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ASME
1261
machinery. Many of the smaller water undertakers are obliged to rely on part-time or semi-skilled staffwhich means that too much is left to luck. Whether radical reorganisation would bring more efficiency is a A national water grid has been but the countryside seems sceptical about suggested; promises of economy and better service from nationalisation of industries, and has said so quite clearly. The Government have compromised by pressing for a limited amalgamation of water undertakings as a first step. At present about half the population are served by the 55 largest undertakers, while the other half are served by about 900 smaller bodies. It is these 900 that are the targets for the Government’s fire. They have been encouraged to get together, to prepare plans for amalgamation ; they have been exhorted to bestir themselves; and they have been threatened with force. A handful have taken heed; and by the end of last year twelve amalgamation orders had been made, affecting 25 undertakings, and a further eight orders affecting 30 were awaiting the Minister’s approval. The Government are steadily intensifying their attack: compulsory powers are to be invoked in five areas, and the shadow lies over many more. It is a pity that such coercion should be necessary and that a rational policy should have to be applied against local opposition. But many a matter
of
opinion.
Annotations ASME
IN theory, the General Medical Council have always wanted each medical school to use its teaching resources in the way it thinks best; but in practice their Recommendations have been so detailed as to prevent any considerable departure from the conventional curricula. In education, as elsewhere in medicine, progress is often impossible without experiment, and anyone who doubts whether the present training of medical students is the best possible should be grateful to the Council for the courageous decision they made last year, which promises much more liberty to any medical school which qualifies for it by devising a well-considered plan. In commenting a fortnight ago on Dr. Tanner’s proposals for a new kind of preclinical curriculum, we expressed some doubt as to whether the teachers of any existing school would be able to agree on so radical a change from what is customary ; and we shall in fact be surprised if the majority of schools accept the Council’s challenge. But what is important is that a few should do so, and that the way is at last open to pioneers-even if one or two new schools have to be created in order to put their ideas to the test. Thus the reform of medical education, so often debated in theory, has become something practicable even in Great Britain. No better moment, therefore, could have been chosen for establishing the new Association for the Study of Medical Education (AsME), which should prove as useful in this country as the Association of American Medical Colleges has proved in the United States. The intention is that it shall represent all interests in medical education, but particularly perhaps the people actually responsible for training students; and it will therefore have corporate as well as individual members. These corporate members will be universities, medical schools, and licensing
countryman would sooner go down fighting under the might of compulsory powers than be hurried by circulars from Whitehall. It is essentially a matter of public relations. If the Government have neither the time nor the patience to pursue the reasoned approach, then their bulldozer technique seems the only alternative. But more than administrative efficiency is at stake; for there is a very real need to conserve Britain’s water resources and use them to the best advantage. Many
underground waterbearing strata are becoming seriously depleted, or contaminated by saline infiltration. Abstraction of well water on a large scale has now been brought under some measure of control, and in waterscarce areas restrictions or refusals have been imposed on sinking extra bore-holes. Also the question of waste during distribution has been raised: some water undertakers tolerate enormous leakage in their systemssometimes because they find it more profitable to catch additional water for the headworks than to relay the leaking mains. Some authorities eagerly undertake capital expenditure on long loans but cavil at paying for proper routine maintenance out of their current revenue. Water-supplies evoke a curious mixture of business, engineering, and public-service interests, whose interplay can notably affect the happiness and health of a
community. and other bodies interested in medical education, and they will be entitled to send two delegates to each meeting. The functions formally laid down for the Association are
(1) (3)
to
exchange information, (2)
to
organise meetings,
maintain an information bureau, (4) to encourage, promote, or conduct research into matters connected with medical education, and (5) generally to do such other things as it may think useful. Its first conference will be held on Sept. 25 and 26, when the subject will be Experiment in Education. Though the Association was formed at a meeting called by the Royal College of Physicians of London, and has the use of the college premises, it is an independent organisation. The executive committee for 1958 has the following members: to
.
Prof. Robert Platt, P.R.C.P. (Manchester), Sir Russell Brain (London), Prof. J. H. F. Brotherston (Edinburgh), Sir David Campbell (Aberdeen), Prof. A. M. Claye, P.R.C.O.G. (Leeds), Dr. John Ellis (London), Prof. H. W. Fullerton (Aberdeen), Prof. I. Goldby (London), Prof. J. W. Howie (Glasgow), Dr. Alastair Hunter (London), Dr. J. G. McCrie (ShefEeld), Prof. G. P. Meredith (Leeds), Mr. M. F. Nicholls (London), Sir Harry Platt (Manchester), Prof. H. Scarborough (Cardiff), Dr. Richard Scott (Edinburgh), and Prof. A. P. Thomson (Birmingham). ’
ANÆSTHESIA FOR THE EMPHYSEMATOUS
EMPHYSEMATOUS patients give the anxsthetist many some of which have been reviewed by Nunn.1 Induction of general anaesthesia may be troublesome, since emphysematous patients are usually bronchitic as well, and the sensitive bronchial mucosa is easily irritated by gases such as ether or by the mechanical stimulation incidental to intubation. Moreover, induction may take longer than usual owing to dilution of the gas in the abnormally voluminous lungs, inefficient gas mixing, and reduced absorption of gas from poorly perfused alveoli-
problems,
1. Nunn, J. F.
Brit. J. Anœsth. 1958, 30, 134.
machinery. Many of the smaller water undertakers are obliged to rely on part-time or semi-skilled staffwhich means that too much is left to luck. Whether radical reorganisation would bring more efficiency is a A national water grid has been but the countryside seems sceptical about suggested; promises of economy and better service from nationalisation of industries, and has said so quite clearly. The Government have compromised by pressing for a limited amalgamation of water undertakings as a first step. At present about half the population are served by the 55 largest undertakers, while the other half are served by about 900 smaller bodies. It is these 900 that are the targets for the Government’s fire. They have been encouraged to get together, to prepare plans for amalgamation ; they have been exhorted to bestir themselves; and they have been threatened with force. A handful have taken heed; and by the end of last year twelve amalgamation orders had been made, affecting 25 undertakings, and a further eight orders affecting 30 were awaiting the Minister’s approval. The Government are steadily intensifying their attack: compulsory powers are to be invoked in five areas, and the shadow lies over many more. It is a pity that such coercion should be necessary and that a rational policy should have to be applied against local opposition. But many a matter
of
opinion.
Annotations ASME
IN theory, the General Medical Council have always wanted each medical school to use its teaching resources in the way it thinks best; but in practice their Recommendations have been so detailed as to prevent any considerable departure from the conventional curricula. In education, as elsewhere in medicine, progress is often impossible without experiment, and anyone who doubts whether the present training of medical students is the best possible should be grateful to the Council for the courageous decision they made last year, which promises much more liberty to any medical school which qualifies for it by devising a well-considered plan. In commenting a fortnight ago on Dr. Tanner’s proposals for a new kind of preclinical curriculum, we expressed some doubt as to whether the teachers of any existing school would be able to agree on so radical a change from what is customary ; and we shall in fact be surprised if the majority of schools accept the Council’s challenge. But what is important is that a few should do so, and that the way is at last open to pioneers-even if one or two new schools have to be created in order to put their ideas to the test. Thus the reform of medical education, so often debated in theory, has become something practicable even in Great Britain. No better moment, therefore, could have been chosen for establishing the new Association for the Study of Medical Education (AsME), which should prove as useful in this country as the Association of American Medical Colleges has proved in the United States. The intention is that it shall represent all interests in medical education, but particularly perhaps the people actually responsible for training students; and it will therefore have corporate as well as individual members. These corporate members will be universities, medical schools, and licensing
countryman would sooner go down fighting under the might of compulsory powers than be hurried by circulars from Whitehall. It is essentially a matter of public relations. If the Government have neither the time nor the patience to pursue the reasoned approach, then their bulldozer technique seems the only alternative. But more than administrative efficiency is at stake; for there is a very real need to conserve Britain’s water resources and use them to the best advantage. Many
underground waterbearing strata are becoming seriously depleted, or contaminated by saline infiltration. Abstraction of well water on a large scale has now been brought under some measure of control, and in waterscarce areas restrictions or refusals have been imposed on sinking extra bore-holes. Also the question of waste during distribution has been raised: some water undertakers tolerate enormous leakage in their systemssometimes because they find it more profitable to catch additional water for the headworks than to relay the leaking mains. Some authorities eagerly undertake capital expenditure on long loans but cavil at paying for proper routine maintenance out of their current revenue. Water-supplies evoke a curious mixture of business, engineering, and public-service interests, whose interplay can notably affect the happiness and health of a
community. and other bodies interested in medical education, and they will be entitled to send two delegates to each meeting. The functions formally laid down for the Association are
(1) (3)
to
exchange information, (2)
to
organise meetings,
maintain an information bureau, (4) to encourage, promote, or conduct research into matters connected with medical education, and (5) generally to do such other things as it may think useful. Its first conference will be held on Sept. 25 and 26, when the subject will be Experiment in Education. Though the Association was formed at a meeting called by the Royal College of Physicians of London, and has the use of the college premises, it is an independent organisation. The executive committee for 1958 has the following members: to
.
Prof. Robert Platt, P.R.C.P. (Manchester), Sir Russell Brain (London), Prof. J. H. F. Brotherston (Edinburgh), Sir David Campbell (Aberdeen), Prof. A. M. Claye, P.R.C.O.G. (Leeds), Dr. John Ellis (London), Prof. H. W. Fullerton (Aberdeen), Prof. I. Goldby (London), Prof. J. W. Howie (Glasgow), Dr. Alastair Hunter (London), Dr. J. G. McCrie (ShefEeld), Prof. G. P. Meredith (Leeds), Mr. M. F. Nicholls (London), Sir Harry Platt (Manchester), Prof. H. Scarborough (Cardiff), Dr. Richard Scott (Edinburgh), and Prof. A. P. Thomson (Birmingham). ’
ANÆSTHESIA FOR THE EMPHYSEMATOUS
EMPHYSEMATOUS patients give the anxsthetist many some of which have been reviewed by Nunn.1 Induction of general anaesthesia may be troublesome, since emphysematous patients are usually bronchitic as well, and the sensitive bronchial mucosa is easily irritated by gases such as ether or by the mechanical stimulation incidental to intubation. Moreover, induction may take longer than usual owing to dilution of the gas in the abnormally voluminous lungs, inefficient gas mixing, and reduced absorption of gas from poorly perfused alveoli-
problems,
1. Nunn, J. F.
Brit. J. Anœsth. 1958, 30, 134.