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matters of national health but elsewhere, because

they took a scientific attitude towards public affairsin general. Medical questions asked on the floorof the House of Commons would be of benefit bothto the country and to Parliament. A private noticequestion put to a Minister at the end of ordinaryquestions would gain publicity on any importantsubject and was a means of bringing pressure to bearon the Government. Merely to send polite letters toMembers of Parliament would not produce mucheffect. There must be doctors in the House ready tosay true and forcible things for the profession and theAssociation. There was a tendency in Parliament toneglect the opinion of the medical profession. Anarrangement had been made for two membersof the medical parliamentary committee, Sir FrancisFremantle, representing the Government, and him-self, representing the Opposition, to meet the publicrelations officer of the B.M.A. every week.

Matrimonial Causes Act

The Council had expressed the opinion that " itwould be unethical for a medical practitioner inmedical charge of a patient of unsound mind to giveto a declared prospective petitioner in a suit for divorceinstituted against the patient information which hehas obtained as the patient’s medical adviser, andthat such information should be given only to theguardian ad litem or other person responsible forthe protection of the patient’s interests."

Dr. N. E. WATERFIELD said that the Council hadno wish whatever to obstruct the decision of Parlia-ment that insanity should be accepted as a groundfor divorce. It was the duty of a medical man toassist the legislature, but he must also respect therights of his patient. It had been laid down by adeclaration in the House of Lords in 1905 that, inthe interests of justice, the parties in an actionshould have some indication beforehand of theevidence likely to be given, in order to know whetherit was worth while to bring an action. This informa-tion was privileged and might be given to theaccredited agent of the petitioner but not in the formof a certificate or formal return. The Council’s viewwas that before the institution of divorce proceedingsthe spouse would be in close communication with thedoctor in attendance on the insane partner, and sowould be able to ascertain the likely evidence before-hand. When, however, the spouse became a declaredprospective petitioner, the position was altered, andthe information should only be given by a doctor tothe person appointed to look after the interests ofthe patient, and communication with the personlikely to be the petitioner should cease. Records ofState-aided hospitals were the property of the localauthority and the Ministry of Health. It had beendecided, with the concurrence of the Ministry, thatsuch records should be made available in cases triedunder the Act. The responsibility for producingthem would lie with the proprietor of the records,and in no case should the medical man produce themwithout permission from the authority to whom theybelonged. (A statement that the Council was indiscussion with the Board of Control and the medicalcommittee of the House of Commons on the possibilityof amending the present law was issued to the press.)

Dr. Waterfield paid a graceful tribute to Dr.Hawthorne, his predecessor as chairman of theethical committee, who had decided not to seek

1 An announcement made by Sir Laurence Brock, chairmanof the Board of Control, appeared in THE LANCET of July 16th,p. 150. See also p. 200 of this issue.—ED. L.

re-election to the Council. Dr. Hawthorne could notbe allowed to go without an" expression of theiraffectionate regard (prolonged applause). Dr. Haw-thorne replied that these experiences providedpleasant and grateful memories, and it was a welcomethought that colleagues who knew him well bore himfeelings of goodwill. He thought it possible to

contemplate the idea of temporary reappearance infuture.

(To be continued)

THE MEDICAL CURRICULUM

STUDENTS CONFER

LAST week a conference of a type new to this

country was held in London ; it was the first annualconference of the medical committee of the NationalUnion of Students which was formed last year. Toit came delegates from all parts of the British Islesand from nearly every university. By’ invitationalso came deans, professors, and other teachers frommany medical schools ; for the subject of the con-ference was the Training of the Doctor.Lord HoRDER replied to the toast of The Profession

at the dinner on the opening night and referred tothe question many had raised, whether medicalstudents ought to express an opinion on medicaleducation. " Why not ? " he asked. " I always didwhen I was a student." He added that he wasentirely in favour of this kind of gathering, par-ticularly among senior students. The same note ran

through many of the addresses made at the con-ference. Sir Henry Brackenbury, in pointing outthat the British Medical Association’s proposals fora revised curriculum had been drawn up almost

entirely by teachers of medicine, said that the viewsof those being taught were just as important as thoseof the teachers. Prof. W. W. Jameson was evenmore emphatic. He instanced how he always con-ferred with students at the London School of Hygieneand Tropical Medicine at the end of their diplomacourse, as a result of which the curriculum wasmodified nearly every year, and added that heconsidered discussions by medical students infinitelyimportant. " Much will come of it. The people whoare being taught are the people who know best howand what they ought to be taught."

AIMS AND APTITUDES

The subject was a wide one, and, though discussedagainst a background of the B.M.A.’s proposals andthe General Medical Council’s new regulations,together with a recently published report by theAssociation of Scientific Workers, ranged over a

variety of questions. There was general approval ofthe necessity for a broad education for youths con-sidering entering upon a medical career, because ofthe need for culture, a critical faculty, and an abilityto think in a doctor. Opinions differed, however, asto whether there ought to be a special examination toensure this ; a Dublin delegate said that no specialeffort should be made, as such efforts always defeatedtheir own ends. A point was made about the valueof tutorial classes or seminars in developing a criticalattitude towards his subject in a student, bydiscussing in groups points of interest or difficultywith one of the teaching staff. Such seminars aresaid to be successful in Edinburgh and elsewhere.Prof. C. Lovatt Evans, F.R.S., said he tried themonce, but when he was unable to conduct themhimself they degenerated into cramming courses.

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Prof. Lovatt Evans spoke of certain aptitude teststhat were being introduced in America, with a viewto discovering whether an individual was likely totake well to medical study. The results, thoughdifficult to obtain, were encouraging. Some such testwould be a great help in deciding whether it wasworth while spending an extra two and a half yearsat school before starting the preclinical course. Mr.Eric Pearce Gould pointed out that this period wasapt to be wasted, if the candidate proved unsuitablein the end. An opinion was expressed that suchaptitude, however it was gauged, should be the onlycriterion regulating entry into medical schools. Manywould-be students were being kept out either bytheir lack of means, their sex, or their nationality,whose talents were thereby lost to the community.

THE " OVERCROWDED PROFESSION "

Mr. Pearce Gould and Prof. Lovatt Evans agreedthat there was no unemployment at present amongnewly qualified doctors, in spite of their recentincrease in numbers, largely as a result of the expan-sion of the national and public health services. The

prospects for the near future were good, even with amoderate increase in the number of students quali-fying each year, though what lay further ahead it wasdifficult to say.At this point arose the thorny problem of whether

foreigners, unable to practise in their own country,either for racial, political, or religious reasons, shouldbe allowed to study for a degree in this country.Some pointed out that the science of medicine wasinternational and that talent ought to be allowed todevelop wherever it lay, while others regarded sucharguments as mere sentimentality. It was resolvedthat the medical committee of N.U.S. should investigatethe question, and in the event of there not beingenough available positions for newly qualified British

. subjects to recommend the severe limitation of

foreign entry. The suggestion that more scholarshipsand maintenance grants were needed to allow menof slender means to study met with considerableapproval.

REARRANGEMENT OF STUDIES

About the curriculum itself all agreed that a

period of five years was quite long enough-perhapstoo long. And yet so great were the strides beingmade in medical science to-day, and so much greaterthan before were the demands being made by adoctor’s patient on his consideration, that a rearrange-ment of the curriculum seemed to be the only way ofincluding certain studies without lengthening its

period. Not all doctors went into general practice,though three-quarters of them might. Prof. LovattEvans pointed out that the administrators and

investigators also had to be trained. The latter

required a long preclinical training ending in the

taking of a science degree. There was, he said,relatively too much money available for research,since there was not enough to train people to do it.Moreover, to give every student as long a preclinicaltraining as in the United States or Scandinaviawould be to neglect the interests of the generalpractitioner, for whom it was not necessary.The preclinical period could further be rearranged

by regarding organic chemistry as part of bio-

chemistry and pharmacology, and normal psychologyas part of physiology. There were many whoexpressed opinions that much time was wasted in

laboratories, particularly in having to dissect theentire cadaver. Others, again, were keen that themaximum possible amount of time saved by shorten-

ing the curriculum should be utilised in recreationsand social activities. The most popular condemna.tion was that of the system of compulsory lectures,which found support from no one in the conference.

PREVENTIVE MEDICINE AND THE ART OF PRACTICE

One of the constructive suggestions that camebefore the conference was that of Prof. Jameson fora department of social and preventive medicine ineach medical school. He pointed out that the subjecthad become neglected in the curriculum since it

early became one for post-graduate study. When, inaddition, it became divorced from venereology andtuberculosis, students lost interest in it. The resultwas that the whole of their training appeared to befitting them to serve the sick rather than to preservehealth. Each department of social and preventivemedicine should be run by a young enthusiasticunprejudiced and specially trained man. It shouldbe engaged in the study of normality, particularlyamong the student population. Each student shouldhave a free health inspection at the beginning of hiscareer and supervision from year to year. Studentsshould study immunological reactions on one another.As well as epidemiology the effects of working con-ditions on the health of the people should be studied;also they should carry out research in such things asthe discovery of early signs of disease ; the wholeatmosphere of the department should be one ofhealth and active investigation, helping the’ work ofall other departments. The Scottish and Welshdelegates were surprised to hear that it was not therule in English universities to have a professor of

public health.There was much discussion of the present inade-

quacy of instruction in the art of practice. Mr.Pearce Gould pointed out that it was not just aquestion of knowing the ropes of panel practice.Many suggestions were made. The necessary back-ground must be provided by understanding thecircumstances and home life of the patient. Thiscould not be learned in the wards of a teachinghospital. Study in out-patients, in the casualtydepartment, in a visiting dispensary (as at Aberdeen),and in the wards of a municipal hospital were allvaluable-the last particularly, since careful con-

sideration always had to be given to the question ofhow a patient would fare at home, if he were dis-

charged. Voluntary teaching hospitals, with muchpressure on their bed space, always tended to getrid of their patients in the shortest possible time. Itwas a great pity that, for historical reasons, thereshould be a certain amount of tension in the relationsbetween the teaching staff of many voluntary hos-pitals and the superintendents of the neighbouringmunicipal hospitals. Such relations were in manycases being improved, and students were more andmore coming to be able to make use of the clinicalmaterial provided by municipal hospitals. Prof.Jameson emphasised that such advances as had beenmade in this direction must be continued. It wasregrettable, however, that instruction in mentaldiseases was usually carried out in an asylum con-taining only hopeless cases. Instruction in psychiatrycould only be of value in a clinic for psychoneurosesand mild psychoses, where treatment and its resultscould be seen.

Consideration was given to the possibility of holdinga special appointment before graduating, along thelines of the B.M.A.’s scheme for a " final clinicalperiod." A Durham delegate considered it iraprac-ticable for practitioners to take pupils at this stage,for they were too busy. An Edinburgh delegate

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described a scheme for a course of instruction in theart of practice which was taken voluntarily at thisstage by many students at his university. It

appeared to work very satisfactorily.The value of a period of responsible work as a

resident in a hospital, preferably the one from whichthe student graduated, was generally recognised. Itwas regretted that it was not always possible fornewly qualified men to apply for and receive thesejobs, either for financial reasons or because therewere too few available. An Edinburgh delegatedescribed the efforts being made by residents thereto obtain a modest degree of remuneration in additionto board and lodging. The conference sympathisedwith this effort and recorded its opinion that theaffairs of qualified men holding resident appointmentswere very much the concern of the medical committeeof N.U.S., and that any help which could be giventhem by the students’ organisation in a case like thisshould be given.

EXAMINATIONS

The whole question of examinations was discussedthoroughly, both in general and in detail. The valueof written papers as opposed to oral examinationswas doubted by some ; others recommended the useof " objective tests," while others again condemnedthese as spoon-feeding. It was generally agreed thatthe criterion for passing a student in, say, a physiologyexamination should be first, whether he has enoughacquaintance with his subject to use it intelligently asa basis for clinical work, and secondly, whether hehas that personality and common sense which go tomake a reliable practitioner later.What was described as a growing practice of

limiting admission to the profession by ploughinglarger numbers of students than usual in theirfinal examinations, regardless of their previousrecords, was criticised by a student from Glasgow,where the number of failures has lately givenrise to much heart-burning. The practice was

roundly condemned. It results, so it is said, ina great increase in the number of examinees eachsix months ; it causes widespread financial hardship,coming as it does at the end of a long and expensivecourse; and it leads to stagnation of university lifeand activity, through students becoming buried intheir books trying to avoid a failure. For example, thisdelegate said that in Glasgow the medical students’journal had almost gone out of business, because noone had any time to think about writing for it.

PLANS OF THE STUDENTS’ ORGANISATION

The medical committee of the National Union ofStudents has given itself much work for the comingyear. It was unanimously resolved that meetings ofstudents, especially those in their final year, shouldtake place in each medical school, wherever possible,in order to discuss the curriculum with specialreference to the situation in their own school; andthat from such meetings representatives should goto meet the directors of studies and lay before themand discuss with them any proposals for reformwhich might have been made. Where possible, apermanent joint committee of students and staffshould be established to consider such matters. Itwas recognised, however, that the authorities (andeven the students) in some schools do not agree thatstudents have any important contribution to maketo discussion of their own education. In this con-nexion, as well as in its social activities (inter-schoolclinical visits, medical tours abroad, cinematographlibrary), the medical committee believes it can beuseful to its affiliated organisations.

BEIT MEMORIAL FELLOWSHIPS FOR

MEDICAL RESEARCH

A MEETING of the trustees of the Beit MemorialFellowships for Medical Research was held on

July 13th for the election of fellows and otherbusiness. It was reported that F. R. Winton(1927-31) had been appointed to the professorship inpharmacology in the University of London at Univer-sity College ; G. R. Cameron (1930-33) to the profes-sorship of morbid anatomy in the University ofLondon at University College Hospital medicalschool; and A. R. Todd (1935-36) to the professorshipof chemistry in the University of Manchester; andthat R. J. Kellar (1935-37) had been appointedreader in obstetrics and gynaecology in the Universityof London at the British Postgraduate Medical School.The total number of fellowships held by full-timeworkers during the year 1937-38 was 23. Thenumber of candidates at the present election was

higher than usual. Five applied from Canada andthree from Australia. Fortunately, reserve fundsmade it possible to award more junior fellowshipsthan are ordinarily given each year, and the electionof 12 new junior fellows brought the total of thoseelected since the beginning of the Trust in 1910 toexactly 200. A fresh edition has been printed thisyear of the green-book which summarises briefly theafter-careers of the fellows and their present positionin research.The following elections to fellowships were made :—

SENIOR FELLOWSHIP

DAVID EZRA GREEN, M.Sc. New York, Ph.D. Camb.To continue his research on the r6le of vitamin Bl in theoxidation of pyruvic acid, and to study a new flavin-protein compound in milk. At the institute of bio-chemistry, University of Cambridge.

FOURTH-YEAR ’FHLLOWSHIP

MYER HEAD SALAMAN, M.D. Camb. To continue hisresearch on vaccinia and animal pox viruses. At theLister Institute of Preventive Medicine, London.

JUNIOR FELLOWSHIPS

GEOFFREY BOURNE, D.Sc. Western Australia. Director,department of experimental biology, Australian Instituteof Anatomy, Canberra, 1935-36. Biochemist, Common-wealth Advisory Council on Nutrition, Sydney, 1937.Proposed research : the significance of vitamin C in theendocrine system. At the department of human anatomy,University of Oxford.ANDREW LAWRENCE CHUTE, M.D. Toronto. Intern,

Toronto General Hospital, 1935-36. Proposed research : -experimental studies in metabolism of the brain. At the

department of physiology, University College, Universityof London.ROBERT OSWALD LENNARD CURRY, Ph.D. Durh.

Commonwealth Fund fellow, 1935-37. Proposed research :the physiology of speech disorders by photographic studyof laryngeal movements. At University College, Universityof London.JAMES FREDERIC DANIELLI, Ph.D. Lond. Common-

wealth Fund fellow, 1933. Since 1935 demonstrator in

biochemistry and biophysics, University College, London.Proposed research : the permeability of normal anddenervated muscle to metabolic products and to drugs.At the institute of biochemistry, University of Cambridge.JOHN GEORGE DEWAN, M.D. Western Ontario. Assistant

physician, Toronto Psychiatric Hospital, 1933-35. Since1936 research worker at the institute of biochemistry,Cambridge. Proposed research : "insulin shock " treat-ment of schizophrenia by experimental studies of brainmetabolism. At the institute of biochemistry, Universityof Cambridge.CATHERINE OLDING HEBB, Ph.D. Dalhousie. Banting

research fellow, 1934-37. Since 1937 research assistant