arate up to 15 amperes through the coil. The resonance coilhas no condenser and gives sparks up to 16 inches in lengthand of immense magnitude. The coil is said to be equal inefficiency to an ordinary coil of 28 inch spark-length workedwith an interrupter. The reserve of energy in the Grissonresonator amounts, it is stated, to more than 100 per cent.The resonance coil acts by suddenly forcing current throughthe primary coil in a succession of impulses. The equip-ment includes a very ingenious arrangement of controllinggear with coarse and fine adjustment rheostats for the

primary or alternating circuit, control lamps for the con-densers and magnet, hot wire ammeter for primary circuit,change-over switches, fuses, and double pole switches. The

controlling gear may be mounted on a wall, switchboard, orattached to a cabinet as shown in the illustration. Thiscabinet is designed for x ray work, high frequency, electro-magnetic therapy, vibration, cautery, sinusoidal currents,&c. One important feature of the apparatus is the simplemanner in which its working may be controlled and theoperating of the switches for the various applications is freefrom complication while the chances of ’’ turning on thewrong tap" are reduced to an impossibility by the specialdisposition of the connexions. There is a rheostat for themotor and until this is in operation no effects, of course, areobtainable.

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AUTOMATIC DISINFECTANT DELIVERY MACHINE.

FROM time to time a number of appliances have beendevised providing for the automatic discharge of a dis-infectant into the water used for flushing the water closetand those succeed best which are simple in construction and

which deliver a definite quantity of disinfectant each time theflushing cistern is emptied. The merit of simplicity as wellas efficiency certainly belongs to the apparatus of the Auto-matic Disinfectant Delivery Machine Company, Limited, of I

2 and 4, Tudor-street, London, E.C. The manner of workingof the apparatus will readily appear from the accompanyingillustration. A small metal container is fastened by meansof a thumbscrew to the top of the cistern. A valve inthis container is operated by a chain attached to the chainof the cistern itself. When the cistern chain is pulledthe valve of the disinfectant container is opened and ameasured volume of the fluid is released which, mixing withthe flush, provides an effective disinfecting " wash down."It is a decided advantage also that the method leaves in thetrap and pan a quantity of disinfecting fluid so that anyreturn gases that may escape would be submitted to theaction of the disinfecting agent. The fluid used in themodel with which we made a practical trial appeared toconsist of an alkaline mixture of phenols and pine oil butobviously any other fluid may be used for the purpose. Thedisinfectant container, of course, requires to be filled at

intervals, but for ordinary purposes it holds sufficient dis-infectant for a month’s use. Assuming that the addition ofa disinfectant fluid to excreta is desirable, this plan seemsto be a very convenient and satisfactory way of effectingthat end.

MEDICINE, ITS PRACTICE AND ITSPUBLIC RELATIONS.

CHAPTER XIX.1

THE AMENDMENT OF THE MEDICAL ACTS.The Constitution of the General Medical Oonncil.-The One-

Portal System.-The Legal Prohibition of Quackery.MEDICAL organisation, however perfect, and public

opinion, however sympathetic, will not accomplish theremovals of all the evils that have been displayed. Theywould do a great deal and would pave the way for morebut the law of the land expressly permits a state of thingswhich cannot be altered by any united effort on the part ofmedical men, be it ever so kindly received by the people.As long as there are over 20 ways of entering the medicalprofession so long will there be a certain amount of dis-order in medical education and jealousy in the ranks ofmedical practitioners; and as long as the only existinglegislation against quackery is limited to the imposition ofa small fine for falsely pretending to be a medical man,so long will the chailatan, run riot amongst us. As boththe disorderly condition of medical education and the

impunity of quackery depend upon the wording of theMedical Acts it is not surprising that all medical reformershave put in the front of their programme the amendmentof these Acts. The suggested amendments are usually asfollows : (1) the alteration of the personnel of the GeneralMedical Council so as to make it a more representativebody; (2) the institution of one State examination by whichthe medical profession must be entered ; and (3) the legalprohibition of medical practice by persons not registered asmedical men. We may consider the amendments in thatorder.

1. The Alteration of the Personnel of the General MedicalCouncil.

The General Medical Council, as the Council is at

present constituted, is not representative of the medical

profession. It has been generally assumed that, if its con-stitution were altered until the Council was more represen-tative in character, its deliberations would be of a more

practical sort, while, its intimacy with the troubles of thegeneral practitioner being greater, it would be more capableof bringing public needs into line with medical service andof interpreting professional views so that laymen wouldrecognise their justice. These things and more have beenassumed on apparently good grounds, but it must beremembered that until a reconstituted Council has actuallytaken over the work to be done assumption is all that wehave to go upon.

1 Chapters I., II., III., IV., V., VI., VII., VIII., IX., X., XI., XII.XIII., XIV., XV., XVI., XVII., and XVIII. were published inTHE LANCET of Feb. 18th (p. 447) and 25th (p. 517), March 4th(p. 593), 18th (p. 736), and 25th (p. 817), April 1st (p. 877), 15th(p. 1017), 22nd (p. 1089), and 29th (p. 1151), May 6th (p. 1218), 13th(p. 1287), 20th (p. 1375), and 27th (p. 1449), June 3rd (p. 1533), 10th(p. 1584), 17th (p. 1651), and 24th (p. 1741), and July 1st (p. 43), 1905,respectively.

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TheGeneral Medical Council is at present made up of 32persons, five of whom (three for England and one each forScotland and Ireland) are elected by the registered practi-tioners resident in the different countries, four of whom arenominated by the Crown, and 22 of whom are chosen by thegoverning bodies of the 22 universities and corporations themedical tests of which admit to the Register. The univer-sities and corporations enjoy, therefore, a very powerfulposition. In many directions their interests must be iden-tical, and where those interests clash with the interestseither of the medical profession at large or of the publican effective combination could be made to uphold the

teaching bodies. Such an abuse of position is not as likelyto occur as some would have us believe, but the ques-tion is whether it can be made a complete impossibility.The numerical ratio of Crown members and direct repre-sentatives to that of the representatives of the universitiesand corporations can be raised either by adding to the formeror subtracting from the latter. But there are valid objec-tions to either course. The General Medical Council is inthe opinion of good judges, persons who are, or who havebeen, influential members of the Council, too large already.The deliberations of the Council are hampered by its sizeand the expense of the sessions is increased. But to take

away from any of the universities or corporations their rightto a representative is a serious step. The British MedicalAssociation has prepared a Bill for amendment of theMedical Acts in which this course has been adopted in adrastic manner. The examining bodies are to send only ninerepresentatives instead of 22. The University of Oxford andthe University of London, the University of Cambridge, andthe University of Birmingham, Trinity College, Dublin,and the Royal University of Ireland, the University of

Edinburgh, and the University of St. Andrews under thisscheme are to be bracketed together and alternately dis-franchised, while the representation on the Council of thecorporations is to be curtailed still more rigidly. Thenumber of direct representatives is to be increased from fiveto eight and a dental representative is to be added. In this

way the personnel of the Council is changed from 32 to 23,while the representatives of the examiniDg bodies can be putin a minotitv by unanimous action on the part of the Crownmembers and the direct representatives. The attempt to Ireduce the numbers of the Council so made is a brave onebut the deprivation of certain examining bodies, though onlytemporarily, of their votes is a step so serious that it mustcertainly provoke opposition. To take the educationalfunction of the General Medical Council into considerationalone, it would be clearly inadvisable that a debate shouldbe held upon the educational standards of a university or acorporation without there being present at the Council tablea representative of the body in question. On the otherhand, to increase the General Medical Council until a com-bination of the representatives of the examining bodiescould not outvote the rest of the Council would meanadding 12 more members at least as Crown representativesor direct representatives. And addition could not end there,for the examining bodies tend to increase in number-theUniversity of Birmingham, for example, obtained a

representative in 1903 and Liverpool one in 1904, while theUniversity of Wales, the University of Leeds, and the

University of Sheffield will presumably have the same

privilege granted to them shortly. Each such addition mustbe counterbalanced if the chance of abuse of power on thepart of the educational bolies is to be removed, and theCouncil would tend to become in the end an unwieldy body.The difficulties involved in alteration of the numbers of

the Council have led to the suggestion that the medical

profession as a whole might be more adequately representedupon the Council if the representatives of the qualifyingbodies were chosen by the vote of the members of the

corporations, or by the medical graduates of the universities,instead of being delegates from the respective rulingbodies of the universities and corporations. Undoubtedlyif the representatives of the educational bodies were chosen Iby the votes of the constituency at large the general practi-tioner would feel himself much more fully in touch withthe disciplinary body of the profession. He would have avote for the election of his own representative, which is inaccordance with all popular notions of reform, but there isnone the less a good deal to be said against the idea. The

university graduates (at any rate an ascertainable portion ofthem) do not ask for the privilege of voting for their- representatives on the General Medical Council, while thecharters of the corporations appear to vest the -power of

appointment of a representative on the Council in their

governing bodies. Before the reform can take place thesecharters must be abrogated. Again, elections are a weari-ness to the voters, as is shown by the small number ofmedical men who register their votes at the comparativelyinfrequent elections for direct representatives on the GeneralMedical Council. Elections also impose much trouble andannoyance upon candidates and it would not be easy in allinstances to secure the candidature of the best man, becausehe would not care to submit himself to the worries and

personalities of an election. It may be all in a day’s workfor a politician, but a medical man is not inured by his pro-fessional life to being called, even by implication, a time-server, an anarchist, or an idiot, which might be the fate ofany candidate who happened to seek election to the GeneralMedical Council at a time when medical opinion was dividedand feelings were running high. We have only to refer tothe incidents of the election for direct representatives in1901, when the registration of midwives was on the tapis, tofeel certain of this. A large section of the medical pro-fession at the time was bitterly opposed to the suggestedlegislation and the amenities of debate were considerablystrained by the champions of either side. This acrimonycould again be caused by the public discussion of manytopics of politico-medical or ethico-medical interest and aseries of elections might come to mean a series of rows.

Besides it is, to say the least, doubtful whether the medicalprofession would be better served if the representativesof the various examining bodies were to be selectedby the whole constituency. Such a body as the Councilof the Royal College of Surgeons of England, for example, issure to be represented under existing methods by a tried andcapable official-a past examiner familiar with educationaltheory and routine, a man who can carry weight amonghis colleagues on the General Medical Council. His qualitiesare known au fond by the Council of his College before theinterests of the College are confided to him. But if theFellows and Members of the Royal College of Surgeons ofEngland, a constituency of 18,000 persons, were allowed toselect one man among them as a representative the chancesof their choosing the man who asked most urgently for theirsuffrages and who was most prolific of promises would begreat. And similarly great would the chances be that sucha representative would turn out a failure on taking his seatat the Council board. I have selected the Royal College ofSurgeons of England as an example, because it is a verylarge constituency, numbering over 18,000, governed by avery small body which, in its turn, is elected by an upperclass numbering about 1200-that is to say, that 17,000Members of the College have no voice in the election oftheir representative on the General Medical Council eitherdirectly or indirectly.There is a way out of this position. The Council which

chooses the representative might itself be elected by the17,000 Members and not by the 1200 Fellows-a liberaldevelopment that has for three-quarters of a centurybeen urged by THE LANCET. And in a similar waythe General Medical Council might be liberalised throughout.The Council of the Royal College of Surgeons of Englandis understood to have no serious objections to the changeof constitution by which it would itself become a repre-sentative body, and at one time a majority of the Fellows,who might be expected to wish to retain their consti-tutional prerogative, was actually in favour of the reform.THE LANCET aided the movement unceasingly and a decadeago it seemed that the Members of the College were in afair way to obtain a share in the management of their affairs.but the untactful behaviour of a few " whole-hoggers

" rmnfdthe entente cordiale between Fellows and Members. Rela-tions could be renewed again if the proper course were

taken. This is a very suggestive fact, for if the governingbodies of the corporations were selected by the members ofthe corporations then the members would feel that repre-sentatives appointed to the General Medical Councilby such governing bodies were really appointed by the

corporations as a whole-that is, by themselves-andtheir confidence in the deliberations of the GeneralMedical Council would be much increased. The changein the constitution of the General Medical Councilthat would be produced by the change in the electionmachinerv of the various universities and corporationsneed not be great, but, it would be a wise and good reform,because it would give the General Medical Council more thecharacter of a popularly elected body. To proceed furtherin making the Council popularly elective would be to call

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upon the members of the profession to go frequently to thehustings, and this they would not do, nor is it certain thatthe best candidates would seek their suffragts.

2. The One-Portal System.We come next to the proposal that all medical men

should enter the medical profession after passing one

State examination. The " one-portal system " has beendesired ardently by some of the most liberal thinkersas doing away with all possible opportunities that somestudents may enjoy for entering the medical profession uponeasier terms than their fellows ; and the British MedicalAssociation has provided in its new Bill for a State examina-tion to precede admission to the Register. The simpleway of securing a one-portal system that would givesatisfaction to the medical profession would be for theState to hold identical examinations in certain capitals anduniversity towns simultaneously and to admit the successfulcandidates to the Medical Register under the title of M.D., orat least with the clearly sp3cified right for each man to callhimself "Doctor." As far as the public would be concernedall medical men would then be equal, and any favour which aman enjoyed with the public would be due to his work andhis character. Appointments would no longer be open onlyto graduates of certain universities or diplomates of surgeryof certain corporations. Every candidate for a post couldproduce, as additional evidence of fitness, any testamursthat he possessed, but the non-possession of them would barno man from competing. The London student, working inthe splendid clinical field of the metropolitan hospitals withthe elaborate scientific environment of a metropolitanmedical school, when entering private practice would nolonger find himself described as "not a real doctor" "

because he did not possess a university degree. Allmedical men would be equal in the eye of the publicand the substantial grievance under the present régime,that of two equally well-informed men one has andthe other has not an academic right to the popular titleof "Doctor," would disappear. Is there anything to be saidagainst so simple a reform, so sure a way of makingmedical education uniform, so obvious a way of avoiding amultiplicity of examinations, so complete a way out of thedifficulties that have arisen from the use of the word Doctor" "

as a popular style as well as an academic title? Unfortu-

nately, there is another side to the question ; the institutionof a State examination to the medical profesion wouldprobably be opposed by the medical corporations. TheUniversities might have nothing to say against the immediateadoption of such a system but the corporations would belikely to take an opposite view. A student commencing hismedical career at a university would naturally desire to

graduate in medicine at that university. He would pas anyexamination additional to the State examination and payany fees additional to the State fees, so that he mightreceive the hall-mark of his a77M niater. But thestudent not entering the medical profession by way of auniversity, having passed the State examinations in medi-cine, surgery, and obstetrics, and having obtained a

place on the Medical Register with the right to stylehimself "Doctor," would have little inducement to seek froma College or a Hall any Diploma ? The honour diplomas orfellowships might still command candidates, but the rank andfile of the medical profession would hardly consent to pay feesfor pass diplomas when they already possessed the legal titleof "Doctor." The corporations would probably suffer

considerably, so that a one-portal system would have far-reaching consequences of a sort that mut provoke opposi-tion. And very awkward opposition, too, for the presidentsand office-bearers of the Royal Colleges have a way of

being the friends as well as the medical advisers ofthose who make the law of the land, and an amendment tothe Medical Acts which the Royal Colleges decided to

oppose would have but small chance of becoming law. Afinal examination of all students, wherever educated, for theright to a place on the Medical Register with the title of"Doctor has so long been the conception of the reformer thatthe ic’ea cannot be given up without reluctance ; indeed, itshould not be iven up altogether, but those who hope forit will urely have to exercise patience, for no such reformwill imnndiatt ly be granted.3. The Legal Prohibition of Nedical Practice by -1-lersons not

Registered Medical Men.Such a prohibition would be to do away with the

impunity now erjoyed by quacks and would necessitate an

alteration of the Medical Acts of a decided sort. TheMedical Act of 1858 in its opening clause says that theMedical Register is to enable the public to ascertains ho isand who is not a bond-fide medical practitioner, but it leavesthe public to choose between the qualified man and the quack,merely supplying the necessary information so that thechoice reed not be made blindfold. The State recognisesnothing but the qualified man. Only he can give a deathcertificate, or mtdical evidence, or express a medical opinionof any sort that will carry legal weight. But anyone in this

country can practise medicine and practice it for gain ; thelaw will only interfere with a man who says he is a regis-tered medical practitioner under the Act when he is nothingof the sort, or who pretends to have a legal position as amedical man. The amount of that interference is shown byClause XL. of the same Act, which runs as follows :-Any person who shall wilfully and falsely pretend to be or take or

use the name or title of a physician, doctor of medicine, licentiate inmedicine and surgery, bachelor of medicine, surgeon, general practi.-tioner or apothecary, or any name, title, addition, or descriptionimplying that he is registered under this Act, or that he is recognisedby law as a physician, or surgeon, or licentiate in medicine andsurgery, or a practitioner in medicine, or an apothecary, shall, upona summary conviction for any such offence, pay a sum not exceedingtwenty pounds.

It is quite clear that almost no one will ever be convictedunder such a clause. An irregular practitioner has only totell the public that he belongs to no benighted medical cor-poration, but is practicing upon some eclectic system of hisown, to escape all penalty for his action. This positionought to be altered and as public appreciation of sciencegrows it will undoubtedly be altered ; but before Parliamentwill sanction reform it will have to be clear to the countrythat restraint upon quackery is called for on public grounds.Medical men naturally, but unfortunately, have been in thehabit ’;f regarding everything in the nature of medical treat-ment by unqualified persons as so productive of evil thatthey have a little blinded themselves to the fact that theirfellocr-me n are free agents, free to ask whom they like to treatthtir bodies or their souls. A man need not belong to theEstablished Church because he happens to be an Englishman,nor need he employ a registered medical man. This mustnot be forgotten nor must the effect of coercion be disregarded.Any attempt to make it illegal to en.ploy unqualified menmight lead to a still largeremployment of them, for the publicwould consider the restraint imposed upon it intolerable.Members of the public have a right to consult whom theylike when they are sick, even no one at all if it is they them-selves Vlho are sick and not their infant children. Yet thereare good grounds for Parliament interfering with the presentunbridled liberty of ur qualified practitioners and it is certainthat the wiser soit of the community would welcome anattempt to do so. The misery that is wrought by quack?,the lives that are sacrificed by tluir lust for gain, the falsehopes that are inspired by their advertisement?, the hard-earned money that is wasted upon their rubbish,-all thesemake it necessary in the public interest that a check shouldre e put upon the nefarious practices of charlatans. In theMedical Acts Amendment Bill, prepared by the BritishMedical Association, there is a clause to nu et the situation,which runs as follows:-

Penalty for practice by unregistered persons -Any person who is notregistefed underthis Act andwho medically treats patients, or otherwisepractises medicine, surgery, or midwifery, or performs any surgicaloperation for which he demands or receives any fee, gratuity, or re-muneration. and also any person who not being registered under the Act,pretends to be, or takes or uses the name or title of physician, or

surgeon, doctor of medicine, licentiate of, or bathelfr of. medicine eor surgery, or master in surgery, or assuims any other style, title,addition, designation, or description, either attached to the name ofthe person or to his place of residence or business, or otherwiseexhibited, imply ing that he posse scs the skill and knowledge necessaryfor the practice 4,f medicine, surgery, or midwifery. or that he isrecognised by law as a physician or surgeon or licentiate, in medic neor surgery or midwifery, or a practitioner in medicine, or an apothecaty shall be guilty of an offence under t).is Act. and shall on summaryconviction under the Summary Jurisdiction Acts be liable (1) ior tt efrst offence to the penalty of not Itss than tell and not exceedingtwenty pounds, and t,o imprisonment in default of payment of notlonger than two calendar months; and (2) for each subsequent offenceto a penalty of not than less twenty and nut exceeding forty pounds,and to imprisonment in default 01 layment for not longer than sixcalendar months.

With this clause every medical man must be in accord,and members of the public who have realised the real dangers of quackery, its horrible menace to pullic health, its extra-ordmary depletion of the public purse, should take the sameview. The clause wants cejtain modification, as it must bemade quite clear that the ministations of the neighbour,the nurse, or the masseur are not illegal, but with this

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alteration it would serve the purpose of protecting thepublic. It would not stop quackery, for while men are

greedy there will be disgraceful advertisements and themoney of the public will be divided between rogues and theproprietors of unscrupulous newspapers. But this scandalwould be lessened if the complete impunity of the quackwere lessened. The chances of fine and imprisonment wouldgive pause to the quack desiring to claim openly that hepossesses the skill and knowledge necessary for the practiceof medicine, surgery, or midwifery," and editors could notplead convenient ignorance concerning convicted quackswhen the propriety of an advertisement was called inquestion.But though an amendment of the Medical Acts which

should prevent quackery is called for, and although to manymedical men the call seems particularly loud and clear, nolegislation is likely to occur without opposition. Parliamentin its dislike to the appearance of granting a monopoly toany class, will require much persuasion, and even here thereis wanting the unanimity of voice among medical men, thelack of which has been noted as standing in the way of somany reforms. Legislation against quackery appears tosome of the most enlightened members of the medicalprofession unnecessary and undesirable as savouring ofan undignified protection of true science. More thanhalf a century ago, when the question of makingunqualified practice illegal was being discussed, SirBenjamin Brodie spoke strongly against the view. He

urged that the medical profession should stand or fall

upon its merits and did not require any legal protection.Things have changed for the worse since Sir BenjaminBrodie’s time, yet we know that even then quackery wasrampant. The dignified attitude that this great surgeontook up is one that many medical men will be found toadopt to-day, and even legislation against quackery will notbe pressed upon Parliament with the complete unanimity ofthe medical profession that might have been expected.

While the majority of medical men, at any rate of thosewho give heed to the public relations of medicine, are infavour of amendments to the Medical Acts on the lines thathave just been discussed, it must be borne in mind that nolegislation is likely to occur without considerable struggle.The reasons for the alteration of the constitution of theGeneral Medical Council are not incontrovertible, while noalteration, it would seem, can be suggested that will notgive rise to some friction among the bodies to be repre-sented, and so prevent that unanimity of view that the publicwill almost require of the medical profession before it willgive support to any amendment of the Medical Acts. Theinstitution of a State doctorate, though so desirable a reform,can hardly take place without seriously damaging thevarious medical corporations. Anything like drastic pre-vention of quackery by law, though this would mean a

saving in lives and money to the nation of many thousandsof pounds annually, is sure to be resisted strongly when it ismooted in ,Parliament.These things must be remembered and the difficulties

ahead should make medical reformers additionally anxiousto be unanimous in their aims.

(To be concluded.)

THE MEDICAL CURRICULUM.

Mr. John Tweedy, the President of the Royal College ofSurgeons of England, speaking at the prize-giving at

the Medical School of Westminster Hospital on June 28th,drew attention to the present condition of the medicalcurriculum and observed that there was danger sometimes inover-rating mere academic successes during the student’searlier life. After all, the medical profession required thepower of doing something and successes in class examina-tions might only imply a power of acquiring knowledge.Knowledge and power, he need scarcely tell them, were twovery different departments of life. Knowledge was noteven synonymous always with wisdom. Many of them, nodoubt, would remember Cowper’s lines :-

" Knowledge and wisdom, far from being one.Ila-re oft-times no connexion. Knowledge dwellsIn keads replete with thoughts of other men ;Wisdom in minds attentive to their own."

When a student came to a medical school very oftento his surprise, instead of beginning, as. he imagined,the practical study of his profession, he found thathe had to encounter several so-called preliminarysciences-chemistry, physics, and biology-before he couldbegin what are known as the early medical subjects of

anatomy and physiology. That arrangement had been forcedupon them by the kind of patchwork legislation that hadbeen going on in the medical curriculum during recent years.If he were to criticise the medical curriculum he believed

he would have the sympathy of a good many of those

present when he said that the first thing he should liketo see in it was a great simplification. So far fromadding bit by bit to the burden which the student now-

adays had to bear, he would take off a good many ofthe subjects which were now put upon the over-burdenedstudent, taking care that he had more time for thethorough training of his faculties and the training ofhis powers of observation, instead of merely converting him.self into a grinding machine in order to pass examinations.The teaching of these preliminary subjects in medical

schools connected with hospitals had stood in the way, forsome time, of the best medical education and he congratu-lated the authorities of Westminster Hospital on being thefirst to complete the arrangements for removing the teachingof those preliminary subjects from a medical school and

arranging for the students to study those departments ofnatural science at a science institution. That was

good, he was sure, for the medical students and itwas good for medical education. The practice of medi-cine was largely one of applied science, and it was

but right that those who were about to enter uponthe medical profession should be trained in scientificmethods. Those methods could best be taught in greatscientific institutions. So long as the teaching of those

preliminary sciences was kept in the medical schools one

could not but feel that their importance as disciplines of themind was somewhat lessened. On the other hand, the menwho learned physical science in a great science centre bene-fited by great traditions and they acquired the best methodsof observation and of reasoning. The student’s scholastictraining was generally a literary training, a training in whichauthority counted for everything ; but in sciences authoritycounted for nothing except so far as it was based uponaccurately observed data. That was one of the great benefitswhich medical education would derive and medical studentswould gain from eliminating those preliminary sciencesfrom the medical course of studies at a hospital. Assumingthat the student had completed his preliminary sciencetraining and had also completed those earlier medical studies,such as anatomy and physiology, upon the importance ofwhich it was unnecessary for him to dwell, he then cameto the great work of his life, the study of disease inthe wards of the hospital, and he insisted that it was thework done in those wards that determined a man’s career.An experiment was to be tried at Westminster Hospital inregard to the lectures to be delivered there. Instead ofhaving the whole course of lectures on systematic medicineor systematic surgery given by one man it was proposed tobreak up those subjects and to intrust to different membersof the staff different subjects. That was an experiment forwhich much might be said and it was an experiment whichhe should watch with a good deal of interest. He hoped,however, that in that arrangement there would not be

neglected what he thought was necessary in all studies-a sort of propaedeutic or introductory course expound-ing the great principles of medicine and surgery. Ifthat were done he thought the experiment of handingover the several departments to experts might be success-ful. Otherwise he feared that it would lead rather to tooearly specialisation. Students were prone to think thatmedicine was so rapidly progressive that knowledge soonbecame obsolete, but the knowledge which students wouldacquire in the wards of the hospital during their course oftraining would be the basis upon which they would have tobuild the whole of their practice in the future. Knowledgegrew, but truly and carefully observed phenomena did notchange. Their conceptions had to be changed, their

explanations of phenomena had to be readjusted, theirtheories often had to be recast entirely, but the fundamentalproblems of knowledge remained the same. If the clinicalcases which might come under their observation were

observed by them without prejudice they would constitutethe true foundation of their knowledge and remain as theworking capital of the whole of their subsequent lives.