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LONDON TEACHING-HOSPITAL TEACHING
1133 and p-hydroxyphenylpyruvic-acid-uria.21 One of these children died aged 3 months. She had pronounced hypermethioninaemia with 2-3 times more methionine than tyrosine in the serum and in the ascites fluid. Her sister survived. When she was 1 year old she had 5 times more tyrosine than methionine in her serum, and her methionine level was normal. Since these two cases were in sisters with very similar manifestations except in regard to the methionine content in the blood, we assume that hypermethioninaemia is a terminal symptom in tyrosinosis, present in the acute stage or just before death with seriously damaged liver function, but absent in surviving chronic cases. Dikemark Hospital,
Asker, Norway. Paediatric Research Laboratory,
Rikshospitalet, Oslo, Norway.
LEIV R. GJESSING SVERRE HALVORSEN.
INTEGRATION IN THE N.H.S. delight, a relief, and a belated stimulus to read Dr. Ellis Smith’s plea for integration in the National Health Service (Nov. 13). Once upon a time a committee, called the Medical Services Review Committee, worked for four years to produce a report 22 in which the predominant theme was integration of the politically tripartite N.H.S. The least responsive part of the profession to the suggestions in the report were the medical officers of health-or, at least, the society which represents them-and this despite the fact that they stood to gain more in status, increased fields of activity, and symbiosis with their hospital and general practitioner colleagues than any other group in the profession. The Medical Services Review Committee envisaged, in their suggestions, that social, preventive, environmental, or epidemiological medicine would become the spearhead of future developments in medicine, and expressed the hope that an expanded sphere of influence for the medical officer of health might be the means of achieving this object. Dr. Ellis Smith’s views may imply a new appreciation of the situation by his colleagues-at a time when recrudescence of interest in the Medical Services Review Committee’s report is becoming more obvious in many quarters. Whatever the administrative machinery required, medicine in this country will never regain its pristine robust health until its three parts are again fused into one profession. ARTHUR PORRITT. London, W.1.
SIR,-It
was a
THE ORGANISATION OF THE N.H.S. SIR,-Dr. Discombe’s article (Nov. 13) on the National Health Service, and particularly the hospital service, is very
timely. The hospital in which I work has recently been visited by senior officials of the regional board. It is a temporary hospital built during the 1914-18 war, and the building programme has recently been put back a number of years, leaving us with bits of old and bits of new, which are going to be even more difficult and frustrating to work in than the entirely old (but fairly unified) hospital. The object of the officials’ visit was to see what was the least money that could be spent to make the temporary buildings habitable and usable as a "hospital" for the now greatly prolonged time before we get our own completely
It appears to me that all doctors who have anything to do with the hospital service, whether as administrators or clinicians, have a duty to impress on all their contacts, official or personal, the following: 1. The hospital service is slowly running down. Its plant is becoming more inadequate every day, and its doctors, both senior and junior, more overworked and frustrated, knowing much about modern diagnostic and treatment methods yet in many instances not being able to apply them. 2. It does not appear possible to finance the hospitals from direct Exchequer funds, either now or in the future. 3. Therefore these courses are open to the Government: (a) to continue as at present with an ever-worsening hospital service; (b) to raise money by other means. I am no financier, but even I can think of several methods. This country has a mania for gambling. Why not a hospital sweep as in Ireland ? Or a bond issue ? Or, unpalatable as it may be to politicians, make the patient pay something ?
Only when enough people are aware of the facts can pressure be applied to politicians of all parties to make them face the facts and act. Beckenham, F. G. HERMAN. Kent. LONDON TEACHING-HOSPITAL TEACHING SIR,-As a London University medical student nearing finals, I feel that the course has been inadequate and that the old teaching hospitals of London have had their day. Admittedly the medical schools have to conform to the syllabus laid down by the university. But the second M.B. examination should be reformed. The pathology examination should take place early in the clinical period and not be part of finals. The examiners require a type of knowledge which leads to unreasoning rote-learning. But even if the syllabus were reformed-as it would be if the consultants and medical-school staff were interested-the teaching-hospital system would still be unsound. Hospital staff are rightly more concerned with the patients than with the students. The curriculum tends to be disorganised, the teaching to be didactic, unsystematic, and uninspiring; practical details tend to submerge basic principles; and nonhospital specialties such as social medicine, public health, experimental pathology, and tropical medicine tend to be neglected. The medical student is isolated socially and intellectually from students of other subjects. The circumstance that his teachers are also his potential employers leads to a stifling of criticism and an obsequious conformity. Above all he lacks a broad education. The medical profession is an influential body; its members must not be ignorant and narrow-minded. Nowadays every doctor must learn to keep up with technical advances, to examine critically what he reads in journals, and to adjust himself to the changing pattern of medical care. He requires therefore an academic background which the teaching hospital cannot provide. Much of medicine can only be taught at the bedside. The rest is better taught elsewhere. R. J. ROWLATT. London, S.W.9. AGRONOMY AND HEALTH
SIR,-In my article (Oct. 2) two thoughts were expressed: non-fragmentation of learning, and the other, the
new one.
one, the
After the meeting I remarked to one of the officials, a doctor, that this seemed to be an exercise in futility, in that we had spent a morning trying to reach the minimal standard possible, rather than working on a plan to make a local service of a high standard with adequate facilities for diagnosis and treatment. He seemed surprised, and said in effect that it was his job to carry out board policy and that it was up to the politicians, not the administrators, to change things and provide enough
need for the universities of underdeveloped territories to teach their students vocational skills. The article dealt with education at two levels-at the level of the illiterate group and the level of the university undergraduate group. As a belated postscript I would like to refer briefly to higher learning, and the founding of an institute of higher learning devoted solely to the interests of the less-privileged countries. The purpose of such an institute would be to give an understanding to present leaders and potential future leaders of the need for a balanced ecological process. The interrelationship of the various government ministries and departments, the interactions of the public sector and the private sector, the coordina-
money. 21.
Halvorsen, S., Pande, H., Gjessing, press).
L. R. Archs Dis. Childh.
22. A Review of the Medical Services in Great Britain. see Lancet, 1962, ii, 925.
(in the
London, 1962.
Asker, Norway. Paediatric Research Laboratory,
Rikshospitalet, Oslo, Norway.
LEIV R. GJESSING SVERRE HALVORSEN.
INTEGRATION IN THE N.H.S. delight, a relief, and a belated stimulus to read Dr. Ellis Smith’s plea for integration in the National Health Service (Nov. 13). Once upon a time a committee, called the Medical Services Review Committee, worked for four years to produce a report 22 in which the predominant theme was integration of the politically tripartite N.H.S. The least responsive part of the profession to the suggestions in the report were the medical officers of health-or, at least, the society which represents them-and this despite the fact that they stood to gain more in status, increased fields of activity, and symbiosis with their hospital and general practitioner colleagues than any other group in the profession. The Medical Services Review Committee envisaged, in their suggestions, that social, preventive, environmental, or epidemiological medicine would become the spearhead of future developments in medicine, and expressed the hope that an expanded sphere of influence for the medical officer of health might be the means of achieving this object. Dr. Ellis Smith’s views may imply a new appreciation of the situation by his colleagues-at a time when recrudescence of interest in the Medical Services Review Committee’s report is becoming more obvious in many quarters. Whatever the administrative machinery required, medicine in this country will never regain its pristine robust health until its three parts are again fused into one profession. ARTHUR PORRITT. London, W.1.
SIR,-It
was a
THE ORGANISATION OF THE N.H.S. SIR,-Dr. Discombe’s article (Nov. 13) on the National Health Service, and particularly the hospital service, is very
timely. The hospital in which I work has recently been visited by senior officials of the regional board. It is a temporary hospital built during the 1914-18 war, and the building programme has recently been put back a number of years, leaving us with bits of old and bits of new, which are going to be even more difficult and frustrating to work in than the entirely old (but fairly unified) hospital. The object of the officials’ visit was to see what was the least money that could be spent to make the temporary buildings habitable and usable as a "hospital" for the now greatly prolonged time before we get our own completely
It appears to me that all doctors who have anything to do with the hospital service, whether as administrators or clinicians, have a duty to impress on all their contacts, official or personal, the following: 1. The hospital service is slowly running down. Its plant is becoming more inadequate every day, and its doctors, both senior and junior, more overworked and frustrated, knowing much about modern diagnostic and treatment methods yet in many instances not being able to apply them. 2. It does not appear possible to finance the hospitals from direct Exchequer funds, either now or in the future. 3. Therefore these courses are open to the Government: (a) to continue as at present with an ever-worsening hospital service; (b) to raise money by other means. I am no financier, but even I can think of several methods. This country has a mania for gambling. Why not a hospital sweep as in Ireland ? Or a bond issue ? Or, unpalatable as it may be to politicians, make the patient pay something ?
Only when enough people are aware of the facts can pressure be applied to politicians of all parties to make them face the facts and act. Beckenham, F. G. HERMAN. Kent. LONDON TEACHING-HOSPITAL TEACHING SIR,-As a London University medical student nearing finals, I feel that the course has been inadequate and that the old teaching hospitals of London have had their day. Admittedly the medical schools have to conform to the syllabus laid down by the university. But the second M.B. examination should be reformed. The pathology examination should take place early in the clinical period and not be part of finals. The examiners require a type of knowledge which leads to unreasoning rote-learning. But even if the syllabus were reformed-as it would be if the consultants and medical-school staff were interested-the teaching-hospital system would still be unsound. Hospital staff are rightly more concerned with the patients than with the students. The curriculum tends to be disorganised, the teaching to be didactic, unsystematic, and uninspiring; practical details tend to submerge basic principles; and nonhospital specialties such as social medicine, public health, experimental pathology, and tropical medicine tend to be neglected. The medical student is isolated socially and intellectually from students of other subjects. The circumstance that his teachers are also his potential employers leads to a stifling of criticism and an obsequious conformity. Above all he lacks a broad education. The medical profession is an influential body; its members must not be ignorant and narrow-minded. Nowadays every doctor must learn to keep up with technical advances, to examine critically what he reads in journals, and to adjust himself to the changing pattern of medical care. He requires therefore an academic background which the teaching hospital cannot provide. Much of medicine can only be taught at the bedside. The rest is better taught elsewhere. R. J. ROWLATT. London, S.W.9. AGRONOMY AND HEALTH
SIR,-In my article (Oct. 2) two thoughts were expressed: non-fragmentation of learning, and the other, the
new one.
one, the
After the meeting I remarked to one of the officials, a doctor, that this seemed to be an exercise in futility, in that we had spent a morning trying to reach the minimal standard possible, rather than working on a plan to make a local service of a high standard with adequate facilities for diagnosis and treatment. He seemed surprised, and said in effect that it was his job to carry out board policy and that it was up to the politicians, not the administrators, to change things and provide enough
need for the universities of underdeveloped territories to teach their students vocational skills. The article dealt with education at two levels-at the level of the illiterate group and the level of the university undergraduate group. As a belated postscript I would like to refer briefly to higher learning, and the founding of an institute of higher learning devoted solely to the interests of the less-privileged countries. The purpose of such an institute would be to give an understanding to present leaders and potential future leaders of the need for a balanced ecological process. The interrelationship of the various government ministries and departments, the interactions of the public sector and the private sector, the coordina-
money. 21.
Halvorsen, S., Pande, H., Gjessing, press).
L. R. Archs Dis. Childh.
22. A Review of the Medical Services in Great Britain. see Lancet, 1962, ii, 925.
(in the
London, 1962.