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He wants the decks cleared, partly to providemore room for

the study of morphogenetic principles either in

embryological development or in the post-natalgrowth and repair of tissues, a thorough groundingin radiological and surface anatomy, a more

systematic study of muscle actions and joint move-ments, a fuller consideration of the anatomy of thenervous system and the special senses (with specialreference to their functional disorders), and an

introduction to the principles and methods ofexperimental anatomy."

Most clinical teachers will find these views full ofcommon sense ; but do they go far enough ? ’? Is a" fuller consideration of the anatomy of the nervoussystem " justified ? The practitioner who knows howlittle of the anatomy of the nervous system heremembers from second M.B. days may well feelthat he should have been taught the broad principlesof nervous-system anatomy, on which he now depends,rather than a mass of indigestible detail about thecaudate nucleus and the bundle of Vicq d’Azyrwhich bewildered him and obscured the pertinentfacts. The neurologist, the ophthalmologist, and theotologist should, like the surgeon, defer the acquisitionof special knowledge until they are qualified. Again,does the future general practitioner need to studymore systematically the movements of joints andmuscles when the orthopaedic surgeon or neurologistcan advise on cases of difficulty ? Surely time savedon topographical detail should be devoted to subjectsof great vocational use (such as surface and radiologicalanatomy) or pre-eminent in educational value (suchas the principles and methods of experimentalanatomy). The change needed is reorientation of theanatomical course with emphasis onfunction rather thanstructure. The preclinical student needs to be fittedby his anatomical knowledge to appreciate more readilyand intelligently what is to follow in the clinical years.Some bold spirits have suggested that the education

of the future general practitioner and specialist shoulddiverge at a very early stage and that different coursesof anatomy should be provided ; but no student inthe early stages of training can be sure where hisabilities lie ; moreover, in these days at least, adecision to marry may oblige him, as soon as he isqualified, to exchange the dream of the consulting-room for the reality of the surgery. Some thinkit a waste of time for every student to dissectthe entire body ; but actual dissection gives a

familiarity and contact with the structures ofthe body which cannot be gained from specimensand models. There is much to be said, how-

ever, for allowing students to attend a few pre-liminary classes at which an expert rapidly dissectsand demonstrates the whole body. The beginnerwill then start work with a mind oriented to thinkin systems rather than structures.

Professor LE GROS CLARK’s book, with some 450pages, still seems to us to be on the large side ; or

rather it combines in one book what we should liketo see as two. Not long ago we advocated 2 a revivalof the small inexpensive dissecting manual, whichcan be used for practical work and thrown awaywhen soiled. Students can use such a work con-

currently with a textbook designed to give them acoherent knowledge of the systems. Complete accounts

2. Lancet, 1944, i, 569.

of the bodily structures, for the use of teachers,students of surgery, and research-workers, should bereserved for reference works. In covering dissectionas well as the fundamentals of anatomy, Prof. LE GROSCLARK has been obliged to approach his subject byregions instead of by systems. Though he seems tous to give much more detail than the general practi-tioner may reasonably be expected to need, he fearsthat his fellow anatomists may think he has omittedmany essentials. Some light might be thrown onthis point by setting a test paper on anatomy to agroup of general practitioners of 10-15 years’ standing :what they know would surely be a useful index ofwhat they need to know. But whether his bookis too long or too short, or of exactly the right length,Professor LE GROS CLARK can be sure that mostteachers, and all students, will welcome his positiveeffort to reform the teaching of anatomy.

Annotations

MORAL AND INTELLECTUAL LEADERSHIP

THE British Institute of Philosophy was founded 21years ago to serve as a link between philosophy and theeveryday world. At its coming-of-age meeting lastmonth it listened to a symposium of papers by a philo-sopher, a scientist, a divine, and a classicist, on theNeed for Moral and Intellectual Leadership. Through allthat was said ran an urgent sense of apprehension forthe future of our civilisation, now threatened withdestruction because science has put in our hands toolsof immense power and reach, which we yet lack thewisdom to use in our own best interests. The themeis of importance-not merely of theoretical interestbut of plain practical importance-for every educatedman, and not least for the doctor.

Viscount Samuel, speaking for and to the philosophers,urged that in this crisis their duty does not end withthe serene detached contemplation of human life andhuman thought ; they must emerge from their academicseclusion and say something that will affect human action.That a philosophy can be a motive force, Nietsche isevidence enough ; Hitler chose his works as a presentfor Mussolini. That recent years have heard no clearexpression of a beneficent philosophy may be due tothe discordant voice and laboured utterance of present-day philosophers, and their greater concern with thelimits of human knowledge than with the needs of humanwelfare. But it is possible, and desirable, that " philo-sophy, in this country and other countries, condescend-ing to be comprehensible, inspired by a Socratic senseof mission, linking hands with religion, science, andscholarship, may yet renew her great days, teaching theteachers of the peoples and leading the leaders."

zn

Prof. A. V. Hill, F.u.s., described human society today-in scientific phrase, and mild enough at that-as beingin a highly reactive sta,te. But reactions in human society,unlike those in chemical mixtures, depend on the initialactivity of a few of the members, not on a general bulkinitiative. These few are the leaders. Good leaderswill use their reason and acknowledge moral principles.The majority of mankind " will respond to leadership,but the leadership, if it is to be effective, must appealfor the most part to feeling rather than to reason. The

problem, therefore, is to find leaders who, basing theirpolicy on reason and morality, are capable neverthelessof appealing enough to the feelings of their fellow citizensto cause them to follow." Science, so far as it can do sowithout compromising its prime loyalty to truth, shouldmake some contribution to that leadership.Canon Leonard Hodgson, professor of divinity in

Oxford, trying to define a creed or philosophy of life,

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quoted Shaw: " what a man believes may be ascertained... from the assumptions on which he habitually acts,"whether those assumptions are expressed or implied. A

satisfactory creed must be rationally coherent, and itmust empirically fit the facts of life and experience.The Christiaen theologist’s contribution to the discussionon leadership is his claim that the events describedin the Bible story are of central significance to the properunderstanding of human life, and to the development of asatisfactory creed. But Canon Hodgson rightly addsthat this claim must be continually subjected to thecriticism of philosophy and of experience.

Prof. E. R. Dodds, regius professor of Greek in Oxford,was concerned with the responsibility of the universitiesin training leaders. He condemned the nineteenth-

century conception of a university as " a holy citadelof pure scholarship " because it was incomplete. He

urged that the universities should today make a deliberatecontribution to the needs of a planned democratic society.Their problem is to provide society with the men it needs,and at the same time retain their freedom to pursuetruth for its own sake. Their difficulty is that societydemands mostly technicians and specialists, whereas

society needs leaders with general wisdom, vision, andperspective. Their answer must be a continued effortto train students to think and to judge for themselves,on a broad basis of knowledge and experience, and withabsolute intellectual honesty.

These stirrings are not merely pious panic inducedby the atom bomb. They are the response of honestmen whose social conscience has been moved, who areaware of the process of social integration that is the pathof British democratic development, and who feel it theirduty to take an active part in it. Most doctors owe some

thought to these questions too. For medicine is-

naturally and inevitably-caught up in the integrationprocess. Doctors are now confronted with duties to

society as well as with duties to the individual patient,and must face and deal with both. The peculiarintimacy of their relations with their fellow men givesthem an influence on the behaviour and the mentalattitudes of the community more powerful than theyrealise. The success with which the profession solvesits major problem of preserving freedom and initiativewithin a nationally organised medical service will influencea whole series of similar questions of administrativestructure in other spheres of activity. The medicalschools, on the one hand more than ever built in to theuniversities, on the other in close contact with the socialand individual problems of health and disease, are wellplaced to design the bridge between university studiesand the human affairs of today, between honest thoughtand unselfish action. Medicine is in a position to showthe world, by example rather than precept, that goodleaders cannot be made to order, but that a free andstimulating intellectual climate will favour their develop-ment and that recognition and responsibility are theirdue when they appear. In sum, medicine is no longeran isolated affair between doctor and patient : therelations of both to the community are claiming anincreasing amount of attention. In a more closely knitsociety medicine faces new difficulties, new responsi-bilities, and a more complicated task. The problem ofleadership closely concerns it.

MODELLING IN MEDICINE

MOST of us can recall times, particularly during ourdissecting days, when a model of an obscure anatomicalrecess served to enlighten our perplexity. Models may alsobe used for demonstrating pathological lesions and forillustrating surgical techniques and approaches. Bul-bulian 1 discusses the ways of making them of plaster-of-paris, papier-mâché, wax, plastics, metal, or glass.

_

1. Bulbulian, A. H. Proc. Mayo Clin. 1945, 20, 383.

Direct freehand modelling, which involves the difficultand tedious procedure of copying, is necessary only forlarge-scale reproductions of intimate structure, such ascells or parasites. This method, which was used by theGreeks and Egyptians in antiquity for the portrayalof deformities, has now been replaced for general purposesby simpler techniques. A direct cast from the actual

specimen is the easiest and best method, the mediumbeing applied over the object to produce a negativecast from which the final positive cast is moulded. Withhollow structures like the bronchial tree or cerebralventricles no intermediate stage is needed, for a directnegative cast can be made by filling the lumen with thecasting material. Though the casting method is quickand accurate, care is needed to procure a smoothimpression and to impart the correct colouring. Directcasting is sometimes impracticable, as with the irregularsurfaces and crevices of surgical exposures and post-mortem dissections. Here an indirect method is used,by making a freehand model in clay or other plastic,which is then reproduced by casting. With this processessentials can be judiciously emphasised and non-

essentials eliminated ; and it is particularly suitable forsuch intricate structures as the ear, eye, or embryo inmagnification. But it is very lengthy, and the colouringis quite inaccurate unless it is incorporated in the mediumfrom the start.

Finally, various composite models have been designedto illustrate particular techniques ; thus for trainingstudents in endoscopy a plaster cast of head and trunkcan be combined with a modelled lesion at the end ofa dummy gastroscope. On another page, Professorde Seigneux describes the use of models made from

gelatin on a gauze basis to give the student experienceof the appearance of tissues and their consistence to

palpation. Though useful in imparting basic principles,especially in obstetrics, models can never replace practiceon living tissues ; passing a catheter on a dummyurethra or setting a fracture in a limb which does notswell after injury is not the best of preparations for

undertaking these operations on patients. It is a pitythat the modern increase in the student-patient ratiomakes such substitutes necessary.

PHYSIOLOGY OF THE NEWBORN INFANT

THERE may now be little need to emphasise the

principle that consideration of disease should be precededby study of the normal. There are still, however, manygaps in our physiological knowledge, one of the largestbeing the effect of age on body processes. Physiology,as generally taught, is based on observation of fullygrown animals and men. Differences between speciesare largely neglected ; students sometimes feel that frogsare not quite the same as men, but the view of theirelders and betters seems to be that physiology is essen-tially the same throughout the vertebrate kingdom.The effect of age on a normal process is seldom demon-strated ; and because few physiologists have interestedthemselves in the significance of age, progress has beenretarded. Paediatricians, for example, have been ham-pered in investigations and treatment by not knowingwhere the normal ended and the abnormal began ; theyhave often been forced to work out the normal and itsvariations for themselves, and physiology owes these mena debt. Their findings, however, are scattered throughthe literature, and the time has come for a book on thephysiology of infancy, bringing together all this knowledge.

Clement Smith 1 has now compiled just such a book,which will be welcomed by everyone interested in thesubject. It is not very long-the second edition willprobably be longer-but it is packed with facts, mostly1. Physiology of the Newborn Infant. Clement A. Smith, M.D.,

professor of pædiatrics, Wayne University; medical director,the Children’s Hospital, Michigan. Springfield, Illinois: CharlesC. Thomas. Pp. 312. $5.50.