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A SCHEMATIC MODEL OF THE SPINAL CORD AND BRAIN STEM
409 Student Life
The American student his British counterpart.
everywhere
A SCHEMATIC MODEL OF THE works harder than
entering medical school he has had four years general college education. This is the time to enjoy himself, to take part in social, sporting, and cultural affairs. When he goes to medical school, he is about 22, and he realises that the halcyon days are over. He has to master what is very often a new type of discipline in a Before
SPINAL CORD AND BRAIN STEM PAUL J. CANNON M.Sc., M.B. N.U.I.
of
short four years, and he sets to work in no uncertain fashion. Organised extracurricular activities are practically in abeyance. The day starts at 8.0 A.M. or earlier, either at a lecture or on the wards, and finishes in the evening either when the student has discharged his responsibilities or when there is nothing of particular interest going on-and this is often not till very late at night. Most students work on four or five nights a week. There is usually up to three months vacation per year and this further increases the necessity for working at medicine to the virtual exclusion of other activities.
It is not surprising therefore that, when they came to The London Hospital, the Americans were amazed, and at first disconcerted, by " the lenient working hoursalmost unbelievable to us at first." Such spare time as remains is used in various ways. There is very much less collegiate life than in this country - clubs and societies are almost non-existent. ::B1 any students contribute considerably towards their expenses by taking part-time jobs, which are usually much more lucrative than in Britain. In their final year many hold student externships during their vacations in shortThe responsibilities are staffed outside hospitals. virtually those of an intern—i.e.. complete charge of
PROFESSOR OF PHYSIOLOGY
M. J. T. FITZGERALD M.B. N.U.I. LECTURER IN ANATOMY
J. SHEEHAN M.D. N.U.I., M.R.C.P. LECTURER IN PHYSIOLOGY
DEPARTMENTS OF PHYSIOLOGY AND UNIVERSITY COLLEGE, CORK
MANY anatomy schools at home and abroad have three-dimensional models of the central nervous system, whose use in teaching neurology needs no stating. These models often have the disadvantage that they are horizontal, not vertical ; and the further disadvantage that the courses of nerve-fibres are indicated by threads or thin wires. Moreover, they are constructed
medical school, and wives’ incomes (at one school 80% of the students are married by the final year). There are practically no scholarships and grants. The student is certainly helped in his financial dealings by knowing exactly when he will qualify.
’
-
Conclusions
clerkships. We were extremely fortunate to have the opportunity to visit these schools and we should liko to thank The London Hospital Medical College for arranging the visit and for helping us financially from the Eliza Anno Alston Fund. We should also like to thank all those in the -United States whose hospitality made our visit possible and so very pleasant. REFERENCES
Ellis, J. R. (1956) In 4th Interim Report of the Committee on Medical Teaching of the Royal College of Physicians of London. Ham, T. H. (1954) An Experiment in Medical Education at Western Reserve University. New York. Sinclair, D. C. (1953) Lancet, ii, 463.
scale ; consequently, the student cannot take in the sweep of any one tract at a glance. Lastly, the position of the central neural canal and its encephalic extensions is usually not shown. The following robust model has been designed to avoid these drawbacks. Six anatomical levels are represented by’Perspex’ sheets cut to the outline of magnified cross-sections of (1) midbrain, (2) pons, (3) medulla, and (4-6) the spinal cord at three levels. The sheets are mounted on a length of 3/4 in. tubular steel set The tube in a heavy base. indicates the central canal which, at hindbrain level, is represented by a " fourth ventricle " constructed from sheet1., aluminium. A bundle from each of the main neural pathways is indicated by a distinctively coloured welding rod which perforates the perspex. Where several
to
patients supervised only by a registrar. At Virginia many did night duty in various departments of the hospital-for example, the blood-bank, surgery, the clinical laboratory--in return for the free board and lodging. Students’ fees and expenses are covered by a combination of private funds, loans from banks, and the
We have described those features of American medical We feel that education which impressed us most. American medical students enjoy the advantages of better incentives to work, and greater security than British students do. It became clear to us how much the pattern of education and the reactions of both the teachers and the taught depend upon the assessment system. We think that the introduction of progressive assessment in this country would enable the student to acquire a freer and more critical outlook the teaching staffswould be less bound by the necessity of teaching with examination requirements in mind. We were most impressed with the outpatient courses, which are designed to give the student a large measure of responsible practice, and with the system of elective
ANATOMY,
pathways converge-for example, upon internuncial
or
lower-motor-
groups-the " common is stippled to indicate the comnosite oriein of its are Nerve-cell groups impulses. depicted by nuts The bolted to the perspex sheets where necessary. grey matter is shown by magnesium-sulphate crystals ; these adhere to a colourless cement painted on the sheet. Although the general topological relationships are correctly shown, rigid adherence to anatomical proportions is deliberately avoided. The result is a threedimensional diagram in which axon bundles and nervecell groups are the structural units. The model is 6 feet high and is used to greatest advantage in teaching small groups, for whom it was primarily designed. Its applicability to clinical neurology, however, is also obvious. neurone
The model.
path "
410
Reviews of Books Biochemical Disorders in Human Disease Editors : R. H. S. THOMPSON, D.M., professor of chemical pathology, University of London ; E. J. KING, D.SC., F.R.I.c., professor of chemical pathology, University of London. London : J. & A. Churchill. 1957. Pp. 843. 90s. BIOCHEMISTRY is so rapidly invading every aspect of the biological sciences that all the old concepts of physiology and stereotyped pathology are being revised. So much is clear from this book, written by thirty-one knowledgeable men and women, stimulated, supported, and drawn together by two experienced editors. In part the approach is along lines familiar in all medical textbooks, and some of the chapters deal with the organs and organ systems of the body. Thus, there are chapters devoted to the gastro-intestinal tract, the liver and biliary tract, the muscles, the kidney and genito-urinary tract, the adrenal glands, the connective tissues, and so on. Where, however, the present state of knowledge or the feelings of the authors suggested it, the chapters have been written round Thus we find chapters on the biochemical abnormalities. diabetes mellitus and hypoglycsemia, disorders of nutrition, the porphyrias, the glycogen-storage diseases, and the
lipidoses. These little
problems
of
presentation,
and indeed the whole
book, have been coordinated by the splendid subject and author indexes which the editors have provided, and the reader who is still not satisfied will find plenty of references to original papers at the end of each chapter. There are no sections devoted to the diseases of pregnancy or of children, though some aspects of paediatrics are covered by the chapters on bones and faulty amino-acid and haemoglobin metabolism and by the short note on Rh incompatibility. The section on the nervous system shows (and quite simply too) the inroads that biochemistry is making into the hidden secrets of the brain. There is also a chapter on hypertension and there might well have been one on the heart and heartfailure, or on the circulatory system, and perhaps another on the water compartments of the body.
Professor
Thompson and Professor King have scored magnificent success : their book is undoubtedly one to buy rather than borrow.
a
" tions and ending with what some people call psycho. on abnormal His thinking and chapters pharmacology." on the processes of creative and scientific thinking are the most interesting; and, though they contain nothing that is particularly new, they serve to bring together much information scattered in psychological and other journah, Rather oddly, one of the chief sources examined in " chapter 9, on works of art as thought products," has been the introspections of Miss Enid Blyton, a writer whose prolific output-several hundreds of books, Dr. McKellar tells us-perhaps falls short of the standards required in a work of art.
Clinical Use of Radioisotopes A Manual of Technique. Editors : THEODORE FIELDS, M.S., assistant director, radioisotope service, Veterans Administration Hospital, Hines, Illinois ; LINDON SEED, M.D., director of isotope laboratory, Augustana Hospital, Chicago, Illinois. Chicago : The Year Book Publishers Inc. London : Interscience Publishers. 1957. Pp. 455. 72s. THE increasing availability and widespread use of radioactive isotopes in many branches of medicine have naturally encouraged the publication of several books describing the clinical use of these new substances. This manual describes techniques that may be applied to routine clinical use. Little mention is made of the action of ionising radiations on living cells. There is a useful summary of Dr. Marshall Brucer’s investigation on the standardisation of measurements of thyroidal uptake of radioiodine, and the chapter on radioautography (by Dr. P. J. Fitzgerald) is particularly notable. Adequate references are given and special sources of Health hazards and radiation information are listed. safety precautions are adequately described, and the various relevant American regulations are given in detail. The emphasis on practice in that country may reduce its it provides an adequate guide to the usefulness here, but that can be used in clinical medicine, isotopic techniques Instinct in Man In the Light of Recent Work in Comparative Psychology. . RONALD FLETCHER, B.A., PH.D., lecturer in sociology, Bedford College, University of London. London : Allen& Unwin. 1957. Pp. 348. 40s. "
Medical Ethics A Guide to Students and Practitioners.
DAVIDSON,
Hospital,
"
Editor : MAURICE
consulting physician, Brompton London : Lloyd-Luke. 1957. Pp. 165.
D.M., F.R.C.P.,
London.
20s.
THE chosen
subjects discussed in this symposium have been largely as the result of suggestions made by a medical student: for example, the care of the dying, the management of the hopeless case, the information that should properly be imparted to a gravely ill patient (or one about to undergo a serious operation), the doctor’s responsibility to his own family. Lord Cohen of Birkenhead writes on the doctor-patient relationship, and the Lord Bishop of Durham on Medicine and the Church ; and Sir Heneage Ogilvie, Dr. Hugh Clegg, the Registrar
to the General Medical Council, and a barrister-atThe book’s final law make valuable contributions. item is an able account by Dr. Douglas Guthrie of the Hippocratic oath. With the State now such an active and sometimes obtrusive partner of Medicine, it is more than ever necessary to identify and review the principles and problems of medical ethics, morals, and even etiquette. In a world of rapidly changing values, the medical profession should be more hesitant than ever to abandon any of the manifestations of its traditional ethos. For this reason alone, there is clearly a need for a book of this kind, and the editor and his colleagues have done their job well.
Imagination
and
Thinking
PH.D., head of psychological of Sheffield. London : Cohen & West. 1957. Pp. 219. 21s. Dr. McKellar’s interest in hypnagogic imagery has led him to consider the part played by images in the mental life of healthy and psychotic persons. He has reviewed
PETER
McKELLAR,
M.A.,
laboratory, University
an
extensive literature,
SiNcE Harvey wrote of a connate genius or disposi. tion many thousands of words have been written about instinct. Dr. Fletcher has tried to integrate the theories about instinct of Charles Darwin, William James, Lloyd Morgan, L. T. Hobhouse, William McDougall, James Drever, and Morris Ginsberg with Sigmund Freud’s psycho-analytical theory and the more recent theories of Lorenz and Tinbergen on comparative ethology. To do this he has to defend the earlier theories against their critics over the years, so as to be able to use them in his final synthesis of what he calls the contemporary theory of instinct. The reader will have to decide for himself whether Dr. Fletcher has successfully proved his theory or not. The preliminary analysis of the earlier theories at any rate forms a valuable and handy reference book.
starting with the study of associa-
Manual of Pharmacology. (8th ed. Philadelphia and London:W. B. Saunders. 1957. Pp. 1535. f:7).-Prof. Torald Sollmann’s book has become one of the classics of pharmaco. logy. The new edition contains a substantial amount of revision and addition which emphasise the sweeping advances which are being made in this subject. Unfortunately, in some sections description of recent findings have been added piecemeal, resulting in a mass of isolated facts with very little attempt at integration. Furthermore, in places, the space allotted to various drugs bears little relation to their pharmacological importance. In spite of these criticisms, Sollmann remains a very valuable book to those working in pharmacology, for it contains a tremendous number of facts about every aspect of drugs and their use, and as a pure reference book it is unbeatable. "
"
Spot Diagnosis (Vol. 3. London: Harvey & Blythe. 1957. Pp. 140. 10s. 6d.).-The clinician who wishes to test his acumen in a wide variety of disorders may turn to this book, compiled by the editors of the British Journal of Clinical 101 photographs each pose questions which are Practice. answered on the next page, and a series of clinical histories is appended to provide further torment.
,
The American student his British counterpart.
everywhere
A SCHEMATIC MODEL OF THE works harder than
entering medical school he has had four years general college education. This is the time to enjoy himself, to take part in social, sporting, and cultural affairs. When he goes to medical school, he is about 22, and he realises that the halcyon days are over. He has to master what is very often a new type of discipline in a Before
SPINAL CORD AND BRAIN STEM PAUL J. CANNON M.Sc., M.B. N.U.I.
of
short four years, and he sets to work in no uncertain fashion. Organised extracurricular activities are practically in abeyance. The day starts at 8.0 A.M. or earlier, either at a lecture or on the wards, and finishes in the evening either when the student has discharged his responsibilities or when there is nothing of particular interest going on-and this is often not till very late at night. Most students work on four or five nights a week. There is usually up to three months vacation per year and this further increases the necessity for working at medicine to the virtual exclusion of other activities.
It is not surprising therefore that, when they came to The London Hospital, the Americans were amazed, and at first disconcerted, by " the lenient working hoursalmost unbelievable to us at first." Such spare time as remains is used in various ways. There is very much less collegiate life than in this country - clubs and societies are almost non-existent. ::B1 any students contribute considerably towards their expenses by taking part-time jobs, which are usually much more lucrative than in Britain. In their final year many hold student externships during their vacations in shortThe responsibilities are staffed outside hospitals. virtually those of an intern—i.e.. complete charge of
PROFESSOR OF PHYSIOLOGY
M. J. T. FITZGERALD M.B. N.U.I. LECTURER IN ANATOMY
J. SHEEHAN M.D. N.U.I., M.R.C.P. LECTURER IN PHYSIOLOGY
DEPARTMENTS OF PHYSIOLOGY AND UNIVERSITY COLLEGE, CORK
MANY anatomy schools at home and abroad have three-dimensional models of the central nervous system, whose use in teaching neurology needs no stating. These models often have the disadvantage that they are horizontal, not vertical ; and the further disadvantage that the courses of nerve-fibres are indicated by threads or thin wires. Moreover, they are constructed
medical school, and wives’ incomes (at one school 80% of the students are married by the final year). There are practically no scholarships and grants. The student is certainly helped in his financial dealings by knowing exactly when he will qualify.
’
-
Conclusions
clerkships. We were extremely fortunate to have the opportunity to visit these schools and we should liko to thank The London Hospital Medical College for arranging the visit and for helping us financially from the Eliza Anno Alston Fund. We should also like to thank all those in the -United States whose hospitality made our visit possible and so very pleasant. REFERENCES
Ellis, J. R. (1956) In 4th Interim Report of the Committee on Medical Teaching of the Royal College of Physicians of London. Ham, T. H. (1954) An Experiment in Medical Education at Western Reserve University. New York. Sinclair, D. C. (1953) Lancet, ii, 463.
scale ; consequently, the student cannot take in the sweep of any one tract at a glance. Lastly, the position of the central neural canal and its encephalic extensions is usually not shown. The following robust model has been designed to avoid these drawbacks. Six anatomical levels are represented by’Perspex’ sheets cut to the outline of magnified cross-sections of (1) midbrain, (2) pons, (3) medulla, and (4-6) the spinal cord at three levels. The sheets are mounted on a length of 3/4 in. tubular steel set The tube in a heavy base. indicates the central canal which, at hindbrain level, is represented by a " fourth ventricle " constructed from sheet1., aluminium. A bundle from each of the main neural pathways is indicated by a distinctively coloured welding rod which perforates the perspex. Where several
to
patients supervised only by a registrar. At Virginia many did night duty in various departments of the hospital-for example, the blood-bank, surgery, the clinical laboratory--in return for the free board and lodging. Students’ fees and expenses are covered by a combination of private funds, loans from banks, and the
We have described those features of American medical We feel that education which impressed us most. American medical students enjoy the advantages of better incentives to work, and greater security than British students do. It became clear to us how much the pattern of education and the reactions of both the teachers and the taught depend upon the assessment system. We think that the introduction of progressive assessment in this country would enable the student to acquire a freer and more critical outlook the teaching staffswould be less bound by the necessity of teaching with examination requirements in mind. We were most impressed with the outpatient courses, which are designed to give the student a large measure of responsible practice, and with the system of elective
ANATOMY,
pathways converge-for example, upon internuncial
or
lower-motor-
groups-the " common is stippled to indicate the comnosite oriein of its are Nerve-cell groups impulses. depicted by nuts The bolted to the perspex sheets where necessary. grey matter is shown by magnesium-sulphate crystals ; these adhere to a colourless cement painted on the sheet. Although the general topological relationships are correctly shown, rigid adherence to anatomical proportions is deliberately avoided. The result is a threedimensional diagram in which axon bundles and nervecell groups are the structural units. The model is 6 feet high and is used to greatest advantage in teaching small groups, for whom it was primarily designed. Its applicability to clinical neurology, however, is also obvious. neurone
The model.
path "
410
Reviews of Books Biochemical Disorders in Human Disease Editors : R. H. S. THOMPSON, D.M., professor of chemical pathology, University of London ; E. J. KING, D.SC., F.R.I.c., professor of chemical pathology, University of London. London : J. & A. Churchill. 1957. Pp. 843. 90s. BIOCHEMISTRY is so rapidly invading every aspect of the biological sciences that all the old concepts of physiology and stereotyped pathology are being revised. So much is clear from this book, written by thirty-one knowledgeable men and women, stimulated, supported, and drawn together by two experienced editors. In part the approach is along lines familiar in all medical textbooks, and some of the chapters deal with the organs and organ systems of the body. Thus, there are chapters devoted to the gastro-intestinal tract, the liver and biliary tract, the muscles, the kidney and genito-urinary tract, the adrenal glands, the connective tissues, and so on. Where, however, the present state of knowledge or the feelings of the authors suggested it, the chapters have been written round Thus we find chapters on the biochemical abnormalities. diabetes mellitus and hypoglycsemia, disorders of nutrition, the porphyrias, the glycogen-storage diseases, and the
lipidoses. These little
problems
of
presentation,
and indeed the whole
book, have been coordinated by the splendid subject and author indexes which the editors have provided, and the reader who is still not satisfied will find plenty of references to original papers at the end of each chapter. There are no sections devoted to the diseases of pregnancy or of children, though some aspects of paediatrics are covered by the chapters on bones and faulty amino-acid and haemoglobin metabolism and by the short note on Rh incompatibility. The section on the nervous system shows (and quite simply too) the inroads that biochemistry is making into the hidden secrets of the brain. There is also a chapter on hypertension and there might well have been one on the heart and heartfailure, or on the circulatory system, and perhaps another on the water compartments of the body.
Professor
Thompson and Professor King have scored magnificent success : their book is undoubtedly one to buy rather than borrow.
a
" tions and ending with what some people call psycho. on abnormal His thinking and chapters pharmacology." on the processes of creative and scientific thinking are the most interesting; and, though they contain nothing that is particularly new, they serve to bring together much information scattered in psychological and other journah, Rather oddly, one of the chief sources examined in " chapter 9, on works of art as thought products," has been the introspections of Miss Enid Blyton, a writer whose prolific output-several hundreds of books, Dr. McKellar tells us-perhaps falls short of the standards required in a work of art.
Clinical Use of Radioisotopes A Manual of Technique. Editors : THEODORE FIELDS, M.S., assistant director, radioisotope service, Veterans Administration Hospital, Hines, Illinois ; LINDON SEED, M.D., director of isotope laboratory, Augustana Hospital, Chicago, Illinois. Chicago : The Year Book Publishers Inc. London : Interscience Publishers. 1957. Pp. 455. 72s. THE increasing availability and widespread use of radioactive isotopes in many branches of medicine have naturally encouraged the publication of several books describing the clinical use of these new substances. This manual describes techniques that may be applied to routine clinical use. Little mention is made of the action of ionising radiations on living cells. There is a useful summary of Dr. Marshall Brucer’s investigation on the standardisation of measurements of thyroidal uptake of radioiodine, and the chapter on radioautography (by Dr. P. J. Fitzgerald) is particularly notable. Adequate references are given and special sources of Health hazards and radiation information are listed. safety precautions are adequately described, and the various relevant American regulations are given in detail. The emphasis on practice in that country may reduce its it provides an adequate guide to the usefulness here, but that can be used in clinical medicine, isotopic techniques Instinct in Man In the Light of Recent Work in Comparative Psychology. . RONALD FLETCHER, B.A., PH.D., lecturer in sociology, Bedford College, University of London. London : Allen& Unwin. 1957. Pp. 348. 40s. "
Medical Ethics A Guide to Students and Practitioners.
DAVIDSON,
Hospital,
"
Editor : MAURICE
consulting physician, Brompton London : Lloyd-Luke. 1957. Pp. 165.
D.M., F.R.C.P.,
London.
20s.
THE chosen
subjects discussed in this symposium have been largely as the result of suggestions made by a medical student: for example, the care of the dying, the management of the hopeless case, the information that should properly be imparted to a gravely ill patient (or one about to undergo a serious operation), the doctor’s responsibility to his own family. Lord Cohen of Birkenhead writes on the doctor-patient relationship, and the Lord Bishop of Durham on Medicine and the Church ; and Sir Heneage Ogilvie, Dr. Hugh Clegg, the Registrar
to the General Medical Council, and a barrister-atThe book’s final law make valuable contributions. item is an able account by Dr. Douglas Guthrie of the Hippocratic oath. With the State now such an active and sometimes obtrusive partner of Medicine, it is more than ever necessary to identify and review the principles and problems of medical ethics, morals, and even etiquette. In a world of rapidly changing values, the medical profession should be more hesitant than ever to abandon any of the manifestations of its traditional ethos. For this reason alone, there is clearly a need for a book of this kind, and the editor and his colleagues have done their job well.
Imagination
and
Thinking
PH.D., head of psychological of Sheffield. London : Cohen & West. 1957. Pp. 219. 21s. Dr. McKellar’s interest in hypnagogic imagery has led him to consider the part played by images in the mental life of healthy and psychotic persons. He has reviewed
PETER
McKELLAR,
M.A.,
laboratory, University
an
extensive literature,
SiNcE Harvey wrote of a connate genius or disposi. tion many thousands of words have been written about instinct. Dr. Fletcher has tried to integrate the theories about instinct of Charles Darwin, William James, Lloyd Morgan, L. T. Hobhouse, William McDougall, James Drever, and Morris Ginsberg with Sigmund Freud’s psycho-analytical theory and the more recent theories of Lorenz and Tinbergen on comparative ethology. To do this he has to defend the earlier theories against their critics over the years, so as to be able to use them in his final synthesis of what he calls the contemporary theory of instinct. The reader will have to decide for himself whether Dr. Fletcher has successfully proved his theory or not. The preliminary analysis of the earlier theories at any rate forms a valuable and handy reference book.
starting with the study of associa-
Manual of Pharmacology. (8th ed. Philadelphia and London:W. B. Saunders. 1957. Pp. 1535. f:7).-Prof. Torald Sollmann’s book has become one of the classics of pharmaco. logy. The new edition contains a substantial amount of revision and addition which emphasise the sweeping advances which are being made in this subject. Unfortunately, in some sections description of recent findings have been added piecemeal, resulting in a mass of isolated facts with very little attempt at integration. Furthermore, in places, the space allotted to various drugs bears little relation to their pharmacological importance. In spite of these criticisms, Sollmann remains a very valuable book to those working in pharmacology, for it contains a tremendous number of facts about every aspect of drugs and their use, and as a pure reference book it is unbeatable. "
"
Spot Diagnosis (Vol. 3. London: Harvey & Blythe. 1957. Pp. 140. 10s. 6d.).-The clinician who wishes to test his acumen in a wide variety of disorders may turn to this book, compiled by the editors of the British Journal of Clinical 101 photographs each pose questions which are Practice. answered on the next page, and a series of clinical histories is appended to provide further torment.
,