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SANITARY CONGRESS IN SCOTLAND
408
place of their chief. With our happy faculty for evading unpleasant issues the question of conflicting loyalties as far as hospital and private practice was concerned never
for the latter came first. The evacuation of the hospitals and medical schools has changed all this. No longer are patients, organisation or juniors supplied with unfailing regularity. No longer are there alternatives to which the students can Organisation has been go if a round is cancelled. necessary, planning has been indicated, awkward questions have had to be faced. What constitutes a medical curriculum ? How can the absence of outpatients be compensated for by the use of inpatients ? Are medical and surgical lectures essential ? If so, how many should be given, what subjects should they cover and who should deliver them ? How long should any one student spend in any one hospital ? Can students be left for, say, a term in a hospital with ample clinical material but little in the way of teaching ? The response of the average clinical teacher to this barrage can only be described as lamentable. There have been notable exceptions and the picture has perhaps been overpainted, but the essentials are true enough to life to be depressing. Alas that such august institutions should be so bankrupt of ideas. Not only the existence of our London medical schools is involved, but the whole future of the medical If medical education is - to keep pace curriculum. with the progress of medical science and medical service to the community, reform must be drastic. A wholetime dean, as he exists in many American medical schools, will be needed, for the organisation of a medical school can no longer be left to the whims of consultants fastened into an unstable framework by a part-time dean in his spare moments. We must produce an adequate supply of whole-time deans from among the most able members of the profession-men with experience of clinical work and research and with a flair for administration who will be prepared to give their lives to the absorbing probems of medical education. As a corollary, the clinicians must realise that teaching is as important a part of their life as medical practice and that to conform to the requisite standards they will need to give a much larger part of their time, energies and abilities to the task than many of them do now. arose,
ij:
it!
*
A fantastic thing happens every month or so in my area which I suppose has its counterpart in every section of the kingdom. Eight or ten commercial competitors, none of whom have military interests, sit round a table to decide which among them or among other competitors not directly represented (at any rate in a voting capacity), should go into the Army. Their choice is guided by the imposition of a quota, an arbitrary number of Army " vacancies " to be filled. Consideration of the needs of the district does not seem to be within the competence of the meeting. The picture is made all the more bizarre when you realise that these men are not only commercial competitors but also professional colleagues ; they are in fact medical practitioners. Doctors by and large seem to take an individualistic view of their relations to society. This is illustrated by the fractional attendances at B.M.A. meetings, and it seems an odd anomaly of war-time planning that the health of the nation should be exposed to the voracious demands of the fighting Services transmitted through the very coarse filter’ of local medical war committees. So far as can be seen these committees, subject to an occasional appeal to the more balanced central body, are the real and deciding factor in shaping the civilian health services. It is hard to find any other principle in the adoption of this method of medical conscription " except perhaps the old one of set a thief to catch a thief " which was, after all, abandoned by the administration of Sir Robert Peel so far as it concerned the police about 100 years ago. I am not suggesting that the personnel of committeesdo not try to be honest, but the general practitioner member is qualified neither by experience nor his own interests to make a good job of it. There is no " consumer " advice to the committee, since neither local governments, public-health authorities or insurance committees have a vote. The Shakespeare Committee was said to be on tour finding out just what the medical needs of the community are. If silence and inconspicuousness be a mark of
its report should be good, though it does not committee to show that reception areas need more doctors, that public-health responsibilities increase with war, and that hospital treatment is no more efficacious to soldier patients if the doctor has got a Sam Brown belt.
efficiency
need
a
*
*
*
A minor revolution gets scant notice these days and it is not surprising that the fall of a distinguished leader and the establishment of a new orderhave caused no stir in the medical world. The pituitary has always occupied an exalted anatomical position but in recent years its prestige in the endocrine system also has been steadily growing. America’s leading brain surgeon honoured it by special study and summed up his views of its importance in the famous phrase " the leader of the endocrine orchestra." And then we came to learn how " the leader " exercised control by this and that tropic factor. The hormonal jigsaw puzzle was all but solved. But now Dr. Cramer {Bull. N.Y. Acad. Med. 1941, 17, 3) comes along to make us start all over again. The pituitary, he says, is not the leader. The endocrine orchestra has no leader. The members know the secret of working together and are a model for any League of Nations. Their bond is simple and is based on one point, not on eight or fourteen points. The One Point is the necessity of keeping the peace, or, if you prefer it in terms of physiology, of keeping the internal environment constant. They know, what the human race has still to learn, that by pulling together they
survive ; by pulling apart they perish. SANITARY CONGRESS IN SCOTLAND Sir Alexander Russell, M.D., whom the Department of Health for Scotland has charged with the organisation of their diphtheria immunisation campaign, at the annual meeting in Glasgow of the Royal Sanitary Association of Scotland said it was ironical that the first national effort to immunise British children against diphtheria should have been postponed until the time of a world-wide war.. During 1940 there had. been 15,711 notifications compared with an average of 10,000, and the total deaths numbered 676, the highest recorded for many years. During the first quarter of 1941 the epidemic continued but there had been a steep fall in the notifications from April to June. Recent weekly figures were still above average and there was reason to expect that the number of cases might shortly increase, perhaps reaching epidemic numbers during the winter. Analysis of the deaths showed clearly that pre-school children were far the most susceptible, and it was disturbing that of the total immunised 60% were school-children and only 33% preschool. Immunisation against diphtheria should now take a permanent place in every health officer’s annual programme. Sir Alexander Macgregor, M.O.H. for Glasgow, gave a warning that the wave of incidence of diphtheria was not over. He said that half the child population of Glasgow had been immunised but there was a serious need to protect the remainder of the children. Dr. G. V. T. McMichael, M.O.H. for Pa.isley, suggested that doctors should make it a routine practice to advocate immunisation in every home they visited. He could not see how 75-80% of the children could be immunised without another intensified national propaganda campaign. Mr. William Cunningham, chief sanitary inspector for Clydebank, said that before the raids they had theorised about emergency measures ; in practice they found many of their pre-war deductions were wrong. He was convinced that mutual help was the only way to meet the disorganisation which might be caused by attack. All local authorities would do well to arrange for their public-health departments in an emergency to be augmented from the staffs of other authorities. Dr. Nora Wattie, senior child welfare M.O. for Glasgow, had been surprised that most children had come through the bombing with so little effect. But the small amount of clinical air-raid shock did not mean that no harmful influence was at work and the evacuation of children was still an urgent problem. Dr. Frank Main, M.O.H. for Perth, thought that a drastic overhaul of school quarantine for infectious diseases was overdue. Thousands of school attendances were unnecessarily lost each year by the exclusion of contacts, while a child with a severe cold might, and usually did, remain at school to infect the whole class.
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place of their chief. With our happy faculty for evading unpleasant issues the question of conflicting loyalties as far as hospital and private practice was concerned never
for the latter came first. The evacuation of the hospitals and medical schools has changed all this. No longer are patients, organisation or juniors supplied with unfailing regularity. No longer are there alternatives to which the students can Organisation has been go if a round is cancelled. necessary, planning has been indicated, awkward questions have had to be faced. What constitutes a medical curriculum ? How can the absence of outpatients be compensated for by the use of inpatients ? Are medical and surgical lectures essential ? If so, how many should be given, what subjects should they cover and who should deliver them ? How long should any one student spend in any one hospital ? Can students be left for, say, a term in a hospital with ample clinical material but little in the way of teaching ? The response of the average clinical teacher to this barrage can only be described as lamentable. There have been notable exceptions and the picture has perhaps been overpainted, but the essentials are true enough to life to be depressing. Alas that such august institutions should be so bankrupt of ideas. Not only the existence of our London medical schools is involved, but the whole future of the medical If medical education is - to keep pace curriculum. with the progress of medical science and medical service to the community, reform must be drastic. A wholetime dean, as he exists in many American medical schools, will be needed, for the organisation of a medical school can no longer be left to the whims of consultants fastened into an unstable framework by a part-time dean in his spare moments. We must produce an adequate supply of whole-time deans from among the most able members of the profession-men with experience of clinical work and research and with a flair for administration who will be prepared to give their lives to the absorbing probems of medical education. As a corollary, the clinicians must realise that teaching is as important a part of their life as medical practice and that to conform to the requisite standards they will need to give a much larger part of their time, energies and abilities to the task than many of them do now. arose,
ij:
it!
*
A fantastic thing happens every month or so in my area which I suppose has its counterpart in every section of the kingdom. Eight or ten commercial competitors, none of whom have military interests, sit round a table to decide which among them or among other competitors not directly represented (at any rate in a voting capacity), should go into the Army. Their choice is guided by the imposition of a quota, an arbitrary number of Army " vacancies " to be filled. Consideration of the needs of the district does not seem to be within the competence of the meeting. The picture is made all the more bizarre when you realise that these men are not only commercial competitors but also professional colleagues ; they are in fact medical practitioners. Doctors by and large seem to take an individualistic view of their relations to society. This is illustrated by the fractional attendances at B.M.A. meetings, and it seems an odd anomaly of war-time planning that the health of the nation should be exposed to the voracious demands of the fighting Services transmitted through the very coarse filter’ of local medical war committees. So far as can be seen these committees, subject to an occasional appeal to the more balanced central body, are the real and deciding factor in shaping the civilian health services. It is hard to find any other principle in the adoption of this method of medical conscription " except perhaps the old one of set a thief to catch a thief " which was, after all, abandoned by the administration of Sir Robert Peel so far as it concerned the police about 100 years ago. I am not suggesting that the personnel of committeesdo not try to be honest, but the general practitioner member is qualified neither by experience nor his own interests to make a good job of it. There is no " consumer " advice to the committee, since neither local governments, public-health authorities or insurance committees have a vote. The Shakespeare Committee was said to be on tour finding out just what the medical needs of the community are. If silence and inconspicuousness be a mark of
its report should be good, though it does not committee to show that reception areas need more doctors, that public-health responsibilities increase with war, and that hospital treatment is no more efficacious to soldier patients if the doctor has got a Sam Brown belt.
efficiency
need
a
*
*
*
A minor revolution gets scant notice these days and it is not surprising that the fall of a distinguished leader and the establishment of a new orderhave caused no stir in the medical world. The pituitary has always occupied an exalted anatomical position but in recent years its prestige in the endocrine system also has been steadily growing. America’s leading brain surgeon honoured it by special study and summed up his views of its importance in the famous phrase " the leader of the endocrine orchestra." And then we came to learn how " the leader " exercised control by this and that tropic factor. The hormonal jigsaw puzzle was all but solved. But now Dr. Cramer {Bull. N.Y. Acad. Med. 1941, 17, 3) comes along to make us start all over again. The pituitary, he says, is not the leader. The endocrine orchestra has no leader. The members know the secret of working together and are a model for any League of Nations. Their bond is simple and is based on one point, not on eight or fourteen points. The One Point is the necessity of keeping the peace, or, if you prefer it in terms of physiology, of keeping the internal environment constant. They know, what the human race has still to learn, that by pulling together they
survive ; by pulling apart they perish. SANITARY CONGRESS IN SCOTLAND Sir Alexander Russell, M.D., whom the Department of Health for Scotland has charged with the organisation of their diphtheria immunisation campaign, at the annual meeting in Glasgow of the Royal Sanitary Association of Scotland said it was ironical that the first national effort to immunise British children against diphtheria should have been postponed until the time of a world-wide war.. During 1940 there had. been 15,711 notifications compared with an average of 10,000, and the total deaths numbered 676, the highest recorded for many years. During the first quarter of 1941 the epidemic continued but there had been a steep fall in the notifications from April to June. Recent weekly figures were still above average and there was reason to expect that the number of cases might shortly increase, perhaps reaching epidemic numbers during the winter. Analysis of the deaths showed clearly that pre-school children were far the most susceptible, and it was disturbing that of the total immunised 60% were school-children and only 33% preschool. Immunisation against diphtheria should now take a permanent place in every health officer’s annual programme. Sir Alexander Macgregor, M.O.H. for Glasgow, gave a warning that the wave of incidence of diphtheria was not over. He said that half the child population of Glasgow had been immunised but there was a serious need to protect the remainder of the children. Dr. G. V. T. McMichael, M.O.H. for Pa.isley, suggested that doctors should make it a routine practice to advocate immunisation in every home they visited. He could not see how 75-80% of the children could be immunised without another intensified national propaganda campaign. Mr. William Cunningham, chief sanitary inspector for Clydebank, said that before the raids they had theorised about emergency measures ; in practice they found many of their pre-war deductions were wrong. He was convinced that mutual help was the only way to meet the disorganisation which might be caused by attack. All local authorities would do well to arrange for their public-health departments in an emergency to be augmented from the staffs of other authorities. Dr. Nora Wattie, senior child welfare M.O. for Glasgow, had been surprised that most children had come through the bombing with so little effect. But the small amount of clinical air-raid shock did not mean that no harmful influence was at work and the evacuation of children was still an urgent problem. Dr. Frank Main, M.O.H. for Perth, thought that a drastic overhaul of school quarantine for infectious diseases was overdue. Thousands of school attendances were unnecessarily lost each year by the exclusion of contacts, while a child with a severe cold might, and usually did, remain at school to infect the whole class.
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